Spine Journal最新文献

{"title":"Optimizing surgical strategies: a systematic review of the effectiveness of preoperative arterial embolization for hyper vascular metastatic spinal tumors.","authors":"Abdel-Hameed Al-Mistarehi, Hasan Slika, Bachar El Baba, Shahab Aldin Sattari, Carly Weber-Levine, Kelly Jiang, Sang H Lee, Kristin J Redmond, Nicholas Theodore, Daniel Lubelski","doi":"10.1016/j.spinee.2024.12.032","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.12.032","url":null,"abstract":"<p><strong>Background: </strong>The vertebral column is the most common site of bony metastasis. When indicated, surgical resection of hypervascular metastatic lesions may be complicated by significant blood loss, the need for blood transfusion, and incomplete tumor resection due to poor visualization and premature abortion of the operation. In select cases, preoperative arterial embolization of hypervascular metastatic tumors may help minimize intraoperative bleeding and reduce operative times.</p><p><strong>Objective: </strong>Our aim was to evaluate the effectiveness of preoperative arterial embolization of metastatic tumors to the spine.</p><p><strong>Study design: </strong>A systematic review of the literature with a subsequent metaanalysis of the collected data was conducted to achieve this aim.</p><p><strong>Methods: </strong>PubMed and MEDLINE were searched since inception until May 22, 2023. The primary outcome of this study was Estimated Blood Loss (EBL), while secondary outcomes included number of patients requiring blood transfusions, duration of operation, and survival.</p><p><strong>Results: </strong>Twenty-nine studies were included, yielding 14,199 patients, from which 1,134 underwent surgery with adjunctive embolization. Our review demonstrated that preoperative arterial embolization in patients with spinal metastatic tumors can help reduce EBL by a mean of -284.37 mL (95% CI 462.43-276. 21, p=.002) and improve survival by 1.20 months (95% CI 1.14-1.26, p<.001) compared to those without embolization. Upon running subgroup analyses, the reduction in EBL appeared to be mainly driven by the embolization of hypervascular tumors, while that of nonhypervascular ones appeared to have no significant impact. The pooled analysis shows that preoperative embolization did not impact operative time and the need for transfusion.</p><p><strong>Conclusions: </strong>Preoperative arterial embolization of metastatic tumors to the spine has a relatively mild effect in reducing blood loss and improving patient survival. No effect was observed for preoperative embolization on operative time or the need for transfusion.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014695","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":"Neuroinflammation and nociception in intervertebral disc degeneration: a review of precision medicine perspective.","authors":"Nurul Fariha Zàaba, Raed H Ogaili, Fairus Ahmad, Isma Liza Mohd Isa","doi":"10.1016/j.spinee.2024.12.033","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.12.033","url":null,"abstract":"<p><p>Intervertebral disc (IVD) degeneration is a major cause of low back pain (LBP), which results in disability worldwide. However, the pathogenesis of IVD degeneration mediating LBP remains unclear. Current conservative treatments and surgical interventions are both to relieve the symptoms and minimise pain; nevertheless, they are unable to reverse the degeneration. Previous studies have shown that inflammation and nociception markers are important indicators of pain mechanisms in IVD degeneration underlying LBP. As such, multiomics profiling allows the discovery of these target markers to understand the key pathological mechanisms mediating IVD degeneration underpinnings of LBP. This article provides insights into a precision medicine approach for identifying and understanding the pathophysiology of IVD degeneration associated with LPB based on the severity of the disease from early and mild to severe degenerative stages. Molecular profiling of key markers in degenerative IVDs based on patient stratification at early, mild, and severe stages will contribute to the identification of target markers associated with signalling pathways in mediating neuroinflammation, innervation, and nociception underlying painful IVD degeneration. This approach will offer an understanding of establishing personalised clinical strategies tailored to the severity of IVD degeneration for the treatment of LBP.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014693","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 diagnostic accuracy of ChatGPT-4 and machine learning in differentiating spinal tuberculosis and spinal tumors.","authors":"Xiaojiang Hu, Dongcheng Xu, Hongqi Zhang, Mingxing Tang, Qile Gao","doi":"10.1016/j.spinee.2024.12.035","DOIUrl":"10.1016/j.spinee.2024.12.035","url":null,"abstract":"<p><strong>Background: </strong>In clinical practice, distinguishing between spinal tuberculosis (STB) and spinal tumors (ST) poses a significant diagnostic challenge. The application of AI-driven large language models (LLMs) shows great potential for improving the accuracy of this differential diagnosis.</p><p><strong>Purpose: </strong>To evaluate the performance of various machine learning models and ChatGPT-4 in distinguishing between STB and ST.</p><p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Patient sample: </strong>143 STB cases and 153 ST cases admitted to Xiangya Hospital Central South University, from January 2016 to June 2023 were collected.</p><p><strong>Outcome measures: </strong>This study incorporates basic patient information, standard laboratory results, serum tumor markers, and comprehensive imaging records, including Magnetic Resonance Imaging (MRI) and Computed Tomography (CT), for individuals diagnosed with STB and ST. Machine learning techniques and ChatGPT-4 were utilized to distinguish between STB and ST separately.</p><p><strong>Method: </strong>Six distinct machine learning models, along with ChatGPT-4, were employed to evaluate their differential diagnostic effectiveness.</p><p><strong>Result: </strong>Among the 6 machine learning models, the Gradient Boosting Machine (GBM) algorithm model demonstrated the highest differential diagnostic efficiency. In the training cohort, the GBM model achieved a sensitivity of 98.84% and a specificity of 100.00% in distinguishing STB from ST. In the testing cohort, its sensitivity was 98.25%, and specificity was 91.80%. ChatGPT-4 exhibited a sensitivity of 70.37% and a specificity of 90.65% for differential diagnosis. In single-question cases, ChatGPT-4's sensitivity and specificity were 71.67% and 92.55%, respectively, while in re-questioning cases, they were 44.44% and 76.92%.</p><p><strong>Conclusion: </strong>The GBM model demonstrates significant value in the differential diagnosis of STB and ST, whereas the diagnostic performance of ChatGPT-4 remains suboptimal.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980405","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":"Characteristics of upper lumbar spondylolysis in children.","authors":"Kohei Kuroshima, Shingo Miyazaki, Yoshiaki Hiranaka, Masao Ryu, Shinichi Inoue, Takashi Yurube, Kenichiro Kakutani, Ko Tadokoro","doi":"10.1016/j.spinee.2024.12.026","DOIUrl":"10.1016/j.spinee.2024.12.026","url":null,"abstract":"<p><strong>Background: </strong>Pediatric lumbar spondylolysis (LS) is common in junior and senior high school athletes. Lower LS (L4-L5 level) is more common in children, and upper LS (L1-L3 level) is relatively rare; therefore, the pathogenesis of upper LS remains unclear.</p><p><strong>Purpose: </strong>To elucidate the mechanisms of upper LS by identifying and comparing characteristics between upper and lower LS cases.</p><p><strong>Study design/setting: </strong>Retrospective cross-sectional study.</p><p><strong>Patient sample: </strong>This study included 842 pediatric patients aged ˂18 years diagnosed with single-level acute LS at a single outpatient clinic between 2015 and 2022.</p><p><strong>Outcome measures: </strong>The rate of upper LS, age, sex, participation in flexibility sports, presence of spina bifida occulta (SBO), and radiological parameters including lumber lordosis, L1-L4 lordosis, L4-S1 lordosis, and sacral slope.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of all patients with acute LS diagnosed using plain radiography, multidetector computed tomography, and magnetic resonance imaging. The upper and lower LS groups were subsequently compared using univariate and multivariate analyses to investigate factors associated with upper LS.</p><p><strong>Results: </strong>Of the included 842 patients, 88 (10.5%) had upper LS. Multivariate analysis showed that older age (odds ratio, 1.62; p<.001), flexibility sports participation (odds ratio, 2.50; p=.041), lower prevalence of SBO (odds ratio, 0.49; p=.011), increased L1-L4 lordosis (odds ratio, 1.16; p<.001), and decreased L4-S1 lordosis (odds ratio, 0.84; p<.001) were significantly associated with upper LS development.</p><p><strong>Conclusions: </strong>Patients with upper LS had clearly different characteristics from those with lower LS in terms of age, participation in flexibility sports, presence of SBO, and segmental lordosis of the lumbar spine. This study will help further research in elucidating the mechanisms of upper LS.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972896","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":"Cost-utility of lumbar interbody fusion surgery: A systematic review.","authors":"Viraj Deshpande, Evan Simpson, Jesse Caballero, Chris Haddad, Jeremy Smith, Vance Gardner","doi":"10.1016/j.spinee.2024.12.027","DOIUrl":"10.1016/j.spinee.2024.12.027","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Lumbar interbody fusion (LIF) is a common surgical intervention for treating lumbar degenerative disorders. Increasing demand has contributed to ever-increasing healthcare expenditure and economic burden. To address this, cost-utility analyses (CUAs) compare value in the context of patient outcomes. CUAs quantify health improvements using quality-adjusted life years (QALYs), allowing decision-makers to determine procedure value.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;While there is a growing body of literature assessing LIF value, a comprehensive synthesis of LIF CUAs is lacking. This systematic review aims to address this gap by assessing all available CUAs of LIF techniques, to support evidence-based practices that improve outcomes and promote efficient resource use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study sample: &lt;/strong&gt;This study sample consisted of adult patients with lumbar degenerative conditions specifically treated with lumbar interbody fusion, including grade I or II degenerative spondylolisthesis, lumbar spinal stenosis, disc degeneration, and spondylosis, with or without low back and/or leg pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Direct (healthcare) and indirect (non-healthcare) costs, cost sources and calculation methods, utility scores, QALY gain, cost-utility, incremental cost-effectiveness ratios, and willingness-to-pay thresholds. Outcomes were reported as median and interquartile ranges (IQR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review was conducted following PRISMA guidelines. PubMed, Web of Science, and Embase were searched from inception to October 23, 2023, for CUAs reporting QALYs and costs of LIF procedures. Relevant studies were selected and data extracted. Subgroup analyses compared minimally invasive versus open surgery and anterior versus posterior approaches. Study quality was assessed using the CHEC-Extended tool. Quantitative meta-analysis was not performed due to methodological heterogeneity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 2047 identified studies, 14 met inclusion criteria. The mean CHEC-Extended score was 72.1%. Most studies reported on TLIF (n=11) and utilized EQ-5D questionnaire to calculate utility (n=9). Direct costs were sourced from institutional databases, Medicare, DRGs, Redbook, and a variety of other sources. Most indirect costs were estimated from productivity loss. TLIF demonstrated the highest median QALY gain over 1 year (0.43, IQR 0.121-0.705), while PLIF was highest over 2 years (1.33). ALIF was most favorable over 1 year ($30901/QALY) and OLIF was most favorable over 2 years ($11187/QALY). PLIF, TLIF, and LLIF exhibited similar cost-utility over 2 years ($44383, $45628, $48576/QALY). MIS was substantially favorable to OS at 1 year ($42635 vs. $226304), though similar at 2 years ($48576 vs. $45628/QALY). Anterior approach was favorable to posterior approach at 1 year ($30901.5 vs. $81038) and 2 years ($29","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980411","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 clinical and radiological outcomes of three-column lumbar osteotomies with and without interbody cages for adult spinal deformity.","authors":"Jeffrey P Mullin, Esteban Quiceno, Mohamed A R Soliman, Alan H Daniels, Justin S Smith, Michael P Kelly, Christopher P Ames, Shay Bess, Douglas Burton, Bassel Diebo, Robert K Eastlack, Richard Hostin, Khaled Kebaish, Han Jo Kim, Eric Klineberg, Virginie Lafage, Lawrence G Lenke, Stephen J Lewis, Gregory Mundis, Peter G Passias, Themistocles S Protopsaltis, Frank J Schwab, Jeffrey L Gum, Thomas J Buell, Christopher I Shaffrey, Munish C Gupta","doi":"10.1016/j.spinee.2025.01.001","DOIUrl":"10.1016/j.spinee.2025.01.001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Correcting sagittal malalignment in adult spinal deformity (ASD) is a challenging task, often requiring complex surgical interventions like pedicle subtraction osteotomies (PSOs). Different types of three-column osteotomies (3COs), including Schwab 3, Schwab 4, Schwab 4 with interbody cages, and the \"sandwich\" technique, aim to optimize alignment and fusion outcomes. The role of interbody cages in enhancing fusion and segmental correction remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to compare outcomes among these 4 3CO techniques, evaluating the impact of cage use at the osteotomy site on postoperative radiographic imaging and clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;This is a multicenter retrospective study utilizing data from a prospective multicenter database of patients undergoing complex ASD surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Ninety-seven patients who underwent 1 of 4 3CO techniques for thoracolumbar ASD correction with at least 2 years of follow-up were included. The sample consisted of 29 patients who underwent Schwab 3 osteotomy, 20 Schwab 4, 28 Schwab 4 with interbody cages, and 20 who underwent \"sandwich\" osteotomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The Scoliosis Research Society-22 revised (SRS22r) questionnaire evaluating pain, activity, appearance, mental health, and satisfaction was used to evaluate patient reported outcomes and radiographic measures including segmental lordosis and fusion rates determined by 3 blinded reviewers were used to evaluate physiologic outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study analyzed demographic data, radiographic outcomes, patient-reported outcomes, complications, and fusion rates over a 2-year follow-up period. Fusion status was determined via serial radiographs and evaluated independently by 3 blinded reviewers. Univariate and multivariate statistical analyses were performed to assess differences among the groups and the impact of interbody cage use on outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients undergoing \"sandwich\" osteotomy exhibited worse preoperative leg pain scores and lower SRS22r activity (p=.015), appearance (p=.007), and mental health domain scores (p=.0015). No differences in complications were found among groups (p&gt;.05). Patients who underwent osteotomy with a cage were more likely to have had previous spine fusion (91.7% vs. 71.4%, p=.010). Additionally, these patients had lower preoperative SRS22r mental domain (2.9±1 vs. 3.5±1, p=.009), satisfaction (2.3±1 vs. 2.7±1.2, p=.034), and SRS22r total scores (2.3±0.6 vs. 2.6±0.6, p=.0026) but demonstrated the greatest improvement in the mental health domain (0.9±0.7 vs. 0.3±0.9, p=.002). Cage use was associated with a larger mean change in segmental lordosis at the osteotomy site (32.9±9.6 vs. 28.7±9.5, p=.038). Fusion rates were significantly higher in the cage group (79.2% vs. 55.1%, p=.0012). Regression analysis identif","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972897","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":"Scoliosis progression after lung transplantation.","authors":"Takayoshi Shimizu, Satona Tanaka, Bungo Otsuki, Koki Kawasaki, Takashi Sono, Koichi Murata, Daisuke Nakajima, Shuichi Matsuda, Hiroshi Date","doi":"10.1016/j.spinee.2024.12.030","DOIUrl":"10.1016/j.spinee.2024.12.030","url":null,"abstract":"<p><strong>Background context: </strong>Scoliosis is a potential postoperative complication of various pediatric cardiothoracic conditions.</p><p><strong>Purpose: </strong>To investigate the incidence of scoliosis in pediatric lung transplant patients and explore the factors associated with its development.</p><p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Patient sample: </strong>About 330 consecutive lung transplant recipients at a single institution between April 2002 and June 2022.</p><p><strong>Outcome measures: </strong>The incidence of scoliosis.</p><p><strong>Methods: </strong>After excluding 45 patients with <1 year of follow-up, 285 patients were analyzed: 43 pediatric (≤17 years) and 242 adult (>18 years) patients. Data on baseline demographics, Cobb angle measurements pre- and posttransplant, and lung volumes at 1-year posttransplant in pediatric patients were collected. The prevalence of scoliosis was compared between pediatric and adult patients. Additionally, the impact of lung volume differences (right minus left) on scoliosis progression was assessed.</p><p><strong>Results: </strong>Pediatric (n=43) and adult (n=242) patients had a mean age of 10.3 and 44.9 years, respectively. Scoliosis was significantly more prevalent in pediatric patients, with 30.2% having a Cobb angle >10° and 13.9% having a Cobb angle >20°, compared to 11.5% and 1.6% in adults, respectively. Pediatric patients with Cobb angles >20° exhibited significant lung volume differences 1-year posttransplant. Lung volume disparities increased the risk of scoliosis progression, particularly in patients with unilateral lung collapse.</p><p><strong>Conclusions: </strong>Pediatric lung transplant recipients have a higher incidence of significant scoliosis than adult recipients. Posttransplant lung volume disparities, especially in cases of unilateral lung collapse, may contribute to scoliosis progression. Routine spinal assessments are necessary for managing scoliosis in pediatric lung transplant patients to prevent curvature progression and ensure long-term musculoskeletal health.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive value of multifidus degeneration in osteoporotic vertebral compression fracture patients with kyphosis deformity.","authors":"Junyu Li, Zimo Wang, Gengyu Han, Zhuoran Sun, Yongqiang Wang, Miao Yu, Weishi Li, Lin Zeng, Yan Zeng","doi":"10.1016/j.spinee.2024.12.031","DOIUrl":"10.1016/j.spinee.2024.12.031","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Osteoporotic vertebral compression fracture (OVCF) causes pain, kyphosis and neurological damage, which significantly affect patients' quality of life. Patients with OVCF are often elderly and have severe osteoporosis, which makes preoperative symptom more serious, postoperative recovery worse and the incidence of postoperative complications high. The paraspinal muscles have been well studied in adult spinal deformities, but there is no conclusive evidence that their findings can be applied to OVCF. The purpose of this study was to evaluate the associations between multifidus (MF) parameters including fat infiltration (FI), relative functional sectional area (rFCSA), relative gross cross-sectional area (rGCSA) and the sagittal parameters, symptom score, and postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To figure out the potential associations between multifidus muscle (MF) degeneration and patients' quality of life (QoL), sagittal parameters and mechanical complications in osteoporotic vertebral compression fracture (OVCF) patients with kyphosis deformity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study PATIENT SAMPLE: OVCF patients with kyphosis deformity who underwent corrective surgery between 2008 to 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measurements: &lt;/strong&gt;MF fat infiltration (MFFI), relative functional cross-sectional area (MFrFCSA), MF relative gross cross-sectional area (MFrGCSA), VAS, ODI, JOA, SRS-22, preoperative, postoperative and last-follow up spine sagittal parameters, postoperative mechanical complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study included 108 OVCF patients with kyphosis deformity who underwent corrective surgery and were followed for 2 years. MRI were performed preoperatively to evaluate the paraspinal muscle morphology, including MF fat infiltration (MFFI), relative functional cross-sectional area (MFrFCSA), and MF relative gross cross-sectional area (MFrGCSA). VAS, ODI, JOA, and SRS-22 were conducted preoperatively. Preoperative, postoperative and last-follow up spine sagittal parameters were recorded, as well as sagittal balance, loss of correction results and improvement and deterioration of sagittal parameters. The occurrence of postoperative mechanical complications, including adjacent segment disease, screw loosening, proximal junctional kyphosis, and distal junctional problem were recorded. We analyzed the relationship between MF degeneration and the above parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Strong correlation was observed in VAS and MFFI (rr=0.597, p=.000),MF rFCSA (rr=-0.520, p=.001) and MF rGCSA (rr=-0.461, p=.005), as well as ODI and MF rFCSA (rr=-0.336, p=.042). Preoperatively, strong correlations were observed between MF rFCSA and LL (rr=-0.320, p=.010), TLK (rr=-0.271, p=.026), TK (rr=-0.251,p=.048). MF rGCSA and LL (rr=-0.259, p=.039), TLK (rr=-0.247, p=.043), TK (rr=-0.273, p=.030), GK (rr=-0.381, p=.002) were also strongly ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972899","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":"A retrospective analysis of spinal teratomas and spinal lipomas: overlaps and differences in presentation, surgical treatments, and outcomes","authors":"Hongmei Song,&nbsp;Mingxin Yu,&nbsp;Yang Song,&nbsp;Shuanglin Deng","doi":"10.1016/j.spinee.2024.08.026","DOIUrl":"10.1016/j.spinee.2024.08.026","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Spinal teratomas and lipomas, both adult and pediatric cases, are rare diseases with many similarities, but have yet to be systematically compared.</div></div><div><h3>PURPOSE</h3><div>To systematically compare spinal teratomas and lipomas to optimize management.</div></div><div><h3>STUDY DESIGN</h3><div>Retrospective.</div></div><div><h3>PATIENT SAMPLE</h3><div>Symptomatic spinal teratoma and lipoma patients surgically treated at our center.</div></div><div><h3>OUTCOME MEASURES</h3><div>Anatomical distribution, clinical manifestations, resection status, and outcomes.</div></div><div><h3>METHODS</h3><div>Spinal teratoma and lipoma patients with complete data treated during 2008 to 2023 in our center were enrolled. Electrophysiological monitoring was routinely performed after 2012. Patient characteristics, anatomical distribution, clinical manifestations, surgical resection, and outcomes were analyzed.</div></div><div><h3>RESULTS</h3><div>We enrolled 86 teratoma patients (71 adults) and 51 lipoma patients (39 adults). Most tumors were lumbosacral lesions; cervical/thoracic involvement was more common with lipomas. Pain, the most frequent manifestation, was more common in teratomas. Gross total resection (GTR) was achieved in 51.1% and 49% of teratomas and lipomas, respectively. Electrophysiological monitoring increased the GTR rate from 38.8% to 48.6%. Age independently predicted (OR: 1.040, 95% CI: 1.008–1.078) GTR/near-total resection (NTR). Symptom relief occurred in 81.4% teratoma patients and 64.7% lipoma patients. Recurrence/symptomatic progression occurred in 19 teratomas and 7 lipomas after a median of 95 and 115 months, respectively. Adult lipoma patients without spinal dysraphism had lower recurrence rates. GTR (HR: 0.172, 95% CI: 0.02557–0.7028) and lesion length (HR: 1.351, 95% CI: 1.138–1.607) independently predicted recurrence/progression.</div></div><div><h3>CONCLUSIONS</h3><div>GTR should be pursued for adult/pediatric spinal teratomas and pediatric spinal lipomas. For adult spinal lipoma patients without dysraphism, conservative surgery could be considered.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 111-126"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180816","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 analysis of early versus late surgical intervention for lumbosacral hemivertebra: a minimum 2-year follow-up retrospective study","authors":"Zhuosong Bai MD ,&nbsp;Haoran Zhang MD ,&nbsp;Yuechuan Zhang MD ,&nbsp;Tongyin Zhang MD ,&nbsp;Xiangjie Yin MD ,&nbsp;Yunze Han MD ,&nbsp;Yiqiao Zhang MD ,&nbsp;Qianyu Zhuang MD ,&nbsp;Jianguo Zhang MD","doi":"10.1016/j.spinee.2024.09.005","DOIUrl":"10.1016/j.spinee.2024.09.005","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Lumbosacral hemivertebra (LSHV) is a complex and unique congenital spinal deformity characterized by early severe trunk imbalance and progressive compensatory curve. Previous studies have proved the efficiency of posterior LSHV resection. However, the optimal timing for surgical intervention of LSHV still remains controversial. Few studies compare the surgical outcomes in patients of different age groups.</div></div><div><h3>PURPOSE</h3><div>To evaluate the influence of posterior-only LSHV resection surgery timing on clinical and radiographic results.</div></div><div><h3>STUDY DESIGN</h3><div>Retrospective analysis.</div></div><div><h3>PATIENT SAMPLE</h3><div>We retrospectively analyzed 58 LSHV patients undergoing posterior-only LSHV resection with short-segment fusion at our institution between 2010 and 2020, with a mean follow-up of 7.5 years.</div></div><div><h3>OUTCOME MEASURE</h3><div>The following data were observed for all cases: patient demographics, clinical outcomes measured by operating time, intraoperative blood loss, complications, and Health-Related Quality of Life, radiographic parameters included Cobb angles, trunk shift and sagittal spinal parameters.</div></div><div><h3>METHODS</h3><div>From 2010 to 2020, a consecutive series of 58 LSHV patients treated by posterior LSHV resection with short segmental fusion were investigated retrospectively, with a 7.5-year average follow-up period. Patients were stratified into 2 groups based on the timing of surgery: Group E (≤6 years old, representing the early-surgery) and Group L (&gt;6 years old, representing the late-surgery). Radiographic assessments included pre- and postoperative measurements of main scoliosis, compensatory scoliosis, trunk shift, and sagittal balance parameters. Operative data, perioperative complications and SRS-22 questionnaires were also collected.</div></div><div><h3>RESULTS</h3><div>Compared to Group L, Group E exhibited a lower intraoperative blood loss (p&lt;.001), higher final main curve correction rate (p=.037), smaller postop compensatory curve (p=.031), higher sagittal vertical axis correction rates at immediate postop (p=.045) and last follow-up (p=.027), and lower implant failure complications incidence (p=.006).</div></div><div><h3>CONCLUSIONS</h3><div>This study suggested that early surgical intervention in LSHV patients can achieve better correction outcomes, while reducing blood loss and postoperative complications in a large-scale cohort.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 145-153"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331027","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}