Spine Surgery and Related Research最新文献

{"title":"Identifying Anatomical Predictors of Median Arcuate Ligament Overlap to Guide Selective Use of Contrast-Enhanced Computed Tomography in Adult Spinal Deformity Surgery.","authors":"Yasushi Iijima, Toshiaki Kotani, Tsuyoshi Sakuma, Shunji Kishida, Shohei Ise, Sho Inoue, Fumiya Shimizu, Yusuke Setojima, Shuhei Ohyama, Shuhei Iwata, Masaya Mizutani, Kotaro Sakashita, Takahiro Sunami, Shun Okuwaki, Yosuke Ogata, Yasuhiro Shiga, Shohei Minami, Seiji Ohtori","doi":"10.22603/ssrr.2025-0285","DOIUrl":"10.22603/ssrr.2025-0285","url":null,"abstract":"<p><strong>Introduction: </strong>Acute celiac artery compression syndrome (ACACS) is a rare but potentially life-threatening complication following surgery for adult spinal deformity (ASD); it is caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). MAL overlap, the condition in which the MAL overlaps the base of the CA, has been identified as a potential risk factor for ACACS after ASD surgery. However, the routine use of contrast-enhanced computed tomography (CT) to assess this condition poses risks such as allergy and renal dysfunction. The aim of this study was to identify anatomical predictors of MAL overlap using non-contrast imaging markers.</p><p><strong>Methods: </strong>We retrospectively reviewed the data of 43 patients who underwent contrast-enhanced abdominal CT and non-contrast thoracolumbar CT as part of their preoperative evaluation. MAL overlap and MAL levels were assessed using reconstructed contrast-enhanced abdominal CT images; non-contrast thoracolumbar CT was reviewed for comparison. To determine the risk factors for MAL overlap, patients were divided into two groups based on their MAL overlap. The patient characteristics, spinopelvic parameters obtained from radiographs, and MAL levels of the two groups were compared. Diagnostic agreement between contrast-enhanced and non-contrast CT was evaluated using kappa statistics.</p><p><strong>Results: </strong>MAL overlap was observed in 15 of 43 patients (34.8%); it was significantly associated with MAL levels below T12 (p=0.004). The agreement between contrast-enhanced and non-contrast CT assessments was perfect for MAL level (κ=1.000).</p><p><strong>Conclusions: </strong>The prevalence of MAL overlap was 34.8% in patients with ASD preoperatively. MAL levels below the T12 vertebra are risk factors for MAL overlap. Importantly, the MAL level could be accurately evaluated using plain CT. This is useful to clinicians for the selection of patients with ASD who require further examination using contrast agents to evaluate preoperative CA stenosis or MAL overlap.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"253-262"},"PeriodicalIF":1.6,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692358","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":"Description of Scatter Radiation Exposure to the Eye Lenses and Direct Exposure to the Hands in Orthopedic and Spinal Procedures.","authors":"Yasukazu Hijikata, Kazuta Yamashita, Naoki Okubo, Masazumi Saito, Junji Morii, Masayuki Nakahara, Munehiko Kowatari, Satoru Matsuzaki, Yuta Hirai, Yosuke Yamamoto, Takashi Moritake","doi":"10.22603/ssrr.2025-0262","DOIUrl":"10.22603/ssrr.2025-0262","url":null,"abstract":"<p><strong>Introduction: </strong>The increasing adoption of minimally-invasive spinal surgery has resulted in more frequent use of fluoroscopy, heightening concerns regarding radiation-induced cataracts and hand skin cancer in spinal surgeons. We investigated indirect and direct radiation exposure during spinal and orthopedic procedures to enhance radiation protection and explored the factors associated with high dose.</p><p><strong>Methods: </strong>We used data from 60 procedures performed in the operating and fluoroscopy rooms of a hospital in Japan between January and July 2024. Radiation doses to the eye lenses of the surgeon and scrub nurse and hands of the surgeon were measured using radiophotoluminescence glass dosimeters. Factors associated with high doses (≥0.1 mSv per procedure) were explored using the Wilcoxon rank-sum and Fisher's exact tests. We developed a preliminary predictive model using logistic regression to identify high doses, combine key predictors, and evaluate discriminative ability.</p><p><strong>Results: </strong>In the 41 operating room procedures, the mean radiation dose to the left eye was higher than that to the right eye (0.038 mSv vs. 0.012 mSv), and the left-hand dose was also higher (0.105 mSv vs. 0.082 mSv). During the 19 fluoroscopy room procedures, the mean dose to the right eye was higher than that to the left eye (0.029 vs. 0.012 mSv), as was that to the hands (0.859 vs. 0.050 mSv). The surgeon's hand dose reached 7.7 mSv. High doses were associated with younger age (p=0.008), male sex (p=0.002), and obesity (p<0.001). A preliminary prediction model for high dose showed a c-statistic of 0.914 (95% confidence interval, 0.882-0.947).</p><p><strong>Conclusion: </strong>This study highlights the need for better radiation protection for spinal procedures, including the increased use of lead goggles and measures to prevent direct hand exposure. Findings support larger studies to develop more accurate dose estimation formulas.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"276-283"},"PeriodicalIF":1.6,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692417","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":"Postoperative Progression of Cervical Ossification of the Posterior Longitudinal Ligament: A Narrative Review Comparing Posterior Decompression with Fixation and Posterior Decompression Alone.","authors":"Takashi Hirai, Hiroshi Takahashi, Narihito Nagoshi, Kanji Mori, Kanichiro Wada, Satoshi Maki, Yasushi Oshima, Go Yoshida, Shiro Imagama, Masahiko Takahata, Hirotaka Chikuda, Masahiro Yoshida, Masao Koda, Motoki Iwasaki, Yoshiharu Kawaguchi, Masashi Yamazaki, Toshitaka Yoshii","doi":"10.22603/ssrr.2025-0243","DOIUrl":"10.22603/ssrr.2025-0243","url":null,"abstract":"<p><p>This narrative review compares decompression alone and decompression with fixation in the surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) in terms of postoperative progression of ossification. Using published studies, we analyzed ossification size changes at the surgical site and adjacent segments. The results suggest that fixation not only stabilizes the spine but may also suppress the progression of ossification, although neurological outcomes were comparable between decompression with fixation and decompression alone. However, the enlargement of ossification observed at the segments adjacent to the operated levels is occasionally greater in cases treated with decompression with fixation than in those treated with decompression alone. These results may be important in determining the optimal surgical strategy based on OPLL morphology and spinal alignment.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"174-178"},"PeriodicalIF":1.6,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692415","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":"A Predictive Formula for Sagittal Vertical Axis in Japanese Women Using Spinopelvic-Hip Mismatch.","authors":"Kohei Takahashi, Ryo Fujita, Ko Hashimoto, Yu Mori, Kenichiro Yahata, Kazuyoshi Baba, Takahiro Onoki, Keisuke Ishikawa, Junya Kusakabe, Michiyoshi Sato, Takeshi Nakamura, Ryo Sugawara, Kyoichi Handa, Haruo Kanno, Hiroshi Ozawa, Yasuhisa Tanaka, Toshimi Aizawa","doi":"10.22603/ssrr.2025-0291","DOIUrl":"10.22603/ssrr.2025-0291","url":null,"abstract":"<p><strong>Introduction: </strong>To develop a novel and simplified predictive formula for sagittal vertical axis (SVA) in women by incorporating spinopelvic-hip mismatch, aiming to improve accuracy while considering hip joint alignment.</p><p><strong>Methods: </strong>A total of 257 female patients who underwent whole-spine radiography including the proximal femur were retrospectively analyzed. Patients were categorized into three cohorts: osteoporosis outpatients (n=152), conservatively treated adult spinal deformity (ASD) cases (n=32), and surgical ASD cases (n=73). Radiographic parameters including pelvic incidence (PI), pelvic tilt, thoracic kyphosis (TK) at T9-12, lumbar lordosis (LL), pelvic femoral angle (PFA), and derived indices such as PI-LL and spinopelvic-hip mismatch [PFA-(PI-LL)] were measured. The dataset was randomly divided into a training group (70%) and a validation group (30%). In the training group, Lasso regression with five-fold cross-validation was used for variable selection, followed by multiple linear regression to construct the predictive formula. The final model was then tested in the independent validation group to assess external validity.</p><p><strong>Results: </strong>PI, TK at T9-12, and [PFA-(PI-LL)] were identified as significant contributors to SVA prediction. The final formula was: SVA=627.588+0.8612×PI+2.637×TK (T9-12)-3.616×{PFA-(PI-LL)}. The model demonstrated a coefficient of determination of 0.858 in the training group and 0.851 in the external validation group.</p><p><strong>Conclusions: </strong>This study presents a novel, practical predictive formula for SVA in women that incorporates spinopelvic-hip mismatch and relies solely on parameters measurable from lateral radiographs. By reflecting hip extension capacity as a compensatory mechanism, this formula may enable more accurate SVA prediction and individualized surgical planning using standard lateral radiographs.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"220-227"},"PeriodicalIF":1.6,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692228","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.2025-0181","DOIUrl":"10.22603/ssrr.2025-0181","url":null,"abstract":"<p><strong>Introduction: </strong>Skeletal-related events (SREs), including pathological fractures and spinal cord compression, significantly reduce the quality of life and survival in patients with metastatic spinal tumors. Although multidisciplinary \"liaison treatment\" has been implemented at our institution to detect and manage all metastatic spinal lesions, some patients still develop SREs. This study aims to analyze the characteristics and circumstances of patients who experienced SREs despite this system, with particular focus on referrals from other hospitals.</p><p><strong>Methods: </strong>We reviewed patients who developed SREs between December 2013 and December 2023 at our institution. Clinical data including age, sex, performance status (PS), spinal instability neoplastic score (SINS), primary tumor type, spinal lesion level, histologic subtype, epidural spinal cord compression (ESCC) grade, and timing of spine intervention were analyzed. PS at initial and final visits was compared using the Wilcoxon signed-rank test.</p><p><strong>Results: </strong>Among 1,479 patients with metastatic spinal tumors, 72 (4.8%) developed SREs. Median age was 71 years; 69% were male. PS significantly improved from 3.1 to 2.4 (p=0.0002). SINS averaged 8.9, with 72.4% of cases showing intermediate instability. Thoracic spine involvement was most frequent (59.7%). Prostate, lung, and breast cancers accounted for over 50% of cases. ESCC grade ≥II was present in 62.5%. Notably, 54.2% (39/72) were referred after the onset of an SRE; 77% of these occurred at other hospitals. Furthermore, 69.5% had no prior cancer diagnosis before the SRE.</p><p><strong>Conclusions: </strong>Despite an in-house liaison system, SREs frequently occurred in patients referred from external institutions. Early recognition of red-flag symptoms, such as back pain in cancer patients and timely referral for imaging and specialist evaluation are essential. Regional collaboration and education are crucial to prevent avoidable SREs.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"290-295"},"PeriodicalIF":1.6,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692424","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":"Prognostic Accuracy of Eight Scoring Systems in Untreated Patients with Spinal Metastases: A Comparative Study.","authors":"Shuhei Ohyama, Yasuhiro Shiga, Yuki Shiratani, Noriyasu Toshi, Yuki Nagashima, Kosuke Takeda, Soichiro Tokeshi, Kohei Okuyama, Noritaka Suzuki, Masahiro Inoue, Kazuhide Inage, Sumihisa Orita, Seiji Ohtori, Takeo Furuya","doi":"10.22603/ssrr.2025-0252","DOIUrl":"10.22603/ssrr.2025-0252","url":null,"abstract":"<p><strong>Introduction: </strong>To compare the prognostic accuracy of eight widely used scoring systems and their Primary Tumor-Independent (PTI) versions in untreated patients with spinal metastases (SPM).</p><p><strong>Methods: </strong>Data from 108 untreated patients with SPM diagnosed between 2017 and 2023 were retrospectively analyzed. Prognostic accuracy was assessed for eight scoring systems: Skeletal Oncology Research Group (SORG) Nomogram, New Katagiri score, Revised Tokuhashi Score, Tomita Score, New England Metastatic Spinal Score, Modified Bauer Score, Oswestry Spinal Risk Index, and van der Linden Score. PTI versions were also evaluated by excluding primary tumor information. Predictive accuracy was assessed using receiver operating characteristic analysis at 90 days, 180 days, and 1 year.</p><p><strong>Results: </strong>At 90 days, the New Katagiri score demonstrated the highest predictive accuracy (area under the curve [AUC]=0.788). The SORG Nomogram exhibited the highest accuracy at 180 days (AUC=0.759) and 1 year (AUC=0.749). In PTI analysis, the SORG Nomogram-PTI retained the highest accuracy at 90 days (AUC=0.728) and 180 days (AUC=0.719).</p><p><strong>Conclusions: </strong>The New Katagiri score and the SORG Nomogram demonstrated high prognostic accuracy for untreated SPM patients, with the SORG Nomogram-PTI maintaining strong predictive performance even without primary tumor information. These scoring systems are valuable tools for survival estimation and clinical decision-making in this challenging patient population.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"195-203"},"PeriodicalIF":1.6,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692329","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":"Cervical Myelopathy Caused by Ossification of the Posterior Atlantoaxial Membrane and Heterotopic Ossification between the Posterior Arches of the Atlas and Axis: A Case Report.","authors":"Hiromi Kumamaru, Yoshihiro Ito, Taro Tobo, Yudai Tsumura, Yasuharu Nakashima, Katsumi Harimaya","doi":"10.22603/ssrr.2025-0255","DOIUrl":"10.22603/ssrr.2025-0255","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 1","pages":"142-146"},"PeriodicalIF":1.2,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202509","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":"Geriatric Locomotive Function Scale Assessment of Surgical Treatment Outcomes in Older Lumbar Spinal Stenosis Patients with Locomotive Syndrome Stage Three: Comparing Stage-Based and Minimal Clinically Important Difference-Based Improvements.","authors":"Yuki Akaike, Takehiro Michikawa, Soya Kawabata, Takaya Imai, Sota Nagai, Hiroki Takeda, Shinjiro Kaneko, Nobuyuki Fujita","doi":"10.22603/ssrr.2025-0270","DOIUrl":"10.22603/ssrr.2025-0270","url":null,"abstract":"<p><strong>Background: </strong>The 25-item Geriatric Locomotive Function Scale (GLFS-25) is often used to assess locomotive syndrome stage in older adults with lumbar spinal stenosis (LSS). However, locomotive syndrome stage three encompasses a wide score range, potentially masking clinically meaningful improvements. This study aimed to establish the minimal clinically important difference (MCID) for the GLFS-25 and determine whether MCID-based assessment better reflects surgical outcomes than stage-based evaluation.</p><p><strong>Methods: </strong>This study included 314 patients aged 65 years and older with LSS who were preoperatively classified as having locomotive syndrome stage three. Patient-reported outcome measures, including the GLFS-25, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and Zurich Claudication Questionnaire (ZCQ), were administered before and at six months and 1 year after surgery. The MCID for the GLFS-25 was calculated using an anchor-based method, with the satisfaction item from the ZCQ at 1 year after surgery serving as the anchor. Patients were then categorized into four groups based on whether they achieved improvements in locomotive syndrome stage and/or the GLFS-25 MCID.</p><p><strong>Results: </strong>A 19-point improvement in the GLFS-25 was determined to be the MCID, with an area under the receiver operating characteristic curve, sensitivity, and specificity of 0.80, 65.8%, and 90.2%, respectively. Based on postoperative changes, 129, 49, 33, and 103 patients achieved both stage and MCID improvement (group C), improvement in MCID alone (group M), improvement in stage alone (group S), and no improvement, respectively. Group C showed significantly better surgical effectiveness across all JOABPEQ domains. Group M showed significant improvements in four domains, whereas group S showed significant improvement in only one domain.</p><p><strong>Conclusions: </strong>The newly established 19-point MCID for the GLFS-25 more accurately represented clinically meaningful improvement than stage-based evaluation. The combined use of MCID and stage classification may enhance outcome assessment after LSS surgery in older adults.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"228-235"},"PeriodicalIF":1.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692379","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":"Clinical Significance of Difference in Lumbar Lordosis (DiLL) as a Dynamic Spinal Alignment Parameter: A Narrative Review.","authors":"Yasuchika Aoki, Masahiro Inoue, Masashi Sato, Takahito Arai, Shuhei Ohyama, Yuki Akiyama, Akihiro Iida, Arata Nakajima, Yawara Eguchi, Sumihisa Orita, Kazuhide Inage, Yasuhiro Shiga, Junya Saito, Masaki Norimoto, Koichi Nakagawa, Seiji Ohtori","doi":"10.22603/ssrr.2025-0205","DOIUrl":"10.22603/ssrr.2025-0205","url":null,"abstract":"<p><strong>Background: </strong>Lumbar lordosis (LL) varies with posture due to spinal mobility. The difference in LL (DiLL) between supine and standing positions (DiLL: supine LL - standing LL) is a novel dynamic parameter reflecting functional spinal alignment. Recent studies suggest its potential utility in predicting outcomes after lumbar spine surgery.</p><p><strong>Methods: </strong>A narrative review of the literature was conducted to examine posture-related changes in LL, with a particular focus on DiLL. Recent studies assessing LL in different postures and its association with postoperative outcomes following lumbar decompression and fusion surgeries were included.</p><p><strong>Results: </strong>Standing LL is typically greater than supine LL in healthy individuals, resulting in negative DiLL. However, elderly individuals and patients with adult spinal deformity (ASD) often show positive DiLL, indicating reduced ability to maintain lordosis when standing. Patients with a positive DiLL value (DiLL [+]) tend to have worse postoperative outcomes than DiLL (-) patients after short-segment fusion or decompression surgeries. Among DiLL (+) patients, those with mild or no vacuum phenomena in non-fused intervertebral discs (retaining postoperative mobility) exhibited better surgical outcomes than those with severe vacuum phenomena in such discs.</p><p><strong>Conclusions: </strong>DiLL is an easily obtainable dynamic parameter using standard imaging and may serve as a useful predictor of surgical outcomes, particularly in procedures that preserve lumbar mobility. While static parameters like pelvic incidence-LL mismatch remain essential in long-segment fusions, DiLL provides additional insight into functional alignment. In lumbar decompression or short-segment fusion surgeries, DiLL (+) patients who are expected to have non-fused intervertebral discs with severe disc vacuum phenomena postoperatively may experience poorer surgical outcomes. Therefore, if such patients present with severe ASD-specific symptoms, such as fatigue-induced low back pain when standing, we recommend considering long-segment fusion surgery or informing patients about the potential for residual postoperative symptoms and postoperative kyphosis.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"179-187"},"PeriodicalIF":1.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692410","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":"Adjacent Nonbridged Ossification Near the Fixation Poses a Risk of Postoperative Progression of Ossification After Posterior Decompression and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament.","authors":"Jun Hashimoto, Takashi Hirai, Yu Matsukura, Satoru Egawa, Motonori Hashimoto, Hiroaki Onuma, Kentaro Yamada, Shigenori Kawabata, Toshitaka Yoshii","doi":"10.22603/ssrr.2025-0074","DOIUrl":"10.22603/ssrr.2025-0074","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative progression of ossification of the posterior longitudinal ligament (OPLL) has been noted after posterior decompression surgery that does not involve direct resection of OPLL. It appeared that posterior decompression and fusion (PDF) may be more effective in preventing OPLL progression than posterior decompression alone; however, the connection between progression and the extent of fixation remains unclear. This study aimed to identify the ideal fixation range in PDF concerning the progression of OPLL after surgery. We also examined the OPLL progression characteristics post-PDF and the correlation between progression and fixation range.</p><p><strong>Methods: </strong>This retrospective study included 52 patients with cervical OPLL who underwent PDF and had both pre- and post-operative computed tomography images. We examined OPLL progression in thickness, width, and sagittal extension at each vertebra and intervertebral level. We statistically compared patient demographics and radiological data in patients with and without OPLL progression.</p><p><strong>Results: </strong>Throughout the average follow-up of 3.0 years, OPLL progression was observed in the fixed segments in one case (1.9%). However, 16 cases (31%) exhibited progression in the adjacent levels to the fusion. In one case (1.9%), reoperation was necessary owing to spinal cord compression resulting from the advanced OPLL. A comparison of patients with and without OPLL progression revealed that those with progression had a notably higher rate of nonbridged OPLL in the adjacent intervertebral space (94.1% versus 31.4%; p<0.001). A multivariate logistic analysis revealed that fewer fixation levels and nonbridged OPLL adjacent to the fixation were independent risk factors for OPLL progression.</p><p><strong>Conclusions: </strong>Fixation with instrumentation could prevent OPLL progression in the fixation area in 98% of cases. However, 31% of cases progressed at the adjacent segment to the fixed end. Nonbridged OPLL at the segment adjacent to the fixation and fewer fixation levels were significant risk factors for OPLL progression.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 2","pages":"188-194"},"PeriodicalIF":1.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692377","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}