Spine[JOURNAL]
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200 papers
Response to Letter to the Editor Regarding "The Impact of Teaching Hospital Status on Postoperative Outcomes Among Adults Undergoing Short Segment Lumbar Instrumentation".
Kaghazchi A, Karnati J, Ashraf A … +2 more , Jelkin G, Adogwa O
Spine (Phila Pa 1976) · 2026 Jul · PMID 42118250 · Publisher ↗
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Pathogenicity and Survival of Cutibacterium Acnes in Intervertebral Discs at Different Time Points : An In Vivo Study in Rats.
Zhang M, Deng L, Jia J … +8 more , Lei S, Cao Z, Ma M, Wang J, Xing S, Hu X, Huang L, Kang X
Spine (Phila Pa 1976) · 2026 Jul · PMID 42118249 · Publisher ↗
STUDY DESIGN: An animal laboratory study. OBJECTIVE: This study aimed to investigate the pathogenicity and survival of Cutibacterium acnes ( C. acnes ) in rat intervertebral discs (IVD) across different time periods. SUM...
STUDY DESIGN: An animal laboratory study. OBJECTIVE: This study aimed to investigate the pathogenicity and survival of Cutibacterium acnes ( C. acnes ) in rat intervertebral discs (IVD) across different time periods. SUMMARY OF BACKGROUND DATA: Since C. acnes was proposed as a potential causative agent of intervertebral disc degeneration (IDD), it has been the subject of widespread controversy. This study examined the removal of C. acnes from IVD, supporting the theory of its role in IDD. MATERIALS AND METHODS: Fifty rats were randomly assigned to a control group or groups with different C. acnes -causing bacterial exposure periods (4, 8, 12, and 16 wk). Except for the control group, rats in the experimental group received 5 μl of C.acnes (1×10⁷ CFU/mL) injected at L5-6. X-ray examinations, magnetic resonance imaging (MRI), fluorescence in situ hybridization (FISH) assays, tissue staining, tissue immunofluorescence (IF), and real-time polymerase chain reaction (RT-PCR) were performed. RESULTS: X-rays revealed that the C. acnes group exhibited mild narrowing of the intervertebral space four weeks postoperatively. MRI revealed that the T2-weighted signal intensity of the nucleus pulposus (NP) in the C. acnes group decreased at four weeks after operation. Histochemical staining revealed that at 4, 8, 12, and 16 weeks postinfection, the C. acnes group exhibited reduced IVD height and structural disruption of the IVD. IF results indicated a significant decrease in Aggrecan expression and a significant increase in MMP3 expression in the C. acnes group. C.acnes were cultured in IVD samples at 4, 8, and 12 weeks, while C.acnes were not cultured in IVD tissues at 16 weeks. CONCLUSION: Infection of rat IVD with C. acnes -induced IDD at all time points postinfection. Furthermore, as the duration of infection increased, C. acnes became increasingly difficult to culture from IVD tissue.
Spinal Injury Trends During Swords of Iron War.
Chechik Y, Abuhasira S, Akler D … +2 more , Shapiro A, Shapira S
Spine (Phila Pa 1976) · 2026 Jul · PMID 42118169 · Publisher ↗
OBJECTIVES: To analyze the incidence, mechanisms, anatomic distribution, and clinical outcomes of combat-related spinal injuries during high-intensity modern warfare ("Swords of Iron War"). SUMMARY OF BACKGROUND DATA: Co...
OBJECTIVES: To analyze the incidence, mechanisms, anatomic distribution, and clinical outcomes of combat-related spinal injuries during high-intensity modern warfare ("Swords of Iron War"). SUMMARY OF BACKGROUND DATA: Combat-related spinal trauma has seen a rising incidence in recent conflicts, primarily driven by high-energy mechanisms such as explosive devices. These injuries often result in severe neurological deficits and present as part of complex polytrauma, yet data regarding the specific trends in recent urban warfare remain limited. MATERIALS AND METHODS: A retrospective observational study was conducted in two stages using the Israel Defense Force (IDF) Trauma Registry and Electronic Medical Records between October 2023 and June 2025. Stage one analyzed 3972 urgent prehospital casualties to determine the incidence and systemic severity of spinal injuries. Stage two focused on 105 hospital-confirmed spinal injury cases to delineate specific anatomic patterns, injury mechanisms, and surgical management. RESULTS: The incidence of spinal injury was 2.2% among urgent casualties. Spinal trauma served as a significant marker for injury severity, with 45.0% of patients exhibiting an injury severity score (ISS) ≥25, compared with 12.0% in the nonspinal group ( P <0.001). Explosive mechanisms (including combined explosion and ballistic trauma) predominated, accounting for 47.6% of cases. While total injuries were relatively balanced across spinal regions, major fractures were disproportionately concentrated in the lower segments, with the lumbar and sacral regions accounting for 35% and 26% of all major fractures, respectively. Neurological deficits were present in 42.9% of the cohort. Spinal fixation was the most frequent surgical intervention, primarily in the lumbar region, and 66.7% of all cases were managed nonoperatively. CONCLUSIONS: Combat-related spinal injuries are uncommon but serve as a critical indicator of high-energy multisystem polytrauma. The distinct pattern of major fractures favoring the lower spinal segments, likely due to axial blast loading, necessitates specialized triage and care to optimize functional outcomes.
Incidence and Causes of Death after Cervical or Thoracolumbar Adult Spinal Deformity Surgery.
Mo K, Sulieman A, Smith JS … +25 more , Passias PG, Tretiakov P, Bess S, Wang KY, Yeramaneni S, Neuman BJ, Hostin RA, Gum JL, Lafage R, Protopsaltis TS, Gupta MC, Ames CP, Klineberg EO, Hamilton DK, Schwab FJ, Daniels AH, Soroceanu A, Kim HJ, Line BG, Lafage V, Shaffrey CI, Lenke LG, Lee SH, Kebaish KM, International Spine Study Group
Spine (Phila Pa 1976) · 2026 May · PMID 42118075 · Publisher ↗
STUDY DESIGN: Prospective multicenter study. OBJECTIVE: To determine the incidence of all-cause mortality after adult spinal deformity surgery. SUMMARY OF BACKGROUND DATA: Patients undergoing adult spinal deformity surge...
STUDY DESIGN: Prospective multicenter study. OBJECTIVE: To determine the incidence of all-cause mortality after adult spinal deformity surgery. SUMMARY OF BACKGROUND DATA: Patients undergoing adult spinal deformity surgery are often frail and the procedures are invasive. The incidence of all-cause mortality among patients undergoing cervical or thoracolumbar deformity surgery is unclear. METHODS: Using 2 prospective, multicenter databases, we identified patients who underwent surgery for cervical deformity surgery from 2013-2020 (n=169) or thoracolumbar deformity from 2008-2020 (n=1507). Mortality incidence density was calculated as follows: 100 × (number of deaths) / (sum of total years of follow-up for all patients). RESULTS: Of 169 participants in the cervical group (mean±standard deviation age, 61±10 y), death occurred in 19 (11%). The mean time to death was 25±19 months. Mortality incidence density was 4.4 deaths per 100 person-years. The 30-day mortality rate was 0.6% (1/169) and 90-day mortality rate was 1.2% (2/169). The 3 most common causes of death were arrhythmia/cardiac arrest (16%), congestive heart failure (11%), and pneumonia (11%). There were no intraoperative deaths. Of 1507 participants in the thoracolumbar group (mean±standard deviation age, 61±14 y), death occurred in 53 (3.5%). The mean time to death was 32.5±21.5 months. Mean duration of follow-up was 1.8±1.5 years. The mortality incidence density was 0.8 deaths per 100 person-years. The 30-day mortality rate was 0.1% (1/1507) and 90-day mortality rate was 0.3% (4/1507). The 3 most common causes of death were non-spine malignancy (13%), pneumonia (9%), and arrhythmia/cardiac arrest (6%). CONCLUSIONS: The number of deaths per year was higher among cervical deformity patients (4.4 per 100 person-years) than among thoracolumbar deformity patients (0.8 per 100 person-years). Pneumonia and arrhythmia/cardiac arrest were among the most common causes of death in both groups. LEVEL OF EVIDENCE: III.
Impact of the Level of Maximal Spinal Canal Stenosis on Clinical Manifestations and Surgical Outcomes in Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study.
Nagoshi N, Egawa S, Sakai K … +39 more , Kusano K, Tsutsui S, Hirai T, Matsukura Y, Wada K, Katsumi K, Koda M, Kimura A, Furuya T, Maki S, Nishida N, Nagamoto Y, Oshima Y, Ando K, Nakashima H, Endo T, Mori K, Nakajima H, Murata K, Miyagi M, Kaito T, Yamada K, Banno T, Kato S, Ohba T, Takahata M, Moridaira H, Fujibayashi S, Katoh H, Kanno H, Watanabe K, Taneichi H, Imagama S, Kawaguchi Y, Takeshita K, Nakamura M, Matsumoto M, Yamazaki M, Yoshii T
Spine (Phila Pa 1976) · 2026 May · PMID 42118055 · Publisher ↗
STUDY DESIGN: Prospective multicenter cohort study. OBJECTIVES: To clarify whether differences in the level of maximal spinal canal stenosis are associated with distinct patterns of neurological impairment and postoperat...
STUDY DESIGN: Prospective multicenter cohort study. OBJECTIVES: To clarify whether differences in the level of maximal spinal canal stenosis are associated with distinct patterns of neurological impairment and postoperative functional recovery in patients with cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA: Although cervical OPLL is a major cause of compressive myelopathy, it remains unclear whether the level of maximal stenosis influences symptom severity and postoperative functional recovery in this disease entity. METHODS: A total of 402 patients who underwent surgery for cervical OPLL were prospectively enrolled from a nationwide multicenter cohort. Patients were stratified according to the level of maximal stenosis into an upper cervical stenosis group (C4/5 or more cranial) and a lower cervical stenosis group (C5 or more caudal). Clinical outcomes were assessed preoperatively and at 2-year follow-up using the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). Multivariable analyses were performed to adjust for potential confounders. RESULTS: Patients with upper cervical stenosis exhibited significantly worse preoperative neurological function than those with lower cervical stenosis. Despite this baseline difference, postoperative neurological improvement was comparable between groups. Improvement in arm and hand pain or numbness was significantly greater in the upper stenosis group, whereas improvement in lower extremity function, assessed by the JOACMEQ, was significantly poorer in patients with lower cervical stenosis. The incidence of perioperative complications did not differ significantly between groups. CONCLUSION: The level of maximal spinal canal stenosis significantly influences symptom patterns and domain-specific functional recovery in cervical OPLL. These findings provide important information for surgical decision-making and prognostic counseling in cervical OPLL.
Preoperative CT-Based Finite Element Vertebral Modulus Analysis Predicts Bone Quality-Related Complications After Lumbar Spine Fusion.
Chang G, Rajapakse CS, Philipp TC … +3 more , Madi R, Sheth NP, Protopsaltis TS
Spine (Phila Pa 1976) · 2026 Apr · PMID 42118036 · Publisher ↗
STUDY DESIGN: Retrospective single-center cohort study. OBJECTIVE: To evaluate whether preoperative CT-based finite element analysis (FEA) of vertebral bone modulus predicts bone quality-related complications after lumba...
STUDY DESIGN: Retrospective single-center cohort study. OBJECTIVE: To evaluate whether preoperative CT-based finite element analysis (FEA) of vertebral bone modulus predicts bone quality-related complications after lumbar spine fusion. SUMMARY OF BACKGROUND DATA: In spine surgery patients, poor bone quality increases the risk of proximal junctional kyphosis/failure, pedicle screw loosening, adjacent segment disease, and pseudoarthrosis, leading to higher revision rates. DXA-based areal bone mineral density (BMD) often fails to identify high-risk patients, particularly in degenerative spines. Three-dimensional CT-based methods, such as Hounsfield units (HU), volumetric BMD, and CT-based FEA, may better capture vertebral mechanical competence by integrating density and microarchitecture. METHODS: Patients undergoing lumbar fusion at a single academic center in 2017 with ≥2-year follow-up were included (n=85) and classified by the presence of bone quality-related complications. For L1-L5 on preoperative CT, trabecular VOIs were analyzed to obtain mean HU, phantomless-calibrated BMD, and FEA-derived bone modulus. Group differences were assessed with independent-samples t tests, and ROC analysis and multivariable logistic regression examined associations with complication status. RESULTS: Thirty-one patients (36.5%) experienced ≥1 bone quality-related complication; 18 had ≥2 events. Bone modulus was significantly lower in the complication cohort (-15.7% to -23.2%; all p≤0.02), whereas HU and BMD differences were nonsignificant. Bone modulus showed greater ability to distinguish patients with and without complications (AUC 0.65-0.70; all P<0.03), while HU and BMD did not (AUC ~0.57-0.60; all P>0.10). Multivariable models including modulus, BMD, and demographics achieved AUC up to 0.81 at L5 (P<0.001). CONCLUSION: Preoperative CT-based FEA of vertebral bone modulus outperforms HU and BMD in identifying lumbar fusion patients at risk for bone quality-related complications and may provide a useful adjunct for preoperative risk stratification and surgical planning.
Multimodal Imaging Predictors of FEA-Derived Lumbar Vertebral Compression Strength.
Mielke AM, Tani S, Ishikawa K … +11 more , Burkhard MD, Verna B, Guven AE, Tan ET, Carrino JA, Zhu J, Shue J, Girardi FP, Sama AA, Cammisa FP, Hughes AP
Spine (Phila Pa 1976) · 2026 Apr · PMID 42118026 · Publisher ↗
STUDY DESIGN: Retrospective cross-sectional study. OBJECTIVE: To identify multimodal imaging predictors of lumbar vertebral compression strength (CS), focusing on volumetric bone mineral density (vBMD), vertebral bone qu...
STUDY DESIGN: Retrospective cross-sectional study. OBJECTIVE: To identify multimodal imaging predictors of lumbar vertebral compression strength (CS), focusing on volumetric bone mineral density (vBMD), vertebral bone quality (VBQ), abdominal aortic calcification (AAC), and multifidus fatty infiltration (FI), and to evaluate the cumulative and incremental predictive value of these routinely available imaging and patient-level factors for FEA-derived CS. SUMMARY OF BACKGROUND DATA: Preoperative assessment of vertebral strength is essential in spine surgery. While quantitative CT (QCT)-derived vBMD and MRI-based VBQ have been proposed as surrogate markers of bone integrity, their relative predictive value for biomechanical failure remains unclear. Paraspinal muscle FI has been associated with poorer functional and postoperative outcomes, yet its contribution to vertebral CS is underexamined. METHODS: A retrospective analysis of 76 patients undergoing lumbar fusion with preoperative CT and MRI (2014-2020) was performed. Vertebral CS at L1 was calculated using CT-based finite element analysis (FEA). vBMD at L1-L2 was measured using asynchronous QCT. VBQL1/2 was derived from T1-weighted MRI normalized to cerebrospinal fluid. Multifidus FI was quantified at L4 on axial T2-weighted MRI. AAC was graded on lateral lumbar radiographs. Spearman correlation and multivariable linear regression were used to identify CS predictors. RESULTS: Higher vBMD was associated with greater CS across all models (β=64.7-67.3 N per mg/cm³; all P <0.001). Neither VBQL1/2 nor AAC showed independent associations with CS or improved model performance. Multifidus FI showed a positive but non-significant association with CS (β=51.3 N per % increase; P=0.078), representing a trend, and its inclusion modestly increased overall model fit (adjusted R²=0.781). Sex remained a significant predictor in all models (P <0.001). CONCLUSION: vBMD was the only imaging biomarker reliably predicting vertebral CS, underscoring its central role in preoperative bone quality assessment. VBQ, AAC, and multifidus FI, did not independently predict CS. Although multifidus FI was not statistically significant, its modest improvement of model performance suggests a potential secondary contribution to vertebral biomechanics. CT-based evaluation remains essential for identifying patients at risk of vertebral fragility.
Editorial. Blurring boundaries: revisiting scope, training, and competency in spine intervention.
Gelinne AM, Harbert A, Hadar E … +1 more , Upadhyaya CD
J Neurosurg Spine · 2026 May · PMID 42102411 · Publisher ↗
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Prevalence of interventional spine procedures performed by pain management physicians: blurred boundaries.
Giraldo JP, Williams GP, Dholaria N … +5 more , Haberman B, Lee KE, Lee JJ, Turner JD, Uribe JS
J Neurosurg Spine · 2026 May · PMID 42102410 · Publisher ↗
OBJECTIVE: Interventional pain management physicians (IPMPs) and spine surgeons are allies in treating spinal disorders. In addition to medical management, IPMPs can perform procedures such as epidural injections, rhizot...
OBJECTIVE: Interventional pain management physicians (IPMPs) and spine surgeons are allies in treating spinal disorders. In addition to medical management, IPMPs can perform procedures such as epidural injections, rhizotomies, or kyphoplasties to bring relief to patients. However, some IPMPs perform procedures traditionally performed by spine surgeons, such as minimally invasive spine surgery, neural decompression, and spinal fusion. The line between spine procedures performed by spine surgeons and interventional pain management procedures performed by IPMPs has blurred. This study aimed to determine the incidence of IPMPs performing interventional spinal procedures traditionally performed by spine surgeons. METHODS: IPMPs were identified through the American Society of Interventional Pain Physicians (ASIPP) DoctorFinder database. Each physician's Scopus profile was evaluated to determine academic productivity. Personal physician websites were queried to determine whether they offered minimally invasive or open spinal procedures. Potential associations and differences among IPMPs performing interventional spinal procedures were analyzed using descriptive statistics, independent-sample t-tests, and chi-square analyses. RESULTS: After neurosurgeons and orthopedic surgeons were removed from the initial list of 325 registered healthcare providers, 269 providers were included in the analysis (mean [SD] age, 56.3 [9.6] years). Physician degrees included MD (n = 237) and DO (n = 32). Some physicians held an additional degree (MS [n = 4], PhD [n = 4], and unspecified [n = 38]). Of the 269 healthcare providers, 130 had Scopus research profiles (mean publications, 24.2; mean h-index, 6.0; mean citations, 925.6). Seventy-four physicians (27.5%) performed interventional spinal procedures: 35 (13.0%) performed minimally invasive lumbar decompression (mild procedure), 33 (12.3%) performed Superion or Vertiflex interspinous spacer insertion, 18 (6.7%) performed spinal arthrodesis or fusion, 26 (9.7%) performed discectomies, 11 (4.1%) performed Minuteman interspinous-interlaminar fusion, 1 (0.4%) performed disc replacement, and 14 (5.2%) performed other unspecified decompressive spinal procedures. There were no significant differences in age (p = 0.62), publication number (p = 0.19), h-index (p = 0.53), citation count (p = 0.44), and fellowship incidence (p = 0.19) between IPMPs who performed interventional spine procedures and those who did not. No significant associations were found between sex (p = 0.19), medical degree (MD: p = 0.07, DO: p = 0.11), or number of publications (p = 0.38) and whether interventional spinal procedures were performed. CONCLUSIONS: The incidence of invasive spine procedures performed by IPMPs is high. Future studies must analyze patient-reported outcomes, and differences in the training for traditional spine surgery interventions performed by surgeons and interventional pain spinal procedures performed by IPMPs must be better defined.
Age-related differences in surgical outcomes for traumatic central cord syndrome: a multi-institutional causal machine learning analysis.
Aude CA, Vattipally VN, Jillala R … +13 more , Khalifeh J, Hughes LP, Jo J, Byrne JP, Witiw CD, Chryssikos T, Schwartzbauer G, Williams JR, Lubelski D, Bydon A, Witham TF, Theodore N, Azad TD
J Neurosurg Spine · 2026 May · PMID 42102409 · Publisher ↗
OBJECTIVE: Traumatic central cord syndrome (TCCS) is the most common incomplete spinal cord injury, yet the optimal management strategy remains controversial, particularly for older adults who often present with worse ou...
OBJECTIVE: Traumatic central cord syndrome (TCCS) is the most common incomplete spinal cord injury, yet the optimal management strategy remains controversial, particularly for older adults who often present with worse outcomes. The authors aimed to determine whether surgical intervention confers different benefits across age groups, focusing on 1-year functional and neurological recovery. METHODS: The authors retrospectively analyzed 890 patients with TCCS from the multi-institutional Spinal Cord Injury Model Systems (SCIMS) Database between 2006 and 2021. TCCS was defined as an American Spinal Injury Association (ASIA) Impairment Scale grade C or D cervical injury and at least a 5-point discrepancy favoring lower extremity motor score over upper extremity motor score. Missing admission ASIA data were addressed via validated random forest imputation. The authors compared surgical versus nonsurgical groups using full optimal matching to reduce confounding, achieving balanced cohorts (698 patients in the surgical group vs 179 in the nonsurgical group). The authors then applied a causal forest algorithm to detect heterogeneous treatment effects and used segmented regression to identify age-related inflection points. The primary outcome was the Physical Function Composite Score (PFCS) (range 0-300), which captures physical independence, mobility, and occupational function. Sensitivity analyses further evaluated neurological recovery on the basis of ASIA motor scores and stricter criteria for TCCS identification after the exclusion of imputed data. RESULTS: Across the matched cohort, surgery was associated with mean PFCS improvement of 6.6 points (95% CI -4.5 to 17.8), which did not reach statistical significance. However, subgroup analysis revealed that age was the strongest effect modifier of surgical benefit (relative importance 42.8%, p < 0.001). Segmented regression identified an inflection at approximately 64 years of age. Patients older than 64 years demonstrated a significant improvement of 34.7 points (95% CI 12.2-57.2), whereas younger individuals showed no statistically significant surgical benefit (-4.1 points, 95% CI -16.8 to 8.6). All sensitivity analyses were consistent with the results of our primary findings. CONCLUSIONS: The authors' findings suggest that the effectiveness of surgical intervention for TCCS may be influenced by age, with adults older than 64 years experiencing differentially greater functional and neurological benefit. These results may inform patient-specific treatment decisions and clinical guidelines. Prospective research is needed to validate these observations, elucidate underlying mechanisms, and guide evidence-based TCCS management.
Initial follow-up results in patients undergoing uniportal full endoscopic cervical unilateral laminotomy for bilateral decompression.
Cho SS, Hwang YH, Madi M … +2 more , Heo DH, Kim HS
J Neurosurg Spine · 2026 May · PMID 42102404 · Publisher ↗
OBJECTIVE: Cervical spondylosis affects 5%-20% of the population and is commonly managed with posterior decompression. However, early studies of laminectomy without fusion revealed a significant risk of postoperative kyp...
OBJECTIVE: Cervical spondylosis affects 5%-20% of the population and is commonly managed with posterior decompression. However, early studies of laminectomy without fusion revealed a significant risk of postoperative kyphosis, leading to the adoption of laminectomy with posterior fixation or laminoplasty as the standard of care. The aim of this study was to assess whether posterior decompression performed via a uniportal full endoscopic approach can achieve adequate decompression of the cervical spinal cord while preserving postoperative alignment. METHODS: This single-surgeon single-institution retrospective case series included patients who underwent uniportal full endoscopic cervical unilateral laminotomy for bilateral decompression (UNI-CE-ULBD) between August 2023 and August 2024. Radiography, CT, and MRI performed preoperatively and at 1, 3, 6, and 12 months postoperatively were used to assess canal decompression, cervical alignment, and range of motion (ROM). RESULTS: UNI-CE-ULBD was performed in 42 patients, and 15 patients (10 male, mean age 61.1 ± 9.9 years) who completed ≥ 9 months of follow-up (mean 12.1 ± 3.8 months, range 9.0-18.1) were included in the analysis. The mean canal stenosis improved from 37.2% ± 12.1% preoperatively to 5.2% ± 14.5% 6 months postoperatively (p < 0.0001). No significant change in cervical alignment, segmental angles, or ROM was observed. Four patients exhibited mild reductions in cervical lordosis. Clinically, patients showed significant improvements in neck/arm pain and myelopathy. Of 6 patients with preoperative motor deficits, 4 improved measurably and none experienced new or worsening deficits. The mean modified Japanese Orthopaedic Association score increased from 14.0 ± 1.7 to 15.7 ± 1.0 (p = 0.0001). There were no intraoperative complications, perioperative adverse events, or reoperations. CONCLUSIONS: In this retrospective case series, UNI-CE-ULBD achieved effective cervical cord decompression without short-term postoperative malalignment and might offer a minimally invasive alternative to traditional fusion-based posterior approaches in appropriately selected patients.
From anticipation to achievement: evaluating the impact of preoperative expectations on postoperative patient satisfaction in lumbar decompression surgeries.
Edalati K, Bansal A, Nguyen KT … +5 more , Jeffko M, Wilson P, Lipson P, Saifi C, Louie PK
J Neurosurg Spine · 2026 May · PMID 42102403 · Publisher ↗
OBJECTIVE: Patient expectations significantly influence perceived success and satisfaction following spine surgery. While objective metrics assess outcomes, patient-reported outcomes (PROs) are the gold standard for eval...
OBJECTIVE: Patient expectations significantly influence perceived success and satisfaction following spine surgery. While objective metrics assess outcomes, patient-reported outcomes (PROs) are the gold standard for evaluating subjective outcomes and health-related quality of life. Recent studies highlight the complex relationship between preoperative expectations and postoperative satisfaction in spine surgeries. However, the impact of preoperative expectations on PROs for lumbar decompression remains unexplored. The objective of this study was to examine how preoperative expectations influence postoperative satisfaction following lumbar decompression surgery. METHODS: This prospective cohort study included adults undergoing primary or revision 1- to 2-level lumbar laminectomy or discectomy at a single center between July 2023 and August 2024. PRO measures included the Musculoskeletal Outcomes Data Evaluation and Management Systems instrument, Oswestry Disability Index (ODI), SF-36, and satisfaction (scale 0-100) collected before surgery and 6 weeks, 3 months, and 6 months after surgery. Expectation-outcome mismatch was calculated as preoperative expectation minus postoperative outcome. Multivariable linear regression was used to assess the association between mismatch and satisfaction while adjusting for demographic and clinical covariates. RESULTS: Of 104 enrolled patients, 89 (mean age 64.9 years) were included in this analysis. Preoperative expectation for pain relief was high, with 91% of patients anticipating significant improvement, yet this was achieved postoperatively in only 69%-71%. Lumbar decompression produced substantial functional gains, with the mean ODI score improving from 39.9 ± 17.8 preoperatively to 19.7 ± 19.4 at 3 months, and SF-36 scores showing marked improvement. Expectation-outcome mismatch was the strongest predictor of satisfaction at all time points. Each 10-point increase in mismatch was associated with an approximately 8-point decrease in satisfaction postoperatively at 6 weeks, 3 months, and 6 months (all p < 0.001). No demographic or clinical factors predicted satisfaction at 6 months. CONCLUSIONS: Expectation-outcome alignment was the primary determinant of postoperative satisfaction following lumbar decompression. Although patients experienced substantial improvements in disability and quality of life, many did not experience the degree of pain relief they anticipated, and unmet expectations were closely associated with lower satisfaction across all recovery stages. These findings highlight the clinical value of structured realistic preoperative counseling focused on anticipated pain relief, functional recovery, and expected recovery timelines. Incorporating expectation management into routine preoperative discussions might reduce mismatch, improve satisfaction, and support more patient-centered perioperative care.
The Prevalence and Characteristics of Operative Tandem Spinal Stenosis: A Retrospective Database Study of 4,484 Patients at a Single Center.
Furuya M, Okuda S, Nagamoto Y … +7 more , Matsumoto T, Takahashi Y, Iwasaki M, Fujimori T, Kanie Y, Shinyashiki K, Okada S
Spine (Phila Pa 1976) · 2026 Apr · PMID 42102259 · Publisher ↗
STUDY DESIGN: A retrospective database study. OBJECTIVE: To clarify the prevalence and characteristics of Operative Tandem Spinal Stenosis (O-TSS)-the condition requiring surgery in at least two different spinal regions...
STUDY DESIGN: A retrospective database study. OBJECTIVE: To clarify the prevalence and characteristics of Operative Tandem Spinal Stenosis (O-TSS)-the condition requiring surgery in at least two different spinal regions (cervical, thoracic, or lumbosacral)-focusing on patients with a history of thoracic spine surgery. SUMMARY OF BACKGROUND DATA: While repeat surgery for adjacent or same-level disease is well-documented, the characteristics of patients requiring surgery in different spinal regions-defined here as O-TSS-are not well understood, particularly regarding the thoracic spine due to lower surgical volumes. METHODS: We analyzed 4,484 patients who underwent primary surgery for degenerative spinal disease at a single institution over a 20-year period (2000-2019). O-TSS was defined as a history of surgery in ≥2 different spinal regions (cervical, thoracic, or lumbosacral), including both concurrent and subsequent identification of multi-regional lesions. Prevalence and surgical intervals were analyzed across cohorts. RESULTS: The overall prevalence of O-TSS was 5.0% (224/4,484; 95% CI, 4.4%-5.7%). The prevalence among patients with a history of thoracic surgery was a striking 42.0% (95% CI, 34.7%-49.7%), significantly higher than in the cervical (16.0%) and lumbosacral (6.0%) cohorts (P<0.0001). Intriguingly, while older age and male sex were associated with O-TSS in the cervical or lumbosacral cohorts, these factors were not significant in the thoracic cohort. Furthermore, the high prevalence in thoracic patients was consistent across different pathologies (myelopathy, OPLL/OLF, and disc herniation). The mean interval to a subsequent surgery was shortest after a thoracic procedure. CONCLUSION: Patients with a history of degenerative thoracic spine surgery represent a unique population with a significantly high prevalence of O-TSS (42.0%). This high prevalence appears to be independent of patient demographics or the specific underlying pathology. Maintaining a high index of clinical suspicion for additional lesions is warranted in this specific population.
Filling A Critical Gap in Metastatic Spine Care: A Novel Classification System for Neoplastic Cauda Equina Compression.
Younus I, Jain H, Sarikonda A … +21 more , Bonday R, Ahluwalia R, Zeoli T, Jonzzon S, Peterson K, Liles C, Perrone G, Chanbour H, Nian H, Kelly P, Lee R, Dewan M, Luo L, Whitaker R, Kohutek Z, Gaines D, Bonfield C, Lugo-Pico J, Abtahi AM, Stephens BF, Zuckerman SL
Spine (Phila Pa 1976) · 2026 Apr · PMID 42102256 · Publisher ↗
STUDY DESIGN: Cross-sectional survey and retrospective-cohort study (2010-21). OBJECTIVES: We sought to:1) create a novel epidural cauda-equina compression (ECEC) grading system, 2) determine its inter/intrarater reliabi...
STUDY DESIGN: Cross-sectional survey and retrospective-cohort study (2010-21). OBJECTIVES: We sought to:1) create a novel epidural cauda-equina compression (ECEC) grading system, 2) determine its inter/intrarater reliability, and 3) report its ability to predict preoperative neurologic status. SUMMARY OF BACKGROUNDS DATA: While metastatic epidural spinal-cord compression is well characterized, ECEC remains poorly understood. METHODS: Patients undergoing ECEC surgery were included. Severity was graded on axial MRI using a novel 4-point scale:Grade-0=Bone-only; Grade-1=Thecal sac indented<50% effaced; Grade-2=≥50% thecal sac effaced; Grade-3=Entire thecal sac effaced, no cerebrospinal fluid seen; +F modifier signified foraminal stenosis. Primary outcomes were inter/intrarater reliability, and the score's ability to predict baseline neurologic deficits. Reliability was assessed among spine surgeons, trainees, and radiation oncologists using intraclass correlation coefficient. RESULTS: The survey included 9 spine-attendings, 7 trainees, and 4 radiation oncologists. Among 45 patients (mean age:61.6±10.6 y; 64.4% male), 15.5% each had Grade-1/2 compression, while 68.9% had Grade-3; foraminal stenosis was present in 82.2%. Grade 0-3: Overall inter/intrarater reliability was good at 0.635(95%CI:0.412-0.776) and 0.676(95%CI:0.503-0.810), with similar performance among spine-attendings (inter/intrarater:0.611;0.662), trainees (inter/intrarater:0.685;0.707), and radiation oncologists (inter/intrarater:0.634;0.679). Sensory deficits (28.6% vs. 28.6% vs. 16.1%,P=0.627), motor deficits (71.4% vs. 57.1% vs. 35.5%,P=0.171) and bowel/bladder disturbances (0% vs. 28.6% vs. 19.4%,P=0.346) were similar across grades. +F Modifier: Overall inter/intrarater reliability were poor at 0.350 (95%CI:0.180-0.505) and 0.391(95%CI:0.219-0.555), with fair reliability for spine-attendings (inter/intrarater:0.421;0.485), and trainees (inter/intrarater:0.414;0.443), and poor for radiation oncologists (inter/intrarater:0.259;0.299). Baseline neurological status showed no association with foraminal stenosis. CONCLUSION: The novel ECEC grading system provides a reliable framework for characterizing metastatic ECEC, demonstrating good reliability for Grades-0-3 across spine surgeons, trainees, and radiation oncologists. Although compression grade was not associated with neurologic deficits, bowel/bladder deficit rates were non-significantly higher in Grades-2/3. Conversely, foraminal-modifier's poor reliability underscores limitations of static MRI in assessing foraminal stenosis. Overall, ECEC scale may enhance communication in describing neoplastic ECEC.
Risk Factors for Venous Thromboembolism Following Surgery for Thoracolumbar Fractures.
Goheer HE, Kolady R, Yang PT … +5 more , Botros M, Malhotra A, Haddas R, Molinari RW, Puvanesarajah V
Spine (Phila Pa 1976) · 2026 Apr · PMID 42085705 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To identify risk factors for venous thromboembolism (VTE) following operative intervention for thoracolumbar (TL) fractures. SUMMARY OF BACKGROUND DATA: VTE is a commo...
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To identify risk factors for venous thromboembolism (VTE) following operative intervention for thoracolumbar (TL) fractures. SUMMARY OF BACKGROUND DATA: VTE is a common complication following spine surgery. However, there is a paucity of literature focusing on risk factors for VTE in patients undergoing operative intervention for TL fractures. METHODS: The TriNetX research database was queried to identify patients undergoing operative intervention for TL fractures between 2016 and 2024. Chi-square for categorical values and Student's t-test for continuous variables were performed on demographic variables and preoperative comorbidities. Multivariable logistic regression analysis with restricted cubic splines for age and body mass index was performed to identify independent risk factors for VTE within 90 days postoperatively. RESULTS: A total of 4737 patients undergoing operative intervention for TL fractures were identified between 2016 and 2024, of whom 192 (4.1%) developed VTE and 4545 (95.9%) did not. Patients who developed VTE had a significantly higher prevalence of concurrent femur fractures (2.6% vs. 0.8%; P=0.044), surgical complications (3.6% vs. 1.0%; P=0.002), and major medical complications (40.1% vs. 21.0%; P<0.001). After adjustment, male sex (OR: 1.767; 95 CI [1.266-2.506]; P<0.001), preoperative anemia (OR: 3.035; 95 CI [2.130-4.274]; P<0.001), congestive heart failure (OR: 1.632; 95 CI [1.042-2.511]; P<0.001), osteoporosis (OR: 1.671; 95 CI [1.065-2.563]; P=0.022), and femur fracture (OR: 1.2.752; 95 CI [1.001-6.767]; P=0.044) independently increased the risk for VTE within 90 days following a TL fracture. CONCLUSION: Male sex, preoperative anemia, congestive heart failure, osteoporosis, and concurrent femur fracture were identified as independent risk factors for the development of VTE following operative intervention for TL fractures. These findings may improve stratification of VTE risk in this population.
Revisiting Survival in the Treatment of Spinal Metastases From Lung Cancer in the Modern Era of Immunotherapy and Molecular Targeted Treatment (2017-2022).
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 Jul · PMID 42085700 · Publisher ↗
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To assess survival among patients with spinal metastases from lung cancer treated over a time period that accounts for advances in immunotherapy and targeted treatments. SUM...
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To assess survival among patients with spinal metastases from lung cancer treated over a time period that accounts for advances in immunotherapy and targeted treatments. SUMMARY OF BACKGROUND DATA: The use of immunotherapy and targeted treatments has improved survival for patients with lung cancer, questioning whether secular trends have ushered in a new landscape in the field of spinal metastases. MATERIALS AND METHODS: We identified patients who underwent operative or nonoperative treatment for spinal metastases (2017-2022). The primary outcome was one-year survival. We used multivariable logistic regression analysis to adjust for confounders, including all variables abstracted as covariates based on the conceptual model. We also assessed for interactions between lung cancer and surgical intervention and between surgical intervention and immunotherapy. RESULTS: We included 997 patients, with 228 (22.9%) possessing a primary lung cancer diagnosis. At one year, lung cancer was significantly associated with the odds of mortality (OR: 2.01; 95% CI: 1.44-2.82). Surgical intervention (OR: 0.70; 95% CI: 0.53-0.92), serum albumin of 3.5 g/dL or greater (OR: 0.34; 95% CI: 0.24-0.47) and ambulatory status (OR: 0.47; 95% CI: 0.34-0.64) were all significantly associated with reduced likelihood of mortality. There was no significant association between immunotherapy and one-year survival (OR: 0.82; 95% CI: 0.61-1.11; P =0.19). At 30 days (OR: 0.55; 95% CI: 0.29-0.98) and 90 days (OR: 0.65; 95% CI: 0.45-0.93), immunotherapy was significantly associated with survival. CONCLUSIONS: One-year survival in the cohort of patients with spinal metastases derived from lung cancer was significantly lower than that of metastases from other cancers. Surgical intervention did not mitigate this fact. Immunotherapy may exert an effect on near-term survival only. The signals for some of these temporal changes are robust enough to warrant consideration of their impact on traditional prognostic utilities in the future. LEVEL OF EVIDENCE: Level III.
Risk Factors for Multiregional Spinal Column Injury: A Western Pediatric Surgery Research Consortium and Western Trauma Association Prospective Multicenter Study.
Hongsermeier-Graves N, Dantam C, Kahan AM … +14 more , Eldredge RS, Kurudza E, Larsen KE, Swendiman RA, Rampton JW, Wan HY, Inaba K, Iyer RR, Brockmeyer DL, Kelly MP, Katsma MS, Russell KW, Ravindra VM, Western Pediatric Surgery Research Consortium
Spine (Phila Pa 1976) · 2026 Apr · PMID 42085693 · Publisher ↗
STUDY DESIGN: Subanalysis of a prospective, multicenter, observational study at 72 US adult, pediatric, and mixed trauma centers. OBJECTIVE: We investigated trauma-related risk factors and patient-level factors associate...
STUDY DESIGN: Subanalysis of a prospective, multicenter, observational study at 72 US adult, pediatric, and mixed trauma centers. OBJECTIVE: We investigated trauma-related risk factors and patient-level factors associated with multiregional spinal column injury, defined as cervical spine injury (CSI) requiring treatment and thoracolumbar injury (TLI). SUMMARY OF BACKGROUND DATA: Traumatic spinal injury causes morbidity and mortality in pediatric patients. Injuries to multiple spinal column regions require early identification and thoughtful management. METHODS: All children <18 years undergoing cervical spine evaluation after blunt multisystem trauma were prospectively identified and enrolled. Clinically significant CSI was defined by cervical spine surgery or halo placement. TLI incidence and management was recorded. The primary outcome was multiregional spinal column injury (CSI+TLI). RESULTS: Of 19,651 enrolled patients, 1484 children (7.5%) experienced a TLI, 159 (0.81%) had CSI requiring treatment, and 30 (0.15%) had CSI+TLI. Multivariate analysis revealed that the trauma-related factors mechanism of injury (P<0.001), rib fractures (odds ratio (OR) 2.8 [2.3-3.4]), hemothorax/pneumothorax (OR 2.0 [1.7-2.4]), bowel injury (OR 4.0 [2.9-5.4]), pelvic fracture (OR 1.5 [1.2-1.9]), and clinically significant CSI (OR 1.9 [1.2-2.9]) were independently associated with TLI. Of the 159 children with clinically significant CSI, 30 also experienced TLI (19%). Multivariate analysis identified prehospitalization intubation (OR 3.1 [1.1-8.4]) and rib fractures (OR 3.9 [1.2-12.8]) as independent associations with CSI+TLI. CONCLUSIONS: Of children with CSI requiring treatment, 19% experienced TLI. MOI and various trauma-related injuries were independently associated with TLI, whereas prehospitalization intubation and rib fractures were independent risk factors for CSI+TLI. These factors should trigger screening for multiregional spinal column injury in pediatric trauma patients. Furthermore, if there is known TLI, the cervical spine should be evaluated, and if there is significant CSI, then dedicated imaging of the thoracic and lumbar spine is indicated. LEVEL OF EVIDENCE: III.
The Aging World of Spinal Deformity Surgery: Epidemiological Trends Over A 12-Year Period.
Diebo BG, Singh M, Toavs TL … +7 more , Jain R, Nassar JE, Kang D, Farias MJ, Chisango ZM, Carayannopoulos N, Daniels AH
Spine (Phila Pa 1976) · 2026 Apr · PMID 42085667 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Assess epidemiological patterns in the rate and age distribution of surgically treated adult spinal deformity (ASD) over the last decade. BACKGROUND: Advances in patie...
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Assess epidemiological patterns in the rate and age distribution of surgically treated adult spinal deformity (ASD) over the last decade. BACKGROUND: Advances in patient selection, preoperative optimization, operative technique, and postoperative care have influenced trends in surgical management of ASD. However, nationwide epidemiological data of surgically treated ASD is lacking. METHODS: Adults who underwent corrective ASD surgery between 2010-2022 were identified from a large insurance claims database. Age, sex, year, region, and insurance plan distribution were extracted. Yearly trends in case counts and mean age were assessed using linear regression. Incidence rate ratios were calculated to evaluate differences in case rates. RESULTS: Among 141,604 surgically treated ASD patients, incidence increased from 4.5 to 15.5cases per 100,000, an increase of 1.2cases per 100,000 every year over the study period (P<0.001). Mean age increased from 63.3 to 66.7years, an increase of 2.5years every 10 years over the study period (P<0.001). Incidence rates also increased with age, with a peak of 88.5cases per 100,000 in 65-69 year olds. Female incidence rate was 90.9cases per 100,000 and male incidence rate was 78.4cases per 100,000. Regionally, Midwest had the highest incidence rate, and Northeast had the lowest incidence rate. Most (63.8%) patients were covered by commercial insurance, but Medicare had higher incidence rates than commercial insurance (71.7 Medicare vs. 57.1 Commercial cases per 100,000). Medicare incidence rates increased from 1.5 to 4.6cases per 100,000 while Commercial insurance incidence rates increased from 2.9 to 9.8cases per 100,000 (P<0.001). CONCLUSION: Between 2010-2022, surgically treated ASD rates rose by nearly 250%, with the average age of the operative patients increasing by 3.4years. As surgical volume for ASD continues to grow, continued efforts to improve outcomes and payment models will be necessary for sustainability. LEVEL OF EVIDENCE: IV.
Cognitive Impairment in Patients with Degenerative Cervical Myelopathy: A Cross-Sectional Comparative Study and Its Correlation with Spinal Cord Compression.
Li H, Cui J, Wu J … +6 more , Ge Y, Yang G, Yu R, Zhang Z, Wang H, He D
Spine (Phila Pa 1976) · 2026 May · PMID 42081653 · Publisher ↗
STUDY DESIGN: A cross-sectional study. OBJECTIVE: This study aimed to investigate cognitive impairment in degenerative cervical myelopathy (DCM) and examine its relationship with radiographic spinal cord compression. SUM...
STUDY DESIGN: A cross-sectional study. OBJECTIVE: This study aimed to investigate cognitive impairment in degenerative cervical myelopathy (DCM) and examine its relationship with radiographic spinal cord compression. SUMMARY OF BACKGROUND DATA: Degenerative cervical myelopathy is a leading cause of chronic non-traumatic spinal cord injury. While its motor and sensory manifestations are well established, the potential impact on cognitive function remains underexplored. METHODS: A total of 965 participants were enrolled: 383 DCM patients (Group A), 122 cervical spondylotic radiculopathy (CSR) patients (Group B), and 460 healthy controls (Group C). Cognitive performance was evaluated with the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and the Basic Cognitive Aptitude Test (BCAT). Propensity-score matching (A:B:C=2:1:2) was used to balance age, sex, and education; additional stratified analyses by age (≤50, 51-60, 61-70, and >70 years) and education (≤6, 7-12, and ≥13 years of education) were performed. Compression ratio (CR) and maximum spinal cord compression (MSCC) were measured on cervical MRI. Correlation analyses were used to explore the association between radiographic spinal cord compression and cognitive function. RESULTS: After matching, DCM patients exhibited significantly lower MoCA (20.61 ± 3.76) and MMSE (26.23 ± 2.84) scores than both CSR and control group (all P < 0.001); this disadvantage persisted across every age and educational stratum. MSCC correlated negatively with MoCA (r = -0.118, P = 0.022) and MMSE (r = -0.124, P = 0.017), with stronger associations in single-level DCM (MoCA r = -0.218, P = 0.008; MMSE r = -0.237, P = 0.004). The number of compressed segments did not influence global cognition. CONCLUSION: Cognitive impairment is significantly associated with DCM, which is influenced by age, education, and the degree of spinal cord compression.
Clinical outcomes and prognostic factors in patients with spinal dural arteriovenous fistula: a nearly 10-year prospective cohort study.
Pang H, Yang C, Song Z … +12 more , Su X, Chen Y, Liu H, Bian L, Hu P, He C, Ye M, Li G, Hong T, Zhang P, Zhang H, Ma Y
J Neurosurg Spine · 2026 May · PMID 42066375 · Full text
OBJECTIVE: This prospective cohort study aimed to evaluate the long-term outcomes of patients with spinal dural arteriovenous fistulas (SDAVFs) nearly 10 years after treatment and identify prognostic factors influencing...
OBJECTIVE: This prospective cohort study aimed to evaluate the long-term outcomes of patients with spinal dural arteriovenous fistulas (SDAVFs) nearly 10 years after treatment and identify prognostic factors influencing recovery and progression. METHODS: Seventy-six patients diagnosed with SDAVF from two centers in China were treated with microsurgery, endovascular therapy, or combined therapy based on angiographic findings. Baseline data collected included age, gender, disease duration, modified Aminoff-Logue Scale (mALS) scores, the presence of numbness and pain (modified Denis Scale [mDS] scores), fistula location, and treatment method. Follow-up evaluations were conducted at 3 months, 6 months, 1 year, 6 years, and nearly 10 years after treatment, in which mALS and mDS scores were recorded. RESULTS: The mean follow-up duration was 121.6 (SD 3.8) months. Fistulas were predominantly in the lower thoracic spine (T7-12, 48.7%), and 82.9% of the patients were male. Improvement was observed in 63.2% of the patients, whereas 55.3% had poor outcomes (mALS score ≥ 4) and 32.9% showed late clinical deterioration. Patient age > 55 years (OR 4.316, 95% CI 1.312-14.196; p = 0.016) and pretreatment disability (moderate: OR 10.160, 95% CI 1.932-53.433, p = 0.006; severe: OR 22.112, 95% CI 2.440-200.344, p = 0.006) were predictors of poor 10-year outcomes. Pretreatment disability (moderate: OR 8.432, 95% CI 1.008-70.512, p = 0.049; severe: OR 12.838, 95% CI 1.231-133.907, p = 0.033) were further associated with late clinical deterioration. CONCLUSIONS: Patients with SDAVFs show early functional improvement but progressive decline over time. Older age and moderate to severe pretreatment disability predicted poor outcomes, while moderate to severe pretreatment disability was associated with late clinical deterioration. These findings highlight the need for early intervention and long-term rehabilitation to mitigate functional decline.
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