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Study Design: A retrospective cohort study of patients with surgically treated thoracolumbar fractures. Purpose: This study aimed to describe the incidence of adverse events (AEs) after surgical stabilization of thoracolumbar spine injuries and to identify predictive factors for the occurrence of AEs. Overview of Literature: Thoracolumbar spine fractures are frequently present in patients with blunt trauma and are associated with significant morbidity. AEs can occur due to the initial spinal injury or secondary to surgical treatment. There is a lack of emphasis in the literature on the AEs that can occur after operative management of thoracolumbar fractures. Methods: We performed a retrospective review of 199 patients with surgically treated thoracolumbar fractures operated between January 2007 and January 2018. The potential risk factors for the development of AEs as well as the development of common complications were evaluated by univariate analysis, and a multivariate logistic regression analysis was performed to identify independent risk factors predictive of the above. Results: The overall rate of AEs was 46.7%; 83 patients (41.7%) had nonsurgical AEs, whereas 24 (12.1%) had surgical adverse events. The most common AEs were urinary tract infections in 43 patients (21.6%), and hospital-acquired pneumonia in 21 patients (10.6%). On multivariate logistic regression, a Thoracolumbar Injury Classification and Severity (TLICS) score of 8-10 (odds ratio [OR], 6.39; 95% confidence interval [CI], 2.33-17.51), the presence of polytrauma (OR, 2.64; 95% CI, 1.17-5.99), and undergoing open surgery (OR, 2.31; 95% CI, 1.09-4.88) were significant risk factors for AEs. The absence of neurological deficit was associated with a lower rate of AEs (OR, 0.47; 95% CI, 0.31-0.70). Conclusions: This study suggests the presence of polytrauma, preoperative American Spinal Injury Association score, and TLICS score are predictive of AEs in patients with surgically treated thoracolumbar fractures. The results might also suggest a role for minimally invasive surgical methods in reducing AEs in these patients. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective study of all patients with histologically confirmed breast cancer spinal metastases presenting to a single institution between May 2001 and April 2012.Objectives: The aim of this study was to investigate whether the 2014mT is more accurate than the 2005mT.Summary Of Background Data: The commonly used 2005 modified Tokuhashi score (2005mT) has become more inaccurate as oncologists move toward treating tumors according to their molecular and genomic profile, rather than their tissue-of-origin. In attempts to improve the accuracy of the 2005mT, a revised score (2014mT) was published, suggesting that hormone receptor negative and triple-negative breast cancer patients be given a modified Tokuhashi histological score of 3 rather than 5.Methods: Demographic characteristics, tumor receptor status, clinical findings in relation to the primary tumor and its metastases, and actual survival time were collated. The 2005mT was compared with the 2014mT. Univariate and multivariate Cox regression analyses were used to evaluate the influence of each parameter on survival, and receiver operating characteristic curves were used to determine predictive values of each score version.Results: Of the 185 patients included, 32 underwent operative treatment, while 153 were managed nonoperatively for their spinal metastases. The overall cohort had a median survival time of 24 months following the diagnosis of spinal metastases, with a 6-month survival rate of 90%. Hormone, HER2 and triple-negative receptor statuses were significant predictors of poorer survival upon multivariate analysis (P = 0.004, P = 0.007, P < 0.001, and P < 0.001, respectively). Age, the original Tokuhashi score components, previous breast surgery for cancer, previous radiotherapy to the breast, previous radiotherapy to the spine, previous chemotherapy, and previous immunotherapy were not significant. At 6 months, the 2005mT AUROC was 0.62, while that of the 2014mT was 0.64 (P = 0.5394).Conclusion: Tumor histological subtype is crucial when prognosticating the survival of patients with breast cancer spinal metastases. Although the 2014mT was marginally more accurate than the 2005mT, its predictive ability remains poor.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective study of 180 patients with lung cancer spinal metastases, wherein prognostic score-predicted survival was compared with actual survival.Objective: To evaluate and compare the accuracy of prognostic scoring systems in lung cancer spinal metastases.Summary Of Background Data: The modified Tokuhashi, Tomita, modified Bauer, and Oswestry scores are currently used to guide decisions regarding operative treatment of patients with spinal metastases. The best system for predicting survival in patients with lung cancer spinal metastases remains undetermined. The high incidence of spinal metastases from lung cancer and improved survival of patients treated with systemic therapy warrants evaluation of these scoring systems in this particular context.Methods: Patients with lung cancer spinal metastases treated at our institution between May 2001 and August 2012 were studied. Fifty-one patients were treated surgically. The primary outcome measure was survival from the time of diagnosis. Scoring-predicted survival was compared with actual survival. Potential prognostic factors were investigated using Cox regression analyses. Predictive values of each scoring system for 3- and 6-month survival were measured via receiver operating characteristic (ROC) curves.Results: Histological subtype (P = 0.015), sex (P = 0.001), Karnofsky performance scale (P = 0.001), extent of neurological palsy (P = 0.002), and visceral metastases (P = 0.037) are significant predictors of survival. Besides the Oswestry spinal risk index, no significant differences were found between different prognostic subgroups within the individual scoring systems. Although the modified Bauer score was most accurate, all four scoring systems had areas under the ROC curve 0.5 or less.Conclusion: Although better prognostic scores correlated with longer survival, all four scoring systems are inaccurate in prognosticating patients with lung cancer spinal metastases. Specific lung cancer histology appears prognostic and should be considered, especially given the increased survival of patients receiving new targeted therapies appropriate to their disease.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

The article discusses the development of a deep learning model for automated Cobb angle measurement in scoliosis radiographs, aiming to enhance screening efficiency and consistency. The model outperformed manual calculations by residents and showed promise for clinical use, especially with high-resolution screenshots. However, the model's performance was slightly reduced with handphone images. The study acknowledges limitations and the need for external validation to confirm the model's effectiveness in diverse settings. [Extracted from the article]

Purpose: To evaluate the incidence and presentation of symptomatic failures (SFs) after metastatic spine tumor surgery (MSTS). To identify the associated risk factors. To categorize SFs based on the management in these patients. Overview of Literature: Few studies have reported on the incidence (1.9%-16%) and risk factors of SF after MSTS. It is unclear whether all SFs, occurring in MSTS-patients, result in revision surgery. Methods: We conducted a retrospective analysis on 288 patients (246 for final analysis) who underwent MSTS between 2005-2015. Data collected were demographics and peri/postoperative clinical and radiological features. Early and late radiological SF were de- fined as presentation before and after 3 months from index surgery, respectively. Univariate and multivariate models of competing risk regression analysis were designed to determine the risk factors for SF with death as a competing event. Results: We observed 14 SFs (5.7%) in 246 patients; 10 (4.1%) underwent revision surgery. Median survival was 13.4 months. The mean age was 58.8 years (range, 21-87 years); 48.4% were women. The median time to failure was 5 months (range, 1-60 months). Patients with SF were categorized into three groups: (1) SF when the primary implant was revised (n=5, 35.7%); (2) peri-construct progression of disease requiring extension (n=5, 35.7%); and (3) SFs that did not warrant revision (n=4, 28.5%). Four patients (28.5%) presented with early failure. SF commonly occurred at the implant-bone interface (9/14) and all patients had a spinal instability neoplastic score (SINS) >7. Thirteen patients (92.8%) who developed failure had fixation spanning junctional regions. Multivariate competing risk regression showed that preoperative Eastern Cooperative Oncology Group score was a significant risk factor for implant failure (adjusted sub-hazard ratio, 7.0; 95% confidence interval, 1.63-30.07; p<0.0009). Conclusions: The incidence of SF (5.7%) was low in patients undergoing MSTS although these patients did not undergo spinal fusion. Preoperative ambulators involved a 7 times higher risk of failure than non-ambulators. Preoperative SINS >7 and fixations spanning junctional regions were associated with SF. Majority of construct failures occurred at the implant-bone interface. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study. Purpose: To study the incidence, onset, underlying mechanism, clinical course, and factors leading to asymptomatic construct failure (AsCF) after metastatic spinal tumor surgery (MSTS). Overview of Literature: The reported incidence rates for implant and/or construct failure after MSTS are low (1.9%-16%) and based on clinical presentations and revisions required for symptomatic failures (SFs). AsCF after MSTS has not been reported. Methods: We conducted a retrospective analysis of 288 patients (246 for final analysis) who underwent MSTS between 2005-2015. Data collected were demographics and peri/postoperative clinical and radiological features. Early and late radiological AsCF were defined as presentation before and after 3 months, respectively. We analyzed patients with AsCF for risk factors and survival duration by performing competing risk regression analyses where AsCF was the event of interest, with SF and death as competing events. Results: We observed AsCF in 41/246 patients (16.7%). The mean time to onset of AsCF after MSTS was 2 months (range, 1-9 months). Median survival of patients with AsCF was 20 and 41 months for early and late failures, respectively. Early AsCF accounted for 80.5% of cases, while late AsCF accounted for 19.5%. The commonest radiologically detectable AsCF mechanism was angular deformity (increase in kyphus) in 29 patients. Increasing age (p <0.02) and primary breast (13/41, 31.7%) (p <0.01) tumors were associated with higher AsCF rates. There was a non-significant trend towards AsCF in patients with a spinal instability neoplastic score =7, instrumentation across junctional regions, and construct lengths of 6-9 levels. None of the patients with AsCF underwent revision surgery. Conclusions: AsCF after MSTS is a distinct entity. Most patients with early AsCF did not require intervention. Patients who survived and maintained ambulation for longer periods had late failure. Increasing age and tumors with a better prognosis have a higher likelihood of developing AsCF. AsCF is not necessarily an indication for aggressive/urgent intervention. [ABSTRACT FROM AUTHOR]