Spine Journal最新文献

{"title":"Deep learning model for automated diagnosis of degenerative cervical spondylosis and altered spinal cord signal on MRI","authors":"Aric Lee MBBS, MMed, FRCR ,&nbsp;Junran Wu BSc (Hons) ,&nbsp;Changshuo Liu BSc (Hons) ,&nbsp;Andrew Makmur MBBS, BmedSc, MMed, FRCR ,&nbsp;Yong Han Ting MBBS, FRCR ,&nbsp;Faimee Erwan Muhamat Nor MBBCh, BAO (Hons), FRCR, Mmed ,&nbsp;Loon Ying Tan MBBS, FRCR ,&nbsp;Wilson Ong MBBS, FRCR ,&nbsp;Wei Chuan Tan MBBS, FRCR ,&nbsp;You Jun Lee MBBS ,&nbsp;Juncheng Huang MBBS ,&nbsp;Joey Chan Yiing Beh MBBS, FRCR ,&nbsp;Desmond Shi Wei Lim MBBS, FRCR ,&nbsp;Xi Zhen Low MBBS, FRCR ,&nbsp;Ee Chin Teo MMRT ,&nbsp;Yiong Huak Chan PhD ,&nbsp;Joshua Ian Lim MBBS ,&nbsp;Shuxun Lin MBBS, MRCS, MMed, FRCSEd ,&nbsp;Jiong Hao Tan MBBS, MRCS, MMed, FRCS (Orth) ,&nbsp;Naresh Kumar MBBS, MS, DNB, FRCS, FRCS, DM ,&nbsp;James Thomas Patrick Decourcy Hallinan MBChB (Hons), BSc (Hons), FRCR","doi":"10.1016/j.spinee.2024.09.015","DOIUrl":"10.1016/j.spinee.2024.09.015","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>A deep learning (DL) model for degenerative cervical spondylosis on MRI could enhance reporting consistency and efficiency, addressing a significant global health issue.</div></div><div><h3>PURPOSE</h3><div>Create a DL model to detect and classify cervical cord signal abnormalities, spinal canal and neural foraminal stenosis.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective study conducted from January 2013 to July 2021, excluding cases with instrumentation.</div></div><div><h3>PATIENT SAMPLE</h3><div>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).</div></div><div><h3>OUTCOME MEASURES</h3><div>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.</div></div><div><h3>METHODS</h3><div>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.</div></div><div><h3>RESULTS</h3><div>The DL model exhibited substantial agreement surpassing all readers in all classes for spinal canal (κ=0.78, p&lt;.001 vs κ range=0.57–0.70 for readers) and neural foraminal stenosis (κ=0.80, p&lt;.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&lt;.001 for spinal canal; κ=0.90, p&lt;.001 for neural foramina). External testing showed substantial agreement using all classes (κ=0.76, p&lt;.001 for spinal canal; κ=0.66, p&lt;.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.</div></div><div><h3>CONCLUSIONS</h3><div>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.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 255-264"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","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":"A cost-effectiveness analysis of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain","authors":"Matthew Smuck MD ,&nbsp;Zachary L. McCormick MD ,&nbsp;Chris Gilligan MD ,&nbsp;Mary K. Hailey ,&nbsp;Michelle L. Quinn ,&nbsp;Anthony Bentley BSc, MSc ,&nbsp;Kaylie Metcalfe BSc, MSc ,&nbsp;Benjamin Bradbury BSc ,&nbsp;Dylan J. Lukes PhD ,&nbsp;Rod S. Taylor MSc, PhD","doi":"10.1016/j.spinee.2024.09.016","DOIUrl":"10.1016/j.spinee.2024.09.016","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Randomized trials have demonstrated the superiority of intraosseous basivertebral nerve ablation (BVNA) compared with sham and standard care in terms of improvements in pain, disability, and health-related quality of life in patients with vertebrogenic chronic low back pain (cLBP).</div></div><div><h3>PURPOSE</h3><div>To assess the cost effectiveness of BVNA in patients with vertebrogenic cLBP compared to standard care alone.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A model-based economic analysis.</div></div><div><h3>PATIENT SAMPLE</h3><div>Base case analysis used INTRACEPT, a randomized trial comparing BVNA with standard care in 140 patients with vertebrogenic cLBP, recruited from 23 sites across the United States, with a follow-up, up to 5 years. Scenario analyses compared data from the Surgical Multicenter Assessment of Radiofrequency Ablation for the Treatment of Vertebrogenic Back Pain (SMART) randomized trial against a sham control, and a single-arm study.</div></div><div><h3>OUTCOME MEASURES</h3><div>Costs and quality-adjusted life years (QALYs) were calculated to determine the incremental cost-effectiveness ratio (ICER).</div></div><div><h3>METHODS</h3><div>A cost-effectiveness model was built in Microsoft Excel to evaluate the costs and health outcomes of patients undergoing BVNA using the Intracept Procedure (Relievant Medsystems) to treat vertebrogenic cLBP from a US payor perspective. Alternative scenario sensitivity analyses and probabilistic sensitivity analyses were conducted to assess the robustness of the model results. QALYs were discounted at 3.0% per year.</div></div><div><h3>RESULTS</h3><div>Base case analysis showed that BVNA relative to standard care alone was a cost-effective strategy for the management of patients with vertebrogenic cLBP, with an ICER of US$11,376 per QALY at a 5-year time horizon from introduction of the procedure. Modeling demonstrated a &gt;99% probability that this was cost effective in the US, based on a willingness-to-pay threshold of US$100,000 to US$150,000. Various sensitivity and scenario analyses produced ICERs that all remained below this threshold.</div></div><div><h3>CONCLUSIONS</h3><div>BVNA with the Intracept Procedure offers patients with vertebrogenic cLBP, clinicians, and healthcare systems a cost-effective treatment compared to standard care alone.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 201-210"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discectomy versus sequestrectomy in the treatment of lumbar disc herniation: a systematic review and meta-analysis","authors":"Luca Ambrosio MD ,&nbsp;Gianluca Vadalà MD, PhD ,&nbsp;Elisabetta de Rinaldis MS ,&nbsp;Sathish Muthu MS, MD ,&nbsp;Stipe Ćorluka MD ,&nbsp;Zorica Buser PhD ,&nbsp;Hans-Jörg Meisel MD, PhD ,&nbsp;S. Tim Yoon MD, PhD ,&nbsp;Vincenzo Denaro MD ,&nbsp;AO Spine Knowledge Forum Degenerative","doi":"10.1016/j.spinee.2024.09.007","DOIUrl":"10.1016/j.spinee.2024.09.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Lumbar disc herniation (LDH) is a leading cause of low back pain (LBP) and leg pain and may require surgical treatment in case of persistent pain and/or neurological deficits. Conventional discectomy involves removing the herniated fragment and additional material from the disc space, potentially accelerating disc degeneration and contributing to chronic LBP. Conversely, by resecting the herniated fragment only, sequestrectomy may reduce postoperative LBP while increasing the risk of LDH recurrence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To compare discectomy versus sequestrectomy in terms of risk of reherniation, reoperation rate, complications, pain, satisfaction, and perioperative outcomes (operative time, blood loss, length of stay [LOS]).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;Systematic review and meta-analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;A systematic search of PubMed/MEDLINE and Scopus databases was performed through May 1, 2024 for both randomized and nonrandomized studies. The search was conducted according to PRISMA guidelines. The RoB-2 and MINORS tools were utilized to assess the risk of bias in included studies. The quality of the evidence was evaluated according to the GRADE approach. Relevant outcomes were pooled for meta-analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 16 articles (1 randomized controlled trial with 2 follow-up studies, 6 prospective studies, and 7 retrospective studies) published between 1991 and 2020 involving 2009 patients were included for analysis. No significant differences were noted between discectomy versus sequestrectomy in terms of risk of reherniation (OR: 0.85, 95% CI: 0.57 to 1.26, p=.42), reoperation rate (OR: 0.95, 95% CI: 0.64 to 1.40, p=.78), and complications (OR: 1.03, 95% CI: 0.50 to 2.11, p=.94). Although LBP (MD: −0.06, 95% CI: −0.39 to 0.28, p=.74) and leg pain intensity (MD: 0.11, 95% CI: −0.21 to 0.42, p=.50) were similar postoperatively, significantly better outcomes were reported by patients treated with sequestrectomy at 1 year (leg pain: MD: 0.37, 95% CI: 0.19 to 0.54, p&lt;.0001) and 2 years (LBP: MD: 0.19, 95% CI: 0.03 to 0.34, p=.02; leg pain: MD: 0.20, 95% CI: 0.09 to 0.31, p=.0005). Sequestrectomy also resulted in a higher patient satisfaction (OR: 0.60, 95% CI: 0.40 to 0.90, p=.01) and shorter operative time (MD: 8.71, 95% CI: 1.66 to 15.75, p=.02), while blood loss (MD: 0.18, 95% CI: −2.31 to 2.67, p=.89) and LOS (MD: 0.02 days, 95% CI: −0.07 to 0.12, p=.60) did not significantly differ compared to discectomy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;Based on the current evidence, discectomy and sequestrectomy do not significantly differ in terms of risk of reherniation, reoperation rate, and postoperative complications. Patients treated with sequestrectomy may benefit from a marginally higher pain improvement, better satisfaction outcomes, and a shorter operative time, although the clinical relevance of these differences","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 211-226"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient acceptance of reoperation risk for lumbar decompression versus fusion","authors":"Alexa K. Pius MD ,&nbsp;Yemisi D. Joseph BS ,&nbsp;Danielle M. Mullis BS ,&nbsp;Susmita Chatterjee MS ,&nbsp;Jyotsna Koduri MD ,&nbsp;Josh Levin MD ,&nbsp;Todd F. Alamin MD","doi":"10.1016/j.spinee.2024.09.003","DOIUrl":"10.1016/j.spinee.2024.09.003","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Lumbar decompression and lumbar fusion are effective methods of treating spinal compressive pathologies refractory to conservative management. These surgeries are typically used to treat different spinal problems, but there is a growing body of literature investigating the outcomes of either approach for patients with lumbar degenerative spondylolisthesis and stenosis. Different operations are associated with different risks and different potential needs for reoperation. Patient acceptance of reoperation rates after spinal surgery is currently not well understood.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;The purpose of this study is to identify patient tolerance for reoperation rates following lumbar decompression and lumbar fusion surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;DESIGN&lt;/h3&gt;&lt;div&gt;A qualitative and quantitative survey intended to capture information on patient preferences was administered.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;Written informed consent was obtained from patients presenting to 2 spinal clinics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Patients were asked their threshold tolerance for reoperation rates in the context of choosing a smaller (decompression) versus larger (fusion) spinal surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;A survey was administered to patients at 2 spinal clinics—1 surgical and 1 nonsurgical. A consecutive series of new patients over multiple clinic days who agreed to participate in the study and filled out the survey are reported on here. Patients were asked to assess, contemplating a problem that could either be treated with lumbar decompression or lumbar fusion, the level at which 1) the likelihood that needing a repeat surgery within 3 to 5 years would change their mind about choosing the decompression operation and cause them to choose the fusion operation and then 2) the likelihood of needing a repeat surgery within 3 to 5 years that would be acceptable to them after the fusion operation. The distribution of patient responses was assessed with histograms and descriptive statistics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Ninety patients were surveyed, and of these, 73 patients (81.1%) returned fully completed questionnaires. The median reoperation acceptance rates after a decompression was &lt;60%, while the median acceptable revision rate when contemplating the fusion surgery was 10%.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;Patient acceptance for the potential need for revision surgery is higher when considering a decompression compared to a fusion operation. Reoperation risk rates along with the magnitude of the surgical intervention are important considerations in determining patients’ surgical preferences. Understanding patient preferences and risk tolerances can aid clinicians in shared decision-making, potentially improving patient satisfaction and outcomes in the several lumbar pathologies which can be ameliorated with either decompression or fusion.&lt;/div&gt;&lt;/div","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 227-236"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299503","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 MD ,&nbsp;Dingyu Du MD ,&nbsp;Jie Tian MD ,&nbsp;Dean Chou MD ,&nbsp;Longyi Chen MD ,&nbsp;Hailong Feng MD ,&nbsp;Jinping Liu MD","doi":"10.1016/j.spinee.2024.09.006","DOIUrl":"10.1016/j.spinee.2024.09.006","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background Context&lt;/h3&gt;&lt;div&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;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To analyze the long-term clinical and radiographic outcomes of ACDI in the treatment of degenerative cervical disorders.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients Sample&lt;/h3&gt;&lt;div&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;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome Measures&lt;/h3&gt;&lt;div&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;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&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 &lt;em&gt;t&lt;/em&gt;-tests or chi-square tests. Statistical significance was defined as p&lt;.05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&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","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 244-254"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","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":"Predicting postoperative mechanical complications with the ethnicity-adjusted global alignment and proportion score in degenerative scoliosis: does paraspinal muscle degeneration matter?","authors":"Peiyu Li PhD ,&nbsp;Jie Li PhD ,&nbsp;Abdukahar Kiram PhD ,&nbsp;Zhen Tian PhD ,&nbsp;Xing Sun PhD ,&nbsp;Xiaodong Qin PhD ,&nbsp;Benlong Shi PhD ,&nbsp;Yong Qiu PhD ,&nbsp;Zhen Liu MD ,&nbsp;Zezhang Zhu MD","doi":"10.1016/j.spinee.2024.09.029","DOIUrl":"10.1016/j.spinee.2024.09.029","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&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;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&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;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A retrospective case-control study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Sample Size&lt;/h3&gt;&lt;div&gt;A total of 107 adult degenerative scoliosis patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome Measures&lt;/h3&gt;&lt;div&gt;Demographic information, postoperative sagittal spinopelvic parameters, the GAP score, the C-GAP score, and paraspinal muscle degeneration parameters.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&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;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&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=","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 347-358"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","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":"Who gets better after surgery for degenerative cervical myelopathy? A responder analysis from the multicenter Canadian Spine Outcomes and Research Network","authors":"Husain Shakil MD, MSc ,&nbsp;Nicolas Dea MD, MSc ,&nbsp;Armaan K. Malhotra MD ,&nbsp;Ahmad Essa MD, MPH ,&nbsp;W. Bradley Jacobs MD ,&nbsp;David W. Cadotte MD, PhD ,&nbsp;Jérôme Paquet MD, PhD ,&nbsp;Michael H. Weber MD, MSc, PhD ,&nbsp;Philippe Phan MD, PhD ,&nbsp;Christopher S. Bailey MD, MSc ,&nbsp;Sean D. Christie MD ,&nbsp;Najmedden Attabib MD, MBBCH ,&nbsp;Neil Manson MD ,&nbsp;Jay Toor MD, MBA ,&nbsp;Andrew Nataraj MD ,&nbsp;Hamilton Hall MD ,&nbsp;Greg McIntosh MSc ,&nbsp;Charles G. Fisher MD, MHSC ,&nbsp;Y. Raja Rampersaud MD ,&nbsp;Nathan Evaniew MD, PhD ,&nbsp;Jefferson R. Wilson MD, PhD","doi":"10.1016/j.spinee.2024.09.033","DOIUrl":"10.1016/j.spinee.2024.09.033","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Degenerative cervical myelopathy (DCM) is the most common cause of acquired nontraumatic spinal cord injury worldwide. Surgery is a common treatment for DCM; however, outcomes often vary across patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To inform preoperative education and counseling, we performed a responder analysis to identify factors associated with treatment response.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;An observational cohort study was conducted utilizing prospectively collected data from the Canadian Spine Outcomes Research Network (CSORN) registry collected between 2015–2022.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;We included all surgically treated DCM patients with complete 12-month follow-up and patient-reported outcomes (PROs) available at 1-year.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Treatment response was measured using the minimal clinically important difference (MCID) in PROs including the Neck Disability Index (NDI) and EuroQol-5D (EQ-5D) at 12 months postsurgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;A Least Absolute Shrinkage and Selection Operator (LASSO) machine learning model was used to identify significant associations between 14 preoperative patient factors and likelihood of treatment response measured by achievement of the MCID in NDI, and EQ-5D. Variable importance was measured using standardized coefficients. To test robustness of findings we trained a separate XGBOOST model, with variable importance measured using SHAP values.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Among the 554 DCM patients included, 229 (41.3%) and 330 (59.6%) patients responded to treatment by meeting or surpassing MCID thresholds for NDI and EQ-5D at 1-year, respectively. LASSO regression for likelihood of treatment response measured through NDI found the variable importance rank order to be baseline NDI (OR 1.06 per 1 point increase; 95% CI 1.04–1.07), then symptom duration (OR 0.65; 95% CI 0.44–0.97). For EQ-5D, the variable importance rank order was baseline EQ-5D (OR 0.16 per 0.1-point increase; 95% CI 0.03–0.78), living independently (OR 2.17; 95% CI 1.22–3.85), symptom duration (OR 0.62; 95% CI 0.40–0.97), then number of levels affected (OR 0.80 per additional level; 95% CI 0.67–0.96). A separate XGBoost model of treatment response measured through NDI, corroborated findings that patients with higher baseline NDI, and shorter symptom duration were more likely to respond to treatment, and additionally found older patients, and those with kyphosis on baseline upright X-ray were less likely to respond. Similarly, an XGBoost model for treatment response measured through EQ-5D corroborated findings that patients with higher baseline EQ-5D, shorter symptom duration, living independently, with fewer affected levels were more likely to respond to treatment, and additionally found older patients were less likely to respond.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;Our findings suggest pa","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 276-289"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478951","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 interbody cages for lumbar spinal fusion: a systematic review.","authors":"Daniel Orr, Ron Anderson, Anna Jensen, Tyler Peterson, John Edwards, Anton E Bowden","doi":"10.1016/j.spinee.2025.01.013","DOIUrl":"10.1016/j.spinee.2025.01.013","url":null,"abstract":"<p><strong>Background context: </strong>Since the early 2000s, various expandable spinal fusion cages have been developed to facilitate less invasive procedures, however, expandable cages have often been evaluated as a homogeneous group, neglecting differences in shape, size, material, expandability and lordotic adjustability. This systematic review aimed to comprehensively survey the literature on expandable spinal fusion cages, discuss their differentiating factors, and identify gaps in the literature regarding these devices.</p><p><strong>Purpose: </strong>To demonstrate the range of design features included in expandable interbody devices and identify which of these features are associated with improved surgical outcomes.</p><p><strong>Study design: </strong>Systematic review.</p><p><strong>Methods: </strong>The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. An electronic search of MEDLINE and Embase using the search terms \"lumbar\" AND \"fusion\" AND (\"expandable cage\" OR \"expandable interbody\") including only English language articles that contained sufficient detail to correlate a specific expandable cage design to patient outcomes. Relevant elements, including device design parameters, patient population information, details of the intervention, comparison data, outcome variables, and the timeframe were extracted. Statistical analysis was conducted to correlate patient outcomes with different device features.</p><p><strong>Results: </strong>While 387 different articles were initially identified, 49 met all the criteria for inclusion. Design differences contributed to disparate outcomes, with rectangular titanium cages featuring medial-lateral and vertical expansion and continuous lordotic adjustability being correlated with significantly improved patient-reported outcomes. The surgical approach and location were also found to be correlated with patient outcomes, indicating that confounding factors are present.</p><p><strong>Conclusions: </strong>We recommend that expandable cage technologies not be considered a homogenous group, as long-term outcomes likely are dependent upon specific design characteristics. Categorizing devices based on design features such as material composition, shape, vertical expandability, horizontal expandability, and restoration of segmental lordosis may allow for more rapid identification of device characteristics associated with better outcomes.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123991","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 MD, MPA ,&nbsp;Marie-Rosa Fasser PhD ,&nbsp;Mazda Farshad MD, MPH ,&nbsp;Caroline Passaplan MD ,&nbsp;Frederic Cornaz MD, MSc ,&nbsp;Jonas Widmer PhD ,&nbsp;José Miguel Spirig MD","doi":"10.1016/j.spinee.2024.09.008","DOIUrl":"10.1016/j.spinee.2024.09.008","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>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.</div></div><div><h3>PURPOSE</h3><div>The present study investigates whether screw misplacement in the lumbar spine reduces mechanical screw hold.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Cadaveric biomechanical study.</div></div><div><h3>METHODS</h3><div>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.</div></div><div><h3>RESULTS</h3><div>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).</div></div><div><h3>CONCLUSIONS</h3><div>Medial misplacement is associated with increased axial screw hold against static loads compared to correctly placed screws and laterally placed screws.</div></div><div><h3>CLINICAL SIGNIFICANCE</h3><div>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.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 380-388"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","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":"Bodily growth and the intervertebral disc: a longitudinal MRI study in healthy adolescents","authors":"Teija Lund MD, PhD ,&nbsp;Leena Ristolainen DSc ,&nbsp;Hannu Kautiainen PhD ,&nbsp;Martina Lohman MD, PhD ,&nbsp;Dietrich Schlenzka MD, PhD","doi":"10.1016/j.spinee.2024.09.013","DOIUrl":"10.1016/j.spinee.2024.09.013","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Low back pain (LBP) among children and adolescents is a growing global concern. Disc degeneration (DD) is considered a significant factor in the clinical symptom of LBP. Both LBP and DD become more prevalent as adolescents transition into emerging adulthood. However, the relationship between growth during the pubertal growth spurt and the morphology of lumbar discs has yet to be elucidated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;This study aimed to assess the relationship between bodily growth during the pubertal growth spurt and the morphology of lumbar discs at age 18.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;This study was a prospective longitudinal cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A randomly selected cohort of healthy children was examined at ages 8, 11, and 18. Participants with complete data sets (semi-structured interview, anthropometric measurements and lumbar spine MRI) at age 11 and 18 were included in this analysis (n=59).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;The morphological characteristics of lumbar discs were evaluated on MRI. Anthropometric measures including height, sitting height and weight were obtained to calculate the Body Surface Area (BSA) and the Body Mass Index (BMI).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;The morphology of the lumbar discs was evaluated on T2-weighted midsagittal MRI using the Pfirrmann classification. A disc with a Pfirrmann grade of 3 or higher was considered degenerated at age 18. The relationship between relative growth between ages 11 and 18 (adjusted to sex and baseline values) and DD at age 18 was assessed. To analyze the relationship between the relative increase in BSA and DD, the participants were categorized into three equal-sized categories (tertiles). For all other anthropometric measures, the analysis was based on the relative increase in each measure between ages 11 and 18.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;In the highest tertile of relative increase in BSA (≥43%), 76% of participants had at least 1 disc with a Pfirrmann grade 3 or higher at age 18 while only 10% and 21% of participants in the lowest and medium tertiles had DD, respectively. The sex- and baseline-adjusted odds ratio (OR) for DD at age 18 for every additional 10% increase in BSA was 1.08 (1.02–1.15). The sex- and baseline-adjusted OR (95% CI) for DD at age 18 was 10.5 (1.60–68.7) and 7.92 (1.19–52.72) with every additional 10% increase in height and sitting height, respectively. For every additional 10% increase in weight, the adjusted OR for DD at age 18 was 1.51 (1.12–2.04) and for BMI 1.05 (1.01–1.09).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;More relative growth between ages 11 and 18 is significantly associated with the occurrence of DD in emerging adulthood. Among the measures investigated, height and sitting height are nonmodifiable. Maintaining an ideal body weight during the pubertal growth spurt may be beneficial for the health of the lumbar di","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 317-323"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}