Spine[JOURNAL]
Sun
200 papers
A Novel Clinical Classification for Atlantoaxial Dislocation: Based on Surgical Outcomes of 1032 Cases.
Ma X, Chen Z, Zou X … +8 more , Cai M, Chen J, Ma R, Huang X, Xiao Z, Wang J, Yi H, Xia H
Spine (Phila Pa 1976) · 2026 May · PMID 42263167 · Publisher ↗
STUDY DESIGN: A retrospective cohort study. OBJECTIVES: To propose a novel clinical classification system for atlantoaxial dislocation (AAD) that modifies and subclassifies existing systems. SUMMARY OF BACKGROUND DATA: D...
STUDY DESIGN: A retrospective cohort study. OBJECTIVES: To propose a novel clinical classification system for atlantoaxial dislocation (AAD) that modifies and subclassifies existing systems. SUMMARY OF BACKGROUND DATA: Driven by the controversial definition of irreducible atlantoaxial dislocation (IAAD) and recent advancements in reduction techniques, existing AAD classifications require modification to enhance their clinical applicability. METHODS: We retrospectively reviewed 1032 patients diagnosed with AAD who had a minimum two-year follow-up. Clinical and neurological outcomes were assessed using the japanese orthopaedic association (JOA) score, while primary outcomes included reduction status, bone fusion, complications, and the change in atlantoaxial angle (ΔAAA). Beyond standard dynamic radiographs, CT, and skull traction assessments, a novel classification system was developed incorporating the ΔAAA. Furthermore, receiver operating characteristic (ROC) curve analysis was employed to establish the optimal ΔAAA cut-off value for subclassifying IAAD. RESULTS: The cohort comprised 537 males and 495 females. Patients were classified into six types: 231 cases as Type I, 304 as Type II, 209 as Type III, 212 as Type IV, 49 as Type V, and 27 as Type VI. Except for three patients who died, the remaining 1029 patients were followed up for a mean of 33 months. Anatomical reduction was achieved in 661 patients, functional reduction in 324 patients, and partial reduction in 41 patients; six patients required odontoidectomy. At the last follow-up, the mean JOA score improved significantly from 12.40 ± 3.71 to 15.18 ± 2.32 (t=-35.714, P<0.001). CONCLUSION: In this novel system, AAD is classified into six subtypes: atlantoaxial instability (Type Ⅰ), reducible AAD (Type Ⅱ), IAAD is subdivided into traction-loosen (Type III) and traction-stable (Type IV) types, while the fixed atlantoaxial dislocation (FAAD) is categorized into limited fusion (Type V) and extensive fusion (Type VI) types. Consequently, surgical strategies can be optimized according to these specific subtypes.
Publication patterns of posters and oral presentations at the annual joint AANS/CNS Spine Summit.
Francois H, Soliman MAR, Quiceno E … +7 more , Okai BK, Greisman JD, Khan A, Levy HW, Chan DG, Pollina J, Mullin JP
J Neurosurg Spine · 2026 Jun · PMID 42247699 · Publisher ↗
OBJECTIVE: The American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Disorders of the Spine and Peripheral Nerves' annual Spine Summit brings together researchers and specialists to c...
OBJECTIVE: The American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Disorders of the Spine and Peripheral Nerves' annual Spine Summit brings together researchers and specialists to collaborate and advance science. An increase in publication patterns in neurosurgical journals has been seen in recent years, reflecting advancements in the 21st century. However, previous studies on publication patterns for the Spine Summit are outdated and do not account for recent clinical and technological advancements. The aim of this study was to assess recent publication patterns to compare them with previous trends to explore recent changes and developments. METHODS: Abstract titles from Spine Summits between 2014 and 2020 were searched using PubMed and Google Scholar, with matches between presentations and articles defined by similarities in title, authors, methods, and results. Collected variables included article title, first author, publication year, journal impact factor, and citation counts from the Scopus database. Due to a change in presentation format in 2015, analysis was conducted separately for 2014 (oral platform vs oral posters) and collectively for 2015 through 2020 (awarded vs nonawarded oral presentation abstracts). RESULTS: A total of 1592 abstracts were analyzed, with a publication rate of 64.5% (n = 1027) and a mean time from presentation to publication of 0.92 ± 1.14 years. Notably, 57.7% (n = 919) of presented abstracts were published within 4 years. The number of presented abstracts in 2020 reached 297, a 290.8% increase from 2014. Papers based on these abstracts appeared in 109 journals, accumulating 23,126 citations, with a mean of 24.79 ± 35.26 citations per article. The top 5 journals with the most abstract-associated publications, representing the highest percentages of all abstract-related publications, were World Neurosurgery (14.5% [149/1027]), Journal of Neurosurgery: Spine (14.8% [152/1027]), Neurosurgery (10.9% [112/1027]), Spine (8.8% [90/1027]), and The Spine Journal (6.4% [66/1027]). The percentage of presented abstracts that were published as articles between 2014 and 2020 significantly increased to 64.5% from 54% between 2009 and 2012 (p < 0.05). CONCLUSIONS: Almost two-thirds of the abstract-based articles were published in peer-reviewed journals. Compared with an earlier study on publication trends for abstracts presented at the Spine Summit, there has been a notable increase.
Frailty index, accelerometer-measured physical activity, and delayed physical functional recovery after spinal fusion surgery in older adults.
Wang S, Li J, Han D … +4 more , Wang W, Wang P, Chen X, Lu S
J Neurosurg Spine · 2026 Jun · PMID 42247698 · Publisher ↗
OBJECTIVE: Despite the growing implementation of preoperative physical exercise in frail individuals, no research has explored whether low physical activity mediates the relationship between frailty and delayed physical...
OBJECTIVE: Despite the growing implementation of preoperative physical exercise in frail individuals, no research has explored whether low physical activity mediates the relationship between frailty and delayed physical functional recovery (PFR) after spinal fusion surgery. This study aimed to investigate whether, and to what extent, low physical activity mediates the association between frailty and delayed PFR in older adults undergoing lumbar fusion surgery. METHODS: The authors enrolled 419 patients aged ≥ 65 years scheduled for elective lumbar fusion. Frailty was assessed using the modified 5-item frailty index. Physical activity was measured both subjectively (International Physical Activity Questionnaire-Short Form) and objectively (ActiGraph accelerometers). The primary outcome was delayed PFR, defined as delayed ambulation (> 48 hours) plus either prolonged length of hospital stay or nonhome discharge. Multivariate regression and mediation analyses with bootstrap resampling were applied. RESULTS: Of 419 patients, 146 (34.8%) were frail. Frail patients had higher rates of low physical activity and delayed PFR (31.5% vs 15.1%, p < 0.001). Frailty was associated with delayed PFR (β 0.84, 95% CI 0.43-1.26), attenuated after adjusting for low physical activity (β 0.79, 95% CI 0.44-1.26). Mediation analysis showed low physical activity partially mediated the frailty-PFR relationship (average causal mediation effect 0.012, 95% CI 0.001-0.03). Results were consistent using accelerometer-based moderate to vigorous physical activity classification. CONCLUSIONS: Low physical activity partly mediates the effect of frailty on delayed functional recovery after lumbar fusion surgery. These findings highlight the importance of incorporating physical activity assessment and optimization into perioperative care pathways for frail patients.
The association of neighborhood disadvantage, preoperative serum albumin, and health resource utilization after minimally invasive lumbar spine surgery.
Sun Y, Howell S, Laskay NMB … +6 more , Juarez LD, Vandeberg BG, Mahavadi A, Tracz J, Mooney J, Godzik J
J Neurosurg Spine · 2026 Jun · PMID 42247696 · Publisher ↗
OBJECTIVE: Preoperative albumin has been explored as a potential predictor of outcomes following spine surgery. However, given the lower levels of invasiveness and faster recoveries in minimally invasive (MIS) spine surg...
OBJECTIVE: Preoperative albumin has been explored as a potential predictor of outcomes following spine surgery. However, given the lower levels of invasiveness and faster recoveries in minimally invasive (MIS) spine surgeries, the value of albumin as a predictor of outcomes is unknown. The authors sought to uncover the association of preoperative albumin on outcomes following MIS lumbar spine surgery. METHODS: The authors identified all patients undergoing MIS lumbar decompressions or decompression with fusions at our institution using Current Procedural Terminology codes. Preoperative serum hypoalbuminemia was categorized as < 3.5 g/dL. Area Deprivation Indices (ADIs) were retrieved based on patient addresses, with higher national rankings indicating greater levels of relative socioeconomic deprivation. To assess the relationship between serum albumin and length of stay (LOS) and ADI, the authors used multivariate linear regressions. Multivariate logistic regression models with robust standard errors to adjust for clustering were used to assess the effect of serum albumin on readmissions and complications. RESULTS: A total of 465 patients with preoperative serum albumin levels were included for analysis (median age 65 [IQR 57-72] years), of whom 8.2% had hypoalbuminemia preoperatively. On multiple linear regression, for every 1-g/dL decrease in preoperative albumin, the LOS increased by an mean of 0.9 (95% CI 0.51-1.3) days. Lower serum albumin was associated with greater levels of socioeconomic disadvantage as well (β -8.9, 95% CI -14 to -3.7). Patients with any degree of hypoalbuminemia preoperatively had increased odds of requiring reoperation within 90 days (OR 5.39, 95% CI 1.95-14.9) and postoperative complications (OR 3.68, 95% CI 1.56-8.72) after adjustment for potential confounders. A multivariate model with preoperative serum albumin predicting prolonged LOS displayed high discriminative ability (area under the receiver operating characteristic curve 0.87, 95% CI 0.80-0.94). CONCLUSIONS: Low serum albumin is associated with longer LOS, readmissions, and complications in MIS lumbar spine surgery despite the decreased invasiveness. Notably, low preoperative serum albumin was also associated with socioeconomic disadvantage. Preoperative optimization of both albumin and socioeconomic factors may improve outcomes in patients undergoing MIS lumbar spine surgery and represents an important area of future research.
Editorial. Podium to press: what counts as progress?
Godzik J
J Neurosurg Spine · 2026 Jun · PMID 42247694 · Publisher ↗
Abstract loading — click title to view on PubMed.
Utilization of artificial intelligence-based writing assistance in contemporary spine literature.
Singh M, Nassar JE, Farias MJ … +5 more , Daher M, Sahhar M, Callanan T, Diebo BG, Daniels AH
J Neurosurg Spine · 2026 May · PMID 42214108 · Publisher ↗
OBJECTIVE: With the advent of artificial intelligence (AI), scientific research and writing has benefitted from large language models to generate hypotheses, evaluate data, and draft manuscripts. However, this brings int...
OBJECTIVE: With the advent of artificial intelligence (AI), scientific research and writing has benefitted from large language models to generate hypotheses, evaluate data, and draft manuscripts. However, this brings into question the prevalence, impact, and ethics of AI writing assistance on published literature. The purpose of this study was to quantify the extent of AI involvement in published spine articles and establish a statistical threshold for scientific integrity. METHODS: Spine-focused clinical journals were selected for their impact factor and comprehensive representation of the specialty. All full-length research articles published in 2005 and 2023-2024 in these journals were extracted. ZeroGPT was used to assess AI content in each article. Baseline AI utilization was evaluated on the 2005 data, with 2 standard deviations above the mean serving as the threshold for significant AI usage. Based on pre-AI era articles, a threshold ZeroGPT score of 48.8% was established. Articles exceeding this threshold in the 2023-2024 data were assessed across spine journals and years of publication. RESULTS: In total, 2790 post-AI articles published across 6 spine journals in 2023-2024 were examined. Among these spine journal articles, 25.7% were considered to have significant AI involvement. AI involvement varied significantly across spine journals, ranging from 20.2% for Spine (Phila Pa 1976) to 31.1% for Journal of Neurosurgery: Spine (p < 0.01). Likewise, AI involvement varied significantly across the years, with peak utilization at 32.0% at the start of 2023 and plateau in utilization at 20.7% by the second quarter of 2024 (p < 0.01). CONCLUSIONS: AI involvement in drafting manuscripts was observed in 25% of articles in recent spine literature. Although the use of AI has plateaued since mid-2024, likely due to the implementation of clear ethical guidelines and utilization of improved detection tools, continued efforts should be made with the evolving AI landscape to the ensure quality, authenticity, and integrity of spine research.
The association of decompression and fusion with improved patient-reported outcome measures in patients with degenerative spondylolisthesis and a hypolordotic lordosis distribution index when compared with decompression alone.
Herrington BJ, Urquhart JC, Rodrigues Fernandes RJ … +8 more , Glennie RA, Fisher CG, Dea N, Thomas K, Soroceanu A, Manson N, Rampersaud YR, Bailey CS
J Neurosurg Spine · 2026 May · PMID 42214107 · Publisher ↗
OBJECTIVE: The aim of this study was to compare patient-reported outcome measures among patients with degenerative lumbar spondylolisthesis (DLS) who underwent either decompression alone (DA) or decompression and fusion...
OBJECTIVE: The aim of this study was to compare patient-reported outcome measures among patients with degenerative lumbar spondylolisthesis (DLS) who underwent either decompression alone (DA) or decompression and fusion (DF) stratified by preoperative lumbar lordosis distribution index (LDI). METHODS: Patients with DLS from 2 of the 7 centers enrolled in the Canadian Spine Outcomes and Research Network prospective study between 2015 and 2022 were retrospectively analyzed. Patients were stratified into an LDI < 50% and an LDI 50%-80% cohort, and whether they underwent DF or DA. Radiographic parameters were obtained from preoperative radiographs and included global lumbar lordosis, lower lumbar lordosis, and the LDI. The primary outcomes included achieving the minimal clinically important difference (MCID) for the numeric rating scale (NRS) score for back pain, the NRS score for leg pain, and the Oswestry Disability Index (ODI) at 24 months postoperatively. RESULTS: One hundred seventy-nine patients were available for analysis. There were 73 patients with a preoperative LDI < 50% (32 with DA, 41 with DF), while 106 patients had a preoperative LDI 50%-80% (51 with DA, 55 with DF). In the LDI < 50% group, the MCID for back pain was achieved at 24 months in significantly more patients with DF than with DA (85.7% vs 48.3%, p = 0.002) and for the ODI (91.4% vs 62.1%, p = 0.006). These differences were not observed in the LDI 50%-80% group. After multivariate analysis, in the LDI < 50% cohort DF was associated with improved odds of achieving the MCID at 24 months for back pain (OR 12.614, 95% CI 1.899-83.767; p = 0.009) and ODI (OR 10.479, 95% CI 1.423-77.156; p = 0.021) scores compared to DA. These differences were not found in the LDI 50%-80% cohort. CONCLUSIONS: In patients with DLS, a preoperative LDI < 50% may be helpful in identifying those who may benefit from DF over DA.
Advantages of vertebral coplanar alignment technique for restoring physiological thoracic kyphosis in hypokyphotic adolescent idiopathic scoliosis with < 10° of kyphosis.
Yamada K, Uchino Y, Moridaira H … +14 more , Takada S, Nojiri H, Shimura A, Tomori M, Murakami Y, Katayanagi J, Akeda K, Nagai T, Nakamura E, Otani K, Nikaido T, Tsushima M, Toyoda H, Taneichi H
J Neurosurg Spine · 2026 May · PMID 42214104 · Publisher ↗
OBJECTIVE: Conventional segmental pedicle screw fixation for thoracic adolescent idiopathic scoliosis (AIS) often compromises the ability to restore physiological thoracic kyphosis (TK). The vertebral coplanar alignment...
OBJECTIVE: Conventional segmental pedicle screw fixation for thoracic adolescent idiopathic scoliosis (AIS) often compromises the ability to restore physiological thoracic kyphosis (TK). The vertebral coplanar alignment (VCA) technique addresses 3D deformity correction on the convex side in thoracic scoliosis. In particular, it enhances sagittal plane correction by adding kyphotic contouring via the concave-side rod while preserving the ideal thoracic curvature, including the physiological TK apex location on the convex side. This multicenter cohort study aimed to analyze the surgical outcomes of the VCA technique and demonstrate its effectiveness in restoring physiological TK in hypokyphotic AIS patients with < 10° of kyphosis. METHODS: Data from 127 consecutive patients who underwent corrective surgery using the VCA technique for hypokyphotic (TK < 10°) thoracic AIS at 13 institutions, with a minimum follow-up of 2 years, were retrospectively analyzed. Outcome measures included patient demographics, radiographic parameters, TK apex location, and Scoliosis Research Society (SRS)-22 scores assessed preoperatively and at 2 years postoperatively. RESULTS: The mean main thoracic Cobb angle improved significantly from 55.0° to 14.1° at 2 years postoperatively, with a mean correction rate of 74%. The mean TK (T5-12) increased significantly from 4.4° to 19.5°. The proportion of patients with the TK apex located at T6-8 significantly increased from 22% to 73%. The mean SRS-22 total score improved from 3.6 to 4.5 at 2 years postoperatively. CONCLUSIONS: This multicenter study highlights the advantages of VCA, particularly in restoring physiological TK in hypokyphotic (TK < 10°) thoracic AIS. The VCA procedure contributed to maintaining an ideal thoracic shape with the physiological TK apex on the convex side prior to rod placement and before performing various manipulations via the rod on the concave side.
Patient-reported outcomes following operative and nonoperative management of A3 versus A4 thoracolumbar burst fractures.
Kweh BTS, Dandurand C, Vaccaro AR … +10 more , Schnake KJ, El-Sharkawi M, Bransford RJ, Joaquim AF, Chhabra HS, Spiegl UJA, Hauri D, Öner FC, Schroeder GD, Tee JW
J Neurosurg Spine · 2026 May · PMID 42214102 · Publisher ↗
OBJECTIVE: The aim of this study was to compare patient-report outcome measures in patients with thoracolumbar burst fractures managed either operatively or nonoperatively. METHODS: A prospective multicenter observationa...
OBJECTIVE: The aim of this study was to compare patient-report outcome measures in patients with thoracolumbar burst fractures managed either operatively or nonoperatively. METHODS: A prospective multicenter observational study was conducted of neurologically intact patients who sustained traumatic thoracolumbar burst fractures managed operatively or nonoperatively. Outcome measures included scores on the EQ-5D index, EQ-5D visual analog scale (VAS), pain numerical rating scale (NRS), and AO Spine Patient Reported Outcome Spine Trauma (PROST) tool and patient satisfaction with follow-up up to 2 years. The Wilcoxon rank-sum test and Cochran-Armitage test were used to evaluate differences between continuous and ordinal variables, respectively. Mixed models for repeated measures (MMRM) were used for continuous outcomes using unstructured covariance. A generalized estimating equations (GEE) model was employed for the ordinal outcomes of anxiety and depression. RESULTS: In total, 198 patients were identified. The EQ-5D index scores were similar for A3 and A4 fractures at long-term 2-year follow-up with respect to operative (p = 0.48) and nonoperative (p = 0.51) management. This was paralleled by EQ-5D VAS scores for surgical (p = 0.33) and nonsurgical (p = 0.21) treatment. The adjusted mixed-effects model for EQ-5D index and EQ-5D VAS scores showed significant improvements for both operatively and nonoperatively treated A3 and A4 fractures at all follow-up evaluations (p < 0.05), except for EQ-VAS at 6 weeks in the nonsurgical group (p = 0.812). The GEE model confirmed that there was a higher proportion of patients who were less anxious or depressed among operatively managed patients with A4 fractures compared to those with A3 fractures at 2-year follow-up (OR 7.7, 95% CI 1.5-40.5, p = 0.02). MMRM for pain NRS and AO Spine PROST suggested that there was a significant improvement in outcome compared to discharge for both surgically and nonsurgically treated patients (p < 0.05) but no significant difference between the surgical subgroups. Patient satisfaction was similar between those with A3 and A4 fractures for nonoperatively (p = 0.62) and operatively (p = 0.50) treated patients at final follow-up. CONCLUSIONS: The contemporary management of thoracolumbar burst fractures in neurologically intact patients has evolved to the extent that there is improvement in function, pain, and disability for both A3 and A4 fractures regardless of whether surgical or nonsurgical management is pursued. Patients who sustained the more severe A4 morphology experienced improved mental health outcomes at the final 2-year follow-up if operatively managed. Ultimately, patient satisfaction was similar when compared with the EQ-5D index and EQ-5D VAS.
The Use of Corticosteroid Treatment Protocols in Compressive Epidural Spinal Metastases: Current Practice and the Need for Consensus.
Botterbush KS, Patel MS, Srinivas AN … +4 more , McLaughlin ND, Wilson KL, Urquiaga JF, Avila MJ
Spine (Phila Pa 1976) · 2026 May · PMID 42206376 · Publisher ↗
STUDY DESIGN: Systematic review. OBJECTIVE: To evaluate current protocols for corticosteroid use in patients with compressive epidural spinal metastasis. SUMMARY OF BACKGROUND DATA: Spinal metastases are common in oncolo...
STUDY DESIGN: Systematic review. OBJECTIVE: To evaluate current protocols for corticosteroid use in patients with compressive epidural spinal metastasis. SUMMARY OF BACKGROUND DATA: Spinal metastases are common in oncological patients. Although spinal cord compression is a less frequent manifestation, its occurrence represents a medical emergency. Despite over three decades of literature reporting recommendations for corticosteroid use in patients with metastatic spinal cord compression, there remains a lack of consensus regarding the optimal timing, dosage and duration of treatment. METHODS: A systematic review was conducted in May 2025, including terms for epidural spinal metastasis and corticosteroids. 835 articles were screened for compressive metastatic epidural spinal lesions treated with systemic corticosteroids. Ultimately, 39 articles were included for final analysis, which included patient demographics, clinical characteristics, treatment modalities, adverse effects, and survival and ambulation outcomes. Studies were grouped into pre- and post-1997 based on NASCIS III, as well as evenly across three time periods. RESULTS: Dexamethasone, hydrocortisone, methylprednisolone, and prednisone were used, with dexamethasone being the most common. The proportion of patients receiving steroid treatment and experiencing adverse effects were both significantly higher pre-1997 (P<0.0001). Survival outcomes were significantly higher post-1997 at all time frames. Pre-treatment ambulation was significantly higher post-1997 (P<0.0001). The proportion of patients ambulating pre-treatment was significantly higher with each subsequent period (42.11% vs. 62.72% vs. 70.59%; P<0.0001, P<0.0001, P<0.0001). CONCLUSION: There remains a lack of consensus on literature for steroid use in compressive metastatic spine disease. Recent studies generally suggest 12-32 mg/day of dexamethasone. There are improvements in overall survival but not ambulation in patients with symptomatic metastatic spine disease, likely from improved overall oncological care but not necessarily treatment of the spinal metastases themselves. Development of clear guidelines for corticosteroid use in this population is imperative to optimize prognostic outcomes.
Recovery of Preoperative Neurogenic Bladder Dysfunction and Identification of Risk Factors for Persistent Bladder Impairment Following Surgical Intervention for Degenerative Cervical Myelopathy: A Prospective Multicenter Cohort Study.
Okubo T, Nagoshi N, Yamane J … +13 more , Fujii T, Horiuchi Y, Kamata Y, Isogai N, Kono H, Shibata R, Iga T, Takeda K, Ozaki M, Suzuki S, Matsumoto M, Nakamura M, Watanabe K
Spine (Phila Pa 1976) · 2026 May · PMID 42206345 · Publisher ↗
STUDY DESIGN: Prospective multicenter cohort study. OBJECTIVES: To investigate the postoperative recovery trajectory of preoperative neurogenic bladder dysfunction (NBD) in patients with degenerative cervical myelopathy...
STUDY DESIGN: Prospective multicenter cohort study. OBJECTIVES: To investigate the postoperative recovery trajectory of preoperative neurogenic bladder dysfunction (NBD) in patients with degenerative cervical myelopathy (DCM) and identify factors linked to persistent NBD after surgery. SUMMARY OF BACKGROUND DATA: Although surgical intervention typically enhances neurological function, post-surgery bladder function recovery varies and may not align with improvements in other neurological areas. Longitudinal data on the postoperative progression of bladder functional recovery remain limited. METHODS: This prospective study included 352 DCM patients with preoperative NBD who underwent surgery. Patients were categorized into a full recovery group (Japanese Orthopaedic Association [JOA] bladder function score = 3 at 2-year) or a persistent dysfunction group (≤2). Patient-reported bladder outcomes were evaluated using the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). General health-related quality of life was assessed using the Short Form36 Health Survey (SF-36). Binary logistic regression analysis was conducted to identify factors associated with persistent NBD. RESULTS: NBD showed progressive improvement over time, and 2-year post-surgery, 71.3% of patients achieved complete recovery of bladder function. Older age at the time of surgery (odds ratio [OR], 1.029; 95% confidence interval [CI], 1.002-1.055) and lower preoperative JOA bladder function scores (OR, 0.631; 95% CI, 0.406-0.982) were independently associated with postoperative persistent NBD. The overall effective rate based on the JOACMEQ bladder function domain was 26.5%, with higher postoperative scores and effective rates observed in the full recovery group. The SF-36 Physical and Mental Component Summary scores showed no significant intergroup differences. CONCLUSIONS: Approximately 70% of patients with DCM and preoperative NBD achieved complete bladder functional recovery within 2-year post-surgery. Postoperative bladder functional recovery was mainly influenced by patient age and baseline NBD severity, following a recovery pattern that was distinct from other neurological domains. Bladder-specific evaluation remains crucial for postoperative assessment and patient counseling in DCM. LEVEL OF EVIDENCE: II.
Intracranial, Intra-, and Epidural Pressure Changes During Endoscopic Lumbar Discectomy: A Comparison Between Transforaminal and Interlaminar Approach.
Stauffer A, Schader JF, Zipser CM … +6 more , Kheram N, Fasser MR, Spirig JM, Widmer J, Hagel V, Farshad M
Spine (Phila Pa 1976) · 2026 May · PMID 42202837 · Publisher ↗
STUDY DESIGN: Cadaveric laboratory study. OBJECTIVES: To characterize and compare intracranial, intradural (cervical, thoracic, lumbar), and lumbar epidural pressure changes during transforaminal and interlaminar endosco...
STUDY DESIGN: Cadaveric laboratory study. OBJECTIVES: To characterize and compare intracranial, intradural (cervical, thoracic, lumbar), and lumbar epidural pressure changes during transforaminal and interlaminar endoscopic lumbar procedures under gravity and pump irrigation, with and without simulated outflow occlusion. SUMMARY OF BACKGROUND DATA: High-pressure irrigation improves visualization and hemostasis during endoscopic lumbar discectomy but may increase spinal canal and intracranial pressures and contribute to neurologic complications if not well controlled. METHODS: Three fresh-frozen human cadavers were instrumented with pressure probes in the lumbar epidural space (L3-4), intradural space at C5-6, T8-9, and L3-4, and intracranially. At L3-4, transforaminal and interlaminar uniportal approaches were performed using gravity irrigation (50, 100, 130 cmH2O) and two pump systems (30-120 mmHg; arthroscopy pump and spine-certified pump). Each setting was tested with open outflow and with temporary outflow occlusion by blocking the working channel. Pressure readings were recorded as relative increases (Delta mmHg) from baseline. RESULTS: Without occlusion, the interlaminar approach produced higher lumbar epidural pressure increases than the transforaminal approach across all irrigation modalities (up to 10 mmHg). Differences at intradural levels and intracranially were small (<5 mmHg). With outflow occlusion, the pressure differential narrowed or reversed, with transforaminal access producing higher lumbar epidural and intradural pressures at higher pump settings. Intracranial pressure differences remained modest, with only small increases under occlusion at higher pump settings. CONCLUSIONS: Irrigation generates compartment- and approach-specific pressure responses. Interlaminar access shows higher baseline lumbar epidural pressure, whereas transforaminal access is more susceptible to pressure surges during occlusion. Even small intracranial pressure increases may be clinically important in susceptible patients; careful irrigation pressure control and avoidance of prolonged outflow occlusion are recommended.
The Variability of MCID, SCB, and PASS Thresholds in the Adult Spinal Deformity Literature: A Systematic Review.
Song J, Locke AR, Koehne NH … +12 more , Huang JJ, Issa TZ, Maayan O, Subramanian T, Lovecchio F, Passias P, Diebo BG, Daniels AH, Kim HJ, Lafage V, Kim JS, Cho SK
Spine (Phila Pa 1976) · 2026 May · PMID 42202809 · Publisher ↗
STUDY DESIGN: Systematic review. OBJECTIVE: We aimed to evaluate the variability in minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) threshol...
STUDY DESIGN: Systematic review. OBJECTIVE: We aimed to evaluate the variability in minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) thresholds utilized in the adult spinal deformity (ASD) literature. SUMMARY OF BACKGROUND DATA: Patient-reported outcome measures (PROMs) are increasingly employed to evaluate the outcomes in ASD patients. To distinguish clinically meaningful changes in numerical PROM values, thresholds such as MCID, SCB, and PASS have been developed. Yet, standardized thresholds for these metrics have not been established in the ASD population, potentially affecting clinical decision-making and outcome comparisons across studies. METHODS: PubMed and Embase were systematically searched for studies published from January 2000 to May 2024 that reported MCID, SCB, or PASS values following ASD surgery. Extracted data included patient demographics, study characteristics, reported threshold values, and threshold calculation methodologies. RESULTS: A total of 87 studies encompassing 23,553 ASD surgery patients were included (mean age: 59.3 y, BMI: 26.6). The most frequently reported PROMs were Oswestry Disability Index (ODI), Scoliosis Research Society-22 (SRS-22), Short Form-36 Physical Component Scale (SF-36 PCS). Overall, 371 MCID thresholds, 57 SCB thresholds, and 10 PASS thresholds were documented. Most studies (73/87) referenced previously established threshold values. Novel MCID thresholds were calculated in 14 studies, yielding 54 novel MCID thresholds for 24 different PROMs. The ranges of MCID thresholds reported were 6.8-36 for ODI, 3.3-7.83 for SF-36 PCS, 0.4-0.85 for SRS-22 Pain, and 0.4-1.6 for SRS-22 Appearance. The standard deviation of the SF-36 PCS SCB threshold (9.64) exceeded its mean value (9.4), underscoring extreme variability. CONCLUSION: MCID, SCB, and PASS threshold values in the ASD literature exhibit considerable variability, particularly among the most commonly used PROMs. Standardization of these thresholds specific to the ASD population is essential to enhance accuracy in outcome assessment, facilitate inter-study comparability, and improve clinical decision-making.
Comparison of 1-Level to 2-Level Cervical Disc Arthroplasty: A Network Meta-Analysis of Adjacent Segment Disease and All-cause Reoperations.
Guppy KH, Sulman M, Guppy HM … +4 more , Castillo JA, Hawk CW, Martin AR, Kim KD
Spine (Phila Pa 1976) · 2026 May · PMID 42202808 · Publisher ↗
STUDY DESIGN: Systematic review with network meta-analysis (NMA). OBJECTIVE: To determine if there is a difference in adjacent segment disease (ASD) and all-cause reoperations between 1-level and contiguous 2-level cervi...
STUDY DESIGN: Systematic review with network meta-analysis (NMA). OBJECTIVE: To determine if there is a difference in adjacent segment disease (ASD) and all-cause reoperations between 1-level and contiguous 2-level cervical disc arthroplasty (CDA1, CDA2). SUMMARY OF BACKGROUND DATA: There are conflicting results from previous studies that there is a difference in reoperations between CDA1 and CDA2 possibly reflecting undertreatment of adjacent cervical degenerative disc disease with its natural history in CDA1. METHODS: We conducted a random-effects NMA with only FDA Investigational Device Exemption (IDE) studies and international randomized controlled trials (RCTs) with more than 5 years of follow-up. Direct comparisons included CDA1 versus 1-level anterior cervical discectomy with fusion (ACDF1), CDA2 versus 2-level ACDF (ACDF2), and ACDF2 versus ACDF1; together, these formed a connected network in which ACDF served as the anchoring comparator, enabling anchored indirect comparisons between CDA1 and CDA2. Binary outcomes (ASD and all-cause reoperations) were analyzed using odds ratios within a frequentist framework in Stata. RESULTS: NMA for ASD reoperations had 13 studies directly comparing CDA1 vs ACDF1 (n=4,135), 2 studies comparing 2-level CDA2 vs ACDF2 (n=789), and 1 study comparing ACDF2 vs ACDF1 (n=207). Results demonstrated no significant difference in ASD reoperation (OR 0.98, 95% CI 0.38-2.54) for CDA1 versus CDA2. For all-cause reoperations there were 14 studies directly comparing CDA1 vs ACDF1 (n=4,246), 2 studies comparing CDA2 vs ACDF2 (n=837), and 1 study comparing ACDF2 vs ACDF1 (n=223). CDA1 versus CDA2, demonstrated no significant difference in all-cause reoperation (OR 0.98, 95% CI 0.40-2.39). CONCLUSIONS: In our comprehensive NMA of selected FDA IDE studies and international RCTs with long-term follow-up, we found no significant difference between 1-level CDA and 2-level CDA with respect to ASD and all-cause reoperations. Future research is needed to see if our results are replicated in real world data.
Endoscopic Lumbar Surgery in the Elderly: An Age-Stratified Systematic Review and Meta-Analysis.
Elgeadi G, Caballero A, de Pedro M
Spine (Phila Pa 1976) · 2026 May · PMID 42202774 · Publisher ↗
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To evaluate the safety and clinical effectiveness of endoscopic spinal surgery (ESS) for degenerative lumbar disease in very elderly patients, comparing outco...
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To evaluate the safety and clinical effectiveness of endoscopic spinal surgery (ESS) for degenerative lumbar disease in very elderly patients, comparing outcomes in patients aged <80 versus ≥80 years, and summarizing age-stratified symptom and disability changes. SUMMARY OF BACKGROUND DATA: ESS has gained adoption as a minimally invasive alternative to conventional lumbar decompression for degenerative lumbar pathology. However, its safety and effectiveness in very elderly patients remain uncertain, and age is often treated as a relative contraindication despite limited comparative evidence. METHODS: We systematically searched PubMed, Scopus, Web of Science, and CENTRAL from inception to October 2025 for observational studies evaluating ESS for lumbar disc herniation, lumbar spinal stenosis, or degenerative lumbar pathology with age-stratified outcomes. Eligible studies reported Visual Analog Scale (VAS) leg and/or back pain, Oswestry Disability Index (ODI), Modified Macnab criteria, or complications. Comparative random-effects meta-analyses were performed for patients aged <80 versus ≥80 years. Single-arm meta-analyses summarized mean changes in pain and disability in <70 and ≥70-year strata. RESULTS: Nineteen studies (14 retrospective cohorts, 3 prospective cohorts, 2 case series; 5753 patients) published between 2014-2025 were included. ESS was predominantly performed for lumbar spinal stenosis (11 studies) and disc herniation (7 studies), with follow-up ranging 3-120 months. In pairwise analyses, patients ≥80 years achieved comparable improvements in VAS leg pain, VAS back pain, ODI, and Modified Macnab success to those <80 years, with no significant excess in complications. Single-arm pooling demonstrated large, clinically meaningful reductions in pain and disability in both <70 and ≥70-year groups without significant between-group differences. CONCLUSIONS: ESS provides substantial and comparable symptom relief and functional improvement across age strata, supporting its use in carefully selected elderly and very elderly patients. Chronological age alone should not contraindicate ESS; future prospective, age-focused comparative studies are warranted.
Complications Following Cervical Laminoplasty With Reconstruction: A Systematic Review and Meta-Analysis.
Jain C, Yu J, Huang JJ … +9 more , Ren EM, Song J, Namiri NK, Maayan O, Corvi JJ, Issa TZ, Lin J, Crawford AM, Hecht AC
Spine (Phila Pa 1976) · 2026 May · PMID 42202771 · Publisher ↗
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To synthesize pooled complication rates following cervical laminoplasty with reconstruction and to evaluate differences by surgical indication. SUMMARY OF BAC...
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To synthesize pooled complication rates following cervical laminoplasty with reconstruction and to evaluate differences by surgical indication. SUMMARY OF BACKGROUND DATA: Cervical laminoplasty with reconstruction is a widely and increasingly used posterior decompression technique for degenerative cervical myelopathy (DCM) and ossification of the posterior longitudinal ligament (OPLL). Despite effectiveness, postoperative complications remain a concern, and a focused quantitative synthesis of complication incidence is lacking. METHODS: PubMed, Embase, and Scopus were searched from inception to March 2026 for clinical studies reporting postoperative complications after cervical laminoplasty with reconstruction. Random-effects meta-analysis of proportions using Freeman-Tukey double arcsine transformation was performed for each complication category. Subgroup analysis compared DCM and OPLL cohorts, and meta-regression assessed the association between follow-up duration and complication incidence. Sensitivity analyses included leave-one-out analysis, exclusion of large registry studies, and restriction to studies with minimum 12-month follow-up. RESULTS: Sixty-eight studies (n=6,732 patients) met inclusion criteria. Pooled complication incidences were: C5 palsy 4.07% (95% CI: 3.08-5.17%), axial neck pain 13.74% (9.14-19.02%), reoperation 2.72% (1.38-4.39%), dural/CSF complications 1.48% (0.60-2.62%), wound infection 1.89% (1.16-2.75%), hematoma 0.25% (0.00-0.89%), airway issues/dysphagia 0.68% (0.16-1.45%), and progressive kyphosis 0.80% (0.03-2.11%). C5 palsy was significantly higher in OPLL (5.86%) than DCM (3.34%) cohorts (P=0.021). Meta-regression revealed no significant association between follow-up duration and complication incidence for any category. Substantial heterogeneity (I² 34.9-91.3%) reflected variability in complication definitions and reporting practices across studies. CONCLUSIONS: This meta-analysis provides pooled incidence estimates for complications following cervical laminoplasty with reconstruction. C5 palsy is the most reliably reported complication and occurs more frequently in OPLL populations. Axial neck pain is the most common complication but is limited by highly variable definitions. Standardized complication definitions and consistent reporting are needed to improve future comparisons. LEVEL OF EVIDENCE: III: Systematic review of observational studies.
Cervical Disc Arthroplasty Has Higher Rates of Revision, But Lower Rates of Adjacent Segment Disease, Compared to ACDF.
Friedman LIN, Truumees H, Gonzalez F … +6 more , Geerling DM, Spina NT, Spiker WR, Brodke DS, Lawrence BD, Karamian BA
Spine (Phila Pa 1976) · 2026 May · PMID 42202766 · Publisher ↗
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To evaluate differences, if any, in patient selection, patient-reported outcomes, and complication profiles between anterior cervical discectomy and fusion (ACDF) and cervic...
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To evaluate differences, if any, in patient selection, patient-reported outcomes, and complication profiles between anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA). SUMMARY OF BACKGROUND DATA: ACDF has long been the standard for cervical degenerative disc disease (DDD), but concerns about adjacent segment disease (ASD) have driven interest in CDA as a motion-preserving alternative. We hypothesize that there will be differences in patient demographics, but not outcomes, for those undergoing ACDF and CDA for cervical DDD. METHODS: A retrospective review was conducted of patients undergoing single-level ACDF or CDA at a single academic institution between 2014 and 2024. Demographics, surgical characteristics, patient-reported outcomes, and complications were extracted from electronic medical records. Primary outcomes included postoperative hematoma, 30-day readmissions, ASD noted by radiology reads or in orthopedic spine clinic notes, and reoperations. RESULTS: Data from 337 patients (207 ACDF, 130 CDA) was analyzed. Compared to ACDF patients, CDA patients were younger (44.44 vs. 54.43 y, P<0.001), had lower osteoporosis rates (1.54% vs. 11.11%, P<0.001), and were most frequently ASA Class II (67.69% vs. 50.24%, P<0.001). Patient-reported outcomes generally did not differ across procedure types. Revision at the index level was more common in CDA (5.38% vs. 0.48%, P=0.006), whereas extension to an adjacent level was more common in ACDF (9.66% vs. 2.31%, P=0.008). Regression analyses controlling for age, BMI, osteoporosis, and surgical levels confirmed CDA as a unique predictor of increased revision risk (OR 12.48, P=0.042), and ACDF as a unique predictor of increased ASD risk (OR 0.11, P<0.001). CONCLUSIONS: ACDF and CDA are safe and effective for single-level cervical DDD. CDA was associated with lower readmissions and reduced adjacent pathology, but higher index-level revision risk. These findings support CDA as a motion-preserving alternative to ACDF in appropriately selected patients. LEVEL OF EVIDENCE: III.
Symptom Duration of 1 Year or More Is Associated With Worse Absolute Outcomes but Similar Clinically Meaningful Improvement After ACDF for Cervical Myelopathy.
Lee Y, Baek G, Ng M … +12 more , Dalton J, Hitchner M, Eichbaum Y, Green WA, Mathew J, Giakas A, Thomas G, Hilibrand A, Vaccaro A, Cha T, Schroeder G, Kepler C
Spine (Phila Pa 1976) · 2026 May · PMID 42202763 · Publisher ↗
STUDY DESIGN: Retrospective Cohort Study. OBJECTIVE: To evaluate the association between preoperative symptom duration and neurologic and patient-reported outcomes following anterior cervical discectomy and fusion (ACDF)...
STUDY DESIGN: Retrospective Cohort Study. OBJECTIVE: To evaluate the association between preoperative symptom duration and neurologic and patient-reported outcomes following anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA: Prior studies suggest longer duration of preoperative myelopathic symptoms may impair neurologic recovery after surgery, but its relationship with patient-reported outcome measures (PROMs) and clinically meaningful improvement remains unclear. METHODS: Adult patients undergoing primary ACDF for myelopathy at a single academic institution (2017-2023) were identified. Patients were stratified by symptom duration (<1 y versus ≥1 y). Demographic, surgical, and clinical outcomes were collected. PROMs included Short Form-12 mental and physical component scores (MCS, PCS), Visual Analog Scale (VAS) Neck and Arm, Neck Disability Index (NDI), and modified Japanese Orthopaedic Association (mJOA) scores collected preoperatively and at 3, 6, and 12 months postoperatively. Achievement of minimal clinically important difference (MCID) was assessed. RESULTS: A total of 139 patients met inclusion criteria, including 75 (54.0%) with symptom duration <1 year. Patients with <1 year of symptoms were older, less likely to have commercial insurance, less likely to undergo inpatient surgery, and underwent fusion of fewer levels. Six-month MCS (55.1 versus 50.2, P=0.038) and 3-month PCS (38.5 versus 34.3, P=0.030) were greater in the <1 year cohort. VAS Neck and NDI scores were lower at select postoperative time points in the <1 year cohort. The ≥1 year cohort demonstrated higher rates of MCID achievement for VAS Neck at 6 and 12 months. No differences were observed in mJOA scores or MCID achievement for other outcomes. CONCLUSION: Longer preoperative symptom duration was associated with worse absolute postoperative pain and disability but not neurologic recovery, with largely comparable rates of MCID achievement following ACDF. These findings suggest that delayed presentation does not preclude meaningful postoperative improvement for cervical myelopathy. LEVEL OF EVIDENCE: III.
The Performance of Prognostic Measures for Survival in Spinal Metastatic Disease in Light of Modern Advancements in Medical and Surgical Management.
Striano BM, Ferrone ML, Holly KE … +9 more , Zheng C, Nguyen A, Macksood J, Osgood A, Coan JM, Chan JP, Cronin PK, Tobert DG, Schoenfeld AJ
Spine (Phila Pa 1976) · 2026 May · PMID 42202761 · Publisher ↗
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To compare the performance of four of the most widely used scoring systems for survival in spinal metastatic disease among a representative battery of cases treated in our h...
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To compare the performance of four of the most widely used scoring systems for survival in spinal metastatic disease among a representative battery of cases treated in our health system during 2017-2022. SUMMARY OF BACKGROUND DATA: None of the popular risk scores in use today effectively account for improved survival due to advancements in immunotherapy, molecular targeted treatment and surgical techniques. METHODS: We assembled a representative battery of 997 patients who underwent operative or non-operative treatment for spinal metastases (2017-22). All patients were assigned a Tokuhashi, Tomita, Skeletal Oncology Research Group (SORG) and New England Spinal Metastasis Score (NESMS) based on data at initial presentation. The primary outcome was the discriminative capacity of the scoring utilities in predicting one-year mortality. This was evaluated using multivariable logistic regression with all variables included as co-variates. The discriminative capacity for each model was compared using the c-statistic. We also assessed the performance of operative management in conjunction with the survival score. RESULTS: One year mortality was 54%. The SORG's c-statistic was 0.75 (95% CI 0.71, 0.78), compared to 0.68 (95% CI 0.65, 0.71) for the NESMS. The c-statistic for the Tokuhashi score was 0.70 (95% CI 0.67, 0.73), while that of the Tomita scale was 0.66 (95% CI 0.63, 0.69). Only the SORG (OR 0.64; 95% CI 0.46, 0.90; P=0.01) and NESMS (OR 0.74; 95% CI 0.56, 0.97; P=0.03) preserved a significant association between surgical intervention and survival. CONCLUSIONS: We found that the performance of all scores were diminished relative to historical reports but remained adequate for the NESMS and SORG algorithm. In current practice, we believe the optimal approach entails initial use of the NESMS when considering treatment approach, with the SORG used for re-calculating survival if surgical intervention has been selected as a treatment strategy. LEVEL OF EVIDENCE: III.
Assessing the Comparative Ability of Early Postoperative T4-L1PA Mismatch versus L1PA or T4PA Alone for Predicting Mechanical Complications or Spinal Reoperations: A Retrospective Analysis.
Baumann AN, Chatzis K, Son E … +13 more , Cottrill EJ, Diebo BG, Daniels AH, Nassar JE, Janjua MB, Burke JF, Than KD, Rocos B, Pneumaticos SG, Theologis A, Schoenfeld AJ, Conry KT, Passias PG
Spine (Phila Pa 1976) · 2026 May · PMID 42202760 · Publisher ↗
STUDY DESIGN: Retrospective single-center study. OBJECTIVE: We aim to compare the prognostic capacity of postoperative T4-L1PA mismatch versus T4PA and L1PA alone. SUMMARY OF BACKGROUND DATA: The assessment of T4-L1PA mi...
STUDY DESIGN: Retrospective single-center study. OBJECTIVE: We aim to compare the prognostic capacity of postoperative T4-L1PA mismatch versus T4PA and L1PA alone. SUMMARY OF BACKGROUND DATA: The assessment of T4-L1PA mismatch, the difference between traditional radiographic parameters T4PA and L1PA, is a newer radiographic measurement that has generated interest due to the potential ability to predict complications. METHODS: We performed a retrospective analysis of a prospective single-center database and included surgical patients for ASD with pelvic fixation with complete baseline and two-year follow-up. Primary outcomes included mechanical complications and reoperation rates. Secondary outcomes included proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Predictors included were six-week T4-L1PA mismatch, T4PA, L1PA, corrected T4-L1PA mismatch defined by pelvic incidence, SAAS score, and SRS-Schwab Score. We utilized receiver operating curve bivariable analyses and multivariable regression analyses for adjustment of confounding. RESULTS: A total of 486 patients (mean age: 63.7 y; 75.5% female; mean preoperative T4-L1PA mismatch: 9.7 degrees; mean number of levels fused: 11.9 levels) had 88 mechanical complications (18.1%) and 125 reoperations (25.7%). In a multivariable regression model for mechanical complications, adding six-week T4-L1PA mismatch did not improve the model (P=0.698) in contrast to six-week T4PA (Δ-2LL: 6.9), L1PA (Δ-2LL: 7.5), and SAAS score (Δ-2LL: 6.4) (P<0.05). For spinal reoperations, adding six-week T4PA (Δ-2LL: 4.4; P=0.036) or T4-L1PA mismatch (Δ-2LL: 3.9; P=0.049) improved the regression model; however, six-week L1PA did not improve the model (P>0.05). Among patients with inadequate preoperative T4-L1PA mismatch (n=401), adding six-week L1PA improved model fit for mechanical complications (Δ-2LL: 4.7; P=0.031); however, six-week T4PA or T4-L1PA mismatch did not improve the model (P>0.05). Six-week L1PA consistently outperformed T4-L1PA mismatch on bivariable analysis. CONCLUSION: Early postoperative T4-L1PA mismatch may not serve as a greatly enhanced radiographic predictor of all-type mechanical complications or spinal reoperations, especially in comparison to either six-week T4PA or L1PA alone. LEVEL OF EVIDENCE: III.
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