Spine Journal最新文献

{"title":"Spinal cord status assessment and early interventional personalized rehabilitation after endoscopic surgery for cervical compressive myelopathy: a randomized trial.","authors":"Yiwei Ding, Fengtong Lou, Rui Cao, Zhengcao Lu, Guangnan Yang, Qiang Jiang, Mei Shuai, Yuxian Zhong","doi":"10.1016/j.spinee.2025.05.024","DOIUrl":"10.1016/j.spinee.2025.05.024","url":null,"abstract":"<p><strong>Background context: </strong>Cervical compressive myelopathy (CCM), frequently arising from spinal degeneration, results in significant motor and sensory deficits. Currently, there is a lack of precise prognostic evaluation methods following decompression surgery for CCM, which hinders the optimization of personalized rehabilitation therapy. However, the combination of intraoperative endoscopic visualization of dural sac compression morphology and electrophysiological functional assessment holds promise in addressing this gap.</p><p><strong>Purpose: </strong>To determine whether a personalized rehabilitation strategy, informed by intraoperative endoscopic and electrophysiological assessments, enhances postoperative functional outcomes in CCM patients compared to traditional rehabilitation after canal decompression surgery.</p><p><strong>Study design/setting: </strong>Prospective single-center randomized controlled study, trial registration: ChiCTR2400081458.</p><p><strong>Patient sample: </strong>Seventy-eight patients underwent spinal decompression surgery at The Sixth Medical Center of Chinese PLA General Hospital. The inclusion criteria included a diagnosis of CCM due to spondylosis or ossification of the longitudinal ligament. Participants were excluded if they had prior spinal surgeries or comorbidities unrelated to CCM.</p><p><strong>Outcome measures: </strong>The primary outcome was the Japanese Orthopaedic Association (JOA) score, assessing spinal function. Secondary outcomes included the Neck Disability Index (NDI), Visual Analogue Scale (VAS) for pain, and three-dimensional gait analysis.</p><p><strong>Methods: </strong>This study was a double-blind randomized controlled trial comparing two postoperative rehabilitation strategies for patients with CCM following endoscopic spinal decompression surgery. After surgery, patients were randomly assigned to two groups. The experimental group received personalized rehabilitation based on real-time intraoperative spinal cord status assessments, using a combination of endoscopic visualization and electrophysiological grading. Interventions included lower limb exoskeleton-assisted walking and targeted motor function training. The control group received conventional standard rehabilitation treatment. Both groups were assessed using the JOA, NDI, and VAS scores before rehabilitation, 1 month, 3 months, and 12 months after the start of rehabilitation. Additionally, gait analysis (including stride frequency, gait velocity, and stride length) was performed before and 3 months after the start of rehabilitation to evaluate the clinical rehabilitation outcomes in both groups.</p><p><strong>Results: </strong>Both groups showed significant improvements in JOA, NDI, VAS scores, and gait tests during the postoperative rehabilitation process. The experimental group demonstrated a more substantial increase in the primary outcome measure, the JOA score (12 months: 4.79±0.74 vs 3.53±0.93, p<.05). Addit","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081434","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":"Risk of ossification of posterior longitudinal ligament (OPLL) volume progression following laminoplasty.","authors":"Qu Ruomu, Qin Siyuan, Wang Ben, Zhao Yanbin, Pan Shengfa, Chen Xin, Liu Zhongjun, Jiang Liang, Lang Ning, Zhou Feifei","doi":"10.1016/j.spinee.2025.05.028","DOIUrl":"10.1016/j.spinee.2025.05.028","url":null,"abstract":"<p><strong>Background context: </strong>Progression of ossification of posterior longitudinal ligament (OPLL) after laminoplasty (LP) can lead to recurrent compression of the spinal cord, neurological progression, and possibly revision surgery. Continuity of OPLL across segments, termed true continuous segments (TCS), has been previously found to help maintaining lordosis after LP. However, the impact of TCS on post-LP OPLL volume progression remains unknown.</p><p><strong>Purpose: </strong>This study aimed to investigate the influence of TCS in post-LP OPLL volume progression.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Patients who underwent LP during 2006 to 2017 and had preoperative computed tomography (CT) and a minimum 5 year CT follow-ups.</p><p><strong>Outcome measures: </strong>Progression of OPLL volume as measured on CT.</p><p><strong>Methods: </strong>Preoperative CT images were assessed, dividing patients into TCS and non-TCS groups. The demographics, preoperative segments of OPLL were recorded. As per the previously described classification, TCS was recorded as I (continuous type OPLL on disc space spanning the upper and lower adjacent vertebral bodies for more than half of their height without any bony crack regardless of bridge formation between vertebral bodies), II (OPLL adherent to both upper and lower adjacent vertebral bodies by bridging) or III (obvious interbody auto-fusion), and the TCS II and III were defined as true bridging segments (TBS). The number of disc levels which have a TCS was documented as the TCS counts. OPLL volume was calculated by manually segmenting images using 3D slicers (Figure 2). OPLL annual volume progression rate (AVPR) was calculated by the volume change of OPLL divided by follow-up period. An AVPR greater than 5% was defined as OPLL progression. The AVPR of both groups were compared. Multivariable logistic analysis was conducted to account for confounders.</p><p><strong>Results: </strong>A total of 56 patients (33 males and 23 females) were included in this study, with a mean age of 53.2±8.7. The average CT follow-up durations were 95.1±33.8 months. The preoperative OPLL segments of non-TCS and TCS groups were 2.9±1.0 and 4.4±1.3 (p<0.001) and the preoperative volume of non-TCS and TCS groups were 986.3±603.7 and 3,512.1±1,909.8 mm³ (p<0.001), respectively. At final follow-up, the AVPR of non-TCS and TCS groups were 12.7%±18.2% and 5.9%±4.7% (p=0.393), respectively. Nineteen (54.3%) patients in the non-TCS group and 10 (47.6%) patients in the TCS group showed OPLL progression (p=0.632). Correlation analysis revealed that the TCS Type I counts did not present significant correlation with AVPR, while preoperative CL (p=0.021), TBS counts (p=0.029) and age (p=0.001) significantly negatively correlated with AVPR. Multivariable logistics analysis results revealed that more TBS counts (OR=0.095, p=0.026) and higher age (OR=0.894, p=","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037187","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":"Comparative cost-effectiveness analysis between navigated robot-assisted platforms and O-arm navigation in minimally invasive transforaminal interbody fusion (MIS-TLIF).","authors":"Joseph Jon Yin Wan, Jonathan Yeo, Zhihong Chew, Shree Kumar Dinesh","doi":"10.1016/j.spinee.2025.05.027","DOIUrl":"10.1016/j.spinee.2025.05.027","url":null,"abstract":"<p><strong>Background context: </strong>Minimal invasive Transforaminal Lumbar Interbody Fusion (TLIF) is an increasingly common procedure used in treating degenerative lumbar spine conditions. Advancement of robot-assisted technology has improved accuracy of instrumentation with smaller incisions, resulting in better surgical outcomes and shorter hospital stay.</p><p><strong>Purpose: </strong>This study aims to assess cost effectiveness of robot-assisted minimally invasive TLIF (RA-TLIF) in our institution; and compare patient outcomes with conventional O-arm navigated minimally invasive TLIF (ON-TLIF).</p><p><strong>Design: </strong>Single-center, retrospective case cohort series between elective RA-TLIF and ON-TLIF groups.</p><p><strong>Patient sample: </strong>About 27 patients who underwent elective RA-TLIF and control group of 50 elective ON-TLIF.</p><p><strong>Outcome measures: </strong>Operative duration, length of inpatient stay, postoperative ambulation, rates of intraoperative and postoperative complications and inpatient costs.</p><p><strong>Methods: </strong>Patient demographics (age, gender, Charlson Co-morbidity Index (CCI), BMI), postoperative outcomes and inpatient costs were used in comparative analysis.</p><p><strong>Results: </strong>No significant differences were found in patient demographics, baseline CCI, operative duration, length of inpatient stay, and postoperative ambulation. Rates of intraoperative and postoperative complications were similar between the 2 groups (OR=0.93, p=.112). Inpatient hospitalization costs were not significantly different between both groups.</p><p><strong>Conclusion: </strong>RA-TLIF has shown similar cost-effectiveness and surgical outcomes in comparison with conventional ON-TLIF. While not demonstrated in this study, RA-TLIF has been associated with a longer operative duration due to higher learning curve, set-up time and possible hardware/ software errors. Ultimately, more case numbers are required for the operating staff to overcome this learning curve to achieve optimal results. Spine surgical centers evaluating both techniques may consider either with confidence.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047348","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":"Orthostatic intolerance following posterior lumbar interbody fusion: incidence, risk factors, and impact on postoperative recovery: a prospective cohort study.","authors":"Xiaoxia Kang, Jiayuan Wu, Andrew Y Xu, Audrey Y Su, Mingming Liu, Jie Huang, Wenli Zhu, Cheng Zeng, Fangfang Duan, Bassel G Diebo, Alan H Daniels, Da He","doi":"10.1016/j.spinee.2025.05.020","DOIUrl":"10.1016/j.spinee.2025.05.020","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Despite the well-established consensus about the importance of early ambulation, the causes of orthostatic intolerance and its impact on patient recovery after posterior lumbar interbody fusion (PLIF) remain poorly understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To determine the incidence of orthostatic intolerance and relevant risk factors after PLIF in an enhanced recovery after surgery (ERAS) program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A prospective observational cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;This study investigated perioperative data collected from 378 patients who underwent PLIF at one center between September 2023 and July 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measure: &lt;/strong&gt;Patients' postoperative orthostatic intolerance symptoms were recorded and graded by a standardized evaluation scale. The occurrence of any symptom that resulted in termination of ambulation (dizziness, nausea, vomiting, a feeling of heat, visual disturbances, hypotension, and syncope) was classified as orthostatic intolerance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Possible risk factors were identified through univariate and multivariate analysis. The length of postoperative hospitalization, catheterization, and ambulation delay in orthostatic intolerance patients versus orthostatic tolerant patients was compared.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For orthostatic intolerance patients, the median time to first attempted ambulation was 26.0 (IQR: 20.8-31.2) hours after surgery. Overall, the observed incidence of orthostatic intolerance was 15.3%. Univariate analysis showed that a higher incidence of orthostatic intolerance was associated with history of orthostatic intolerance (6 vs. 13, p=.044), low hemoglobin on postoperative day 1 (103.8±14.8g/L vs. 110.7±13.3g/L, p&lt;.001), and high postoperative back pain visual analog scale (VAS) scores while supine (4.0 [2.0] [4.0±1.8] vs. 3.0 [1.0] [3.4±1.8], p=.015). Multivariate analysis through logistic regression controlling for covariates established the same three variables as independent risk factors: history of orthostatic intolerance (OR=3.029, 95% CI 1.021-8.988, p=.046), low hemoglobin on postoperative day 1 (OR=2.890, 95% CI 1.566-5.334, p&lt;.001), and high postoperative back pain VAS scores while supine (OR=1.218, 95% CI 1.030-1.441, p=.021). Overall, orthostatic intolerance patients had a longer postoperative hospital stay (6.0 [2.0] [6.3±1.8] vs. 6.0 [2.0] [5.8±1.8], p=.013), catheterization period (24.1 [5.2] [26.0±8.9] vs. 22.6 [4.7] [22.8±4.0], p=.042), and ambulation delay (48.2 [6.3] [48.7±7.8] vs. 25.0 [4.5] [25.0±3.9], p&lt;.001) than orthostatic tolerance patients. However, there were no clinically meaningful differences regarding postoperative hospital stay or catheterization period found between the two groups in this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Orthostatic intolerance is a common complication that prevents early ambulation in ERAS programs after PLIF. ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040640","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":"Validation of an updated patient-reported outcomes questionnaire for sacral tumors.","authors":"Jordan O Gasho, Joshua M Coan, Patrick J Boland, John H Healey, Jay S Wunder, Matthew T Houdek, Francis J Hornicek, Joseph H Schwab, Daniel G Tobert","doi":"10.1016/j.spinee.2025.05.023","DOIUrl":"10.1016/j.spinee.2025.05.023","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Assessing functional outcomes and quality of life is crucial in evaluating patient and disease management. Sacral tumors are rare and present with complex oncologic backgrounds and diverse symptoms, complicating the development of a clinically relevant and generalizable tool. A previous validation study refined an initial attempt to create a tool specific to sacral tumor patients. This study is the first independent validation of the revised shorter outcome tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To validate a revised patient-reported outcomes questionnaire specific to patients with sacral tumors. Secondarily, to assess the functional outcomes of patients with sacral tumors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;A survey study from a tertiary care multidisciplinary clinic was used for this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;This study included 70 patients with sacral tumors who presented to our institution between October 2017 and June 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The following eight questionnaires included in the revised sacral tumor survey were evaluated: the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health short form v1.1, PROMIS Pain Intensity 3a v1.0, PROMIS Gastrointestinal Bowel Incontinence 4a v1.0, PROMIS Gastrointestinal Constipation 9a v1.0, PROMIS Sexual Function and Satisfaction v1.0 Male and Female, Urogenital Distress Inventory (UDI-6), and PROMIS Ability to Participate in Social Roles and Activities v2.0.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Reliability, validity, and instrument coverage were evaluated by determining item completion rate, median score with interquartile range (IQR), and floor and ceiling effects. Internal consistency was measured using Cronbach's alpha. Bias-corrected bootstrapping (1,000 resamples) was applied to calculate the standard error and 95% confidence intervals. Spearman rank correlation coefficients were used to assess the extent of questionnaire convergence and divergence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our analysis demonstrates moderate to significant floor and ceiling effects among PROMIS Gastrointestinal Symptoms Scale, PROMIS Sexual Function, and Urinary Distress Inventory (16%-61%) with predominantly more ceiling effects. Floor effects were notable for male interest (27%), female interest (29%), and female orgasm (38%). Moderate floor effects were noted for male satisfaction (11%), male orgasm (10%), and lubrication (14%). When controlling for patients with a colostomy, floor effects generally decreased, while ceiling effects showed variable changes. The revised questionnaire demonstrated strong internal consistency, with Cronbach's alpha values exceeding the threshold of 0.7 for all assessments except lubrication. GI bowel incontinence, male satisfaction, female satisfaction, and female interest were potentially redundant with a Cronbach's alpha above 0.9. In convergent validity, we found no signi","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042119","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":"Risk factors for in-hospital mortality in cervical spinal cord injuries: a nationwide, cross-sectional analysis of concomitant injuries, comorbidities, and treatment strategies in 3.847 cases.","authors":"Melanie Schindler, Jonas Krückel, Josina Straub, Lisa Klute, Jan Reinhard, Sebastian Siller, Maximilian Kerschbaum, Dietmar Dammerer, Volker Alt, Siegmund Lang","doi":"10.1016/j.spinee.2025.05.004","DOIUrl":"10.1016/j.spinee.2025.05.004","url":null,"abstract":"<p><strong>Background context: </strong>Cervical spinal cord injuries (CSCIs) present challenges with potential severe neurological complications. Despite advances in care, in-hospital mortality remains a concern.</p><p><strong>Purpose: </strong>This study explores the impact of patient-related factors and therapeutic strategies on in-hospital mortality in individuals with CSCIs.</p><p><strong>Study design/setting: </strong>Retrospective cross-sectional study.</p><p><strong>Patient sample: </strong>Admissions with CSCIs recruited between January 2019 and December 2023.</p><p><strong>Outcome measures: </strong>Data from the German Diagnosis Related Groups (DRG) system were used to analyze main diagnoses, patient demographics, concomitant diagnoses (ICD-10), and procedures (OPS). Specific data were extracted from the database of the German Institute for the Hospital Remuneration System (InEK GmbH).</p><p><strong>Methods: </strong>Differences in comorbidities and injuries were analyzed using the Chi-square test. Odds ratios (OR) were calculated to analyze potential risk factors for in-hospital mortality.</p><p><strong>Results: </strong>In the analysis of 3.847 hospital admission cases, an in-hospital mortality rate of 11.7% (n=451) was observed. The patient cohort demonstrated a male predominance at 72.9%. The overall incidence of CSCI in Germany is 9.2 per million annually, with a significant increase in incidence rate observed with age, particularly after 60 years. The majority of admissions were aged over 65 years and this age group (>65 years) was identified as a significant risk factor for increased in-hospital mortality (n=2.064; OR 1.83; p<.001). Vertebral fractures at the levels C4 (n=364; 9.5%), C5 (n=582; 15.1%), and C6 (n=598; 15.5%) were the most common spinal injuries, while concomitant fractures at atlas (C1), axis (C2) and C7 fractures were associated with an elevated significant risk for in-hospital mortality (OR 2.40, OR=2.67, OR=2.21; p<.001). The need for blood transfusion was associated with a high in-hospital mortality rate of 31.3%. Amongst others, hypothermia, acute kidney failure, pleural effusion, and atrial fibrillation were significantly associated with in-hospital mortality (all p<.001). Additionally, aspiration pneumonia and hospital-acquired pneumonia were linked to increased in-hospital mortality risk (OR 2.21, OR 1.52; p<.001).</p><p><strong>Conclusions: </strong>Concomitant injuries and comorbidities indicating frailty and medical complications increase in-hospital mortality risk. The study highlights the need for thorough health assessments in patients with CSCIs, encouraging personalized and optimized treatment strategies.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056648","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":"Human versus machine: deciding on high-stakes surgery in possible Cauda Equina syndrome.","authors":"Elie Najjar, Ahmed Abdelazim Hassan, Rodrigo Muscogliati, Khalid M Salem, Nasir A Quraishi","doi":"10.1016/j.spinee.2025.05.026","DOIUrl":"10.1016/j.spinee.2025.05.026","url":null,"abstract":"<p><strong>Background context: </strong>Cauda Equina Syndrome (CES) is a spine surgical urgency requiring prompt intervention to prevent neurological deficits. Accurate identification of CES cases needing urgent surgery is essential to avoid long-term sequelae.</p><p><strong>Purpose: </strong>To evaluate the concordance between an AI language model (ChatGPT) and a Spinal Multidisciplinary Team (MDT) in recommending surgical intervention for suspected CES cases.</p><p><strong>Study design/setting: </strong>Retrospective concordance analysis comparing surgical recommendations between ChatGPT and a Spinal MDT.</p><p><strong>Patient sample: </strong>Among 160 referrals presenting with red flags for possible CES, 10 cases were used to calibrate ChatGPT to specific clinical and diagnostic parameters, with the remaining 150 cases included in the primary analysis. The average patient age was 50.6 years (range 18-87), with a male-to-female ratio of 68:82.</p><p><strong>Outcome measures: </strong>The primary outcome was the concordance rate between ChatGPT and the MDT in recommending surgery, evaluated through agreement rates and statistical analysis.</p><p><strong>Methods: </strong>Each of the 150 cases was presented as standardized slides including clinical history, imaging, and examination findings. Both the MDT and ChatGPT assessed the need for urgent surgery. Discordant cases (n=17) were further reviewed by 3 spinal surgeons blinded to prior decisions.</p><p><strong>Results: </strong>ChatGPT and the MDT agreed on surgical recommendations in 133 out of 150 cases, achieving an 88.7% concordance (Cohen's Kappa = 0.764, p<.001). ChatGPT recommended surgery more frequently in the 17 discordant cases, but this difference was not statistically significant (McNemar's test statistic = 1.23, p=.46). Review by 3 independent surgeons reached consensus on 11 of the 17 discordant cases (64.7%), highlighting variability among experts; individual surgeons aligned with ChatGPT in 5 to 6 cases each (29.4%-35.3%).</p><p><strong>Conclusions: </strong>Substantial agreement between ChatGPT and the MDT suggests ChatGPT's comparable sensitivity in detecting surgical candidates in CES cases. Variability among surgeons on discordant cases underscores subjectivity in CES triage. ChatGPT may be a valuable adjunct in high-stakes clinical decision-making, though further validation and refinement are needed.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044466","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":"Predicting survival outcomes in renal cell carcinoma spinal metastases: a multicenter evaluation of existing prognostic systems.","authors":"Zhehuang Li, Feng Wei, Jinxin Hu, Youyu Zhang, Xiaoying Niu, Po Li, Xiance Tang, Weitao Yao, Suxia Luo, Peng Zhang","doi":"10.1016/j.spinee.2025.05.025","DOIUrl":"10.1016/j.spinee.2025.05.025","url":null,"abstract":"<p><strong>Background context: </strong>Survival prediction models for patients with spinal metastases are crucial for guiding clinical decision-making and optimizing treatment strategies. Renal cell carcinoma spinal metastases (RCC-SM) present unique challenges due to their distinct biological behavior and variable response to systemic therapies.</p><p><strong>Purpose: </strong>To externally validate existing prognostic scoring systems for predicting survival in patients with RCC-SM using multicenter data from China.</p><p><strong>Study design: </strong>Retrospective external validation study.</p><p><strong>Patient sample: </strong>103 patients with RCC-SM who underwent surgical treatment at three specialized spine oncology centers in China between 2015 and 2023.</p><p><strong>Outcome measures: </strong>Survival at 90 days, 180 days, and 1 year postsurgery, assessed using area under the curve (AUC), calibration intercept and slope, and Brier scores.</p><p><strong>Methods: </strong>Six prognostic scoring systems were evaluated, including Tomita, revised Tokuhashi, revised Katagiri, New England Spinal Metastasis Score, Skeletal Oncology Research Group (SORG) nomogram, and SORG machine learning (ML) model. Discrimination and calibration were assessed using ROC curves, calibration plots, and Brier scores. Cox regression identified independent prognostic factors. The study was funded by Henan Province Key Science and Technology Project (252102311081). A total amount of RMB 20,000 ($2,740) was received.</p><p><strong>Results: </strong>SORG ML demonstrated the highest discriminative ability for 90-day survival (AUC: 0.765), while revised Tokuhashi performed best for 180-day survival (AUC: 0.754), and revised Katagiri for 1-year survival (AUC: 0.806). However, nearly all models exhibited underestimation of survival probabilities, particularly in high-risk subgroups. Independent prognostic factors included American Spinal Injury Association grade, visceral metastases, preoperative systemic therapy, preoperative radiotherapy, and neutrophil-to-lymphocyte ratio.</p><p><strong>Conclusions: </strong>Existing prognostic models for RCC-SM show varying predictive accuracy, with SORG ML and revised Katagiri performing best for short- and long-term survival, respectively. However, recalibration is needed to address underestimation, particularly in East Asian populations. Future models should incorporate dynamic treatment responses and molecular biomarkers to improve predictive accuracy and clinical utility.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994987","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":"Is osteoporosis an independent risk factor for sacral fracture after lumbosacral spinal fusion in adults? A retrospective cohort study","authors":"Anthony N. Baumann MD, DPT ,&nbsp;Robert J. Trager DC ,&nbsp;Shahabeddin Yazdanpanah MS ,&nbsp;Tyler Metcalf MD ,&nbsp;Keegan T. Conry MD ,&nbsp;Jacob C. Hoffmann MD ,&nbsp;Gordon Preston DO","doi":"10.1016/j.spinee.2025.05.022","DOIUrl":"10.1016/j.spinee.2025.05.022","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Sacral fracture is a rare complication following lumbosacral fusion in adults linked to postsurgical biomechanical changes. There are mixed research results suggesting that osteoporosis may or may not be a contributing factor.</div></div><div><h3>PURPOSE</h3><div>To determine if osteoporosis is an independent risk factor for sacral fracture after lumbosacral fusion.</div></div><div><h3>STUDY DESIGN</h3><div>A propensity-matched retrospective cohort study that was preregistered on open science framework.</div></div><div><h3>PATIENT SAMPLE</h3><div>After matching, patients (<em>n</em>=14,302; 82% female) who underwent lumbosacral fusion had a mean age of 64 years and were divided into the osteoporosis cohort (<em>n</em>=7,151) or the no osteoporosis cohort (<em>n</em>=7,151).</div></div><div><h3>OUTCOME MEASURES</h3><div>The primary outcome measure was the risk ratio (RR) of sacral fracture through 2 years after lumbosacral fusion. We secondarily explored the RR for pelvic fixation with instrumentation. We assessed negative control outcomes such as further imaging and major trauma, targeting near-null point estimates.</div></div><div><h3>METHODS</h3><div>We included adults (≥18 years old) in the TriNetX database from 2005 to 2023 who underwent primary lumbosacral fusion, divided into two cohorts depending on the presence or absence of osteoporosis (ie, osteoporosis and no osteoporosis cohorts) and propensity matched via key risk factors.</div></div><div><h3>RESULTS</h3><div>There were 261 (1.8%) sacral fractures in the entire patient population (<em>n</em><span>=14,302). Comparing the osteoporosis cohort to no osteoporosis cohort, there was a statistically significant increase in risk of sacral fracture (RR: 1.75 [1.36, 2.24]; p&lt;.001; 166 [2.3%] vs 95 [1.3%] cases), with a median time to event of 154 and 181 days in each cohort, respectively. There was also a statistically significant increase in risk of pelvic fixation with instrumentation (RR: 1.87 [1.25, 2.78]; p=.002). The likelihood of polytrauma<span> (RR=0.98), subdural hemorrhage (RR=1.24), and diagnostic imaging (RR: 0.93) approximated the null between cohorts, suggesting findings would not be explained by differences in these variables.</span></span></div></div><div><h3>CONCLUSION</h3><div>Osteoporosis appears to be independently associated with a statistically and clinically significant risk of sacral fracture through 2 years after lumbosacral fusion. Further research may be warranted for corroboration.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 9","pages":"Pages 1910-1917"},"PeriodicalIF":4.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010181","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 comprehensive treatment algorithm for tandem spinal stenosis: decision making and surgical strategy.","authors":"Rishi M Kanna, Praveen R Iyer, Ajoy Prasad Shetty, Shanmuganathan Rajasekaran","doi":"10.1016/j.spinee.2025.05.021","DOIUrl":"10.1016/j.spinee.2025.05.021","url":null,"abstract":"<p><strong>Background context: </strong>Tandem spinal stenosis (TSS) can present with a constellation of myriad neurological symptoms and signs. Whole spine MRI has improved the diagnosis but does not aid therapeutic decision-making. While most studies have focused on cervico-lumbar TSS, there is inadequate literature on TSS of other regions. Further, there are no guidelines on the optimal surgical strategy for patients with TSS.</p><p><strong>Study design: </strong>Retrospective evaluation of prospectively collected data PURPOSE: To develop a clinico-radiological treatment algorithm for TSS involving all the regions of the spine PATIENT SAMPLE: About 238 patients treated for TSS with a minimum follow-up of 2 year.</p><p><strong>Methodology: </strong>The patients were classified based on the areas of stenosis namely cervico-lumbar (Type A -186), cervico-thoracic (Type B -11), thoracolumbar (Type C -24), and cervical, thoracic & lumbar (Type D -17). The criteria for diagnosis of TSS were cord compression and T2 signal intensity changes in cervical/ thoracic regions, and/or Schiza's grade ≥C lumbar canal stenosis (LCS). In the sequence of surgical algorithm, clinical severity was taken as the prime factor followed by cord signal changes. In clinical severity, symptoms were given predominance over clinical signs, myelopathy over radiculopathy and proximal over distal compressions. The outcomes were evaluated through Nurick's grade (NG) and ODI.</p><p><strong>Results: </strong>Type A cervico-lumbar TSS was divided into four sub-types. Type A1-patients with clinical myelopathy without symptoms of LCS underwent cervical decompression alone (n=58). NG improved from 3.8±0.98 to 1.74±0.74 (p<.05). Only 11(18%) required lumbar decompression later. Patients with LCS (Type A2) without clinical myelopathy underwent lumbar decompression alone (n=97). Four (4.1%) developed myelopathy during follow-up requiring a cervical surgery. Patients with predominant LCS symptoms with only signs of myelopathy (Type A3, n=7) underwent lumbar decompression initially but all required cervical surgery within 2 years. Type A4 (n=24) with both myelopathy and claudication symptoms were treated by combined staged decompressions procedures. The NG improved from 3.4±0.7 to 1.6±0.4 (p<.05). Type B (n=11) had patients with myelopathy due to compression at cervical and thoracic regions. They were sub-divided based on upper limb myelopathy. In patients with both upper and lower limb myelopathy (Type B1, n=11), cervical decompression was done first (n=6) followed by staged thoracic decompression. The NG improved from 4.6±0.5 to 1.8±0.3 (p<.05). In patients with predominant lower limb myelopathy (Type B2, n=5), only thoracic surgery was performed. Only one required cervical surgery later. In Type C thoracic & lumbar TSS (n=24), 20 were treated by thoracic decompression based on signs of myelopathy. The mean NG improved from 4.1±0.7 to 1.9±0.9 (p<.05). Six cases required lumbar level surge","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049103","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}