Asian Spine Journal最新文献

{"title":"Transforaminal \"in-out-in\" screw technique for posterior C2 fixation in cases with a narrow C2 pedicle: anatomical considerations, technical notes, and preliminary clinical results.","authors":"Jun Yan, Cheng Qiu, Lei Qi, Lei Cheng, Yan-Ping Zheng, Xin-Yu Liu","doi":"10.31616/asj.2025.0160","DOIUrl":"https://doi.org/10.31616/asj.2025.0160","url":null,"abstract":"<p><p>Numerous techniques for C2 screw fixation have been recently reported. However, concerns remain regarding the risk of spinal cord or vertebral artery injury and inadequate biomechanical stability. To our knowledge, the specific transforaminal \"in-out-in\" screw fixation technique has not been previously reported. This study aimed to investigate the feasibility and preliminary clinical outcomes of a transforaminal \"in-out-in\" multi-cortical purchase screw for posterior C2 screw fixation. Between October 2022 and March 2023, 10 patients underwent posterior atlantoaxial internal fixation. All patients had severe hypoplasia of the C2 pedicle on at least one side, precluding the use of standard C2 pedicle screws. A transforaminal \"in-out-in\" screw was used as an alternative. No spinal cord injury, vascular injury, or other major complications were observed. No implant failure was noted at the final follow-up. In conclusion, the transforaminal \"in-out-in\" screw may achieve rigid three-column fixation with multiple cortical purchases. It represents a safe and effective alternative for posterior C2 fixation in patients with severely narrow C2 pedicles where traditional pedicle screw placement is not feasible.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of C5 palsy in anterior cervical decompression & fusion, posterior cervical decompression & fusion and laminoplasty for degenerative cervical myelopathy: systematic review and meta-analysis of 21,231 cases.","authors":"Sathish Muthu, Guna Pratheep Kalanchiam, Sathish Munisamy, Vibhu Krishnan Viswanathan","doi":"10.31616/asj.2025.0220","DOIUrl":"https://doi.org/10.31616/asj.2025.0220","url":null,"abstract":"<p><p>C5 palsy (C5P) is a common, yet poorly understood complication of cervical decompressive surgery, causing substantial disability and impacting postoperative quality of life. Despite extensive research, the actual incidence and distribution of C5P across different cervical surgical approaches over the past decade remain unclear. A comprehensive literature search was conducted on October 15, 2024, across Google Scholar, Embase, PubMed, Web of Science, and Cochrane Library databases. Studies reporting C5P incidence following surgery for degenerative cervical conditions, published until 2024, were included, excluding reviews, opinions, letters, and non-English manuscripts. Ninety-seven articles were included, encompassing 21,231 patients undergoing decompressive cervical surgery for degenerative cervical myelopathy. The overall incidence of postoperative C5P was 7% (95% confidence interval [CI], 4%-10%). The highest incidence was observed with circumferential fusion (combined anterior-posterior approach) at 16% (95% CI, 8%-24%), while the lowest was with anterior cervical decompression and fusion at 4% (95% CI, 3%-5%). Incidence rates following laminoplasty and laminectomy and fusion were 6% (95% CI, 5%-7%) and 10% (95% CI, 8%-12%), respectively. Recovery time ranged from 20.9 to 35 weeks, with 19.1%-33% of patients experiencing residual weakness. Significant risk factors included male sex, preoperative intervertebral foraminal stenosis, ossified posterior longitudinal ligament, open-door laminoplasty, laminectomy (with/without fusion), and excessive spinal cord shift. The role of C4-5 foraminotomy remains contested. Our meta-analysis identifies the posterior surgical approach as a significant risk factor for C5P. Circumferential fusion poses the highest risk, while laminoplasty can reduce the risk compared to laminectomy (alone or with instrumented fusion).</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of lateral fusion in single-level oblique lateral lumbar interbody fusion: a retrospective analysis of fusion patterns and clinical outcomes.","authors":"Tong Yongjun, Song Haixin, Fu Chudi, Liu Junhui, Huang Bao, Fan Shunwu, Zhao Fengdong","doi":"10.31616/asj.2025.0191","DOIUrl":"https://doi.org/10.31616/asj.2025.0191","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>This study aimed to (1) determine the incidence of lateral fusion following single-level oblique lateral interbody fusion (OLIF); (2) identify risk factors associated with the development of lateral fusion; (3) evaluate the effect of different fusion patterns on interbody cage subsidence rates; and (4) assess whether fusion patterns influence postoperative clinical outcomes.</p><p><strong>Overview of literature: </strong>Fusion characteristics following OLIF differ from those seen in conventional transforaminal lumbar interbody fusion, most notably due to lateral fusion marked by extra-vertebral bony bridging (EVB). EVB may develop early postoperatively, suggesting a potential mechanism for early interbody fusion.</p><p><strong>Methods: </strong>This retrospective cohort study included 153 single-level OLIF cases between January 2016 and December 2023. Postoperative computed tomography was used to classify patients into central fusion, lateral fusion, and non-fusion groups. Demographic, surgical, and radiographic parameters-including osteophyte grade, Hounsfield unit (HU) values, and cage positioning-were analyzed to identify factors affecting fusion. Cage subsidence and clinical outcomes (Oswestry Disability Index [ODI], Visual Analog Scale) were compared across groups.</p><p><strong>Results: </strong>Lateral fusion occurred in 39.9% of cases, central in 56.9%, and non-fusion in 3.2%. Preoperative osteophytes and higher HU values were associated with lateral fusion (p<0.001). OLIF with standalone cages (OLIF-SA) had a significantly higher lateral fusion rate than OLIF with posterior screw fixation (OLIF-PS) (p=0.002). Smoking was a significant risk factor for non-fusion (p=0.005). No significant difference in cage subsidence was observed between central and lateral fusion, but non-fusion showed more severe subsidence. Clinical outcomes improved across fusion groups, though non-fusion cases had worse ODI scores at follow-up.</p><p><strong>Conclusions: </strong>Lateral fusion is a distinct OLIF feature influenced by osteophytes, bone density, and fixation type. It does not negatively affect cage subsidence or outcomes, but solid fusion remains essential for recovery. These findings enhance understanding of OLIF fusion and may guide surgical planning.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Verification of ideal screw size, trajectory, and shape for single and double endplate penetrating screw trajectories using osteoporotic vertebral body models based on the finite element method.","authors":"Takumi Takeuchi, Kaito Jinnai, Yosuke Kawano, Kazumasa Konishi, Masahito Takahashi, Hitoshi Kono, Naobumi Hosogane","doi":"10.31616/asj.2025.0268","DOIUrl":"https://doi.org/10.31616/asj.2025.0268","url":null,"abstract":"<p><strong>Study design: </strong>This is a finite element study.</p><p><strong>Purpose: </strong>To identify optimal trajectory, screw size, and screw shape using the finite element method.</p><p><strong>Overview of literature: </strong>Patients with diffuse idiopathic skeletal hyperostosis often develop spinal instability after fractures due to ankylosis and bone fragility. We developed single or double endplate penetrating screw trajectory (SEPST/DEPST) to improve fixation strength by penetrating the vertebral endplate. However, the optimal screw length, diameter, and shape remain unclear.</p><p><strong>Methods: </strong>Finite element models of T12 and L1 were constructed from computed tomography images of osteoporotic patients. Three analyses were conducted: (1) the impact of various screw diameters with DEPST, (2) a comparison of fixation strength between short DEPST (S-DEPST), which penetrates the posterolateral endplate, and conventional DEPST (C-DEPST), and (3) a comparison between conventional cancellous thread screws (CTS) and endplate screws (ETS). Pullout strength (POS) was measured in all analyses. Vertebral motion angle (VMA) of the lower instrumented vertebra (LIV) was measured in analyses (2) and (3), and the four-directional load test (4DLT) was performed in analysis (2).</p><p><strong>Results: </strong>Larger screw diameters with DEPST correlated with elevated POS. S-DEPST demonstrated significantly better fixation strength with a POS 1.46 times higher than C-DEPST and 2.5 times higher than traditional trajectories. S-DEPST also demonstrated higher fixation in all directions in 4DLT. However, no significant difference was observed in the VMA of LIV. ETS demonstrated slightly higher fixation than CTS, but the difference was not statistically significant.</p><p><strong>Conclusions: </strong>Fixation strength improved with larger screw diameters in DEPST. S-DEPST provided additional fixation due to rim penetration. ETS may offer a higher fixation strength and warrants further validation.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trans-spinal myogenic evoked potentials: a novel intraoperative technique for localizing motor deficits following loss of transcranial motor evoked potentials.","authors":"Heena Parihar, Uditi Gupta, Megha Bir, Ashok Kumar Jaryal, Bhavuk Garg, Parin Lalwani","doi":"10.31616/asj.2025.0307","DOIUrl":"https://doi.org/10.31616/asj.2025.0307","url":null,"abstract":"<p><p>Trans-spinal motor evoked potentials (TsMEP) represent a novel intraoperative neuromonitoring technique designed to localize motor deficits when transcranial motor evoked potentials (TcMEP) are lost or unreliable. This technique involves direct electrical stimulation of the spinal cord through pedicle screws using a train of biphasic square-wave pulses, with myogenic responses recorded from limb muscles. In the presented case of kyphoscoliosis correction, TsMEP was employed after TcMEP signals failed to recover despite corrective measures. Stimulation at various vertebral levels allowed TsMEP to localize the level of motor pathway compromise, guiding targeted decompression. Unlike sensory-based methods such as dynamic spinal cord mapping, TsMEP directly evaluates motor tract integrity and provides real-time, segmental information without the need for epidural instrumentation. This technique also enabled monitoring of functional recovery through threshold changes, demonstrating its clinical utility. TsMEP holds promise as an intraoperative diagnostic and decision-making tool, especially in complex spinal surgeries with high neurological risk.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of screw loosening on health-related quality of life following single-level posterior lumbar interbody fusion: a retrospective study in Japan.","authors":"Hiroki Ushirozako, Tomohiko Hasegawa, Shigeto Ebata, Tetsuro Ohba, Hiroki Oba, Keijiro Mukaiyama, Yu Yamato, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Koichiro Ide, Tomohiro Yamada, Kenta Kurosu, Toshiyuki Ojima, Jun Takahashi, Hirotaka Haro, Yukihiro Matsuyama","doi":"10.31616/asj.2025.0295","DOIUrl":"https://doi.org/10.31616/asj.2025.0295","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective multicenter study.</p><p><strong>Purpose: </strong>This study aimed to examine the impact of screw loosening (SL) on health-related quality of life (HRQOL) following posterior lumbar interbody fusion (PLIF).</p><p><strong>Overview of literature: </strong>The rising prevalence of degenerative spinal conditions has led to an increase in lumbar surgeries, including PLIF. SL after PLIF remains challenging; however, its impact on HRQOL remains unclear.</p><p><strong>Methods: </strong>This study included 138 patients who underwent PLIF, with a mean age of 67 years and a follow-up period of 12 months. At 12 months postoperatively, lumbar computed tomography (CT) was performed to assess SL, and patients were categorized into SL and nonloosening (NL) groups accordingly. A propensity score-matched model was used to adjust for age, sex, and body mass index (BMI). Propensity score matching was performed to compare outcomes between the SL and NL groups.</p><p><strong>Results: </strong>Among the 138 patients, 29 (21%) developed SL following PLIF. Preliminary analysis revealed that the patients in the SL group were older and exhibited decreased femoral neck bone mineral density, preoperative pelvic retroversion, poor whole spine alignment, and lesser improvement in HRQOL compared with the NL group. Using propensity score matching, 22 patients were selected from each group (mean age, 72 years) (C-statistic=0.78). The propensity score-matched analysis demonstrated significant differences in the preoperative pelvic tilt (25.9° vs. 17.8°, p=0.010) between the matched SL and NL groups. Furthermore, the Oswestry Disability Index scores indicated poorer improvements in the matched SL group than in the matched NL group at 9 months postoperatively (p=0.025).</p><p><strong>Conclusions: </strong>After matching, pre- and postoperative pelvic retroversion were significantly associated with SL. Patients with SL experienced significantly poorer improvement in HRQOL at 9 months postoperatively. Therefore, implementing strategies for preventing SL may enhance early postoperative HRQOL.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting residual neurologic deficits using the Spinal Infection Treatment Evaluation score after surgery for thoracic and lumbar spinal epidural abscess: a retrospective study in Taiwan.","authors":"Jian-Jiun Chen, Hsi-Hsien Lin, Po-Hsin Chou, Shih-Tien Wang, Chien-Lin Liu, Yu-Cheng Yao","doi":"10.31616/asj.2025.0285","DOIUrl":"https://doi.org/10.31616/asj.2025.0285","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, consecutive case series.</p><p><strong>Purpose: </strong>We assessed the predictive validity of the Spinal Infection Treatment Evaluation (SITE) score to determine the likelihood of residual neurological deficits (ND) following surgical treatment of spinal epidural abscess (SEA).</p><p><strong>Overview of literature: </strong>SEA is a severe spinal infection that can result in irreversible ND and sepsis if left untreated. Although various risk factors have been proposed to predict postoperative neurological outcomes, the optimal predictors remain unclear.</p><p><strong>Methods: </strong>A total of 45 patients diagnosed with de novo thoracic or lumbar SEA who underwent posterior-only surgical decompression between 2005 and 2014, with a minimum postoperative follow-up of 2 years, were included. Patients were stratified based on the presence or absence of postoperative residual ND, and neurological function was assessed immediately after surgery and at the final followup using the Frankel grading system. SITE scores, along with clinical and radiological data associated with residual ND, were collected. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify significant predictors.</p><p><strong>Results: </strong>Patients with residual ND had significantly lower SITE scores than those without residual ND (4.3±1.3 vs. 7±1.8, p<0.0001). Multivariate analysis identified the SITE score as an independent predictor (odds ratio, 2.70; p=0.012). ROC analysis showed that a SITE score ≤6 predicted residual ND with 73.3% sensitivity and 100% specificity, with an area under the curve of 0.877 (p<0.001). Other significant predictors included cauda equina syndrome and a shorter symptom-to-surgery interval, both of which were associated with a higher risk of residual ND.</p><p><strong>Conclusions: </strong>The SITE score is a reliable and independent predictor of residual ND after surgery for SEA. SITE scores <6 indicate a significantly higher risk of postoperative ND.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to work rate and long-term effectiveness of delayed versus early surgery for back pain and sciatica in Russian Railways employees: a single-center retrospective study.","authors":"Vadim Byvaltsev, Andrei Kalinin, Yurii Pestryakov, Elmira Satardinova, Ravshan Yuldashev, Marat Aliyev, Yermek Dyussembekov, Andrei Shcherbatykh, K Daniel Riew","doi":"10.31616/asj.2025.0132","DOIUrl":"https://doi.org/10.31616/asj.2025.0132","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Purpose: </strong>To evaluate the return-to-work rate and long-term outcomes of delayed versus early surgery for back pain and sciatica among railway workers.</p><p><strong>Overview of literature: </strong>The timing of conservative versus surgical treatment and their long-term clinical effectiveness remain controversial. To our knowledge, there are no studies on the long-term postoperative outcomes and risk factors for unsatisfactory long-term clinical outcomes after conservative and surgical treatment of lumbar degenerative diseases in railway workers.</p><p><strong>Methods: </strong>We identified patients with persistent back pain and sciatica due to lumbar degeneration at L4-L5 or L5-S1 treated between 2010 and 2020. Two groups of patients were identified: The Delayed group (n=692) initially refused operative care despite 6-12 weeks of non-operative care, and the Early group (n=1,687) underwent surgery immediately after routine (6-12 weeks) non-operative care was unsuccessful. Perioperative clinical data and return-to-work rates were obtained before surgery and at a minimum of 40 months postoperatively. Factors associated with unfavorable outcomes were also identified.</p><p><strong>Results: </strong>At baseline, the two groups had comparable clinical data, demographics, and workload intensity. There were significantly better clinical results, fewer complications, and a higher frequency of return to work in the Early group than in the Delayed group (p<0.05); 15.3% (209) and 25.7% (147) of the patients in the Early and Delayed groups, respectively, had unsatisfactory long-term clinical outcomes. Specific factors associated with unsatisfactory long-term clinical outcomes in the delayed surgery group were male sex, diabetes mellitus, lower extremity pain Visual Analog Scale >40 mm, Oswestry Disability Index >48%, physical component score <18 points, preoperative use of narcotic analgesics, and light-to-medium and heavy-to-very heavy preoperative workload.</p><p><strong>Conclusions: </strong>In this single-center study involving railway workers with lumbar degenerative back pain and sciatica, early surgery was superior to delayed surgery in terms of pain intensity, functional status, quality of life, return-to-work rate, and reoperation rate at the long-term follow-up. Further prospective studies with larger sample sizes are required to clarify this association.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new logistic regression model for the detection of chronic low back pain, based on a case-control study in the Spanish population.","authors":"Pilar Alberola-Zorrilla, Ana Queralt, Maria Ángeles Pamblanco-Valero, Daniel Sánchez-Zuriaga","doi":"10.31616/asj.2025.0336","DOIUrl":"https://doi.org/10.31616/asj.2025.0336","url":null,"abstract":"<p><strong>Study design: </strong>Case-control study comparing healthy individuals and patients with chronic non-specific low back pain (NSLBP).</p><p><strong>Purpose: </strong>To compare detailed spinal motion and muscle activity patterns-recorded simultaneously using non-invasive methods-between chronic NSLBP patients and pain-free individuals, and to identify the most clinically useful variables for discriminating between the two groups.</p><p><strong>Overview of literature: </strong>Motion analysis and electromyography (EMG) have been widely used to differentiate NSLBP patients from pain-free individuals. However, due to methodological heterogeneity across studies, the results have been inconsistent, limiting the clinical applicability of the findings.</p><p><strong>Methods: </strong>Forty-three pain-free controls and 43 patients with chronic NSLBP were enrolled. Using non-invasive techniques, synchronized lumbar spine motion and erector spinae (ES) EMG activity were recorded during standardized trunk flexion-extension cycles.</p><p><strong>Results: </strong>Several variables differed significantly between the two groups. Logistic regression identified two variables with significant odds ratios for the presence of chronic NSLBP: time spent with the spine flexed beyond 90% of its maximum range (odds ratio, 0.92; 95% confidence interval, 0.86-0.99) and the ES relaxation ratio (odds ratio, 1.08; 95% confidence interval, 1.04-1.13).</p><p><strong>Conclusions: </strong>Individuals with and without chronic NSLBP exhibit distinct spinal motion and ES activity patterns during trunk flexionextension. These differences-specifically the time of maximum lumbar flexion and the relaxation ratio-can be objectively and easily measured. Their assessment may offer valuable clinical utility for the diagnosis and follow-up of NSLBP patients.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of multilevel anterior cervical discectomy and fusion utilizing zero-profile self-locking cages versus the cage-with-plate system: a 5-year-minimum follow-up study.","authors":"Haoyu He, Zhiwei Yang, Lini Dong, Ou Zhang, Yunlong Liao, Changyu Pan, Lei Kuang","doi":"10.31616/asj.2025.0107","DOIUrl":"https://doi.org/10.31616/asj.2025.0107","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Purpose: </strong>To compare the clinical and radiological outcomes of self-locking cage (SC) and cage-with-plate (PC) systems in three-level anterior cervical discectomy and fusion (ACDF) over a 5-year follow-up period.</p><p><strong>Overview of literature: </strong>The durability of SCs in maintaining cervical alignment and preventing complications over an extended period of time remains uncertain.</p><p><strong>Methods: </strong>Sixty-two patients (2014-2019) were divided into the SC (n=32) and PC (n=30) groups. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), modified Japanese Orthopedic Association (mJOA) score, and Neck Disability Index (NDI). Radiological parameters, including cervical lordosis (CL), fused segment angle (FSA), and disc height (DH), were assessed. Cage subsidence, adjacent segment degeneration (ASD), and other complications were also documented. The relationship between postoperative radiological changes and symptoms was also analyzed.</p><p><strong>Results: </strong>Both groups showed significant improvement in symptoms, with fusion achieved in all surgical segments. The SC group had a shorter operative time and reduced intraoperative blood loss. However, the SC group had a higher subsidence rate (16.7% vs. 5.6%, p=0.017). The PC group maintained better cervical alignment in terms of CL, FSA, and DH (p<0.05), with an increased incidence of dysphagia and ASD (p<0.05). Spearman correlation analyses showed that neither CL nor FSA loss at the 5-year follow-up was significantly associated with improvements in the mJOA, VAS, and NDI scores (p>0.05) in either group. Regression analyses indicated that subsidence or loss of lordosis did not correlate with the degree of postoperative symptoms (p<0.05).</p><p><strong>Conclusions: </strong>Both SC and PC achieved sustained pain relief, neurological improvement, and solid fusion in three-level ACDF at the 5-year follow-up. SC demonstrated significant advantages in reducing dysphagia and ASD, while PC better maintained cervical alignment and segmental stability. Patient-specific factors should be used to guide implant selection. Further multicenter studies are required to validate these findings.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}