Spine Journal最新文献

{"title":"Association between glucagon-like peptide-1 receptor agonists and non-fusion risk after single-level anterior cervical discectomy and fusion.","authors":"Yu Chang, Kuan-Yu Chi, Junmin Song, Hong-Min Lin","doi":"10.1016/j.spinee.2025.07.010","DOIUrl":"10.1016/j.spinee.2025.07.010","url":null,"abstract":"<p><strong>Background: </strong>Anterior cervical discectomy and fusion (ACDF) is a common procedure for treating degenerative cervical spine diseases. Successful fusion is essential for spinal stability, while pseudarthrosis can lead to pain and revision surgery. Glucagon-like peptide-1 (GLP-1) drugs, used for type 2 diabetes (T2DM) and obesity, have demonstrated benefits in vascular and bone health.</p><p><strong>Purpose: </strong>This study investigates whether perioperative GLP-1 drug use affects fusion rates in T2DM patients undergoing single-level ACDF.</p><p><strong>Design: </strong>Retrospective cohort study PATIENT SAMPLE: T2DM patients undergoing single-level ACDF.</p><p><strong>Outcome measurement: </strong>Risk of pseudarthrosis, identified using ICD-10 code M96.0, at 6 months, 1 year, and 2 years postoperatively.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using the TriNetX database, identifying T2DM patients who underwent single-level ACDF via CPT codes. Patients were categorized based on GLP-1 drug use within 6 months before or after surgery. A 1:1 propensity score matching (PSM) controlled for age, sex, race, and comorbidities.</p><p><strong>Results: </strong>Before propensity score matching (PSM), 1,245 GLP-1 drug users and 13,519 non-users were included. After matching, 1,242 patients remained in each group. At 6 months, the non-fusion rate was 7.9% in the GLP-1 drug group and 13.6% in the non-user group (OR=0.55, 95% CI: 0.42-0.72, p<.001), indicating 45% lower odds of pseudarthrosis in GLP-1 drug users. This trend remained consistent at 1 year (8.8% vs. 14.5%, OR=0.57, 95% CI: 0.44-0.74, p<.001) and 2 years postoperatively (10.0% vs. 15.5%, OR=0.61, 95% CI: 0.48-0.78, p<.001), suggesting a sustained reduction in the risk of non-fusion with GLP-1 drug use.</p><p><strong>Conclusions: </strong>Perioperative GLP-1 drug use is associated with a lower risk of pseudarthrosis in T2DM patients undergoing ACDF. These findings suggest a potential role for GLP-1 drugs in improving spinal fusion outcomes.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602082","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":"International consensus on the content of prehabilitation in spine surgery: results of a nominal group technique.","authors":"Esther R C Janssen, James E Eubanks, Michael J Schneider, Rob J E M Smeets, Richard L Skolasky","doi":"10.1016/j.spinee.2025.07.002","DOIUrl":"10.1016/j.spinee.2025.07.002","url":null,"abstract":"<p><strong>Background context: </strong>Spine surgery, like all major surgeries, carries the risk of adverse events and delayed recovery. Prehabilitation programs may mitigate negative prognostic factors to reduce complications and promote faster recovery postoperatively following spine surgery. There is no international consensus or recommendations regarding prehabilitation components in spine surgery.</p><p><strong>Purpose: </strong>This study aims to establish international consensus on important modalities of prehabilitation before spine surgery for patients appropriate for prehabilitation using a modified nominal group technique (NGT).</p><p><strong>Study design/setting: </strong>A modified NGT.</p><p><strong>Patient sample: </strong>This study used a modified NGT to establish consensus among 50 participants during the International Forum for Back and Neck Pain (ILBP Forum) 2023 and International Society for the Study of the Lumbar Spine (ISSLS) 2024 conference.</p><p><strong>Outcome measures: </strong>The rank for each theme and component was computed as the mean of the ranking. We expressed the dispersion in ranking as a measure of consensus.</p><p><strong>Methods: </strong>During the workshops participants consisting of clinicians and researchers ranked themes and components of a prehabilitation intervention for patients scheduled for spine surgery. The rank for each theme and component was calculated as the mean rank, the dispersion in rankings was used as a measure of consensus.</p><p><strong>Results: </strong>Five main prehabilitation themes were identified and ranked from most to least important by the participants: education (consensus=0.65), psychological prehabilitation (consensus=0.56), physical prehabilitation (consensus=0.37), multidisciplinary prehabilitation (consensus=0.54) and lifestyle factors (consensus=0.53). Within themes, different prehabilitation components were identified and ranked by priority.</p><p><strong>Conclusions: </strong>The 5 themes identified by this NGT consensus process (education, psychological prehabilitation, physical prehabilitation, multidisciplinary prehabilitation and lifestyle factors) can help inform the design of innovative prehabilitation interventions for optimizing recovery from spine surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602095","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":"Optimizing lumbar lordosis orientation to reduce proximal junctional failure in lumbar flatback deformity surgery: Insights from sacral slope-to-lumbar lordosis ratio analysis.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Kyunghun Jung, Minwook Kang, Chong-Suh Lee","doi":"10.1016/j.spinee.2025.07.021","DOIUrl":"10.1016/j.spinee.2025.07.021","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar flatback deformity (LFBD) is a condition commonly seen in the aging population, characterized by progressive loss of lumbar lordosis (LL), which results in stooped posture, pain, and gait disturbance. Adequate restoration of LL is crucial in surgical treatment; however, the orientation of LL in the standing position and its impact on proximal junctional failure (PJF) remains unclear.</p><p><strong>Purpose: </strong>This study aims to investigate the impact of the sacral slope (SS)/LL ratio on the occurrence of PJF in patients undergoing corrective surgery for LFBD. Additionally, factors influencing the SS/LL ratio were analyzed.</p><p><strong>Study design: </strong>A retrospective cohort study using prospectively collected data PATIENT SAMPLE: 277 patients who underwent corrective surgery for symptomatic LFBD with severe sagittal malalignment (pelvic incidence [PI] minus LL≥20°) and were followed up for ≥2 years.</p><p><strong>Outcome measures: </strong>PJF, which was defined either radiographically, as a proximal junctional angle (PJA) ≥28° plus a difference in PJA of ≥22° or clinically, as the necessity for revision surgery for junctional complications.</p><p><strong>Methods: </strong>Baseline demographic and radiographic data were collected. SS/LL ratio was calculated in the postoperative 6-week standing radiographs. Multivariate logistic regression analysis was performed to identify independent risk factors for PJF. Patients were categorized based on their SS/LL ratio using a cutoff value determined via receiver operating characteristic (ROC) curve analysis. Linear regression models were developed to predict the postoperative SS/LL ratio.</p><p><strong>Results: </strong>The mean SS/LL ratio was significantly lower in the PJF group than in the non-PJF group (71.0% vs. 78.3%, P=.012). Multivariate analysis identified a lower SS/LL ratio as a single independent risk factor for PJF (Odds ratio=0.972, P=.037). The optimal SS/LL ratio cutoff value was calculated as 73.8% with patients below this threshold experiencing higher PJF rates (32.0% vs. 14.1%, P<.001). Linear regression analysis showed that high PI, low PI-LL, and high PT significantly increased the SS/LL ratio.</p><p><strong>Conclusions: </strong>The SS/LL ratio can serve as a reliable indicator for predicting PJF in the standing position. A low postoperative SS/LL ratio, specifically below 73.8%, was associated with an increased risk of PJF. Optimizing the SS/LL ratio through appropriate PI-LL corrections is crucial for mitigating PJF risk in corrective surgery for LFBD.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592743","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":"The hidden cost of robotic spine surgery: real-world adverse events cause 58-minute delays and undermine economic viability.","authors":"Daniel Schneider, Ethan D L Brown, Aladine A Elsamadicy, Daniel M Sciubba, Sheng-Fu Larry Lo","doi":"10.1016/j.spinee.2025.07.014","DOIUrl":"10.1016/j.spinee.2025.07.014","url":null,"abstract":"<p><strong>Background context: </strong>Robotic spine surgery has experienced substantial market growth with global projections exceeding $1.2 billion by 2026. Manufacturers prominently promote enhanced screw placement accuracy, reduced radiation exposure, and improved surgical efficiency as primary value propositions.</p><p><strong>Purpose: </strong>To provide a comprehensive economic analysis incorporating the impact of adverse events on manufacturer claimed benefits.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Patient sample: </strong>This study included 1346 robotic spine surgery adverse events (812 MazorX and 534 Globus Excelsius) reported to the FDA Manufacturer and User Facility Device Experience (MAUDE) database from 2016 to 2025.</p><p><strong>Outcome measures: </strong>Adverse event characterizations and procedural delay.</p><p><strong>Methods: </strong>Using a structured extraction methodology, we quantified procedural time impacts, workflow modifications, and resource utilization requirements associated with robotic complications. These measured parameters were subsequently incorporated into an economic model evaluating financial viability across 189 scenarios with varied operating room costs, annual case volumes, and complication rates.</p><p><strong>Results: </strong>Adverse events resulted in a mean procedural delay of 58.1 minutes (95% CI, 54.7-61.5 minutes), with significant variation between robotic systems (Globus: 88.5 minutes vs. MazorX: 45.3 minutes; p<.001). Precision issues, despite representing the central marketing claim of robotic technology, constituted 66.4% of reported complications. Robot abandonment occurred in 34.4% of cases, resulting in significantly longer delays (71.4 vs. 44.8 minutes; p<.001). Economic analysis incorporating these measured disruptions demonstrated that none of the 189 modeled scenarios achieved financial breakeven within the systems' 7-year useful life, with even optimal conditions requiring 33.8 years to recover initial investment costs.</p><p><strong>Conclusion: </strong>Our findings highlight a disconnect between the marketed efficiency of robotic spine surgery and its observed economic and clinical realities. The increased procedural delays and predominance of precision-related adverse events suggest that current robotic platforms may require further refinement to align more closely with the operational needs of surgeons and the fiscal priorities of healthcare systems striving to balance innovation, quality, and value.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592744","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":"Traditional versus magnetically controlled growing rods for idiopathic early-onset scoliosis: outcomes at 5-year follow-up.","authors":"Antti J Saarinen, John M Flynn, George H Thompson, John B Emans, Peter F Sturm, Paul D Sponseller, Ilkka J Helenius","doi":"10.1016/j.spinee.2025.07.011","DOIUrl":"10.1016/j.spinee.2025.07.011","url":null,"abstract":"<p><strong>Background context: </strong>Growing rods are the most common surgical treatment for EOS. However, in children with idiopathic EOS, it is unclear how clinical, radiographic, and HRQoL outcomes differ between those treated with MCGRs versus TGRs.</p><p><strong>Purpose: </strong>To investigate how clinical, radiographic, and health-related quality-of-life (HRQoL) outcomes differ between children with idiopathic early-onset scoliosis (EOS) treated with magnetically controlled growing rods (MCGRs) versus traditional growing rods (TGRs).</p><p><strong>Study design: </strong>A retrospective review.</p><p><strong>Patient sample: </strong>Children with idiopathic EOS who have underwent treatment with MCGR.</p><p><strong>Outcome measures: </strong>A disease-specific Early Onset Scoliosis Questionnaire 24, radiographic measurements, and complications.</p><p><strong>Methods: </strong>Using an international database, we identified 92 children aged ≤9 years with idiopathic EOS (major curve >30°) treated with TGRs (n=54) or MCGRs (n=38) from 2002 to 2018. Mean age at index surgery was 6.4 years for both groups. The mean preoperative major coronal curve was 77° in the TGR group and 67° in the MCGR group (p=.04).</p><p><strong>Results: </strong>At 5-year follow-up, mean (± standard deviation) major curves were 46°±18° in the TGR group and 38°±15° in the MCGR group (p=.03). Median annual thoracic growth (T1-T12) was 4.1 mm (interquartile range, 4.7 mm) in the TGR group and 3.2 mm (interquartile range, 5.6 mm) in the MCGR group (p=.29). More complications occurred in the TGR group (mean 2.1 per patient) than in the MCGR group (mean 1.0 per patient) (risk ratio, 2.1; 95% confidence interval: 1.3-3.2). More revisions occurred in the TGR group (2.0 per patient) than in the MCGR group (0.9 per patient) (risk ratio, 2.2; 95% confidence interval: 1.4-3.4). Both groups achieved maximum scores in HRQoL domains of pulmonary function, transfer, physical function, daily living, and financial impact; no other measured domains differed between groups.</p><p><strong>Conclusions: </strong>The risks of complications and revision surgery in children with idiopathic EOS were lower for those treated with MCGRs than for those treated with TGRs. HRQoL scores were similar and high in both groups at 5-year follow-up. MCGRs provide safe, effective surgical treatment for idiopathic EOS.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592745","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":"Validity, reliability and responsiveness of a low-cost activity monitor for assessing walking in patients with lumbar spinal stenosis.","authors":"Paraskevi Drakoulidou, Michael Knox, Biara M Webster, James Meares, Christella Mylordi, Raoul Pope, Omprakash Damodaran, James M van Gelder, David B Anderson","doi":"10.1016/j.spinee.2025.07.017","DOIUrl":"10.1016/j.spinee.2025.07.017","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Reduced walking capacity is the hallmark of lumbar spinal stenosis (LSS). Currently, walking capacity in LSS is assessed with self-reported questionnaires. The Self-Paced Walking Test (SPWT) has been recommended as an objective capture of walking capacity, but takes up to 30 minutes to complete, preventing its widespread use by clinicians. Consumer-based activity monitors and smartphones have been suggested as an alternative but have not been validated in the LSS population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To determine the measurement properties of criterion validity, reliability and responsiveness of a low-cost consumer-based wrist activity monitor, smartphone walking app, SPWT and 2 patient-reported outcomes, the Oswestry Disability Index (ODI) walk item and the Physical Function Scale of the Swiss Spinal Stenosis Questionnaire (PFS) within an LSS population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Measurement properties study utilizing observational cohort design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;124 subjects with LSS (confirmed by a spinal surgeon from a combination of imaging and clinical symptoms) were recruited prospectively from the private consulting rooms of 3 spinal surgeons between May 2019 and August 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Wrist activity monitor distance, smartphone walking app distance, SPWT, ODI walk item, and PFS from the Swiss Spinal Stenosis Questionnaire.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Walking capacity was assessed on 3 occasions, with the first/baseline assessment before surgery. The first assessment was conducted to determine the criterion validity of the wrist activity monitor, phone app, ODI walk item and PFS by comparison against the SPWT. The reliability of all 5 walking capacity measures was assessed 1-3 weeks following initial assessment. Responsiveness was assessed in a subset of participants following their spinal procedure. Responsiveness was calculated using both the SPWT and a self-perceived recovery scale as the external anchor. COSMIN criteria was used to determine adequate and inadequate results for each measurement property.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Criterion validity of the activity monitor (n=123) and smartphone app (n=89) was strong with r=0.96 and r=0.93, respectively. There was only a moderate correlation between the SPWT and subjective walking measures ODI (n=121) and PFS (n=123) with r=-0.33 and r=-0.39 respectively. Objective measures of walking capacity demonstrated excellent reliability based on the intraclass correlation coefficient (ICC) results. The activity monitor, smartphone application and SPWT showed an ICC of 0.96, 0.97, and 0.96, respectively. The PFS showed good reliability (ICC=0.76) while the reliability of the ODI walk item was poor (ICC=0.45). When responsiveness was assessed based on self-perceived recovery, only the PFS demonstrated acceptable responsiveness with an Area Under the Curve (AUC) value of 0","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592746","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":"Paraspinal sarcopenia independently predicts patient-reported outcomes following open but not minimally invasive single-level lumbar decompression.","authors":"Robert J Oris, Rushmin Khazanchi, Jacob R Staub, Jonathan Dalton, Anitesh Bajaj, Jeremy Marx, Tyler Compton, Jae Jang, Shyam Chandrasekar, Alpesh A Patel, Wellington K Hsu, Srikanth N Divi","doi":"10.1016/j.spinee.2025.07.012","DOIUrl":"10.1016/j.spinee.2025.07.012","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Sarcopenia is a known risk factor for inferior outcomes following spine surgery. However, few studies have investigated the optimal method or cutoff to quantify paraspinal sarcopenia on MRI for outcome prediction. Furthermore, no studies have compared the impact of paraspinal sarcopenia on outcomes after minimally invasive versus open decompression surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The objectives of this study were 1) to quantitatively measure sarcopenia of the lumbar paraspinal muscles on MRI to determine the impact on patient-reported outcomes (PROs) following minimally invasive surgery (MIS) versus open single-level lumbar decompression, and 2) to calculate an optimal cutoff for measurements of paraspinal sarcopenia that is predictive of achieving a minimum clinically important difference (MCID) in PROs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients undergoing single-level lumbar decompression with MIS or open technique at an academic institution with a lumbar MRI within 1 year prior to surgery were identified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Whether or not a minimum clinically important difference (MCID) was achieved 1 year postoperatively for Patient-Reported Outcome Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Demographic variables including age, sex, BMI, 5-factor modified frailty index (mFI-5), and operative level and length were collected. Measurements of the lumbar paraspinal muscles (e.g., multifidus, psoas, and erector spinae) included the cross-sectional area (CSA) and fatty infiltration (FI). Demographic characteristics and paraspinal morphology were compared on bivariable and multivariable analyses between patients who met versus failed to meet an MCID of 8 on PROMIS-PF and -PI scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 152 patients met the inclusion criteria for this study: 99 with MIS and 53 with an open surgical approach. For the MIS cohort, higher psoas FI was associated with less common achievement of MCID for PROMIS-PF (8.60%±4.31 vs. 7.17%±5.08, p=.042) and -PI (8.74%±4.43 vs. 7.23%±4.97, p=.038), and greater multifidus FI was associated with less common PROMIS-PF MCID achievement (28.2%±14.5 vs. 21.1%±11.9, p=.010). However, these relationships did not persist after controlling for confounding variables. In the open laminectomy cohort, higher multifidus FI (32.8%±18.5 vs. 22.4%±12.3, p=.040) and CSA (271mm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;±59.1 vs. 234 mm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;±53.2, p=.041) and higher erector spinae (ES) FI (31.7%±15.5 vs. 20.9%±10.5, p=.017) and CSA (850mm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;±184 vs. 703mm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;±116, p=.008) were associated with less common achievement of MCID for PROMIS-PI. However, multivariable analysis revealed that only ES FI (odds ratio: 0.91, p=.045) was independently predict","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585414","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":"Spatial patterns of fat within the deep multifidus as a biomarker for chronic low back pain.","authors":"Karim Khattab, Lucas K Dziesinski, Jessica Ornowski, Jiamin Zhou, Noah B Bonnheim, Rebecca Crawford, Aaron Scheffler, Aaron J Fields, Conor W O'Neill, Jeffrey C Lotz, Jeannie F Bailey","doi":"10.1016/j.spinee.2025.07.022","DOIUrl":"10.1016/j.spinee.2025.07.022","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Chronic low back pain (cLBP) patients often have elevated fat infiltration (FI) in the multifidus (MF), but it is unclear how this relates to pain and degenerative spine features. Most prior work assess MF degeneration as the average whole-muscle fat content even though deep and superficial fascicles of the MF have different structural and functional characteristics. Assessing the spatial distribution of MF FI may provide regional context for causal mechanisms which may have distinct regional presentations within the muscle.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study assesses spatial patterns of MF FI at each lumbar level to identify regional differences associated with cLBP symptoms and degenerative spine features.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This is an observational cross-sectional study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Our study sample consisted of 230 cLBP patients from the BACPAC comeback cohort who reported low back pain that has persisted for the past 3 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Measures included MF fat-maps-a FI curve showing the spatial distribution of fat moving radially through the MF-created at each lumbar level (L1L2-L5S1). Other measures included average fat fraction in the deepest 15% of the MF (deep15 FI%), average whole-muscle fat fraction (overall FI%) and the Pain, Enjoyment of Life, and General Activity (PEG) survey score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We collected 3T MRI and used advanced sequences (IDEAL) to map the spatial distribution of MF FI at each lumbar level. We used statistical parametric mapping to identify spatial patterns of fat in the MF associated with age, sex, and BMI. Then, we tested for differences in spatial patterns of MF FI associated with pain and adjacent disc degeneration. Next, we calculated the fat fraction in a region of interest in the deepest 15% of the MF (deep15 FI%) and used linear mixed effects modeling to compare ho w age, sex, BMI, pain, and degenerative spine features associate with the deep15 FI% and the overall FI% separately. Lastly, we used linear regression models of PEG to compare FI measures as predictors for pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Elevated FI associated with PEG and adjacent disc degeneration only within the deepest 10% (p&lt;.05) and deepest 25% (p&lt;.01) of the MF respectively at the lower lumbar levels. Associations between demographic factors and FI were not specific to the deep MF. Older age and female sex associated with elevated FI throughout the muscle (p&lt;.001) while higher BMI associated with elevated FI in only the superficial 60% of the MF (p&lt;.001). Lastly, higher mean deep15 FI% but not mean overall FI% at the lower lumbar levels associated with higher PEG (p=.023).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;FI in deep regions of the MF at L4L5 and L5S1 is more strongly associated with pain and adjacent disc degeneration and less associated with age, sex, and BMI than overall FI%. We ide","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585423","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":"Static versus expandable transforaminal lumbar interbody fusion cages: a meta-analysis of complications, clinical, and radiographic outcomes.","authors":"Mohammad Daher, Marven Aoun, Richard K Hurley, William F Lavelle, Bassel G Diebo, Amer Sebaaly, Andrew J Schoenfeld, Alan H Daniels","doi":"10.1016/j.spinee.2025.07.018","DOIUrl":"10.1016/j.spinee.2025.07.018","url":null,"abstract":"<p><strong>Background: </strong>Surgical management of degenerative spinal disorders commonly includes lumbar interbody fusion. Transforaminal lumbar interbody fusion (TLIF) is an approach where the cages may be either static or expandable. However, published studies have reported disparate outcomes based on cage type.</p><p><strong>Purpose: </strong>Therefore, this meta-analysis will compare the radiographic outcomes as well as the complications and clinical outcomes between static and expandable TLIF cages.</p><p><strong>Study design: </strong>Meta-analysis.</p><p><strong>Methods: </strong>Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1-20) were accessed and explored until December 2024. The extracted data consisted of complications (subsidence, radiculitis, adjacent segment disease, pseudoarthrosis, hardware failure, and durotomies), 90-day readmissions, reoperations, patient-reported outcomes measures (PROMs) at ≤3 months and ≥6 months, and improvement in radiographic parameters at ≥6 months. Heterogeneity was evaluated by Q tests and I² statistics. If considerable heterogeneity was identified, a random-effects model was used. Otherwise, fixed-effect models were employed.</p><p><strong>Results: </strong>Fifteen retrospective articles were included in the meta-analysis, including 2247 patients, with 1359 in the static TLIF group and 888 in the expandable TLIF group. While there was no difference in most of the assessed complications or 90-day readmission, patients in the static TLIF group had a trend towards a lower rate of subsidence (OR=0.50; 95% CI: 0.25-1.00, p=.05) and a higher rate of reoperations (OR=1.96; 95% CI: 1.18-3.25, p=.01). When examining PROMs, there was no significant difference in back or leg pain. However, the static TLIF group had worse ODI at ≥6 months (mean difference=3.77; 95% CI: 0.34-7.19, p=.03). Furthermore, there was no difference in segmental lordosis improvement between the 2 groups. Nevertheless, the static TLIF group had less improvement in disc height (Standardized mean difference = -1.90; 95% CI: -2.98- -0.82, p<.001, p<.001), and foraminal height (Standardized mean difference=-3.76; 95% CI: -6.33- -1.19, p=.004).</p><p><strong>Conclusion: </strong>We found limited evidence of superior outcomes for most clinical parameters when comparing expandable to static TLIF. Surgeons should weigh anticipated benefits in case-specific scenarios against associated costs when selecting to use expandable devices.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585424","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":"Advances in endoscopic lumbar spine surgery: a comprehensive review of the techniques used for the treatment of lumbar disc herniations and spinal stenosis and lumbar spinal fusion.","authors":"Brian Kwon, Andrew Moon","doi":"10.1016/j.spinee.2025.06.004","DOIUrl":"10.1016/j.spinee.2025.06.004","url":null,"abstract":"<p><p>Endoscopic lumbar spine surgery has been practiced for decades but has recently gained popularity as a minimally invasive technique for treating the most common spinal pathologies treated by spine surgeons. These include lumbar disc herniations, spinal stenosis, and lumbar spinal fusion. This review provides comprehensive, up-to-date analyses of the 2 main approaches-uniportal and biportal endoscopy-utilized for discectomy, foraminotomy, laminectomy, and interbody fusion. The key advantages of endoscopic spine surgery include smaller incisions, less soft tissue disruption, reduced blood loss, shorter hospital stays, and faster recovery times, all of which collectively contribute to positive patient outcomes. Advances in visualization and instrumentation as well as surgeon training and experience have expanded the indications for endoscopic spine surgery beyond herniated discs, allowing its application in more complex conditions, such as highly migrated disc herniations, spinal tumors, and trauma. Moreover, endoscopic surgery has shown promising results in special populations, such as obese patients, where traditional open approaches can be challenging. Despite its advantages, adopting endoscopic spine surgery poses several challenges: particularly a steep learning curve related to issues with depth perception, maneuvering instruments in narrow spaces, and managing technical pitfalls like dural tears and hemostasis. There are also limitations with endoscopic interbody fusions, in particular the use of smaller cages that have a limited fusion surface area and sagittal alignment; newer expandable cages may circumvent these shortcomings, however. As the body of literature demonstrates comparable, if not superior, outcomes to traditional open surgery, the adoption of endoscopic techniques is expected to increase. Continued innovation, surgeon education and experience, and most important, patient demand are driving the growth of this technique. It is the authors' opinions that in the near future, endoscopic spine surgery will become a fundamental approach utilized in the treatment of degenerative lumbar spine conditions.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512640","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}