Spine最新文献

{"title":"Contrast-Enhanced MRI-Based Grading of Nuchal Ligament Failure in Dropped Head Syndrome Caused by Isolated Neck Extensor Myopathy.","authors":"Kenji Endo, Hirosuke Nishimura, Yasunobu Sawaji, Hideya Yamauchi, Taro Uehara, Tomoyuki Ueshima, Takato Aihara, Hidekazu Suzuki, Kengo Yamamoto","doi":"10.1097/BRS.0000000000005738","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005738","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational cohort study.</p><p><strong>Objective: </strong>To establish a contrast-enhanced MRI-based grading system for imaging-defined nuchal ligament disruption in dropped head syndrome (DHS) caused by isolated neck extensor myopathy (INEM), and to evaluate its association with sagittal head alignment, cervical extension function, pain, and quality of life.</p><p><strong>Methods: </strong>A total of 130 patients with INEM-related DHS who underwent contrast-enhanced cervical MRI were retrospectively analyzed, along with 21 non-DHS controls. Nuchal ligament findings were classified into four grades (Grade 0-3) based on contrast enhancement patterns and ligament continuity. Clinical parameters included chin-brow vertical angle (CBVA), pain severity assessed using the Numerical Rating Scale (NRS), health-related quality of life assessed using EuroQol 5 Dimensions (EQ-5D), and the ability to actively achieve cervical extension in the prone all-fours position. Associations among MRI grades were evaluated using one-way analysis of variance and multivariable regression adjusted for age and sex.</p><p><strong>Results: </strong>All patients with INEM-related DHS demonstrated intraligamentous contrast enhancement, whereas non-DHS controls showed no such findings. CBVA differed significantly across MRI grades, with higher values observed in patients with advanced-grade disruption. However, when MRI grade was treated as an ordinal variable, a strictly linear association with CBVA was not observed. Active cervical extension was rare in patients with Grade ≥2 disruption. Pain severity did not differ among grades. In contrast, EQ-5D scores were significantly lower in higher grades and remained independently associated with MRI grade after adjustment for age and sex. Interobserver reliability was moderate (weighted κ=0.62).</p><p><strong>Conclusions: </strong>Contrast-enhanced MRI-based grading of imaging-defined nuchal ligament disruption provides a structural marker associated with sagittal head alignment and cervical extension dysfunction in INEM-related DHS. This classification may serve as a clinically useful adjunctive tool for severity assessment and stratification in selected patients.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875732","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":"Pathogenicity and Survival of Cutibacterium Acnes in Intervertebral Discs at Different Time Points: An in vivo Study in Rats.","authors":"Mingtao Zhang, Liangna Deng, Jingwen Jia, Shuanhu Lei, Zhenyu Cao, Mingdong Ma, Jing Wang, Shuai Xing, Xuchang Hu, Liangzeng Huang, Xuewen Kang","doi":"10.1097/BRS.0000000000005740","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005740","url":null,"abstract":"<p><strong>Study design: </strong>An animal laboratory study.</p><p><strong>Objective: </strong>This study aimed to investigate the pathogenicity and survival of Cutibacterium acnes (C. acnes) in rat Intervertebral Discs (IVD) across different time periods.</p><p><strong>Summary of background data: </strong>Since C. acnes was proposed as a potential causative agent of intervertebral disc degeneration (IDD), it has been the subject of widespread controversy. This study examined the removal of C. acnes from IVD, supporting the theory of its role in IDD.</p><p><strong>Methods: </strong>Fifty rats were randomly assigned to a control group or groups with different C. acnes-causing bacterial exposure periods (4, 8, 12, and 16 wk). Except for the control group, rats in the experimental group received 5 μl of C.acnes (1×10⁷ CFU/mL) injected at L5-6. X-ray examinations, magnetic resonance imaging (MRI), fluorescence in situ hybridization (FISH) assays, tissue staining, tissue immunofluorescence (IF), and real-time polymerase chain reaction (RT-PCR) were performed.</p><p><strong>Results: </strong>X-rays revealed that the C. acnes group exhibited mild narrowing of the intervertebral space 4 weeks postoperatively. MRI revealed that the T2-weighted signal intensity of the nucleus pulposus (NP) in the C. acnes group decreased at 4 W after operation. Histochemical staining revealed at 4, 8, 12, and 16 weeks post-infection, the C. acnes group exhibited reduced IVD height and structural disruption of the IVD. IF results indicated a significant decrease in Aggrecan expression and a significant increase in MMP3 expression in the C. acnes group. C.acnes were cultured in IVD samples at 4 W, 8 W and 12 W, while C.acnes were not cultured in IVD tissues at 16 W.</p><p><strong>Conclusion: </strong>Infection of rat IVD with C. acnes-induced IDD at all time points post-infection. Furthermore, as the duration of infection increased, C. acnes became increasingly difficult to culture from IVD tissue.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875746","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":"Response to Letter to the Editor Regarding \"The Impact of Teaching Hospital Status on Postoperative Outcomes among Adults Undergoing Short Segment Lumbar Instrumentation\".","authors":"Aydin Kaghazchi, Janesh Karnati, Ahmed Ashraf, Gabriel Jelkin, Owoicho Adogwa","doi":"10.1097/BRS.0000000000005736","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005736","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875749","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":"Preoperative Predictors of Poor Outcomes Following Lumbar Discectomy. A Study Based on the National Finspine Registry.","authors":"Antti Saarinen, Eetu Suominen, Liisa Pekkanen, Antti Malmivaara, Jukka Huttunen, Katri Pernaa, Henri Salo, Jussi P Repo","doi":"10.1097/BRS.0000000000005425","DOIUrl":"10.1097/BRS.0000000000005425","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To identify predictors for poor outcome after lumbar discectomy for herniated disc.</p><p><strong>Background: </strong>Lumbar discectomy for herniated disc is a common spinal procedure. Despite the surgical treatment, some patients are left with persistent pain and poor health-related quality of life. We aim to research preoperative predictive factors associated with poor outcome after lumbar discectomy.</p><p><strong>Materials and methods: </strong>National Spine Surgery Registry was searched for patients who underwent primary discectomy for lumbar disc herniation between 2017 and 2022. All patients had a minimum of 2 years of follow-up. The primary outcome was disability at 12 months postoperatively, assessed using the Oswestry Disability Index (ODI). Patients were categorized into satisfactory (ODI: 0-40) and poor outcome groups (ODI: 41-100). Logistic regression was used to identify preoperative predictors of poor outcome. Variables for multivariable analysis were selected based on clinical relevance assessed by senior authors and bivariate associations. Secondary outcomes included pain scores and patient-reported satisfaction.</p><p><strong>Results: </strong>In all, 3339 patients were included, of whom 2991 (90%) had minimal to moderate disability and 348 (10%) had severe disability assessed with ODI at the follow-up. Several factors were identified to associate with poor outcome after the surgery: older age (OR: 1.03, 95% CI: 1.02-1.03), female sex (OR: 1.28, 95% CI: 1.03-1.61), higher body mass index (OR: 1.06, 95% CI: 1.02-1.09), cardiologic comorbidity (OR: 4.27, 95% CI: 2.4-7.3), regular preoperative painkiller use (OR: 2.2, 95% CI: 1.5-3.3), and higher number of operated vertebrae (OR: 2.4, 95% CI: 1.6-3.6). Symptom lasting over 1 year was associated with worse outcomes when compared with symptoms for 3 to 12 months (OR: 0.42, 95% CI: 0.29-0.60), 6 to 12 weeks (OR: 0.23, 95% CI: 0.12-0.39), and those with symptoms for <6 weeks (OR: 0.35, 95% CI: 0.19-0.62). Employed individuals were significantly associated with better outcomes when compared other statuses. Worse preoperative quality of life scores were associated with poor outcome.</p><p><strong>Conclusion: </strong>Several preoperative factors were associated with poor outcome after lumbar discectomy. Identifying higher-risk patients-such as those with high BMI, older age, or significant comorbidities-can support preoperative counseling and targeted interventions. Optimizing modifiable factors preoperatively may improve outcomes.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"640-645"},"PeriodicalIF":3.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13056403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286560","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":"Automated Detection of Cervical Spinal Cord Compression on MRI Using YOLO11 Deep Learning Architecture: A Two-Center External Validation Study.","authors":"Qian Du, Weijun Kong, Yonghu Chang, Zhijun Xin, Xinxin Shao, Libo Feng, Jiaxiang Zhou, Yuancheng Zhang, Xinjuan Li, Guangru Cao, Rao Fu, Qingde Wa, Zhiyu Zhou","doi":"10.1097/BRS.0000000000005639","DOIUrl":"10.1097/BRS.0000000000005639","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective two-center external validation study was conducted at two medical centers, collecting cervical spine MRI data from patients suspected of degenerative cervical myelopathy (DCM) between March 2022 and August 2024, forming a consecutive series with external validation.</p><p><strong>Objective: </strong>To develop and validate a deep learning model utilizing YOLO11 architecture for automated detection of cervical spinal cord compression on MRI and evaluate its performance against expert annotations.</p><p><strong>Summary of background data: </strong>DCM represents the leading cause of nontraumatic spinal cord injury in adults. While MRI facilitates early detection and provides the foundation for timely intervention, image interpretation remains subjective and dependent on physician experience, resulting in diagnostic variability and challenges in clinical consistency.</p><p><strong>Materials and methods: </strong>A YOLO11-based deep learning model was implemented with a binary classification scheme (Normal vs . Compression). Five physicians annotated 1431 sagittal T2-weighted cervical MRI images from 735 patients using standardized protocols, achieving excellent interobserver agreement. The data set comprised training/validation sets (577 patients, 1141 images), an internal test set (64 patients, 115 images), and an external test set (94 patients, 175 images). Five-fold cross-validation assessed model robustness. Standardized preprocessing incorporating contrast enhancement, noise reduction, and normalization was applied. Gradient-weighted Class Activation Mapping enhanced model interpretability.</p><p><strong>Results: </strong>Five-fold cross-validation yielded consistent performance with mAP50 ranging from 0.917 to 0.970, precision from 0.897 to 0.923, and recall from 0.922 to 0.946. External testing demonstrated statistically superior agreement with expert annotations (mAP50=0.944, 95% CI: 0.934-0.953) compared with mid-level physician annotations (mAP50=0.912, 95% CI: 0.908-0.919), with the difference being statistically significant (95% CI of difference: 0.015-0.043, P <0.05).</p><p><strong>Conclusion: </strong>The YOLO11-based model demonstrated stable two-center performance with close alignment to expert-level clinical standards. The rapid inference, high sensitivity, and integrated visualization system address key challenges related to efficiency and interpretability in clinical AI applications for cervical spinal cord compression assessment.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"610-621"},"PeriodicalIF":3.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13056408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114359","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":"Prospective Comparison of Posterior Decompression and ACDF for 1- to 2-level Degenerative Cervical Myelopathy.","authors":"Tatsuya Yamamoto, Narihito Nagoshi, Junichi Yamane, Toshiki Okubo, Yasuhiro Kamata, Norihiro Isogai, Hitoshi Kono, Kanehiro Fujiyoshi, Yoshiomi Kobayashi, Reo Shibata, Takahiro Kitagawa, Takahito Iga, Kazuki Takeda, Satoshi Suzuki, Masahiro Ozaki, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.1097/BRS.0000000000005491","DOIUrl":"10.1097/BRS.0000000000005491","url":null,"abstract":"<p><strong>Study design: </strong>Prospective multicenter cohort study.</p><p><strong>Objective: </strong>To compare clinical outcomes between posterior decompression without fusion (PD) and anterior cervical discectomy and fusion (ACDF) in patients with 1- to 2-level degenerative cervical myelopathy (DCM).</p><p><strong>Summary of background data: </strong>While numerous studies have assessed surgical strategies for multilevel DCM, limited evidence is available for cases involving only one or two levels.</p><p><strong>Methods: </strong>Among 1482 patients with degenerative cervical spine disorders from 10 Japanese institutions, 353 patients with 1- to 2-level DCM treated with either PD (n=233) or ACDF (n=120) and followed for 2 years were included. Clinical outcomes included the Japanese Orthopaedic Association (JOA) score, Visual Analog Scale (VAS), Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and Short Form-36 (SF-36). Group comparisons were adjusted for baseline characteristics and preoperative clinical outcomes using a general linear model.</p><p><strong>Results: </strong>Perioperative complication and reoperation rates did not significantly differ between groups. ACDF provided significantly greater improvements in VAS scores for neck pain (-22.6 vs . -6.1 mm, P =0.003), upper extremity pain/numbness (-32.7 vs . -18.3 mm, P =0.011), and SF-36 bodily pain (22.8 vs . 10.1, P =0.003) and physical component summary (PCS) scores (9.1 vs . 3.5, P =0.007) compared with the PD group. Conversely, PD yielded greater improvement in the SF-36 social functioning domain (13.3 vs . 2.6, P =0.011). No significant differences were observed in JOA scores, the five domains of JOACMEQ, or other SF-36 domains.</p><p><strong>Conclusions: </strong>Both PD and ACDF provided comparable improvements in neurological function as measured by JOA and JOACMEQ scores, indicating similar efficacy in treating DCM. ACDF was more effective for alleviating neck and arm pain and enhancing physical health, while PD resulted in social functioning. Given similar complication rates, surgical strategy should be individualized based on each patient's clinical presentation.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"603-609"},"PeriodicalIF":3.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970036","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 Regarding \"Vertebral Fracture Prediction From MRI-Based Vertebral Bone Quality Scores in Postmenopausal Women\".","authors":"Yifeng Wang, Chunyu Zhang","doi":"10.1097/BRS.0000000000005537","DOIUrl":"10.1097/BRS.0000000000005537","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E240"},"PeriodicalIF":3.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Causes of Death after Cervical or Thoracolumbar Adult Spinal Deformity Surgery.","authors":"Kevin Mo, Ahmed Sulieman, Justin S Smith, Peter G Passias, Peter Tretiakov, Shay Bess, Kevin Y Wang, Samrat Yeramaneni, Brian J Neuman, Richard A Hostin, Jeffrey L Gum, Renaud Lafage, Themistocles S Protopsaltis, Munish C Gupta, Christopher P Ames, Eric O Klineberg, D Kojo Hamilton, Frank J Schwab, Alan H Daniels, Alex Soroceanu, Han Jo Kim, Breton G Line, Virginie Lafage, Christopher I Shaffrey, Lawrence G Lenke, Sang Hun Lee, Khaled M Kebaish","doi":"10.1097/BRS.0000000000005733","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005733","url":null,"abstract":"<p><strong>Study design: </strong>Prospective multicenter study.</p><p><strong>Objective: </strong>To determine the incidence of all-cause mortality after adult spinal deformity surgery.</p><p><strong>Summary of background data: </strong>Patients undergoing adult spinal deformity surgery are often frail and the procedures are invasive. The incidence of all-cause mortality among patients undergoing cervical or thoracolumbar deformity surgery is unclear.</p><p><strong>Methods: </strong>Using 2 prospective, multicenter databases, we identified patients who underwent surgery for cervical deformity surgery from 2013-2020 (n=169) or thoracolumbar deformity from 2008-2020 (n=1507). Mortality incidence density was calculated as follows: 100 × (number of deaths) / (sum of total years of follow-up for all patients).</p><p><strong>Results: </strong>Of 169 participants in the cervical group (mean±standard deviation age, 61±10 y), death occurred in 19 (11%). The mean time to death was 25±19 months. Mortality incidence density was 4.4 deaths per 100 person-years. The 30-day mortality rate was 0.6% (1/169) and 90-day mortality rate was 1.2% (2/169). The 3 most common causes of death were arrhythmia/cardiac arrest (16%), congestive heart failure (11%), and pneumonia (11%). There were no intraoperative deaths. Of 1507 participants in the thoracolumbar group (mean±standard deviation age, 61±14 y), death occurred in 53 (3.5%). The mean time to death was 32.5±21.5 months. Mean duration of follow-up was 1.8±1.5 years. The mortality incidence density was 0.8 deaths per 100 person-years. The 30-day mortality rate was 0.1% (1/1507) and 90-day mortality rate was 0.3% (4/1507). The 3 most common causes of death were non-spine malignancy (13%), pneumonia (9%), and arrhythmia/cardiac arrest (6%).</p><p><strong>Conclusions: </strong>The number of deaths per year was higher among cervical deformity patients (4.4 per 100 person-years) than among thoracolumbar deformity patients (0.8 per 100 person-years). Pneumonia and arrhythmia/cardiac arrest were among the most common causes of death in both groups.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875651","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":"Association of Glucagon-Like Peptide-1 Receptor Agonist Use With Complications Following Thoracic and/or Lumbar Spinal Fusion for Degenerative Spine Disease: A BMI-Stratified Retrospective Study.","authors":"Arman Kishan, Harmon S Khela, Nicolas L Carayannopoulos, Manjot Singh, Lara Cohen, Zvipo Chisango, Kyriakos Chatzis, Peter S Tretiakov, Shaleen Vira, Pawel P Jankowski, Andrew J Schoenfeld, Peter G Passias, Alan H Daniels","doi":"10.1097/BRS.0000000000005494","DOIUrl":"10.1097/BRS.0000000000005494","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Summary of background data: </strong>Spinal fusions are common interventions for degenerative spine disease (DSD), with increasing utilization in obese and metabolic syndrome populations. Glucagon-like peptide-1 (GLP-1) receptor agonists (RA), widely adopted for diabetes and weight management, may offer systemic benefits that exert a parallel influence on surgical outcomes.</p><p><strong>Objective: </strong>We aimed to evaluate whether preoperative GLP-1 RA use influences 90-day medical and 2- and 10-year surgical complications following thoracic and/or lumbar spinal fusion for DSD, stratified by BMI.</p><p><strong>Methods: </strong>Using a national claims database (2010-2023), we identified patients undergoing thoracic and/or lumbar spinal fusion for degenerative conditions. GLP-1 RA users within 6 months pre-op were 4:1 matched to controls by age, sex, and CCI across six BMI strata. Outcomes included 90-day medical and 2- and 10-year surgical complications (eg, revisions for infection, pseudoarthrosis, and mechanical failure). χ 2 , t tests, and Cox models were used for statistical analysis.</p><p><strong>Results: </strong>Among 291,677 patients, 19,232 GLP-1 RA users were matched to 76,778 controls. Ninety-day medical complications-such as infection, pneumonia, thromboembolism, sepsis, stroke, and UTI-were significantly reduced in GLP-1 RA users across BMI categories ≥25. Two-year surgical complications were lower among GLP-1 RA users in BMI 35 ti 39.9 (1.1% vs . 1.6%, P =0.007 for pseudarthrosis-related revision; 0.8% vs . 1.2%, P =0.038 for mechanical failure) and ≥40 groups. At 10 years, GLP-1 RA use was associated with significantly reduced risk of revision in the 25.0 to 29.9 (HR 0.79, P =0.046) BMI group. Revision due to pseudarthrosis was reduced in BMI 35.0 to 39.9 (HR 0.69, P =0.014) and ≥40.0 (HR 0.73, P =0.041), while revision for mechanical failure was lower in BMI 35.0 to 39.9 (HR 0.65, P =0.013) and ≥40.0 (HR 0.57, P =0.003).</p><p><strong>Conclusion: </strong>GLP-1 RA use was linked with reduced perioperative and long-term surgical complications in patients undergoing thoracic and/or lumbar fusions for degenerative spine disease, particularly in those with BMI ≥25. This risk reduction may be attributed to weight loss and/or the systemic metabolic, inflammatory, and vascular benefits of these medications.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E218-E228"},"PeriodicalIF":3.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993449","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":"Breaking Down Instability: The Associations Between Muscle Health, Facet Joint Morphology, Spinopelvic Alignment, and Stability Status in Degenerative Lumbar Spondylolisthesis.","authors":"Eric R Zhao, Sereen Halayqeh, Troy B Amen, Austin C Kaidi, Zora Hahn, John E Lama, Arsen M Omurzakov, Tim Xu, Felipe Luis Colon, Tomoyuki Asada, Stephane Owusu-Sarpong, Quante Singleton, Farah Musharbash, Atahan Durbas, Adrian T H Lui, Andrea Pezzi, Adin M Ehrlich, Myles R J Allen, Olivia C Tuma, Kasra Araghi, Tarek Harhash, James E Dowdell, Kyle W Morse, Francis Lovecchio, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.1097/BRS.0000000000005393","DOIUrl":"10.1097/BRS.0000000000005393","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To compare muscle health and imaging markers in patients with 1-level L4-L5 stable versus unstable degenerative lumbar spondylolisthesis (DLS).</p><p><strong>Background: </strong>DLS may be stable or unstable. It is unknown how muscle health and other imaging markers are associated with DLS stability.</p><p><strong>Materials and methods: </strong>Patients 18 years or older with 1-level L4-L5 DLS and preoperative flexion/extension radiographs were included. Normalized total psoas area (NTPA), body mass index (BMI)-normalized paralumbar [PL; multifidus (MF)+erector spinae (ES)] cross-sectional area (PL-CSA/BMI), and Goutallier were assessed. Other L4-L5 markers included: facet orientation, slip percentage, pelvic incidence (PI), tilt (PT), sacral slope (SS), lumbar lordosis (LL), and PI-LL. Instability was defined as >3 mm translation or >10° endplate change on flexion-extension. Low versus normal muscle health was defined as NTPA or PL-CSA/BMI below the lowest sex-specific quartile. Multivariate logistic regression was used to determine variables associated with instability.</p><p><strong>Results: </strong>Two hundred fifty-one patients (unstable = 50; stable = 201) were included. There were no significant differences in muscle health at L3, L4, or L5 or Goutallier on univariate analysis. The stable cohort had smaller slip percentage (19 ± 9% vs . 15 ± 8%, P = 0.007) and PI-LL (13.56 ± 12.75 vs . 5.81 ± 14.46, P = 0.001). The stable cohort had more patients with MF and ES total Goutallier ≤2 ( P = 0.031, P = 0.002, respectively) at L3-L4 versus L4-L5 and more patients with MF and ES total Goutallier ≤2 ( P = 0.013, P = 0.004, respectively) at L4-L5 versus L5-S1. On regression, low L4-L5 MF Goutallier was associated with instability [OR: 2.50 (95% CI: 1.01-6.20), P = 0.047].</p><p><strong>Conclusion: </strong>Patients with unstable L4-L5 spondylolisthesis have lower multifidus Goutallier at the slip level, greater slip percentage, and greater PI-LL mismatch. Patients with stable L4-L5 spondylolisthesis have greater Goutallier of the caudal paralumbars.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"659-666"},"PeriodicalIF":3.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094239","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}