Spine最新文献

{"title":"Measuring Spine Surgeon Performance: A Scoping Review of Assessment Metrics and Evaluation Methods Used to Assess Surgeon Competency.","authors":"Sara R McMahan, Emily C Courtois, Alexander M Satin, Richard D Guyer, Bethany A Wilson, Kyle T Robinson, Donna D Ohnmeiss","doi":"10.1097/BRS.0000000000005451","DOIUrl":"10.1097/BRS.0000000000005451","url":null,"abstract":"<p><strong>Study design: </strong>This is a scoping review.</p><p><strong>Objective: </strong>To systematically review and synthesize the performance metrics used to assess surgical competency during spine surgery training.</p><p><strong>Summary of background data: </strong>The complexity of spine surgery requires prolonged training and careful competency evaluation. Simulation-based training offers scalable, repeatable, and ethically feasible alternatives to cadaver-based education. However, the assessment of surgeon performance across these platforms varies widely in scope and standardization.</p><p><strong>Methods: </strong>A scoping review was conducted following the PRISMA-ScR guidelines and registered in the Open Science Framework. Three databases were searched through February 2025 for prospective studies assessing surgeon performance in spine surgery training. Included studies evaluated technical and/or nontechnical skills using defined metrics across various simulation platforms. Data extraction focused on surgical procedure, simulator type, assessment metrics, and scoring methods.</p><p><strong>Results: </strong>From 974 screened records, 44 studies were included. Technical skills (TS) were assessed in all studies, primarily focusing on accuracy, efficiency, handling, safety, and efficacy. Nontechnical skills (NTS)-including cognition, communication, and self-assessment-were reported in 12 studies. Assessment metrics were influenced by surgical procedure and simulation modality. Physical models were most frequently used (n=25), followed by virtual (n=8), hybrid (n=9), and cadaveric or patient models. Scoring systems ranged from validated tools (eg, OSATS, GRS) to piloted instruments. TS were often measured via reviewer scoring or automated simulator output, while NTS assessments lacked consistency and standardization.</p><p><strong>Conclusion: </strong>Performance assessments in spine surgery simulation training vary significantly across platforms and procedures. TS are widely measured using objective or structured scoring systems, whereas NTS remain underassessed. This review underscores the need for validated, comprehensive, and procedure-specific performance metrics-integrating both TS and NTS-to enhance training, standardize evaluation, and ensure clinical readiness.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E407-E421"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761420","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":"Comparison of Recruitment Method on Clinical Outcomes Following Cervical Disk Arthroplasty.","authors":"David P Foley, Graham J Beutler, Daniel L Robinson, Michael H McCarthy, Rick C Sasso","doi":"10.1097/BRS.0000000000005253","DOIUrl":"10.1097/BRS.0000000000005253","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To compare the clinical outcomes of trial versus standard clinical practice (SCP) patients following cervical disk arthroplasty (CDA).</p><p><strong>Background: </strong>CDA is hypothesized to reduce the shear strain and related complications resulting from fusion procedures. CDA has gained significant traction in recent decades. The typical nontrial patient undergoing CDA does not undergo the same level of preoperative scrutiny as those treated in formal clinical trials. Concerns exist about diverging clinical outcomes between these groups.</p><p><strong>Methods: </strong>This investigation retrospectively reviews prospectively collected data on one and two-level CDA patients from C3-T1. Patients were recruited into randomized, controlled trials or SCP practice beginning in 2002 or 2018, respectively. One-year minimum follow-up was required. Hybrid constructs and prior cervical spine surgical history have been excluded. Clinical assessments included reoperation history and the patient-reported outcome measures of Visual Analog Scale (VAS) neck, VAS arm, and Neck Disability Index (NDI). Data were collected at the preoperative, postoperative, one-year, two-year, three-year, five-year, and 10-year time points.</p><p><strong>Results: </strong>One hundred sixty-eight patients underwent CDA at 193 cervical levels, including 104 trial patients and 64 SCP patients. The mean follow-up for the entire cohort was 6.1 years (0.9-20.4 yr). Eight unique disk designs were utilized. Trial patients had a greater proportion of females and longer follow-up duration ( P <0.05). Trial patients had significantly worse preoperative clinical scores with greater improvements at each follow-up time point. SCP patients had significantly higher index-level reoperation rates at five years.</p><p><strong>Conclusions: </strong>Trial patients have lower rates of reoperation and improved clinical performance which could be in part due to more stringent selection criteria. This study is limited by long-term SCP response rates. Additional studies with larger cohorts are needed to improve our understanding of disk implant performance.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1444-1450"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980035","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":"Single-position Prone Lateral Interbody Fusion is Associated With Improved Radiographic and Clinical Outcomes at One Year Compared With Single-position Lateral Interbody Fusion: A Single Institution Experience.","authors":"Anthony Yung, Oluwatobi O Onafowokan, Peter S Tretiakov, Max R Fisher, Ankita Das, Ethan J Cottrill, Isabel P Prado, Iryna Ivasyk, Olivia K Blaber, Caroline M Wu, Tyler K Williamson, Zach Thomas, Clifford L Crutcher, Paul Park, Andrew J Schoenfeld, Muhammad M Abd-El-Barr, Peter G Passias","doi":"10.1097/BRS.0000000000005239","DOIUrl":"10.1097/BRS.0000000000005239","url":null,"abstract":"<p><strong>Background: </strong>Recent studies highlight the increasing adoption of single-position prone lateral (SP-PL) and single-position lateral decubitus (SP-LD) in minimally invasive spine surgery (MISS) to reduce operative time, enhance patient safety, and improve surgical accessibility.</p><p><strong>Objective: </strong>To assess the differences between SP-PL and SP-LD achievement of optimal postoperative outcomes and postoperative complication rates.</p><p><strong>Study design: </strong>Retrospective review of prospectively collected MIS database.</p><p><strong>Materials and methods: </strong>Consecutive series of 152 patients with baseline (BL) and 1-year (1Y) postoperative radiographic/HRQL data were included. Patients placed in the SP-PL or SP-LD were isolated. Optimal outcome (OO) was defined as patients who experienced no complication requiring reoperation and achieved substantial clinical benefit (SCB) for NRS-leg or NRS-back. Means comparison analysis assessed differences in radiographic and clinical outcomes. ANCOVA and multivariable backward stepwise logistic regression were used to adjust for confounders.</p><p><strong>Results: </strong>Totally, 59 SP-PL and 93 SP-LD patients were included. At baseline, cohorts were comparable in terms of age, gender, BMI, and CCI. Perioperatively, SP-PL patients had a significantly lower operative time (207.22 vs . 317.5 min; P <0.001), LOS (3.1 vs . 3.6 d; P =0.033), EBL (244.5 vs . 376.3 mL; P =0.023), and demonstrated lower perioperative complication rate (25.4% vs . 41.9%; P =0.038). Multivariable analysis indicated that SP-PL patients had a lower likelihood of cardiac perioperative complications (OR: 0.012, 95% CI: 0.0-0.6; P =0.026). Immediate postoperatively, SP-PL has a greater degree of segmental lordosis improvement from L1-L2 to L5-S1 (all; P <0.05). SP-PL patients have a higher likelihood of achieving SCB NRS-back at 1Y (OR: 8.0, 95% CI: 1.5-42.0; P =0.014) and MCID NRS-leg at 1Y (OR: 4.6, 95% CI: 1.002-21.2; P =0.49). The SP-PL cohort had a significantly greater percentage of OO (96.6% vs . 78.5%; P =0.002) and a higher likelihood of achieving OO in adjusted analysis (OR: 10.6, 95% CI: 2.1-53.3; P =0.004).</p><p><strong>Conclusions: </strong>Patients placed in the SP-PL during minimally invasive spine surgery exhibit a reduced rate of perioperative complications, higher incidence of SCB, and a superior rate of achieving optimal outcome at the one-year follow-up. These findings underscore the SP-PL position as a potentially advantageous approach for minimally invasive lumbar fusion.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1427-1434"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839682","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 Surgical Upper Lumbar Changes on Unfused Lower Lumbar Segments in Adolescent Idiopathic Scoliosis.","authors":"Arun R Hariharan, Tracey Bryan, Hans K Nugraha, David S Feldman, Craig R Louer, John S Vorhies, Peter O Newton, Suken A Shah, Harry L Shufflebarger, Nicholas D Fletcher, Baron S Lonner, Michael P Kelly","doi":"10.1097/BRS.0000000000005240","DOIUrl":"10.1097/BRS.0000000000005240","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objective: </strong>To determine the impact of upper lumbar lordosis changes in the fused segment on compensatory kyphotic or lordotic changes in the unfused lower lumbar spine in patients with adolescent idiopathic scoliosis (AIS).</p><p><strong>Summary of background data: </strong>While the distribution of lordosis and interplay between fused/unfused segments has been studied in adults, less is known about this in AIS. We hypothesize that increased FSLL can result in compensatory kyphosis of the unfused distal segments.</p><p><strong>Materials and methods: </strong>A retrospective review of Lenke 1/2 patients who underwent posterior spinal fusion (PSF) to L1, L2, or L3 with a minimum follow-up of 2 years. Coronal Cobb angles, thoracic kyphosis, lumbar lordosis, and spino-pelvic parameters (T4PA, L1PA, PT, SS, PI, PI-LL, SVA) were measured. Custom MATLAB scripts were used for 3D segmental lordosis calculations. Statistical analysis, including linear regression analyses and interaction models, assessed the relationship between fused segment lumbar lordosis (FSLL), LIV, and thoracic kyphosis (TK) on lower lumbar compensatory alignment.</p><p><strong>Results: </strong>A total of 158 patients met the inclusion criteria. Changes in FSLL affected segmental lordosis of unfused segments, including loss of distal lordosis. In the L1 LIV group, increased FSLL increased L1-L2 lordosis ( B =0.35, P =0.003). In LIV L2, increased FSLL increased L3-4 lordosis ( B =0.2, P =0.001) and decreased L4-L5 lordosis ( B =-0.23, P =0.012). For LIV L3, increased FSLL caused a reduction in lordosis of L4-5 ( B =-0.14, P =0.026) and L5-S1 ( B =-0.14, P =0.034). Changes in TK also had varying impacts on the unfused segments. The interaction model with LIV levels reveals that the compensation strategy can vary depending on specific fusion levels, although not significant. Overall sagittal alignment was maintained, and PI-LL remained <10°. Preoperative and postoperative T4-L1PA had minimal difference to each other indicating maintained sagittal harmony.</p><p><strong>Conclusions: </strong>In this observational study of segmental changes in lumbar lordosis in AIS, postoperative changes in the fused segments can result in iatrogenic changes in the unfused lower segments to maintain spinal balance. Understanding normal segmental lumbar lordosis distribution is critical in surgical planning (ie, rod contouring) and understanding the health of the unfused segments in the long term.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1435-1443"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819262","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":"Revisiting the Treatment Algorithm for Atlantoaxial Dislocation After 10 Years: A Multicenter Study With Mid-to-long-term Follow-up.","authors":"Nanfang Xu, Yinglun Tian, Haoliang Zhao, Hongling Chu, Fangcai Li, Bing Wang, Peng Liu, Fei Yin, Lei Li, Linfeng Wang, Yannan Zhang, Linwei Chen, Lingqiang Chen, Jun Zhu, Zhisen Tian, Cheng Li, Feng Wang, Shilin Xue, Cheng Zhang, Weishi Li, Shenglin Wang","doi":"10.1097/BRS.0000000000005318","DOIUrl":"10.1097/BRS.0000000000005318","url":null,"abstract":"<p><strong>Study design: </strong>A multicenter retrospective cohort study.</p><p><strong>Objective: </strong>To overcome the limitations of former single-center strategy studies, an updated classification guiding surgical management of Atlantoaxial dislocation (AAD) is proposed in this study based on a large multicenter retrospective cohort study with mid-to-long-term follow-up.</p><p><strong>Summary of background data: </strong>AAD is the most prevalent disorder affecting the craniovertebral junction, often leading to myelopathy and impairment of cranial nerve function, which can result in significant morbidity or even mortality. Although the treatment algorithm we previously proposed for these diseases in 2013 has been widely adopted, its effectiveness and safety in multicenter settings have yet to be thoroughly evaluated.</p><p><strong>Methods: </strong>Patients with AAD who underwent surgical treatment were recruited from eight tertiary spine centers in eight provinces (two northeastern, two southwestern, one northwestern, one southeastern, and two central) across China between January 2011 and December 2021. Patient classification, surgical procedure, postoperative recovery progress, and occurrence of complications of the patients were collected and analyzed.</p><p><strong>Results: </strong>In total, 2354 patients were included. Type I and type II constituted most patients (76.0%). For type III AAD, our goal was conversion to type II, first using posterior intra-articular release (212/523 patients, 40.5%), and if failed, transoral release (311/523 patients, 59.5%). For type IV, we also attempted conversion to type II, using posterior or transoral osteotomy (37/42 patients, 88.1%). Transoral and transnasal odontoidectomy was the last resort for decompression for patients whose AAD could not be reduced despite all efforts (5/42 patients, 11.9%). At an average follow-up of 5.3 years, 85.9% of patients achieved complete anatomical AAD reduction, and 98.8% demonstrated clinical or radiological signs of solid fusion.</p><p><strong>Conclusions: </strong>The classification system of AAD was updated. Advancements have been made in the management of irreducible and bony AAD, and the transoral release and odontoidectomy procedures were required by less AAD patients.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1420-1426"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606350","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":"The Impact of Prior Hip or Knee Arthroplasty on Oswestry Disability Index Two Years After Elective Lumbar Surgery.","authors":"Jan Hambrecht, Paul Köhli, Erika Chiapparelli, Krizia Amoroso, Roland Duculan, Jiaqi Zhu, Ali E Guven, Gisberto Evangelisti, Marco D Burkhard, Koki Tsuchiya, Jennifer Shue, Andrew A Sama, Frank P Cammisa, Federico P Girardi, Carol A Mancuso, Alexander P Hughes","doi":"10.1097/BRS.0000000000005229","DOIUrl":"10.1097/BRS.0000000000005229","url":null,"abstract":"<p><strong>Study design: </strong>Secondary analysis of prospective study.</p><p><strong>Objective: </strong>To analyze the impact of prior total knee arthroplasty (TKA), total hip arthroplasty (THA), or both on the Oswestry Disability Index (ODI) two years after elective lumbar surgery.</p><p><strong>Background: </strong>Degenerative conditions that cause pain and mobility loss significantly reduce quality of life. The rising prevalence of total joint arthroplasties (TJA) and spinal surgeries complicates treatment and may result in persistent postoperative symptoms. Understanding how these surgeries interact and how surgical history and underlying conditions influence postoperative outcomes is crucial.</p><p><strong>Methods: </strong>A secondary analysis was performed on a prospective study of patients undergoing lumbar surgery for degenerative conditions. Patients with a two-year ODI follow-up were included. ODI was prospectively assessed preoperatively and postoperatively. Patients without ODI assessment were excluded. Differences in preoperative and postoperative ODI were evaluated, and patients were categorized based on ODI improvement. Statistical analyses included Mann-Whitney U test, univariable logistic regression, and multivariable logistic regression adjusted for age, sex, and BMI.</p><p><strong>Results: </strong>Overall, 385 patients (57% female, 65±10 yr) were included. Forty-six patients (12%) had prior THA, 34 (9%) patients had prior TKA, and 11 (3%) patients had both. ODI improvement was achieved in 91%. After adjusting for covariates, combined TKA and THA were significantly associated with postoperative ODI nonimprovement (OR: 9.96, 95% CI: 2.53-38.3, P =0.001). Prior TKA also tended to be a risk factor for ODI nonimprovement, although not statistically significant ( P =0.052) after adjusting for covariates.</p><p><strong>Conclusions: </strong>Patients with prior concomitant TKA and THA have higher odds of ODI nonimprovement two years postoperatively, suggesting that concurrent musculoskeletal degeneration of the spine and lower extremities may negatively impact improvement after lumbar surgery. These results highlight the connection not only between the hip but also between the knee and spine.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1451-1457"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772485","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 Editor on \"Long-Term Bladder, Bowel, and Ambulatory Function After Sacrectomy Surgery\".","authors":"Chengri Liu, Qingyu Xu, Yanqun Liu","doi":"10.1097/BRS.0000000000005374","DOIUrl":"10.1097/BRS.0000000000005374","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E430"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018838","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":"Development and Validation of Interpretable Machine Learning Models Incorporating Paraspinal Muscle Quality to Predict Cage Subsidence Risk Following Posterior Lumbar Interbody Fusion.","authors":"Haifu Sun, Wenxiang Tang, Lei Deng, Xingyu You, Zhairui Shen, Xiao Sun, Jun Zou, Fanguo Lin, Zhonglai Qian, Huilin Yang, Hao Liu","doi":"10.1097/BRS.0000000000005388","DOIUrl":"10.1097/BRS.0000000000005388","url":null,"abstract":"<p><strong>Study design: </strong>A real-world, multicenter retrospective study.</p><p><strong>Objective: </strong>To identify independent risk factors for cage subsidence after Posterior Lumbar Interbody Fusion (PLIF) and develop an interpretable machine learning model for risk prediction.</p><p><strong>Materials and methods: </strong>Patients with degenerative lumbar disease who underwent single-level PLIF (January 2018-October 2023) were retrospectively included. A training set (n=620) came from the First Affiliated Hospital of Soochow University, and a validation set (n=100) from the Second Affiliated Hospital. Cage subsidence (≥2 mm intervertebral height loss) was assessed radiographically. Parameters included paraspinal muscle indices [psoas muscle index (PMI), multifidus muscle index (MMI), fat infiltration (FI)], bone density markers [Hounsfield Unit (HU) value, Vertebral Bone Quality (VBQ), Endplate Bone Quality (EBQ)], cage position, and postoperative alignment. Multivariate logistic regression identified risk factors; multiple machine learning models were developed and evaluated. A web-based tool was created for clinical deployment.</p><p><strong>Results: </strong>Multivariate analysis identified PMI, FI, HU value, VBQ, cage position, cage height, postoperative Intervertebral Height (IH), corrected IH, and corrected SA as independent risk factors for cage subsidence. Light Gradient Boosting Machine (LightGBM) outperformed other models, achieving the highest AUC (0.9752), accuracy (0.92), and F1-score (0.9216), with the lowest Brier score (0.0660). After excluding indicators related to paravertebral muscle function from the prediction model, the predictive accuracy of the model decreased substantially. (SHapley Additive exPlanations) SHAP analysis confirmed VBQ, FI and PMI as the most influential predictors. The final model was deployed as a web-based tool for real-time clinical risk assessment.</p><p><strong>Conclusions: </strong>Key risk factors for PLIF cage subsidence were identified, and a validated machine learning model was developed. The high-performance LightGBM model, deployed in a user-friendly web application, enables spine surgeons to optimize surgical planning and reduce subsidence risk.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1375-1385"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047251","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":"Machine Learning-Based Prediction of Quality of Life Improvement After Surgery for Spinal Metastases: A Prospective Multicenter Study.","authors":"Kyota Kitagawa, Satoshi Maki, Yuki Shiratani, Akinobu Suzuki, Koji Tamai, Takaki Shimizu, Kenichiro Kakutani, Yutaro Kanda, Hiroyuki Tominaga, Ichiro Kawamura, Masayuki Ishihara, Masaaki Paku, Yohei Takahashi, Toru Funayama, Kousei Miura, Eiki Shirasawa, Hirokazu Inoue, Atsushi Kimura, Takuya Iimura, Hiroshi Moridaira, Hideaki Nakajima, Shuji Watanabe, Koji Akeda, Norihiko Takegami, Kazuo Nakanishi, Hirokatsu Sawada, Koji Matsumoto, Masahiro Funaba, Hidenori Suzuki, Haruki Funao, Tsutomu Oshigiri, Takashi Hirai, Bungo Otsuki, Kazu Kobayakawa, Koji Uotani, Koichi Sairyo, Shinji Tanishima, Ko Hashimoto, Chizuo Iwai, Daisuke Yamabe, Akihiko Hiyama, Shoji Seki, Kenji Kato, Masashi Miyazaki, Kazuyuki Watanabe, Toshio Nakamae, Takashi Kaito, Hiroaki Nakashima, Narihito Nagoshi, Satoshi Kato, Shiro Imagama, Kota Watanabe, Seiji Ohtori, Gen Inoue, Takeo Furuya","doi":"10.1097/BRS.0000000000005367","DOIUrl":"10.1097/BRS.0000000000005367","url":null,"abstract":"<p><strong>Study design: </strong>A prospective multicenter cohort study.</p><p><strong>Objective: </strong>To develop and validate machine learning models for predicting health-related quality of life (HRQoL) improvements in patients after one month and six months of surgery for spinal metastases.</p><p><strong>Summary of background data: </strong>The prediction of postoperative HRQoL of spinal metastases surgery remains understudied compared with studies of survival outcomes.</p><p><strong>Methods: </strong>We analyzed data from 413 patients who underwent surgery for spinal metastases at 40 participating institutions in Japan. The primary outcome was HRQoL improvement, defined as an increase in the EuroQol 5-Dimension 5-Level (EQ-5D) utility value of ≥0.32 from baseline. We developed two models for 1-month (n=360) and 6-month (n=189) outcomes using various machine learning algorithms. Missing values were imputed, and feature selection was performed using recursive feature elimination with cross-validation. We split the data into training (80%) and test (20%) sets for each model. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, precision, and F1-score. SHapley Additive exPlanations (SHAP) analysis was used to interpret feature importance.</p><p><strong>Results: </strong>The 6-month model outperformed the 1-month model across all metrics. For 1-month predictions, Logistic Regression achieved an AUC of 0.8136 and an accuracy of 0.7639 on the test set. For 6-month predictions, Naive Bayes demonstrated an AUC of 0.8928 and an accuracy of 0.8684. The 1-month model used 12 features, while the 6-month model required seven. SHAP analysis revealed that EQ-5D Mobility was the most influential feature in both models.</p><p><strong>Conclusions: </strong>Our models demonstrate high predictive accuracy for HRQoL improvements following spinal metastases surgery, with superior performance of the 6-month model. These models could enhance clinical decision-making and patient counseling by providing personalized predictions of postoperative QoL. Future research should focus on external validation and integration of these models into clinical practice.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 20","pages":"1410-1419"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132008","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":"Patients With Osteoporotic Vertebral Fractures in Denmark 2010-2018: A National Registry Analysis.","authors":"Mikkel Ø Andersen, Andreas K Andresen, Jacob Stampe Frølich, Karen Højmark Hansen, Line Nielsen, Anne Pernille Hermann, Tanja Gram Petersen, Leah Y Carreon, Jan Sørensen","doi":"10.1097/BRS.0000000000005220","DOIUrl":"10.1097/BRS.0000000000005220","url":null,"abstract":"<p><strong>Study design: </strong>Register-based cohort study based on linked data from multiple national registries.</p><p><strong>Objective: </strong>To describe the sociodemographic and health characteristics of individuals in Denmark with osteoporotic vertebral fractures (OVF) and analyze time trends. The study compares labor market participation and comorbidities between patients with OVF and a matched control group without these fractures.</p><p><strong>Summary of background data: </strong>The incidence and characteristics of patients with OVF in Denmark are not well-documented. Multiple national health and economic registries enable the linking of individual patient data, providing new insights.</p><p><strong>Methods: </strong>We identified individuals with hospital-diagnosed vertebral compression fractures from 2010 to 2018 using the Danish National Patient Register. A control group was matched by sex, age, and municipality. Work status before OVF was categorized as employed, on paid sickness benefits, in early retirement, or on old-age pension. Comorbidities were analyzed based on hospital diagnoses within 10 years before the fracture.</p><p><strong>Results: </strong>From 2010 to 2018, 20,262 individuals had hospital contact with an OVF. Sixty-four percent were women and the mean age was 73.6 (SD 12.4) years. OVF incidence increased from 86 in 2010 to 142 per 100,000 persons in 2018. In 2018, the regional incidence ranged from 120 to 154 per 100,000. More than a fifth of the patients were working before the fracture, while 77% were in early retirement or old-age pension. The population with OVF had more comorbidities than the matched comparison group.</p><p><strong>Conclusions: </strong>The incidence of hospital-diagnosed OVFs has risen over the last decade, with regional differences. Notably, over 20% of patients with OVFs were still employed, highlighting the socioeconomic impact of this condition.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1386-1391"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682835","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}