Spine Surgery and Related Research最新文献

{"title":"Preoperative Thoracolumbar Mobility (ΔTLK) Predicts Early Upper Instrumented Vertebra-Adjacent Fracture after Lower Thoracic-Pelvic Fusion in Elderly Patients with Adult Spinal Deformity.","authors":"Shimei Tanida, Kazutaka Masamoto","doi":"10.22603/ssrr.2025-0389","DOIUrl":"10.22603/ssrr.2025-0389","url":null,"abstract":"<p><strong>Introduction: </strong>To determine whether preoperative thoracolumbar mobility predicts early upper instrumented vertebra-adjacent fracture (eUIVAF) after lower thoracic (LT)-pelvic fusion for adult spinal deformity (ASD) in elderly patients, in whom fracture-type proximal junctional failure is most prevalent.</p><p><strong>Methods: </strong>Seventy-four ASD patients aged ≥40 years who underwent corrective fusion spanning ≥6 vertebrae (2018-2024) by a single surgeon were analyzed. Sagittal parameters were measured on preoperative standing radiographs and supine computed tomographic (CT) images. ΔTLK and ΔTK were defined as angular changes in thoracolumbar (T10-L2) and thoracic (T5-T12) kyphosis between standing and supine positions. eUIVAF was defined as a new vertebral fracture at or adjacent to the UIV within 3 months. Given that all eUIVAFs occurred in patients aged ≥70 years who underwent LT-pelvic fusion (n=40), this elderly LT-pelvic subgroup constituted the primary analytic cohort for group comparisons, logistic regression, and receiver operating characteristic (ROC) analyses.</p><p><strong>Results: </strong>eUIVAF occurred in 14 of 74 patients (18.9%), exclusively among those aged ≥70 years with LT-pelvic fusion. In this subgroup, ΔTLK was greater in patients with eUIVAF than in those without (17.6°±8.0° vs 7.2°±7.0°, p<0.001), whereas ΔTK did not differ significantly. In a multivariable model including ΔTLK and ΔTK, only ΔTLK remained associated with eUIVAF (odds ratio, 1.27; 95% confidence interval, 1.09-1.47). ROC analysis for ΔTLK showed excellent discrimination (area under the curve, 0.90), with an optimal cutoff of 12°.</p><p><strong>Conclusions: </strong>In elderly patients undergoing LT-pelvic fusion, preoperative ΔTLK was a strong radiographic predictor of eUIVAF. ΔTLK ≥12° identified a high-risk group, although this ROC-derived cutoff from a small single-center cohort without internal validation remains exploratory and requires confirmation in larger multicenter studies. Given that ΔTLK can be obtained from routine preoperative standing radiographs and supine CT, incorporating it into preoperative planning may help tailor fixation range, construct design, and correction magnitude in elderly ASD patients.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"464-475"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Skeletal-Related Events in a Liaison Treatment for Metastatic Spinal Tumors: A 10-Year Retrospective Study.","authors":"Seiya Watanabe, Kazuo Nakanishi, Kazuya Uchino, Hideaki Iba, Yoshihisa Sugimoto, Shigeru Mitani","doi":"10.22603/ssrr.2025-0393","DOIUrl":"10.22603/ssrr.2025-0393","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"531-532"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Appraisal of \"Anterolateral Versus Transpedicular Decompression with Posterior Instrumentation: A Randomized Prospective Study in Paradiscal Thoracic Spine Tuberculosis.\"","authors":"Mohammad Idrees","doi":"10.22603/ssrr.2026-0008","DOIUrl":"10.22603/ssrr.2026-0008","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"533-534"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Follow-Up of Hydrocephalus with Atlantoaxial Subluxation Treated using Posterior Atlantoaxial Fusion: A Case Report.","authors":"Tetsushi Oyama, Taito Itabashi, Takuya Numasawa, Kanichiro Wada, Gentaro Kumagai, Naoya Suzuki, Yasuyuki Ishibashi","doi":"10.22603/ssrr.2025-0376","DOIUrl":"10.22603/ssrr.2025-0376","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"516-519"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Cement Leakage into Segmental Veins during Posterior Spinal Fusion Using Fenestrated Pedicle Screws.","authors":"Hayato Futakawa, Hiroto Makino, Shoji Seki, Katsuhiko Kamei, Yushi Yashima, Yasuhito Yahara, Yoshiharu Kawaguchi","doi":"10.22603/ssrr.2025-0336","DOIUrl":"10.22603/ssrr.2025-0336","url":null,"abstract":"<p><strong>Introduction: </strong>Although fenestrated screws enhance pull-out strength, cement leakage into segmental veins carries a risk of pulmonary embolism. This study aimed to identify factors that contribute to cement leakage during posterior spinal fusion with fenestrated screws.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 32 patients who underwent posterior spinal fusion with fenestrated pedicle screws. A total of 147 screws were evaluated using postoperative computed tomography (CT) scans. Risk factors were assessed by measuring vertebral CT values, the volume of injected cement and its ratio to vertebral body volume, and screw positioning parameters, including deviation and distance to the anterior and lateral walls.</p><p><strong>Results: </strong>Cement leakage occurred in 75% of patients (24 of 32) and in 35% of screws (52 of 147). All leakages were classified as leakage into segmental veins. No symptomatic pulmonary embolism was observed. The thoracic spine exhibited a higher leakage rate than the lumbar spine (47.5% vs. 28.4%, p<0.05). Leakage was significantly associated with shorter distances from the screw tip to the anterior (5.1 mm vs. 7.8 mm) and lateral (4.8 mm vs. 7.3 mm) vertebral walls, as well as a higher cement-to-vertebral-volume ratio (7.1% vs. 4.7%, p<0.01). Leakage also correlated with higher CT values in the posterior vertebral region (126 Hounsfield Unit [HU] vs. 103 HU; p<0.05). Screw deviation showed no association.</p><p><strong>Conclusions: </strong>Proximity of the screw tip to the anterior and lateral walls, as well as excessive cement injection relative to vertebral body size, significantly increases the risk of leakage. To mitigate this risk, screws should be placed centrally within the vertebral body and at a safe distance from the cortical boundaries. The amount of injected cement should also be determined according to the volume of the individual vertebral body. These findings provide practical guidance for safer screw placement in spinal fusion using fenestrated screws.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"600-606"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gluteal Muscle Degeneration Is Associated with Compensation Failure in Age-Related Spinopelvic Malalignment: A Cross-Sectional Study.","authors":"Shizumasa Murata, Hiroshi Hashizume, Hiroshi Iwasaki, Shunji Tsutsui, Masanari Takami, Keiji Nagata, Yuyu Ishimoto, Masatoshi Teraguchi, Kimihide Murakami, Ryo Taiji, Takuhei Kozaki, Ryuichiro Nakanishi, Hiroshi Yamada","doi":"10.22603/ssrr.2025-0368","DOIUrl":"10.22603/ssrr.2025-0368","url":null,"abstract":"<p><strong>Introduction: </strong>The role of pelvic stabilizing muscles, particularly the gluteus muscles, remains largely unexplored in the context of sagittal alignment. Understanding the relative vulnerability of each muscle group during the sequential breakdown of sagittal alignment is thus important. We hypothesize that gluteal muscle degeneration precedes or accompanies the failure of pelvic compensation in sagittal malalignment, making it a key indicator of early decompensation. Here, we examine which trunk or pelvic muscles demonstrate the greatest deterioration in morphology and quality across progressive stages of sagittal alignment decompensation, and aim to identify muscle-related predictors of spinopelvic malalignment.</p><p><strong>Methods: </strong>In this cross-sectional study, we analyzed 204 outpatients stratified into groups based on standing whole-spine radiographic parameters: normal (sagittal vertical axis [SVA] ≤50 mm and pelvic tilt [PT] ≤20°), compensated (SVA ≤50 mm and PT >20°), and decompensated (SVA >50 mm). We measured computed tomography-derived cross-sectional area (CSA) and Hounsfield unit (HU) values for the paravertebral (erector spinae and multifidus), psoas, gluteus medius, and gluteus maximus muscles. Group comparisons were performed using non-parametric tests, and logistic regression models were used to identify independent predictors of alignment deterioration.</p><p><strong>Results: </strong>Both gluteal and paraspinal muscles exhibited significant declines in CSA and HU values across worsening alignment stages, whereas the psoas muscle did not. In multivariate analyses, reduced HU values of the gluteus medius and maximus and decreased paraspinal CSA values were independently associated with abnormal and decompensated alignment. Notably, the gluteus medius HU value was positively associated with compensation maintenance, whereas the gluteus maximus HU value had a negative association.</p><p><strong>Conclusions: </strong>Degeneration of the gluteal muscles, especially in muscle quality, is strongly associated with the breakdown of sagittal alignment compensation. Our results suggest the gluteal musculature is a useful early biomarker and therapeutic target in preventing age-related spinal imbalance.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"486-494"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-Guided Lumbar Nerve Root Hydrodissection: Fluoroscopy-Assisted Evaluation of Injectate Distribution and Feasibility.","authors":"Yu Arima, Yoshiyuki Okamoto, Kazunari Kuroda, Masaki Takahashi, Ryosuke Asa, Shota Takemoto, Yasuo Katsuki","doi":"10.22603/ssrr.2025-0359","DOIUrl":"10.22603/ssrr.2025-0359","url":null,"abstract":"<p><strong>Introduction: </strong>Selective nerve root block is commonly performed under fluoroscopy, but reports of ultrasound (US) guidance remain limited. Although hydrodissection has shown favorable outcomes in peripheral nerves, few studies have evaluated the lumbar nerve root. Therefore, we aimed to evaluate the injectate distribution, reproducibility, safety, and clinical efficacy of US-guided hydrodissection of the lumbar nerve root (US-HNR) using fluoroscopic assistance.</p><p><strong>Methods: </strong>US-HNR was performed in 46 patients with lumbar radiculopathy between January and September 2025. A standardized injectate (contrast agent 3 mL, saline 6 mL, and lidocaine 1% 1 mL; total 10 mL) was administered. Distribution was classified into four types under fluoroscopy. The Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), and patient satisfaction were evaluated pre- and postprocedurally.</p><p><strong>Results: </strong>Contrast evaluation was possible in 40 patients. Distribution patterns were localized within the periradicular region of the target nerve root in 30%, ipsilateral epidural in 38%, contralateral epidural in 25%, and contralateral nerve root in 8%, suggesting localized spread in one-third of cases. NRS improved significantly from 7.1 to 5.0 at 1 week, 4.2 at 1 month, and 3.8 at 3 months (all <i>p</i><0.001), with responder rates of 52%, 60%, and 58%. ODI improved from 42 to 32 at 1 month and 28 at 3 months (p<0.01), with responder rates of 54% and 62%. No serious complications were observed. Two experienced transient radiating pain during injection.</p><p><strong>Conclusions: </strong>US-HNR was safe and feasible, avoiding radiation and direct nerve puncture. This simple technique showed favorable clinical outcomes and may represent a promising treatment for lumbar radiculopathy.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"456-463"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Corticosteroid Addition to Selective Nerve Root Block for Lumbar Radiculopathy: A Multicenter Prospective Cohort Study.","authors":"Jun Ouchida, Hiroaki Nakashima, Masayuki Miyagi, Gen Inoue, Keiji Nagata, Kei Watanabe, Hidetomi Terai, Yu Yamato, Norihiro Nishida, Hidenori Suzuki, Sumihisa Orita, Shiro Imagama, Naohisa Miyakoshi, Hiroshi Yamada, Hiroshi Hashizume, Yukihiro Matsuyama, Hirotaka Haro, Masaya Nakamura, Takashi Kaito, Toshitaka Yoshii","doi":"10.22603/ssrr.2025-0327","DOIUrl":"10.22603/ssrr.2025-0327","url":null,"abstract":"<p><strong>Introduction: </strong>The addition of corticosteroids to selective nerve root block (SNRB) is widely practiced for lumbar radiculopathy, yet robust evidence regarding its efficacy for functional outcomes remains limited. We evaluated whether adding corticosteroids to local anesthetic in SNRB relieves functional disability and improves quality of life in patients with lumbar radiculopathy.</p><p><strong>Methods: </strong>This multicenter, prospective cohort study enrolled 78 patients with single-level lumbar radiculopathy. Patients received fluoroscopy-guided SNRB with either corticosteroids (dexamethasone, betamethasone) plus 1% lidocaine (n=64) or lidocaine alone (n=14). The primary outcome was the Oswestry Disability Index (ODI) at 90 and 180 days. Secondary outcomes included visual analog scale (VAS) scores for leg pain, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and minimal clinically important difference (MCID) achievement rates. Linear mixed-effects models were used for analysis.</p><p><strong>Results: </strong>The steroid group indicated significantly greater ODI improvement at 90 days (27.9 vs 47.1; mean difference, 19.2 points [95% confidence interval (CI), 6.8-31.6]; p=0.002) and 180 days (29.0 vs 44.1; mean difference, 15.1 points [95% CI, 2.3-27.9]; p=0.022), with large effect sizes (Cohen d>0.8). Significant improvements favoring corticosteroids were observed for VAS scores at 90 days (3.5 vs 5.7; p=0.018) and 180 days (3.7 vs 5.9; p=0.023) and multiple JOABPEQ domains. MCID achievement was significantly higher in the steroid group at 90 days (75.0% vs 33.3%; p=0.043); the number needed to treat was 2.4. Adverse event rates were similar in the groups, and no serious adverse events occurred. Benefits plateaued between 90 and 180 days.</p><p><strong>Conclusions: </strong>Adding non-particulate corticosteroids to SNRB significantly relieved functional disability and pain and improved quality of life in patients with lumbar radiculopathy, with the most pronounced group differences occurring at 90 days and sustained through 180 days. Clinically, the 90-day timepoint is optimal for evaluating treatment success and determining the need for alternative treatments.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"495-503"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Multi-Segmental Motor Paralysis Following Posterior Decompression and Fusion for Cervical and Thoracic Ossification of the Posterior Longitudinal Ligament: A Case Report.","authors":"Jun Hashimoto, Takashi Hirai, Kentaro Sakaeda, Motonori Hashimoto, Hiroaki Onuma, Kentaro Yamada, Satoru Egawa, Yu Matsukura, Shigenori Kawabata, Toshitaka Yoshii","doi":"10.22603/ssrr.2025-0414","DOIUrl":"10.22603/ssrr.2025-0414","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"641-644"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoliosis in Patients with Trisomy 18 Surviving More Than One Year.","authors":"Masayoshi Machida, Katsuaki Taira, Brett Rocos, Naho Nemoto, Noboru Oikawa, Takumi Kiyama, Kazuyoshi Nakanishi","doi":"10.22603/ssrr.2025-0375","DOIUrl":"10.22603/ssrr.2025-0375","url":null,"abstract":"<p><strong>Introduction: </strong>Trisomy 18 is a chromosomal abnormality with an estimated prevalence of 4.8 per 10,000 births. The condition is associated with scoliosis; however, the nature of this relationship is incompletely understood, as historically the 1-year mortality rate has ranged from 75% to 95%. With modern treatment, many individuals with trisomy 18 are now surviving beyond their first year of life, and consequently treating teams are encountering a greater number of patients with trisomy 18-associated spinal deformity. This case series makes recommendations for the early identification of deformity in patients with trisomy 18.</p><p><strong>Methods: </strong>The clinical records and spine or chest radiographs of 18 consecutive patients aged at least one year who were diagnosed with trisomy 18 were reviewed. The results of radiological assessment for the presence, prevalence, and time of onset of associated spinal deformity were described.</p><p><strong>Results: </strong>Seventeen of 18 patients who survived beyond one year from birth demonstrated scoliosis. Eleven patients survived and seven died during follow-up. The average age at diagnosis was 2.1±1.5 years (range: 0.1-6.5), and the average age at final follow-up was 4.4±4.1 years (range: 1.1-19.1). The coronal angular deformity at final follow-up was 35.2°±30.4° (range: 14.0°-141.9°). Five patients were diagnosed with scoliosis before one year of age, two of whom had severe scoliosis greater than 45° at the time of diagnosis. Although one patient was treated with bracing, bracing failed to prevent progression of the coronal deformity. No patients underwent surgical correction due to poor health status.</p><p><strong>Conclusions: </strong>Individuals with trisomy 18 develop scoliosis with very early onset. Screening for scoliosis from birth is recommended to facilitate early identification and characterization of spinal deformities in patients with trisomy 18.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"607-612"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}