Spine最新文献

{"title":"Pediatric Chiari Malformation Management: WFNS Spine Committee Recommendations.","authors":"Ricardo Gepp, June Ho Lee, Jutty Parthiban, Francesco Costa, Fernando Dantas, Francisco Sampaio, Zan Chen, Joachim Oertel, Salman Sharif, Jörg Klekamp, Ricardo Botelho, Mehmet Zileli, Óscar L Alves","doi":"10.1097/BRS.0000000000005290","DOIUrl":"10.1097/BRS.0000000000005290","url":null,"abstract":"<p><strong>Study design: </strong>A systematic literature review and consensus using Delphi method.</p><p><strong>Objective: </strong>This review aims to provide an overview on Chiari malformation in pediatric patients, highlighting the specific clinical manifestations and surgical treatment options.</p><p><strong>Summary of background: </strong>Chiari malformation in children presents a real difficulty to the general neurosurgeon because children are not smaller adults. In the absence of pediatric neurosurgeons, as in many countries of the world, a need for education of general neurosurgeons on the management of Chiari malformation in children was identified.</p><p><strong>Material and methods: </strong>The authors carried out an extensive review of the literature in PubMed database of the last 10 years addressing the topic of Chiari malformation in children. A total of 64 studies were selected for analysis and five statements were drawn to be voted by a panel of expert spine surgeons in two consensus meetings organized by the World Federation of Neurosurgical Societies (WFNS) Spine Committee. A consensus was reached using the Delphi method.</p><p><strong>Results: </strong>In children with CM1, a decompressive surgery with duraplasty before puberty may avoid scoliosis progression. In Chiari type 2, the recommendation is to perform urgently extensive decompression of the craniovertebral junction and cervical canal if there is no decompensation of hydrocephalus. Cranial vault expansion may be recommended in pediatric Chiari malformation associated with craniosynostosis. Children with Chiari type I can play sports because of the low risk of worsening.</p><p><strong>Conclusion: </strong>Pediatric age is a modifier for the management of Chiari malformation (CM). Prompt diagnosis and appropriate decompressive surgery with duraplasty before puberty are essential to mitigate the impact of the condition on the child's well-being. Increased awareness among health care professionals, timely access to specialized expertise in neurosurgical interventions are crucial, especially for type 2 CM patients that require urgent decompression of CVJ and cervical spine.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E208-E212"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383353","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":"Statistics for Spine Care Practitioners and Clinician-scientists: A Practical Guide to Study Design, Analysis, and Interpretation.","authors":"Alexander M Crawford, Brendan M Striano, Grace X Xiong, Jonathan Dalton, Robert J Oris, Andrew J Schoenfeld, Alexander R Vaccaro","doi":"10.1097/BRS.0000000000005332","DOIUrl":"10.1097/BRS.0000000000005332","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"721-729"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658659","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":"Shanmuganathan Rajasekaran: 2025 ISSLS Wiltse Lifetime Achievement Award.","authors":"Dino Samartzis, Robert Gunzburg, Jill Urban","doi":"10.1097/BRS.0000000000005349","DOIUrl":"10.1097/BRS.0000000000005349","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"737-742"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796565","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":"Indications for Surgery and Surgical Options in Chiari Malformation: WFNS Spine Committee Recommendations.","authors":"Massimiliano Visocchi, Francesco Signorelli, Óscar L Alves, Atul Goel, Jutty Parthiban, Saleh Baeesa, Salman Sharif, Francisco Sampaio, Sait Ben Ali, June Ho Lee, Joachim Oertel, Mehmet Zileli, Ricardo Botelho","doi":"10.1097/BRS.0000000000005288","DOIUrl":"10.1097/BRS.0000000000005288","url":null,"abstract":"<p><strong>Study design: </strong>A systematic literature review and consensus using Delphi method.</p><p><strong>Objectives: </strong>This review aims to create recommendations on the surgical indications and approaches to treat Chiari malformation (CM) with or without syringomyelia.</p><p><strong>Summary of background data: </strong>Despite the growing body of knowledge on CM, there are diverse and sometimes contradicting perspectives about surgical indications and procedures in both pediatric and adult populations.</p><p><strong>Methods: </strong>The authors reviewed the literature on CM published from 2011 to 2022. Two consensus conferences were organized by WFNS Spine Committee. The first one was held in Sao Paulo, Brazil on August 2022, and the second one was held in Porto, Portugal on December 2022. Using the Delphi method, a panel of expert spine surgeons and members of the WFNS Spine Committee examined the strength of the literature, elaborated and voted statements about the surgical management of CM.</p><p><strong>Results: </strong>We present 11 consensus statements on the surgical management of CM. Surgery is recommended for patients who have symptoms or if an MRI shows progression in asymptomatic patients. In pediatrics, osteoligamentous decompression only is indicated, whereas adults can have foramen magnum decompression with duroplasty, which is usually sufficient to control the associated syringomyelia. Syrinx drainage is the last option. Arachnoid opening can be performed in patients who have previously failed surgery or if arachnoid morphological anomalies are identified during the initial procedure. Tonsillar shrinkage provides somewhat better clinical efficacy than decompression alone, but at a larger risk of complications. Only patients with concurrent basilar invagination and atlanto-axial instability are advised to undergo atlanto-axial fixation alone.</p><p><strong>Conclusions: </strong>The consensus statements created by a collaborative work provide useful information for surgeons treating CM worldwide to achieve better surgical outcomes and avoid complications.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"760-766"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383350","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":"Management Guidelines for Anterior Column Reconstruction in Spinal Tuberculosis - A Comparative Outcome Analysis.","authors":"Pankaj Kandwal, Siddharth Sekhar Sethy, Aman Verma, Parshwanath Bondarde, Aakash Jain, Vibhor Abrol, Kaustubh Ahuja, Bhaskar Sarkar","doi":"10.1097/BRS.0000000000005403","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005403","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Comparative Study.</p><p><strong>Objective: </strong>A comparative analysis was aimed at evaluating the clinical and radiological outcomes of cases managed with versus without ACR.</p><p><strong>Summary of background data: </strong>Management of spinal tuberculosis (STB) is accomplished with or without anterior column reconstruction (ACR). However, no objective criterion has been defined citing absolute indication.</p><p><strong>Methods: </strong>A retrospective analysis of prospectively collected data of STB was carried out with a minimum follow-up of one year. Along with basic demography, radiological parameters like vertebral body height loss (VHL), column height loss (CHL), segmental kyphosis (SK), adjusted kyphosis (AK) were calculated. A ROC curve analysis was done to identify cut-off values, followed by subgroup analysis for each parameter.</p><p><strong>Results: </strong>In total 103 patients (60 female, 43 male), 55 cases were managed operatively and ACR was done in 39 of those. Change in ODI, VHL, and kyphosis correction were significantly better in ACR (P<0.01). ROC analysis identified cut-off values for VHL 0.55 (Sensitivity 0.87, 1-specificity 0.37), CHL 1.12 (Sensitivity 0.76, 1-specificity 0.25), and AK 15° (Sensitivity 0.74, 1-specificity 0.43). Subgroup analysis was carried out in operated patients segregated above these cutoff values. Though vertebral height gain was better with ACR, no significant differences across the change in ODI and loss of correction were noted between ACR vs N-ACR. However, the instruments to disease vertebrae (I/D) ratio was significantly different across all subgroups (P<0.05).</p><p><strong>Conclusion: </strong>A similar functional outcome, kyphosis correction, and mechanical stability (loss of correction) can be achieved without ACR if index screw purchase with increasing the implant density is feasible. In cases where the index screw deems impossible, the objective criteria of VHL ≥0.55, CHL ≥1.1, and AK ≥150 should be considered for deciding the need for anterior column reconstruction to achieve better outcomes.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151709","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":"Classification of Adolescent Idiopathic Scoliosis Curvature Using Contrastive Clustering.","authors":"Dae Hwan Kim, Sehan Park, Da Woon Kwon, Choon Sung Lee, Dong-Ho Lee, Jae Hwan Cho, Chang Ju Hwang","doi":"10.1097/BRS.0000000000005381","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005381","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective image analysis study.</p><p><strong>Objective: </strong>To propose a novel classification system for adolescent idiopathic scoliosis (AIS) curvature using unsupervised machine learning and evaluate its reliability and clinical implications.</p><p><strong>Summary of background data: </strong>Existing AIS classification systems, such as King and Lenke, have limitations in accurately describing curve variations, particularly long C-shaped curves or curves with distinct characteristics. Unsupervised machine learning offers an opportunity to refine classification and enhance clinical decision-making.</p><p><strong>Methods: </strong>A total of 1,156 AIS patients who underwent deformity correction surgery were analyzed. Standard posteroanterior radiographs were segmented using U-net algorithms. Contrastive clustering was employed for automatic grouping, with the number of clusters ranging from three to 10. Cluster quality was assessed using t-SNE and Silhouette scores. Clusters were defined based on consensus among spine surgeons. Interobserver reliability was evaluated using kappa coefficients.</p><p><strong>Results: </strong>Six clusters were identified, reflecting variations in structural curve location, single (C-shaped) versus double (S-shaped) curves, and thoracolumbar curve characteristics. Cluster reliability was moderate (kappa = 0.701-0.731). The silhouette score was 0.308, with t-SNE demonstrating distinct clustering patterns. The classification highlighted differences not captured by the Lenke classification, such as thoracic curves confined to the thoracic spine versus those extending to the lumbar spine.</p><p><strong>Conclusion: </strong>Unsupervised machine learning successfully categorized AIS curvatures into six distinct clusters, revealing meaningful patterns such as unique variations in thoracic and lumbar curves. These findings could potentially inform surgical planning and prognostic assessments. However, further studies are needed to validate clinical applicability and improve clustering quality.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128709","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":"Normative Thoracic, Lumbar, Pelvic and Global Sagittal Alignment Parameters for Asymptomatic Adults: A Systematic Review and Meta-Analysis of >35,900 Volunteers.","authors":"Alexandra C Dionne, Prakash Gorroochurn, Roy Miller, Prerana Katiyar, Samuel Bennion, Lisa Bonsignore-Opp, Josephine R Coury, Fthimnir M Hassan, Joseph M Lombardi, Lawrence G Lenke, Justin L Reyes, Zeeshan M Sardar","doi":"10.1097/BRS.0000000000005274","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005274","url":null,"abstract":"<p><strong>Study design: </strong>Systematic Review and Meta-Analysis.</p><p><strong>Objective: </strong>To describe regional and global spinopelvic sagittal parameters in asymptomatic adults.</p><p><strong>Summary of background data: </strong>Understanding normal alignment is important for management of patients with spinal deformities and essential for patient well-being following corrective surgery. To our knowledge, there exists no meta-analyses on normative alignment.</p><p><strong>Methods: </strong>We searched PubMed for primary studies on asymptomatic individuals with normal spinal anatomy and no prior spinal intervention. The collected variables included: age, gender percentage, global thoracic kyphosis (T1-3 to T12 TK), regional TK (T4-5 to T12), lumbar lordosis to L5 (T12-L1 to L5, LL-L5), LL to S1 (T12-L1 to S1, LL-S1), sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), PI-LL mismatch, sagittal vertical axis (SVA), T1 pelvic angle (TPA), and spinosacral angle (SSA). Data was analyzed according to sex, age (20-40 vs. 40-60 vs. >60 yrs), ethnic group (Asian, Caucasian, Hispanic, Middle Eastern), and Asian subgroup (Chinese, Japanese, Korean).</p><p><strong>Results: </strong>A total of 191 articles from 27 countries including 35,913 participants were reviewed: 16,125 men (44.9%), 18,222 women (50.7%), age range: 18-93 years were included. Regional TK and PT increased significantly in patients >60 compared to other groups. Globally, SVA, TPA, and changed with age in patients >60.</p><p><strong>Conclusion: </strong>LL-S1, PI and PT were all higher in women. Regional TK, PT, PI-LL, SVA, TPA all increased with age, while LL-S1 and SSA decreased. Global TK, regional TK, LL-S1, PI, and PI-LL all had significant differences across broad ethnic groups, and LL-S1, PI, PT and SVA showed differences within Asian subgroup. Global alignment was largely equivalent across ethnic groups.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128764","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":"Paraspinal Muscle Parameters Predict Postoperative Sagittal Balance in Cervical Disc Arthroplasty: A Structural Equation Model Analysis.","authors":"Junbo He, Tingkui Wu, Zijiao Liu, Zhaodian Wu, Xingjin Wang, Beiyu Wang, Kangkang Huang, Ying Hong, Yong Li, Chen Ding, Hao Liu","doi":"10.1097/BRS.0000000000005389","DOIUrl":"10.1097/BRS.0000000000005389","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Objective: </strong>To identify the associations between preoperative paraspinal muscle parameters and postoperative outcomes following cervical disc arthroplasty (CDA), while screening for predictors.</p><p><strong>Summary of background data: </strong>Paraspinal muscles play a critical role in maintaining cervical alignment, significantly contributing to cervical mobility and stability. To date, there is limited evidence regarding the impact of paraspinal muscles on CDA.</p><p><strong>Methods: </strong>This study included 185 patients who underwent single-level CDA. Preoperative paraspinal muscle parameters, including fatty infiltration (FI), cross-sectional area ratio (CSA r), and muscle asymmetry (ASY%), were assessed using MRI. Correlation analysis was employed for preliminary screening. Finally, structural equation modeling (SEM) was employed for comprehensive analysis.</p><p><strong>Results: </strong>Paraspinal muscle degeneration was prevalent in this cohort, with a higher proportion of moderate to severe FI (Goutallier Grade > 2) from the cranial to caudal levels. According to the correlation analysis, at the final follow-up, cervical lordosis was most strongly correlated with CSA r at C4/5 ( P =0.010); SVA was most related to CSA r at C5/6 ( P =0.030); and the T1 slope was associated with CSA r at C4/5 ( P <0.001), C5/6 ( P <0.001), as well as at the surgical level ( P <0.001). Moreover, a positive correlation was observed between preoperative pain scores and FI ( P =0.035). However, no such correlation was identified in the postoperative period. Comparative analysis of SEMs across different muscle variables revealed variations in predictive factors for postoperative sagittal balance parameters, with CSA r emerging as the significant contributor ( P =0.019, Estimate=0.176), rather than FI or ASY%.</p><p><strong>Conclusions: </strong>Compared with postoperative clinical outcomes, mobility, and prosthesis stability, preoperative muscle parameters were most correlated with sagittal balance after CDA. Specifically, CSA r outperformed in predicting postoperative sagittal balance. These findings suggest CDA may be associated with an elevated risk of sagittal imbalance when performed on patients with significant preoperative muscle degeneration.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995701","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":"12th Rib Length as a Predictor of Anatomical Variations in the Lumbosacral Plexus Associated with Atypical Radiculopathy in Lumbar Disc Herniation.","authors":"Hidaka Anetai, Juri Teramoto, Takafumi Ono, Toshiaki Kiribayashi, Hidetoshi Nojiri, Yukoh Ohara, Muneaki Ishijima, Koichiro Ichimura","doi":"10.1097/BRS.0000000000005400","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005400","url":null,"abstract":"<p><strong>Study design: </strong>A combined clinical and cadaveric observational study.</p><p><strong>Objectives: </strong>To investigate whether anatomical variations in the lumbosacral plexus (LSP) are associated with diagnostic discrepancies in lumbar disc herniation (LDH) and to corroborate clinical findings with anatomical evidence.</p><p><strong>Summary of background data: </strong>LDH is typically diagnosed based on clinical neurological symptoms and the level of the compressed spinal nerve root (the responsible lesion) identified by magnetic resonance imaging. However, in some patients, radiculopathy symptoms do not always align with the responsible lesion, complicating the diagnosis. This discrepancy may be linked to anatomical variations in the LSP, although the exact cause remains unclear. LSP roots may exhibit cranio-caudal deviations, which tends to be associated with shorter or longer 12th ribs, providing a potential basis for investigation.</p><p><strong>Methods: </strong>We examined 12th rib length in 144 patients with LDH at Juntendo University Hospital and investigated the relationship between LSP branch deviations and 12th rib length in 29 Japanese cadavers, donated to Juntendo University School of Medicine.</p><p><strong>Results: </strong>Of the total, 102 cases showed matching radiculopathies and responsible lesions (matched group), while 42 cases exhibited discrepancies (mismatched group). The mismatched group was subdivided into: 19 cases with radiculopathy at a lower level than predicted by the responsible lesion (lower-level radiculopathy type) and 23 cases with radiculopathy at a higher level (higher-level radiculopathy). These types were significantly associated with shorter and longer 12th ribs, respectively, suggesting cranial and caudal deviations in LSP branches, confirmed by anatomical examination.</p><p><strong>Conclusion: </strong>These findings suggest that contradictory neurological symptoms in LDH may be largely due to cranio-caudal deviations in the LSP and its branches. Furthermore, the 12th rib length may help predict these anatomical variations, potentially improving diagnostic accuracy in LDH.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120901","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":"Risk Factor Analysis and Risk Prediction Model Construction of Ossification Progression after Postoperative Cervical Ossification of Posterior Longitudinal Ligament.","authors":"Changlin Lv, Jianyi Li, Jianwei Guo, Tianyu Bai, Xiaofan Du, Guodong Zhang, Jiale Shao, Han Zhang, Wenkang Yang, Shiqi Xu, Yukun Du, Jun Dong, Yongming Xi","doi":"10.1097/BRS.0000000000005286","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005286","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Objective: </strong>To develop a nomogram to predict the progression of ossification of the posterior longitudinal ligament (OPLL) after surgery, identify potential risk factors, and provide a theoretical basis for preventing postoperative ossification progression.</p><p><strong>Summary of background data: </strong>OPLL is a degenerative condition prevalent in Asian populations, leading to spinal cord and nerve root compression. While surgery is the primary treatment, postoperative ossification progression, particularly after posterior surgeries, remains a challenge, potentially requiring reoperation. Current methods for predicting risk factors rely on clinical experience, highlighting the need for a multi-dimensional prediction model to identify at-risk patients and improve outcomes.</p><p><strong>Methods: </strong>This retrospective study analyzed 271 patients who underwent posterior cervical spine surgery for OPLL. Univariate and multivariate logistic regression were used to identify independent risk factors for postoperative ossification progression. A nomogram was constructed based on these factors. The model's performance was evaluated using the C-index, ROC curve, calibration curve, and decision curve analysis (DCA), with validation conducted using data from a separate group.</p><p><strong>Results: </strong>Multivariate logistic regression analysis identified four independent risk factors for ossification progression after OPLL. A nomogram was subsequently constructed based on these factors. The C-index values in both the training and validation groups demonstrated high accuracy and stability of the model. The area under the ROC curve (AUC) indicated excellent discriminative ability, while the calibration curves showed high agreement between predicted and observed outcomes in both groups. The decision curve analysis demonstrated that the nomogram provided the highest net clinical benefit within a probability threshold range 0.01-1.</p><p><strong>Conclusion: </strong>Younger patients with OPLL, greater initial ossification thickness, more than three affected levels, or continuous/mixed ossification types are at higher risk of postoperative progression. The nomogram provides clinicians with an effective tool to predict and prevent postoperative ossification progression.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120902","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}