Spine最新文献

{"title":"Establishment of a Rabbit Model of Rib Tethering-induced Early-onset Scoliosis: Insights into Lung Evaluation Using Design-based Stereology.","authors":"Yonggang Wang, Dongmin Wang, Guangzhi Zhang, Xuegang He, Kun Wang, Bing Ma, Yong Yang, Xuewen Kang","doi":"10.1097/BRS.0000000000005237","DOIUrl":"10.1097/BRS.0000000000005237","url":null,"abstract":"<p><strong>Study design: </strong>Experimental study.</p><p><strong>Objective: </strong>To create an early-onset scoliosis (EOS) rabbit model and use a design-based stereological method to quantitatively assess lung structure changes at 24 weeks of age.</p><p><strong>Summary of background data: </strong>Scoliosis affects thoracic and lung development, impacting children's chest and lung growth.</p><p><strong>Materials and methods: </strong>EOS was induced via rib tethering in 4-week-old rabbits with ongoing CT scans and weight measures. Lungs were extracted postfixation for volume estimation and tissue sampling, followed by microscopic analysis of lung morphology.</p><p><strong>Results: </strong>The mean Cobb angle increased with the rabbits' growth. The EOS group showed significant decreases in total and right lung volumes. Quantitative lung stereology revealed reduced volumes of lung parenchyma and nonparenchymal tissue in all lobes. Alveolar duct volumes decreased significantly in multiple lobes, and alveolar septal volume was notably reduced in the right upper, middle, and lower lobes. The alveolar septal area decreased, and septal thickness increased in the EOS group. Alveoli numbers dropped, with variable changes in mean alveolar volume across lobes. Vascular lumen volume decreased in the right middle and lower lobes, and blood vessel and perivascular tissue volumes were significantly reduced in the right lung. Vessel diameter changes varied across lobes, with significant decreases in the right middle and lower lobes and increases in the left upper and lower lobes. Vascular endothelial surface area decreased in the left lower, right middle, and right lower lobes, with increased vessel and perivascular tissue thickness in the left upper and lower lobes compared with the right lobes.</p><p><strong>Conclusion: </strong>The EOS rabbit model demonstrated reduced lung volume, impaired alveolarization, septal thickening, and vascular changes, indicating scoliosis's negative impact on thoracic and lung development, especially on the concave lung.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E85-E100"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to SPINE Letter-to-the-Editor Re: Enhancing the Clinical Applicability of the Novel Classification System for Proximal Junctional Degeneration.","authors":"Riza Mert Cetik, Steven D Glassman, John R Dimar, Mitchell J Campbell, Mladen Djurasovic, Charles H Crawford, Jeffrey L Gum, R Kirk Owens, Kathryn J McCarthy, Leah Y Carreon","doi":"10.1097/BRS.0000000000005234","DOIUrl":"10.1097/BRS.0000000000005234","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E102"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772483","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":"Establishing a Benchmark for Iatrogenic Hemodilution and Blood Transfusion in Long-Segment Spine Fusion Surgery.","authors":"Spencer Twitchell, Matthew C Findlay, Jayson Nelson, Brandon A Sherrod, Sarah T Menacho, David Dorsey, Andrew T Dailey, Marcus D Mazur","doi":"10.1097/BRS.0000000000005049","DOIUrl":"10.1097/BRS.0000000000005049","url":null,"abstract":"<p><strong>Study design: </strong>Single-center retrospective cohort study.</p><p><strong>Objective: </strong>To identify risk factors for transfusion during long-segment thoracolumbar fusion surgery and benchmark cutoffs that could be used by the operative team to guide the use of transfusion.</p><p><strong>Summary of background data: </strong>Perioperative transfusion for patients undergoing long-segment thoracolumbar fusion surgery is common. To date, no standardized intraoperative and perioperative management of transfusion administration has been defined.</p><p><strong>Methods: </strong>Patients who underwent thoracolumbar fusion surgeries of 8 or more levels between 2015 and 2020 were identified. Patient demographics, surgical details, anesthesia and critical care records, and laboratory data were compared between patients who received intraoperative and postoperative blood transfusions and those who did not. Univariate and multivariate propensity-matched analyses were performed to identify independent predictors for blood transfusion, and ordinal analysis was performed to identify possible benchmark cutoffs.</p><p><strong>Results: </strong>Among 233 patients identified who underwent long-segment fusions, 133 (57.1%) received a blood transfusion. Multivariate propensity-matched logistic regression showed that intravenous (IV) fluid volume was an independent predictor for transfusion (transfusion group 8051 mL vs. non-transfusion group 5070 mL, P <0.01). Patients who received ≥4 L total IV fluids were more likely to undergo transfusion than those who received <4 L (93.2% vs. 50.7%, P <0.01). Those receiving total IV fluids at a rate ≥60 mL/kg (OR 10.45; 95% CI, 2.62-41.72; P <0.01) or intraoperative IV fluids at a rate ≥9 mL/kg/hr (OR 4.46; 95% CI, 1.39-14.32; P <0.01) were more likely to require transfusions.</p><p><strong>Conclusions: </strong>IV fluid administration is an independent predictor for blood transfusion after long-segment fusion surgery. Limiting IV fluid administration may prevent iatrogenic hemodilution and decrease transfusion rates. These data can be used to create perioperative protocols with the goal of decreasing transfusion rates when not indicated and allowing earlier administration when indicated.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"311-317"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071951","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":"Return to Work After Anterior Cervical Disc Replacement vs. Fusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Alejandro Perez-Albela, Joseph E Nassar, Cameron Thomson, Ishan Shah, Bassel G Diebo, Alan H Daniels, Bryce A Basques","doi":"10.1097/BRS.0000000000005319","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005319","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To compare return-to-work (RTW) outcomes between anterior cervical discectomy and fusion (ACDF) and anterior cervical disc replacement (CDR) in working-aged patients with degenerative cervical spine disease.</p><p><strong>Summary of background: </strong>Degenerative cervical spine disease frequently affects individuals in their prime working years, causing physical and economic burden. While both ACDF and CDR are effective surgical options, CDR may allow for faster recovery and earlier RTW. However, prior studies have reported inconsistent findings on RTW outcomes.</p><p><strong>Methods: </strong>Medline, PubMed, Cochrane, and Google Scholar (pages 1-20) were searched from January 2000 through October 15, 2024 in accordance with the PRISMA guidelines. Data regarding RTW by 6 weeks, 3 months, 6 months, 1 year, 2 years, 2+ years, and mean days to RTW were extracted. Study demographics including levels operated on, BMI, age, and gender were also collected. Odds ratios (OR) and mean differences were calculated for RTW.</p><p><strong>Results: </strong>Sixteen studies comprising 5,657 patients (2,650 ACDF, 3,007 CDR) and a total of 9,202 RTW outcomes recorded (4,024 ACDF, 5,178 CDR) were included in the study. CDR patients had significantly higher odds of RTW at 6 weeks (OR=1.33, P=0.01), 3 months (OR=1.58, P=0.001), and 1 year (OR=1.35, P=0.04). CDR also led to an earlier RTW by an average of 9.91 days (95% CI [2.01, 17.81], P=0.01). No significant differences were observed at 2 years (OR=1.12, P=0.18) or beyond 2 years (OR=1.28, P=0.20).</p><p><strong>Conclusion: </strong>CDR facilitates earlier RTW compared to ACDF within the first postoperative year, reflecting the benefits of its motion-preserving design and reduced fusion-related recovery restrictions. These findings highlight the value of CDR for working-aged individuals, particularly those prioritizing a faster return to professional and social activities.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606347","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":"Revisiting the Treatment Algorithm for Atlantoaxial Dislocation after 10 Years: A Multi-center Study with Mid-to-long-term Follow-up.","authors":"Nanfang Xu, Yinglun Tian, Haoliang Zhao, Hongling Chu, Fangcai Li, Bing Wang, Peng Liu, Fei Yin, Lei Li, Linfeng Wang, Yannan Zhang, Linwei Chen, Lingqiang Chen, Jun Zhu, Zhisen Tian, Cheng Li, Feng Wang, Shilin Xue, Cheng Zhang, Weishi Li, Shenglin Wang","doi":"10.1097/BRS.0000000000005318","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005318","url":null,"abstract":"<p><strong>Study design: </strong>A multi-center retrospective cohort study.</p><p><strong>Objective: </strong>To overcome the limitations of former single-center strategy studies, an updated classification guiding surgical management of Atlantoaxial dislocation (AAD) is proposed in this study based on a large multi-center retrospective cohort study with mid-to-long-term follow-up.</p><p><strong>Summary of background data: </strong>AAD is the most prevalent disorder affecting the cranio-vertebral junction, often leading to myelopathy and impairment of cranial nerve function, which can result in significant morbidity or even mortality. Although the treatment algorithm we previously proposed for these diseases in 2013 has been widely adopted, its effectiveness and safety in multi-center settings have yet to be thoroughly evaluated.</p><p><strong>Methods: </strong>Patients with AAD who underwent surgical treatment were recruited from eight tertiary spine centers in eight provinces (two northeastern, two southwestern, one northwestern, one southeastern, and two central) across China between January 2011 and December 2021. Patient's classification, surgical procedure, postoperative recovery progress, and occurrence of complications of the patients were collected and analyzed.</p><p><strong>Results: </strong>2354 patients were included. Type I and Type II constituted most patients (76.0%). For Type III AAD, our goal was conversion to Type II, first using posterior intra-articular release (212/523 patients, 40.5%), and if failed, trans-oral release (311/523 patients, 59.5%). For Type IV, we also attempted conversion to Type II, using posterior or trans-oral osteotomy (37/42 patients, 88.1%). Trans-oral and trans-nasal odontoidectomy was the last resort for decompression for patients whose AAD could not be reduced despite all efforts (5/42 patients, 11.9%). At an average follow-up of 5.3 years, 85.9% patients achieved complete anatomical AAD reduction, 98.8% demonstrated clinical or radiological signs of solid fusion.</p><p><strong>Conclusion: </strong>The classification system of AAD was updated. Advancements have been made in the management of irreducible and bony AAD, and the trans-oral release and odontoidectomy procedures were required by less AAD patients.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606350","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 Indicator Analysis: Unraveling the Distinct Clinical Characteristics of Kümmell's Disease Compared to Osteoporotic Vertebral Compression Fractures.","authors":"Fu-Kuan Zhu, Ding-Zhi Gao, Feng Xiang, Hao Hu, Ya-Feng Wen, Zhong-Liang Deng, Yuan-Yuan Wu, Yu-Tian Niu, Lei Chu, Xiao-Min Sheng, Lei Shi","doi":"10.1097/BRS.0000000000005313","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005313","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case-control study.</p><p><strong>Objective: </strong>To examine the differences in various clinical indicators between Kümmell's disease (KD) and osteoporotic vertebral compression fractures (OVCF), in order to assist in the diagnosis of KD and provide a foundation for further analysis of its risk factors.</p><p><strong>Summary of background data: </strong>The mechanisms underlying the progression of OVCF to KD remain unclear, and research analyzing the indicators between the two conditions is still limited.</p><p><strong>Patients and methods: </strong>We conducted a retrospective analysis of 21 males and 59 females patients diagnosed with KD, among those admitted for OVCF at our hospital from January 2018 to January 2023. We defined all KD patients as the kümmell group (K group). In the same period, we randomly selected 71 males and 301 females patients with OVCF as OVCF group (O group). We conducted statistical descriptions and analyses comparing both groups based on sex, bone density, age, serum calcium, serum phosphorus, endogenous creatinine clearance rate (Ccr), glomerular filtration rate (GFR), alkaline phosphatase (ALP), total protein (TP), albumin, (1, 25-(OH)2 D3), calcitonin, parathyroid hormone (PTH), N-mid osteocalcin (N-MID-OT), β-isomerized C-terminal telopeptides (β-CTX), procollagen 1 N-terminal propeptide (P1NP), body mass index (BMI), history of fragility fracture (HFF), hypertension, diabetes, and coronary heart disease.</p><p><strong>Results: </strong>We found that the albumin level in K group (P<0.001) was significantly lower than that in the O group, and the serum phosphorus (P=0.002), PTH (P=0.037), and HFF (P<0.001) in K group were significantly higher than those in the O group.</p><p><strong>Conclusion: </strong>Patients with KD have lower albumin levels, higher blood phosphorus levels and PTH, and a greater likelihood of a HFF compared to those with OVCF. If patients with low back pain exhibit these issues, timely medical attention is essential to rule out OVCF and prevent its progression to KD.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Multiple Revision Cervical Surgeries After Single-Level Anterior Cervical Discectomy and Fusion.","authors":"Wesley M Durand, Amir Human Hoveidaei, Micheal Raad, Rajan Khanna, Amit Jain","doi":"10.1097/BRS.0000000000005317","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005317","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis using the MarketScan private insurance database from 2010-2020.</p><p><strong>Objective: </strong>Determine the incidence of multiple revision cervical surgeries at 5 years following primary, single-level ACDF and assess the risk of subsequent revisions after the first and second surgeries.</p><p><strong>Summary of background data: </strong>The rate of revision surgery after ACDF is well-documented, but data on multiple revision surgeries is limited.</p><p><strong>Methods: </strong>Adult patients ≤65 years undergoing primary, single-level ACDF were identified. Patients with infectious, traumatic, or neoplastic etiologies were excluded. The primary endpoint was any revision cervical surgery with follow-up ending at 5 years. Kaplan-Meier and Cox proportional hazards regression were used, adjusting for sex, age, CCI, and region.</p><p><strong>Results: </strong>A total of 42,845 patients undergoing primary, single-level ACDF (P) were included, with a mean age of 48.9 years (SD 9.0); 52.8% were female. The \"first revision\" (R1) group included 2,374 patients, and the \"second revision\" (R2) group had 195 patients. The mean revision-free follow-up was significantly different across the P, R1, and R2 groups, though with small absolute differences (P 2.2 years, R1 2.0 years, R2 2.0 years; P<0.0001). At 5-years post-operatively, the incidence of revision surgery was 10.8% after primary surgery, 24.1% after one revision, and 42.5% after two revisions. In multivariable Cox regression, the risk of subsequent revision surgery was significantly higher after one revision (HR 1.6 vs. primary, P<0.0001) and even more so after two revisions (HR 2.6 vs. primary, P<0.0001). Interval hazard analysis showed a significantly higher incidence of revision from 2-5 years with each subsequent revision (all P<0.05).</p><p><strong>Conclusion: </strong>After primary ACDF in patients <65 years, approximately 10% underwent revision at 5 years post-operatively. The occurrence of subsequent revision surgery was higher; >20% after one revision, and >40% after two revisions, which is critical for patient decision-making.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524511","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":"Transforaminal vs Anterior Lumbar Interbody Fusion at L5-S1 for Degenerative Spine Disease: A Meta-analysis.","authors":"Alan H Daniels, Mohammad Daher, Joseph E Nassar, Sleiman Haddad, Louis Boissiere, Richard K Hurley, William F Lavelle, Peter G Passias, Bassel G Diebo, Amer Sebaaly","doi":"10.1097/BRS.0000000000005315","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005315","url":null,"abstract":"<p><strong>Study design: </strong>Meta-Analysis.</p><p><strong>Objective: </strong>This meta-analysis will compare transforaminal lumbar interbody fusion (TLIF) to Anterior lumbar interbody fusion (ALIF) at L5-S1 in lumbar degenerative spine diseases (DSD).</p><p><strong>Background: </strong>Interbody device placement is indicated for alignment correction, sustaining decompression, achieving fusion, and is an effective and widely performed surgical treatment for lumbar DSD. ALIF and TLIF are the two most commonly performed approaches for the management of DSD at L5-S1.</p><p><strong>Methods: </strong>Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1-20) were accessed and explored until December 2024. The extracted data consisted of complications, reoperations, surgery-related parameters, patient-reported outcome measures (PROMs), and post-operative radiographic parameters. Across all studies, mean differences (MD) with 95% CI were used for continuous data while odds ratio (OR) was utilized for dichotomous data.</p><p><strong>Results: </strong>Nine retrospective articles were included in the meta-analysis, including 1292 patients, with 694 in the TLIF group and 598 in the ALIF group. Patients undergoing TLIF were found to have higher rates of overall complications (OR=1.66; P=0.005) and reoperations (OR=5.92; P=0.03; although 2 studies were included in this analysis), shorter operative time in MIS TLIF compared to ALIF (MD=-47.00; P<0.001), more blood loss in open TLIF compared to ALIF (MD=135.05; P<0.001), and less improvement in lumbar lordosis and segmental lordosis (MD=-3.48; P=0.03; MD=-5.86; P<0.001). However, there was no difference in PROMs between the 2 groups.</p><p><strong>Conclusion: </strong>Patients undergoing TLIF at L5-S1 for their DSD, compared to ALIF, had higher rates of complications and reoperations, greater blood loss, and less improvement in sagittal alignment. These results highlight the efficacy, power, and safety of ALIF and its benefits in restoring alignment, which may optimize long-term outcomes.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606352","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 Non-Satisfaction despite ODI Improvement in Patients undergoing Elective Lumbar Surgery.","authors":"Jan Hambrecht, Paul Köhli, Erika Chiapparelli, Ranqing Lan, Marco D Burkhard, Franziska C S Altorfer, Gisberto Evangelisti, Ali E Guven, Koki Tsuchiya, Roland Duculan, Jennifer Shue, Andrew A Sama, Frank P Cammisa, Federico P Girardi, Carol A Mancuso, Alexander P Hughes","doi":"10.1097/BRS.0000000000005316","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005316","url":null,"abstract":"<p><strong>Study design: </strong>Secondary analysis of prospective study.</p><p><strong>Objective: </strong>To assess the risk factors for postoperative non-satisfaction despite improvement in the Oswestry Disability Index (ODI) two years after elective lumbar surgery.</p><p><strong>Background: </strong>The ODI and postoperative satisfaction are important markers of postoperative success. While ODI improvement is expected to correlate with satisfaction, their exact relationship remains unclear. Additionally, some patients may achieve functional improvement yet report non-satisfaction postoperatively.</p><p><strong>Methods: </strong>A secondary analysis was performed on a prospective study of patients undergoing lumbar surgery for degenerative conditions. Patients with a 2-year ODI and satisfaction follow-up were included. Risk factors for non-satisfaction despite ODI improvement were investigated using t-tests, Wilcoxon-tests, and Fisher's-exact-tests. Significant variables were analyzed with multivariable logistic regression, adjusting for covariates.</p><p><strong>Results: </strong>355 patients (65±10 y, 58% female) were included. Non-satisfied patients showed significantly higher scores in pre- (64[52-76], P<0.001) and postoperative (36[20-44], P<0.001) ODI and lower absolute (18[8-30], P<0.001) and percentage (30[17-52], P<0.001) improvement rates from pre- to postoperatively. Higher baseline (OR1.03, 95%CI 1.01-1.05, P<0.001) and postoperative (OR1.08, 95%CI 1.06-1.10, P<0.001) ODI scores, and lower absolute (OR0.94, 95%CI 0.92-0.96, P<0.001) and percentage (OR0.95, 95%CI 0.94-0.97, P<0.001) improvement rates, were significant risk factors for experiencing non-satisfaction, despite ODI improvement. Higher fat infiltration (FI) of the multifidus (MF) (OR1.03, 95%CI 1.00-1.06, P=0.042) or the erector spinae (ES) (OR1.06, 95%CI 1.03-1.09, P<0.001) were significantly correlated with postoperative non-satisfaction, after adjusting for covariates.</p><p><strong>Conclusion: </strong>Higher pre- and postoperative ODI scores and lower ODI improvement were linked to postoperative non-satisfaction. Higher FI in the MF or ES was also a significant risk factor for postoperative non-satisfaction, despite ODI improvement. The findings highlight that postoperative satisfaction is influenced by various factors affected by ODI-measured disability. Additionally, paraspinal muscle health greatly affects postoperative outcomes and should guide preoperative planning and postoperative care.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504347","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":"Automated Scoliosis Cobb Angle Classification in Biplanar Radiograph Imaging with Explainable Machine Learning Models.","authors":"Jennifer Yu, Yash Lahoti, Kyle C McCandless, Nikan K Namiri, Matthew S Miyasaka, Hamza Ahmed, Junho Song, John J Corvi, Daniel C Berman, Samuel K Cho, Jun S Kim","doi":"10.1097/BRS.0000000000005312","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005312","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objective: </strong>To quantify the pathology of the spine in patients with scoliosis through one-dimensional feature analysis.</p><p><strong>Summary of background data: </strong>Biplanar radiograph (EOS) imaging is a low-dose technology offering high-resolution spinal curvature measurement, crucial for assessing scoliosis severity and guiding treatment decisions. Machine learning (ML) algorithms, utilizing one-dimensional image features, can enable automated Cobb angle classification, improving accuracy and efficiency in scoliosis evaluation while reducing the need for manual measurements, thus supporting clinical decision-making.</p><p><strong>Methods: </strong>This study used 816 annotated AP EOS spinal images with a spine segmentation mask and a 10-degree polynomial to represent curvature. Engineered features included the first and second derivatives, Fourier transform, and curve energy, normalized for robustness. XGBoost selected the top 32 features. The models classified scoliosis into multiple groups based on curvature degree, measured through Cobb angle. To address class imbalance, stratified sampling, undersampling, and oversampling techniques were employed, with 10-fold stratified K-fold cross-validation for generalization. An automatic grid search was used for hyperparameter optimization, with K-fold cross-validation (K=3).</p><p><strong>Results: </strong>The top-performing model was Random Forest, achieving an ROC AUC of 91.8%. An accuracy of 86.1%, precision of 86.0%, recall of 86.0%, and an F1 score of 85.1% were also achieved. Of the three techniques employed to address class imbalance, stratified sampling produced the best out-of-sample results. SHAP values were generated for the top 20 features, including spine curve length and linear regression error, with the most predictive features ranked at the top, enhancing model explainability.</p><p><strong>Conclusions: </strong>Feature engineering with classical ML methods offers an effective approach for classifying scoliosis severity based on Cobb angle ranges. The high interpretability of features in representing spinal pathology, along with the ease of use of classical ML techniques, makes this an attractive solution for developing automated tools to manage complex spinal measurements.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504331","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}