Juan Esteban Muñoz Montoya, Karthik Ramachandran, Praveen R Iyer, Ajoy Prasad Shetty, Shanmuganathan Rajasekaran
{"title":"Is there a direct correlation between cervical sagittal alignment and spinopelvic sagittal alignment?: an observational study from asymptomatic Indian adults.","authors":"Juan Esteban Muñoz Montoya, Karthik Ramachandran, Praveen R Iyer, Ajoy Prasad Shetty, Shanmuganathan Rajasekaran","doi":"10.31616/asj.2025.0145","DOIUrl":"https://doi.org/10.31616/asj.2025.0145","url":null,"abstract":"<p><strong>Study design: </strong>Observational study.</p><p><strong>Purpose: </strong>Cervical parameters play a vital role in maintaining global spinal sagittal alignment, but their correlation with spinopelvic parameters remains unclear. This study aimed to investigate potential direct correlations between cervical sagittal alignment and spinopelvic alignment in an asymptomatic population.</p><p><strong>Overview of literature: </strong>Previous studies have demonstrated a direct relationship between pelvic parameters, lumbar lordosis (LL), and thoracic kyphosis (TK), as well as a direct correlation between cervical lordosis (CL) and TK. However, the direct influence of pelvic parameters and LL on cervical parameters remains unclear, warranting further research.</p><p><strong>Methods: </strong>This study involved 104 asymptomatic adults (females 62 [59.6%]) aged 18-50 years. Whole-spine standing lateral radiographs were obtained, and the pelvic, lumbar, thoracic, cervicothoracic, and cervical parameters were studied. Pearson's correlation coefficient was used to assess correlations, with a significance threshold of p<0.05.</p><p><strong>Results: </strong>The mean age of participants was 38.27±9.93 years. The pelvic incidence (PI) significantly correlated with C7 slope (r=-0.212, p=0.05). The pelvic tilt (PT) exhibited significant correlations with T1 slope-CL mismatch (r=-0.229, p=0.05) and C2 slope (r=-0.202, p=0.05). Furthermore, PI-LL mismatch showed a significant correlation with TIA (r=-0.197, p=0.05), T1 slope (r=-0.228, p=0.05), and C7 slope (r=-0.251, p=0.05).</p><p><strong>Conclusions: </strong>This study reveals a significant correlation between cervical and spinopelvic parameters, emphasizing the interconnectedness of pelvic, lumbar, thoracic, and cervical spine parameters.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940311","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":"Identifying early risk factors for chronic pain development following vertebral fractures: a single-center prospective cohort study.","authors":"Yutaro Kondo, Hideki Kataoka, Kyo Goto, Koichi Nakagawa, Yutaro Nomoto, Junichiro Yamashita, Kaoru Morita, Nobuya Aso, Yuki Nshi, Junya Sakamoto, Minoru Okita","doi":"10.31616/asj.2025.0147","DOIUrl":"https://doi.org/10.31616/asj.2025.0147","url":null,"abstract":"<p><strong>Study design: </strong>Longitudinal cohort study.</p><p><strong>Purpose: </strong>To investigate factors associated with chronic pain (CP) development following vertebral fracture (VF).</p><p><strong>Overview of literature: </strong>Factors contributing to CP development after VFs are not well characterized.</p><p><strong>Methods: </strong>Hospitalized patients with acute VFs underwent assessment of vertebral morphology and paraspinal muscles. Two weeks post-admission, patients were evaluated for pain intensity (using the Verbal Rating Scale [VRS]), pain sensitivity (Pressure Pain Threshold [PPT] and Conditioned Pain Modulation), psychological factors, physical function, and activity levels. At 12 weeks, patients were categorized into CP and non-CP (NCP) groups based on VRS scores. Between-group comparisons and logistic regression analysis were performed to identify predictors of CP development.</p><p><strong>Results: </strong>The CP group exhibited significantly lower remote PPT and reduced low-intensity physical activity time, but higher Pain Catastrophizing Scale rumination scores and prolonged 5-Times Sit-to-Stand Test (5SST) compared to the NCP group. Logistic regression identified prolonged 5SST and reduced low-intensity physical activity as independent predictors of CP development.</p><p><strong>Conclusions: </strong>Prolonged 5SST and reduced low-intensity physical activity may predict CP development after VFs. Early assessment of these factors may facilitate CP risk screening in hospitalized patients with VFs.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940356","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":"Preoperative bone mineral density quantitatively assessed by Hounsfield units is associated with failed back surgery syndrome after lumbar fusion surgery: a retrospective study.","authors":"Longlong Qiu, Haocheng Xu, Liming Yu, Xiaojie Chen, Junwei Qu, Xinlei Xia, Chaojun Zheng, Qiwang Chen","doi":"10.31616/asj.2025.0129","DOIUrl":"https://doi.org/10.31616/asj.2025.0129","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Purpose: </strong>To evaluate preoperative bone mineral density (BMD), as quantified by computerized tomography (CT)-derived Hounsfield unit (HU) values, in patients who underwent lumbar fusion and to examine the link between BMD and failed back surgery syndrome (FBSS).</p><p><strong>Overview of literature: </strong>FBSS is a serious complication affecting 10%-40% of patients undergoing lumbosacral spinal surgery. Given the detrimental impact of FBSS on the psychological and physiological wellbeing of patients, preoperative identification of those at risk for developing FBSS and the implementation of targeted interventions to minimize this complication are highly important.</p><p><strong>Methods: </strong>Preoperatively, all 115 patients underwent BMD assessments using both CT-derived HUs and dual-energy X-ray absorptiometry and were administered multiple questionnaires, including the Pain Catastrophizing Scale (PCS), Beck Anxiety Inventory (BAI), and Beck Depression Index (BDI). Both pain intensity and pain-related disability were assessed before and after lumbar fusion surgery.</p><p><strong>Results: </strong>Postoperatively, 14 patients (14/115, 12.2%) experienced FBSS. Multivariate logistic regression was used to examine all preoperative covariates with significant differences between the patients with and without FBSS. The numeric rating pain scale score at rest, BAI score, PCS score, and HU value were found to be independently associated with FBSS (p<0.05).</p><p><strong>Conclusions: </strong>This study revealed that preoperative BMD, as quantified by CT-derived HU values, may be associated with FBSS. Preoperative assessments of CT-derived HU values might provide additional details for identifying patients susceptible to FBSS, which could help prevent this complication.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940380","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}
Jose Luis Bas, Jorge Campos, Gonzalo Mariscal, Hashem Altabbaa, Paloma Bas, Teresa Bas
{"title":"The influence of obesity on the outcomes of endoscopic spinal surgery: a meta-analysis.","authors":"Jose Luis Bas, Jorge Campos, Gonzalo Mariscal, Hashem Altabbaa, Paloma Bas, Teresa Bas","doi":"10.31616/asj.2025.0121","DOIUrl":"https://doi.org/10.31616/asj.2025.0121","url":null,"abstract":"<p><p>Obesity is an escalating health problem that has been increasingly associated with surgical complications. In general, open surgical techniques worsen these complications, because they are more tissue-destructive and associated with a relatively long recovery period. Minimally invasive techniques, such as endoscopic spine surgery, appear to be good substitutes, because they reduce tissue iatrogenic injury and hasten recovery. However, the effect of obesity on the performance of endoscopic spine surgery remains uncertain. This metaanalysis was designed to evaluate the safety and efficacy of endoscopic spine surgery in patients with obesity compared with those without obesity. This study adhered to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. We conducted a thorough search using PubMed, Scopus, and Virtual Health Library. Methodological quality was assessed using the MINORS (Methodological Index for Non-randomized Studies) criteria. Mean differences (MD) and standardized mean differences with 95% confidence intervals (CI) were calculated. Statistical analyses were conducted using Review manager ver. 5.4.1. Seven studies involving 659 participants were analyzed. The obese and nonobese groups had no significant differences in operative time (MD, 9.86 minutes; 95% CI, -4.93 to 24.65); Visual Analog Scale (VAS) scores for back pain at 3 months (MD, 0.26; 95% CI, -0.11 to 0.63), 6 months (MD, 0.26; 95% CI, -0.05 to 0.56), and 12 months (MD, -0.54; 95% CI, -1.70 to 0.62); VAS leg pain scores at 3 months (MD, 0.17; 95% CI, -0.06 to 0.41), 6 months (MD, 0.23; 95% CI, -0.13 to 0.59), and 12 months (MD, 0.18; 95% CI, -0.10 to 0.45); Oswestry Disability Index scores at 3 months (MD, 1.02; 95% CI, -0.14 to 2.18) and 12 months (MD, 0.10; 95% CI, -1.14 to 1.33); and reherniation rate (odds ratio, 1.35; 95% CI, 0.73 to 2.49). Endoscopic surgery demonstrated no significant differences in outcomes between obese and nonobese patients and was safe and effective for this patient population.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940330","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":"Comparative efficacy of S2-alar-iliac versus iliac screw techniques in treating adult spinal deformity: a meta-analysis of postoperative outcomes and complications.","authors":"Amit Saraf, Sanjeev Kumar Jain, Sonika Sharma","doi":"10.31616/asj.2024.0506","DOIUrl":"https://doi.org/10.31616/asj.2024.0506","url":null,"abstract":"<p><p>Pelvic fixation has become increasingly important in treating spinal deformities that affect the lumbosacral junction. The sacral 2 alariliac screw (S2AI) and iliac screw (IS) fixations are two commonly used techniques. This meta-analysis aimed to systematically compare the clinical outcomes of S2AI and IS techniques in adult spinal deformity. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science databases, using combinations of keywords such as \"S2-alar-iliac,\" \"iliac screw,\" \"spinopelvic fixation,\" \"lumbosacral surgery,\" and \"clinical outcomes.\" The search was restricted to articles published up to October 2024. Sixteen studies were included in the analysis. The S2AI cohort showed significant advantages in terms of reduced estimated blood loss (mean difference [MD], -140.70; p=0.006), shorter hospital stays (MD, -1.50; p=0.01), and improved ambulatory status (MD, 0.22; p=0.004). Additionally, the S2AI group had significantly lower incidence of complications, including screw prominence (odds ratios [OR], 0.08; p=0.001), wound infection (OR, 0.24; p=0.0001), wound dehiscence (OR, 0.14; p=0.0001), and reduced need for revision surgeries (OR, 0.32; p=0.0001). There were no significant differences between the S2AI and IS cohorts regarding the sagittal vertical axis (MD, 1.49; p=0.23), Visual Analog Scale pain scores (MD, 0.01; p=0.94), operation time (MD, -31.23; p=0.28), postoperative Oswestry Disability Index (ODI) (MD, 0.14; p=0.84), implant failure (OR, 0.74; p=0.23), pelvic tilt (MD, -0.44; p=0.65), sacral slope (MD, -0.82; p=0.46), lumbar lordosis (MD, -0.19; p=0.89), or pelvic incidence (MD, -0.38; p=0.78). This meta-analysis suggests that while both S2AI and IS fixations have similar outcomes in terms of implant failure, operation time, and postoperative ODI, S2AI may have better outcomes in terms of revision, screw prominence, and wound complications.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940304","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}
Anthony E Bishay, Harsh Jain, Hani Chanbour, Jeffrey W Chen, Tyler Metcalf, Alexander T Lyons, Amir M Abtahi, Iyan Younus, Byron F Stephens, Scott L Zuckerman
{"title":"Predictors of blood loss, operative time, and length of stay in adult spinal deformity surgery: a retrospective cohort study in Southeastern United States.","authors":"Anthony E Bishay, Harsh Jain, Hani Chanbour, Jeffrey W Chen, Tyler Metcalf, Alexander T Lyons, Amir M Abtahi, Iyan Younus, Byron F Stephens, Scott L Zuckerman","doi":"10.31616/asj.2025.0154","DOIUrl":"https://doi.org/10.31616/asj.2025.0154","url":null,"abstract":"<p><strong>Study design: </strong>Single-center, retrospective cohort study of patients undergoing adult spinal deformity (ASD) surgery between 2009 and 2021.</p><p><strong>Purpose: </strong>To identify preoperative and intraoperative risk factors associated with increased estimated blood loss (EBL), operative time, and length of stay (LOS) in ASD surgery.</p><p><strong>Overview of literature: </strong>Identifying risk factors associated with these outcomes may help improve surgical planning and outcomes in ASD surgery.</p><p><strong>Methods: </strong>Inclusion criteria: ≥5-level fusion, sagittal/coronal deformity, and minimum 2-year follow-up. Primary outcomes were the highest quartile of EBL (mL), operative time (minutes), and LOS (days). EBL was calculated based on the hemoglobin drop. Bivariate analysis and multivariable logistic regression were performed, controlling for age, comorbidities, and preoperative radiographic parameters.</p><p><strong>Results: </strong>Among 238 patients (mean age, 63.4±17.4 years), the highest EBL quartile (2,594.0±1,550.5 mL) had more three-column osteotomies (3CO) (30.5% vs. 14.8%, p=0.008). Multivariable predictors of highest EBL were older age (odds ratio [OR], 1.03; p=0.039) and 3CO (OR, 3.60; p=0.007). The highest operative time quartile (618.9±99.4 minutes) had more 3CO (27.1% vs. 15.3%, p=0.041) and higher rod fracture rates (30.5% vs. 15.8%, p=0.014). Multivariable predictors of the highest operative time were higher total instrumented levels (TIL) (OR, 1.26; p<0.001) and older age (OR, 1.05; p=0.003). The highest LOS quartile (14.5±18.5 days) had more 3CO (27.3% vs. 14.3%, p=0.045). The multivariable predictor of highest LOS was higher TIL (OR, 1.23; p<0.001).</p><p><strong>Conclusions: </strong>Three-column osteotomy was the strongest predictor of perioperative morbidity in ASD surgery, consistently associated with higher blood loss, longer operative times, and prolonged hospital stays. Recognizing its impact can inform surgical strategies to improve patient outcomes.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940308","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 prospective study on age-specific normative values of the prognostic nutritional index and the effects of malnutrition on spinal alignment using health checkup data of elderly residents.","authors":"Shin Oe, Yu Yamato, Koichiro Ide, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Tomohiro Yamada, Kenta Kurosu, Yukihiro Matsuyama","doi":"10.31616/asj.2024.0547","DOIUrl":"https://doi.org/10.31616/asj.2024.0547","url":null,"abstract":"<p><strong>Study design: </strong>A prospective cohort study.</p><p><strong>Purpose: </strong>To determine the age-specific normative values of the prognostic nutritional index (PNI) among elderly residents in Japan and explore the relationship between malnutrition and spinal alignment.</p><p><strong>Overview of literature: </strong>Nutritional status affects postoperative recovery, with malnourished patients often experiencing severe postoperative complications. PNI is a known nutritional indicator based on serological value; however, there is a dearth of age-specific normative values for PNI, with even less research on the impact of malnutrition on spinal alignment.</p><p><strong>Methods: </strong>We included 237 participants from a 2-yearly resident health checkup conducted in Toei, Aichi, Japan. Participants underwent blood tests and whole-spine standing radiography, and were stratified based on age (60s, 70s, and 80s) and sex to determine age-specific normative PNI values. Additionally, participants were categorized into a lower PNI (PNI <50) or higher PNI (PNI ≥50) group to compare spinal alignment.</p><p><strong>Results: </strong>The average PNI values for different age groups were: 60s: males (n=13): 50.7, females (n=31): 50.9; 70s: males (n=55): 50.3, females (n=57): 50.1; 80s: males (n=28): 49.1, females (n=53): 48.3. For females, the radiographic spinal alignment parameters were comparable between the lower and higher PNI groups; however, in males, significant differences were noted for pelvic tilt (20° vs. 16°, p=0.020), lumbar lordosis (35° vs. 44°, p<0.001), and pelvic incidence minus lumbar lordosis (10° vs. 4°, p=0.013).</p><p><strong>Conclusions: </strong>Malnutrition in males negatively impacts their lumbar-pelvic alignment. While the normative PNI value decreases with age, the two variables show a very weak correlation.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939694","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}
Sehan Park, Dong-Ho Lee, San Kim, Chang Ju Hwang, Jae Hwan Cho
{"title":"Does residual foraminal stenosis at levels not covered by anterior cervical discectomy and fusion aggravate postoperative outcomes in cervical radiculopathy?","authors":"Sehan Park, Dong-Ho Lee, San Kim, Chang Ju Hwang, Jae Hwan Cho","doi":"10.31616/asj.2024.0501","DOIUrl":"https://doi.org/10.31616/asj.2024.0501","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>To evaluate whether untreated foraminal stenosis (FS) at levels not included in anterior cervical discectomy and fusion (ACDF) impacts postoperative outcomes in patients with cervical radiculopathy and assess if residual FS increases the risk of adjacent segment disease (ASD).</p><p><strong>Overview of literature: </strong>Level selection for ACDF for cervical radiculopathy is complex, considering variable patient anatomy and symptoms. It is unclear whether treating only potentially symptomatic levels could provide equivalent results to managing all pathologic levels.</p><p><strong>Methods: </strong>This was a retrospective cohort study of 188 patients undergoing ACDF for degenerative cervical radiculopathy between 2014 and 2020. Patients were divided into two groups: those with all symptomatic levels decompressed (No-FS group, n=162) and those with untreated FS at levels not targeted in surgery (FS group, n=26). Postoperative outcomes, including neck pain, arm pain, and Neck Disability Index (NDI), were evaluated at 3 months and 2 years. Radiographic parameters and ASD incidence were also compared between groups.</p><p><strong>Results: </strong>Both groups showed significant improvement in neck pain, arm pain, and NDI postoperatively, with no significant intergroup differences at 3 months and 2 years. C2-C7 lordosis and sagittal vertical axis showed similar improvement in both groups postoperatively. Rates of ASD and revision surgery did not differ significantly between No-FS and FS groups (5.6% vs. 7.7%, respectively; p=0.652). Logistic regression revealed no significant predictors of NDI improvement >50% among preoperative demographic or radiographic factors.</p><p><strong>Conclusions: </strong>Untreated FS at levels outside the surgical target area did not adversely affect ACDF outcomes or increase ASD risk over a 2-year follow-up. These findings suggest that ACDF can be safely limited to levels directly associated with patient symptoms without compromising clinical outcomes, potentially reducing the surgical extent and associated risks.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940363","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}
Guillermo Alejandro Ricciardi, Juan P Cabrera, Oscar Martínez, Javier Matta, Hugo Vilchis, Jeasson Javier Perez Ríos, Charles André Carazzo, Michael Dittmar, Ratko Yurac
{"title":"Spinal gunshot wounds and infection: a multicenter cohort study.","authors":"Guillermo Alejandro Ricciardi, Juan P Cabrera, Oscar Martínez, Javier Matta, Hugo Vilchis, Jeasson Javier Perez Ríos, Charles André Carazzo, Michael Dittmar, Ratko Yurac","doi":"10.31616/asj.2025.0119","DOIUrl":"https://doi.org/10.31616/asj.2025.0119","url":null,"abstract":"<p><strong>Study design: </strong>A multicenter retrospective cohort study.</p><p><strong>Purpose: </strong>To analyze the development of infectious complications from civilian gunshot wounds to the spine and their association with the type of prophylactic antibiotics administered and the duration of administration.</p><p><strong>Overview of literature: </strong>Despite the risk for infections following spinal gunshot wounds, no standardized guidelines exist for their management. The limited and low-quality evidence available underscores the need for further research.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated adult civilian patients (≥18 years) treated for spinal gunshot wounds at Latin American institutions between 2014 and 2022. Demographic, clinical, and injury characteristics, treatment approaches, and infectious complications were analyzed.</p><p><strong>Results: </strong>After exclusions, 292 patients, primarily adult males (n=251, 86.0%) with a mean age of 32.6 years (standard deviation=11), were included. Most injuries affected the thoracic (n=135; 46.2%) and lumbosacral (n=95; 32.5%) spine. Infectious complications occurred in 20 patients (6.8%), including spinal infections (n=3; 1.0%), non-spinal infections (n=6; 2.1%), and wound infections (n=11; 3.8%). Most patients received prolonged antibiotic prophylaxis. The median duration of antibiotic administration was significantly increased in patients with dirty wounds (p<0.001) and high-velocity injuries (p=0.001). However, the duration of antibiotic administration did not influence spinal infection rates.</p><p><strong>Conclusions: </strong>Our findings indicate a low incidence (1%) of spinal infections among patients with spinal gunshot wounds. Prolonged antibiotic use failed to reduce the risk of spinal infectious complications. Standardized guidelines for antibiotic prophylaxis in these injuries remain necessary to optimize care.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940319","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":"Gender-specific patterns of external occipital protuberance hyperplasia: associations with nuchal ligament ossification and cervical sagittal imbalance in myelopathy patients.","authors":"Zhaoyang Gong, Hanqiu Sun, Dachuan Li, Xiao Lu, Siyang Liu, Ximeng Wang, Xinlei Xia, Feizhou Lyu, Jianyuan Jiang, Fei Zou, Hongli Wang, Xiaosheng Ma","doi":"10.31616/asj.2025.0109","DOIUrl":"https://doi.org/10.31616/asj.2025.0109","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cross-sectional analysis of 187 consecutive patients undergoing surgical treatment for cervical spondylotic myelopathy (CSM).</p><p><strong>Purpose: </strong>To investigate sexual dimorphism in external occipital protuberance (EOP) hyperplasia morphology and elucidate its clinical correlation with ossification of the nuchal ligament (ONL) and cervical sagittal imbalance.</p><p><strong>Overview of literature: </strong>Emerging evidence implicates EOP hyperplasia as potential biomarker of chronic neck strain, yet its relationship with ONL and cervical sagittal imbalance remains underexplored in surgical CSM cohorts.</p><p><strong>Methods: </strong>Cervical radiographs were analyzed. EOP hyperplasia was classified into three subtypes with standardized length measurements. Variables encompassed demographics, ONL-related indices, and sagittal parameters. Subtype comparisons and multivariate regression analyses (with EOP length as dependent variable) were conducted.</p><p><strong>Results: </strong>Analysis of 187 CSM patients (64.2% male) identified gender-specific patterns: males exhibited greater EOP length (9.4±6.8 mm vs. 4.6±3.4 mm, p<0.001). Type III EOP demonstrated male predominance (82.4% vs. type I 31.8%, type II 51.4%; p<0.001), with associated longer hyperplasia length (11.6±6.6 mm vs. type II 5.1±1.9 mm, p<0.001). Type III EOP was associated with higher ONL prevalence (type III 64.8% vs. type I 45.5%, type II 41.9%; p=0.010) and longer ONL osteophyte length (type III 18.8±9.8 mm vs. type I 14.2±8.1 mm, type II 14.2±9.4 mm; p=0.046). Multivariate regression confirmed male sex (β=-3.82, p=0.009), ONL osteophyte length (β=0.16, p=0.017), T1 slope (β=0.27, p=0.041), and spino-cranial angle (β=-0.19, p=0.009) as factors independently associated with EOP length (adjusted R²=0.382).</p><p><strong>Conclusions: </strong>Severe EOP hyperplasia exhibits a male-predominant distribution pattern and demonstrates significant radiological associations with ONL and cervical sagittal imbalance in CSM patients. These findings advocate for EOP evaluation in clinical evaluations to identify high-risk biomechanical profiles.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940331","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}