Spine最新文献

Study design: Retrospective, single-center, observational study.

Objective: To evaluate the diagnostic reliability of magnetic resonance (MR) bone imaging in stage classification of adolescent lumbar spondylolysis, assessing its clinical applicability as an alternative to computed tomography (CT).

Background: The diagnosis of adolescent lumbar spondylolysis typically requires CT; however, concerns regarding medical radiation exposure have been raised. With recent advancements in magnetic resonance imaging (MRI) technology, MR bone imaging has been developed, enabling the acquisition of CT-like images.

Materials and methods: This study included 116 adolescent patients diagnosed with lumbar spondylolysis between August 2022 and April 2024. In addition to conventional MRI, MR bone imaging and CT scans were performed on the affected vertebrae. Two independent raters assessed sagittal images and classified the fractures using the Oba classification system. MRI examinations were performed using either a 1.5T or 3T scanner. For statistical analysis, CT classification was used as the reference standard. Interrater and intermodality agreements for both CT and MR bone imaging were evaluated using the weighted kappa coefficient (linear weights).

Results: Among the 116 patients, 70 cases (140 pars) underwent 3T MRI, while 46 cases (92 pars) underwent 1.5T MRI. In the 3T MRI group, the interrater agreement was κ = 0.98 for CT and κ = 0.91 for MR bone imaging, while intermodality agreement was κ = 0.89 for rater A and κ =0.83 for rater B. In the 1.5T MRI group, interrater agreement was κ = 0.94 for CT and κ = 0.92 for MR bone imaging, while intermodality agreement was κ = 0.83 for rater A and κ = 0.84 for rater B.

Conclusion: These results indicate that MR bone imaging provides stage classification accuracy comparable to that of CT in the evaluation of adolescent lumbar spondylolysis. Furthermore, similar findings were observed for both 1.5T and 3T MRI.

Study design: Single-center, survey-based study.

Objective: This study aims to assess patient experiences in ambulatory lumbar spine surgery, with a focus on their expectations and preferences regarding discharge disposition and the impact of discharge timing and alignment with patient preferences on satisfaction and early recovery outcomes.

Summary of background data: While the safety and efficacy of ambulatory spine surgery have been well established, patient perceptions and experiences with these accelerated recovery pathways remain underexplored.

Methods: A custom survey, designed by the authors, assessed patient experiences, preferences, and satisfaction related to discharge disposition. Respondents were asked to reflect on their surgical experience, focusing on their preferences for discharge timing and the reasons behind those preferences. The survey was administered to adult patients who underwent primary single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) or laminectomy (MI-Lami) and were discharged either on the same day of surgery (SDD) or after an overnight hospital stay (OVN). Patient preferences were qualitatively analyzed to identify recurring themes, while their postoperative night one experience was quantitatively scored across multiple domains, including sleep quality, comfort, hygiene management, and overall satisfaction. These data were then used to explore the relationship between discharge timing and preference concordance.

Results: A total of 227 responses were collected, with 64 (28.2%) undergoing MI-TLIF and 163 (71.8%) undergoing MI-Lami. Of these, 116 (51.1%) were discharged on the same day (SDD) and 111 (48.9%) had an overnight stay (OVN). While 36% preferred SDD and 49.8% preferred OVN, 56.9% reported feeling ready for same-day discharge. Qualitative analysis revealed that SDD preferences were driven by comfort at home, better sleep, and avoiding hospital inconveniences. Conversely, OVN preferences emphasized medical support, pain control, and logistical ease. Patients discharged the same day reported better care, sleep, hygiene, and comfort ( P <0.05 for all). Those discharged in concordance with their preferences reported significantly lower rates of feeling discharged prematurely (3.4% vs. 32.3%; P <0.001) and superior outcomes across multiple domains, including pain control, comfort, and reduced burden on families ( P <0.05 for all).

Conclusions: SDD patients reported improved postoperative experiences, including sleep and satisfaction. Aligning discharge timing with patient preferences further enhanced outcomes, emphasizing the importance of patient-centered discharge planning in spine surgery.

Study design: Prospective cohort study.

Objective: The aims of this study were primarily to evaluate the association between patient-reported symptom duration and postoperative outcomes in patients with degenerative cervical myelopathy (DCM). Secondly, to identify factors associated with the extended duration of symptoms before surgical consultation for DCM.

Summary of background data: Surgery is the gold standard treatment for progressive or at least moderate DCM; however, the impact of extended symptom duration on patient outcomes remains unknown.

Materials and methods: This study analyzed patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) from 2015 to 2023. Patients with mild to severe DCM with 1-year follow-up were included. During initial assessment, surgeons recorded symptom duration as reported by patients categorically with six choices, which were then dichotomized as a binary variable using a 1-year threshold. Differences between groups were analyzed using unadjusted bivariate analysis, and the associations between symptom duration on achievement of minimally clinically important differences (MCID) of PROMs were assessed using multivariable logistic regression analysis.

Results: A total of 483 patients (227 with symptoms less than 1 year and 256 with symptoms 1 year or greater) were included. At baseline, BMI (mean=28.2 vs . 29.5, P <0.008), number of comorbidities (2.8 vs . 3.1, P <0.029), and proportion of tobacco users (51% vs . 82%, P <0.027) were significantly higher among those with symptoms 1 year or greater, who also had higher baseline mJOA scores (12.5 vs . 13.2, P <0.002) and worse neck pain (5.63 vs . 4.92, P <0.004). Symptom duration of less than 1 year was associated with higher odds of achieving MCID for the outcomes Neck Disability Index (OR=1.64, 95% CI=1.05-2.55, P <0.030), SF-12 PCS (OR=1.98, 95% CI=1.22-3.19, P <0.005), and EQ-5D (OR=2.08, 1.30-3.33, P <0.002) at 12 months after surgery. The odds of reaching the MCID for the mJOA did not significantly differ by symptom duration (OR=1.41, 95% CI=0.88-2.24, P <0.153).

Conclusion: Patients with symptom durations1 year or greater at the time of consulting a spine surgeon experienced inferior postoperative outcomes for disability and health-related quality of life compared with patients with symptom durations of less than 1 year, despite similar neurological outcomes. Smoking was among the factors associated with a prolonged duration of symptoms. These results suggest that efforts to prioritize early diagnosis by primary care physicians and timely referral for surgery are warranted.

Level of evidence: Level 3.

Study design: Retrospective cohort study.

Objective: To evaluate the predictive value of T4-L1 Hip Axis Error (HAE) and L1PA Error (L1PAE) on mechanical failure following adult spinal deformity (ASD) surgery, and to assess how error directionality and fusion length influence outcomes.

Summary of background data: The T4-L1 Hip Axis is a novel framework for defining normative sagittal alignment by aligning thoracic and lumbar curvatures relative to the pelvis. Prior studies suggest that deviation from this axis may contribute to mechanical complications following ASD surgery. However, the impact of directionality, construct length, and specific risk factors remains underexplored.

Methods: A retrospective review was conducted of 271 ASD patients who underwent fusion from L2 or above to the pelvis between 2016 and 2024. T4PA and L1PA were measured from six-week postoperative standing radiographs. Alignment errors (HAE, L1PAE) were calculated based on the target threshold derived from prior normative studies. Multivariate logistic regression identified predictors of mechanical failures. Subgroup analyses were stratified by fusion length and error direction.

Results: HAE was a significant predictor of mechanical failure (OR=1.20 per degree, P <0.001), whereas L1PAE was not. HAE remained predictive regardless of whether patients achieved L1PA targets. In short fusions, both the signed and absolute value of HAE were associated with mechanical failure. Positive HAE (anterior T4 alignment) conferred the highest risk. Higher BMI and short constructs were independent predictors of increased HAE.

Conclusions: HAE is a robust, direction-sensitive predictor of mechanical failure in ASD surgery. Its predictive power surpasses L1PAE and remains significant in both long and short segment fusions. HAE should be routinely measured and minimized intraoperatively to reduce postoperative mechanical complications.

Study design: Retrospective cohort study from a tertiary academic medical center.

Objective: To build a prognostic machine learning model to predict 1-year FBSS incidence after lumbar spine surgery.

Summary of background data: A minority of patients who undergo degenerative lumbar spine surgery will have persistent postoperative pain, characterized as "Failed Back Surgery Syndrome" (FBSS). Adequate preoperative identification of patients at risk of having an undesirable outcome after surgery is an essential part of a spine surgeon's workflow. Although several studies have proposed mechanisms and risk factors for FBSS, no studies have developed a prognostic machine learning model to quantify and functionalize predictions.

Methods: A cohort of lumbar fusion and lumbar decompression surgeries was queried from a tertiary academic medical center from 2002 to 2022. Patient and operative characteristics were systematically extracted for each surgery. Several machine learning algorithms were used and optimized to predict FBSS occurrence within 1 year of surgery. SHAP feature importance values were computed for the top-performing model.

Results: A total of 10,128 unique lumbar decompression surgeries and 2890 unique lumbar fusion surgeries were included. The Random Forest model had the highest performance of tested models (AUROC of 0.715 for lumbar decompression, 0.701 for lumbar fusion). For lumbar decompression, the top three predictors of FBSS were absence of microdiscectomy, lack of preoperative immunosuppressant usage, and preoperative benzodiazepine usage. For lumbar fusion, prior FBSS diagnosis, lack of preoperative immunosuppressant usage, and operating room duration were the most important predictors. Other key variables spanned several domains, including preoperative medication usage, patient demographics, and operative indications and characteristics.

Conclusion: This study demonstrates the successful creation of a prognostic machine learning model for prediction of FBSS within one year postoperatively. These models, after external validation, have the potential to be instrumental aspects of a spine surgeon's workflow.

Level of evidence: Level III.

Study design: Systematic review and meta-analysis.

Objective: To compare perioperative, radiographic, and functional outcomes between open and percutaneous posterior fixation following anterior or lateral lumbar interbody fusion (ALIF/LLIF).

Background: Posterior fixation enhances construct stability after ALIF or LLIF, yet the optimal approach, open versus percutaneous, remains debated. While minimally invasive surgery (MIS) reduces tissue disruption, open fixation may offer superior sagittal correction, particularly in adult spinal deformity (ASD). Prior meta-analyses have not isolated ALIF/LLIF procedures.

Materials and methods: Following PRISMA guidelines, PubMed, Embase, and Google Scholar were searched (January 2000-January 2025). Comparative studies evaluating open versus percutaneous posterior fixation after ALIF/LLIF were included. Outcomes included sagittal parameters, perioperative variables, postoperative events and patient-reported outcomes. Meta-analyses were performed using random- or fixed-effects models depending on heterogeneity ( I2 >50%).

Results: Thirteen studies (912 patients; 454 open, 458 percutaneous) met inclusion criteria. For radiographic outcomes: No overall difference in Δ lumbar lordosis (LL), Δ pelvic incidence-LL, or Δ sacral slope; however, open fixation achieved greater sagittal correction in ASD (ΔLL=12.9° [95% CI: 0.01-25.87, P =0.05], PI-LL=-4.1° [95% CI: -7.88, -0.38, P =0.03], SS=+2.5° [95% CI: 0.38-4.58, P =0.02]). For perioperative outcomes, percutaneous fixation reduced EBL (-387 mL [95% CI: -575.72, -197.71, P <0.0001]), OR time (-65 min [95% CI: -93.90, -15.82, P =0.006]), LOS (-1.7 d [95% CI: -2.42, -1.01, P < 0.00001]), and transfusion risk (OR: 0.26 [95% CI: 0.11-0.58, P =0.001]). For postoperative outcomes, no significant differences in reoperation, fusion, or adjacent segment disease incidence; percutaneous fixation improved pain-medication independence (OR: 4.29 [95% CI: 1.20-15.36, P =0.03]). For patient-reported outcomes, percutaneous fixation yielded superior ODI (-7.1 [95% CI: -11.07, -3.21, P =0.0004]) improvements early; at 2 years, it maintained minimally better VAS back (-0.31 [95% CI: -0.54, -0.08, P =0.009]) and ODI (-2.9 [95% CI: -5.04, -0.68, P =0.01]) scores.

Conclusions: Percutaneous posterior fixation after ALIF/LLIF offers clear perioperative advantages, reduced blood loss, operative time, LOS, and transfusion need, without compromising fusion or long-term outcomes. Open fixation remains preferable for ASD cases requiring extensive sagittal realignment. Surgical approach should therefore be individualized based on deformity rigidity and alignment goals.

Study design: Randomized controlled trial.

Objective: The aim of this study was to investigate whether ABM/P-15 was cost-effective compared with allograft as a bone graft extender for uninstrumented posterolateral fusion for degenerative spondylolisthesis with spinal stenosis in elderly patients.

Summary of background data: In an increasingly elderly population with higher expectations of good health and quality of life, the need for durable surgery with minor risks of implant-related reoperations is growing. Specifically for lumbar fusion surgery, the need for a reliable bone graft material with acceptable fusion rates and low graft-related morbidity and risk of reoperation is important.

Methods: This cost-effectiveness analysis was based on a single-center, blinded, randomized controlled trial, where patients with symptomatic degenerative spondylolisthesis were randomly assigned 1:1 to either ABM/P-15 or Allograft as bone graft material in uninstrumented posterolateral fusion. Quality-adjusted life years (QALY) were obtained from EQ-5D-3L. Use of health services was obtained from patient charts, costed and accumulated up to 10 years after index surgery.

Results: The study included 101 patients with no inter-group differences in preoperative characteristics. On the basis of a bootstrapped analysis, the estimated the mean QALY gain for the ABM/P-15 group was 0.42 points (95% CI [-0.17; 1.08], P =0.185) greater compared with the Allograft group. Compared with the Allograft group, patients in the ABM/P-15 group had 20% less costs due to a significantly lower reoperation rate (18% vs. 43%, P =0.024), fewer visits to the outpatient clinic, magnetic resonance images, and fewer days of hospitalization.

Conclusions: The choice of bone graft material significantly affected cost-effectiveness of posterolateral lumbar fusion in elderly patients with degenerative spondylolisthesis at 10-year follow-up. ABM/P-15 showed dominance over Allograft with improved outcomes, lower health care costs, and lower reoperation rate.

Study design: Retrospective study.

Objective: To develop and validate a computed tomography-based deep learning (DL) model for diagnosing cervical spinal stenosis (CSS).

Background: Although magnetic resonance imaging (MRI) is widely used for diagnosing CSS, its inherent limitations, including prolonged scanning time, limited availability in resource-constrained settings, and contraindications for patients with metallic implants, make computed tomography (CT) a critical alternative in specific clinical scenarios. The development of CT-based DL models for CSS detection holds promise in transcending the diagnostic efficacy limitations of conventional CT imaging, thereby serving as an intelligent auxiliary tool to optimize health care resource allocation.

Materials and methods: Paired CT/MRI images were collected. CT images were divided into training, validation, and test sets in an 8:1:1 ratio. The 2-stage model architecture employed: (1) A Faster R-CNN-based detection model for localization, annotation, and extraction of regions of interest (ROI), (2) Comparison of 16 Convolutional Neural Network (CNN) models for stenosis classification to select the best-performing model. The evaluation metrics included accuracy, F1-score, and Cohen κ coefficient, with comparisons made against diagnostic results from physicians with varying years of experience.

Results: In the multiclass classification task, 4 high-performing models (DL1-b0, DL2-121, DL3-101, and DL4-26d) achieved accuracies of 88.74%, 89.40%, 89.40%, and 88.08%, respectively. All models demonstrated >80% consistency with senior physicians and >70% consistency with junior physicians. In the binary classification task, the models achieved accuracies of 94.70%, 96.03%, 96.03%, and 94.70%, respectively. All 4 models demonstrated consistency rates slightly below 90% with junior physicians. However, when compared with senior physicians, 3 models (excluding DL4-26d) exhibited consistency rates exceeding 90%.

Conclusions: The DL model developed in this study demonstrated high accuracy in CT image analysis of CSS, with a diagnostic performance comparable to that of senior physicians.

Study design: Retrospective cohort study.

Objective: To compare intraoperative complications, 90-day medical complications, and 2-year surgical reoperation rates between endoscopic discectomy (ED) and open discectomy (OD).

Background: Symptomatic lumbar disc herniation is common, with discectomy serving as a common surgical intervention. Previous studies comparing ED and OD show inconsistent findings regarding complications and long-term outcomes, often limited by small sample sizes and study heterogeneity.

Materials and methods: Patients undergoing ED (CPT-62380) and OD (CPT-63030) from 2010 to 2022 were identified using PearlDiver database. Propensity score matching (1:1) controlled for age, sex, and Charlson Comorbidity Index (CCI). Outcomes included intraoperative complications such as dural tears and nerve injuries, 90-day medical complications including deep vein thrombosis (DVT), surgical site infections (SSI), dura repair, and urinary tract infections (UTI), and 2-year reoperations. Statistical analyses utilized χ 2 tests, t tests, and multivariate logistic regression adjusting for comorbidities. Odds ratios (OR) with 95% CIs were reported.

Results: A total of 2618 patients were identified and examined (1309 ED, 1309 OD). On multivariate analysis, ED was associated with a significantly lower risk of dural tears (0.15% vs . 1.15%, OR: 0.179, P = 0.006), surgical site infections (0.08% vs . 1.15%, OR: 0.082, P = 0.001), wound complications (0.38% vs . 1.07%, OR: 0.342, P = 0.023), and dura repair (0.08% vs . 0.69%, OR: 0.091, P = 0.021). ED was also associated with lower odds of persistent pain (2.22% vs . 2.83%, OR: 0.665, P = 0.048). No significant differences were observed in nerve injuries, DVT, UTI, or readmissions.

Conclusion: ED is associated with fewer dural tears, surgical site infections, wound complications, and dura repairs, along with lower odds of persistent pain compared with OD. Rates of DVT, UTI, and reoperations were not significantly different between groups.

Study design: A cross-sectional study.

Objective: This study aimed to investigate cognitive impairment in degenerative cervical myelopathy (DCM) and examine its relationship with radiographic spinal cord compression.

Summary of background data: Degenerative cervical myelopathy is a leading cause of chronic non-traumatic spinal cord injury. While its motor and sensory manifestations are well established, the potential impact on cognitive function remains underexplored.

Methods: A total of 965 participants were enrolled: 383 DCM patients (Group A), 122 cervical spondylotic radiculopathy (CSR) patients (Group B), and 460 healthy controls (Group C). Cognitive performance was evaluated with the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and the Basic Cognitive Aptitude Test (BCAT). Propensity-score matching (A:B:C=2:1:2) was used to balance age, sex, and education; additional stratified analyses by age (≤50, 51-60, 61-70, and >70 years) and education (≤6, 7-12, and ≥13 years of education) were performed. Compression ratio (CR) and maximum spinal cord compression (MSCC) were measured on cervical MRI. Correlation analyses were used to explore the association between radiographic spinal cord compression and cognitive function.

Results: After matching, DCM patients exhibited significantly lower MoCA (20.61 ± 3.76) and MMSE (26.23 ± 2.84) scores than both CSR and control group (all P < 0.001); this disadvantage persisted across every age and educational stratum. MSCC correlated negatively with MoCA (r = -0.118, P = 0.022) and MMSE (r = -0.124, P = 0.017), with stronger associations in single-level DCM (MoCA r = -0.218, P = 0.008; MMSE r = -0.237, P = 0.004). The number of compressed segments did not influence global cognition.

Conclusion: Cognitive impairment is significantly associated with DCM, which is influenced by age, education, and the degree of spinal cord compression.