North American Spine Society Journal最新文献

{"title":"Comparative analysis of acute postoperative pain and opioid use between lateral transpsoas, anterior, and transforaminal lumbar interbody fusions","authors":"Ekrem M. Ayhan BS ,&nbsp;Thomas Giannasca BS ,&nbsp;Jake Laverdiere BS ,&nbsp;Laura Sanzari MS ,&nbsp;Gina Panek BS ,&nbsp;Aris Yannopoulos MD","doi":"10.1016/j.xnsj.2025.100781","DOIUrl":"10.1016/j.xnsj.2025.100781","url":null,"abstract":"<div><h3>Background</h3><div>The lateral transpsoas lumbar interbody fusion is associated with transient postoperative anterior thigh and inguinal dysesthesias and hip flexor weakness from manipulation of the psoas and interposed lumbar plexus. However, it remains unclear whether this translates to higher pain scores and opioid requirements.</div></div><div><h3>Methods</h3><div>Patients who had undergone one- or two-level extreme/direct (XLIF/DLIF), anterior (ALIF), or transforaminal lumbar interbody fusion (TLIF) between January 2018 and December 2023 for degenerative spinal pathology were included. All cases were further classified as standalone or pedicle screw-fixated, and pedicle screw-fixated was included as a covariate. Outcomes were assessed using multivariable linear or binary logistic regression and included length of stay (LOS), inpatient daily maximum pain scores, inpatient morphine-equivalent daily dosage, and total inpatient morphine milligram equivalents, 30- and 90-day complications, emergency department visits, return to operating room, and readmission, and 90-day and 1-year Oswestry Disability Index (ODI) and EuroQuol-5 Dimension (EQ5D).</div></div><div><h3>Results</h3><div>A total of 936 patients were assessed, including 90 (9.6%) XLIF/DLIFs, 587 (62.7%) TLIFs, and 259 (27.6%) ALIFs. Pedicle screw fixation differed significantly between approaches (TLIF: 100%, ALIF: 51.0%, XLIF/DLIF: 51.1%; p&lt;.001). The XLIF/DLIF approach had the shortest operative time compared to ALIF and TLIF (p&lt;.003). Furthermore, XLIF/DLIF approach was associated with lower 90-day ODI than TLIF (<em>β</em>=–21.185; p=.002) and ALIF (<em>β</em>=–9.275; p=.043), higher 90-day EQ5D than TLIF (<em>β</em>=+27.389; p&lt;.001) and ALIF (<em>β</em>=+13.897; p=.001), higher morphine-equivalent daily dosage than TLIF (<em>β</em>=+29.115; p&lt;.001) and ALIF (<em>β</em>=+11.959; p=.006), and shorter LOS than TLIF (<em>β</em>=–45.500 hours; p=.014) and ALIF (<em>β</em>=–24.447 hours; p=.049). No significant differences were observed in maximum pain scores, total inpatient morphine milligram equivalents, complications, readmissions, or return to operating room.</div></div><div><h3>Conclusions</h3><div>Despite a shorter operative time, shorter LOS, and better 90-day ODI and EQ5D, the lateral transpsoas lumbar interbody fusion is associated with higher postoperative inpatient opioid consumption than TLIF and ALIF.</div></div><div><h3>Level of Evidence</h3><div>III</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100781"},"PeriodicalIF":2.5,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ``P72. Change of spinal cord alignment within one week after cervical laminoplasty'' [North American Spine Society Journal (NASSJ) 18S (2024) 100476]","authors":"Tatsuya Shibata MD ,&nbsp;Yoshikuni Kida MD, PhD ,&nbsp;Jun Tanaka MD, PhD ,&nbsp;Hideki Ota MD ,&nbsp;Yohei Iguchi MD ,&nbsp;Teruaki Shiokawa MD ,&nbsp;Kyoichi Sanada MD ,&nbsp;Shusuke Hagihara MD ,&nbsp;Sota Sasaki MD ,&nbsp;Akitaka Yoshimura MD ,&nbsp;Takuaki Yamamoto MD, PhD","doi":"10.1016/j.xnsj.2025.100772","DOIUrl":"10.1016/j.xnsj.2025.100772","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100772"},"PeriodicalIF":2.5,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The kiva system versus balloon kyphoplasty for vertebral compression fracture: a meta-analysis of randomized control trials","authors":"Humaid Al Farii MD,&nbsp;Nikhil Gattu MD,&nbsp;Caleb M. Yeung MD,&nbsp;Christopher A. Alvarez-Breckenridge MD,&nbsp;Robert Y. North MD,&nbsp;Claudio E. Tatsui MD,&nbsp;Laurence D. Rhines MD,&nbsp;Valerae O. Lewis MD,&nbsp;Justin E. Bird,&nbsp;Shalin S. Patel","doi":"10.1016/j.xnsj.2025.100778","DOIUrl":"10.1016/j.xnsj.2025.100778","url":null,"abstract":"<div><h3>Background</h3><div>Vertebral compression fractures (VCFs) are the most common type of vertebral body fracture. The Kiva VCF Treatment System is a relatively novel technique to manage VCFs. The aim of this study was to compare the efficacy of Kiva versus standard Balloon Kyphoplasty (BK) through evaluation of published randomized controlled trials (RCTs).</div></div><div><h3>Methods</h3><div>This study was performed following the guidelines for PRISMA. We performed a systematic literature search using PubMed and MEDLINE in June 2023. The search keywords were “Kiva” and “Kyphoplasty” which yielded a total of 112 articles. Outcome measures included pain, measured through the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), and cement leakage rates.</div></div><div><h3>Results</h3><div>Three RCTs were included in this meta-analysis. A total of 468 patients (Kiva=232 patients and BK=236 patients) and 694 fractures (351 treated with Kiva and 343 treated with BK) were included after fulfilling the inclusion criteria. The VAS score in both the Kiva and BK group improved significantly. There was no difference in VAS improvement between the 2 groups (p-value=.84). Of the 694 fractures that were treated procedurally, the Kiva system had significantly less cement leakage than BK (95% CI [-0.89, -0.22], p-value=.00). However, and collectively out of those who had cement leakage, there was only 2 patients (2.1%) developed adverse events of acute paraplegia required reoperation.</div></div><div><h3>Conclusions</h3><div>This meta-analysis demonstrates that the Kiva system and balloon kyphoplasty are both strong treatment options for the purpose of reducing pain associated with VCFs, whether osteoporotic or metastatic in etiology. However, Kiva system was favorable over balloon kyphoplasty in terms of rates of cement leakage.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100778"},"PeriodicalIF":2.5,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of intraoperative neuromonitoring (IONM) in spinal surgery1","authors":"W. Bryan Wilent PhD, DABNM ,&nbsp;Marcia-Ruth Ndege BS, CNIM ,&nbsp;Adam Doan DC, DABNM","doi":"10.1016/j.xnsj.2025.100777","DOIUrl":"10.1016/j.xnsj.2025.100777","url":null,"abstract":"<div><h3>Preface</h3><div>On behalf of the NASS section on intraoperative neuromonitoring (IONM), we present a narrative perspective exploring the future of IONM in spine surgery in the US, drawing on current evidence and future projections.</div></div><div><h3>Present state</h3><div>IONM is used during hundreds of thousands of spinal procedures each year to enhance patient safety via real-time neurodiagnostic feedback. The most common service model is an in-room technologist and a remote supervising professional who interprets the neurophysiological data. The primary goal of IONM is to: (1) detect significant signal changes from baseline, (2) identify the cause—whether technical, positional, anesthetic, or iatrogenic, and (3) pinpoint the site of injury. This diagnostic process is time-sensitive, complex, and dependent on both the signal pattern change and patient and procedural factors that are dynamically variable.</div></div><div><h3>Future: integrating and advancing technology</h3><div>Artificial intelligence (AI) and machine learning (ML) hold promise to enhance the accuracy in detecting and interpreting signal changes for IONM clinicians and be integrated into surgeon-directed software platforms. However, widespread AI/ML adoption depends on the availability of large, validated IONM datasets—currently hindered by practice variation, inconsistent perioperative documentation, and unharmonized IONM, anesthetic, surgical, and patient medical records.</div></div><div><h3>Future: maturation in Profession</h3><div>IONM can improve in the consistency in which optimal IONM is delivered, how IONM is utilized with evidence-based planning for alerts, and the collection of harmonized and complete signal and clinical records. Most publications have focused on the diagnostic accuracy of IONM in predicting deficits, but more emphasis is needed on demonstrating the therapeutic impact of interventions to alerts and their role in preventing new deficits.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100777"},"PeriodicalIF":2.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Responsiveness of the PROMIS-10 global compared to the neck disability index in patients undergoing 1 and 2 level anterior cervical discectomy and fusion","authors":"Matthew J. Solomito PhD ,&nbsp;Heeren Makanji MD","doi":"10.1016/j.xnsj.2025.100780","DOIUrl":"10.1016/j.xnsj.2025.100780","url":null,"abstract":"<div><h3>Background</h3><div>The reliance on patient reported outcomes (PROs) has substantially increased not only to augment current metrics of clinical success, but to capture the patient’s perspective on the benefit of their treatment. As more PROs become utilized, the time and cost of longitudinal data collection and survey fatigue must be tempered with the benefit of the data collected. Therefore, this study sought to assess the responsiveness of the Neck Disability Index (NDI) compared to the PROMIS-10 Global Health Survey physical function T-score (PFT) and mental health T-score (MHT).</div></div><div><h3>Methods</h3><div>A total of 264 patients that had undergone a single or two level anterior cervical discectomy and fusion (ACDF) between June 2021 and January 2024 were included. All patients completed their preoperative, 3-, and 12-month postoperative PRO assessments. A responsiveness analysis was performed and included: floor and ceiling effects, correlations among the PRO scores, and effect size indices (ESI) calculations.</div></div><div><h3>Results</h3><div>There were no floor or ceiling effects for the NDI and only 5.8% of the study cohort reached the floor or ceiling for the PROMIS-10 scores. The PROMIS T-scores showed weak to moderate correlations to the NDI, with the PFT having stronger correlations than the mental health T-score (MHT). The ESI demonstrated that the NDI was the most responsive tool with a maximum ESI of 0.98.</div></div><div><h3>Conclusions</h3><div>The PROMIS-10 is a responsive and valid tool that provides insight into both the general physical function and mental health of a patient; however, it does not display the same discretionary ability to detect small changes in neck function that the NDI demonstrated. Therefore, the PROMIS-10 may be useful to provide preoperative assessment for patients undergoing ACDF but longitudinal evaluation to assess the outcomes of this surgery may be best left to the NDI.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100780"},"PeriodicalIF":2.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DCM-72 (dexterity, cutaneous, and muscle-72): A composite scoring system for objective assessment of upper limb dysfunction in patients with degenerative cervical myelopathy","authors":"Harshit Arora MBBS ,&nbsp;Hassan Darabi MD ,&nbsp;Kelsey Karnik PhD ,&nbsp;Jared T. Wilcox MD, PhD ,&nbsp;Jan M. Schwab MD, PhD ,&nbsp;Francis Farhadi MD, PhD","doi":"10.1016/j.xnsj.2025.100775","DOIUrl":"10.1016/j.xnsj.2025.100775","url":null,"abstract":"<div><h3>Background Context</h3><div>Degenerative cervical myelopathy (DCM) is characterized by spinal cord compression, which can present with limb weakness and numbness, loss of fine motor skills, gait disturbance, and bladder dysfunction. The modified Japanese Orthopedic Association (mJOA) and Graded Redefined Assessment of Strength, Sensibility, and Prehension Version Myelopathy (GRASSP-M) scores evaluate distinct aspects to assess the severity of upper and lower extremity dysfunction. Our study aims to develop an integrative, multidimensional Dexterity, Cutaneous, and Muscle (DCM-72) scoring system to provide a more comprehensive and objective evaluation of upper extremity functional impairment.</div></div><div><h3>Methods</h3><div>Within this prospective, 2 center study, a total of 123 participants, comprising of 94 subjects with confirmed DCM and 29 controls with cervical radiculopathy were enrolled. A composite DCM-72 score was developed incorporating several upper extremity functional assessments with 24 total points allocated to each of the 3 components: dexterity, sensation, and muscle strength. Descriptive statistics were used with a p≤0.05 indicating statistical significance.</div></div><div><h3>Results</h3><div>The mean age of the participants is 60.2±12.1 years, with a female-to-male ratio of 1:1.2. The average DCM-72 scores for the dominant and nondominant upper extremities are 28.0±6.0 and 27.3±6.5. Analysis of variance with posthoc analysis identified significant differences between mild-severe and moderate-severe cases as stratified by mJOA subclassification. The proposed composite DCM-72 severity score ranges are defined as: 68.5-72 (normal), 64.3-68.4 (mild), 56.7-62.3 (moderate), and &lt;56.7 (severe).</div></div><div><h3>Conclusion</h3><div>The DCM-72 score effectively stratifies upper extremity dysfunction in patients with DCM through a set of well-established quantitative assessments offering objective performance evaluations as compared to existing scoring systems. DCM-72 can further assist clinicians to monitor outcome trajectories to support decision-making and prognostication and further serves as a candidate tool to improve sensitivity for interventional trial testing.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100775"},"PeriodicalIF":2.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Historical trends and future projections of cervical disc arthroplasty and removal cervical disc arthroplasty in the United States Medicare population","authors":"Tarun Mattikalli BS,&nbsp;Jeremy Steinberger MD,&nbsp;Konstantinos Margetis MD, PhD","doi":"10.1016/j.xnsj.2025.100774","DOIUrl":"10.1016/j.xnsj.2025.100774","url":null,"abstract":"<div><h3>Background</h3><div>Cervical disc arthroplasty (CDA) has become an increasingly utilized alternative to anterior cervical discectomy and fusion (ACDF), offering potential benefits such as motion preservation and reduced incidence of adjacent segment disease. However, long-term utilization trends and future procedural burden remain unclear.</div></div><div><h3>Methods</h3><div>Medicare fee-for-service (FFS) cervical disc arthroplasty (CDA) volumes were extracted from the Medicare Part B National Summary between 2009 and 2022, excluding 2020, and uplifted to account for Medicare Advantage enrollment. Statistical models developed included ordinary least squares (OLS), generalized linear models (GLM), and segmented regression to detect any inflection points in utilization. Autoregressive and alternative GLMs such as Poisson and negative binomial were used for validation. For each procedure type, the model that best aligned with observed trends and statistical fit (AIC, R²) was used to generate forecasts through 2035.</div></div><div><h3>Results</h3><div>Primary CDA utilization demonstrated an inflection point in 2018, after which growth stabilized. Post 2018 OLS modeling estimated a 6.2% annual growth rate, reaching an estimated 9,422 procedures by 2035 (95% CI: 5,494–16,159). Removal CDA exhibited consistent exponential growth, with GLM estimated 22.9% annual increase and a projected volume of 1,773 procedures by 2035 (95% CI: 1,183–2,656).</div></div><div><h3>Conclusions</h3><div>Primary CDA may be entering a mature adoption phase with modest projected growth, while removal CDA is expected to grow more substantially. These projections reflect trends in an older population, which may not generalize to younger individuals undergoing CDA. Our findings reinforce the need for continued surveillance, resource planning, and better understanding of long-term CDA complications in the increasingly aging population.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100774"},"PeriodicalIF":2.5,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144813947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of transversus abdominis plane block on length of stay and postoperative opioid use in anterior lumbar interbody fusions.","authors":"Katherine Drexelius, Steven Baltic, Kennedy Gachigi, Caleb Lifsey, Rebecca Kelso, P Bradley Segebarth","doi":"10.1016/j.xnsj.2025.100771","DOIUrl":"10.1016/j.xnsj.2025.100771","url":null,"abstract":"<p><strong>Background: </strong>Anterior lumbar interbody fusion (ALIF) is an increasingly common surgical procedure for a variety of spinal pathologies. As both opioid use and healthcare costs remain major national healthcare crises, it is crucial to understand methods of effective pain management in spine surgery, including regional anesthesia. While transversus abdominis plane (TAP) blocks are also commonly performed for anterior spinal surgery, literature evaluating outcomes after TAP blocks for ALIF patients is sparse. This retrospective cohort study aims to determine the effect of TAP blocks on perioperative opioid use and hospital length of stay.</p><p><strong>Methods: </strong>Retrospective chart review was performed for patients 18 years or older undergoing 1- or 2-level ALIF with or without posterior percutaneous instrumented fusion. Baseline demographics, surgical details, length of stay (LOS), and data on inpatient opioid use (converted to morphine milliequivalents, MME) was collected. Total MME and MME stratified by postoperative day (POD) was collected. Bivariable and multivariable regression models were used to analyze the relationship of TAP blocks with LOS and narcotic use postoperatively.</p><p><strong>Results: </strong>About 295 patients were included, with 102 (34.6%) undergoing TAP block and 193 (65.4%) patients without TAP block. There were no significant differences in baseline patient characteristics. Use of a TAP block had no statistically significant effect on LOS, and bivariable analysis revealed no effect when groups were analyzed by sex, age, BMI, preoperative opioid use, or number of levels fused. TAP block patients received significantly more MME on POD 0 and on combined POD 1 and 2 than those without a TAP block. Bivariable analysis did not reveal any subgroup who benefitted from a TAP block.</p><p><strong>Conclusions: </strong>With the largest patient cohort reported to date, we found no statistically significant improvements in length of stay or short-term postoperative opioid usage when patients received TAP blocks for anterior lumbar interbody fusion.</p>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"100771"},"PeriodicalIF":2.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875592","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":"Medical and recreational cannabis use in patients undergoing one- or two-level lumbar spine fusion correlated with postoperative outcomes.","authors":"Andrea T Kwaczala, Matthew J Solomito, Caitlin McCracken, Heeren Makanji","doi":"10.1016/j.xnsj.2025.100773","DOIUrl":"10.1016/j.xnsj.2025.100773","url":null,"abstract":"<p><strong>Background: </strong>Cannabis use in the United States has become increasingly prevalent due to the legislation leading to decriminalization in several states; with increased social acceptance, patients are more willing to disclose cannabis use. Few studies have explored how cannabis may influence a patient's recovery following elective lumbar fusion. Therefore, the purpose of this study was to investigate how cannabis use was associated with patient recovery following elective lumbar fusions.</p><p><strong>Methods: </strong>This retrospective single institution study included patients ages 35 through 80 years old who had undergone an elective single- or 2-level lumbar fusion between January 2021 and June 2024. Patients were placed into 1 of 3 study groups based on cannabis use, medical cannabis (MC), recreational cannabis (RC), and nonusers (NU). Differences in patient outcomes were assessed through univariate comparison and multivariate regression analyses.</p><p><strong>Results: </strong>627 patients were included, 129 (20.3%) admitted to cannabis use, 42 (32.5%) used medical cannabis and 87 (67.5%) used recreationally. Cannabis users were younger than NU (<i>p</i><0.001) but reported increased pain (<i>p</i>=0.026) and required more opioids (<i>p</i>=0.017). Surgical site infections at 90 days (SSIs) were significantly greater in the MC group (<i>p</i><0.001).</p><p><strong>Conclusions: </strong>Cannabis use and type of usage had an impact on patient-reported outcomes, pain level, and measures of surgical success. The MC group had significantly higher opioid consumption and SSI rates at 90 days compared to nonusers and recreational groups. Therefore, this study suggests cannabis use may influence postoperative recovery following elective spine fusion. Additionally, medical cannabis users may be a high-risk group not previously identified in the literature.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"100773"},"PeriodicalIF":2.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875593","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":"Implant density reduction to avoid proximal junctional failure in adult spine surgery: Computer models and simulations","authors":"Morteza Rasouligandomani PhD ,&nbsp;Alex del Arco MD-PhD ,&nbsp;Tomaso Villa PhD ,&nbsp;Luigi La Barbera PhD ,&nbsp;Miguel A. González Ballester PhD ,&nbsp;Fabio Galbusera PhD ,&nbsp;Jérôme Noailly PhD","doi":"10.1016/j.xnsj.2025.100770","DOIUrl":"10.1016/j.xnsj.2025.100770","url":null,"abstract":"<div><h3>Background</h3><div>Proximal Junctional Failure (PJF) is a common complication in Adult Spine Deformity (ASD) surgeries, often leading to reoperations. While revision surgeries with osteotomies carry high complication rate of 34.8%, alternatives such as hardware proximal extension may increase PJF risk in patients with severe Global Alignment and Proportion (GAP) scores. Implant Density Reduction (IDR) has emerged to mitigate PJF risk. This study assessed the impact of IDR on PJF risk and explored sub-optimal strategies.</div></div><div><h3>Methods</h3><div>Two patient-personalized Finite Element (FE) models were used and expanded into a virtual cohort. Implant Density (ID), rod material, bone quality, and GAP were systematically varied. Thoracolumbar FE models were developed using structured Statistical Shape Modeling (SSM). Biomechanical metrics of Intervertebral Disk (IVD) fiber strain, Screw Pull-out Force (SPF), and rod stress, were evaluated. Trade-off analyses could determine sub-optimal configurations avoiding PJF.</div></div><div><h3>Results</h3><div>IDR significantly decreased IVD strain (up to −70%) and improved screw stability (up to +142%), for patients with titanium (Ti) rods and normal bone. However, IDR effectiveness was limited for cases with GAP ≥12, osteoporotic bone, and Cobalt-Chromium (Cr-Co) rods. No IDR strategy could prevent PJF for cases with GAP 12 or 13, regardless of rod type. For cases with GAP 11 and Upper Instrumented Vertebra (UIV) at T10, IDR was effective with only Ti rods. For cases with GAP 13 and UIV at T3, none of IDRs, independent of rod material, offered benefit. Notably, Ti rods may support IDR-based risk reduction in borderline cases, such as GAP 12, UIV at T3.</div></div><div><h3>Conclusions</h3><div>IDR is a promising strategy to lower PJF risk in high-risk spine revision cases, though its effectiveness depends on surgical and anatomical factors. This study provides an in-silico tool to support personalized surgical planning and guide future clinical trials aimed at reducing reoperations and healthcare costs.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100770"},"PeriodicalIF":2.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}