Spine最新文献

{"title":"Return-to-Play Outcomes in Elite Athletes After Cervical and Lumbar Motion Preservation Spine Surgery: A Systematic Review.","authors":"Justin L Reyes, Elisabeth Geraghty, Josephine R Coury, Varun Arvind, Andrew J Luzzi, Michael A Mastroianni, Cole R Morrissette, Kyle O Obana, David P Trofa, Christopher S Ahmad, Zeeshan M Sardar, Ronald A Lehman, Joseph M Lombardi","doi":"10.1097/BRS.0000000000005164","DOIUrl":"10.1097/BRS.0000000000005164","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>The primary purpose of this article was to survey the present literature and report on return-to-play (RTP) outcomes in elite athletes after undergoing motion preservation spinal surgery (MPSS).</p><p><strong>Background: </strong>For elite performance, athletes require adequate mobility throughout the trunk, torso, and spine to achieve maximal force production. Therefore, elite athletes who have failed conservative treatment may seek to undergo motion-preserving surgical options, such as total disc arthroplasty and lumbar microdiscectomy. Individual studies have reported on RTP outcomes following individual motion preservation surgical procedures, but no systematic reviews have formally reported on RTP outcomes, postoperative performance, and reoperation rates on these procedures in elite athletes.</p><p><strong>Materials and methods: </strong>A systematic review was conducted from inception until February 2024 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. One reviewer queried PubMed for relevant studies that reported on RTP outcomes in elite athletes after MPSS based on title and abstract (n = 1404). After the original search query, an additional reviewer screened full-length articles. A total of 11 studies met the inclusion criteria. Special consideration was given to RTP rates, postoperative performance, and reoperation rates.</p><p><strong>Results: </strong>A total of 612 elite athletes from the National Basketball Association, Major League Baseball, National Football League, National Hockey League, and other professional sporting organizations underwent cervical and lumbar MPSS to treat various spinal pathologies. Various motion-sparing techniques were used to treat various pathologies. After undergoing MPSS, RTP rates ranged from 75% to 100% for lumbar cases and 83.3% to 100% for cervical cases. Postoperative performance varied with some athletes performing at the same level before surgery and some performing at a decreased level.</p><p><strong>Conclusions: </strong>MPSS is a feasible option when properly indicated. Future studies are needed to compare return to sport rates, postoperative performance, and reoperation rates between MPSS to spinal arthrodesis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"122-128"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354329","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":"Letter to the Editor: Application of the Six-Minute Walk Test in Assessment of the Cardiopulmonary Function of Children With Idiopathic Scoliosis.","authors":"Shiwei Xie","doi":"10.1097/BRS.0000000000005102","DOIUrl":"10.1097/BRS.0000000000005102","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E38"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Hypotension Is an Important Modifiable Risk Factor for Major Complications in Spinal Fusion Surgery.","authors":"Steven D Glassman, Leah Y Carreon, Mladen Djurasovic, Desiree Chappell, Wael Saasouh, Christy L Daniels, Colleen H Mahoney, Morgan E Brown, Jeffrey L Gum","doi":"10.1097/BRS.0000000000005030","DOIUrl":"10.1097/BRS.0000000000005030","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational cohort.</p><p><strong>Objectives: </strong>This study explores the impact of Intraoperative hypotension (IOH) on postoperative complications for major thoracolumbar spine fusion procedures.</p><p><strong>Summary of background data: </strong>IOH with mean arterial pressure (MAP) <65 mm Hg is associated with postoperative acute kidney injury (AKI) in general surgery. In spinal deformity surgery, IOH is a contributing factor to MEP changes and spinal cord dysfunction with deformity correction.</p><p><strong>Methods: </strong>A total of 539 thoracolumbar fusion cases, more than six surgical levels and >3 hours duration, were identified. Anesthetic/surgical data included OR time, fluid volume, blood loss, blood product replacement and use of vasopressors. Arterial-line based MAP data was collected at 1-minute intervals. Cummulative duration of MAP <65 mm Hg was recorded. IOH within the first hour of surgery vs. the entire case was determined. Post-op course and complications including SSI, GI complications, pulmonary complications, MI, DVT, PE, AKI, and encephalopathy were noted. Cumulative complications were grouped as none, one to two complications, or more than three complications.</p><p><strong>Results: </strong>There was a significant association between occurrence of complications and duration of IOH within the first hour of surgery (8.2 vs . 5.6 min, P <0.001) and across the entire procedure (28.1 vs . 19.3 min, P =0.008). This association persisted for individual major complications including SSI, acute respiratory failure, PE, ileus requiring NGT, and postoperative cognitive dysfunction. Comparison of patients with zero versus one to two versus three or more complications demonstrated that patients with three or more complications had a longer duration of IOH in the first hour of the surgery and that patients who had no complications received less vasopressor than patients who had one to two or three or more complications.</p><p><strong>Conclusion: </strong>This study identifies duration of IOH during the first hour of surgery as a previously unrecognized modifiable risk associated with major complications for multilevel lumbar fusion surgery.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"75-80"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877400","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":"Assessing Abnormal Proximal Junctional Angles in Adult Spinal Deformity: A Normative Data Approach to Define Proximal Junctional Kyphosis.","authors":"Marc Khalifé, Renaud Lafage, Alan H Daniels, Bassel G Diebo, Jonathan Elysée, Christopher P Ames, Shay R Bess, Douglas C Burton, Robert K Eastlack, Munish C Gupta, Richard A Hostin, Khaled Kebaish, Han-Jo Kim, Eric O Klineberg, Gregory Mundis, David O Okonkwo, Olivier Gille, Pierre Guigui, Emmanuelle Ferrero, Wafa Skalli, Ayman Assi, Claudio Vergari, Christopher I Shaffrey, Justin S Smith, Frank J Schwab, Virginie Lafage","doi":"10.1097/BRS.0000000000005141","DOIUrl":"10.1097/BRS.0000000000005141","url":null,"abstract":"<p><strong>Study design: </strong>Multicentric retrospective study of prospectively collected data.</p><p><strong>Objective: </strong>On the basis of normative data from a cohort of asymptomatic volunteers, this study sought to determine the rate of abnormal values of proximal junctional angles (PJA) in adult spinal deformity (ASD) surgery patients, and compare it with PJK rate.</p><p><strong>Summary of background data: </strong>Proximal junctional kyphosis (PJK) definition does not take the vertebral level into account.</p><p><strong>Patients and methods: </strong>This study included 721 healthy volunteers and 824 ASD surgery patients with two-year postoperative follow-up. Normative values for each disc and vertebral body between T1 and T12 were analyzed, then normative values for PJA at each thoracic level were defined in the volunteer cohort as the mean±2SD. PJA abnormal values at the upper instrumented vertebra (UIV) were compared with Glattes' and Lovecchio's definitions for PJK in the ASD population at two years.</p><p><strong>Results: </strong>Mean age was 37.7±16.3 in the volunteer cohort, with 50.5% of females. Mean thoracic kyphosis (TK) was -50.9±10.8°. Corridors of normality included PJA greater than 20° between T3 and T12. Mean age was 60.5±14.0 years in the ASD cohort, with 77.2% of females. Mean baseline TK was -37.4±19.9°, with a significant increase after surgery (-15.6±15.3°, P <0.001). There was 46.2% of PJK according to Glattes' versus 8.7% according to Lovecchio's and 22.9% of kyphotic PJA compared with normative values ( P <0.001).</p><p><strong>Conclusion: </strong>This study provides normative values for segmental and regional alignment of thoracic spine, used to describe abnormal values of PJA for each level. Using level-adjusted PJA values allows a more precise assessment of abnormal proximal angles and question the definition for PJK.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"103-109"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354304","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":"Scoliosis Research Society-22r and Ceiling Effects: Limited Capabilities for Precision Medicine With Adolescent Idiopathic Scoliosis.","authors":"Lauren E Stone, Christopher P Ames, Ferran Pellise, Peter O Newton, Vidyadhar V Upasani, Michael P Kelly","doi":"10.1097/BRS.0000000000004993","DOIUrl":"10.1097/BRS.0000000000004993","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective registry analysis.</p><p><strong>Objective: </strong>To examine predictions of individual Scoliosis Research Society-22r (SRS-22r) questions one year after surgery for adolescent idiopathic scoliosis (AIS).</p><p><strong>Summary of background data: </strong>A precision-medicine approach to AIS surgery will inform patients of the likelihood of achieving particular results from surgery, specifically individual responses to the SRS-22r questionnaire.</p><p><strong>Methods: </strong>A multicenter AIS registry was queried for surgical AIS patients treated between 2002 and 2020. Preoperative data collected included standard demographic data, deformity descriptive data, and SRS-22r scores. Postoperative one-year SRS-22r scores were modeled using ordinal logistic regression. The highest probability was the most likely response. Model performance was examined by c-statistics, where c >0.8 was considered excellent. Ceiling effects were measured by the proportion of patients reporting \"5\" to each question.</p><p><strong>Results: </strong>A total of 3251 patients contributed data to the study; mean age 14.4 (±2.2) years, female 2631 (81%), major thoracic coronal curve 53°, mean lumbar 41°. C-statistic values ranged from 0.6 (poor) to 0.8 (excellent), evidence of varied predictive capabilities. Q17 (\"days off work/school,\" c = 0.84, ceiling achieved 75%) and Q15 (\"financial difficulties,\" c = 0.86, ceiling achieved 82%) had the greatest predictive capabilities while Q11 (\"pain medication,\" c=0.73, ceiling achieved 67%), Q10 (\"appearance,\" c=0.72, ceiling achieved 35%), and Q19 (\"attractive,\" c=0.69, ceiling achieved 37%) performed poorly.</p><p><strong>Conclusions: </strong>Prediction of individual SRS-22r item responses, perhaps most germane to AIS treatment, was poor. The prediction of less relevant outcomes, where ceiling effects are present, was greater as the models chose \"5\" for all responses. These ceiling effects may limit discrimination and hamper efforts at personalized outcome predictions.</p><p><strong>Level of evidence: </strong>Level 3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"34-39"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159101","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":"Impact of Prior Cervical Fusion on Patients Undergoing Thoracolumbar Deformity Correction.","authors":"Manjot Singh, Mariah Balmaceno-Criss, Mohammad Daher, Renaud Lafage, Robert K Eastlack, Munish C Gupta, Gregory M Mundis, Jeffrey L Gum, Kojo D Hamilton, Richard Hostin, Peter G Passias, Themistocles S Protopsaltis, Khaled M Kebaish, Lawrence G Lenke, Christopher P Ames, Douglas C Burton, Stephen M Lewis, Eric O Klineberg, Han Jo Kim, Frank J Schwab, Christopher I Shaffrey, Justin S Smith, Breton G Line, Shay Bess, Virginie Lafage, Bassel G Diebo, Alan H Daniels","doi":"10.1097/BRS.0000000000005119","DOIUrl":"10.1097/BRS.0000000000005119","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of prospectively collected data.</p><p><strong>Objective: </strong>Evaluate the impact of prior cervical constructs on upper instrumented vertebrae (UIV) selection and postoperative outcomes among patients undergoing thoracolumbar deformity correction.</p><p><strong>Background: </strong>Surgical planning for adult spinal deformity (ASD) patients involves consideration of spinal alignment and existing fusion constructs.</p><p><strong>Methods: </strong>ASD patients with (ANTERIOR or POSTERIOR) and without (NONE) prior cervical fusion who underwent thoracolumbar fusion were included. Demographics, radiographic alignment, patient-reported outcome measures (PROMs), and complications were compared. Univariate and multivariate analyses were performed on POSTERIOR patients to identify parameters predictive of UIV choice and to evaluate postoperative outcomes impacted by UIV selection.</p><p><strong>Results: </strong>Among 542 patients, with 446 NONE, 72 ANTERIOR, and 24 POSTERIOR patients, mean age was 64.4 years and 432 (80%) were female. Cervical fusion patients had worse preoperative cervical and lumbosacral deformity, and PROMs ( P <0.05). In the POSTERIOR cohort, preoperative LIV was frequently below the cervicothoracic junction (54%) and uncommonly (13%) connected to the thoracolumbar UIV. Multivariate analyses revealed that higher preoperative cervical SVA (coeff=-0.22, 95% CI=-0.43 to -0.01, P =0.038) and C2SPi (coeff=-0.72, 95% CI=-1.36 to -0.07, P =0.031), and lower preoperative thoracic kyphosis (coeff=0.14, 95% CI=0.01-0.28, P =0.040) and thoracolumbar lordosis (coeff=0.22, 95% CI=0.10-0.33, P =0.001) were predictive of cranial UIV. Two-year postoperatively, cervical patients continued to have worse cervical deformity and PROMs ( P <0.05) but had comparable postoperative complications. Choice of thoracolumbar UIV below or above T6, as well as the number of unfused levels between constructs, did not affect patient outcomes.</p><p><strong>Conclusions: </strong>Among patients who underwent thoracolumbar deformity correction, prior cervical fusion was associated with more severe spinopelvic deformity and PROMs preoperatively. The choice of thoracolumbar UIV was strongly predicted by their baseline cervical and thoracolumbar alignment. Despite their poor preoperative condition, these patients still experienced significant improvements in their thoracolumbar alignment and PROMs after surgery, irrespective of UIV selection.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"26-33"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988992","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":"Foot Tapping Test as a Simple Quantitative Index of Motor Function for Lumbosacral Radiculopathy.","authors":"Hiroshi Kobayashi, Takuya Nikaido, Koji Otani, Kazuyuki Watanabe, Kinshi Kato, Yoshihiro Kobayashi, Michiyuki Hakozaki, Takuya Kameda, Yoichi Kaneuchi, Miho Sekiguchi, Shoji Yabuki, Shin-Ichi Konno, Yoshihiro Matsumoto","doi":"10.1097/BRS.0000000000005063","DOIUrl":"10.1097/BRS.0000000000005063","url":null,"abstract":"<p><strong>Study design: </strong>We conducted a retrospective review of data from patients who underwent surgical treatment for lumbosacral radiculopathy.</p><p><strong>Objective: </strong>To assess the effectiveness of the foot tapping test (FTT) in evaluating lower limb motor function in patients with lumbosacral radiculopathy pre and postsurgery.</p><p><strong>Background: </strong>Lumbosacral radiculopathy is becoming increasingly common in aging populations. Despite standard treatments, paralysis often leads to incomplete postoperative recovery, necessitating early detection and interventions.</p><p><strong>Patients and methods: </strong>We enrolled individuals who underwent surgery for lumbosacral radiculopathy at our facility between 2009 and 2020. Patients with a history of lumbar surgeries, dialysis, rheumatoid arthritis, and transitional vertebrae were excluded. The FTT score was measured by having the sole of the foot tap as many times as possible for 10 seconds while keeping the heel in contact with the floor. The L4, L5, and S1 groups were assigned using the scores on the side of the radiculopathy, and the control group was assigned using the scores on the intact side. Data were analyzed using the Dunnett test for group comparisons and paired t -tests for pre and postsurgery comparisons.</p><p><strong>Results: </strong>Of the 522 eligible patients, 80 (159 nerve roots, 1 patient with hemi-prosthetic leg) were analyzed. The preoperative FTT scores in the L4 and L5 groups were significantly lower than those in the control group, indicating functional impairment. One year postsurgery, all groups showed improvements in FTT scores, with the L5 group exhibiting significant improvements compared with the control; this was supported by the results of sensitivity analyses considering the effects of paralysis and pain.</p><p><strong>Conclusion: </strong>The FTT is a valuable tool for the early detection of lower limb motor dysfunction in lumbosacral radiculopathy, particularly for L5 nerve root impairment, where it aids in timely surgical intervention and may improve postoperative outcomes and quality of life.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"60-66"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301651","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":"Therapeutic Potential of Mesenchymal Stem Cell-Derived Extracellular Vesicles Carrying MicroRNAs for Modulating Autophagy and Cellular Degeneration in Intervertebral Disc Degeneration.","authors":"LinFeng Wang, Yang Wang, Jianhang Jiao, Weibo Jiang, Tong Yu, Zhonghan Wang, Mufeng Li, Minfei Wu, Pan Su","doi":"10.1097/BRS.0000000000005167","DOIUrl":"10.1097/BRS.0000000000005167","url":null,"abstract":"<p><strong>Study design: </strong>This research utilized bioinformatics and in vitro modeling to assess the effects of mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) containing specific microRNAs (miRNAs) on the autophagy and degeneration of nucleus pulposus cells in intervertebral disc degeneration (IDD).</p><p><strong>Objective: </strong>To determine the therapeutic potential of MSC-EVs loaded with miRNAs in modulating pathologic changes in IDD.</p><p><strong>Background: </strong>IDD is characterized by changes in gene expression that contribute to cell degeneration and reduced disc integrity. MSC-EVs are known for their role in cellular communication and potentially reversing these degenerative processes.</p><p><strong>Materials and methods: </strong>Key differentially expressed miRNAs and mRNAs in MSC-EVs were identified using bioinformatics analysis. Three miRNAs (miR-486-5p, miR-3648, and miR-1827) typically downregulated in IDD were selected for further study. The bone marrow-derived MSC-EVs used in this study were cultured in a two-dimensional environment. These MSC-EVs were isolated with the purpose of delivering the selected miRNAs to IDD nucleus pulposus cells in vitro, targeting specifically the upregulated genes ( SMAD2 , ESR1 , MAVS , and MMP14 ) associated with autophagy and degeneration.</p><p><strong>Results: </strong>MSC-EV treatment led to significant downregulation of target genes, enhanced cellular proliferation, and decreased apoptosis and autophagy. Overexpression of these target genes produced the opposite effects, confirming the miRNAs' regulatory roles.</p><p><strong>Conclusions: </strong>MSC-EVs carrying specific miRNAs can effectively modulate gene expression, reduce degenerative processes, and promote cellular proliferation in IDD, indicating a promising therapeutic strategy for treating IDD and potentially other degenerative diseases. Further investigations are warranted to explore MSC-EV applications in regenerative medicine.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E7-E19"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366623","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":"Incidence and Risk Factors for Mechanical Failure After Anterior Column Realignment in Adult Spinal Deformity Surgery.","authors":"Se-Jun Park, Jin-Sung Park, Minwook Kang, Kyunghun Jung, Chong-Suh Lee, Dong-Ho Kang","doi":"10.1097/BRS.0000000000005114","DOIUrl":"10.1097/BRS.0000000000005114","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objectives: </strong>To investigate the incidence and risk factors of mechanical failure (MF) following anterior column realignment (ACR) in patients with severe degenerative sagittal imbalance (DSI).</p><p><strong>Summary of background data: </strong>Considering the biomechanical properties of the procedure, ACR may increase the risk of MF, including proximal junctional kyphosis (PJK) and rod fracture (RF). However, this issue has been poorly documented in the literature.</p><p><strong>Methods: </strong>We included patients aged ≥60 years with severe DSI radiographically defined by pelvic incidence (PI)-lumbar lordosis (LL) ≥20° undergoing ≥5-level fusion, including the sacrum. PJK was defined radiographically as a proximal junctional angle (PJA) >28° plus Δ PJA of >22°. RF was evaluated at ACR levels performed. Clinical and radiographic variables were compared with identify the risk factors for PJK and RF, then multivariate analysis was performed by combining PJK and RF into a single composite outcome of MF.</p><p><strong>Results: </strong>We included a total of 147 patients in the final study cohort. The mean age was 70.3 years, and there were 126 women (90.6%). The median fusion length was 8 levels. After surgery, PI-LL was corrected from 48.1° to 4.3°. MF developed in 49 patients (33.3%); PJK in 41 (27.9%), RF in 11 (7.5%), and both PJK and RF in 3 (2.0%) patients. Multivariate analyses revealed that osteoporosis (odds ratio [OR]=2.361, 95% confidence interval [CI]=1.270-5.590, P =0.048) and an increased number of ACR levels (OR=1.762, 95% CI=1.039-3.587, P =0.036) were significant risk factors for MF.</p><p><strong>Conclusions: </strong>A considerable number of patients (33.3%) developed MF after deformity correction using ACR procedures. Therefore, appropriate surgical strategies are necessary to prevent MF in patients undergoing deformity correction using ACR, with special attention to the risk factors we identified here.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"10-18"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860952","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":"Change in Lumbar Lordosis After Decompressive Surgery in Lumbar Spinal Stenosis Patients and Associations With Patient-Related Outcomes Two Years After Surgery: Radiologic and Clinical Results From the NORDSTEN Spinal Stenosis Trial.","authors":"Josefin Åkerstedt, Johan Wänman, Hasan Banitalebi, Tor Åge Myklebust, Clemens Weber, Kjersti Storheim, Christian Hellum, Kari Indrekvam, Erland Hermansen, Helena Brisby","doi":"10.1097/BRS.0000000000005037","DOIUrl":"10.1097/BRS.0000000000005037","url":null,"abstract":"<p><strong>Study design: </strong>A prospective cohort study.</p><p><strong>Objective: </strong>The aim was to investigate changes in lumbar lordosis (LL) and its association to changes in patient-reported outcome measures (PROMs) after decompressive surgery for lumbar spinal stenosis (LSS).</p><p><strong>Summary of background: </strong>Few studies have addressed change in LL after decompression surgery for LSS in relation to outcomes.</p><p><strong>Materials and methods: </strong>Preoperative and postoperative data from 310 patients having standing x-ray both before and two years after surgery were included. The patients were grouped based on the change in LL preoperatively to two years after surgery; group 1: <5° (n=196), group 2: ≥5 <10° (n=55), or group 3: ≥10° (n=59) of change in LL. The changes in function, disability and pain were assessed by the Oswestry disability index (ODI), numeric rating scale (NRS), and the Zurich claudication questionnaire (ZCQ). The three groups were compared regarding baseline variables using the ANOVA test for continuous variables and the χ 2 test for categorical variables. The groups were further compared with a likelihood ratio test in relation to changes in PROMs two years after surgery and outcomes were adjusted for respective baseline PROMs, age, sex, smoking, BMI, Schizas, and Pfirrmann scores.</p><p><strong>Results: </strong>LL was significantly changed at group level two years after surgery with a mean difference of 2.2° (SD: 9.4°) ( P =0.001). The three LL change groups did not show any significant differences in patient characteristics, function, disability, and pain at baseline. The two groups with a change of more than 5° in LL two years after surgery (group 2 and 3) had significantly greater improvements in ODI ( P =0.022) and ZCQ function ( P =0.016) in the adjusted analyses, but was not significant for back and leg pain.</p><p><strong>Conclusion: </strong>Changed LL after decompressive surgery for LSS was associated with improved ODI and physical function.</p><p><p>Level of Evidence. Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"40-45"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11627310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}