Spine[JOURNAL]
Sun
200 papers
Antipsychotic Medications are Associated with Higher Rates of Healthcare Utilization, Complications, Opioid Prescriptions, and Subsequent Cervical Surgery after Anterior Cervical Discectomy and Fusion.
Hirpara A, Ding I, Abid R … +5 more , Jayakumar P, Warren J, Cheng CW, Furey CG, Rajan PV
Spine (Phila Pa 1976) · 2026 Jun · PMID 42348795 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate the impact of pre-operative antipsychotic medication (APM) exposure on healthcare utilization, complications, opioid prescriptions, and subsequent cervical...
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate the impact of pre-operative antipsychotic medication (APM) exposure on healthcare utilization, complications, opioid prescriptions, and subsequent cervical surgery following anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: While psychiatric disorders have been linked to poorer outcomes after ACDF, the impact of psychotropics, like APMs, remains unclear. This is important considering 40.4% of patients with mental disorders receive pharmacologic treatments, many of which are also used for off-label purposes. Moreover, APMs have antagonistic effects on histamine, muscarinic, dopamine, and alpha-adrenergic receptors, leading to systemic physiologic changes that may affect peri-operative recovery and outcomes. METHODS: The TriNetX database was queried to identify patients over 18 years old who underwent primary ACDF. Patients were stratified into two cohorts based on APM prescription within six months prior to surgery. Cohorts underwent propensity score matching in a 1:1 ratio based on 45 covariates. The following outcomes were collected: 1) medical complications and healthcare utilization within three months, 2) opioid prescriptions within two years, and 3) surgical complications and subsequent surgery within two years. RESULTS: Within three months, APM exposure was associated with higher rates of readmission (P<0.001) and emergency department visits (P<0.001). APM exposure was also associated with higher rates of medical complications, including venous thromboembolism (P<0.001) and dysphagia (P<0.001). Patients in the APM group received a greater number of opioid prescriptions at all time points within two years, accumulating nearly 45% more prescriptions than controls by two-year follow-up (9.9 vs. 6.9 mean prescriptions, P<0.001). Lastly, APM exposure was associated with higher rates of subsequent cervical fusion (P=0.006) and subsequent cervical surgery (P=0.010) at two-year follow-up. CONCLUSION: APM exposure is associated with greater healthcare utilization, medical morbidity, opioid prescriptions, and subsequent cervical surgery after ACDF. These risks may be mitigated through opioid stewardship, multi-disciplinary collaboration, and targeted patient counseling. LEVEL OF EVIDENCE: IV.
Long-Term Mechanical Complications After Lumbar Fusion in Patients Receiving Tirzepatide vs Other GLP-1 Receptor Agonists.
Wang R, Islam H, Karikaran A … +5 more , Zeng W, Hong AT, Cho H, Khalid SI, Mehta AI
Spine (Phila Pa 1976) · 2026 Jun · PMID 42348793 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare short-term outcomes and long-term mechanical complications following lumbar fusion in patients receiving tirzepatide versus non-tirzepatide glucagon-like pe...
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare short-term outcomes and long-term mechanical complications following lumbar fusion in patients receiving tirzepatide versus non-tirzepatide glucagon-like peptide-1 receptor agonists (GLP-1 RAs). SUMMARY OF BACKGROUND DATA: GLP-1 RAs have demonstrated metabolic and anti-inflammatory effects that may influence postoperative recovery. Tirzepatide, a dual GLP-1/ glucose-dependent insulinotropic polypeptide (GIP), has shown greater metabolic efficacy than traditional GLP-1 RAs, though its impact on spinal fusion outcomes remains unclear. METHODS: A retrospective cohort analysis was performed using the TriNetX Global Collaborative Network for adult patients undergoing lumbar fusion. Exposure was defined by tirzepatide or non tirzepatide GLP-1 RAs prescription within one year before surgery. Propensity score matching (1:1) was conducted using demographic and clinical covariates. Ninety-day complications and mechanical outcomes from 1-3 years were evaluated using risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS: After matching, ninety-day medical complications, hospitalizations and emergency department visits were similar between groups (P>0.05). At one year, pseudoarthrosis (3.0% vs 3.8%), instrumentation failure (1.4% vs 1.7%), and revision surgery (1.3% vs 1.3%) were comparable between groups (P>0.05). By two years, tirzepatide was associated with significantly lower pseudoarthrosis (3.1% vs 5.5%, RR 0.56, 95% CI 0.35-0.90, P=0.016) and instrumentation failure (1.5% vs 3.5%, RR 0.42, 95% CI 0.22-0.80, P=0.006), with similar revision rates. At three years, pseudoarthrosis (3.1% vs 6.0%, RR 0.51, 95% CI 0.32-0.82, P=0.005) and instrumentation failure (1.6% vs 3.7%, RR 0.43, 95% CI 0.23-0.79, P=0.005) remained significantly lower, while revision surgery remained nonsignificant. CONCLUSION: Tirzepatide was associated with comparable short-term safety and lower rates of long-term mechanical complications after lumbar fusion. These findings suggest differences in mechanical outcomes that emerge over extended follow-up and warrant prospective comparative evaluation.
Outside-in foraminal access for cervical dumbbell tumors: a surgical paradigm shift with technical insights and clinical outcomes.
Yan H, Liu Y, Lin H … +8 more , Wang L, Han B, Yu L, Wu X, Chai R, Qiao H, Jia W, Wang Y
J Neurosurg Spine · 2026 Jun · PMID 42320063 · Publisher ↗
OBJECTIVE: Cervical dumbbell tumors present surgical challenges due to their proximity to critical structures, including the facet joints and vertebral artery (VA). Conventional posterior approaches often require facet j...
OBJECTIVE: Cervical dumbbell tumors present surgical challenges due to their proximity to critical structures, including the facet joints and vertebral artery (VA). Conventional posterior approaches often require facet joint resection and fusion, risking spinal instability. This study summarizes the authors' experience with a lateral foraminal approach that preserves facet integrity through a minimally invasive corridor. METHODS: The lateral foraminal approach begins with an incision along the lateral border of the sternocleidomastoid, proceeding obliquely "outside-in" through the interscalene space between the scalene muscles. Depending on the specific spinal level and corresponding orientation of the intervertebral foramen, this surgical concept incorporates both the anterolateral approach (C2-3 to C7-T1) and the posterolateral approach (C1-2 and occasionally C2-3). RESULTS: The study comprised 30 males and 25 females with a median (range) age of 45 (11-69) years. The tumors were located from C1-2 to C7-T1 intervertebral foramina. Gross-total resection with preserved facet joint integrity was achieved in all cases, with visualization safeguarding brachial plexus and VA integrity during resection. Surgery resulted in significant improvements in neurological function and pain, with mean Japanese Orthopaedic Association (JOA) scores increasing from 13.3 to 15.1 (p < 0.001) and mean visual analog scale (VAS) scores decreasing from 4.3 to 2.4 (p < 0.001). CONCLUSIONS: The lateral foraminal approach is a minimally invasive technique for resecting cervical dumbbell tumors via an anatomical corridor. It preserves the facet joint entirely, eliminating the need for internal fixation or fusion. Under direct visualization, the brachial plexus and VA are microsurgically protected throughout dissection.
Risk factors for unplanned reoperation after the treatment of early-onset scoliosis with traditional dual growing rods combined with apical control techniques.
Li C, Han B, Li B … +8 more , Yang Y, Lin G, Du Y, Zhao Y, Zhang H, Ye X, Zhang J, Wang S
J Neurosurg Spine · 2026 Jun · PMID 42320062 · Publisher ↗
OBJECTIVE: This study aimed to identify the incidence of and potential risk factors for unplanned reoperations following traditional dual growing rods (TDGRs) combined with apical control techniques (ACTs; TDGRs+ACTs). M...
OBJECTIVE: This study aimed to identify the incidence of and potential risk factors for unplanned reoperations following traditional dual growing rods (TDGRs) combined with apical control techniques (ACTs; TDGRs+ACTs). METHODS: A retrospective study of patients with early-onset scoliosis treated with TDGRs+ACTs from June 2006 to November 2022 was conducted. The patients were grouped based on the occurrence of unplanned reoperations. Demographic characteristics, surgery-related data, radiographic parameters, complications, unplanned reoperations, and clinical outcomes were collected. Univariate and multivariate analyses were conducted to identify potential risk factors for unplanned reoperation following TDGR+ACT treatment. Receiver operating characteristic (ROC) curve analysis was used to identify the cutoff values. RESULTS: A total of 60 patients were enrolled. The mean age at initial surgery was 7.2 years, with a mean follow-up duration of 6.5 years. Eleven patients (18.3%) underwent 14 unplanned reoperations by the final follow-up. Logistic regression analysis revealed that the 1-year progression rate of global kyphosis (GK; OR 1.211, p = 0.018) was a significant independent risk factor for unplanned reoperation. ROC analysis revealed that the 1-year progression rate of GK had good discriminatory ability (area under the curve 0.855, 95% CI 0.743-0.966), and the cutoff value was 12.5°/year. At the last follow-up, the mean emotion score in the reoperation group was significantly lower than that in the nonreoperation group (63.18 ± 20.16 vs 76.54 ± 18.90, p = 0.042). CONCLUSIONS: The unplanned reoperation rate of TDGR+ACT treatment was 18.3%. The 1-year progression rate of GK was an independent risk factor for unplanned reoperation after TDGR+ACT, with the incidence of unplanned reoperation significantly increasing when the 1-year progression rate exceeded 12.5°/year. Unplanned reoperations not only affect the physical health of patients but also impose a heavy burden on their mental health.
Can patient-specific precontoured rod instrumentation reduce the rate of proximal junctional kyphosis for adult spinal deformity? A propensity score-matched analysis.
Fields MW, Lombardi JM, Lee NJ … +8 more , Greisberg G, Reyes JL, Herbert MM, Malka MS, Morrissette C, Sardar ZM, Lenke LG, Lehman RA
J Neurosurg Spine · 2026 Jun · PMID 42320061 · Publisher ↗
OBJECTIVE: The objective of this study was to determine whether patient-specific precontoured rod (PCR) instrumentation is associated with lower rates of proximal junctional kyphosis (PJK) compared with manually contoure...
OBJECTIVE: The objective of this study was to determine whether patient-specific precontoured rod (PCR) instrumentation is associated with lower rates of proximal junctional kyphosis (PJK) compared with manually contoured conventional rods (CRs) in adult spinal deformity (ASD) surgery. METHODS: The data of ASD patients (age ≥ 18 years) undergoing posterior spinal instrumentation and fusion of a minimum of 5 levels were consecutively reviewed from 2016 to 2021. A propensity score-matching algorithm was used to match patients undergoing instrumentation with PCRs (n = 80) to those treated with CRs (n = 210). The primary outcome was the rate of radiographic PJK at a minimum follow-up of 1 year. PJK was defined by two criteria: a postoperative proximal junctional sagittal angle (PJA) 1) ≥ 10° and 2) at least 10° greater than the preoperative measurement. RESULTS: Following propensity score matching, 160 patients were included in the study (80 per group). Patients demonstrated similar preoperative baseline characteristics and preoperative radiographic alignment. Preoperatively, the mean PJAs measured 9.24° ± 6.8° and 8.8° ± 7.3° for the PCR and CR groups, respectively (p = 0.751). At the most recent follow-up, the PCR and CR groups demonstrated mean PJAs of 11.6° ± 9.1° and 10.8° ± 8.3°, respectively (p = 0.545). Ten (12.5%) patients experienced PJK in the PCR group compared to 16 (20%) patients in the CR group (p = 0.199). In patients with upper instrumented vertebrae in the lower thoracic region, 5 (11.1%) patients in the PCR group experienced PJK versus 12 (26.7%) patients in the CR group (p = 0.059). Furthermore, 7 (10.9%) patients in the PCR group experienced PJK compared to 14 (21.5%) patients in the CR group after including patients with fusion to the sacrum/pelvis (p = 0.103). CONCLUSIONS: Lower rates of PJK were observed in the PCR group when compared to the CR cohort. However, this relationship was not statistically significant. Future studies with longer-term follow-up and larger sample sizes are warranted to investigate the relationship between PCR instrumentation and PJK prophylaxis. While PCR technology alone is likely not a definitive solution for preventing PJK, its strength lies in enabling rigorous preoperative planning and thoughtful deformity correction strategies. When integrated into a comprehensive approach to patient optimization, alignment, and junctional control, PCRs may serve as a useful adjunct in mitigating PJK risk.
Physical activity and patient-reported outcomes after decompressive endoscopic lumbar spine surgery.
Noroozi Gilandehi S, Shoubash L, Leyendecker J … +6 more , Konakondla S, Kashlan O, Derman P, Telfeian AE, Hofstetter CP, Mahan MA
J Neurosurg Spine · 2026 Jun · PMID 42320056 · Publisher ↗
OBJECTIVE: Although patients often report improvements in pain and functional capacity after endoscopic lumbar spine surgery, objectively measured real-life physical activity may differ from that reported. This multicent...
OBJECTIVE: Although patients often report improvements in pain and functional capacity after endoscopic lumbar spine surgery, objectively measured real-life physical activity may differ from that reported. This multicenter prospective study aimed to assess the correlations between physical activity and patient-reported outcomes (PROs). METHODS: All adult patients undergoing endoscopic lumbar spine surgery were offered enrollment in the SPINEhealthie smartphone app to assess physical activity. Estimated daily step counts (SCs) and serial PROs, including visual analog scale (VAS) leg pain, VAS back pain, and Oswestry Disability Index (ODI) scores, were collected. RESULTS: Of the 289 patients with pre- and postoperative SC data (mean follow-up 11.4 months), > 70% of patients achieved minimal clinically important difference (MCID) for VAS back and leg pain at 2 weeks and remained stable at 1 year (p < 0.05). Although patients demonstrated substantial improvement in VAS leg (-3.4, p < 0.001) and VAS back (-3.1, p < 0.001) pain scores at 2 weeks, the mean SC decreased significantly at 2 weeks (-632.4, p < 0.001). SC began to increase at 3 months (+265.7, p = 0.004). VAS scores demonstrated minimal further improvement beyond 2 weeks, but SCs continued to improve at all subsequent time points (p < 0.001), as did ODI (-12.2 at 3 months and -13.6 at 1 year, p < 0.001 for both). Preoperative SC was highly predictive of 1-year SC (r = 0.86, p < 0.001) and mildly predictive of ODI at 1 year (r = -0.31, p = 0.006). No preoperative PRO was correlated with PROs or SC at 1 year (r ≤ 0.10, p > 0.2 for all). Quartile analysis of SC revealed that pain scores did not correlate with functional measures. The patient quartiles' recovery patterns remained distinct (p < 0.05 between quartiles at 1 year). ODI improvement was greater in patients with higher baseline SCs (-15.6 vs -13.8 in the lowest quartile at 1 year, p = 0.047). Stratification of patients by baseline scores did not distinguish improvement in SC, or ODI, VAS leg pain, or VAS back pain (p > 0.05 for all) scores, indicative that baseline scores did not predict outcomes. CONCLUSIONS: Patients demonstrated immediate reduction in pain but delayed improvement in SC and ODI score. Among preoperative assessments, only SCs were predictive of postoperative outcomes. Furthermore, pain scores did not correlate with disability or activity. SC demonstrated interquartile stability, suggesting that SC may provide a reliable and independent perspective and may be predictive of outcomes.
Extended Postoperative Risk of Venous Thromboembolism After Degenerative Spine Surgery: A Nationwide Cohort Study.
Kim J, Kim TH
Spine (Phila Pa 1976) · 2026 Jun · PMID 42308362 · Publisher ↗
STUDY DESIGN: Retrospective population-based nationwide cohort study. OBJECTIVE: To determine the incidence, risk factors, and optimal surveillance interval of postoperative VTE after degenerative spine surgery. SUMMARY...
STUDY DESIGN: Retrospective population-based nationwide cohort study. OBJECTIVE: To determine the incidence, risk factors, and optimal surveillance interval of postoperative VTE after degenerative spine surgery. SUMMARY OF BACKGROUND DATA: VTE, including pulmonary embolism (PE), is a leading cause of postoperative morbidity and mortality after spine surgery. Recent evidence suggests that VTE risk may already be elevated before surgery, yet the temporal distribution of postoperative VTE risk and the appropriate duration of surveillance remain poorly defined. METHODS: A total of 200,792 adults who underwent degenerative spine surgery in Korea between 2014 and 2018 were identified from the Korean Health Insurance Review and Assessment Service database. Overall VTE, PE, and VTE-related invasive procedures were estimated as incidence rates per 10,000 person-years over a mandatory one-year follow-up. Multivariable logistic regression with bootstrap validation was used to identify risk factors. Sequential trends were assessed across twelve 30-day intervals, with subgroup analyses stratified by age, spinal region, and comorbidities. RESULTS: Postoperative VTE occurred in 1,282 patients (0.64%), PE in 321 (0.16%), and invasive procedures in 213 (0.11%), with annual incidence rates of 64, 16, and 11 per 10,000 person-years, respectively. Independent risk factors included older age, congestive heart failure, cerebrovascular and peripheral vascular disease, renal disease, end-stage renal disease, concurrent knee arthritis, and thoracic or lumbar surgery. Sequential analysis showed that 61% of all VTE events occurred within the first four postoperative months, peaking in month 2. Subgroup analyses demonstrated delayed return to baseline and additional late-phase peaks among older adults, patients with thoracic pathology, and those with renal comorbidities. CONCLUSION: Postoperative VTE risk remains elevated for up to four months following degenerative spine surgery, with high-risk subgroups demonstrating additional late-onset events. These epidemiologic findings underscore the importance of maintaining thromboembolic vigilance beyond the conventional early perioperative window, though prospective studies will be necessary to translate these observations into actionable clinical guidelines. LEVEL OF EVIDENCE: III.
The Role of L4-L5 Facet Joint and Disc-Related Anatomy in Lumbar Spondylolisthesis: An Imaging Study.
Cherel M, Bansal A, Fujii T … +11 more , Nguyen K, Yamanouchi K, Sedwick J, Reynolds L, Jeffko M, Kumar R, Lipson P, Garcia De Oliveira R, Nemani VM, Leveque JC, Louie PK
Spine (Phila Pa 1976) · 2026 Jun · PMID 42308353 · Publisher ↗
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To compare morphologic anatomic features of individual with L4-L5 degenerative pathology with and without listhesis to identify predictive factors of instability. SUMMARY OF...
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To compare morphologic anatomic features of individual with L4-L5 degenerative pathology with and without listhesis to identify predictive factors of instability. SUMMARY OF BACKGROUND DATA: Aging-related degenerative changes in the lumbar spine can lead to instability in the form of a listhesis. Previous studies have identified elements of lumbar facet joint morphology that may be risk factors for instability when compared to an asymptomatic population. METHODS: Patients with single-level L4-L5 degenerative pathology, with or without spondylolisthesis, who underwent L4-5 surgery were evaluated. Facet joint anatomic features were measured on standing radiographs and supine MRI. Multivariate stepwise regression was used to identify anatomic factors associated with L4-5 spondylolisthesis. Outcomes included: (1) change in % listhesis from standing radiographs to supine MRI, (2) change in listhesis between flexion and extension radiographs, (3) change in translation from standing radiographs to MRI, and (4) change in L4-5 disc angle between standing radiographs and MRI. Univariate Pearson correlation was performed for the strongest predictors. RESULTS: Among 231 L4-L5 surgical patients (100 with spondylolisthesis; mean age 64.3 ± 12.6; BMI 29.0 ± 5.9; 23.8% female), anterior disc height predicted % listhesis change from MRI to standing radiographs (β=-0.33, P=0.01). Middle disc height predicted change in disc angle (β=-1.17, P=0.01). Anterior disc height correlated with preoperative listhesis (r=-0.51, P<.001). Facet effusion width predicted flexion-extension disc angle change (β=0.32, P=0.05). CONCLUSIONS: In L4-L5 degeneration, spondylolisthesis was associated with sagittal facet orientation, greater effusion, and reduced anterior disc height, which most strongly correlated with increased translation. These features help interpret differences between standing radiographs and MRI and may assist in identifying segments where instability should influence surgical planning.
Full Endoscopic versus Microscopic Lumbar Discectomy for Lumbar Disc Herniation: A Meta-analysis of Randomized-controlled Trials.
Patel S, Nischal SA, Kale KM … +7 more , Dubb A, Sarikonda A, Quraishi D, Hines K, Jallo J, Harrop JS, Prasad SK
Spine (Phila Pa 1976) · 2026 Jun · PMID 42308350 · Publisher ↗
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To compare safety, recovery metrics, and patient-reported outcomes between full endoscopic discectomy (FED) and microscopic discectomy (MSD) for lumbar disc h...
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To compare safety, recovery metrics, and patient-reported outcomes between full endoscopic discectomy (FED) and microscopic discectomy (MSD) for lumbar disc herniation (LDH). SUMMARY OF BACKGROUND DATA: Full-endoscopic techniques aim to reduce access-related soft tissue injury compared with conventional MSD but rely on fluoroscopic guidance and constrained working corridors. Prior syntheses frequently pooled heterogeneous minimally invasive approaches or non-randomized studies, limiting interpretability for contemporary practice. METHODS: PubMed, Embase, and CENTRAL were searched from inception to 16 February 2026 for randomized controlled trials comparing FED with MSD in adults with LDH. Prespecified outcomes included complications, Visual Analog Scale (VAS) back and leg pain, Oswestry Disability Index (ODI), and perioperative/recovery measures. Random-effects meta-analyses were performed throughout. Risk of bias (RoB 2) and certainty of evidence (GRADE) were assessed. RESULTS: Seventeen trials including 2238 patients (FED 1070; MSD 1168) were analyzed (mean follow-up 14.6-14.7 mo). Leg pain trajectories were comparable. Back VAS favored FED at 1 year (MD -0.18; 95% CI: -0.35--0.01) and ODI at 2 years (MD -5.72; 95% CI: -11.24--0.21). FED reduced blood loss (MD -38.62 mL; 95% CI: -67.69--9.54) and return-to-work time (MD -22.68 d; 95% CI: -32.85--12.50), but increased radiation exposure (MD 0.92; 95% CI: 0.84-1.00). Operative time and length of stay were similar. FED lowered postoperative infection (RR 0.30; 95% CI: 0.12-0.78), poor wound healing (RR 0.25, 95% CI: 0.07-0.96), and hematoma (RR 0.47; 95% CI: 0.23-0.94). Other non-wound-related complications did not differ. Risk of bias was low-to-moderate; certainty of evidence was moderate. CONCLUSION: FED and MSD provide comparable decompressive efficacy and patient-reported outcomes. FED reduces wound-related morbidity and may accelerate return to work, at the cost of greater fluoroscopic exposure, without consistent long-term superiority in pain or disability.
What are the Optimal Age Thresholds for qCT-based Osteoporosis and Osteopenia Screening in Patients Undergoing Lumbar Fusion Surgery?
Köhli P, Hambrecht J, Zhu J … +15 more , Chiapparelli E, Schönnagel L, Guven AE, Evangelisti G, Amoroso K, Duculan R, Shue J, Tsuchiya K, Burkhard MD, Pumberger M, Mancuso CA, Sama AA, Girardi FP, Cammisa FP, Hughes AP
Spine (Phila Pa 1976) · 2026 Jun · PMID 42302175 · Publisher ↗
STUDY DESIGN: Secondary analysis of two prospective single-center studies. OBJECTIVE: To evaluate the effectiveness of guideline-recommended osteoporosis screening age cutoffs in lumbar fusion surgery (LFS) patients and...
STUDY DESIGN: Secondary analysis of two prospective single-center studies. OBJECTIVE: To evaluate the effectiveness of guideline-recommended osteoporosis screening age cutoffs in lumbar fusion surgery (LFS) patients and identify optimized thresholds for osteoporosis and osteopenia detection. BACKGROUND: Poor bone quality impacts lumbar fusion surgery (LFS) outcomes. Current general population screening guidelines recommend starting at 65 years for women and 70 years for men in the absence of other risk factors. This study evaluates their effectiveness and refines age-based screening strategies for LFS patients. METHODS: This post-hoc analysis included patients ≥50 years of two prospective studies enrolling patients undergoing LFS for degenerative conditions. Patients with unsuitable imaging for quantitative CT (qCT) bone mineral density measurements were excluded. Osteoporosis and osteopenia status was determined by medical history and qCT in all patients. Uni- and multivariable logistic regression and ROC analysis to optimize age cut-offs for BMD screening were performed. The number needed to screen (NNS) for age cut-offs to detect one case was calculated. RESULTS: Among 515 patients (56% female, median age 66 years), impaired bone quality was present in 70%. Osteoporosis was found in 34%, with 38% of cases previously undiagnosed. Age was the only significant risk factor for low BMD for both sexes. Guideline age cutoffs yielded a sensitivity of 78% in females (NNS 1.8) and 58% in males (NNS 2.4) for osteoporosis and 68% (NNS 1.2) and 39% (NNS 1.2), respectively, for impaired bone status. Sensitivity-optimized screening for osteoporosis required lowering the age threshold to 58 for men (NNS 4) and 62 for women (NNS 2). Screening all patients for impaired bone status had an NNS of 1.4. CONCLUSIONS: General population age cutoffs inadequately detect osteoporosis in LFS patients. We propose individualized osteoporosis screening with sensitivity-optimized age thresholds and osteopenia screening for higher-risk procedures in patients aged ≥50 years.
Clinical Timing and Patient Heterogeneity in Interpreting Minimal Important Change After Vertebroplasty for Osteoporotic Vertebral Compression Fractures.
Sun JL, Shao N, Huang YF
Spine (Phila Pa 1976) · 2026 Jun · PMID 42302171 · Publisher ↗
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Post-Operative Coronal Malalignment is Associated with Delayed Deterioration Following Minimally Invasive Surgery for Adult Spinal Deformity.
Chan AK, Winans NJ, Mummaneni PV … +18 more , Park P, Uribe JS, Turner JD, Le VP, Eastlack RK, Fessler RG, Fu KM, Wang MY, Kanter AS, Okonkwo DO, Nunley PD, Anand N, Mundis GM, Passias PG, Bess S, Shaffrey CI, Chou D, International Spine Study Group
Spine (Phila Pa 1976) · 2026 Jun · PMID 42302166 · Publisher ↗
STUDY DESIGN: Retrospective analysis of prospectively collected database. OBJECTIVE: Adult spinal deformity (ASD) has increasingly been treated with minimally invasive surgical (MIS) techniques. The authors sought to ide...
STUDY DESIGN: Retrospective analysis of prospectively collected database. OBJECTIVE: Adult spinal deformity (ASD) has increasingly been treated with minimally invasive surgical (MIS) techniques. The authors sought to identify factors associated with delayed deterioration of ODI between 1 and 2 years postoperatively following minimally invasive surgery (MIS) for adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: Coronal malalignment is known to be associated with patient disability but the extent to which coronal alignment is associated with delayed deterioration after circumferential MIS surgery for ASD is unknown. METHODS: A retrospective analysis of prospectively collected data from the Minimally Invasive Surgery International Spine Study Group (MIS-ISSG) was conducted, including 67 patients who underwent circumferential MIS for ASD with one and two-year follow-ups. The patient cohort was dichotomized by identifying patients who reported higher ODI scores at 2 years than 1 year (somewhat improved) and compared with patients who reported stable or improved ODI over the same time course (very improved). Preoperative and postoperative factors influencing ODI changes were analyzed, focusing on radiographic outcomes and complications. RESULTS: Of the 67 patients, 31 reported an increase in ODI at two years compared with one year but these patients continued to show an improvement in ODI compared to preoperative baseline. Statistical analyses revealed no significant differences in baseline demographic, surgical, or preoperative characteristics between the "somewhat improved" (2-year ODI>1-year ODI) and "very improved" (2 y ODI≤1 y ODI) cohorts (P>0.05). However, the somewhat improved group had a significantly higher mean central sacral vertical line (CSVL) at all follow-up intervals (6-week CSVL mean 36.26 mm in the Somewhat improved group versus 22.8 mm in the very improved group, P=0.01). CONCLUSION: Early post-operative coronal malalignment is associated with delayed changes in functional outcomes following MIS for ASD.
Circumferential ALIF Provides Superior Sagittal Alignment and Lower Reoperation Rates Than TLIF in Patients ≤50 Years Undergoing Lumbar Interbody Fusion.
Sadh P, Sharma M, Sharma V … +6 more , Ma S, Basavatia V, Carayannopoulos N, Chisango Z, Daniels AH, Basques BA
Spine (Phila Pa 1976) · 2026 Jun · PMID 42302163 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare sagittal alignment, reoperation rates, and patient-reported outcomes between anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fus...
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare sagittal alignment, reoperation rates, and patient-reported outcomes between anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF) in patients ≤50 years. SUMMARY OF BACKGROUND DATA: ALIF and TLIF are commonly used lumbar fusion techniques with known differences in alignment restoration and complication profiles. However, comparative outcomes in younger patients, who have greater long-term biomechanical demands, remain poorly defined. METHODS: A single-institution retrospective analysis was performed on patients ≤50 years undergoing 1-2 level ALIF (stand-alone or with posterior instrumentation) or TLIF at L4-S1. Radiographic parameters (lumbar lordosis [LL], PI-LL mismatch, pelvic tilt [PT]) were assessed preoperatively and up to 2 years postoperatively. Reoperation rates and indications were recorded, with Kaplan-Meier and Cox regression analyses evaluating reoperation-free survival. Patient-reported outcomes included PROMIS Global Mental Health (GMH) and Physical Health (GPH). Multivariable regression adjusted for age, BMI, CCI, and multilevel fusion. RESULTS: A total of 218 patients were included (ALIF stand-alone: n=60; ALIF+posterior (ALIF +P): n=47; TLIF: n=111). At 2 years, ALIF+P demonstrated greater LL and lower PI-LL mismatch compared to TLIF (P≤0.02). Reoperation rates were highest in TLIF (20.7%) versus ALIF stand-alone (10.0%) and ALIF+P (8.5%) (P=0.03). TLIF was associated with increased reoperation risk compared to ALIF+P (HR 2.13, 95% CI 1.62-2.71). Adjacent segment disease was more common in TLIF (P=0.040). Early (6-week) GMH and GPH favored TLIF (P<0.001), whereas final GPH was highest in ALIF+P (P=0.001). Subsidence rates were similar across groups (P=0.627). CONCLUSION: In patients ≤50 years, ALIF with posterior instrumentation provides superior and durable sagittal alignment, lower reoperation rates, and improved long-term physical health compared to TLIF. Although TLIF demonstrates favorable early recovery, circumferential ALIF may offer greater long-term biomechanical and clinical benefit in younger patients.
Surgical Versus Nonoperative Treatment for Adult Spinal Deformity: A Multicenter Propensity Score-Matched Study of 2-Year Patient-Reported Outcomes.
Baroncini A, Boissiere L, Roscop C … +11 more , Larrieu D, Takemoto M, Vila L, Pellisé F, Alanay A, Kleinstueck F, Pizones J, Charles YP, Bourghli A, Obeid I, European Spine Study Group
Spine (Phila Pa 1976) · 2026 Jun · PMID 42302161 · Publisher ↗
STUDY DESIGN: Retrospective comparative study using prospectively collected data from a multicenter adult spinal deformity (ASD) registry across six centers, with propensity score (PS) matching to compare surgical versus...
STUDY DESIGN: Retrospective comparative study using prospectively collected data from a multicenter adult spinal deformity (ASD) registry across six centers, with propensity score (PS) matching to compare surgical versus nonoperative management. OBJECTIVE: To compare 2-year patient-reported outcomes and serious adverse events after surgical versus nonoperative management of adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: Randomized trials comparing operative and nonoperative treatment for ASD are rarely feasible, and ASD presents heterogeneous clinical and radiographic features, complicating treatment decisions. Propensity score methods can reduce measured confounding and strengthen comparative effectiveness estimates from observational cohorts. METHODS: Consecutive adults meeting radiographic criteria for ASD were identified from six participating centers. The primary endpoint was change in Oswestry Disability Index (ODI) at 2 years; secondary endpoints included SRS-22 outcomes. Propensity scores for surgery were estimated using logistic regression including age, sex, body mass index, major Cobb angle, pelvic incidence-lumbar lordosis mismatch, global tilt, pelvic tilt, baseline ODI, and SRS-22 total score. One-to-one nearest-neighbor matching (caliper 0.25) generated balanced pairs. Outcomes were compared within the matched cohort. RESULTS: Among 764 screened patients, 580 were eligible (338 surgical; 242 nonoperative). Propensity score matching produced 160 well-balanced pairs (n=320). In the matched cohort, mean age was ~45 years in both groups. At 2 years, ODI improvement was greater after surgery than after nonoperative care (-19.4±14.2 vs. -4.2±12.3; P <0.001); 72% of surgical patients versus 29% of nonoperative patients achieved a clinically meaningful ODI improvement (≥15 points; P <0.001). SRS-22 outcomes favored surgery, including higher 2-year SRS-22 total score (3.95±0.67 vs. 3.46±0.75; P <0.0001) and a higher proportion achieving MCID for SRS-22 total score (81.3% vs. 36.9%; P <0.001). CONCLUSION: In a multicenter PS-matched ASD cohort largely representing younger patients with mild-to-moderate baseline impairment, surgery was associated with superior 2-year disability and HRQoL outcomes compared with nonoperative care.
A novel fully visualized transparent channel in posterior uniportal endoscopic spine surgery: a paradigm shift for nerve root exposure and decompression under direct visualization.
Sun M, Shah SAA, Zhang J … +4 more , Feng S, Sun Y, Pan B, Yuan F
J Neurosurg Spine · 2026 Jun · PMID 42284613 · Publisher ↗
OBJECTIVE: The aim of this study was to explore the technical advantages and clinical efficacy of the fully visualized transparent channel in posterior uniportal endoscopic spine surgery for direct nerve root exposure. M...
OBJECTIVE: The aim of this study was to explore the technical advantages and clinical efficacy of the fully visualized transparent channel in posterior uniportal endoscopic spine surgery for direct nerve root exposure. METHODS: A retrospective analysis was conducted on 120 patients with lumbar spinal stenosis who underwent posterior uniportal endoscopic spine surgery between January 2022 and December 2023. Patients were divided into a transparent channel group (60 cases) and a metal channel group (60 cases). A polypropylene/polyamide 6 nanocomposite transparent channel system was used in the transparent channel group, whereas a traditional titanium alloy channel was used in the metal channel group. The two groups were compared in terms of surgical field coverage (structural similarity index measure [SSIM]), nerve root traction time, intraoperative blood loss, operation time, postoperative complications, and follow-up outcomes (visual analog scale, Oswestry Disability Index, and Macnab scores). RESULTS: The surgical field coverage in the transparent channel group was significantly higher than that in the metal channel group (SSIM 0.89 ± 0.05 vs 0.52 ± 0.08, p < 0.001). Nerve root traction time (2.3 ± 0.6 minutes vs 4.1 ± 1.1 minutes, p < 0.01) and intraoperative blood loss (18.5 ± 3.2 mL vs 24.7 ± 4.5 mL, p < 0.05) were significantly reduced. The incidence of postoperative nerve irritation signs was 0% in the transparent channel group and 10% in the metal channel group (p < 0.01). The excellent/good rates of Macnab scores at 1 year postoperatively were 96.7% versus 88.3% (p < 0.05). CONCLUSIONS: The fully visualized transparent channel significantly improves surgical field clarity and operational safety, providing a more surgically aligned minimally invasive solution for posterior endoscopic spine surgery.
Subaxial cervical spine fractures in ankylosing spondylitis: management and outcomes from a 10-year population-based cohort.
Rydning PNF, Linnerud H, Mirzamohammadi J … +6 more , Brommeland T, Evjensvold M, Stenset V, Netteland DF, Helseth E, Wiedmann MKH
J Neurosurg Spine · 2026 Jun · PMID 42284611 · Publisher ↗
OBJECTIVE: Patients with ankylosing spondylitis (AS) are predisposed to unstable cervical spine fractures with a high risk of cervical spinal cord injury (cSCI). Evidence regarding optimal management and outcomes in this...
OBJECTIVE: Patients with ankylosing spondylitis (AS) are predisposed to unstable cervical spine fractures with a high risk of cervical spinal cord injury (cSCI). Evidence regarding optimal management and outcomes in this population remains limited. This study aimed to describe treatment strategies and short-term outcomes in a prospectively collected, population-based cohort. METHODS: This 10-year (2015-2024) population-based study included all traumatic subaxial cervical spine fractures in patients with AS treated at Oslo University Hospital, the sole neurotrauma center serving Southeast Norway. Data were prospectively collected and analyzed for fracture morphology, management approach, surgical technique, complications, and 90-day mortality. RESULTS: A total of 132 fractures occurred in 127 patients (median age 70 years, 88% male). Most injuries (86%) resulted from low-energy falls. AO Spine type B or C fractures accounted for 94% of the fractures, and 20% were associated with cSCI. Primary management was surgical in 67% and conservative in 33%. Posterior fixation was the predominant surgical approach (77%). Among patients initially managed conservatively, 14% required delayed surgery. Revision surgery was performed in 9%, most commonly for implant failure after anterior-only fixation or deep infection. The 90-day mortality rate was 16% and was independently associated with advanced age, higher American Society of Anesthesiologists class, and in-hospital pneumonia, but not with cSCI, functional status, or treatment modality. CONCLUSIONS: Most AS-related subaxial cervical spine fractures are highly unstable and benefit from early surgical stabilization. Conservative management carries a substantial risk of failure. The high short-term mortality rate reflects patient frailty rather than treatment strategy. Multidisciplinary evaluation and close follow-up are essential, particularly for patients managed nonoperatively.
The "one-and-a-half" minimally invasive transforaminal lumbar interbody fusion: a single-center retrospective case series.
Farooq M, Kartal A, Ikwuegbuenyi CA … +9 more , Hamad MK, Robayo A, Wang E, Manalil NF, Willett N, Kramer A, Villalobos-Díaz R, Hussain I, Härtl R
J Neurosurg Spine · 2026 Jun · PMID 42284604 · Publisher ↗
OBJECTIVE: Symptomatic lumbar spondylolisthesis with multilevel spinal stenosis poses a complex surgical challenge, often managed through multilevel decompression and fusion. There is a hybrid surgical approach, termed "...
OBJECTIVE: Symptomatic lumbar spondylolisthesis with multilevel spinal stenosis poses a complex surgical challenge, often managed through multilevel decompression and fusion. There is a hybrid surgical approach, termed "one-and-a-half," that combines minimally invasive transforaminal lumbar interbody fusion (mTLIF) at the unstable segment with unilateral laminotomy for bilateral decompression (ULBD) at an adjacent stenotic level without fusion. The aim of this study was to assess the reoperation rate, specifically fusion extension to adjacent decompressed segments, in patients who underwent the one-and-a-half mTLIF technique. METHODS: This retrospective analysis reviewed patients who underwent one-and-a-half mTLIF performed by a single surgeon between January 2016 and February 2023 at a single institution. The revision surgery rate, as well as radiographic and clinical outcomes, was assessed. RESULTS: Thirty-three patients (57.6% male, mean age 67.9 years) who underwent one-and-a-half mTLIF were included, with a median follow-up of 26 months. Fusion was achieved in 96.2% (25/26) of patients. The reoperation rate was 9.1% (3/33); 2 patients (6.1%) required subsequent fusion at the previously decompressed (ULBD-treated) level and 1 patient (3.0%) at the index level. The perioperative complication rate was 12.1% (4/33), and neurological complications were not observed. CONCLUSIONS: The one-and-a-half mTLIF technique is a promising alternative to traditional multilevel fusion in patients with lumbar spondylolisthesis and concurrent multilevel stenosis. This hybrid approach offers a biomechanically stable alternative to multilevel fusion by selectively fusing the unstable segment while preserving spinal motion through decompression alone at the adjacent stenotic level. This study highlights its long-term effectiveness in reducing the necessity for reoperation and fusion extension, suggesting one-and-a-half mTLIF as a less invasive yet durable solution for managing complex lumbar spine pathology with promising radiographic and clinical outcomes.
Medium Term Outcomes of Single-Level Posterior Cervical Foraminotomy versus Single-Level Anterior Cervical Decompression and Fusion versus Single-Level Cervical Disc Replacement for Cervical Radiculopathy.
Sabha M, Yoon K, Quan T … +6 more , Japa JP, Ehioghae M, Bellaire C, Lee L, Singh A, Mesfin A
Spine (Phila Pa 1976) · 2026 Jun · PMID 42263223 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare rates of revision fusion after posterior cervical foraminotomy, anterior cervical decompression and fusion, and total disc replacement for radiculopathy. SU...
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare rates of revision fusion after posterior cervical foraminotomy, anterior cervical decompression and fusion, and total disc replacement for radiculopathy. SUMMARY OF BACKGROUND DATA: Cervical radiculopathy is one of the most common conditions in the US. Surgical treatment typically involves a single-level anterior cervical decompression and fusion (ACDF). However, the posterior cervical foraminotomy (PCF) and the total disc replacement (TDR) have become popular options. Few studies have reviewed how rates of subsequent revision surgery differ between the three procedures. METHODS: The TriNetX Global Collaborative Network database was queried using ICD-10 and CPT codes to identify adult patients (≥ 18 years old) diagnosed with cervical radiculopathy who underwent single-level ACDF, TDR, or PCF within the past 20 years. Propensity score matching (1:1) was performed and rates of revision ACDF were evaluated at 1-year and 3-year post-operatively. RESULTS: At 1-year post-operatively, ACDF (RR 0.63, P = 0.017) had lower risk for subsequent ACDF versus PCF. Foraminotomy had a higher risk for subsequent ACDF compared with index TDR (RR 2.56, P < 0.001). Similar outcomes were seen at 3-years post-operatively. Patients with an index ACDF had a significantly higher risk at 3-year versus TDR (RR = 1.68, P = 0.027), and a non-significant elevated risk of implant-related complication at both 1-year (RR = 1.3, P = 0.45), and 3-year (RR = 1.39, P = 0.28) versus TDR. CONCLUSION: TDR tended to have the lowest risk of subsequent ACDF and implant failure at both 1-year and 3-year, while PCF had the highest risk of subsequent ACDF compared with both the index ACDF and index TDR group. LEVEL OF EVIDENCE: IV.
Redefining Clinical Success Following Adult Spine Deformity Surgery Using a Multifactorial Composite Metric.
Budani B, Kaur P, Bess SR … +18 more , Daniels AH, Diebo BG, Eastlack RE, Gupta MC, Hostin R, Kebaish KM, Ames CP, Klineberg EO, Mundis G, Okonkwo DO, Passias PG, Protopsaltis T, Schwab FJ, Shaffrey CI, Smith JS, Lafage V, Lafage R, International Spine Study Group (ISSG)
Spine (Phila Pa 1976) · 2026 Jun · PMID 42263194 · Publisher ↗
STUDY DESIGN: Retrospective multicenter registry. OBJECTIVE: To establish a multidimensional definition of surgical success in ASD surgery and evaluate achievement rates across diverse patient subgroups. SUMMARY OF BACKG...
STUDY DESIGN: Retrospective multicenter registry. OBJECTIVE: To establish a multidimensional definition of surgical success in ASD surgery and evaluate achievement rates across diverse patient subgroups. SUMMARY OF BACKGROUND DATA: Adult spinal deformity (ASD) encompasses diverse deformity types, disability levels, and treatment options. Optimal surgery aims in part to improve function, reduce radicular pain, and minimize revisions. Despite some studies considering combined outcomes, comprehensive multifactorial evaluation remains limited. METHODS: Success was assessed across disability (2-year ODI ≤20 or ∆ODI >14), radicular pain (NRS Leg ≤3 or ∆NRS Leg >3), and reoperation (no mechanical/neurologic revision). Patients were categorized by preoperative high disability (ODI >40) and/or high pain (NRS Leg >5). Individual and composite success rates were compared across preoperative deficits and deformity types. Satisfaction and treatment repetition willingness were analyzed by success achievement. RESULTS: Of 1,504 patients, 1,084 (71.9%) completed 2-year follow-up (median age 64 years, 75.4% female, 50.7% prior surgery). Median preoperative scores: ODI 44, NRS Back 8, NRS Leg 5. Preoperatively, 40.7% had combined high disability and pain, 21.6% high disability only, 13.5% high pain only, and 20.2% neither. At 2 years, success rates were 60.9% for disability, 64.8% for leg pain, 81.2% for revision avoidance, and 40.5% composite. Composite success was highest without preoperative deficits (59.4%), intermediate with isolated deficits (38.0% high disability, 43.8% high pain), and lowest with combined deficits (32.2%). Severe coronal deformities achieved highest composite success (51.7%) versus 32.0%-41.3% for other types. Composite success strongly correlated with satisfaction (87.2%) and willingness to repeat treatment (94.4%). CONCLUSIONS: Success in ASD surgery should reflect both improvement and final outcomes. Composite success measures provide more comprehensive surgical assessment than single metrics. By identifying patient characteristics associated with higher success rates, this framework informs evidence-based patient selection, enables realistic preoperative counseling, and guides outcome-driven surgical planning.
Epinephrine-added Irrigation Shortens and Stabilizes Operative Time in Full-endoscopic Lumbar Decompression after Adjusting for the Learning Curve: An Interrupted Time Series Study.
Takenaka S, Kanayama S, Yamada S … +1 more , Kono T
Spine (Phila Pa 1976) · 2026 Jun · PMID 42263186 · Publisher ↗
STUDY DESIGN: Single-center, single-surgeon retrospective observational study using segmented regression interrupted time series (ITS) analysis. OBJECTIVE: To evaluate whether epinephrine-added irrigation improves operat...
STUDY DESIGN: Single-center, single-surgeon retrospective observational study using segmented regression interrupted time series (ITS) analysis. OBJECTIVE: To evaluate whether epinephrine-added irrigation improves operative efficiency and visualization during uniportal full-endoscopic unilateral laminotomy for bilateral decompression (FESS-ULBD) after adjusting for the learning curve. SUMMARY OF BACKGROUND DATA: Maintaining a clear operative field under continuous irrigation is a major challenge in full-endoscopic lumbar decompression. Epinephrine-added irrigation improves visualization in arthroscopy, but evidence in endoscopic spine surgery is limited and may be confounded by learning curve effects. METHODS: Fifty consecutive single-level FESS-ULBD cases for degenerative lumbar spinal stenosis were analyzed (saline-only irrigation [SAL], n=24; epinephrine-added irrigation [EPI], n=26). Segmented regression ITS models were applied to evaluate operative time, endoscopic visibility, and hemostasis while adjusting for case sequence (learning curve), post-implementation slope change, and sex. RESULTS: Mean operative time decreased from 99.3 minutes (SD 18.5) in SAL to 60.7 minutes (SD 9.4) in EPI (P<0.001). ITS analysis demonstrated a significant immediate reduction in operative time (level change -18.3 minutes, 95% CI -33.7 to -2.9; P=0.024) and reduced variability (residual SD 17.5 to 7.2 minutes; P=0.001). Visibility improved (median "Good" 44.4% vs. 100%; ITS OR 668.8; P=0.004), and the need for hemostasis decreased (ITS OR 0.021; P=0.032). Under routine monitoring, intraoperative hypertension events occurred at similar rates between groups (17% vs. 15%), and no antihypertensive medication was required. CONCLUSION: After adjusting for learning curve effects using segmented regression ITS analysis, epinephrine-added irrigation during FESS-ULBD improved visualization and reduced hemostasis burden, resulting in shorter and more consistent operative times without clinically apparent hemodynamic instability under routine monitoring or increased postoperative bleeding.
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