bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spine Surgeon Assessments of Patient Psychological Distress are Inaccurate and Bias Treatment Recommendations
Authors: Moon Andrew S. , Menendez Mariano E. , Moverman Michael A. , Proal Joshua D , Kim David H. , Ohaegbulam Chima , Kwon Brian 
Published: February 2023

Study Design.
Prospective cohort study.

Objective.
This study determined (1) the surgeon accuracy of psychological assessment in patients in spine clinic, (2) the impact of psychological distress on surgical recommendation, and (3) the correlation between patient-reported disability and psychological distress.

Summary of Background Data.
Psychological distress is common among patients presenting for spine surgery. Surgeon estimations of patients’ distress may influence treatment recommendations, but little is known as to whether these assessments accurately mirror patient-perceived psychological distress.

Methods.
A sample of new patients was recruited from an academic spine center. Prior to their initial consultation, patients completed the Modified Somatic Perception Questionnaire and Zung Depression Index to assess mental and physical manifestations of distress, which generated a Distress and Risk Assessment Method (DRAM) score of N (normal), R (at risk), or D (distressed). The Oswestry Disability Index (ODI) and Neck Disability Index (NDI) scores were also collected. Surgeons provided their estimates of the DRAM score after the visit and indicated their surgery recommendation.

Results.
Of 296 patients, 40.5% reported some level of psychological distress (DRAM=R) and 15.9% had a high level of distress (DRAM=D). All three surgeons’ ability to accurately assess the participant DRAM score was poor, with an overall kappa of 0.13 (0.08-0.18), biased towards underestimating the patient’s true level of psychological distress. Patients rated as normal (N) by the surgeon were 3.78 times more likely to be recommended for surgery compared to those assessed as distressed (D) (P=0.007). Patients with higher DRAM scores had higher ODI (P=0.008) and NDI (P=0.005) scores compared to those with lower DRAM scores.

Conclusions.
Spine surgeons have limited ability to detect psychological profiles in patients, with a tendency to underestimate levels of distress. The finding that these inaccurate assessments influence surgical recommendations underscores the importance of limiting surgeon bias in the decision-making process.

Level of Evidence.
Diagnostic Level II
Spine Metastasis: Patients With Poor Performance Status (ECOG) Could benefit From Palliative Surgical Care! A Prospective Cohort Study
Authors: Amelot Aymeric , Terrier Louis-Marie , Le Nail Louis-Romée , Buffenoir Kévin , Cook Ann-Rose , François Patrick , Marie-Hardy Laura , Mathon Bertrand 
Published: February 2023

Study Design.
This study used a French prospective national multi-center database of patients with spine metastasis (SpM).

Objective.
The main challenge was to clarify if SpM patients presenting poor ECOG-PS could benefit from a surgical intervention.

Background.
Spine metastases (SpM) are debilitating lesions commonly found in the evolution of cancer. At present, patients with poor ECOG-PS do not benefit from surgical care.

Materials and Methods.
Between 2014 and 2017, 176 SpM patients with poor initial ECOG-PS (3 or 4) were identified.

Results.
The median overall survival of patients was 2.1 months (SD 0.2). Seventy-one patients (40.3%) underwent surgery: for 49 patients (27.8%) the intervention consisted of a simple decompression and for 22 patients (12.5%) the previous was associated with an osteosynthesis. Patients who underwent surgery demonstrated significantly longer median overall survival than those who did not: 3.5 months (SD 0.4) versus 1.6 (SD 0.2) (P<0.0001). No significant differences between operated/nonoperated patients were noted concerning median age (66.4 vs. 64.2 y, P=0.897), the median number of SpM (4.1 vs. 4.2, P=0.374), ECOG-PS 4 ratio (41.6 vs. 39.3%, P=0.616), or for primary tumors (P=0.103). Patients who underwent surgery statistically improved their neurological impairment according to the Frankel score: 5/11 (45.4%) from A to C, 5/17 (29.4%) from B to C or D, 6/11 (54.5%) from C to D and 2/4 (50%). Twelve patients (16.9%) presented a postoperative complication.

Conclusion.
Patients with poor ECOG-PS could benefit from surgery. Even though survival gain is small, it permits the preservation of their neurological function. By making ambulation possible, pain is decreased during the last months of their lives.
External Validation of SpineNet, an Open-Source Deep Learning Model for Grading Lumbar Disk Degeneration MRI Features, Using the Northern Finland Birth Cohort 1966
Authors: McSweeney Terence P. , Tiulpin Aleksei , Saarakkala Simo , Niinimäki Jaakko , Windsor Rhydian , Jamaludin Amir , Kadir Timor , Karppinen Jaro , Määttä Juhani 
Published: February 2023

Study Design.
This is a retrospective observational study to externally validate a deep learning image classification model.

Objective.
Deep learning models such as SpineNet offer the possibility of automating the process of disk degeneration (DD) classification from magnetic resonance imaging (MRI). External validation is an essential step to their development. The aim of this study was to externally validate SpineNet predictions for DD using Pfirrmann classification and Modic changes (MCs) on data from the Northern Finland Birth Cohort 1966 (NFBC1966).

Summary of Data.
We validated SpineNet using data from 1331 NFBC1966 participants for whom both lumbar spine MRI data and consensus DD gradings were available.

Materials and Methods.
SpineNet returned Pfirrmann grade and MC presence from T2-weighted sagittal lumbar MRI sequences from NFBC1966, a data set geographically and temporally separated from its training data set. A range of agreement and reliability metrics were used to compare predictions with expert radiologists. Subsets of data that match SpineNet training data more closely were also tested.

Results.
Balanced accuracy for DD was 78% (77%–79%) and for MC 86% (85%–86%). Interrater reliability for Pfirrmann grading was Lin concordance correlation coefficient=0.86 (0.85–0.87) and Cohen κ=0.68 (0.67–0.69). In a low back pain subset, these reliability metrics remained largely unchanged. In total, 20.83% of disks were rated differently by SpineNet compared with the human raters, but only 0.85% of disks had a grade difference >1. Interrater reliability for MC detection was κ=0.74 (0.72–0.75). In the low back pain subset, this metric was almost unchanged at κ=0.76 (0.73–0.79).

Conclusions.
In this study, SpineNet has been benchmarked against expert human raters in the research setting. It has matched human reliability and demonstrates robust performance despite the multiple challenges facing model generalizability.
Vertebral Bone Quality Score as a Predictor of Pedicle Screw Loosening Following Surgery for Degenerative Lumbar Disease
Authors: Li Wenshuai , Zhu Houze , Hua Zijian , Miao Dechao , Wang Feng , Tong Tong , Wang Linfeng 
Published: February 2023

Study Design.
Retrospective study.

Objective.
To investigate whether magnetic resonance imaging-based vertebral bone quality (VBQ) score can predict pedicle screw loosening in patients who underwent pedicle screw fixation, and to compare, which measurement, the VBQ score or the Hounsfield unit (HU) value, is more predictive of pedicle screw loosening.

Summary of Background Data.
In clinical work, we found that patients with screw loosening had higher VBQ scores. In addition, some studies have found a correlation between VBQ scores and osteoporosis.

Patients and Methods.
Patients who were treated with lumbar pedicle screw fixation were reviewed. The VBQ score was measured using magnetic resonance imaging scans. The HU value for L1 to L4 lumbar bone mineral density was measured with computed tomography scans. Logistic regression analysis was used to identify factors associated with pedicle screw loosening. Receiver-operating characteristic curve analysis was used to evaluate the value of VBQ scores in predicting pedicle screw loosening.

Results.
A total of 156 patients were included in the final analysis. The pedicle screw loosening rate was 35% (55 of 156 patients). The postoperative low-back pain visual analog scale score was higher in the loosening group (3.0 ± 2.0 vs. 2.4 ± 1.8; P < 0.05). The VBQ score was higher in the loosening group than in the nonloosening group (3.28 ± 0.58 vs. 2.82 ± 0.50; P < 0.01). In multivariable analysis, nonsingle segment fixation [odds ratio (OR): 3.992; 95% CI: 1.643–9.701; P = 0.002], lowest instrumented vertebrae at S1 (OR: 3.378; 95% CI: 1.387–8.226; P = 0.007), HU value (OR: 0.988; 95% CI: 0.976–1.000; P = 0.047), and VBQ score (OR: 3.908; 95% CI: 1.624–9.405; P = 0.002) were factors associated with screw loosening. The areas under the curve for using the VBQ score and HU value to predict pedicle screw loosening were 0.720 and 0.702, respectively. The optimal VBQ score threshold was 3.05 for predicting pedicle screw loosening (sensitivity: 0.655; specificity: 0.713).

Conclusions.
The VBQ score was an influential factor associated with lumbar pedicle screw loosening, and a higher VBQ score was significantly correlated with a higher risk of screw loosening. The VBQ score was a better predictor of pedicle screw loosening than the HU value in patients who underwent pedicle screw fixation for degenerative lumbar disease.
How Sagittal Spinal Parameters Predict Anterolateral Spinal Ossification Severity: A Study Based on CT Classification
Authors: Sun Qingyu , Wang Lianlei , Chen Xing , Zhang Yuchen , Tian Yonghao , Yuan Suomao , Liu Xinyu 
Published: February 2023

Study Design.
Retrospective observational study.

Objective.
The purpose of this study was to establish a CT classification system of anterolateral spinal ossification and analyze the effects of sagittal spinal parameters on ossification.

Summary of Background Data.
Patients with diffuse idiopathic skeletal hyperostosis often present with anterolateral ossification of the spine. Few reports consider anterolateral spinal ossification at each spinal level or explore the influence of sagittal alignment.

Materials and Method.
One hundred and twenty patients (79 males and 41 females) over 60 years old who underwent whole spinal CT scans from October 2018 to November 2021 were analyzed. Volume rendering technique images were used to assess the degree of anterolateral spinal ossification in each intervertebral space, and a classification system was established. Sagittal parameters, such as thoracic kyphosis, lumbar lordosis (LL), cervical lordosis, sacral slope, and thoracolumbar junction angle of the patients were measured. Multifactor stepwise linear regression analysis and ordered logistic regression analysis were used to study the effects of the sagittal parameters on ossification grades.

Results.
The median age of the study population was 67 years (63–72 IQR). The new classification system classifies the severity of anterolateral spinal ossification in each intervertebral space into grades 0 to 3 with an intra-observer intraclass correlation coefficient value of 0.909 and inter-observer intraclass correlation coefficient value of 0.900. Multivariate stepwise linear regression analysis showed that age (OR=1.30, P<0.001), weight (OR=1.23, P=0.013), and cervical lordosis (OR=1.19, P<0.001) were significantly correlated with total ossification grade. Multifactor ordered logistic regression analysis showed that there was a statistically significant correlation between cervical lordosis and the ossification grades of each intervertebral space of T1~T4 (P≤0.005), between thoracic kyphosis and each intervertebral space in T4~T12 (P≤0.019), and between thoracolumbar junction angle and each intervertebral space in T10~L3 (P≤0.025). LL was significantly and positively correlated with the ossification grades of each intervertebral space in T7~T11 (P≤0.041). LL and sacral slope were significantly negatively correlated with the ossification grades of each intervertebral space in L3~S1 (P≤0.047).

Conclusion.
Our new classification scheme demonstrated good accuracy and reliability for the evaluation of the severity of anterolateral spinal ossification. The effect of sagittal parameters on anterolateral spinal ossification was position-specific. The greater the kyphosis or the smaller the lordosis of a spinal region, the more severe the degree of ossification in the corresponding region.

Level of Evidence.
3
An Analysis of a Decade of Lumbar Interbody Cage Failures in the United States: A MAUDE Database Study
Authors: Piple Amit S. , Ungurean Victor , Raji Oluwatodimu R. , Rowland Andrea , Schlauch Adam , Kondrashov Dimitriy G. , Hsu Ken , Zucherman James 
Published: February 2023

Study Design.
A retrospective case series.

Objective.
This study aims to assess the rates of lumbar interbody cage failures based on their material and manufacturer.

Summary of Background Data.
Perioperative lumbar interbody cage malfunctions are underreported events in the spine literature and may result in complications. Although the Food and Drug Administration ensures the safety of these devices under physiological conditions after implantation, these devices may experience nonphysiological conditions during implantation, which may be overlooked.

Materials and Methods.
The MAUDE database was examined for reports of lumbar cage device malfunctions from 2012 to 2021. Each report was categorized based on failure type and implant design. A market analysis was performed by dividing the total number of failures per year for each manufacturer by their approximate yearly revenue from spinal implants in the United States. Outlier analysis was performed to generate a threshold value above which failure rates were defined as greater than the normal index.

Results.
Overall, 1875 lumbar cage malfunctions were identified. Of these, 1230 (65.6%) were cage breakages, 257 (13.7%) were instrument malfunctions, 177 (9.4%) were cage migrations, 143 (7.6%) were assembly failures, 70 (4.5%) were screw-related failures, and 21 (1.1%) were cage collapses. Of the breakages, 923 (74.9%) occurred during insertion or impaction and 97 entries detailed a medical complication or a retained foreign body. Of the migrations, 155 (88.6%) were identified postoperatively, of which 73 (47.1%) detailed complications and 52 (33.5%) required a revision procedure. Market analysis demonstrated that Medtronic, Zimmer Biomet, Stryker, Seaspine, and K2M exceeded the calculated threshold.

Conclusions.
Lumbar cages with polyether ether ketone core material failed more frequently by breakage, whereas titanium surface cages failed more frequently by migration. Failure rates varied depending on the manufacturer. Most cage breakages identified in the present study occurred intraoperatively during implantation. These findings call for a more detailed Food and Drug Administration evaluation of these intraoperative malfunctions before commercial approval.

Level of Evidence.
Level 4.
A Simple Preoperative Score Predicting Failure Following Decompression Surgery for Degenerative Lumbar Spinal Stenosis
Authors: Dimitriou Dimitris , Winkler Elin , Weber Sabrina , Haupt Samuel , Betz Michael , Farshad Mazda 
Published: February 2023

Background Context.
Proper patient selection is crucial for the outcome of surgically treated degenerative lumbar spinal stenosis (DLSS). Nevertheless, there is still not a clear consensus regarding the optimal treatment option for patients with DLSS.

Purpose.
To investigate the treatment failure rate and introduce a simple, preoperative score to aid surgical decision-making.

Study Design/Setting.
Retrospective observational study

Patient Sample.
Four hundred forty-five patients who underwent surgical decompression for DLSS.

Outcome Measures.
Treatment failure (defined as conversion to a fusion of a previously decompressed level) of lumbar decompression

Materials and Methods.
Several risk factors associated with worse outcomes and treatment failures, such as age, body mass index, smoking status, previous surgery, low back pain (LBP), facet joint effusion, disk degeneration, fatty infiltration of the paraspinal muscles, the presence of degenerative spondylolisthesis and the facet angulation, were investigated.

Results.
At a mean follow-up of 44±31 months, 6.5% (29/445) of the patients underwent revision surgery with spinal fusion at an average of 3±9 months following the lumbar decompression due to low back or leg pain. The baseline LBP (≥7) [odds ratio (OR)=5.4, P<0.001], the presence of facet joint effusion (>2 mm) in magnetic resonance imaging (OR=4.2, P<0.001), and disk degeneration (Pfirrmann >4) (OR=3.2, P=0.03) were associated with an increased risk for treatment failure following decompression for DLSS. The receiver operating characteristic curve analysis demonstrated that a score≥6 points yielded a sensitivity of 90% and specificity of 64% for predicting a treatment failure following lumbar decompression for DLSS in the present cohort.

Conclusions.
The newly introduced score quantifying amounts of LBP, facet effusions, and disk degeneration, could predict treatment failure and the need for revision surgery for DLSS patients undergoing lumbar decompression without fusion. Patients with scores >6 have a high chance of needing fusion following decompression surgery.

Level of Evidence.
Retrospective observational study, Level III
Surgery on the Day of Admission Decreases Postoperative Complication Rates for Patients With Central Cord Syndrome
Authors: Smith Spencer , Somogyi Rita , Wright James , Lin Clifford , Yoo Jung 
Published: February 2023

Study Design:
Retrospective review.

Objective:
This study was undertaken to determine what constitutes “early optimal timing” of surgical management of central cord syndrome (CCS) with respect to a reduction of medical complications.

Summary of Background Data:
Data varies on the optimal time for surgical treatment of CCS with some studies favoring early intervention and others advocating that surgery can or should be delayed for 2–6 weeks.

Methods:
This IRB-approved study was a retrospective cross-sectional review of surgical management outcomes for patients diagnosed with CCS using the National Surgical Quality Improvement Program database, which consists of anonymized medical record data from the year 2010 to 2020. Patient data included age, sex, American Society of Anesthesiologists score, current procedural terminology codes, length of stay, and postoperative complications. Patients were grouped into admission-day surgery, next-day surgery, and late-surgery groups.

Results:
A total of 738 patients who underwent surgery to treat CCS were identified in the National Surgical Quality Improvement Program database from 2010 to 2020 and included in this study. Admission-day surgery compared with next-day surgery was associated with a decreased postoperative complication rate after multivariate analysis (odds ratio: 0.52; 95% CI: 0.28–0.97; P=0.0387) as well as shorter length of stay (P <0.0001). Complication rates between the next-day-surgery cohort and late-surgery cohort did not differ after multivariate analysis (odds ratio: 1.02; 95% CI: 0.63–1.65; P=0.9451), but the length of stay was shorter for next-day surgery (P <0.0001). Two-year rolling averages for the admission-day-surgery rate and next-day-surgery rate show a compound annual growth rate of 2.52% and 4.10%, respectively.

Conclusions:
In patients admitted for surgical treatment of CCS, those who receive admission-day surgery have significantly reduced 30-day complication rates as well as shorter length of stays. Therefore, we advocate that “early surgery” should be defined as surgery on the day of admission and should occur in as timely a manner as possible. Prior studies, which define “early surgery” as within 24 hours might, unfortunately, fall short of reaching the optimal threshold for the reduction of 30-day medical complications associated with the treatment of patients with CCS.
Comparison of Surgical Outcomes Between Anterior and Posterior Cervical Fusions Stratified by Levels Decompressed
Authors: Bajouri Zabiullah , Reyes Orozco Francis , Fresquez Zoe , Safaee Michael M. , Hsieh Patrick , Liu John , Buser Zorica 
Published: February 2023

Study Design:
Retrospective database study.

Objective:
To compare outcomes between 1-, 2-, 3-, and 4- level anterior cervical discectomy and fusions (ACDF) and posterior cervical fusions (PCF) procedures using a national database.

Summary of Background Data:
Surgical outcomes involving 3- or 4-level ACDF and PCF cases are not well-described. As there are situations where both ACDF and PCF can be employed, it is important to compare the risks and benefits of both procedures.

Materials and Methods:
Patients who underwent ACDF or PCF between 2010 and 2020 were identified in PearlDiver using current procedural terminology codes. Surgeries done for infectious, traumatic, or neoplastic etiologies were excluded. 2-year reoperations and 90-day readmissions were queried. Surgical complications and transfusions were compiled using ICD-9/10 billing codes. ACDF and PCF procedures were then matched by age, sex, Charlson Comorbidity Index, and a number of levels fused, and the above outcomes were compared.

Results:
In all, 31,301 PCFs and 110,526 ACDFs were identified. After matching for age, sex, and Charlson Comorbidity Index, a total of 30,353 ACDF and PCF procedures were compared. Three-level and 4-level PCFs had higher rates of 90-day postoperative surgical complications compared with ACDF (OR=2.4 and 2.87, respectively; P<0.001). In addition, higher rates of 90-day readmissions were noted in 3-level PCF compared with 3-level ACDF (OR=1.24, P<0.001). Ninety-day postoperative transfusions were higher in both 3- and 4-level PCFs (OR=2.44 and 18.27, respectively; P<0.001). Two-year reoperations rates were higher for 3-level PCF procedures than 3-level ACDF (OR=1.22; P=0.01).

Conclusions:
Patients who underwent 3-4-level ACDF had lower rates of readmission, blood transfusions, and postoperative complications compared with 3-4-level PCF. This data suggests that in cases of 3-4-level pathology with clinical equipoise regarding approach, ACDF may be associated with less short-term morbidity, however, data on fusion rates and adjacent level disease are needed.
Standardizing Lumbar Interbody Fusion Nomenclature
Authors: McCloskey Kyle , Singh Shikha , Ahmad Hasan S. , Turlip Ryan , Ghenbot Yohannes , Yoon Jang W. 
Published: February 2023

Study Design:
This article is a research methodology study.

Objective:
We summarize current ambiguities and inaccuracies regarding lumbar interbody fusion nomenclature and propose a standardized reporting method to improve the clarity of future research and communication among spine surgeons and researchers.

Summary of Background Data:
Lumbar interbody fusion techniques have seen an impressive degree of refinement over recent years. This innovation has ushered in a plethora of naming conventions for these new surgical approaches. Many of the current trends in naming lumbar fusion techniques are, however, redundant and contradictory, creating unnecessary confusion in the field.

Methods:
Following an extensive literature review, we developed a 4-part naming convention that highlights the crucial features of lumbar fusion surgical procedures.

Results:
Current literature regarding lumbar fusions is rife with inconsistent usage and privatization of terminology that can inadvertently result in ambiguous operative vocabulary, potentially compromising the accuracy of future research. We propose a 4-part naming system that highlights crucial features of lumbar interbody fusions, including (1) intra-operative repositioning, (2) patient position, (3) surgical technique, and (4) orientation of the surgical corridor to the psoas muscle.

Conclusions:
This study raises awareness of current inconsistencies in naming conventions and proposes a standardized system for improving the clarity of lumber interbody fusion terminology for the broader spine community.

Level of Evidence:
Level V.