North American Spine Society Journal最新文献

{"title":"18. Prevalence and independent predictors of mortality in patients initially diagnosed with spinal infection","authors":"Jiunhuan Liau MD","doi":"10.1016/j.xnsj.2025.100712","DOIUrl":"10.1016/j.xnsj.2025.100712","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Spinal infection had been an emerging issue worldwide due to its potential of contributing to life-threatening disease, and though rare as it was in the past, spondylodiscitis still encountering with an incidence of 0.4-2 cases per 100,000 patients each year.</div></div><div><h3>PURPOSE</h3><div>The goal of this study is to focus on the independent risk factors for spinal infection without previous surgical intervention.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A retrospective chart review revealed patients with initial admission of spinal infection whether treated by conservative antibiotics treatment or surgery thereafter, following for one year after the patients discharged from our ward, excluding the patients who had received spinal surgery or treated with antibiotics within one year before the diagnosis.</div></div><div><h3>PATIENT SAMPLE</h3><div>There were 340 patients enrolled to the study with spontaneous spondylodiscitis managed in the neurosurgery, infection, or orthopedic department during the period between January 2014 and December 2021, which had received full clinical assessment, laboratory test, radiological study, and clinical management, indicating intact medical remedies being applied based on the individuals. MRI was performed for the initial diagnosis and up to 12 months following the first hospitalization.</div></div><div><h3>OUTCOME MEASURES</h3><div>Our primary outcome is the patient mortality, secondary outcome is the LOS.</div></div><div><h3>METHODS</h3><div>We aim to issue a predictive model for the factors that potentially affect the clinical result of the patient. We had placed the patients into two groups the mortality one and the survival. Several clinical factors were considered.</div></div><div><h3>RESULTS</h3><div>Forty patients (12%) expired due to the infection within 12 months of diagnosis, of which 5 patients received surgical intervention compared to 97 patients for the survival group. Univariable logistic regression analysis demonstrated hypertension (OR: 2.44 [1.21-4.91], p=0.013), renal impairment (OR: 2.97 [1.45-6.12], p=0.003), without surgical intervention (OR: 3.35 [1.27-8.00], p=0.014), hemoglobin (OR: 0.77 [0.67-0.90], p= 0.001), CRP (OR: 1.03 [0.99-1.07], p= 0.061). while Multivariable logistic regression analysis (area under curve 0.689) demonstrated renal impairment (OR: 2.95 [1.39-6.27], p=0.005), without surgical intervention (OR: 2.99 [1.11-8.07], p=0.030) as the independent factors toward mortality for spinal infection, and furthermore, patients with BMI >30, hypertension, renal failure, poor nutrition had tend to be candidate of factors that influenced the mortality rate.</div></div><div><h3>CONCLUSIONS</h3><div>Impaired renal function and surgical intervention had been the independent predictors of one year mortality for the patients with spondylodiscitis, but still plenty of novel and potential factors were considered, including obesity, v","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100712"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672509","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":"19. Radiographic progression of lumbar degenerative spondylolisthesis: natural history and associated risk factors","authors":"Hae-Dong Jang PhD, MD , Jae Chul Lee MD, PhD , Byung-Joon Shin PhD","doi":"10.1016/j.xnsj.2025.100713","DOIUrl":"10.1016/j.xnsj.2025.100713","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>The natural history of degenerative spondylolisthesis (DS) remains poorly understood, particularly regarding its progression and related factors.</div></div><div><h3>PURPOSE</h3><div>To evaluate the radiographic progression rate of DS and its associated risk factors over a long-term follow-up period.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective comparative study.</div></div><div><h3>PATIENT SAMPLE</h3><div>We enrolled patients with DS (at L3-4, L4-5, or L5-S1) who underwent at least 5 years of follow-up. We retrospectively analyzed 76 patients with DS (80 levels) with a mean age at diagnosis of 60.2 years. The mean follow-up period was 104.8 months (range, 60.7-239.4 months).</div></div><div><h3>OUTCOME MEASURES</h3><div>We evaluated the demographics, comorbidities, smoking history, follow-up duration, and the presence of surgery (after at least 5 years of nonsurgical follow-up). The degree of DS was measured using the slippage distance (mm) and Taillard method (%) on the standing plain radiographs. Patients with a slippage increase of at least 3 mm during follow-up compared to the initial status were classified as having progression of DS.</div></div><div><h3>METHODS</h3><div>The variables were compared between two groups (progression vs nonprogression). Statistical analysis identified factors associated with progression, including age, follow-up duration, and initial spondylolisthesis severity. In addition, we performed logistic regression analyses and survival analysis to evaluate the related factors associated with DS progression.</div></div><div><h3>RESULTS</h3><div>Initial slippage distance averaged 3.9 mm (9.6% of the Taillard method), increasing to 6.7 mm (16.6% of the Taillard method) at the final follow-up. The DS progression (=3 mm increased slippage distance) occurred in 41.3% (33/80) during follow-up. When comparing the two groups, the progression group exhibited younger age at diagnosis (57.6 vs 62.1 years, p=0.009), longer follow-up (117.9 vs 95.6 months, p=0.043), and milder initial slippage (2.3 mm vs 5.0 mm, p< 0.001). Multiple logistic regression analysis identified an initial degree of DS (slippage distance) as the determinant factor, with a cutoff of < 4 mm indicating higher progression risk (AUC: 0.751, sensitivity: 81.8%, specificity: 61.7%). Patients with =4 mm initial slippage distance exhibited significantly reduced DS progression. Kaplan-Meier survivorship curve showed DS progression rates were 15% at 5 years and 54% at 10 years. Cox proportional hazards modeling confirmed significantly higher progression rates for initial slippage < 4 mm (p=0.011).</div></div><div><h3>CONCLUSIONS</h3><div>The overall rate of DS progression (=3 mm increased slippage distance compared to initial diagnosis) was 41.3% (33/80). DS progression predominantly occurred in patients with mild initial degree (< 4 mm of slippage distance), younger age at diagnosis, and longer follo","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100713"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672510","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":"P6. The application of a gait analysis system in a patient with cervical myelopathy: a case report and literature review","authors":"Wu Guan-Sian MD ,&nbsp;Yu-Ning Chen MD ,&nbsp;Hao-Hsiang Hsu MD ,&nbsp;E-Jian Lee MD, PhD ,&nbsp;Shih-Huang Tai PhD","doi":"10.1016/j.xnsj.2025.100630","DOIUrl":"10.1016/j.xnsj.2025.100630","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Cervical myelopathy is the most common cause of spinal cord dysfunction, and age-related degeneration has been well documented. Gait impairment is one of the most frequent signs of cervical myelopathy, often resulting from hyperreflexia.</div></div><div><h3>PURPOSE</h3><div>N/A</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>N/A</div></div><div><h3>PATIENT SAMPLE</h3><div>We reported a 26-year-old male presenting with lower limb spasticity and unsteady gait, and he was diagnosed with C5/6 HIVD. He received surgical intervention of discectomy and disc replacement for spinal cord decompression. We collected preoperative and postoperative 3D gait analysis parameters and ground reaction force data to identify the gait pattern associated with cervical myelopathy in young adults.</div></div><div><h3>OUTCOME MEASURES</h3><div>N/A</div></div><div><h3>METHODS</h3><div>N/A</div></div><div><h3>RESULTS</h3><div>N/A</div></div><div><h3>CONCLUSIONS</h3><div>Based on our literature review, we observed slight differences in gait patterns in our patient. Our report reviews the gait performance of cervical myelopathy patients in the current literature and attempts to analyze the gait patterns of our patient.</div></div><div><h3>FDA Device/Drug Status</h3><div>Gait analysis (Approved for this indication).</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100630"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672519","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":"7. A clinical study on the treatment of cervical OPLL with spinal endoscopic minimally invasive surgery","authors":"Xifeng Zhang MD, PhD","doi":"10.1016/j.xnsj.2025.100701","DOIUrl":"10.1016/j.xnsj.2025.100701","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;To thoroughly investigate the practical clinical outcomes and safety of using spinal endoscopic minimally invasive surgery in the treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;A retrospective analysis&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;A retrospective analysis was conducted on the clinical data of 39 patients with cervical OPLL who underwent spinal endoscopic minimally invasive surgery at our hospital from May 2022 to July 2023. Among them, 32 were male and 7 were female, with an average age of 61.8 years. There were 18 cases of single-segment surgery, 10 cases of double-segment surgery, 7 cases of triple-segment surgery, 2 cases of quadruple-segment surgery, 1 case of penta-segment surgery, and 1 case of hexa-segment surgery. Surgeries involving two or fewer segments were performed under local anesthesia, while surgeries involving three or more segments were performed under general anesthesia. Operation time, intraoperative blood loss, hospitalization time, and other indicators were recorded. The preoperative and postoperative symptoms, imaging features, Japanese Orthopaedic Association (JOA) score, visual analog score (VAS) score for pain, neck disability index (NDI) score for cervical dysfunction were recorded to evaluate the improvement of neurological function and recovery of cervical function before and after surgery. The occurrence of postoperative complications was also observed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 31 patients underwent local anesthesia and 8 patients underwent general anesthesia. Three patients with multiple segments underwent staged surgical treatment. The average operation time was 144.53±93.46 minutes, the average intraoperative blood loss was [32.91±20.10] milliliters, and the average hospitalization time was 7.06±3.82 days. Long-term follow-up after surgery showed that the preoperative JOA score was 10.25±2.06 points, the NDI score was 47.73±16.28 points, and the VAS score was 5.10±1.42 points. The postoperative final follow-up JOA score was 14.25±1.71 points, NDI score was 20.75±13.55 points, and VAS score was 2.36±1.65 points. There was a significant difference in these scores at different times compared to the preoperative scores. The postoperative JOA score improved significantly compared to the preoperative score, while both the NDI and VAS scores decreased significantly. Postoperative complications occurred in two patients with C5 nerve root traction symptoms, which improved within three months after surgery. Two patients had unsatisfactory postoperative symptom improvement and were recommended for further open surgical treatment, but they opted for conservative treatment instead.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;Spine","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100701"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672548","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":"16. Long-term Impact of Erector Spinae Plane Block on Chronic Postsurgical Pain after MIS-TLIF: A Retrospective Study","authors":"Ling-Ya Chen MD ,&nbsp;Lin Jia-Yi MD ,&nbsp;JiannHer Lin MD","doi":"10.1016/j.xnsj.2025.100710","DOIUrl":"10.1016/j.xnsj.2025.100710","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Chronic postsurgical pain (CPSP) is a significant issue following lumbar surgery, often linked to inadequate perioperative pain control. Current strategies remain unsatisfactory, increasing the risk of postsurgical low back pain. The erector spinae plane block (ESPB) has shown promise for early pain management, but its long-term effects on CPSP remain unclear.</div></div><div><h3>PURPOSE</h3><div>This study aims to investigate the efficacy of ESPB in early postoperative pain control and its impact on the development of CPSP.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients with degenerative lumbar disorders who underwent MIS-TLIF.</div></div><div><h3>OUTCOME MEASURES</h3><div>Short-term outcomes (length of stay, morphine equivalent dose) and long-term measures (1-year postoperative Sng-Pain VAS, ODI, PCS) were collected.</div></div><div><h3>METHODS</h3><div>CPSP was defined as a VAS score &gt;3 one year after surgery. Propensity score matching was applied to balance baseline differences between groups before analysis.</div></div><div><h3>RESULTS</h3><div>A total of 46 patients receiving ESPB were compared to 175 patients in the control group. In short-term outcomes, the ESPB group had significantly lower Morphine Equivalent Dose (mean 28.13 mg vs 41.83 mg, p&lt; .01) and length of stay (mean 2.45 days vs 4.03 days, p&lt; .001). For long-term outcomes, the ESPB group showed a significantly reduced incidence of CPSP in the back (OR 0.15, 95% CI 0.02-1.16, p&lt; .05) and leg (OR 0.10, 95% CI 0.01-0.80, p&lt; .01). However, there were no significant differences in 1-year postoperative Sng (soreness) VAS, ODI, and PCS scores.</div></div><div><h3>CONCLUSIONS</h3><div>ESPB is associated with a reduced incidence of CPSP after MIS-TLIF surgery, suggesting that improved perioperative pain control may provide long-term benefits.</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 100710"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672608","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":"40. Postoperative outcomes in cervical fusion for Ehlers-Danlos syndrome: lower nonunion but higher dysphagia and CSF leak rates","authors":"Logan Karlen BS ,&nbsp;Liliane Luu BS ,&nbsp;Kushagra Verma MD, MS","doi":"10.1016/j.xnsj.2025.100734","DOIUrl":"10.1016/j.xnsj.2025.100734","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Ehlers-Danlos syndrome (EDS) is a genetic connective tissue disorder that manifests as joint hypermobility, skin hyperelasticity, and vascular fragility. This systemic pathology may affect surgical outcomes, most notably cervical fusions, by potentially increasing the risks of complications namely nonunion, dysphagia and cerebrospinal fluid (CSF) leaks postoperatively. Cervical fusions are a common procedure to address degenerative spine pathologies; however, there is minimal data on postoperative outcomes in EDS patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;This study investigates the rates of nonunion, dysphagia, and CSF leak in EDS patients and non-EDS patients who underwent cervical fusion procedures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;N/A&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;The outcomes measured were the possibility of nonunion, dysphagia, and CSF between EHS and non-EHS patients in percentages associated with the risk difference and p-value.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Using TriNetX, a retrospective cohort study was performed to study the rates of postoperative nonunion, dysphagia, and CSF leak. Patients aged 18-65 were categorized into EDS (ICD-10: Q79.6, n=527) and non-EDS (n=73,130) cohorts. Those with diabetes, tobacco use, cancer, chronic steroid use, and other connective tissue disorders were excluded. ICD-10 codes for nonunion, dysphagia, and CSF leaks (M96.0, R13.10, and G96.0, respectively) were utilized as data collection parameters. ICD-10 codes must also be added to the patient’s encounter within 3 years postoperative to be included in the study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;The nonunion rate is notably lower in EDS patients (11.195%) compared to non-EDS patients (16.663%) (p=0.0008). Additionally, the occurrence of dysphagia was seen to be higher in EDS patients (11.006%) when compared to non-EDS patients (7.201%) (p&lt;0.0008). Finally, CSF leak in EDS patients (3.605%) is higher than non-EDS patients (0.655%) (p&lt;0.0001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;EDS patients who underwent cervical fusion procedures had notably lower nonunion rates than non-EDS patients, regardless of the abnormalities within their connective tissues. This is potentially a result of external influences akin to surgeon selection bias, innovative fixation approaches, or innate differences in bone metabolism associated with joint hypermobility. In contrast, EDS patients exhibited significantly higher rates of dysphagia and CSF leaks, emphasizing the impact EDS pathology has on surgical outcomes. Increased dysphagia in EDS patients may be connected to their autonomic dysfunction, as their joint hypermobility tends to manifest vagus nerve constriction, resulting in swallowing and gastrointestinal motility deficits. Interestingly, dysphagia rates among EDS patients appear comparable between cervical and lumbar fusions, de","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100734"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672415","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":"45. Diffuse idiopathic skeletal hyperostosis is a risk factor of new adjacent compression fracture after percutaneous vertebroplasty","authors":"Yu-Cheng Yao MD ,&nbsp;Po Wei Chen MD ,&nbsp;Po-Hsin Chou MD ,&nbsp;Bruce H Lin MD ,&nbsp;Shih-Tien Wang MD","doi":"10.1016/j.xnsj.2025.100739","DOIUrl":"10.1016/j.xnsj.2025.100739","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory spinal ossification condition that limits mobility and can cause stress concentration at fractures, leading to pseudoarthrosis or adjacent fractures. Nevertheless, limited research has specifically examined the relationship between DISH and adjacent fractures</div></div><div><h3>PURPOSE</h3><div>This study aims to examines the prevalence of new adjacent fractures following percutaneous vertebroplasty (PVP) in patients with and without DISH as a primary outcome. The secondary outcome is to identify additional risk factors associated with the development of new adjacent fractures after PVP.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 238 patients with single-level TL spine osteoporotic fractures who underwent PVP were analyzed.</div></div><div><h3>OUTCOME MEASURES</h3><div>Radiographic parameters, cement leakage, adjacent fractures and any revisions.</div></div><div><h3>METHODS</h3><div>We included patients with single-level TL spine osteoporotic fractures who underwent PVP between 2016 and 2021. Demographic, surgical, and radiographic data were collected, and follow-up X-rays were obtained for a minimum of 12 months. Adjacent fractures were defined as new vertebral fractures occurring at one level above or below the PVP level.</div></div><div><h3>RESULTS</h3><div>Among 238 cases analyzed, 59 (24.8%) had DISH. Adjacent fractures occurred in 27.3% of cases, with three instances requiring revisions due to neurological deficits. Patients with adjacent fractures were older, had more diabetes, and higher rates of DISH (38.5% vs. 19.7%, p=0.003). Identified risk factors included older age, DISH, type C cement leakage, and preoperative wedge angle. Patients with DISH are 2.3 times more likely to develop adjacent fractures compared to those without DISH. Furthermore, most adjacent fractures in DISH patients occurred when the DISH-PVP distance was = 2 levels (92.3%, p=0.007), with an overall incidence of 55% among DISH patients.</div></div><div><h3>CONCLUSIONS</h3><div>Older age, DISH, type C cement leakage, and preoperative wedge angle were significant risk factors for adjacent fractures post-PVP. These findings assist clinicians in patient discussions and highlight the potential benefits of implementing prophylactic strategies for high-risk individuals.</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 100739"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672417","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":"21. Comparison of spinopelvic parameters of multilevel TLIF and 360 lumbar fusion adult spinal deformity procedures via UNiD technology","authors":"Taha Khalilullah BS,&nbsp;Ripul R. Panchal DO, FACS","doi":"10.1016/j.xnsj.2025.100715","DOIUrl":"10.1016/j.xnsj.2025.100715","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;The goal of surgical treatment for patients with ASD is to achieve sagittal and coronal balance, relieve axial pain, and achieve fusion. Attaining normative ranges of spinopelvic parameters, such as sagittal vertical axis (SVA), pelvic incidence/lumbar lordosis mismatch (PI-LL), and pelvic tilt (PT) has exhibited improved patient outcomes. Prior studies employing patient-specific rods, through UNiD Artificial Spine Intelligence, have demonstrated a statistically significant correlation between postoperative and predicted spinopelvic alignment with correction of SVA, PI-LL, and lumbar lordosis (LL) maintained at 2 years postoperatively. However, the most optimal surgical approach to attain optimal alignment remains inconclusive.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To compare the correction of spinopelvic parameters of patients who have undergone adult spinal deformity (ASD) surgery with either transforaminal lumbar interbody fusion (TLIF) approach or a posterior approach and anterior lumbar interbody fusion (ALIF+PSF) by employing artificial intelligence (AI) guided preoperative surgical plan to generate patient-specific UNiD rods.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;Single&lt;strong&gt;-&lt;/strong&gt;center retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;The study cohort included patients who underwent spinal deformity surgery with patient specific UNiD rods with either a TLIF or ALIF + PSF approach.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Sagittal spinopelvic parameters sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence and lumbar lordosis mismatch (PI-LL) measured by EOS scans preoperatively, during planning, and postoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Fourteen patients underwent ASD surgery (TLIF = 9, ALIF+PSF = 5). Independent 2-sample t&lt;strong&gt;-&lt;/strong&gt;tests of (Postoperative - Planned) (Postoperative - Preoperative) were analyzed for all spinopelvic parameters (p&lt; 0.05). Each variable was similarly compared with univariate analysis for ALIF and TLIF groups. Postoperative data analyzed at 1 year postoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;The TLIF group reported ideal alignment with PT &lt; 20° and PI-LL &lt; 10° in 89% and 78% of the population respectively. The ALIF+PSF group reported ideal alignment with PT &lt; 20° and PI-LL &lt; 10° in 80% of the population (p = .891). The TLIF group presented with significantly greater lordosis correction compared to the ALIF group from the postoperative-preoperative perspective (12.89 ± 11.62 vs 5.2 ± 3.97) (p = .049). There was no statistical difference in PT, PI-LL and PI. Despite smaller spinopelvic differences (Postoperative-Planned) in the ALIF-PSF group, statistical significance was also not present.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;In patients undergoing ASD surgery with patient-specific UNiD rods, the TLIF group revealed a statistically greater correction of lordosis tha","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100715"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672443","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":"P40. Endoscopic transverse processectomy for treatment of bertolotti syndrome","authors":"Ashton Huppert Steed BS ,&nbsp;Kenneth Nwosu MD","doi":"10.1016/j.xnsj.2025.100664","DOIUrl":"10.1016/j.xnsj.2025.100664","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Bertolotti Syndrome (BS) is a unique, and often missed, cause of chronic back pain due to pseudoarticulation in lumbosacral transitional vertebrae (LSTV). While transverse processectomy can alleviate mechanical stress and pain, reports of its treatment using endoscopic techniques remain rare.</div></div><div><h3>PURPOSE</h3><div>N/A</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Case Report</div></div><div><h3>PATIENT SAMPLE</h3><div>A 69-year-old female presented with left-sided low back pain exacerbated by activity, significantly impairing her quality of life (QOL) and activities of daily living (ADLs). Preoperative Oswestry Disability Index (ODI) was 60%, indicating severe disability, and her visual analog scale (VAS) pain score averaged 6/10. Lumbar CT revealed a left L5 transverse process-S1 sacral ala pseudoarticulation. A diagnostic block resulted in 100% symptom relief. After failing extensive conservative treatments, the patient elected to undergo endoscopic left L5-S1 transverse processectomy.</div></div><div><h3>OUTCOME MEASURES</h3><div>VAS score, ODI, EQ-5D-5L, and surgical outcome including complications.</div></div><div><h3>METHODS</h3><div>Surgical Technique: Using imaging navigation, a uniportal endoscopic approach was employed to access the left L5-S1 pseudoarticulation. The caudal half of the left L5 transverse process was resected with a high-speed burr and Kerrison rongeurs. Adequacy of decompression was confirmed intraoperatively through manual palpation and post-decompression intraoperative CT imaging, ensuring complete removal of the pseudoarticulation.</div></div><div><h3>RESULTS</h3><div>Postoperatively, the patient experienced no complications and reported complete resolution of symptoms. At six weeks, her VAS pain score was 0, and sustained through six months of follow-up. By six months, her ODI was 0, and her EQ-5D-5L score was 1, reflecting full restoration of function and QOL.</div></div><div><h3>CONCLUSIONS</h3><div>Endoscopic transverse processectomy demonstrates potential as a safe, ultra-minimally invasive surgical option for BS patients unresponsive to non-surgical treatments. Further research is necessary to validate its efficacy in larger patient cohorts.</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 100664"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672557","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":"P21. Revision cervical disc arthroplasty without fusion: a novel “leverage” technique for artificial disc removal","authors":"Sheng Jia Huang MD","doi":"10.1016/j.xnsj.2025.100645","DOIUrl":"10.1016/j.xnsj.2025.100645","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Cervical disc arthroplasty (CDA) is an established motion-preserving procedure for cervical degenerative disc disease. However, revision CDA is challenging and often requires fusion or posterior decompression techniques.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;We present a case of revision CDA performed without fusion due to previous incomplete decompression of the uncovertebral joints. This report details a novel “leverage” technique used during revision CDA, providing a comprehensive step-by-step description of the procedure. To our knowledge, this is the first report documenting the entire process of revision CDA without fusion.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;N/A&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A 54-year-old female, with no significant medical history, underwent primary CDA at C5/6 and C6/7 for neck pain radiating to the right upper limb, attributed to herniated intervertebral discs (HIVD) at these levels. Despite the procedure, her symptoms persisted for one year. Follow-up cervical spine computed tomography (CT) revealed bilateral foraminal stenosis due to incomplete decompression of the uncovertebral joints at C5/6 and C6/7, which was the indication of revision CDA.&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;The patient underwent revision CDA over C5/6 and C6/7 using the Synthes Prodisc-C Vivo prosthesis. After adequate exposure, the anterior aspect of the previously implanted artificial disc was excised using a high-speed diamond burr (Medtronic Legend® Metal Cutter MC30, 3 mm). The anterior gap was sufficiently widened to facilitate the removal of the core from its socket. Following core extraction, a Freer elevator was employed to disengage the remaining metal components using “leverage” technique, preserving the endplates for the placement of a new artificial disc after thorough decompression of the uncovertebral joints. Postoperatively, the patient experienced significant symptomatic relief while maintaining cervical motion. At the two-year follow-up, cervical spine radiographs confirmed stable prosthesis positioning without evidence of neurological deterioration, subsidence, or malalignment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Standard revision strategies for failed CDA typically involve prosthesis removal followed by fusion, posterior foraminotomy, or laminectomy with fixation. In this case, we performed a revision CDA by “disrupting” the previous artificial disc rather than sacrificing the endplates, allowing for optimal preservation of bony structures. This technique minimizes bone loss and reduces the risk of postoperative subsidence. However, the applicability of the “leverage” technique depends on specific factors, including the reason for revision and the type of the previously implanted disc. This approach is particularly suited for cases involving heterotopic ossification or incomplete initial decompression. Additiona","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100645"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670169","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}