North American Spine Society Journal最新文献

{"title":"Use of awl for screw pilot hole creation increases strength of anterior cervical discectomy and fusion plate constructs in biomimetic model","authors":"Andrew B. Rees MD ,&nbsp;Katherine Drexelius MD ,&nbsp;Rebecca DeCarlo MD ,&nbsp;Austin J. Allen MD ,&nbsp;Samuel J. Chewning MD ,&nbsp;Michael A. Bohl MD","doi":"10.1016/j.xnsj.2025.100796","DOIUrl":"10.1016/j.xnsj.2025.100796","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cervical discectomy and fusion (ACDF) hardware failure can have serious complications for patients. Various advances in screw and plate design have increased the pullout strength of ACDF constructs, yet failure with screw pullout still occurs. One previously unexplored factor influencing pullout strength is the method of screw pilot hole creation. We aimed to compare pullout strength, stiffness, and strain of ACDF constructs in 3D-printed cervical spine vertebral bodies based on pilot hole creation with a drill versus an awl.</div></div><div><h3>Methods</h3><div>Spine models were 3D-printed into uniform testing blocks to mimic cervical vertebrae, according to previously validated methods. Four pilot holes per block for eventual screw placement were made with a 3 mm drill (n = 20) or a 3mm awl (n = 20). Using a biomimetic model, a plate and four 3.5 mm screws were affixed to each testing block. Pullout strength, stiffness, and strain of the final construct were collected. Maximum axial pullout forces and forces over distance curves were recorded for statistical analysis.</div></div><div><h3>Results</h3><div>Pullout strength of the construct was significantly greater in the awl group compared to the drill group (mean force during load-to-failure 810.8 N vs. 765.6 N, respectively; p = .002). No significant difference was observed in the stiffness (p = .434) or strain (p = .526) of the constructs based on method of pilot hole creation.</div></div><div><h3>Conclusions</h3><div>This study aimed to evaluate the influence of pilot hole creation technique on biomechanical characteristics of ACDF constructs in a high fidelity 3D-printed biomimetic model. The results—favoring creation of pilot holes with an awl—highlight a biomechanical benefit of a previously unexplored surgical technique for the placement of ACDF screws. This may guide surgeons in choosing the optimal surgical technique to improve the strength of an ACDF construct, potentially minimizing complications and improving fusion rates.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100796"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268456","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 predictive value of the global alignment and proportion (GAP) score for mechanical complications following adult spinal deformity surgery: A systematic review and meta-analysis","authors":"Vinicius Ricieri Ferraz MD ,&nbsp;Guilherme Santos Piedade MD, PhD ,&nbsp;Carlos R. Goulart MD ,&nbsp;Maria Fernanda Ricieri Ferraz Franco de Souza MD ,&nbsp;Marcelo Ochoa Coelho de Souza Furlan MD ,&nbsp;Philippe A. Mercier ,&nbsp;Tobias A. Mattei MD","doi":"10.1016/j.xnsj.2025.100816","DOIUrl":"10.1016/j.xnsj.2025.100816","url":null,"abstract":"<div><h3>Background</h3><div>Mechanical complications (MCs) remain a significant challenge in adult spinal deformity (ASD) surgery. The global alignment and proportion (GAP) score, a pelvic incidence-based metric, was introduced to predict the risk of postoperative MCs by assessing the proportionality of spinopelvic alignment.</div></div><div><h3>Methods</h3><div>We systematically reviewed the evidence on the predictive validity of the GAP score and its modifications with regard to postoperative MCs (eg, proximal junctional kyphosis/failure, rod fracture, or implant failure) and patient-reported outcomes in adult spinal deformity (ASD) surgery. A systematic search of PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library was conducted for studies published from January 2017 to July 2025. A proportion meta-analysis regarding the occurrence of MCs was performed using those articles that divided the patients in the three original GAP categories.</div></div><div><h3>Results</h3><div>A total of 32 studies met the inclusion criteria, encompassing over 5,700 patients. The reported incidence of MCs varied from 17.6% to 61%. The predictive accuracy of the GAP score was inconsistent, with reported Area Under the Curve (AUC) values for predicting MCs ranging from a low of 0.53 to a moderately accurate 0.86. A meta-analysis found a significant association, with an odds ratio (OR) of 2.65 for MCs in severely disproportioned patients. However, the score's validity was diminished in specific cohorts, particularly for circumferential minimally invasive surgery (cMIS). Recent evidence demonstrates that the GAP score's predictive power is enhanced when combined with biological factors. The modified GAPB score, which incorporates Body Mass Index and Bone Mineral Density, demonstrated superior predictive accuracy (AUC=0.885 vs. 0.798). Machine learning models utilizing these multifactorial inputs achieved predictive accuracies over 73%.</div></div><div><h3>Conclusions</h3><div>The predictive value of the GAP score with regard to MCs in ASD surgery is moderate but context-dependent. Its utility as a stand-alone predictor is limited, and the current evidence in the scientific literature supports the use of multifactorial predictive models, such as the GAPB score, and the application of machine learning to integrate patient-specific biological and biomechanical factors.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100816"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520080","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":"Safety and functional evaluation of a synthetic lamina cover that replaces lost autologous spinal bone after laminectomy, in a sheep and human study","authors":"Cheng-Kuang Chen MD ,&nbsp;Ming-Fu Chiang MD, PhD ,&nbsp;Yu-Cheng Yao MD ,&nbsp;Ming-Chau Chang MD ,&nbsp;Axel H. Schönthal PhD ,&nbsp;Thomas C. Chen MD, PhD","doi":"10.1016/j.xnsj.2025.100795","DOIUrl":"10.1016/j.xnsj.2025.100795","url":null,"abstract":"<div><h3>Background</h3><div>Laminectomies involve removal of the lamina, usually to relieve pressure on the spinal cord. We are developing a synthetic lamina cover (SLC) that can replace the resected bone, functioning as an artificial shield, with the objective to minimize common postsurgical risks associated with laminectomies. The SLC is designed to be affixed to a common pedicle screw fixation system.</div></div><div><h3>Methods</h3><div>Lumbar laminectomies with posterior fusions were performed in 6 sheep and 30 human patients. Both cohorts were separated into 2 groups, where 1 group received the SLC to replace the lamina, whereas the other group did not. Otherwise, postsurgical care and medical attention were the same in both groups. After 26 weeks, the sheep were euthanized and histopathological and histomorphometrical evaluation of spine sections was performed. Human patients were followed for up to 6 months, and functional recovery was evaluated using the Oswestry Disability Index (ODI) questionnaire.</div></div><div><h3>Results</h3><div>In sheep, the overall host tissue response was minimal, without any signs of irritation, inflammation, or aberrant changes potentially caused by the SLC. Human patients that had received the SLC reported better and faster functional recovery (p&lt;.05) than the group without the SLC. Neither patient group experienced complications from surgery.</div></div><div><h3>Conclusions</h3><div>Application of the SLC was safe and showed benefit as a shield to replace the autologous spinal lamina postlaminectomy. In its presence, functional recovery not only was faster, but also overall more pronounced.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100795"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362759","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":"Utility of the L1 pelvic angle (L1PA) for assessment of sagittal alignment of the lumbar spine following short segment fusion: Comparison to segmental measures","authors":"Zvipo M. Chisango BA ,&nbsp;Catherine B. Hurley MS ,&nbsp;Gabriel A. Gonzalez BS ,&nbsp;Michael J. Farias BS ,&nbsp;Nicolas L. Carayannopoulos BS ,&nbsp;Joseph P. Carroll BS ,&nbsp;Manjot Singh MD ,&nbsp;Jinseong Kim MD ,&nbsp;Bryce A. Basques MD ,&nbsp;Bassel G. Diebo MD ,&nbsp;Alan H. Daniels MD","doi":"10.1016/j.xnsj.2025.100798","DOIUrl":"10.1016/j.xnsj.2025.100798","url":null,"abstract":"<div><h3>Objective</h3><div>The Lumbar Pelvic Angle (L1PA) was introduced as a convenient intraoperative and postoperative measure of sagittal alignment. However, the utility of L1PA for short segment lumbar fusions remains incompletely understood. This study investigates the relationship between L1PA and segmental parameters of spinal alignment for short segment lumbar fusions.</div></div><div><h3>Methods</h3><div>This retrospective analysis was conducted on adult patients with degenerative conditions undergoing primary spinal fusion surgery between L4 and S1. Patients with &lt;5° change in L1PA from pre- to postoperative measurements were stratified into 2 groups: those (1) achieving &gt;35° of regional lordosis at L4-S1 postoperatively and (2) those with &gt;5% change in Lumbar Distribution Index (LDI). Spinopelvic parameters were compared between preoperative and postoperative measurements.</div></div><div><h3>Results</h3><div>The study cohort included 539 patients, of which 360 (66.8%) had an L1PA change less than &lt;5° pre- to postoperatively. Patients in both Group 1 and 2 had significant increases in the L5-S1 segmental angle (both p&lt;.001) without a significant change at the L4-L5 segment. In Group 2, there was a significant increase in PI-LL mismatch (p&lt;.001). In both groups there was a significant increase in L4-S1 lordosis, a relaxation in L1-L4 lordosis (both p&lt;.001), and no significant change in total LL.</div></div><div><h3>Conclusions</h3><div>This investigation assessed L1PA in over 500 patients undergoing lumbar fusion between L4 and S1 and found that despite value to the measure, important changes to spinal shape and segmental alignment may occur even in the face of Δ L1PA &lt;5°. As such, L1PA serves as a potentially useful adjunct to clinical assessment and radiographic measurement in lumbar degenerative fusion but should not serve as a stand-alone measurement.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100798"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325758","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":"Implementation of artificial intelligence (AI) in ASD treatment1","authors":"Kyriakos D. Chatzis BS,&nbsp;Peter Tretiakov BS,&nbsp;Peter G. Passias MD","doi":"10.1016/j.xnsj.2025.100787","DOIUrl":"10.1016/j.xnsj.2025.100787","url":null,"abstract":"<div><h3>Background</h3><div>Adult spinal deformity (ASD) surgery remains one of the most complex and complication-prone areas of spine care, with significant variability in outcomes and high complication rates. Recent advances in artificial intelligence (AI) have shown to be promising tools to address these challenges by improving planning, prediction, and personalization. This narrative review explores the role of AI across the surgical workflow for ASD, from preoperative decision-making to intraoperative execution and postoperative care.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive narrative review of current literature and technologies related to AI in ASD surgery. Focus areas included evidence synthesis, predictive analytics, automated radiographic assessment, intraoperative navigation, patient-specific implants, and digital patient engagement. We also present a representative case example of AI-assisted deformity correction to illustrate practical clinical application.</div></div><div><h3>Results</h3><div>AI tools have demonstrated strong potential in improving accuracy and efficiency across various domains. Machine learning algorithms outperform traditional statistical models in predicting complications, length of stay, and functional outcomes. Automated radiographic platforms reliably reproduce spinal alignment measurements and support surgical planning. Personalized instrumentation has been associated with improved alignment fidelity. Lastly, Intraoperative AR/VR platforms and AI-enhanced robotics are helping to standardize execution and reduce variability.</div></div><div><h3>Conclusions</h3><div>AI is redefining the landscape of ASD surgery through its ability to enhance decision-making, reduce variability, and enable personalized, data-driven care. While widespread adoption requires ongoing validation and integration, current evidence supports the clinical utility of AI-assisted strategies in improving alignment outcomes and surgical safety. This review highlights the growing potential of AI to serve as a cornerstone of precision spine surgery.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100787"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325761","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":"Long-term outcomes of total lumbar disc prosthesis: Sustained pain relief","authors":"Vicente Vanaclocha PhD MD ,&nbsp;Pablo Jordá-Gómez PhD MD ,&nbsp;Nieves Saiz-Sapena PhD MD ,&nbsp;Juan Martínez-Leon PhD MD ,&nbsp;Leyre Vanaclocha MD","doi":"10.1016/j.xnsj.2025.100813","DOIUrl":"10.1016/j.xnsj.2025.100813","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar degenerative disc disease (DDD) is a leading cause of chronic low back pain and work-related disability. Total lumbar disc prosthesis offers motion preservation and may reduce adjacent segment degeneration compared to fusion. However, long-term functional and occupational outcomes remain underreported.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 130 patients (mean age 37.3±7.9 years; 71.54% male) who underwent total lumbar disc replacement between 2008 and 2020. Patients were assessed preoperatively and at a mean follow-up of 13.88 years using Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and occupational status. Statistical analyses included ANOVA, regression modeling, and correlation analysis.</div></div><div><h3>Results</h3><div>VAS scores improved significantly (back: 8.6±1.7 to 1.6±2.4; leg: 7.3±2.9 to 1.1±0.9; p&lt;.001). ODI decreased from 46.12±7.3 to 27±9.3. At final follow-up, 73.84% of patients returned to their original job, 13.84% transitioned to alternative roles, and 3.07% were pensioned. Patient satisfaction was high (77.69% rated outcome as 10/10). Complication and reoperation rates were low (3.08% and 12.31%, respectively), with no prosthesis revisions.</div></div><div><h3>Conclusions</h3><div>Total lumbar disc prosthesis provides durable pain relief, functional improvement, and high rates of occupational reintegration. These findings support its use as a motion-preserving alternative to fusion in appropriately selected patients.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100813"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466435","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":"Cervical myelopathy symptom severity, posterior-based cervical surgical approach, and lower body mass index are associated with postoperative delirium: A retrospective observational study","authors":"Catherine R. Olinger MD ,&nbsp;Pei-fu Chen MD, PhD ,&nbsp;Sarah J. Lee BS ,&nbsp;Daniel F. Waldschmidt BSN ,&nbsp;Reagan A. Grieser-Yoder BS ,&nbsp;Lauren G. Havertape BA ,&nbsp;Debra J. O’Connell-Moore MBA ,&nbsp;Lanchi B. Nguyen BS ,&nbsp;Jill D. Corlette MS ,&nbsp;Bradley J. Hindman MD ,&nbsp;Matthew A. Howard III MD","doi":"10.1016/j.xnsj.2025.100789","DOIUrl":"10.1016/j.xnsj.2025.100789","url":null,"abstract":"<div><h3>Background</h3><div>Cervical spine surgery is often performed to alleviate symptoms of cervical spondylotic myelopathy (CSM) and/or cervical radiculopathy (CR). Although postoperative delirium (POD) is common after cervical spine surgery, it is not known if CSM, CSM symptom severity, and/or surgical approach (anterior vs. posterior) affect POD incidence or severity. The purpose of this study was to determine 1) If the preoperative diagnosis of CSM was an independent risk factor for POD incidence or severity; 2) Among patients who had CSM, which patient and intraoperative characteristics, including CSM symptom severity, were independently associated with POD incidence or severity.</div></div><div><h3>Methods</h3><div>A retrospective search of the electronic medical record of a tertiary academic medical center identified patients undergoing cervical spine surgery. Patients who had: 1) POD assessments within the first 7 days of surgery (Delirium Observation Screening Scale [DOSS]; and 2) preoperative clinical diagnoses of CSM or CR were selected for analysis. Patient and surgical characteristics were extracted from the medical record, including CSM symptom severity (modified Japanese Orthopedic Association [mJOA] scores). Characteristics that were univariately associated with POD were included in multivariable models to determine characteristics that were independently associated with POD incidence and severity.</div></div><div><h3>Results</h3><div>In the entire cohort (755 patients), POD incidence was (139/755) 18.4%, and 4 characteristics were independently associated with greater POD incidence: posterior-based surgical approach (adjusted odds ratio [aOR]=2.27, p=.0005), greater American Society of Anesthesiologists (ASA) class (aOR=1.66, p=.0432), obstructive sleep apnea (OSA) (aOR=1.76, p=.0280), and depression (aOR = 2.20, p=.0138). In this cohort, POD severity was independently associated with posterior-based surgical approach (Beta coefficient=0.4346, p=.0000) greater ASA class (Beta coefficient=0.1648, p=.0326), and lower preoperative hemoglobin (Beta coefficient=-0.0663, p=.0014). In the CSM subgroup (<em>n</em> = 629), POD severity was independently associated with posterior-based surgical approach (Beta coefficient=0.5527, p=.0002), OSA (Beta coefficient=0.4650, p=.0100), lower body mass index (BMI) (Beta coefficient = -0.0246, p=.0194) and lower (more severe) mJOA scores (Beta coefficient = -0.0465, p=.0197).</div></div><div><h3>Conclusions</h3><div>For patients who have CSM, more severe symptoms (lower mJOA scores) and lower BMI were independently associated with greater POD severity. In addition, posterior-based surgical procedures were independently associated with greater POD incidence and severity.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100789"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362866","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":"Prospective evaluation of mechanomyography versus triggered electromyography for intraoperative assessment of cortical breaches during instrumented lumbar surgery","authors":"Harshit Arora MBBS ,&nbsp;Hassan Darabi MD ,&nbsp;Francis Farhadi MD, PhD","doi":"10.1016/j.xnsj.2025.100797","DOIUrl":"10.1016/j.xnsj.2025.100797","url":null,"abstract":"<div><h3>Introduction</h3><div>Pedicle screws are essential in spinal arthrodesis surgeries but pose potential risks due to their proximity to neural and vascular structures. Traditionally, tEMG has been used to assess screw placement, though its invasiveness, low specificity, and cost limit its applicability. MMG may offer a promising alternative for routine clinical use. Our study compares the relative accuracy of triggered electromyography (tEMG) versus mechanomyography (MMG) in detecting intraoperative cortical bony breaches.</div></div><div><h3>Methods</h3><div>Using an equivalence trial design, consecutive patients undergoing posterior lumbosacral spinal arthrodesis were prospectively enrolled at a single institution. Pedicle screw trajectories were queried in real-time using combined tEMG and MMG-based evaluations at pretap, tap, post-tap and postscrew placement stages. Intraoperative computed tomography (CT) scans were performed to evaluate pedicle screw trajectories according to the Gertzbein-Robbins (GR) classification. Receiver operating characteristic curve analysis were performed to evaluate the relative accuracy of tEMG and MMG threshold potentials to detect cortical breaches. Pain and quality-of-life outcomes were evaluated up to 3 months postoperatively.</div></div><div><h3>Results</h3><div>A total of 303 consecutive lumbar pedicle screw trajectories were included (61 participants; mean age: 61.3 ± 9.7 years; male-to-female ratio: 32:29). 7 grade C-E GR cortical breaches were identified in a total of 5 subjects, with 5 (71.4%) classified as Grade C and 2 (28.6%) as Grade E. Baseline demographics were comparable between the breach and nonbreach groups. The tEMG and MMG AUC values determining predictive ability for breach detection were comparable for the pretap (AUC 0.82 vs. 0.80, p = .442) and post-tap stages (AUC 0.71 vs. 0.79, p = .380). Follow-up pain and functional assessments revealed significant improvements at last follow-up.</div></div><div><h3>Conclusion</h3><div>tEMG and MMG demonstrate high and equivalent accuracy to detect cortical breaches intraoperatively. Adequate utilization of either technique may enhance pedicle screw placement accuracy, reducing intraoperative complications and improving surgical outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100797"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325759","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":"Robotic-assisted bilateral lumbar pars fracture endoscopic debridement and direct repair as treatment for lumbar radiculopathy: A case report","authors":"S. Garg BS ,&nbsp;Y. Wang MD ,&nbsp;N. Lehman MSPA ,&nbsp;M. Gallizzi MD, MS","doi":"10.1016/j.xnsj.2025.100823","DOIUrl":"10.1016/j.xnsj.2025.100823","url":null,"abstract":"<div><h3>Background</h3><div>Management of lumbar spondylolysis in the athletic population can be successful with conservative means, however surgical intervention may be required for fractures presenting with radiculopathy. Direct repair with intralaminar screws is a commonly used technique which has been described previously with various rates of success. Technological advancements now allow minimally invasive direct pars repair with robotic assistance as a viable option. Robotic assistance for instrumentation and stabilization of the fracture can also be combined with endoscopic spine techniques, to debride the fracture site, to effectively treat this issue<em>.</em></div></div><div><h3>Methods</h3><div>A 16-year-old giant slalom skier presented with low back pain and associated bilateral L5 radiculopathy to our facility. Using MRI and CT, they were diagnosed with bilateral L5 pars interarticularis fractures with bony edema and with subtle hypermobile retrolisthesis in combination with bilateral foraminal stenosis at the L5-S1 disc space. Due to patient’s active sports participation and continued symptoms despite rest, physical therapy, chiropractic therapy, and bracing, the patient decided to undergo elective, outpatient, bilateral robotic-assisted percutaneous endoscopic debridement of the pars fractures through 7-mm skin incisions, and bilateral percutaneous intralaminar fixation of the pars fractures with pedicle screws through 1.5-cm skin incisions.</div></div><div><h3>Results</h3><div>In the immediate postoperative period, the patient reported complete resolution of mechanical low back pain and associated bilateral radiculopathy. The patient had resolution of incisional low back pain by 6 weeks postoperatively and demonstrated stable healing with no evidence of hardware failure radiographically through their 6-month postoperative x-rays. This 16-year-old was able to return to prior level of sport and competition at 3-months postoperatively.</div></div><div><h3>Conclusions</h3><div>This novel minimally invasive robotic-assisted percutaneous approach for lumbar spondylolysis fracture debridement and direct repair is a suitable option for nonhealing pars fracture with radiculopathy in high performing active adolescent patients.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100823"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681369","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":"Development and reliability of a systematic method to evaluate lumbar paraspinal muscle size and quality in computed tomography images","authors":"Cristiane R. Carlesso PT, PhD ,&nbsp;Jaclyn M. Sions PT, DPT, PhD ,&nbsp;William J. Anderst PhD ,&nbsp;Charity G. Patterson PhD ,&nbsp;Rafaela M. Barbosa PT ,&nbsp;Luiza P. Weissmann ,&nbsp;Tom Gale MS ,&nbsp;Michael J. Schneider DC, PhD ,&nbsp;Sara R. Piva PT, PhD","doi":"10.1016/j.xnsj.2025.100822","DOIUrl":"10.1016/j.xnsj.2025.100822","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar paraspinal muscles (LPMs) are critical for spinal stability, and their morphological alterations are associated with chronic low back pain (cLBP). Computed tomography (CT) offers a feasible alternative to magnetic resonance imaging for assessing LPM morphology; however, its broader use has been hindered by inconsistent measurement methods and limited reliability data. This study aimed to describe a systematic CT-based method for evaluating LPM cross-sectional area (CSA) and attenuation (MA) in adults with cLBP and to determine its intra and inter-examiner procedural reliability.</div></div><div><h3>Methods</h3><div>High-resolution CT images were used to analyze bilateral LPMs: erector spinae (L1–L5), multifidi (L1–S1), psoas (L3), and quadratus lumborum (L3). Two trained examiners independently performed image selection and analysis, blinded to subject identity and prior results. Procedural reliability was quantified using intraclass correlation coefficients (ICC_2,1) with 95% confidence intervals (CI). Mean ICCs&lt;0.50 indicated poor, 0.50–0.74 moderate, 0.75–0.90 good, and &gt;0.90 excellent procedural reliability.</div></div><div><h3>Results</h3><div>Thirty-six participants (40% female; age 48±15 years; BMI 27.2±4.3 kg/m²) with moderate disability were included. Intraexaminer procedural reliability was excellent for CSA of the erector spinae, psoas, and quadratus lumborum (ICC point estimates &gt;0.916, &gt;0.959, and &gt;0.962, respectively); and good to excellent for multifidi CSA (ICC point estimates: 0.770–0.916), with greater variability at L1 and L2. Inter-examiner procedural reliability was excellent for CSA of the erector spinae, psoas, and quadratum lumborum (ICC point estimates &gt;0.916, &gt;0.946, and &gt;0.941, respectively); and moderate to excellent for multifidi CSA (ICC point estimates: 0.593–0.945), with lower reliability at upper lumbar levels. Intra and inter-examiner procedural reliability for MA was excellent across all LPMs.</div></div><div><h3>Conclusions</h3><div>The presented CT-based protocol provides a standardized and reproducible method for assessing LPM CSA and MA in adults with cLBP. Demonstrated high procedural reliability—including image selection and analysis—supports its use for consistent evaluation of LPM morphology in both clinical and research contexts, particularly where muscle degeneration complicates image-based assessment.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100822"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736472","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}