Spine最新文献

{"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":"Identifying Predictors of Failed Back Surgery Syndrome Following Lumbar Spine Surgery: A Machine Learning Approach.","authors":"Rushmin Khazanchi, Divy Kumar, Robert J Oris, Anitesh Bajaj, Daniel E Herrera, Austin R Chen, Rohan M Shah, Shravan Asthana, Samuel G Reyes, Pranav Bajaj, Wellington K Hsu, Alpesh A Patel, Srikanth N Divi","doi":"10.1097/BRS.0000000000005411","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005411","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study from a tertiary academic medical center.</p><p><strong>Objective: </strong>To build a prognostic machine learning model to predict 1-year FBSS incidence following lumbar spine surgery.</p><p><strong>Summary of background data: </strong>A minority of patients who undergo degenerative lumbar spine surgery will have persistent postoperative pain, characterized as \"Failed Back Surgery Syndrome\" (FBSS). Adequate preoperative identification of patients at risk of having an undesirable outcome after surgery is an essential part of a spine surgeon's workflow. While several studies have proposed mechanisms and risk factors for FBSS, no studies have developed a prognostic machine learning model to quantify and functionalize predictions.</p><p><strong>Methods: </strong>A cohort of lumbar fusion and lumbar decompression surgeries was queried from a tertiary academic medical center from 2002-2022. Patient and operative characteristics were systematically extracted for each surgery. Several machine learning algorithms were employed and optimized to predict FBSS occurrence within 1 year of surgery. SHAP feature importance values were computed for the top performing model.</p><p><strong>Results: </strong>A total of 10,128 unique lumbar decompression surgeries and 2,890 unique lumbar fusion surgeries were included. The Random Forest model had the highest performance of tested models (AUROC of 0.715 for lumbar decompression, 0.701 for lumbar fusion). For lumbar decompression, the top three predictors of FBSS were absence of microdiscectomy, lack of preoperative immunosuppressant usage, and preoperative benzodiazepine usage. For lumbar fusion, prior FBSS diagnosis, lack of preoperative immunosuppressant usage, and operating room duration were the most important predictors. Other key variables spanned several domains including preoperative medication usage, patient demographics, and operative indications and characteristics.</p><p><strong>Conclusion: </strong>This study demonstrates the successful creation of a prognostic machine learning model for prediction of FBSS within 1 year postoperatively. These models, after external validation, have the potential to be instrumental aspects of a spine surgeon's workflow.</p><p><strong>Level of evidence: </strong>3.</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":"144181193","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}

{"title":"Letter to the Editor on \"Three-Level Anterior Cervical Discectomy and Fusion With or Without an Investigational Posterior Stabilization System\".","authors":"Tatsuya Tanaka, Akira Matsuno","doi":"10.1097/BRS.0000000000005407","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005407","url":null,"abstract":"","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":"144162399","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":"Potential Physiological Factors Underlying Diagnostic Discrepancies between MRI-based Cervical Vertebral Bone Quality Scores and dual-energy X-ray Absorptiometry T-scores.","authors":"Yaoyu Wang, Yuchen Zhang, Shuo Wang, Jinbo Zhao, Xing Chen, Hui Wang, Yonghao Tian, Xinyu Liu, Lianlei Wang","doi":"10.1097/BRS.0000000000005406","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005406","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Objective: </strong>This study aims to: (1) identify physiological factors influencing cervical vertebral bone quality (C-VBQ) scores, and (2) elucidate the mechanistic basis for diagnostic discrepancies between C-VBQ scores and dual-energy X-ray absorptiometry (DEXA) in bone quality evaluation.</p><p><strong>Summary of background data: </strong>C-VBQ scores have emerged as a novel indicator for evaluating cervical bone quality. However, the potential influencing factors of C-VBQ scores, and the reasons for diagnostic discrepancies between C-VBQ scores and DEXA methods, have not been elucidated.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 264 patients with cervical spondylotic myelopathy treated from July 2017 to July 2024. Correlation analyses and multiple linear regression were used to explore the associations between physiological factors and C-VBQ scores. The predictive performance of C-VBQ scores for bone quality was evaluated via receiver operating characteristic analysis. Bone quality was independently assessed using both T-scores and C-VBQ scores. Accordingly, participants were classified into four groups: Healthy Bone (HBG), Damaged Bone (DBG), T-Healthy but VBQ-Damaged (TH-VDG), and T-Damaged but VBQ-Healthy (TD-VHG). Intergroup differences in physiological indicators were analyzed by ANOVA, Kruskal-Wallis test, Chi-square test, and Fisher's exact test.</p><p><strong>Results: </strong>The C-VBQ score demonstrated a significant positive correlation with glycated albumin (GA) (r=0.425, P<0.001), high-density lipoprotein cholesterol (HDL-C) (r=0.402, P<0.001), and conjugated bilirubin (CB) (r=0.366, P<0.001). Multiple linear regression analysis revealed that GA (β=0.095, P<0.001), HDL-C (β=0.669, P<0.001), and CB (β=0.141, P<0.001) were significant factors contributing to changing C-VBQ scores. The patients in TH-VDG had significantly higher levels of GA, HDL-C, and CB compared to HBG patients.</p><p><strong>Conclusions: </strong>GA, HDL-C, and CB are positively correlated with C-VBQ scores, and these correlations are significantly stronger than those with T-scores. Based on C-VBQ scores, patients with higher levels of GA, HDL-C, and CB tend to be diagnosed with impaired bone quality.</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":"144162326","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":"Classification of Adolescent Idiopathic Scoliosis Curvature Using Contrastive Clustering.","authors":"Dae Hwan Kim, Sehan Park, Da Woon Kwon, Choon Sung Lee, Dong-Ho Lee, Jae Hwan Cho, Chang Ju Hwang","doi":"10.1097/BRS.0000000000005381","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005381","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective image analysis study.</p><p><strong>Objective: </strong>To propose a novel classification system for adolescent idiopathic scoliosis (AIS) curvature using unsupervised machine learning and evaluate its reliability and clinical implications.</p><p><strong>Summary of background data: </strong>Existing AIS classification systems, such as King and Lenke, have limitations in accurately describing curve variations, particularly long C-shaped curves or curves with distinct characteristics. Unsupervised machine learning offers an opportunity to refine classification and enhance clinical decision-making.</p><p><strong>Methods: </strong>A total of 1,156 AIS patients who underwent deformity correction surgery were analyzed. Standard posteroanterior radiographs were segmented using U-net algorithms. Contrastive clustering was employed for automatic grouping, with the number of clusters ranging from three to 10. Cluster quality was assessed using t-SNE and Silhouette scores. Clusters were defined based on consensus among spine surgeons. Interobserver reliability was evaluated using kappa coefficients.</p><p><strong>Results: </strong>Six clusters were identified, reflecting variations in structural curve location, single (C-shaped) versus double (S-shaped) curves, and thoracolumbar curve characteristics. Cluster reliability was moderate (kappa = 0.701-0.731). The silhouette score was 0.308, with t-SNE demonstrating distinct clustering patterns. The classification highlighted differences not captured by the Lenke classification, such as thoracic curves confined to the thoracic spine versus those extending to the lumbar spine.</p><p><strong>Conclusion: </strong>Unsupervised machine learning successfully categorized AIS curvatures into six distinct clusters, revealing meaningful patterns such as unique variations in thoracic and lumbar curves. These findings could potentially inform surgical planning and prognostic assessments. However, further studies are needed to validate clinical applicability and improve clustering quality.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128709","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":"Normative Thoracic, Lumbar, Pelvic and Global Sagittal Alignment Parameters for Asymptomatic Adults: A Systematic Review and Meta-Analysis of >35,900 Volunteers.","authors":"Alexandra C Dionne, Prakash Gorroochurn, Roy Miller, Prerana Katiyar, Samuel Bennion, Lisa Bonsignore-Opp, Josephine R Coury, Fthimnir M Hassan, Joseph M Lombardi, Lawrence G Lenke, Justin L Reyes, Zeeshan M Sardar","doi":"10.1097/BRS.0000000000005274","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005274","url":null,"abstract":"<p><strong>Study design: </strong>Systematic Review and Meta-Analysis.</p><p><strong>Objective: </strong>To describe regional and global spinopelvic sagittal parameters in asymptomatic adults.</p><p><strong>Summary of background data: </strong>Understanding normal alignment is important for management of patients with spinal deformities and essential for patient well-being following corrective surgery. To our knowledge, there exists no meta-analyses on normative alignment.</p><p><strong>Methods: </strong>We searched PubMed for primary studies on asymptomatic individuals with normal spinal anatomy and no prior spinal intervention. The collected variables included: age, gender percentage, global thoracic kyphosis (T1-3 to T12 TK), regional TK (T4-5 to T12), lumbar lordosis to L5 (T12-L1 to L5, LL-L5), LL to S1 (T12-L1 to S1, LL-S1), sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), PI-LL mismatch, sagittal vertical axis (SVA), T1 pelvic angle (TPA), and spinosacral angle (SSA). Data was analyzed according to sex, age (20-40 vs. 40-60 vs. >60 yrs), ethnic group (Asian, Caucasian, Hispanic, Middle Eastern), and Asian subgroup (Chinese, Japanese, Korean).</p><p><strong>Results: </strong>A total of 191 articles from 27 countries including 35,913 participants were reviewed: 16,125 men (44.9%), 18,222 women (50.7%), age range: 18-93 years were included. Regional TK and PT increased significantly in patients >60 compared to other groups. Globally, SVA, TPA, and changed with age in patients >60.</p><p><strong>Conclusion: </strong>LL-S1, PI and PT were all higher in women. Regional TK, PT, PI-LL, SVA, TPA all increased with age, while LL-S1 and SSA decreased. Global TK, regional TK, LL-S1, PI, and PI-LL all had significant differences across broad ethnic groups, and LL-S1, PI, PT and SVA showed differences within Asian subgroup. Global alignment was largely equivalent across ethnic groups.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128764","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":"Paraspinal Muscle Parameters Predict Postoperative Sagittal Balance in Cervical Disc Arthroplasty: A Structural Equation Model Analysis.","authors":"Junbo He, Tingkui Wu, Zijiao Liu, Zhaodian Wu, Xingjin Wang, Beiyu Wang, Kangkang Huang, Ying Hong, Yong Li, Chen Ding, Hao Liu","doi":"10.1097/BRS.0000000000005389","DOIUrl":"10.1097/BRS.0000000000005389","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Objective: </strong>To identify the associations between preoperative paraspinal muscle parameters and postoperative outcomes following cervical disc arthroplasty (CDA), while screening for predictors.</p><p><strong>Summary of background data: </strong>Paraspinal muscles play a critical role in maintaining cervical alignment, significantly contributing to cervical mobility and stability. To date, there is limited evidence regarding the impact of paraspinal muscles on CDA.</p><p><strong>Methods: </strong>This study included 185 patients who underwent single-level CDA. Preoperative paraspinal muscle parameters, including fatty infiltration (FI), cross-sectional area ratio (CSA r), and muscle asymmetry (ASY%), were assessed using MRI. Correlation analysis was employed for preliminary screening. Finally, structural equation modeling (SEM) was employed for comprehensive analysis.</p><p><strong>Results: </strong>Paraspinal muscle degeneration was prevalent in this cohort, with a higher proportion of moderate to severe FI (Goutallier Grade > 2) from the cranial to caudal levels. According to the correlation analysis, at the final follow-up, cervical lordosis was most strongly correlated with CSA r at C4/5 ( P =0.010); SVA was most related to CSA r at C5/6 ( P =0.030); and the T1 slope was associated with CSA r at C4/5 ( P <0.001), C5/6 ( P <0.001), as well as at the surgical level ( P <0.001). Moreover, a positive correlation was observed between preoperative pain scores and FI ( P =0.035). However, no such correlation was identified in the postoperative period. Comparative analysis of SEMs across different muscle variables revealed variations in predictive factors for postoperative sagittal balance parameters, with CSA r emerging as the significant contributor ( P =0.019, Estimate=0.176), rather than FI or ASY%.</p><p><strong>Conclusions: </strong>Compared with postoperative clinical outcomes, mobility, and prosthesis stability, preoperative muscle parameters were most correlated with sagittal balance after CDA. Specifically, CSA r outperformed in predicting postoperative sagittal balance. These findings suggest CDA may be associated with an elevated risk of sagittal imbalance when performed on patients with significant preoperative muscle degeneration.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995701","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}