Spine最新文献

Study design: Subanalysis of a prospective, multicenter, observational study at 72 US adult, pediatric, and mixed trauma centers.

Objective: We investigated trauma-related risk factors and patient-level factors associated with multiregional spinal column injury, defined as cervical spine injury (CSI) requiring treatment and thoracolumbar injury (TLI).

Summary of background data: Traumatic spinal injury causes morbidity and mortality in pediatric patients. Injuries to multiple spinal column regions require early identification and thoughtful management.

Methods: All children <18 years undergoing cervical spine evaluation after blunt multisystem trauma were prospectively identified and enrolled. Clinically significant CSI was defined by cervical spine surgery or halo placement. TLI incidence and management was recorded. The primary outcome was multiregional spinal column injury (CSI+TLI).

Results: Of 19,651 enrolled patients, 1484 children (7.5%) experienced a TLI, 159 (0.81%) had CSI requiring treatment, and 30 (0.15%) had CSI+TLI. Multivariate analysis revealed that the trauma-related factors mechanism of injury (P<0.001), rib fractures (odds ratio (OR) 2.8 [2.3-3.4]), hemothorax/pneumothorax (OR 2.0 [1.7-2.4]), bowel injury (OR 4.0 [2.9-5.4]), pelvic fracture (OR 1.5 [1.2-1.9]), and clinically significant CSI (OR 1.9 [1.2-2.9]) were independently associated with TLI. Of the 159 children with clinically significant CSI, 30 also experienced TLI (19%). Multivariate analysis identified prehospitalization intubation (OR 3.1 [1.1-8.4]) and rib fractures (OR 3.9 [1.2-12.8]) as independent associations with CSI+TLI.

Conclusions: Of children with CSI requiring treatment, 19% experienced TLI. MOI and various trauma-related injuries were independently associated with TLI, whereas prehospitalization intubation and rib fractures were independent risk factors for CSI+TLI. These factors should trigger screening for multiregional spinal column injury in pediatric trauma patients. Furthermore, if there is known TLI, the cervical spine should be evaluated, and if there is significant CSI, then dedicated imaging of the thoracic and lumbar spine is indicated.

Level of evidence: III.

Study design: Retrospective cohort study.

Objective: Assess epidemiological patterns in the rate and age distribution of surgically treated adult spinal deformity (ASD) over the last decade.

Background: Advances in patient selection, preoperative optimization, operative technique, and postoperative care have influenced trends in surgical management of ASD. However, nationwide epidemiological data of surgically treated ASD is lacking.

Methods: Adults who underwent corrective ASD surgery between 2010-2022 were identified from a large insurance claims database. Age, sex, year, region, and insurance plan distribution were extracted. Yearly trends in case counts and mean age were assessed using linear regression. Incidence rate ratios were calculated to evaluate differences in case rates.

Results: Among 141,604 surgically treated ASD patients, incidence increased from 4.5 to 15.5cases per 100,000, an increase of 1.2cases per 100,000 every year over the study period (P<0.001). Mean age increased from 63.3 to 66.7years, an increase of 2.5years every 10 years over the study period (P<0.001). Incidence rates also increased with age, with a peak of 88.5cases per 100,000 in 65-69 year olds. Female incidence rate was 90.9cases per 100,000 and male incidence rate was 78.4cases per 100,000. Regionally, Midwest had the highest incidence rate, and Northeast had the lowest incidence rate. Most (63.8%) patients were covered by commercial insurance, but Medicare had higher incidence rates than commercial insurance (71.7 Medicare vs. 57.1 Commercial cases per 100,000). Medicare incidence rates increased from 1.5 to 4.6cases per 100,000 while Commercial insurance incidence rates increased from 2.9 to 9.8cases per 100,000 (P<0.001).

Conclusion: Between 2010-2022, surgically treated ASD rates rose by nearly 250%, with the average age of the operative patients increasing by 3.4years. As surgical volume for ASD continues to grow, continued efforts to improve outcomes and payment models will be necessary for sustainability.

Level of evidence: IV.

Study design: Retrospective cohort study at a single institution.

Objective: To determine the incidence of postoperative lumbar radiculopathy (PLR) following single-level anterior lumbar interbody fusion (ALIF) at L4-L5 or L5-S1, evaluate the unplanned return-to-operating-room (UPROR) rate, and assess associations of posterolateral foraminal cephalad endplate osteophytes (PFO) and superior articular process hooks (SAH) with PLR.

Summary of background data: Limited research exists on PLR incidence after ALIF or its association with PFO and SAH, which may contribute to indirect nerve root compression postoperatively.

Methods: Patients undergoing single-level L4-L5 or L5-S1 ALIF from January 2022 to December 2023 were reviewed, excluding those with spinal deformity, trauma, or infection. PLR was categorized as new, persisting, or worsening. Data included PLR presence, new postoperative weakness, direct decompression history, Bone Morphogenetic Protein-2 (BMP-2) usage, PFO (>50% exiting nerve root width), and SAH (>2 mm foraminal extension) on preoperative imaging. Radiographic parameters, including posterior disc height (PDH), spondylolisthesis, and lordosis at the operative level (L4-L5 or L5-S1), were measured preoperatively and 1-month postoperatively. Pearson chi-square tests assessed associations between PFO, SAH, decompression history, dynamic spondylolisthesis, and PLR. Multivariable logistic regression evaluated these as PLR predictors.

Results: Of 204 patients (mean age, 62.8 y; 51% male), 37 (18.1%) developed PLR. SAH (P=.015) and PFO (P=.001) were significantly associated with PLR in chi-square analyses and remained independent predictors in multivariate regression (SAH: odds ratio [OR], 2.82; P=.017; PFO: OR, 3.25; P=.005). Among PLR patients, 27.0% had new weakness, 43.2% new radiculopathy, 24.3% worsening radiculopathy, and 32.4% persisting radiculopathy (categories not mutually exclusive). Symptoms resolved in 78.4% by 5.9 months (range, 0.07-23.7). UPROR occurred in 18 patients (8.8% total; 48.6% PLR), primarily for decompression (72.2% resolution post-reoperation). Ten patients (27.0%) received epidural steroid injections.

Conclusion: PLR occurred in 18.1% of single-level ALIF patients; 78.4% resolved by 6 months. SAH and PFO independently predict PLR, necessitating preoperative evaluation to mitigate complications and reoperation risk.

Study design: Multicenter retrospective cohort study.

Objective: To determine how preoperative neurological severity influences postoperative recovery and achievement of clinically meaningful improvement following anterior cervical decompression and fusion (ACDF/ACCF) for degenerative cervical myelopathy (DCM).

Summary of background data: Anterior cervical decompression procedures are widely used for DCM, including ossification of the posterior longitudinal ligament, with favorable outcomes reported over decades. However, the impact of preoperative neurological severity on recovery after anterior surgery remains insufficiently defined. Large anterior-only cohorts evaluating severity-adjusted minimal clinically important difference (MCID) are lacking.

Methods: We retrospectively analyzed 1,024 patients who underwent anterior cervical decompression and fusion at three spine centers between 2011 and 2021. Patients were stratified by preoperative JOA score into a severe group (JOA <10; n=320) and a mild-moderate group (JOA ≥10; n=704). Neurological outcomes were assessed using the JOA score, JOA recovery rate, and severity-specific MCID thresholds (≥3-point improvement for severe and ≥2-point improvement for mild-moderate myelopathy). Perioperative complications, including dysphagia, segmental motor deficit, and graft-related events, were recorded.

Results: Preoperative JOA scores were significantly lower in the severe group (7.4 ± 2.2) than in the mild-moderate group (12.4 ± 1.6; P<0.001). Both groups showed substantial improvement at 1 year (11.7 ± 3.1 vs. 14.6 ± 1.8; P<0.001). Recovery rates were similar (44.6% vs. 48.2%; P=0.74). MCID achievement was significantly higher in the severe group (66.9%) than in the mild-moderate group (49.0%; P<0.001). Excellent recovery (JOA recovery rate ≥80%) was more frequent in the mild-moderate group (23.4% vs. 12.5%; P<0.01). Complication rates did not differ significantly.

Conclusion: In this large multicenter cohort, patients with severe preoperative myelopathy achieved meaningful neurological improvement and high rates of severity-adjusted MCID after anterior cervical decompression and fusion. These findings provide practical, severity-based prognostic information for preoperative counseling in DCM surgery.

Study desing: Retrospective cohort study.

Objective: To characterize the association between paraspinal musculature at C3 and cervical volumetric bone mineral density (vBMD) derived from quantitative computed tomography (QCT) and vertebral bone quality (VBQ) scores from magnetic resonance imaging (MRI).

Summary of background data: Osteoporosis and sarcopenia are prevalent among elderly patients and often coexist. Prior studies have shown a positive association between lumbar paraspinal functional cross-sectional area (fCSA) and bone mineral density, but the relationship between cervical paraspinal muscles and cervical bone quality remains unclear. Although dual-energy X-ray absorptiometry (DEXA) is the clinical gold standard for assessing bone density, newer modalities such as QCT and VBQ can evaluate site-specific bone health. Understanding this muscle-bone relationship in the cervical spine may improve preoperative risk stratification and surgical planning.

Methods: Patients with preoperative cervical MRI and CT who underwent anterior cervical discectomy and fusion between 2015 and 2018 were reviewed. Muscles at C3 were categorized into four functional groups: sternocleidomastoid, anterior, posteromedial, and posterolateral. For all groups, cross-sectional area (CSA), fCSA, and fat infiltration (FI) were measured. QCT and VBQ analyses were performed using established methodologies. Multivariable linear regression adjusted for age, sex, and body mass index (BMI) and Benjamini-Hochberg correction were performed.

Results: A total of 100 patients (median age, 56.5 years; 38 females) were included. After adjusting, regression analyses demonstrated a significant negative association between fCSA of the anterior group and VBQ scores from C2 to T1, as well as a significant positive association between FI of the same group and VBQ scores. Additionally, a significant positive association was observed between CSA of the posteromedial group and vBMD at C1 and C3.

Conclusion: Significant associations were observed between cervical paraspinal muscle morphology and vertebral bone quality and density measured using VBQ and QCT, respectively.

Study design: Systematic review and meta-analysis.

Objective: To conduct a meta-analysis of high-level prospective evidence studies evaluating changes in Visual Analogue Scale (VAS), SI joint pain scores, Oswestry Disability Index (ODI) outcomes, and adverse events (SAE) requiring an additional operation.

Summary of background data: Low back pain is a leading cause of disability, and the sacroiliac joint (SIJ) is implicated as a primary pain generator in up to 25% of cases. However, SIJ-mediated pain is difficult to diagnose, and is often one of exclusion confirmed by diagnostic injections. Minimally invasive SIJ fusion has emerged as a treatment option for patients with confirmed SIJ dysfunction who fail nonoperative care.

Methods: A systematic review and meta-analysis were performed according to PRISMA guidelines. Eleven studies (9 prospective cohort and 2 randomized control trials) met inclusion criteria based on study design, quality of evidence, and reporting of patient-reported outcomes. Demographic data, baseline characteristics, surgical indications, and outcomes were extracted. Meta-analyses were conducted to calculate pooled estimates of VAS and ODI improvements, and reoperation rates.

Results: Eleven studies reporting on 1,181 sacroiliac joint fusions were included, with a mean follow-up of 27.8 months. Sacroiliac joint pathology was confirmed by diagnostic SIJ injection in 92.7% of patients. Meta-analysis showed a VAS improvement of 45.5 points (95% CI: 38.6-52.3) and an ODI improvement of 23.3 points (95% CI: 21.0-25.7), both exceeding established MCID thresholds (P < 0.001). The meta-analysis of reoperation rates for implant-related serious adverse events was 3% (95% CI: 2%-4%).

Conclusion: Minimally invasive SIJ fusion, performed across multiple implant systems and surgical techniques, yields large, clinically meaningful, and reproducible improvements in pain and disability with a low reoperation rate. Outcomes are most favorable when patient selection is rigorous and SIJ dysfunction is accurately identified as the primary pain generator using diagnostic SIJ injection, underscoring the importance of standardized diagnostic pathways in optimizing surgical benefit.

Study design: Literature review and international cross-sectional survey with Rasch psychometric analysis.

Objective: To evaluate the clinical, economic, and operational impact of navigation and robotics in spine surgery by integrating evidence from the best literature and real-world surgeon practice patterns.

Summary of background data: Robotics and computer-assisted navigation (CAN) are increasingly adopted in spine surgery, with well-documented technical advantages in surgical accuracy and safety. However, their translation into improved patient outcomes, cost-effectiveness, and broad real-world applicability remains uncertain.

Methods: A scoping review and synthesis of published studies and meta-analyses was performed. In parallel, a 93-item international survey was distributed to spine surgeons across multiple countries, capturing perceptions of accuracy, radiation safety, costs, training, workflow, and patient outcomes. Responses (n = 195) were analyzed using Rasch modeling to assess consensus strength and item difficulty, supplemented by descriptive statistics.

Results: Published data and meta-analyses confirm superior screw accuracy with robotics/CAN (≥95% safe-zone placement) and consistent reductions in staff radiation. Real-world surgeon survey responses showed high concordance on these technical benefits but persistent concerns regarding cost (37.4%), equipment availability (55.9%), workflow burden, and limited training access (8.2%). While 74.9% of surgeons anticipated global adoption as standard of care within 10 years, only 52.3% endorsed cost justification. Rasch analysis demonstrated strong consensus on accuracy and complication reduction but skepticism regarding economic viability.

Conclusion: Navigation and robotics in spine surgery offer robust technical benefits but remain constrained by cost, training, and workflow barriers. Balanced integration-expanding applications beyond pedicle screw placement, supported by automation, standardized metrics, and scalable financial models-is essential to realize their full clinical and societal value.

Study design: Retrospective cohort study.

Objective: To evaluate whether abdominal circumference (AC) and abdominal-to-pelvic circumference (ACPC) ratio, derived from CT imaging, offer improved prediction of cardiometabolic comorbidities compared with body mass index (BMI) in orthopedic patients.

Background: BMI is a widely used measure for assessing obesity-related risk but lacks sensitivity to fat distribution and body composition. In surgery, where central adiposity contributes to surgical complexity and metabolic risk, BMI alone may be insufficient for accurate preoperative assessment.

Methods: Preoperative abdominopelvic CT scans were reviewed for 134 adults who underwent orthopedic surgery between January 2022 and December 2023. Abdominal circumference, pelvic circumference, and BMI were recorded. Cardiometabolic conditions (type 2 diabetes, hypertension) and lipid profiles were extracted from medical records. Associations between body composition measures and cardiometabolic outcomes were assessed using logistic regression and ROC curve analysis.

Results: Among 134 patients included in this study, the mean age was 62.8 years, 63.4% were of female sex, the mean BMI was 28.6 kg/m², and 23.9% had sarcopenia. BMI correlated strongly with AC (r=0.761) and ACPC ratio (r=0.721), though correlations diminished in patients with BMI >30 kg/m². AC demonstrated the strongest associations with diabetes (Cohen's d= -0.84) and hypertension (Cohen's d= -0.61), and had the highest area-under-curve values for both conditions. ACPC ratio, but not BMI, was significantly correlated with high-density lipoproteins (r= -0.288, P =0.027) and triglycerides (r=0.266, P =0.042).

Conclusions: Radiographic AC and ACPC ratios are strongly associated with central adiposity and cardiometabolic risk factors and may outperform BMI for risk stratification, especially in higher-weight patients. These metrics represent practical, objective tools for enhancing preoperative optimization protocols in spine surgery, and may be generalizable to other surgical and medical specialties.