Spine[JOURNAL]
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200 papers
Necessary cervical kyphosis correction angle (NeckCA) for ideal alignment in cervical spinal deformity.
Jang SW, Shin HK, Chong S … +3 more , Park D, Kim C, Park JH
J Neurosurg Spine · 2026 Mar · PMID 41825069 · Publisher ↗
OBJECTIVE: The authors propose a formula to calculate the angle required for cervical kyphosis correction and validate its utility in achieving and maintaining optimal cervical alignment. METHODS: The authors introduce a...
OBJECTIVE: The authors propose a formula to calculate the angle required for cervical kyphosis correction and validate its utility in achieving and maintaining optimal cervical alignment. METHODS: The authors introduce a novel radiographic parameter, the necessary cervical kyphosis correction angle (NeckCA), defined as NeckCA = C2 slope (C2S) + center of gravity - T1 tilt (COG-T1 tilt) - 15. Using this formula, the authors retrospectively reviewed 29 cervical spinal deformity (CSD) correction surgical procedures performed at a single center from 2012 to 2024. Patients were categorized into two groups based on their radiological outcome: favorable (F group) and unfavorable (U group). The following criteria defined the U group: 1) T1 slope (T1S) - cervical lordosis (CL) > 25°; 2) C2-7 sagittal vertical axis (SVA) > 70 mm; or 3) segmental angle change > 10°. The authors compared clinical and radiological parameters between the groups and evaluated the discriminatory capacity of NeckCA using receiver operating characteristic (ROC) curve analysis. RESULTS: Among the 29 patients (19 degenerative, 6 oncological, and 4 infectious etiologies), 17 were classified into the F group and 12 into the U group. Preoperative radiological parameters such as CL, C2S, and segmental angle did not differ significantly between groups, except for C2-7 SVA, which was much greater in the U group. ROC curve analysis showed that NeckCA served as a critical predictor of radiological outcomes, with an area under the curve of 0.806 (p = 0.006). CONCLUSIONS: In CSD correction, increasing CL alone to meet a T1S - CL < 15° often results in compensatory increases in T1S, leading to undercorrection. To counteract this, preoperative planning should include an additional corrective angle represented by the COG-T1. The authors' analysis of 29 cases confirms the use of NeckCA as a practical and predictive parameter for achieving optimal cervical alignment.
Disparities and institutional variation in time to surgery for traumatic cervical spinal cord injury: a multicenter cohort study.
Karthikeyan V, Badhiwala JH, Malhotra AK … +11 more , Shakil H, Lozano CS, Ye V, Essa A, Yuan EY, He Y, Srbely JM, Jack AS, Wilson JR, Fehlings MG, Witiw CD
J Neurosurg Spine · 2026 Mar · PMID 41825068 · Publisher ↗
OBJECTIVE: Early access to surgical care is increasingly recognized as an important principle in the management of traumatic spinal cord injury (SCI); however, systems-level barriers that hinder delivery of care exist. T...
OBJECTIVE: Early access to surgical care is increasingly recognized as an important principle in the management of traumatic spinal cord injury (SCI); however, systems-level barriers that hinder delivery of care exist. Therefore, the aim of this study was to evaluate the associations of race, insurance status, and frailty with the time to surgical intervention in patients with traumatic SCI, and to quantify institutional variation in surgical timing across North American trauma centers. METHODS: A multicenter retrospective cohort study was conducted using the American College of Surgeons Trauma Quality Improvement Program database (2010-2020). Adult patients (age ≥ 16 years) with blunt traumatic cervical SCI who underwent surgical decompression were included. A mixed-effects regression model was used to identify independent predictors of the time to surgery and to assess variation between and within trauma centers. Variance components from a null model (intercept only) and full model (case-mix adjusted) were compared, and the proportional change in variance at the hospital and individual levels was calculated to quantify the explanatory value of hospital- and patient-level characteristics, respectively. RESULTS: The cohort included 20,566 patients (15,977 male, mean age 53 years) from 503 trauma centers. The mean time to surgery was 30 hours (SD 28 hours), and 57% of patients underwent decompression within 24 hours of presentation. Black race, lack of insurance, and increasing frailty were independently associated with delayed surgery. Patients categorized as frail experienced a 3.4-hour longer delay in time to surgery (95% CI 2.03-4.63, p < 0.001). Uninsured patients waited 1.6 hours longer (95% CI 0.24-2.94, p = 0.023). Black patients experienced a 1.4-hour delay (95% CI 0.81-2.80, p = 0.005) compared with White patients. Observed case-mix and hospital-level characteristics did not account for between-hospital variability in surgical timing (proportional change in variance of -5.3%). Only 8.6% of the individual-level proportional change in variance was explained by these factors. The adjusted intraclass correlation coefficient was 8%, indicating low correlation in surgical timing for patients with similar characteristics treated at the same center. CONCLUSIONS: Delays in surgical treatment for cervical SCI persist, particularly among patients categorized as frail, those who were uninsured, and Black patients. Institutional variation remains substantial and largely unexplained by case-mix or hospital-level characteristics. These findings highlight the need for equity-focused quality improvement efforts and system-level interventions to improve timely care for individuals with SCI.
Correlation of antithrombotic medication use with lower incidence of postoperative dysphagia following anterior cervical spine surgery.
Foreit AM, Tippins NP, Alentado VJ … +4 more , Bisson EF, Foley KT, Porche K, Potts EA
J Neurosurg Spine · 2026 Mar · PMID 41825063 · Publisher ↗
OBJECTIVE: Previous studies have identified decreased esophageal blood flow during anterior cervical surgery as a contributing factor to postoperative dysphagia. However, the effects of antithrombotic agents on esophagea...
OBJECTIVE: Previous studies have identified decreased esophageal blood flow during anterior cervical surgery as a contributing factor to postoperative dysphagia. However, the effects of antithrombotic agents on esophageal blood flow during recovery from surgery have yet to be explored. This study examines the relationship between antithrombotic medication use and postoperative dysphagia in patients undergoing anterior cervical spine procedures. METHODS: A prospectively collected multi-institutional quality registry was retrospectively reviewed. Patients undergoing cervical spine surgery were categorized based on preoperative antithrombotic drug usage and propensity score matched by age, race, sex, and other baseline characteristics. Dysphagia rates were compared between groups using Eating Assessment Tool-10 questionnaires. Univariate analyses were used to examine the effects of antithrombotic medications on the rates of postoperative dysphagia. RESULTS: Of 1661 patients meeting inclusion criteria, 629 (37.9%) reported taking antithrombotic agents preoperatively. Propensity score matching yielded 784 patients, with 392 (50%) who took prescription antithrombotic medications. Patients taking antithrombotic agents experienced significantly lower rates of postoperative dysphagia at 1 (48% vs 58%, p = 0.049), 3 (21% vs 28%, p = 0.033), and 12 (19% vs 26%, p = 0.048) months after surgery compared with those who did not. After separating the cohorts by surgical approach, patients taking antithrombotic medications who underwent anterior cervical surgery experienced significantly lower rates of dysphagia at 3 months (21% vs 30%, p = 0.019) but not at 1 month (51% vs 59%, p = 0.2) or 12 months (19% vs 26%, p = 0.058) postoperatively, while rates for patients undergoing a posterior approach were similar regardless of antithrombotic drug use. CONCLUSIONS: Patients taking antithrombotic medications experience significantly lower rates of dysphagia after anterior cervical surgery. Antithrombotic drugs may enhance microcirculation within the esophagus postoperatively, protecting against the detrimental effects of prolonged esophageal retraction during anterior cervical surgery that have been found to contribute to postoperative dysphagia. This novel finding warrants further investigation.
Analysis of 5317 Consecutive Pediatric Spinal Deformity Intraoperative Neuromonitoring (IONM) Alerts: Importance of Normotension at Correction and IONM Recovery.
Bozorgmehr CK, Rakers L, Kelly B … +1 more , Luhmann SJ
Spine (Phila Pa 1976) · 2026 Mar · PMID 41817468 · Publisher ↗
STUDY DESIGN: Case Series. OBJECTIVE: The study's objective is to detail the chronology of intraoperative neuromonitoring (IONM) alerts during pediatric spinal deformity surgery, the corrective maneuvers taken, and the i...
STUDY DESIGN: Case Series. OBJECTIVE: The study's objective is to detail the chronology of intraoperative neuromonitoring (IONM) alerts during pediatric spinal deformity surgery, the corrective maneuvers taken, and the immediate and final neurologic outcomes. SUMMARY OF BACKGROUND DATA: IONM reduces the risk of spinal cord dysfunction during pediatric spinal deformity surgery by enabling timely intraoperative intervention. However, limited data exists regarding the chronology of alerts and the effectiveness of specific corrective actions. METHODS: An institutional neuromonitoring database was reviewed (1992-2024) to identify all consecutive patients (0-18 y) who underwent pediatric spine deformity surgery with at least one IONM alert. RESULTS: A total of 223 patients (4.2%) were identified out of 5,317 consecutive cases, of which 156 had data recovery intraoperatively, and 67 did not. Diagnoses were kyphosis (n=66), idiopathic (n=63), neuromuscular (n=43), congenital (n=24), syndromic (n=11), and other (n=16). There were 348 corrective actions for 237 alerts, most commonly correction of hypotension (n=91) and adjustment of deformity correction (n=63). Postoperatively, 34 patients with IONM alerts had neurological change from baseline. 29 patients had documented final neurological status; 21 had full recovery to baseline, 5 had partial recovery, 3 had no recovery. Among patients available for final follow-up, neurologic decline occurred in 0.15% (8/5,312) and in 3.7% (8/218) of those with intraoperative IONM alerts. CONCLUSION: IONM alerts occurred in 4.2% of cases, most frequently at correction/following correction. Corrective actions, most commonly correction of hypotension, theoretically reduced spinal cord dysfunction from 4.2% intraoperatively, to 0.5% (29/5,312) at wake-up and 0.15% (8/5,312) at final exam. This largest single-center experience with IONM in pediatric spinal deformity surgery supports the use of a multimodal IONM, systematic alert response protocol and allows for better preoperative shared-decision making.
Identifying Key Risk Factors in Elective 1 or 2 Level Lumbar Spine Fusion Patients: A Focus on Patients Classified High Medical Risk who are Cannabis Users.
Kwaczala AT, Solomito MJ, McCracken C … +2 more , Hillery C, Makanji H
Spine (Phila Pa 1976) · 2026 Mar · PMID 41812686 · Publisher ↗
STUDY DESIGN: Retrospective case-control study. OBJECTIVES: The goal of this study was to identify key risk factors that were associated with 90-day complication rates, and 12-month recovery metrics following an elective...
STUDY DESIGN: Retrospective case-control study. OBJECTIVES: The goal of this study was to identify key risk factors that were associated with 90-day complication rates, and 12-month recovery metrics following an elective single or 2-level lumbar fusion. SUMMARY OF BACKGROUND DATA: Preoperative screening for risk factors associated with poor outcomes is common in elective surgeries. Recent changes in legal status of cannabis has led to questions concerning the impact of cannabis use on postoperative recovery, complications, and pain management in patients undergoing elective lumbar fusions. METHODS: This retrospective study included patients ages 35 to 80 who underwent elective single- or two-level lumbar fusions between January 2022 and May 2025. Patients were classified as either high-risk or normal risk during their preoperative optimization visit. Four groups were created based on risk classification and cannabis use: high-risk cannabis users (HR-C), high-risk non-users (HR), normal risk cannabis users (NR-C), and normal risk non-users (NR). Differences were compared using Chi-squared tests and ANOVAs. Regression analyses identified preoperative metrics associated with poor outcomes. RESULTS: A total of 575 patients (142 HR, 30 HR-C, 433 NR, 101 NR-C) were included. HR-C patients showed two-fold higher opioid use ( P <0.001), longer length of stay ( P <0.001), and higher incidents of surgical site infections compared to NR- patients ( P <0.01). Cannabis use was associated with increased SSI rates, while tobacco use and mental illness were associated with emergency department utilization and readmissions, and alcohol use and preoperative pain were associated with return to the OR. CONCLUSIONS: This study identifies specific risk factors in patients with poor outcomes. Cannabis use was associated with adverse spinal fusion outcomes and should be included as a preoperative screen, with others such as alcohol and tobacco use, and mental health. Screening can determine which patients may benefit from preoperative optimization and postoperative follow-up using patient-centered targeted interventions. LEVEL OF EVIDENCE: III.
Letter to the Editor: The Effect of Night-Time Versus Full-Time Bracing on the Sagittal Profile in Adolescent Idiopathic Scoliosis : A Propensity Score-Matched Study.
Heegaard M, Ragborg L, McIntosh AL … +5 more , Johnson ME, Gehrchen M, Sucato DJ, Dahl B, Ohrt-Nissen S
Spine (Phila Pa 1976) · 2026 May · PMID 41812673 · Publisher ↗
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Comparative Analysis of Three Lordosis Correction Parameters for Predicting Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery.
Park SJ, Park JS, Kang DH … +2 more , Lee CS, Kim HJ
Spine (Phila Pa 1976) · 2026 Mar · PMID 41812670 · Publisher ↗
STUDY DESIGN: Retrospective study. OBJECTIVE: To compare the predictive performance of three lordosis correction parameters for proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery. SUMMARY OF BACKG...
STUDY DESIGN: Retrospective study. OBJECTIVE: To compare the predictive performance of three lordosis correction parameters for proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Although the extent of lordosis correction, as measured by pelvic incidence minus lumbar lordosis (PI-LL), age-adjusted PI-LL, and L1PA, has been identified as a risk factor for PJK, direct comparison of their predictive ability has not been fully explored. METHODS: A total of 323 patients who underwent lower thoracic spine to pelvis fusion with a 2-year follow-up were included. Three lordosis correction parameters were measured postoperatively: PI-LL, age-adjusted PI-LL offset, and L1PA offset. PJK was defined both radiographically and clinically. Logistic regression models with restricted cubic splines were used to assess the relationship between each parameter and the occurrence of PJK. Discriminative performance was evaluated using the area under the receiver operating characteristic curve (AUC), and calibration performance was assessed using Brier scores (lower scores indicate better performance). Odds ratios were calculated at multiple offset levels to evaluate effect sizes. RESULTS: All three parameters demonstrated similar discriminative abilities (AUCs: 0.638 for PI-LL, 0.648 for age-adjusted PI-LL offset, and 0.704 for L1PA offset; P>0.05). However, the L1PA offset model showed significantly superior calibration performance (Brier score=0.196) compared to PI-LL (0.211) and age-adjusted PI-LL offset (0.210). Effect size analysis revealed that while overcorrection (negative offset values) increased PJK risk across all models, only the L1PA offset demonstrated a clear dose-response relationship. Correlation analysis showed that L1PA had only a moderate correlation with PI-based parameters, suggesting it captures distinct alignment features. CONCLUSIONS: All three lordosis correction parameters were predictive of PJK, but the L1PA offset showed improved calibration and more consistent risk stratification. L1PA may serve as a more robust and individualized metric for guiding alignment in ASD surgery.
Can Preoperative Nutritional Status be one of the Parameters Evaluating Biological Age for Elderly Patients Undergoing Spinal Surgery? A Propensity Score-matched Analysis.
Kinoshita Y, Tamai K, Oka M … +15 more , Kato M, Suzuki A, Toyoda H, Takahashi S, Sawada Y, Iwamae M, Okamura Y, Kobayashi Y, Taniwaki H, Uematsu M, Sasaki R, Suzuki M, Tsujino M, Nakamura H, Terai H
Spine (Phila Pa 1976) · 2026 Feb · PMID 41802447 · Publisher ↗
STUDY DESIGN: Retrospective cohort study with propensity score-matched analysis. OBJECTIVE: To evaluate the association between preoperative nutritional indices and postoperative health-related quality of life (HRQOL) in...
STUDY DESIGN: Retrospective cohort study with propensity score-matched analysis. OBJECTIVE: To evaluate the association between preoperative nutritional indices and postoperative health-related quality of life (HRQOL) in elderly patients who have undergone spinal surgery. SUMMARY OF BACKGROUND DATA: In elderly patients, surgical decisions should also consider biological age. We hypothesized that preoperative nutritional status would be associated with postoperative improvement in HRQOL, independent of chronological age. METHODS: We retrospectively analyzed 600 patients aged≥60 years who underwent spinal surgery at a single institution. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), the Prognostic Nutritional Index (PNI), and the Controlled Nutritional Status (CONUT) scores. HRQOL was evaluated using the EuroQol-5 Dimensions 5-level questionnaire (EQ-5D-5L) preoperatively and 1 and 2 years postoperatively. Propensity score matching was used to compare changes in EQ-5D-5L scores between the malnutrition and control groups for each index, while adjusting for age, sex, body mass index, surgical procedure, and surgical region. Malnutrition was defined as GNRI <98, PNI<45, or CONUT≥2, as previously reported. RESULTS: Patients with a low preoperative GNRI demonstrated significantly lower EQ-5D-5L scores than those with a high GNRI (P=0.031), with lower postoperative scores at years 1 (P=0.001) and 2 (P=0.047). No differences were observed between the groups stratified by PNI (P=0.085) or CONUT (P=0.306). Patients who failed to achieve the minimal clinically important difference (ΔEQ-5D-5L≥0.08) showed significantly higher scores in the low GNRI group at postoperative years 1 and 2 (P<0.001). No such association was found for PNI or CONUT. CONCLUSIONS: Preoperative malnutrition evaluated by GNRI was independently associated with impaired postoperative HRQOL in elderly patients undergoing spinal surgery. The GNRI may serve as a nutritional marker and a surrogate for biological age.
L1-S1 Posterior Paraspinal Muscle Fatty Infiltration and a Radiomics Signature Predict Prolonged Length of Stay After Lumbar Spine Surgery in Older Adults.
Guo M, Wang S, Li X … +2 more , Liu Y, Lu S
Spine (Phila Pa 1976) · 2026 Jun · PMID 41802437 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine whether multilevel L1 to S1 paraspinal muscle fatty infiltration (FI) and a posterior paraspinal radiomics signature improve prediction of prolonged lengt...
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine whether multilevel L1 to S1 paraspinal muscle fatty infiltration (FI) and a posterior paraspinal radiomics signature improve prediction of prolonged length of stay (LOS) after lumbar spine surgery in geriatric patients. METHODS: We retrospectively included 248 patients aged older than or equal to 75 years undergoing open posterior transforaminal lumbar interbody fusion (TLIF) with preoperative axial T2-weighted MRI covering L1 to S1. Paraspinal muscles were segmented (MuscleMap) to derive global L1 to S1 fatty infiltration (all muscle FI) and CSA/BMI. A posterior paraspinal radiomics score (RadScore) was developed from multifidus+erector spinae radiomics features using L1-penalized logistic regression within leakage-free nested cross-validation (outer five-fold; inner five-fold). Prolonged LOS was defined as LOS ≥16 days (75th percentile). Discrimination (AUC), calibration, and clinical utility (DCA) were assessed using out-of-fold predictions; bootstrap 95% CIs were reported. RESULTS: Prolonged LOS occurred in 62/248 (25.0%). Patients with prolonged LOS had lower BMI and a markedly higher prevalence of frailty (Fried ≥3: 87.1% vs. 22.6%). All muscle FI was strongly associated with prolonged LOS after adjustment for clinical and operative factors, and RadScore remained independently associated in radiomics-augmented models; in the combined model, the association for All muscle FI was attenuated, suggesting shared prognostic information between conventional FI and radiomics-derived muscle heterogeneity. In leakage-free nested cross-validation, the clinical model achieved AUC 0.848, which improved to 0.922 after adding All muscle FI, and to 0.933 with RadScore; the combined model yielded the highest AUC (0.936). CONCLUSIONS: In older adults undergoing lumbar fusion, global multilevel paraspinal degeneration measured by conventional FI provides major incremental value for predicting prolonged LOS beyond clinical and geriatric factors, whereas posterior paraspinal radiomics offers an additional but more modest improvement. Leakage-free validation supports the robustness and clinical relevance of integrating automated muscle quantification with imaging-based risk stratification.
Cost-Effectiveness of ABM/P-15 Versus Allograft in Degenerative Spondylolisthesis Surgery : Ten-Year Follow-Up on a Randomized Controlled Trial.
Andresen AK, Carreon LY, Andersen MØ … +2 more , Nielsen L, Sørensen J
Spine (Phila Pa 1976) · 2026 May · PMID 41802428 · Full text
STUDY DESIGN: Randomized controlled trial. OBJECTIVE: The aim of this study was to investigate whether ABM/P-15 was cost-effective compared with allograft as a bone graft extender for uninstrumented posterolateral fusion...
STUDY DESIGN: Randomized controlled trial. OBJECTIVE: The aim of this study was to investigate whether ABM/P-15 was cost-effective compared with allograft as a bone graft extender for uninstrumented posterolateral fusion for degenerative spondylolisthesis with spinal stenosis in elderly patients. SUMMARY OF BACKGROUND DATA: In an increasingly elderly population with higher expectations of good health and quality of life, the need for durable surgery with minor risks of implant-related reoperations is growing. Specifically for lumbar fusion surgery, the need for a reliable bone graft material with acceptable fusion rates and low graft-related morbidity and risk of reoperation is important. METHODS: This cost-effectiveness analysis was based on a single-center, blinded, randomized controlled trial, where patients with symptomatic degenerative spondylolisthesis were randomly assigned 1:1 to either ABM/P-15 or Allograft as bone graft material in uninstrumented posterolateral fusion. Quality-adjusted life years (QALY) were obtained from EQ-5D-3L. Use of health services was obtained from patient charts, costed and accumulated up to 10 years after index surgery. RESULTS: The study included 101 patients with no inter-group differences in preoperative characteristics. On the basis of a bootstrapped analysis, the estimated the mean QALY gain for the ABM/P-15 group was 0.42 points (95% CI [-0.17; 1.08], P =0.185) greater compared with the Allograft group. Compared with the Allograft group, patients in the ABM/P-15 group had 20% less costs due to a significantly lower reoperation rate (18% vs. 43%, P =0.024), fewer visits to the outpatient clinic, magnetic resonance images, and fewer days of hospitalization. CONCLUSIONS: The choice of bone graft material significantly affected cost-effectiveness of posterolateral lumbar fusion in elderly patients with degenerative spondylolisthesis at 10-year follow-up. ABM/P-15 showed dominance over Allograft with improved outcomes, lower health care costs, and lower reoperation rate.
Assessment of Bone Mineral Density in Patients With Degenerative Spinal Disease by MRI-based Vertebral Bone Quality Score at Different Lumbar Vertebral Levels: An Observational Prospective Study.
Ai Y, Zhu C, Wang J … +10 more , Ding H, Zhang Q, Wang Y, Xiao Z, Shao X, Zhu L, Song Y, Feng G, Chen Q, Liu L
Spine (Phila Pa 1976) · 2026 Jun · PMID 41802418 · Publisher ↗
STUDY DESIGN: Prospective observational cohort study. OBJECTIVE: To prospectively evaluate the utility of traditional and single-level vertebral bone quality (VBQ) scores for preoperative bone mineral density (BMD) asses...
STUDY DESIGN: Prospective observational cohort study. OBJECTIVE: To prospectively evaluate the utility of traditional and single-level vertebral bone quality (VBQ) scores for preoperative bone mineral density (BMD) assessment in patients undergoing lumbar fusion surgery, and to validate their diagnostic performance against dual-energy x-ray absorptiometry (DEXA) and quantitative computed tomography (QCT). SUMMARY OF BACKGROUND DATA: Magnetic resonance imaging (MRI)-based VBQ score has been proposed to assess BMD, but prospective evidence comparing different vertebral levels is lacking. MATERIALS AND METHODS: Participants were classified into normal, osteopenia, and osteoporosis groups based on DEXA T -score and QCT-vBMD. Intergroup differences were analyzed, with post hoc corrections for multiple comparisons. Correlations between VBQ scores and BMD were evaluated, while receiver operating characteristic (ROC) analysis assessed their diagnostic performance. Linear and logistic regression models were further applied to examine the independent association between VBQ scores and osteoporosis. RESULTS: Among 198 patients (58.9±11.8 yr; 56.6% female), groups differed significantly in age and sex ( P <0.001). VBQ scores varied significantly across groups and were negatively correlated with both DEXA T -score and QCT-vBMD at most vertebral levels, with stronger correlations observed for QCT ( r =-0.412 to -0.563). ROC analysis confirmed that VBQ scores effectively differentiated normal, osteopenia, and osteoporosis. Multivariable regression identified higher L1-L4 VBQ scores as independent predictors of lower BMD (DEXA: β=-0.412; QCT: β=-0.469) and increased osteoporosis risk (DEXA: OR=3.201, 95% CI=1.056-9.704; QCT: OR=2.741, 95% CI=1.061-7.080). CONCLUSION: This prospective study demonstrated that the L1-L4 VBQ score exhibited superior stability and generalizability compared with single-level measurements, supporting its potential use as a practical surrogate marker for opportunistic BMD screening in patients undergoing spinal surgery. Specific single-level scores, such as those at L1, L2, and S1, may still provide supplementary diagnostic value in detecting early bone quality alterations. LEVEL OF EVIDENCE: Level 2.
Influence of predominant back versus leg pain on clinical outcomes in unilateral biportal endoscopic lumbar decompression.
Salazar LM, Ward SO, Patel SN … +1 more , Singh K
J Neurosurg Spine · 2026 Mar · PMID 41791117 · Publisher ↗
OBJECTIVE: Limited research has explored the impact of predominant back pain (pBP) versus predominant leg pain (pLP) in patients undergoing unilateral biportal endoscopic lumbar decompression (UBE-LD). This study aimed t...
OBJECTIVE: Limited research has explored the impact of predominant back pain (pBP) versus predominant leg pain (pLP) in patients undergoing unilateral biportal endoscopic lumbar decompression (UBE-LD). This study aimed to evaluate and compare the perioperative and postoperative clinical outcomes, using patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID), between patients with pBP and pLP who underwent UBE-LD. METHODS: Patients who underwent primary UBE-LD were divided into either the pBP or pLP cohort. Exclusion criteria included patients with a diagnosis of degenerative scoliosis, trauma, malignancy, or infection. Demographic, perioperative characteristics, PROMs, and MCID were compared between cohorts using inferential statistics. PROMs were collected at preoperative and postoperative 6-week, 12-week, and 6-month time points. Assessed PROMs included the Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), Veterans Rand 12-Item Health Survey (VR-12) physical component score (PCS), VR-12 mental component score (MCS), visual analog scale (VAS) for back pain, VAS for leg pain, and Oswestry Disability Index (ODI). MCID attainment was determined by comparing the change in PROMs to established thresholds in the literature. RESULTS: A total of 98 patients were included in the study, with 52 in the pBP cohort and 46 in pLP cohort. After analysis, there were no significant differences in baseline demographic or perioperative characteristics between the two groups. The majority of patients had a diagnosis of herniated nucleus pulposus (81.6%), central stenosis (93.9%), and foraminal stenosis (77.6%). At 6 months, both cohorts experienced significant postoperative improvements in PROMIS-PF, VAS back pain, VAS leg pain, VR-12 PCS, and ODI scores (all p ≤ 0.011). VR-12 MCS scores did not demonstrate sustained postoperative improvement in either cohort. High rates of MCID achievement were observed across both cohorts for multiple PROMs, with no statistically significant differences in MCID attainment between patients with pBP and pLP at any postoperative time point. CONCLUSIONS: Regardless of the preoperative predominant pain location, patients undergoing UBE-LD reported significant improvements in physical function, back and leg pain, and disability. Patients in both cohorts demonstrated improvements in mental health outcomes, with comparable MCID achievement rates for VR-12 MCS. These findings suggest that UBE-LD might be effective for patients with both predominant back and leg pain presentations, although differences in specific outcome domains should be interpreted with caution due to potential selection bias. Consideration of predominant pain location might help inform preoperative patient counseling regarding expected outcomes following UBE-LD.
Rates of nonoperative management and secondary overtriage in patients with spine fracture transferred to level I or II trauma centers.
Ye VC, Shakil H, Malhotra AK … +4 more , Essa A, Yuan EY, He Y, Witiw CD
J Neurosurg Spine · 2026 Mar · PMID 41791108 · Publisher ↗
OBJECTIVE: Traumatic spine fractures are common in trauma patients, and with an aging population, the incidence of spine fractures will continue to increase. However, wide variability in injury severity can lead to unnec...
OBJECTIVE: Traumatic spine fractures are common in trauma patients, and with an aging population, the incidence of spine fractures will continue to increase. However, wide variability in injury severity can lead to unnecessary transfers to higher-level trauma centers (TCs), potentially resulting in the overuse of healthcare resources. The primary objective of this study was to assess the rate of nonoperative management and the extent of secondary overtriage (SOT) among patients with traumatic spine fractures. The secondary objective was to identify patient and hospital factors associated with SOT. METHODS: This retrospective observational cohort study used data from between 2017 and 2020 from the American College of Surgeons Trauma Quality Improvement Program database. The study included adult patients with traumatic spine fractures who had been transferred to level I (LI) or level II (LII) TCs. Patients with multisystem polytrauma and spinal cord injuries were excluded. The primary outcome was the rate of SOT among the patients, and secondary outcomes included factors associated with SOT, which were identified using mixed-effects logistic regression. RESULTS: A total of 29,591 patients from 629 centers were analyzed. Most of the patients were managed nonoperatively (n = 24,007, 81.1%), with a high rate of SOT (18.2%). Patients with spine fractures who were less likely to experience SOT included those with lumbar spine fractures (OR 0.75, 95% CI 0.69-0.82, p < 0.001) and an age over 60 years (OR 0.42, 95% CI 0.39-0.46, p < 0.001). There was significant variability in center-dependent rates of early discharge and interfacility transfer, but this variance appeared to be unaffected by patient volume. CONCLUSIONS: The current pattern of care for patients with traumatic spine fracture includes high proportions of nonoperatively managed patients and those who undergo SOT. Optimizing triage protocols, particularly for older patients and those with lumbar spine fractures, may reduce unnecessary transfers and improve healthcare resource utilization.
Smoking Increases the Risk of Reoperation After Anterior Cervical Disc Replacement.
Shah ID, Sadh P, Sheth S … +4 more , Suleman Y, Greenberg M, Foster T, Basques BA
Spine (Phila Pa 1976) · 2026 Feb · PMID 41775247 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Evaluate the effect of smoking on complication rates, radiographic parameters, and patient-reported outcomes (PROs) after anterior cervical disc replacement (ACDR). SU...
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Evaluate the effect of smoking on complication rates, radiographic parameters, and patient-reported outcomes (PROs) after anterior cervical disc replacement (ACDR). SUMMARY OF BACKGROUND DATA: ACDR is a motion-preserving procedure used to treat cervical radiculopathy and myelopathy. Although tobacco use is known to adversely affect outcomes after fusion-based procedures, its impact on ACDR remains underexplored. METHODS: Patients who underwent ACDR for myelopathy or radiculopathy between 2017 and 2025 at a single institution were identified and categorized as smokers or non-smokers. Outcomes included complication rates, global and segmental radiographic parameters (i.e. Cobb angle, range of motion [ROM]), and PROs (neck and arm Visual Analog Score, Neck Disability Index). Univariate analyses used chi-square and t-tests, and Firth logistic regression was applied for multivariate analysis of binary variables. RESULTS: A total of 102 patients were included (19 smokers, 83 non-smokers). Baseline characteristics, including age, sex, BMI, and comorbidities, were similar between groups. Postoperatively, smokers demonstrated a significantly higher rate of reoperation than non-smokers (15.8% vs. 1.2%; P=0.003), all due to loosening or migration of the arthroplasty device. No significant differences were found in radiographic alignment or PROs, though smokers exhibited greater segmental ROM (9.5° vs. 6.8°; P=0.04). CONCLUSIONS: While ACDR appears to preserve functional outcomes in smokers, tobacco use is associated with an increased risk of reoperation, likely resulting from reduced implant stability. Surgeons should monitor smokers closely postoperatively and consider enhanced follow-up for this at-risk population.
Anatomical Study and Clinical Significance of Cervical Sinuvertebral Nerves.
Lin R, Liu Y, Fang D … +8 more , Peng J, Zhang B, Li Y, Chen K, Xu S, Chen J, Li Q, Zhao Q
Spine (Phila Pa 1976) · 2026 Feb · PMID 41775080 · Publisher ↗
STUDY DESIGN: This was a microanatomical study of human cadaveric specimens. OBJECTIVE: This study aimed to elaborate on the anatomical characteristics of the cervical sinuvertebral nerve (CSVN) and to discuss their poss...
STUDY DESIGN: This was a microanatomical study of human cadaveric specimens. OBJECTIVE: This study aimed to elaborate on the anatomical characteristics of the cervical sinuvertebral nerve (CSVN) and to discuss their possible clinical significance. SUMMARY OF BACKGROUND DATA: Cervical spondylosis (CS) is frequently associated with atypical symptoms, such as vertigo and headache, which are considered to be mediated primarily by the CSVN. While the lumbar sinuvertebral nerve has been extensively studied with respect to discogenic low back pain, the origin and distribution patterns of the CSVN remain unclear, particularly concerning their relationship with these atypical symptoms. METHODS: A microsurgical anatomical investigation was conducted on 10 human cadaveric specimens (120 intervertebral foramina). At each segmental level from C2-C3 to C7-T1, the number, origin, course, and distribution of the CSVN were observed and recorded. To ensure accuracy, all measurements were independently recorded by three observers. RESULTS: A total of 656 CSVNs were identified and classified into main trunks (n=215) and deputy branches (n=441). They originated from the spinal nerve root, from the vertebral nerve, and from dual sources. The main trunks traveled medially into the spinal canal to innervate the posterior longitudinal ligament and intervertebral disc. The deputy branches were primarily distributed within the intervertebral foramina and along the surface of the vertebral artery. The CSVN's distribution on the vertebral artery was mainly concentrated on its second segment and was observed from the C2-C3 to the C5-C6 intervertebral foramina; no CSVNs were found on the vertebral artery surface from the C6-C7 to the C7-T1 intervertebral foramina. CONCLUSIONS: The anatomical characteristics of the CSVN may enhance clinicians' understanding of the pathogenesis of atypical symptoms in patients with cervical spondylosis, potentially contributing to improved therapeutic outcomes.
Robotic-Assisted Muscle-Preserving (RAMP) Decompression in the Thoracic and Lumbar Spine: A Cadaveric Validation.
Loggia G, Avrumova F, Burkhard MD … +6 more , Kelly MJ, Altorfer FCS, Zhu J, Chazen JL, Tan ET, Lebl DR
Spine (Phila Pa 1976) · 2026 Feb · PMID 41775072 · Publisher ↗
STUDY DESIGN: Cadaver validation study. OBJECTIVE: To evaluate the accuracy and feasibility of a novel robotic-assisted muscle-preserving (RAMP) decompression technique in human cadavers. SUMMARY OF BACKGROUND DATA: Robo...
STUDY DESIGN: Cadaver validation study. OBJECTIVE: To evaluate the accuracy and feasibility of a novel robotic-assisted muscle-preserving (RAMP) decompression technique in human cadavers. SUMMARY OF BACKGROUND DATA: Robotic-assisted (RA) platforms have shown their capability to advance the precision of spinal instrumentation, yet their integration into decompression procedures remains limited. Conventional decompression techniques often disrupt paraspinal musculature and stabilizing structures, underscoring the need for a controlled, tissue-sparing approach. METHODS: Eight human cadavers underwent RAMP decompressions via a muscle-sparing approach, performing unilateral laminotomy with contralateral "over-the-top" decompression at ten levels (T8-L5) each, using a robotic bone removal instrument. Computed tomography (CT) was used for preoperative planning and radiographic evaluation of deviations at the posterior laminar bone removal site and the remaining anterior laminar cortex. Anterior cortical bone removal (ACBR) were classified as substantial if >3 mm ipsilaterally or >7.5 mm contralaterally. RESULTS: A total of 80 levels underwent RAMP decompressions (40 thoracic, 40 lumbar). The median deviation from preplanned trajectories to postintervention CT was 0.7 mm (IQR 0.4-1.1 mm) at the posterior laminar bone removal site and 0.3 mm (IQR 0.1-0.6 mm) at the anterior laminar cortex bilaterally. ACBR occurred in 41.3% (33/80), with only one being unplanned and substantial (1.3%). Ipsilateral ACBR accounted for 4 (12.1%), with a median distance of 2.3 mm (IQR 2.1-3.4 mm). Contralateral ACBR were more frequent (29, 87.9%) with a median distance of 4.3 mm (IQR 2.7-5.8 mm). CONCLUSION: This study represents the first cadaveric validation of the novel RAMP decompression, demonstrating the feasibility and precision of this robotic technique for controlled laminar bone removal. This muscle-sparing approach may reduce morbidity while preserving long-term spinal stability, thereby supporting the expansion of robotic platforms into decompression procedures.
Revision Lumbar Fusion Patients Exhibit Higher Long-Term Opioid and Gabapentinoid Needs Despite Similar Early Postoperative Use.
Olson J, Green WA, Dalton J … +20 more , Ng M, Baidya J, Huang R, Oris RJ, Herczeg C, Sherman M, Eichbaum Y, Baek G, Mathew J, Lee Y, Hitchner M, Duggan S, DeMario N, Goldberg M, Kaffenes A, Cha T, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD
Spine (Phila Pa 1976) · 2026 Mar · PMID 41774932 · Publisher ↗
STUDY DESIGN: Retrospective Cohort. OBJECTIVE: This study aimed to: (1) compare opioid use between primary and revision fusion patients; (2) evaluate differences in non-opioid analgesic use; and (3) identify risk factors...
STUDY DESIGN: Retrospective Cohort. OBJECTIVE: This study aimed to: (1) compare opioid use between primary and revision fusion patients; (2) evaluate differences in non-opioid analgesic use; and (3) identify risk factors of long-term opioid consumption. SUMMARY OF BACKGROUND DATA: Preoperative opioid exposure and revision surgery are recognized risk factors for prolonged postoperative opioid use after lumbar fusion, yet long-term data remain limited. METHODS: Patients who underwent elective 1-3 level lumbar spine fusion between were retrospectively identified and chart reviewed (2018-2023). Opioid and non-opioid prescription data was extracted from the state prescription drug monitoring program (PDMP) at 30 days, 90 days, 1 year, and 2 years. Patients were stratified into primary versus revision fusion cohorts and compared using bivariate and multivariable analyses. RESULTS: A total of 1,938 patients were analyzed (1,498 primary, 440 revision). Revision patients had greater preoperative opioid morphine milligram equivalent (MME) burden (953 vs. 334, P<0.001). Postoperatively, opioid use rates were similar through 30 days, but revision patients demonstrated higher MME use at 90 days (428 vs. 219, P<0.001), 1 year (1,142 vs. 382, P<0.001), and 2 years (1,550 vs. 497, P<0.001). Gabapentinoid use was also higher in revision patients beginning at 90 days (19.3% vs. 13.4%, P=0.003). Multivariable regression confirmed preoperative MME as the strongest risk factor of long-term opioid burden. Revision status was independently associated with higher MME use at 1 year (β=348.3, P=0.011) and 2 years (β=964.4, P<0.001), but not at 90 days. CONCLUSIONS: Revision lumbar fusion patients demonstrate a greater pre- and postoperative opioid burden, and a greater postoperative gabapentinoid burden. Multivariable analysis confirms revision status as an independent risk factor of greater long-term MME use, beginning at 1 year. Together these findings suggest a complex, possibly neuropathic pain phenotype in revision patients, underscoring the need for tailored perioperative counseling and consistent long-term, multidisciplinary pain management.
Incidence and risk factors of adjacent segment degeneration in lumbosacral or lumbo-iliac fusion with L2 as the uppermost instrumented vertebra.
Yen CP, Park BJ, Ben-Israel D … +3 more , Kumar R, Moon HJ, Smith JS
J Neurosurg Spine · 2026 Feb · PMID 41759093 · Publisher ↗
OBJECTIVE: Lumbosacral or lumbo-iliac fusion may be warranted in patients with symptomatic diffuse lumbar spondylosis or mild to moderate lumbar spinal deformity. Depending on the extent of pathology, the L2 vertebra may...
OBJECTIVE: Lumbosacral or lumbo-iliac fusion may be warranted in patients with symptomatic diffuse lumbar spondylosis or mild to moderate lumbar spinal deformity. Depending on the extent of pathology, the L2 vertebra may be chosen as the uppermost instrumented vertebra (UIV) to avoid fusion crossing the thoracolumbar junction. However, the incidence of adjacent segment degeneration (ASD) following L2 to sacrum or ilium fusion has not been well studied. The authors aimed to determine the incidence of ASD following instrumented fusion in adult patients undergoing L2 to sacrum or ilium fusion and to identify the risk factors for this complication. METHODS: The medical records of adult patients who underwent decompression and lumbosacral or lumbo-iliac instrumented fusion for diffuse lumbar spondylosis, degenerative scoliosis, or sagittal malalignment with L2 as the UIV between January 2016 and December 2023 were retrospectively reviewed. ASD is defined as the progression of disc degeneration, worsening of spinal stenosis, junctional kyphosis, UIV or UIV+1 compression fracture, and screw pullout or loosening that caused pain or neurological deficits. The incidence of ASD was analyzed. Kaplan-Meier analysis was used to evaluate symptomatic ASD-free survival. Univariate and multivariate logistic regression were used to assess potential risk factors, including patient-related factors, surgery-related factors, and pre- and postoperative spinopelvic parameters. RESULTS: Eighty-nine patients (57 males, 32 females; mean age 68.5 years) were included. The mean duration of follow-up was 38.6 months. Thirty-six (40%) patients developed symptomatic ASD, and 21 (23.6%) required reoperation. Simultaneous decompression at L2-3, preexisting L1-2 disc degeneration, greater postoperative pelvic incidence-lumbar lordosis (PI-LL) mismatch, and higher lordosis distribution index were risk factors for the development of ASD. Twelve (13.5%) patients developed distal failure, including 9 pseudarthroses at L5-S1, 2 sacral fractures, and 1 rod fracture between S1 and the iliac screw. Male sex, young age, and lack of iliac screws were risk factors for distal failure. CONCLUSIONS: These findings suggest that the overall incidence of ASD is high in adult patients with lumbar degeneration or spinal deformity who undergo instrumented fusion from L2 to the sacrum or ilium. Significant risk factors for developing ASD include simultaneous decompression at L2-3, preexisting advanced disc degeneration at L1-2, greater postoperative PI-LL mismatch, and higher lordosis distribution index.
Editorial. L2 as the uppermost instrumented vertebra in lumbopelvic fusion: preserving mobility at the cost of adjacent segment degeneration?
Buckley N, Dsouza AC, Tan LA
J Neurosurg Spine · 2026 Feb · PMID 41759089 · Publisher ↗
Abstract loading — click title to view on PubMed.
Disruptive technologies in spine surgery: current trends, outcomes, and ethical implications.
Bartlett AM, Robertson FC, Shaker E … +8 more , Than KD, Godzik J, Hofstetter CP, Pollina J, Shin JH, Urakov T, Fessler RG, Abd-El-Barr MM
J Neurosurg Spine · 2026 Feb · PMID 41759085 · Publisher ↗
Disruptive technologies are reshaping the landscape of spine surgery by enhancing precision, improving patient outcomes, and transforming surgical training and planning. This review explores the integration of augmented...
Disruptive technologies are reshaping the landscape of spine surgery by enhancing precision, improving patient outcomes, and transforming surgical training and planning. This review explores the integration of augmented reality (AR), virtual reality (VR), patient-specific implants, endoscopic techniques, advanced navigation, and robotics in spine surgery. Preoperative applications include immersive VR-based resident training and AR-assisted surgical planning, which have demonstrated improved accuracy and confidence in trainees. Patient-specific surgeries leverage advanced segmentation and 3D printing to tailor implants and procedures to individual anatomy. Intraoperative technologies such as endoscopic and robot-assisted spine surgery offer minimally invasive alternatives with favorable recovery profiles, while neuronavigation improves workflow and reduces radiation exposure. Despite their potential, these innovations face challenges related to high costs, limited accessibility, and the need for rigorous validation. This narrative review highlights current trends, clinical outcomes, and ethical considerations in the adoption of these technologies, emphasizing the importance of equitable implementation and standardization of outcomes and training across diverse healthcare settings.
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