North American Spine Society Journal最新文献

{"title":"31. Impact of multirod reinforcement on rod fractures in adult spinal deformity: a retrospective case series with a minimum follow-up of 5 years","authors":"Yu Yamato MD, PhD ,&nbsp;Tomohiko Hasegawa MD, PhD ,&nbsp;Go Yoshida MD ,&nbsp;Tomohiro Banno MD ,&nbsp;Shin Oe MD, PhD ,&nbsp;Hideyuki Arima MD, PhD ,&nbsp;Tomohiro Yamada MD ,&nbsp;Kenta Kurosu PhD ,&nbsp;Yuh Watanabe MD, PhD ,&nbsp;Koichiro Ide MD, PhD ,&nbsp;Yukihiro Matsuyama MD, PhD","doi":"10.1016/j.xnsj.2024.100369","DOIUrl":"10.1016/j.xnsj.2024.100369","url":null,"abstract":"<div><p>This abstract contains content that is significantly similar to the authors' previously published abstract in the <em>Journal of Orthopaedic Science</em>. For access to the original publication, please visit the following DOI: <span><span>https://doi.org/10.1016/j.jos.2024.01.010</span><svg><path></path></svg></span>.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100369"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000623/pdfft?md5=7a93382cfdd7b8848c41f8d166d723e5&pid=1-s2.0-S2666548424000623-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"9. Demographic representation in the North American Spine Society Appropriate Use Criteria for Cervical Fusion and Degenerative Lumbar Spondylolisthesis","authors":"Jason Silvestre MD ,&nbsp;Sarah R Bradley BS ,&nbsp;James P. Lawrence MD, MBA ,&nbsp;Robert Andrew Ravinsky MD, MPH, FRCSC ,&nbsp;Charles A. Reitman MD","doi":"10.1016/j.xnsj.2024.100347","DOIUrl":"10.1016/j.xnsj.2024.100347","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;In the United States (US), there have been increasing efforts for diverse clinical trial recruitment with hopes of addressing inequities in health care and providing representative data for clinical decision-making. There has been no published evidence to analyze the current state of spine literature and representation among its studies.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;The primary aim of this study was to investigate the racial and ethnic representation in studies referenced in the North American Spine Society (NASS) 2022 &lt;em&gt;Appropriate Use Criteria (AUC) for Cervical Fusion (CF)&lt;/em&gt; and 2020 &lt;em&gt;AUC Degenerative Lumbar Spondylolisthesis&lt;/em&gt; for (LS) were analyzed.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;Review.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;Participants were pooled from studies included in the NASS CF and LS AUC.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;The primary outcome measure of this study was participation-to-prevalence ratio (PPR). The numerator (participation) was defined as the representation of a demographic group pooled across included studies. The PPR denominator (prevalence) was defined as the representation of a demographic group in the US population.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;p&gt;Articles included in the NASS 2022 &lt;em&gt;CF&lt;/em&gt; and 2020 &lt;em&gt;DLS AUC&lt;/em&gt; were analyzed. Main study details and the demographic characteristics they reported were collected. US census data from 2020 was used to calculate the representation of each demographic group relative to their proportion in the US population, demonstrated as participation-to-prevalence ratio (PPR). PPR&lt;0.80 were classified as underrepresented and PPR&gt;1.2 were classified as overrepresented.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;A total of 84 studies published from 1998 to 2020 were included, 44 of which were &lt;em&gt;CF AUC&lt;/em&gt; references and 40 of which were &lt;em&gt;DLS AUC&lt;/em&gt; references. Race was reported in 8 (9.5%) of the studies, ethnicity in 4 (4.7%) and gender in 63 (75%). There were 43 US-based studies (24 &lt;em&gt;CF AUC&lt;/em&gt;, 19 &lt;em&gt;DLS AUC&lt;/em&gt;), 7 reported race and of those 5 were published after 2014. Of the US-based studies 57% (4/7) reported race and ethnicity separately, three reported Asian participants and 2 reported American Indian/Alaska Native participants. Representation of White participants was calculated using pooled data from all 7 studies and revealed an overrepresentation when compared to the US population (PPR=1.52). When the 2 studies that reported all demographic groups were analyzed, an overrepresentation of White participants was again demonstrated (PPR=1.45), in addition to an underrepresentation of Black, Hispanic, and Asian participants (PPR=0.82, 0.39, 0.67 respectively).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;p&gt;This study demonstrates a failure to consider race and ethnicity among the studies used to develop NASS AUCs for CF and DLS. Among the evidence base, the US studies that reported race and ethnici","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100347"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000404/pdfft?md5=c0cb12ad70b623ae15c2c3f0272f2b6e&pid=1-s2.0-S2666548424000404-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"13. Preoperative range of motion from neutral to extension position can be a predictive factor for loss of cervical lordosis after cervical laminoplasty.","authors":"Jun Wakasa MD ,&nbsp;Koji Tamai MD ,&nbsp;Hidetomi Terai MD, PhD ,&nbsp;Minori Kato MD ,&nbsp;Hiromitsu Toyoda MD, PhD ,&nbsp;Akinobu Suzuki MD, PhD ,&nbsp;Shinji Takahashi MD ,&nbsp;Yuta Sawada MD ,&nbsp;Masayoshi Iwamae MD ,&nbsp;Yuki Okamura MD ,&nbsp;Yuto Kobayashi MD","doi":"10.1016/j.xnsj.2024.100351","DOIUrl":"10.1016/j.xnsj.2024.100351","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;Cervical laminoplasty is one of the effective surgical procedures for degenerative cervical myelopathy (DCM). However, kyphotic deformity due to loss of cervical lordosis (CL) is a relatively common complication after cervical laminoplasty, which can be a risk factor for poor surgical outcomes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;Current study aimed to identify the predictive factors for loss of CL after cervical laminoplasty and to demonstrate the effect of the loss of CL on clinical outcomes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;Multicenter, retrospective cohort study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;Patients with DCM who underwent open-door laminoplasty between February 2019 and December 2021 were included.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;Demographic, operative, radiographic and clinical score data were collected preoperatively and 1 year postoperatively. Radiographic factors included cervical sagittal vertical axis (cSVA), C2-7 lordotic angle (neutral, extension, and flexion position), C2-7 range of motion (ROM), C2-7 extension ROM (neutral to extension: eROM), and C2-7 flexion ROM (neutral to flexion). Clinical scores included JOA scores, VAS (neck pain, upper extremity paresthesia, and pain), EQ-5D-5l, JOACMEQ, and NDI. Clinical scores were also collected at 2-years postoperatively.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;p&gt;Loss of CL was defined as decreasing of C2-7 lordotic angle &gt;10° from preoperative to 1-year postoperative ones. Patients were divided into two groups based on loss of CL: the Loss group and the No-loss group. As univariate analysis, all collected data were compared between groups. Receiver Operating Characteristic (ROC) curve analysis was performed for the significant variables in the univariate comparisons. Finally, multivariate logistic regression analysis was performed to identify the factors relating to loss of CL development. As subanalysis, clinical scores at 2-years postoperatively were also compared between groups using the data of patients who could followed &gt;2 years postoperatively by December 2022.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;Among 178 patients (mean age 73.2 years), 40 patients (22.5%) demonstrated loss of CL at 1-year postoperatively. In univariate comparisons, preoperative eROM was significantly smaller in the Loss group than in the No-loss group (6.9 vs 13.3, p&lt;0.001). However, no other factors showed significant differences between groups. ROC analysis demonstrated that preoperative eROM could predict the development of loss of CL significantly (area under curve=0.74, 95% confidence interval [CI]: 0.65 to 0.82, p&lt;0.001) with a threshold as 9.0° (sensitivity 0.66, specificity 0.65). Multivariate logistic regression analysis revealed that preoperative eROM &lt;9.0 was significantly related with loss of CL development at 1-year postoperatively independent from patient age, sex, preoperative JOA score, cSVA, C2-7 lordotic angle at neutral pos","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100351"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000441/pdfft?md5=bcdd2ae7e320d0d6d95817dad2c89369&pid=1-s2.0-S2666548424000441-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P29. Deep learning-based identification of lumbar spondylolysis on plain X-ray images using convolutional neural networks","authors":"Takahiko Hyakumachi MD ,&nbsp;Yoko Ishikawa MD ,&nbsp;Akito Yabu MD ,&nbsp;Terufumi Kokabu MD ,&nbsp;Hisataka Suzuki MD ,&nbsp;Katsuhisa Yamada MD, PhD ,&nbsp;Takamasa Watanabe MD, PhD","doi":"10.1016/j.xnsj.2024.100433","DOIUrl":"10.1016/j.xnsj.2024.100433","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background Context&lt;/h3&gt;&lt;p&gt;Lumbar spondylolysis is a common cause of low back pain in young patients, which is stress fracture of pars interarticularis due to excessive sports activity. Although most patients are treated by limitation of sporting activities and brace, accurate diagnosis is important because missed or delayed intervention can result in future spondylolisthesis. Based on plain X-ray imaging, it is difficult for the non-specialist to diagnose or decide to require an MRI scan as the next diagnostic step. Deep learning with the convolutional neural networks (CNNs) has attracted attention in the medical imaging field.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;To construct deep learning algorithms using CNNs to identify spondylolysis on plain X-ray images.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design/Setting&lt;/h3&gt;&lt;p&gt;Retrospective analysis using CT and plain X-ray images.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient Sample&lt;/h3&gt;&lt;p&gt;This retrospective study included 100 patients with spondylolysis and 100 patients without spondylolysis under 20 years old.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome Measures&lt;/h3&gt;&lt;p&gt;We plotted the receiver operating characteristic curve and calculated the area under the curve (AUC) in order to evaluate the performance of the CNNs. Consequently, the sensitivity, specificity, and accuracy of the diagnosis by CNNs were calculated.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;First, a digitally reconstructed radiograph (DRR) images were created from the CT image from 43 patients with spondylolysis, and the CNN was trained to identify vertebrae with and without spondylolysis on DRR images. Next, 100 vertebrae with spondylolysis and 100 normal vertebrae with matched levels were extracted from the anteroposterior and lateral plain X-ray images, respectively. The extracted images of 200 vertebrae were randomly divided into 150 vertebrae images for internal validation and 50 vertebrae images for external validation. Utilizing the trained model created from DRR images, fine tuning was conducted in training the plain X-ray images for internal validation. Finally, an external validation dataset was classified using 5 trained models created from plain X-ray images to validate the work of five models. In this study, a 25-layer CNN was used, including convolutional and pooling layers. Output information was binary classification regarding the presence or absence of spondylolysis. Five-fold cross-validation were conducted to assess the performance of CNNs. In addition, heatmaps of the CNNs focus site was created using the gradient-weighted class activation mapping method.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;In training using anteroposterior, X-ray images, five models of CNNs had performance with AUC of 0.82, sensitivity of 0.77, specificity of 0.80 and accuracy of 0.79 in internal validation, and AUC of 0.83, sensitivity of 0.77, specificity of 0.68 and accuracy of 0.74 in external validation. In training lateral plain X-ray images, five models of CNNs had higher performance with AUC of 0.97","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100433"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001264/pdfft?md5=b6eae0f5b3adcebff4590ea761e3b5d6&pid=1-s2.0-S2666548424001264-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P20. Risk factors for postoperative unexpected ambulatory status after spinal surgery for metastatic spinal tumor","authors":"Kentaro Yamada MD, PhD,&nbsp;Toshitaka Yoshii MD,&nbsp;Mikayo Toba MD,&nbsp;Satoru Egawa MD,&nbsp;Yu Matsukura MD,&nbsp;Hiroyuki Inose MD, PhD,&nbsp;Kiyohide Fushimi MD, PhD","doi":"10.1016/j.xnsj.2024.100424","DOIUrl":"10.1016/j.xnsj.2024.100424","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background Context&lt;/h3&gt;&lt;p&gt;Surgical treatment for metastatic spinal tumors is performed to improve ambulatory status or quality of life (QOL). However, the postoperative complication rate for surgical treatment in patients with cancer is high, and there are many cases in which patients fail to gain the ability to walk, resulting in poor outcomes. There is no large-scale study that discussed risk factors for postoperative poor ambulatory status, although many case series and meta-analyses suggested several risk factors such as preoperative non-ambulatory.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;The purpose of the study was to investigate risk factors for patients with postoperative unexpected ambulatory status using large-scale in-hospital data.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design/Setting&lt;/h3&gt;&lt;p&gt;Analysis of nationwide administrative hospital discharge data.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient Sample&lt;/h3&gt;&lt;p&gt;This study included spinal surgery cases for metastatic spinal tumors including vertebroplasty using the Diagnosis Procedure Combination (DPC) database: a national inpatient database in Japan, from 2018 to 2019. We excluded cases with surgery of total en bloc spondylectomy, cases of death during hospitalization, and cases with whose Barthel Index data at admission or discharge were missing.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome Measures&lt;/h3&gt;&lt;p&gt;Postoperative unexpected ambulatory status was defined as (1) nonambulatory at discharge or (2) a decrease in mobility score of Barthel Index between admission and discharge.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;The risk factors for postoperative unexpected ambulatory status were analyzed using multiple logistic regression analysis, adjusting for age, gender, surgical volume, primary site of tumor, surgical procedure, nonskeletal metastasis, comorbidity, and ambulatory status at admission.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 1786 eligible patients were analyzed. There are 1061 (59%) ambulatory patients on admission and 1249 (70%) on discharge. Postoperative unexpected ambulatory status was observed in 597 patients (33%), with a significantly lower rate of discharge to home (41%/81% p&lt;.001) and a longer postoperative hospital stay (46.2 days/31.4 days p&lt;.001). Multivariate analysis indicated that risk factors for postoperative unexpected ambulatory status were male (odds ratio [OR] 1.44, p=.002), laminectomy without fusion (OR 1.55, p=0.03), comorbidity (OR 1.35, p=.01), and preoperative non-ambulatory status (OR 6.61, p&lt;.001).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Laminectomy without fusion is performed in limited pathology for metastatic spinal tumors when the spinal instability is small such as involvement in the posterior element only, or the risk of invasive surgery is high due to comorbidity. In this study, laminectomy without fusion was one of the risk factors for postoperative unexpected ambulatory status, which accounted for 33% of all cases. The indication for surgery with laminectomy alone needs further consid","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100424"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001173/pdfft?md5=df23a495e3c46885a61614ff54709db0&pid=1-s2.0-S2666548424001173-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"48. A comparative study of the sagittal and coronal balance of the spine measured using a 3D full-body scanner and whole spine X-ray","authors":"Tae Hoon Kang MD,&nbsp;Minjoon Cho MD","doi":"10.1016/j.xnsj.2024.100386","DOIUrl":"10.1016/j.xnsj.2024.100386","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;Spinal balance analysis is critical to the diagnosis and treatment of ASD, and radiography is the current gold standard. Radiation-free 3D full body scanner has been developed to overcome drawbacks of X-ray such as radiation exposure and limited reflection of actual daily activity.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;This study aims to develop a spinal balance analysis system based on the 3D full body scanner and compare it to X-ray parameters. This study aims to develop a spinal balance analysis system based on the 3D full body scanner and compare it to X-ray parameters.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;This study is a prospective observational study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;Ninety-seven participants recruited from our hospital patient clinic and underwent both 3D body scanning and whole spine X-rays. The participants completed the clinical questionnaire and body composition analyses.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;The 3D scanner spinal balance parameters were defined as the angles between two points relative to the plumb line, the horizontal distances between two points, the angle between three points, and shoulder gradient. The X-ray spinal balance parameters were C2-7 sagittal vertical axis (SVA), T1 slope, sagittal vertical axis (SVA), odontoid hip axis angle (ODHA), clavicle angle, T1 coronal tilt, lumbar lordosis, sacral slope, and pelvic incidence-lumbar lordosis (PI-LL) mismatch. Body composition scores were body mass index (BMI), percentage body fat (PBF), and skeletal muscle index (SMI). Patient-reported clinical symptoms included the visual analog scale (VAS, 0-10) score of low back pain and the modified Oswestry Disability Index (mODI, 0-45).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;p&gt;Five inflection points were automatically labeled by AI from the 3D scanner data and spinal balance parameters were subsequently calculated. Correlation analysis was conducted to compare spinal balance parameters obtained from a 3D full-body scanner and X-ray imaging. The same analysis was also conducted to identify correlation between spinal parameters and clinical symptoms. Partial correlation analysis and multiple regression analysis were conducted to determine the impact of body composition on spinal balance.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;The study indicated statistically significant correlations between sagittal parameters of X-ray and 3D body scanner. The correlation coefficient of dAB_hor (horizontal distance between ear and shoulder in the sagittal plane) and C2-C7 SVA was 0.478 (p-value &lt;0.001). The correlation coefficient between aAC_sag (sagittal angle of ear-hip from the plumb line) and ODHA was 0.336 (p &lt;0.001). For coronal spinal balance, the shoulder gradient calculated by AI was compared to the clavicle angle from the X-ray, resulting in a correlation coefficient of 0.373 (p &lt;0.001). In contrast, the differences between 3D scanning and radiography were unaffected b","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100386"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000799/pdfft?md5=5afe3831f5fcd2c339b6e0a214fd6834&pid=1-s2.0-S2666548424000799-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P18. Postoperative complications in anterior cervical surgery: is there a higher incidence of dysphagia and respiratory complications with long-segment anterior cervical surgery?","authors":"Yuki Shiratani MD ,&nbsp;Takeo Furuya MD, PhD ,&nbsp;Satoshi Maki MD, PhD ,&nbsp;Juntaro Maruyama MD ,&nbsp;Kyota Kitagawa MD ,&nbsp;Masao Koda MD, PhD ,&nbsp;Masashi Yamazaki MD, PhD ,&nbsp;Seiji Ohtori MD, PhD","doi":"10.1016/j.xnsj.2024.100422","DOIUrl":"10.1016/j.xnsj.2024.100422","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background Context&lt;/h3&gt;&lt;p&gt;In anterior cervical spine surgery, complications such as dysphagia and respiratory disorders can be problematic.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;This study investigates whether the length of fixation in anterior cervical spine surgery is associated with perioperative dysphagia and respiratory complications.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design/Setting&lt;/h3&gt;&lt;p&gt;Retrospective study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient Sample&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome Measures&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;The subjects were 105 cases who underwent anterior cervical spine surgery at our hospital since April 2013. Cases involving surgery for trauma or infection were excluded. Cases with fixation of two or fewer vertebrae were classified as Group S, and those with fixation of three or more vertebrae as Group L. In our hospital, when anterior fixation of 3 or more vertebrae is performed, airway management is generally conducted in the ICU by emergency physicians, with the timing of extubation determined based on the cuff leak test, lateral cervical spine X-rays, and fiberscope if necessary.&lt;/p&gt;&lt;p&gt;The parameters examined were the frequency of dysphagia, the frequency of serious respiratory complications such as reintubation or tracheostomy, and pneumonia, as well as the number of days required for discharge or transfer postoperatively.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;There were 61 cases in Group S and 44 in Group L. The average number of fixed vertebrae was 1.5 in Group S and 3.5 in Group L. There was no significant difference in average age or sex between the two groups. Surgeries for ossification of the posterior longitudinal ligament were significantly more frequent in Group L. The proportion of severe dysphagia requiring gastrostomy tube for nutritional management was significantly higher in Group L (Group S; 3%, Group L; 13%). The number of cases requiring treatment for severe pneumonia, reintubation, or tracheostomy was one in Group S and four in Group L. One case in Group S developed severe pneumonia early postoperatively and required reintubation, and three cases in Group L required airway resecuring due to laryngeal edema post-extubation. The number of days required for discharge or transfer postoperatively was 11.9 days in Group S and 24.7 days in Group L, but cases with respiratory complications required an average of 58.8 days of hospital management.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Cases with short-segment anterior cervical surgeries had relatively few complications and could be discharged early. Long-segment anterior cervical spine surgeries are associated with higher rates of postoperative complications, including severe dysphagia in 13% of cases and significant respiratory issues in 9%. Cases with these complications required long-term hospitalization. These findings emphasize the necessity of careful monitoring and management following long-range anterior surgeries.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;FDA Device/Drug Status","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100422"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266654842400115X/pdfft?md5=422ca835c52f9bfac85d1fbc6c0dfd80&pid=1-s2.0-S266654842400115X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"23. Mechanical stress induces degeneration and hypertrophy of ligamentum flavum in lumbar spinal canal stenosis","authors":"Takayuki Nakamura MD, PhD","doi":"10.1016/j.xnsj.2024.100361","DOIUrl":"10.1016/j.xnsj.2024.100361","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;Ligamentum flavum (LF) hypertrophy is characterized histologically by LF degeneration, including the loss of elastic fibers and the increase collagen. In patients with lumbar spinal canal stenosis (LSCS), chronic inflammation and subsequent fibrosis induced by mechanical stress play an important role in LF hypertrophy and degeneration. Several molecules, such as transforming growth factor (TGF)-β1, inflammatory cytokines, and matrix metalloproteinase (MMPs) participate in the pathological processes; however, the mechanisms underlying the induction of these molecules and process of degeneration have not been fully elucidated. Angiopoietin-like protein 2 (Angptl2), a tissue remodeling factor, is induced by various stress conditions and regulates TGF-β1, inflammatory cytokines such as interleukin (IL)-6, and MMPs. Therefore, Angptl2 induced by mechanical stress may contribute to the pathogenesis of LSCS.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;Analyzing the role of Angptl2 and elucidating the mechanism of degenerative processes of ligamentum flavum caused by mechanical stress.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;This study was conducted after approval was obtained from the Kumamoto University Ethics Committee and written informed consent was received from each patient. LF samples for this study were provided by patients who underwent lumbar surgery with LSCS or non-LSCS such as disc herniation and cauda equina tumors. For in vitro experiments, LF fibroblasts were isolated from LF tissue and cultured.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;p&gt;Total RNA was extracted from LF tissue. &lt;em&gt;Angptl2, TGF-β1, IL-6, MMP-2, collagen,&lt;/em&gt; and &lt;em&gt;elastin&lt;/em&gt; mRNA expression was evaluated by real-time polymerase chain reaction (PCR). Anti-human Angptl2 TGF-β1, IL-6 and MMP-2 antibody was used for immunohistochemistry. For in vitro experiments, LF fibroblasts were isolated from LF tissue and cultured. LF fibroblasts were applied to stretching stimulation (10% elongation, 10 cycles/min) for 12 h, and Angptl2 expression was investigated by PCR and ELISA. Recombinant Angptl2 protein (5 μg/ml) was added to the cells, followed by 6 h incubation, after which the RNA was extracted, and &lt;em&gt;TGF-β1, IL-6, MMP-2&lt;/em&gt; and &lt;em&gt;collagen&lt;/em&gt; mRNA expression was evaluated by PCR. To evaluate activating Smad signaling, p-Smad3 was analyzed by western blot after Angptl2 stimulation. MMP-2 expression was evaluated by Recombinant IL-6 protein(300ng/ml). The concentration of elastin in the supernatant was measured using a competitive ELISA kit, after 300ng/ml IL-6 protein stimulation adding 1mg elastin protein.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;&lt;em&gt;Angptl2, TGF-β1, IL-6, MMP-2 and collagen&lt;/em&gt; mRNA expression in hypertrophied LF tissue from the LSCS group were significantly increased relative to that in LF tissue from the non-LSCS group. On the other hand, there","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100361"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000544/pdfft?md5=10e2bc0d0eb3d6f369e8862d65d9402b&pid=1-s2.0-S2666548424000544-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"List of Contents","authors":"","doi":"10.1016/S2666-5484(24)00217-8","DOIUrl":"10.1016/S2666-5484(24)00217-8","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100524"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002178/pdfft?md5=c28b24b692fb8c04d93c6d4772e4b638&pid=1-s2.0-S2666548424002178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141959801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"59. Longitudinal changes in outcomes of transcranial motor evoked potential monitoring during intra- and extramedullary spinal cord tumor surgeries","authors":"Go Yoshida MD,&nbsp;Yukihiro Matsuyama MD, PhD","doi":"10.1016/j.xnsj.2024.100397","DOIUrl":"10.1016/j.xnsj.2024.100397","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;The use of transcranial motor evoked potential (Tc-MEP) has been recognized as an indispensable tool in high-risk spine surgeries, particularly in cases involving spinal tumors, ossification of the posterior longitudinal ligament, and spinal deformities. These surgeries have an increased likelihood of intraoperative spinal cord and nerve root injuries.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;Given the significance of Tc-MEP in mitigating these risks, this research undertakes a comprehensive analysis of the annual changes in the precision of Tc-MEP monitoring, the incidence of postoperative paralysis, and the success rate of rescue interventions during surgeries for intramedullary spinal cord tumors (IMSCT) and extramedullary spinal cord tumors (EMSCT).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;Prospective multicenter study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;We examined data spanning 5 years, from 2017-2022, covering 163 IMSCT patients (92 male, 71 female, average age 48, BMI 23.2) and 754 EMSCT patients (325 male, 429 female, average age 58, BMI 23.2). These patients were treated in 17 prominent domestic institutions, all affiliated with the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;We assessed the Tc-MEP monitoring results, postoperative incidence of a de novo paralysis, and the rescue rate (number of rescue cases / number of true-positive + rescue cases).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;p&gt;We established an alarm threshold when the Tc-MEP waveform in one or more limbs exhibited a decrease of 70% or more from the baseline. A postoperative disability was determined as a one-grade decline in muscle strength immediately after the procedure. From 2010, the committee convened regular meetings to assess and enhance waveform judgment protocols, with a focus on evaluating true-positive and rescue cases. The rescue case was defined as a patient with recovered TcMEP amplitudes after certain procedures and without a de novo paralysis.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;For IMSCT resection surgeries, Tc-MEP monitoring results were: Sensitivity/Specificity/Positive predictive value/Negative predictive value: 95%/83%/75%/97% (2017-18, n=58), 89%/73%/42%/97% (2019-20, n=52), and 64%/67%/35%/87% (2021-22, n=53). Postoperative paralysis incidence/rescue cases/rescue rate were: 33%/3 cases/14% (2017-18), 17%/2 cases/20% (2019-20), and 21%/2 cases/22% (2021-22), indicating a gradual decline in postoperative paralysis over the years. For EMSCT resection surgeries, Tc-MEP monitoring results were: Sensitivity/Specificity/Positive predictive value/Negative predictive value: 88%/91%/47%/99% (2017-18, n=205), 87%/85%/27%/99% (2019-20, n=261), and 67%/93%/37%/98% (2021-22, n=288). Postoperative paralysis incidence/rescue cases/rescue rate were: 8%/7 cases/33% (2017-18), 6%/15 cases/54% (2019-20), and 5%/11 cases/52% (2021-22), showcasing an annual increa","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100397"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000908/pdfft?md5=034830c421c3c204e8a718d9e1276543&pid=1-s2.0-S2666548424000908-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}