Spine最新文献

{"title":"Cost-effectiveness of Risk Stratified Care Versus Usual Care for Low Back Pain in the Military Health System.","authors":"Daniel I Rhon, Minchul Kim, Carl Asche, Steven Z George","doi":"10.1097/BRS.0000000000005145","DOIUrl":"10.1097/BRS.0000000000005145","url":null,"abstract":"<p><strong>Study design: </strong>Cost-effectiveness of two trial interventions for low back pain.</p><p><strong>Objective: </strong>To investigate the incremental cost-effectiveness between risk-stratified and usual care for low back pain.</p><p><strong>Summary of background data: </strong>A recent trial compared risk-stratified care to usual care for patients with low back pain (LBP) in the US Military Health System. While the outcomes were no different between groups, risk-stratified care is purported to use fewer resources and therefore could be a more cost-effective intervention. Risk-stratified care matches treatment based on low, medium, or high risk for poor prognosis.</p><p><strong>Methods: </strong>The cost-effectiveness of usual care versus risk-stratified care for low back pain was assessed, using the health care perspective. Patients were recruited from primary care. The main outcome indicated incremental cost-effectiveness between two alternative treatments. Acceptability curves of bootstrapped incremental cost-effectiveness ratios (ICER) were used to identify the proportion of ICERs under the specific willingness-to-pay (WTP) level ($50,000 to $100,000). Health system costs (total and back-related) and health-related quality-of-life (HRQoL) based on quality-adjusted life-years (QALYs) were obtained.</p><p><strong>Results: </strong>Two hundred seventy-one participants (33.6% female), mean age 34.3 +/-8.7 were randomized 1:1 and followed for one year. Mean back-related medical costs were not significantly different (mean difference $95; 95% CI: -$398, $407; P =0.982), nor were total medical costs (mean difference $827, 95% CI: -$1748, $3403; P =0.529). The mean difference in QALYs was not significantly different between groups (0.009; 95% CI: -0.014, 0.032; P =0.459). The incremental net monetary benefit (NMB) at the willingness to pay (WTP) threshold of $100,000 was $792 for back-related costs, with the lower bound CI negative at all WTP levels.</p><p><strong>Conclusions: </strong>Risk-stratified care was not cost-effective for medium-risk and low-risk individuals compared with usual care. Further research is needed to assess whether there is value for high-risk individuals or for other risk-stratification approaches.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E270-E277"},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141128","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 Patients With and Without Predicted Surgical Indication Between Clusters of Adult Spine Deformity (ASD) Patients.","authors":"Alice Baroncini, Louis Boissiere, Daniel Larrieu, Sleiman Haddad, Ferran Pellisé, Ahmet Alanay, Frank Kleinstueck, Javier Pizones, Anouar Bourghli, Ibrahim Obeid","doi":"10.1097/BRS.0000000000005173","DOIUrl":"10.1097/BRS.0000000000005173","url":null,"abstract":"<p><strong>Study design: </strong>Multicentric, retrospective analysis of prospectively collected data.</p><p><strong>Objective: </strong>To utilize machine learning (ML) for clustering and management prediction (conservative vs . operative) in surgically treated adult spine deformity (ASD) patients, and to compare the attainment of the minimum clinically important difference (MCID) between predicted surgical and conservative patients.</p><p><strong>Summary of background data: </strong>Management choice in ASD is complex. ML can identify patient clusters and predict treatment, but it is unclear whether patients treated according to the prediction also show better clinical outcomes.</p><p><strong>Materials and methods: </strong>ASD patients (2-yr follow-up) were divided into groups using k-means clustering. Management choice was predicted among operated patients in each cluster. The MCID for the Oswestry Disability Index (ODI) and the Scoliosis Research Society-22 (SRS-22) were calculated and compared between patients with and without surgical prediction.</p><p><strong>Results: </strong>In cluster 1 (idiopathic scoliosis, n=675, 150 surgeries), 57% of patients had a conservative prediction. Of these, 52% and 49% achieved MCID for ODI and SRS-22, respectively, compared with 68% and 75% for those with surgical predictions [odds ratio (OR)=2 and 3.1, respectively].In cluster 2 (moderate sagittal imbalance, n=561, 200 surgeries), 12% had a conservative prediction. Of these, 29% and 46% achieved MCID for ODI and SRS-22, respectively, compared with 47% and 56% for those with surgical predictions.In cluster 3 (significant sagittal imbalance, n=537, 197 surgeries), 17% had a conservative prediction. Of these, 12% and 15% achieved MCID for ODI and SRS-22, respectively, compared with 37% and 45% for those with surgical predictions (OR=4.2 and 4.5, respectively).</p><p><strong>Conclusion: </strong>Patients with concordant surgical prediction and management had higher odds of achieving the MCID, indicating a good correlation between prediction and clinical outcomes. In cluster 3, the low percentage of patients with conservative prediction achieving the MCID suggests that ML could well identify patients with poor clinical outcomes.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"975-980"},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354318","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":"Effect of Low-dose Methylprednisolone in Promoting Neurological Function Recovery After Spinal Cord Injury: Clinical and Animal Studies.","authors":"Yu Zhang, Shining Xiao, Liangbo Zhu, Xinrong Gan, Yongquan Huang, Fan Dan, Jiangwei Chen, Rongping Zhou, Wen Tang, Jiaming Liu, Zhili Liu","doi":"10.1097/BRS.0000000000005269","DOIUrl":"10.1097/BRS.0000000000005269","url":null,"abstract":"<p><strong>Study design: </strong>Subgroup analysis of a retrospective clinical and animal trial [study of different doses of methylprednisolone (MP) on functional recovery of spinal cord injury (SCI)].</p><p><strong>Objective: </strong>The aim is to investigate the efficacy of low-dose MP regimens in promoting neural repair after SCI.</p><p><strong>Background: </strong>SCI can result in sensory, motor, and autonomic nerve dysfunction, often leading to disability or death. MP is a preferred medication for the clinical treatment of SCI. Low-dose regimen may be a safer and more effective approach.</p><p><strong>Patients and methods: </strong>A subgroup comprising 705 patients with traumatic cervical SCI from 4 medical centers between January 2015 and December 2020 was retrospectively analyzed. Patients were stratified based on treatment regimen: low-dose MP, high-dose MP, or no MP use. All patients underwent spinal decompression surgery. The degree of neurological recovery and the incidence of complications during follow-up were compared among these 3 groups. In addition, we investigated the disparities in neurological function recovery, neuronal death, and neural axon regeneration between the low-dose and high-dose MP treatment regimens using a SCI rat model.</p><p><strong>Results: </strong>Patients receiving the low-dose MP regimen exhibited superior neurological recovery compared with those receiving the high-dose regimen and those not receiving MP (82.0% vs . 74.0%, P = 0.030; 82.0% vs . 63.4%, P = 0.001). Moreover, patients in the low-dose MP group demonstrated the lowest rates of perioperative pulmonary infections and gastrointestinal bleeding among these 3 groups. Evaluation of the SCI rat model through Basso-Beattie-Bresnahan score, footprint analysis, electrophysiological tests, hematoxylin and eosin staining, immunofluorescence staining, and Nissl staining further corroborated that the low-dose MP treatment regimen enhanced transport function recovery, reduced neuronal death, and promoted neural axon regeneration.</p><p><strong>Conclusion: </strong>The low-dose MP regimen may have a more positive therapeutic effect on the recovery of neurological function after SCI than other regimens.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"965-974"},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060673","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":"Deep Learning-Based Prediction for Bone Cement Leakage During Percutaneous Kyphoplasty Using Preoperative Computed Tomography: MODEL Development and Validation.","authors":"Ruiyuan Chen, Tianyi Wang, Xingyu Liu, Yu Xi, Dong Liu, Tianlang Xie, Aobo Wang, Ning Fan, Shuo Yuan, Peng Du, Shuncheng Jiao, Yiling Zhang, Lei Zang","doi":"10.1097/BRS.0000000000005448","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005448","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To develop a deep learning (DL) model to predict bone cement leakage (BCL) subtypes during percutaneous kyphoplasty (PKP) using preoperative computed tomography (CT) as well as employing multicenter data to evaluate the effectiveness and generalizability of the model.</p><p><strong>Summary of background data: </strong>DL excels at automatically extracting features from medical images. However, there is a lack of models that can predict BCL subtypes based on preoperative images.</p><p><strong>Methods: </strong>This study included an internal dataset for DL model training, validation, and testing as well as an external dataset for additional model testing. Our model integrated a segment localization module based on vertebral segmentation via three-dimensional (3D) U-Net with a classification module based on 3D ResNet-50. Vertebral level mismatch rates were calculated, and confusion matrixes were used to compare the performance of the DL model with that of spine surgeons in predicting BCL subtypes. Furthermore, the simple Cohen's kappa coefficient was used to assess the reliability of spine surgeons and the DL model against the reference standard.</p><p><strong>Results: </strong>A total of 901 patients containing 997 eligible segments were included in the internal dataset. The model demonstrated a vertebral segment identification accuracy of 96.9%. It also showed high area under the curve (AUC) values of 0.734-0.831 and sensitivities of 0.649-0.900 for BCL prediction in the internal dataset. Similar favorable AUC values of 0.709-0.818 and sensitivities of 0.706-0.857 were observed in the external dataset, indicating the stability and generalizability of the model. Moreover, the model outperformed nonexpert spine surgeons in predicting BCL subtypes, except for type II.</p><p><strong>Conclusion: </strong>The model achieved satisfactory accuracy, reliability, generalizability, and interpretability in predicting BCL subtypes, outperforming nonexpert spine surgeons. This study offers valuable insights for assessing osteoporotic vertebral compression fractures, thereby aiding preoperative surgical decision-making.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627125","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":"Timelines and Associated Factors for Return-To-Work of Patients with Painful Lumbar Radiculopathy who Undergo Lumbar Microdiscectomy Followed by Physiotherapy: A Prospective Cohort Study.","authors":"Servan Rooker, Stijn J Willems, Niels Franken, Martijn W Heymans, Michel W Coppieters, Martijn S Stenneberg, Gwendolyne G M Scholten-Peeters","doi":"10.1097/BRS.0000000000005443","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005443","url":null,"abstract":"<p><strong>Study design: </strong>Prospective cohort study with a 52 weeks follow-up.</p><p><strong>Objective: </strong>To describe the probability of return to work and explore associations between routinely collected pre-operative factors and return to work for patients with painful lumbar radiculopathy undergoing lumbar microdiscectomy and post-operative physiotherapy. Summary of background data. Medical absenteeism in patients with painful lumbar radiculopathy undergoing lumbar microdiscectomy followed by physiotherapy is associated with high socioeconomic costs. We lack good quality information about the time to return to work and the factors associated with returning to work in this patient group.</p><p><strong>Methods: </strong>We included 257 patients with clinical signs and symptoms of painful lumbar radiculopathy in whom nerve root compression was confirmed by Magnetic Resonance Imaging, and who underwent microdiscectomy and post-operative physiotherapy. Time to return to work was evaluated using Kaplan-Meier survival analysis. The association between independent factors and return to work was examined through Cox regression analysis.</p><p><strong>Results: </strong>Full resumption of their original paid job (i.e., same role with the same physical demands and responsibilities) occurred in 178 (69.3%) of participants by 52 weeks. In these patients, the median (IQR) return to work time was 16 weeks (14-16), with 85.0% of patients resuming work within 26 weeks. Higher education (HR=1.82), self-employment (HR=1.84), and the absence of predominant physical work (HR=1.61) were significantly associated with a faster return to work, while higher disability scores negatively impacted return to work time (HR=0.56).</p><p><strong>Conclusion: </strong>At 52 weeks following lumbar microdiscectomy and post-operative physiotherapy for painful lumbar radiculopathy, approximately two-thirds of individuals returned to work in their original roles, while some transitioned to different roles. Work-related and personal factors play a key role in determining the timing of this return. Recognizing these predictors in clinical practice can help surgeons, physiotherapists, and occupational health professionals guide patient expectations, provide more individualized workplace counselling, and support realistic, timely, and sustainable work reintegration.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627126","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":"Reduced Endurance Duration of Cervical Paraspinal Extensors Serves as an Independent Risk Factor for Axial Symptoms after Laminoplasty in Cervical Spondylotic Myelopathy Patients: A Prospective Study.","authors":"Xinhang Li, Haoxiang Wang, Zhenxu Li, Jiyan Jin, Xinrui Wang, Feifei Zhou","doi":"10.1097/BRS.0000000000005449","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005449","url":null,"abstract":"<p><strong>Study design: </strong>Prospective observational study.</p><p><strong>Objective: </strong>To investigate the impact of paraspinal extensor endurance duration on the development of axial symptoms (AS) following laminoplasty (LP).</p><p><strong>Summary of background data: </strong>AS is a common complication after LP. Although various factors, including cervical paraspinal extensors, have been implicated in its occurrence, the relationship between paraspinal extensor endurance duration and AS remains unexplored. Muscle endurance duration is a widely used indicator of muscle function and may offer predictive value.</p><p><strong>Methods: </strong>Patients with cervical spondylotic myelopathy (CSM) who underwent LP were included. Based on the presence or absence of AS at six months postoperatively, patients were divided into AS and non-AS groups. A custom-designed device was used to measure paraspinal extensor endurance duration. Demographic data, radiographic parameters, and patient-reported outcome measures (PROMs) were collected. Intergroup comparisons and multivariate logistic regression analyses were performed to identify risk factors for AS.</p><p><strong>Results: </strong>A total of 105 patients were enrolled, with 61 (58.1%) in the non-AS group and 44 (41.9%) in the AS group. The non-AS group demonstrated significantly longer preoperative endurance duration (P<0.001). No significant differences were observed in preoperative sagittal alignment or paraspinal muscle morphology. The non-AS group had lower preoperative VAS-neck and NDI scores (P=0.002 and P=0.006, respectively). Logistic regression identified endurance duration as the sole independent predictor of AS (Odds ratio [OR]=0.975, P=0.003). The receiver operating characteristic (ROC) analysis yielded an area under the curve (AUC) of 0.740, with an optimal cutoff of 42 seconds (sensitivity: 75.4%, specificity: 63.6%).</p><p><strong>Conclusion: </strong>Reduced paraspinal extensor endurance duration is an independent risk factor for AS after LP, demonstrating moderate predictive accuracy.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609581","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":"Timing of Intrathecal Morphine Administration and its Impact on Pain Control in Pediatric Spine Surgery.","authors":"Jacob Maier, Andrew Meyer, Catherine Hord, Richard Steiner, Tarun Bhalla, Todd Ritzman, Lorena Floccari","doi":"10.1097/BRS.0000000000005398","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005398","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The purpose of this study is to compare outcomes of intrathecal morphine (ITM) administered preemptively versus intraoperatively, either before or after correction, in adolescent idiopathic scoliosis (AIS) patients.</p><p><strong>Summary of background data: </strong>As a component of a multimodal pain regimen, ITM can reduce postoperative pain in pediatric patients undergoing spinal fusion, but the optimal timing of administration is unclear.</p><p><strong>Methods: </strong>Consecutive AIS patients who underwent posterior spinal fusion at a single institution were retrospectively reviewed. Patients were either given ITM prior to incision, during exposure, or after deformity correction. Opiate consumption was measured and converted to milligram of morphine equivalents (MME).</p><p><strong>Results: </strong>A total of 146 patients were included (85 pre-operative, 17 intraoperative before correction, and 45 intraoperative after correction). There were no statistically significant differences among groups in patient demographics or curve characteristics (P>0.05). ITM dosages were similar among groups, as were other intraoperative anesthetic infusions, including vasopressors and total intraoperative MME. There were no significant differences in operative time, blood loss, transfusion rate, or postoperative opioid consumption, including daily and total hospitalization MME (69.7 v 60.7 v 75.3, P=0.365). Hospital length of stay (2.9 v 2.8 v 2.9 d, P=0.749), potential side effects (hypotension, pruritis, nausea/vomiting), 30-day emergency department visits, and readmissions were all similar among groups (all P>0.05).</p><p><strong>Conclusion: </strong>For AIS patients undergoing posterior spinal fusion, the timing of intrathecal morphine administration has no significant impact on perioperative pain control, functional recovery, or early outcomes. No difference in MME administration, length of stay, potential side effects (hypotension, pruritis, nausea/vomiting), or early outcomes was observed between groups. Thus, ITM can be given either pre- or intra-operatively at the discretion of the surgical and anesthetic teams.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609582","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":"Patient Perceptions After Elective, Outpatient Lumbar Spine Surgery: Do Patients Prefer Same Day Discharge or an Overnight Stay?","authors":"Tejas Subramanian, Stephane Owusu Sarpong, Chad Z Simon, Robert Uzzo, Mihir Dekhne, Austin C Kaidi, Gregory S Kazarian, Eric Zhao, Farah Musharbash, Luis Felipe Colon, Adin Ehrlich, Kasra Araghi, Junho Song, Tomoyuki Asada, Pratyush Shahi, Troy B Amen, Kyle Morse, Francis C Lovecchio, James Dowdell, Sheeraz Qureshi, Sravisht Iyer","doi":"10.1097/BRS.0000000000005446","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005446","url":null,"abstract":"<p><strong>Study design: </strong>Single-center, survey-based study.</p><p><strong>Objective: </strong>This study aims to assess patient experiences in ambulatory lumbar spine surgery, with a focus on their expectations and preferences regarding discharge disposition, as well as the impact of discharge timing and alignment with patient preferences on satisfaction and early recovery outcomes.</p><p><strong>Summary of background data: </strong>While the safety and efficacy of ambulatory spine surgery have been well established, patient perceptions and experiences with these accelerated recovery pathways remain underexplored.</p><p><strong>Methods: </strong>A custom survey, designed by the authors, assessed patient experiences, preferences, and satisfaction related to discharge disposition. Respondents were asked to reflect on their surgical experience, focusing on their preferences for discharge timing and the reasons behind those preferences. The survey was administered to adult patients who underwent primary single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) or laminectomy (MI-Lami) and were discharged either on the same day of surgery (SDD) or after an overnight hospital stay (OVN). Patient preferences were qualitatively analyzed to identify recurring themes, while their postoperative night one experience was quantitatively scored across multiple domains, including sleep quality, comfort, hygiene management, and overall satisfaction. These data were then used to explore the relationship between discharge timing, and preference concordance.</p><p><strong>Results: </strong>A total of 227 responses were collected, with 64 (28.2%) undergoing MI-TLIF and 163 (71.8%) undergoing MI-Lami. Of these, 116 (51.1%) were discharged on the same day (SDD) and 111 (48.9%) had an overnight stay (OVN). While 36% preferred SDD and 49.8% preferred OVN, 56.9% reported feeling ready for same-day discharge. Qualitative analysis revealed that SDD preferences were driven by comfort at home, better sleep, and avoiding hospital inconveniences. Conversely, OVN preferences emphasized medical support, pain control, and logistical ease. Patients discharged the same day reported better care, sleep, hygiene, and comfort (P<0.05 for all). Those discharged in concordance with their preferences reported significantly lower rates of feeling discharged prematurely (3.4% vs. 32.3%; P<0.001) and superior outcomes across multiple domains, including pain control, comfort, and reduced burden on families (P<0.05 for all).</p><p><strong>Conclusions: </strong>SDD patients reported improved postoperative experiences, including sleep and satisfaction. Aligning discharge timing with patient preferences further enhanced outcomes, emphasizing the importance of patient-centered discharge planning in spine surgery.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609580","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 \"Association Between Paraspinal Muscle Parameters and Single-Segment Degenerative Lumbar Spondylolisthesis: Retrospective, Cross-Sectional Cohort Study\" by Liu, et al.","authors":"Guoyu Dai, Mingfeng Xue","doi":"10.1097/BRS.0000000000005452","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005452","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609609","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":"Mechanical Failures as Predicted by Achieving Local vs Global T4-L1 Hip Axis Goals: A Single Center Experience.","authors":"Karan Joseph, Tim T Bui, Alexander T Yahanda, Vivek P Gupta, Samuel Vogl, Salim Yakdan, Jeffrey T Galla, Miguel A Ruiz-Cardozo, Karma Barot, Sundeep Chakladar, Noah D Poulin, Anurag Challagundla, Jason Ng, Anitra Krishnan, Samuel N Brehm, Braeden Benedict, John C Clohisy, Nicholas Pallotta, Munish C Gupta, Brian J Neuman, Jeffrey Hills, Michael P Kelly, Daniel Hafez, Jacob K Greenberg, Wilson Z Ray, Camilo A Molina","doi":"10.1097/BRS.0000000000005450","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005450","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the predictive value of T4-L1 Hip Axis Error (HAE) and L1PA Error (L1PAE) on mechanical failure following adult spinal deformity (ASD) surgery, and to assess how error directionality and fusion length influence outcomes.</p><p><strong>Summary of background data: </strong>The T4-L1 Hip Axis is a novel framework for defining normative sagittal alignment by aligning thoracic and lumbar curvatures relative to the pelvis. Prior studies suggest that deviation from this axis may contribute to mechanical complications following ASD surgery. However, the impact of directionality, construct length, and specific risk factors remains underexplored.</p><p><strong>Methods: </strong>A retrospective review was conducted on 271 ASD patients who underwent fusion from L2 or above to the pelvis between 2016-2024. T4PA and L1PA were measured from six-week postoperative standing radiographs. Alignment errors (HAE, L1PAE) were calculated based on target threshold derived from prior normative studies. Multivariate logistic regression identified predictors of mechanical failures. Subgroup analyses were stratified by fusion length and error direction.</p><p><strong>Results: </strong>HAE was a significant predictor of mechanical failure (OR=1.20 per °, P<0.001), whereas L1PAE was not. HAE remained predictive regardless of whether patients achieved L1PA targets. In short fusions, both signed and absolute value of HAE were associated with mechanical failure. Positive HAE (anterior T4 alignment) conferred the highest risk. Higher BMI and short constructs were independent predictors of increased HAE.</p><p><strong>Conclusion: </strong>HAE is a robust, direction-sensitive predictor of mechanical failure in ASD surgery. Its predictive power surpasses L1PAE and remains significant in both long and short segment fusions. HAE Should be routinely measured and minimized intraoperatively to reduce postoperative mechanical complications.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609610","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}