Spine最新文献

{"title":"One-Level Versus Two-Level Anterior Lumbar Interbody Fusion (ALIF) From L4 to S1 : Comparison of Complications, Alignment, and Patient Outcomes.","authors":"Manjot Singh, Ashley Knebel, Michael J Kuharski, Joseph E Nassar, Tucker Callanan, Bryce A Basques, Eren O Kuris, Bassel G Diebo, Alan H Daniels","doi":"10.1097/BRS.0000000000005133","DOIUrl":"10.1097/BRS.0000000000005133","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Compare outcomes in patients undergoing one-level or two-level anterior lumbar interbody fusion (ALIF) at L4-S1.</p><p><strong>Background: </strong>Although ALIF may deliver restoration of lumbar lordosis and improvement in clinical outcomes, it also carries risk of complications including major vascular injury. Whether one-level and two-level ALIF offers similar outcomes is not known.</p><p><strong>Materials and methods: </strong>Adults who underwent one-level L4-L5 or L5-S1 ALIF and two-level L4-S1 ALIF at a single academic institution were identified. Patient demographics, procedural characteristics, improvement in spinopelvic alignment, and one-year postoperative patient-reported outcome measures (PROMs) and complications were compared. Multivariate regression analyses, accounting for age, sex, and Charlson comorbidity index (CCI), were also performed.</p><p><strong>Results: </strong>In total, 158 ALIF patients (111 one-level and 47 two-level) were included, with mean age of 51.4 years, 57.0% female, mean CCI of 1.2, and mean follow-up of 27.0 months. Surgical time (147.3 vs. 124.6 min, P =0.002) and hospital length of stay (3.5​​​ vs. 2.9 d, P =0.036) were higher for two-level ALIF. One-year postoperatively, two-level ALIF patients had more caudal apex of lordosis ( P =0.016) and 4.1 mm ( P =0.002) and 2.0 mm ( P =0.019) higher L4-L5 anterior and posterior disc heights, respectively. PROMs were not statistically different across groups ( P >0.05). Finally, two-level ALIF patients were 10.9 times more likely to have in-hospital complications ( P =0.040), such as intraoperative vascular injury (11.1% vs. 1.5%, P =0.040) or postoperative ileus (7.4% vs. 0.0%, P =0.027), than one-level ALIF patients.</p><p><strong>Conclusion: </strong>In this investigation with greater than one-year follow-up, two-level ALIF in the L4-S1 spine had higher procedural time, length of stay, and approach-related complications than one-level ALIF. Although there were minor improvements in alignment with two-level ALIF, PROMs were comparable with improvements from baseline to last follow-up. These findings may help surgeons carefully weigh the risks and benefits of one-level versus two-level ALIF when determining surgical plans for patients.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"271-276"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081601","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":"Morphologic and Clinical Aspects of Pott Disease in Ancient Human Remains: A Scoping Review.","authors":"Veronica Papa, Elena Varotto, Mauro Vaccarezza, Francesco Maria Galassi","doi":"10.1097/BRS.0000000000005190","DOIUrl":"10.1097/BRS.0000000000005190","url":null,"abstract":"<p><strong>Study design: </strong>The present study is a scoping review of the literature on Pott disease in ancient human remains.</p><p><strong>Objective: </strong>Comprehending the origin and history of Pott disease is relevant to assessing this pathologic condition from an evolutionary perspective.</p><p><strong>Summary of background data: </strong>Tuberculosis (TB) is an ancient pulmonary disease that remains the leading cause of death from a single infectious agent, rating above HIV/AIDS. The disease typically affects the lungs but can also target other anatomic sites. Of those, the most common and characteristic are the skeletal changes involving the spine, such as in Pott disease. Spinal tuberculosis accounts for approximately half of all cases of musculoskeletal tuberculosis. It can lead to loss of function in the lower limbs due to damage to the spinal column. Nevertheless, its origin and evolution are still not fully understood and need further investigation.</p><p><strong>Materials and methods: </strong>The authors investigated the published studies on Pott disease in ancient human remains, intending to survey the literature, map the evidence and identify gaps and future perspectives on TB in paleopathology. The search strategy was conducted between September 2021 and March 2023 using keywords including the terms \"Pott disease\" OR \"tuberculosis\" AND \"skeletal remains\" in PubMed Biomed Central , Scopus , and Google Scholar search engines and biomedical databases. Five hundred and three records were initially identified, and 66 studies were finally included and assessed for qualitative analysis. Finally, the included records were analyzed in terms of non-narrative data, including the type of publication, country of excavation, dating of the sample, the number of human remains, and their details. Furthermore, the type of bone lesion was indicated as well as the diagnostic method if detailed.</p><p><strong>Results: </strong>Among articles identified, most were classified as original articles, and were published between 2011 and 2020. Close to 77% of the reported records are excavations in Europe and the Near East. Included studies considered a total of 3388 human remains, mostly excavated in archeological sites and necropoles. Interestingly, the reported prevalence was higher among young males and adults.</p><p><strong>Conclusions: </strong>Although most of the findings are consistent with the literature, since the majority of the human remains were from Europe and the Near Middle East, more research is necessary in other sectors of the world. The suggestion of a male predominance needs to be confirmed and questions about the possible pathognomic role of rib lesions as well Serpes endocranica symmetrica (SES) represent further areas of research that need to be explored.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E56-E69"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508388","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":"Erector Spinae Plane Block With Liposomal Bupivacaine for Adolescent Idiopathic Scoliosis Surgery: No Patient-controlled Analgesia Needed.","authors":"Ernest Y Young, David Gurd, Thomas Kuivila, John Seif, Leah Bess, Ryan Goodwin","doi":"10.1097/BRS.0000000000005185","DOIUrl":"10.1097/BRS.0000000000005185","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective controlled cohort.</p><p><strong>Objective: </strong>To evaluate the effect of intraoperative liposomal bupivacaine (LB) through erector spinae plane block (ESPB) on patients with postoperative adolescent idiopathic scoliosis (AIS) with and without patient-controlled analgesia (PCA).</p><p><strong>Background: </strong>Pain control after posterior spinal fusion (PSF) for AIS includes opioids and other modalities. The goal of these modalities is to reduce pain and opioid consumption. Two new modalities for pain control include LB and ESPB. There are scant studies on these modalities tested in concert on patients undergoing PSF for AIS.</p><p><strong>Patients and methods: </strong>Seventy-two consecutive patients with AIS who underwent PSF were separated into patients who had a PCA (group A) as part of their postoperative pain management and those who did not (group B). Opioid consumption was measured through morphine milligram equivalents. Pain scores were measured through the visual acuity score (Visual Analog Scale). Patient mobility was measured by steps taken. These were measured by the function of postoperative days from surgery.</p><p><strong>Results: </strong>Group B had significantly lower morphine milligram equivalents at every point after surgery, most notably throughout the entire hospital stay (99.8 vs . 200.7). Postoperative pain scores in group B were the same if not better than group A. There was no difference in mobility between the cohorts. Group B had lower LOS (3.7 vs . 4.1).</p><p><strong>Conclusion: </strong>In postoperative PSF for patients with AIS receiving LB through ESPB, those who did not receive a PCA had lower opioid consumption without worse pain scores or mobility and had a lower LOS. Adding LB through ESPB to postoperative pain regimens effectively replaces a PCA by providing the same pain control and reducing overall opioid consumption and LOS.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"266-270"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508377","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":"Response to Letter to the Editor Regarding: Intraoperative Hypotension is an Important Modifiable Risk Factor for Major Complications in Spinal Fusion Surgery.","authors":"Steven D Glassman, Desiree Chappell, Leah Y Carreon","doi":"10.1097/BRS.0000000000005092","DOIUrl":"10.1097/BRS.0000000000005092","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E78"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555497","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":"Large L5-S1 Lordosis is an Independent Risk Factor for recurrENCE AFTER BOne Union of Pediatric Lumbar Spondylolysis at L5: A Retrospective Case-control Study.","authors":"Kohei Kuroshima, Shingo Miyazaki, Yoshiaki Hiranaka, Masao Ryu, Shinichi Inoue, Takashi Yurube, Kenichiro Kakutani, Ko Tadokoro","doi":"10.1097/BRS.0000000000005285","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005285","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case-control study.</p><p><strong>Objective: </strong>To determine risk factors for recurrence of pediatric lumbar spondylolysis at L5 after return to sport in patients who achieved bone union with conservative treatment.</p><p><strong>Summary of background data: </strong>Pediatric lumbar spondylolysis is a stress fracture commonly observed in adolescent athletes, particularly at the L5 vertebra. Because some patients experience a recurrence of spondylolysis after bone fusion with conservative treatment, identifying risk factors for recurrence may help athletes continue sports activities, maintain performance levels, and preserve mental health.</p><p><strong>Methods: </strong>Of the 375 pediatric patients (<18 years of age) who received conservative treatment for lumbar spondylolysis at L5 between 2015 and 2021, 296 patients who achieved bone fusion and returned to their original sports activities were analyzed. Recurrence rate, sports, pathological stage of spondylolysis at initial examination, presence of spina bifida occulta (SBO), duration of conservative treatment for initial spondylolysis, and radiological parameters including lumber lordosis, L5-S1 lordosis, and sacral slope were examined. Recurrence and non-recurrence groups were compared using univariate and multivariate analyses to investigate risk factors for recurrence. A receiver operating characteristic (ROC) curve was drawn to determine cut-off values of the parameters to predict spondylolysis recurrence.</p><p><strong>Results: </strong>Recurrence was observed in 52 out of 296 patients (17.6%). Multivariate logistic regression analysis revealed that a large L5-S1 lordosis was a significant independent risk factor for recurrence. ROC analysis demonstrated a cut-off value of 24.5° for L5-S1 lordosis. Age, sex, SBO, and duration of conservative treatment for initial spondylolysis were not significant predictors of recurrence.</p><p><strong>Conclusion: </strong>We identified large L5-S1 lordosis as an independent risk factor for recurrence of pediatric lumbar spondylolysis at L5 following conservative treatment. Intensive athletic rehabilitation to prevent recurrence and follow-up measures to monitor and detect recurrence are recommended for patients with large L5-S1 lordosis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190629","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":"GLP-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":"https://doi.org/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>Summary of background data: </strong>GLP-1 RAs have been shown to be beneficial when used perioperatively in clinical orthopaedic 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 (BMI) and GLP-1 RA usage. Propensity score matching was employed to create balanced cohorts utilizing BMI, Hemoglobin A1c (HbA1c), surgical intervention, as well as other demographic characteristics. Orthopedic outcomes were compared between GLP-1 RA users and non-users. The primary outcomes included post-operative infection, readmission, revision surgery, and quality of life metrics.</p><p><strong>Results: </strong>After matching, the study cohort consisted of 2,263 patients, with 1,560 classified as obese. GLP-1 RA use was associated with significantly reduced post-operative 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 post-operative 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":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-03","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":"Quantitative Analysis of Relationship between Paraspinal Muscle Degeneration and Degree of Degenerative Lumbar Spondylolisthesis.","authors":"Weiwei Da, Qiang Jian, Joiner Evan, Andrew K Chan, Paul C McCormick, Christopher E Mandigo, Justin Anthony Neira, Peter D Angevine, Xiaofeng Li, Dean Chou","doi":"10.1097/BRS.0000000000005270","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005270","url":null,"abstract":"<p><strong>Study design: </strong>Clinical retrospective study.</p><p><strong>Objective: </strong>The authors aim to analyze the relationship between paraspinal muscle degeneration and degree of L4-5 Degenerative lumbar spondylolisthesis (DLS).</p><p><strong>Summary of background data: </strong>While paraspinal muscle degeneration is thought to contribute to spondylolisthesis severity, this relationship has yet to be fully characterized.</p><p><strong>Methods: </strong>A retrospective analysis was performed of all neurosurgical patients admitted to the Columbia Neurosurgery Spine Division for treatment of L4-5 DLS between January 2018 and March 2024. Preoperative lumbopelvic parameters and slip percentage (SP) were calculated from standing radiographs; paraspinal muscle volume (MV), fatty volume (FV) and fatty infiltration (FI) of posterior paraspinal muscle were derived from MRI images using 3D Slicer (Earth, TX). Correlation and multiple linear regression analyses were used to assess the relationship between SP and paraspinal MV, FV, FI, and spinopelvic parameters.</p><p><strong>Results: </strong>221 patients with average SP of 23.74±0.09% were included. The female patients had higher SP, lumbar lordosis (LL), pelvic incidence (PI) and lower IVA than the male patients. However, paraspinal MV was lower and FI was higher in the Meyerding Grade II and female groups compared to the Grade I and male groups (P<0.01). There was a positive correlation between SP and metrics of fat replacement (P<0.01) and a negative correlation between SP and metrics of paraspinal muscles volume (P<0.01) at the L4-5 level. A stepwise multivariate regression ultimately included MFI, IVA, and LL and accounted for 15.2% of the variance in SP.</p><p><strong>Conclusion: </strong>In this single center retrospective study, greater degree of spondylolisthesis was modestly associated with lower MV and increased FI of the lumbar paraspinal muscles, suggesting that paraspinal muscle degeneration may be one of several important factors in the development of spondylolisthesis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080947","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 Factors for Postoperative Shoulder Imbalance in Patients With Lenke Type 1 and 2 Scoliosis Treated Using the Vertebral Coplanar Alignment Technique.","authors":"Arihisa Shimura, Hidetoshi Nojiri, Muneaki Ishijima, Hiroshi Moridaira, Hidekazu Arai, Satoshi Takada, Katsutaka Yamada, Naoya Kondo, Tadao Morino, Eiichiro Nakamura, Masaki Tomori, Kazuyuki Otani, Koji Akeda, Takuya Nagai, Hiromitsu Toyoda, Kenyu Ito, Junya Katayanagi, Hiroshi Taneichi","doi":"10.1097/BRS.0000000000005171","DOIUrl":"10.1097/BRS.0000000000005171","url":null,"abstract":"<p><strong>Study design: </strong>This was a multicenter retrospective cohort study.</p><p><strong>Objective: </strong>We investigated the incidence of postoperative shoulder imbalance (PSI) and its risk factors in patients with Lenke types 1 and 2 scoliosis corrected using vertebral coplanar alignment (VCA).</p><p><strong>Summary of background data: </strong>PSI in scoliosis affects patient quality of life. While other correction methods have reported a high correction rate for the main thoracic curve (MTC) in relation to PSI, this correlation has not been confirmed for the VCA technique.</p><p><strong>Materials and methods: </strong>We studied 176 patients with Lenke types 1 and 2 scoliosis who underwent posterior corrective fusion surgery using the VCA technique at 11 institutions. At 2 years postoperatively, patients were divided into two groups based on radiographic shoulder height (RSH): PSI- (RSH<2 cm) and PSI+ (RSH ≥2 cm) groups. We analyzed the risk factors for PSI.</p><p><strong>Results: </strong>The overall incidence of PSI 2 years postoperatively was 11.4% (20/176), with 9.2% (11/119) and 15.8% (9/57) in patients with Lenke types 1 and 2, respectively. Contrary to a previous study, a high MTC correction rate did not emerge as a risk factor for PSI. Instead, preoperative left shoulder elevation, low postoperative thoracic kyphosis, greater T1 tilt, and high apical vertebral body-to-rib ratio were associated with PSI in patients with Lenke type 1. Preoperative left shoulder elevation and a low postoperative proximal thoracic curve (PTC) correction rate were identified as risk factors for PSI in patients with Lenke type 2.</p><p><strong>Conclusion: </strong>Our results suggest that proper PTC correction, rather than compromising MTC correction, may help prevent PSI in the VCA technique. This method is particularly advantageous for addressing Lenke type 1 scoliosis and yields favorable outcomes in shoulder balance. Patients with preoperative left shoulder elevation, especially Lenke type 2, are at high risk of developing PSI.</p><p><strong>Level of evidence: </strong>Level 4.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"179-186"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558846","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 and Radiologic Predictors of Slower Improvement and Nonimprovement After Surgical Treatment of L4-L5 Degenerative Spondylolisthesis: Preliminary Results.","authors":"Sumedha Singh, Pratyush Shahi, Junho Song, Tejas Subramanian, Kyle Morse, Omri Maayan, Kasra Araghi, Nishtha Singh, Olivia Tuma, Tomoyuki Asada, Maximilian Korsun, Eric Mai, James Dowdell, Evan Sheha, Harvinder Sandhu, Todd Albert, Sheeraz Qureshi, Sravisht Iyer","doi":"10.1097/BRS.0000000000005019","DOIUrl":"10.1097/BRS.0000000000005019","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To identify the predictors of slower and nonimprovement after surgical treatment of L4-5 degenerative lumbar spondylolisthesis (DLS).</p><p><strong>Summary of background data: </strong>There is limited evidence regarding clinical and radiologic predictors of slower and nonimprovement following surgery for L4-5 DLS.</p><p><strong>Methods: </strong>Patients who underwent minimally invasive decompression or fusion for L4-5 DLS and had a minimum of 1-year follow-up were included. Outcome measures were: (1) minimal clinically important difference (MCID), (2) patient acceptable symptom state (PASS), and (3) global rating change (GRC). Clinical variables analyzed for predictors were age, gender, body mass index (BMI), surgery type, comorbidities, anxiety, depression, smoking, osteoporosis, and preoperative patient-reported outcome measures (PROMs) (Oswestry disability index, ODI; visual analog scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS). Radiologic variables analyzed were slip percentage, translational and angular motion, facet diastasis/cyst/orientation, laterolisthesis, disc height, scoliosis, main and fractional curve Cobb angles, and spinopelvic parameters.</p><p><strong>Results: </strong>Two hundred thirty-three patients (37% decompression and 63% fusion) were included. At less than three months, high pelvic tilt (PT) (OR: 0.92, P= 0.02) and depression (OR: 0.28, P= 0.02) were predictors of MCID nonachievement and GRC nonbetterment, respectively. Neither retained significance at above six months and hence, were identified as predictors of slower improvement. At above six months, low preoperative VAS leg (OR: 1.26, P= 0.01) and high facet orientation (OR: 0.95, P= 0.03) were predictors of MCID nonachievement, high L4-5 slip percentage (OR: 0.86, P= 0.03) and L5-S1 angular motion (OR: 0.78, P= 0.01) were predictors of GRC nonbetterment, and high preoperative ODI (OR: 0.96, P= 0.04) was a predictor of PASS nonachievement.</p><p><strong>Conclusions: </strong>High PT and depression were predictors of slower improvement and low preoperative leg pain, high disability, high facet orientation, high slip percentage, and L5-S1 angular motion were predictors of nonimprovement. However, these are preliminary findings and further studies with homogeneous cohorts are required to establish these findings.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"187-195"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852782","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":"Cranio-Vertebral Junction Anomalies: WFNS Spine Committee Recommendations Overview.","authors":"Óscar L Alves, Mehmet Zileli, Salman Sharif, Ricardo Botelho","doi":"10.1097/BRS.0000000000005281","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005281","url":null,"abstract":"<p><strong>Introduction: </strong>The published literature on Cranio-vertebral Junction (CVJ) anomalies lacks a comprehensive appraisal that integrates common diagnostic, management and treatment concepts for different conditions, such as Chiari Malformation (CM), Basilar Invagination (BI), Os Odontoideum (OO) and Syndromic Malformations. The authors aimed to fill this knowledge gap offering guidelines and recommendations with a global outreach and applicability.</p><p><strong>Methods: </strong>A group of expert spine surgeons and WFNS Spine Committee members, most of which extensively published on CVJ anomalies in the past, reviewed the literature issued from 2011 to 2022. Following a common methodology, based on the Delphi method, the authors analyzed the strength of the literature and voted statements concerning diagnosis and management of these conditions.</p><p><strong>Results: </strong>A total of eight papers were produced: (1) Chiari Malformation diagnosis, classifications, natural history, and conservative management, (2) Chiari malformation: indications for surgery and surgical options, (3) Pediatric Chiari malformation, (4) Syndromic atlanto-axial instability, (5) Os odontoideum, (6) Basilar invagination: diagnosis, radiology, and classification, (7) Surgical treatment of Basilar Invagination, and (8) Basilar invagination with associated Chiari malformation.</p><p><strong>Conclusions: </strong>Despite grey zones on natural history of CVJ anomalies and controversies on timing and type of surgical treatments, whenever atlantoaxial instability is present, C1-C2 stabilization through instrumentation and fusion is necessary. If only recurrent pain and neurological dysfunction occurs, surgical decompression is appropriate. If no atlantoaxial instability is present, Down's patients can participate in competitive sports. In general, contact sports are not recommended.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081017","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}