Spine最新文献

{"title":"Symptom-specific Analysis of Surgical Outcomes and Predictors of Residual Symptoms in Patients with Mild Degenerative Cervical Myelopathy: An Analysis of Cases with Severe Cord Compression or Progressive Symptoms.","authors":"Masahiro Ozaki, Narihito Nagoshi, Junichi Yamane, Takahito Iga, Toshiki Okubo, Kazuki Takeda, Satoshi Suzuki, Akimasa Yasuda, Yohei Takahashi, Hitoshi Kono, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.1097/BRS.0000000000005423","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005423","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective multicenter study.</p><p><strong>Objectives: </strong>To analyze symptom-specific surgical outcomes in patients with mild degenerative cervical myelopathy (DCM) and identify predictors of postoperative residual symptoms.</p><p><strong>Summary of background data: </strong>DCM is the most common cause of spinal cord impairment in adults. While surgical intervention is recommended for moderate to severe DCM, optimal treatment strategies for mild DCM remain unclear. Previous studies have focused on total Japanese Orthopaedic Association (JOA)/modified JOA (mJOA) score without detailed symptom-specific analyses.</p><p><strong>Methods: </strong>We reviewed 679 consecutive patients who underwent surgical decompression with or without fusion for DCM across three institutions in Japan. Among them, 104 patients with mild DCM (JOA score 14.5-16.5) were included. We assessed demographic data, radiographic factors, magnetic resonance imaging parameters, and clinical scores. Symptom-specific analyses were conducted using preoperative and 2-year postoperative JOA scores, and the predictors of persistent symptoms were analyzed using multivariable logistic regression.</p><p><strong>Results: </strong>The mean maximum canal compromise was 49.7%, and maximum spinal cord compression was 37.2%. The most common factors leading to surgery was symptom deterioration (94.2%). In symptom-specific analysis, 60.9% of patients exhibited persistent upper extremity sensory impairment, significantly higher than other domains. Multivariable analysis identified angular-edged deformity of the spinal cord on axial MRI as an independent predictor of persistent upper extremity sensory impairment (Odds Ratio: 4.264, 95% confidence interval: 1.312-13.854, P=0.016).</p><p><strong>Conclusion: </strong>The majority of mild DCM patients who underwent surgery had severe spinal cord compression, with symptom progression serving as the trigger for surgical intervention. While surgical intervention improves overall function, upper extremity sensory impairments frequently persisted postoperatively, even in mild cases. Angular-edged deformity was a significant predictor for postoperative upper extremity sensory deficits, emphasizing the need for careful preoperative evaluation of spinal cord morphology to better inform prognosis and guide treatment decisions in patients with mild DCM.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258997","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 the Letter Regarding \"The Role of the Lumbar Paravertebral Muscles in the Development of Short-term Residual Pain after Lumbar Fusion Surgery\".","authors":"Hao Liu","doi":"10.1097/BRS.0000000000005421","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005421","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258993","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 Closing Triradiate Cartilage Sign in Pelvic Radiographs is an Important Marker in Maturity Assessment in Patients with Idiopathic Scoliosis: A Study on Agreement between the Sanders Maturity Scale and Pelvic Maturity Indicators.","authors":"Vojtech Capek, Helena Brisby, Olof Westin","doi":"10.1097/BRS.0000000000005419","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005419","url":null,"abstract":"<p><strong>Study design: </strong>Agreement analysis of retrospectively collected data.</p><p><strong>Objective: </strong>To perform an agreement analysis between Sanders maturity scale and pelvic maturity indicators in patients with idiopathic scoliosis.</p><p><strong>Summary of background data: </strong>A reliable maturity assessment is mandatory for Adolescent Idiopathic Scoliosis treatment. The two most common skeletal maturity surrogates are the Sanders maturity scale (SMS) and Risser staging (RS). The relationship between these has been scarcely investigated.</p><p><strong>Methods: </strong>From a previous brace study, 130 consecutive patients with both pelvic and hand radiographs with a maximum 3-month interval between examinations were selected. The pelvic maturity indicators (PMI) scale combining the Risser sign and triradiate cartilage stage was developed. The PMI consist of 6 stages (2-7) that were tested against corresponding SMS stages. An agreement analysis between the PMI based on pelvic radiograph and SMS of the hand image was conducted. The Spearman's rank correlation and Cohen's kappa with Gwet's AC1 coefficient were the measures of correlation and agreement, respectively.</p><p><strong>Results: </strong>The PMI and SMS showed a strong correlation (Spearman's rho= 0.79; 95% CI [0.72, 0.85]) as well as substantial agreement (Gwet's AC1 = 0.76; 95% CI [0.70, 0.82]). The highest accuracy in matching PMI to SMS was observed for PMI 2, 3 and 7, with 83.3%, 80.0% and 88.9% correctly matched SMS stage to corresponding PMI stage. The regression model accurately predicted five of six SMS stages from pelvic radiographs.</p><p><strong>Conclusions: </strong>The triradiate cartilage staging facilitated the maturity assessment of the pelvic radiographs and showed a strong correlation to and substantial agreement with the SMS. The most important stages for AIS development, SMS 2, 3 and 7, showed the best matching accuracy to PMI. The pelvic image of PMI 3 with closing triradiate cartilage corresponds to SMS stage 3.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258998","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":"Staging Lumbar Spondylolysis in Adolescents: Can MR Bone Imaging Replace CT?","authors":"Kohei Okuyama, Yasuchika Aoki, Satoshi Maki, Yukio Matsushita, Takeshi Toyooka, Sumihisa Orita, Kazuhide Inage, Shiro Sugiura, Masahiro Inoue, Takayuki Sakai, Yasuhiro Shiga, Takashi Hozumi, Seiji Ohtori, Satoru Nishikawa","doi":"10.1097/BRS.0000000000005416","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005416","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, single-center, observational study.</p><p><strong>Objective: </strong>To evaluate the diagnostic reliability of magnetic resonance (MR) Bone Imaging in stage classification of adolescent lumbar spondylolysis, assessing its clinical applicability as an alternative to computed tomography (CT).</p><p><strong>Summary of background data: </strong>The diagnosis of adolescent lumbar spondylolysis typically requires CT; however, concerns regarding medical radiation exposure have been raised. With recent advancements in magnetic resonance imaging (MRI) technology, MR bone imaging has been developed, enabling the acquisition of CT-like images.</p><p><strong>Methods: </strong>This study included 116 adolescent patients diagnosed with lumbar spondylolysis between August 2022 and April 2024. In addition to conventional MRI, MR Bone Imaging and CT scans were performed on the affected vertebrae. Two independent raters assessed sagittal images and classified the fractures using the Oba classification system. MRI examinations were performed using either a 1.5T or 3T scanners. For statistical analysis, CT classification was used as the reference standard. Inter-rater and inter-modality agreements for both CT and MR Bone Imaging were evaluated using the weighted kappa coefficient (linear weights).</p><p><strong>Results: </strong>Among the 116 patients, 70 cases (140 pars) underwent 3T MRI, while 46 cases (92 pars) underwent 1.5T MRI. In the 3T MRI group, the inter-rater agreement was κ=0.98 for CT and κ=0.91 for MR Bone Imaging, while inter-modality agreement was κ=0.89 for Rater A and κ=0.83 for Rater B. In the 1.5T MRI group, inter-rater agreement was κ=0.94 for CT and κ=0.92 for MR Bone Imaging, while inter-modality agreement was κ=0.83 for Rater A and κ=0.84 for Rater B.</p><p><strong>Conclusion: </strong>These results indicate that MR Bone Imaging provides stage classification accuracy comparable to that of CT in the evaluation of adolescent lumbar spondylolysis. Furthermore, similar findings were observed for both 1.5T and 3T MRI.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209583","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":"Does Advanced Age Negatively Impact Treatment Outcomes of Cervical Ossification of the Posterior Longitudinal Ligament? A Prospective Multicenter Study.","authors":"Narihito Nagoshi, Satoru Egawa, Kenichiro Sakai, Kazuo Kusano, Shunji Tsutsui, Takashi Hirai, Yu Matsukura, Kanichiro Wada, Keiichi Katsumi, Masao Koda, Atsushi Kimura, Takeo Furuya, Satoshi Maki, Norihiro Nishida, Yukitaka Nagamoto, Yasushi Oshima, Kei Ando, Hiroaki Nakashima, Tsutomu Endo, Kanji Mori, Hideaki Nakajima, Kazuma Murata, Masayuki Miyagi, Takashi Kaito, Kei Yamada, Tomohiro Banno, Satoshi Kato, Tetsuro Ohba, Masahiko Takahata, Hiroshi Moridaira, Shunsuke Fujibayashi, Hiroyuki Katoh, Haruo Kanno, Kota Watanabe, Hiroshi Taneichi, Shiro Imagama, Yoshiharu Kawaguchi, Katsushi Takeshita, Masaya Nakamura, Morio Matsumoto, Masashi Yamazaki, Toshitaka Yoshii","doi":"10.1097/BRS.0000000000005415","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005415","url":null,"abstract":"<p><strong>Study design: </strong>A multicenter prospective cohort study.</p><p><strong>Objective: </strong>To comprehensively evaluate the surgical impact, including patient-reported outcomes (PROs), in elderly patients with cervical ossification of the posterior longitudinal ligament (OPLL).</p><p><strong>Summary of background data: </strong>With the rise of aging populations worldwide, understanding the impact of age on treatment outcomes for cervical OPLL has become increasingly important. Previous studies on degenerative cervical myelopathy have highlighted inconsistent outcomes for elderly patients, with limited focus on OPLL and PROs.</p><p><strong>Methods: </strong>This prospective, multi-institutional study included 402 cervical OPLL patients from 2014 to 2017, categorized into elderly (≥75 y, n=79) and non-elderly (<75 y, n=323) groups. Clinical outcomes were assessed preoperatively and two years postoperatively using cervical Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) scores, and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). Multivariable regression analyses were conducted, adjusting for potential confounders, including demographic variables and imaging characteristics.</p><p><strong>Results: </strong>Elderly patients had worse preoperative JOA scores (9.6 vs. 11.1, P<0.01) and lower postoperative scores at two years (12.3 vs. 14.0, P<0.01). However, the improvement in JOA scores was comparable (2.7 vs. 3.0, P=0.48), with both exceeding the minimum clinically important difference (MCID). Complication rates and VAS score improvements were also comparable. JOACMEQ outcomes demonstrated significantly poorer upper extremity function in the elderly group following surgery (P=0.02), whereas no significant differences were observed between the two groups in other functional domains.</p><p><strong>Conclusion: </strong>Despite worse baseline neurological function, elderly OPLL patients achieved similar degrees of postoperative neurological improvement as non-elderly patients. However, upper extremity function is unlikely to show significant improvement following surgery in elderly patients.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209581","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 Classification of Cervical Spinal Stenosis using Deep Learning on CT Scans.","authors":"Yu-Long Zhang, Jia-Wei Huang, Kai-Yu Li, Hua-Lin Li, Xin-Xiao Lin, Hao-Bo Ye, Yu-Han Chen, Nai-Feng Tian","doi":"10.1097/BRS.0000000000005414","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005414","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To develop and validate a computed tomography-based deep learning(DL) model for diagnosing cervical spinal stenosis(CSS).</p><p><strong>Summary of background data: </strong>Although magnetic resonance imaging (MRI) is widely used for diagnosing CSS, its inherent limitations, including prolonged scanning time, limited availability in resource-constrained settings, and contraindications for patients with metallic implants, make computed tomography (CT) a critical alternative in specific clinical scenarios. The development of CT-based DL models for CSS detection holds promise in transcending the diagnostic efficacy limitations of conventional CT imaging, thereby serving as an intelligent auxiliary tool to optimize healthcare resource allocation.</p><p><strong>Methods: </strong>Paired CT/MRI images were collected. CT images were divided into training, validation, and test sets in an 8:1:1 ratio. The two-stage model architecture employed: (1) a Faster R-CNN-based detection model for localization, annotation, and extraction of regions of interest (ROI); (2) comparison of 16 convolutional neural network (CNN) models for stenosis classification to select the best-performing model. The evaluation metrics included accuracy, F1-score, and Cohen's κ coefficient, with comparisons made against diagnostic results from physicians with varying years of experience.</p><p><strong>Results: </strong>In the multiclass classification task, four high-performing models (DL1-b0, DL2-121, DL3-101, and DL4-26d) achieved accuracies of 88.74%, 89.40%, 89.40%, and 88.08%, respectively. All models demonstrated >80% consistency with senior physicians and >70% consistency with junior physicians.In the binary classification task, the models achieved accuracies of 94.70%, 96.03%, 96.03%, and 94.70%, respectively. All four models demonstrated consistency rates slightly below 90% with junior physicians. However, when compared with senior physicians, three models (excluding DL4-26d) exhibited consistency rates exceeding 90%.</p><p><strong>Conclusions: </strong>The DL model developed in this study demonstrated high accuracy in CT image analysis of CSS, with a diagnostic performance comparable to that of senior physicians.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209580","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":"Letter to the Editor \"Chronic Gabapentinoid Use and Lumbar Fusion Outcomes A Comparative Analysis of Gabapentinoids Alone and in Combination With Opioids\" by Cetik, et al.","authors":"Guoyu Dai, Mingfeng Xue","doi":"10.1097/BRS.0000000000005417","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005417","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209582","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 Relationship of CT Hounsfield Units at UIV+1 and UIV+2 Relative to UIV Predicts Proximal Junctional Kyphosis in Patients with Long Spinal Constructs.","authors":"Josephine R Coury, Justin L Reyes, Fthimnir M Hassan, Natalia Czerwonka, Gabriela Greisberg, Luke Whitmer, Oluwademilade O Tega, Joseph M Lombardi, Ronald A Lehman, Lawrence G Lenke, Zeeshan M Sardar","doi":"10.1097/BRS.0000000000005413","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005413","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Review.</p><p><strong>Objective: </strong>To determine CT Hounsfield units (CTHU) thresholds at the upper instrumented vertebra (UIV), UIV+1, and UIV+2 that preclude adult spinal deformity (ASD) patients to develop proximal junctional kyphosis (PJK).</p><p><strong>Summary of background data: </strong>Low CTHU at the UIV and UIV+1 have been shown to increase risk of PJK, pseudarthrosis, and pedicle screw loosening. In contrast, higher CTHU values have been associated with greater fusion potential. For this study, we studied the relationship of CTHU at the UIV, UIV+1, UIV+2 in ASD patients with long fusion constructs and sacropelvic fixation.</p><p><strong>Materials and methods: </strong>191 ASD patients with a UIV at L2 or cephalad and pelvic fixation were identified with minimum 2-year follow up. Patients with UIV distal to L2, prior anterior fusion at UIV, or UIV at C2 were excluded. CTHU were measured at the UIV, UIV+1, and UIV+2 of each patient. Statistical analysis was performed with significance set to P<0.05.</p><p><strong>Results: </strong>40 patients (20.9%) developed radiographic PJK, of which 19 went on to have revision surgery. PJK was more common at lower thoracic or thoracolumbar UIVs, as compared to upper thoracic and cervical (P=0.0048). After multivariable logistic regression, CTHU below 160 at the UIV+1 and UIV+2 was found to be a significant predictor of PJK (OR=8.10, P=0.0002 and OR=4.60, P=0.106, respectively). Cox proportional hazards regression analysis also identified CTHU at UIV+1 and UIV+2 as significant predictors of PJK (HR=6.52, P=0.0002 and HR=3.59, P=0.0131, respectively). Kaplan-Meier survival analysis demonstrates that patients with CTHU ≥160 at UIV+1 and UIV+2 demonstrated significantly greater PJK free survival. Lastly, a sub-analysis found that patients with CTHU at UIV+1 ≥UIV, were significantly less likely to develop PJK (P=0.0035). If patients with CTHU at the UIV <160, if the CTHU at UIV+1 increased, these patients were less likely to develop PJK.</p><p><strong>Conclusions: </strong>CTHU under 160 was a risk factor for developing PJK in ASD patients undergoing deformity correction with long fusion constructs. CTHU at UIV+1 ≥UIV were significantly less likely to develop PJK, even among those with CTHU <160 at the UIV. These findings highlight the critical role of regional bone health in mitigating PJK risk.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209584","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":"Basilar Invagination Diagnosis, Classification, and Radiology: WFNS Spine Committee Recommendations.","authors":"Onur Yaman, Mehmet Zileli, İdris Avci, Zan Chen, June Ho Lee, Geraldo Sá-Carneiro, Francesco Costa, Said Ait Ben Ali, Fernando Dantas, Joachim Oertel, Massimiliano Visocchi, Jutty Parthiban, Atul Goel, Ricardo Botelho, Oscar L Alves","doi":"10.1097/BRS.0000000000005308","DOIUrl":"10.1097/BRS.0000000000005308","url":null,"abstract":"<p><strong>Study design: </strong>A systematic literature review and consensus using Delphi method.</p><p><strong>Objective: </strong>This review aimed to analyze recent literature on diagnosis, classification, and radiologic characteristics of Basilar Invagination (BI) to generate recommendations on these topics.</p><p><strong>Summary of background: </strong>Basilar invagination diagnosis, classifications, and radiologic characteristics evolved during the last decade; however, many debatable criteria disturb a common language fundamental to compare clinical research.</p><p><strong>Material and methods: </strong>The WFNS Spine Committee organized two separate consensus meetings to discuss and create statements that were voted on to reach a consensus.</p><p><strong>Results: </strong>Basilar invagination mainly results from a CVJ developmental abnormality and is often associated with congenital anomalies. There is also an acquired type that occurs by bone softening, such as rheumatoid arthritis. It can be classified as type I (atlantoaxial dislocation) and type II (without atlantoaxial dislocation) basilar invagination. Clinical signs may either be due to brainstem compression or cervical spinal cord compression and instability. Although many radiologic measurements are proposed, the most reliable ones are the McRae line, Chamberlain line, and Boogard angle.</p><p><strong>Conclusions: </strong>Diagnosis of basilar invagination should be made by midsagittal craniocervical x-rays, CTs or MRI. There are two types of basilar invagination: type I basilar invagination is associated with instability, and treatment can focus on stabilization. However, type II basilar invagination may need decompressive surgeries.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 11","pages":"E200-E207"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982190","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":"A Biomechanical Analysis of Instrumentation Constructs During Vertebral Column Resection: Stability When You Need It!","authors":"K Aaron Shaw, Brad Niese, Daniel J Sucato","doi":"10.1097/BRS.0000000000005198","DOIUrl":"10.1097/BRS.0000000000005198","url":null,"abstract":"<p><strong>Study design: </strong>Biomechanical testing.</p><p><strong>Objective: </strong>Investigate the optimal construct for stabilization of the spine during vertebral column resection (VCR).</p><p><strong>Background: </strong>VCR is a powerful technique for achieving correction in severe cases of spinal deformity. However, this also creates an unstable spine, which requires stable fixation to prevent iatrogenic neurological injury. It is common practice to place a temporary unilateral rod configuration to achieve this stability during surgery but no study to date has investigated the optimal construct configuration.</p><p><strong>Materials and methods: </strong>A unilateral VCR model representing an acute 50° kyphotic deformity with a standardized 30 mm resection was created. Three conditions underwent testing: (1) Rod material and diameter, (2) Rod configuration, and (3) Number of fixation points. Six unique samples were tested in each group in both flexion and extension. Before testing, a 10N preload and underwent cyclical testing in flexion/extension. System stiffness was calculated and compared across groups.</p><p><strong>Results: </strong>Assessment of rod size and composition using a single screw construct (2 total screws) demonstrated that for titanium rods, increasing rod size significantly increased the construct stiffness ( P = 0.001). Although cobalt-chromium (Co-Cr) rods were significantly stiffer than the corresponding sized titanium rods, there was no significant difference between rod diameters for Co-Cr ( P = 0.98). However, when tested using a dual screw (4 total screws) construct, these constructs were significantly stiffer than the corresponding single screw constructs ( P < 0.0001). Of the various rod configurations, the dual rod demonstrated the greatest stiffness (34.8 ± 2.1 N/mm; P < 0.0001).</p><p><strong>Conclusion: </strong>Surgical construct stiffness during a VCR is multifactorial. Larger rod diameter, increased number of fixation points, stiffer rod material, and increased number of rods across the resection site increase the construct stiffness. With minimal points of fixation using Co-Cr rods, increasing rod diameter does not impart greater construct stiffness unless additional fixation points are included.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E219-E222"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547600","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}