Spine Journal最新文献

{"title":"A prospective multicenter randomized controlled trial on safety and procedural competency in SI joint fusion performed by interventional pain physicians trained by a spine surgeon.","authors":"Kingsley R Chin, Erik Spayde, William M Costigan, Soubrata V Raikar, Yeshvant A Navalgund, Paul Pannozzo, Jessen J Mukalel, Steven Siwek, Sachin Narain, Luis Fandos, Paul Ky, Shaun Jackson, Ajay Yeddu, Michael Rock, Randolph Chang, Tian Xia, Abdul Shahid, Vasilios Kountis, Mark H Coleman, Azhar Pasha, Boleslav Kosharskyy, Christine Haddad, Faris Abusharif, Matthew McCarty, Michael D Danko, Justice Otchere, Michael Hunter, Matthias Wiederholz, Abram Burgher, Vito Lore, Angel Walker, Hope Estevez, Chukwunonso C Ilogu, Jason A Seale","doi":"10.1016/j.spinee.2025.05.014","DOIUrl":"10.1016/j.spinee.2025.05.014","url":null,"abstract":"<p><strong>Background context: </strong>Sacroiliac joint (SIJ) fusion was traditionally performed exclusively by spine surgeons using a minimally invasive direct lateral approach. With advancements in technology, SIJ fusion has evolved into percutaneous techniques which have been adopted by interventional pain management (IPM) physicians due to their expertise in interventional techniques. However, this expansion has raised safety concerns among spine surgeons regarding \"practice creep\" and procedural competency gaps. Furthermore, the lack of uniform outpatient credentialing has created an environment where safety oversight may be inconsistent.</p><p><strong>Purpose: </strong>To evaluate and compare the safety and procedural competency of percutaneous posterior-oblique SIJ fusions performed by trained IPM physicians using titanium screws plus a synthetic bioactive glass flowable biologics under direct spine surgeon supervision versus nonspine surgeon supervision.</p><p><strong>Study design/setting: </strong>A prospective multicenter randomized controlled trial conducted across multiple ambulatory surgery centers between 2020 and 2022.</p><p><strong>Patient sample: </strong>About 276 adult patients (mean age 56.7 years; 72.1% female) scheduled for SIJ fusion.</p><p><strong>Outcome measures: </strong>The primary outcome measures were surgical complications, deviations, and revisions. These were assessed through medical records and radiographs for at least 6 months post operative.</p><p><strong>Methods: </strong>About 276 patients were in this study and were randomly assigned to Group 1 or Group 2. Sixty-six patients (Group 1; spine surgeon supervised). Sixty-seven patients, clinical specialist supervised, plus 143 assigned to sales representatives/independent distributors supervised (Group 2; nonspine surgeon supervised). All primary procedures were performed by 47 IPM physicians who received structured training on the percutaneous posterior-oblique technique by a board-certified orthopedic spine surgeon. Surgical complications, deviations, and revisions were recorded, with follow-up data collected for at least 12 months.</p><p><strong>Results: </strong>A total of 9 complications (3.3%), 4 deviations (1.4%), and 5 revision cases (1.8%) were observed. Group 1 experienced no complications, deviations, or revisions. In Group 2, 9 complications (4.3%) and 4 deviations (1.9%) occurred between the second and fifth operative days. 5 cases were revised (2.4%).</p><p><strong>Conclusions: </strong>Spine surgeon training equipped IPM physicians to safely performed percutaneous posterior-oblique SIJ fusions with titanium screws plus biologics, achieving low complication and revision rates. These findings highlight the importance of incorporating standardized surgeon-led training and certification programs to bridge the competency gap and ensure safe adoption of interventional spine surgery practices by IPM physicians.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095508","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":"The effect of L5-S1 fusion on global spine motion: a range of motion analysis comparing 2-level TDR versus hybrid at L4-S1 in 235 patients.","authors":"Thierry Marnay, Guillaume Geneste, Gregory Edgard-Rosa, Martin Grau-Ortiz, Caroline Hirsch, Georges Negre","doi":"10.1016/j.spinee.2025.05.029","DOIUrl":"10.1016/j.spinee.2025.05.029","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Lumbar total disc replacement (TDR) is a treatment option with 30 years of experience and extensive publications on clinical results. However, there is sparse literature on mid- and long-term mobility or the difference between L4-S1 two-level TDR and TDR/ALIF hybrid constructs with anterior lumbar interbody fusion (ALIF) at L5-S1 and TDR at L4-L5.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The purpose of this study was to measure and compare key mobility parameters in flexion-extension for both groups. These included motion at L4-L5, participation of pelvis mobility, global lumbar motion, and the effectiveness of overall lumbar flexion-extension. In addition, we looked for potential compensation above and below L5-S1 fusion in the hybrid group versus two-level TDR group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective clinical study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;We analyzed 235 patients who had surgery between 2003 and 2013; 170 patients received 2-level TDR (TDR group) and 65 received L4-L5 TDR and L5-S1 ALIF (Hybrid group). The average follow-up was 124 months for TDR group and 97 months for the hybrid group. Baseline demographics and patient-reported preoperative clinical parameters were equivalent in both groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Clinical measures included the following: Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back and leg pain, Satisfaction Index Scores and time of patient return to work after surgery. Complication, reoperation, and revision rates, and perioperative data points were also assessed. Radiographic evaluation included measurement of the following: pelvic parameters (Incidence, Pelvic Tilt, Sacral Slope), L4-L5 and L5-S1 flexion-extension range of motion (ROM), pelvic motion as measured by sacral slope in flexion-extension, and flexion-extension L1 ROM (newly described in the body of manuscript as \"L1 Race\") to show the effect the lumbopelvic complex has on global motion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The radiographic evaluation was performed on pre- and postoperative lateral and dynamic flexion-extension X-rays at the latest follow-up (minimum of 24 months follow-up).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;When L5-S1 is fused, there is no compensation from pelvic motion to overcome the loss of mobility. TDR group shows a pelvi-femoral ROM (defined as sacral slope in extension minus sacral slope in flexion) gain of 16.77°, vs a gain of only 6.11° in the Hybrid group. L5-S1 fusion also reduces L4-L5 TDR mobility in the Hybrid group compared to the 2-level TDR group and decreases flexion compared to baseline. There is a mean reduction in lumbar (L1-S1) ROM of 1.53° in Hybrid group versus 20.02° gain in TDR group. L1 Race also reflects the superiority of 2-level TDR vs hybrid with a gain of 32.58° in TDR vs 4.68° in Hybrid, demonstrating that reduced global motion is principally due to the loss of L5-S1 influence on motion above and below. ODI, VA","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086907","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":"TBRG4 regulates ubiquitination of Beclin1 and participates in autophagy pathway to inhibit intervertebral disc degeneration.","authors":"Xilong Cui, Feng Zhang, Di Cui, Wei Zhang, Hao Wu, Xi Chen, Haiyang Yu","doi":"10.1016/j.spinee.2025.05.018","DOIUrl":"10.1016/j.spinee.2025.05.018","url":null,"abstract":"<p><strong>Background: </strong>IDD is commonly observed in symptomatic spinal disorders and is associated with mitochondrial dysfunction and NPC apoptosis. Current therapeutic targets remain theoretical, highlighting the need to explore alternative molecular targets.</p><p><strong>Purpose: </strong>To investigate the role of TBRG4 in regulating mitochondrial function, autophagy, and apoptosis in IDD, and to evaluate its therapeutic potential.</p><p><strong>Study design/settings: </strong>This study combines molecular and cellular biology techniques with an in vivo rat model of IDD.</p><p><strong>Methods: </strong>Human NPCs were isolated and characterized from IDD patients and controls. TBRG4 expression was modulated using plasmid transfection. Autophagy, apoptosis, and mitochondrial function were assessed using immunofluorescence, Western blot, and flow cytometry. Co-immunoprecipitation and mass spectrometry identified TBRG4-interacting proteins. A rat IDD model evaluated TBRG4's therapeutic effects in vivo.</p><p><strong>Results: </strong>TBRG4 expression was significantly downregulated in degenerated NPCs. TBRG4 knockdown exacerbated mitochondrial dysfunction, increased apoptosis via the BCL2/C-caspase3 pathway, and inhibited autophagy. Mechanistically, TBRG4 interacted with Beclin1 and reduced its ubiquitination, thereby promoting autophagy. Overexpression of TBRG4 in NPCs restored mitochondrial function and suppressed apoptosis. In a rat IDD model, TBRG4 overexpression alleviated disc degeneration, as evidenced by MRI, histological analysis, and decreased Pfirmmann grading.</p><p><strong>Conclusions: </strong>TBRG4 plays a crucial protective role in IDD by promoting autophagy and maintaining mitochondrial homeostasis. It interacts with Beclin1 to enhance autophagy by reducing ubiquitination. TBRG4 shows potential as a novel therapeutic target for IDD.</p><p><strong>Clinical significance: </strong>TBRG4-based therapies may represent a promising strategy to mitigate IDD progression, improve NPC survival, and restore disc function. Future research should focus on the development of TBRG4 activators and large-scale clinical validation.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086903","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":"Spinal cord status assessment and early interventional personalized rehabilitation after endoscopic surgery for cervical compressive myelopathy: a randomized trial.","authors":"Yiwei Ding, Fengtong Lou, Rui Cao, Zhengcao Lu, Guangnan Yang, Qiang Jiang, Mei Shuai, Yuxian Zhong","doi":"10.1016/j.spinee.2025.05.024","DOIUrl":"10.1016/j.spinee.2025.05.024","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Cervical compressive myelopathy (CCM), frequently arising from spinal degeneration, results in significant motor and sensory deficits. Currently, there is a lack of precise prognostic evaluation methods following decompression surgery for CCM, which hinders the optimization of personalized rehabilitation therapy. However, the combination of intraoperative endoscopic visualization of dural sac compression morphology and electrophysiological functional assessment holds promise in addressing this gap.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To determine whether a personalized rehabilitation strategy, informed by intraoperative endoscopic and electrophysiological assessments, enhances postoperative functional outcomes in CCM patients compared to traditional rehabilitation after canal decompression surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Prospective single-center randomized controlled study, trial registration: ChiCTR2400081458.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Seventy-eight patients underwent spinal decompression surgery at The Sixth Medical Center of Chinese PLA General Hospital. The inclusion criteria included a diagnosis of CCM due to spondylosis or ossification of the longitudinal ligament. Participants were excluded if they had prior spinal surgeries or comorbidities unrelated to CCM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome was the Japanese Orthopaedic Association (JOA) score, assessing spinal function. Secondary outcomes included the Neck Disability Index (NDI), Visual Analogue Scale (VAS) for pain, and three-dimensional gait analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study was a double-blind randomized controlled trial comparing two postoperative rehabilitation strategies for patients with CCM following endoscopic spinal decompression surgery. After surgery, patients were randomly assigned to two groups. The experimental group received personalized rehabilitation based on real-time intraoperative spinal cord status assessments, using a combination of endoscopic visualization and electrophysiological grading. Interventions included lower limb exoskeleton-assisted walking and targeted motor function training. The control group received conventional standard rehabilitation treatment. Both groups were assessed using the JOA, NDI, and VAS scores before rehabilitation, 1 month, 3 months, and 12 months after the start of rehabilitation. Additionally, gait analysis (including stride frequency, gait velocity, and stride length) was performed before and 3 months after the start of rehabilitation to evaluate the clinical rehabilitation outcomes in both groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both groups showed significant improvements in JOA, NDI, VAS scores, and gait tests during the postoperative rehabilitation process. The experimental group demonstrated a more substantial increase in the primary outcome measure, the JOA score (12 months: 4.79±0.74 vs 3.53±0.93, p&lt;.05). Addit","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081434","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":"Risk of ossification of posterior longitudinal ligament (OPLL) volume progression following laminoplasty.","authors":"Qu Ruomu, Qin Siyuan, Wang Ben, Zhao Yanbin, Pan Shengfa, Chen Xin, Liu Zhongjun, Jiang Liang, Lang Ning, Zhou Feifei","doi":"10.1016/j.spinee.2025.05.028","DOIUrl":"10.1016/j.spinee.2025.05.028","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Progression of ossification of posterior longitudinal ligament (OPLL) after laminoplasty (LP) can lead to recurrent compression of the spinal cord, neurological progression, and possibly revision surgery. Continuity of OPLL across segments, termed true continuous segments (TCS), has been previously found to help maintaining lordosis after LP. However, the impact of TCS on post-LP OPLL volume progression remains unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to investigate the influence of TCS in post-LP OPLL volume progression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients who underwent LP during 2006 to 2017 and had preoperative computed tomography (CT) and a minimum 5 year CT follow-ups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Progression of OPLL volume as measured on CT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Preoperative CT images were assessed, dividing patients into TCS and non-TCS groups. The demographics, preoperative segments of OPLL were recorded. As per the previously described classification, TCS was recorded as I (continuous type OPLL on disc space spanning the upper and lower adjacent vertebral bodies for more than half of their height without any bony crack regardless of bridge formation between vertebral bodies), II (OPLL adherent to both upper and lower adjacent vertebral bodies by bridging) or III (obvious interbody auto-fusion), and the TCS II and III were defined as true bridging segments (TBS). The number of disc levels which have a TCS was documented as the TCS counts. OPLL volume was calculated by manually segmenting images using 3D slicers (Figure 2). OPLL annual volume progression rate (AVPR) was calculated by the volume change of OPLL divided by follow-up period. An AVPR greater than 5% was defined as OPLL progression. The AVPR of both groups were compared. Multivariable logistic analysis was conducted to account for confounders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 56 patients (33 males and 23 females) were included in this study, with a mean age of 53.2±8.7. The average CT follow-up durations were 95.1±33.8 months. The preoperative OPLL segments of non-TCS and TCS groups were 2.9±1.0 and 4.4±1.3 (p&lt;0.001) and the preoperative volume of non-TCS and TCS groups were 986.3±603.7 and 3,512.1±1,909.8 mm&lt;sup&gt;3&lt;/sup&gt; (p&lt;0.001), respectively. At final follow-up, the AVPR of non-TCS and TCS groups were 12.7%±18.2% and 5.9%±4.7% (p=0.393), respectively. Nineteen (54.3%) patients in the non-TCS group and 10 (47.6%) patients in the TCS group showed OPLL progression (p=0.632). Correlation analysis revealed that the TCS Type I counts did not present significant correlation with AVPR, while preoperative CL (p=0.021), TBS counts (p=0.029) and age (p=0.001) significantly negatively correlated with AVPR. Multivariable logistics analysis results revealed that more TBS counts (OR=0.095, p=0.026) and higher age (OR=0.894, p=","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037187","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":"Comparative cost-effectiveness analysis between navigated robot-assisted platforms and O-arm navigation in minimally invasive transforaminal interbody fusion (MIS-TLIF).","authors":"Joseph Jon Yin Wan, Jonathan Yeo, Zhihong Chew, Shree Kumar Dinesh","doi":"10.1016/j.spinee.2025.05.027","DOIUrl":"10.1016/j.spinee.2025.05.027","url":null,"abstract":"<p><strong>Background context: </strong>Minimal invasive Transforaminal Lumbar Interbody Fusion (TLIF) is an increasingly common procedure used in treating degenerative lumbar spine conditions. Advancement of robot-assisted technology has improved accuracy of instrumentation with smaller incisions, resulting in better surgical outcomes and shorter hospital stay.</p><p><strong>Purpose: </strong>This study aims to assess cost effectiveness of robot-assisted minimally invasive TLIF (RA-TLIF) in our institution; and compare patient outcomes with conventional O-arm navigated minimally invasive TLIF (ON-TLIF).</p><p><strong>Design: </strong>Single-center, retrospective case cohort series between elective RA-TLIF and ON-TLIF groups.</p><p><strong>Patient sample: </strong>About 27 patients who underwent elective RA-TLIF and control group of 50 elective ON-TLIF.</p><p><strong>Outcome measures: </strong>Operative duration, length of inpatient stay, postoperative ambulation, rates of intraoperative and postoperative complications and inpatient costs.</p><p><strong>Methods: </strong>Patient demographics (age, gender, Charlson Co-morbidity Index (CCI), BMI), postoperative outcomes and inpatient costs were used in comparative analysis.</p><p><strong>Results: </strong>No significant differences were found in patient demographics, baseline CCI, operative duration, length of inpatient stay, and postoperative ambulation. Rates of intraoperative and postoperative complications were similar between the 2 groups (OR=0.93, p=.112). Inpatient hospitalization costs were not significantly different between both groups.</p><p><strong>Conclusion: </strong>RA-TLIF has shown similar cost-effectiveness and surgical outcomes in comparison with conventional ON-TLIF. While not demonstrated in this study, RA-TLIF has been associated with a longer operative duration due to higher learning curve, set-up time and possible hardware/ software errors. Ultimately, more case numbers are required for the operating staff to overcome this learning curve to achieve optimal results. Spine surgical centers evaluating both techniques may consider either with confidence.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047348","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":"Orthostatic intolerance following posterior lumbar interbody fusion: incidence, risk factors, and impact on postoperative recovery: a prospective cohort study.","authors":"Xiaoxia Kang, Jiayuan Wu, Andrew Y Xu, Audrey Y Su, Mingming Liu, Jie Huang, Wenli Zhu, Cheng Zeng, Fangfang Duan, Bassel G Diebo, Alan H Daniels, Da He","doi":"10.1016/j.spinee.2025.05.020","DOIUrl":"10.1016/j.spinee.2025.05.020","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Despite the well-established consensus about the importance of early ambulation, the causes of orthostatic intolerance and its impact on patient recovery after posterior lumbar interbody fusion (PLIF) remain poorly understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To determine the incidence of orthostatic intolerance and relevant risk factors after PLIF in an enhanced recovery after surgery (ERAS) program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A prospective observational cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;This study investigated perioperative data collected from 378 patients who underwent PLIF at one center between September 2023 and July 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measure: &lt;/strong&gt;Patients' postoperative orthostatic intolerance symptoms were recorded and graded by a standardized evaluation scale. The occurrence of any symptom that resulted in termination of ambulation (dizziness, nausea, vomiting, a feeling of heat, visual disturbances, hypotension, and syncope) was classified as orthostatic intolerance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Possible risk factors were identified through univariate and multivariate analysis. The length of postoperative hospitalization, catheterization, and ambulation delay in orthostatic intolerance patients versus orthostatic tolerant patients was compared.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For orthostatic intolerance patients, the median time to first attempted ambulation was 26.0 (IQR: 20.8-31.2) hours after surgery. Overall, the observed incidence of orthostatic intolerance was 15.3%. Univariate analysis showed that a higher incidence of orthostatic intolerance was associated with history of orthostatic intolerance (6 vs. 13, p=.044), low hemoglobin on postoperative day 1 (103.8±14.8g/L vs. 110.7±13.3g/L, p&lt;.001), and high postoperative back pain visual analog scale (VAS) scores while supine (4.0 [2.0] [4.0±1.8] vs. 3.0 [1.0] [3.4±1.8], p=.015). Multivariate analysis through logistic regression controlling for covariates established the same three variables as independent risk factors: history of orthostatic intolerance (OR=3.029, 95% CI 1.021-8.988, p=.046), low hemoglobin on postoperative day 1 (OR=2.890, 95% CI 1.566-5.334, p&lt;.001), and high postoperative back pain VAS scores while supine (OR=1.218, 95% CI 1.030-1.441, p=.021). Overall, orthostatic intolerance patients had a longer postoperative hospital stay (6.0 [2.0] [6.3±1.8] vs. 6.0 [2.0] [5.8±1.8], p=.013), catheterization period (24.1 [5.2] [26.0±8.9] vs. 22.6 [4.7] [22.8±4.0], p=.042), and ambulation delay (48.2 [6.3] [48.7±7.8] vs. 25.0 [4.5] [25.0±3.9], p&lt;.001) than orthostatic tolerance patients. However, there were no clinically meaningful differences regarding postoperative hospital stay or catheterization period found between the two groups in this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Orthostatic intolerance is a common complication that prevents early ambulation in ERAS programs after PLIF. ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040640","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":"Validation of an updated patient-reported outcomes questionnaire for sacral tumors.","authors":"Jordan O Gasho, Joshua M Coan, Patrick J Boland, John H Healey, Jay S Wunder, Matthew T Houdek, Francis J Hornicek, Joseph H Schwab, Daniel G Tobert","doi":"10.1016/j.spinee.2025.05.023","DOIUrl":"10.1016/j.spinee.2025.05.023","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Assessing functional outcomes and quality of life is crucial in evaluating patient and disease management. Sacral tumors are rare and present with complex oncologic backgrounds and diverse symptoms, complicating the development of a clinically relevant and generalizable tool. A previous validation study refined an initial attempt to create a tool specific to sacral tumor patients. This study is the first independent validation of the revised shorter outcome tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To validate a revised patient-reported outcomes questionnaire specific to patients with sacral tumors. Secondarily, to assess the functional outcomes of patients with sacral tumors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;A survey study from a tertiary care multidisciplinary clinic was used for this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;This study included 70 patients with sacral tumors who presented to our institution between October 2017 and June 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The following eight questionnaires included in the revised sacral tumor survey were evaluated: the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health short form v1.1, PROMIS Pain Intensity 3a v1.0, PROMIS Gastrointestinal Bowel Incontinence 4a v1.0, PROMIS Gastrointestinal Constipation 9a v1.0, PROMIS Sexual Function and Satisfaction v1.0 Male and Female, Urogenital Distress Inventory (UDI-6), and PROMIS Ability to Participate in Social Roles and Activities v2.0.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Reliability, validity, and instrument coverage were evaluated by determining item completion rate, median score with interquartile range (IQR), and floor and ceiling effects. Internal consistency was measured using Cronbach's alpha. Bias-corrected bootstrapping (1,000 resamples) was applied to calculate the standard error and 95% confidence intervals. Spearman rank correlation coefficients were used to assess the extent of questionnaire convergence and divergence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our analysis demonstrates moderate to significant floor and ceiling effects among PROMIS Gastrointestinal Symptoms Scale, PROMIS Sexual Function, and Urinary Distress Inventory (16%-61%) with predominantly more ceiling effects. Floor effects were notable for male interest (27%), female interest (29%), and female orgasm (38%). Moderate floor effects were noted for male satisfaction (11%), male orgasm (10%), and lubrication (14%). When controlling for patients with a colostomy, floor effects generally decreased, while ceiling effects showed variable changes. The revised questionnaire demonstrated strong internal consistency, with Cronbach's alpha values exceeding the threshold of 0.7 for all assessments except lubrication. GI bowel incontinence, male satisfaction, female satisfaction, and female interest were potentially redundant with a Cronbach's alpha above 0.9. In convergent validity, we found no signi","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042119","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":"Risk factors for in-hospital mortality in cervical spinal cord injuries: a nationwide, cross-sectional analysis of concomitant injuries, comorbidities, and treatment strategies in 3.847 cases.","authors":"Melanie Schindler, Jonas Krückel, Josina Straub, Lisa Klute, Jan Reinhard, Sebastian Siller, Maximilian Kerschbaum, Dietmar Dammerer, Volker Alt, Siegmund Lang","doi":"10.1016/j.spinee.2025.05.004","DOIUrl":"10.1016/j.spinee.2025.05.004","url":null,"abstract":"<p><strong>Background context: </strong>Cervical spinal cord injuries (CSCIs) present challenges with potential severe neurological complications. Despite advances in care, in-hospital mortality remains a concern.</p><p><strong>Purpose: </strong>This study explores the impact of patient-related factors and therapeutic strategies on in-hospital mortality in individuals with CSCIs.</p><p><strong>Study design/setting: </strong>Retrospective cross-sectional study.</p><p><strong>Patient sample: </strong>Admissions with CSCIs recruited between January 2019 and December 2023.</p><p><strong>Outcome measures: </strong>Data from the German Diagnosis Related Groups (DRG) system were used to analyze main diagnoses, patient demographics, concomitant diagnoses (ICD-10), and procedures (OPS). Specific data were extracted from the database of the German Institute for the Hospital Remuneration System (InEK GmbH).</p><p><strong>Methods: </strong>Differences in comorbidities and injuries were analyzed using the Chi-square test. Odds ratios (OR) were calculated to analyze potential risk factors for in-hospital mortality.</p><p><strong>Results: </strong>In the analysis of 3.847 hospital admission cases, an in-hospital mortality rate of 11.7% (n=451) was observed. The patient cohort demonstrated a male predominance at 72.9%. The overall incidence of CSCI in Germany is 9.2 per million annually, with a significant increase in incidence rate observed with age, particularly after 60 years. The majority of admissions were aged over 65 years and this age group (>65 years) was identified as a significant risk factor for increased in-hospital mortality (n=2.064; OR 1.83; p<.001). Vertebral fractures at the levels C4 (n=364; 9.5%), C5 (n=582; 15.1%), and C6 (n=598; 15.5%) were the most common spinal injuries, while concomitant fractures at atlas (C1), axis (C2) and C7 fractures were associated with an elevated significant risk for in-hospital mortality (OR 2.40, OR=2.67, OR=2.21; p<.001). The need for blood transfusion was associated with a high in-hospital mortality rate of 31.3%. Amongst others, hypothermia, acute kidney failure, pleural effusion, and atrial fibrillation were significantly associated with in-hospital mortality (all p<.001). Additionally, aspiration pneumonia and hospital-acquired pneumonia were linked to increased in-hospital mortality risk (OR 2.21, OR 1.52; p<.001).</p><p><strong>Conclusions: </strong>Concomitant injuries and comorbidities indicating frailty and medical complications increase in-hospital mortality risk. The study highlights the need for thorough health assessments in patients with CSCIs, encouraging personalized and optimized treatment strategies.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056648","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":"Human versus machine: deciding on high-stakes surgery in possible Cauda Equina syndrome.","authors":"Elie Najjar, Ahmed Abdelazim Hassan, Rodrigo Muscogliati, Khalid M Salem, Nasir A Quraishi","doi":"10.1016/j.spinee.2025.05.026","DOIUrl":"10.1016/j.spinee.2025.05.026","url":null,"abstract":"<p><strong>Background context: </strong>Cauda Equina Syndrome (CES) is a spine surgical urgency requiring prompt intervention to prevent neurological deficits. Accurate identification of CES cases needing urgent surgery is essential to avoid long-term sequelae.</p><p><strong>Purpose: </strong>To evaluate the concordance between an AI language model (ChatGPT) and a Spinal Multidisciplinary Team (MDT) in recommending surgical intervention for suspected CES cases.</p><p><strong>Study design/setting: </strong>Retrospective concordance analysis comparing surgical recommendations between ChatGPT and a Spinal MDT.</p><p><strong>Patient sample: </strong>Among 160 referrals presenting with red flags for possible CES, 10 cases were used to calibrate ChatGPT to specific clinical and diagnostic parameters, with the remaining 150 cases included in the primary analysis. The average patient age was 50.6 years (range 18-87), with a male-to-female ratio of 68:82.</p><p><strong>Outcome measures: </strong>The primary outcome was the concordance rate between ChatGPT and the MDT in recommending surgery, evaluated through agreement rates and statistical analysis.</p><p><strong>Methods: </strong>Each of the 150 cases was presented as standardized slides including clinical history, imaging, and examination findings. Both the MDT and ChatGPT assessed the need for urgent surgery. Discordant cases (n=17) were further reviewed by 3 spinal surgeons blinded to prior decisions.</p><p><strong>Results: </strong>ChatGPT and the MDT agreed on surgical recommendations in 133 out of 150 cases, achieving an 88.7% concordance (Cohen's Kappa = 0.764, p<.001). ChatGPT recommended surgery more frequently in the 17 discordant cases, but this difference was not statistically significant (McNemar's test statistic = 1.23, p=.46). Review by 3 independent surgeons reached consensus on 11 of the 17 discordant cases (64.7%), highlighting variability among experts; individual surgeons aligned with ChatGPT in 5 to 6 cases each (29.4%-35.3%).</p><p><strong>Conclusions: </strong>Substantial agreement between ChatGPT and the MDT suggests ChatGPT's comparable sensitivity in detecting surgical candidates in CES cases. Variability among surgeons on discordant cases underscores subjectivity in CES triage. ChatGPT may be a valuable adjunct in high-stakes clinical decision-making, though further validation and refinement are needed.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044466","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}