Spine Journal最新文献

{"title":"In vitro comparison of endplate preparation in biportal endoscopic and microscopic tubular transforaminal lumbar interbody fusion procedures.","authors":"Min-Seok Kang, Samuel K Cho, Samuel Q Li, Fady Y Hijji, Jun S Kim, Sang-Min Park, Ki-Han You, Hyun-Jin Park","doi":"10.1016/j.spinee.2025.04.019","DOIUrl":"10.1016/j.spinee.2025.04.019","url":null,"abstract":"<p><strong>Background: </strong>Successful spinal fusion heavily depends on the condition of endplate preparation in transforaminal lumbar interbody fusion (TLIF). The microscopic tubular (MT) approach offers a fixed surgical field outside the body and primarily relies on tactile feedback for endplate preparation. In contrast, the biportal endoscopic (BE) approach offers a flexible surgical field of view inside the body, allowing for direct visualization of the entire process of endplate preparation. These differences may affect the adequacy and completeness of endplate preparation.</p><p><strong>Purpose: </strong>To evaluate the adequacy and completeness of endplate preparation in BE- and MT-TLIF.</p><p><strong>Study design/setting: </strong>Anatomical study of human cadavers.</p><p><strong>Outcome measures: </strong>A quantitative assessment was performed using digital imaging software to calculate the percentage of the prepared endplate area (Prep %), which evaluated the adequacy of endplate preparation by comparing the prepared endplate cross-sectional area to the total endplate area. The entire endplate was divided into a grid of 6 × 8 pixels to evaluate the completeness of endplate preparation. Each pixel was qualitatively scored on a 4-point scale (0-3 points) based on the extent of bony endplate exposure and was counted based on its score. The percentage relative to the total number of pixels (Pixel%) was calculated.</p><p><strong>Methods: </strong>Four cadaveric torsos were procured for the study. Three lumbar segments were prepared using BE- and MT-TLIF techniques in each cadaver, totaling twelve intervertebral discs and twenty-four endplates. After completing endplate preparations using each approach, the lumbar spines were excised from the cadaveric torsos. Each disc space of the lumbar spine was dissected and split open in the axial plane at the center to expose the cranial and caudal endplates. These endplates were digitally photographed, followed by a quantitative and qualitative assessment of endplate preparation. The difference between the 2 approaches was then evaluated.</p><p><strong>Results: </strong>In terms of adequacy of endplate preparation, the Prep% was significantly larger with the BE than with the MT approach (55.10%; 44.94%; p=.001). Notably, when the entire endplate was divided into quadrants for analysis, the BE approach had significantly larger Prep% in the contralateral anterior and contralateral posterior quadrants (p<.001). In evaluating the completeness of endplate preparation, the Pixel% with complete endplate exposure (3 points) was significantly higher with the BE approach than with the MT approach (15.60%; 5.93%; p<.001). There was no significant difference in the Pixel% scored as 0, 1, or 2 points (p>.05).</p><p><strong>Conclusion: </strong>The results of this study indicate that the BE approach provides significantly better adequacy and completeness of endplate preparation than the MT approach in TLIF sur","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059318","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":"Anti-osteoporosis medication in patients with posterior spine fusion: a systematic review and meta-analysis.","authors":"HyungSub Jin, HyungJu Jin, Kyung-Soo Suk, Byung Ho Lee, Si Young Park, Hak-Sun Kim, Seong-Hwan Moon, Sub-Ri Park, Namhoo Kim, Jae Won Shin, Ji-Won Kwon","doi":"10.1016/j.spinee.2025.04.018","DOIUrl":"10.1016/j.spinee.2025.04.018","url":null,"abstract":"<p><strong>Background context: </strong>Osteoporosis and osteopenia are common among patients undergoing posterior spine fusion surgery, presenting challenges such as pseudarthrosis, screw loosening, and poor patient outcomes. While pharmacological interventions are available, no consensus exists regarding the optimal perioperative treatment for these patients. Furthermore, the effectiveness of various treatment options in improving fusion rates and minimizing complications remains uncertain.</p><p><strong>Purpose: </strong>To compare the effects of teriparatide, bisphosphonates, denosumab, and romosozumab in patients with posterior spine fusion with low bone mineral density (BMD).</p><p><strong>Study design: </strong>Systematic review and meta-analysis PATIENT SAMPLE: Adult patients with low BMD receiving osteoporosis medications and undergoing posterior spine fusion surgery OUTCOME MEASURES: Fusion rate, subsequent vertebral fracture (VF), screw loosening, cage subsidence, proximal junctional kyphosis(PJK), and patient-reported outcomes (PROs), particularly the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI).</p><p><strong>Methods: </strong>A systematic search was conducted using PubMed, EMBASE, and Cochrane Library. Two reviewers independently selected and assessed relevant studies. Four groups were analyzed to evaluate the comparative effectiveness of antiosteoporosis medication on the outcome measures: Bisphosphonate versus Control; Teriparatide versus Control; Teriparatide versus Bisphosphonate; and Denosumab versus Control.</p><p><strong>Results: </strong>Bisphosphonate showed reduced subsequent VFs (odds ratio [OR]=0.27, 95% confidence interval [CI]=0.09-0.81) and cage subsidence (OR=0.29, 95% CI=0.11-0.75) and improved ODI scores at 12 months (standardized mean difference [SMD] [95% CI]=-0.75 [-1.42, -0.08]) compared to the control. Teriparatide showed a higher fusion rate (OR=3.52, 95% CI=1.84-6.75), lower screw loosening (OR=0.23, 95% CI=0.09-0.60), and improved ODI scores at 24 months (SMD [95% CI]=-0.57 [-0.99, -0.15]) compared to the control. Moreover, teriparatide showed a higher fusion rate (OR=2.28, 95% CI=1.67-3.11), lower subsequent VF (OR=0.22, 95% CI=0.09-0.51), and improved VAS score for back pain (VASB) (mean difference [MD] [95% CI]=-0.30 [-0.54, -0.07]) and ODI (SMD [95% CI]=-0.38[-0.64, -0.12]) scores at 12 months compared to bisphosphonate. Denosumab showed no significant difference in fusion rate or other complications compared to control.</p><p><strong>Conclusion: </strong>Our results indicated that teriparatide should be used as the first-line perioperative treatment for patients with poor bone quality scheduled for posterior spine fusion. Teriparatide exhibited better fusion rates and reduced complications than controls and bisphosphonates, resulting in improved PROs. Moreover, bisphosphonates can be utilized in patients with contraindications to teriparatide since the former prevents osteoporosis-re","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055444","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":"NF-kappa B Oligo DNA decoy provides 12 months of pain relief and disc height restoration for patients with chronic discogenic low back pain-a randomized clinical trial.","authors":"Scott P Bruder, Melton Affrime, Howard An, Susan J Drapeau, Kazi Hassan, Yoshiyuki Takasu, Neil Ellis, Koichi Masuda, Steven Garfin","doi":"10.1016/j.spinee.2025.04.021","DOIUrl":"10.1016/j.spinee.2025.04.021","url":null,"abstract":"<p><strong>Background context: </strong>Low back pain is responsible for patient disability, extraordinary health care costs, and significant loss of productivity. Inhibition of the NF-κB-mediated signaling pathways by AMG0103, an NF-kappa B oligonucleotide decoy, may result in a reduction of pro-inflammatory cytokines and catabolic enzymes involved in intervertebral disc disease and pain.</p><p><strong>Purpose: </strong>To evaluate the safety, tolerability and preliminary efficacy of AMG0103 in patients with chronic discogenic low back pain.</p><p><strong>Study design: </strong>A Phase 1b, multicenter, double-blind, randomized, placebo-controlled, single ascending-dose clinical study.</p><p><strong>Patient sample: </strong>Patients with chronic symptomatic single level discogenic pain for at least 6 months, where back pain is greater than leg pain.</p><p><strong>Outcome measures: </strong>Self-reported Measures: VAS, ODI, PGI-C, RMDQ Physiological Measures: adverse events, laboratory values, and imaging METHODS: Patients with chronic discogenic back pain for more than 6 months who had failed at least 3 months of conservative care were evaluated. Inclusion criteria designated a Pfirrmann score of 3 or 4, with or without contained disc herniations of ≤3 mm protrusion, and disc height loss of the symptomatic disc is less than 50% of the adjacent discs. Nineteen adult patients received AMG0103 (0.3, 3.0 and 10.0 mg), an NF-kappa B oligo DNA decoy, while 6 patients received a placebo injection of phosphate buffered saline directly injected into the intervertebral disc. Safety and preliminary efficacy patient-reported outcome measures were obtained through 12 months in a 2-part study.</p><p><strong>Results: </strong>The safety of AMG0103 was confirmed through an absence of neurologic, sensory or motor function decline in the placebo and all treatment groups. Additionally, there were no clinically relevant renal, hepatic or hematologic dysfunctions. Moreover, a single injection of AMG0103 resulted in a dose-dependent and sustained reduction in back pain, measured on a 100 mm VAS scale, with the high dose reaching a mean pain reduction of 77% and a median pain reduction of 97.5% compared to baseline at 12 months. Further, disc height declined by 0.25 mm at 12 months for the placebo group, while the 10 mg AMG0103 cohort disc height increased by 0.31 mm over the same period. Dose dependent improvements were also seen via PGI-C, RMDQ, and ODI, with a reduction in rescue medications for AMG0103 patients.</p><p><strong>Conclusion: </strong>A single intradiscal injection of AMG0103 demonstrated clinically meaningful and statistically significant improvements in back pain, disc height and patient satisfaction throughout 1 year. Further investigation in a larger patient population is warranted.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044471","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":"Improving equitable collection and analysis of PROMIS Global health data over time following spine surgery: characterizing survey nonresponse and missing data.","authors":"David Shin, Seth Meade, Gabrielle Scariano, Yadi Li, Arpan A Patel, Brittany Lapin, Michael P Steinmetz, Thomas Mroz, Ghaith Habboub","doi":"10.1016/j.spinee.2025.04.022","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.022","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Patient-reported outcome measures (PROMs), the gold standard for outcome assessment in spine surgery, exhibit variability over time. Incomplete PROM collection, however, introduces nonresponse bias and limits the generalizability of time-based analyses of outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study compared PROM-respondents and nonrespondents in spine surgery to characterize survey nonresponse and improve equitable patient representation in time series PROM analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients undergoing surgery at a large, tertiary care center in the United States between July 2009 and February 2023 for lumbar spinal stenosis without spondylolisthesis (LSS), lumbar spinal stenosis with spondylolisthesis (LSP), or cervical spondylotic myelopathy (CSM).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome was completeness of available PROM records, which was defined as having Patient-Reported Outcomes Measurement Information System (PROMIS)-Global Health scores once within 2 years preoperatively and twice within 2 years postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Demographic variables of age, sex, race, marital status, employment, insurance, body mass index (BMI), smoking, and Area Deprivation Index (ADI) were obtained from the electronic medical record. These characteristics were compared by PROM-completeness within each pathology group. Comparative analyses between the PROM-complete and PROM-incomplete patients within each pathology group were conducted using the Satterthwaite t-test for continuous variables, Pearson's chi-square test for categorical variables, and Mann-Whitney U test for ordinal variables. Among patients with complete PROMs, availability of PROMIS-Global Health within 2 years pre- and postoperatively was plotted in bins of 84- and 168-days width to characterize the distribution of time points represented in PROM data for these patients. To visualize geographic variation in likelihood of representation in time series PROMs analyses, census block-level heatmaps were generated for each pathology group showing predicted probability of PROM-completeness by logistic regression with age, sex, race, marital status, employment status, insurance category, BMI, and smoking status as predictor variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;About 4,938 patients (1,751 LSS, 1,711 LSP, 1,476 CSM) were analyzed. PROM-complete patients varied significantly from PROM-incomplete patients in demographic distributions. PROM-complete patients were more likely of White race, married, retired, and less likely to be current smokers. LSS and CSM PROM-complete patients were more likely to have Medicare insurance than PROM-incomplete patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients completing PROMs for spine surgery may differ from those who do not, with greater representation of White race, being married, retiree s","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054739","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":"Quantifying in vitro load-sharing in spinal fusion surgical constructs using strain sensor-equipped fixation rods and force sensor-equipped intervertebral cages.","authors":"Mohsen Khodaee, Philipp Sager, Tobias Götschi, Mauro Suter, Brian Allen, Taekwang Jang, Mazda Farshad, Jonas Widmer","doi":"10.1016/j.spinee.2025.04.020","DOIUrl":"10.1016/j.spinee.2025.04.020","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Posterior and transforaminal lumbar interbody fusion (PLIF, TLIF) are widely recognized techniques for achieving spinal fusion. However, the biomechanical load-sharing interactions between the intervertebral cage, posterior instrumentation, and anatomical structures in the instrumented lumbar spine-particularly before and after cage subsidence and decompression procedures-remain insufficiently understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to quantify the load-sharing proportions of cages, rods, and anatomical structures in various spinal fusion configurations by comparing the load-sharing behavior of fusion components with intact IVD, after microdiscectomy, midline decompression, and cage instrumentation (uni- and bilateral PLIF, and TLIF) with and without endplate disruption.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Biomechanical cadaveric study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Sixteen lumbar spinal segments were mechanically tested using strain sensor-equipped rods and force sensor-equipped cages under uniaxial compression ranging from 0 to 1,000 N. The specimens were randomized into 4 groups based on cage configuration: unilateral PLIF (uPLIF), bilateral PLIF (bPLIF), TLIF, and a group with no cage. Each group included specimens from the T12-L1, L2-L3, and L4-L5 spinal segments. Instrumented fixation rods were mounted after applying a 55 N compression on each side to maintain spinal segment lordosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Independent of the applied force, anatomical structures, and cages consistently carried the highest force, with median load proportions at 1,000 N being 44.55% for anatomical structures, 36.3% for cages, and 14.44% for rods (n=12). In the absence of a cage, with an intact IVD, fixation rods contributed less to load carriage with a median of 9.0% (n=4). Endplate disruption, serving as a surrogate for cage subsidence, resulted in a 2.5% increase in the absolute load proportion on rods and a 4.4% increase on anatomical structures at 1000 N, while the proportion on the cages decreased by 14.6%. Removing the cage further increased the proportions on rods by 8.3% and on anatomical structures by 32.9%. Among the decompression steps, only small and full nucleotomy increased the load on the rods, with the median load proportions increasing by 1.6% and 4.8% at 1,000 N, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study reveals that regardless of the applied force, anatomical structures and cages consistently carried higher loads compared to the rods. The load taken by the fixation rods was smaller when the IVD was intact and no cage was used, compared to the samples in which cages were inserted. After endplate disruption, cages carried less force whereas rods and anatomical structures took more. Among decompression steps, only small and full nucleotomy increased the load on the rods, consequently decreasing the load on anatomical structures. Anatomical structures co","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049333","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 preoperative anemia on hospital costs in children and adolescents undergoing pediatric spinal deformity surgery.","authors":"Tanay Sorathia, Jennifer J Lee, David Faraoni, Lawrence G Lenke, Guohua Li, Lisa Eisler","doi":"10.1016/j.spinee.2025.04.023","DOIUrl":"10.1016/j.spinee.2025.04.023","url":null,"abstract":"<p><strong>Background context: </strong>Preoperative anemia is associated with the need for red blood cell (RBC) transfusion and extended hospital stays in pediatric patients undergoing spinal deformity surgery.</p><p><strong>Purpose: </strong>This study sought to identify excess hospital costs associated with preoperative anemia in this population.</p><p><strong>Design: </strong>Retrospective review of linked procedure records from prospectively maintained institutional databases.</p><p><strong>Patient sample: </strong>Patients aged 2 to 18 years old who underwent posterior spinal fusion surgery at our institution from 2017 to 2023 were identified through procedure-related data collected as part of the National Surgical Quality Improvement Program and Pediatric Health Information Systems databases.</p><p><strong>Outcome measures: </strong>The primary outcome measure was total hospital costs, as derived from billed services and the hospital's department level costs-to-charge ratios, with RBC transfusion as a mediating outcome.</p><p><strong>Methods: </strong>Linear regression estimated the association between preoperative anemia and increased hospital costs, adjusting for age, sex, American Society of Anesthesiologists physical status classification, number of spinal levels fused, and surgical duration. The unified framework for mediation and interaction identified whether RBC transfusion was a significant mediator of this association.</p><p><strong>Results: </strong>Of 672 patients, 10.6% (n=71) were anemic on preoperative testing. Higher median total hospital costs were seen for those with preoperative anemia than those without ($49,370 vs. $41,044; p<.001). Linear regression on log-transformed cost data indicated that those with anemia had 18.0% (95% CI: 4.5%-33.2%; p=.008) higher total hospital costs after adjustment for covariates, highlighting 95% confidence in a cost excess of at least $2,448 in anemic patients. RBC transfusion was more common in anemic patients (63.4% vs. 46.8%, p=.008) and significantly mediated the observed association with costs.</p><p><strong>Conclusions: </strong>Preoperative anemia is independently associated with increased healthcare costs during the surgical treatment of spinal deformity in children, with anemic patients incurring thousands of dollars of additional costs driven in part by those associated with RBC transfusion. Depending on the expense and efficacy of hemoglobin optimization strategies, these findings highlight the potential for a cost-effective intervention to treat preoperative anemia in vulnerable populations.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992601","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":"Wearable sensors: a valid tool for quantifying cervical spondylotic myelopathy (CSM).","authors":"Justin Mathew, Steven D Glassman, Jeffrey L Gum, Mladen Djurasovic, Charles H Crawford, Leah Y Carreon","doi":"10.1016/j.spinee.2025.04.024","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.024","url":null,"abstract":"<p><strong>Background context: </strong>Though nearly ubiquitous in testing for cervical spondylotic myelopathy (CSM), the conventional Romberg test is constrained by its binary nature. Differentiating which patients have mild cases from those who require surgery more urgently is challenging without objective metrics. The recent advance of performing a Romberg test on a force plate enables a more granular measure of imbalance in patients with CSM. Nonetheless, the use of force plates limits the amount of patient data that can be collected and the setting in which they can be collected. The advent of wearable sensors offers the opportunity to measure imbalance in patients when they are away from the clinical setting.</p><p><strong>Purpose: </strong>To determine if wearable sensors provide quantitative Romberg test data comparable to that of using a force plate.</p><p><strong>Study design: </strong>Prospective longitudinal cohort.</p><p><strong>Patient sample: </strong>Subjects with CSM scheduled for surgery.</p><p><strong>Outcome measure: </strong>Quantitative Romberg test.</p><p><strong>Methods: </strong>Patients scheduled for surgical treatment of CSM underwent Romberg testing on a force plate with wearable sensors placed at the C7 level. Data on force plate displacement (measured in mm of displacement) was compared to motion data from the wearable sensor (measured in degrees of angular displacement).</p><p><strong>Results: </strong>Data was collected on 48 patients, mean age of 57.77 years, mean BMI of 31.69 kg/m², with 23 (48%) females. There were strong statistically significant correlations between data from the force plate and from the wearable sensor with eyes closed for total lateral motion (r=0.766, p<.001), total path travelled (r=0.658, p<.001) and maximum lateral sway (r=0.800, p<.001) CONCLUSION: Wearable sensors present a growing subset of remote digital health technology to gather biomechanical gait and stance data. The results of this study suggest the feasibility of using sensors to quantify CSM severity. These data can elucidate the disease course and manifestations of conditions like CSM and may drive diagnostic and therapeutic decisions in the future.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028947","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":"Goutallier grading of psoas major and lumbar extensor muscles as a predictor of cage subsidence and reoperation following transforaminal and posterior lumbar interbody fusion.","authors":"Frank Vazquez, Alex Tang, Ara Khoylyan, Tan Chen","doi":"10.1016/j.spinee.2025.04.016","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.016","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Cage subsidence after transforaminal or posterior lumbar interbody fusion (TLIF/PLIF) is a complication that can lead to recurrence of radiculopathy, loss of correction, and poor patient outcomes. A reliable method to predict subsidence has not yet been established. One recently proposed method involves measuring the degree of fatty degeneration and Goutallier grading of the psoas major (PM) and lumbar extensors (LE) muscle groups, as well as the cross-sectional area (CSA) ratio between these muscle groups and the corresponding vertebrae.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The purpose of this study was to determine the relationship between (1) Goutallier grading of PM/LE and subsidence, (2) CSA ratio and subsidence, (3) identify the most predictive vertebral level, (4) examine the relationship between these measurements and rates of reoperation, and (5) examine the relationship between these measurements and patient-reported outcome measures (PROMs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;This study is a retrospective chart review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;This study included one hundred and sixty-two patients who underwent elective single level TLIF/PLIF from 2007 to 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Outcome data collected included cage subsidence rates, reoperation rates, Oswestry disability index (ODI), and Patient-Reported Outcomes Measurement Information System (PROMIS) Global scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was performed identifying patients who underwent elective single level TLIF/PLIF from 2007 to 2022. Muscle parameters collected include the CSA ratio and Goutallier grade of the PM/LE muscle groups at L3/L4, L4/L5, and L5/S1 based on axial CT and MRI. Clinical and radiographic data collected include cage subsidence, osteoporosis diagnosis, reoperation rates, and PROMs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;One hundred sixty-two patients met inclusion criteria. Average follow-up time was 1.6±1.1 years (range:0.13-7.3 years). Eighty-one (50%) patients experienced cage subsidence. Compared to the non-subsidence group, the subsidence group had higher mean Goutallier grade at L3/4 measured in the PM (1.10±1.05 vs. 0.60±0.84, p&lt;.001) and LE (1.40±0.89 vs. 1.18±0.76, p=.047) muscle groups. A Goutallier grade ≥ 2 at L3/4 was associated with an increased risk of subsidence based on PM (OR=4.585, p&lt;.001; AUC=0.635; r=0.258, p=.001) measurements. Increased risk of reoperation was observed in patients with higher Goutallier grades at L3/L4, L4/L5, and L5/S1 based on PM parameters (OR=3.997, p=.004; OR=3.516, p=.008; and OR=3.124, p=.016, respectively), and at L3/4 based on LE parameters (OR 3.462, p=.009). A significant correlation was found between worse ODI and a higher Goutallier grade at L3-L4 for PM (B=2.105, p=.043). Worse PROMIS Global scores were significantly correlated with higher Goutallier grades at L3-L4 for LE (B= -4.455, p=.002). CSA ratio","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990135","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 simple etiology of scoliosis, low back pain, and herniated lumbar disks.","authors":"Tadhg O'Gara","doi":"10.1016/j.spinee.2025.04.014","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.014","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037191","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":"Radiographic phenotype-driven clustering in lumbar decompression: comparative study of outcome and reoperation risk.","authors":"Tomoyuki Asada, Sereen Halayqeh, Adrian Lui, Andrea Pezzi, Eric R Zhao, Adin M Ehrlich, Olivia C Tuma, Kasra Araghi, Tarek Harhash, Rujvee Patel, Kyle Morse, James E Dowdell, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.1016/j.spinee.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.015","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar spinal canal stenosis (LSCS) presents with various radiographic findings, often including concurrent degenerative changes. Prior studies have investigated the effects of individual radiographic findings and parameters separately using conventional methods such as logistic regression. However, applying these independent effects to real-world patients remains challenging due to an unknown interaction effect among multiple degenerative radiographic findings.</p><p><strong>Purpose: </strong>To identify distinct patient phenotypes based on preoperative radiographic findings using unsupervised clustering and to evaluate their associations with postoperative patient-reported outcomes and reoperation rates.</p><p><strong>Study design: </strong>Retrospective cohort study PATIENT SAMPLE: Patients undergoing single-level lumbar decompression OUTCOME MEASURES: Oswestry Disability Index (ODI), Short Form-12 physical component scale (SF-12 PCS), reoperation rates METHODS: Unsupervised clustering was performed using preoperative radiographic data from standing X-ray imaging and magnetic resonance imaging (MRI). Variable selection was optimized through preliminary correlation analysis, causal assessment using a directed acyclic graph, and expert review. A multivariable mixed-effects model was used to assess the impact of cluster membership on postoperative outcomes. Reoperation rates were compared using Kaplan-Meier survival analysis and Cox proportional hazards models.</p><p><strong>Results: </strong>Unsupervised clustering identified four distinct clusters base on 10 radiographic variables: cluster 1 as \"Young and Less Degenerative Spine\" (cluster Y), cluster 2 as \"Combined Coronal and Sagittal Spondylosis\" (cluster CS), cluster 3 as \"Coronal Spondylosis Characterized by Laterolisthesis\" (cluster C), and cluster 4 as \"Sagittal Spondylosis Characterized by Degenerative Spondylolisthesis\" (cluster S). Multivariable regression analysis, adjusting for comorbidity, sex, and body mass index have revealed cluster C demonstrated slower improvement in ODI (β = 5.4, SE = 2.7, p=.043) and SF-12 PCS (β=-2.9, SE=1.4, p=.045) compared to cluster Y. Regarding reoperation, cluster CS showed the highest hazard ratio (24.3%, HR=4.18, 95% CI: 1.48-13.07, p=.007) compared to cluster S with the lowest reoperation rate (6.8%).</p><p><strong>Conclusion: </strong>Unsupervised clustering based on preoperative radiographic findings identified four distinct degenerative phenotypes in LSCS. Patients with coronal spondylosis was associated with slower improvements in disability and function compared to those with minimal degeneration. Additionally, patients with combined sagittal and coronal degeneration exhibited the highest reoperation rates. These findings highlight the clinical relevance of coronal and sagittal degeneration in surgical decision-making.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038026","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}