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Prognosis & Risk

Risk stratification for spinal pathology and musculoskeletal oncology, including HIF-1α biomarkers for bone tumors and ASIA motor scores for SCI prognosis.

Overview

Prognosis studies evaluate disease outcomes and procedural probabilities, requiring representative, homogeneous patient samples to ensure validity [3]. In chondrosarcoma, histological grading is a critical prognostic factor, and ten- or fifteen-year survival rates provide more meaningful assessment of cure than five-year rates [2]. The modified Glasgow Prognostic Score is recommended for early stratification to reinforce decision-making and potentially improve outcomes [1]. For pathological fractures, novel scoring systems can guide specialist management and offer accurate expectations of functional outcome and survival time [4].

Surgical strategy significantly influences prognosis across various conditions. In mobile spine chondrosarcoma, tumor-free margin resection reduces local recurrence risk, prolongs recurrence-free and overall survival, and provides better prognoses compared to intralesional spondylectomy, despite carrying higher risks of perioperative complications [7]. For developmental dysplasia of the hip, proposed prognostication charts and thresholds assist surgeons and parents in selecting intervention versus surveillance to optimize long-term outcomes [14]. In osteonecrosis, delphi-based models enable early identification of high-risk patients for femoral head collapse and guide personalized treatment strategies to reduce invasive procedures [13].

Specific risk factors and management principles further define prognostic trajectories. Functional dependence predicts increased complications and post-operative mortality following elective cervical spine surgery [15]. Lower C2 slope and milder uncovertebral joint degeneration are risk factors for pseudarthrosis after single-level anterior cervical corpectomy and fusion, necessitating their consideration in surgical planning [22]. While the Delphi Trial aims to identify optimal surgical timing for neurological risk, definitive mortality benefits for surgical versus conservative management in geriatric odontoid fractures remain undetermined due to evidence heterogeneity [9, 20]. Finally, maximizing prognosis in orthopedic infections requires adherence to a high index of suspicion, correct data interpretation, thorough surgery, host optimization, and pathogen-specific antibiotic therapy [23].

Anatomy & Pathophysiology

Osseous and Deformity Progression

A thorough knowledge of the natural history of congenital kyphosis and kyphoscoliosis is essential to prevent progression of the deformity and neurological complications [5]. In adolescent idiopathic scoliosis, apical wedging and coronal imbalance may identify patients with curves of 40° to 50° suited for closer monitoring and early spinal fusion [17]. For juvenile idiopathic scoliosis, the chief prognostic feature at an early stage is the level of the most rotated vertebra at the apex of the primary curve [18], while the final pattern of deformity is defined by the level of the caudad neutral vertebra [18]. Supine flexibility of 18.1% and a correction rate of 28.8% in adolescent idiopathic scoliosis predict a lower risk of progression [66], as does a supine correction index (SCI) greater than 1.21 [66]. The thoracolumbar spine carries a 2-fold higher risk of osteoporotic vertebral compression fractures than the non-thoracolumbar spine [75].

Degenerative and Instrumentation Risks

Pre-existing L5-S1 degeneration does not affect clinical and radiographical outcomes after isolated L4-5 fusion for spondylolisthesis [31]. Surgical planning for degenerative lumbar scoliosis with concomitant thoracolumbar kyphosis must account for spinal morphological characteristics to prevent placing the upper instrumented vertebra within the kyphotic region [63]. Low bone mineral density of the upper instrumented vertebra is a predictor of proximal junctional kyphosis in elderly patients with degenerative spinal diseases [73], as is paraspinal muscle degeneration [73]. A personalized risk calculator for proximal junctional kyphosis after adult spinal deformity surgery is based on novel and modifiable clinical features [74]. Low bone mineral density is a predictive factor for distal pedicle screw loosening following posterior corrective surgery for degenerative lumbar scoliosis [82], as is large correction of both the main curve and fractional curve [82]. Conversely, posterolateral fusion is a protective factor against distal pedicle screw loosening following posterior corrective surgery for degenerative lumbar scoliosis [82].

Kinematics and Alignment

Few MRI findings of the spine show large magnitude associations with chronic low back pain or radicular symptoms [16]. Posterior and posterior superior labral injuries produce alterations in glenohumeral kinematics with implications for joint instability, increased joint loading, and potential joint damage [72]. Alignment targets based on the Global Alignment and Proportion (GAP) score alone were not associated with increased risks of mechanical complications or mechanical revisions in patients with complex adult spinal disorders [81].

Classification

Modified Glasgow Prognostic Score: Recommended for early assessment to stratify prognosis in patients with chondrosarcoma [1].

Histological Grading: Of prognostic importance in chondrosarcoma, where a ten or fifteen-year survival rate is more meaningful than a five-year rate for assessing cure [2]. Musculoskeletal oncology classification is based on histomorphology to yield insight into behavior and prognosis [61].

Pathological Fracture Scoring: A novel scoring system can guide specialist management and offer patients a more accurate expectation of functional outcome and survival time in pathological fractures [4].

Cervical Ossification of the Posterior Longitudinal Ligament: A developed nomogram provides a reliable tool for individualized risk assessment and clinical decision-making [8].

Low Back Pain Screening: The StarT back screening tool identifies individuals at risk of a worse prognosis [10]. A pain mannequin also identifies individuals at risk of a worse prognosis [10]. These two tools capture different aspects and different numbers of individuals at high risk of a worse prognosis [10]. A risk classification schema using recommended cut-off scores with items similar to the STarT-Back had limited ability to identify persons who progressed to chronic pain in a primary care population with strictly defined acute low back pain [50]. Latent Class-derived subgroups of low back pain patients provided additional prognostic information compared to a range of variables, though the improvements were not substantial enough to warrant further development into a new prognostic tool [43].

Post-Tuberculosis Kyphosis: Clinical classification systems facilitate precise risk stratification for postoperative neurological complications [19].

Proximal Humeral Fracture: The PHARON model can accurately estimate the risk of nonunion after nonoperative treatment of a proximal humeral fracture using standard clinical assessment tools [48]. A simple scoring system based on fracture characteristics and patient age is able to assess bone quality with solid predictive characteristics in proximal humerus fractures [60].

Lumbar Fusion Surgery: The predictive ability of logistic regression, classification tree, and random forest models for postoperative adverse events in elderly patients undergoing lumbar fusion surgery was comparable [55]. The logistic regression model showed a higher net benefit for clinical intervention compared to classification tree and random forest models [55]. Multivariable prediction models for patient-reported outcomes following lumbar spine surgery appear robust and generalisable across different outcomes and modelling approaches, yet produced only borderline acceptable discrimination ability [68].

Vertebroplasty: A predictive nomogram constructed based on risk actors for patients after vertebroplasty had good predictive ability and potential for clinical decision making [65].

Other Considerations: Demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores in patients with symptoms related to the knee [67].

Clinical Presentation

Prognostic stratification in chondrosarcoma relies on the modified Glasgow Prognostic Score for early assessment [1] and histological grading [2]. While five-year rates are common, a ten or fifteen-year survival rate is more meaningful for assessing cure [2]. Valid prognosis studies require representative samples with sufficient homogeneity regarding prognostic risk [3]. In primary bone sarcoma, a longer duration of symptoms prior to diagnosis is not associated with poorer overall survival [6]. Conversely, for localized high-grade soft-tissue sarcoma of the extremity or trunk, a time to treatment initiation exceeding 30 days after diagnosis is independently associated with poorer survival [12].

Risk assessment tools vary by pathology to guide management and expectations. A novel scoring system for pathological fractures offers accurate expectations of functional outcome and survival time [4]. For cervical ossification of the posterior longitudinal ligament, a developed nomogram provides a reliable tool for individualized risk assessment [8]. In osteonecrosis, a Delphi-based model allows for early identification of high-risk patients regarding femoral head collapse [13]. For degenerative cervical myelopathy, better diagnostic tools are needed to identify patients at risk of rapid neurological deterioration [32]. In elderly patients with conservatively managed odontoid fractures, low haemoglobin, admission from an institution, neurological deficit, and type 3 fractures are easily identifiable predictors of high mortality risk [33].

Screening and classification systems refine triage and surgical timing. The StarT back screening tool and a pain mannequin improve triage for low back pain at risk of a worse prognosis, though they capture different aspects and numbers of high-risk individuals [10]. In children with bilateral Perthes' disease, distinguishing between concurrent and sequential onset is necessary as outcomes differ [11]. For idiopathic scoliosis, prognosis varies considerably by curve pattern and age at onset, with main thoracic curves increasing to greater deformities than other patterns [21]. Clinical classification systems for post-tuberculosis kyphosis facilitate precise risk stratification for targeted preoperative interventions [19].

Specific prognostic indicators and intervention windows exist for complex presentations. The Delphi Trial aims to identify the best timing of surgery for patients at risk of developing neurological signs and symptoms [9]. The Metastatic Early Prognostic (MEP) score identifies a delay to surgery as a potential window to intervene and correct abnormalities to improve survival [34]. For sciatica referred to secondary care, prognosis is generally poor and only slightly better after surgery; comorbidity should be assessed in these patients [35]. Regarding spine-related symptom outcomes, few MRI findings showed large magnitude associations in the LAIDBACK study [16]. Finally, a risk prediction model for preoperative deep venous thrombosis following elderly intertrochanteric fractures exhibited improved specificity, though its validity requires further verification [36].

Investigations

Plain radiography: In adolescent idiopathic scoliosis, apical wedging and coronal imbalance may identify patients with curves of 40° to 50° suited for closer monitoring and early spinal fusion upon validation in larger cohorts [17]. For juvenile idiopathic scoliosis, the level of the most rotated vertebra at the apex of the primary curve serves as the chief prognostic feature at an early stage, while the final pattern of deformity is defined by the level of the caudad neutral vertebra [18]. In congenital kyphosis and kyphoscoliosis, knowledge of the natural history is essential for planning appropriate and timely treatment to prevent deformity progression and neurological complications [5].

MRI: MRI findings generally show limited utility; few demonstrate large magnitude associations with spine-related symptom outcomes even when applying more specific definitions for symptom outcomes [16], and MRI abnormalities are not major predictors of outcome in patients with low back pain [40]. However, specific components can guide management: a reliable 6-stage MRI-based classification addressing ulnar collateral ligament tear grade and location may confer decision-making between operative and nonoperative management [25]. In multilevel cervical spondylotic myelopathy, higher intramedullary signal intensity of T2W MRI and a greater contrast-to-noise ratio (CNR) predict poorer prognoses in ten-year surgical outcomes for French-door laminoplasty [58]. Similarly, increased signal intensity (ISI) of the spinal cord on T2WI and a high degree of cranial adjacent disc degeneration are independent risk factors for poor neurological recovery after anterior cervical discectomy and fusion [71]. For thoracolumbar injuries, MRI-based components of mTLICS support personalized, image-guided management for stratifying three-tier treatment, though prospective validation is needed [38].

CT: Pre-existing L5-S1 degeneration does not affect clinical and radiographical outcomes after isolated L4-5 fusion for spondylolisthesis [31]. The occurrence of symptomatic adjacent segment degeneration requiring surgery after posterior lumbar fusion is multifactorial and related to BMI, preoperative adjacent disc degeneration on MRI, and disc bulge in preoperative CT examination [64].

Bone scan: 18F-fluoride PET/CT performed six weeks after posterior lumbar interbody fusion provides prognostic information on bony fusion at one year [70].

Other Considerations: The modified Glasgow Prognostic Score is recommended for early assessment to stratify prognosis, reinforce decision-making, and potentially improve outcomes in patients with chondrosarcoma [1]. A developed nomogram provides a reliable tool for individualized risk assessment and clinical decision-making regarding postoperative clinical outcomes of cervical ossification of the posterior longitudinal ligament [8]. The StarT back screening tool and a pain mannequin both identify individuals at risk of a worse prognosis in low back pain, though they capture different aspects and different numbers of high-risk individuals [10]. In children with bilateral Perthes' disease, distinguishing between concurrent and sequential onset is necessary as outcomes differ [11]. A longer duration of symptoms prior to diagnosis is not associated with poorer overall survival in patients with primary bone sarcoma [6]. Prognostic factors influencing outcomes after lumbar fusion surgery include higher BMI, larger facet joint angle (FJA), and wider sagittal and coronal diameters [56].

Treatment

Non-Operative

Observation is a viable strategy for moderate, nonprogressive deformity in childhood coxa vara, whereas surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy [53]. In the context of desmoid tumors, upfront surgery offers no advantage over conservative treatments such as observation or medical management [62]. For geriatric odontoid fractures, no definitive conclusions regarding mortality benefit of surgical intervention over conservative management could be determined due to interstudy heterogeneity and lack of standardized evidence [20]. Among patients with TLICS scores of 4 or 5, conservative treatment failure is associated with unfavorable initial radiological findings, a higher proportion of women, advanced age, and osteoporosis [59]. Bracing significantly reduces the risk of curve progression to 50 degrees or greater compared to observation in high-risk patients with adolescent idiopathic scoliosis [30].

Operative

Indications: Surgical intervention is recommended for patients with spinal metastasis presenting as the initial manifestation of malignancy, who demonstrate an acceptable prognosis with treatment [45]. For dedifferentiated chondrosarcoma, complete surgical excision is the initial recommended treatment, whereas chemotherapy lacks convincing evidence of benefit [37]. Stabilization of the clavicle provides better functional scores compared to conservative treatment in the short term for patients with a 'floating shoulder' [27]. A reliable 6-stage MRI-based classification addressing ulnar collateral ligament (UCL) tear grade and location may confer decision-making between operative and nonoperative management [25]. The Elbow UCL Injury Prognosis Score was created to predict which patients would succeed with nonoperative management and avoid unnecessary surgery, or to identify patients for whom nonoperative management would delay the inevitable need for a surgical intervention [41].

Surgical Approach / Technique: Tumor-free margin resection for chondrosarcoma in the mobile spine reduces the risk of local tumor recurrence and prolongs recurrence-free survival and overall survival compared to intralesional spondylectomy, though it carries higher risks and is associated with a greater number of perioperative complications [7]. A novel scoring system for pathological fractures can guide specialist management and offer patients a more accurate expectation of functional outcome and survival time [4]. Adherence to principles of high index of suspicion, correct interpretation of data, thorough surgery, optimization of host factors, and pathogen-specific antibiotic therapy will maximize the patient's prognosis in orthopedic infections [23].

Adjuncts: Machine learning models have the potential to predict treatment failure in patients with thoracolumbar burst fractures treated with short-segment posterior spinal fixation [46]. A time to treatment initiation of more than 30 days after diagnosis is independently associated with poorer overall survival after definitive surgery for localized high-grade soft-tissue sarcoma in the extremity or trunk [12].

Other Considerations: The modified Glasgow Prognostic Score is recommended for early assessment to stratify prognosis, reinforce decision-making, and potentially improve outcomes in patients with chondrosarcoma [1]. Histological grading is of prognostic importance in chondrosarcoma, and a ten or fifteen-year survival rate is more meaningful than a five-year rate for assessing cure [2]. Validity of prognosis studies requires determining if there was a representative sample of patients and if patients were sufficiently homogeneous with respect to prognostic risk [3]. A thorough knowledge of the natural history of congenital kyphosis and kyphoscoliosis is essential in planning appropriate and timely treatment to prevent progression of the deformity and neurological complications [5]. A delphi-based model for prognosis of femoral head collapse in osteonecrosis allows for early identification of high-risk patients to guide personalized treatment strategies and aims to improve patient outcomes and reduce the need for invasive surgical procedures [13]. The necrosis lesion boundary has a high value in predicting osteonecrosis of the femoral head (ONFH) prognosis and informing clinical treatment strategies [42]. Lower C2 slope and milder uncovertebral joint degeneration are risk factors for pseudarthrosis after single-level anterior cervical corpectomy and fusion (ACCF) [22]. Ten factors were identified as significant predictors of delayed union after surgical treatment in patients with osteoporotic vertebral compression fractures, encompassing five baseline characteristics, three biological molecular factors, one outcome measure, and one therapeutic intervention [29]. The incidence of symptomatic non-fusion segment disease after anterior cervical arthrodesis has multifactorial causes [54]. Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is of critical importance for their utilization [39].

Complications

Other Considerations: Longer duration of symptoms prior to diagnosis is not associated with poorer overall survival in patients with primary bone sarcoma [6]. Tumor-free margin resection carries higher risks and is associated with a greater number of perioperative complications compared to intralesional spondylectomy for chondrosarcoma in the mobile spine [7]. Functional dependence significantly predicts increased risk of complications and post-operative mortality after elective cervical spine surgery [15]. Postoperative complications are independently associated with higher mortality, particularly when occurring early, following hip fracture among nonagenarians [47]. Patients undergoing three-column osteotomies in the later cohort (2014-2018) demonstrated lower rates of proximal junctional failure and overall hardware complications compared to the earlier cohort [52]. Despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis for radial head arthroplasty [79]. Vertebral height deterioration in fractured vertebrae operated by percutaneous vertebroplasty might be due to the natural course of fracture or osteoporosis [83].

Recovery

Prognostic Determinants: Histological grading serves as a critical prognostic indicator for chondrosarcoma of the pelvis and upper femur [2]. For assessing cure in chondrosarcoma, ten- or fifteen-year survival rates provide more meaningful data than five-year rates [2]. In pathological fractures, survival time is short and correlates with the primary tumor type, with lung cancer acting as the strongest negative predictor [84]. Conversely, a longer duration of symptoms prior to diagnosis does not correlate with poorer overall survival in primary bone sarcoma patients [6]. For localized high-grade soft-tissue sarcoma of the extremity or trunk, a time to treatment initiation exceeding 30 days after diagnosis is independently associated with poorer survival following definitive surgery [12]. Functional dependence significantly predicts increased risks of complications and post-operative mortality after elective cervical spine surgery [15].

Surgical Outcomes and Complications: In mobile spine chondrosarcoma, tumor-free margin resection reduces local recurrence risk and prolongs both recurrence-free and overall survival, yet carries higher risks and a greater number of perioperative complications compared to intralesional spondylectomy [7]. For patients with a 'floating shoulder,' clavicle stabilization yields better short-term functional scores than conservative treatment [27]. In thoracolumbar fractures with incomplete spinal cord injury, approximately 70% of patients recover sexual function to pre-injury levels at the two-year postoperative follow-up [51]. Age and baseline AMS are the most important predictors of functional outcome in acute traumatic spinal cord injury [49]. Ten factors, encompassing five baseline characteristics, three biological molecular factors, one outcome measure, and one therapeutic intervention, were identified as significant predictors of delayed union after surgical treatment for osteoporotic vertebral compression fractures [29].

Long-Term Monitoring and Natural History: Prognosis studies require representative samples and patient homogeneity regarding prognostic risk to ensure validity [3]. A novel scoring system can guide specialist management to offer more accurate expectations of functional outcome and survival time in pathological fractures [4]. Knowledge of the natural history of congenital kyphosis and kyphoscoliosis is essential to prevent deformity progression and neurological complications [5]. Distinguishing between concurrent and sequential onset is necessary as outcomes differ in children with bilateral Perthes' disease [11]. The prognosis in idiopathic scoliosis varies considerably by curve pattern and age at onset, with main thoracic curves increasing to greater deformities than other patterns [21]. Evidence suggests the natural history of idiopathic scoliosis may be becoming more benign spontaneously in late-onset cases in children aged six to fourteen years [26]. For residual dysplasia at skeletal maturity following closed reduction for developmental dysplasia of the hip, prognostication charts and thresholds can guide intervention versus surveillance decisions [14]. Upon validation, apical wedging and coronal imbalance may identify patients suited for closer monitoring and early spinal fusion in post-maturity progression of adolescent idiopathic scoliosis curves between 40° and 50° [17]. Further long-term follow-up is required to determine if the grafted area maintains structural and functional integrity over time for autologous matrix-induced chondrogenesis in focal knee cartilage defects [24].

Risk Stratification Tools: The Delphi Trial aims to identify the optimal timing of surgery for patients at risk of developing neurological signs and symptoms [9]. The Recurrent Instability of the Patella Score holds significant potential for identifying patients at high risk for recurrent instability after primary patellar dislocation [28].

Key Evidence

  • [L3] The authors recommend its use in early assessment to better stratify prognosis, reinforce decision-making, and potentially improve outcomes. (10.1302/0301-620x.107b6.bjj-2024-0596.r2)
  • [L5] Prognosis studies are investigations examining the possible outcomes of a disease or operative procedure and the probability with which they can be expected to occur; primary guides for assessing their validity include determining if there was a representative sample of patients and if patients were sufficiently homogeneous with respect to prognostic risk. (10.2106/00004623-200110000-00017)
  • [L3] This can guide specialist management and offer patients a more accurate expectation of functional outcome and survival time. (10.1186/s13018-018-0931-x)
  • [L3] A thorough knowledge of the natural history is essential in the planning of appropriate and timely treatment to prevent progression of the deformity and neurological complications. (10.2106/00004623-199910000-00002)
  • [L3] A longer duration of symptoms prior to diagnosis is not associated with a poorer overall survival in patients with a primary bone sarcoma. (10.1302/0301-620x.100b5.bjj-2017-1235.r1)
  • [L3] Tumor-free margin resection carries higher risks and is associated with a greater number of perioperative complications, but reduces the risk of local tumor recurrence and prolongs recurrence-free survival and overall survival, providing patients with better prognoses. (10.1186/s13018-025-05712-4)
  • [L3] The developed nomogram provides a reliable tool for individualized risk assessment and clinical decision-making. (10.1186/s13018-025-06276-z)
  • [L2] The objective of this study is to identify the best timing of surgery for patients at risk for the development of neurological signs and symptoms. (10.1186/1471-2474-7-14)
  • [L3] Both screening tools identified individuals at risk, but they captured different aspects and different numbers of individuals at high risk of a worse prognosis. (10.1186/s12891-019-2836-1)
  • [L2] Distinguishing between concurrent and sequential onset is necessary as outcomes differ. (10.1302/0301-620x.98b4.36045)
  • [L3] A time to treatment initiation of more than 30 days after diagnosis was independently associated with poorer survival. (10.1302/0301-620x.103b6.bjj-2020-2087.r1)
  • [L3] It allows for early identification of high-risk patients, guiding personalized treatment strategies to improve patient outcomes and reduce the need for invasive surgical procedures. (10.1186/s13018-024-05247-0)
  • [L3] The proposed prognostication chart and thresholds can help guide orthopaedic surgeons and parents when contemplating the use of an intervention versus surveillance to optimize long-term outcomes. (10.2106/jbjs.23.01484)
  • [L3] Functional dependence is a significant predictor of an increased risk of complications and post-operative mortality. (10.1302/0301-620x.99b6.bjj-2016-1149.r1)
  • [L2] Even when applying more specific definitions for spine-related symptom outcomes, few MRI findings showed large magnitude associations with symptom outcomes. (10.1186/1471-2474-15-152)
  • [L3] Upon validation in larger cohorts, apical wedging and coronal imbalance may identify patients suited for closer monitoring and early spinal fusion. (10.2106/jbjs.22.00939)
  • [L4] The chief prognostic feature at an early stage was the level of the most rotated vertebra at the apex of the primary curve, and the final pattern of deformity was defined by the level of the caudad neutral vertebra. (10.2106/00004623-199608000-00003)
  • [L3] The clinical classification systems established herein facilitate precise risk stratification, enabling targeted preoperative interventions to mitigate surgical risks and enhance surgical outcomes. (10.1186/s13018-025-06112-4)
  • [L1] Despite high morbidity and mortality, no definitive conclusions regarding mortality benefit of surgical intervention over conservative management could be determined due to interstudy heterogeneity and lack of standardized evidence. (10.5435/jaaos-d-23-00389)
  • [L3] The prognosis in idiopathic scoliosis varies considerably by curve pattern and age at onset, with main thoracic curves increasing to greater deformities than other patterns. (10.2106/00004623-195032020-00017)
  • [L3] These characteristics should be further considered in surgical planning to identify high-risk patients. (10.1186/s13018-025-05629-y)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L4] A reliable 6-stage MRI-based classification addressing UCL tear grade and location may confer decision making between operative and nonoperative management. (10.1016/j.jse.2018.11.063)
  • [L4] The results suggest that the natural history of idiopathic scoliosis may be becoming more benign spontaneously. (10.2106/00004623-199609000-00006)
  • [L2] Stabilisation of the clavicle gives better functional scores compared to conservative treatment in the short term. (10.1302/0301-620x.95b6.31060)
  • [L3] This long-term risk stratification holds significant potential clinical utility for determination of patients who are at high risk for recurrent instability after primary patellar dislocation. (10.1016/j.arthro.2018.09.017)
  • [L1] A total of ten factors were identified as significant predictors of delayed union, encompassing five baseline characteristics, three biological molecular factors, one outcome measure, and one therapeutic intervention. (10.1186/s13018-025-06581-7)
  • [L1] Bracing significantly reduces the risk of curve progression to 50 degrees or greater compared to observation in high-risk patients. (10.2106/jbjs.o.00330)
  • [L3] Pre-existing L5-S1 degeneration does not affect clinical and radiographical outcomes after isolated L4-5 fusion. (10.1186/s13018-015-0186-8)
  • [L5] It emphasizes the need for better diagnostic tools to identify patients at risk of rapid neurological deterioration to enable timely surgical intervention. (10.1530/eor-2025-0070)
  • [L3] Easily identifiable predictors present on admission, including low haemoglobin, admission from an institution, neurological deficit, and type 3 fractures, can be used to identify patients at high risk and guide management by a multidisciplinary team. (10.1302/0301-620x.99b1.37989)
  • [L3] The delay to surgery identifies a potential window to intervene and correct abnormalities with the aim of improving survival. (10.1302/0301-620x.102b1.bjj-2019-0794.r1)
  • [L2] The results indicate that the prognosis for sciatica referred to secondary care is not that good and only slightly better after surgery and that comorbidity should be assessed in patients with sciatica. (10.1186/1471-2474-13-183)
  • [L3] The risk prediction model exhibited the improved specificity, but its validity required further studies to verify. (10.1186/s12891-022-05381-y)
  • [L4] Complete surgical excision is the initial recommended treatment, while chemotherapy lacks convincing evidence of benefit. (10.1186/1749-799x-7-38)
  • [L3] Its MRI-based components support personalized, image-guided management, though prospective validation is needed. (10.1186/s12891-025-09124-7)
  • [L2] Our findings suggest that the MRI abnormalities examined are not major predictors of outcome in patients with LBP. (10.1186/1471-2474-12-234)
  • [L3] The Elbow UCL Injury Prognosis Score was created to predict which patients would succeed with nonoperative management and avoid unnecessary surgery while simultaneously identifying patients for whom nonoperative management would delay the inevitable need for a surgical intervention. (10.1177/03635465251366318)
  • [L3] The necrosis lesion boundary has a high value in predicting ONFH prognosis and informing clinical treatment strategies. (10.3389/fendo.2023.1137786)
  • [L2] Latent Class-derived subgroups provided additional prognostic information when compared to a range of variables, but the improvements were not substantial enough to warrant further development into a new prognostic tool. (10.1186/s12891-017-1708-9)
  • [L3] The SM-IMM group had an acceptable prognosis with surgical treatment. (10.1302/0301-620x.101b11.bjj-2018-1600.r2)
  • [L3] The findings support the potential of MLMs to predict treatment failure in this patient population, offering valuable prognostic information for early intervention and cost savings. (10.1186/s13018-024-04690-3)
  • [L3] Postoperative complications were independently associated with a higher mortality, particularly when occurring early. (10.1186/s13018-021-02807-6)
  • [L3] The risk can be accurately estimated with the PHARON model using standard clinical assessment tools. (10.2106/jbjs.20.01139)
  • [L2] Age and baseline AMS play the most important role in predicting the functional outcome. (10.1186/s13018-022-03343-7)
  • [L2] A risk classification schema using the recommended cut-off scores with items similar to the STarT-Back in a primary care population with strictly defined acute LBP had limited ability to identify persons who progressed to chronic pain. (10.1002/ejp.615)
  • [L3] Approximately 70% of patients have sexual function recover to pre-injury levels at the 2-year postoperative follow-up. (10.1186/s13018-025-05587-5)
  • [L3] Patients undergoing 3COs in the later cohort (2014-2018) demonstrated improved outcomes, including lower rates of proximal junctional failure and overall hardware complications compared to the earlier cohort. (10.2106/jbjs.21.01172)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L3] The incidence of symptomatic non-fusion segment disease after anterior cervical arthrodesis has multifactorial causes. (10.1186/s13018-018-0717-1)
  • [L3] The predictive ability of the three models (logistic regression, classification tree, and random forest) was comparable, with the logistic regression model showing a higher net benefit for clinical intervention. (10.1186/s13018-023-04490-1)
  • [L3] It also identifies several prognostic factors that influence outcomes after lumbar fusion surgery, including higher BMI, larger FJA, and wider sagittal and coronal diameters. (10.1186/s13018-025-05835-8)
  • [L3] Higher intramedullary signal intensity of T2W MRI and a greater CNR predicted poorer prognoses. (10.1155/2020/3627071)
  • [L3] Among patients with TLICS scores of 4 or 5, those experiencing conservative treatment failure exhibited unfavorable initial radiological findings, a higher proportion of women, advanced age, and osteoporosis. (10.1186/s12891-024-07543-6)
  • [L3] A simple scoring system developed based on these variables is able to assess bone quality with solid predictive characteristics. (10.1186/s12891-023-06883-z)
  • [L3] Upfront surgery is not advantageous compared to more conservative treatments such as observation or medical treatment for patients with desmoid tumors. (10.1186/s12891-020-03897-9)
  • [L3] The spinal morphological characteristics of thoracolumbar kyphosis must be taken into account during surgical planning to prevent placing the UIV within the kyphotic region. (10.1186/s13018-025-05458-z)
  • [L3] The occurrence of a symptomatic adjacent segment degeneration surgery is most likely multifactorial and is related to BMI, preoperative adjacent disc degeneration on MRI, and disc bulge in preoperative CT examination. (10.1186/s13018-014-0097-0)
  • [L3] The predictive nomogram constructed based on these risk actors had a good predictive ability and certain potential for clinical decision making. (10.5435/jaaos-d-25-00094)
  • [L2] A higher supine flexibility (18.1%) and correction rate (28.8%), and a SCI of greater than 1.21 predicted a lower risk of progression. (10.1302/0301-620x.104b4.bjj-2021-1220.r1)
  • [L4] Numerous scoring systems have been devised to evaluate patients who have symptoms related to the knee, but demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores. (10.2106/00004623-199706000-00009)
  • [L2] The developed models appear robust and generalisable across different outcomes and modelling approaches but produced only borderline acceptable discrimination ability, suggesting the need to assess further prognostic factors. (10.1186/s12891-023-06446-2)
  • [L2] 18F-fluoride PET/CT six weeks after PLIF provides prognostic information on bony fusion at one year. (10.1186/s13018-025-05814-z)
  • [L3] Increased signal intensity (ISI) of the spinal cord on T2WI and high degree of cranial adjacent disc degeneration are independent risk factors for poor neurological recovery after anterior cervical discectomy and fusion. (10.1186/s13018-024-04886-7)
  • [L5] The PPS injury produces alterations in GH kinematics with implications for GH joint instability, increased GH joint loading, and potential joint damage. (10.1016/j.jse.2024.12.023)
  • [L3] Paraspinal muscle degeneration and low bone mineral density of the upper instrumented vertebra are predictors of proximal junctional kyphosis. (10.1186/s12891-022-05960-z)
  • [L3] The study developed a personalized risk calculator to assess the risk of proximal junctional kyphosis after adult spinal deformity surgery based on novel and modifiable clinical features, facilitating individualized risk factor assessment and guiding perioperative management. (10.1302/0301-620x.107b8.bjj-2024-1474.r2)
  • [L3] Thoracolumbar spine has 2-folds higher risk of OVCF than non-thoracolumbar spine. (10.1186/s13018-023-04140-6)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L3] Alignment targets based on the GAP score alone were not associated with increased risks of mechanical complications and mechanical revisions in patients with complex adult spinal disorders. (10.1097/corr.0000000000001521)
  • [L3] Low bone mineral density, large correction of both main curve and fractional curve are predictive factors for loosening, while posterolateral fusion is a protective factor. (10.1186/s12891-025-08519-w)
  • [L3] VHD might be due to natural course of fracture/ osteoporosis. (10.1186/s12891-025-08574-3)
  • [L3] Survival time is short and correlated with primary tumor type, with lung cancer as the strongest negative predictor of survival. (10.1186/s13018-023-03620-z)

See Also

References

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