Spine最新文献

{"title":"Mental Health Recovery Trajectories After Surgery for Degenerative Cervical Myelopathy: A Canadian Spine Outcomes Research Network Study.","authors":"Vishwathsen Karthikeyan, Nathan Evaniew, Armaan K Malhotra, Christopher S Lozano, Andrew Glennie, Christopher S Bailey, David Cadotte, Zhi Wang, Supriya Singh, Philippe Phan, Jérôme Paquet, Chris Small, Andrew Nataraj, Charles G Fisher, Michael H Weber, Raja Rampersaud, Jefferson R Wilson, Nicolas Dea","doi":"10.1097/BRS.0000000000005893","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005893","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of a multicenter, prospective observational cohort.</p><p><strong>Objective: </strong>To identify distinct postoperative trajectories of mental health following surgery for degenerative cervical myelopathy (DCM) and to assess the independent association between trajectory membership and 12-month patient satisfaction.</p><p><strong>Summary of background data: </strong>Although surgery improves neurological and functional outcomes for patients with DCM, its impact on mental health remains poorly characterized. Patients with DCM frequently report poor mental well-being, which may influence quality of life and satisfaction with treatment.</p><p><strong>Methods: </strong>We analyzed data from the ongoing Canadian Spine Outcomes Research Network (CSORN) multicenter prospective observational DCM study. Group-based trajectory modeling (GBTM) was used to identify latent MCS recovery trajectories. Logistic regression evaluated associations between trajectory group membership and 12-month satisfaction, adjusting for demographic and clinical variables.</p><p><strong>Results: </strong>Among the 729 patients included, four distinct trajectories of mental health HRQoL recovery were identified based on longitudinal MCS scores: Low-stable (persistently low MCS [12%]), Moderate-stable (intermediate and unchanged MCS [36%]), Good-stable (high and stable MCS [38%]), and Improved (low baseline MCS with postoperative improvement [14%]). Pairwise comparisons showed that the Improved group achieved significantly greater gains in disability (NDI, P<0.001), neck pain (NRS neck, P=0.002), mental health HRQoL (MCS, P<0.001), and physical health (PCS, P=0.001) compared with the Low-stable group, while changes in neurologic function and arm pain did not differ. Trajectory group membership was associated with satisfaction: compared with Low-stable, Good-stable (OR 7.39, 95% CI 3.09-17.70) and Improved (OR 4.18, 95% CI 1.77-9.87) groups were significantly more likely to report being satisfied at 12 months.</p><p><strong>Conclusion: </strong>Mental health HRQoL recovery following DCM surgery is heterogeneous, with only a minority of patients achieving substantial postoperative improvement. Whether routine assessment of mental-health HRQoL or targeted perioperative support alters outcomes is an area of research that warrants prospective study.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Relationship Between Hospital Price Markup and Outcomes After Anterior Cervical Discectomy and Fusion.","authors":"Jacob W McDevitt, Andre C Ferreria, Theodore A Joaquin, Anoop Sunkara, Cade F Bennett, Austin R Chen, Tyler M Compton, Mark A Plantz, Wellington K Hsu, Matthew Colman, Alpesh A Patel, Srikanth N Divi","doi":"10.1097/BRS.0000000000005890","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005890","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the association between hospital price markup and perioperative and long-term outcomes following elective anterior cervical discectomy and fusion (ACDF).</p><p><strong>Summary of background data: </strong>Hospital price markup, defined as the ratio of billed charges to actual costs, varies widely across U.S. institutions and is largely unregulated. While prior studies in general surgery have linked high-markup hospitals to poorer outcomes, this relationship has not been characterized in cervical spine surgery.</p><p><strong>Methods: </strong>Adult patients undergoing elective ACDF from 2016 to 2022 were identified from the PINC AI Healthcare Database. Hospital-level charge-to-cost ratios were calculated using ACDF encounters, and hospitals in the highest regional markup decile were designated as high-markup hospitals (HMH). Outcomes included perioperative complications, 30-day readmission, long-term complications, and reoperation. Multivariable regression models adjusted for patient-, procedural-, and hospital-level covariates.</p><p><strong>Results: </strong>A total of 241,965 patients were included; 22,495 (9.3%) were treated at HMH. Mean markup was significantly higher at HMH versus non-HMH (7.81x vs. 4.10x, P<0.001). After multivariable adjustment, HMH were associated with higher 30-day readmission (2.94% vs. 2.63%, P=0.007), perioperative complications (2.61% vs. 2.36%, P=0.020), long-term complications (6.99% vs. 6.58%, P=0.021), and reoperation (4.07% vs. 3.75%, P=0.020).</p><p><strong>Conclusion: </strong>Among patients undergoing elective ACDF, treatment at high-markup hospitals was independently associated with worse postoperative outcomes despite greater expenditure. These findings challenge the assumption that higher-cost care confers higher quality and have important implications for spine surgery healthcare policy.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Lenke Classification Stratifies Brace Initiation Risk and Longitudinal Cobb Angles Trajectories in Female Patients With Adolescent Idiopathic Scoliosis.","authors":"Shuhei Ohyama, Toshiaki Kotani, Yosuke Ogata, Tsuyoshi Sakuma, Yasushi Iijima, Sumihisa Orita, Yawara Eguchi, Kazuhide Inage, Yasuhiro Shiga, Masahiro Inoue, Noritaka Suzuki, Kosuke Takeda, Akihiro Iida, Yu Otake, Fumiya Shimizu, Shun Yuki, Shohei Minami, Seiji Ohtori","doi":"10.1097/BRS.0000000000005892","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005892","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective single-center cohort study.</p><p><strong>Objective: </strong>To determine whether baseline modified Lenke classification (MLC), assessed from standing whole-spine radiographs, stratifies brace initiation risk and longitudinal Cobb-angle trajectories in female patients with adolescent idiopathic scoliosis (AIS) before reaching the conventional bracing threshold.</p><p><strong>Summary of background data: </strong>AIS progression is heterogeneous. Baseline Cobb angle and skeletal maturity are established risk factors, but whether simple baseline curve-pattern classification adds risk-stratification information during nonoperative follow-up remains unclear.</p><p><strong>Methods: </strong>We included female AIS patients aged 10 to <18 years with a baseline maximum Cobb angle ≥10° and <25°. Patients with prior brace treatment, brace initiation at the first visit, insufficient pre-brace follow-up, or missing baseline variables were excluded. The primary outcome was brace initiation. Brace-free survival was assessed using Kaplan-Meier analysis and multivariable Cox models adjusted for baseline maximum Cobb angle, age, body mass index, menarche status, and Risser status. Model fit was compared between a conventional baseline model and a model additionally including MLC. Two-year risks were estimated at fixed baseline Cobb angles. Longitudinal trajectories were analyzed using a linear mixed-effects model with natural cubic splines, an age-by-MLC interaction, and patient-specific random intercepts and slopes for age.</p><p><strong>Results: </strong>A total of 1087 patients were included; 210 (19.3%) underwent brace initiation. Brace-free survival differed across MLC groups. In multivariable Cox analysis, MLC 2, 3, 4, and 6 showed higher hazards of brace initiation than MLC 1, with the highest risk in MLC 4. Adding MLC improved likelihood-based model fit (χ²=19.35, df=5, P=0.002) and reduced AICc, although BIC increased. At baseline Cobb 20°, adjusted 2-year risk ranged from 23.3% in MLC 1 to 55.9% in MLC 4. Longitudinal Cobb-angle trajectories differed according to MLC.</p><p><strong>Conclusion: </strong>Baseline MLC may provide complementary information for stratifying brace-initiation risk and longitudinal Cobb-angle trajectories before the conventional bracing threshold.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mode-Specific Association Between Tri-Cortical Pedicle Screws and Proximal Junctional Kyphosis in Adult Spinal Deformity: A Propensity Score-Matched Cohort Study.","authors":"Xinjie Wu, Gongheng Xie, Ziyang Tang, Xiaodong Qin, Hongda Bao, Benlong Shi, Saihu Mao, Yong Qiu, Zezhang Zhu, Zhen Liu","doi":"10.1097/BRS.0000000000005889","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005889","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective propensity score-matched cohort study.</p><p><strong>Objective: </strong>To evaluate the association between tri-cortical pedicle screw (TPS) fixation and radiographic proximal junctional kyphosis (PJK) after adult spinal deformity (ASD) surgery and to explore mode-specific associations.</p><p><strong>Summary of background data: </strong>PJK is common after long-segment fusion for ASD. Binary PJK endpoints may overlook heterogeneous PJK modes. The mode-specific association of TPS fixation remains uncertain.</p><p><strong>Methods: </strong>Adults undergoing long-segment posterior fusion with a lower thoracic upper instrumented vertebra (T9-T12) and at least 2 years of follow-up were retrospectively identified. Patients were categorized according to TPS use at the upper instrumented vertebra. Propensity score matching was performed to address baseline differences. The primary outcome was radiographic PJK, defined as a ≥10-degree increase in proximal junctional angle from the immediate postoperative radiograph. PJK modes were classified using a published system. Overall and mode-specific associations were evaluated using LASSO-selected and adjusted logistic regression, bias-reduced multinomial regression, and E-value sensitivity analysis.</p><p><strong>Results: </strong>Of 304 eligible patients, 189 received conventional pedicle screw fixation and 115 received TPS fixation. Propensity score matching generated 110 pairs. In the matched cohort, radiographic PJK occurred in 8.2% of the TPS group and 27.3% of the Control group (P<0.001). TPS fixation was associated with lower PJK odds in the LASSO-selected model (OR, 0.36, 95% CI, 0.14-0.87, P=0.028). Type 2 PJK occurred in 10 Control patients and in no TPS patients. Type 1 and combined Type 3-4 PJK showed no significant association with TPS. The E-value for the point estimate was 5.00.</p><p><strong>Conclusions: </strong>TPS fixation was associated with a lower incidence of radiographic PJK after ASD surgery. Mode-specific analysis suggested fewer Type 2 PJK events with TPS fixation, supporting mode-specific radiographic assessment and further evaluation of TPS as a proximal fixation strategy.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbidity-Specific Risk of Revision Following Single-Level Degenerative Spinal Fusion (2010-2023): US Cohort Study Among Over 399K Patients.","authors":"Arman Kishan, Harmon S Khela, Alex Hernandez Manriquez, Gregory S Kazarian, Mihir S Dekhne, Dhiraj J Pangal, Andrew J Schoenfeld, William C Eward, Sami H Tuffaha, Alan H Daniels, Raffi S Avedian, Han Jo Kim, Peter G Passias, Sravisht Iyer, Anand Veeravagu","doi":"10.1097/BRS.0000000000005888","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005888","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To evaluate the associations of 28 preoperative comorbidities with all-cause and etiology-specific revisions (pseudarthrosis, mechanical failure, adjacent segment disease [ASD], infection) following single-level degenerative spinal fusion.</p><p><strong>Summary of background data: </strong>Revision following spinal fusion for degenerative spinal disease remains frequent and costly. While technical factors are well studied, the extent to which preoperative comorbidities differentially predispose to specific revision etiologies is unclear.</p><p><strong>Materials and methods: </strong>Using the PearlDiver Mariner170 claims database (2010-2023), we identified adults undergoing single-level degenerative spinal fusion and followed them for 2 years for reoperation. All-cause and etiology-specific revisions were defined by CPT/ICD codes. Preoperative comorbidities were analyzed using multivariable cox proportional hazards models adjusted for age, sex, and all comorbidities. Bonferroni correction set significance at P≤0.00036.</p><p><strong>Results: </strong>Among 399,186 patients (mean age 59.7±13.0; 56.7% female; mean CCI 1.4±1.2), anaemia (HR 1.33), osteoporosis (HR 1.31), substance-related disorders (HR 1.25), and depression (HR 1.19) conferred the greatest risk of all-cause revision. Type 2 diabetes (HR 1.07) and essential hypertension (HR 1.14) had smaller but significant effects. Etiology-specific analyses showed that osteoporosis, anaemia, depression, and substance-related disorders were consistently associated with increased risk across pseudarthrosis, mechanical failure, and ASD. Mechanical failure was additionally associated with hypertension (HR 1.20) and diabetes (HR 1.28), which were not significant in the other revision subtypes. In contrast, ASD revisions were uniquely associated with osteoarthritis (HR 1.26). No comorbidity was significantly associated with infection-related revision. All hazard ratios were significant at P<0.001 unless otherwise specified.</p><p><strong>Conclusion: </strong>In this national cohort of patients, osteoporosis, anaemia, depression, and substance-related disorders emerged as significant predictors of non-infectious revision within two years. Hypertension and type 2 diabetes conferred more modest risks for mechanical failure. These findings support the integration of comorbidity-informed risk stratification into preoperative planning and highlight the potential optimization to minimize revisions and enhance clinical outcomes.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Regarding \"Explainable Machine Learning for Perioperative Risk Stratification of Radiographic Adjacent Segment Degeneration After Short-Segment Lumbar Fusion\".","authors":"Chunyu Zhang, Yulei Xie, Jun He","doi":"10.1097/BRS.0000000000005882","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005882","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075812","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":"Effect Modifiers of the Association Between Physical Activities and Subsequent Low Back Pain Flares.","authors":"Jason S Silver, Andrew Timmons, Jihong Min, Hannah F Brubeck, Adrienne D Tanus, Anna Korpak, Albert Chang, Srecharan Gorukanti, Bianca I Dowling, Clinton J Daniels, Mark P Jensen, Pradeep Suri","doi":"10.1097/BRS.0000000000005886","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005886","url":null,"abstract":"<p><strong>Study design: </strong>Prospective case-crossover study.</p><p><strong>Objective: </strong>This study evaluated whether concurrent actions, work-relatedness, and analgesic use modify the associations between physical activities and subsequent LBP flares.</p><p><strong>Summary of background data: </strong>Prior longitudinal case-crossover studies found transient risks of various activities on LBP flares. These studies have focused on the main effects of exposures for LBP. However, little is known about contextual factors that could modify activity-flare relationships.</p><p><strong>Methods: </strong>This was a secondary analysis of a 1-year prospective case-crossover study evaluating transient risks of 10 common physical activities on LBP flares. Participants completed scheduled surveys and self-initiated flare surveys inquiring about potential modifiers and activity exposures. Multivariate-adjusted conditional logistic regression analyses evaluated various concurrent actions, work-relatedness, and analgesic use as potential modifiers of the association between each activity and subsequent flares.</p><p><strong>Results: </strong>Of 416 participants, the mean age was 47.6 years and 77% had LBP duration >5 years. Many concurrent actions (15 of 21 candidate effect modifiers) were significantly associated with greater activity-flare associations, including but not limited to twisting (odds ratio [OR]=1.48, [95% confidence interval [CI] 1.23-1.78]), bending (OR=1.32 [95% CI 1.10-1.59]), lifting weights of 20-29 pounds (OR=1.70 [95% CI 1.30-2.23]), and vibration exposure (OR=2.00 [95% CI 1.24-3.21]). Work-relatedness was associated with lower flare risk for 3 out of 10 activities (lifting, climbing, and squatting), but these findings were not directionally consistent in secondary analyses using 2-hour exposure windows, suggesting that work-relatedness does not modify activity-flare associations. Analgesic use did not meaningfully modify activity-flare associations.</p><p><strong>Conclusions: </strong>Concurrent biomechanical actions were generally associated with greater activity-flare risk. Work-relatedness and analgesic administration did not modify activity-flare associations. These findings provide the first epidemiologic evidence that contextual factors, and not solely the type of activity, may influence activity-associated LBP flare risk for some activities.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075833","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":"Regarding \"Prospective, Multicenter Study of Two-Level Cervical Arthroplasty With a PEEK-On-Ceramic Cervical Total Disc Replacement: Five-Year Follow-Up\".","authors":"Aikeremujiang Muheremu, Yangjie Qin, Yisimayi Aihemaitijiang","doi":"10.1097/BRS.0000000000005883","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005883","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075848","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 Lower Lordotic Arch More Precisely Predicts Pelvic Positioning for Adult Spinal Deformity Patients with an Aligned T4-L1-Hip Axis.","authors":"Alexander T Yahanda, Tim T Bui, Karan Joseph, Samuel Vogl, Munish C Gupta, Jeffrey Hills, Eric O Klineberg, Gregory M Mundis, Christopher P Ames, Han Jo Kim, Michael P Kelly, Camilo A Molina","doi":"10.1097/BRS.0000000000005885","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005885","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To assess the combined effect of lower lordotic arch (LLA) and thoracolumbar (T4-L1-hip axis) alignment correction on the ability to predict sacral slope (SS) (i.e. pelvic retroversion) in adult spinal deformity (ASD).</p><p><strong>Summary of background data: </strong>The Roussouly framework characterizes the spine through a series of lordotic and kyphotic arches. The LLA should be equivalent to SS, meaning that pelvic positioning should be predicted by lumbar lordosis modifications between the lordotic apex and S1. However, positive T4-L1-hip axis mismatches will drive persistent pelvic retroversion. We hypothesized that postoperative SS prediction from LLA correction will be highest among patients with aligned T4-L1 hip axes.</p><p><strong>Methods: </strong>339 ASD patients receiving fusions of ≥L2-pelvis had spinopelvic parameters measured on preoperative and 6-week scoliosis radiographs to determine LLA-SS correlations. Uni- and multivariable analyses were used to ascertain the effect of the LLA, T4-L1-hip axis, and other factors on pre-/postoperative SS.</p><p><strong>Results: </strong>LLA and SS were correlated among all patients preoperatively (ρ=0.68, R2=0.47, P<0.0001) and postoperatively (ρ=0.74, R2=0.55, P<0.0001). Postoperative strength and predictive ability of these correlations improved when the T4-L1-hip axis was respected (ρ=0.82, R2=0.68, P<0.0001) versus non-respected (ρ=0.68, R2=0.47, P<0.0001). Multivariable analysis demonstrated that preoperative LLA (P<0.0001), T4-L1-hip axis alignment (P=0.02), pelvic incidence (P<0.0001) and sex (P=0.01) were predictors of preoperative SS. Postoperative LLA (P<0.0001), aligned T4-L1-hip axis (P=0.04), pelvic incidence (P=0.0005), and revision surgery (P=0.01) were significant predictors of postoperative SS.</p><p><strong>Conclusions: </strong>LLA and SS were correlated pre-and postoperatively for all patients. Correlation strength and predictive ability was superior for patients with aligned T4-L1-hip axes, highlighting the importance of proper alignment of the arches cranial to the LLA. Focusing on the LLA and T4-L1-hip axis should be a priority for surgical planning to optimize prediction of SS (and thus elimination of pathologic pelvic retroversion) after LLA modification regardless of fusion length or Roussouly curve type.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075815","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":"Association of CT-Based Body Composition Phenotypes With Lumbar Degenerative Disease Characteristics: A Two-Center Cross-Sectional Study.","authors":"Qiao Xu, Xiaohong Wang, Mengchao Zhang, Liang Chen","doi":"10.1097/BRS.0000000000005881","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005881","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A two-center retrospective cross-sectional study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the association between CT-derived body composition phenotypes and lumbar degenerative disease (LDD) characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary of background data: &lt;/strong&gt;While individual measures of fat distribution and muscle status are known to be associated with LDD, their combined synergistic or antagonistic effects remain largely uncharacterized. Furthermore, conventional body mass index (BMI) often fails to accurately represent the complexity of individual body composition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 262 patients with chronic low back pain were retrospectively included. Subcutaneous adipose tissue area (SAT), visceral adipose tissue area (VAT), abdominal muscle fat area (AMF), paraspinal muscle fat area (PMF), abdominal muscle area (AMA), and paraspinal muscle area (PMA) were quantified on axial CT images at the L3-L4 vertebral levels. After variable selection using Spearman correlation analysis (P&lt;0.05) and variance inflation factor (VIF) diagnostics (VIF &lt;5), K-means clustering was performed to derive distinct body composition phenotypes. Three BMI groups based on Chinese standards were used as the comparative classification. The primary outcome was the lumbar composite degeneration grade (grades I-IV). Trend tests were performed using the Jonckheere-Terpstra and Cochran-Armitage tests. Age- and sex-adjusted ordinal logistic regression was used to evaluate the association between phenotypes and degenerative grade.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;VAT, AMF, PMF, AMA, and PMA were identified as key clustering variables. K-means clustering identified three distinct body composition phenotypes: high-fat muscle-rich (n=95), low-fat muscle-preserved (n=112), and fat-infiltrated muscle-atrophic (n=55). The three phenotypes exhibited significant gradient trends in degeneration grade, anterior osteophytes, posterior osteophytes, intervertebral space narrowing, and facet joint changes (all trend P&lt;0.01). After adjustment for age and sex, the fat-infiltrated muscle-atrophic phenotype was associated with higher degenerative grade (ordered logistic regression, OR=3.02, 95% CI 1.45-6.31, P=0.003). The Oswestry Disability Index (ODI) differed across phenotypes (trend P=0.008), with the lowest adjusted ODI in the low-fat muscle-preserved phenotype (0.300±0.020) and similar adjusted ODI values in the high-fat muscle-rich (0.327±0.025) and fat-infiltrated muscle-atrophic phenotypes (0.333±0.031). In contrast, the conventional BMI groups showed no significant trend for any degenerative outcome (all P&gt;0.05). No significant differences were observed in supine sagittal parameters under either classification system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Body composition-based phenotypes are significantly associated with lumbar degenerative features, reflecting the synergistic and antagonistic interplay between fat distr","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025662","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}