Spine Journal最新文献

{"title":"Vancomycin powder mixed with autogenous bone graft and bone substitute may decrease the deep surgical site infections in elective lumbar instrumented fusion surgery for degenerative disorders: a prospective randomized study.","authors":"Shih-Tien Wang, Hsi-Hsien Lin, Yu-Cheng Yao, Nicole Huang, Wei Hsiung, Ming-Chau Chang, Chien-Lin Liu, Po-Hsin Chou","doi":"10.1016/j.spinee.2025.05.001","DOIUrl":"10.1016/j.spinee.2025.05.001","url":null,"abstract":"<p><strong>Background context: </strong>Deep surgical site infections (DSSI) following lumbar instrumented fusion surgery are associated with considerable morbidity. Intraoperative application of vancomycin powder (VP) has been widely used to prevent DSSI; however, the effects of VP mixed with local autogenous bone graft (ABG) and bone substitute on DSSI prevention and bone fusion remains unclear.</p><p><strong>Purpose: </strong>To examine the effects of VP mixed with ABG and bone substitute on DSSI and fusion rate.</p><p><strong>Study design/setting: </strong>A prospective randomized case-controlled study at a single medical center. (ClinicalTrials.gov Identifier: NCT03883022) PATIENTS' SAMPLE: Adult patients who underwent decompression along with instrumented fusion surgery for a degenerative lumbar condition were recruited from October 2017 to May 2023. Patients were randomly allocated to vancomycin (n=357) or control (without vancomycin) (n=348) groups. In the vancomycin group, 1 g of antibiotic powder was used for 2- and 3-level fusions (no 1 level fusions?) while 2 g was used for >3-level.</p><p><strong>Outcomes measures: </strong>The primary outcome was DSSI within 90 days after index surgery. Secondary outcomes included surgical and vancomycin-related complications, functional outcomes and bone fusion.</p><p><strong>Methods: </strong>All patients were followed up with plain spine radiographs at 1, 2, 3, 6, and 12 months after surgery. The definition of DSSI was based on the Centers for Disease Control and Prevention criteria for SSI. Posterolateral fusion was assessed using the Lenke criteria and interbody fusion was assessed using the Brantigan-Steffee-Fraser (BSF) definition. Solid fusion was defined as an angular change of <5° of the fused segments in supine dynamic flexion and extension lateral radiographs, Lenke grade A and B or BSF-3 definition. Antibiotic concentrations in the vancomycin group were measured in the serum and at the surgical site in the drain on days 1 and 3 after the index surgery. Functional outcomes were evaluated by Oswestry Disability Index (ODI) and visual analog scale (VAS) for leg pain.</p><p><strong>Results: </strong>In total, 357 and 348 patients were enrolled in the vancomycin and control groups, respectively. Mean patient age was 67.7±11.0 years and 63.0% were female. There were no DSSIs in the vancomycin group and five in the control group (0 vs. 1.4%, p=.029). All five patients with DSSI had diabetes (100%). None of the patients with diabetes in the vancomycin group developed DSSI (0/119 vs. 5/105 in control group, p=.021). Postoperative serum vancomycin levels were undetectable and no vancomycin-related complications were observed. The mean vancomycin concentrations at surgical site in the drain were 524.5±209.9 μg/mL and 217.4±97.2 μg/mL on postoperative days 1 and 3, respectively (measured in a drain?). At the final follow-up, functional outcomes and bone fusion rates were similar between the two gro","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055588","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 and validation of a novel survey measuring lumbar activity levels: the Hospital for Special Surgery Core Health Evaluation-Lumbar Activity Rating Scale (HSS CHEV-LARS).","authors":"Eric R Zhao, Luis Colon, Kasra Araghi, Olivia C Tuma, Aiyush Bansal, Troy B Amen, Jung Kee Mok, Tomoyuki Asada, Austin C Kaidi, Gregory S Kazarian, Stephane Owusu-Sarpong, Quante Singleton, Farah Musharbash, Kevin J DiSilvestro, Kristin Halvorsen, Michael Parides, Evan D Sheha, James E Dowdell, Kyle W Morse, Philip K Louie, Todd J Albert, Francis C Lovecchio, Han Jo Kim, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.1016/j.spinee.2025.05.005","DOIUrl":"10.1016/j.spinee.2025.05.005","url":null,"abstract":"<p><strong>Background content: </strong>Preoperative activity level provides a key baseline metric to evaluate postoperative recovery. Preoperative physical therapy also may positively impact length of stay and postoperative mobility after spine surgery. While there are surveys measuring activity levels in other areas of orthopedics (eg knee, shoulder, ankle), there are no such validated surveys in spine surgery. Stratifying patients by preoperative activity level may help guide treatment decisions such as conservative versus surgical management and decompression alone versus fusion in select patients.</p><p><strong>Purpose: </strong>To develop and validate an activity rating scale for lumbar spine patients.</p><p><strong>Study design: </strong>Phased prospective validation study.</p><p><strong>Patient sample: </strong>Item Generation/Item Reduction/Pilot-Testing Phases: clinic patients ≥18 years with lumbar pathology and no prior lumbar surgery. Validation phase: volunteer respondents ≥18 and ≤89 years currently in the United States.</p><p><strong>Outcome measures: </strong>demographics (age, sex, body mass index [BMI]), level of activity, Oswestry disability index (ODI), patient-reported outcomes measurement information system physical function computer adaptive test (PROMIS PF CAT).</p><p><strong>Methods: </strong>In phase 1 (item generation), 40 patients were interviewed on activities that involve and are most limited by their low back symptoms. Responses were used to generate a list of 12 activities. In phase two (item reduction), 40 separate patients rated activities on a scale from 1 to 10 for \"importance\" and \"difficulty\". Correlation matrices and clinical judgement were used to generate a pilot survey. In phase 3 (pilot-testing), 40 separate patients provided feedback on clarity, structure, and relevance to generate a final survey: The Hospital for Special Surgery Core Health Evaluation - Lumbar Activity Rating Scale (HSS CHEV-LARS). In phase 4 (validation) 205 respondents from a secure research crowdsourcing platform (CloudResearch<sup>TM</sup>) completed the HSS CHEV-LARS, ODI, and PROMIS PF CAT. The same respondents were asked to complete the HSS CHEV-LARS again 1 week later to assess test-retest validity via intraclass correlation coefficient (ICC). Construct validity was assessed by correlating the HSS CHEV-LARS with ODI, PROMIS PF CAT, age, and BMI. Internal consistency was assessed with Cronbach's alpha.</p><p><strong>Results: </strong>The 12 activities from phase 1 involved q1) elevation change q2) running q3) walking q4) standing q5) sitting q6-7) carrying objects below and above the waist q8) repetitive or heavy lifting q9) moving objects across the floor q10) bending forward or down q11) handling objects overhead q12) twisting. Q2 was removed due to low importance; q5) was removed due to low difficulty; q3/q4 and q6/q7 were combined due to high correlations; q8/q10 were combined due to movement similarity; q9 was removed due t","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056827","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":"Does intraoperative antiseptic solution soaking reduce microbial contamination in spine surgery? A randomized controlled trial.","authors":"Yuan-Fu Liu, Yu-Chia Hsu, Po-Lin Chen, Hao-Jun Chuang, Ting-Yuan Tu, Chao-Jui Chang, Yu-Meng Hsiao, Cheng-Li Lin","doi":"10.1016/j.spinee.2025.05.002","DOIUrl":"10.1016/j.spinee.2025.05.002","url":null,"abstract":"<p><strong>Background context: </strong>Surgical site infections (SSIs) are a significant complication in spine surgery, particularly in instrumented procedures, leading to increased morbidity and healthcare costs. Despite standard preoperative disinfection protocols, bacterial contamination remains prevalent. Strategies such as intraoperative antiseptic irrigation have been explored to mitigate contamination, yet the comparative efficacy of different antiseptic solutions remains unclear.</p><p><strong>Purpose: </strong>This study aimed to evaluate the effectiveness of intraoperative antiseptic solution soaking with normal saline (NS), povidone-iodine (PVP-I), and chlorhexidine gluconate (CHG) in reducing bacterial contamination in lumbar instrumented fusion surgery.</p><p><strong>Study design/setting: </strong>A single-center, single-blinded, randomized controlled trial was conducted at a tertiary medical center in Taiwan.</p><p><strong>Patient sample: </strong>A total of 105 patients undergoing posterior lumbar interbody fusion surgery were enrolled and randomly assigned to three groups: NS (n=35), PVP-I (n=35), or CHG (n=35). Patients with prior lumbar procedures, known allergies to antiseptics, previous spinal infections, trauma, or tumors were excluded.</p><p><strong>Outcome measures: </strong>The primary outcome was the reduction in bacterial contamination, assessed via intraoperative cultures from three sites-superficial tissues, deep tissues, and implant surfaces-before and after antiseptic irrigation. Secondary outcomes included the incidence of postoperative SSIs and clinical complications over a 6-month follow-up period.</p><p><strong>Methods: </strong>Patients were randomized into three groups, each receiving a 3-minute soak with the assigned antiseptic solution before wound closure, followed by normal saline irrigation. Swab samples were collected pre- and postirrigation for bacterial culture and 16S rRNA PCR analysis. Statistical analysis was performed using logistic regression and Bonferroni correction for multiple comparisons.</p><p><strong>Results: </strong>Among 105 patients, preirrigation bacterial culture positivity rates were 49.5% in superficial tissues, 31.4% in deep tissues, and 32.4% on implants. Postirrigation, NS showed no significant bacterial reduction, while PVP-I reduced superficial contamination (55.0%, p=.015) but no significant effect in deeper tissues and implants. CHG showed the greatest bacterial reduction, significantly outperforming NS (OR: 0.06, 95% CI: 0.01-0.54, p=.011) and PVP-I (OR: 0.06, 95% CI: 0.01-0.56, p=.012) on implant surfaces. Despite these differences in culture rate, SSI rates remained low and comparable among groups (p=.72), with no reported antiseptic-related complications.</p><p><strong>Conclusion: </strong>This study confirms that bacterial contamination remains high despite standard preoperative disinfection in lumbar fusion surgery. Among the tested antiseptic solutions, CHG demonstrate","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065075","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":"Accuracy and safety assessment of subaxial cervical pedicle screw instrumentation: a systematic review.","authors":"Yasin Irmak, Fabian Peter, Manuel Moser, Dominik Baschera, Gregory Jost, Cristina Goga, Ulf Schneider, Edin Nevzati","doi":"10.1016/j.spinee.2025.05.006","DOIUrl":"10.1016/j.spinee.2025.05.006","url":null,"abstract":"<p><strong>Background context: </strong>Given increasing use of both cervical pedicle screw (CPS) fixation in the subaxial cervical spine (C3-C7) and emerging navigation technologies, a quantitative profile of safety and accuracy remains wanting. Compared with lateral mass instrumentation of this region, CPS fixation shows superior biomechanical properties but poses higher risk of complications because of the narrow cervical pedicle width and proximity to neurovascular structures.</p><p><strong>Purpose: </strong>This systematic review quantifies the accuracy and safety of all types of subaxial CPS insertion, with or without navigation or template-based methods, to weigh the strengths and limitations of each technique.</p><p><strong>Study design: </strong>Systematic review according to PRISMA guidelines.</p><p><strong>Patient sample: </strong>Patients who underwent CPS instrumentation since its introduction.</p><p><strong>Outcome measures: </strong>Primary and secondary outcomes in our review included pedicle screw breach in the subaxial cervical spine determined on intra- or postoperative imaging, and screw-related operative complications, respectively.</p><p><strong>Methods: </strong>Following the PRISMA guidelines, our literature search of PubMed, Cochrane, and Scopus databases identified 3,312 clinical studies (1980--2024) using subaxial CPS that assessed for screw accuracy. After full-text analysis, data extracted included number of CPS, level of placement, number of patients, indications, insertion techniques, accuracy assessment method, classification of accuracy, breach rate, complication rate, and study origin.</p><p><strong>Results: </strong>The 73 studies included in final analysis from Asia (80%), Europe (12%) and North America (8%) yielded 14,118 CPS in 3,342 patients (1999-2024). Accuracy rates were 85.3% for 10,108 CPS placed with nonnavigated techniques (free-hand and fluoroscopy), 82.7% for 3,067 with navigation techniques, and 96.3% for 943 CPS placed using 3D templates. Complication rates were 1.1%, 2.1%, and zero, respectively.</p><p><strong>Conclusion: </strong>Our comprehensive review of more than 14,000 subaxial CPSs inserted found rates of high 84% overall accuracy and low 1.2% perioperative complications (ie, attributed to a misplaced screw). With biomechanical advantages superior to lateral mass screws, our quantitative findings support consideration for CPS instrumentation in select patients by experienced surgeons.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055477","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":"Influence of postoperative coronal malalignment following long-instrumented fusion in patients with adult spinal deformity: evaluation of clinical outcomes and mechanical complications.","authors":"Jin-Sung Park, Dong-Ho Kang, Se-Jun Park, Chong-Suh Lee, Hyun-Jun Kim","doi":"10.1016/j.spinee.2025.05.010","DOIUrl":"10.1016/j.spinee.2025.05.010","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Achieving satisfactory sagittal alignment in patients with adult spinal deformity (ASD) is a major goal of deformity correction, which leads to high health-related quality. However, compared with the literature on sagittal alignment, studies on postoperative coronal malalignment in ASD are limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to investigate the impact of coronal malalignment on clinical outcomes and mechanical complications after corrective surgery for ASD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective observational study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Among patients who underwent deformity correction with ≥5-level fusion to the sacrum, this study focused on those who achieved optimal sagittal correction, defined as a pelvic incidence minus lumbar lordosis (PI-LL) of ≤10° postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Incidence of coronal malalignment; clinical outcomes using the visual analog scale (VAS), Oswestry disability index (ODI), and Scoliosis Research Society Outcomes Questionnaire-22 (SRS-22); and mechanical complications such as proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and rod fracture.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Coronal malalignment was evaluated using the coronal balance distance (CBD), defined as the horizontal distance between the C7 plumb line and the central sacral vertical line. Postoperative coronal malalignment was classified as CBD&gt;3 cm. Patients were divided into two groups based on CBD as follows: the coronal balance (CB) group (balanced, CBD&lt;3 cm) and the coronal imbalance (CI) group (imbalanced, CBD≥3 cm). Clinical outcomes and the incidence of mechanical complications were compared between the groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included 112 patients, with a mean follow-up duration of 46.8 months. Among them, 24 patients (21.4%) were included in the CI group, with a mean CBD of 3.6±0.4 cm, whereas 88 patients comprised the CB group, with a mean CBD of 1.1±0.7 cm. The back pain VAS scores indicated that the CI group had significantly worse clinical outcomes than the CB group (52.5±19.8 vs. 40.1±24.0, p=.022). The appearance domain of the SRS-22 was also significantly lower in the CI group than in the CB group (2.8±0.6 vs. 3.4±0.9, p=.002). However, no significant differences in leg pain VAS scores, ODI scores, or other SRS-22 domains, except appearance, were observed between the two groups. The incidences of PJK, PJF, and rod fractures were similar between the groups. However, the rate of revision surgery for rod fractures was significantly higher in the CI group than in the CB group (5/5 in the CI group vs. 5/29 in the CB group, p&lt;.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;After correction surgery for ASD, coronal malalignment demonstrated an association with increased back pain VAS scores and lower appearance scores on the SRS-22. The incidence of mechanical complications, incl","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044469","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":"Impact of rod placement and tulip design on screw-rod gripping capacity in spinopelvic fixation: evaluation across a spectrum of recessed to extended lengths.","authors":"Arin M Ellingson, Cale J Hendricks, Ashley M Abbott, Matthew R MacEwen, David W Polly","doi":"10.1016/j.spinee.2025.05.016","DOIUrl":"10.1016/j.spinee.2025.05.016","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;High rates of pelvic instrumentation failure (4.5%-38%) have been reported, often attributed to issues within the screw-tulip-rod connection. While previous research has explored various aspects of this connection, the influence of tulip design and relative rod placement on mechanical failure remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aims to investigate how screw-tulip design and variations in rod placement relative to the tulip affect the integrity of the screw-tulip-rod connection, utilizing axial and torsional gripping capacity tests to evaluate mechanical stability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Biomechanical.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Mechanical testing was conducted following ASTM F1798-21 to assess the interconnection mechanisms in pelvic fixation constructs. Using 5.5 mm Cobalt Chromium rods with porous fusion/fixation (PFFS) screws, axial gripping capacity (AGC) tests measured the axial load before translatory slippage of the rod, while torsional gripping capacity (TGC) tests assessed the torque required to induce rotational slippage. Variations in rod placement at the tulip head were tested in recessed (-2 mm, -1 mm), flush (0mm), and extended positions (+1 mm, +10 mm), simulating failure during flexion, extension, and rotation for both open and closed tulip-head designs. ANOVA was used to evaluate the effects of rod placement on connection failure, with significance set at p&lt;.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;AGC and TGC tests revealed significant reductions for recessed rod placements, indicating suboptimal placement. At -1 mm and -2 mm, AGC for simulated flexion decreased by 28.8% (p&lt;.010) and 45.6% (p&lt;.001) for the open-head design and 30.5% (p&lt;.018) and 57.5% (p&lt;.001) for the closed-head design, respectively, compared to the nonrecessed rod placement. TGC also showed a significant decline at -2 mm, with a 25.4% reduction compared to the +1 mm extended length (p&lt;.001) and a 20.3% reduction compared to the -1 mm recessed length (p=.005), irrespective of head design. The open and closed-head designs exhibited similar trends; however, the closed-head design was shown to better resist structural failure at recessed lengths. At -2 mm simulating extension, the closed-head design was 54.8% greater than the open-head design for AGC (p&lt;.001) and 28.3% greater for TGC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our findings underscore that both flush (0mm) and extended (+1, +10 mm) rod placements relative to the screw-tulip offer sufficient gripping capacity whereas recessed placements (-1, -2 mm) have substantial reductions. The closed-head design was shown to better resist structural failure at recessed placements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical significance: &lt;/strong&gt;Rod placement relative to the most distal pelvic screw during spinopelvic fixation varries in surgical practice - whether flush to, extended past, or recessed into the screw-head. Biomechanical evaluating of the ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009932","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":"Mid-term outcomes of revision anterior fusion versus cervical disc arthroplasty in patients with prior single-level anterior cervical fusion.","authors":"Justin J Turcotte, Jane C Brennan, Andrea H Johnson, Chad M Patton","doi":"10.1016/j.spinee.2025.05.007","DOIUrl":"10.1016/j.spinee.2025.05.007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Revision cervical surgery presents unique challenges due to altered anatomy and biomechanics from the previous fusion. Revision anterior cervical discectomy and fusion (ACDF) offers the benefit of immediate stability but further reduces cervical mobility and may increase stress on remaining segments, potentially leading to additional degeneration. By performing a cervical disc arthroplasty (CDA) in the presence of a prior ACDF, a hybrid surgery (HS) construct is created, potentially combining the benefits of fusion stability with CDA motion preservation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the outcomes of one-level ACDF or CDA in patients with a history of prior one-level ACDF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients undergoing one-level ACDF or CDA with a history of prior one-level ACDF, with records in the Pearl Diver database from 2010 to April 30, 2023. All patients had 1-year minimum follow-up; surgeries for trauma, infection, or neoplasm, and those with concomitant cervical procedures were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome was any cervical reoperation at 2-years and 5-years postoperatively. Types of reoperations, 90-day complications, 2-year complications, and 2-year cost were evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The ACDF and CDA groups were propensity score matched in a 3:1 ratio. Univariate analyses (chi-square and independent samples t-tests) were performed to compare demographics, comorbidities, and outcomes after matching. Kaplan Meir analysis was performed to compare 5-year reoperation-free survival between the ACDF and CDA groups; survival rates were compared using the Log Rank test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After matching, 792 ACDF and 264 CDA patients were included. No significant differences in demographics or comorbidities were observed. The overall rate of 90-day complications was 3.9% in the ACDF and 3.0% in the CDA group; no significant differences in complication rates were found. ACDF patients experienced higher rates of pseudoarthrosis (6.4 vs. 1.1%, p=.001) at 2-years postoperatively. Overall, two-year reoperation rates were similar between groups (ACDF: 10.7 vs. CDA: 7.6%, p=.172). Over the 5-year postoperative period, no significant differences in ACDF, ACDF or CDA, other cervical, or any cervical reoperations were observed. The rate of any cervical reoperation was 13.5% in the ACDF group and 13.3% in the CDA group (p=1.000). No significant differences in 5-year reoperation-free survival were found between ACDF and CDA patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Both single-level ACDF and CDA yielded similar complication and reoperation rates at 2- and 5-years postoperatively in patients with a history of prior single-level ACDF. Either approach appears to be a viable treatment strategy in patients requiring reoperation after single-level ACDF. However","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003328","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 novel machine learning model to automate vertebral column segmentation utilizing biplanar full-body imaging.","authors":"Yash Lahoti, Skanda Sai, Wasil Ahmed, Rami Rajjoub, Michael Li, Bashar Zaidat, Samuel K Cho, Jun S Kim","doi":"10.1016/j.spinee.2025.05.003","DOIUrl":"10.1016/j.spinee.2025.05.003","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Degenerative scoliosis (DS) is a common spinal disorder among adults, characterized by lateral curvature of the spine. Recent advancements in biplanar full-body imaging, a low-dose and weight-bearing X-ray modality, facilitate safer and longitudinal imaging of DS patients. Quantifying spinal curvature serves as a valuable metric for assessing DS severity and informing surgical planning. However, manual annotation of vertebral structures in radiographic images is labor-intensive, necessitating specialized expertise and resulting in significant inter- and intraobserver variability. Advances in deep learning computer models, particularly with convolutional neural networks (CNNs) employing UNET architecture, offer robust solutions for image segmentation tasks. These deep learning approaches have the potential to standardize and expedite the analysis of spinal alignment alterations throughout disease progression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The purpose of this study is to develop an artificial intelligence algorithm capable of automating the segmentation of the vertebral column from biplanar full-body radiographic images regardless of spinal pathologies and previous hardware.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;This was a retrospective study designed to create and evaluate a proposed AI algorithm for spinal imaging. It was conducted in 2023 at a tertiary medical center and utilized weight-bearing, full-length biplanar full-body X-ray images in AP and Lateral orientations. The images were retrieved from the institutional picture archiving and communication system (PACS), anonymized, and exported as high resolution files.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;This study consisted of 250 images of patients who were either positive or negative for AIS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome of this study was to identify the accuracy of the segmentation model using the Dice-Sørensen coefficient for anterior-posterior and lateral views.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Biplanar full-body X-ray images were retrieved from the institutional picture archiving and communication system (PACS), anonymized, and exported as high-resolution files. Image dataset was crafted to include DS positive and negative samples. For each orientation, 200 images were used to train the model, and 50 radiographs were withheld for model performance evaluation. A two-stage deep learning model was developed to first identify the spine region from a full-body X-ray image, and then isolate the spine curvature from the output of the first stage of the model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The model was successful in segmenting the vertebral column, with Dice-Sørensen coefficient of 0.92 and 0.96 for anterior-posterior and lateral views respectively. The model was capable of accurately segmenting images involving complex spinal pathologies, such as lordosis and scoliosis, and noise from spinal instrumentation, suc","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037096","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":"Global trends and cross-country inequalities in spinal cord injury attributable to falls: a systematic analysis of the Global Burden of Disease Study 2021.","authors":"Wanguo Liu, Qinli Xu, Xu Wang, Sibo Wang, Zhongwen Gao, Rui Gu, Han Wu, Yuhang Zhu","doi":"10.1016/j.spinee.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.008","url":null,"abstract":"<p><strong>Background context: </strong>Falls are the leading cause of spinal cord injury (SCI), imposing profound disability, mortality, and socioeconomic burden. However, the global trends, regional patterns, and health disparities in SCI attributable to falls remain inadequately explored.</p><p><strong>Purpose: </strong>To provide a comprehensive analysis of the global, regional, and national burden of SCI attributable to falls from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 database. This study identifies epidemiologic trends, quantifies cross-country inequalities, and forecasts future challenges.</p><p><strong>Study design/setting: </strong>A cross-sectional study utilizing data from the GBD 2021.</p><p><strong>Patient sample: </strong>Patients from 204 countries and territories who sustained SCI due to falls.</p><p><strong>Outcome measures: </strong>Age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized years lived with disability (YLDs).</p><p><strong>Methods: </strong>Data were extracted from the GBD 2021. Descriptive analyses were conducted to evaluate ASIR, ASPR, and ASYR globally and across socio-demographic index (SDI) quintiles. Temporal trends were evaluated using joinpoint regression and age-period-cohort models. Decomposition analysis quantified the impact of aging, population growth, and epidemiologic shifts on the burden. Frontier analysis and inequality assessments assessed disparities, while Bayesian modeling forecasted the burden through 2035.</p><p><strong>Results: </strong>Between 1990 and 2021, global age-standardized rates of SCI attributable to falls declined in high-SDI regions but increased in middle- and low-SDI regions. Australasia and Western Europe had the highest burden in 2021, while East Asia and Oceania exhibited the fastest-growing trends. Population growth was the primary driver of the global burden increase, as revealed by decomposition analysis. Inequality assessments uncovered widening SDI-related disparities, with both absolute and relative inequalities. Projections through 2035 indicate a continued rise in the burden in the coming decades.</p><p><strong>Conclusions: </strong>SCI attributable to falls poses a significant and growing global health challenge, with stark regional and socioeconomic disparities. While high-SDI regions have seen progress, rising burdens in low- and middle-SDI areas demand urgent, region-specific preventive measures and equitable healthcare interventions. Policymakers must act decisively to address demographic transitions, reduce disparities, and prioritize fall prevention strategies to mitigate the growing burden.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047342","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":"Comparison of posterior approach surgical techniques for cervical spondylotic myelopathy: laminectomy with fusion, laminoplasty, and laminoplasty with fusion.","authors":"Seung Hyeon Han, Sang Hyun Kim, Sung Hyun Noh, Jong Joo Lee, Yoon Ha, Pyung Goo Cho","doi":"10.1016/j.spinee.2025.04.017","DOIUrl":"10.1016/j.spinee.2025.04.017","url":null,"abstract":"<p><strong>Background context: </strong>Laminectomy with fusion (LF), laminoplasty (LP), and laminoplasty with fusion (LPF) are three techniques for posterior cervical decompression. LF can provide stability, but postoperative dural membrane adhesion and fusion failure can occur. LP can prevent postoperative dural membrane adhesion, but it can lead to kyphotic change. To address the disadvantages and further enhance the strengths of each, the LPF technique can be a good option.</p><p><strong>Purpose: </strong>This study aimed to confirm whether LPF can overcome the disadvantages of LF and LP.</p><p><strong>Study design: </strong>Single-center, retrospective cohort study.</p><p><strong>Patient sample: </strong>Twenty patients for each technique were randomly selected.</p><p><strong>Outcome measures: </strong>Δ C2-7 sagittal vertical axis (SVA), Δ T1 slope, Δ C2-7 Cobb's angle, Δ spinal canal length, and fusion success rate were measured for radiologic outcomes. Preoperative and postoperative Japanese Orthopedic Association (JOA) scores and recovery rates (RRs) were measured for clinical outcomes.</p><p><strong>Methods: </strong>Patients who underwent LF, LP, or LPF between 2012 and 2023 were enrolled, and 20 patients for each technique were randomly selected. Δ C2-7 sagittal vertical axis (SVA), Δ T1 slope, Δ C2-7 Cobb's angle, Δ spinal canal length, fusion success rate, complications, operation time, blood loss, JOA scores, visual analog scale (VAS) scores, and RRs were measured.</p><p><strong>Results: </strong>Δ C2-7 Cobb's angle (LPF, -2.62±5.0; LP, -6.43±4.9; p=.020) and Δ C2-7 SVA (LPF, 6.48±8.3; LP, 13.84±9.9; p=.015) were significantly different between LPF and LP. No significant changes in Δ spinal canal length between LPF and LP were observed (LPF, 2.93±1.3; LP, 3.05±1.5; p=.780). The fusion success rate with LPF was higher than that with LF (LPF, 80.0%; LF, 45.0%; p=.027). The JOA RR was the highest with LPF (LPF, 49.96%±24.7; LF, 31.70%±27.8; LP, 29.31%±30.8, p=.045).</p><p><strong>Conclusions: </strong>LPF can overcome the disadvantages of LF and LP while retaining their benefits.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995253","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}