Spine Journal最新文献

{"title":"Contemporary decision-making factors leading to cervical disc replacement vs. fusion for the treatment of single-level degenerative cervical radiculopathy or myelopathy: survey opinions from members of the Society of Minimally Invasive Spine Surgeon and Cervical Spine Research Society.","authors":"Karim A Shafi, Adrian T H Lui, Christopher Mikhail, Kyle Morse, Joshua Zhang, Cole Kwas, Hyun Bae, Sravisht Iyer, Sheeraz Qureshi","doi":"10.1016/j.spinee.2025.08.334","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.08.334","url":null,"abstract":"<p><strong>Background: </strong>Degenerative cervical radiculopathy and myelopathy are frequently encountered pathologies in spine surgery. Cervical disc replacement (CDR) offers a motion-preserving alternative to conventional anterior cervical discectomy and fusion (ACDF). Presently, there is limited consensus on which variables impact the decision to perform fusion vs. arthroplasty for this disease.</p><p><strong>Purpose: </strong>This study aims to characterize current practices for the treatment of single-level degenerative cervical radiculopathy or myelopathy and to identify and rank clinical and radiographic variables that most influence surgical decision making with regards to ACDF and arthroplasty.</p><p><strong>Study design/setting: </strong>Descriptive, cross-sectional survey SUBJECT SAMPLE: An 11-item survey was distributed to surgeon attendees of the Cervical Spine Research Society's (CSRS) 52nd Annual Meeting and members of Society for Minimally Invasive Spine Surgery (SMISS) in 2024.</p><p><strong>Outcome measures: </strong>Surgeons reported practice demographics, CDR training, attitude towards current literature, and adoption patterns. Surgeons were asked to rank 7 clinical factors and 8 radiographic parameters in order of importance when deciding between CDR vs ACDF.</p><p><strong>Methods: </strong>Primary analysis was performed to summarize demographic data, surgeon attitudes, and adoption. Descriptive and stratified analysis was performed to identify significant trends and associations among these factors. Clinical and radiographic parameters were ranked in order of importance and were compared. Rankings for each parameter were reported as means, highest and lowest rankings, and percentiles. Each parameter's ranking frequency was then reported as most important, top 3 most important, and top 5 most important.</p><p><strong>Results: </strong>Seventy-five completed responses were received. Most respondents performed fewer than 25% CDR for primary cases, with only 4% reporting utilization rates of >75%. More private surgeons (50%) adopt CDR in >25% of their cases compared to academic surgeons (13%). CDR adoption varied significantly by region, with the Southwest (71%) and Southeast (57%) regions having the highest proportions of surgeons adopting >25% CDR in their practices as opposed to ACDF. The most cited barrier was risk-benefit trade-offs (28%). 87% of respondents viewed the current evidence for CDR as high quality, 11% rated it as low quality and unconvincing. Hypermobility/connective tissue disease and severe myelopathy were clinical deterrents for CDR. Segmental instability and significant kyphotic deformity were radiographic determinants for choosing ACDF over CDR.</p><p><strong>Conclusions: </strong>There is limited evidence on the variables that most affect surgical decision-making when choosing between ACDF and CDR for degenerative cervical radiculopathy/myelopathy. Geographic location and practice type appear to be ass","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing economic models for emerging surgical technologies: a reply to stockman et al.","authors":"Daniel Schneider, Ethan D L Brown, Aladine A Elsamadicy, Daniel M Sciubba, Sheng-Fu Larry Lo","doi":"10.1016/j.spinee.2025.08.328","DOIUrl":"10.1016/j.spinee.2025.08.328","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicentre external validation of the new England spinal metastasis score (NESMS) in operative and nonoperative patients with metastatic spinal cord compression.","authors":"William Giles, Lori Low, Anna L Watts, Vasudha Narayanaswamy, Osanmofe Gbenebichie, Alex Burnett, Doreen Koske, Caroline Wilson, Neil Chiverton, James Tomlinson, Shreya Srinivas","doi":"10.1016/j.spinee.2025.08.333","DOIUrl":"10.1016/j.spinee.2025.08.333","url":null,"abstract":"<p><strong>Background context: </strong>Metastatic spinal cord compression (MSCC) presents complex treatment dilemmas where predicting survival is crucial for clinical decision-making.</p><p><strong>Purpose: </strong>The New England Spinal Metastasis Score (NESMS) has shown promise, but external validation is needed to confirm its broader applicability.</p><p><strong>Study design: </strong>Patients were assigned NESMS retrospectively based on ambulatory status, serum albumin level, and modified Bauer score.</p><p><strong>Patient sample: </strong>This retrospective multicentre study included 322 adult patients with radiologically confirmed MSCC who presented for initial treatment over a 3-year period at 2 partner institutions.</p><p><strong>Outcome measures: </strong>The primary outcome was mortality at 12 months, with secondary outcomes of mortality at 3 and 6 months.</p><p><strong>Methods: </strong>Kaplan-Meier survival analysis and multivariate logistic regression were used to evaluate NESMS performance in predicting mortality and its discriminative capacity, while adjusting for potential confounders.</p><p><strong>Results: </strong>The cohort had a median age of 70 years, with 65% male patients. Overall 12-month mortality was 75%. NESMS demonstrated excellent discriminative capacity for predicting 12-month mortality (c-statistic 0.82, p<.001) with clear stepwise differences in survival between NESMS levels (mortality: NESMS 0=98%, NESMS 1=88%, NESMS 2=75%, NESMS 3=46%). Multivariate analysis confirmed significantly greater odds of mortality with decreasing NESMS (NESMS 0: OR 35.92, CI 6.90-662.6; NESMS 1: OR 6.97, CI 3.22-16.02; NESMS 2: OR 2.69, CI 1.35-5.42; all p<.05 compared to NESMS 3). Operative management was associated with significantly lower mortality (OR 0.28, CI 0.15-0.51; p<.001).</p><p><strong>Conclusions: </strong>This study externally validates the usefulness of the NESMS in predicting survival for both operative and nonoperative patients with MSCC. Further, we observed clear stepwise increases in mortality with worsening NESMS.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative function of lower extremity muscles and walking ability after total en bloc spondylectomy for lumbar spinal tumors.","authors":"Satoshi Kato, Yuki Kurokawa, Noriaki Yokogawa, Takaki Shimizu, Hideki Murakami, Satoru Demura","doi":"10.1016/j.spinee.2025.08.338","DOIUrl":"10.1016/j.spinee.2025.08.338","url":null,"abstract":"<p><strong>Background context: </strong>Total en bloc spondylectomy (TES) for lumbar tumors significantly impacts lower extremity motor function because of surgical stress on the lumbar nerve roots and psoas muscles.</p><p><strong>Purpose: </strong>The aim of this study was to assess the strength of the major lower extremity muscles and walking function following lumbar TES using prospectively collected data and identify functional differences based on the levels of the resected vertebrae.</p><p><strong>Study design/setting: </strong>Retrospective study with prospectively collected data.</p><p><strong>Patient sample: </strong>Data were collected from 34 patients who underwent single-level TES for lumbar spinal tumors at our institution between January 2010 and December 2021.</p><p><strong>Outcome measures: </strong>Lower extremity motor function and walking ability were evaluated pre- and postsurgery. Lower extremity motor function was analyzed using Manual Muscle Testing of the iliopsoas, quadriceps femoris, and tibialis anterior muscles at baseline and 1, 3, and 6 months postsurgery. The Spinal Cord Independent Measure indoor mobility was used to evaluate ambulation status at baseline and 1, 3, 6, and 12 months postsurgery.</p><p><strong>Methods: </strong>In lumbar TES at our institution, L1 and L2 nerve roots were often transected while L3-L5 nerve roots were preserved. Dissection of the segmental vessels and detachment of the diaphragmatic crura via an anterior approach were often employed before posterior TES for L1-L3 lesions. Vertebral body resection and cage insertion via an anterior approach were performed following posterior element resection and instrumentation for L4 and L5 lesions.</p><p><strong>Results: </strong>The incidence of postoperative lower extremity muscle weakness was 75% in the TES group at L1 and 100% at L2 or below. Quadriceps muscle weakness was most pronounced in patients who underwent L4-TES, involving wide dissection of the L3 and L4 nerve roots. Tibialis anterior muscle weakness was most severe in patients who underwent L5-TES with wide dissection of the L4 and 5 nerve roots. At 12 months postsurgery, walking ability normalized in all patients except some who underwent L4-TES or L5-TES.</p><p><strong>Conclusions: </strong>Postoperative lower extremity muscle weakness was severe in patients undergoing TES involving the middle or lower lumbar spine. Patients who underwent L5-TES were more likely to experience residual gait disturbances.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shifts in diversity along the spine surgery training pathway: racial, ethnic, and gender representation from medical school to fellowship.","authors":"Jason Silvestre, Jaslyn A Hernandez, Robert A Ravinsky, James D Kang, Hao Hua Wu, Charles A Reitman, James P Lawrence","doi":"10.1016/j.spinee.2025.08.332","DOIUrl":"10.1016/j.spinee.2025.08.332","url":null,"abstract":"<p><strong>Background context: </strong>Racial and ethnic minorities are underrepresented among healthcare providers in the United States (US).</p><p><strong>Purpose: </strong>This study analyzed the training pathway of underrepresented groups in spine surgery relative to earlier stages of training and the US population.</p><p><strong>Study design/setting: </strong>This was a cross-sectional analysis of medical students, orthopedic surgery residents, and spine surgery fellows at accredited training programs (2014-2024).</p><p><strong>Patient sample: </strong>N/A.</p><p><strong>Outcome measures: </strong>Representation (%) and participation-to-prevalence ratios (PPRs) defined as the participation of demographic groups in spine surgery training over their prevalence in earlier stages of training cohorts. PPRs <0.80 were classified as underrepresented and PPRs>1.2 were classified as overrepresented.</p><p><strong>Methods: </strong>Self-reported demographics were compared between the US population, medical students, orthopedic surgery residents, and spine surgery fellows.</p><p><strong>Results: </strong>There were demographic disparities between medical students, orthopedic surgery residents, and spine surgery fellows including female (48.7% vs. 16.7% vs. 6.6%, p<.001), White (54.7% vs. 73.1% vs. 52.6%, p<.001), Black (6.1% vs. 4.4% vs. 8.4%, p<.001), Native Hawaiian/Pacific Islander (0.04% vs. 0.08% vs. 0.70%, p<.001), and Asian (21.3% vs. 13.0% vs. 17.1%, p<.001) trainees. There were no significant disparities among Hispanic (5.4% vs. 5.3% vs. 7.7%, p=.292) and American Indian/Alaska Native (0.15% vs. 0.13% vs. 0.35%, p=.888) trainees. Relative to the US population, female (PPR=0.13), Hispanic (PPR=0.41), American Indian/Alaska Native (PPR=0.64), and Black (PPR=0.68) trainees were underrepresented in spine surgery. In contrast, Asian (PPR=2.85), male (PPR=1.89), Native Hawaiian/Pacific Islander (PPR=1.75) were overrepresented in accredited spine surgery training relative to the US population.</p><p><strong>Conclusions: </strong>Diversity by gender, race, and ethnicity in accredited spine surgery training is limited relative to the US population. There may be opportunities to recruit underrepresented groups during earlier stages of medical training to promote diversity, equity, and inclusion in the emerging spine surgery workforce.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translating academic excellence to broader healthcare implementation: a reply to \"robotic spine surgery: beyond adverse event reports and operative time\" by Chan et al.","authors":"Daniel Schneider, Ethan D L Brown, Aladine A Elsamadicy, Daniel M Sciubba, Sheng-Fu Larry Lo","doi":"10.1016/j.spinee.2025.08.329","DOIUrl":"10.1016/j.spinee.2025.08.329","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing optimal protocols with real-world implementation challenges: a reply to Mcafee et al.","authors":"Daniel Schneider, Ethan D L Brown, Aladine A Elsamadicy, Daniel M Sciubba, Sheng-Fu Larry Lo","doi":"10.1016/j.spinee.2025.08.327","DOIUrl":"10.1016/j.spinee.2025.08.327","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: the hidden cost of robotic spine surgery: real-world adverse events cause 58-minute delays and undermine economic viability.","authors":"Arjun K Menta, Patrick Kramer, Vikas N Vattipally, Antony A Fuleihan, Tej D Azad, Themistocles Protopsaltis, Nicholas Theodore","doi":"10.1016/j.spinee.2025.07.036","DOIUrl":"10.1016/j.spinee.2025.07.036","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to editor: the hidden cost of robotic spine surgery: real-world adverse events cause 58-minute delays and undermine economic viability.","authors":"Isabelle Stockman, Asham Khan, Mohamed A R Soliman, Esteban Quiceno, John Pollina","doi":"10.1016/j.spinee.2025.08.326","DOIUrl":"10.1016/j.spinee.2025.08.326","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging evidence gaps in real-world healthcare decision-making: a reply to \"letter: the hidden cost of robotic spine surgery\" by Menta et al.","authors":"Daniel Schneider, Ethan D L Brown, Aladine A Elsamadicy, Daniel M Sciubba, Sheng-Fu Larry Lo","doi":"10.1016/j.spinee.2025.08.330","DOIUrl":"10.1016/j.spinee.2025.08.330","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}