Spine Journal最新文献

{"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}

{"title":"Is osteoporosis an independent risk factor for sacral fracture after lumbosacral spinal fusion in adults? A retrospective cohort study.","authors":"Anthony N Baumann, Robert J Trager, Shahabeddin Yazdanpanah, Tyler Metcalf, Keegan T Conry, Jacob C Hoffmann, Gordon Preston","doi":"10.1016/j.spinee.2025.05.022","DOIUrl":"10.1016/j.spinee.2025.05.022","url":null,"abstract":"<p><strong>Background context: </strong>Sacral fracture is a rare complication following lumbosacral fusion in adults linked to postsurgical biomechanical changes. There are mixed research results suggesting that osteoporosis may or may not be a contributing factor.</p><p><strong>Purpose: </strong>To determine if osteoporosis is an independent risk factor for sacral fracture after lumbosacral fusion.</p><p><strong>Study design: </strong>A propensity-matched retrospective cohort study that was preregistered on open science framework.</p><p><strong>Patient sample: </strong>After matching, patients (n=14,302; 82% female) who underwent lumbosacral fusion had a mean age of 64 years and were divided into the osteoporosis cohort (n=7,151) or the no osteoporosis cohort (n=7,151).</p><p><strong>Outcome measures: </strong>The primary outcome measure was the risk ratio (RR) of sacral fracture through 2 years after lumbosacral fusion. We secondarily explored the RR for pelvic fixation with instrumentation. We assessed negative control outcomes such as further imaging and major trauma, targeting near-null point estimates.</p><p><strong>Methods: </strong>We included adults (≥18 years old) in the TriNetX database from 2005 to 2023 who underwent primary lumbosacral fusion, divided into two cohorts depending on the presence or absence of osteoporosis (ie, osteoporosis and no osteoporosis cohorts) and propensity matched via key risk factors.</p><p><strong>Results: </strong>There were 261 (1.8%) sacral fractures in the entire patient population (n=14,302). Comparing the osteoporosis cohort to no osteoporosis cohort, there was a statistically significant increase in risk of sacral fracture (RR: 1.75 [1.36, 2.24]; p<.001; 166 [2.3%] vs. 95 [1.3%] cases), with a median time to event of 154 and 181 days in each cohort, respectively. There was also a statistically significant increase in risk of pelvic fixation with instrumentation (RR: 1.87 [1.25, 2.78]; p=.002). The likelihood of polytrauma (RR=0.98), subdural hemorrhage (RR=1.24), and diagnostic imaging (RR: 0.93) approximated the null between cohorts, suggesting findings would not be explained by differences in these variables.</p><p><strong>Conclusion: </strong>Osteoporosis appears to be independently associated with a statistically and clinically significant risk of sacral fracture through 2 years after lumbosacral fusion. Further research may be warranted for corroboration.</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":"144010181","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 survival outcomes in renal cell carcinoma spinal metastases: a multicenter evaluation of existing prognostic systems.","authors":"Zhehuang Li, Feng Wei, Jinxin Hu, Youyu Zhang, Xiaoying Niu, Po Li, Xiance Tang, Weitao Yao, Suxia Luo, Peng Zhang","doi":"10.1016/j.spinee.2025.05.025","DOIUrl":"10.1016/j.spinee.2025.05.025","url":null,"abstract":"<p><strong>Background context: </strong>Survival prediction models for patients with spinal metastases are crucial for guiding clinical decision-making and optimizing treatment strategies. Renal cell carcinoma spinal metastases (RCC-SM) present unique challenges due to their distinct biological behavior and variable response to systemic therapies.</p><p><strong>Purpose: </strong>To externally validate existing prognostic scoring systems for predicting survival in patients with RCC-SM using multicenter data from China.</p><p><strong>Study design: </strong>Retrospective external validation study.</p><p><strong>Patient sample: </strong>103 patients with RCC-SM who underwent surgical treatment at three specialized spine oncology centers in China between 2015 and 2023.</p><p><strong>Outcome measures: </strong>Survival at 90 days, 180 days, and 1 year postsurgery, assessed using area under the curve (AUC), calibration intercept and slope, and Brier scores.</p><p><strong>Methods: </strong>Six prognostic scoring systems were evaluated, including Tomita, revised Tokuhashi, revised Katagiri, New England Spinal Metastasis Score, Skeletal Oncology Research Group (SORG) nomogram, and SORG machine learning (ML) model. Discrimination and calibration were assessed using ROC curves, calibration plots, and Brier scores. Cox regression identified independent prognostic factors. The study was funded by Henan Province Key Science and Technology Project (252102311081). A total amount of RMB 20,000 ($2,740) was received.</p><p><strong>Results: </strong>SORG ML demonstrated the highest discriminative ability for 90-day survival (AUC: 0.765), while revised Tokuhashi performed best for 180-day survival (AUC: 0.754), and revised Katagiri for 1-year survival (AUC: 0.806). However, nearly all models exhibited underestimation of survival probabilities, particularly in high-risk subgroups. Independent prognostic factors included American Spinal Injury Association grade, visceral metastases, preoperative systemic therapy, preoperative radiotherapy, and neutrophil-to-lymphocyte ratio.</p><p><strong>Conclusions: </strong>Existing prognostic models for RCC-SM show varying predictive accuracy, with SORG ML and revised Katagiri performing best for short- and long-term survival, respectively. However, recalibration is needed to address underestimation, particularly in East Asian populations. Future models should incorporate dynamic treatment responses and molecular biomarkers to improve predictive accuracy and clinical utility.</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":"143994987","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":"Development of a comprehensive treatment algorithm for tandem spinal stenosis: decision making and surgical strategy.","authors":"Rishi M Kanna, Praveen R Iyer, Ajoy Prasad Shetty, Shanmuganathan Rajasekaran","doi":"10.1016/j.spinee.2025.05.021","DOIUrl":"10.1016/j.spinee.2025.05.021","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Tandem spinal stenosis (TSS) can present with a constellation of myriad neurological symptoms and signs. Whole spine MRI has improved the diagnosis but does not aid therapeutic decision-making. While most studies have focused on cervico-lumbar TSS, there is inadequate literature on TSS of other regions. Further, there are no guidelines on the optimal surgical strategy for patients with TSS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective evaluation of prospectively collected data PURPOSE: To develop a clinico-radiological treatment algorithm for TSS involving all the regions of the spine PATIENT SAMPLE: About 238 patients treated for TSS with a minimum follow-up of 2 year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methodology: &lt;/strong&gt;The patients were classified based on the areas of stenosis namely cervico-lumbar (Type A -186), cervico-thoracic (Type B -11), thoracolumbar (Type C -24), and cervical, thoracic & lumbar (Type D -17). The criteria for diagnosis of TSS were cord compression and T2 signal intensity changes in cervical/ thoracic regions, and/or Schiza's grade ≥C lumbar canal stenosis (LCS). In the sequence of surgical algorithm, clinical severity was taken as the prime factor followed by cord signal changes. In clinical severity, symptoms were given predominance over clinical signs, myelopathy over radiculopathy and proximal over distal compressions. The outcomes were evaluated through Nurick's grade (NG) and ODI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Type A cervico-lumbar TSS was divided into four sub-types. Type A1-patients with clinical myelopathy without symptoms of LCS underwent cervical decompression alone (n=58). NG improved from 3.8±0.98 to 1.74±0.74 (p&lt;.05). Only 11(18%) required lumbar decompression later. Patients with LCS (Type A2) without clinical myelopathy underwent lumbar decompression alone (n=97). Four (4.1%) developed myelopathy during follow-up requiring a cervical surgery. Patients with predominant LCS symptoms with only signs of myelopathy (Type A3, n=7) underwent lumbar decompression initially but all required cervical surgery within 2 years. Type A4 (n=24) with both myelopathy and claudication symptoms were treated by combined staged decompressions procedures. The NG improved from 3.4±0.7 to 1.6±0.4 (p&lt;.05). Type B (n=11) had patients with myelopathy due to compression at cervical and thoracic regions. They were sub-divided based on upper limb myelopathy. In patients with both upper and lower limb myelopathy (Type B1, n=11), cervical decompression was done first (n=6) followed by staged thoracic decompression. The NG improved from 4.6±0.5 to 1.8±0.3 (p&lt;.05). In patients with predominant lower limb myelopathy (Type B2, n=5), only thoracic surgery was performed. Only one required cervical surgery later. In Type C thoracic & lumbar TSS (n=24), 20 were treated by thoracic decompression based on signs of myelopathy. The mean NG improved from 4.1±0.7 to 1.9±0.9 (p&lt;.05). Six cases required lumbar level surge","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":"144049103","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":"Academic and demographic characteristics of spine societies presidents.","authors":"Lancelot Benn, Gonzalo F Del Rio Montesinos, Mina Botros, Ram Haddas, Addisu Mesfin","doi":"10.1016/j.spinee.2025.05.019","DOIUrl":"10.1016/j.spinee.2025.05.019","url":null,"abstract":"<p><strong>Background context: </strong>There is limited information on spine society presidents' training backgrounds, academic productivity, and demographics. This is crucial because the individuals elected to this role are thought leaders and can impact the future trajectory of spine surgery.</p><p><strong>Purpose: </strong>To characterize the training backgrounds, academic productivity, and demographics of presidents elected to serve in 7 spine societies: Scoliosis Research Society (SRS), Cervical Spine Research Society (CSRS), North American Spine Society (NASS), Lumbar Spine Research Society (LSRS), International Society for the Study of the Lumbar Spine (ISSLS), American Association of Neurological Surgeons Spine (AANS Spine) and International Society for the Advancement of Spine Surgery (ISASS).</p><p><strong>Study design/setting: </strong>Retrospective Cohort Study.</p><p><strong>Outcome measures: </strong>Training backgrounds, academic productivity, and demographics of spine societies presidents.</p><p><strong>Methods: </strong>This was a retrospective cohort study of 7 spine society presidents (n=156) from 2000 to 2024. The information was retrieved via society websites for the SRS (n=24), CRSR (n=25), NASS (n=25), (n=25), ISSLS (n=25), AANS Spine (n=25), and ISASS (n=23). LSRS provided their list of presidents (n=9) upon request. Training backgrounds, current academic productivity, and demographic characteristics were obtained from online curriculum vitae, academic websites and Scopus. Data collection occurred from June 19, 2024 to September 14, 2024.</p><p><strong>Results: </strong>Most presidents (95.5%) were surgical providers (orthopedic surgeons 106/156, 67.9%; 43/156, 27.6% neurosurgeons). Only 7/156 (4.5%) were nonsurgical providers. CSRS and SRS presidents had the highest cumulative publications and H-index, respectively. The academic rank at appointment was professor for 122/156 (78.2%) presidents. Of the 156 presidents, 12.9% were MD/PhDs. There were 150/156 males (96.2%), and 122/156 were white (78.2%).</p><p><strong>Conclusion: </strong>Spine society presidents are mostly male orthopedic surgeons with high scholarly output. Most had the academic rank of professor. As orthopedic and neurosurgery training programs become more representative of the population, more leaders from diverse backgrounds may become future presidents of these societies.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the predictive value of K-line conversion in surgical outcomes for K-line negative cervical ossification of the posterior longitudinal ligament (OPLL): laminectomy with fusion versus laminoplasty.","authors":"San Kim, Sehan Park, Chang Ju Hwang, Jae Hwan Cho, Dong-Ho Lee","doi":"10.1016/j.spinee.2025.05.015","DOIUrl":"10.1016/j.spinee.2025.05.015","url":null,"abstract":"<p><strong>Background context: </strong>Laminectomy with fusion (LF) and laminoplasty are common treatments for K-line negative cervical ossification of the posterior longitudinal ligament (OPLL). However, the clinical significance of postoperative K-line conversion from negative to positive remains unclear.</p><p><strong>Purpose: </strong>To determine whether converting a K-line from negative to positive improves surgical outcomes in patients with cervical OPLL by comparing LF and laminoplasty.</p><p><strong>Study design/setting: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Patients with cervical myelopathy due to K-line negative OPLL who underwent LF or laminoplasty, with ≥1 year of follow-up.</p><p><strong>Outcome measures: </strong>Primary outcomes included neck and arm pain visual analog scale (VAS) scores, neck disability index (NDI), Japanese Orthopedic Association (JOA) score, JOA recovery rate, and radiographic parameters (C2-C7 lordosis, modified K-line interval).</p><p><strong>Methods: </strong>We compared radiographic and clinical outcomes between the 2 groups.</p><p><strong>Results: </strong>Among 85 patients with K-line-negative OPLL (39 LF, 46 laminoplasty), postoperative K-line conversion occurred significantly more frequently in the LF group (56.4% vs. 16.8%; p<.001). Although laminoplasty better preserved cervical range of motion and reduced neck pain, LF provided superior neurologic outcomes, as indicated by higher final JOA scores and recovery rates. Patients who achieved K-line conversion had significantly higher rates of favorable clinical outcomes compared to those who did not (58.1% vs. 27.7%; p=.019). Multivariate regression analyses further demonstrated that K-line conversion independently predicted favorable clinical outcomes (odds ratio [OR]: 3.900; p=.023), and LF was significantly associated with a higher likelihood of K-line conversion compared to laminoplasty (OR: 3.683; p=.033).</p><p><strong>Conclusion: </strong>In patients with K-line-negative cervical OPLL, postoperative conversion to K-line-positive status is significantly associated with improved neurological outcomes. Although laminoplasty provides advantages regarding neck pain relief and motion preservation, LF more reliably facilitates K-line conversion and suppresses kyphosis, leading to superior clinical outcomes. Careful preoperative evaluation of cervical alignment, combined with surgical strategies aimed at promoting K-line conversion, may optimize surgical results.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059317","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":"Hounsfield unit measurements to predict odontoid fracture union in elderly patients: post-hoc subgroup analysis from an international prospective comparative study.","authors":"Jeroen G J Huybregts, Wilco C H Jacobs, Luc W F van Haaster, Emma K Ruitenbeek, Mark P Arts, Michael Osti, Willem-Bart M Slooff, F Cumhur Öner, Sasha Gulati, Natasha M Appelman-Dijkstra, Ewout W Steyerberg, Geert J Lycklama À Nijeholt, Wilco C Peul, Carmen L A Vleggeert-Lankamp","doi":"10.1016/j.spinee.2025.05.011","DOIUrl":"10.1016/j.spinee.2025.05.011","url":null,"abstract":"<p><strong>Background context: </strong>Decreased bone mineral density (BMD) has been associated with worse fracture healing in vertebral fractures. In the absence of dual-energy X-ray absorptiometry (DXA) scans, CT-derived Hounsfield units (HU) may serve as a surrogate marker for BMD.</p><p><strong>Purpose: </strong>To study whether baseline HU measurements in the C2 and C3 vertebrae could predict odontoid fracture union in elderly patients.</p><p><strong>Study design/setting: </strong>Subgroup analysis from an international prospective comparative study.</p><p><strong>Patient sample: </strong>142 prospectively included patients aged ≥55 years with acute (<2 weeks) type II/III odontoid fractures.</p><p><strong>Outcome measures: </strong>Fracture union at 52 weeks.</p><p><strong>Methods: </strong>Standardized HU measurements were obtained from baseline CT scans in both mid-sagittal and mid-axial planes of C2 and C3. Fracture union at 52 weeks was compared between patients with and without union. Multivariable regression analyses with fracture union as the dependent variable adjusted for age, gender, fracture type, fracture displacement, other C1-C2 fractures, and treatment modality.</p><p><strong>Results: </strong>There were no relevant differences in HU values between the union and nonunion groups. Mean (SE) C2 HU was 246 (6.3) in the union group vs. 282 (33) in the nonunion group (p=.29), and mean C3 HU was 260 (6.5) vs. 251 (15), respectively (p=.56). No association was found between baseline HU and fracture union (aOR 1.00 (95% CI 0.99, 1.01) per HU increase for both C2 and C3). None of the baseline characteristics were significant predictors of union at 52 weeks. Compared to control patients in the literature, both the union and nonunion groups had reduced HU (cervical HU <300), indicating osteopenia.</p><p><strong>Conclusions: </strong>Baseline HU measurements in C2 and C3 did not predict fracture union at 52 weeks. Given that both groups exhibited decreased BMD, all elderly patients with odontoid fractures should be referred for osteoporosis screening and appropriate treatment.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994986","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":"Radiation exposure in XLIF surgery utilizing ultra-low radiation imaging with image enhancement software: a randomized controlled trial.","authors":"Benno Bullert, Jula Gierse, Eric Mandelka, Paul A Gruetzner, Sven Y Vetter","doi":"10.1016/j.spinee.2025.05.013","DOIUrl":"10.1016/j.spinee.2025.05.013","url":null,"abstract":"<p><strong>Background context: </strong>Minimally invasive spine surgery has grown significantly over the last decade. Lateral approaches for interbody fusion, such as XLIF/LLIF result in higher radiation exposure for the operating room (OR) staff and the patient compared to posterior techniques. New technologies such as ultra-low radiation imaging (ULRI) combined with image enhancement (IE) software may help reduce this exposure while maintaining procedural efficacy.</p><p><strong>Purpose: </strong>To evaluate whether using ULRI with IE software (mFluoro) reduces radiation exposure for OR staff and patients during lateral interbody fusion via the XLIF approach without increasing procedure time.</p><p><strong>Study design: </strong>Prospective, randomized controlled trial.</p><p><strong>Patient sample: </strong>The sample consists of 60 patients.</p><p><strong>Outcome measures: </strong>Primary outcome: Radiation exposure of the OR staff, measured in microsieverts (μSv), documented by personal dosimetry centrally in front of the sternum above the lead apron.</p><p><strong>Secondary outcomes: </strong>Radiation exposure of the patient, measured in cGy*cm², documented by the fluoroscopy unit's dose report; Procedure time, measured in minutes.</p><p><strong>Methods: </strong>This single-center prospective randomized controlled single-blind study included 60 patients who all underwent single-level lateral interbody fusion via XLIF approach between March, 2023 and December, 2024. Patients were randomized into two groups: intervention group (mFluoro) or control group (cFluoro). Radiation exposure of the OR staff was measured using dosimeters, and imaging parameters were extracted from the fluoroscopy unit's dose report.</p><p><strong>Results: </strong>No significant difference was found between the two groups regarding age, gender, BMI, implant type, and diagnosis (all p>.05). The mFluoro group showed a significant reduction in radiation exposure for the OR staff: 72.1% for the surgeon (p<.001), 76.1% for the assistant (p<.001), and 67.5% for the scrub nurse (p<.001). Patient radiation exposure was also significantly reduced in the intervention group, with dose area product (DAP) values lowered by 66.1% (p<.001). Fewer images were acquired in the mFluoro group (31.3% reduction, p<.001), and procedure time was reduced by 17.7% (71.3±21.3 minutes vs. 86.6±31.5 minutes; p=.034).</p><p><strong>Conclusion: </strong>Using ULRI with IE software significantly reduces radiation exposure for the OR staff in single-level lateral interbody fusion via the XLIF approach. Furthermore, the radiation exposure for the patient was also significantly reduced.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038025","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":"Multidomain postoperative recovery trajectories after lumbar and thoracolumbar spine surgery.","authors":"Salim Yakdan, Jingwen Zhang, Braeden Benedict, Ziqi Xu, Saad Javeed, Justin K Zhang, Benjamin A Steel, Vivek P Gupta, Kathleen Botterbush, Jay F Piccirillo, Thomas L Rodebaugh, Burel R Goodin, Jacob M Buchowski, Brian Neuman, Daniel Hafez, Michael Kelly, Wilson Z Ray, Chenyang Lu, Madelyn Frumkin, Jacob K Greenberg","doi":"10.1016/j.spinee.2025.05.017","DOIUrl":"10.1016/j.spinee.2025.05.017","url":null,"abstract":"<p><strong>Background context: </strong>Understanding early postoperative recovery is crucial for improving perioperative care and long-term outcomes. Traditional recovery assessments relying primarily on cross-sectional patient-reported measures may not fully capture the complexity of the recovery process.</p><p><strong>Purpose: </strong>Our study evaluates early postoperative recovery using mobile health assessment and explores the relationship between early recovery patterns, multidomain recovery, and long-term outcomes.</p><p><strong>Study design/setting: </strong>A prospective observational study.</p><p><strong>Patient sample: </strong>A total of 129 patients were included in the analysis.</p><p><strong>Outcome measures: </strong>Patient-reported outcome measures (PROMs) of pain, physical function, and disability at 1, 6 and 12 months postoperatively.</p><p><strong>Methods: </strong>This study recruited patients aged 21 to 85 undergoing lumbar/thoracolumbar surgery for degenerative diseases. During the first month postoperatively, patients completed daily Ecological Momentary Assessment (EMA) surveys assessing pain, depression, and physical function and were passively monitored with Fitbit. EMA and Fitbit data (steps per minute, Maximum 30-minute cadence, and activity bout number) were clustered using functional principal component analysis.</p><p><strong>Results: </strong>129 patients were included (median age: 62; 56% female). Two dominant recovery patterns were identified across all domains. At 12 months, patients with more favorable recovery across all domains except for activity bout number and depression, showed better outcomes. Favorable recovery in pain intensity and steps per minute was associated with greater improvements in all outcomes, while favorable recovery in maximum 30-minute cadence was associated with greater improvement in disability and physical function. Patients with less favorable pain recovery had a significantly higher complication rate (23% vs. 7%). A greater number of favorable recovery domains was associated with better 12-month outcomes improvement and demonstrated superior prognostic value compared to traditional patient assessment methods.</p><p><strong>Conclusion: </strong>Early postoperative recovery patterns and multidomain recovery, captured using mHealth tools, provide valuable insights into long-term outcomes. With further validation, these findings highlight the potential of integrating mHealth into clinical practice to personalize rehabilitation strategies, improve resource allocation, and enhance patient care.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990046","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":"Cervical disc replacement in athletes: a modified Delphi Consensus Survey of expert opinion.","authors":"Scott L Zuckerman, Jacob Jo, Grant H Rigney, Julian E Bailes, Christopher M Bonfield, Robert C Cantu, Patrick C H Chan, Andrew M Cordover, Domagoj Coric, Hank Feuer, Raymond J Gardocki, Andrew C Hecht, Wellington K Hsu, Jacob R Joseph, Ronald A Lehman, Allan D Levi, Susan M Liew, Philip K Louie, Steven C Ludwig, Joseph Maroon, Vincent J Miele, Jeff Mullin, Venu M Nemani, Frank M Phillips, Sheeraz Qureshi, K Daniel Riew, Myron A Rogers, Rick C Sasso, Gabriel A Smith, Jay D Turner, Alexander R Vaccaro, Robert G Watkins, Nicholas Theodore, David O Okonkwo, Allen K Sills, Gavin A Davis","doi":"10.1016/j.spinee.2025.05.009","DOIUrl":"10.1016/j.spinee.2025.05.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;The safety and efficacy of cervical disc replacement (CDR) for spinal disorders in contact sport athletes is unclear. Current research is limited and highlights mixed results regarding return-to-sport (RTS) among athletes with CDR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;We sought to perform a modified Delphi consensus survey of expert opinion on CDR in athletes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;A cross-sectional, modified Delphi consensus survey of different scenarios regarding RTS for athletes with CDR was conducted among a panel of expert spine surgeons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient/respondent sample: &lt;/strong&gt;An international panel of 34 spine surgeons involving both neurosurgeons and orthopedic surgeons with sport expertise was identified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Consensus regarding return to any level of sport as defined above was queried as the main outcome measure, with consensus defined a-priori at ≥70%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 2×2 scheme was used to classify sport risk: 1=low impact/low frequency; 2=low impact/high frequency; 3=high impact/low frequency; 4=high impact/high frequency that also served as the different levels of sport that respondents could recommend returning to for the theoretical athlete. Descriptive statistics were performed with survey respondent data to generate the percentages of respondents recommending return to each level of sport for all scenarios.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 34 sports spine surgeons invited to participate (55.9% neurosurgeons and 44.1% orthopedic surgeons), all completed nine questions as part of a larger survey. Regarding radiculopathy, consensus was achieved that CDR is an acceptable treatment for cervical radiculopathy in a high impact/high frequency athlete for one-level disease (73.5%). However, only 58.8% responded that they would offer a CDR in this scenario. Regarding spinal cord compression, consensus was not achieved that CDR is an acceptable treatment for a high impact/high frequency forces athlete for one-level disease with cord compression with/without myelopathy (47.1%). The most common reasons behind not offering a CDR included certainty of the anterior cervical discectomy and fusion (ACDF), safety concerns (eg, adequacy, efficacy, stability), and lack of data/evidence. Postoperatively, following a one-level CDR for myelopathy or radiculopathy, 57.6% of participants responded that they would advise the athlete may return to high impact/high frequency sport, whereases following a two-level CDR, only 23.5% of all participants responded they would advise the same. For one-level CDR, the most endorsed timelines for return to practice were 6 weeks (26.5%) and 3 months (26.5%) and for games was 3 months (41.2%). For two-level CDR, the most endorsed timeline for return to practice was 3 months (26.5%) and for games was 3 months (41.2%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Consensus was achieved that CDR is an acc","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039434","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}