Spine最新文献

{"title":"Optimal Selection of Lower Instrumented Vertebra Can Minimize Distal Junctional Kyphosis After Posterior Spinal Fusion for Thoracic Adolescent Idiopathic Scoliosis.","authors":"Yusuke Hori, Akira Matsumura, Takashi Namikawa, Norihiro Isogai, Luiz Carlos Almeida da Silva, Burak Kaymaz, Petya K Yorgova, Peter G Gabos, Nicholas D Fletcher, Michael P Kelly, Harry L Shufflebarger, Peter O Newton, Burt Yaszay, Paul D Sponseller, Baron S Lonner, Amer F Samdani, Firoz Miyanji, Suken A Shah","doi":"10.1097/BRS.0000000000005336","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005336","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study of a prospectively collected multicenter database.</p><p><strong>Objective: </strong>To identify risk factors for developing distal junctional kyphosis (DJK) and elucidate optimal selection of the lowest instrumented vertebra (LIV) utilizing sagittal stable vertebra (SSV) and preoperative distal junctional angle (DJA) to prevent DJK.</p><p><strong>Summary of background data: </strong>While including the SSV may minimize DJK following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis, relying solely on the SSV criteria can necessitate more extensive fusion. As LIV moves distally, a patient's motion, function, and chance of degeneration may all be negatively affected.</p><p><strong>Methods: </strong>This study included patients with Lenke 1/2 curves who underwent thoracic PSF (LIV≤L1); development of DJK (DJA≥10°) was evaluated 2 years postoperatively. Preoperative DJA was measured between LIV and LIV+1, consistent with postoperative measurements. Multiple logistic regression models identified risk factors for developing DJK. DeLong's test compared area under the curve (AUC) from different receiver operating characteristic curves to assess DJK predictive accuracy between models.</p><p><strong>Results: </strong>Of 1,034 patients, 86 (8%) developed DJK 2 years postoperatively. Identified risk factors included preoperative DJA, LIV at ≥SSV-2, an upper instrumented vertebra of ≥T2, lumbar modifiers B or C, and larger T5-12 kyphosis. Incorporating preoperative DJA and SSV-1 for LIV selection enhanced DJK prediction accuracy over solely considering SSV inclusion (AUC=0.81 vs. 0.72, P<0.001). Furthermore, a multivariate model with risk factors achieved the highest AUC (0.87). Patients with DJK experienced worsening of T10-L2 kyphosis and lumbar lordosis over time, without affecting the Scoliosis Research Society-22 quality of life score. Among those who developed DJK, five required an extension of fixation distally.</p><p><strong>Conclusion: </strong>To prevent DJK, PSF should end below preoperative kyphosis and no more proximal than SSV-1 in patients with thoracic adolescent idiopathic scoliosis, particularly for high-risk cases. DJK led to kyphotic regional thoracolumbar alignment at 2-year follow-up.</p><p><strong>Level of evidence: </strong>Level Ⅲ-retrospective comparative study.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658620","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":"Proximal Junction and Transitional Mechanics and Effect of a Novel Tether Pedicle Screw in Long-Segment Spinal Instrumentation.","authors":"Raphael Gmeiner, Heiko Koller, Sara Lener, Christoph Orban, Anto Abramovic, Marko Konschake, Werner Schmoelz, Claudius Thomé, Sebastian Hartmann","doi":"10.1097/BRS.0000000000005329","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005329","url":null,"abstract":"<p><strong>Study design: </strong>A biomechanical study of ten human thoracolumbar (T7-L2) spine specimens was performed.</p><p><strong>Objective: </strong>To analyse the biomechanical characteristics of a Tether pedicle screw (TPS) in long-segment thoracolumbar instrumentation in terms of proximal junction mechanics and transitional motion patterns.</p><p><strong>Summary of background data: </strong>Adult spinal deformity correction carries a high junctional failure risk. A soft-landing construct at a rigid construct cranial end might reduce the proximal junctional kyphosis (PJK) and failure (PJF) risks. Therefore, a novel TPS was designed to mitigate the PJK/PJF risk. The pedicle screw is characterized by a tether between the threaded shaft and the screw head, enabling motion among parts.</p><p><strong>Methods: </strong>For initial flexibility tests, three instrumentation patterns were tested. Representing conventional instrumentation, standard thoracolumbar pedicle screw-rod instrumentation at T10-L2 was used (STD group). The TPS was tested at T9 (TPS+1 group), one level above the upper instrumented vertebra (UIV), and at T9 and T8 (TPS+2 group). Flexibility tests (±5 Nm) in all three motion directions were performed and repeated after cyclic loading (250 cycles, 1-10 Nm). Finally, specimens in the STD and TPS groups were subjected to screw pull-out testing at the index level to analyse the TPS stress-shielding effects.</p><p><strong>Results: </strong>The TPS+2 group demonstrated the largest range of motion (ROM) decrease at T9-10 in the flexibility tests, with a smaller effect in the second adjacent segment at T8-9. No significant change in ROM was observed in the uppermost segment (T7-8) among all instrumentation pattern studies. Pull-out testing revealed greater mean forces at the T10 end-level in the TPS+2 group than in the STD group.</p><p><strong>Conclusion: </strong>The TPS effectively distributed the loads across three adjacent levels and softened the load transition compared to the rigid construct. The TPS also showed the potential to stress-shield the UIV (T10) and reduce the end-level screw loosening risk.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658633","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":"Statistics for Spine Care Practitioners and Clinician-Scientists: A Practical Guide to Study Design, Analysis and Interpretation.","authors":"Alexander M Crawford, Brendan M Striano, Grace X Xiong, Jonathan Dalton, Robert J Oris, Andrew J Schoenfeld, Alexander R Vaccaro","doi":"10.1097/BRS.0000000000005332","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005332","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658659","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":"Long-Term Bladder, Bowel, and Ambulatory Function After Sacrectomy Surgery.","authors":"Joshua M Coan, Jordan O Gasho, Joseph J Connolly, Santiago A Lozano-Calderon, Kevin A Raskin, Joseph H Schwab, Daniel G Tobert","doi":"10.1097/BRS.0000000000005326","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005326","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To assess 5-year bladder, bowel, and ambulatory function in patients receiving sacral tumor resection surgery.</p><p><strong>Summary of background data: </strong>Sacral tumors are rare and slow growing, often leading to late diagnoses and large tumor size. Surgical resection is the standard of care, and frequently involves nerve root sacrifice. These structures are important for bladder, bowel, and ambulatory function, and previous studies have limited follow-up. Hence, little is known regarding how sacral nerve function changes over time after sacrectomy surgery.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 43 patients who received surgery at our institution. Patients were stratified into groups based on osteotomy level (intralesional, low, mid, and high). Descriptive statistics were calculated with point estimates. Kruskal-Wallis tests were used to compare oncologic, surgical, and functional outcomes across sacrectomy groups. Cumulative link mixed models (CLMMs) were used to assess functional trends over time.</p><p><strong>Results: </strong>There were significant differences in preoperative and 1-year bladder, bowel, and ambulatory function (P<0.05). However, there were no significant differences between 1-year and 5-year bladder, bowel, and ambulatory function (P=0.99, P=0.80, and P=0.72). At 5-years, bladder function was significantly better in the intralesional and low sacrectomy versus the mid sacrectomy group (P=0.04 and P=0.002). At 5-years, bowel function was significantly better in the intralesional and low sacrectomy versus the mid sacrectomy group (P=0.01 and P=0.01). At 5-years, ambulatory function was significantly better in the low sacrectomy versus the high sacrectomy group (P=0.006).</p><p><strong>Conclusion: </strong>As expected, higher osteotomy level was associated with poorer function. Bladder, bowel, and ambulatory function was shown to stabilize at 1-year postoperatively. This can serve as an assessment point for long-term function and can help set patient expectations after surgery.</p><p><strong>Level of evidence: </strong>Level III, cohort study.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650840","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":"How Do Functional Comorbidities Affect PROMIS-PF Scores Following Lumbar Fusion Surgery?","authors":"Joshua Mizels, Jake Connelly, Brook Martin, Brian Karamian, W Ryan Spiker, Brandon D Lawrence, Darrel S Brodke, Nicholas T Spina","doi":"10.1097/BRS.0000000000005153","DOIUrl":"10.1097/BRS.0000000000005153","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective review.</p><p><strong>Objective: </strong>The purpose of this study is to trend PROMIS PF scores following lumbar fusion surgery and to investigate how the presence of functional comorbidities affects PROMIS PF scores. In addition, we compare trends in PROMIS PF scores to the Oswestry Disability Index (ODI) and PROMIS Pain Interference (PI) scores.</p><p><strong>Summary of background data: </strong>National Institute of Health's (NIH) Patient-reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) domain has been validated in spine surgery. However, little is known about how PROMIS-PF scores are affected by functional comorbidities and how these scores change in patients recovering from lumbar fusion surgery over time. In this study, we hypothesize that functional comorbidities negatively affect recovery.</p><p><strong>Materials and methods: </strong>We retrospectively identified 1893 patients who underwent thoracolumbar, lumbar, or lumbosacral fusion for degenerative conditions between January 2, 2014, and January 7, 2022. We summarized PF at three-month intervals for 2 years following surgery between those with and without functional comorbidity, defined as the presence of congestive heart failure (HF), chronic obstructive pulmonary disease (COPD), cerebrovascular disease (CVD), or paraplegia. Mixed effects multivariable regressions were used to model between group trends in PF through 2 years postoperatively controlling for age, gender, indication, and surgical invasiveness. The minimally clinically important difference (MCID) was defined as 5+ point improvement from baseline in PF.</p><p><strong>Results: </strong>The cohort includes 1224 (65%) patients without functional comorbidity and 669 (35%) with functional comorbidity. The mean age was 65.0, and the Charlson index was 1.0 in the cohort without functional comorbidity compared with 65.4 and 3.8 in the cohort with functional comorbidity ( P =0.552 and <0.001, respectively). The groups were otherwise similar with respect to surgical invasiveness index, vertebral levels, and spine diagnosis (all P >0.05). At 24 months postoperatively, the functional comorbidity group had a 2.5-point lower absolute PF score and a 1.3-point less improvement from baseline ( P =0.012 and 0.190, respectively). 19.3% of patients in the functional comorbidity group achieved the MCID compared with 80.9% in patients without functional comorbidity ( P <0.001).</p><p><strong>Conclusions: </strong>Based on PROMIS PF scores, patients with functional comorbidities do not recover to the same extent and are less likely to achieve an MCID compared with patients without baseline functional comorbidities. PROMIS-PF can help benchmark patients along their recovery, and other metrics may be needed to better understand the recovery of patients with functional comorbidities.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"383-388"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133850","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 Evolution of Curve Patterns in Adolescent Idiopathic Scoliosis During Chêneau Brace Treatment.","authors":"Hao Hou, Dong Guo, Haonan Liu, Yanzhong Luo, Ziming Yao, Lei Feng, Jun Cao, Rongxuan Gao, Xuejun Zhang","doi":"10.1097/BRS.0000000000005059","DOIUrl":"10.1097/BRS.0000000000005059","url":null,"abstract":"<p><strong>Study design/setting: </strong>This retrospective study analyzed bracing outcomes in patients with adolescent idiopathic scoliosis (AIS), focusing on curve pattern changes and brace efficacy.</p><p><strong>Objective: </strong>To analyze the effectiveness of the Chêneau brace across different curve patterns and to evaluate the tendencies in curve evolution during treatment.</p><p><strong>Background: </strong>AIS presents diverse curve patterns, each responding differently to bracing. Understanding these variations is crucial for optimizing treatment strategies.</p><p><strong>Patients and methods: </strong>The study included 177 patients with AIS treated with Chêneau orthoses, categorized based on curve patterns as per the main curve and modified Lenke (mLenke) classifications. We compared patients according to curve patterns and assessed changes in curve magnitude and pattern before and after treatment.</p><p><strong>Results: </strong>Over an average follow-up of 28.1 ± 10.7 months, the primary curve magnitude decreased from 28.8 ± 6.6° to 25.9 ± 10.5°. Significant reductions were observed in mLenke V and VI patients ( P < 0.05). Patients with main lumbar curves showed better initial in-brace correction and curve control compared with those with main thoracic curves ( P < 0.05). In single-curve patterns, binary logistic regression indicated that mLenke V patients demonstrated higher rates of curve control compared with mLenke I patients ( P < 0.05). No significant differences were found in double-curve patterns between mLenke III and VI ( P > 0.05). At the final follow-up, thoracolumbar/lumbar curves improved significantly in mLenke III and VI patients ( P < 0.05), whereas thoracic curves did not ( P > 0.05). Furthermore, at the last follow-up, the proportions of mLenke I, II, and IV increased, whereas mLenke III, V, and VI decreased.</p><p><strong>Conclusions: </strong>Bracing outcomes were more favorable in patients with main lumbar curves than those with main thoracic curves. However, no significant differences were found in patients with double-curve patterns. Thoracic curves exhibited a higher progression risk compared with thoracolumbar/lumbar curves within the same curve pattern. During bracing, a tendency for primary curves to shift proximally was noted.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"368-374"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248605","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":"Are Surgical Outcomes Different According to Baseline Balance Status in Elderly Patients with Degenerative Sagittal Imbalance?","authors":"Se-Jun Park, Chong-Suh Lee, Jin-Sung Park, Dong-Ho Kang","doi":"10.1097/BRS.0000000000005090","DOIUrl":"10.1097/BRS.0000000000005090","url":null,"abstract":"<p><strong>Study design: </strong>This is a retrospective study.</p><p><strong>Objective: </strong>We sought to compare surgical outcomes according to baseline balance statuses in elderly patients with degenerative sagittal imbalance (DSI).</p><p><strong>Summary of background: </strong>Although optimal sagittal correction has been emphasized for good surgical outcomes, the effect of the state of preoperative balance on surgical outcomes has been adequately described at present.</p><p><strong>Methods: </strong>Patients aged 60 years and above with DSI who underwent ≥5-level fusion to the sacrum were included. Among them, only those who postoperatively achieved the optimal age-adjusted pelvic incidence (PI) - lumbar lordosis (LL) target were included in this study. Study participants were divided into two groups according to their preoperative sagittal vertical axis (SVA): compensatory balance (SVA <5 cm, group CB) and decompensation (SVA ≥5 cm, group D). Comparisons between the two groups were performed using the χ 2 test or Fisher exact test for categorical variables and the independent t -test or Wilcoxon rank-sum test for continuous variables.</p><p><strong>Results: </strong>A total of 156 patients whose postoperative sagittal alignment matched the age-adjusted PI-LL target constituted the study cohort. There were 59 patients in group CB and 97 patients in group D. Mean follow-up duration was 50.0 months after surgery. Immediate postoperatively, sacral slope and SVA were significantly greater in group D than in group CB. At the last follow-up, the SVA was significantly greater in group D than in group CB (43.6 vs. 22.7 mm), while no significant differences were found in other sagittal parameters. The Oswestry disability index and Scoliosis Research Society -22 scores at the last follow-up were significantly worse in group D than in group CB.</p><p><strong>Conclusion: </strong>The SVA tended to experience less correction postoperatively, with evidence of further deterioration during follow-up in group D than in group CB. This suboptimal correction of SVA may contribute to the inferior clinical outcomes encountered in group D relative to group CB. Therefore, we recommend correction of PI-LL as close as possible to the lower limit of the suggested PI-LL target range in patients with evidence of preoperative decompensation.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"395-404"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493479","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 the Biomechanical Effects of Vertebral Body Tethering With Apical Fusion.","authors":"Jil Frank, Per David Trobisch, Miguel Pishnamaz, Frank Hildebrand, Maximilian Praster","doi":"10.1097/BRS.0000000000005261","DOIUrl":"10.1097/BRS.0000000000005261","url":null,"abstract":"<p><strong>Study design: </strong>Biomechanical study by using a multibody simulation approach.</p><p><strong>Objective: </strong>Objectification of spinal biomechanics after vertebral body tethering with and without apical fusion.</p><p><strong>Summary of background data: </strong>Vertebral body tethering, a motion-preserving surgical technique for correction of adolescent idiopathic scoliosis, is increasingly being used for thoracolumbar curves. However, tether breakage remains a common problem with breakage rates up to 60% for TL curves. Therefore, surgeons have begun to adapt their surgical technique by fusing the apex. The short-term clinical studies show a significant reduction of the tether breakage rate to 10%, but little is known about the biomechanical reasons. Therefore, this study analyzes the intervertebral compression and tether force in a tethered spine without apical fusion and in a tethered spine with apical fusion between L1/2.</p><p><strong>Methods: </strong>A multibody simulation approach was chosen to analyze the biomechanical effects of two surgical techniques during different physiological movements. The tether and intervertebral compression forces in the different instrumented segments are once analyzed for a T10 to L3 tethered spine and once for a T10 to L3 tethered with additional L1/2 fusion using an intervertebral cage.</p><p><strong>Results: </strong>VBT with apical fusion reduces the prevailing tether forces not only at the fused level by nearly 861 N but also at the adjacent spinal segments by around 100 N. However, a significant increase in intervertebral compression force of ~706 N can be observed, especially at the adjacent spinal segments.</p><p><strong>Conclusion: </strong>L1/2 fusion in a tethered spine reduces tether forces in adjacent segments and thus might decrease the rate of tether breakage. However, fusion results in increased intervertebral compression forces by up to 31% compared with an unfused spine. Long-term clinical studies are needed to further analyze and evaluate the biomechanical consequences.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E110-E117"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012089","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 Enhanced Recovery After Surgery Protocols on Outcomes Up to Two Years After Adult Structural Spine Disorder Surgery.","authors":"Anthony Yung, Oluwatobi O Onafowokan, Ankita Das, Max R Fisher, Ethan J Cottrill, Isabel P Prado, Iryna Ivasyk, Caroline M Wu, Peter S Tretiakov, Elizbeth L Lord, Pawel P Jankowski, Douglas G Orndorff, Andrew J Schoenfeld, Christopher I Shaffrey, Peter G Passias","doi":"10.1097/BRS.0000000000005213","DOIUrl":"10.1097/BRS.0000000000005213","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study of prospectively enrolled database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We analyze the recovery pattern of patients with adult structural spine disorder (ASD) who underwent corrective surgery with enhanced recovery after surgery (ERAS+) protocol, including physical and psychological prehabilitation components, compared with a non-ERAS protocol (ERAS-) up to 2 years (2Y) after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Spine surgery for ASD is often highly invasive, which can contribute to prolonged recovery. The trajectory of recovery may be accelerated by the application of enhanced recovery principles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Inclusion criteria were operative patients with ASD older than 18 years with complete baseline, 90 days perioperative, and 2Y postoperative data. We assessed differences in baseline demographics, surgical details, baseline health-related quality of life (HRQL), and surgical outcomes between ERAS+ and ERAS- patients. Outcomes included adverse events, reoperations, and radiographic parameters such as sacral slope, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, sagittal vertical axis, lumbar lordosis, T2 to T12 kyphosis, and maximum Cobb angle. In addition, HRQL measures included the physical component summary, Oswestry Disability Index, Neck Disability Index, EuroQol 5 dimensions, Scoliosis Research Society Questionnaire 22r total and domain scores, Numeric Pain Rating Scale-back, and Numeric Pain Rating Scale-leg. We used multivariable logistic regression and analysis of covariance to adjust for confounding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 471 patients with ASD met the inclusion criteria, with 59 designated ERAS+. Those individuals with ERAS+ were older (64.1 ± 13.0 vs. 58.0 ± 16.0; P = 0.005), had a higher Charlson Comorbidity Index, (2.4 ± 1.8 vs. 1.4 ± 1.6; P &lt; 0.001), and exhibited a higher modified ASD frailty index (8.2 ± 5.4 vs. 6.3 ± 4.9; P = 0.019). The adjusted analysis demonstrated the ERAS+ cohort demonstrated a lower likelihood of overall reoperations (Odds ratio (OR): 0.3; 95% CI: 0.13-0.89), and a lower likelihood of overall adverse events (OR: 0.4; 95% CI: 0.19-0.93). ERAS+ was more likely to achieve the minimal clinically important difference in the Scoliosis Research Society Questionnaire 22r total scores at 6 months (6M; OR: 3.1; 95% CI: 1.2-8.4), self-image domain at 6M (OR: 9.0; 95% CI: 1.6-50.0), in the pain domain at 6M (OR: 3.5; 95% CI: 1.01-11.9) and 1 year postoperatively (OR: 2.6; 95% CI: 1.03-6.7), and in the SF-36's physical component summary (PCS) scores at 1 year (OR: 2.1; 95% CI: 1.05-4.2). No other statistically significant differences in HRQL were observed at the remaining time points (P &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our work is the first to evaluate HRQL metrics and complications over 2Y following ASD correction with ERAS. Despite presenting with more severe baseline frailty ","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 6","pages":"357-367"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484047","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 Fate of The Broken Tether: How Do Curves Treated With Vertebral Body Tethering Behave After Tether Breakage?","authors":"Tyler A Tetreault, Tiffany N Phan, Tishya A L Wren, Michael J Heffernan, Michelle C Welborn, John T Smith, Ron El-Hawary, Kenneth Cheung, Kenneth D Illingworth, David L Skaggs, Lindsay M Andras","doi":"10.1097/BRS.0000000000005072","DOIUrl":"10.1097/BRS.0000000000005072","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, multicenter.</p><p><strong>Objective: </strong>The aim of this study was to assess curve progression and occurrence of revision surgery following tether breakage after vertebral body tethering (VBT).</p><p><strong>Summary of background data: </strong>Tether breakage after VBT is common with rates up to 50% reported. In these cases, it remains unknown whether the curve will progress or remain stable.</p><p><strong>Materials and methods: </strong>Adolescent and juvenile idiopathic scoliosis patients in a multicenter registry with ≥2-year-follow-up after VBT were reviewed. Broken tethers were listed as postoperative complications and identified by increased screw divergence of >5 degrees on serial radiographs. Revision procedures and curve magnitude at subsequent visits were recorded.</p><p><strong>Results: </strong>Of 186 patients who qualified for inclusion, 84 (45.2%) patients with tether breakage were identified with a mean age at VBT of 12.4±1.4 years and mean curve magnitude at index procedure of 51.8±8.1 degrees. Tether breakage occurred at a mean of 30.3±11.8 months and mean curve of 33.9±13.2 degrees. Twelve patients (12/84, 14.5%) underwent 13 revision procedures after tether breakage, including six tether revisions and seven conversions to fusion. All tether revisions occurred within 5 months of breakage identification. No patients with curves <35 degrees after breakage underwent revision. Revision rate was greatest in skeletally immature (Risser 0-3) patients with curves ≥35 degrees at time of breakage (Risser 0-3: 9/17, 53% vs. Risser 4-5: 3/23, 13%, P =0.01). Curves increased by 3.1 and 3.7 degrees in the first and second year, respectively. By 2 years, 15/30 (50%) progressed >5 degrees and 8/30 (26.7%) progressed >10 degrees. Overall, 66.7% (40/60) reached a curve magnitude >35 degrees at their latest follow-up, and 14/60 (23.3%) reached a curve magnitude >45 degrees. Skeletal maturity did not affect curve progression after tether breakage ( P >0.26), but time to rupture did ( P =0.048).</p><p><strong>Conclusions: </strong>While skeletal immaturity and curve magnitude were not independently associated with curve progression, skeletally immature patients with curves ≥35 degrees at time of rupture are most likely to undergo additional surgery. Most patients can expect progression at least 5 degrees in the first 2 years after tether breakage, though longer term behavior remains unknown.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"405-411"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306929","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}