Spine Journal最新文献

{"title":"The Application Value of Intraoperative Neurophysiological Monitoring in Cervical Spinal Canal Stenosis Decompression Surgery.","authors":"Yongjie Zhang, Jialiang Li, Yang Yuan, Yuchen Wang, Dageng Huang, Huaguang Qi","doi":"10.1016/j.spinee.2025.03.029","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.029","url":null,"abstract":"<p><strong>Background context: </strong>Although intraoperative neurophysiological monitoring (IONM) has been widely recognized and used in spine surgery, its characteristics vary for different types of spinal disorders, necessitating the development of tailored monitoring strategies. Cervical spinal stenosis presents complex clinical symptoms and carries significant surgical risks, creating a critical need to clarify the monitoring features, alert patterns, and their relationship with outcomes in such surgeries. A comprehensive assessment and the development of a refined IONM monitoring plan throughout the perioperative period is an important direction for future research.</p><p><strong>Purpose: </strong>This study aims to investigate the influencing factors of intraoperative neurophysiological monitoring (IONM) alarm events in patients with cervical spinal canal stenosis and to evaluate the predictive value of different IONM alarm patterns on neurological recovery following decompression surgery.</p><p><strong>Design: </strong>Retrospective study PATIENT SAMPLES: This analysis included 1,622 patients who underwent cervical spinal canal decompression surgery and had complete IONM monitoring data between February 2017 and December 2022.</p><p><strong>Outcome measures: </strong>The preoperative and postoperative neurological status of the patients was assessed using the modified Japanese Orthopaedic Association (mJOA) score. The primary IONM alarm indicators included somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (MEP), compared to the preoperative baseline.</p><p><strong>Methods: </strong>Logistic regression was employed to analyze the correlation between preoperative diagnostic risk factors and intraoperative alarm events. Additionally, a multifactorial interaction analysis was performed to determine the relationship between IONM changes and the reversibility of alarms with the six-month mJOA recovery rate.</p><p><strong>Results: </strong>Preoperative diagnoses of the ligamentum flavum hypertrophy and/or ossification of the posterior longitudinal ligament, combined with an mJOA score <12, were identified as high-risk factors for intraoperative alarms. The sensitivity of alarms in the high-risk group was 100%, with a positive predictive value of 90.6%; in the low-risk group, the sensitivity was 91.7%, with a positive predictive value of 40.74%. Variance analysis indicated that the mJOA improvement rate at six months was significantly lower in patients with irreversible IONM alarms compared to those with reversible alarms. Interaction analysis suggested that the reversibility of intraoperative alarm events was a principal predictor of postoperative outcomes, while risk factors for alarms had predictive value only in patients with irreversible alarms.</p><p><strong>Conclusions: </strong>In patients with cervical spinal canal stenosis caused by disc degeneration, the presence of ligamentum flavum hypertrophy, ossific","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744325","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":"Adverse respiratory events during treatment with gabapentin and opioids among older adults with spine-related conditions: a propensity-matched cohort study in the US Medicare population.","authors":"Laura S Gold, Patrick J Heagerty, Ryan N Hansen, Janna L Friedly, Richard A Deyo, Michele Curatolo, Judith A Turner, Sean D Rundell, Jeffrey G Jarvik, Pradeep Suri","doi":"10.1016/j.spinee.2025.03.014","DOIUrl":"10.1016/j.spinee.2025.03.014","url":null,"abstract":"<p><strong>Background context: </strong>Recent work indicates no increased mortality risk with concurrent gabapentin and opioid use when using an active comparator control design. However, concurrent gabapentin and opioid prescriptions have been associated with greater risk of respiratory depression in some studies.</p><p><strong>Purpose: </strong>To compare the risk of respiratory events among Medicare enrollees with histories of spine-related diagnoses treated with gabapentin + opioids vs those treated with tricyclic antidepressants (TCA) or duloxetine + opioids. We hypothesized that enrollees treated with gabapentin + opioids would have increased risk of adverse respiratory events compared to those treated with an active control + opioids.</p><p><strong>Study design/setting: </strong>Propensity score-matched cohort study with an incident user, active comparator (TCA/duloxetine) control design. The primary analysis included those who concurrently (within 30 days) filled ≥1 incident gabapentin + ≥1 opioid or ≥1 incident TCA/duloxetine + ≥1 opioid prescription.</p><p><strong>Patient sample: </strong>U.S. Medicare beneficiaries with histories of spine-related diagnoses 2017-2019. People treated with gabapentin + opioids (n=66,860) were matched on demographic and clinical factors to people treated with TCAs/duloxetine + opioids (n=66,860).</p><p><strong>Outcome measures: </strong>Time to a composite respiratory outcome consisting of mechanical ventilation, intubation, respiratory failure, pneumonia, or acute respiratory distress syndrome.</p><p><strong>Methods: </strong>Cox proportional hazard regression was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs).</p><p><strong>Results: </strong>Among 133,720 Medicare enrollees (median age 73.3 years; 66.9% female), 6277 (4.7%) experienced respiratory events before the end of follow-up. A total of 3469 (5.2%) of people who were treated with gabapentin + opioids (median initial dose/day of gabapentin was 300 mg) had respiratory events compared to 2808 (4.2%) of those treated with an active control + opioids. The increased risk in those treated with gabapentin + opioids was statistically significant after adjustment (HR 1.19; 95% CI 1.13, 1.25; p<0.0001). The most common respiratory events were pneumonia (3.7% of people in the gabapentin + opioids group versus 3.0% of people in the TCA/duloxetine + opioids group) and respiratory failure (2.3% in the gabapentin + opioids group versus 1.8% in the TCA/duloxetine + opioids group). Results were similar in analyses (a) restricted to ≤30-day follow-up and (b) that required ≥2 fills of each prescription.</p><p><strong>Conclusions: </strong>While recent work indicates no increased mortality risk with concurrent gabapentin and opioid use in this population, the current findings suggest clinicians should exercise caution in prescribing gabapentin to older adults with spine conditions who are using opioids, due to possible impacts o","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of a machine learning prediction model for massive blood loss during surgery for spinal metastases: a multi-institutional study using 880 patients.","authors":"Daniël C de Reus, R Harmen Kuijten, Priyanshu Saha, Diego A Abelleyra Lastoria, Aliénor Warr-Esser, Charles F C Taylor, Olivier Q Groot, Darren Lui, Jorrit-Jan Verlaan, Daniel G Tobert","doi":"10.1016/j.spinee.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.018","url":null,"abstract":"<p><strong>Background context: </strong>A machine learning (ML) model was recently developed to predict massive intraoperative blood loss (>2500mL) during posterior decompressive surgery for spinal metastasis that performed well on external validation within the same region in China.</p><p><strong>Purpose: </strong>We sought to externally validate this model across new geographic regions (North America and Europe) and patient cohorts.</p><p><strong>Study design: </strong>Multi-institutional retrospective cohort study PATIENT SAMPLE: We retrospectively included patients 18 years or older who underwent decompressive surgery for spinal metastasis across three institutions in the United States, the United Kingdom and the Netherlands between 2016 and 2022. Inclusion and exclusion criteria were consistent with the development study with additional inclusion of (1) patients undergoing palliative decompression without stabilization, (2) patients with multiple myeloma and lymphoma, and (3) patients who continued anticoagulants perioperatively.</p><p><strong>Outcome measures: </strong>Model performance was assessed by comparing the incidence of massive intraoperative blood loss (>2,500mL) in our cohort to the predicted risk generated by the ML model. Blood loss was quantified in 7 ways (including the formula from the development study) as no gold standard exists, and the method in the development paper was not clearly defined. We estimated blood loss using the anesthesia report, and calculated it using transfusion data, and preoperative and postoperative hematocrit levels.</p><p><strong>Methods: </strong>The following five input variables necessary for risk calculation by the ML model were manually collected: tumor type, smoking status, ECOG score, surgical process, and preoperative platelet count. Model performance was assessed on overall fit (Brier score), discriminatory ability (area under the curve (AUC)), calibration (intercept & slope), and clinical utility (decision curve analysis (DCA)) for the total validation cohort, and for the North American and European cohorts separately. A sub-analysis, excluding the additional included patient groups, assessed the predictive model's performance with the same inclusion and exclusion criteria as the development cohort.</p><p><strong>Results: </strong>A total of 880 patients were included with a massive blood loss range from 5.3% to 18% depending on which quantification method was used. Using the most favorable quantification method, the predictive model overestimated risk in our total validation cohort and scored poorly on overall fit (Brier score: 0.278), discrimination (AUC: 0.631 [95%CI: 0.583, 0.680]), calibration, (intercept: -2.082, [95%CI: -2.285, -1.879]), slope: 0.283 [95%CI: 0.173, 0.393]), and clinical utility, with net harm observed in decision curve analysis from 20%. Similar poor performance results were observed in the sub-analysis excluding the additional included patients (n=676) and when ana","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744278","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":"GPT4LFS (generative pre-trained transformer 4 omni for lumbar foramina stenosis): enhancing lumbar foraminal stenosis image classification through large multimodal models.","authors":"Elzat Elham-Yilizati Yilihamu, Fan-Shuo Zeng, Jun Shang, Jin-Tao Yang, Hai Zhong, Shi-Qing Feng","doi":"10.1016/j.spinee.2025.03.011","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.011","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar foraminal stenosis (LFS) is a common spinal condition that requires accurate assessment. Current magnetic resonance imaging (MRI) reporting processes are often inefficient, and while deep learning has potential for improvement, challenges in generalization and interpretability limit its diagnostic effectiveness compared to physician expertise.</p><p><strong>Purpose: </strong>The present study aimed to leverage a multimodal large language model to improve the accuracy and efficiency of LFS image classification, thereby enabling rapid and precise automated diagnosis, reducing the dependence on manually annotated data, and enhancing diagnostic efficiency.</p><p><strong>Study design/setting: </strong>Retrospective study conducted from April 2017 to March 2023.</p><p><strong>Patient sample: </strong>Sagittal T1-weighted MRI data for the lumbar spine were collected from 1,200 patients across three medical centers. A total of 810 patient cases were included in the final analysis, with data collected from seven different MRI devices.</p><p><strong>Outcome measures: </strong>Automated classification of LFS using the multi modal large language model. Accuracy, sensitivity, Specificity and Cohen's Kappa coefficient were calculated.</p><p><strong>Methods: </strong>An advanced multimodal fusion framework GPT4LFS was developed with the primary objective of integrating imaging data and natural language descriptions to comprehensively capture the complex LFS features. The model employed a pre-trained ConvNeXt as the image processing module for extracting high-dimensional imaging features. Concurrently, medical descriptive texts generated by the multimodal large language model GPT-4o and encoded and feature-extracted using RoBERTa were utilized to optimize the model's contextual understanding capabilities. The Mamba architecture was implemented during the feature fusion stage, effectively integrating imaging and textual features and thereby enhancing the performance of the classification task. Finally, the stability of the model's detection results was validated by evaluating classification task metrics, such as the accuracy, sensitivity, specificity, and Kappa coefficients.</p><p><strong>Results: </strong>The training set comprised 6,299 images from 635 patients, the internal test set included 820 images from 82 patients, and the external test set was composed of 930 images from 93 patients. The GPT4LFS model demonstrated an overall accuracy of 93.7%, sensitivity of 95.8%, and specificity of 94.5% in the internal test set (Kappa = 0.89,95% confidence interval (CI): 0.84-0.96, p<.001). In the external test set, the overall accuracy was 92.2%, with a sensitivity of 92.2% and a specificity of 97.4% (Kappa = 0.88, 95% CI: 0.84-0.89, p<.001). Both the internal and external test sets showed excellent consistency in the model. After the article is published, we will make the full code publicly available on GitHub.</p><p><s","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal manifestations of diffuse large B-cell lymphoma.","authors":"Aymeric Amelot, Louis-Marie Terrier, Gabrielle Cognacq, Lotfi Benboubker, Christophe Destrieux, Ilyess Zemmoura, Patrick Francois, Mourad Aggad, Bertrand Mathon","doi":"10.1016/j.spinee.2025.03.025","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.025","url":null,"abstract":"<p><strong>Background context: </strong>Spinal diffuse large B-cell lymphoma (DLBCL) can be divided into two categories: primary non-Hodgkin's lymphoma (PNHL) and metastases from disseminated DLBCL. Prognostic factors of spinal DLBCL metastases seem to differ from those of other spine metastases and PNHL, although the data in the literature remains scarce.</p><p><strong>Purpose: </strong>This study aims at investigating prognostic factors associated with overall survival (OS) in patients with spine DLBCL metastases.</p><p><strong>Study design: </strong>a retrospective study PATIENT SAMPLE: 371 patients treated for DLBCL, including 62 cases of spine DLBCL metastases OUTCOME MEASURES: Patient demographics were collected with survival.</p><p><strong>Methods: </strong>This study is based on consecutive prospective population of, between January 2015 and 2019.</p><p><strong>Results: </strong>The median age of the 371 patients was 68.4 years (range 19.1 to 94.0 years) and 58.8% were males (218 patients). The median OS for our whole series was 82.06 months (SD 11.2.), and 53.0 months (SD 41.2, p=0.622) for the 62 patients with spine DLBCL metastases. The mean duration between DLBCL diagnosis and development of spine metastases (SpM) was 9.0 months (range 0.0-160.8 months). Cox multivariate proportional hazard model identified ECOG <2 [HR: 0.O59, 95 % CI 0.019-0.075; p< 0.0001], age <40 years [HR: 0.206, 95 % CI 0.08-0.506; p =0.001], and IPI score ≤ 2 [HR: 0.472, 95 % CI 0.03-2.104; p =0.001] as predictors of longer survival. In contrast, age >80 years [HR: 2.198, 95 % CI 1.481-3.261; p < 0.0001], IPI score > 4 [HR: 3.232, 95 % CI 1.765-4.654; p =0.008] were independent poor prognostic factors of survival.</p><p><strong>Conclusion: </strong>Spinal lesions in DLBCL are metastatic in nature whereas spine PNHL, similar to multiple myeloma, appears to be a primary spinal malignancy. The main prognostic factors of DLBCL spine metastases are those of the primary disease itself, and should be considered before spinal surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744324","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":"Can Treatment with Human Mesenchymal Stem Cells Rescue the Degenerative Disc Phenotype? An in Vitro Pilot Study of Induced Cytokine Expression.","authors":"Jonathan Dalton, Rajkishen Narayanan, Robert J Oris, Teeto Ezeonu, Evan Bradley, Jose A Canseco, Alexander R Vaccaro, John D Koerner, Dessislava Markova, Christopher Kepler","doi":"10.1016/j.spinee.2025.03.026","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.026","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Given the relatively low cell density in degenerative discs, strategies intended to bolster disc cellularity through stem cell injections have come into clinical use. Stem cell therapy is meant to provide a source of viable disc cells that can promote a healthy disc phenotype. Nevertheless, there is a limited understanding of the mechanisms through which stem cell therapy impacts degeneration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The objectives of this pilot study were: 1) to evaluate gene expression changes associated with an in vitro induced degenerative phenotype in human nucleus pulposus (NP) cells, 2) to co-culture these degenerative NP cells with human mesenchymal stem cells (hMSCs) and investigate the impact this has on gene expression, 3) to investigate possible mechanisms by which hMSCs may impact the degenerative phenotype.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Laboratory study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;NP cells were isolated and cultured from patients undergoing anterior lumbar interbody fusion for degenerative disc disease. A degenerative phenotype was induced in cultured NP cells by treatment with an inflammatory protocol (10pg/ml IL-1β and 100pg/ml TNF-α) for 7 days. Gene expression of Treated NP cells was compared to Untreated NP cells via reverse transcriptase polymerase chain reaction. NP cells were then co-cultured with hMSCs in vitro and treated with the inflammatory protocol. Gene expression of Treated NP cells co-cultured with hMSCs was compared to Treated NP cells alone. Preliminary co-culture data demonstrated that IL-10 was uniquely and dramatically upregulated. Therefore, gene expression of Treated NP cells exposed to IL-10 for 24 hours was compared to Treated NP cells alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Treated NP cells compared to Control NP cells showed upregulation of numerous pro-inflammatory cytokines, including CXCL5, IL-8, and IL-6 and downregulation of several anti-inflammatory cytokines, including IL-10. After co-culture of Treated NP cells with hMSCs, a significant increase in gene expression was identified in IL-10 (+15.34 fold), BMP-6 (+2.32 fold), and LIF (+2.14 fold). A significant decrease in gene expression (p &lt; 0.05) was seen in CCL7 (-2.03) and CXCL12 (-1.67). Exposure of Treated NP cells to IL-10 resulted in upregulation of COL-2 (+1.55 fold, p=0.013) and downregulation of IL-8 (-1.4 fold), CXCL-5 (-1.58 fold,), and MMP-3 (-2.02 fold).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This in vitro pilot study shows that co-culture of degenerative phenotype NP cells with hMSCs produces multiple gene regulatory changes associated with an anti-inflammatory phenotype. Additionally, exposure of degenerative phenotype NP cells to IL-10 produces gene regulation associated with both anti-inflammatory and pro-extracellular matrix effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical significance: &lt;/strong&gt;These findings provide mechanistic support for the use of stem cell therapy as a strategy to decrea","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteosarcoma of the mobile spine: A single-institution experience of 32 patients.","authors":"Jordan O Gasho, Vineet Desai, Santiago Lozano-Calderón, Gunnlaugur P Nielsen, Yin P Hung, Joseph H Schwab, Daniel G Tobert","doi":"10.1016/j.spinee.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.017","url":null,"abstract":"<p><strong>Background context: </strong>Osteosarcoma of the mobile spine is a rare and complex condition, with limited case series informing treatment decisions. Recent advancements in treatment paradigms, particularly in en bloc resection and novel radiation techniques, may incite new treatment guidelines and improve patient outcomes. The clinical outcomes of patients treated for osteosarcoma of the mobile spine at our institution were reported over a decade ago, and this study provides an updated assessment of management strategies and patient outcomes since the initial publication.</p><p><strong>Purpose: </strong>To provide an updated analysis of clinical results for the treatment of mobile spine osteosarcoma.</p><p><strong>Study design/setting: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Thirty-two patients treated at a single center for osteosarcoma of the spine over 22 years.</p><p><strong>Outcome measures: </strong>Estimation of overall patient survival, local recurrence, and the presence of metastatic disease.</p><p><strong>Methods: </strong>Inclusion criteria were adult patients treated for osteosarcoma originating in the vertebral column with the exclusion of the sacrum at Massachusetts General Hospital between 2001 and 2023. The overall survival was evaluated using the Kaplan-Meier method, grouped by type of resection (en bloc versus intralesional) and histological subtype (osteoblastic, chondroblastic, other/unknown). Prognostic factors were assessed using Cox proportional hazards modeling.</p><p><strong>Results: </strong>Twenty-two of the 32 patients were given en bloc resection, while ten received piecemeal resection. We found higher overall survival with en bloc resection compared to intralesional resection (median survival 81.54 months versus 12.42 months, p=0.006) using Kaplan-Meier analysis techniques. However, in multivariable regression, neither en bloc resection nor histological subtype were predictive of better outcomes. Resection of greater than one level and younger age were associated with poor survival (p<0.05).</p><p><strong>Conclusions: </strong>This study highlights the continued challenges for patients with spinal osteosarcoma despite advances in surgical techniques and radiation modalities. If feasible, en bloc resection yields improved overall survival compared to intralesional resection, but the five-year mortality rate remains high. Histological subtype did not significantly predict outcomes, while tumors involving multiple vertebral levels and younger age were associated with worse survival.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline summary review: An evidence-based clinical guideline for the diagnosis and treatment of adults with neoplastic vertebral fractures.","authors":"Charles H Cho, Steven W Hwang, Daniel J Mazanec, John E O'Toole, William C Watters, Thiru M Annaswamy, Allan L Brook, David S Cheng, Sean D Christie, Zachary A Cupler, Dennis E Enix, Marjorie Eskay-Auerbach, Justin M Goehl, G Alexander Jones, Piyush Kalakoti, Manish K Kasliwal, Niranjan U Kavadi, Cumhur Kilincer, Justin M Lantz, Gazanfar Rahmathulla, Tom Reinsel, K Aaron Shaw, Ahmed Shawky Abdelgawaad, Amy M Skuteris, Jeffrey A Stone, Andrea L Strayer, Andrew N Vo","doi":"10.1016/j.spinee.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.019","url":null,"abstract":"<p><strong>Background context: </strong>The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Adults with Neoplastic Vertebral Fractures features evidence-based recommendations for diagnosing and treating adult patients with neoplastic vertebral fractures. The guideline is intended to reflect contemporary treatment concepts for neoplastic vertebral fractures as reflected in the highest quality clinical literature available on this subject as of October 2020.</p><p><strong>Purpose: </strong>The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with neoplastic vertebral fractures. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition.</p><p><strong>Study design: </strong>This is a guideline summary review.</p><p><strong>Methods: </strong>This guideline is the product of NASS' Clinical Practice Guidelines Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with a medical librarian. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors.</p><p><strong>Results: </strong>Twenty-two clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature.</p><p><strong>Conclusions: </strong>The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with neoplastic vertebral fractures. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at http://www.spine.org/guidelines.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normalizing Spinal Cord Compression Measures in Degenerative Cervical Myelopathy.","authors":"Sandrine Bédard, Jan Valošek, Maryam Seif, Armin Curt, Simon Schading-Sassenhausen, Nikolai Pfender, Patrick Freund, Markus Hupp, Julien Cohen-Adad","doi":"10.1016/j.spinee.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.012","url":null,"abstract":"<p><strong>Background context: </strong>Accurate and automatic MRI measurements are relevant for assessing spinal cord compression severity in degenerative cervical myelopathy (DCM) and guiding treatment. The widely-used maximum spinal cord compression (MSCC) index has limitations. Firstly, it normalizes the anteroposterior cord diameter by that above and below the compression but does not account for cord size variation along the superior-inferior axis, making MSCC sensitive to compression level. Secondly, cord shape varies across individuals, making MSCC sensitive to this variability. Thirdly, MSCC is typically calculated by an expert-rater from a single sagittal slice, which is time-consuming and prone to variability.</p><p><strong>Purpose: </strong>This study proposes a fully automatic pipeline to compute MSCC.</p><p><strong>Design: </strong>We developed a normalization strategy for traditional MSCC (anteroposterior diameter) using a healthy adults database (n=203) to address cord anatomy variability across individuals and evaluated additional morphometrics (transverse diameter, area, eccentricity, and solidity).</p><p><strong>Patient sample: </strong>DCM patient cohort of n=120.</p><p><strong>Outcome measures: </strong>Receiver operating characteristic (ROC) and area under the curve (AUC) were used as evaluation metrics.</p><p><strong>Methods: </strong>We validated the method in a mild DCM patient cohort against manually derived morphometrics and predicted the therapeutic decision (operative/conservative) using a stepwise binary logistic regression incorporating demographics and clinical scores.</p><p><strong>Results: </strong>The automatic and normalized MSCC measures correlated significantly with clinical scores and predicted the therapeutic decision more accurately than manual MSCC. Significant predictors included upper extremity sensory dysfunction, T2w hyperintensity, and the proposed MRI-based measures. The model achieved an area under the curve of 0.80 in receiver operating characteristic analysis.</p><p><strong>Conclusion: </strong>This study introduced an automatic method for computing normalized measures of cord compressions from MRIs, potentially improving therapeutic decisions in DCM patients. The method is open-source and available in Spinal Cord Toolbox v6.0 and above.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe neck pain among patients with Degenerative Cervical Myelopathy: An observational study from the Canadian Spine Outcomes and Research Network.","authors":"Nikolaus Kögl, Nathan Evaniew, Nicolas Dea, W Bradley Jacobs, Jérome Paquet, Jefferson R Wilson, Hamilton Hall, Supriya Singh, Michael H Weber, Andrew Nataraj, Najmedden Attabib, David W Cadotte, Raja Y Rampersaud, Philippe Phan, Sean D Christie, Charles G Fisher, Christopher Small, Christopher S Bailey, Kenneth Thomas, Neil Manson, Greg McIntosh, Zhi Wang, Andrew Glennie, Raphaële Charest-Morin","doi":"10.1016/j.spinee.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.03.001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. While surgical intervention is widely recognized as the primary treatment to halt disease progression and improve neurological function, its effectiveness in alleviating neck pain remains poorly understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The aims of this study were to identify DCM patients that presented with severe neck pain and to compare their baseline characteristics and surgical outcomes to those who presented with less severe neck pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;This is a prospective, multicenter observational cohort study of the Canadian Spine Outcomes and Research Network (CSORN).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sample: &lt;/strong&gt;Patients surgically treated for DCM between 2015 and 2022 were enrolled.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measure: &lt;/strong&gt;Baseline demographics, clinical/surgical details, PROs and mJOA were assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Baseline demographics, clinical/ surgical details, preoperative PROs and mJOA were compared between the patients with severe patient-rated neck pain (NP, defined as NRS-NP ≥ 8), and those with less severe NP. Between group improvements at 12 months were assessed using ANCOVA to adjust for any baseline significant differences between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included data from 725 DCM patients, 31.7 % (n=230) of whom presented with severe NP. Patients with severe NP were significantly more likely to be younger, smokers, unemployed, working rather than retired, unmarried, using pain medication, have a history of depression, have more comorbidities, and be physically less active (all p&lt; 0.05). Baseline PROs (NRS AP and NP, NDI, SF-12 MCS and PCS and EQ5D) were significantly worse (p&lt;0.01), but mJOA scores were similar to those without severe NP. Among patients with severe NP, mean NRS-NP improved from 8.6 (SD 0.8) to 3.9 (SD 2.9, p&lt;0.01) at 12 months after surgery. Patients with severe NP were more likely to achieve MCID for neck pain in comparison to those without severe NP (74% vs. 33%, p&lt;0.01), but mean NRS-NP remained worse in this subgroup (3.9 vs. 2.6, p&lt;0.01) at one year after surgery. When adjusted for baseline characteristics, there were no differences between the 2 groups for the following PROs at 12 months post-operatively: NRS arm pain, NDI, SF-12 PCS, EQ5D. SF-12 MCS remained significantly worse among patients who presented with severe NP (p&lt; 0.05). There was no significant difference in mJOA scores (report data) at one year after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Severe neck pain affects about a third of the DCM population. Most patients who presented with severe neck pain experienced substantial improvement of their neck pain after surgery. Except for mental health scores which remained worse, patients with severe neck pain experienced similar improvements in other outcome measures such as neurological function an","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}