The Spine Journal (SPINE J )

Publisher: North American Spine Society, Elsevier


The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.

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  • 5-year impact
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  • Article influence
  • Website
    Spine Journal, The website
  • Other titles
    Spine journal (Online)
  • ISSN
  • OCLC
  • Material type
    Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Voluntary deposit by author of pre-print allowed on Institutions open scholarly website and pre-print servers
    • Voluntary deposit by author of authors post-print allowed on institutions open scholarly website including Institutional Repository
    • Deposit due to Funding Body, Institutional and Governmental mandate only allowed where separate agreement between repository and publisher exists
    • Set statement to accompany deposit
    • Published source must be acknowledged
    • Must link to journal home page or articles' DOI
    • Publisher's version/PDF cannot be used
    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PMC after 12 months
    • Authors who are required to deposit in subject repositories may also use Sponsorship Option
    • Pre-print can not be deposited for The Lancet
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Context During quiet standing, the gravity line (GL) can be located according to the sum of the ground reaction forces (GRF) measured with a force platform. C7 plumb line (C7PL) is an easy method to estimate sagittal trunk balance, but discordance between C7PL and the GL is widely recognized. However, the prevalence of occiput-trunk (O-T) discordance (GL-C7PL > 3 cm) and the factors affecting this type of discordance have not yet been determined. Purpose The purpose of this study was to report the prevalence of O-T discordance in adult spinal deformity (ASD) patients and identify the factors affecting this type of discordance. Study Design This was a retrospective consecutive case series of ASD. Patient Sample This retrospective case series included 300 consecutive ASD patients. The inclusion criteria were age > 50 years, Cobb angle of the main curve > 20°, and C7PL > 5 cm. The exclusion criteria consisted of inappropriate radiography; syndromic, neuromuscular, or other pathological conditions; and previous joint replacement. Outcome Measures The outcome measures included self-reported measures (SRS22 and ODI) and radiographic measures. Methods Study funding sources and a study-specific appraisal of potential conflict of interest. No external funding was used for this study. No appraisal of potential conflict of interest. In a retrospective consecutive case series, demographic and radiographic patient data were reviewed. Demographic data included age, gender, curve type, SRS22, and ODI. Radiographic data included GL, C7PL, C2-C7, T2-T5, T5-T12, T10-L2, T2 tilt, LL, SS, PT, and PI. Global sagittal alignment and spinopelvic alignment were also reviewed. Patients were categorized in either a concordance group (C group; GL-C7PL < 3 cm) or discordance group (D group; GL-C7PL > +3 cm), and the demographic, radiographic, and clinical outcome data were compared between these groups. One-way ANOVA, correlation coefficient tests, multiple regression analysis, and logistic regression analysis were performed for statistical analysis. P < 0.01 was considered statistically significant. Force platform analysis was performed to assess the relationship among GRF, GL, and C7PL. Results Among 300 consecutive ASD patients, 72 (24%) patients were categorized in the D group. There was no significant difference in terms of demographic data between the C and D groups. The SRS and ODI of patients with GL > 10 cm were significantly lower than those of patients with GL < 10 cm. Comparisons of regional sagittal alignment showed significantly higher T5-T12 values in the D group, and MRL analysis revealed significant correlations among T2-T5, T5-T12, and GL-C7PL. In contrast, the analysis of global sagittal alignment revealed a significantly large T2 sagittal tilt in the D group compared to the C group. Force platform analysis showed concordance between GRF and GL, whereas discordance was observed between GRF and C7PL. The D group could be classified into 2 groups based on the global sagittal alignment: 10 patients were classified as the hypo-compensation type (small SVA, small CL, small TK, and normal-to-small LL), whereas 62 patients were classified as the forward-leaning type (large SVA, large CL, large TK, and small LL). Conclusion The prevalence of discordance between GL and C7PL in ASD patients was 24%, and thoracic kyphosis and global sagittal alignment were significantly correlated with this discordance. The concordance of GRF and GL and the discordance of GRF and C7PL highlight the importance and necessity of accounting for GL when considering surgical treatment.
    The Spine Journal 08/2014;
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    ABSTRACT: Commentary on an article by Adam Goode, DPT, PhD, et al: “Complications, revision fusions, re-admissions and utilization over a one-year period following bone morphogenetic protein use during primary cervical spine fusions.”
    The Spine Journal 05/2014;
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    ABSTRACT: Background Context. Cadaveric descriptions of the deep layer of the lumbar ligamentum flavum extending between contiguous borders of adjacent laminae and into the lateral spinal canal region are limited. Purpose. To provide detailed descriptions of the lumbar ligamentum flavum. Study Design. Cadaveric dissection. Methods. The deep ligamentum flava of fourteen formalin-fixed human cadaver lumbar spines (140 levels) were examined to assess their laminar attachments and lateral extents in relation to the intervertebral foramen. No funding was received or used in this study, and there were no author conflicts of interest. Results. The variable attachment of the deep layer of the ligamentum flavum with respect to cephalad and caudad laminae was identified and described. At each successive caudal level of the lumbar spine, the deep layer appeared to become a more prominent feature of the posterior vertebral column, lining more of the laminae to which it attached and encroaching further into the posteroinferior region of the intervertebral foramen at its lateral margins. Conclusion. We describe our observations of the deep ligamentum flavum in the human lumbar spine. These observations have clinical relevance for the interpretation of radiological imaging and the performance of adequate decompression in the setting of spinal stenosis.
    The Spine Journal 05/2014; In Press.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Various studies have previously reported on the rising utilization and costs of diagnostic imaging for low back pain (LBP) in the United States (US). However, it is unclear if the methods used in these studies allowed for meaningful comparisons, or if the reported utilization data can be used to develop evidence-based benchmarks. The primary purpose of this study was to review previous estimates of the utilization of diagnostic imaging for LBP reported in the US. Systematic review of published literature. A search through May 2012 was conducted using keywords and free text terms related to health services and LBP in Medline and Health Policy Reference; results were screened for relevance independently, and full-text studies were assessed for eligibility. Only studies published in English since the year 2000 reporting on utilization of diagnostic imaging for LBP using claims data from the US were included. Reporting quality was assessed using a modified Downs and Black tool for observational studies. This study was funded by Palladian Health. Study authors were paid consultants and shareholders of Palladian Health when this study was conducted. The search strategy yielded 1102 citations, of which 7 met the criteria for eligibility. Studies reported utilization from commercial health plans (n=4) and Medicare (n=3), with sample sizes ranging from 13,760 to 740,467 members with LBP from specific states or across the US. The number of diagnostic codes used to identify nonspecific LBP ranged from 2 to 66; other heterogeneity was noted in the methods used across these studies. In commercial health plans, utilization of x-rays was 12.0% to 32.2% of patients with LBP, magnetic resonance imaging (MRI) was used in 16.0% to 21.0%, computed tomography (CT) was used in 1.4% to 3.0%, and MRI and/or CT was used in 10.9% to 16.1%. Findings in Medicare populations were 22.9% to 48.2% for x-rays, 11.6% for MRI, and 10.4% to 16.3% for MRI and/or CT. The reported utilization of diagnostic imaging for LBP varied across the studies reviewed; differences in methodology made meaningful comparisons difficult. Standardizing methods for performing and reporting analyses of claims data related to utilization could facilitate efforts by third-party payers, health care providers, and researchers to identify and address the perceived overuse of diagnostic imaging for LBP.
    The Spine Journal 11/2013;
  • The Spine Journal 10/2013;
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND CONTEXT: The influence of the posterior pelvic ring ligaments on pelvic stability is poorly understood. Low back pain and sacroiliac joint (SIJ) pain are described being related to these ligaments. Computational approaches involving finite element (FE) modeling may aid to determine their influence. Previous FE models lacked in precise ligament geometries and material properties, which might have influence on the results. PURPOSE AND STUDY DESIGN: The aim of this study is to investigate ligamentous influence in pelvic stability by means of FE using precise ligament material properties and morphometries. METHODS: An FE model of the pelvis bones was created from computer tomography, including the pubic symphysis joint (PSJ) and the SIJ. Ligament data were used from 55 body donors: anterior (ASL), interosseous (ISL), and posterior (PSL) sacroiliac ligaments; iliolumbar (IL), inguinal (IN), pubic (PL), sacrospinous (SS), and sacrotuberous (ST) ligaments; and obturator membrane (OM). Stress-strain data were gained from iliotibial tract specimens. A vertical load of 600 N was applied. Pelvic motion related to altered ligament and cartilage stiffness was determined in a range of 50% to 200%. Ligament strain was investigated in the standing and sitting positions. RESULTS: Tensile and compressive stresses were found at the SIJ and the PSJ. The center of sacral motion was at the level of the second sacral vertebra. At the acetabula and the PSJ, higher ligament and cartilage stiffnesses decrease pelvic motion in the following order: SIJ cartilage>ISL>ST+SS>IL+ASL+PSL. Similar effects were found for the sacrum (SIJ cartilage>ISL>IL+ASL+PSL) but increased ST+SS stiffnesses increased sacral motion. The influence of the IN, OM, and PL was less than 0.1%. Compared with standing, total ligament strain was reduced to 90%. Increased strains were found for the IL, ISL, and PSL. CONCLUSIONS: Posterior pelvic ring cartilage and ligaments significantly contribute to pelvic stability. Their effects are region- and stiffness dependent. While sitting, load concentrations occur at the IL, ISL, and PSL, which goes in coherence with the clinical findings of these ligaments serving as generators of low back pain.
    The Spine Journal 06/2013;
  • The Spine Journal 03/2013;
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    ABSTRACT: BACKGROUND CONTEXT: Spinal cord injuries (SCIs) related to cervical spine (C-spine) fractures can cause significant morbidity and mortality. Aggressive treatment often required to manage instability associated with C-spine fractures is complicated and hazardous in the elderly population. PURPOSE: To determine the mortality rate of elderly patients with SCIs related to C-spine fractures and identify factors that contribute toward a higher risk for negative outcomes. STUDY DESIGN/SETTING: Retrospective cohort study at two Level 1 trauma centers. PATIENT SAMPLE: Thirty-seven consecutive patients aged 60 years and older who had SCIs related to C-spine fractures. OUTCOME MEASURES: Level of injury, injury severity, preinjury medical comorbidities, treatment (operative vs. nonoperative), and cause of death. METHODS: Hospital medical records were reviewed independently. Baseline radiographs and computed tomography or magnetic resonance imaging scans were examined to permit categorization according to the mechanistic classification by Allen and Ferguson of subaxial C-spine injuries. Univariate logistic regression analyses were performed to identify factors related to in-hospital mortality and ambulation at discharge. There were no funding sources or potential conflicts of interest to disclose. RESULTS: The in-hospital mortality rate was 38%. Respiratory failure was the leading cause of death. Preinjury medical comorbidities, age, and operative versus nonoperative treatment did not affect mortality. Injury level at or above C4 was associated with a 7.1 times higher risk of mortality compared with injuries below C4 (p=.01). Complete SCI was associated with a 5.1 times higher risk of mortality compared with incomplete SCI (p=.03). Neurological recovery was uncommon. Apart from severity of initial SCI, no other factor was related to ambulatory disposition at discharge. CONCLUSIONS: In this elderly population, neurological recovery was poor and the in-hospital mortality rate was high. The strongest risk factors for mortality were injury level and severity of SCI. Although each case of SCI related to C-spine fractures is different, physicians may be able to use these findings to help better determine the prognosis and guide subsequent treatment.
    The Spine Journal 02/2013;
  • The Spine Journal 01/2013;
  • The Spine Journal 01/2013;
  • The Spine Journal 12/2012; 12(12):1161-2.

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