International Journal of Spine Surgery最新文献

{"title":"Patient-Reported and Radiological Outcomes of Primary Bilateral Sacroiliac Joint Fusion Using a Principles-Based Approach.","authors":"Megan L Anderson, Nicholas G Rhodes, Michelle Y Hung, Ankur Khanna, William W Cross","doi":"10.14444/8789","DOIUrl":"https://doi.org/10.14444/8789","url":null,"abstract":"<p><strong>Background: </strong>Bilateral sacroiliac joint fusion (BSIJF) is an accepted management strategy for sacroiliac joint dysfunction, though outcomes data are limited by patient number and lack of long-term follow-up. This study investigated the clinical, radiological, and patient-reported outcomes of BSIJF.</p><p><strong>Methods: </strong>A retrospective review was conducted of all patients who underwent BSIJF with a single surgeon between 2020 and 2023. All BSIJF utilized a principles-based approach: joint decortication, bone grafting, compression, and rigid stability. Patient-reported outcomes at preoperative, 6-month, 1-year, and 2-year follow-up timepoints were recorded for the Numeric Pain Rating Scale, Oswestry Disability Index (ODI), Single Assessment Numeric Evaluation (SANE), PROMIS Pain Interference (PI), and PROMIS Physical Function (PF). Fusion grading was assessed by computed tomography after 1 and 2 years.</p><p><strong>Results: </strong>Forty-eight patients who underwent BSIJF were included, of whom 31 (65%) were women with a mean age of 54 ± 14 years and a mean body mass index of 29 ± 5. Twenty-five patients (52%) had prior lumbar spine surgery (PLSS). One patient required revision for implant malpositioning and nerve impingement. Bridging bone across the sacroiliac joint was observed in 85% of patients. Numeric Pain Rating Scale scores dropped significantly from 7.6 preoperatively to 3.9, 3.3, and 3.7 at 6-month, 1-year, and 2-year follow-ups, respectively (<i>P</i> ≤ 0.004). PI and PF scores were significantly improved at all timepoints (all <i>P</i> < 0.001). ODI scores demonstrated sustained improvement from 52.3 preoperatively to 33.3 at 1-year follow-up and 29.3 at 2-year follow-up (<i>P</i> < 0.001). SANE scores were 80% at 1-year follow-up and 85% at 2-year follow-up. PI, PF, and ODI scores were significantly improved at all timepoints, independent of PLSS status. The mean SANE score in patients with PLSS was 82% ± 22% at 2-year follow-up. Patient history of hip surgery prior to BSIJF was associated with inferior postoperative ODI and SANE scores.</p><p><strong>Conclusions: </strong>BSIJF is a safe and effective treatment that is associated with high rates of bony bridging at the sacroiliac joint and long-term clinically significant improvements in pain and function.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040841","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":"O-Arm Vs Surgivisio for Pedicle Screw Insertion: A Prospective Study on Screw Accuracy and Irradiation on 100 Patients.","authors":"Marc Prod'homme, Maxime Saad, Jérôme Tonetti, Guillaume Cavalié, Gaël Kerschbaumer, Arun Thangavelu, Jean-Loup Gassend, Mehdi Boudissa","doi":"10.14444/8766","DOIUrl":"10.14444/8766","url":null,"abstract":"<p><strong>Background: </strong>Computerized navigation improves the accuracy of spine procedures. However, intraoperative imaging is plagued by ionizing irradiation and its cancer risk. Advanced technologies attempt to optimize the radiation dose. The goal of this study was to compare radiation exposure and screw accuracy of O-arm navigation and the Surgivisio device (SD) in pedicle screw insertion.</p><p><strong>Methods: </strong>All patients operated on by navigated pedicle screw insertion during a 19-month period were prospectively included in 2 spine centers: the first with the O-arm and the second with the SD. Demographic, operative, and irradiation data were collected. The accuracy of the screw positioning was assessed using the Heary and Gertzbein classifications. The effective dose in millisievert (mSv) was calculated.</p><p><strong>Results: </strong>One hundred patients were included, 50 per group. Five hundred and twelve screws were inserted, among them 228 in 120 vertebrae with the O-am and 284 in 145 vertebrae with the SD. Screw accuracy was 99.1% with the O-arm vs 93.3% with the SD (<i>P</i> = 0.07). Operative times were similar, with 145 vs 139 minutes respectively, <i>P</i> = 0.68. The effective dose was significantly higher in the O-arm group, with 5.43 vs 2.70 mSv with the SD (<i>P</i> < 0.01). The effective dose related to 2-dimensional imaging was significantly lower in the O-arm group than in the SD group, with 0.26 vs 1.16 mSv, respectively, <i>P</i> < 0.01, related to a shorter imaging duration (4 vs 109 seconds respectively, <i>P</i> < 0.01).</p><p><strong>Conclusions: </strong>Accuracy of pedicle screws was higher with the O-arm than with the Surgivisio, but the latter showed less radiation exposure. Despite promising results, improvements in technology should be pursued for ergonomics and surgical safety.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"383-391"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318233","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":"Ninety-Day Complication and Revision Surgery Rates Using Navigated Robotics in Thoracolumbar Spine Surgery: A PRoGRSS Interim Analysis.","authors":"Lindsay D Orosz, Nathan J Lee, Jeffery L Gum, Ronald A Lehman, Tamer R Hage, Jack Katz, Tyler Amell-Angst, Rita T Roy, Gregory T Poulter, Colin M Haines, Ehsan Jazini, Christopher R Good","doi":"10.14444/8777","DOIUrl":"10.14444/8777","url":null,"abstract":"<p><strong>Background: </strong>Individually, robotic guidance and 3-dimensional navigation assistance have been shown to improve surgical outcomes and accuracy in spine surgery. The pairing of these technologies may further improve outcomes; however, data are needed to support this theory. In the Prospective Robotic-Guided Registry of Spine Surgery (PRoGRSS), outcomes were tracked for cases using a bone-mounted integrated robotic-assisted navigation system. This interim analysis reports on 90-day complications and revisions.</p><p><strong>Methods: </strong>Adults undergoing navigated robotic thoracolumbar surgery from 2020 to 2022 were prospectively enrolled by 6 surgeons at 4 distinct centers. Medical, surgical, and robot-related complications and revision surgeries were collected postoperatively for up to 90 days and analyzed.</p><p><strong>Results: </strong>Of 411 surgeries, 3469 screws were implanted. The mean number of levels fused was 4.4 ± 3.7. Intraoperative adverse events occurred in 4.1% of cases, and 0.5% were robot related. The frequency of patients with at least 1 postoperative surgical complication was 6.6%, none being robot related. The frequency of patients with at least 1 postoperative medical complication was 18.2%. The revision surgery rate at 90 days was 1.5%, none of which were robot related.</p><p><strong>Conclusion: </strong>This first-of-its-kind study of an integrated navigation and robotic spine platform demonstrates low complication and revision surgery rates for thoracolumbar fusion. This interim analysis of PRoGRSS showed 4.1% intraoperative complications, 6.6% postoperative surgical complications, and 1.5% revision surgeries. With advancements in technology and increased surgical expertise, navigated robotics continues to demonstrate consistently low rates of 90-day complications and revision surgeries, supporting its reliability.</p><p><strong>Clinical relevance: </strong>The interim analysis of PRoGRSS suggests that the integration of robotic guidance with 3-dimensional navigation is reproducibly effective in the surgical setting.</p><p><strong>Level of evidence: 2: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"437-443"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668630","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":"Motion-Sparing Spine Surgery in the Treatment of High-Grade Spondylolisthesis.","authors":"Jonathan Dalton, Alexander R Vaccaro","doi":"10.14444/8786","DOIUrl":"10.14444/8786","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"371-373"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884002","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":"Trends in Lumbosacral-Pelvic Fixation Strategies.","authors":"Pawel P Jankowski, Sohaib Z Hashmi, Elizabeth L Lord, Joshua E Heller, David A Essig, Peter G Passias, Paritash Tahmasebpour, Robyn A Capobianco, Christopher J Kleck, David W Polly, Scott L Zuckerman","doi":"10.14444/8765","DOIUrl":"10.14444/8765","url":null,"abstract":"<p><strong>Background: </strong>We sought to better understand the current decision-making criteria and surgical strategies for pelvic fixation in spinal surgery.</p><p><strong>Methods: </strong>A 28-question survey was distributed to an international group of practicing spine surgeons. Questions included training, practice type, criteria for using pelvic fixation, and strategies for pelvic fixation, including the type and technique employed.</p><p><strong>Results: </strong>Of the 56 responders, 32% were neurosurgeons, and 67% were affiliated with academic institutions. Factors that most influenced the use of pelvic fixation were 3-column osteotomy (3CO), high-grade spondylolisthesis, and L5 to S1 pseudarthrosis. Most report using a single point of pelvic fixation per side for the following: deformity 4+ levels without 3CO (55%) and spondylolisthesis grade 3 (59%). The upper instrumented vertebra threshold for pelvic fixation in degenerative pathology was L2 (70%) or L3 (16%). Most surgeons chose 2 points of fixation per side in the setting of 4 or more levels with 3CO (69%) and revision of at least 3 levels (68%). The predominant (77.6%) fixation preference was S2-alar-iliac screws. Surgeons report using navigation (70%), fluoroscopy (23%), free hand (21%), and robot-assisted (7%) for screw placement. The most common pelvic screw diameter and length were 8.5 mm and 90 mm, respectively. A 5% to 10% pelvic fixation revision rate was reported, primarily for instrumentation failure or pseudarthrosis.</p><p><strong>Conclusion: </strong>This survey-based study highlights factors influencing surgeons' decisions on pelvic instrumentation. While complex corrections or revisions often require robust fixation, variability arises in simpler cases, influenced by factors like age, obesity, and bone quality.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"402-408"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295055","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":"Clinical Efficiency and Radiation Safety of Fluoroscopy-Based 2D Intraoperative Computer Navigation in Biportal Spinal Endoscopy.","authors":"Don Young Park, Haley Nadone, Andy Ton, Ryan Hoang, Arthur Cowman, Michael Kim, Hao-Hua Wu, Hansen Bow, Sohaib Hashmi, Yu-Po Lee, Michael Oh, Cheol Wung Park, Heo Dong Hwa, Nitin Bhatia","doi":"10.14444/8780","DOIUrl":"10.14444/8780","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic spine surgery is a minimally invasive technique that can treat spinal conditions while resulting in less pain and faster recovery than alternative techniques. However, achieving precise navigation is challenging without significant radiation exposure and increased surgical times. Fluoroscopy-based 2-dimensional navigation (2DNAV) is an emerging technology that offers real-time navigation using intraoperative fluoroscopy. This study evaluated the clinical efficiency and radiation safety of 2DNAV in biportal endoscopic spine surgery as compared with conventional C-arm fluoroscopy.</p><p><strong>Methods: </strong>This prospective comparative cohort study included 20 biportal endoscopic patients using 2DNAV and 20 case-matched control patients using C-arm fluoroscopy. Primary outcomes included operative time, number of fluoroscopic images, radiation exposure time, and total radiation dose. Additionally, a visual analog scale for back and leg pain and the Oswestry Disability Index were obtained.</p><p><strong>Results: </strong>Mean operative time in the 2DNAV group (67.95 ± 14.4 minutes) was significantly shorter compared with the control group (83.0 ± 16.0 minutes, <i>P</i> = 0.003). The mean number of fluoroscopic images required was significantly less in the 2DNAV group (3.15 ± 1.6 images) with vs control group (17.95 ± 5.7 images, <i>P</i> < 0.001). Total radiation exposure time was significantly lower in the 2DNAV group (mean 1.9 ± 1.1 min:sec) vs the control group (mean 9.21 ± 5.6 min:sec, <i>P</i> < 0.001). 2DNAV group experienced mean radiation dose of 0.77 ± 0.4 mGy vs 6.21 ± 3.8 mGy in control (<i>P</i> < 0.001). There were no significant differences in clinical outcomes.</p><p><strong>Conclusions: </strong>2DNAV significantly reduced operative times and required significantly fewer fluoroscopic images with lower radiation exposure for patients. 2DNAV allowed for the successful completion of the procedures with no difference in clinical outcomes.</p><p><strong>Clinical relevance: </strong>2DNAV provides real-time instrument tracking and computer navigation during endoscopic spine surgery with significantly decreased operative time and radiation exposure with similar clinical outcomes as conventional fluoroscopy.</p><p><strong>Level of evidence: 2: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"494-502"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875743","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":"Combined Total Disc Replacement and Total Posterior Facet Replacement System Device.","authors":"William C Welch","doi":"10.14444/8782","DOIUrl":"10.14444/8782","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"370"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875744","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":"Measurement of Intraoperative Insertional Torque: Usefulness for Prediction of the Deviation of Pedicle Screw Insertion in Lumbar Degenerative Diseases.","authors":"Sho Nakamura, Toshiyuki Takahashi, Tomoo Inoue, Manabu Minami, Ryo Kanematsu, Izumi Suda, Shu Takeuchi, Shinya Tokunaga, Junya Hanakita","doi":"10.14444/8785","DOIUrl":"10.14444/8785","url":null,"abstract":"<p><strong>Background: </strong>Measurement of screw insertional torque (SIT) can be valuable to predict rigid pedicle screw (PS) fixation without instrumentation failure. Numerous biomechanical studies support this concept; however, the value of measuring intraoperative SIT has not been well investigated. The aim of this study was to identify the relationship between the SIT values in PS fixation surgery and clinical factors in lumbar degenerative surgery.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 492 PSs in 114 patients who underwent lumbar fusion surgery between July 2014 and April 2022. Intraoperative SIT values were measured using an analog torque wrench. Patient characteristics, radiological factors, and the accuracy of PS insertion were analyzed to assess their associations with the strength of the SIT.</p><p><strong>Results: </strong>Intraoperative SIT showed significant correlations with age (<i>r</i> = -0.196, <i>P</i> < 0.001), bone mineral density (<i>r</i> = 0.399, <i>P</i> < 0.001), and body mass index (<i>r</i> = 0.165, <i>P</i> < 0.001). The torque ratio, reflecting bilateral SIT difference within the same vertebra, was significantly higher in cases with unilateral PS deviation >2 mm compared with ≤2 mm.</p><p><strong>Conclusions: </strong>The findings suggest that patient-related factors play a role in screw fixation strength, and the torque ratio may serve as a useful indicator for assessing PS placement accuracy.</p><p><strong>Clinical relevance: </strong>Intraoperative screw insertional torque measurement correlates with bone mineral density, age, and body mass index and may help predict fixation rigidity and prevent instrumentation failure in lumbar fusion surgery.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"19 4","pages":"452-458"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972584","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":"Opioid-Induced Hyperalgesia and Inflammaging in the Management of Spine Pain: The Case for Genetically Directed Dopamine Homeostasis.","authors":"Kai-Uwe Lewandrowski, Rossano Kepler Alvim Fiorelli, Sergio Schmidt, Alireza Sharafshah, David Baron, Mark S Gold, Panayotis K Thanos, Igor Elman, Debasis Bagchi, Abdalla Bowirrat, Albert Pinhasov, Morgan P Lorio, Kenneth Blum","doi":"10.14444/8756","DOIUrl":"10.14444/8756","url":null,"abstract":"<p><strong>Background: </strong>The management of spine-related pain with narcotics, both before and after surgery, poses major challenges, including drug diversion, limited effectiveness, and worsening of pain symptoms over time. Chronic opioid use is associated with hypodopaminergia-induced hyperalgesia, whereby dopamine depletion increases pain sensitivity. Patients with inherently low dopaminergic function are particularly predisposed to hyperalgesia and reduced pain tolerance.</p><p><strong>Methods: </strong>An alternative therapeutic strategy centers on genetically guided pro-dopamine regulation, which aims to transmodulate dopaminergic signaling to mitigate hyperalgesia. Early identification of predisposition through genetic testing, combined with pharmacogenetic and pharmacogenomic monitoring, is proposed to optimize treatment approaches.</p><p><strong>Results: </strong>Pro-dopamine regulators have demonstrated promising results across 43 clinical studies, showing potential to reduce stress, craving, and relapse rates, while improving emotional well-being and attenuating pain sensitivity. These findings suggest that pro-dopamine regulation may serve as a viable frontline therapy for managing chronic pain and associated Reward Deficiency Syndrome behaviors, offering a significant reduction in the adverse effects commonly observed with chronic opioid therapy.</p><p><strong>Conclusions: </strong>Given the limitations of dopaminergic blockade through chronic opioid agonist therapy, there is a critical need to reevaluate current pain management practices. The induction of dopamine homeostasis via pro-dopamine regulation represents a novel and potentially transformative strategy. Spine surgeons, pain specialists, and addiction medicine practitioners are urged to consider this approach as a promising alternative for improving long-term outcomes in patients suffering from chronic pain.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"459-484"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620757","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":"Retiring CPT 62380: Why Endoscopic Lumbar Decompression Should Be Defined by Surgical Work, Not Optics.","authors":"Morgan P Lorio, Kai-Uwe Lewandrowski","doi":"10.14444/8776","DOIUrl":"10.14444/8776","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"492-493"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709279","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}