Spine最新文献

{"title":"Breaking Down Instability: The Associations between Muscle Health, Facet Joint Morphology, Spinopelvic Alignment, and Stability Status in Degenerative Lumbar Spondylolisthesis.","authors":"Eric Zhao, Sereen Halayqeh, Troy Amen, Austin Kaidi, Zora Hahn, John Lama, Arsen Omurzakov, Tim Xu, Luis Colon, Tomoyuki Asada, Stephane Owusu-Sarpong, Quante Singleton, Farah Musharbash, Atahan Durbas, Adrian Lui, Andrea Pezzi, Adin Ehrlich, Myles Allen, Olivia Tuma, Kasra Araghi, Tarek Harhash, James Dowdell, Kyle Morse, Francis Lovecchio, Sheeraz Qureshi, Sravisht Iyer","doi":"10.1097/BRS.0000000000005393","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005393","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>to compare muscle health and imaging markers in patients with 1-level L4-L5 stable versus unstable degenerative lumbar spondylolisthesis (DLS).</p><p><strong>Summary of background data: </strong>DLS may be stable or unstable. It is unknown how muscle health and other imaging markers are associated with DLS stability.</p><p><strong>Methods: </strong>Patients≥18 years with 1-level L4-L5 DLS and preoperative flexion/extension radiographs were included. Normalized total psoas area (NTPA), body mass index (BMI)-normalized paralumbar (PL) (multifidus [MF]+erector spinae [ES]) cross-sectional area (PL-CSA/BMI), and Goutallier were assessed. Other L4-L5 markers included: facet orientation, slip percentage, pelvic incidence (PI), tilt (PT), sacral slope (SS), lumbar lordosis (LL), and PI-LL. Instability was defined as>3 mm translation or>10 degrees endplate change on flexion-extension. Low versus normal muscle health was defined as NTPA or PL-CSA/BMI below the lowest sex-specific quartile. Multivariate logistic regression was used to determine variables associated with instability.</p><p><strong>Results: </strong>251 patients (unstable=50; stable=201) were included. There were no significant differences in muscle health at L3, L4, or L5 or Goutallier on univariate analysis. The stable cohort had smaller slip percentage (19±9% vs. 15±8%, P=0.007) and PI-LL (13.56±12.75 vs. 5.81±14.46, P=0.001). The stable cohort had more patients with MF and ES total Goutallier≤2 (P=0.031, P=0.002, respectively) at L3-L4 versus L4-L5 and more patients with MF and ES total Goutallier≤2 (P=0.013, P=0.004, respectively) at L4-L5 versus L5-S1. On regression, low L4-L5 MF Goutallier was associated with instability (OR: 2.50, 95% CI [1.01 - 6.20], P=0.047).</p><p><strong>Conclusion: </strong>Patients with unstable L4-L5 spondylolisthesis have lower multifidus Goutallier at the slip level, greater slip percentage, and greater PI-LL mismatch. Patients with stable L4-L5 spondylolisthesis have greater Goutallier of the caudal paralumbars.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094239","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":"Posterior Spinal Fusion with Rib Resection Allows for Improved Deformity Correction as well as Patient Satisfaction.","authors":"Vishal Sarwahi, Katherine Eigo, Effat Rahman, Brian Li, Victor Koltenyuk, Sayyida Hasan, Keshin Visahan, Yungtai Lo, Jon-Paul DiMauro, Terry Amaral","doi":"10.1097/BRS.0000000000005392","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005392","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objective: </strong>This study aimed to compared radiographic and clinical outcomes in Adolescent Idiopathic Scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) with and without thoracoplasty.</p><p><strong>Summary of background data: </strong>Scoliosis is a three-dimensional deformity. As a result, patients often have an associated rib cage deformity, with clinical and aesthetic implications. Direct vertebral rotation (DVR) allows for some reduction of the rib hump; however, the deformed ribs remain deformed. Rib resection has been utilized to further reduce the rib hump, however there are concerns of increased pain, operative time, and blood loss.</p><p><strong>Methods: </strong>Retrospective review of 400 AIS patients undergoing PSF between 2018-2023. Patients were stratified based on those who underwent rib resectioning (RR) and those who did not (Non-Rib Resection, N-RR). Radiographic, surgical, and clinical outcomes were compared. Clinical outcomes were collected utilizing SRS-22 and our institution's activity questionnaire, validated via \"test-retest\" method. All data is presented as medians, IQR, frequencies, and percents. Fisher's Exact, Chi-squared, and Wilcoxon rank-sum tests were used.</p><p><strong>Results: </strong>153 patients were in the RR group, 247 were in the N-RR. Preoperative rib hump was not statistically significant between the two groups (P=0.49). Final rib hump was 16.3 mm in RR patients and 29.8 mm in N-RR (P<0.001). RR had 60.5% rib hump correction; N-RR had 30.4% correction (P<0.001). Patient reported self-image (P=0.02) and mental health (P=0.01) scores had significantly improved in RR. No differences in 90-day complication rates (P=0.19) or self-reported return to activities (P>0.05).</p><p><strong>Conclusion: </strong>Rib resectioned patients had approximately double the amount of rib hump correction at 60.5%, compared to those who did not undergo rib resectioning at 30.4%, with no increase in the rate of complications. RR patients had improved self-reported self-image and mental health scores, with no difference in timing for return to activities.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094625","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":"Identification of Optimal Candidates for Operative Management of Mild Degenerative Cervical Myelopathy: A Novel trajectory-based Analysis of Postoperative Recovery.","authors":"Alex B Bak, Mohammed Ali Alvi, Ali Moghaddamjou, Michael G Fehlings","doi":"10.1097/BRS.0000000000005394","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005394","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study using prospectively accrued data.</p><p><strong>Objective: </strong>To describe the functional recovery trajectories after surgery for mild degenerative cervical myelopathy (DCM) and identify trajectory-associated preoperative factors.</p><p><strong>Summary of background data: </strong>Indications for surgical intervention of mild DCM remain a topic of discussion and uncertainty. We sought to address the hypothesis that optimal surgical candidates with mild DCM could be identified based on their predicted postoperative functional recovery after surgery.</p><p><strong>Methods: </strong>We identified patients that underwent surgical decompression for mild DCM (modified Japanese Orthopedic Association score 15 - 17) enrolled in the prospective, multicenter AO Spine CSM-NA and CSM-I trials. Patients were classified using trajectory modelling into distinct recovery trajectories for their mJOA and Short Form 36, version 2 Physical Component Summary (SF36-PCS) scores over 2yr follow up. Predictors of recovery trajectories were identified using multivariate logistic regression.</p><p><strong>Results: </strong>Of 198 patients with mild DCM, two distinct functional recovery trajectories for mJOA and two trajectories for SF36-PCS were identified. The good recovery trajectory for mJOA included 138 patients (69.7%) that achieved clinically important improvements in their function through two-year follow up while 60 patients (30.3%) followed a marginal recovery trajectory, whereas the SF36-PCS good recovery trajectory group captured 166 patients (59.5%), and 79 patients (40.5%) in the marginal recovery group. Achieving good recovery in both mJOA and SF36-PCS was associated with higher self-reported baseline physical functioning. Patients who were older or current or former tobacco smokers were less likely to have a good postoperative recovery.</p><p><strong>Conclusion: </strong>Most mild DCM patients achieve clinically important recoveries of their function and selfreported physical function after surgery. However, there is a heterogenous group of patients that do not improve after surgical management. Further prospective studies are needed to evaluate clinically relevant factors associated with varying postoperative trajectories.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094624","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":"Change in Lumbar Lordosis After Decompressive Surgery in Lumbar Spinal Stenosis Patients and Associations With Patient-Related Outcomes Two Years After Surgery:: Radiological and Clinical Results from the NORDSTEN Spinal Stenosis Trial.","authors":"Josefin Åkerstedt, Johan Wänman, Hasan Banitalebi, Tor Åge Myklebust, Clemens Weber, Kjersti Storheim, Christian Hellum, Kari Indrekvam, Erland Hermansen, Helena Brisby","doi":"10.1097/BRS.0000000000005263","DOIUrl":"10.1097/BRS.0000000000005263","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E197"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012052","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":"Biplane Ultrasound Versus Fluoroscopy for Guidance of Percutaneous Lumbar Intervertebral Foramen Insertion : A Randomized Controlled Clinical Trial.","authors":"Yi Mao, Peng Huang, Yuhong Tao, Chao Zhang, Mingbo Zhang","doi":"10.1097/BRS.0000000000005295","DOIUrl":"10.1097/BRS.0000000000005295","url":null,"abstract":"<p><strong>Study design: </strong>A randomized controlled study.</p><p><strong>Objective: </strong>The aim of this study was to develop a clinical process of biplane ultrasound (US) guided percutaneous lumbar intervertebral foramen insertion (PLIFI) and to verify that biplane US can improve accuracy and reduce number of fluoroscopies.</p><p><strong>Summary of background data: </strong>PLIFI is crucial for drug injection and establishment of transforaminal surgical channel. The traditional fluoroscopy guidance involves radiation and requires practical experience.</p><p><strong>Methods: </strong>Patients with lumbar disc herniation scheduled for an epidural steroid injection or percutaneous endoscopic lumbar discectomy were randomized to the biplane US and fluoroscopy groups. The biplane US group was divided into training and proficiency stages using a learning curve fitted by cumulative sum analysis. All punctures were performed by a junior spine surgeon and a junior sonographer. The primary outcomes were the first success rate, number of punctures and radiographs, puncture time, and confidence score.</p><p><strong>Results: </strong>Sixty-eight patients (age 51.4±15.4 yr, 36 males) were divided into the biplane US and fluoroscopy groups. According to the 12th turning point of a learning curve, the biplane US group was divided into training and proficiency periods. The first-attempt success rate was achieved in 61% using biplane US at the proficiency period, compared with 32% using fluoroscopy [ P =0.033, RR: 1.634]. The number of radiographies [1 (IQR 1-2) vs . 2 (IQR 2-3), P =0.001] was significantly smaller, and puncture time [120 s (IQR 57-210) vs. 197 s (IQR 159-341), P =0.001] was significantly faster using biplane US at the proficiency period.</p><p><strong>Conclusion: </strong>Biplane US provides an accurate, safe, and convenient approach for PLIFI. With further clinical practice, biplane US would be conducive to rapid skill acquisition for novices and has the potential to achieve a completely radiation-free puncture process.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"686-693"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650838","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 Minimal Clinically Important Difference for the Oswestry Disability Index Substantially Varies Based on Calculation Method: Implications to Value-Based Care.","authors":"Matthew J Solomito, Cameron Kia, Heeren Makanji","doi":"10.1097/BRS.0000000000005074","DOIUrl":"10.1097/BRS.0000000000005074","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>Evaluate differences in the minimal clinically important difference (MCID) threshold value based on various acceptable statistical methods and how these differences may influence the interpretation of surgical benefit following elective 1- and 2-level lumbar fusion.</p><p><strong>Summary of background data: </strong>The MCID is a statistically determined threshold value to evaluate if a patient has received benefit from a medical procedure. In the era of value-based medicine, the MCID has become increasingly important. However, there is substantial ambiguity surrounding the interpretation of this value, given that it can be influenced by both demographic and methodological factors.</p><p><strong>Methods: </strong>A total of 371 patients who underwent 1- or 2-level elective lumbar fusions between June 2021 and June 2023 were included in this study. All patients completed both their preoperative and 6-month postoperative Oswestry Disability Index (ODI), as well as 2 anchor questions concerning satisfaction with their surgical procedure. The MCID values were calculated using 16 accepted statistical methods, and the resulting MCID values were applied to the cohort to determine how many patients reached MCID by 6 months postfusion.</p><p><strong>Results: </strong>Results demonstrated significant variability in the MCID value. The average MCID value for all 16 methods was 10.5±7.0 points in the in the range (0.8 to 25). Distribution methods provided lower threshold MCID values but had greater variability while the Anchor methods resulted in higher threshold values but had lower variability. Depending on the method used 30% to 83% of the cohort reached MCID by 6 months.</p><p><strong>Conclusion: </strong>The statistical method used to calculate the MCID resulted in significantly different threshold values and greatly affected the number of patients meeting MCID. The results demonstrates the complexity surrounding the interpretation of MCID values and calls into question the utility of a single statistically determined value to assess surgical success.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"707-712"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421075","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":"Relationship Between Lumbar Foraminal Stenosis and Multifidus Muscle Atrophy: A Retrospective Cross-Sectional Study.","authors":"Ali E Guven, Lukas Schönnagel, Erika Chiapparelli, Gaston Camino-Willhuber, Jiaqi Zhu, Thomas Caffard, Artine Arzani, Kyle Finos, Isaac Nathoo, Krizia Amoroso, Jennifer Shue, Andrew A Sama, Frank P Cammisa, Federico P Girardi, Alexander P Hughes","doi":"10.1097/BRS.0000000000005113","DOIUrl":"10.1097/BRS.0000000000005113","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cross-sectional study.</p><p><strong>Objective: </strong>To evaluate the relationship between lumbar foraminal stenosis (LFS) and multifidus muscle atrophy.</p><p><strong>Background: </strong>The multifidus muscle is an important stabilizer of the lumbar spine. In LFS, the compression of the segmental nerve can give rise to radicular symptoms and back pain. LFS can impede function and induce atrophy of the segmentally innervated multifidus muscle.</p><p><strong>Materials and methods: </strong>Patients with degenerative lumbar spinal conditions who underwent posterior spinal fusion for degenerative lumbar disease from December 2014 to February 2024 were analyzed. Multifidus fatty infiltration (FI) and functional cross-sectional area (fCSA) were determined at the L4 upper endplate axial level on T2-weighted MRI scans using dedicated software. The severity of LFS was assessed at all lumbar levels and sides using the Lee classification (grade: 0-3). For each level, Pfirrmann and Weishaupt gradings were used to assess intervertebral disc disease (IVDD) and facet joint osteoarthritis (FJOA), respectively. Multivariable linear mixed models were run for the LFS grade of each level and side separately as the independent predictor of multifidus FI and fCSA. Each analysis was adjusted for age, sex, BMI, as well as FJOA and IVDD of the level corresponding to the LFS.</p><p><strong>Results: </strong>A total of 216 patients (50.5% female) with a median age of 61.6 years (interquartile range=52.0-69.0) and a median BMI of 28.1 kg/m 2 (interquartile range=24.8-33.0) were included. Linear mixed model analysis revealed that higher multifidus FI [estimate (CI)=1.7% (0.1-3.3), P =0.043] and lower fCSA [-18.6 mm 2 (-34.3 to -2.6), P =0.022] were both significantly predicted by L2-L3 level LFS severity.</p><p><strong>Conclusion: </strong>The observed positive correlation between upper segment LFS and multifidus muscle atrophy points toward compromised innervation. This necessitates further research to establish the causal relationship and guide prevention efforts.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"702-706"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860954","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":"Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery.","authors":"Mohammad Daher, Andrew Xu, Manjot Singh, Renaud Lafage, Breton G Line, Lawrence G Lenke, Christopher P Ames, Douglas C Burton, Stephen M Lewis, Robert K Eastlack, Munish C Gupta, Gregory M Mundis, Jeffrey L Gum, Kojo D Hamilton, Richard Hostin, Virginie Lafage, Peter G Passias, Themistocles S Protopsaltis, Khaled M Kebaish, Frank J Schwab, Christopher I Shaffrey, Justin S Smith, Shay Bess, Eric O Klineberg, Bassel G Diebo, Alan H Daniels","doi":"10.1097/BRS.0000000000005250","DOIUrl":"10.1097/BRS.0000000000005250","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of prospectively collected data.</p><p><strong>Objective: </strong>This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery.</p><p><strong>Background: </strong>Current definitions of excessive blood loss after spine surgery are highly variable and may be suboptimal in predicting adverse events (AEs).</p><p><strong>Materials and methods: </strong>Adults undergoing complex ASD surgery were included. Estimated blood loss (EBL) was extracted for investigation, and estimated blood volume loss (EBVL) was calculated by dividing EBL by the preoperative blood volume utilizing Nadler's formula. \"Least Absolute Shrinkage and Selection Operator\" regression was performed to identify 5 variables from demographic and perioperative parameters. Logistic regression was subsequently performed to generate a receiver operating characteristic curve and estimate an optimal threshold for EBL and EBVL. Finally, the proportion of patients with AE was plotted against EBL and EBVL to confirm the identified thresholds.</p><p><strong>Results: </strong>In total, 552 patients were included with a mean age of 60.7 ± 15.1 years, 68% females, mean Charlson Comorbidity Index was 1.0 ± 1.6, and 22% experienced AEs. Least Absolute Shrinkage and Selection Operator regression identified the American Society of Anesthesiologists score, baseline hypertension, preoperative albumin, and use of intraoperative crystalloids as the top predictors of an AE, in addition to EBL/EBVL. Logistic regression resulted in the receiver operating characteristic curve, which was used to identify a cutoff of 2.3 L of EBL and 42% for EBVL. Patients exceeding these thresholds had AE rates of 36% (odds ratio: 2.1, 95% CI: 1.2-3.6) and 31% (odds ratio: 1.7, 95% CI: 1.1-2.8), compared with 21% for those below the thresholds of EBL and EBVL, respectively.</p><p><strong>Conclusion: </strong>In complex ASD surgery, intraoperative EBL of 2.3 L and an EBVL of 42% are associated with clinically significant AEs. These thresholds may be useful in guiding preoperative-patient-counseling, health care system quality initiatives, and clinical perioperative blood loss management strategies in patients undergoing complex spine surgery. In addition, a similar methodology could be performed in other specialties to establish procedure-specific clinically relevant blood loss thresholds.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"645-651"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898299","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":"Ideal Lumbar Lordosis Correction in Patients With Adult Spinal Deformity Without Adversely Impacting Pelvic Tilt and Pelvic Incidence Minus Lumbar Lordosis: A Study of 426 Cases.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee","doi":"10.1097/BRS.0000000000005077","DOIUrl":"10.1097/BRS.0000000000005077","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objectives: </strong>To determine the ideal pelvic incidence (PI)-lumbar lordosis (LL) range to prevent pelvic tilt (PT) undercorrection while avoiding PI-LL overcorrection following adult spinal deformity (ASD) surgery.</p><p><strong>Summary of background: </strong>PI-LL and PT are the important sagittal parameters to be restored to an adequate range by surgery. Ideal PI-LL target without causing PI-LL overcorrection and PT undercorrection has not been documented.</p><p><strong>Methods: </strong>We included patients with ASD undergoing ≥5-level fusion, including the sacrum. Receiver operating characteristic (ROC) curve analysis was performed to calculate the lower limit of the ideal PI-LL without causing PI-LL overcorrection and the upper limit of the ideal PI-LL without causing PT undercorrection. The calculated ideal PI-LL was validated in terms of proximal junctional kyphosis and failure (PJK and PJF) rates and clinical outcomes. Analyses were performed according to age subgroups (below 70 and 70 yr or above).</p><p><strong>Results: </strong>In total, 426 patients were included in the study. Female patients were predominant (85.4%), with a mean age of 69.8 years. The lower limits of PI-LL were calculated as 4.9° for all patients, 2.3° for patients aged below 70 years, and 7.9° for patients aged 70 years or above. Meanwhile, the upper limits of PI-LL were calculated as 12.7° for all patients, 12.5° for patients aged below 70 years, and 13.3° for patients aged 70 years or above. There were no significant differences in the PJK and PJF rates among the new three PI-LL groups. Clinical outcomes were significantly better in patients with the ideal PI-LL group than those in patients with overcorrection or undercorrection groups for all age groups.</p><p><strong>Conclusions: </strong>The ideal PI-LL correction target without adversely impacting PT and PI-LL was calculated at 2.3° to 12.5° for patients aged below 70 years and 7.9° to 13.3° for patients aged 70 years or above. These guideline parameters may help ensure optimal clinical outcomes without increasing the risk of PJK/F.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"694-701"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447168","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":"Single-Position Prone Lateral Interbody Fusion Is Associated With Improved Radiographic and Clinical Outcomes at One Year Compared With Single-Position Lateral Interbody Fusion: A Single Institution Experience.","authors":"Anthony Yung, Oluwatobi O Onafowokan, Max R Fisher, Ethan J Cottrill, Isabel P Prado, Iryna Ivasyk, Caroline M Wu, Alexander W Parsons, Tyler K Williamson, Andrew Eck, Jamshaid Mir, Ankita Das, Mateo Gilsilvetti, Peter S Tretiakov, Christopher I Shaffrey, Peter G Passias","doi":"10.1097/BRS.0000000000005320","DOIUrl":"10.1097/BRS.0000000000005320","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E198-E199"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630812","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}