Spine最新文献

{"title":"Development of Screening Criteria to Detect Transthyretin Amyloid in the Ligamentum Flavum: Early Detection of Amyloidosis.","authors":"Sree M Vemu, Takashi Hirase, Roxanne R Miller, Mark L Prasarn, Comron Saifi, Jeffrey J Ratusznik, Bradley K Weiner, Barry H Trachtenberg, Shari R Liberman","doi":"10.1097/BRS.0000000000005884","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005884","url":null,"abstract":"<p><strong>Study design: </strong>Prospective cross-sectional study.</p><p><strong>Objective: </strong>To develop and apply screening criteria for patients at risk of systemic amyloidosis undergoing routine lumbar decompression, using histopathological evaluation of ligamentum flavum (LF) tissue.</p><p><strong>Summary of background data: </strong>Amyloidosis is the extracellular deposition of insoluble, misfolded proteins, leading to progressive multiorgan dysfunction. Although recent therapies can slow disease progression, they do not reverse existing organ damage, underscoring the importance of early detection. Musculoskeletal manifestations of amyloidosis, such as lumbar stenosis (LS), can precede cardiac symptoms, providing an opportunity for early detection and treatment. Amyloid deposition within the LF has been identified as a contributing factor to LF hypertrophy and spinal stenosis, yet no standardized guidelines exist for determining which patients should undergo LF tissue sampling during lumbar decompression surgery.</p><p><strong>Methods: </strong>Patients with conditions linked to amyloidosis and axial T2 magnetic resonance imaging (MRI) LF thickness >4.9 mm were prospectively enrolled. LF tissue samples were stained with Congo red (CR), and positive cases were subtyped. Patients with confirmed amyloid were referred for cardiac evaluation.</p><p><strong>Results: </strong>Fifty patients were enrolled in the study; 14 (28%) had positive CR staining, and 10 (20%) were determined to have transthyretin amyloidosis (ATTR) (95% CI, 17.5-41.7% and 11.2-33.0%, respectively). LF was thicker in the positive cohort (6.3±0.6 vs. 5.6±0.8; P≤.001). There was no difference in age or number of levels decompressed. Six of the 14 patients elected to undergo further cardiac evaluation, including a 99mTc-PYP scan; all results were negative.</p><p><strong>Conclusion: </strong>The screening criteria identified patients at risk for amyloidosis. 20% of patients were found to have ATTR, and those who completed cardiac evaluation had no evidence of cardiac involvement at the time of evaluation. While larger studies are needed, LF analysis during routine decompression may provide a practical method for early detection.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115124","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":"Optimising Region of Interest Characteristics and Standardisation Methodologies for Lumbar Magnetic Resonance Imaging Vertebral Bone Quality Scoring: Reproducibility, Precision, and Validation for Thoracolumbar Fragility Fractures.","authors":"Omar Lubbad, Wajeeh Ullah Mahmood, Yumna Saleem, Akram Hagos, Laila Lubbad, Yusef Mohammed, Giuseppe Lambros Morassi, Nektarios K Mazarakis","doi":"10.1097/BRS.0000000000005887","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005887","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective multi-cohort methodological and validation study.</p><p><strong>Objective: </strong>To evaluate the impact of region of interest (ROI) size, placement, and calibration on MRI-derived vertebral bone quality (VBQ), and to assess the performance of VBQ methodologies for fragility fracture discrimination.</p><p><strong>Summary of background data: </strong>VBQ has emerged as a promising opportunistic biomarker of bone quality on routine MRI, with potential applications in preoperative risk stratification. However, lack of methodological standardisation, particularly regarding ROI placement and signal normalisation, limits reproducibility and contributes to variable diagnostic performance.</p><p><strong>Methods: </strong>Three independent cohorts were analysed: (1) an optimisation cohort (n=50) evaluating ROI size, placement, and calibration, (2) a scan-rescan cohort (n=30) assessing reproducibility, and (3) a validation cohort of 100 fragility fracture patients and 100 matched controls. VBQ metrics, including anterior (AVBQ), posterior (PVBQ), and calibrated variants (cVBQ, cPVBQ), were compared. Reproducibility was assessed using intraclass correlation coefficients and precision metrics. Diagnostic performance was evaluated using ROC analysis, with comparisons performed using DeLong's test. Multivariable logistic regression models were constructed for each VBQ metric.</p><p><strong>Results: </strong>ROI size had no significant effect on SI (P=0.14), whereas ROI placement significantly influenced measurements (P<0.001), with posterior regions demonstrating higher SI. Calibration improved reproducibility, with cVBQ showing superior precision (RMS SD 0.157 vs. 0.346; %CV 7.1% vs. 14.1%). In validation, discriminatory performance improved progressively from VBQ (AUC 0.718) to PVBQ (0.734), cVBQ (0.800), and cPVBQ (0.829). cPVBQ outperformed conventional VBQ (P=0.015). cPVBQ demonstrated the strongest independent association with fragility fractures (OR 4.65 per SD).</p><p><strong>Conclusion: </strong>VBQ measurement is highly sensitive to methodological variation. Approaches incorporating posterior sampling and signal calibration may improve reproducibility and diagnostic performance but require validation in unselected clinical populations.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114839","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":"Can Preoperative Nutritional Status Be One of the Parameters Evaluating Biological Age for Elderly Patients Undergoing Spinal Surgery?: A Propensity Score-Matched Analysis.","authors":"Yuki Kinoshita, Koji Tamai, Makoto Oka, Minori Kato, Akinobu Suzuki, Hiromitsu Toyoda, Shinji Takahashi, Yuta Sawada, Masayoshi Iwamae, Yuki Okamura, Yuto Kobayashi, Hiroshi Taniwaki, Masato Uematsu, Ryo Sasaki, Maya Suzuki, Masashi Tsujino, Hiroaki Nakamura, Hidetomi Terai","doi":"10.1097/BRS.0000000000005670","DOIUrl":"10.1097/BRS.0000000000005670","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study with propensity score-matched analysis.</p><p><strong>Objective: </strong>To evaluate the association between preoperative nutritional indices and postoperative health-related quality of life (HRQOL) in elderly patients who have undergone spinal surgery.</p><p><strong>Summary of background data: </strong>In elderly patients, surgical decisions should also consider biological age. We hypothesized that preoperative nutritional status would be associated with postoperative improvement in HRQOL, independent of chronological age.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 600 patients aged 60 years or older who underwent spinal surgery at a single institution. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), the Prognostic Nutritional Index (PNI), and the Controlled Nutritional Status (CONUT) scores. HRQOL was evaluated using the EuroQol-5 Dimensions 5-level questionnaire (EQ-5D-5L) preoperatively and one and two years postoperatively. Propensity score matching was used to compare changes in EQ-5D-5L scores between the malnutrition and control groups for each index, while adjusting for age, sex, body mass index, surgical procedure, and surgical region. Malnutrition was defined as GNRI <98, PNI <45, or CONUT ≥2, as previously reported.</p><p><strong>Results: </strong>Patients with a low preoperative GNRI demonstrated significantly lower EQ-5D-5L scores than those with a high GNRI ( P =0.031), with lower postoperative scores at years 1 ( P =0.001) and 2 ( P =0.047). No differences were observed between the groups stratified by PNI ( P =0.085) or CONUT ( P =0.306). Patients who failed to achieve the minimal clinically important difference (ΔEQ-5D-5L ≥0.08) showed significantly higher scores in the low GNRI group at postoperative years 1 and 2 ( P <0.001). No such association was found for PNI or CONUT.</p><p><strong>Conclusions: </strong>Preoperative malnutrition evaluated by GNRI was independently associated with impaired postoperative HRQOL in elderly patients undergoing spinal surgery. The GNRI may serve as a nutritional marker and a surrogate for biological age.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1374-1380"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390512","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":"Impact of Posterior Cord Compression From Ligamentum Flavum on Clinical Outcomes Following ACDF or CDR.","authors":"Andrea Pezzi, Tomoyuki Asada, Atahan Durbas, Eric Zhao, Adrian Lui, Adin Ehrlich, Sereen Halayqeh, Kasra Araghi, Tarek Harshash, Olivia Tuma, Tejas Subramanian, Courtney Harris, Sophie Kush, Amy Lu, Karim Shafi, James E Dowdell, Kyle Morse, Stravisht Iyer, Sheeraz Qureshi","doi":"10.1097/BRS.0000000000005546","DOIUrl":"10.1097/BRS.0000000000005546","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To determine the impact of hypertrophied ligamentum flavum (HLF) on outcomes following anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR).</p><p><strong>Summary of background data: </strong>HLF contributes to spinal cord compression in cervical myelopathy. While ACDF's effectiveness in decompressing HLF is debated and severe HLF may worsen its outcomes, CDR's role with HLF is unclear.</p><p><strong>Materials and methods: </strong>A retrospective study was performed on patients following 1- or 2-level ACDF or CDR for cervical myelopathy or myeloradiculopathy. Patients with cervical deformity, fracture, or OPLL were excluded. HLF was dichotomized as non-HLF and HLF based on previously reported HLF grading. The HLF group was then categorized into \"severe\" and \"mild\" cases. PROMs included neck disability index (NDI), numerical rating scale (NRS) for neck and arm, and SF-12 PCS. Multivariable linear mixed-effects models (LMMs) were used for longitudinal outcome assessments, including three-way interaction term among postoperative time, ACDF or CDR, and HLF. IPTW-adjusted LMM was utilized to compare outcomes in patients with HLF between ACDF and CDR.</p><p><strong>Results: </strong>A total of 240 patients were assessed, of whom 228 met the inclusion criteria, with 160 ACDF and 68 CDR. Both groups experienced significant improvements in NDI, NRS neck, and arm over time [ F(5, 835.67) =70.03, P <0.001]. HLF status did not significantly influence these outcomes in both ACDF and CDR cohorts [ F(5, 835.68) =0.65, P =0.66]. Subgroup analyses by the existence of radiculopathy and the number of surgical levels revealed no significant impact of HLF. IPTW-adjusted comparisons in HLF patients with balanced-cohort showed no significant difference in NDI trajectories between ACDF and CDR [ F(5, 472.19) =1.30, P =0.26].</p><p><strong>Conclusion: </strong>CDR can be offered to carefully selected patients with mild HLF, challenging the traditional view that excludes them from arthroplasty, with significant improvements in patient-reported outcomes.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1363-1373"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688365","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":"Coronal Plane Correction in Adults With Patient-Specific Rods.","authors":"Anna Sater, Alexander Ho, Christina Koshak, Andriy Noshchenko, Evalina Burger, David C Ou-Yang, Christopher J Kleck","doi":"10.1097/BRS.0000000000005574","DOIUrl":"10.1097/BRS.0000000000005574","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate radiographic and patient-reported outcomes of adult spinal deformity (ASD) correction using patient-specific rods (PSRs), with emphasis on coronal alignment.</p><p><strong>Summary of background data: </strong>While the sagittal plane has long been the primary focus in ASD correction, coronal malalignment contributes significantly to pain, disability, and mechanical complications. PSRs have demonstrated utility in improving sagittal alignment, but their impact on coronal deformities remains underinvestigated.</p><p><strong>Methods: </strong>We retrospectively analyzed 118 patients who underwent thoracolumbar or lumbar fusion with UNiD™ PSRs at a single academic center (2014-2021). Inclusion criteria required preoperative radiographic evidence of scoliosis (Cobb angle ≥10°) or coronal imbalance (C7 plumb line deviation ≥30 mm). Radiographic parameters-including maximal coronal Cobb angle, absolute C7PL deviation, sagittal vertical axis (SVA), lumbar lordosis (LL), and pelvic tilt (PT)-as well as patient-reported outcomes [Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for back and leg pain], were collected preoperatively and postoperatively. Patients were followed up for 2 years. Complications and reoperations were documented. Paired t tests and multivariate regression analyses assessed changes and predictors of postoperative alignment.</p><p><strong>Results: </strong>Preoperative maximal coronal Cobb angle improved from 35.0° to 18.0° postoperatively ( P <0.0001). SVA decreased from 62.9 mm to 28.6 mm ( P <0.0001). ODI improved from 21.1 to 13.6, and NRS decreased from 6.1 to 2.3 at 9 to 12 months (both P <0.0001). Coronal correction did not correlate with increased rates of dural tears or blood loss >2500 mL. Reoperation rate due to hardware-related complications was 9.3%.</p><p><strong>Conclusions: </strong>Significant improvements in coronal and sagittal alignment were observed following surgery incorporating PSRs, along with reductions in disability and pain. These findings demonstrate adequate coronal correction while maintaining sagittal alignment; however, causality cannot be inferred in this retrospective series.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1390-1398"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148035359","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":"Mental Health Recovery Trajectories After Surgery for Degenerative Cervical Myelopathy: A Canadian Spine Outcomes Research Network Study.","authors":"Vishwathsen Karthikeyan, Nathan Evaniew, Armaan K Malhotra, Christopher S Lozano, Andrew Glennie, Christopher S Bailey, David Cadotte, Zhi Wang, Supriya Singh, Philippe Phan, Jérôme Paquet, Chris Small, Andrew Nataraj, Charles G Fisher, Michael H Weber, Raja Rampersaud, Jefferson R Wilson, Nicolas Dea","doi":"10.1097/BRS.0000000000005893","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005893","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of a multicenter, prospective observational cohort.</p><p><strong>Objective: </strong>To identify distinct postoperative trajectories of mental health following surgery for degenerative cervical myelopathy (DCM) and to assess the independent association between trajectory membership and 12-month patient satisfaction.</p><p><strong>Summary of background data: </strong>Although surgery improves neurological and functional outcomes for patients with DCM, its impact on mental health remains poorly characterized. Patients with DCM frequently report poor mental well-being, which may influence quality of life and satisfaction with treatment.</p><p><strong>Methods: </strong>We analyzed data from the ongoing Canadian Spine Outcomes Research Network (CSORN) multicenter prospective observational DCM study. Group-based trajectory modeling (GBTM) was used to identify latent MCS recovery trajectories. Logistic regression evaluated associations between trajectory group membership and 12-month satisfaction, adjusting for demographic and clinical variables.</p><p><strong>Results: </strong>Among the 729 patients included, four distinct trajectories of mental health HRQoL recovery were identified based on longitudinal MCS scores: Low-stable (persistently low MCS [12%]), Moderate-stable (intermediate and unchanged MCS [36%]), Good-stable (high and stable MCS [38%]), and Improved (low baseline MCS with postoperative improvement [14%]). Pairwise comparisons showed that the Improved group achieved significantly greater gains in disability (NDI, P<0.001), neck pain (NRS neck, P=0.002), mental health HRQoL (MCS, P<0.001), and physical health (PCS, P=0.001) compared with the Low-stable group, while changes in neurologic function and arm pain did not differ. Trajectory group membership was associated with satisfaction: compared with Low-stable, Good-stable (OR 7.39, 95% CI 3.09-17.70) and Improved (OR 4.18, 95% CI 1.77-9.87) groups were significantly more likely to report being satisfied at 12 months.</p><p><strong>Conclusion: </strong>Mental health HRQoL recovery following DCM surgery is heterogeneous, with only a minority of patients achieving substantial postoperative improvement. Whether routine assessment of mental-health HRQoL or targeted perioperative support alters outcomes is an area of research that warrants prospective study.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114732","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 Relationship Between Hospital Price Markup and Outcomes After Anterior Cervical Discectomy and Fusion.","authors":"Jacob W McDevitt, Andre C Ferreria, Theodore A Joaquin, Anoop Sunkara, Cade F Bennett, Austin R Chen, Tyler M Compton, Mark A Plantz, Wellington K Hsu, Matthew Colman, Alpesh A Patel, Srikanth N Divi","doi":"10.1097/BRS.0000000000005890","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005890","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the association between hospital price markup and perioperative and long-term outcomes following elective anterior cervical discectomy and fusion (ACDF).</p><p><strong>Summary of background data: </strong>Hospital price markup, defined as the ratio of billed charges to actual costs, varies widely across U.S. institutions and is largely unregulated. While prior studies in general surgery have linked high-markup hospitals to poorer outcomes, this relationship has not been characterized in cervical spine surgery.</p><p><strong>Methods: </strong>Adult patients undergoing elective ACDF from 2016 to 2022 were identified from the PINC AI Healthcare Database. Hospital-level charge-to-cost ratios were calculated using ACDF encounters, and hospitals in the highest regional markup decile were designated as high-markup hospitals (HMH). Outcomes included perioperative complications, 30-day readmission, long-term complications, and reoperation. Multivariable regression models adjusted for patient-, procedural-, and hospital-level covariates.</p><p><strong>Results: </strong>A total of 241,965 patients were included; 22,495 (9.3%) were treated at HMH. Mean markup was significantly higher at HMH versus non-HMH (7.81x vs. 4.10x, P<0.001). After multivariable adjustment, HMH were associated with higher 30-day readmission (2.94% vs. 2.63%, P=0.007), perioperative complications (2.61% vs. 2.36%, P=0.020), long-term complications (6.99% vs. 6.58%, P=0.021), and reoperation (4.07% vs. 3.75%, P=0.020).</p><p><strong>Conclusion: </strong>Among patients undergoing elective ACDF, treatment at high-markup hospitals was independently associated with worse postoperative outcomes despite greater expenditure. These findings challenge the assumption that higher-cost care confers higher quality and have important implications for spine surgery healthcare policy.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082119","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":"Modified Lenke Classification Stratifies Brace Initiation Risk and Longitudinal Cobb Angles Trajectories in Female Patients With Adolescent Idiopathic Scoliosis.","authors":"Shuhei Ohyama, Toshiaki Kotani, Yosuke Ogata, Tsuyoshi Sakuma, Yasushi Iijima, Sumihisa Orita, Yawara Eguchi, Kazuhide Inage, Yasuhiro Shiga, Masahiro Inoue, Noritaka Suzuki, Kosuke Takeda, Akihiro Iida, Yu Otake, Fumiya Shimizu, Shun Yuki, Shohei Minami, Seiji Ohtori","doi":"10.1097/BRS.0000000000005892","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005892","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective single-center cohort study.</p><p><strong>Objective: </strong>To determine whether baseline modified Lenke classification (MLC), assessed from standing whole-spine radiographs, stratifies brace initiation risk and longitudinal Cobb-angle trajectories in female patients with adolescent idiopathic scoliosis (AIS) before reaching the conventional bracing threshold.</p><p><strong>Summary of background data: </strong>AIS progression is heterogeneous. Baseline Cobb angle and skeletal maturity are established risk factors, but whether simple baseline curve-pattern classification adds risk-stratification information during nonoperative follow-up remains unclear.</p><p><strong>Methods: </strong>We included female AIS patients aged 10 to <18 years with a baseline maximum Cobb angle ≥10° and <25°. Patients with prior brace treatment, brace initiation at the first visit, insufficient pre-brace follow-up, or missing baseline variables were excluded. The primary outcome was brace initiation. Brace-free survival was assessed using Kaplan-Meier analysis and multivariable Cox models adjusted for baseline maximum Cobb angle, age, body mass index, menarche status, and Risser status. Model fit was compared between a conventional baseline model and a model additionally including MLC. Two-year risks were estimated at fixed baseline Cobb angles. Longitudinal trajectories were analyzed using a linear mixed-effects model with natural cubic splines, an age-by-MLC interaction, and patient-specific random intercepts and slopes for age.</p><p><strong>Results: </strong>A total of 1087 patients were included; 210 (19.3%) underwent brace initiation. Brace-free survival differed across MLC groups. In multivariable Cox analysis, MLC 2, 3, 4, and 6 showed higher hazards of brace initiation than MLC 1, with the highest risk in MLC 4. Adding MLC improved likelihood-based model fit (χ²=19.35, df=5, P=0.002) and reduced AICc, although BIC increased. At baseline Cobb 20°, adjusted 2-year risk ranged from 23.3% in MLC 1 to 55.9% in MLC 4. Longitudinal Cobb-angle trajectories differed according to MLC.</p><p><strong>Conclusion: </strong>Baseline MLC may provide complementary information for stratifying brace-initiation risk and longitudinal Cobb-angle trajectories before the conventional bracing threshold.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114911","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":"Mode-Specific Association Between Tri-Cortical Pedicle Screws and Proximal Junctional Kyphosis in Adult Spinal Deformity: A Propensity Score-Matched Cohort Study.","authors":"Xinjie Wu, Gongheng Xie, Ziyang Tang, Xiaodong Qin, Hongda Bao, Benlong Shi, Saihu Mao, Yong Qiu, Zezhang Zhu, Zhen Liu","doi":"10.1097/BRS.0000000000005889","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005889","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective propensity score-matched cohort study.</p><p><strong>Objective: </strong>To evaluate the association between tri-cortical pedicle screw (TPS) fixation and radiographic proximal junctional kyphosis (PJK) after adult spinal deformity (ASD) surgery and to explore mode-specific associations.</p><p><strong>Summary of background data: </strong>PJK is common after long-segment fusion for ASD. Binary PJK endpoints may overlook heterogeneous PJK modes. The mode-specific association of TPS fixation remains uncertain.</p><p><strong>Methods: </strong>Adults undergoing long-segment posterior fusion with a lower thoracic upper instrumented vertebra (T9-T12) and at least 2 years of follow-up were retrospectively identified. Patients were categorized according to TPS use at the upper instrumented vertebra. Propensity score matching was performed to address baseline differences. The primary outcome was radiographic PJK, defined as a ≥10-degree increase in proximal junctional angle from the immediate postoperative radiograph. PJK modes were classified using a published system. Overall and mode-specific associations were evaluated using LASSO-selected and adjusted logistic regression, bias-reduced multinomial regression, and E-value sensitivity analysis.</p><p><strong>Results: </strong>Of 304 eligible patients, 189 received conventional pedicle screw fixation and 115 received TPS fixation. Propensity score matching generated 110 pairs. In the matched cohort, radiographic PJK occurred in 8.2% of the TPS group and 27.3% of the Control group (P<0.001). TPS fixation was associated with lower PJK odds in the LASSO-selected model (OR, 0.36, 95% CI, 0.14-0.87, P=0.028). Type 2 PJK occurred in 10 Control patients and in no TPS patients. Type 1 and combined Type 3-4 PJK showed no significant association with TPS. The E-value for the point estimate was 5.00.</p><p><strong>Conclusions: </strong>TPS fixation was associated with a lower incidence of radiographic PJK after ASD surgery. Mode-specific analysis suggested fewer Type 2 PJK events with TPS fixation, supporting mode-specific radiographic assessment and further evaluation of TPS as a proximal fixation strategy.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082127","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":"Comorbidity-Specific Risk of Revision Following Single-Level Degenerative Spinal Fusion (2010-2023): US Cohort Study Among Over 399K Patients.","authors":"Arman Kishan, Harmon S Khela, Alex Hernandez Manriquez, Gregory S Kazarian, Mihir S Dekhne, Dhiraj J Pangal, Andrew J Schoenfeld, William C Eward, Sami H Tuffaha, Alan H Daniels, Raffi S Avedian, Han Jo Kim, Peter G Passias, Sravisht Iyer, Anand Veeravagu","doi":"10.1097/BRS.0000000000005888","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005888","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To evaluate the associations of 28 preoperative comorbidities with all-cause and etiology-specific revisions (pseudarthrosis, mechanical failure, adjacent segment disease [ASD], infection) following single-level degenerative spinal fusion.</p><p><strong>Summary of background data: </strong>Revision following spinal fusion for degenerative spinal disease remains frequent and costly. While technical factors are well studied, the extent to which preoperative comorbidities differentially predispose to specific revision etiologies is unclear.</p><p><strong>Materials and methods: </strong>Using the PearlDiver Mariner170 claims database (2010-2023), we identified adults undergoing single-level degenerative spinal fusion and followed them for 2 years for reoperation. All-cause and etiology-specific revisions were defined by CPT/ICD codes. Preoperative comorbidities were analyzed using multivariable cox proportional hazards models adjusted for age, sex, and all comorbidities. Bonferroni correction set significance at P≤0.00036.</p><p><strong>Results: </strong>Among 399,186 patients (mean age 59.7±13.0; 56.7% female; mean CCI 1.4±1.2), anaemia (HR 1.33), osteoporosis (HR 1.31), substance-related disorders (HR 1.25), and depression (HR 1.19) conferred the greatest risk of all-cause revision. Type 2 diabetes (HR 1.07) and essential hypertension (HR 1.14) had smaller but significant effects. Etiology-specific analyses showed that osteoporosis, anaemia, depression, and substance-related disorders were consistently associated with increased risk across pseudarthrosis, mechanical failure, and ASD. Mechanical failure was additionally associated with hypertension (HR 1.20) and diabetes (HR 1.28), which were not significant in the other revision subtypes. In contrast, ASD revisions were uniquely associated with osteoarthritis (HR 1.26). No comorbidity was significantly associated with infection-related revision. All hazard ratios were significant at P<0.001 unless otherwise specified.</p><p><strong>Conclusion: </strong>In this national cohort of patients, osteoporosis, anaemia, depression, and substance-related disorders emerged as significant predictors of non-infectious revision within two years. Hypertension and type 2 diabetes conferred more modest risks for mechanical failure. These findings support the integration of comorbidity-informed risk stratification into preoperative planning and highlight the potential optimization to minimize revisions and enhance clinical outcomes.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075845","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}