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 MD , Hsi-Hsien Lin MD , Yu-Cheng Yao MD , Nicole Huang PhD , Wei Hsiung MD , Ming-Chau Chang MD , Chien-Lin Liu MD , Po-Hsin Chou MD, PhD","doi":"10.1016/j.spinee.2025.05.001","DOIUrl":"10.1016/j.spinee.2025.05.001","url":null,"abstract":"<div><h3>Background Context</h3><div>Deep surgical site infections<span> (DSSI) following lumbar instrumented fusion surgery are associated with considerable morbidity. Intraoperative application of vancomycin<span> powder (VP) has been widely used to prevent DSSI; however, the effects of VP mixed with local autogenous bone graft<span> (ABG) and bone substitute on DSSI prevention and bone fusion remains unclear.</span></span></span></div></div><div><h3>Purpose</h3><div>To examine the effects of VP mixed with ABG and bone substitute on DSSI and fusion rate.</div></div><div><h3>Study Design/Setting</h3><div>A prospective randomized case-controlled study at a single medical center. (ClinicalTrials.gov Identifier: NCT03883022).</div></div><div><h3>Patients’ Sample</h3><div><span>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 </span>antibiotic powder was used for 2- and 3-level fusions (no 1 level fusions?) while 2 g was used for >3-level.</div></div><div><h3>Outcomes Measures</h3><div>The primary outcome was DSSI within 90 days after index surgery. Secondary outcomes included surgical and vancomycin-related complications, functional outcomes and bone fusion.</div></div><div><h3>Methods</h3><div>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<span> (ODI) and visual analog scale (VAS) for leg pain.</span></div></div><div><h3>Results</h3><div>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 (m","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 9","pages":"Pages 1866-1876"},"PeriodicalIF":4.7,"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 MD , Yu-Chia Hsu MD , Po-Lin Chen MD, PhD , Hao-Jun Chuang MD , Ting-Yuan Tu PhD , Chao-Jui Chang MD , Yu-Meng Hsiao MD , Cheng-Li Lin MD, PhD","doi":"10.1016/j.spinee.2025.05.002","DOIUrl":"10.1016/j.spinee.2025.05.002","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Surgical site infections<span><span> (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 </span>antiseptic solutions remains unclear.</span></div></div><div><h3>PURPOSE</h3><div>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.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A single-center, single-blinded, randomized controlled trial was conducted at a tertiary medical center in Taiwan.</div></div><div><h3>PATIENT SAMPLE</h3><div><span>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, </span>trauma, or tumors were excluded.</div></div><div><h3>OUTCOME MEASURES</h3><div>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.</div></div><div><h3>METHODS</h3><div><span><span><span>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 </span>bacterial culture and </span>16S rRNA PCR analysis. Statistical analysis was performed using </span>logistic regression and Bonferroni correction for multiple comparisons.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>CONCLUSION</h3><div>This study confirms that bacterial contamination remains high despite stand","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 9","pages":"Pages 1857-1865"},"PeriodicalIF":4.7,"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":"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":"<p><strong>Background context: </strong>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.</p><p><strong>Purpose: </strong>This study aimed to investigate the impact of coronal malalignment on clinical outcomes and mechanical complications after corrective surgery for ASD.</p><p><strong>Study design/setting: </strong>Retrospective observational study.</p><p><strong>Patient sample: </strong>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.</p><p><strong>Outcome measures: </strong>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.</p><p><strong>Methods: </strong>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>3 cm. Patients were divided into two groups based on CBD as follows: the coronal balance (CB) group (balanced, CBD<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.</p><p><strong>Results: </strong>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<.001).</p><p><strong>Conclusions: </strong>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 PhD , Cale J. Hendricks BS , Ashley M. Abbott , Matthew R. MacEwen PhD , David W. Polly Jr MD","doi":"10.1016/j.spinee.2025.05.016","DOIUrl":"10.1016/j.spinee.2025.05.016","url":null,"abstract":"<div><h3>Background Context</h3><div>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.</div></div><div><h3>Purpose</h3><div>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.</div></div><div><h3>Study Design/Setting</h3><div>Biomechanical.</div></div><div><h3>Methods</h3><div>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<span> 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<.05.</span></div></div><div><h3>Results</h3><div>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<.010) and 45.6% (p<.001) for the open-head design and 30.5% (p<.018) and 57.5% (p<.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<.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<.001) and 28.3% greater for TGC.</div></div><div><h3>Conclusion</h3><div>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.</div></div><div><h3>Clinical Significance</h3><div>Rod placement relative to the most distal pelvic screw during spinopelvic fixation varries in surgical practice - whether flush to, extended past, or r","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 9","pages":"Pages 2117-2126"},"PeriodicalIF":4.7,"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":"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":"<p><strong>Background context: </strong>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.</p><p><strong>Purpose: </strong>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.</p><p><strong>Study design/setting: </strong>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.</p><p><strong>Patient sample: </strong>This study consisted of 250 images of patients who were either positive or negative for AIS.</p><p><strong>Outcome measures: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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":"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}

{"title":"Antiosteoporosis medication in patients with posterior spine fusion: a systematic review and meta-analysis","authors":"HyungSub Jin MD ,&nbsp;HyungJu Jin ,&nbsp;Kyung-Soo Suk MD, PhD ,&nbsp;Byung Ho Lee MD, PhD ,&nbsp;Si Young Park MD, PhD ,&nbsp;Hak-Sun Kim MD, PhD ,&nbsp;Seong-Hwan Moon MD, PhD ,&nbsp;Sub-Ri Park MD ,&nbsp;Namhoo Kim MD ,&nbsp;Jae Won Shin MD ,&nbsp;Ji-Won Kwon MD, PhD","doi":"10.1016/j.spinee.2025.04.018","DOIUrl":"10.1016/j.spinee.2025.04.018","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background Context&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To compare the effects of teriparatide, bisphosphonates, denosumab, and romosozumab in patients with posterior spine fusion with low bone mineral density (BMD).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Systematic review and meta-analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient Sample&lt;/h3&gt;&lt;div&gt;Adult patients with low BMD receiving osteoporosis medications and undergoing posterior spine fusion surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome Measures&lt;/h3&gt;&lt;div&gt;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).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;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","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 9","pages":"Pages 1877-1898"},"PeriodicalIF":4.7,"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":"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":"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}