Spine最新文献

{"title":"Quantitative Analysis of Relationship between Paraspinal Muscle Degeneration and Degree of Degenerative Lumbar Spondylolisthesis.","authors":"Weiwei Da, Qiang Jian, Joiner Evan, Andrew K Chan, Paul C McCormick, Christopher E Mandigo, Justin Anthony Neira, Peter D Angevine, Xiaofeng Li, Dean Chou","doi":"10.1097/BRS.0000000000005270","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005270","url":null,"abstract":"<p><strong>Study design: </strong>Clinical retrospective study.</p><p><strong>Objective: </strong>The authors aim to analyze the relationship between paraspinal muscle degeneration and degree of L4-5 Degenerative lumbar spondylolisthesis (DLS).</p><p><strong>Summary of background data: </strong>While paraspinal muscle degeneration is thought to contribute to spondylolisthesis severity, this relationship has yet to be fully characterized.</p><p><strong>Methods: </strong>A retrospective analysis was performed of all neurosurgical patients admitted to the Columbia Neurosurgery Spine Division for treatment of L4-5 DLS between January 2018 and March 2024. Preoperative lumbopelvic parameters and slip percentage (SP) were calculated from standing radiographs; paraspinal muscle volume (MV), fatty volume (FV) and fatty infiltration (FI) of posterior paraspinal muscle were derived from MRI images using 3D Slicer (Earth, TX). Correlation and multiple linear regression analyses were used to assess the relationship between SP and paraspinal MV, FV, FI, and spinopelvic parameters.</p><p><strong>Results: </strong>221 patients with average SP of 23.74±0.09% were included. The female patients had higher SP, lumbar lordosis (LL), pelvic incidence (PI) and lower IVA than the male patients. However, paraspinal MV was lower and FI was higher in the Meyerding Grade II and female groups compared to the Grade I and male groups (P<0.01). There was a positive correlation between SP and metrics of fat replacement (P<0.01) and a negative correlation between SP and metrics of paraspinal muscles volume (P<0.01) at the L4-5 level. A stepwise multivariate regression ultimately included MFI, IVA, and LL and accounted for 15.2% of the variance in SP.</p><p><strong>Conclusion: </strong>In this single center retrospective study, greater degree of spondylolisthesis was modestly associated with lower MV and increased FI of the lumbar paraspinal muscles, suggesting that paraspinal muscle degeneration may be one of several important factors in the development of spondylolisthesis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080947","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":"Risk Factors for Postoperative Shoulder Imbalance in Patients With Lenke Type 1 and 2 Scoliosis Treated Using the Vertebral Coplanar Alignment Technique.","authors":"Arihisa Shimura, Hidetoshi Nojiri, Muneaki Ishijima, Hiroshi Moridaira, Hidekazu Arai, Satoshi Takada, Katsutaka Yamada, Naoya Kondo, Tadao Morino, Eiichiro Nakamura, Masaki Tomori, Kazuyuki Otani, Koji Akeda, Takuya Nagai, Hiromitsu Toyoda, Kenyu Ito, Junya Katayanagi, Hiroshi Taneichi","doi":"10.1097/BRS.0000000000005171","DOIUrl":"10.1097/BRS.0000000000005171","url":null,"abstract":"<p><strong>Study design: </strong>This was a multicenter retrospective cohort study.</p><p><strong>Objective: </strong>We investigated the incidence of postoperative shoulder imbalance (PSI) and its risk factors in patients with Lenke types 1 and 2 scoliosis corrected using vertebral coplanar alignment (VCA).</p><p><strong>Summary of background data: </strong>PSI in scoliosis affects patient quality of life. While other correction methods have reported a high correction rate for the main thoracic curve (MTC) in relation to PSI, this correlation has not been confirmed for the VCA technique.</p><p><strong>Materials and methods: </strong>We studied 176 patients with Lenke types 1 and 2 scoliosis who underwent posterior corrective fusion surgery using the VCA technique at 11 institutions. At 2 years postoperatively, patients were divided into two groups based on radiographic shoulder height (RSH): PSI- (RSH<2 cm) and PSI+ (RSH ≥2 cm) groups. We analyzed the risk factors for PSI.</p><p><strong>Results: </strong>The overall incidence of PSI 2 years postoperatively was 11.4% (20/176), with 9.2% (11/119) and 15.8% (9/57) in patients with Lenke types 1 and 2, respectively. Contrary to a previous study, a high MTC correction rate did not emerge as a risk factor for PSI. Instead, preoperative left shoulder elevation, low postoperative thoracic kyphosis, greater T1 tilt, and high apical vertebral body-to-rib ratio were associated with PSI in patients with Lenke type 1. Preoperative left shoulder elevation and a low postoperative proximal thoracic curve (PTC) correction rate were identified as risk factors for PSI in patients with Lenke type 2.</p><p><strong>Conclusion: </strong>Our results suggest that proper PTC correction, rather than compromising MTC correction, may help prevent PSI in the VCA technique. This method is particularly advantageous for addressing Lenke type 1 scoliosis and yields favorable outcomes in shoulder balance. Patients with preoperative left shoulder elevation, especially Lenke type 2, are at high risk of developing PSI.</p><p><strong>Level of evidence: </strong>Level 4.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"179-186"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558846","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":"Clinical and Radiologic Predictors of Slower Improvement and Nonimprovement After Surgical Treatment of L4-L5 Degenerative Spondylolisthesis: Preliminary Results.","authors":"Sumedha Singh, Pratyush Shahi, Junho Song, Tejas Subramanian, Kyle Morse, Omri Maayan, Kasra Araghi, Nishtha Singh, Olivia Tuma, Tomoyuki Asada, Maximilian Korsun, Eric Mai, James Dowdell, Evan Sheha, Harvinder Sandhu, Todd Albert, Sheeraz Qureshi, Sravisht Iyer","doi":"10.1097/BRS.0000000000005019","DOIUrl":"10.1097/BRS.0000000000005019","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To identify the predictors of slower and nonimprovement after surgical treatment of L4-5 degenerative lumbar spondylolisthesis (DLS).</p><p><strong>Summary of background data: </strong>There is limited evidence regarding clinical and radiologic predictors of slower and nonimprovement following surgery for L4-5 DLS.</p><p><strong>Methods: </strong>Patients who underwent minimally invasive decompression or fusion for L4-5 DLS and had a minimum of 1-year follow-up were included. Outcome measures were: (1) minimal clinically important difference (MCID), (2) patient acceptable symptom state (PASS), and (3) global rating change (GRC). Clinical variables analyzed for predictors were age, gender, body mass index (BMI), surgery type, comorbidities, anxiety, depression, smoking, osteoporosis, and preoperative patient-reported outcome measures (PROMs) (Oswestry disability index, ODI; visual analog scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS). Radiologic variables analyzed were slip percentage, translational and angular motion, facet diastasis/cyst/orientation, laterolisthesis, disc height, scoliosis, main and fractional curve Cobb angles, and spinopelvic parameters.</p><p><strong>Results: </strong>Two hundred thirty-three patients (37% decompression and 63% fusion) were included. At less than three months, high pelvic tilt (PT) (OR: 0.92, P= 0.02) and depression (OR: 0.28, P= 0.02) were predictors of MCID nonachievement and GRC nonbetterment, respectively. Neither retained significance at above six months and hence, were identified as predictors of slower improvement. At above six months, low preoperative VAS leg (OR: 1.26, P= 0.01) and high facet orientation (OR: 0.95, P= 0.03) were predictors of MCID nonachievement, high L4-5 slip percentage (OR: 0.86, P= 0.03) and L5-S1 angular motion (OR: 0.78, P= 0.01) were predictors of GRC nonbetterment, and high preoperative ODI (OR: 0.96, P= 0.04) was a predictor of PASS nonachievement.</p><p><strong>Conclusions: </strong>High PT and depression were predictors of slower improvement and low preoperative leg pain, high disability, high facet orientation, high slip percentage, and L5-S1 angular motion were predictors of nonimprovement. However, these are preliminary findings and further studies with homogeneous cohorts are required to establish these findings.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"187-195"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852782","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":"Cranio-Vertebral Junction Anomalies: WFNS Spine Committee Recommendations Overview.","authors":"Óscar L Alves, Mehmet Zileli, Salman Sharif, Ricardo Botelho","doi":"10.1097/BRS.0000000000005281","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005281","url":null,"abstract":"<p><strong>Introduction: </strong>The published literature on Cranio-vertebral Junction (CVJ) anomalies lacks a comprehensive appraisal that integrates common diagnostic, management and treatment concepts for different conditions, such as Chiari Malformation (CM), Basilar Invagination (BI), Os Odontoideum (OO) and Syndromic Malformations. The authors aimed to fill this knowledge gap offering guidelines and recommendations with a global outreach and applicability.</p><p><strong>Methods: </strong>A group of expert spine surgeons and WFNS Spine Committee members, most of which extensively published on CVJ anomalies in the past, reviewed the literature issued from 2011 to 2022. Following a common methodology, based on the Delphi method, the authors analyzed the strength of the literature and voted statements concerning diagnosis and management of these conditions.</p><p><strong>Results: </strong>A total of eight papers were produced: (1) Chiari Malformation diagnosis, classifications, natural history, and conservative management, (2) Chiari malformation: indications for surgery and surgical options, (3) Pediatric Chiari malformation, (4) Syndromic atlanto-axial instability, (5) Os odontoideum, (6) Basilar invagination: diagnosis, radiology, and classification, (7) Surgical treatment of Basilar Invagination, and (8) Basilar invagination with associated Chiari malformation.</p><p><strong>Conclusions: </strong>Despite grey zones on natural history of CVJ anomalies and controversies on timing and type of surgical treatments, whenever atlantoaxial instability is present, C1-C2 stabilization through instrumentation and fusion is necessary. If only recurrent pain and neurological dysfunction occurs, surgical decompression is appropriate. If no atlantoaxial instability is present, Down's patients can participate in competitive sports. In general, contact sports are not recommended.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081017","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":"Surgical Treatment of Basilar Invagination: WFNS Spine Committee Recommendations.","authors":"Ricardo Vieira Botelho, Oscar L Alves, Geraldo de Sá Carneiro, Zan Chen, Onur Yaman, Jutty Parthiban, Massimiliano Visocchi, Jörg Klekamp, Atul Goel, Mehmet Zileli","doi":"10.1097/BRS.0000000000005282","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005282","url":null,"abstract":"<p><strong>Study design: </strong>A systematic literature review and consensus using Delphi method.</p><p><strong>Objective: </strong>This review aims to outline the therapeutic criteria and clarify the best surgical options for the different types of basilar invagination (BI).</p><p><strong>Summary of background: </strong>BI is a complex developmental malformation for which many surgical remedies have been proposed without clear consensus.</p><p><strong>Material and methods: </strong>Using PubMed, the authors reviewed the literature on the surgical treatment of BI published from 2011 to 2022 looking at different surgical options. A panel of spine surgeons and members of the WFNS Spine Committee used the Delphi technique to assess the strength of literature, elaborate, and vote on statements regarding the surgical management of BI.</p><p><strong>Results: </strong>Thirteen recommendations were issued covering the most relevant topics related to the surgical treatment of BI. Posterior fossa decompression alone is an option to treat BI without instability. Most cases of BI and AAI can be treated by C1-C2 fixation. In selected cases, distraction of the atlantoaxial joint may be required. Current evidence is lacking which technique is better to correct irreducible BI. OCF can be used in case of atlas assimilation, dysgenesis of C1 lateral mass, in irreducible cases, odontoidectomy and revision of failed C1-C2 fixation. Complications of the OCF may reach up to 50%. The role for anterior fusion for treatment of BI need to be better assessed by further studies. In the setting of irreducible anterior compression caused by BI, the anterior odontoidectomy can be indicated supplemented by C1-C2/occipital-cervical fusion.</p><p><strong>Conclusions: </strong>There are multiple surgical options for basilar invagination depending on the existence of compression, AAD or irreducibility. The WFNS spine committee proposed consensus recommendations based on relevant literature published after 2011 to help surgeons standardize the level of care and improve outcomes following treatment across the globe.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081006","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":"Staged versus Simultaneous Surgery for Adult Spinal Deformity - A Systematic Review and Meta-analysis.","authors":"Aman Verma, Parshwanath Bondarde, Anil Kumar, Siddharth Sekhar Sethy, Aakash Jain, Vibhor Abrol, Kaustubh Ahuja, Pankaj Kandwal","doi":"10.1097/BRS.0000000000005279","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005279","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta analysis.</p><p><strong>Objective: </strong>To assess the safety and efficacy of staged versus same-day spinal fusion surgeries in Adult spinal deformity (ASD).</p><p><strong>Background: </strong>ASD surgeries are associated with high complication rates, ranging from 10% to 40%. Among the strategies to enhance safety, staging the procedure into two smaller procedures has been evaluated as an effective alternative.</p><p><strong>Methods: </strong>A systematic literature review following PRISMA guidelines was conducted using PubMed, Cochrane, Scopus, and Embase. Studies comparing staged and same-day spinal fusion for ASD were included. Perioperative data, patient-reported outcomes (ODI, SRS), radiological outcomes, and complication rates were analysed. The extracted data was analyzed and forest plots were generated to draw comparisons between the staged and the same day groups.</p><p><strong>Results: </strong>Eleven studies, including 1323 patients (541 staged, 782 same-day) were analyzed. Staged surgeries were associated with longer operative time and length of hospital stay. There was no significant difference in estimated blood loss, clinical and radiological outcomes, or overall complication rates between groups. However, venous thrombo-embolism (VTE) rates were significantly higher in staged surgeries (odds ratio=4.33). In the staged group, surgical site infections was the most common complication with a rate of 10.5%, whereas neurological complications were the most frequent group of complications in same-day group.</p><p><strong>Conclusion: </strong>Staged surgeries for ASD result in longer operative time, length of hospital stay and increased VTE risk but show similar efficacy in clinical and radiological outcomes compared to same-day surgeries. Careful patient selection is crucial to balance risks and optimize outcomes in ASD surgical planning.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068092","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":"Defining Substantial Clinical Benefits of PROMIS Pain Interference and Physical Function in Patients Undergoing Lumbar and Thoracolumbar Spine Surgery.","authors":"Salim Yakdan, Madelyn R Frumkin, Saad Javeed, Benjamin A Plog, Justin K Zhang, Braeden Benedict, Kathleen Botterbush, Burel R Goodin, Jay F Piccirillo, Jacob M Buchowski, Thomas L Rodebaugh, Wilson Z Ray, Michael P Kelly, Jacob K Greenberg","doi":"10.1097/BRS.0000000000005276","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005276","url":null,"abstract":"<p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Objective: </strong>This study aims to define Substantial Clinical Benefit (SCB) thresholds for PROMIS physical function (PF) and pain interference (PI) in lumbar or thoracolumbar spine surgery population.</p><p><strong>Summary of background data: </strong>Patient-reported outcome measures (PROMs) are widely used in spine surgery to assess treatment efficacy. SCB is a relatively new concept that represents a substantial improvement perceived by the patient.</p><p><strong>Methods: </strong>This is a prospective study that included adults aged 21-85 years, undergoing lumbar/ thoracolumbar surgery for degenerative spine disease, and reporting at least 3/10 back or leg pain on a numeric rating scale. PROMs including Oswestry Disability Index, PROMIS PF, and PROMIS PI were collected preoperatively and at one year postoperatively. The North American Spine Surgery Patient Satisfaction (NASS) Index was collected one year postoperatively. SCB thresholds of absolute and percentage changes were calculated using anchor-based methods with ODI and NASS index as anchors. ROC analysis was used to determine optimal SCB cutoffs.</p><p><strong>Results: </strong>We included 137 patients. Using a fixed 19-point reduction in ODI as an anchor yielded SCB thresholds of 6.8 and 11.3 points for PROMIS PF and PI respectively. When using a dynamic anchor based on preoperative disability (50% ODI improvement), SCB thresholds were defined as achieving 18 and 27% of maximum possible improvement for PROMIS PF and PI respectively. Using NASS index, thresholds were 11 points or 24% for PROMIS PF, and 11.2 points or 21% for PROMIS PI. ROC values ranged from 0.81 to 0.9, with the dynamic ODI anchor cutoffs demonstrating the best discrimination.</p><p><strong>Conclusion: </strong>Our study is the first to define SCB thresholds for PROMIS PF and PROMIS PI using both fixed and dynamic cutoffs based on preoperative disability in lumbar and thoracolumbar patients. These thresholds will help in patient counseling and outcome evaluation for spine surgery research.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068090","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":"Analysis of Delirium Risk Assessment Tools for Prediction of Postoperative Delirium Following Lumbar Spinal Fusion.","authors":"Manjot Singh, Maxwell Sahhar, Joseph E Nassar, Michael J Farias, Rhea Rasquinha, Jinseong Kim, Bassel G Diebo, Alan H Daniels","doi":"10.1097/BRS.0000000000005271","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005271","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Evaluate the utility of Delirium Risk Assessment Score (DRAS), Delirium Risk Assessment Tool (DRAT), and Delirium Elderly At-Risk (DEAR) in patients undergoing posterior lumbar interbody fusions.</p><p><strong>Background: </strong>Surgical interventions can place patients at risk for postoperative delirium (POD), an acute and often severe cognitive impairment associated with poor outcomes. However, common risk assessment tools have not been validated in patients undergoing spine surgery.</p><p><strong>Methods: </strong>Adults who underwent posterior lumbar fusion were queried using PearlDiver. Baseline demographics, comorbidities, and delirium occurrence within 7 days of surgery were extracted. Delirium risk scores were calculated using DRAS (15 points total; threshold 5 points), DRAT (8 points total; threshold 3 points), and DEAR (5 points total; threshold 2 points) scales. Receiver operating characteristic (ROC) curves were generated, and optimal risk scores maximizing Youden's Index were established for each measure.</p><p><strong>Results: </strong>Among 37,119 patients, 70 patients (0.2%) developed POD. The mean age was 60.1 y, 56.6% were female, and mean Charlson Comorbidity Index (CCI) was 2.1. POD patients had lower mean age and percent female sex, but higher mean CCI and percent medical comorbidities (all P<0.05). ROC curve analyses revealed that a DRAS score of 5 (Sensitivity=62.9%, Specificity=63.9%), DRAT score of 3 (Sensitivity=31.4%, Specificity=81.0%), and DEAR score of 2 (Sensitivity=40.0%, Specificity=82.9%) maximized the Youden's Index value. Patients above these thresholds were 6.0, 2.0, and 3.2 times more likely to develop POD after posterior lumbar fusion, respectively.</p><p><strong>Conclusion: </strong>Delirium risk assessments tools were found to be useful in stratifying patients at high risk of POD following posterior lumbar fusion. Specifically, patients above the pre-defined thresholds were 2 to 6 times more likely to develop delirium postoperatively. Careful stratification of patients' risk of delirium using highly sensitive and specific tools like DRAS may guide preoperative surgical planning and postoperative management plans.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068084","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":"The Correlation Between Gender, Age, Curvature, and Symptom-related Changes in C6 and C7 Slope in 10,000 Subjects.","authors":"Zongshuo Sha, Xue Yang, Yu Ran, Yixing Liu, Zerui Qin, Lin Xu, Xiaohong Mu, Jinyu Li, Lei Quan, Jiang Chen, Dongran Han","doi":"10.1097/BRS.0000000000005278","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005278","url":null,"abstract":"<p><strong>Study design: </strong>A cross-sectional analysis of 10,000 cervical spine X-rays.</p><p><strong>Objective: </strong>This study investigates the variations in C6S and C7S across demographic factors (gender, age, cervical curvature, symptoms) and explores their correlation. Additionally, machine learning models are applied to improve the accuracy of C7S prediction.</p><p><strong>Summary of background data: </strong>The C7S is crucial for assessing cervical balance but is often limited by visibility issues. This study uses a large sample to validate the feasibility of the C6S as a substitute for C7S across diverse populations with varying ages, genders, symptoms, and cervical curvatures.</p><p><strong>Methods: </strong>A retrospective study was conducted on 10,000 subjects who underwent cervical sagittal X-ray imaging. Four orthopedic specialists labeled key points, which were cross-validated, and an algorithm was then used to measure C6S and C7S. Pearson correlation coefficients were calculated to assess the relationship between C6S and C7S, and linear regression derived a predictive equation for C7S. Various machine learning models were compared to improve C7S prediction accuracy.</p><p><strong>Results: </strong>The average angles for C6S and C7S were 15.4° (16.8° in males, 14.7° in females) and 19.1° (21.1° in males, 18.2° in females), respectively, with C7S generally larger than C6S, except in Sigmoid 1 curvature. Males exhibited higher values for both C6S and C7S, and both slopes increased after age 20. Both angles increased significantly with age from 20 to 90 years. A strong positive correlation was found between C6S and C7S (r>0.75, P<0.001), confirmed by linear regression (R²=0.688). Among the machine learning models, both Ridge Regression and Linear Regression performed better than the others, with R²=0.855 in predicting C7S.</p><p><strong>Conclusion: </strong>The strong correlation between C6S and C7S suggests that C6S can substitute for C7S when visibility is limited. Machine learning models further enhance prediction accuracy, demonstrating promising clinical potential.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068096","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":"Linking American Spine Registry (ASR) and Medicare Data:an analysis of 8,755 Lumbar Fusion Cases.","authors":"Steven D Glassman, Mladen Djurasovic, Anthony L Asher, Ayushmita De, Jayson Murray, Aleeza Safdar, Kimberly R Porter, Mohamad Bydon","doi":"10.1097/BRS.0000000000005273","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005273","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Objective: </strong>To evaluate whether the combined American Spine Registry and Medicare (ASR/CMS) data yields substantially different findings versus ASR data alone with regard to key parameters such as risk stratification, complication rates and readmission rates in lumbar surgery investigated through an analysis of 8,755 spondylolisthesis cases.</p><p><strong>Summary of background data: </strong>Medicare data correlation has been effective for determining revision rates for other procedures such as total hip replacement. Our aim is to determine whether these findings are translatable in the realm of lumbar spinal surgery investigated through an analysis of 8,755 spondylolisthesis cases.</p><p><strong>Methods: </strong>The American Spine Registry (ASR) was queried for Medicare-eligible patients who underwent lumbar spinal fusion for lumbar spondylolisthesis. This cohort was analyzed based upon ASR data alone in comparison to the same patients in the combined ASR/Medicare (ASR/CMS) dataset. The primary outcome of interest was readmission at 30 and 90 days postoperatively.</p><p><strong>Results: </strong>There were 8,755 Medicare-eligible cases with a diagnosis of spondylolisthesis within the ASR. The mean age was 72.7 years, 60.8% were female. Medical comorbidities were more frequently detected in the combined ASR/CMS dataset, reflected by a higher mean Charlson Comorbidity Index score (3.49 vs. 3.27, P<0.001). Hospital readmission rates were significantly higher in the combined ASR/CMS dataset at both 30 days (4.89% vs. 1.83%, P<0.001) and 90 days (7.68% vs. 2.66%, P<0.001), with notable increases in readmissions for infections and medical complications. Discharge disposition remained comparable across datasets, with most patients discharged to home or home health care.</p><p><strong>Conclusion: </strong>This study demonstrates that integrating patient-identified Medicare data with the ASR provides a more comprehensive assessment of outcomes for lumbar spinal fusion surgery as demonstrated through an analysis of 8,755 spondylolisthesis cases. These findings, establish the importance of multi-source data linkage to overcome the limitations of single-source registries, thereby enhancing data quality for clinical decision-making and quality improvement in spinal surgery.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060687","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}