Spine最新文献

{"title":"Diagnosis, Classifications, and Treatment of Os Odontoideum: WFNS Spine Committee Recommendations.","authors":"Oscar L Alves, June Ho Lee, Djamel Kitumba, Agnaldo Lucas, Saleh Baeesa, Said Ben Ali, Francisco Sampaio, Gustavo Uriza, Ricardo Gepp, Mehmet Zileli, Ricardo Botelho, Jörg Klekamp, Atul Goel","doi":"10.1097/BRS.0000000000005277","DOIUrl":"10.1097/BRS.0000000000005277","url":null,"abstract":"<p><strong>Study design: </strong>A systematic literature review and consensus using the Delphi method.</p><p><strong>Objective: </strong>The aim was to formulate consensus recommendations regarding the natural history, diagnosis, classification, and optimal treatment of os odontoideum with global applicability.</p><p><strong>Summary of background: </strong>Os odontoideum (OO) is a rare anomaly of the cranio-vertebral junction (CVJ). Due to the paucity of literature, there is still considerable debate about the clinical management of OO.</p><p><strong>Materials and methods: </strong>Using PubMed, the authors reviewed the literature on OO published from 2011 to 2022. Using the Delphi method, a panel of expert spine surgeons and members of the WFNS Spine Committee analyzed the strength of the published literature and elaborated and voted on statements concerning diagnosis and management.</p><p><strong>Result: </strong>The diagnosis may be established incidentally. Symptoms may manifest as neck discomfort or encompass occipital-cervical pain, myelopathy, or vertebrobasilar ischemia. Diagnosis is usually made with plain radiographs and CT scans. Dynamic x-rays identify C1-C2 instability, whereas MRI assesses spinal cord integrity and compression. Asymptomatic cases lacking radiologic instability are generally handled through regular observation and serial imaging until predictors of neurological deterioration necessitate surgical intervention. In the event of atlantoaxial instability or neurological dysfunction, surgical intervention with instrumentation and fusion is required to maintain stability. In irreducible cases, C1-2 joint manipulation and distraction permits realignment and deformity correction avoiding decompression, either from anterior or posterior.</p><p><strong>Conclusions: </strong>The management guidelines for asymptomatic OO are still a gray zone as our understanding of the natural history is still vague. Therefore, we need more large-center studies to investigate this condition further. Whenever symptomatic, unstable, or asymptomatic presenting with risk factors, OO is better managed with atlantoaxial fusion, avoiding occipital inclusion in the construct. In irreducible OO, C1-C2 joint manipulation and distraction are preferred to decompression.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"743-750"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060670","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":"Jiri Dvorak: 2025 ISSLS Wiltse Lifetime Achievement Award.","authors":"Dino Samartzis, Robert Gunzburg","doi":"10.1097/BRS.0000000000005339","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005339","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 11","pages":"733-736"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049254","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":"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":"Pelvic Incidence Changes in Patients with Adult Spinal Deformity Following S2AI Fixation: Is the Hip Joint Involved?","authors":"Dongyue Li, Jie Li, Yanjie Xu, Zongshan Hu, Yinyu Fang, Yong Qiu, Zezhang Zhu, Zhen Liu","doi":"10.1097/BRS.0000000000005405","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005405","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To investigate whether the hip joints are involved in PI changes and explore its implications on pre-to-post PI changes.</p><p><strong>Summary of background data: </strong>Pelvic incidence (PI) is a key parameter in formulating surgical strategies for adult spinal deformity (ASD) patients requiring spinopelvic fixation. Emerging evidence of PI variability has challenged traditional formulations based on PI being a fixed parameter. Serving as a hinge between spine and lower extremity, the hip joints are involved in the compensation for spinal sagittal imbalance, yet its role in PI changes is poorly understood.</p><p><strong>Methods: </strong>A total of 155 consecutive patients were enrolled, with 121 patients following S2 alar-iliac fixation (S2AI group) and 34 following iliac screw fixation (IS group). Patients with S2AI fixation were further categorized into C and NC groups. The preoperative supine CT scout-view images were retrieved from S2AI group to compare the differences in hip parameter changes during positional changes. Finally, a correlation analysis was performed between hip parameters changes and ∆PI in S2AI group, with further validation conducted using fluoroscopic imaging of a 3D-printed pelvic model.</p><p><strong>Results: </strong>Patients in both S2AI and IS groups showed a significant decrease in PI postoperatively, with subsequent rebound during follow-up. Compared to group NC, patients in group C showed significantly greater pre-to-post changes in hip parameters. In S2AI group, pre-to-post ∆PI showed a significant negative correlation with preoperative position-related ∆femoral head coverage (FHC) and ∆lateral center-edge (LCE) angle, and a positive correlation with ∆extrusion index (EI). Based on the ROC curve, the optimal threshold of preoperative position-related ∆FHC, ∆LCE angle, ∆EI were 6.65%(AUC=0.844), 5.40°(AUC=0.664), and 4.55%(AUC=0.792), respectively.</p><p><strong>Conclusion: </strong>The pre-to-post PI changes in ASD patients following S2AI fixation are significantly associated with the hip joint coverage changes. These findings suggest that hip joints should be considered in formulating surgical corrective strategies based on PI in patients with ASD.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174967","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":"Adverse Impact of Obesity on Lumbar Spine Fusion, Patient-Reported Outcomes and Costs: A Systematic Review and Meta-Analysis.","authors":"John E O'Toole, Rick C Sasso, James S Harrop, Gonzalo Mariscal, Christopher D ChapuT, Paul M Arnold, Christopher D Witiw, W Bradley Jacobs, Michael P Steinmetz","doi":"10.1097/BRS.0000000000005395","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005395","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Purpose: </strong>The objective of this study is to determine the impact of obesity on three key lumbar spinal surgery outcomes: the incidence of spinal nonunion, patient-reported outcome measures (PROMs), and the associated healthcare costs.</p><p><strong>Summary of background data: </strong>Obesity is a well-recognized risk factor in various medical fields, notably impacting outcomes in orthopedics and traumatology. While there is substantial documentation of the complications associated with obesity in general surgical procedures, the relationship between obesity and spinal surgery outcomes remains less clear. The inconsistency in the evidence presents a significant gap in our understanding of how obesity influences the results of spinal surgeries, particularly in terms of nonunion rates, patient-reported outcomes, and the associated healthcare costs.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, EMBASE, Scopus, and the Cochrane Library following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing patients with or without obesity with lumbar spinal fusion were included. Comparative studies (cohort and case-control) were included. For dichotomous variables such as spinal nonunion, analysis was conducted using odds ratios (OR); for continuous variables such as PROMs (Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and 12/36-Item Short Form Survey (SF-12/36), and costs, analyses were performed using mean differences (MD) or standardized mean differences (SMD).</p><p><strong>Results: </strong>Fifteen studies with a pool of 61341 patients were included. Obesity (BMI≥30) was significantly associated with a higher nonunion frequency (OR 2.10, 95%CI 1.23 to 3.60, P<0.01). The ODI was significantly worse in the obesity group (MD 6.29, 95% CI 4.71 to 7.88, P<0.001). Greater pain was measured by the VAS back pain (MD 0.95, 95% CI 0.17 to 1.73, P<0.05) and VAS leg pain (MD 0.94, 95% CI 0.68 to 1.20, P<0.001) scales for lumbar surgery patients with obesity. The SF-12/36 showed significantly worse outcomes in patients with obesity (SMD -0.46, 95%CI -0.82 to -0.09, P=0.01). Hospitalization costs were significantly higher in patients with obesity (SMD 0.09, 95%CI 0.05 to 0.12, P<0.001).</p><p><strong>Conclusion: </strong>This meta-analysis suggests that obesity is significantly associated with higher nonunion rates, poorer patient-reported outcome measures including Oswestry Disability Index, Visual Analogue Scale, and 36-Item Short Form Survey, and higher hospitalization costs following lumbar spinal fusion.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162397","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":"Lumbar Multifidus Intramuscular fat Concentrations are Associated With Recovery Following Decompressive Surgery for Lumbar Spinal Stenosis. A Longitudinal Cohort Study With 5-year Follow-up.","authors":"Evert Onno Wesselink, Eduard Verheijen, Niek Djuric, Michel Coppieters, James Elliott, Kenneth Arnold Weber, Moojen Wouter, Carmen Vleggeert-Lankamp, Annelies Pool-Goudzwaard","doi":"10.1097/BRS.0000000000005408","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005408","url":null,"abstract":"<p><strong>Study design: </strong>Longitudinal cohort study.</p><p><strong>Objective: </strong>To explore the association between pre-operative lumbar paraspinal intramuscular fat (IMF) and recovery over a 5-year period following surgical decompression for lumbar spinal stenosis (LSS)-related intermittent neurogenic claudication.</p><p><strong>Summary of background data: </strong>The literature is inconclusive whether higher IMF concentrations on MRI are related to unfavorable outcomes following lumbar decompressive surgery for intermittent neurogenic claudication due to LSS.</p><p><strong>Methods: </strong>Patients(N=149) with LSS-related intermittent neurogenic claudication (52% male; mean (SD) age: 65.5 (9.1) years; BMI: 27.9 (4.3)) were included for this study. Pre-operative lumbar paraspinal IMF was quantified and categorized as non-severe (<50%) and severe (≥50%) IMF for each muscle (left and right lumbar multifidus and erector spinae) from axial T2-weighted MRI scans using automated computer-vision models. Logistic regression was used to investigate the association between IMF and global perceived effect as well as surgical success. Linear mixed-effects models were used to assess the difference in the clinical course of leg and back pain and disability between the IMF groups. The models were corrected for potential confounders.</p><p><strong>Results: </strong>Overall, participants with non-severe IMF in the lumbar multifidus reported a higher percentage of successful recovery (53.7% versus 37.5%) and surgical success (76.5% versus 59.9%) compared to the severe IMF group. This association was not present for erector spinae IMF. After adjusting for the potential confounders, the associations between lumbar multifidus IMF and successful recovery and surgical success remained significant for most timepoints across the 5-year follow-up (Odds ratios: 2.26-7.32, p≤0.049). Patients with non-severe IMF in the right lumbar multifidus experienced less disability (P=0.035). No between-group differences were found for the clinical course of leg and back pain (p≥0.143).</p><p><strong>Conclusions: </strong>Pre-operative levels of IMF in the lumbar multifidus, but not the erector spinae, were associated with 5-year recovery and success following surgery for LSS-related intermittent neurogenic claudication.</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":"144162403","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}