Spine Journal最新文献

{"title":"Accelerated biological aging in patients with degenerative spine diseases: the impact of modifiable lifestyle factors on phenotypic age.","authors":"Mitsuru Yagi, Ryo Mizukoshi, Ryosuke Maruiwa, Norihiro Isogai, Haruki Funao, Retsu Fujita","doi":"10.1016/j.spinee.2025.04.001","DOIUrl":"10.1016/j.spinee.2025.04.001","url":null,"abstract":"<p><strong>Background: </strong>Aging is influenced by genetic, environmental, and lifestyle factors, and chronological age alone may fail to capture one's true biological aging. Degenerative spinal disease (DSD) is associated with accelerated health decline, which could manifest as an increased Phenotypic Age (PhenoAge).</p><p><strong>Purpose: </strong>This study aimed to investigate the association between Phenotypic Age (PhenoAge) and degenerative spine disease (DSD) in a Japanese population using a cross-sectional analysis complemented by a follow-up analysis, while also exploring the impact of modifiable lifestyle factors on biological aging.</p><p><strong>Design/setting: </strong>A cross-sectional design was employed using data from a large health examination program in Japan.</p><p><strong>Patient sample: </strong>A total of 10,205 individuals who underwent health examinations formed the reference cohort. Separately, 2 distinct clinical cohorts were analyzed: an OA cohort of 306 patients with hip or knee osteoarthritis who underwent arthroplasty, and a DSD cohort of 397 patients with adult spinal deformity (ASD) or lumbar spinal stenosis (LSS) who also underwent surgery.</p><p><strong>Outcome measures: </strong>PhenoAge was calculated using clinical biomarkers, and the difference between PhenoAge and chronological age was expressed as PhenoAgeAccel. Additional inflammatory and metabolic markers (e.g., CRP, WBC) were evaluated alongside lifestyle factors such as smoking status, body mass index, and physical activity.</p><p><strong>Method: </strong>Propensity score matching was used to compare PhenoAge between patients and controls. Linear regression examined the influence of lifestyle factors on PhenoAgeAccel. A subgroup analysis assessed differences between ASD and LSS, as well as between hip OA and knee OA. Individuals re-examined in 2023 were followed to evaluate the 3-year change in PhenoAgeAccel.</p><p><strong>Results: </strong>Japanese participants had a mean PhenoAgeAccel of -8.0±4.0 years (p<.01, Cohen's d=0.8). DSD patients showed a 4.2-year elevation in PhenoAge over controls, accompanied by higher CRP and WBC levels (both p<.01 Cohen's d=0.65). Subgroup analyses revealed no significant differences in PhenoAge between ASD versus LSS or hip OA versus knee OA. Smoking (β=0.6; p<.01) and obesity (β=1.5; p<.01) raised PhenoAgeAccel, while physical activity lowered it (β=-0.2; p=.03). Nonrisk individuals improved by -0.5 years, whereas risk individuals worsened by +0.5 years over 3 years.</p><p><strong>Conclusion: </strong>These findings suggest that PhenoAge may serve as a more sensitive marker of biological aging in DSD patients, although the retrospective design and potential confounding variables warrant cautious interpretation.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804672","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":"Health literacy and patient-reported outcomes in preoperative patients undergoing lumbar spine surgery: a cross-sectional study.","authors":"Issei Higashino, Nobuhiro Takiguchi, Shohei Egi, Seiichi Odate, Kazuaki Morizane, Kazuki Uemura","doi":"10.1016/j.spinee.2025.04.010","DOIUrl":"10.1016/j.spinee.2025.04.010","url":null,"abstract":"<p><strong>Background context: </strong>Health literacy (HL) plays an important role in health outcomes (e.g., Activities of Daily Living and Quality of Life) among patients with chronic diseases and elderly persons. The association between functional HL and health outcomes in patients with lumbar degenerative disease has also been revealed. Comprehensive HL includes 3 levels of functional, communicative, and critical HL that may affect the health outcomes of patients undergoing lumbar spine surgery. However, the association between comprehensive HL and health outcomes in patients undergoing lumbar spine surgery has not yet been investigated.</p><p><strong>Purpose: </strong>To examine the impact of comprehensive HL on patient-reported outcomes (PROs) of pain-related disabilities and health-related quality of life in patients undergoing lumbar spine surgery.</p><p><strong>Study design/setting: </strong>Cross-sectional study.</p><p><strong>Patient sample: </strong>Patients aged 18 years or older who presented to a general hospital-based spine center for the surgical treatment of lumbar degenerative disease.</p><p><strong>Outcome measures: </strong>Oswestry Disability Index 2.0 (ODI), EuroQol-5D-5L (EQ-5D-5L).</p><p><strong>Methods: </strong>Between June 2023 and May 2024, consecutive patients aged 18 years or older presenting to the spine center were approached for participation in this cross-sectional study. Patients completed a questionnaire concerning sociodemographic characteristics; Functional, Communicative, and Critical Health Literacy (FCCHL); and PROs, including ODI and EQ-5D-5L. A multivariable linear regression analysis with potential confounders was performed to examine the relationship between FCCHL and PROs.</p><p><strong>Results: </strong>Of 128 eligible patients, 124 (97%) were included in the statistical analysis. Higher total FCCHL score was significantly associated with better PROs (ODI (regression coefficient, -10.6; [95% confidence interval, -17.6, -3.6]), EQ-5D-5L (0.093 [0.022, 0.165])) in a linear dose-response manner. Functional HL was not associated with PROs; however, communicative and critical HL were both associated with PROs.</p><p><strong>Conclusions: </strong>Higher comprehensive HL, including functional, communicative, and critical HL, was associated with better PROs, characterized by lower ODI and higher EQ-5D-5L scores, in a linear dose-response manner in patients undergoing lumbar spine surgery. Our study suggests that comprehensive HL is important to prevent disabilities in daily life due to lumbar degenerative disease.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804675","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":"Effect of enhanced surgical recovery program for thoracolumbar spine surgery on opioid use, length of hospital stay, and hospital readmissions: evaluation of 51,236 cases.","authors":"Christopher R Good, Shay Bess, Lindsay D Orosz, Stephen S Scibelli, Breton Line, Gina Remington, Cecile Roman, Daniel Luckett, Ehsan Jazini","doi":"10.1016/j.spinee.2025.04.011","DOIUrl":"10.1016/j.spinee.2025.04.011","url":null,"abstract":"<p><strong>Background context: </strong>Evidence-based enhanced surgical recovery (ESR) programs integrate a multidimensional approach to optimize patients during the pre-, intra-, and postoperative phases of surgery. Smaller studies suggest several benefits of spine surgery ESR; this study evaluates the effects of ESR for thoracolumbar (TL) fusion surgery on a national scale.</p><p><strong>Purpose: </strong>Determine if ESR is associated with a reduction in daily morphine milligram equivalents (MME), length of hospital stay (LOS), and 30-day readmission (READMIT) rates compared to non-ESR controls.</p><p><strong>Study design: </strong>Multicenter, retrospective, case-control study of a prospectively adopted healthcare system ESR program from October 2018 to December 2021.</p><p><strong>Patient sample: </strong>Consecutive adult patients undergoing TL fusion with known ESR participation status and without a primary diagnosis of tumor, infection, or trauma were included.</p><p><strong>Outcomes measures: </strong>Primary outcomes include daily MME, LOS, and 30-day READMIT rates. Outcomes were analyzed for single-level, multi-level, and all TL fusions.</p><p><strong>Methods: </strong>Data from TL fusion procedures performed within a large healthcare system were extracted from hospital-based electronic medical records derived from 1352 surgeons within 138 facilities. Patients were divided as ESR (cases) or non-ESR (controls) based upon enrollment into an ESR program defined by (1) preoperative patient education, (2) multimodal analgesia, (3) intraoperative fluid optimization, (4) opioid-sparing anesthesia, and (5) early postoperative nutrition and ambulation. Outcomes were compared between groups.</p><p><strong>Results: </strong>Of 51,236 TL fusion cases (45% male, mean age of 63 years), 24,391 participated in an ESR program and 26,845 did not. For single-level TL fusions, ESR was associated with decreased MME (β= -8.76, p<.001), LOS (β= -8.85, p<.001), and READMIT (OR=0.77, 95% CI: 0.67-0.88) compared to controls. For multi-level TL fusions, ESR was associated with decreased MME (β= -7.32, p<.001) and LOS (β= -12.14, p<.001) compared to controls. For all TL fusions, ESR was associated with decreased MME (β= -7.94, p<.001), LOS (β= -10.54, p<.001), and READMIT (OR=0.91, 95% CI: 0.84-0.98) compared to non-ESR controls.</p><p><strong>Conclusions: </strong>This national healthcare system analysis of over 50,000 TL spine fusion cases by 1,352 surgeons at 138 centers across the US confirms that ESR adoption is associated with decreased daily MME, LOS, and READMIT compared to non-ESR controls. Surgeons should consider adoption of ESR programs to improve patient care.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804673","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 spinal alignment on adjacent segment disease and degeneration after short-segment lumbosacral fusion.","authors":"Giuseppe Loggia, Mazda Farshad, Moritz Jokeit, Jonas Widmer, Stefani Dossi, Marco D Burkhard","doi":"10.1016/j.spinee.2025.03.032","DOIUrl":"10.1016/j.spinee.2025.03.032","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Adjacent segment disease (ASDis) and degeneration (ASDeg) are common complications following lumbar fusion, ranging from asymptomatic radiographic changes to debilitating symptoms requiring revision surgery. While the impact of spinopelvic alignment (SPA) on postoperative outcomes and ASDis prevention is well-studied in long-construct fusions, its role in short-segment lumbosacral fusions, particularly over the long term, remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to investigate the association between global and distal lumbar SPA with the development of ASDis and ASDeg in the long-term follow-up of patients undergoing short-segment lumbosacral fusion. Secondary outcomes were patient reported outcome measures (PROMs) in relation to adjacent segment changes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective single-center cohort study with minimum follow-up of 5 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A total of 86 patients who underwent L4-S1 spinal fusion between 2003 and 2015, with a mean follow-up of 12±4 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome was the development of adjacent segment changes, classified into 2 groups: (1) surgically-treated ASDis, and (2) ASDeg, defined as radiographic evidence of adjacent segment changes without surgical intervention. Secondary outcomes included PROMs: the Oswestry Disability Index (ODI) and the European Quality of Life 5 Dimensions 5 Level (EQ5D5L).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Pre- and postoperative standing radiographs were annotated and the following global lumbar SPA parameters analyzed: Pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), PI-LL-mismatch, lumbar pelvic angle (LPA). Additionally, the following distal lumbar SPA parameters were analyzed: Distal lordosis (DL) between L4-S1, lordosis distribution index (LDI=DL/LL), PI-DL-difference, DL-PI-ratio, adjacent segment lordosis (ASL). Postoperative ODI and EQ5D5L were assessed via a telephone interview.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 86 patients with a mean follow-up of 12±4 years the incidence of ASDis was 27.9% (n=24), while 7.0% (n=6) showed ASDeg. No significant differences in pre- and postoperative global lumbar SPA were found in patients who developed ASDis or ASDeg compared to patients who did not. PI (53.6° vs. 59.6°) and preoperative SS (34.9° vs. 40.3°) trended to be lower in the ASDis group compared to controls, although non-significant. Pre- and postoperative distal lumbar SPA parameters did not differ between groups. Patients with adjacent segment changes, regardless of whether they underwent revision surgery, reported worse PROMs. ODI scores were elevated in both the ASDis group (28, IQR 15-42) and the ASDeg group (34, IQR 14-47) compared to controls (10, IQR 2-24; p=.005). EQ5D5L scores were lower in both the ASDis (70, IQR 53-83) and the ASDeg groups (60, IQR 55-85) compared to controls (8","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789305","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":"Multisociety response to The BMJ publications on interventional spine procedures for chronic back and neck pain.","authors":"Andrew J Schoenfeld","doi":"10.1016/j.spinee.2025.03.030","DOIUrl":"10.1016/j.spinee.2025.03.030","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789308","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":"Efficacy and safety of allogeneic mesenchymal precursor cells with and without hyaluronic acid for treatment of chronic low back pain: A prospective, randomized, double blind, concurrent-controlled 36-month study.","authors":"Douglas P Beall, Hyun W Bae, Michael J DePalma, Kasra Amirdelfan, Edward Tavel, Timothy T Davis, James Scott Bainbridge, Arnold Weil, William Beckworth, Kee Kim, Philip Yuan, Pragya B Gupta, Eugene Wang, Bradley S Goodman, Ryan Reeves, Michael B Furman, Nagy Mekhail, David Nunez, Michael DiMuro, Matthew C Shonnard, Eric Rose, Roger D Brown","doi":"10.1016/j.spinee.2025.03.015","DOIUrl":"10.1016/j.spinee.2025.03.015","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Low back pain (LBP) associated with degenerative disc disease (DDD) is a serious condition resulting in significant morbidity, disability, and reduced quality of life for millions of people each year. Patients who fail to improve with conservative/noninvasive treatments including physical therapy and nonopioid analgesic medications have limited options, which include opioid analgesics with their associated significant risks; epidural steroid injections with limited supporting evidence; or surgical interventions such as spine fusion or artificial disc replacement. A safe, minimally invasive, nonopioid treatment that provides prolonged improvement in pain, function, and quality of life is needed for such patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Evaluate the efficacy and safety of a single injection of mesenchymal precursor cells (MPCs) with or without hyaluronic acid (HA) compared to an intradiscal saline injection through 36 months follow-up in subjects with chronic low back pain (CLBP) associated with moderate DDD (mDDD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;A prospective, multicenter, randomized, double-blind, concurrent-controlled study conducted at 49 clinical sites.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Subject sample: &lt;/strong&gt;A total of 404 subjects with CLBP associated with mDDD at one level from L1 to S1 received MPCs without HA (MPC), MPCs with HA (MPC+HA), or saline control (control) treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Subjects were clinically and radiographically evaluated at 1, 3, 6, 12, 18, 24, and 36 months postinjection. Clinical evaluation included adverse events, neurologic evaluation, laboratory tests, LBP intensity measured by Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and EQ-5D-5L Index. Radiographic assessments used Magnetic Resonance (MR) imaging and X-ray imaging studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The primary efficacy endpoint was a composite responder analysis for overall treatment success at both 12 and 24 months that was comprised of:[1] at least a 50% reduction from baseline in low back pain VAS score (average pain over 24 h);[2] at least a 15-point decrease from baseline in ODI score; and[3] no adjudicated posttreatment interventions at the treated level. To assess superiority, a Bayesian analysis used a probability threshold of 0.9875. Additional analyses were performed on a prespecified subpopulation of subjects with CLBP duration at baseline less than the median baseline duration of 68 months (CLBPLTM). Statistical assessments included least squares (LS) mean, LS mean change from baseline (CFB) using the mixed model for repeated measures (MMRM) and categorical responder analyses using stratified Cochran Mantel Haenszel row means score test with p&lt;.05 defined as statistically significant. This study was conducted under a US Food and Drug Administration (FDA) Investigational New Drug (IND) application sponsored and funded by Mesoblast.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774616","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":"Association between obesity and pseuarthrosis risk following lumbar fusion surgery.","authors":"Yu Chang, Kuan-Yu Chi, Junmin Song, Hong-Min Lin, Chien-Min Chen","doi":"10.1016/j.spinee.2025.03.031","DOIUrl":"10.1016/j.spinee.2025.03.031","url":null,"abstract":"<p><strong>Background context: </strong>Obesity is a known risk factor for various adverse health conditions and surgical complications, including in spine surgery. While obesity is associated with increased perioperative risks in lumbar fusion surgery, its impact on long-term fusion success remains controversial.</p><p><strong>Purpose: </strong>To evaluate the effect of obesity on fusion outcomes following posterior lumbar fusion surgery, with a specific focus on the incidence of pseudarthrosis at multiple postoperative time points.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Patients were identified through the TriNetX Global Collaborative Network using ICD-10-PCS and CPT codes specific to lumbar fusion procedures. After propensity score matching for demographic and comorbidity variables, 41,436 obese patients (BMI ≥ 30 kg/m²) were compared with 41,436 non-obese patients (BMI < 30 kg/m²).</p><p><strong>Outcome measures: </strong>The primary outcome was the incidence of pseudarthrosis, identified using ICD-10 code M96.0 at 6 months, 1 year, and 2 years postoperatively.</p><p><strong>Methods: </strong>Propensity score matching (PSM) was applied to minimize confounding. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the risk of pseudarthrosis between obese and non-obese groups.</p><p><strong>Results: </strong>The incidence of pseudarthrosis was consistently lower in the obese cohort across all postoperative time points. At 6 months postoperatively, the incidence was 9.2% in obese patients compared to 11.8% in non-obese patients (OR: 0.75, 95% CI: 0.72-0.79). At 1 year, pseudarthrosis occurred in 10.4% of obese patients versus 13.0% in non-obese patients (OR: 0.78, 95% CI: 0.74-0.81). At 2 years, rates were 11.6% in the obese group and 14.1% in the non-obese group (OR: 0.80, 95% CI: 0.76-0.83). These findings indicate a consistent and statistically significant association between obesity and lower odds of pseudarthrosis following lumbar spine fusion surgery.</p><p><strong>Conclusions: </strong>Despite higher perioperative complication rates typically associated with obesity, our study found that obese patients experienced significantly lower rates of pseudarthrosis following lumbar spine fusion surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774613","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":"Multimodal machine learning for predicting perioperative safety indicators in spinal surgery.","authors":"Kyle Mani, Thomas Scharfenberger, Samuel N Goldman, Emily Kleinbart, Evan Mostafa, Rafael De La Garza Ramos, Mitchell S Fourman, Ananth Eleswarapu","doi":"10.1016/j.spinee.2025.03.021","DOIUrl":"10.1016/j.spinee.2025.03.021","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Machine learning (ML) algorithms can utilize the large amount of tabular data in electronic health records (EHRs) to predict perioperative safety indicators. Integrating unstructured free-text inputs via natural language processing (NLP) may further enhance predictive accuracy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To design and validate a preoperative multimodal ML architecture that integrates structured EHR data (patient demographics, comorbidities, and clinical covariates) with unstructured free-text inputs (past medical and surgical history, medications, and problem lists) via NLP. The multimodal models aim to improve the prediction of perioperative safety indicators compared to baseline ML models that only use structured tabular EHR data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;1,898 patients admitted for elective or emergency spine surgery at four separate large urban academic spine centers during a 5-year period from 2018 to 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Numerical outputs between 0 and 1 corresponding to the likelihood of (I) extended length of stay (LOS), (II) 90-day reoperation, and (III) perioperative intensive care unit (ICU) admission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We predicted the following safety indicators (I) extended length of stay (LOS), (II) 90-day reoperation, and (III) perioperative intensive care unit (ICU) admission. The quanteda package for NLP within the R environment was utilized to preprocess free-text EHR inputs. The refined text was tokenized and transformed into numerical vectors using a bag-of-words approach and integrated with the tabular EHR data to create a document-feature matrix. Two extreme gradient boosted (XGBoost) ML models were trained: a base model utilizing only structured tabular EHR data and a combined multimodal model that leveraged both combined structured tabular EHR data with numerical vectors derived from free-text NLP inputs. Hyperparameter tuning was performed via grid search, and the models were validated using 10-fold cross validation with an 80:20 training/testing split. Word clouds were generated for the free-text data and explainable artificial intelligence (XAI) techniques were employed for feature importance. Metrics calculated for model performance included Area Under the Receiving-Operating Characteristic Curve (AUC-ROC), Brier score, Calibration slope, Calibration Intercept, Precision, Recall and F1-Score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;1,898 patients (60.7% female) were extracted from January 2018 to September 2023, with a median age of 60.0 (IQR: 52.0-68.0) and median body mass index (BMI) of 30.3 kgm&lt;sup&gt;2&lt;/sup&gt; (IQR: 26.3-34.6). Extended LOS was defined as ≥ 14.4 days, constituting 10.1% of all individuals. The median LOS for the entire cohort was 4.0 days (IQR: 2.0-7.0), while the 90-day reoperation rate was 10.54%, and the ICU admission rate was 7.74%. The preoper","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755375","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":"Performance comparison between Hounsfield units and DXA in predicting lumbar cage subsidence in the degenerative population.","authors":"Lindsay D Orosz, Kirsten A Schuler, Brandon J Allen, Wondwossen T Lerebo, Tarek Yamout, Rita T Roy, Thomas C Schuler, Christopher R Good, Colin M Haines, Ehsan Jazini","doi":"10.1016/j.spinee.2025.03.028","DOIUrl":"10.1016/j.spinee.2025.03.028","url":null,"abstract":"<p><strong>Background context: </strong>Bone mineral density assessment is essential for surgical planning for most spine surgeries, but gold standard dual-energy x-ray absorptiometry (DXA) is affected by degeneration often resulting in falsely elevated scores. Studies of the opportunistic measurement of computed tomography (CT) Hounsfield units (HU) suggest lower CTHU values predict interbody cage subsidence, yet cutoff values vary and lack standardization.</p><p><strong>Purpose: </strong>This study aimed to determine if value CTHU<135 was associated with lumbar interbody cage subsidence and to compare the predictive performance of subsidence between CTHU and DXA.</p><p><strong>Study design/setting: </strong>Single-center, multi-surgeon, retrospective cohort study PATIENT SAMPLE: Adult, circumferential lumbar fusions ≤5 interbody levels with DXA, CTs, radiographs, and at least 1 year of follow up.</p><p><strong>Outcome measures: </strong>CTHU at L1, lowest DXA T-score, and postoperative change in disc space height (cage migration) on radiographs METHODS: Lowest DXA T-scores overall and of the lumbar spine were recorded and categorized, and L1 CTHUs were measured. Interbody fusions were analyzed for subsidence ≥2 mm on radiographs by a validated, computer vision algorithmic approach. Analysis determined if an association existed between subsidence and CTHU<135 or DXA lowest T-score. Logistic regression analyzed the performance of predicting subsidence by each method.</p><p><strong>Results: </strong>The 127-patient cohort had 82.7% degenerative pathologies, 45.7% males, median age of 60 years, 2.4% osteoporosis on DXA, 44.1% CTHU<135, and 13.4% subsidence. CTHU<135 (p=.004) and age (p=.016) were significantly associated with subsidence, however DXA lowest T-score (p=.550) was not. The odds of subsidence were significant if CTHU<135 for crude and adjusted (OR=4.0, 95% CI 1.2-13.9, p=.029) comparisons. The odds of subsidence were not significant for DXA_any lowest T-score or DXA_spine lowest T-score (OR=1.8, 95% CI 0.6-4.9, p=.284 and OR=1.1, 95% CI 0.3-4.1, p=.920, respectively).</p><p><strong>Conclusion: </strong>CTHU<135 was associated with subsidence while DXA lowest T-score was not in this study of patients with degenerative pathologies. The odds of subsidence were 4.0 times higher for CTHU<135 after controlling for known risks, supporting this cutoff value. This study suggests that CTHU is a more reliable predictor of subsidence than DXA in this primarily degenerative population and is a useful tool for assessing bone quality at the region of interest when planning lumbar surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755475","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 quantitative instrumentation for cone of economy analysis: bridging radiographic and clinical measures.","authors":"Hsu Ming Chang, Soong Christina, Yeh Ting Jen, Chen Hsuan Yu","doi":"10.1016/j.spinee.2025.03.005","DOIUrl":"10.1016/j.spinee.2025.03.005","url":null,"abstract":"<p><strong>Background context: </strong>Postural misalignment and compromised balance are major contributors to fall risk in the elderly, leading to significant physical injuries, reduced quality of life (QOL), and increased healthcare burdens. Evaluating postural stability is critical for fall prevention. The cone of economy (CoE) concept explores the range of motion of the center of mass and head required to maintain a stable upright posture, yet its measurement remains challenging due to the limitations of existing methods.</p><p><strong>Purpose: </strong>This study introduces a novel apparatus for real-time measurement of both external and internal CoEs, offering a cost-effective alternative to expensive and complex traditional methods that require extensive data processing.</p><p><strong>Study design/setting: </strong>The study employed a controlled experimental design to develop and validate the proposed CoE measurement apparatus in a laboratory setting using a sample of healthy young adults.</p><p><strong>Methods: </strong>The proposed apparatus used 2 spherical measuring units to independently track pelvic and T1 vertebra motion, employing dual rotational magnetic encoders and a linear displacement sensor for precise 3D motion contour capture.</p><p><strong>Results: </strong>Validation experiments confirmed the system's reliability, achieving an average measurement error below 1.5 mm. The CoE is not an idealized cone but has an irregular conical shape, influenced by physiological factors (height and weight). The average range of sway (RoS) for external CoE at T1 was 42.7 (coronal), 47.6 (sagittal), and 12.5 cm (vertical), whereas that at the pelvic position was 14.3, 13.4, and 8 cm, respectively. The average RoS for internal CoE were smaller: 10.4 (coronal), 6.9 (sagittal), and 2 cm (vertical) at T1 and 8.2, 5.8, and 2.2 cm, respectively, at the pelvic position. The external CoE exhibited a larger RoS at the body's front, reflecting the foot's role in balancing forward shifts of gravity.</p><p><strong>Conclusions: </strong>Preliminary findings highlight a stronger correlation between external CoE and height than internal CoE, establishing a foundation for CoE research with implications for fall prevention and balance assessment.</p><p><strong>Clinical significance: </strong>This study introduces a reliable, cost-effective apparatus for real-time cone of economy (CoE) measurement, offering dynamic insights into postural stability, fall risk, and personalized balance assessment in clinical settings.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755373","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}