Spine最新文献

{"title":"Heterogeneity in the Definitions of Proximal Junctional Kyphosis and Failure in Spinal Deformity Literature: A Tower of Babel.","authors":"Izzet Akosman, Takashi Hirase, Jarred Lihan Chow, Tejas Subramanian, Robert Uzzo, Charlotte Henry Jones, Steven Govinda Persaud, Bryce Demopoulos, Olivia Tuma, Matthew Cunningham, Han Jo Kim, Francis Lovecchio","doi":"10.1097/BRS.0000000000005096","DOIUrl":"10.1097/BRS.0000000000005096","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>To describe the various definitions of PJK and PJF used in spinal deformity literature and their utility over time.</p><p><strong>Summary of background data: </strong>Proximal junctional kyphosis or failure (PJK/PJF) is among the most common complications after long-segment fusions, but there is no consensus on their definitions. This presents challenges in understanding risk factors, management, and prevention strategies.</p><p><strong>Methods: </strong>A systematic literature review was performed on studies specifying a definition of PJK and/or PJF. PJK definitions were categorized as radiographic versus nonradiographic, and data were collected on PJK criteria, including the threshold for proximal junctional angle (PJA), change in PJA, vertebra selection for PJA measurement, and follow-up time points. PJF definitions were categorized as structural failure, need for revision, symptomatic failure, and radiographic (angular).</p><p><strong>Results: </strong>A total of 359 studies defining PJK and/or PJF were identified. While 56% of studies used the definition PJA>10 ° and PJA change from baseline>10 ° , the remainder expressed significant heterogeneity with respect to criteria for the magnitude of PJA and degree of PJA change. The most common vertebrae assessed were UIV/UIV+2 (74%), and the most common minimum follow-up (mFU) listed was two years (60%). Mean FUs for studies varied considerably even in studies with the same mFU, from 2.1 to 8.9 years (2-yr mFU) and 1.1 to 4.0 years (1-yr mFU). PJF definitions were most commonly structural (58%) or defined as a need for revision (48%), with a much less common use of PJA thresholds (23%).</p><p><strong>Conclusions: </strong>The challenges faced in preventing proximal junctional complications are mired in the heterogenous groundwork by which PJK and PJF are defined. Most definitions of PJK use radiographic thresholds without consideration of clinical relevance and variations in individual alignment. Conversely, definitions of PJF are based on clinical criteria, which are often subjective. Future research should focus on understanding the mechanisms of PJK/PJF, as only then will we be able to accurately define and prevent these complications.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"485-492"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724563","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":"Adjacent Level Canal Area Changes up to Two Years After Lumbar Spinal Stenosis Decompressive Surgery.","authors":"Helena Brisby, Tor Åge Myklebust, Hasan Banitalebi, Ivar Austevoll, Jorn Aaen, Kjersti Storheim, Christian Hellum, Eric Franssen, Kari Indrekvam, Erland Hermansen","doi":"10.1097/BRS.0000000000005247","DOIUrl":"10.1097/BRS.0000000000005247","url":null,"abstract":"<p><strong>Study design: </strong>A secondary analysis of data from the NORDSTEN-spinal stenosis trial (SST).</p><p><strong>Objective: </strong>The aim of the present study was to investigate whether the dural sac cross-sectional area (DSCA) on magnetic resonance imaging (MRI) of adjacent segments decreases after decompressive surgery due to lumbar spinal stenosis (LSS) up to 2 years postoperatively and to investigate possible associations with baseline variables, including preoperative patient and radiological characteristics, and surgical method used.</p><p><strong>Summary of background data: </strong>Decompressive surgery for LSS is currently the most common spinal surgery procedure; however, there is limited knowledge of changes in the DSCA over time adjacent to a decompressed segment.</p><p><strong>Materials and methods: </strong>In the NORDSTEN-SST, 437 patients were randomized to decompression with one of three minimally invasive surgical methods for LSS. The patients underwent an MRI of the lumbar spine (L2-L5) before surgery and at 3 and 24 months postoperatively. Descriptive statistics of adjacent DSCA and changes in adjacent DSCA are presented. Possible prognostic factors (preoperative factors, radiologic measures, and surgical method) for changes in the adjacent DSCA were examined using multivariate regression analyses.</p><p><strong>Results: </strong>Three hundred twenty-two patients (74%) in the original NORDSTEN-SST had undergone MRI at both 3 and 24 months postoperatively and were included (360 adjacent levels, 263 cranial, and 97 caudal to a decompressed level). Up to two years postoperatively, no decrease in adjacent DSCA was observed. No associations were found between the investigated baseline variables and DSCA change from zero to two years, except for a weak association with baseline adjacent DSCA.</p><p><strong>Conclusions: </strong>Up to two years postoperatively, the DSCA did not decrease at adjacent levels after decompressive surgery. None of the investigated baseline variables showed any clinically meaningful prognostic value regarding adjacent DSCA changes two years postoperatively. The findings support previous reports that decompression of adjacent levels is not required to prevent subsequent stenosis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"429-436"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898296","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":"What is the Association of the Subsections of the Oswestry Disability Index and Overall Improvement 2 Years After Lumbar Surgery for Degenerative Lumbar Spondylolisthesis?","authors":"Jan Hambrecht, Paul Köhli, Roland Duculan, Ranqing Lan, Erika Chiapparelli, 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.0000000000005076","DOIUrl":"10.1097/BRS.0000000000005076","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of a prospective cohort study.</p><p><strong>Objective: </strong>To identify the association between Oswestry Disability Index (ODI) subsections and overall improvement 2 years after lumbar surgery for degenerative lumbar spondylolisthesis (DLS).</p><p><strong>Background: </strong>DLS often necessitates lumbar surgery. The ODI is a trusted measure for patient-reported outcomes (PROMs) in assessing spinal disorder outcomes. Surgeons utilize the ODI for baseline functional assessment and postsurgery progress tracking. However, it remains uncertain if and how each subsection influences overall ODI improvement.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed patients who underwent lumbar surgery for DLS between 2016 and 2018. Preoperative and 2-year postoperative ODI assessments were conducted. The study analyzed postoperative subsection scores and defined ODI improvement as ODIpreop-ODIpostop >0. Univariate linear regression was applied, and receiver operating characteristic (ROC) analysis determined cutoffs for subsection changes and postoperative target values to achieve overall ODI improvement.</p><p><strong>Results: </strong>Two hundred sixty-five patients (60% female, mean age 67±8 yr) with a baseline ODI of 50±6 and a postoperative ODI of 20±7 were included. ODI improvement was noted in 91% (242 patients). Achieving a postoperative target score of ≤2 in subsections correlated with overall ODI improvement. Walking had the highest predictive value for overall ODI improvement (AUC: 0.91, sensitivity: 79%, and specificity: 91%). Pain intensity (AUC: 0.90, sensitivity: 86%, and specificity: 83%) and changing degree of pain (AUC: 0.87, sensitivity: 86%, and specificity: 74%) were also highly predictive. Sleeping had the lowest predictability (AUC: 0.79, sensitivity: 84%, and specificity: 65%). Except for sleeping, all subsections had a Youden index >50%.</p><p><strong>Conclusions: </strong>These findings demonstrate how the different ODI subsections are associated with overall improvement post-lumbar surgery for DLS. This understanding is crucial for refining preoperative education, addressing particular disabilities, and evaluating surgical efficacy. In addition, it shows that surgical treatment does not affect all subsections equally.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"447-453"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440913","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 as a Predictor of Proximal Junctional Kyphosis in Patients With Lenke Type 5 Adolescent Idiopathic Scoliosis.","authors":"Takahiro Kitagawa, Satoshi Suzuki, Kazuki Takeda, Toshiki Okubo, Masahiro Ozaki, Yohei Takahashi, Osahiko Tsuji, Narihito Nagoshi, Mitsuru Yagi, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.1097/BRS.0000000000005108","DOIUrl":"10.1097/BRS.0000000000005108","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective comparative study.</p><p><strong>Objective: </strong>The purpose of this study is to evaluate the relationship between pelvic incidence (PI) and proximal junctional kyphosis (PJK) in patients with Lenke type 5 adolescent idiopathic scoliosis (AIS).</p><p><strong>Background: </strong>Although PJK is a common complication of sagittal malalignment after posterior correction and fusion surgery (PSF), few studies have assessed its risk factors. The significance of pelvic morphology in relation to PJK has been suggested but remains unclear in Lenke type 5 AIS patients.</p><p><strong>Materials and methods: </strong>A total of 92 patients with Lenke type 5 AIS who underwent selective thoracolumbar PSF with a minimum follow-up of two years were included. Patients were divided into PJK and non-PJK groups based on postoperative radiographs. The influence of PI on PJK occurrence was evaluated through binary logistic analysis. Subgroup analysis was performed based on the PI value (low PI, <45°; high PI, ≥ 45°) to identify factors affecting PJK occurrence.</p><p><strong>Results: </strong>PJK was observed in 17.4% of the whole cohort. Binary logistic regression analysis identified low PI and large TL/L curve as a risk factor for PJK (PI, odds ratio, 0.933; TL/L curve, odds ratio, 1.080). Subgroup analysis showed that the postoperative increase in the upper instrumented vertebra slope in PJK cases was comparable in both the low and high PI groups. Meanwhile, lordotic changes in the fused area in the PJK cases were observed only in the low PI group. No difference in the Scoliosis Research Society 22 scores was observed between the two groups.</p><p><strong>Conclusion: </strong>From this study a low PI was identified as a risk factor for the occurrence of PJK in Lenke type 5 AIS patients. The occurrence of PJK is influenced by lordotic changes in the fused area and the limited compensatory capacity of the pelvis in patients with a low PI.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"470-476"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793577","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":"Evaluating the SpineNet Model: Recommendations for Statistical Methods.","authors":"Tianfei Yu, Bingrui Ren, Ming Li","doi":"10.1097/BRS.0000000000005084","DOIUrl":"10.1097/BRS.0000000000005084","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E140"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470818","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":"Global, Regional, and National Burden of Low Back Pain: Findings From the Global Burden of Disease Study 2021 and Projections to 2050.","authors":"Mei Cheng, Yinkai Xue, Min Cui, Xianlin Zeng, Cao Yang, Fan Ding, Lin Xie","doi":"10.1097/BRS.0000000000005265","DOIUrl":"10.1097/BRS.0000000000005265","url":null,"abstract":"<p><strong>Study design: </strong>This was an observational study.</p><p><strong>Objective: </strong>Assessing the global burden of disease for low back pain (LBP) using the 2021 GBD (Global Burden of Disease) database.</p><p><strong>Summary of background data: </strong>LBP is a leading cause of workforce loss and disability. With societal aging and changes in lifestyle and work habits, the incidence of LBP is expected to rise. This study comprehensively analyzes the epidemiological trends of global LBP from 1990 to 2021.</p><p><strong>Methods: </strong>Data publicly available from the 2021 GBD study were utilized, and a systematic analysis was conducted to assess the global burden and epidemiological trends of LBP.</p><p><strong>Results: </strong>From 1990 to 2021, the age-standardized prevalence, incidence, and Years Lived with Disability (YLD) rates of LBP have slightly declined globally. However, the number of affected individuals, new cases, and YLD numbers have significantly increased, making LBP a leading cause of YLD in 2021. The number of affected individuals increases with age, peaking in both men and women between the ages of 50 and 54. Worldwide, women have a higher prevalence of LBP than men, and this increases with age, with both sexes reaching peak prevalence between 80 and 84 years in 2021. Overall, over the past 3 decades, age-standardized YLD rates have shown a positive correlation with the Socio-demographic Index (SDI). In terms of region and nation, Tropical Latin America and Kingdom of Sweden have seen the greatest increase in age-standardized prevalence rates from 1990 to 2021.</p><p><strong>Conclusion: </strong>Globally, LBP remains a notable public health concern, carrying a consistently high burden. To alleviate the future impact of this disease, it is imperative to increase public awareness regarding its risk factors and to implement preventive measures.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E128-E139"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012116","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":"MRI-Based Vertebral Bone Quality Score as a Comprehensive Indicator to Evaluate the Trend of Bone Turnover Markers.","authors":"Dachuan Li, Xiao Lu, Zhaoyang Gong, Wei Zhu, Guangyu Xu, Jiongdong Wu, Chenpei Xu, Yuxuan Zhang, Shuo Yang, Hongli Wang, Xinlei Xia, Feizhou Lu, Jianyuan Jiang, Chi Sun, Yunzhi Guan, Fei Zou, Xiaosheng Ma","doi":"10.1097/BRS.0000000000005346","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005346","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>This study aimed to analyze the correlation between VBQ scores and bone turnover markers in lumbar spine disorders.</p><p><strong>Summary of background data: </strong>Vertebral Bone Quality (VBQ) score is increasingly used in the assessment of bone mineral density, and bone quality profiles are closely related to bone metabolism. However, the level of bone turnover is often overlooked in clinical practice.</p><p><strong>Methods: </strong>We retrospectively analyzed the data from 234 patients who underwent lumbar spine surgery. VBQ scores were evaluated using preoperative lumbar T1-weighted Magnetic Resonance Imaging (MRI), with patients classified into High (>3.3), Middle (2.7-3.3), and Low (<2.7) VBQ groups. The data of Computed Tomography (CT) images and Dual-Energy X-ray Absorptiometry (DEXA) were collected to obtain the Hounsfield unit (HU) and T value. Correlation analysis, linear regression, and one-way ANOVA were used to analyze the relationship between bone turnover markers including Parathyroid hormone (ng/L), 25-hydroxyvitamin D3 (nmol/L), Osteocalcin (ng/mL), β-CTX (ng/mL), and P1NP (ng/mL) and bone quality. P<0.05 was considered statistically different.</p><p><strong>Results: </strong>Comparative analysis showed BTMs varied markedly across VBQ categories (P<0.0001 to P=0.0158), with osteoblast-related markers (25(OH)D3, OC) decreasing and osteoclast-related markers (β-CTX) increasing with higher VBQ scores. Multivariate analysis confirmed age, gender, BMI, and specific BTMs(Except for PINP) as independent predictors of VBQ scores (P=0.0075-0.0256). VBQ demonstrated superior correlations with BTMs (r=0.52-0.63) compared to T-scores and HU values, highlighting its enhanced sensitivity to dynamic bone metabolism. Notably, patients with normal BMD/high HU but intermediate VBQ scores showed suppressed osteoblastic activity (P=0.0009-0.0036), while those with osteopenia-level BMD/HU and elevated VBQ scores exhibited exacerbated bone resorption (P<0.001).</p><p><strong>Conclusion: </strong>This is the first study to link VBQ scores with bone turnover markers in lumbar spine patients. Preoperative VBQ assessment via MRI can initially evaluate bone metabolism without radiation exposure, guiding osteoporosis treatment post-surgery to optimize bone health.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731674","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 a Surgeon-Directed Cocktail of Ropivacaine, Methylprednisolone, and Ketoprofen on Postoperative Pain and Ambulation in Adolescent Idiopathic Scoliosis Surgery: A Double-Blind Randomized Controlled Trial.","authors":"Tomohiro Yamada, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Hiroki Ushirozako, Koichiro Ide, Kenta Kurosu, Yosuke Shibata, Yukihiro Matsuyama","doi":"10.1097/BRS.0000000000005314","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005314","url":null,"abstract":"<p><strong>Study design: </strong>Double-blind randomized controlled trial.</p><p><strong>Objective: </strong>To assess the safety and efficacy of surgeon-directed intraoperative subfascial cocktail analgesics in adolescent scoliosis surgery.</p><p><strong>Summary of background data: </strong>Several studies have demonstrated the efficacy of intraoperative surgeon-directed analgesics in idiopathic scoliosis surgery. However, their retrospective analyses provided limited clinical evidence. Are cocktail analgesics effective in improving postoperative pain in idiopathic scoliosis surgery? Can surgeon-directed intraoperative cocktail analgesics improve postoperative pain scores and help patients ambulate?</p><p><strong>Methods: </strong>Forty-two adolescent patients (mean age 15.8±2.1 years, 31 females) were randomly assigned to two groups: one receiving cocktail analgesics (21 patients), and the other serving as a control (21 patients). The cocktail consisted of 0.75% ropivacaine, methylprednisone, and ketoprofen. The primary outcome measured was postoperative pain (NRS). Secondary outcomes included ambulation timing, fentanyl and acetaminophen usage. Epidural anesthesia usage was recorded but not analyzed as an independent outcome since perceived pain severity may have influenced its administration.</p><p><strong>Results: </strong>Forty-two patients (mean age: 15.8±2.1 years, 31 females) were included. Both groups had comparable baseline characteristics, including age, sex distribution, and preoperative curve severity. The cocktail group showed significantly lower pain scores 1 hour post-surgery (4.1±3.7 vs. 5.6±2.9, P=0.044) and ambulated earlier (2.5±0.5 vs. 3.3±2.5 days, P=0.049). However, there were no significant differences in pain scores after 6 hours or in fentanyl/acetaminophen consumption. Adverse events attributable to the procedures were comparable between both groups.</p><p><strong>Conclusions: </strong>Surgeon-directed cocktail therapy alone is insufficient to achieve significant improvements in pain control, as evidenced by the minimal impact on NRS scores and early ambulation promotion. Clinically, this underscores the need for more comprehensive, multimodal pain management strategies to optimize postoperative recovery and enhance outcomes for patients with adolescent scoliosis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731662","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":"Automated Measurements of Spinal Parameters for Scoliosis Using Deep Learning.","authors":"Xianghong Meng, Shan Zhu, Qilong Yang, Fengling Zhu, Zhi Wang, Xiaoming Liu, Pei Dong, Shuaikun Wang, Lianxi Fan","doi":"10.1097/BRS.0000000000005280","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005280","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective single-institution study.</p><p><strong>Objective: </strong>To develop and validate an automated convolutional neural network (CNN) to measure the Cobb angle, T1 tilt angle, coronal balance, clavicular angle, height of the shoulders, T5-T12 Cobb angle, and sagittal balance for accurate scoliosis diagnosis.</p><p><strong>Summary of background data: </strong>Scoliosis, characterized by a Cobb angle >10°, requires accurate and reliable measurements to guide treatment. Traditional manual measurements are time-consuming and have low inter- and intra-observer reliability. While some automated tools exist, they often require manual intervention and focus primarily on the Cobb angle.</p><p><strong>Methods: </strong>In this study, we utilized four datasets comprising the anterior-posterior (AP) and lateral radiographs of 1682 patients with scoliosis. The CNN includes coarse segmentation, landmark localization, and fine segmentation. The measurements were evaluated using the dice coefficient, mean absolute error (MAE), and percentage of correct key-points (PCK) with a 3-mm threshold. An internal testing set, including 87 adolescent (7-16 years) and 26 older adult patients (≥60 years), was used to evaluate the agreement between automated and manual measurements.</p><p><strong>Results: </strong>The automated measures by the CNN achieved high mean dice coefficients (>0.90), PCK of 89.7%-93.7%, and MAE for vertebral corners of 2.87 mm-3.62 mm on AP radiographs. Agreement on the internal testing set for manual measurements was acceptable, with an MAE of 0.26 mm/°-0.51 mm/° for the adolescent subgroup and 0.29 mm/°-4.93 mm/° for the older adult subgroup on AP radiographs. The MAE for the T5-T12 Cobb angle and sagittal balance, on lateral radiographs, was 1.03° and 0.84 mm, respectively, in adolescents, and 4.60° and 9.41 mm, respectively, in older adults. Automated measurement time was significantly shorter compared to manual measurements.</p><p><strong>Conclusion: </strong>The deep learning automated system provides rapid, accurate, and reliable measurements for scoliosis diagnosis, which could improve clinical workflow efficiency and guide scoliosis treatment.</p><p><strong>The level of evidence of this study: </strong>Level 3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731660","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":"Sustained Prescription Opioid Utilization Following Thoracic and Lumbar Fractures in a Cohort of Over 1,000 Individuals (2015-2021).","authors":"Brendan M Striano, Alexander M Crawford, Mark C Lawlor, Patawut Bovonratwet, Kaitlyn E Holly, Donnell L Williams, Malina O Hatton, Andrew J Schoenfeld","doi":"10.1097/BRS.0000000000005347","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005347","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To characterize opioid utilization following thoracic and lumbar spine fractures and identify risk factors for sustained opioid use.</p><p><strong>Summary of background data: </strong>Thoracic and lumbar spine fractures are common injuries, but despite their frequency, little detailed information is available regarding post-injury pain management. In the setting of the opioid epidemic, it is important to understand opioid utilization patterns following these common spine fractures.</p><p><strong>Methods: </strong>We conducted as a retrospective review of patients who presented to any of four hospitals in a large academic medical system in a major metropolitan area and who were identified to have thoracic or lumbar spine fractures, excluding those in the setting of metastatic disease or infection. Administrative data were used to track opioid prescriptions with persistent use defined as receipt of opioid prescriptions in both the 42 day (d) and 42-90d time windows following injury. Associations with persistent opioid utilization were determined using multivariable logistic regression.</p><p><strong>Results: </strong>We found that 73.1% (762/1042) of patients with thoracic or lumbar fractures were prescribed opioids in the first 6 weeks after injury and 11.9% (124/1042) were persistently prescribed opioids in the 90d following injury. Charlson Comorbidity Index (OR 1.20, 95%CI 1.09-1.32, P<0.001), pre-injury opioid exposure (OR 2.64, 95% CI 1.33-5.14, P < 0.01), and surgical treatment (OR 2.42, 95% CI 1.11-5.13, P=0.02) were all significantly associated with persistent opioid utilization in multivariable analysis.</p><p><strong>Conclusion: </strong>Opioid pain medications are very commonly prescribed in the acute period following thoracic and lumbar fractures. Despite 6 weeks being commonly reported as the initial healing window for these fractures, nearly 12% of patients were persistently prescribed opioids at the 90d post-injury mark. These data help characterize opioid exposure following fracture and identify important prognostic indicators that can be used to help risk stratify patients at elevated risk for persistent opioid use.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731676","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}