Journal of Craniovertebral Junction and Spine最新文献

{"title":"Facet distraction using \"Goel facet spacer:\" A 25-year long journey of evolution of revolution in spinal fixation techniques.","authors":"Atul Goel","doi":"10.4103/jcvjs.jcvjs_56_25","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_56_25","url":null,"abstract":"","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 1","pages":"1-4"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12029395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive guidelines for prehabilitation in spine surgery.","authors":"Paulomi Gohel, Raj Swaroop Lavadi, Mohamed-Ali H Jawad-Makki, Rohit Prem Kumar, Ayesha Akbar Waheed, Lior M Elkaim, Vinay Jaikumar, Nima Alan, Thomas J Buell, Brenton Pennicooke, D Kojo Hamilton, Nitin Agarwal","doi":"10.4103/jcvjs.jcvjs_209_24","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_209_24","url":null,"abstract":"<p><strong>Study design: </strong>Literature review.</p><p><strong>Objectives: </strong>Review prehabilitation techniques used for elective spine surgery to create a comprehensive list of recommendations.</p><p><strong>Methods: </strong>A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines by searching three electronic databases from 1997 to 2021. Pertinent literature reporting information on prehabilitation, applicable to spine surgery, was identified. Seventy studies were selected for further analysis. Findings from the literature were reinforced by practices employed by the authors.</p><p><strong>Results: </strong>Preoperative smoking cessation should be achieved 3-4 weeks before elective spine surgery. Preoperative weight loss programs to reach a goal BMI <35 kg/m² may be a viable solution to minimize wound complications and surgical site infections. To minimize the negative impact of cardiopulmonary comorbidities, patients can enroll in an exercise program prior to surgery. Patients should abstain from alcohol before elective spine surgery. Patients with osteoporosis may benefit from supplementation with Vitamin D, calcium, and parathyroid hormone. Opioids should be weaned to complete cessation 6-8 weeks before surgery. Preoperative cognitive behavioral therapy (CBT) and education seem to be the most beneficial in reducing complications associated with psychiatric comorbidities. Patients should engage in a comprehensive prehabilitation regimen.</p><p><strong>Conclusion: </strong>Targeting patient risk factors with personalized interventions can improve postoperative outcomes in patients undergoing elective spine surgery.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 1","pages":"5-15"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12029390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and outcomes of patients with concomitant cervical spine trauma and vertebral artery injury: A literature review and retrospective analysis.","authors":"Alexander Akoto, Phillip T Yang, Trieu Do, Kate Dellonte, Robert W Molinari, Michael A Vella, Varun Puvanesarajah","doi":"10.4103/jcvjs.jcvjs_207_24","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_207_24","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of a single institution cohort.</p><p><strong>Objective: </strong>To assess the injury characteristics and outcomes in patients who suffered trauma to the cervical spine and vertebral artery injury (VAI).</p><p><strong>Methods: </strong>This was a retrospective study of patients admitted to our trauma center with osseous or ligamentous cervical spine injury and VAI. Imaging findings were reviewed to classify the fracture types and fracture extension into transverse foramina was noted. Electronic medical records were reviewed to capture the mechanism of injury, discharge disposition, neurologic status, and mortality. Kaplan-Meier analysis was performed to determine the mean survival time and cumulative survival rate.</p><p><strong>Results: </strong>Ultimately, 30 patients were included for the analysis. The mean age was 56 years old (range: 18-91 years). There were four major subgroups of cervical injuries: unilateral facet fractures (9 patients, 30%), occipital-cervical junction fractures (15 patients, 50%), translation or distraction injuries (3 patients, 10%), and injuries without extension into transverse foramina (20 patients, 67%). Left-sided VAIs were more common than right-sided (60% vs. 37%). Twelve patients (40%) initially presented with neurological symptoms. Nine patients (30%) died by final follow-up; the mean survival time for the cohort was 704.5 days (95% confidence interval: 440.1-968.9 days).</p><p><strong>Conclusion: </strong>The laterality of facet fractures and fractures extending into the transverse foramina are associated with VAI sidedness. Various mechanisms may account for injury presentation, including rotation and hyperflexion. Given that patients may initially present without neurologic deficits, it is recommended that cervical trauma protocols integrate computed tomography angiography to reduce morbidity and mortality.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 1","pages":"47-53"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12029383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome characteristics of surgical management of single-level junctional thoracolumbar fractures by short segment posterior transpedicular fixation in selected patients.","authors":"Sajad Hussain Arif, Khurram Khan, Mohsin Fayaz, Abrar Ahad Wani, Sarabjit Singh Chibber, Nayil Khursheed Malik, Zulfikar Ali","doi":"10.4103/jcvjs.jcvjs_153_24","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_153_24","url":null,"abstract":"<p><strong>Introduction: </strong>The susceptibility of the thoracolumbar junction to injury is attributed mainly to the transition from a relatively rigid thoracic kyphosis to a more mobile lumbar lordosis that occurs at thoracic T11 to lumbar L2 level.</p><p><strong>Materials and methods: </strong>We present our experience of management of 87 patients of single-level injury who presented with or without neurological deficit between March 2014 and October 2018. All adult patients (18-59 years) were included who were selected for management by single-level posterior transpedicular fixation and followed up for a minimum of 12 months.</p><p><strong>Results: </strong>The male-to-female ratio in our study was 6.3:1 with a mean age of 32 years. Forty-eight percent were in the work-productive age group of 31-40 years. The L1 vertebra was the most commonly fractured (47%) followed by D12, L2, and D11 vertebra, respectively. Thoracolumbar injury classification severity score 6 was the most common score at presentation. More than 80% patients had some degree of neurological deficit on American Spinal Injuries Association grading with Grade C being the most common pattern of presentation of spinal cord neurological deficit. About 25% patients had some degree of neurological improvement at 12 months follow-up. Among them, 10% achieved an ambulatory status from a bed-ridden status signifying the importance of surgical management in appropriately selected patients.</p><p><strong>Conclusions: </strong>Single-level transpedicular fixation can be offered to a group of selected patients for rehabilitative purposes. This is the largest study discussing only junctional thoracolumbar injuries and also outcomes in single-level posterior instrumentation.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 1","pages":"77-80"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12029397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthopedic surgery versus neurosurgery: Prevalence and surgical detail assessment of adult spinal fusion procedures.","authors":"Frank A Segreto, Oscar Krol, Samuel Gedailovich, Asher Ripp, George A Beyer, David Kim, Daniel J Alsoof, Hallie A Tiburzi, Olivia Merola, Neil V Shah, Peter G Passias, Jad Bou Monsef, Alan H Daniels, Carl B Paulino, Bassel G Diebo","doi":"10.4103/jcvjs.jcvjs_159_24","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_159_24","url":null,"abstract":"<p><strong>Background: </strong>A significant procedural overlap exists between orthopedic and neurosurgeons with both subspecialties performing adult spinal fusion procedures. However, the prevalence of varying adult spinal fusion procedures performed by orthopedic surgeons, relative to neurosurgeons, is unknown. This study sought to compare the prevalence of spinal fusion procedures among orthopedic and neurosurgeons.</p><p><strong>Materials and methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program database was queried for adult spinal fusion procedures from 2008 to 2016. Procedure prevalence, operative time, and hospital length of stay (LOS) were recorded and analyzed by surgical subspecialty. Spinal fusion cases investigated include all fusions, 2-3-level lumbar fusion, ≥4-level lumbar fusion, anterior cervical discectomy and fusion (ACDF), 3-6-level posterior cervical fusion, and ≥ 6-level posterior cervical fusion.</p><p><strong>Results: </strong>67,775 spinal fusions were identified, of which 44,879 (66.2%) were performed by neurosurgeons and 22,896 (33.7%) were performed by orthopedic surgeons. Procedures that involved the lumbar spine were more likely to be performed by orthopedic surgeons while cervical fusions like ACDF were more likely to be performed by neurosurgeons. Orthopedic surgeons had significantly shorter operative times (124.0 vs. 134.0 min, P < 0.001) for 2-3-level lumbar fusions while having a similar patient LOS (4.3 vs. 4.2 days, P = 0.196). The remaining procedures saw no significant difference in operative time and patient LOS between orthopedic and neurosurgeons.</p><p><strong>Conclusions: </strong>Neurosurgeons performed nearly double the amount of spinal fusion cases compared to orthopedic surgeons, with an even greater disparity seen in ACDFs, while orthopedic surgeons performed significantly more fusions of the lumbar spine. Orthopedic surgeons had shorter operative times for 2-3-level lumbar fusions.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 1","pages":"61-65"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12029385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of low back pain in hemodialysis patients: A systematic review and meta-analysis with Grading of Recommendations Assessment, Development, and Evaluation evidence classification.","authors":"Marcospaulo Viana Milagres, Juliano Bergamaschine Mata Diz, Alfredo Chaoubah","doi":"10.4103/jcvjs.jcvjs_192_24","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_192_24","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal pain complaints have a high epidemiological and clinical burden in hemodialysis patients. Previous original studies indicate that low back pain (LBP) may have an important contribution to these complaints. This systematic review aimed to estimate the global prevalence of LBP in chronic hemodialysis patients.</p><p><strong>Methods: </strong>Systematic review and meta-analysis with Grading of Recommendations Assessment, Development, and Evaluation approach for quality of evidence. Searches were performed in CINAHL, Embase, LILACS, MEDLINE/PubMed, and Scientific Electronic Library Online databases until July 2023. The Inverse Variance Heterogeneity model was used to pool prevalence estimates.</p><p><strong>Results: </strong>The review included 19 original articles that provided data from 2713 patients. The overall pooled prevalence of LBP was 30.2% (95% confidence interval [CI] =19.0%-42.0%; k = 19 articles). The sex-specific pooled prevalence of LBP was 29.6% (95% CI = 18.7%-41.2%; k = 6 articles) in females and 36.6% (95% CI = 26.0%-47.7%; k = 6 articles) in males. The duration-specific pooled prevalence of LBP was 13.2% (95% CI = 8.6%-18.4%; k = 2 articles) for acute and 30.7% (95% CI = 11.3%-52.2%; k = 7 articles) for chronic LBP. The frequency of LBP estimated over the total number of pain complaints was 39.6% (95% CI = 23.0%-56.8%; k = 10 articles).</p><p><strong>Conclusion: </strong>The overall estimate shows that three out of 10 hemodialysis patients suffer from LBP. This condition is accountable for nearly 40% of pain complaints in such patients. The quality of evidence for the pooled estimates is low or very low, and future prevalence studies with adequate statistical power and definitions of LBP are needed to provide more accurate data.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 1","pages":"16-25"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12029389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric lumbar disc herniation: A systematic review of the state of management strategies and outcomes (2010-2024).","authors":"Gerald Musa, Wila Namonje, Keith Simfukwe, Karina Marisel Familia, Bupe Mumba Mwela, Dimitri T K Ndandja, Manuel De Jesus Encarnacion Ramirez, Samuel Chilawa, Kachinga Agrippa Sichizya, Laston Chikoya, Gennady E Chmutin, Andreas K Demetriades","doi":"10.4103/jcvjs.jcvjs_3_25","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_3_25","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric lumbar disc herniation (LDH) presents unique challenges compared to adult cases due to anatomical and developmental differences in the spine. This systematic review aims to consolidate evidence on the management and outcomes of pediatric LDH.</p><p><strong>Research question: </strong>What are the clinical outcomes and efficacy of conservative and surgical treatments for pediatric LDH?</p><p><strong>Materials and methods: </strong>A systematic review of studies from 2010 to 2024 was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Databases including PubMed, Embase, Scopus, and Cochrane Library were searched for studies reporting on pediatric LDH treatment outcomes. Pain, disability, recurrence, and complication rates were extracted and assessed. The Joanna Briggs Institute checklist was used to evaluate bias.</p><p><strong>Results: </strong>The review included 861 pediatric patients across 14 studies, with a mean age of 14.88 years and a male predominance (59.6%). The most commonly affected levels were L5/S1 (53%) and L4/L5 (43.8%). Conservative treatment was employed in 9.9% (n = 66), whereas microdiscectomy, endoscopic discectomy, and fusion were performed in 53.7% (n = 360), 32.2% (n = 216), 4.2% (n = 28), respectively. Postoperatively, improvements in pain (Visual Analog Scale: 6.15-1.33) and disability (Oswestry Disability Index: 42.09-7.01) were noted. The recurrence rate was 1.7% postoperatively and 42.4% following conservative management (average follow-up period of 23.78 months). Complication rate was 3%.</p><p><strong>Discussion and conclusion: </strong>Pediatric LDH is primarily associated with sports-related trauma. Minimally invasive techniques such as endoscopic and microdiscectomy demonstrate good early and long-term outcomes, and low complications and recurrence rates. There is a paucity of studies comparing management techniques, particularly ones discussing conservative management, which may represent underreporting.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 1","pages":"34-40"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12029382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How does cervical and cervicothoracic alignment impact horizontal gaze?","authors":"Muñoz Montoya Juan Esteban, Ramachandran Karthik, Kelly Razmeender Singh, Shetty Ajoy Prasad, Shanmuganathan Rajasekaran","doi":"10.4103/jcvjs.jcvjs_199_24","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_199_24","url":null,"abstract":"<p><strong>Background: </strong>Cervical sagittal alignment maintains horizontal gaze, supports the axial load of the skull, and has a reciprocal relationship to the cervicothoracic sagittal alignment. Studies are being conducted on different ethnicities, but little literature exists about cervical sagittal alignment and correlation chains in the Indian population. Therefore, we decided to study the impact of cervical and cervicothoracic alignment on horizontal gaze.</p><p><strong>Methods: </strong>This is a retrospective cross-sectional study where an asymptomatic adult population from India was enrolled between 18 and 50 years old. The following parameters were measured on lateral cervical x-ray: McGregor slope (McGS), C0-C2 angle, C1-C2 angle, C2 slope, Cervical Lordosis (CL) C2-C7, C7 slope, sagittal vertical axis C2-C7, thoracic inlet angle, neck tilt and T1 slope (T1S). The results were stratified in upper and lower cervical alignment, cervicothoracic alignment, and horizontal gaze parameters (McGS) using Pearson's correlation coefficient.</p><p><strong>Results: </strong>One hundred and four individuals were included. C7 Slope strongly correlated with T1S (r = 0.675, P = 0.000) and a chain of correlation was found between T1S with CL: C2-C7 (r = --0.602), then C0-C2 angle (r = --0.483) and C1-C2 angle (r = --0.592), finally, the McGS (Horizontal Gaze) (r = -0.709), all with P ≤≤ 0.000. The highest correlation was between the C2 Slope and T1S - CL mismatch (r = -0.946, P = 0.000).</p><p><strong>Conclusion: </strong>In the Indian population, a statistically significant correlation chain was found between the upper and lower cervical alignment parameters, cervicothoracic alignment parameters, and horizontal gaze parameters. T1S and C7 Slope are the foundation for starting this correlation chain between the cervical sagittal alignment and the horizontal gaze. In addition, a very important role of the C2 Slope in the cervical sagittal alignment was observed.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 1","pages":"108-113"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12029384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiological analysis of the sagittal profile of the Indian population according to the theoretical Roussouly classification.","authors":"Juan Esteban Muñoz Montoya, Niventhiran Kuppusamy, Ajoy Prasad Shetty, Rajasekaran Shanmuganathan","doi":"10.4103/jcvjs.jcvjs_152_24","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_152_24","url":null,"abstract":"<p><strong>Background: </strong>Pierre Roussouly et al. classified four distinct types of sagittal profiles in normal individuals based on their sacral slope (SS). It was modified by Laouissat et al., (theoretical) including a fifth type.</p><p><strong>Study design: </strong>The study design was a cross-sectional study.</p><p><strong>Objective: </strong>The objective of this study was to identify and classify the types of sagittal alignment present in an asymptomatic Indian population using the parameters established by Roussouly et al. and modified by Laouissat et al.</p><p><strong>Methods: </strong>The inclusion criteria were asymptomatic adults between 18 and 50 years old, without history of spinal surgery or significant musculoskeletal disorders. The sagittal profile was classified according to the Roussouly modified (theoretical) classification. The spinopelvic parameters were measured using Surgimap and the correlation analysis was performed using Pearson's correlation coefficient.</p><p><strong>Results: </strong>A total of 104 participants (62 females and 42 males) were recruited and it was observed 26 (25%) participants with Type 1, 12 (11.5%) with the Type 2, 26 (25%) with Type 3, 30 (28.8%) Type 3AP, and 10 (9.6%) participants with the Type 4. Furthermore, the study showed that the Type 3 anteverted pelvic (AP) had similar characteristics compared with the Laouissat's study. The pelvic incidence shows a correlation with SS (r = 0.602, P = 0.001) and pelvic tilt (r = 0.613, P = 0.001). SS is also correlated with lumbar lordosis (r = 0.734, P = 0.001).</p><p><strong>Conclusion: </strong>The analysis of the study showed that the Type 3 AP is the sagittal profile more frequency according to the theoretical Roussouly classification in the asymptomatic Indian population.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 1","pages":"66-71"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12029391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The statistical fragility of vertebroplasty outcomes: A systematic review of randomized controlled trials.","authors":"Alexander Yu, Kareem S Mohamed, Mark Kurapatti, Junho Song, Jonathan J Huang, Prabhjot Singh, Yazan Alasadi, Abhijeet Grewal, Avanish Yendluri, Nikan Namiri, John Corvi, Jun S Kim, Samuel K Cho","doi":"10.4103/jcvjs.jcvjs_13_25","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_13_25","url":null,"abstract":"<p><p>Randomized clinical trials (RCTs) on vertebroplasty are crucial for guiding the treatment of vertebral compression fractures, but their overlooked statistical fragility can undermine clinical reliability. Minor outcome changes may overturn significant findings, risking unreliable evidence, and impacting patient care. This study assessed the fragility of significant outcomes in vertebroplasty RCTs, hypothesizing high sensitivity to such changes. PubMed, Embase, and MEDLINE were searched for RCTs on vertebroplasty reporting dichotomous outcomes. The fragility index (FI) and reverse FI quantified the number of outcome reversals needed to change statistical significance for significant and nonsignificant results, respectively. The fragility quotient (FQ) was calculated as the FI divided by the study sample size. Subgroup analysis was conducted by outcome category. A total of 276 outcomes from RCTs were analyzed. The median FI was 5 (interquartile range [IQR]: 4-5), with a FQ of 0.053 (IQR: 0.019-0.088). Statistically significant outcomes (n = 36) had a median FI of 3 (IQR: 2-4) and FQ of 0.034 (IQR: 0.018-0.051), whereas nonsignificant outcomes (n = 240) showed a median FI of 5 (IQR: 4-5) and FQ of 0.062 (IQR: 0.021-0.088). Fracture-related outcomes were the most robust (FI: 5, FQ: 0.088), whereas cement leakage was the most fragile (FI: 3, FQ: 0.041). Pain outcomes had an FI of 5 (FQ: 0.062), and complications and vertebroplasty versus kyphoplasty outcomes were more robust (FI: 5, FQ: 0.013). Patients lost to follow-up exceeded the FI in 79% of outcomes. The statistical findings in vertebroplasty RCTs are fragile and warrant cautious interpretation. A small number of outcome reversals or consistent postoperative follow-up can shift the significance of the results. Standardized reporting of P values alongside FI and FQ metrics is recommended to help clinicians evaluate the robustness of study findings.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 1","pages":"26-33"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12029381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}