Spine Journal最新文献

{"title":"Guideline summary review: An evidence-based clinical guideline for the diagnosis and treatment of adults with neoplastic vertebral fractures.","authors":"Charles H Cho, Steven W Hwang, Daniel J Mazanec, John E O'Toole, William C Watters, Thiru M Annaswamy, Allan L Brook, David S Cheng, Sean D Christie, Zachary A Cupler, Dennis E Enix, Marjorie Eskay-Auerbach, Justin M Goehl, G Alexander Jones, Piyush Kalakoti, Manish K Kasliwal, Niranjan U Kavadi, Cumhur Kilincer, Justin M Lantz, Gazanfar Rahmathulla, Tom Reinsel, K Aaron Shaw, Ahmed Shawky Abdelgawaad, Amy M Skuteris, Jeffrey A Stone, Andrea L Strayer, Andrew N Vo","doi":"10.1016/j.spinee.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.019","url":null,"abstract":"<p><strong>Background context: </strong>The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Adults with Neoplastic Vertebral Fractures features evidence-based recommendations for diagnosing and treating adult patients with neoplastic vertebral fractures. The guideline is intended to reflect contemporary treatment concepts for neoplastic vertebral fractures as reflected in the highest quality clinical literature available on this subject as of October 2020.</p><p><strong>Purpose: </strong>The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with neoplastic vertebral fractures. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition.</p><p><strong>Study design: </strong>This is a guideline summary review.</p><p><strong>Methods: </strong>This guideline is the product of NASS' Clinical Practice Guidelines Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with a medical librarian. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors.</p><p><strong>Results: </strong>Twenty-two clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature.</p><p><strong>Conclusions: </strong>The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with neoplastic vertebral fractures. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at http://www.spine.org/guidelines.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744308","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":"Osteosarcoma of the mobile spine: A single-institution experience of 32 patients.","authors":"Jordan O Gasho, Vineet Desai, Santiago Lozano-Calderón, Gunnlaugur P Nielsen, Yin P Hung, Joseph H Schwab, Daniel G Tobert","doi":"10.1016/j.spinee.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.017","url":null,"abstract":"<p><strong>Background context: </strong>Osteosarcoma of the mobile spine is a rare and complex condition, with limited case series informing treatment decisions. Recent advancements in treatment paradigms, particularly in en bloc resection and novel radiation techniques, may incite new treatment guidelines and improve patient outcomes. The clinical outcomes of patients treated for osteosarcoma of the mobile spine at our institution were reported over a decade ago, and this study provides an updated assessment of management strategies and patient outcomes since the initial publication.</p><p><strong>Purpose: </strong>To provide an updated analysis of clinical results for the treatment of mobile spine osteosarcoma.</p><p><strong>Study design/setting: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Thirty-two patients treated at a single center for osteosarcoma of the spine over 22 years.</p><p><strong>Outcome measures: </strong>Estimation of overall patient survival, local recurrence, and the presence of metastatic disease.</p><p><strong>Methods: </strong>Inclusion criteria were adult patients treated for osteosarcoma originating in the vertebral column with the exclusion of the sacrum at Massachusetts General Hospital between 2001 and 2023. The overall survival was evaluated using the Kaplan-Meier method, grouped by type of resection (en bloc versus intralesional) and histological subtype (osteoblastic, chondroblastic, other/unknown). Prognostic factors were assessed using Cox proportional hazards modeling.</p><p><strong>Results: </strong>Twenty-two of the 32 patients were given en bloc resection, while ten received piecemeal resection. We found higher overall survival with en bloc resection compared to intralesional resection (median survival 81.54 months versus 12.42 months, p=0.006) using Kaplan-Meier analysis techniques. However, in multivariable regression, neither en bloc resection nor histological subtype were predictive of better outcomes. Resection of greater than one level and younger age were associated with poor survival (p<0.05).</p><p><strong>Conclusions: </strong>This study highlights the continued challenges for patients with spinal osteosarcoma despite advances in surgical techniques and radiation modalities. If feasible, en bloc resection yields improved overall survival compared to intralesional resection, but the five-year mortality rate remains high. Histological subtype did not significantly predict outcomes, while tumors involving multiple vertebral levels and younger age were associated with worse survival.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744315","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":"Normalizing Spinal Cord Compression Measures in Degenerative Cervical Myelopathy.","authors":"Sandrine Bédard, Jan Valošek, Maryam Seif, Armin Curt, Simon Schading-Sassenhausen, Nikolai Pfender, Patrick Freund, Markus Hupp, Julien Cohen-Adad","doi":"10.1016/j.spinee.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.012","url":null,"abstract":"<p><strong>Background context: </strong>Accurate and automatic MRI measurements are relevant for assessing spinal cord compression severity in degenerative cervical myelopathy (DCM) and guiding treatment. The widely-used maximum spinal cord compression (MSCC) index has limitations. Firstly, it normalizes the anteroposterior cord diameter by that above and below the compression but does not account for cord size variation along the superior-inferior axis, making MSCC sensitive to compression level. Secondly, cord shape varies across individuals, making MSCC sensitive to this variability. Thirdly, MSCC is typically calculated by an expert-rater from a single sagittal slice, which is time-consuming and prone to variability.</p><p><strong>Purpose: </strong>This study proposes a fully automatic pipeline to compute MSCC.</p><p><strong>Design: </strong>We developed a normalization strategy for traditional MSCC (anteroposterior diameter) using a healthy adults database (n=203) to address cord anatomy variability across individuals and evaluated additional morphometrics (transverse diameter, area, eccentricity, and solidity).</p><p><strong>Patient sample: </strong>DCM patient cohort of n=120.</p><p><strong>Outcome measures: </strong>Receiver operating characteristic (ROC) and area under the curve (AUC) were used as evaluation metrics.</p><p><strong>Methods: </strong>We validated the method in a mild DCM patient cohort against manually derived morphometrics and predicted the therapeutic decision (operative/conservative) using a stepwise binary logistic regression incorporating demographics and clinical scores.</p><p><strong>Results: </strong>The automatic and normalized MSCC measures correlated significantly with clinical scores and predicted the therapeutic decision more accurately than manual MSCC. Significant predictors included upper extremity sensory dysfunction, T2w hyperintensity, and the proposed MRI-based measures. The model achieved an area under the curve of 0.80 in receiver operating characteristic analysis.</p><p><strong>Conclusion: </strong>This study introduced an automatic method for computing normalized measures of cord compressions from MRIs, potentially improving therapeutic decisions in DCM patients. The method is open-source and available in Spinal Cord Toolbox v6.0 and above.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744311","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":"Severe neck pain among patients with Degenerative Cervical Myelopathy: An observational study from the Canadian Spine Outcomes and Research Network.","authors":"Nikolaus Kögl, Nathan Evaniew, Nicolas Dea, W Bradley Jacobs, Jérome Paquet, Jefferson R Wilson, Hamilton Hall, Supriya Singh, Michael H Weber, Andrew Nataraj, Najmedden Attabib, David W Cadotte, Raja Y Rampersaud, Philippe Phan, Sean D Christie, Charles G Fisher, Christopher Small, Christopher S Bailey, Kenneth Thomas, Neil Manson, Greg McIntosh, Zhi Wang, Andrew Glennie, Raphaële Charest-Morin","doi":"10.1016/j.spinee.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. While surgical intervention is widely recognized as the primary treatment to halt disease progression and improve neurological function, its effectiveness in alleviating neck pain remains poorly understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The aims of this study were to identify DCM patients that presented with severe neck pain and to compare their baseline characteristics and surgical outcomes to those who presented with less severe neck pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;This is a prospective, multicenter observational cohort study of the Canadian Spine Outcomes and Research Network (CSORN).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sample: &lt;/strong&gt;Patients surgically treated for DCM between 2015 and 2022 were enrolled.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measure: &lt;/strong&gt;Baseline demographics, clinical/surgical details, PROs and mJOA were assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Baseline demographics, clinical/ surgical details, preoperative PROs and mJOA were compared between the patients with severe patient-rated neck pain (NP, defined as NRS-NP ≥ 8), and those with less severe NP. Between group improvements at 12 months were assessed using ANCOVA to adjust for any baseline significant differences between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included data from 725 DCM patients, 31.7 % (n=230) of whom presented with severe NP. Patients with severe NP were significantly more likely to be younger, smokers, unemployed, working rather than retired, unmarried, using pain medication, have a history of depression, have more comorbidities, and be physically less active (all p&lt; 0.05). Baseline PROs (NRS AP and NP, NDI, SF-12 MCS and PCS and EQ5D) were significantly worse (p&lt;0.01), but mJOA scores were similar to those without severe NP. Among patients with severe NP, mean NRS-NP improved from 8.6 (SD 0.8) to 3.9 (SD 2.9, p&lt;0.01) at 12 months after surgery. Patients with severe NP were more likely to achieve MCID for neck pain in comparison to those without severe NP (74% vs. 33%, p&lt;0.01), but mean NRS-NP remained worse in this subgroup (3.9 vs. 2.6, p&lt;0.01) at one year after surgery. When adjusted for baseline characteristics, there were no differences between the 2 groups for the following PROs at 12 months post-operatively: NRS arm pain, NDI, SF-12 PCS, EQ5D. SF-12 MCS remained significantly worse among patients who presented with severe NP (p&lt; 0.05). There was no significant difference in mJOA scores (report data) at one year after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Severe neck pain affects about a third of the DCM population. Most patients who presented with severe neck pain experienced substantial improvement of their neck pain after surgery. Except for mental health scores which remained worse, patients with severe neck pain experienced similar improvements in other outcome measures such as neurological function an","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744323","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":"Using Deep Learning to Enhance Reporting Efficiency and Accuracy in Degenerative Cervical Spine MRI.","authors":"Aric Lee, Junran Wu, Changshuo Liu, Andrew Makmur, Yong Han Ting, Shannon Lee, Matthew Ding Zhou Chan, Desmond Shi Wei Lim, Vanessa Mei Hui Khoo, Jonathan Sng, Han Yang Ong, Amos Tan, Shuliang Ge, Faimee Erwan Muhamat Nor, Yi Ting Lim, Joey Chan Yiing Beh, Qai Ven Yap, Jiong Hao Tan, Naresh Kumar, Beng Chin Ooi, James Thomas Patrick Decourcy Hallinan","doi":"10.1016/j.spinee.2025.03.009","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.009","url":null,"abstract":"<p><strong>Background context: </strong>Cervical spine MRI is essential for evaluating degenerative cervical spondylosis (DCS) but is time-consuming to report and subject to interobserver variability. The integration of artificial intelligence in medical imaging offers potential solutions to enhance productivity and diagnostic consistency.</p><p><strong>Purpose: </strong>To assess whether a transformer-based deep learning model (DLM) can improve the efficiency and accuracy of radiologists in reporting DCS MRIs.</p><p><strong>Study design/setting: </strong>Retrospective study using external DCS MRIs from December 2015 to August 2018.</p><p><strong>Patient sample: </strong>The test dataset comprised 50 pre-operative DCS MRIs (2,555 images) from 50 patients (mean age = 60 years ± SD 14; 13 women (26%)), excluding cases with instrumentation.</p><p><strong>Outcome measures: </strong>Primary outcomes were interpretation time and interobserver agreement (Gwet's kappa) among radiologists grading spinal canal and neural foramina stenosis with and without DLM-assistance.</p><p><strong>Methods: </strong>A transformer-based DLM was used to classify spinal canal (grades 0/1/2/3) and neural foramina (grades 0/1/2) stenosis at each disc level. Two experienced musculoskeletal radiologists (both with 12-years-of-experience) provided reference standard labels in consensus. Ten radiologists (0-7 years of experience) graded DCS MRIs with and without DLM-assistance, with a 1-month washout period between sessions to minimize recall bias. Interpretation time and interobserver agreement were assessed.</p><p><strong>Results: </strong>DLM-assistance significantly improved interpretation time by 69-308 seconds (p < 0.001), reducing mean time from 159-490 seconds (SD 27-649) to 90-182 seconds (SD 42-218). Radiology residents experienced the largest time savings. DLM-assistance improved interobserver agreement across all stenosis gradings compared to baseline. For dichotomous spinal canal grading, residents had the largest improvement in agreement (κ = 0.63 to 0.77, p < 0.001). Conversely, for dichotomous neural foramina grading, musculoskeletal radiologists had the largest improvement (κ = 0.60 to 0.72, p < 0.001). Notably, independent DLM performance alone was equivalent or superior to all readers.</p><p><strong>Conclusions: </strong>The integration of a deep learning model into the radiological assessment of DCS MRI improved radiologists' interpretation time and interobserver agreement, regardless of experience level.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744326","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":"External performance of the Spinal Infection Treatment Evaluation (SITE) score and Spinal Instability Spondylodiscitis Score (SISS) in predicting operative intervention for de novo spinal infections.","authors":"Grace X Xiong, Rachel Huang, Rajkishen Narayanan, Teeto Ezeonu, Ecaterina Duscova, Steven Banko, Leah Prischak, Anu Senthil, Sam Alfonsi, Matt Clark, Barrett I Woods, Mark F Kurd, Jeff A Rihn, Ian D Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.1016/j.spinee.2025.03.006","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;As the incidence of de novo spinal infections has risen with increasing global medical complexity and intravenous drug use, so has the uncertainty around standard of care and surgical decision making. Non-operative management has increased in popularity albeit with frequent failure rates in up to one-third of patients. Although clinical decision making has largely been guided by clinician experience and institutional preference, two recent scoring systems - the Spinal Instability Spondylodiscitis Score (SISS) and the Spinal Infection Treatment Evaluation score (SITE) provide a promising potential avenue towards evidence-based pathways.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The aim of the current study was to compare external performance of the SITE and the SISS score in predicting operative decision making in patients with de novo spinal infections seen at a tertiary urban referral center, using real-world clinical decision making as a comparison. A secondary aim was to elucidate areas with low reliability or floor or ceiling effects as possible targets for score improvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective external validation study utilizing consecutive cases from an academic tertiary referral center PATIENT SAMPLE: Adult patients undergoing treatment for spondylodiscitis or spinal epidural abscess OUTCOME MEASURES: Using the surgical intervention as the ground truth, the primary outcomes were performance metrics of the SITE and SISS score including receiver operating characteristic curves, specificity, sensitivity, and interrater reliability for both score and classification. Of note, the SITE score increases in severity with lower scores, whereas the SISS score increases in severity with higher scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A panel of three blinded raters scored the clinical data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Two-hundred thirteen patients were included, of which 62% (144/213) underwent non-operative medical management and 38% (80/213) underwent operative management. Mean SITE numerical scores were lower (more severe) in the operative group (5.63 versus 7.45, p &lt; 0.001). The most frequent categorical group for the SITE score was \"severe\" in both the operative group (93%, 74/80, mean score 5.63) and the nonoperative group (68%, 90/133, mean score 7.45). The mean SISS score did not differ between operative and nonoperative groups (6.73 versus 6.25, p = 0.2). ICC agreement was \"almost perfect\" for the SITE score (0.86, 95% CI 0.82 - 0.89) and \"substantial\" for the SISS score (0.68, 95% CI 0.56 - 0.76). Performance metrics for the SITE score were \"good\" (AUC 0.743, 95% CI 0.67 - 0.81), and for the SISS score were \"poor\" (AUC 0.557,n95% CI 0.47 - 0.64). ROC analysis for SITE identified a cutoff score of 6.5 to optimize sensitivity and specificity at 0.692 and 0.700, respectively. If using the established cutoff of 8 for \"severe\" infection as described in the original scoring s","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744277","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":"Semaglutide Use is Associated with Higher Rates of Pseudarthrosis and Dysphagia in Patients Undergoing Posterior Cervical Fusion.","authors":"Mitchell K Ng, Paul G Mastrokostas, Leonidas E Mastrokostas, Ameer Tabbaa, Matthew Johnson, Jad Bou Monsef, Afshin E Razi","doi":"10.1016/j.spinee.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.023","url":null,"abstract":"<p><strong>Background context: </strong>Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has shown efficacy in managing glycemic control and obesity but its effects on surgical outcomes, particularly in posterior cervical fusion (PCF), are underexplored.</p><p><strong>Purpose: </strong>To evaluate the association between semaglutide use and postoperative complications, costs, and readmissions in patients undergoing PCF.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Patients undergoing PCF were queried from the PearlDiver Mariner database between 2010 and 2022.</p><p><strong>Outcome measures: </strong>Outcomes included medical and surgical complications, readmissions, emergency department visits, and associated costs within 90 days and two years postoperatively.</p><p><strong>Methods: </strong>Patients with an active semaglutide prescription were propensity score-matched in a 1:5 ratio to controls based on age, sex, Elixhauser Comorbidity Index, and other clinical variables. Statistical analyses included chi-square tests and logistic regression, with significance set at P < 0.003 after Bonferroni correction.</p><p><strong>Results: </strong>A total of 340 semaglutide users and 1,540 matched controls were included. Semaglutide use was associated with significantly higher odds of pseudoarthrosis at two years (OR 4.79, 95% CI 3.11-7.37; P < 0.001) and dysphagia (OR 2.12, 95% CI 1.46-3.03; P < 0.001). Hospital cost analyses revealed significant differences between groups. Same-day ($5,000 vs. $11,700; P < 0.001) and mean 90-day costs were significantly lower ($12,200 vs. $18,800; P < 0.001) in the semaglutide group. No differences were observed in emergency department visits or readmissions (P > 0.003 for all).</p><p><strong>Conclusions: </strong>Semaglutide use is associated with an increased risk of long-term complications, including pseudoarthrosis and dysphagia, as well as lower same-day and 90-day costs in patients undergoing PCF. These findings highlight the importance of careful perioperative management of semaglutide users to optimize outcomes while leveraging its purported benefits.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744322","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":"Evaluating and Managing Type 2 Odontoid Fractures: An Inter-Rater Reliability Study Assessing Agreement Among Spine Surgeons.","authors":"Sennay G Ghenbot, Janse T Schermerhorn, Cody D Schlaff, Kristopher Hooten, Ross Puffer, Bradley Dengler, Alfred J Pisano, Scott C Wagner, Donald Fredericks, Melvin D Helgeson","doi":"10.1016/j.spinee.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.004","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Consensus agreement exists regarding the management of Anderson and D'Alonzo type 1 and type 3, however management of type 2 odontoid fractures remains largely controversial. Though displaced type 2 odontoid fractures are generally considered operative, in the appropriate patient, the parameters that define \"displacement\" and their relation to fracture stability and outcomes, are poorly defined in the literature. Sagittal fracture displacement, sagittal fracture angulation, fracture comminution, and presence of local cervical deformity impact surgical decision-making, but the effect each characteristic has on clinical decisions has yet to be defined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Our goal in this study is to two-fold: (1) define agreement among spine surgeons, as it relates to five type 2 odontoid parameters: presence of local cervical deformity, presence of fracture comminution, sagittal displacement &gt;5mm, sagittal angulation &gt;11 degrees, and clinical management, (2) assess the impact each variable has on the likelihood of surgical indication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Radiographic analysis study of spine surgeons assessing odontoid fracture morphology and clinical management, using retrospectively collected imaging data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients 65 years or older, treated within the military health system, with type 2 odontoid fractures and CT imaging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Our outcome measures of interest in this study are (1) agreement among spine surgeons, as it relates to radiographic measurements, and (2) the relative impact, measured by odds ratio, that each radiographic parameter has on clinical decision making, METHODS: We queried the Military Health System (MHS) for all type 2 odontoid fractures, between 2016 and 2023, which resulted in 441 patients, of which 37 had viewable CT scans. Six spine surgeons, three orthopaedic-trained spine surgeons and three neurosurgery-trained spine surgeons, reviewed 37 sagittal CT scans of acute type 2 odontoid fractures and recorded \"0' or \"1\" for the presence of local cervical deformity, presence of fracture comminution, sagittal displacement &gt;5mm, sagittal angulation &gt;11 degrees and surgical (1) or non-surgical management (0). We performed an inter-rater reliability analysis using Fleiss' kappa coefficient to assess agreement among raters and binary multivariate regression analysis to quantify the effect of each variable on eventual clinical management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among all spine surgeons, there was substantial agreement with sagittal angulation measurements (k=0.69, p&lt;0.01), moderate agreement with sagittal displacement measurements (k=0.55, p&lt;0.01 and comminution (k=0.40, p&lt;0.01), and fair agreement regarding surgical decision-making (k=0.262, p&lt;0.000001). Subspecialty subgroup analysis demonstrated slight agreement with operative management in, both, orthopaedic-trained spine surgeo","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744276","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":"SAFETY OF NON-OSSEOUS UNION OF TYPE II ODONTOID FRACTURES - A MULTI-INSTITUTIONAL COHORT STUDY.","authors":"Chady Omara, Anna B Lebouille-Veldman, Alexander G Yearley, Azra Gül, James Withers, Helen Karimi, Emma J Steinbuchel, Harshit Arora, John L Kilgallon, Benjamin R Johnston, Jakob V E Gerstl, James T Kryzanski, Rania A Mekary, Michael W Groff, Ron I Riesenburger, Jeroen G J Huybregts, Timothy R Smith, Jeffrey E Florman, Carmen L A Vleggeert-Lankamp","doi":"10.1016/j.spinee.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.013","url":null,"abstract":"<p><strong>Background context: </strong>The management of type II odontoid fractures in elderly patients presents significant clinical challenges. Surgical treatment may lead to operative complications, while conservative management may increase the risk of non-osseous union, potentially compromising fracture stability.</p><p><strong>Purpose: </strong>This study aims to evaluate the safety of non-osseous union subtypes in type II odontoid fractures following conservative treatment and to identify risk factors for unstable fractures.</p><p><strong>Study design: </strong>A multi-institutional retrospective cohort study.</p><p><strong>Patient sample: </strong>A total of 307 patients with acute type II odontoid fractures treated conservatively between 2005 and 2022 were included. The mean age was 76 ± 17 years, with a median follow-up of 24 months (IQR 9 - 55 months).</p><p><strong>Outcome measures: </strong>Fracture healing and stability were assessed. Safety of each healing subtype was determined by the incidence of new neurological deficits post-collar removal or the need for surgical fixation. Risk factors for unstable fractures were also determined.</p><p><strong>Methods: </strong>Fracture healing was classified as osseous union, fibrous non-union, or unstable non-union based on CT and dynamic X-rays at collar removal. Fracture stability was assessed using only dynamic X-rays, with unstable fractures demonstrating active displacement. Neurological outcomes and the necessity for surgical fixation in each group were compared. Multivariable logistic regression was used to analyze risk factors for fracture instability.</p><p><strong>Results: </strong>Unstable non-union occurred in 25% of patients, while fibrous non-union occurred in 47% after a median collar wear of 3.7 months (IQR 2.9 - 6.2 months). New neurological deficits after collar removal were seen in 6% of patients with unstable non-unions during follow-up, but in none of those with fibrous non-unions or osseous unions, even after subsequent trauma. Risk factors for unstable non-union included male sex (OR 2.14; 95% CI: 1.02-4.49), osteoporosis/osteopenia (OR 2.50; 95% CI: 1.17- 5.37), and baseline fracture displacement (OR 4.81; 95% CI: 2.35-9.86).</p><p><strong>Conclusions: </strong>Fibrous non-union is a viable outcome in conservatively managed type II odontoid fractures, reducing the need for surgery or prolonged collar wear. Risk factors for unstable non-union included male sex, osteoporosis/osteopenia, and baseline fracture displacement. Unstable non-unions may lead to new neurological deficits occurring post-collar removal in a small percentage of cases.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744321","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":"Novel Radiologic Parameter for Assessing Decompression Adequacy in Anterior Cervical Decompression Surgery: The V-line.","authors":"Dong-Ho Lee, Sung Tan Cho, Chang Ju Hwang, Jae Hwan Cho, Sehan Park, Jin Hwan Kim, Wongthawat Liawrungrueang","doi":"10.1016/j.spinee.2025.03.007","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Anterior cervical decompression surgeries, such as Vertebral Body Sliding Osteotomy (VBSO) and Anterior Cervical Corpectomy and Fusion (ACCF), serve as vital surgical options for managing cervical myelopathy. Despite their effectiveness, incomplete expansion of the spinal canal can occur in certain cases. However, many patients still experience positive clinical outcomes after these surgeries, suggesting that assessing outcomes based solely on the lesion's canal-occupying effect may be limited. In cases of anterior-based fusion surgery, changes in cervical alignment can occur postoperatively. Since traditional measures like the canal occupying ratio (COR) consider only the absolute size of the lesion, they may overlook improvements in clinical symptoms due to enhanced lordosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study introduces the V-line, a novel radiologic parameter, to universally evaluate decompression outcomes in these procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study PATIENT SAMPLE: This retrospective analysis encompassed 93 patients treated for cervical myelopathy due to ossification of the posterior longitudinal ligament through either VBSO (N=76) or ACCF (N=17) OUTCOME MEASURE: Radiological evaluations included C2-7 lordosis, segmental lordosis, and COR. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively, at 1-year postoperatively, and at the final follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The V-line, defined on a plain lateral radiograph in the neutral position, connects the lowest point on the posterior margin of the vertebral body immediately above the osteotomy site to the highest point on the posterior margin immediately below it. The V-line classification was \"V-line (-)\" if the postoperative pathologic lesion contacted the V-line and \"V-line (+)\" if it did not. Patients were categorized based on postoperative COR and the V-line assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The V-line (+) group achieved a higher final JOA score (15.3 ± 1.91) and JOA recovery rate (62.16 ± 32.22) compared to the V-line (-) group, which recorded a final JOA score (14.25 ± 2.33, p = 0.037) and a JOA recovery rate (24.71 ± 32.00, p&lt;0.001). Additionally, postoperative C2-7 lordosis (18.05 ± 9.59, p &lt; 0.001) and segmental lordosis (18.53 ± 8.49, p = 0.008) in the V-line (+) group were significantly greater than in the V-line (-) group (10.68 ± 8.38; 11.42 ± 7.87). However, when comparing groups based on postoperative COR, significant differences were observed only in the JOA recovery rate, with no notable differences in final JOA score, C2-7 lordosis and segmental lordosis between the groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Since the V-line accounts for both the mass effect of the pathological lesion and cervical alignment, this parameter effectively reflects the reduced impact of spinal cord compression when cervical lordosis is restored, even with residua","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744313","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}