搜索结果：Global spine journal

The mandibular lingula, historically termed the spine of Spix, represents a critical anatomical landmark in oral and maxillofacial surgery. This comprehensive review synthesises findings from major studies spanning 25 years (2000-2025), encompassing 11,937 + mandibular sides across 19 + populations from six continents. The lingula serves as the primary landmark for inferior alveolar nerve blocks (IANB), sagittal split ramus osteotomy, and various orthognathic procedures. Significant morphological variations exist, with five distinct shapes documented: triangular, truncated, nodular, assimilated, and the recently described bridge/M-shaped morphology (Stipo et al., 2022). A critical methodological bias is evident: dry bone studies predominantly report triangular shapes (39%), while Cone-Beam Computed Tomography (CBCT) studies reveal a nodular predominance (50.6%) in many populations. The internal oblique or mylohyoid ridge has emerged as a reliable alternative landmark (95.7% visibility) and yields superior IANB success rates (97.3%) compared with traditional methods (∼85%). Furthermore, the antilingula is critically evaluated and found to have limited value as a sole landmark. However, it may serve as a supplementary guide when used with appropriate posterior safety margins. This review establishes evidence-based, population-specific surgical protocols, emphasizes the unreliability of traditional assumptions regarding bilateral symmetry, and includes critical appraisal of recent data regarding age-related mandibular remodelling. Comprehensive meta-analytic data representing 4694 subjects provides the most comprehensive morphometric reference values currently available.

Trauma is the leading cause of death and disability in children and adolescents worldwide; however, paediatric trauma care is often neglected during health system development. We aimed to understand current global standards of laparotomy care for paediatric patients with blunt or penetrating traumatic injury and variation in patient injury patterns, intervention, and post-operative outcomes. This is a planned post-hoc analysis of the international, multicentre, prospective, observational cohort from the Global Outcomes After Laparotomy for Trauma (GOAL-Trauma) Study, which was conducted between April 1 and Dec 31, 2024. Patients aged 18 years or younger with a blunt or penetrating traumatic injury who underwent a laparotomy within 5 days of presentation were eligible. Countries were stratified by the Human Development Index (HDI), and the primary outcome was post-operative in-hospital 30-day mortality. Adjusted mortality risk was calculated using least absolute shrinkage and selection operator regression analysis. The study was registered with ClinicalTrials.gov (NCT06180668). 237 paediatric patients who underwent a trauma laparotomy were recruited from 85 hospitals in 32 countries, with the highest proportion of patients living in countries in the lower HDI tertile (110 [20%] of 563 cases overall). The median age among paediatric cases was 16·0 years (IQR 12·0-18·0), and most patients were male (195 [82%] of 237 patients) and had sustained a blunt injury (135 [57%] patients). The median time globally from injury to operation was 7·4 h (IQR 3·5-18·8; n=235), with longer times observed across the patient pathway for patients in the lower and middle HDI tertiles than for those in the upper HDI tertile (p=0·0008). The overall 30-day in-hospital crude mortality rate was 8% (19 of 237 patients); however, after adjustment, patients in the lower HDI tertile were nearly six times more likely to die post-operatively than those in the upper HDI tertile (odds ratio 5·69 [95% CI 1·58-20·44], p=0·0079). Proportionally more children undergo trauma laparotomy in lower-resource settings than in higher-resource settings; however, their mortality risk is substantially higher. Marked variation exists in paediatric pathways globally, and policy makers and health-care leaders should prioritise the development of paediatric trauma care worldwide. Royal College of Surgeons Ratanji Dalal Research Fellowship and the Engineering and Physical Sciences Research Council.

Bibliometric analysis. To analyze the global application of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and identify status and emerging trends in SCI research. Not applicable. Articles published between 2020 and 2023 were retrieved from the Web of Science Core Collection. Data on disciplines, ISNCSCI versions, research aims, journals, keywords, countries, authors, and collaboration patterns were manually extracted. Visualization and mapping analyses were performed using VOSviewer and CiteSpace. A total of 595 articles involving 3498 authors from 46 countries were included. Among them, 569 were ISNCSCI application studies and 26 were development or version-related studies. Within the application studies, the leading disciplines were neurology (507 articles), orthopedics (180), and rehabilitation (179). The 2011 ISNCSCI edition was the most frequently reported version (30.8%), although 56.2% of studies did not specify the version. The journals publishing the most articles were Spinal Cord, Journal of Neurotrauma, and Archives of Physical Medicine and Rehabilitation. The main research topics were SCI prognosis (15.8%), rehabilitation efficacy (15.4%), and SCI-related complications (15.4%). The United States, China, and Canada were the top publishing countries. Frequently emerging keywords in 2023 included "predictors," "cardiovascular disease," "features," and "disability." ISNCSCI is a widely accepted standardized tool in SCI research and clinical practice. The field is characterized by expanding international participation, stronger interdisciplinary collaboration, and increasingly diverse applications. Better reporting of ISNCSCI versions may improve consistency and comparability across future studies. None.

Background/Objectives: Traumatic spine injury is a major cause of morbidity and mortality in low- and middle-income countries, yet detailed epidemiologic data from sub-Saharan Africa remain limited. We used a fracture registry to characterize injury patterns, care pathways, and short-term outcomes among patients presenting with traumatic spine injury at a tertiary referral center in Ethiopia. Methods: We performed a retrospective analysis of a prospectively maintained fracture registry at a tertiary referral hospital in Ethiopia from June 2023 to July 2025. Patients with traumatic spine injury were included. Variables included demographics, injury mechanism and context, injury region, AO morphology, neurologic status (ASIA), referral status, mode of transportation, time to presentation, treatment, and 30-day outcomes. Descriptive statistics were used to summarize the cohort. Bivariate associations were assessed using chi-square or Fisher's exact tests, and crude odds ratios were calculated for prespecified 2 × 2 comparisons. Results: A total of 252 patients were included (mean age: 33.1 ± 13.6 years; 81.3% male). Falls (45.2%) and road traffic accidents (26.2%) were the most common mechanisms, and injuries most often occurred on farms (40.1%) and roads/streets (33.7%). The thoracolumbar (31.3%) and cervical (30.6%) regions were most frequently affected. Complete spinal cord injury (ASIA A) occurred in 36.5% of patients. Most patients were referred (88.5%), 62.7% presented >24 h after injury, and 65.5% were managed non-operatively. Referral status was strongly associated with delayed presentation (OR: 10.49, 95% CI: 3.84-28.64). Thirty-day mortality was 22.2%. Complete SCI (OR: 6.17, 95% CI: 3.23-11.90) and cervical/thoracic injuries (OR: 6.54, 95% CI: 3.12-13.70) were associated with higher mortality. Conclusions: Traumatic spine injury in this Ethiopian cohort disproportionately affected young adults and was marked by severe neurologic injury, delayed presentation, and high early mortality.

To examine the relationship between radiographic signs of acetabular retroversion (AR) in symptomatic femoroacetabular impingement syndrome (FAIS) patients and global AR (GAR) measured on 3-dimensional imaging. A retrospective cohort study was conducted to identify patients between 2017 and 2024, with radiographic and clinical FAIS. Standardized pelvic radiographs were analyzed for crossover sign (COS; including crossover percentage), ischial spine sign (ISS), and posterior wall sign (PWS). Alpha angle, femoral torsion, lateral center-edge angle (LCEA), and acetabular version at 1, 2, and 3 o'clock were collected from computed tomography (CT) scans. Patients with AR, defined as >/=5° of retroversion relative to normal values at the 1, 2, and 3 o'clock positions were identified. The sensitivity and specificity of each sign were calculated using CT scans to establish groups of focal and GAR. Continuous variables were compared using one-way analysis of variance and linear regression analyses. Of the 273 cases, 209 were included. Patients were categorized into the following groups: globally retroverted (n = 56), focally retroverted (n = 74), and normal version (n = 79). The GAR minimal clinically important difference (MCID) is .086°, focal AR MCID is .062°, and normal range acetabular version is .063°. COS and PWS were most sensitive at detecting CT-confirmed AR at 91.6%. Combined crossover percentage greater than 30%, with all positive plain X-ray signs of AR, was most specific at 94.6%. A significant association between crossover percentage and extent of AR at the 3 o'clock position was observed (R2 = .1008, P = .0003). Gender-based sensitivity and specific analyses show COS and PWS are most sensitive, and an isolated COS% greater than 30% is most specific at detecting GAR in male patients. A positive ISS was more prevalent among females, whereas a positive PWS was more prevalent among males. This retrospective review of patients with symptomatic FAIS and radiographic signs of FAI accurately detects GAR with high sensitivity and specificity without a CT scan. Crossover percentage was associated with the extent of AR and may be valuable as a predictive tool. This may help identify patients with more complex deformities that may benefit from CT imaging. Level III, retrospective diagnostic case series.

Systemic lupus erythematosus (SLE) is a complex autoimmune disease in which patients have a significantly increased risk of developing osteoporosis (OP) and osteopenia. Despite numerous studies, the global burden of SLE-related OP, its regional distribution patterns and its major risk factors remain poorly quantified and subject to controversy due to heterogeneity in sample sizes, diagnostic criteria and methodologies. To address these gaps in the evidence, we conducted a systematic assessment of the prevalence and risk factors for OP and osteopenia in patients with SLE. We conducted a systematic review and meta-analysis. We performed a comprehensive search of Chinese and English databases, including PubMed, Embase, the Cochrane Library, Web of Science, CNKI and WANFANG, up to 26 September 2025. We included observational studies that met the diagnostic criteria for SLE and reported the prevalence of OP or reduced bone mass, as well as associated risk factors. Two reviewers independently conducted literature screening, data extraction and quality assessment. Statistical analysis was performed using Stata 12.0 software; random-effects or fixed-effects models were employed to pool prevalence rates and odds ratios, and subgroup analysis, meta-regression and sensitivity analysis were used to explore sources of heterogeneity. A total of 59 studies were included. Meta-analysis revealed an overall prevalence of osteoporosis in SLE patients of 16.70% (95% CI: 14.2%, 19.3%) and a prevalence of osteopenia of 39.50% (95% CI: 35.5%, 43.5%). Site-specific analysis indicated that the lumbar spine was the site with the highest prevalence of osteoporosis (10.0%), whilst the femoral neck was the site most commonly affected by osteopenia (44.1%). Subgroup analysis identified several high-risk populations; the prevalence of osteoporosis in postmenopausal women (34.0%) was significantly higher than in premenopausal women (11.6%). Risk factor analysis indicated that advanced age (>50 years, OR = 21.92), long-term glucocorticoid use (OR = 1.63) and prolonged duration of SLE (OR = 1.05) were significant risk factors for OP. Glucocorticoid dosage was positively correlated with risk, with a significant increase in risk observed at daily doses >10 mg. Patients with SLE are at high risk of osteoporosis and osteopenia; postmenopausal women, Asian patients and those on long-term glucocorticoid therapy should be prioritized for screening and intervention. This study has revealed site-specific patterns of skeletal involvement and quantified the impact of key risk factors. In clinical practice, priority should be given to combined bone density monitoring, focusing on the lumbar spine and femoral neck, in high-risk populations. Furthermore, risk-stratified, proactive bone health management strategies should be implemented, with the aim of shifting the focus from 'treating fractures' to 'preventing fractures', thereby improving long-term patient outcomes. https://inplasy.com/inplasy-2025-12-0043/, identifier INPLASY2025120043.

Musculoskeletal health is essential to health, well-being, and independence across the life course. Musculoskeletal conditions including inflammatory joint diseases, osteoarthritis, back pain, osteoporosis, and fragility fractures are among the greatest causes of disability globally imposing a major burden on health and social care and economic impact also through lost productivity. Despite effective ways of preventing, treating, and rehabilitating these problems, lack of priority results in avoidable disability and costs. We consider how the expert community, through lived and learnt experience, can together influence health policy and health priorities, nationally and globally.

Stroke is a leading cause of neurological disability and mortality worldwide, with acute ischemic strokes caused by large-vessel occlusions presenting significant health care challenges. While endovascular thrombectomy has emerged as a gold standard treatment, access to timely stroke care remains severely limited, especially in low- and middle-income countries. This review examines the multifaceted social, cultural, and systemic barriers that impede effective stroke care globally. We performed a comprehensive search of PubMed from 2004 to 2024, using keywords of acute stroke care, low-middle-income countries, social barriers, cultural barriers, and access. There are several recognized obstacles to stroke treatment, especially in the acute settings, including health fatalism, spiritual and religious beliefs that discourage medical intervention, and widespread lack of public awareness about stroke symptoms and urgency. Cultural misconceptions often lead individuals to delay or avoid seeking medical care, with some communities attributing stroke to supernatural forces or divine punishment. Language barriers, insufficient health care infrastructure, and socioeconomic challenges further compound these issues, particularly in regions such as sub-Saharan Africa and parts of Asia. Furthermore, there are critical infrastructural barriers to delivering acute stroke in a timely manner, including limited transportation to health care facilities and inadequate stroke centers in rural areas. A comprehensive strategy to address these challenges should focus on culturally sensitive education, community engagement, and infrastructure development. Recommendations include cooperating with religious and community leaders, developing targeted awareness campaigns, and creating inclusive health care approaches that respect local cultural contexts. Overall, addressing the global stroke burden not only requires technological interventions but also demands a holistic approach that bridges cultural understanding, challenges misconceptions, and empowers communities to recognize and respond to stroke as a critical medical emergency.

Study DesignRandomized controlled trial.ObjectivesTo characterize postoperative C-reactive protein (CRP) trajectories as predictors of surgical site infection (SSI) following lumbar spine surgery, to determine optimal CRP thresholds, and to assess whether intrawound vancomycin powder affects postoperative CRP kinetics.MethodsData were drawn from a prospective randomized controlled trial enrolling 292 patients undergoing posterior lumbar interbody fusion. Patients received intrawound vancomycin powder (1 g) plus standard prophylaxis or standard prophylaxis alone. CRP was measured preoperatively and on days 1, 2, 3, 5, and 7. SSI was classified as overt (CDC criteria) or subclinical. ROC analysis evaluated prediction of any SSI at each time point.Results22 patients (7.5%) developed any SSI: 9 overt (3.1%) and 13 subclinical (4.5%). CRP peaked at day 5 in the overall cohort. SSI patients showed persistently elevated CRP through day 7, while uncomplicated patients declined after day 3. Day 7 CRP showed the highest discriminatory ability (AUC = 0.813; cutoff ≥79 mg/L; sensitivity 61.1%; specificity 91.4%; NPV 95.2%). Vancomycin did not alter CRP kinetics at any time point (all P > 0.08).ConclusionsIn 292 spine surgery patients, day 7 CRP (AUC = 0.813) was the strongest predictor of any SSI. A cutoff of 79 mg/L on day 7 provided NPV of 95.2%, supporting CRP as a rule-out biomarker. Day 3 CRP ≥92 mg/L (AUC = 0.761) offers early warning capability. CRP trajectories did not differ significantly between the vancomycin and control groups. ClinicalTrials.gov: NCT02631408; EudraCT: 2014-002096-29.

Retrospective cohort study. The objectives are to assess changes in cervical sagittal alignment after lumbar pedicle subtraction osteotomy (PSO) surgery and examine their association with preoperative global sagittal alignment (GSA) parameters. Changes in cervical alignment after lumbar PSO have been reported, yet the progression over time and predictors of long-term decompensation are poorly understood. Patients who underwent lumbar PSO between 2016 and 2021 were included. Cervical alignment was assessed preoperatively and at five postoperative time points: 1-30 days (PO1), 31-90 days (PO2), 91-180 days (PO3), 181 days-1 year (PO4), and 1-2 years (PO5). Cervical alignment parameters included cervical lordosis, C2-7 sagittal vertical axis (cSVA), C0-2 angle, T1 slope, C7 slope, C2 slope, T1 slope minus cervical lordosis (TS-CL), cervical tilt, neck tilt, thoracic inlet angle (TIA), cranial slope, cranial tilt, and cranial incidence. Preoperative GSA parameters included pelvic tilt (PT), global SVA and pelvic incidence-lumbar lordosis mismatch (PI-LL). A total of 99 patients were included. Immediate postoperative changes (preoperative to PO1) demonstrated consistent reductions in cSVA, cervical lordosis, T1 slope, C7 slope, cervical tilt, and neck tilt. In the longer-term analysis (PO1 to PO5), progressive increases were observed in cSVA, T1 slope, C2 slope, and cranial slope. Higher preoperative SVA was associated with greater immediate reductions in cSVA, C7 slope, and T1 slope. Higher BMI and older age were associated with reductions in distinct parameters. Longer-term analysis showed that greater preoperative PT was associated with increased TS-CL, neck tilt, cranial tilt, and T1 slope, while greater PI-LL mismatch was linked to smaller increases in these parameters. Our findings suggest that preoperative GSA parameters may influence cervical alignment in a phase-specific manner: Higher preoperative SVA was associated with immediate cervical adaptation, whereas pelvic parameters appear more related to long-term compensatory responses.

Study DesignDiagnostic accuracy study.ObjectivePrior evaluations of frontier models as radiology decision-support tools relied on 2-dimensional images or text reports; their ability to interpret volumetric data remains unclear. This study assessed Google Gemini 3 Pro for grading lumbar spinal canal stenosis on video lumbar magnetic resonance imaging (MRI) and evaluated diagnostic accuracy, agreement with neuroradiologist consensus, and the effect of localizer-assisted input.MethodsThe Radiological Society of North America (RSNA) 2024 Lumbar Spine Degenerative Classification Dataset, with American Society of Neuroradiology (ASNR) consensus labels, served as a reference benchmark; interobserver agreement among contributing readers was not reported. 100 examinations yielded 500 disc-level observations (371 normal/mild, 74 moderate, 55 severe), demonstrating marked class imbalance. Native imaging series were converted into synchronized video montages. Gemini 3 Pro generated one grade per disc level with and without localizer overlays. Primary outcome was linearly weighted kappa (κw); secondary outcomes included class-wise performance, severe-case error patterns, and overall accuracy.ResultsWithout localizer, overall accuracy was 75.6% (378/500) with fair agreement (κw = 0.39). Severe stenosis sensitivity was 41.8%; 43.6% of severe cases were downgraded to normal/mild, and 58.2% to non-severe. With localizer overlays, accuracy was 73.2% (366/500) with κw = 0.32, and severe sensitivity decreased to 30.9%; severe-to-normal/mild misses increased to 52.7%. Differences were not significant.ConclusionsGemini 3 Pro showed fair agreement with the neuroradiologist consensus benchmark, but apparent overall accuracy was inflated by the majority normal/mild class and masked clinically unacceptable under-detection of severe stenosis. Localizer-assisted input did not improve performance.

Study DesignRetrospective, Single-center.ObjectiveTo evaluate preoperative cervical range-of-motion via cervical flexion-extension radiographs and its relation to the development of PJK/PJF following ASD correction in patients with a UIV in the upper thoracic spine.MethodsPatients with an UIV between T1-T4, preoperative cervical flexion/extension radiographs and instrumented to the pelvis, and minimum 1yr follow-up were included. Cervical measurements included range-of-motion (ROM), flexion, extension and cervical SVA (cSVA). Patients were stratified into 3 groups: No-PJK, asymptomatic PJK (A-PJK) and symptomatic PJK including PJF (S-PJK/PJF).Results151 patients were included: Mean age 59.6 &#xb1; 8.0&#xa0;yrs, BMI of 25.1 &#xb1; 4.5, 88.7% (n = 134) were female. PJK status: No PJK = 111 (73.5%) patients, A-PJK = 21 (13.9%), S-PJK/PJF = 19 (12.6%). S-PJK/PJF patients, however, were more likely to be diagnosed with osteopenia/osteoporosis(S-PJK/PJF: 68.4% vs A-PJK: 23.8% vs No PJK: 52.3%, P = 0.0138). S-PJK/PJF patients had significantly less cervical flexion (No PJK: 19.5 &#xb1; 14.2 vs A-PJK: 19.9 &#xb1; 10.9 vs S-PJK/PJF: 7.7 &#xb1; 11.9, P = 0.0029) and ROM than the other groups (No PJK: 52.8 &#xb1; 17.7 vs A-PJK: 53.1 &#xb1; 14.5 vs S-PJK/PJF: 39.2 &#xb1; 17.9, P = 0.0085). On multivariable models for the development of S-PJK/PJF, reduced baseline cervical flexion and ROM were independent risk factors yielding threshold values of 22.8&#xb0; and 48.2&#xb0;, respectively.ConclusionMultivariable models for the development of S-PJK/PJF demonstrated that reduced baseline cervical ROM and flexion were independent risk factors yielding threshold values of 48.2&#xb0; and 22.8&#xb0;, respectively. All of S-PJK/PJF patients had preop flexion <22.8&#xb0;. Flexion-extension radiographs provide a quick and easy option at a relatively low cost to offer additional information that may aid in surgical planning and shared decision making with the patient regarding potential outcomes.

暂无摘要（点击查看详情）

Medical image interpretation plays a critical role in lumbar fusion surgery, where accurate analysis of anatomical structures is essential for clinical assessment. However, most existing deep learning approaches rely primarily on visual features and fail to effectively integrate heterogeneous clinical information. This study proposes a multimodal deep learning framework for lumbar spine image interpretation by jointly modeling medical images and associated clinical text. The framework adopts a global-local representation learning strategy to capture both overall anatomical context and fine-grained structural information. A visual encoder extracts hierarchical features from lumbar radiographs and CT scans, while a transformer-based text encoder captures semantic information from clinical reports. These representations are projected into a shared embedding space to enable cross-modal alignment. To enhance feature interaction, a text-guided attention mechanism is introduced to model correspondence between image regions and textual descriptions. The learned multimodal representations are applied to multiple downstream tasks, including cross-modal retrieval, classification, and lumbar structure segmentation. Experimental results show that the proposed framework outperforms image-only baselines and achieves competitive performance compared with existing multimodal approaches. The integration of global and local representations improves feature discrimination and structural modeling. Visualization results provide qualitative evidence that the model focuses on anatomically relevant regions, although such observations should be interpreted with caution. Overall, the proposed framework demonstrates the potential of multimodal representation learning for lumbar spine image analysis and provides a structured approach for integrating heterogeneous clinical data.

Background: Osteoporosis has a rising global incidence and social burden. Serum uric acid's dual roles in oxidative stress and inflammation may influence bone health, but findings are inconsistent and require further research. This study aimed to evaluate the relationship between SUA levels and osteoporosis in a multicenter cohort obtained from different regions of T&#xfc;rkiye. Methods: This multi-center retrospective study included 3280 individuals, postmenopausal women and men aged 45 and older, from 16 centers in T&#xfc;rkiye. Individuals were excluded if they recently consumed alcohol, had severe renal dysfunction, certain hormonal or mineral disorders, specific medications, or certain menopausal statuses. Bone mineral density (BMD) at the hip and lumbar spine was measured using dual-energy X-ray absorptiometry (DXA), and participants were classified as normal or having osteopenia or osteoporosis based on T-score thresholds. Results: Overall, 34.8% were male, and 65.2% were female. For the lumbar spine, 36.8% had osteopenia, and 13.5% had osteoporosis; similarly, for the total hip, 40.8% had osteopenia, and 7.9% had osteoporosis. ROC analysis identified a threshold of 3.9 mg/dL serum uric acid (SUA) (AUC 0.374; p < 0.001), which was positively associated with both lumbar and total hip BMD. Osteoporosis rates were higher in patients with SUA < 3.9 mg/dL compared to those with SUA &#x2265; 3.9 mg/dL at the lumbar spine (29.1% vs. 14.2%, p < 0.001) and total hip sites (23.6% vs. 15.9%, p = 0.003). After adjustment for potential confounders, SUA was a significant independent predictor of osteoporosis in the lumbar spine (OR 0.70; p < 0.001) and the hip (OR 0.80; p < 0.001). Conclusions: Serum uric acid levels are inversely linked to bone mineral density and osteoporosis risk, indicating a potential role in bone health. However, due to study limitations, causal relationships remain unproven, and further research is needed.

Recently, functional evaluation using 3D gait analysis (3DGA) proved to predict health-related quality-of-life (HRQOL) scores better than static radiographic evaluation in adult spinal deformity (ASD). However, 3DGA provides multiple parameters that can be a burden to interpret by non-experts. A recent study showed that the dynamic pelvic tilt (dPT), the forward projection of the head and thorax (dODHA) and walking step length (SL) are the most representative gait kinematics in ASD patients. To determine whether reducing kinematic parameters to only these 3 key parameters would still predict HRQOL outcomes in ASD based on machine learning (ML) random forest regression model. Single-center prospective study. 197 patients with ASD and 57 control subjects OUTCOME MEASURES: Self-report measures: SF36 with the physical and mental components (PCS & MCS), Oswetry Disability Index (ODI), Beck's depression inventory (BDI) and Visual analogue scale (VAS) for pain. Physiologic measures: low-dose full-body biplanar Xrays with 3D skeletal reconstructions. Functional measures: full-body 3D gait analysis during walking. Prediction accuracy: random forest regression ML model. All subjects underwent low-dose full-body biplanar Xrays with 3D skeletal reconstructions (with the calculation of spino-pelvic and global alignment parameters), full-body 3DGA during walking (with the calculation of full-body joint kinematic parameters), and completed HRQOL questionnaires: SF36 with the physical and mental components (PCS&MCS), ODI, BDI and VAS for pain. A random forest regression machine learning model was used to predict HRQOL scores in 4 simulations: (Sim-1) X-ray parameters (spinopelvic and global alignment); (Sim-2) Key-kinematic parameters (dPT, dODHA and SL); (Sim-3) X-ray parameters and dPT, dODHA and SL; (Sim-4) All-kinematic parameters. The prediction accuracy and root mean squared error (RMSE) were evaluated using a 10-fold cross-validation and compared between simulations. The same methodology was applied on a subset of 30 ASD patients followed (6 months to 2 years) after medical, orthopedic and surgical treatment. Simulations 1, 2, 3 and 4 had a median accuracy of 82, 85, 86 and 86%, respectively. Simulations 2, 3 and 4 had comparable accuracies of prediction for all HRQOL scores and higher predictions compared to Simulation 1 (i.e., accuracy for PCS=86&#xb1;3 vs 90&#xb1;2, 91&#xb1;3% and 91&#xb1;3% for simulations 1, 2, 3 and 4 respectively, p<0.05). Similar results were obtained for the 30 follwed-up ASD patients. Head and pelvis kinematics and step length are sufficient to predict HRQOL scores, even postoperatively, with higher accuracies than classic spinopelvic and global alignment parameters. While the latter play an integrating role in the surgical planning of ASD patients, coupling radiographic to only 3 key functional parameters would be optimal to provide a complete assessment and postoperative follow-up. Future technologies should focus on capturing these 3 parameters alone to allow surgeons to easily access functional assessment, bypassing the complexity of the complete gait analysis process.

Study DesignRetrospective.ObjectiveTo evaluate the association between mechanical instability and neurological deficit in spinal tuberculosis (TB), and compare it against previously recognized radiological parameters.MethodsClinical and radiological data of patients with active thoracic spinal TB were evaluated. Instability was assessed using the Spinal Tuberculosis Instability Scoring System (STISS) by Rajasekaran et al. Neurological status and radiological parameters were analysed to identify the factors associated with neurological deficit.ResultsA total of 122 patients were included. The average age was 51 &#xb1; 18&#xa0;years, and 54.9% were males. 40 (32.8%) patients had neurological deficits at presentation. Based on the STISS, 71 (58%) patients were categorised as stable, 10 (8.2%) as potentially unstable, and 41 (34%) as definitely unstable. On MRI, cord signal changes and epidural compression were noted in 18% and 64% of the patients, respectively. Definite instability was found to be the strongest independent association of neurological deficit (OR 9.77, 95% CI 2.85-38.9, P < 0.001), followed by greater canal encroachment area (CEA) (OR 1.08, 95% CI 1.03-1.13, P = 0.002). In a stable spine with epidural compression, the predicted probability of neurological deficit is 27%. In an unstable spine, the likelihood of neurological deficit is 50% even without epidural compression, and highest (63%) when instability was associated with epidural compression.ConclusionMechanical instability is the strongest independent association of neurological deficit in spinal TB, even in the absence of epidural compression. Incorporating the Spine Instability Scoring System into routine clinical evaluation improves risk stratification, enables timely decision-making, and can prevent irreversible neurological deficits.

Sacral reflex monitoring using bulbocavernosus reflex (BCR) and external urethral sphincter reflex (EUSR) is used to assess neural pathways responsible for bowel and bladder function during spine surgery. However, these techniques are generally considered limited in their ability to determine laterality due to bilateral afferent activation and shared sacral reflex circuitry. An 85-year-old male with progressive lower extremity weakness and worsening urinary incontinence underwent resection of a thoracic epidural tumor and separate sacral tumor involving the left S2 nerve root. BCR responses were recorded from the left and right external anal sphincter hemisphincters, and EUSR responses were recorded from the external urethral sphincter. Baseline recordings were stable. During manipulation of the thecal sac near the left S2 root, global sacral reflex attenuation occurred with complete loss of the left hemisphincter BCR response; release of retraction resulted in prompt bilateral recovery. Later, during targeted dissection adjacent to the left S2 nerve root, an isolated loss of the left hemisphincter BCR response occurred without changes in contralateral BCR or EUSR. Removal of the left S2 root retraction led to immediate return of the ipsilateral BCR response, though at a reduced amplitude. This case provides physiologic support that hemisphincter BCR recordings can reflect unilateral sacral nerve root dysfunction. A maneuver-dependent, reversible loss of the left hemisphincter BCR during S2 root retraction supports interpretation of hemisphincter changes as a marker of lateralized sacral reflex pathway dysfunction rather than global reflex suppression.

Proximal junctional kyphosis/failure (PJK/PJF) remains a frequent and severe complication following adult spinal deformity (ASD) surgery. While alignment risk factors are known, the specific mechanical influence of anterior malalignment and pelvic retroversion across different fusion levels remains poorly understood. How do postoperative anterior malalignment and pelvic retroversion influence PJK/PJF risk and biomechanical forces at the proximal junction based on upper instrumented vertebra (UIV) selection? We retrospectively analyzed 351 ASD patients fused to the pelvis, stratified by UIV: lower thoracic (LT, T9-T11; n&#xa0;=&#xa0;206) or upper lumbar (UL, T12-L2; n&#xa0;=&#xa0;145). Radiographic spinopelvic alignment was evaluated. Additionally, a validated finite element model (FEM) of T10-pelvis and L2-pelvis constructs simulated progressive anterior offsets and pelvic retroversion to quantify UIV endplate compressive and shear forces. PJK/PJF incidence was comparable between groups (LT: 22.4%, UL: 22.2%). In both cohorts, PJK patients exhibited greater 6-week postoperative global sagittal malalignment and pelvic retroversion. LT failures were driven by higher SVA and thoracic kyphosis, whereas UL failures associated with increased segmental T10-L2 kyphosis. FEM showed LT constructs experienced predominant compressive forces scaling with anterior offset, while UL constructs experienced predominant posterior shear forces. Pelvic retroversion offered negligible mitigation against compression and limited shear reduction. UIV selection dictates the biomechanical failure mechanism, not the overall PJK/PJF risk. LT instrumentation exposes the proximal junction to compression, whereas the UL spine is susceptible to shear-driven failure. Pelvic retroversion cannot compensate for residual anterior malalignment. Therefore, UIV choice must account for regional alignment and predictable force vectors.