North American Spine Society Journal最新文献

{"title":"35. The restoration of cervical lordosis in preoperative kyphotic spines after uniportal posterior percutaneous endoscopic cervical foraminotomy: a single center retrospective study","authors":"Kuan-Hung Chen MD , Yu-Jen Lu MD, PhD","doi":"10.1016/j.xnsj.2025.100729","DOIUrl":"10.1016/j.xnsj.2025.100729","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Posterior percutaneous endoscopic cervical foraminotomy (P-PECF) offers an alternative to anterior cervical discectomy and fusion (ACDF) for patients with cervical radiculopathy, demonstrating comparable results in pain relief and functional recovery. However, the clinical and radiological outcome of P-PECF in kyphotic spine patients preoperative cervical remains uncertain.</div></div><div><h3>PURPOSE</h3><div>This study investigates whether patients with preoperative kyphotic spines with cervical radiculopathy are suitable candidates for P-PECF using a single incision.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A retrospective study of 24 kyphotic spine patients with cervical radiculopathy receiving P-PECF at our institute from March 2019 to October 2023 was performed. All patients received P-PECF operation with the L-STEP (Lu's medial Superior articular process Total Enbloc removal and partial pediculotomy) technique to maximize the extent of foraminotomy and ensure the the cervical nerve root not repeatedly being compressed.</div></div><div><h3>PATIENT SAMPLE</h3><div>There were 24 patients with preoperative kyphotic spine patients in total included in our study.</div></div><div><h3>OUTCOME MEASURES</h3><div>Clinical outcomes were assessed using the visual analogue scale (VAS) for arm pain preoperatively and one year postoperatively. Radiological outcomes were evaluated preoperatively and one year postoperatively, including the C2-7 lordotic curve, cervical straight vertical alignment (cSVA), C7 slope, flexion range of motion (fROM) and extension range of motion (eROM).</div></div><div><h3>METHODS</h3><div>The data were analyzed using IBM SPSS (version 22, IBM Corporation) and GraphPad Prism (version 8.0.0). Descriptive analysis for continuous and categorical variables was provided, including mean, standard deviation, and percentage. Comparative analysis of perioperative factors and radiological factors before and after P-PECF was performed using a paired t-test for continuous variables. Chi-square tests and Fisher’s exact tests were performed for categorical variables. Statistical significance was defined as a p-value of less than 0.05.</div></div><div><h3>RESULTS</h3><div>Significant postoperative improvement in VAS-arm scores was noted postoperatively (p=0.00). Significant restoration of cervical lordosis, from -5.2°±3.80 preoperatively to 0.94°±7.38 postoperatively (p=0.001) was noted, while the global cervical sagittal alignment and range of motion remained unchanged.</div></div><div><h3>CONCLUSIONS</h3><div>This is the first study examining the clinical and radiological outcome of uniportal single-incision P-PECF in preoperative kyphotic spines.impact of preoperative cervical curvature on clinical and radiological outcomes after uniportal single-incision P-PECF. The results indicate that P-PECF, either single level or multilevel, effectively restores cervical lordosis in kyphotic spine patients","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100729"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672421","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":"P9. Withdrawn from program","authors":"","doi":"10.1016/j.xnsj.2025.100633","DOIUrl":"10.1016/j.xnsj.2025.100633","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100633"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672422","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":"P44. Full-endoscopic midline foraminoplasty: an alternative method for treating lumbar foraminal stenosis","authors":"Sarun Pairuchvej MD","doi":"10.1016/j.xnsj.2025.100668","DOIUrl":"10.1016/j.xnsj.2025.100668","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Lumbar foraminal stenosis is a condition in which a nerve root or spinal nerve is entrapped in a narrow lumbar foramen in degenerative lumbar spinal disorders. Several different techniques for this problem had been described, including foraminotomy, facetectomy, partial pediculectomy, fusion, and distraction instrumentation. Nowadays full-endoscopic lumbar surgery was able to decompress lumbar foramen, and prevente from proceeding to a more aggressive procedure.</div></div><div><h3>PURPOSE</h3><div>To describe the full-endoscopic lumbar foraminoplasty with midline skin incision (FEFM) and lateral recess decompression procedure and to report its clinical outcomes at the 1-year follow-up.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This is a retrospective study revealed the technique of full-endoscopic midline lumbar foraminoplasty and clinical outcomes of 30 patients up to 1 year.</div></div><div><h3>PATIENT SAMPLE</h3><div>The 30 consecutive patients between August 2021 and August 2022 with lumbar foraminal and/or lateral recess stenosis who underwent FEFM procedure were retrospectively reviewed.</div></div><div><h3>OUTCOME MEASURES</h3><div>Clinical outcomes were evaluated with visual analog scale (VAS) of back and leg pain and Oswestry Disability Index (ODI) up to 1 year postoperatively. The complications and recurrence rate were also recorded</div></div><div><h3>METHODS</h3><div>The detailed of full-endoscopic lumbar midline foraminoplasty was step-by-step demonstrated.</div></div><div><h3>RESULTS</h3><div>A total of 30 cases were included (L3–L4: 6 cases (20%), L4–L5: 23 (76.6%), L5–S1: 22 cases (73.3%). VAS was collected at preoperative, postoperative day1, 3 month, 6 month and 1 year were 9.16,1.7,1.36,1.3,1.43 and respectively. The ODI were collected at preoperative, postoperative 1month, 3 month, 6 month and 1 year were 46.63,11.5,10.66,10.46 respectively (P &lt; 0.05). The mean operation time was 88.7 minutes (45-152 minutes). The length of hospital stay was 1.21 (1-3 days). No immediate complication was identified No patient had recurrence of symptoms that required revision surgery.</div></div><div><h3>CONCLUSIONS</h3><div>FEMF is an effective procedure for the treatment of foraminal and/or lateral recess stenosis. Bilateral foraminal and lateral recess stenosis were able to be decompressed from single entry point.</div></div><div><h3>FDA Device/Drug Status</h3><div>This abstract does not discuss or include any applicable devices or drugs.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100668"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672433","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":"P46. Key factors in fluid irrigation control: a comparative study of arthroscope and monoportal scope in biportal spine surgery","authors":"Takeshi Kaneko MD, PhD","doi":"10.1016/j.xnsj.2025.100670","DOIUrl":"10.1016/j.xnsj.2025.100670","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100670"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672435","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":"20. Single-stage debridement and reconstruction with trabecular metal cage for active infectious spondylodiscitis: a retrospective cohort study","authors":"Mingchi Kuo MD ,&nbsp;Fon-Yih Tsuang MD, PhD","doi":"10.1016/j.xnsj.2025.100714","DOIUrl":"10.1016/j.xnsj.2025.100714","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Early debridement and stabilization for pyogenic spondylodiscitis allow early mobilization of the patient and prevent subsequent spinal deformity. Tantalum (Ta) trabecular metal (TM) components have several potential advantages over conventional implant materials, such as its uniformity and structural continuity, strength, low stiffness, high porosity, and high coefficient of friction. Tantalum trabecular metal also enhances the host defense mechanism by increasing leukocyte chemotaxis, phagocytosis, and the bacterial killing rate. A single-stage surgery with a tantalum trabecular metal cage combining two different approaches is sufficient to maintain vertebral stability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To evaluate the efficacy and benefits of tantalum metal cages for patients with spondylodiscitis, it is advisable to perform single-stage debridement and reconstruction with a trabecular metal cage, which allows abscess drainage and rapid mobilization, prevents deformity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;A single-stage surgery with a tantalum trabecular metal cage combining two different approaches is sufficient to maintain vertebral stability. This retrospective cohort study included 57 patients. Of these, 31 (54%) patients were treated with single-stage debridement and reconstruction with trabecular metal cages, and 26 (45.6%) patients received spine surgery without trabecular metal cages received surgery between January 2018 and March 2021 at our tertiary academic teaching hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;This was a retrospective study of spondylodiscitis patients who underwent surgery between January 2018 and March 2021 in our tertiary academic teaching hospital. We examined clinical records, radiological images, and surgical notes acquired for all patients who underwent surgical procedures for spondylodiscitis with vertebral body lysis and a propensity for deformity in our institution. Fifty-seven patients met the inclusion criteria (35 male, 22 female). The mean age at the time of treatment was 67 ± 14.08 years (range, 25–92 years). Thirty-one patients underwent reconstructive surgery with a tantalum trabecular metal cage [ZimmerR]. For comparison, we also included 26 patients who underwent surgery without tantalum trabecular metal cages in the same period.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;We examined patient demographic data, including age and sex, as well as symptoms, laboratory results, neurological examination, radiographic images, operative reports, postoperative complications, and data from clinical and radiological follow-up. We evaluated the CRP data during therapy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;In all patients, blood tests for CRP levels were obtained 3 days before surgery as baseline data. Further blood chemistry controls in all patients were performed after surgery. As blood tests were not performed on the same day for all patients,","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100714"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672442","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":"24. Evaluating the efficacy of laminoplasty combined with anterior cervical discectomy and fusion (LP-A) versus ACDF alone in optimizing neurological recovery in severe multilevel cervical spondylotic myelopathy with a narrow cervical canal","authors":"LeiPo Chen PhD, MD","doi":"10.1016/j.xnsj.2025.100718","DOIUrl":"10.1016/j.xnsj.2025.100718","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Cervical spinal stenosis with accompanying cervical myelopathy represents a significant clinical challenge, often resulting from a combination of congenital narrowing and degenerative changes such as disc protrusion, ligament hypertrophy, and kyphosis. These factors frequently lead to long-segment spinal cord compression. While multi-level anterior cervical discectomy and fusion (ACDF) remains a standard treatment for alleviating anterior compression and restoring cervical lordosis, its effectiveness is often limited in patients with severe compression or spinal cord signal changes observed on MRI. Additionally, the inability of ACDF to address posterior compressive forces in cases with a narrow spinal canal may contribute to persistent symptoms, suboptimal neurological recovery, and impaired quality of life postoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To address these limitations, combining laminoplasty with ACDF (LP-A) has been proposed as a dual approach to decompress both anterior and posterior aspects of the spinal cord in patients with multilevel cervical spondylotic myelopathy (CSM) and a narrow spinal canal. This study aims to evaluate the clinical outcomes of LP-A compared to ACDF alone, focusing on neurological recovery and complication rates. By identifying patient and surgical factors associated with poor outcomes in ACDF, we seek to establish clearer guidelines for the optimal use of LP-A, ultimately improving care for patients with multilevel severe cervical spinal stenosis and myelopathy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;Single-center retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A total of 72 patients (26 in LP-A group; 56 in ACDF group) with a 12-month follow-up were included.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Clinical outcomes: mJOA, VAS, NDI, myelopathy recovery rate; Radiographic outcomes: cervical lordosis, segmental lordosis, changes in lordosis and segmental lordosis, C2–7 SVA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Data were retrospectively reviewed from adults with CSM involving more than two-disc levels and a narrow cervical canal (&lt; 14 mm) who underwent surgery between January 2017 and June 2023. Two surgical approaches were compared: LP-A method and ACDF alone. We collected quantitative and qualitative parameters of spinal cord compression on T2WI-MRI and used statistical analysis to identify factors related to unfavorable outcomes in the ACDF group. These factors were then used to screen both the LP-A and ACDF groups, and patients meeting the criteria for poor prognosis were further analyzed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Multivariable logistic regression and ROC curve analysis identified that a compression ratio =34% and positive ISI on MRI are risk factors for a recovery rate &lt; 75% in the ACDF group. Patients meeting these criteria were selected for comparison. The LP-A group showed significantly better ou","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100718"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672445","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":"28. Paradoxical outcomes after cervical OPLL surgery: analyzing the causes of neurological recovery with persistent pain","authors":"Sunjoon Yoo MD","doi":"10.1016/j.xnsj.2025.100722","DOIUrl":"10.1016/j.xnsj.2025.100722","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;N/A&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;Cervical ossification of posterior longitudinal ligament (OPLL) surgery is widely performed using anterior, posterior, or combined approaches. The primary goal of OPLL surgery is to decompress the spinal cord, which is under compression, thereby improving neurological symptoms such as paralysis and numbness. While these surgeries often result in improved neurological outcomes, as reflected by measures like the Japanese Orthopedic Association (JOA) score, some patients continue to experience persistent or worsening pain in the neck or arms postoperatively. This study aims to analyze the underlying causes of persistent or worsening pain despite improved neurological outcomes following cervical OPLL surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A retrospective cohort analysis was conducted on 242 patients with cervical OPLL who underwent surgical intervention at our institution.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;N/A&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Patients were categorized into two groups based on postoperative pain outcomes: Group 1 (n = 208, improved visual analog scale (VAS) scores) and Group 2 (n = 34, unchanged or worsened VAS scores). The variables analyzed included demographic factors (age, sex), clinical characteristics (bone mineral density [BMD], body mass index [BMI], symptom duration, comorbid diseases), surgical parameters (surgical technique: anterior fusion, laminoplasty, posterior fusion; number of surgical levels, operative time, blood loss), and radiological factors (OPLL type, K-line classification, occupying ratio, and other radiological characteristics). Statistical analyses were performed using t-tests for continuous variables and chi-squared tests for categorical variables, with logistic regression employed to identify independent predictors of persistent or worsening postoperative pain.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Among the 242 patients analyzed, Group 2 was significantly associated with female sex (p = 0.0009), posterior fusion as the surgical technique (p = 0.00003), and higher preoperative VAS scores (p = 0.0295). Logistic regression identified female sex (OR = 2.1, 95% CI: 1.3–3.4, p &lt; 0.01), posterior fusion (OR = 3.8, 95% CI: 2.1–7.0, p &lt; 0.001), and preoperative VAS scores (OR = 1.1 per unit increase, 95% CI: 1.02–1.15, p = 0.03) as independent predictors of persistent or worsening pain.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;Persistent or worsening postoperative VAS scores in OPLL patients are significantly associated with female sex, posterior fusion and higher preoperative VAS scores. These findings suggest that tailored surgical strategies and preoperative counseling may be necessary to improve pain outcomes in this subgroup.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;FDA Device/Drug Status&lt;/h3&gt;&lt;div&gt;This abstract does not discuss or include any","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100722"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672449","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":"P4. Prevention for cage retropulsion following posterior lumbar interbody fusion","authors":"Hiroyuki Aono MD","doi":"10.1016/j.xnsj.2025.100628","DOIUrl":"10.1016/j.xnsj.2025.100628","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Cage retropulsion following posterior lumbar interbody fusion (PLIF) is a rare but serious complication requiring revision surgery in many cases.</div></div><div><h3>PURPOSE</h3><div>To investigate this complication and potential preventive measures, we retrospectively analyzed a series of PLIF procedures performed at our institution using a consistent surgical technique.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This is a retrospective study.</div></div><div><h3>PATIENT SAMPLE</h3><div>We reviewed the surgical database of our institution for PLIF procedures performed between June 2006 and May 2024 for degenerative lumbar disease. Patients who underwent PLIF and were followed up for at least six months postoperatively were included in this study.</div></div><div><h3>OUTCOME MEASURES</h3><div>Cage retropulsion was defined as posterior migration of the cage into the spinal canal, by lateral radiographs at latest follow up.</div></div><div><h3>METHODS</h3><div>All PLIF procedures were performed using a standardized technique involving bilateral facetectomy, subtotal discectomy, thorough local bone grafting (at least two strut bone blocks with two box-type cages), and pedicle screw instrumentation. Patient demographics (age, sex) and the number of fused levels were also analyzed.</div></div><div><h3>RESULTS</h3><div>A total of 918 patients were included in this study (97% follow-up rate). The cohort consisted of 316 males and 602 females with a mean age of 71 years. A total of 1,133 levels were fused (one-level: 887, two-level: 119, three-level: 6). Ninety-two PLIF procedures were performed to treat adjacent segment disease. No cases of cage retropulsion were observed.</div></div><div><h3>CONCLUSIONS</h3><div>The reported incidence of cage retropulsion after PLIF/TLIF ranges from 0.8% to 4.7%. Risk factors include older age, high body mass index, multi-level fusion, cage size and shape, endplate injury, and disc space morphology. We believe that our consistent surgical technique, particularly emphasizing thorough discectomy and bone grafting, may have contributed to the absence of cage retropulsion in our series.</div></div><div><h3>FDA Device/Drug Status</h3><div>Intervertebral disc cage (Approved for this indication).</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100628"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672517","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":"9. Detection of cervical ossification of the posterior longitudinal ligament with a Dual-Stage Attention and Multi-Scale Feature Fusion Network","authors":"Chun Tseng PhD,&nbsp;Hsiao Pang Hsuan MD","doi":"10.1016/j.xnsj.2025.100703","DOIUrl":"10.1016/j.xnsj.2025.100703","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Cervical ossification of the posterior longitudinal ligament (C-OPLL) is a significant contributor to cervical myelopathy and presents surgical challenges due to its complex pathology. Magnetic resonance imaging (MRI) is the standard modality for evaluating neural compression in cervical spine disorders. However, in cases involving ossified lesions such as C-OPLL or partially calcified herniated intervertebral discs (HIVD), MRI often falls short in precisely identifying calcified structures. Computed tomography (CT) is required for definitive diagnosis but is associated with increased radiation exposure and higher costs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;Recent advances in artificial intelligence (AI)-based imaging techniques offer a novel solution to enhance MRI’s diagnostic capability. By utilizing deep learning models to improve MRI images, AI-driven approaches could potentially reduce the reliance on CT scans, minimizing radiation exposure and associated costs while maintaining diagnostic accuracy. This study introduces a deep learning model designed to enhance MRI-based detection of C-OPLL and improve diagnostic workflows.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;We propose a deep learning framework, the Dual-Stage Attention and Multi-Scale Feature Fusion Network (DAFNet), for detecting C-OPLL using MRI. The model consists of two stages: segmentation and detection. In the segmentation stage, a dedicated segmentation model extracts the cervical spine region (C2–C6) to enhance image features. The refined images are then processed using the U-Coordinate Attention Mobile Inverted Bottleneck Convolution Network (U-CAMBNet), a model based on U-Net incorporating Agile Inverted Bottleneck Convolution (ABconv) and Coordinate Attention mechanisms. These enhancements enable improved feature extraction, allowing for precise classification and localization of ossified lesions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;N/A&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;N/A&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;We propose a deep learning framework, DAFNet, for detecting C-OPLL using MRI. The model consists of two stages: segmentation and detection. In the segmentation stage, a dedicated segmentation model extracts the cervical spine region (C2–C6) to enhance image features. The refined images are then processed using the U-CAMBNet, a model based on U-Net incorporating ABconv and Coordinate Attention mechanisms. These enhancements enable improved feature extraction, allowing for precise classification and localization of ossified lesions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Our AI-driven model demonstrated high diagnostic performance, achieving an accuracy of 0.99, precision of 0.76, recall of 0.77, and an F1 score of 0.76. These metrics surpass those of existing studies, highlighting the model’s potential to enhance MRI-based detection of C-OPLL and reduce dependence on CT imaging.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCL","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100703"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672550","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":"P37. Effect of intraoperative image-guided spinal navigation technologies on endoscopic lumbar spine surgery: a systematic review and meta-analysis","authors":"Hsu I Chou MD ,&nbsp;Yu Che Wang MD ,&nbsp;Meng Huang Wu MD, PhD","doi":"10.1016/j.xnsj.2025.100661","DOIUrl":"10.1016/j.xnsj.2025.100661","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Endoscopic lumbar spine surgery (ELSS) is a mainstream procedure that minimizes soft tissue damage, promotes faster recovery, and enhances surgical visualization. However, its adoption involves a steep learning curve, particularly with conventional fluoroscopic guidance, because it requires precise targeting of spinal pathology and navigating endoscopic anatomy. Intraoperative image-guided spinal navigation provides real-time imaging during surgery and can enhance pathology localization, optimize working channel placement, and facilitate the learning process of ELSS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;This study examined whether intraoperative image-guided spinal navigation offers perioperative and clinical advantages in ELSS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;A systematic review and meta-analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;This analysis included 1390 individuals from 19 studies comparing the outcomes of intraoperative image-guided spinal navigation and conventional C-arm fluoroscopy in ELSS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;The primary outcomes included perioperative metrics such as operation time, number of puncture attempts, cannulation time, fluoroscopy use frequency, and radiation dose. Clinical outcomes included length of stay, Visual Analog Scale (VAS) scores, and Oswestry Disability Index (ODI) scores.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;We systematically searched PubMed, Europe PMC, Scopus, Cochrane Library, and ClinicalTrials.gov for studies comparing the outcomes of intraoperative image-guided navigation with conventional C-arm fluoroscopy in ELSS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 19 studies involving 1,390 patients were included for meta-analysis. Intraoperative image-guided spinal navigation in ELSS was significantly associated with a shorter total operation time (mean difference [MD] = -11.18 min, 95% confidence interval [CI] = -14.67 to -7.70, P &lt; .01; I2 = 83%), fewer puncture attempts (MD = -2.94, 95% CI = -5.02 to -0.87, P &lt; .01, I2 = 99%), shorter cannulation time (MD = -12.59 min, 95% CI = -19.45 to -5.74, P &lt; .01, I2 = 97%), lower fluoroscopy use frequency (MD = -14.75 times, 95% CI = -24.36 to -5.13, P &lt; .01, I2 = 100%), lower radiation exposure (standardized MD = -4.18, 95% CI = -5.58 to -2.78, P &lt; .01, I2 = 93%), and shorter hospital stay (MD = -0.44 days, 95% CI = -0.84 to -0.03, P = .03, I2 = 83%) compared with C-arm fluoroscopy. No significant differences in back VAS scores, leg VAS scores, or ODI scores were observed at up to 1 year of follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;Intraoperative image-guided spinal navigation in ELSS significantly reduces the total operation time and radiation exposure for both patients and surgical staff. Additionally, it may facilitate the learning process of ELSS by reducing the number of puncture attempts and the duration of cannulation. Despite these intraoper","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100661"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672555","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}