Spine[JOURNAL]
Sun
200 papers
Characterizing immune involvement in degenerative cervical myelopathy: a systematic review.
Chabot PJ, Winans NJ, Fuller JS … +7 more , Dadario NB, CreveCoeur TS, Rolfe N, Howell HJ, Sampath SG, Chou D, Chan AK
J Neurosurg Spine · 2026 May · PMID 42066366 · Publisher ↗
OBJECTIVE: Degenerative cervical myelopathy (DCM) is the most common cause of cervical spinal cord impairment in adults. It is described as progressive, age-related spinal cord compression due to degenerative changes in...
OBJECTIVE: Degenerative cervical myelopathy (DCM) is the most common cause of cervical spinal cord impairment in adults. It is described as progressive, age-related spinal cord compression due to degenerative changes in the spinal column. While the mechanical pathology of DCM is well characterized, the immune system's role in the disease's neurological progression and potential as a therapeutic target remains unclear. The authors aimed to comprehensively review the available literature on immunological involvement in DCM pathogenesis. Understanding the interactions between inflammation, apoptosis, and neurodegeneration in DCM may provide insights into novel treatment strategies. METHODS: A systematic literature review was conducted in the PubMed database through August 1, 2024, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Papers met inclusion criteria for the review if they reported on molecular, histological, CSF, or peripheral markers of immune involvement or the immune response, causation, or relation to DCM. Systematic reviews, case reports, or animal studies were excluded. Studies were screened by two blinded authors based on relevance and synthesized to assess the immune environment in DCM. RESULTS: A total of 113 studies were identified, with 10 meeting the inclusion criteria. Findings revealed elevated proinflammatory cytokines in the CSF of DCM patients, including interleukin-8 and tumor necrosis factor-α, as well as increased oligoclonal IgG bands and blood-spinal cord barrier disruption. Histological analysis demonstrated apoptosis via Fas-mediated pathways, impaired autophagy, and increased staining for activated myeloid cells in DCM tissue compared to controls. Peripheral immune profiling indicated increased M2 macrophages and activated CD4 T cells in DCM patients. Furthermore, serum S100b postoperative values and perioperative CSF levels of neurofilament light chain and glial fibrillary acidic protein correlated significantly with clinical improvement and favorable outcomes following treatment. This review is limited by the number of eligible studies, causal interpretation and temporal bias, and lack of standardized interstudy biomarker analysis. These findings identify an immune component of DCM neurodegeneration that may influence disease severity and treatment response. CONCLUSIONS: There is a significant interplay between immune responses and DCM disease progression, revealing how inflammatory mechanisms can influence clinical outcomes and treatment efficacy. Further studies are warranted to understand the immune component of DCM and pave the way for targeted immunotherapies alongside surgical decompression.
Targeting EGFR with miR-148a-3p: a novel approach to mitigate intervertebral disc degeneration.
Zhang L, Cong X, Sun S … +5 more , Li P, Zhao W, Wang N, Shen D, Zhang Y
J Neurosurg Spine · 2026 May · PMID 42066351 · Publisher ↗
OBJECTIVE: In light of microRNA (miRNA)-targeted therapies in the management of intervertebral disc degeneration (IVDD), this study aimed to elucidate the role and mechanism of miRNA (miR)-148a-3p in the pathogenesis of...
OBJECTIVE: In light of microRNA (miRNA)-targeted therapies in the management of intervertebral disc degeneration (IVDD), this study aimed to elucidate the role and mechanism of miRNA (miR)-148a-3p in the pathogenesis of IVDD. METHODS: Human nucleus pulposus (NP) cells treated with interleukin (IL)-1β (10 ng/mL) were used to simulate IVDD in vitro. Gain-of-function experiments were performed by transfecting NP cells with an miR-148a-3p mimic and a pcDNA-epidermal growth factor receptor (EGFR) vector (a mammalian expression encoding EGFR) and evaluated using the CCK-8 assay and TUNEL staining. The target of miR-148a-3p was identified by a dual-luciferase reporter assay. An in vivo IVDD model was established using Sprague-Dawley rats subjected to acupuncture, followed by histological, inflammatory, and expression analyses. RESULTS: Downregulation of miR-148a-3p but upregulation of EGFR was observed in IL-1β-treated NP cells. Increasing miR-148a-3p resulted in elevated cell viability but decreased apoptosis in IL-1β-treated NP cells. Meanwhile, the upregulation of miR-148a-3p effectively counteracted all IL-1β-induced alterations in protein expression, as demonstrated by the enhanced expression of extracellular matrix (ECM)-associated markers, alongside a reduction in autophagy markers such as LC3II/LC3I, Beclin1, and ATG7. MiR-148a-3p was found to exert a negative regulatory effect on EGFR. The overexpression of EGFR negated the alterations induced by the miR-148a-3p mimic. In the IVDD rat model, miR-148a-3p ameliorated histological damage and enhanced ECM marker expression while concurrently reducing the inflammatory response and autophagy markers. CONCLUSIONS: The restoration of miR-148a-3p inhibited EGFR, thereby suppressing inflammation, apoptosis, and autophagy but promoting ECM production in IVDD models. Therefore, miR-148a-3p may serve as a potential therapeutic candidate for the management of IVDD.
Lumbar Spine Research Society 19th Annual Scientific Meeting Abstracts.
May 14-15, 2026 | Chicago, IL
J Neurosurg Spine · 2026 May · PMID 42066343 · Publisher ↗
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Relationship between Preoperative Global Sagittal Alignment and Changes in Cervical Alignment Following Lumbar Pedicle Subtraction Osteotomy.
Verna B, Caffard T, Burkhard MD … +11 more , Guven AE, Chiapparelli E, Mielke AM, Arzani A, Lan R, Shue J, Zippelius T, Sama AA, Girardi FP, Cammisa FP, Hughes AP
Spine (Phila Pa 1976) · 2026 Jul · PMID 42044623 · Publisher ↗
STUDY DESING: Retrospective cohort study. OBJECTIVE: The objectives are to assess changes in cervical sagittal alignment after lumbar pedicle subtraction osteotomy (PSO) surgery and examine their association with preoper...
STUDY DESING: Retrospective cohort study. OBJECTIVE: The objectives are to assess changes in cervical sagittal alignment after lumbar pedicle subtraction osteotomy (PSO) surgery and examine their association with preoperative global sagittal alignment (GSA) parameters. SUMMARY OF BACKGROUND DATA: Changes in cervical alignment after lumbar PSO have been reported, yet the progression over time and predictors of long-term decompensation are poorly understood. METHODS: Patients who underwent lumbar PSO between 2016 and 2021 were included. Cervical alignment was assessed preoperatively and at five postoperative time points: 1-30 days (PO1), 31-90 days (PO2), 91-180 days (PO3), 181 days-1 year (PO4), and 1-2 years (PO5). Cervical alignment parameters included cervical lordosis, C2-7 sagittal vertical axis (cSVA), C0-2 angle, T1 slope, C7 slope, C2 slope, T1 slope minus cervical lordosis (TS-CL), cervical tilt, neck tilt, thoracic inlet angle (TIA), cranial slope, cranial tilt, and cranial incidence. Preoperative GSA parameters included pelvic tilt (PT), global SVA and pelvic incidence-lumbar lordosis mismatch (PI-LL). RESULTS: A total of 99 patients were included. Immediate postoperative changes (preoperative to PO1) demonstrated consistent reductions in cSVA, cervical lordosis, T1 slope, C7 slope, cervical tilt, and neck tilt. In the longer-term analysis (PO1 to PO5), progressive increases were observed in cSVA, T1 slope, C2 slope, and cranial slope. Higher preoperative SVA was associated with greater immediate reductions in cSVA, C7 slope, and T1 slope. Higher BMI and older age were associated with reductions in distinct parameters. Longer-term analysis showed that greater preoperative PT was associated with increased TS-CL, neck tilt, cranial tilt, and T1 slope, while greater PI-LL mismatch was linked to smaller increases in these parameters. CONCLUSION: Our findings suggest that preoperative GSA parameters may influence cervical alignment in a phase-specific manner: Higher preoperative SVA was associated with immediate cervical adaptation, whereas pelvic parameters appear more related to long-term compensatory responses.
The association between lumbopelvic fixation and improved pain and function in patients with unstable pathologic sacral fractures.
Hirase T, Mazzucco M, Vaynrub M
J Neurosurg Spine · 2026 Apr · PMID 42030573 · Publisher ↗
OBJECTIVE: Spinopelvic dissociation from U- or H-type pathologic sacral fractures can be debilitating and often results in chronic pain and functional impairment. In the setting of metastatic disease with prior or planne...
OBJECTIVE: Spinopelvic dissociation from U- or H-type pathologic sacral fractures can be debilitating and often results in chronic pain and functional impairment. In the setting of metastatic disease with prior or planned radiotherapy (RT) and/or chemotherapy, obtaining a successful fracture union is particularly challenging. This study sought to determine the effectiveness of lumbopelvic fixation for the treatment of U- or H-type pathologic sacral fractures. METHODS: The authors reviewed data from patients with metastatic disease who presented with U- or H-type pathologic sacral fractures recalcitrant to nonoperative management and were treated with lumbopelvic instrumentation at a single institution between January 2019 and November 2024. Primary outcome measures were pre- and postoperative sacral pain (assessed using a visual analog scale [VAS]), ambulatory status, and opioid use in morphine milligram equivalents (MMEs). RESULTS: Twenty-two patients (mean age 63.4 [SD 12.8] years) met the inclusion criteria and had a mean of 14.5 (SD 9.2) months of follow-up. Seventeen patients (77.3%) underwent RT prior to surgery with a mean biologically effective dose of 59.1 (SD 14.6) Gy. The mean preoperative sacral VAS pain score was 7.5 (SD 2.2), which decreased to 2.2 (SD 2.2) at 3 weeks postoperatively (p < 0.001) and 0.4 (SD 1.1) at final follow-up (p < 0.001). All 22 patients had radicular symptoms preoperatively, compared to 2 patients (9.1%) at final follow-up (p < 0.001). Improvement in ambulatory status relative to preoperative baseline was evident in 15 patients (68.2%) at 3 weeks and in 19 patients (86.4%) at final follow-up. The mean preoperative daily opioid use was 156.1 (SD 154.9) MMEs, which decreased to 77.0 (SD 92.7) MMEs at 6 weeks postoperatively (p = 0.048) and 59.1 (SD 97.5) MMEs at final follow-up (p = 0.018). There was 1 reoperation (4.5%) at the final follow-up for a set-screw disengagement. CONCLUSIONS: Patients with metastatic disease who present with spinopelvic dissociation from U- or H-type pathologic sacral fractures use fewer opioid medications for axial and radicular pain and have better ambulatory function following lumbopelvic fixation. Larger, prospective studies are needed to confirm the authors' findings.
Editorial. Intraoperative neuromonitoring for intramedullary spinal cord tumors: are we asking the right questions?
Lozano CS, Wilson JR
J Neurosurg Spine · 2026 Apr · PMID 42030570 · Publisher ↗
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Utility of direct wave intraoperative neuromonitoring for intramedullary spinal cord tumor resection.
Jiang K, Al-Mistarehi AH, Zaitoun KJ … +21 more , Weber-Levine C, Xia Y, Mendelson BZ, Ksabi NL, Papali P, Neerumalla S, Antar A, Hersh AM, Davidar AD, Pennington Z, Gokaslan ZL, Lim M, Lin SC, Lo SL, Witham T, Sciubba DM, Jallo G, Wolinsky JP, Weingart J, Theodore N, Lubelski D
J Neurosurg Spine · 2026 Apr · PMID 42030565 · Publisher ↗
OBJECTIVE: Intramedullary spinal cord tumors (IMSCTs) are typically treated with maximal safe resection, during which neurosurgeons often monitor for neurological injury using muscle motor evoked potential (mMEP) and dir...
OBJECTIVE: Intramedullary spinal cord tumors (IMSCTs) are typically treated with maximal safe resection, during which neurosurgeons often monitor for neurological injury using muscle motor evoked potential (mMEP) and direct wave (D-wave) neuromonitoring. The predictive value of changes in D-waves for identifying motor outcomes is underexplored. This study evaluated the utility of D-waves for predicting postoperative motor deficits. METHODS: Patients who underwent resection of a primary IMSCT with mMEP neuromonitoring from 2003 to 2023 at a tertiary care hospital were identified. Patients who underwent D-wave monitoring in addition to mMEP monitoring were compared to those who underwent mMEP monitoring alone using the Mann-Whitney U-test, chi-square test, and Fisher's exact test. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of D-wave and mMEP monitoring for identifying new neurological deficits immediately postoperatively and at 1 month, 6 months, and last follow-up were calculated. RESULTS: After matching, 125 patients were included (median age 42.0 years; 57.6% male; median follow-up 34.0 months), of whom 88 had both mMEP and D-wave data. The most common pathologies were ependymoma (64.0%) and astrocytoma (17.6%). Patients who did and did not undergo D-wave neuromonitoring had similar preoperative neurological function, primary pathology, tumor grade, and tumor location. D-wave use was associated with increased gross-total resection (88.6% vs 64.9%, p = 0.002) and reduced mortality (5.7% vs 24.3%, p = 0.007), length of stay (5.0 vs 6.0 days, p = 0.033), and 30-day readmission (2.3% vs 13.5%, p = 0.013) and reoperation (1.1% vs 10.8%, p = 0.012). At the 6-month follow-up, D-wave monitoring alone was superior to mMEP and combination monitoring for detecting new motor deficits. D-wave monitoring had peak sensitivity (77.8%) and NPV (96.5%) at 6 months and peak specificity (95.8%) and PPV (76.9%) in the immediate postoperative period. CONCLUSIONS: D-wave monitoring was associated with reduced mortality and was more accurate than mMEP monitoring alone or combination monitoring for detecting new postoperative neurological deficits. Further prospective studies are needed to validate these results.
The evolving landscape of spinal cord injury: a tale of 3 decades.
Quddusi AI, Badhiwala JH, Wilson JR … +4 more , Furlan JC, Pedro KM, Alvi MA, Fehlings MG
J Neurosurg Spine · 2026 Apr · PMID 42030563 · Publisher ↗
OBJECTIVE: Considerable advances in the prevention and treatment of traumatic spinal cord injury (SCI) have been made in the last 3 decades; hence, it can be assumed that the groups at risk, etiology, and characteristics...
OBJECTIVE: Considerable advances in the prevention and treatment of traumatic spinal cord injury (SCI) have been made in the last 3 decades; hence, it can be assumed that the groups at risk, etiology, and characteristics of SCI have evolved in tandem. The objective of this study was to analyze SCI data to discern changes in patient demographics, etiology, and characteristics of injury over the last 3 decades. METHODS: Data from 5 multicenter, prospective sources were combined to create a dataset representing the period from 1991 to 2020. The data were divided into 3 decades; 1991-1999, 2000-2009, and 2010-2020. The analyzed variables included patient age, sex, etiology, baseline injury severity based on the American Spinal Injury Association Impairment Scale (AIS), surgery, and timing of surgery. One-way ANOVA was performed to examine the association between patient age and decade, whereas chi-square tests were used to assess the association of sex, etiology, surgery, timing of surgery, and baseline severity with decade. Further analyses were done using univariate and multivariate regression to evaluate the relationship between age and sex, etiology, and decade. RESULTS: The overall dataset included 2642 patients. From the 1990s to the 2010s, the mean age increased independent of changes in etiology (p < 0.001), the frequency of injuries related to falls increased from 20.6% to 42.1% (p < 0.0001), and the frequency of SCIs related to motor vehicle collision decreased from 50.4% to 39.1% (p < 0.0001). Significant changes were observed when examining injury severity between the 1990s and 2010s: the percentage of complete SCI (AIS grade A) decreased from 58.3% to 49.8%, the percentage of incomplete SCI (AIS grades B, C, and D) increased from 41.7% to 50.2%, and the percentage of central cord syndrome increased from 33.7% to 54.7%. The percentage of patients undergoing surgical treatment increased from 73.8% to 96.8% (p < 0.0001), and the proportion that underwent early surgery increased from 20.6% to 43.9% (p < 0.0001). CONCLUSIONS: The changes in the demographics, etiology, and characteristics of SCI reflect a combination of an aging population, an increased public awareness of neurotrauma, and enhanced clinical management of older patients. These findings have implications for further research and the optimization of primary and secondary injury prevention strategies.
Precision Redefined: Robotics and Navigation in Spine Surgery - A Leap Forward or a Technology in Search of Purpose?
Alves ÓL, Lewandrowski KU, Liodakis E … +6 more , Lorio MP, Parajón A, Scott-Young M, Park P, Burkhardt BW, Vaccaro AR
Spine (Phila Pa 1976) · 2026 Apr · PMID 42023817 · Publisher ↗
STUDY DESIGN: Literature review and international cross-sectional survey with Rasch psychometric analysis. OBJECTIVE: To evaluate the clinical, economic, and operational impact of navigation and robotics in spine surgery...
STUDY DESIGN: Literature review and international cross-sectional survey with Rasch psychometric analysis. OBJECTIVE: To evaluate the clinical, economic, and operational impact of navigation and robotics in spine surgery by integrating evidence from the best literature and real-world surgeon practice patterns. SUMMARY OF BACKGROUND DATA: Robotics and computer-assisted navigation (CAN) are increasingly adopted in spine surgery, with well-documented technical advantages in surgical accuracy and safety. However, their translation into improved patient outcomes, cost-effectiveness, and broad real-world applicability remains uncertain. METHODS: A scoping review and synthesis of published studies and meta-analyses was performed. In parallel, a 93-item international survey was distributed to spine surgeons across multiple countries, capturing perceptions of accuracy, radiation safety, costs, training, workflow, and patient outcomes. Responses (n = 195) were analyzed using Rasch modeling to assess consensus strength and item difficulty, supplemented by descriptive statistics. RESULTS: Published data and meta-analyses confirm superior screw accuracy with robotics/CAN (≥95% safe-zone placement) and consistent reductions in staff radiation. Real-world surgeon survey responses showed high concordance on these technical benefits but persistent concerns regarding cost (37.4%), equipment availability (55.9%), workflow burden, and limited training access (8.2%). While 74.9% of surgeons anticipated global adoption as standard of care within 10 years, only 52.3% endorsed cost justification. Rasch analysis demonstrated strong consensus on accuracy and complication reduction but skepticism regarding economic viability. CONCLUSION: Navigation and robotics in spine surgery offer robust technical benefits but remain constrained by cost, training, and workflow barriers. Balanced integration-expanding applications beyond pedicle screw placement, supported by automation, standardized metrics, and scalable financial models-is essential to realize their full clinical and societal value.
Minimally Invasive SI Joint Fusion Improves Pain and Disability With Low Reoperation Rates: A Meta-Analysis of Randomized Control Trials and Prospective Cohort Studies.
Baur A, Nguyen AQ, Prickett M … +5 more , Lewin A, Vemu SM, Song J, Meyer BC, Prasarn ML
Spine (Phila Pa 1976) · 2026 Apr · PMID 42023816 · Publisher ↗
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To conduct a meta-analysis of high-level prospective evidence studies evaluating changes in Visual Analogue Scale (VAS), SI joint pain scores, Oswestry Disabi...
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To conduct a meta-analysis of high-level prospective evidence studies evaluating changes in Visual Analogue Scale (VAS), SI joint pain scores, Oswestry Disability Index (ODI) outcomes, and adverse events (SAE) requiring an additional operation. SUMMARY OF BACKGROUND DATA: Low back pain is a leading cause of disability, and the sacroiliac joint (SIJ) is implicated as a primary pain generator in up to 25% of cases. However, SIJ-mediated pain is difficult to diagnose, and is often one of exclusion confirmed by diagnostic injections. Minimally invasive SIJ fusion has emerged as a treatment option for patients with confirmed SIJ dysfunction who fail nonoperative care. METHODS: A systematic review and meta-analysis were performed according to PRISMA guidelines. Eleven studies (9 prospective cohort and 2 randomized control trials) met inclusion criteria based on study design, quality of evidence, and reporting of patient-reported outcomes. Demographic data, baseline characteristics, surgical indications, and outcomes were extracted. Meta-analyses were conducted to calculate pooled estimates of VAS and ODI improvements, and reoperation rates. RESULTS: Eleven studies reporting on 1,181 sacroiliac joint fusions were included, with a mean follow-up of 27.8 months. Sacroiliac joint pathology was confirmed by diagnostic SIJ injection in 92.7% of patients. Meta-analysis showed a VAS improvement of 45.5 points (95% CI: 38.6-52.3) and an ODI improvement of 23.3 points (95% CI: 21.0-25.7), both exceeding established MCID thresholds (P < 0.001). The meta-analysis of reoperation rates for implant-related serious adverse events was 3% (95% CI: 2%-4%). CONCLUSION: Minimally invasive SIJ fusion, performed across multiple implant systems and surgical techniques, yields large, clinically meaningful, and reproducible improvements in pain and disability with a low reoperation rate. Outcomes are most favorable when patient selection is rigorous and SIJ dysfunction is accurately identified as the primary pain generator using diagnostic SIJ injection, underscoring the importance of standardized diagnostic pathways in optimizing surgical benefit.
Lumbar Microdiscectomy and Postoperative Activity Restrictions: A Randomized Controlled Trial.
Roadley J, Daly C, Rogers M … +8 more , Danks RA, Sher I, Kam J, Castle-Kirszbaum M, Ayton S, Fryer K, Risbey P, Goldschlager T
Spine (Phila Pa 1976) · 2026 Jul · PMID 42023774 · Full text
STUDY DESIGN: Single-blinded randomised controlled trial. OBJECTIVE: To establish the effect of postoperative mobility restrictions on outcome after lumbar microdiscectomy by comparing sitting and activity restrictions t...
STUDY DESIGN: Single-blinded randomised controlled trial. OBJECTIVE: To establish the effect of postoperative mobility restrictions on outcome after lumbar microdiscectomy by comparing sitting and activity restrictions to no restrictions for the first month after surgery. SUMMARY OF BACKGROUND DATA: Lumbar microdiscectomy effectively treats lumbar radiculopathy, improving leg pain and functional outcomes. However, 20% of patients experience residual sciatica and 5% require redo discectomy. Persistent sciatica causes suffering, increases health care costs, and results in work absenteeism. While strategies to prevent reherniation include postoperative mobility restriction, evidence is limited regarding efficacy. Most surgeons still advise sitting or lifting restrictions after microdiscectomy. METHODS: Two hundred patients (ages 18-75) undergoing unilateral microdiscectomy were randomised 1:1 to restricted (n=101) or unrestricted (n=99) groups. Restricted patients received limitations on sitting (15-30 mins per two hours), lifting (<5 kg), and strenuous activities for two weeks. Unrestricted patients resumed normal activities as tolerated. All patients wore activity monitors (ActiV8) for one month. Assessments at baseline, day 1, and 1, 3, 6, and 12 months included VAS pain scores, Oswestry Disability Index, and quality-of-life questionnaires. The primary outcome was a composite of reduced pain, functional improvement, and absence of further interventions at 12 months. RESULTS: At one year, the primary composite outcome showed no significant difference between groups [restricted (41.6%) vs . unrestricted (36.4%), P =0.45]. Secondary outcomes for restricted versus unrestricted groups, respectively, including reherniation rates (10.1% vs . 14.1%, P =0.61), pain measures (VAS back reduction to 23.5 pts vs . 24.5 pts, P =0.83), functional improvements (SF-12 PCS 50.3 vs . 49.7 pts at one year, P =0.57), and reoperation rates (2.9% vs . 5.5%, P =0.68) were similar. Activity monitoring revealed poor adherence to restrictions (10%) with no significant differences in sitting duration or other activities between groups (4102 vs . 4140 mins/wk, P =0.89). CONCLUSIONS: Liberalizing postoperative restrictions following lumbar microdiscectomy does not compromise outcomes. These findings support patient-driven recovery guided by comfort rather than rigid restrictions, potentially standardizing care guidelines and facilitating faster return to activities without compromising safety.
Letter to the Editor on: Predicting Postoperative Neurological Outcomes in Metastatic Spinal Tumor Surgery Using Machine Learning.
Lu H, Cui Y
Spine (Phila Pa 1976) · 2026 Apr · PMID 42013798 · Publisher ↗
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Preoperative Neurological Severity and Clinically Meaningful Recovery After Anterior Cervical Decompression and Fusion: A Multicenter Study of 1,024 Patients.
Hirai T, Onuma H, Sakai K … +21 more , Hashimoto M, Horiuchi A, Inose H, Yamada K, Matsukura Y, Morishita S, Egawa S, Hashimoto J, Sakaeda K, Tamura S, Komiya Y, Torigoe I, Tomori M, Sakaki K, Otani K, Kusano K, Yamada T, Ushio S, Shindo S, Arai Y, Yoshii T
Spine (Phila Pa 1976) · 2026 Apr · PMID 42013797 · Publisher ↗
STUDY DESIGN: Multicenter retrospective cohort study. OBJECTIVE: To determine how preoperative neurological severity influences postoperative recovery and achievement of clinically meaningful improvement following anteri...
STUDY DESIGN: Multicenter retrospective cohort study. OBJECTIVE: To determine how preoperative neurological severity influences postoperative recovery and achievement of clinically meaningful improvement following anterior cervical decompression and fusion (ACDF/ACCF) for degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA: Anterior cervical decompression procedures are widely used for DCM, including ossification of the posterior longitudinal ligament, with favorable outcomes reported over decades. However, the impact of preoperative neurological severity on recovery after anterior surgery remains insufficiently defined. Large anterior-only cohorts evaluating severity-adjusted minimal clinically important difference (MCID) are lacking. METHODS: We retrospectively analyzed 1,024 patients who underwent anterior cervical decompression and fusion at three spine centers between 2011 and 2021. Patients were stratified by preoperative JOA score into a severe group (JOA <10; n=320) and a mild-moderate group (JOA ≥10; n=704). Neurological outcomes were assessed using the JOA score, JOA recovery rate, and severity-specific MCID thresholds (≥3-point improvement for severe and ≥2-point improvement for mild-moderate myelopathy). Perioperative complications, including dysphagia, segmental motor deficit, and graft-related events, were recorded. RESULTS: Preoperative JOA scores were significantly lower in the severe group (7.4 ± 2.2) than in the mild-moderate group (12.4 ± 1.6; P<0.001). Both groups showed substantial improvement at 1 year (11.7 ± 3.1 vs. 14.6 ± 1.8; P<0.001). Recovery rates were similar (44.6% vs. 48.2%; P=0.74). MCID achievement was significantly higher in the severe group (66.9%) than in the mild-moderate group (49.0%; P<0.001). Excellent recovery (JOA recovery rate ≥80%) was more frequent in the mild-moderate group (23.4% vs. 12.5%; P<0.01). Complication rates did not differ significantly. CONCLUSION: In this large multicenter cohort, patients with severe preoperative myelopathy achieved meaningful neurological improvement and high rates of severity-adjusted MCID after anterior cervical decompression and fusion. These findings provide practical, severity-based prognostic information for preoperative counseling in DCM surgery.
Association Between Posterolateral Foraminal Osteophyte and Superior Articular Process Hook With Post-Operative Radiculopathy in ALIF.
Choi TJ, Dhanjani S, Prabhakar G … +5 more , Malone H, Stephan SR, Bagheri A, Eastlack RK, Mundis GM
Spine (Phila Pa 1976) · 2026 Apr · PMID 42013570 · Publisher ↗
STUDY DESIGN: Retrospective cohort study at a single institution. OBJECTIVE: To determine the incidence of postoperative lumbar radiculopathy (PLR) following single-level anterior lumbar interbody fusion (ALIF) at L4-L5...
STUDY DESIGN: Retrospective cohort study at a single institution. OBJECTIVE: To determine the incidence of postoperative lumbar radiculopathy (PLR) following single-level anterior lumbar interbody fusion (ALIF) at L4-L5 or L5-S1, evaluate the unplanned return-to-operating-room (UPROR) rate, and assess associations of posterolateral foraminal cephalad endplate osteophytes (PFO) and superior articular process hooks (SAH) with PLR. SUMMARY OF BACKGROUND DATA: Limited research exists on PLR incidence after ALIF or its association with PFO and SAH, which may contribute to indirect nerve root compression postoperatively. METHODS: Patients undergoing single-level L4-L5 or L5-S1 ALIF from January 2022 to December 2023 were reviewed, excluding those with spinal deformity, trauma, or infection. PLR was categorized as new, persisting, or worsening. Data included PLR presence, new postoperative weakness, direct decompression history, Bone Morphogenetic Protein-2 (BMP-2) usage, PFO (>50% exiting nerve root width), and SAH (>2 mm foraminal extension) on preoperative imaging. Radiographic parameters, including posterior disc height (PDH), spondylolisthesis, and lordosis at the operative level (L4-L5 or L5-S1), were measured preoperatively and 1-month postoperatively. Pearson chi-square tests assessed associations between PFO, SAH, decompression history, dynamic spondylolisthesis, and PLR. Multivariable logistic regression evaluated these as PLR predictors. RESULTS: Of 204 patients (mean age, 62.8 y; 51% male), 37 (18.1%) developed PLR. SAH (P=.015) and PFO (P=.001) were significantly associated with PLR in chi-square analyses and remained independent predictors in multivariate regression (SAH: odds ratio [OR], 2.82; P=.017; PFO: OR, 3.25; P=.005). Among PLR patients, 27.0% had new weakness, 43.2% new radiculopathy, 24.3% worsening radiculopathy, and 32.4% persisting radiculopathy (categories not mutually exclusive). Symptoms resolved in 78.4% by 5.9 months (range, 0.07-23.7). UPROR occurred in 18 patients (8.8% total; 48.6% PLR), primarily for decompression (72.2% resolution post-reoperation). Ten patients (27.0%) received epidural steroid injections. CONCLUSION: PLR occurred in 18.1% of single-level ALIF patients; 78.4% resolved by 6 months. SAH and PFO independently predict PLR, necessitating preoperative evaluation to mitigate complications and reoperation risk.
Cervical Paraspinal Muscle Parameters are Associated With Bone Mineral Density as Measured by Quantitative Computed Tomography and Vertebral Bone Quality in Preoperative Patients.
Verna B, Arzani A, Caffard T … +13 more , Schonnagel L, Nathoo I, Finos K, Camino-Willhuber G, Amoroso K, Chiapparelli E, Zhu J, Carrino JA, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP
Spine (Phila Pa 1976) · 2026 Apr · PMID 42013569 · Publisher ↗
STUDY DESING: Retrospective cohort study. OBJECTIVE: To characterize the association between paraspinal musculature at C3 and cervical volumetric bone mineral density (vBMD) derived from quantitative computed tomography...
STUDY DESING: Retrospective cohort study. OBJECTIVE: To characterize the association between paraspinal musculature at C3 and cervical volumetric bone mineral density (vBMD) derived from quantitative computed tomography (QCT) and vertebral bone quality (VBQ) scores from magnetic resonance imaging (MRI). SUMMARY OF BACKGROUND DATA: Osteoporosis and sarcopenia are prevalent among elderly patients and often coexist. Prior studies have shown a positive association between lumbar paraspinal functional cross-sectional area (fCSA) and bone mineral density, but the relationship between cervical paraspinal muscles and cervical bone quality remains unclear. Although dual-energy X-ray absorptiometry (DEXA) is the clinical gold standard for assessing bone density, newer modalities such as QCT and VBQ can evaluate site-specific bone health. Understanding this muscle-bone relationship in the cervical spine may improve preoperative risk stratification and surgical planning. METHODS: Patients with preoperative cervical MRI and CT who underwent anterior cervical discectomy and fusion between 2015 and 2018 were reviewed. Muscles at C3 were categorized into four functional groups: sternocleidomastoid, anterior, posteromedial, and posterolateral. For all groups, cross-sectional area (CSA), fCSA, and fat infiltration (FI) were measured. QCT and VBQ analyses were performed using established methodologies. Multivariable linear regression adjusted for age, sex, and body mass index (BMI) and Benjamini-Hochberg correction were performed. RESULTS: A total of 100 patients (median age, 56.5 years; 38 females) were included. After adjusting, regression analyses demonstrated a significant negative association between fCSA of the anterior group and VBQ scores from C2 to T1, as well as a significant positive association between FI of the same group and VBQ scores. Additionally, a significant positive association was observed between CSA of the posteromedial group and vBMD at C1 and C3. CONCLUSION: Significant associations were observed between cervical paraspinal muscle morphology and vertebral bone quality and density measured using VBQ and QCT, respectively.
Neurologic Adverse Events Following Three-Column Osteotomy for Adult Spine Deformities: A Prospective Multicenter Study.
Kim AH, Sulieman A, Durand WM … +23 more , Raad M, Lenke LG, Gum JL, Hostin RA, Line BG, Lafage V, Lafage R, Hamilton DK, Smith JS, Diebo BG, Passias PG, Protopsaltis TS, Klineberg EO, Ames CP, Daniels AH, Gupta MC, Schwab FJ, Shaffrey CI, Bess S, Burton DC, Lee SH, Kebaish KM, International Spine Study Group
Spine (Phila Pa 1976) · 2026 Jul · PMID 42013479 · Publisher ↗
STUDY DESIGN: Prospective, multicenter study. OBJECTIVE: To compare and characterize complications in adult spinal deformity (ASD) patients with and without three-column osteotomy (3CO). SUMMARY OF BACKGROUND DATA: Altho...
STUDY DESIGN: Prospective, multicenter study. OBJECTIVE: To compare and characterize complications in adult spinal deformity (ASD) patients with and without three-column osteotomy (3CO). SUMMARY OF BACKGROUND DATA: Although 3CO is associated with increased risk of neurologic adverse events, no study has, to our knowledge, compared and characterized sensory and motor neurologic complications in ASD patients with versus without 3CO. MATERIALS AND METHODS: Demographics, surgical characteristics, and neurologic complications were collected for 553 ASD patients. Lower extremity motor scores (LEMSs) were compared at baseline and postoperatively. Multivariate analysis was performed to identify risk factors associated with neurologic adverse events. RESULTS: Among 553 ASD patients, 130 (23.5%) underwent 3CO. More patients with 3CO were revision patients (67.7% vs . 35.0%; P <0.001), presented with sagittal deformity (43.9% vs . 31.0%; P =0.008), and had longer operative times (455.6 vs . 407.3 min; P =0.001) and greater estimated blood loss (EBL) (1650 vs . 1000 mL; P <0.001) than patients without 3CO. The incidence of neurologic adverse events was greater among patients with versus without 3CO (23.1% vs . 15.4%; P =0.04). Multivariate analysis revealed that older age [odds ratio (OR) 1.288 per 10-year increase, 95% CI: 1.060-1.565, P =0.01] and longer operative time (OR: 1.088, 95% CI: 1.001-1.004, P =0.01) were significant predictors of neurologic adverse events. No between-group difference in LEMS was observed at six-week (49.0 vs . 49.0; P =0.90) or one-year (49.4 vs . 49.3; P =0.71) follow-up. By one-year follow-up, 20.5% of 3CO patients and 21.6% of patients without 3CO had residual motor deficit. CONCLUSIONS: Compared with patients who did not undergo 3CO, more patients with 3CO had prior instrumentation, presented with sagittal deformity, had longer operative time and greater EBL, and were more likely to have a neurologic adverse event. At one-year follow-up, there was no significant difference in LEMS between the two groups. LEVEL OF EVIDENCE: Level III.
Letter to the Editor "Risk factors for Early (Three-Month) Postoperative Mortality in Metastatic Spine Tumor Surgery: A JASA Multicenter Prospective Study" by Uto et al.
Lu H, Cui Y
Spine (Phila Pa 1976) · 2026 Apr · PMID 42013475 · Publisher ↗
Abstract loading — click title to view on PubMed.
Utility of Confirmatory Navigational CT Spins in Patients Undergoing One- to Two-Level Instrumented Posterior Fusions.
Tomberlin CP, Celestre P, Glassman SD … +4 more , Crawford CH, Kostic B, Djurasovic S, Carreon LY
Spine (Phila Pa 1976) · 2026 Apr · PMID 42013473 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To evaluate the clinical utility of confirmatory Navigational CT (NavCT) spins after pedicle screw placement in one- to two-level posterior lumbar fusions. SUMMARY OF...
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To evaluate the clinical utility of confirmatory Navigational CT (NavCT) spins after pedicle screw placement in one- to two-level posterior lumbar fusions. SUMMARY OF BACKGROUND DATA: Navigational CT improves pedicle screw accuracy and reduces blood loss; however, some surgeons perform an additional confirmatory CT spin after screw placement to verify trajectory prior to closure. Confirmatory imaging increases operative time, cost, and radiation exposure, and its benefit in routine lumbar fusion remains unclear. METHODS: Adult patients undergoing one- to two-level posterior instrumented lumbar fusion between January 2020 and June 2021 were identified and stratified into three cohorts: no navigation (NoNav), navigation only (NavCT), and navigation with confirmatory spin (NavCT+C). Primary outcomes included intraoperative screw repositioning and return to the operating room for screw revision. Secondary outcomes included operative duration, estimated blood loss (EBL), discharge disposition, perioperative complications, and one-year follow-up events. RESULTS: A total of 339 patients were included (117 NoNav, 162 NavCT, 60 NavCT+C). Screw-related complications were rare; intraoperative repositioning (1 vs. 2 vs. 0, P=0.683) and reoperation for screw revision (1 vs. 1 vs. 0, P=0.780) did not differ across groups. The absolute risk reduction for reoperation with confirmatory imaging was 0.72%, yielding an NNT of 138.5. Operative time differed significantly (199.3 vs. 176.5 vs. 205.4 min, P=0.01). EBL was significantly lower in both NavCT groups compared with NoNav (P <0.001). Perioperative complications and length of stay were similar. Confirmatory imaging increased radiation exposure and operative duration without improving screw-related outcomes. CONCLUSION: In one- to two-level lumbar fusions, confirmatory NavCT spins provide minimal additional clinical value. Given increased radiation, time, and cost with no observed improvement in screw accuracy or reoperation rates, confirmatory imaging should be used selectively rather than routinely.
Five-Year Segment-Based Analysis of Radiographic and Symptomatic Adjacent Segment Disease Following Transforaminal Lumbar Interbody Fusion.
Akiyama Y, Aoki Y, Nakajima A … +13 more , Sato M, Inagaki K, Arai T, Sakamoto T, Hojo A, Sonobe M, Takahashi H, Saito J, Norimoto M, Koyama K, Ohtori S, Inoue M, Nakagawa K
Spine (Phila Pa 1976) · 2026 Apr · PMID 42013472 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine the 5-year incidence and risk factors of radiological adjacent segment disease (R-ASD) and symptomatic adjacent segment disease (S-ASD) after transforamin...
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine the 5-year incidence and risk factors of radiological adjacent segment disease (R-ASD) and symptomatic adjacent segment disease (S-ASD) after transforaminal lumbar interbody fusion (TLIF) using patient- and segment-based analyses. SUMMARY OF BACKGROUND DATA: Adjacent segment disease (ASD) remains a major concern after lumbar fusion surgery. Although previous studies have reported variable incidence rates, differences between R-ASD and S-ASD and segment-specific risk factors remain unclear. Particularly, evidence comparing cranial and caudal adjacent segments after TLIF with uniform mid-term follow-up is limited. METHODS: Patients who underwent TLIF at two institutions and completed a minimum 5-year follow-up were retrospectively reviewed. The study cohort consisted of 183 patients (mean age, 68.0±9.6 y). Patient-based and segment-based analyses were performed. Potential risk factors including demographic variables, and spinopelvic alignment parameters, preoperative adjacent segment status, and surgical interventions at adjacent levels, were evaluated. RESULTS: At 5-year follow-up, patient-based incidence of R-ASD and S-ASD was 31.1% and 18.6%. Segment-based analysis demonstrated that R-ASD occurred more frequently at the cranial segment than at the caudal segment (25.4% vs. 8.1%, P<0.001), whereas S-ASD incidence did not differ significantly. Multivariate analysis identified preoperative disc degeneration (OR 3.13, 95% CI 1.06-9.23) and additional decompression at the adjacent segment (OR 2.42, 95% CI 1.14-5.13) as independent risk factors for cranial R-ASD. Spinopelvic alignment parameters and preoperative foraminal stenosis were not significantly associated with the development of R-ASD and S-ASD. CONCLUSION: Segment-specific analysis revealed that cranial R-ASD is predominantly influenced by local degenerative changes and surgical intervention rather than global alignment parameters. Careful preoperative assessment of adjacent disc degeneration and cautious postoperative consideration of additional decompression may be important in surgical planning to mitigate ASD development after short-segment TLIF.
Letter to "Letter to the editor regarding "Hypoxia inducible factor-1α (HIF-1α) as a factor to predict prognosis of spinal chordoma" by He et al.".
He G, Liu X
Spine (Phila Pa 1976) · 2026 Apr · PMID 42013471 · Publisher ↗
Abstract loading — click title to view on PubMed.
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