Asian Spine Journal最新文献

{"title":"To Zoom or not to Zoom? A retrospective comparative study to assess the validity of video versus face-to-face consultations and examinations for diagnosing lower back pain in Wales.","authors":"Megan Havard, Ronan McKeogh, Abi Goodier, Gemma Johns, Sashin Ahuja","doi":"10.31616/asj.2024.0344","DOIUrl":"https://doi.org/10.31616/asj.2024.0344","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective comparative study.</p><p><strong>Purpose: </strong>To evaluate the accuracy of examination findings and diagnoses established after initial spinal consultations for low back pain conducted virtually in comparison with face-to-face (F2F) consultations.</p><p><strong>Overview of literature: </strong>The COVID-19 pandemic required a shift from F2F to virtual consultations in healthcare, with documented benefits such as reduced costs, CO2 emissions, and time. However, the diagnostic accuracy of telemedicine for conditions requiring physical examinations, such as low back pain, remains underexplored. Although studies have highlighted the feasibility and high satisfaction of virtual spinal assessments, they have not thoroughly investigated their diagnostic accuracy.</p><p><strong>Methods: </strong>This study included 154 new patients with degenerative lumbar spine problems who were assessed via virtual consultations (VCs) (n=77) or F2F (n=77) by a single orthopedic spinal surgeon between May 2020 and January 2021. Patients were matched by age and sex, and examinations followed the \"telemedicine musculoskeletal examination\" protocol by the Mayo Clinic. Diagnostic changes from initial to definitive diagnoses were recorded and compared between the two groups.</p><p><strong>Results: </strong>The diagnostic accuracy of VCs was comparable with that of F2F examinations, with no significant difference in the rate of diagnostic changes between the groups (p=0.814 for any change; p=0.405 for more significant changes). Motor deficits were the only examination component with significant false-positive rates in the VC group (p=0.023).</p><p><strong>Conclusions: </strong>The study findings indicate that the initial spinal VCs and examinations are effective, safe, and beneficial in the evaluation of low back pain, providing the same diagnostic accuracy as initial F2F consultations. All erroneous motor deficit findings were false positive, which means that no serious pathology was missed during the initial VC evaluation. Future research should focus on refining virtual examination techniques, particularly for assessing motor deficits.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540057","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":"Evaluating the effect of early balloon kyphoplasty on adjacent vertebral fracture risk in osteoporotic vertebral fracture management: a retrospective study.","authors":"Masatoshi Yamamoto, Koji Ohta, Daisuke Hirano, Maki Noguchi, Shuhei Ayukawa, Keigo Shirasaki, Kenya Ishizu, Tetsuya Watanabe, Keiichiro Iida","doi":"10.31616/asj.2024.0494","DOIUrl":"https://doi.org/10.31616/asj.2024.0494","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>To evaluate whether the timing of balloon kyphoplasty (BKP) affects the risk of adjacent vertebral fractures (AVFs) in the management of osteoporotic vertebral fractures.</p><p><strong>Overview of literature: </strong>Osteoporotic vertebral fractures are usually managed conservatively; however, complications such as nonunion, neurologic deficits, and high-grade kyphosis can arise. BKP, a minimally invasive procedure for pain relief, has been associated with AVF risk. Although meta-analyses suggest no significant difference in AVF rates between BKP and conservative treatment, retrospective studies report higher AVF rates after BKP. Many of these cases involve patients resistant to conservative treatment, which implies that differences in the incidence of AVF may be influenced by the delay before performing BKP.</p><p><strong>Methods: </strong>We retrospectively analyzed 189 patients who underwent BKP between 2012 and 2023, excluding those with pathological fractures. The incidence of AVF was assessed at 3 months after BKP. Risk factors, including age, sex, fracture site, prior vertebral fractures, bone mineral density, kyphosis angle, endplate damage, signal changes in the fractured vertebral body on magnetic resonance imaging, vertebral instability, and timing of BKP, were evaluated.</p><p><strong>Results: </strong>The overall incidence of AVFs was 29%. The AVF rate was 21% in patients treated with BKP within 30 days, as compared with 32% in those treated later; however, this difference was not statistically significant (p =0.15). Multivariate analysis identified vertebral instability as the only significant risk factor for AVF (odds ratio, 2.73; p =0.01), whereas the timing of BKP showed no significant association with AVF risk.</p><p><strong>Conclusions: </strong>Early BKP does not significantly reduce the risk of AVF. The findings suggest that the management of osteoporotic vertebral fractures should focus on vertebral stability rather than intervention timing.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539953","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":"Estimation of proximal junctional failure and associated risk factors in adult spine deformity surgery: an observational study from a single institution.","authors":"Vishwajeet Singh, Marcelo Oppermann, Nathan Evaniew, Alexandra Soroceanu, Fred Nicholls, Bradley Jacobs, Kenneth Thomas, Ganesh Swamy","doi":"10.31616/asj.2024.0405","DOIUrl":"https://doi.org/10.31616/asj.2024.0405","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective observational cohort study.</p><p><strong>Purpose: </strong>To estimate the proximal junctional failure (PJF) rate and identify associated factors.</p><p><strong>Overview of literature: </strong>Proximal junctional pathologies are challenging and common complications of adult spine deformity (ASD) surgery. However, the PJF rate was not accurately defined within the ASD cohort. A correct estimate of PJF incidence and associated factors will inform clinicians on reoperation risk and prevention strategies.</p><p><strong>Methods: </strong>This retrospective observational study included patients with degenerative or adult idiopathic thoracolumbar deformity, extended instrumentation, sacropelvic fixation, and more than 2 years of follow-up. Patients with post-traumatic or iatrogenic sagittal malalignment were excluded. Demographic and operative data were obtained from the electronic medical records. Preoperative and followup scoliosis radiographs were reviewed to calculate the spinal alignment parameters. Patients were categorized into the PJF and non- PJF groups using the modified Hart-ISSG criteria, and their demographic, surgical, and radiographic parameters were compared using descriptive statistics. Multivariable logistic regression models were fitted to estimate the association measures of PJF occurrence, and their odds ratios (ORs) were reported with corresponding 95% confidence intervals (CI).</p><p><strong>Results: </strong>Of the eligible 157 patients who underwent surgery between 2011 and 2018, 130 were included. The mean age was 64.6±8 years, and 73% of the patients were female. Moreover, 42 (32%) and 88 patients (68%) were allocated to the PJF and non-PJF groups, respectively. The mean change in the proximal junctional angle (△PJA) in the PJF group was 26°±8.2°, and 33 patients (79%) had a final PJA >20°, 4 (10%) had an additional upper instrumented vertebra (UIV)/UIV+1 fracture, and 5 (12%) had an additional screw dislodgement or fixation failure. Postoperative changes in PJA (OR, 1.23; 95% CI, 1.12-1.37; p <0.001), thoracic kyphosis (TK; OR, 1.06; 95% CI, 1.02-1.11; p =0.004), and the use of a proximal tether (OR, 0.22; 95% CI, 0.04-0.82; p =0.03) were associated with PJF.</p><p><strong>Conclusions: </strong>In this study, the PJF rate was 32%, of which 67% of the patients underwent reoperation. Postoperative PJA and TK changes and the use of proximal tethers were significantly associated with PJF.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539992","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":"Bone density comparison between the normal pedicle trajectory, cortical bone trajectory, and modified cortical bone trajectory using computed tomography: a cross-sectional study.","authors":"Bikash Parajuli, Dipak Shrestha, Kuniyoshi Abumi, Sabik Kayastha, Jagadish Thapa, Sanjay Sharma, Suman Lamichhane, Christian Deininger","doi":"10.31616/asj.2024.0377","DOIUrl":"https://doi.org/10.31616/asj.2024.0377","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Purpose: </strong>To compare bone density by computed tomography Hounsfield unit (CTHU) between the original pedicle trajectory (OPT), cortical bone trajectory (CBT), and modified cortical bone trajectory (MCBT).</p><p><strong>Overview of literature: </strong>The significant pullout strength in CBT is believed to be due to increased screw-cortical bone contact; however, it allows for shorter/less-diameter screw placement, and the fixation is limited to the posterior one-third of the vertebral body, compromising the screw anchorage in the anterior vertebra.</p><p><strong>Methods: </strong>Computed tomography transverse sections of the L1-L5 (1,000 vertebrae) of 200 patients were cut into three planes: (1) horizontal to the pedicle, representing the plane for OPT; (2) in the caudocranial plane in the sagittal plane and divergent in the transverse plane representing the CBT; and (3) the caudocranial plane in the sagittal plane and parallel in the transverse plane representing the MCBT. For each trajectory, the CTHU of four points, namely, posterior cortex, mid-pedicle, midbody, and anterior cortex, were compared within the area of screw insertion.</p><p><strong>Results: </strong>The mean CTHUs of OPT, CBT, and MCBT were 354.2±70 HU, 529.9±75 HU, and 457.3±90 HU, respectively (p <0.01). The CTHU of the posterior cortex in MCBT was 65.6% higher than that in OPT and 14.9% lower than that in CBT. A comparable decline in CTHU with age was noted in CBT and MCBT (Pearson's r : -0.20 vs. -0.22; adjusted R 2: 0.040 vs. 0.047). However, a higher decline in CTHU with age was observed in OPT (Pearson's r =-0.38, adjusted R 2=0.14).</p><p><strong>Conclusions: </strong>MCBT has a significantly higher CTHU than OPT. The density in the posterior cortex in MCBT is comparable to that in the CBT trajectory. MCBT appears to be an alternative trajectory for lumbar spine fixation.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539999","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":"Predictors of hospitalization for longer than one day following elective single-level anterior cervical discectomy and fusion: a retrospective case-control database study.","authors":"Sam Han Jiang, James W Nie, Nauman Shaukat Chaudhry, Saavan Patel, Darius Ansari, Ashwin Ganesh, Jeffrey Z Nie, Jaimin Patel, Ankit Indravadan Mehta","doi":"10.31616/asj.2024.0321","DOIUrl":"https://doi.org/10.31616/asj.2024.0321","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective case-control study.</p><p><strong>Purpose: </strong>To understand the risk factors for prolonged hospitalization following anterior cervical discectomy and fusion (ACDF) to reduce postoperative complications and better identify optimal candidates for elective ACDF.</p><p><strong>Overview of literature: </strong>Despite the proven safety of ACDF, many patients may experience prolonged postoperative hospitalization.</p><p><strong>Methods: </strong>Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset spanning 2017-2019. The primary outcome of interest was the length of stay (LOS). The study population was divided into two cohorts: those with LOS ≤1 day and those with LOS >1 day. Univariate and multivariate analyses were performed to identify predictors of LOS >1 day. Propensity score matching and group comparisons were used to evaluate pre- and post-discharge complication rates between the cohorts.</p><p><strong>Results: </strong>A total of 12,906 patients with ACDF were identified in the database and considered eligible for the study. Of these patients, 69.5% had LOS ≤1 day and 30.5% had LOS >1 day. Factors associated with LOS >1 day included age ≥65 years, female sex, non-White race, American Society of Anesthesiologists classification 3, dependent functional status, and operation length of 120-150 minutes and >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative or postoperative blood transfusions (0.1% vs. 0.7%, p<0.001), unplanned reoperations (0% vs. 1.7%, p<0.001), and develop pneumonia during hospitalization (0% vs. 0.7%, p<0.001). These patients were also more likely to be readmitted (2.7% vs. 4.3%, p<0.001).</p><p><strong>Conclusions: </strong>Older patients, those with poorer functional status, and those who undergo longer operative times are more likely to experience prolonged postoperative hospitalization. These patients are also at increased risk of complications such as pneumonia, blood transfusions, reoperation, and readmission. Careful patient selection for ACDF is essential to reduce the risk of prolonged hospitalization and associated complications.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540021","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":"Impact of sarcopenia on outcomes following vertebral augmentation for osteoporotic vertebral compression fracture: a systematic review and meta-analysis.","authors":"Bao Tu Thai Nguyen, Tan Thanh Nguyen, Yi-Jie Kuo, Yu-Pin Chen","doi":"10.31616/asj.2024.0467","DOIUrl":"https://doi.org/10.31616/asj.2024.0467","url":null,"abstract":"<p><p>Vertebral augmentation is a safe and effective treatment for osteoporotic vertebral compression fractures (OVCFs) in elderly patients. The impact of sarcopenia on post-procedure outcomes has been debated. This meta-analysis examined its effect on outcomes following vertebral augmentation in OVCF patients. Several electronic databases were searched until August 2024 for studies that compared patients with and without sarcopenia after kyphoplasty or vertebroplasty for OVCFs. The outcomes of interest were the rates of vertebral refracture and residual back pain (RBP), clinical outcomes, length of hospital stay, and mortality rate. The pooled results are presented as odds ratios (ORs) or mean differences with corresponding 95% confidence intervals (CIs). Fourteen studies involving 2197 patients with OVCF treated with vertebral augmentation were included. Of these patients, 813 had sarcopenia and 1384 did not, with a mean age of 73.06. Patients with sarcopenia exhibited a higher prevalence of refracture than those without sarcopenia (OR, 2.92; 95% CI, 1.34-6.34; p =0.007). Patients without sarcopenia had a 64% lower risk of RBP than those with sarcopenia (OR, 0.36; 95% CI, 0.23-0.56; p <0.001). Additionally, patients with sarcopenia demonstrated worse postoperative clinical outcomes, longer hospital stays, and a significantly higher risk of mortality. Sarcopenia adversely affects patients undergoing vertebral augmentation for OVCFs. Early diagnosis of sarcopenia in patients with OVCF and the adoption of comprehensive management strategies to improve and maintain muscle health are recommended (PROSPERO registry number: CRD42024578202).</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539959","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":"Can generative artificial intelligence provide accurate medical advice?: a case of ChatGPT versus Congress of Neurological Surgeons management of acute cervical spine and spinal cord injuries clinical guidelines.","authors":"Michael Saturno, Mateo Restrepo Mejia, Wasil Ahmed, Alexander Yu, Akiro Duey, Bashar Zaidat, Fady Hijji, Jonathan Markowitz, Jun Kim, Samuel Cho","doi":"10.31616/asj.2024.0301","DOIUrl":"https://doi.org/10.31616/asj.2024.0301","url":null,"abstract":"<p><strong>Study design: </strong>An experimental study.</p><p><strong>Purpose: </strong>To explore the concordance of ChatGPT responses with established national guidelines for the management of cervical spine and spinal cord injuries.</p><p><strong>Overview of literature: </strong>ChatGPT-4.0 is an artificial intelligence model that can synthesize large volumes of data and may provide surgeons with recommendations for the management of spinal cord injuries. However, no available literature has quantified ChatGPT's capacity to provide accurate recommendations for the management of cervical spine and spinal cord injuries.</p><p><strong>Methods: </strong>Referencing the \"Management of acute cervical spine and spinal cord injuries\" guidelines published by the Congress of Neurological Surgeons (CNS), a total of 36 questions were formulated. Questions were stratified into therapeutic, diagnostic, or clinical assessment categories as seen in the guidelines. Questions were secondarily grouped according to whether the corresponding recommendation contained level I evidence (highest quality) versus only level II/III evidence (moderate and low quality). ChatGPT-4.0 was prompted with each question, and its responses were assessed by two independent reviewers as \"concordant\" or \"nonconcordant\" with the CNS clinical guidelines. \"Nonconcordant\" responses were rationalized into \"insufficient\" and \"contradictory\" categories.</p><p><strong>Results: </strong>In this study, 22/36 (61.1%) of ChatGPT's responses were concordant with the CNS guidelines. ChatGPT's responses aligned with 17/24 (70.8%) therapeutic questions and 4/7 (57.1%) diagnostic questions. ChatGPT's response aligned with only one of the five clinical assessment questions. Notably, the recommendations supported by level I evidence were the least likely to be replicated by ChatGPT. ChatGPT's responses agreed with 80.8% of the recommendations supported exclusively by level II/III evidence.</p><p><strong>Conclusions: </strong>ChatGPT-4 was moderately accurate when generating recommendations that aligned with the clinical guidelines. The model frequently aligned with low evidence and therapeutic recommendations but exhibited inferior performance on topics that contained high-quality evidence or pertained to diagnostic and clinical assessment strategies. Medical practitioners should monitor its usage until further models can be rigorously trained on medical data.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540011","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":"Complications and curve progression in EOS patients with extended distraction surgery intervals in growing rod surgery: a retrospective cohort study in China.","authors":"Jianqiang Wang, Haoshuang Geng, Lijin Zhou, Yong Hai","doi":"10.31616/asj.2024.0426","DOIUrl":"https://doi.org/10.31616/asj.2024.0426","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case-control study.</p><p><strong>Purpose: </strong>This study aimed to explore the relationship between the rod-lengthening interval and the incidence of postoperative complications as well as the outcomes in patients with early-onset scoliosis (EOS) undergoing growing rod surgery.</p><p><strong>Overview of literature: </strong>EOS is characterized by a spinal deformity that manifests before the age of 10 years. The growing rod technique allows for spinal curvature correction while preserving spinal growth through periodic lengthening surgeries typically performed every 6 months. However, we found that due to challenges, many patients undergo a 1-year or even longer interval between lengthening surgeries.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 59 patients with EOS who underwent growing rod surgery at our institution between August 2012 and June 2022. We collected radiographic parameters to compare the differences in outcomes and complications between patients who underwent lengthening surgeries at intervals of 12 months versus those with intervals of >12 months.</p><p><strong>Results: </strong>In this study, we found 29 complications in 59 patients. The complication rate was significantly lower in the group with lengthening intervals of 12 months compared with the group with intervals longer than 12 months (35.3% vs. 68%, p <0.05). In addition, patients in the group with intervals of 12 months showed less progression of the main curve, a lower maximum kyphosis angle, and greater increases in height in the fixed segments (d=7.53±3.69 cm, p <0.05). In contrast, patients with lengthening intervals longer than 12 months were more likely to experience sagittal plane imbalance (p <0.05).</p><p><strong>Conclusions: </strong>Lengthening intervals of greater than 12 months have a higher rate of complications and increase the risk of curve progression and spinal imbalance. Increasing the interval time just to minimize the number of surgeries before the final fusion is unwise.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540031","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":"Bone fusion materials: past, present, and future.","authors":"Young-Hoon Kim, Ki-Won Kim, Kee-Won Rhyu, Jong-Beom Park, Jae-Hyuk Shin, Young-Yul Kim, Jun-Seok Lee, Joong-Hyun Ahn, Ji-Hyun Ryu, Hyung-Youl Park, Sang-Il Kim","doi":"10.31616/asj.2024.0520","DOIUrl":"https://doi.org/10.31616/asj.2024.0520","url":null,"abstract":"<p><p>Bone fusion is one of the mainstay managements for degenerative spinal diseases and critical-sized bone defects resulting from trauma, tumors, infection, and nonunion. Bone graft materials are required for promoting bone healing, with autografts historically considered the gold standard due to their osteogenic, osteoinductive, and osteoconductive properties. However, donor site morbidities have led to the development of alternative bone graft substitutes. Currently available alternative options for bone fusion include allografts, ceramics, demineralized bone matrix (DBM), and bone morphogenetic proteins (BMPs). Each material has its advantages and disadvantages. Allografts avoid donor site morbidities but lack osteogenic properties and pose disease transmission risks. DBMs are acid-extracted allografts that have osteoconductive and osteoinductive properties but require combination with autografts because of the lack of evidence for their stand-alone use. BMP-2 has potent osteoinductive properties and is considered an ideal fusion material, but faces unresolved challenges related to optimal dosage and carrier. Synthetic peptides, mimicking the cell-binding domain of type I collagen, facilitate the attachment of osteogenic cells (such as osteoblasts) to the graft material and the production of extracellular matrix, leading to improved bone growth at the fusion site. The development of materials with ideal properties is a research hotspot. Recent advancements in biomaterials, such as hydrogels, nanomaterials, and three-dimensional-printed biomaterials, offer promising future options for bone fusion. This review provides an overview of available bone fusion materials, their advantages and disadvantages, and introduces emerging candidate options for bone fusion.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188038","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":"Lateral view fulcrum bending radiographs predict postoperative hypokyphosis after selective thoracic fusion in adolescent idiopathic scoliosis.","authors":"Victoria Yuk Ting Hui, Jason Pui Yin Cheung, Prudence Wing Hang Cheung","doi":"10.31616/asj.2024.0491","DOIUrl":"10.31616/asj.2024.0491","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective observational study.</p><p><strong>Purpose: </strong>To identify the surgical and preoperative risk factors on fulcrum bending radiographs for postoperative hypokyphosis in patients with Lenke 1 adolescent idiopathic scoliosis (AIS).</p><p><strong>Overview of literature: </strong>AIS is associated with thoracic hypokyphosis. Persistent hypokyphosis causes reduced pulmonary function and spinopelvic malalignment. Indications for Ponte osteotomies and releases to improve postoperative kyphosis restoration in patients with hypokyphosis are still unclear. Previous studies have demonstrated that kyphosis correction was limited by sagittal flexibility based on lateral view fulcrum bending radiographs.</p><p><strong>Methods: </strong>Patients with Lenke 1 AIS undergoing posterior spinal fusion were included. Standing and fulcrum bending radiographs on the coronal and sagittal planes were analyzed at preoperative, immediate, and 2-year postoperative periods. The primary outcome was postoperative hypokyphosis (T5-12 thoracic kyphosis [TK] <20°). Risk factors for postoperative hypokyphosis were identified by multivariate logistic regression, and the optimal cutoff for significant risk factors was determined by receiver operating characteristic analysis.</p><p><strong>Results: </strong>In total, 156 patients were included in the analysis, of which 68 (43.6%) were hypokyphotic at 2-year follow-up. Low T5-12 TK on lateral view fulcrum bending films (immediate postoperative odds ratio [OR], 0.870; 95% confidence interval [CI], 0.826-0.917; 2-year postoperative OR, 0.916; 95% CI, 0.876-0.959; p<0.001) and high convex side implant density (2-year postoperative OR, 1.749; 95% CI, 1.056-2.897; p=0.03) were significant risk factors for postoperative hypokyphosis. Other baseline demographic and surgical factors did not affect postoperative kyphosis correction. The T5-12 TK cutoff on fulcrum bending for 2-year postoperative hypokyphosis was 12.45° (area under the curve, 0.773; 95% CI, 0.661-0.820).</p><p><strong>Conclusions: </strong>Fulcrum bending radiography is useful in assessing coronal and sagittal flexibility for preoperative planning. In patients with T5-12 kyphosis <12.5° on lateral view fulcrum bending radiographs, Ponte osteotomies or releases, or a decrease in convex side implant density should be considered to improve kyphosis restoration and reduce the risk of 2-year postoperative hypokyphosis.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"19 1","pages":"102-111"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555717","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}