Spine最新文献

{"title":"Thoracolumbar Sagittal Morphology and Segmental Inclination: A Cross-sectional Cohort Study of Asymptomatic Adult Volunteers.","authors":"Weipeng Qiu, Zhuoran Sun, Siyu Zhou, Zimu Chen, Gengyu Han, Da Zou, Yi Zhao, Ze Chen, Qiang Qi, Weishi Li","doi":"10.1097/BRS.0000000000005189","DOIUrl":"10.1097/BRS.0000000000005189","url":null,"abstract":"<p><strong>Study design: </strong>A cross-sectional cohort study.</p><p><strong>Objective: </strong>To present a normative value reference of spinal segmental inclination stratified by age and pelvic incidence (PI), and to clarify the impact of segmental inclination on spinal sagittal morphology.</p><p><strong>Summary of background data: </strong>Thoracolumbar segmental inclination has been shown to correlate with the clinical outcomes of adult spinal deformity surgery. However, there currently exists no normative value reference in a large sample of asymptomatic population.</p><p><strong>Materials and methods: </strong>Asymptomatic adult volunteers were enrolled from the community. All volunteers underwent a standing full-spine anteroposterior and lateral radiograph. Lumbar tilt (LT) and thoracic tilt (TT) were measured to quantify the segmental inclination of the lumbar and thoracic spine. Regional curvature, global balance, and thoracolumbar apex were analyzed across different age and PI groups. The correlation between sagittal parameters and age was analyzed using Pearson correlation tests.</p><p><strong>Results: </strong>A total of 618 volunteers were included with a mean age of 38.7 ± 17.1 years (range 18-82 yr). As age increased, the LT and TT significantly increased ( P <0.001). The LT was significantly correlated with PI (r=0.410, P <0.001), with the low PI group exhibiting a greater negative LT. The TT remained constant across different PI groups. Compared with the young and middle-aged groups, the thoracic apex and lumbar apex were located more caudally in the elderly group ( P <0.001). Subjects with a more caudal lumbar apex exhibited a greater negative LT, and those with a more caudal thoracic apex exhibited a greater positive TT.</p><p><strong>Conclusions: </strong>The thoracic spine naturally adapts to a relatively neutral position, yet it tends to tilt forward with aging. The physiological lumbar inclination is predominantly determined by the PI value with a slight backward tilt and tends to counteract the anterior truncal inclination with advanced age. Physiological segmental inclination should be considered in spinal surgical planning.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"916-923"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-Like Peptide-1 Receptor Agonist Medications Alter Outcomes of Spine Surgery: A Study Among Over 15,000 Patients.","authors":"Joshua M Wiener, Parshva A Sanghvi, Katelyn Vlastaris, Thomas Mroz, Jonathan Belding, David C Kaelber, Thomas Olson, Kevin P Francis, John S Adams, Nicholas Bernthal, William L Sheppard","doi":"10.1097/BRS.0000000000005283","DOIUrl":"10.1097/BRS.0000000000005283","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To investigate the relationship between perioperative glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and postoperative outcomes after spinal fusion in obese and diabetic patient populations.</p><p><strong>Background: </strong>GLP-1 RAs have been shown to be beneficial when used perioperatively in clinical orthopedic arthroplasty literature. Minimal evidence exists showing efficacy with respect to spinal fusion.</p><p><strong>Materials and methods: </strong>This retrospective, multi-center study accessed the TriNetX platform, using the research database to identify diabetic patients who underwent spinal fusion between 2008 and 2022. Cohorts were created based on body mass index and GLP-1 RA usage. Propensity score matching was employed to create balanced cohorts utilizing body mass index, hemoglobin A1c, surgical intervention, as well as other demographic characteristics. Orthopedic outcomes were compared between GLP-1 RA users and non-users. The primary outcomes included postoperative infection, readmission, revision surgery, and quality of life metrics.</p><p><strong>Results: </strong>After matching, the study cohort consisted of 2263 patients, with 1560 classified as obese. GLP-1 RA use was associated with significantly reduced postoperative infection rates [obese: HR = 0.168 (0.086, 0.328), not obese: HR = 0.250 (0.102, 0.612)], fewer revisions [obese: HR = 0.505 (0.368, 0.693), not obese: HR = 0.439 (0.272, 0.708)], decreased postoperative readmission rates [obese: HR = 0.283 (0.243, 0.329), not obese: HR = 0.241 (0.193, 0.301)], and reduced mobility abnormalities [obese: HR = 0.355 (0.230, 0.549), not obese: HR = 0.508 (0.269, 0.959)]. No significant differences were observed in rates of fracture rates between GLP-1 RA users and non-users.</p><p><strong>Conclusions: </strong>GLP-1 RA use in spinal fusion patients was associated with improved postoperative outcomes, including lower infection rates, fewer revisions, and better quality of life metrics. These findings suggest that GLP-1 RAs may be a valuable adjunctive therapy in managing surgical outcomes in diabetic and obese patients undergoing spinal fusion. Further prospective and animal-based studies are needed to confirm these findings and explore the underlying mechanisms.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"871-880"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Comment to Letter to the Editor Regarding the Manuscript \"Adjacent Level Canal Area Changes up to 2 Years After Lumbar Spinal Stenosis Decompressive Surgery\".","authors":"Helena Brisby, Erland Hermansen","doi":"10.1097/BRS.0000000000005378","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005378","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 13","pages":"E269"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Scoliosis Cobb Angle Classification in Biplanar Radiograph Imaging With Explainable Machine Learning Models.","authors":"Jennifer Yu, Yash S Lahoti, Kyle C McCandless, Nikan K Namiri, Matthew S Miyasaka, Hamza Ahmed, Junho Song, John J Corvi, Daniel C Berman, Samuel K Cho, Jun S Kim","doi":"10.1097/BRS.0000000000005312","DOIUrl":"10.1097/BRS.0000000000005312","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To quantify the pathology of the spine in patients with scoliosis through one-dimensional feature analysis.</p><p><strong>Summary of background data: </strong>Biplanar radiograph (EOS) imaging is a low-dose technology offering high-resolution spinal curvature measurement, crucial for assessing scoliosis severity and guiding treatment decisions. Machine learning (ML) algorithms, utilizing one-dimensional image features, can enable automated Cobb angle classification, improving accuracy and efficiency in scoliosis evaluation while reducing the need for manual measurements, thus supporting clinical decision-making.</p><p><strong>Methods: </strong>This study used 816 annotated AP EOS spinal images with a spine segmentation mask and a 10° polynomial to represent curvature. Engineered features included the first and second derivatives, Fourier transform, and curve energy, normalized for robustness. XGBoost selected the top 32 features. The models classified scoliosis into multiple groups based on curvature degree, measured through Cobb angle. To address the class imbalance, stratified sampling, undersampling, and oversampling techniques were used, with 10-fold stratified K-fold cross-validation for generalization. An automatic grid search was used for hyperparameter optimization, with K-fold cross-validation (K=3).</p><p><strong>Results: </strong>The top-performing model was Random Forest, achieving an ROC AUC of 91.8%. An accuracy of 86.1%, precision of 86.0%, recall of 86.0%, and an F1 score of 85.1% were also achieved. Of the three techniques used to address class imbalance, stratified sampling produced the best out-of-sample results. SHAP values were generated for the top 20 features, including spine curve length and linear regression error, with the most predictive features ranked at the top, enhancing model explainability.</p><p><strong>Conclusions: </strong>Feature engineering with classical ML methods offers an effective approach for classifying scoliosis severity based on Cobb angle ranges. The high interpretability of features in representing spinal pathology, along with the ease of use of classical ML techniques, makes this an attractive solution for developing automated tools to manage complex spinal measurements.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E259-E267"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"C2 Pelvic Angle as a Predictive Measure for Decompensated Spinopelvic Alignment and Its Impact on Health-Related Quality of Life.","authors":"Jun Ouchida, Hiroaki Nakashima, Sadayuki Ito, Naoki Segi, Ippei Yamauchi, Yukihito Ode, Shiro Imagama","doi":"10.1097/BRS.0000000000005436","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005436","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To evaluate the C2 pelvic angle (C2PA) as a novel compensatory parameter integrating C2 (center of gravity) and pelvic morphology, and its association with physical function and health-related quality of life (HRQOL). The T4-L1-Hip axis concept was applied to assess individualized spinal alignment.</p><p><strong>Background: </strong>Adult spinal deformity (ASD) impairs physical function and HRQOL in older adults. Pelvic retroversion compensates for spinal degeneration to maintain posture, but standardized evaluative indices linking pelvic parameters to outcomes remain limited.</p><p><strong>Methods: </strong>Cross-sectional analysis of 383 community-dwelling adults (mean age 64.1 ± 10.3 y). Whole-spine radiographs, physical function tests (Timed Up and Go, 10-meter walk), and SF-36 HRQOL scores were analyzed. C2PA mismatch (measured C2PA minus normative value [0.4 × pelvic incidence - 13]) and thoracolumbar decompensation (T4PA-L1PA ≥4°) were assessed. ROC analysis identified optimal C2PA mismatch thresholds; propensity score matching (age/sex/BMI) compared groups.</p><p><strong>Results: </strong>C2PA mismatch correlated strongly with lumbar (r=0.668) and thoracolumbar (r=0.707) mismatches. A 13° C2PA mismatch threshold optimally identified decompensated thoracolumbar alignment (AUC=0.819). Participants with>13° C2PA mismatch demonstrated decreased physical function (Timed Up and Go: 6.4 vs. 5.8 seconds; 10-meter walk: 1.4 vs. 1.5 m/s) and lower SF-36 scores (physical functioning: 65.9 vs. 72.8; bodily pain: 63.1 vs. 70.8; physical component summary: 41.8 vs. 45.7).</p><p><strong>Conclusions: </strong>C2PA is a reliable indicator of decompensated spinopelvic alignment, with>13° mismatch (measured C2PA>0.4 × pelvic incidence) The C2PA threshold correlates with decreased physical function and lower HRQOL, providing a clinical benchmark for evaluating and managing patients with spinal alignment degeneration.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Inequalities in the Burden of Low Back Pain from 1990 to 2021: Findings from the Global Burden of Disease Study 2021.","authors":"Liang Chen, Jian Chen","doi":"10.1097/BRS.0000000000005433","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005433","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of Bone Density Change in L4-L5 Spondylolisthesis.","authors":"Brandon Khoo, Nathan M Cross, Scott Telfer","doi":"10.1097/BRS.0000000000005434","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005434","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of medical imaging data.</p><p><strong>Objective: </strong>This study aimed to determine if there are changes in localized bone density of the L4-L5 vertebrae in patients with spondylolisthesis, with these changes hypothesized to be associated with increasing severity of spinal deformities.</p><p><strong>Summary of background data: </strong>Degenerative spondylolisthesis is a common spinal pathology resulting in pain and functional limitations. The condition may lead to changes in the bone density of the affected vertebrae and subsequent fracture risk and challenges for surgical interventions. However, the specific regions where these changes may occur have not been fully investigated.</p><p><strong>Methods: </strong>Sixty-eight sets of three-dimensional L4-L5 vertebrae models were created from clinical computed tomography (CT) scans, 38 from patients with spondylolisthesis and the remainder matched controls. A calibrated opportunistic quantitative CT approach was used to produce detailed bone density estimates across each vertebrae. The effects of age, sex, and associations with radiographic measures of spinal deformity on bone density patterns were assessed.</p><p><strong>Results: </strong>There was a significant association between diagnosis of spondylolisthesis and full bone density as well as age-related changes, however these overall changes were not found to be associated with any specific measure of deformity. The localized analysis showed that with increasing anterolisthesis, bone density was affected in the anterior, medial, and lateral regions of the L5 body, and the L4-L5 facet joints.</p><p><strong>Conclusions: </strong>These findings demonstrate that there are patterns of region change to L4-L5 bone density associated with spondylolisthesis, however there remains significant variability between patients. Future work will explore if surgical planning of spinal vertebrae correction and assessment of fracture risk may be assisted through detailed bone density mapping for L4-L5 and other vertebrae.</p><p><strong>Level of evidence: </strong>Level 4.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Postoperative Physical Therapy Impact Pain, Opioid Consumption, and Clinical Outcomes after Single-Level Lumbar Fusion?","authors":"Jonathan Dalton, Robert J Oris, Michael A McCurdy, Teeto Ezeonu, Rajkishen Narayanan, Abbey Glover, Molly Milano, Alexander Dawes, Ian David Kaye, Mark F Kurd, Barrett I Woods, John J Mangan, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.1097/BRS.0000000000005431","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005431","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort.</p><p><strong>Objective: </strong>To determine the impact of physical therapy (PT) on opioid consumption, surgical outcomes, and patient-reported outcome measures (PROMs) following single-level lumbar fusion.</p><p><strong>Summary of background data: </strong>Physical therapy following lumbar fusion surgery is variably prescribed, with the goals of pain relief and return to activity. However, existing evidence on the efficacy of postoperative PT after spine surgery is heterogeneous and generally low-quality. Furthermore, the impact of PT on opioid use following lumbar fusion has been minimally studied.</p><p><strong>Methods: </strong>All patients underwent single-level lumbar fusion surgery at a single tertiary academic institution. Insurance claims data was reviewed to determine which patients utilized outpatient PT in the 180 days postoperatively. Patient demographics, surgical variables, surgical outcomes, and PROMs were compared between patients with postoperative PT and those without. The state prescription drug monitoring program (PDMP) database was utilized to record prescription opioid use in the 1-year preoperative and 1-year postoperative periods. Multivariate regression analyses were created to examine the impact of PT on postoperative opioid use.</p><p><strong>Results: </strong>A total of 365 patients were included; 187 patients received postoperative PT while 178 did not. There were no differences in demographics/surgical variables, surgical outcomes, or PROMs between groups. There was no difference in preoperative or postoperative opioid use, total morphine milligram equivalents (MMEs), or total opioid prescriptions between groups. Multivariate regression analyses revealed that the use of PT was not a significant predictor of MME consumption at any time point after surgery.</p><p><strong>Conclusion: </strong>PT does not appear to increase complications after single-level lumbar fusion, and thus is likely a safe consideration during recovery. However, it may not significantly improve outcomes or reduce opioid consumption when implemented routinely for all patients. Surgeons should consider individual patient risk factors when deciding on optimal postoperative management.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Indicators of Surgical Outcomes in Degenerative Cervical Myelopathy Assessed Using the JOACMEQ: A Prospective Multicenter Study.","authors":"Narihito Nagoshi, Junichi Yamane, Toshiki Okubo, Kentaro Fukuda, Takeshi Fujii, Reo Shibata, Takahiro Kitagawa, Kentaro Ago, Yasuhiro Kamata, Takahito Iga, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.1097/BRS.0000000000005428","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005428","url":null,"abstract":"<p><strong>Study design: </strong>Prospective multicenter cohort study.</p><p><strong>Objective: </strong>To identify clinical indicators associated with postoperative functional and quality-of-life (QOL) outcomes in patients with degenerative cervical myelopathy (DCM), using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).</p><p><strong>Summary of background data: </strong>Although surgical intervention is the standard treatment for DCM, a subset of patients experiences suboptimal postoperative outcomes. The specific impact of surgical treatment on various physical functions in patients with DCM remains inadequately understood.</p><p><strong>Methods: </strong>A total of 935 DCM patients were prospectively enrolled across 10 institutions in Japan. Of these, 852 patients with complete JOACMEQ data were included. Pre- and postoperative assessments at 2 years included JOA score, visual analog scale, and JOACMEQ. Logistic regression analyses were conducted to identify indicators of effective outcomes across JOACMEQ domains.</p><p><strong>Results: </strong>Surgical intervention led to significant improvements in JOA scores and pain reduction. Effective rates by the JOACMEQ domain were 49.6% (cervical function), 48.5% (upper extremity), 35.1% (lower extremity), 23.2% (bladder), and 23.8% (QOL). Multivariate analysis revealed that better cervical function was associated with lower body mass index (BMI) and reduced neck pain at 2 years. Shorter symptom duration and upper limb pain improvement predicted better upper extremity outcomes. Younger age, shorter symptom duration, and reduced lower limb pain were linked to improved lower extremity function. Bladder function was negatively affected by longer symptom duration. Lower QOL was associated with longer symptom duration, cardiovascular comorbidities, and persistent neck and upper limb pain at final follow-up.</p><p><strong>Conclusion: </strong>Surgical intervention for DCM generally improves neurological function and pain. However, JOACMEQ analysis reveals that factors such as disease duration, residual pain, age, and BMI significantly influence physical function and QOL. These findings highlight the importance of surgical timing and adequate informed consent to optimize outcomes in DCM patients.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative L1 tilt as a Predictor of Proximal Junctional Kyphosis Following Lower Thoracic Spine-To-Pelvis Fusion for Adult Spinal Deformity.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Kyunghun Jung, Minwook Kang, Chong-Suh Lee","doi":"10.1097/BRS.0000000000005430","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005430","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To investigate the association between postoperative orientation of the L1 vertebra and proximal junctional kyphosis (PJK) occurrence in adult spinal deformity (ASD) surgery.</p><p><strong>Summary of background data: </strong>PJK remains a common complication, with various risk factors identified. However, the role of the orientation of L1 vertebra has not been well studied.</p><p><strong>Methods: </strong>A total of 312 patients who underwent fusion from the pelvis to the lower thoracic spine (T9-12) were analyzed. Patient, surgical, and radiographic variables were evaluated for risk factor analysis of PJK. L1 tilt and L1 slope at six weeks postoperatively were included to represent the L1 orientation. Multivariate logistic regression analysis was performed to identify risk factors for PJK. Receiver operating characteristics (ROC) curve analysis was used to calculate the cutoff value of predictors for PJK.</p><p><strong>Results: </strong>PJK developed in 109 patients (34.9%). Multivariate regression analysis identified postoperative L1 tilt as the only independent risk factor for PJK (odds ratio=1.173, P<0.001). The cutoff value of L1 tilt for predicting PJK was determined as 8.1° based on ROC curve analysis (area under the curve=0.736, P<0.001). The rates of PJK (50.7% vs. 22.1%, P<0.001) and revision surgery (17.1% vs. 5.2%, P<0.001) were significantly higher in the high L1 tilt group than in the low L1 tilt group. The high L1 tilt group also exhibited significantly greater pelvic tilt, thoracic kyphosis, and T1 pelvic angle, as well as worse clinical outcomes at two years compared to the low L1 tilt group.</p><p><strong>Conclusions: </strong>An L1 tilt greater than 8.1° was associated with a higher risk of PJK, suboptimal sagittal alignment, and worse clinical outcomes at 2 years. Therefore, optimizing L1 orientation may reduce PJK risk and improve long-term surgical outcomes.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}