Spine Journal最新文献

{"title":"Osteoporosis is not associated with reoperation or pseudarthrosis after anterior cervical discectomy and fusion through 4-years' follow-up: a retrospective cohort study of US academic health centers.","authors":"Anthony N Baumann, Robert J Trager, Davin C Gong, Omkar S Anaspure, John T Strony, Ilyas Aleem","doi":"10.1016/j.spinee.2024.09.031","DOIUrl":"10.1016/j.spinee.2024.09.031","url":null,"abstract":"<p><strong>Background context: </strong>Osteoporosis has been proposed as a risk factor for reoperation after anterior cervical discectomy and fusion (ACDF), yet this potential association has been understudied, with conflicting results to date.</p><p><strong>Purpose: </strong>This study examines the hypothesis that adults with osteoporosis would have an increased risk of reoperation after ACDF compared to matched adults without osteoporosis.</p><p><strong>Study design/setting: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Two matched cohorts (mean age: 62 years; 75% female), each with 1,019 patients, who underwent primary ACDF. Cohorts were determined by the presence or absence of a diagnosis of osteoporosis.</p><p><strong>Outcome measures: </strong>Incidence of reoperation occurring over 4 years postoperatively, with our primary outcome being the risk ratio (RR) of reoperation with 95% confidence intervals (CI). Secondary outcomes included risk and mean count of oral opioid prescriptions and risk of pseudoarthrosis.</p><p><strong>Methods: </strong>We utilized the TriNetX network to identify adults undergoing their first ACDF from 2004 to 2020, excluding those with serious pathology, and divided patients into 2 cohorts: osteoporosis and nonosteoporosis. Patients were propensity matched according to key risk factors for reoperation.</p><p><strong>Results: </strong>Patients with osteoporosis had no statistically significant or meaningful difference in risk of reoperation compared to nonosteoporotic patients over 4-years' follow-up [95% CI] (17.3% vs. 16.5%; RR: 1.05 [0.86, 1.27]; p=.6361). Similarly, there were no significant differences in the risk of pseudoarthrosis (26.5% vs. 29.1%; RR: 0.91 [0.79, 1.05]; p=.1820), oral opioid prescription (75.0% vs. 76.0%; RR: 0.99 [0.94, 1.04]; p=.6067), or mean oral opioid prescription count (11.5 vs. 11.8; p=.7040).</p><p><strong>Conclusion: </strong>Compared to matched nonosteoporosis controls, osteoporosis was not associated with a statistically significant or clinically meaningful increase in risk of reoperation in adults over 4 years after ACDF. Furthermore, osteoporosis was not associated with a significant or meaningful risk of pseudoarthrosis or oral opioid prescription after ACDF, although more research is needed for corroboration. Additional research is needed to clarify whether those with osteoporosis have meaningful differences in pain and function compared to those without osteoporosis following ACDF.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382164","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":"More is less: image enhancement technology reduces radiation exposure during anterior lumber interbody fusion.","authors":"Brian Kuhn, Joel Hlavaty, Patrick Muck, Matthew Recht, Aaron Kulwicki, Mark Broering, Adam Reichard","doi":"10.1016/j.spinee.2024.09.026","DOIUrl":"10.1016/j.spinee.2024.09.026","url":null,"abstract":"<p><strong>Background context: </strong>Fluoroscopy and radiation exposure occur during anterior lumbar interbody fusion (ALIF). Image enhancement technology is available that can potentially reduce radiation exposure.</p><p><strong>Purpose: </strong>The purpose of this study is to evaluate radiation exposure and fluoroscopy times comparing standard fluoroscopy (FL) with a low dose image enhancement platform (LD).</p><p><strong>Study design: </strong>Retrospective review of prospectively maintained database.</p><p><strong>Patient sample: </strong>Consecutive patients undergoing ALIF with either standard fluoroscopy or low dose image enhancement technology.</p><p><strong>Outcome measures: </strong>Radiation dispersion and fluoroscopy times in ALIF patients with standard fluoroscopy and low dose image enhancement technology.</p><p><strong>Methods: </strong>A retrospective review of a prospective database on consecutive patients who have undergone ALIF, stratified into 2 groups: subjects with standard fluoroscopy (FL), and low dose fluoroscopy with image enhancement technology (LD).</p><p><strong>Results: </strong>A total of 487 ALIF patients were included (FL: 372 vs. LD: 115). LD patients were significantly older (66 vs. 60 years), with more deformity cases (28% vs. 12%), and less degenerative cases (71% vs. 87%), all p<.05; no differences in sex, BMI, or the number of levels operated on between groups. Fluoroscopy time (sec) was significantly higher in LD (51.4 vs. 45.5), with a statistically significant reduction in radiation (mGy) compared to FL (23.3 vs. 48.2), both p<.05. Furthermore, the results showed that radiation dispersion is increasingly reduced as fluoroscopy time increases in LD compared to FL (12%, 56%, and 65% reduction in radiation dispersion for fluoroscopy time <30 sec, between 30 to 60 sec, and >60 sec, respectively).</p><p><strong>Conclusions: </strong>The use of low dose fluoroscopy with image enhancement technology significantly reduces the cumulative dose of radiation during ALIF compared to standard dose fluoroscopy. Also, radiation dispersion increasingly decreases as fluoroscopy time increases using low dose image enhancement technology. Low dose image enhancement technology improves the safety profile of ALIF for patients and operating room staff.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373350","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":"Deep learning model for automated diagnosis of degenerative cervical spondylosis and altered spinal cord signal on MRI.","authors":"Aric Lee, Junran Wu, Changshuo Liu, Andrew Makmur, Yong Han Ting, Faimee Erwan Muhamat Nor, Loon Ying Tan, Wilson Ong, Wei Chuan Tan, You Jun Lee, Juncheng Huang, Joey Chan Yiing Beh, Desmond Shi Wei Lim, Xi Zhen Low, Ee Chin Teo, Yiong Huak Chan, Joshua Ian Lim, Shuxun Lin, Jiong Hao Tan, Naresh Kumar, Beng Chin Ooi, Swee Tian Quek, James Thomas Patrick Decourcy Hallinan","doi":"10.1016/j.spinee.2024.09.015","DOIUrl":"10.1016/j.spinee.2024.09.015","url":null,"abstract":"<p><strong>Background context: </strong>A deep learning (DL) model for degenerative cervical spondylosis on MRI could enhance reporting consistency and efficiency, addressing a significant global health issue.</p><p><strong>Purpose: </strong>Create a DL model to detect and classify cervical cord signal abnormalities, spinal canal and neural foraminal stenosis.</p><p><strong>Study design/setting: </strong>Retrospective study conducted from January 2013 to July 2021, excluding cases with instrumentation.</p><p><strong>Patient sample: </strong>Overall, 504 MRI cervical spines were analyzed (504 patients, mean=58 years±13.7[SD]; 202 women) with 454 for training (90%) and 50 (10%) for internal testing. In addition, 100 MRI cervical spines were available for external testing (100 patients, mean=60 years±13.0[SD];26 women).</p><p><strong>Outcome measures: </strong>Automated detection and classification of spinal canal stenosis, neural foraminal stenosis, and cord signal abnormality using the DL model. Recall(%), inter-rater agreement (Gwet's kappa), sensitivity, and specificity were calculated.</p><p><strong>Methods: </strong>Utilizing axial T2-weighted gradient echo and sagittal T2-weighted images, a transformer-based DL model was trained on data labeled by an experienced musculoskeletal radiologist (12 years of experience). Internal testing involved data labeled in consensus by 2 musculoskeletal radiologists (reference standard, both with 12-years-experience), 2 subspecialist radiologists, and 2 in-training radiologists. External testing was performed.</p><p><strong>Results: </strong>The DL model exhibited substantial agreement surpassing all readers in all classes for spinal canal (κ=0.78, p<.001 vs. κ range=0.57-0.70 for readers) and neural foraminal stenosis (κ=0.80, p<.001 vs. κ range=0.63-0.69 for readers) classification. The DL model's recall for cord signal abnormality (92.3%) was similar to all readers (range: 92.3-100.0%). Nearly perfect agreement was demonstrated for binary classification (grades 0/1 vs. 2/3) (κ=0.95, p<.001 for spinal canal; κ=0.90, p<.001 for neural foramina). External testing showed substantial agreement using all classes (κ=0.76, p<.001 for spinal canal; κ=0.66, p<.001 for neural foramina) and high recall for cord signal abnormality (91.9%). The DL model demonstrated high sensitivities (range:83.7%-92.4%) and specificities (range:87.8%-98.3%) on both internal and external datasets for spinal canal and neural foramina classification.</p><p><strong>Conclusions: </strong>Our DL model for degenerative cervical spondylosis on MRI showed good performance, demonstrating substantial agreement with the reference standard. This tool could assist radiologists in improving the efficiency and consistency of MRI cervical spondylosis assessments in clinical practice.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367192","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":"Stability of medially and laterally malpositioned screws: a biomechanical study on cadavers.","authors":"Christos Tsagkaris, Marie-Rosa Fasser, Mazda Farshad, Caroline Passaplan, Frederic Cornaz, Jonas Widmer, José Miguel Spirig","doi":"10.1016/j.spinee.2024.09.008","DOIUrl":"10.1016/j.spinee.2024.09.008","url":null,"abstract":"<p><strong>Background context: </strong>Pedicle screw instrumentation is widely used in spine surgery. Axial screw misplacement is a common complication. In addition to the recognized neurovascular risks associated with screw misplacement, the biomechanical stability of misplaced screws remains a subject of debate.</p><p><strong>Purpose: </strong>The present study investigates whether screw misplacement in the lumbar spine reduces mechanical screw hold.</p><p><strong>Study design/setting: </strong>Cadaveric biomechanical study.</p><p><strong>Methods: </strong>Pedicle screw (mis)placement was planned for 12 fresh frozen cadaveric spines between the T12 and the L5 levels. The screws were then implanted into the vertebrae with the help of 3D-printed template guides. Pre- and postinstrumentation computed tomography (CT) scans were acquired for instrumentation planning and quantification of the misplacement. The instrumented vertebrae were potted into CT transparent boxes using Polymethyl methacrylate and mounted on a standardized biomechanical setup for pull-out (PO) testing with uniaxial tensile load.</p><p><strong>Results: </strong>The bone density of all the specimens as per HU was comparable. The predicted pull-out force (POF) for screws medially misplaced by 2 , 4, and 6 mm was respectively 985 N (SD 474), 968 N (SD 476) and 822 N (SD 478). For screws laterally misplaced by 2 , 4, and 6 mm the POF was respectively 605 N (SD 473), 411 N (SD 475), and 334 N (SD 477). Screws that did not perforate the pedicle (control) resisted pull-out forces of 837 N (SD 471).</p><p><strong>Conclusions: </strong>Medial misplacement is associated with increased axial screw hold against static loads compared to correctly placed screws and laterally placed screws.</p><p><strong>Clinical significance: </strong>In clinical settings, the reinsertion of medially misplaced screws should primarily aim to prevent neurological complications while the reinsertion of lateral misplaced screws should aim to prevent screw loosening.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367193","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":"Long-term outcomes of anterior cervical dynamic implants: motion-sparing or a delayed fusion?","authors":"Yukai Huang, Dingyu Du, Jie Tian, Dean Chou, Longyi Chen, Hailong Feng, Jinping Liu","doi":"10.1016/j.spinee.2024.09.006","DOIUrl":"10.1016/j.spinee.2024.09.006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Use of an anterior cervical dynamic implant (ACDI) is generally considered a nonfusion technique for treating cervical degenerative disorders. However, there is limited research focused on evaluating the long-term clinical and radiographic outcomes of ACDI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To analyze the long-term clinical and radiographic outcomes of ACDI in the treatment of degenerative cervical disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients sample: &lt;/strong&gt;Patients with degenerative cervical disorders who underwent anterior cervical discectomy and dynamic cervical implant (DCI) implantation between May 2012 and August 2020 at our institution were included in this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Clinical outcomes were assessed using the modified Japanese Orthopedic Association (mJOA), visual analog scale (VAS) scores and patient reported satisfaction rate. Imaging assessment parameters included intervertebral height (IH), intervertebral disc height (IDH), C2-7 range of motion (ROM), segmental ROM, the degree of DCI subsidence and anterior migration, heterotopic ossification (HO) as well as adjacent segment degeneration (ASD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;JOA and VAS scores were obtained through questionnaire. The patient reported satisfaction was rated as very satisfied, satisfied, less satisfied and dissatisfied at the final follow-up. The position of the implants, IDH and IH were evaluated on lateral radiographs. ROM at C2-7, ROM at operated level were measured on dynamic radiographs. Cervical 3 -dimensional computer tomography (CT) and magnetic resonance image (MRI) images were used to assess the presence of HO and ASD. The clinical and radiologic variables between the preoperative period and different follow-up time point were statistically analyzed by unpaired t-tests or chi-square tests. Statistical significance was defined as p&lt;.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 92 patients (51 males and 41 females) were included in this study. Among them, there were 36 cases of cervical spondylotic myelopathy, 26 cases of cervical radiculopathy, and 30 cases of myeloradiculopathy. The mean age was 55.1±12.6 years. The number of operated levels was single level in 57 patients, 2 levels in 31 patients, and 3 levels in 4 patients. The average follow-up period was 81.3 months (range: 35-135 months). The mean JOA scores showed a gradual increase at 1 month, 1 year, and the final follow-up (12.0±0.7,13.5±0.8, and14.4±1.1 respectively) compared to the preoperative score (9.1±0.9, p&lt;.01). VAS scores significantly decreased at 1 month, 1 year, and the final follow-up (4.1±0.7, 2.3±0.9, and 2.0±0.8 respectively) compared to the preoperative score (7.2±l .2, p&lt;.01). At the final follow-up, the patient reported satisfaction was rated as very satisfied, satisfied, less satisfied and dissatisfied (79%, 10%, 10%, 1% respectively). Revision surg","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331035","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":"Multirod posterior occipitocervical instrumentation constructs: a biomechanical analysis and initial case series of 10 patients with complex craniocervical pathology.","authors":"Andrew P Collins, Muzammil Mumtaz, Sudharshan Tripathi, Shruthi K Varier, Alexander W Turner, Aaron J Clark, Vijay K Goel, Alekos A Theologis","doi":"10.1016/j.spinee.2024.09.022","DOIUrl":"10.1016/j.spinee.2024.09.022","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Stabilization of the occipitocervical (OC) junction with posterior instrumentation plays a vital role in addressing a spectrum of pathologies. Due to limited bone surfaces of the occiput and C1 lamina, achieving union across the OC junction is challenging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To explore the biomechanics and a clinical series of patients treated with multirod constructs across the OC junction using a novel occipital plate with single- and dual-headed, modular tulip heads.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Biomechanical analysis and retrospective case series.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Adults at a single institution who underwent posterior cervical multirod constructs across the OC junction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;OC-C4 range of motion (ROM), maximum von Mises stress on the rods, and adjacent segment ROMs and intradiscal parameters. Patient demographics, revision operations, rod breakages, wound complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A validated occiput-cervical finite element (FE) model was used to simulate OC-C4 cervical fixation under multidirectional pure moment loading. A total of 4 rod configurations were simulated: (A) 2-rod-Ti (4.0 mm titanium rods); (B) 2-rod-CoCr (3.5 mm cobalt chrome rods); (C) 3-rods (4.0 mm titanium rods); (D) 4-rods (4.0 mm titanium rods). The aforementioned measures were compared. A retrospective analysis was also performed of adults at a single institution who underwent posterior cervical multirod constructs across the OC junction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Biomechanically, lowest primary rod stresses were observed for 3- and 4-rod constructs. Compared to 2-rod-Ti (121.8 MPa), 2-rod-CoCr showed a 43.2% stress increase in the rods, while 3- and 4-rods experienced rod stress reductions of 20% and 23.2%, respectively. No appreciable differences in OC-C4 ROM, C4-5 ROM, and C4-5 discal stresses were found between multirod and 2-rod constructs. Maximum occipital and C4 screw stresses were decreased in multirod constructs compared to 2-rods, with least stresses noted in the 4-rod construct. Maximum plate stresses were slightly increased in the 4-rod construct compared to 2- and 3-rod fixation, though the forces were largely similar among the constructs. Ten patients (average age 66.4±10.6 years; 8 males) were assessed clinically. Nine of the ten operations were for primary stabilization of pathological fractures and associated craniocervical and/or atlantoaxial instability using 4-rods across the OC junction. At an average follow-up time of 1.58±0.5 years (range, 1-2.3 years), there were no instrumentation failures, no adjacent segment failures, and no wound complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this proof-of-concept investigation, multiple rods (3- and 4-rods) across the OC junction using a novel occipital plate with single- and dual-headed, modular tulips was safe and effective in stabilizing the OC ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331037","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":"Expandable versus static transforaminal lumbar interbody fusion (TLIF) cages: comparing radiographic outcomes and complication profiles.","authors":"Alexander M Crawford, Brendan M Striano, Matthew R Bryan, Ikechukwu C Amakiri, Donnell L Williams, Andrew T Nguyen, Malina O Hatton, Andrew K Simpson, Andrew J Schoenfeld","doi":"10.1016/j.spinee.2024.09.030","DOIUrl":"10.1016/j.spinee.2024.09.030","url":null,"abstract":"<p><strong>Background context: </strong>Expandable transforaminal lumbar interbody fusion (TLIF) cages have become popular in recent years due to anticipated advantages of increased disc height, improved segmental lordosis, and ease of implantation. Such benefits have not been conclusively demonstrated in the literature.</p><p><strong>Purpose: </strong>To determine whether expandable cages increase disc height and segmental lordosis in a durable way following surgery and compare complication profiles between cage types.</p><p><strong>Study design/setting: </strong>Retrospective cohort study conducted within a large academic health system involving 31 different spine surgeons.</p><p><strong>Patient sample: </strong>Adults undergoing single-level TLIF for an indication other than infection, tumor, trauma, or revision instrumentation from 2021 to 2023.</p><p><strong>Outcome measures: </strong>Our primary outcomes were changes in segmental disc height, segmental lordosis, and L4-S1 lordosis at 2 weeks, 6 months, and 1 year following surgery relative to baseline. Our secondary outcomes were frequencies of incidental durotomies, surgical site infections, readmissions, death, subsidence, and unplanned return to the operating room.</p><p><strong>Methods: </strong>Radiographic variables were collected from our institutional imaging registry. Demographics and surgical characteristics were abstracted from chart review. Generalized linear modeling was used for each primary outcome, with cage type (expandable vs. static) as our primary predictor and age, biologic sex, race, CCI, year of surgery, duration of surgery, invasiveness of surgery, surgeon specialty (Orthopedics vs. Neurosurgery), and level of surgery as covariates.</p><p><strong>Results: </strong>Our cohort consisted of 417 patients with a mean age of 62. Static cages were used in 306 patients and expandable cages in 111. Expandable cages were associated with increased changes in disc height relative to static cages at 2 weeks (1.1 mm [0.2-1.9]; p=.01) and 6 months (1.2 mm [0.2-2.3]; p=.02) following surgery, but differences were no longer significant at 1 year (0.4 mm [-0.9-1.8]; p=.4). Expandable cages were found to subside more commonly than static cages (14.1% vs. 6.6%; p=.04). No significant differences between cage types were identified in lordotic parameters at any timepoint (p=0.25 to p=0.97).</p><p><strong>Conclusions: </strong>Expandable cages were associated with an initial increase in disc height relative to static cages, but this difference diminished with the first year of surgery, likely due to a higher rate of subsidence within the expandable cohort.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331030","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":"Predicting postoperative mechanical complications with the ethnicity-adjusted global alignment and proportion score in degenerative scoliosis: does paraspinal muscle degeneration matter?","authors":"Peiyu Li, Jie Li, Abdukahar Kiram, Zhen Tian, Xing Sun, Xiaodong Qin, Benlong Shi, Yong Qiu, Zhen Liu, Zezhang Zhu","doi":"10.1016/j.spinee.2024.09.029","DOIUrl":"10.1016/j.spinee.2024.09.029","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The global alignment and proportion (GAP) score was developed to predict mechanical complications (MCs) after adult spinal deformity surgery but showed limited sensitivity in the Asian population. Considering variations in sagittal parameters among different ethnic groups, our team developed the ethnicity-adjusted GAP score according to the spinopelvic parameters of 566 asymptomatic Chinese volunteers (C-GAP score). Notably, degenerative scoliosis (DS) patients with MCs following corrective surgery have more severe paraspinal muscle degeneration. For DS patients with various sagittal alignments, the unevenly distributed degeneration of paraspinal muscle may exert different influences on MC occurrence and largely affect the accuracy of the C-GAP score in clinical assessment. Therefore, incorporating paraspinal muscle degeneration indices within the C-GAP score may improve its accuracy in predicting MC occurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;We aimed to clarify the influence of paraspinal muscle degeneration on the C-GAP score predicting MC occurrence following DS surgery and modify the C-GAP score with paraspinal muscle degeneration parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A retrospective case-control study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sample size: &lt;/strong&gt;A total of 107 adult degenerative scoliosis patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Demographic information, postoperative sagittal spinopelvic parameters, the GAP score, the C-GAP score, and paraspinal muscle degeneration parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 107 DS patients undergoing posterior spinal fusion surgery (≥4 vertebrae) with a minimum of 2 years follow-up (or experiencing MCs within 2 years) were retrospectively reviewed. Their C-GAP score was calculated based on our previous study and patients were divided into 3 C-GAP categories, \"proportioned\" (P), \"moderately disproportioned\" (MD), and \"severely disproportioned\" (SD). Relative cross-sectional area (cross-sectional area of muscle-disc ratio×100, rCSA) and fat infiltration rate, FI% at L1/2, L2/3, L3/4, and L4/5 discs were quantitatively evaluated using magnetic resonance imaging (MRI). In each C-GAP category, patients were additionally divided into the MC group and the non-MC group to analyze their paraspinal muscle degeneration. A multivariable logistic regression model consisting of the CSA-weighted average FI% (total FI%) and the C-GAP score, C-GAPM was constructed. The area under the curve (AUC) of the receiver operating characteristic (ROC) curves was used to evaluate the predictability of the GAP score, the C-GAP score, FI%, and C-GAPM. This project was supported by the National Natural Science Foundation of China (No.82272545) and Special Fund of Science and Technology Plan of Jiangsu Province (No.BE2023658).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For all 107 patients, FI% at L1/2, L2/3, L3/4, and L4/5 discs and the total FI% of the MC group (n=32) were significantly high","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331039","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":"Contact between leaked cement and adjacent vertebral endplate induces a greater risk of adjacent vertebral fracture with vertebral bone cement augmentation biomechanically.","authors":"Shiming Xie, Liqiang Cui, Chenglong Wang, Hongjun Liu, Yu Ye, Shuangquan Gong, Jingchi Li","doi":"10.1016/j.spinee.2024.09.021","DOIUrl":"10.1016/j.spinee.2024.09.021","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Adjacent vertebral fracture (AVF) is a frequently observed complication after percutaneous vertebroplasty in patients with osteoporotic vertebral compressive fracture (OVCF). Studies have demonstrated that intervertebral cement leakage (ICL) can increase the incidence of AVF, but others have reached opposite conclusions. The stress concentration initially increases the risk of AVF, and dispersive concentrated stress is the main biomechanical function of the intervertebral disc (IVD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study was designed to validate the hypothesis that direct contact between the leaked cement and adjacent bony endplate (BEP) can inhibit this biomechanical function, trigger adjacent vertebral stress concentration and increase the risk of AVF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A retrospective study and corresponding numerical mechanical simulations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Clinical data from 97 OVCF patients treated by bone cement augmentation operations were reviewed in this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Clinical assessments involved measuring ICL and cement-BEP contact status in patients with and without AVF. Numerical simulations were conducted to compute stress values in adjacent vertebral body's BEP and cancellous bone under various body positions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Radiographic and demographic data of 97 OVCF patients (with an average follow-up period of 11.5 months) treated using bone cement augmentation operation were reviewed in the present study. The patients were divided into 2 groups: those with AVF and those without AVF. Bone cement leakage status was judged via 2 different methods: with or without IVD cement leakage and with and without adjacent vertebral endplate contact. The data from patients with and without AVF were compared, and the independent risk factors were identified through regression analysis. Patients without IVD cement leakage, with IVD cement leakage but without adjacent vertebral endplate cement contact, and with direct adjacent vertebral endplate cement contact were simulated using a previously constructed and validated lumbar finite element model, and the biomechanical indicators related to the AVF were computed and recorded in these surgical models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Radiographic analysis revealed that the incidence of AVF was numerically higher, but was not significantly higher in patients with IVD cement leakage. In contrast, patients with direct adjacent vertebral endplate cement contact had a significantly greater incidence of AVF, which has also been proven to be an independent risk factor for AVF. In addition, numerical mechanical simulations revealed an obvious stress concentration tendency (the higher maximum equivalent stress value) in the adjacent vertebral body in the model with endplate cement contact.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Direct adjacent vertebral endpla","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331028","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":"Wide variability of the definitions used for native vertebral osteomyelitis: walking the path for a unified diagnostic framework with a meta-epidemiological approach.","authors":"Francesco Petri, Omar K Mahmoud, Said El Zein, Seyed Mohammad Amin Alavi, Matteo Passerini, Felix E Diehn, Jared T Verdoorn, Aaron J Tande, Ahmad Nassr, Brett A Freedman, M Hassan Murad, Elie F Berbari","doi":"10.1016/j.spinee.2024.09.018","DOIUrl":"10.1016/j.spinee.2024.09.018","url":null,"abstract":"<p><strong>Background context: </strong>Native Vertebral Osteomyelitis (NVO) has seen a rise in incidence, yet clinical outcomes remain poor with high relapse rates and significant long-term sequelae. The 2015 IDSA Clinical Practice Guidelines initiated a surge in scholarly activity on NVO, revealing a patchwork of definitions and numerous synonyms used interchangeably for this syndrome.</p><p><strong>Purpose: </strong>To systematically summarize these definitions, evaluate their content, distribution over time, and thematic clustering.</p><p><strong>Study design/setting: </strong>Meta-epidemiological study with a systematic review of definitions.</p><p><strong>Patients sample: </strong>An extensive search of multiple databases was conducted, targeting trials and cohort studies dating from 2005 to present, providing a definition for NVO and its synonyms.</p><p><strong>Outcome measures: </strong>Analysis of the diagnostic criteria that composed the definitions and the breaking up of the definitions in the possible combinations of diagnostic criteria.</p><p><strong>Methods: </strong>We pursued a thematic synthesis of the published definitions with Boolean logic, yielding single or multiple definitions per included study. Using 8 predefined diagnostic criteria, we standardized definitions, focusing on the minimum necessary combinations used. Definition components were visualized using Sankey diagrams.</p><p><strong>Results: </strong>The literature search identified 8,460 references, leading to 171 studies reporting on 21,963 patients. Of these, 91.2% were retrospective, 7.6% prospective, and 1.2% RCTs. Most definitions originated from authors, with 29.2% referencing sources. We identified 92 unique combinations of diagnostic criteria across the literature. Thirteen main patterns emerged, with the most common being clinical features with imaging, followed by clinical features combined with imaging and microbiology, and lastly, imaging paired with microbiology.</p><p><strong>Conclusions: </strong>Our findings underscore the need for a collaborative effort to develop standardized diagnostic criteria. We advocate for a future Delphi consensus among experts to establish a unified diagnostic framework for NVO, emphasizing the core components of clinical features and MRI while incorporating microbiological and histopathological insights to improve both patient outcomes and research advancements.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331044","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}