Spine最新文献

Study design: Retrospective cohort study.

Objective: To identify predictors for poor outcome after lumbar discectomy for herniated disc.

Background: Lumbar discectomy for herniated disc is a common spinal procedure. Despite the surgical treatment, some patients are left with persistent pain and poor health-related quality of life. We aim to research preoperative predictive factors associated with poor outcome after lumbar discectomy.

Materials and methods: National Spine Surgery Registry was searched for patients who underwent primary discectomy for lumbar disc herniation between 2017 and 2022. All patients had a minimum of 2 years of follow-up. The primary outcome was disability at 12 months postoperatively, assessed using the Oswestry Disability Index (ODI). Patients were categorized into satisfactory (ODI: 0-40) and poor outcome groups (ODI: 41-100). Logistic regression was used to identify preoperative predictors of poor outcome. Variables for multivariable analysis were selected based on clinical relevance assessed by senior authors and bivariate associations. Secondary outcomes included pain scores and patient-reported satisfaction.

Results: In all, 3339 patients were included, of whom 2991 (90%) had minimal to moderate disability and 348 (10%) had severe disability assessed with ODI at the follow-up. Several factors were identified to associate with poor outcome after the surgery: older age (OR: 1.03, 95% CI: 1.02-1.03), female sex (OR: 1.28, 95% CI: 1.03-1.61), higher body mass index (OR: 1.06, 95% CI: 1.02-1.09), cardiologic comorbidity (OR: 4.27, 95% CI: 2.4-7.3), regular preoperative painkiller use (OR: 2.2, 95% CI: 1.5-3.3), and higher number of operated vertebrae (OR: 2.4, 95% CI: 1.6-3.6). Symptom lasting over 1 year was associated with worse outcomes when compared with symptoms for 3 to 12 months (OR: 0.42, 95% CI: 0.29-0.60), 6 to 12 weeks (OR: 0.23, 95% CI: 0.12-0.39), and those with symptoms for <6 weeks (OR: 0.35, 95% CI: 0.19-0.62). Employed individuals were significantly associated with better outcomes when compared other statuses. Worse preoperative quality of life scores were associated with poor outcome.

Conclusion: Several preoperative factors were associated with poor outcome after lumbar discectomy. Identifying higher-risk patients-such as those with high BMI, older age, or significant comorbidities-can support preoperative counseling and targeted interventions. Optimizing modifiable factors preoperatively may improve outcomes.

Study design: A retrospective two-center external validation study was conducted at two medical centers, collecting cervical spine MRI data from patients suspected of degenerative cervical myelopathy (DCM) between March 2022 and August 2024, forming a consecutive series with external validation.

Objective: To develop and validate a deep learning model utilizing YOLO11 architecture for automated detection of cervical spinal cord compression on MRI and evaluate its performance against expert annotations.

Summary of background data: DCM represents the leading cause of nontraumatic spinal cord injury in adults. While MRI facilitates early detection and provides the foundation for timely intervention, image interpretation remains subjective and dependent on physician experience, resulting in diagnostic variability and challenges in clinical consistency.

Materials and methods: A YOLO11-based deep learning model was implemented with a binary classification scheme (Normal vs . Compression). Five physicians annotated 1431 sagittal T2-weighted cervical MRI images from 735 patients using standardized protocols, achieving excellent interobserver agreement. The data set comprised training/validation sets (577 patients, 1141 images), an internal test set (64 patients, 115 images), and an external test set (94 patients, 175 images). Five-fold cross-validation assessed model robustness. Standardized preprocessing incorporating contrast enhancement, noise reduction, and normalization was applied. Gradient-weighted Class Activation Mapping enhanced model interpretability.

Results: Five-fold cross-validation yielded consistent performance with mAP50 ranging from 0.917 to 0.970, precision from 0.897 to 0.923, and recall from 0.922 to 0.946. External testing demonstrated statistically superior agreement with expert annotations (mAP50=0.944, 95% CI: 0.934-0.953) compared with mid-level physician annotations (mAP50=0.912, 95% CI: 0.908-0.919), with the difference being statistically significant (95% CI of difference: 0.015-0.043, P <0.05).

Conclusion: The YOLO11-based model demonstrated stable two-center performance with close alignment to expert-level clinical standards. The rapid inference, high sensitivity, and integrated visualization system address key challenges related to efficiency and interpretability in clinical AI applications for cervical spinal cord compression assessment.

Study design: Prospective multicenter cohort study.

Objective: To compare clinical outcomes between posterior decompression without fusion (PD) and anterior cervical discectomy and fusion (ACDF) in patients with 1- to 2-level degenerative cervical myelopathy (DCM).

Summary of background data: While numerous studies have assessed surgical strategies for multilevel DCM, limited evidence is available for cases involving only one or two levels.

Methods: Among 1482 patients with degenerative cervical spine disorders from 10 Japanese institutions, 353 patients with 1- to 2-level DCM treated with either PD (n=233) or ACDF (n=120) and followed for 2 years were included. Clinical outcomes included the Japanese Orthopaedic Association (JOA) score, Visual Analog Scale (VAS), Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and Short Form-36 (SF-36). Group comparisons were adjusted for baseline characteristics and preoperative clinical outcomes using a general linear model.

Results: Perioperative complication and reoperation rates did not significantly differ between groups. ACDF provided significantly greater improvements in VAS scores for neck pain (-22.6 vs . -6.1 mm, P =0.003), upper extremity pain/numbness (-32.7 vs . -18.3 mm, P =0.011), and SF-36 bodily pain (22.8 vs . 10.1, P =0.003) and physical component summary (PCS) scores (9.1 vs . 3.5, P =0.007) compared with the PD group. Conversely, PD yielded greater improvement in the SF-36 social functioning domain (13.3 vs . 2.6, P =0.011). No significant differences were observed in JOA scores, the five domains of JOACMEQ, or other SF-36 domains.

Conclusions: Both PD and ACDF provided comparable improvements in neurological function as measured by JOA and JOACMEQ scores, indicating similar efficacy in treating DCM. ACDF was more effective for alleviating neck and arm pain and enhancing physical health, while PD resulted in social functioning. Given similar complication rates, surgical strategy should be individualized based on each patient's clinical presentation.

Study design: Retrospective cohort.

Summary of background data: Spinal fusions are common interventions for degenerative spine disease (DSD), with increasing utilization in obese and metabolic syndrome populations. Glucagon-like peptide-1 (GLP-1) receptor agonists (RA), widely adopted for diabetes and weight management, may offer systemic benefits that exert a parallel influence on surgical outcomes.

Objective: We aimed to evaluate whether preoperative GLP-1 RA use influences 90-day medical and 2- and 10-year surgical complications following thoracic and/or lumbar spinal fusion for DSD, stratified by BMI.

Methods: Using a national claims database (2010-2023), we identified patients undergoing thoracic and/or lumbar spinal fusion for degenerative conditions. GLP-1 RA users within 6 months pre-op were 4:1 matched to controls by age, sex, and CCI across six BMI strata. Outcomes included 90-day medical and 2- and 10-year surgical complications (eg, revisions for infection, pseudoarthrosis, and mechanical failure). χ 2 , t tests, and Cox models were used for statistical analysis.

Results: Among 291,677 patients, 19,232 GLP-1 RA users were matched to 76,778 controls. Ninety-day medical complications-such as infection, pneumonia, thromboembolism, sepsis, stroke, and UTI-were significantly reduced in GLP-1 RA users across BMI categories ≥25. Two-year surgical complications were lower among GLP-1 RA users in BMI 35 ti 39.9 (1.1% vs . 1.6%, P =0.007 for pseudarthrosis-related revision; 0.8% vs . 1.2%, P =0.038 for mechanical failure) and ≥40 groups. At 10 years, GLP-1 RA use was associated with significantly reduced risk of revision in the 25.0 to 29.9 (HR 0.79, P =0.046) BMI group. Revision due to pseudarthrosis was reduced in BMI 35.0 to 39.9 (HR 0.69, P =0.014) and ≥40.0 (HR 0.73, P =0.041), while revision for mechanical failure was lower in BMI 35.0 to 39.9 (HR 0.65, P =0.013) and ≥40.0 (HR 0.57, P =0.003).

Conclusion: GLP-1 RA use was linked with reduced perioperative and long-term surgical complications in patients undergoing thoracic and/or lumbar fusions for degenerative spine disease, particularly in those with BMI ≥25. This risk reduction may be attributed to weight loss and/or the systemic metabolic, inflammatory, and vascular benefits of these medications.

Study design: Retrospective cohort study.

Objective: To compare muscle health and imaging markers in patients with 1-level L4-L5 stable versus unstable degenerative lumbar spondylolisthesis (DLS).

Background: DLS may be stable or unstable. It is unknown how muscle health and other imaging markers are associated with DLS stability.

Materials and methods: Patients 18 years or older with 1-level L4-L5 DLS and preoperative flexion/extension radiographs were included. Normalized total psoas area (NTPA), body mass index (BMI)-normalized paralumbar [PL; multifidus (MF)+erector spinae (ES)] cross-sectional area (PL-CSA/BMI), and Goutallier were assessed. Other L4-L5 markers included: facet orientation, slip percentage, pelvic incidence (PI), tilt (PT), sacral slope (SS), lumbar lordosis (LL), and PI-LL. Instability was defined as >3 mm translation or >10° endplate change on flexion-extension. Low versus normal muscle health was defined as NTPA or PL-CSA/BMI below the lowest sex-specific quartile. Multivariate logistic regression was used to determine variables associated with instability.

Results: Two hundred fifty-one patients (unstable = 50; stable = 201) were included. There were no significant differences in muscle health at L3, L4, or L5 or Goutallier on univariate analysis. The stable cohort had smaller slip percentage (19 ± 9% vs . 15 ± 8%, P = 0.007) and PI-LL (13.56 ± 12.75 vs . 5.81 ± 14.46, P = 0.001). The stable cohort had more patients with MF and ES total Goutallier ≤2 ( P = 0.031, P = 0.002, respectively) at L3-L4 versus L4-L5 and more patients with MF and ES total Goutallier ≤2 ( P = 0.013, P = 0.004, respectively) at L4-L5 versus L5-S1. On regression, low L4-L5 MF Goutallier was associated with instability [OR: 2.50 (95% CI: 1.01-6.20), P = 0.047].

Conclusion: Patients with unstable L4-L5 spondylolisthesis have lower multifidus Goutallier at the slip level, greater slip percentage, and greater PI-LL mismatch. Patients with stable L4-L5 spondylolisthesis have greater Goutallier of the caudal paralumbars.

Level of evidence: Level III.

Study design: Retrospective review.

Objective: Specialty palliative care (PC) can be instrumental in improving patient quality of life for patients with spine metastasis. It is important to identify disparities in access to PC to ensure that equitable care is provided to all patients. No prior study has assessed the impact of sociodemographic and treatment factors on the utilization of in-patient (IPPC) and outpatient (OPPC) PCs in patients with spine metastases.

Materials and methods: We examined IPPC and OPPC utilization in a cohort of 265 patients seen by our institution's Brain and Spine Metastases Tumor Board (BSMTB) between February 1, 2018 and February 31, 2020. Statistical analyses were performed comparing characteristics and outcomes between patients who did or did not utilize IPPC and/or OPPC.

Results: We observed no difference in rates of IPPC and OPPC consultation between patients across sex or race. Outpatient PC consultations varied across insurance and primary tumor type ( P = 0.056 and P = 0.025, respectively). Patients who received surgical intervention or radiation therapy within 30 days of being presented at BSMTB had higher rates of OPPC utilization than those who did not ( P = 0.0032 and P = 0.040, respectively). Patients who received an IPPC consult had worse overall survival than patients who did not consult IPPC (6.5 vs . 24.2 mo median survival), while those seen by OPPC had less of a survival disadvantage; median survival for OPPC was 11.2 months versus 19.2 months for those who were not seen by OPPC.

Conclusion: We identified differences in PC utilization across insurance and primary tumor types. In addition, we present the unique finding that patients who receive surgery or RT for their spine metastases had higher rates of OPPC consultations than those who did not. Further work is needed to better appreciate PC utilization trends and identify interventions that improve the accessibility of PC.

Study design: Retrospective cohort study.

Objective: This study aimed to compare radiographic and clinical outcomes in adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) with and without thoracoplasty.

Background: Scoliosis is a three-dimensional deformity. As a result, patients often have an associated rib cage deformity, with clinical and aesthetic implications. Direct vertebral rotation (DVR) allows for some reduction of the rib hump; however, the deformed ribs remain deformed. Rib resection has been utilized to further reduce the rib hump, however, there are concerns of increased pain, operative time, and blood loss.

Materials and methods: Retrospective review of 400 AIS patients undergoing PSF between 2018 and 2023. Patients were stratified based on those who underwent rib resectioning (RR) and those who did not [non-rib resection (N-RR)]. Radiographic, surgical, and clinical outcomes were compared. Clinical outcomes were collected utilizing SRS-22 and our institution's activity questionnaire, validated through "test-retest" method. All data are presented as medians, IQR, frequencies, and percentages. Fisher exact, χ 2 , and Wilcoxon rank-sum tests were used.

Results: One hundred fifty-three patients were in the RR group, and 247 were in the N-RR group. Preoperative rib hump was not statistically significant between the two groups ( P = 0.49). Final rib hump was 16.3 mm in RR patients and 29.8 mm in N-RR ( P < 0.001). RR had 60.5% rib hump correction; N-RR had 30.4% correction ( P < 0.001). Patient-reported self-image ( P = 0.02) and mental health ( P = 0.01) scores had significantly improved in RR. No differences in 90-day complication rates ( P = 0.19) or self-reported return to activities ( P > 0.05).

Conclusion: Rib resectioned patients had approximately double the amount of rib hump correction at 60.5%, compared with those who did not undergo rib resectioning at 30.4%, with no increase in the rate of complications. RR patients had improved self-reported self-image and mental health scores, with no difference in timing for return to activities.

Study design: Retrospective study.

Objective: To determine the prevalence of new chronic pain conditions within one year of whiplash and the factors associated with chronic pain following whiplash exposure.

Summary of background data: Whiplash is among the most common injuries that occur following motor vehicle accidents. Many have postulated that whiplash is a progenitor for the development of chronic pain. Prior research in this arena has been limited.

Materials and methods: We retrospectively identified TRICARE beneficiaries who sustained a whiplash injury between 2017 and 2023. The records of eligible beneficiaries were abstracted to obtain age at the time of injury, race, sex, US census region, sponsor rank, mental health diagnoses, environment of care, beneficiary status, time period of injury, and number of comorbidities. We considered junior enlisted sponsor rank indicative of lower socioeconomic strata. The primary outcome was the development of a chronic pain condition. We used multivariable logistic regression with reweighting to account for confounders. We examined interactions between sex/mental health conditions, sex/socioeconomic status, and sex/time period to address secular trends.

Results: The development of new chronic pain conditions occurred in 23.4%. After adjusting for confounders, we found that women (OR=1.57; 95% CI: 1.49-1.65), pre-existing mental health conditions (OR=1.35; 95% CI: 1.28-1.42) and our proxy for lower socioeconomic status (OR=1.15; 95% CI: 1.04-1.27) were significantly associated with the likelihood of developing chronic pain disorders within one year of whiplash injury. There were interactions between women and mental health conditions, as well as between women and socioeconomic status.

Conclusions: This represents the largest study that longitudinally surveys the development of chronic pain conditions following whiplash. The incidence of chronic pain after whiplash is lower than has been previously postulated. We believe these findings can inform management during the postinjury time period and recommendations for surveillance.