International Journal of Spine Surgery最新文献

{"title":"Safety and Viability of Anterior Lumbar Interbody Fusion in Complex Revision Lumbar Spine Surgeries: Insights From a Case Series of 135 Patients on Transforaminal Lumbar Interbody Fusion/Posterior Lumbar Interbody Fusion Cage Removal.","authors":"Aécio Rubens Dias Pereira Filho, Matheus Galvão Valadares Bertolini Mussalem, Vinicius Santos Baptista, Vinicius de Meldau Benites, Milton Kiyonory Uehara, Nuno Rodolfo Colaço Aguiar, Arthur Cristiano Baston, Alexandre Vinhal Desideri, Francisco Cialdine Frota Carneiro Júnior","doi":"10.14444/8753","DOIUrl":"10.14444/8753","url":null,"abstract":"<p><strong>Background: </strong>Anterior lumbar interbody fusion (ALIF) has emerged as a valuable technique for managing lumbar degenerative conditions and revision surgeries, particularly for addressing complications associated with transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) cages. However, there is limited evidence documenting its safety and feasibility in the context of revision procedures involving cage removal.</p><p><strong>Objective: </strong>To evaluate intraoperative outcomes of ALIF for TLIF/PLIF cage removal, focusing on complications, surgical times, and blood loss in a substantial case series.</p><p><strong>Methods: </strong>This case series analyzed data from 135 patients who underwent ALIF for TLIF/PLIF cage removal between January 2019 and May 2023. Surgical indications included pseudarthrosis, cage migration, and infection. Outcomes assessed included intraoperative complications, surgical duration, and estimated blood loss.</p><p><strong>Results: </strong>Of the 135 patients (median age: 47 years, range: 15-78), vascular injuries occurred in only 4 cases, all involving the left iliac vein, and were managed intraoperatively without sequelae. No injuries to retroperitoneal, neural, or organ structures were observed. Median surgical time was 100 minutes (range: 50-210), with most cases resulting in less than 150 mL of blood loss. These findings demonstrate the feasibility of ALIF for managing TLIF/PLIF complications.</p><p><strong>Conclusion: </strong>ALIF is a safe and effective option for revision surgeries involving TLIF/PLIF cage removal, offering a low complication profile and manageable intraoperative challenges. A critical factor contributing to these favorable outcomes is the multidisciplinary approach, where the collaboration between access and spine surgeons ensures meticulous handling of anatomical and vascular challenges.</p><p><strong>Clinical relevance: </strong>This study provides valuable data for further prospective research to explore long-term outcomes and refine surgical techniques.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"261-268"},"PeriodicalIF":1.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053218","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 Secondary to Bilateral Atlantoaxial Pseudoarticulations in Rheumatoid Arthritis: A Case Report.","authors":"Pragadesh Natarajan, Vignaraja Thirunavukarasu, Yingda Li","doi":"10.14444/8735","DOIUrl":"10.14444/8735","url":null,"abstract":"<p><strong>Background: </strong>Cervical myelopathy caused by pseudarthroses is rare, with the exact pathophysiology of its occurrence unclear and reports scarce. To the best of our knowledge, only a few cases have been reported so far. We present a case of cervical myelopathy secondary to bilateral pseudoarticulations in rheumatoid arthritis and discuss possible pathomechanisms with reference to previously published reports.</p><p><strong>Case presentation: </strong>A 61-year-old woman with rheumatoid arthritis and previous C1 to C2 laminectomy suffered from cervical myelopathy. On preoperative imaging as well as surgical exploration, large osteophytes from bilateral pseudoarticulations between the posterior arches of the atlas and axis were seen to be causing severe compression of the spinal cord.</p><p><strong>Case management: </strong>Posterior instrumented C1 to C2 fusion with patient-specific pedicle screws and surgical planning was performed. The patient had significant clinical improvement after fusion.</p><p><strong>Conclusions: </strong>Ligamentous laxity in rheumatoid arthritis can lead to the development of pseudoarticulations, with dynamic forces of neck motion causing osteophytic bony spurs and cord compression. Posterior decompression and fusion was effective in this case of bilateral pseudoarticulations, which produced a posterolateral or \"lateral recess\" pattern of cord compression refractory to previous central decompression alone.</p><p><strong>Level of evidence: 5: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"346-350"},"PeriodicalIF":1.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742584","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":"High-Value Procedures in Endoscopic Spine Surgery: An Analysis of Clinical Outcomes Based on Surgeon Experience, Skill, and Training.","authors":"Kai-Uwe Lewandrowski, Morgan P Lorio, Benedikt W Burkhardt, Alexander R Vaccaro","doi":"10.14444/8705","DOIUrl":"https://doi.org/10.14444/8705","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227058","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":"A New Chapter for the <i>International Journal of Spine Surgery</i>: Global Perspective, Rapid Publishing, and Author-Centered Innovation.","authors":"James S Harrop, Kai-Uwe Lewandrowski, Oscar L Alves, Albert E Telfeian, Isaac L Moss","doi":"10.14444/8758","DOIUrl":"https://doi.org/10.14444/8758","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"19 2","pages":"129-130"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988508","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":"Postoperative Brace Prescription Practices for Elective Lumbar Spine Surgery: A Questionnaire-Based Study of Spine Surgeons in Japan.","authors":"Michita Noma, Yujiro Takeshita, Kota Miyoshi, Fumiko Saiki, Naohiro Kawamura, Akiro Higashikawa, Nobuhiro Hara, Takashi Ono, So Kato, Yoshitaka Matsubayashi, Yuki Taniguchi, Sakae Tanaka, Yasushi Oshima","doi":"10.14444/8719","DOIUrl":"10.14444/8719","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy of postoperative braces for degenerative lumbar disorders has long been debated, with conflicting reports regarding the promotion of bone fusion and pain relief. The current aspects of postoperative brace prescriptions have been previously reported in Western countries but not in Asia. This study aimed to elucidate prescription practices in Japan and identify factors influencing prescription decisions.</p><p><strong>Materials and methods: </strong>The survey was conducted at a spine group research meeting comprising spine surgeons from multiple institutions. The questionnaire assessed aspects of postoperative brace prescription, including the type, purpose, and duration of usage, categorized by surgical procedures for degenerative lumbar disorders: endoscopic decompression, open surgery decompression, and fusion involving 1 or more than 3 levels. The respondents' backgrounds, scientific knowledge of postoperative braces, nonscientific reasons, and basis for prescription decisions were also investigated.</p><p><strong>Results: </strong>There were 63 valid responses. The overall postoperative brace prescription rate was 83%, with 66% for decompression and 98% for fusion procedures, surpassing the rates reported in Western studies. The primary prescription purpose was to slow down patient activity (83%, double the previously reported rates). Prescription rates for endoscopic and open surgical decompression were significantly correlated with facility attributes and annual number of surgeries. Scientific knowledge of postoperative braces was lacking in 56% of respondents, with scientific evidence being the least frequent decision for brace prescription (14%). Nonscientific reasons influenced the prescription decisions of 84% of participants.</p><p><strong>Conclusion: </strong>The postoperative brace prescription rate among spine surgeons in Japan was significantly higher than that in Western studies, largely due to nonscientific factors such as physician reassurance and the intention to slow down patient activity. Comprehensive, evidence-based guidelines are needed regarding consistent brace usage to optimize patient outcomes.</p><p><strong>Clinical relevance: </strong>This study highlights the high postoperative brace prescription rates among spine surgeons in Japan, which are significantly influenced by nonscientific factors, such as tradition, physician reassurance, and patient satisfaction, rather than scientific evidence. These findings underscore the need for evidence-based guidelines to improve consistency in postoperative brace usage. The results are particularly relevant in regions with aging populations and a high prevalence of osteoporosis, providing insights for improving postoperative management strategies and patient outcomes in Japan as well as in similar demographic settings globally.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"237-245"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068479","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":"Key Considerations in Surgical Decision-Making on the Side of Approach for Lumbar Lateral Transpsoas Interbody Fusion Techniques.","authors":"Brian Owler, Vijidha Shree Rajkumar, Yi Yuen Wang","doi":"10.14444/8721","DOIUrl":"10.14444/8721","url":null,"abstract":"<p><strong>Objectives: </strong>Lumbar lateral transpsoas interbody fusion is a powerful technique for addressing various spinal pathologies, enabling effective anterior column reconstruction. A critical decision in performing this procedure is selecting the appropriate side for the approach to the lumbar spine, whether in the prone or lateral decubitus position. This article outlines a decision-making framework to assist surgeons in deciding the optimal approach for direct lateral surgery to achieve the desired surgical outcome.</p><p><strong>Study design: </strong>Technical note for lateral spinal fusion approaches.</p><p><strong>Methods: </strong>The article explores anatomical considerations, surgical indications, and patient-specific factors relevant to the choice of approach in lateral lumbar transpsoas fusions. Through case examples, various factors influencing side selection are discussed.</p><p><strong>Results: </strong>While many traditionally learn and perform direct transpsoas fusions through left-sided approaches, it is essential to consider pertinent anatomical features or variations, surgical pathologies, and patient-specific symptoms. The optimal side of the approach may vary based on these factors and remain key considerations for a holistic decision.</p><p><strong>Conclusions: </strong>A thoughtful assessment of the factors highlighted here can significantly improve the likelihood of a successful prone or lateral transpsoas fusions. Although comprehensive studies are needed to better guide decisions between right- and left-sided approaches, surgeons currently rely on their clinical judgment and expertise to navigate these choices to maximize safety and efficacy for each patient.</p><p><strong>Clinical relevance: </strong>This study highlights minimizing surgical risk through holistic patient-centered decision-making.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"145-155"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574191","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":"Patient Satisfaction Following Lumbar Fusion Is Associated With Functional Status and Pain More Than the Attainment of Minimal Clinically Important Difference: Implications for Value-Based Medicine.","authors":"Matthew J Solomito, Heeren Makanji","doi":"10.14444/8757","DOIUrl":"https://doi.org/10.14444/8757","url":null,"abstract":"<p><strong>Background: </strong>In an era of value-based medicine, patient-perceived benefit and satisfaction are of paramount importance. However, current metrics of success such as the minimal clinically important difference (MCID) do not always correlate with overall patient satisfaction. Therefore, the purpose of this study was to understand the relationships between self-reported pain, Oswestry Disability Index (ODI) scores, reaching the MCID, and overall patient satisfaction in patients undergoing elective lumbar fusions.</p><p><strong>Methods: </strong>A retrospective study including patients between the ages of 18 and 89 years old who underwent a 1- or 2-level elective lumbar fusion between June 2021 and June 2023. Patients were stratified using this overall level of satisfaction with their procedure. Differences in clinical metrics and patient-reported outcome scores among satisfaction levels were assessed, and predictive analytics were used to determine whether clinical metrics were associated with satisfaction.</p><p><strong>Results: </strong>A total of 343 patients were included in this study; 81% indicated they were satisfied with their overall outcomes. There were differences in both clinical metrics and patient-reported outcomes based on satisfaction level. Current pain and function were found to be independent predictors of satisfaction, while ODI scores and reaching MCID were not.</p><p><strong>Clinical relevance: </strong>Relying on meeting statistically defined benchmarks of success, such as the MCID, may not provide an accurate depiction of procedural success or patient satisfaction, and additional clinically relevant benchmarks should also be assessed.</p><p><strong>Conclusions: </strong>Pain and current function were significantly associated with patient satisfaction; therefore, these metrics may play a larger role in patient satisfaction and perceived benefit than assessment through the ODI alone.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"19 2","pages":"200-206"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003051","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":"Prone Position for Preoperative Planning in Lumbar Endoscopic and Minimally Invasive Fusion Procedures: Insights From a Magnetic Resonance Imaging Study.","authors":"Miguel Relvas-Silva, José Maria Matos Sousa, Daniel Dias, Bernardo Sousa Pinto, António Sousa, José Fonseca, Miguel Loureiro, André Rodrigues Pinho, Vitorino Veludo, António Serdoura, Maria Dulce Madeira, Pedro Alberto Pereira","doi":"10.14444/8731","DOIUrl":"10.14444/8731","url":null,"abstract":"<p><strong>Background: </strong>Differences in lumbar morphology and nerve root positioning between supine and prone decubitus are poorly analyzed. This study aimed to perform a magnetic resonance imaging (MRI) study to describe lumbar morphology, nerve root, and related structures positioning in the prone position, while comparing with conventional supine MRI, in patients with lumbar symptoms. The second aim was to define safe working zones for lumbar surgical procedures.</p><p><strong>Methods: </strong>This study was a prospective, single-center, observational study. Fifty patients with persistent low back and/or radicular pain that was unresponsive to conservative treatment were consecutively selected. Supine and prone 3 Tesla MRIs were performed. Two independent researchers performed an imaging analysis of predefined variables.</p><p><strong>Results: </strong>Lumbar lordosis significantly changed from 49.3° in the supine position to 52.1° in the prone position (<i>P</i> = 0.005), without a statistically significant difference in lower lumbar lordosis. No consistent changes were found regarding foraminal height, root-to-pedicle or root-to-superior articular process distances. The exiting nerve root was found between 42% and 49% of the foraminal height (as measured from the upper border of the lower pedicle). The left retroperitoneal lateral corridor showed no significant size variation from the supine to the prone position (<i>P</i> = 0.196 and <i>P</i> = 0.600, for L3-L4 and L4-L5 levels, respectively).</p><p><strong>Conclusion: </strong>This study suggests prone positioning may increase global lumbar lordosis, without changing the position of other major anatomical structures. The exiting nerve root positioning can be estimated in relation to foraminal height. These finding may help optimizing planning and minimizing iatrogenic lesions.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"179-187"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774432","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":"Endoscopic Spine Surgery: A French National Survey on Practices, Motivations, and Challenges.","authors":"Xavier Castel, Marc Szadkowski, Henri d'Astorg","doi":"10.14444/8722","DOIUrl":"10.14444/8722","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic spine surgery is a minimally invasive approach that offers several advantages over the traditional open approach, including less tissue trauma, faster recovery, and lower rates of complications. However, the learning curve and the requirement of separate equipment limits the acceptability of this technique for many spine surgeons. Using a short survey, the authors sought to report the current status regarding the use of endoscopy among French spine surgeons and to identify the barriers faced by spine surgeons to adopting endoscopy into their practice.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted in which a predefined questionnaire was sent as a Google form to 522 members of the Societe Francaise de Chirurgie du Rachisspine. Respondents were asked to respond within 3 months, with reminders sent regularly to nonresponders. Responses were collected and analyzed.</p><p><strong>Results: </strong>Among all 123 survey respondents, 39 practiced endoscopy and 84 did not practice endoscopy. Most of the surgeons acquired skills by visiting other surgeons (74.4%) or attending cadaver-based workshops (56.4%). A substantial portion of respondents were in between 1 and 3 years of experience (48.7%) and performed 5 to 10 endoscopic procedures per month(30.8%). Although 92.1% of respondents observed better outcomes in their patients with endoscopy, lack of training (26%) and high equipment cost (13.8%) were the most limiting factors reported by surgeons.</p><p><strong>Conclusion: </strong>The results of this survey contribute to the existing literature and highlight the current trends of endoscopic spine surgery in France. Although the benefits of minimally invasive spine surgery are well documented and were confirmed by surgeons in this survey, lack of training and cost of equipment are major barriers that need to be controlled to expand the adoption of this technique.</p><p><strong>Clinical relevance: </strong>Understanding the factors influencing the adoption of endoscopic spine surgery in France provides valuable insights for surgeons and educators. By identifying key barriers and motivations, this study may help guide strategies for improving training, accessibility, and implementation of endoscopic techniques in spinal surgery.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"173-178"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400302","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":"Stem Cells Therapy as a Treatment for Discogenic Low Back Pain: A Systematic Review.","authors":"Randy Randy, Khandar Yosua, Aswin Guntara, Nicko P Hardiansyah","doi":"10.14444/86717","DOIUrl":"10.14444/86717","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is 1 of the most common problems that present in 80% of people. LBP can be caused by some pathologies, with discogenic pain being 1 source. Pain from LBP can become chronic and also cause disability. Treatment options for LBP varied from conservative to operative, and a novel treatment nowadays is using stem cells therapy to treat with pain from LBP.</p><p><strong>Methods: </strong>Database searches from Pubmed and ScienceDirect from inception to 13 September 2023. A total of 283 discogenic LBP cases from 8 articles. This study measured clinical outcomes using a visual analog scale (VAS) and Oswestry Disability Index (ODI) obtained from each study.</p><p><strong>Results: </strong>Functional outcomes in patients treated with stem cell therapy showed significant improvement ODI and VAS (<i>P</i> < 0.00001). Improvement also showed in Pfirrmann grade before and after treatment with stem cells (<i>P</i> = 0.005). Subgroup analyses using bone marrow aspirate concentrate also showed significant differences in both ODI and VAS (<i>P</i> < 0.00001).</p><p><strong>Conclusion: </strong>Stem cells therapy could be beneficial as an option of treatment for discogenic LBP in improving pain and activity of daily living.</p><p><strong>Clinical relevance: </strong>Intradiscal stem cell therapy is a promising alternative for managing discogenic low back pain, offering 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":"156-167"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956416","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}