Spine[JOURNAL]
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200 papers
Staphylococcus aureus colonization before elective posterior spine surgery: is it associated with postoperative S. aureus infections?
Joshi AS, Bronheim RS, Schiedo RM … +5 more , Helbing JA, Botolin P, Jain A, Kebaish KM, Hassanzadeh H
J Neurosurg Spine · 2026 Apr · PMID 41996715 · Publisher ↗
OBJECTIVE: Evidence suggests that preoperative Staphylococcus aureus colonization predicts postoperative superficial surgical site infection (SSI). However, it is unclear how preoperative colonization is related to deep...
OBJECTIVE: Evidence suggests that preoperative Staphylococcus aureus colonization predicts postoperative superficial surgical site infection (SSI). However, it is unclear how preoperative colonization is related to deep surgical site, organ space, and bloodstream infections after spine surgery. Therefore, the objective of this study was to investigate associations between preoperative S. aureus colonization and S. aureus infections following elective, instrumented posterior spine surgery. METHODS: The authors retrospectively analyzed international trial data from 3311 participants who underwent open, instrumented, multilevel posterior spine surgery from 2015 to 2019. Multivariate logistic regression was used to determine associations between preoperative S. aureus colonization and postoperative S. aureus infection. RESULTS: Thirty-five percent of participants (n = 1148) had preoperative S. aureus colonization in the nose or throat. Within 3 months after surgery, 68 of all participants (2%) developed S. aureus infections. Preoperative colonization was associated with greater odds of superficial SSI (OR 1.7, 95% CI 1.2-2.3; p = 0.004) and bloodstream infection (OR 1.8, 95% CI 1.1-4.2; p = 0.017). Other factors associated with postoperative infection included nasal (relative to throat) colonization (OR 1.03, 95% CI 1.01-1.1; p = 0.038), number of vertebrae fused (OR 1.2, 95% CI 1.1-1.2; p < 0.001), and BMI (OR 1.1, 95% CI 1.03-1.1; p < 0.001). Prophylactic decolonization was associated with lower odds of infection (OR 0.6, 95% CI 0.42-0.84; p = 0.003). Specifically, the odds were lower for participants treated with chlorhexidine wash (OR 0.4, 95% CI 0.25-0.64; p < 0.001), intranasal mupirocin (OR 0.13, 95% CI 0.02-0.98; p = 0.048), or both (OR 0.56, 95% CI 0.33-0.98; p = 0.041). CONCLUSIONS: Preoperative S. aureus colonization was associated with superficial SSI and bloodstream S. aureus infections after elective spine surgery. Prophylactic decolonization measures were associated with lower odds of postoperative infection. Future analysis should explore optimal decolonization regimens for at-risk individuals.
Understanding femoral nerve injuries during extreme lateral lumbar interbody fusion using transabdominal muscle action potential and an event-based protocol.
Patel A, McDermott MR, Bayaton AJ … +4 more , Rogers M, Boyett JB, Jakoi AM, Conti Mica MR
J Neurosurg Spine · 2026 Apr · PMID 41996714 · Publisher ↗
OBJECTIVE: Extreme lateral lumbar interbody fusion (XLIF) carries a significant risk of femoral nerve injury, particularly at L4-5, where neural structures are close to the transpsoas corridor. While neuromonitoring tech...
OBJECTIVE: Extreme lateral lumbar interbody fusion (XLIF) carries a significant risk of femoral nerve injury, particularly at L4-5, where neural structures are close to the transpsoas corridor. While neuromonitoring techniques such as triggered electromyography and somatosensory evoked potentials are widely used, they lack the real-time sensitivity and specificity necessary for reliably detecting nerve compromise. The absence of real-time neuromonitoring data in XLIF has limited the understanding of when and how femoral nerve injuries occur, leaving surgeons without a clear strategy to mitigate these injuries intraoperatively. The aim of this study was to evaluate the reliability of detecting nerve injury during XLIF using transabdominal muscle action potential (TMAP) monitoring with an event-based protocol. METHODS: A retrospective analysis of consecutive patients who underwent single-position prone XLIF from 2020 to 2024 was conducted. Patients with lateral implants placed in the femoral nerve distribution (L2-5) were included. TMAP monitoring was performed intraoperatively at predefined procedural steps to monitor nerve integrity. TMAP changes were correlated with postoperative quadriceps motor deficits to determine the timing of injury. Sensitivity, specificity, and predictive thresholds of TMAP were also analyzed. RESULTS: One hundred sixty-one patients (mean age 67.9 ± 9.8 years, BMI 30.7 ± 5.6 kg/m2) were included; 63.4% of patients were female, and 82.6% underwent XLIF at L4-5. Uninterrupted TMAP monitoring was achieved in all cases. Postoperative quadriceps muscle weakness (≤ 3/5 strength) occurred in 4 patients (2.5%), with no significant difference in retractor times between injured and uninjured patients. TMAP monitoring detected all injuries intraoperatively, demonstrating 100% sensitivity. Threshold analysis identified a change in TMAPs of 400-500 mA as clinically significant for the development of a postoperative neurological change (p < 0.01). Specificity at this threshold change ranged from 83.4% to 89.8% while maintaining 100% sensitivity. The event-based protocol revealed that injuries were linked to specific procedural steps, with the docking phase posing a high risk for femoral nerve injury. CONCLUSIONS: This study provides new insights into femoral nerve injuries incurred during XLIF, demonstrating that nerve compromise is more strongly associated with specific procedural steps rather than prolonged retractor time. TMAP monitoring, integrated with an event-based protocol, enabled real-time identification of nerve compromise, revealing that direct mechanical trauma was the primary mechanism of femoral nerve injury in XLIF.
Editorial. Respecting pelvic morphology: low pelvic incidence demands precision to minimize proximal junctional failure.
Nieto D, Buckley N, Tan LA
J Neurosurg Spine · 2026 Apr · PMID 41996713 · Publisher ↗
Abstract loading — click title to view on PubMed.
Use of pelvic incidence to predict proximal junctional failure in long-segment spinal fusion.
Ritchey NP, Weinberg JH, Agner KE … +12 more , Kantemneni E, Holthaus B, Kwok W, Ghaith AK, Comisford L, Ambreen Y, Sette K, Ladd B, Khalsa S, Xu D, Viljoen S, Grossbach A
J Neurosurg Spine · 2026 Apr · PMID 41996710 · Publisher ↗
OBJECTIVE: The objective of this study was to evaluate the impact of pelvic incidence (PI) on spinopelvic correction and complication rates following surgical correction of adult spinal deformity. METHODS: The authors co...
OBJECTIVE: The objective of this study was to evaluate the impact of pelvic incidence (PI) on spinopelvic correction and complication rates following surgical correction of adult spinal deformity. METHODS: The authors conducted a retrospective analysis of a prospectively maintained database and identified 204 patients who underwent long-segment thoracolumbar fusions with pelvic fixation and a minimum of 1-year follow-up for deformity correction defined by the Scoliosis Research Society (SRS)-Schwab criteria. Patients were dichotomized into lower (108 patients) and higher (96 patients) PI groups on the basis of the mean value of 55°. Patient demographic characteristics, spinopelvic parameters, and complications were compared using univariate, multivariate, and mixed-effect analyses. RESULTS: Patients with higher PI demonstrated significantly lower rates of proximal junctional failure (PJF) than the lower PI group (9% vs 21%, p = 0.019). In particular, lower rates of PJF were found in patients with an upper thoracic upper instrumented vertebra (UIV) (0% vs 15%, p = 0.014). Multivariate analysis revealed that lower PI (OR 4.3, 95% CI 1.5-15.4, p = 0.006), lower thoracic UIV (OR 6.5, 95% CI 1.8-24.0, p = 0.005), and reoperation status (OR 23.8, 95% CI 5.8-97.8, p = 0.001) independently predicted PJF while controlling for significant differences. Bayesian mixed-effects modeling confirmed lower PI (OR 6.25, 95% credible interval [CrI] 1.52-50.0, posterior probability = 0.996) and lower thoracic UIV (OR 7.03, 95% CrI 1.6-76.0, posterior probability = 0.997) as significant predictors of PJF while controlling for random effects between patients. CONCLUSIONS: Patients with lower PI are at an increased risk of PJF following long-segment fusion. Preoperative PI morphology may be used to inform surgical planning and reduce the risk of junctional pathologies.
Postoperative opioid utilization following uniportal endoscopic versus open microscopic lumbar discectomy.
Ansari D, Bethel JA, Elbayomy A … +4 more , Greeneway GP, Bryan JE, Talbot G, Brooks NP
J Neurosurg Spine · 2026 Apr · PMID 41996706 · Publisher ↗
OBJECTIVE: Symptomatic lumbar disc herniation refractory to nonoperative management may be treated by traditional open lumbar microdiscectomy or by emerging alternative approaches such as endoscopic discectomy. Although...
OBJECTIVE: Symptomatic lumbar disc herniation refractory to nonoperative management may be treated by traditional open lumbar microdiscectomy or by emerging alternative approaches such as endoscopic discectomy. Although the smaller incision and lesser degree of iatrogenic tissue disruption afforded by endoscopy are hypothesized to minimize postoperative pain, there is a paucity of studies that have evaluated this outcome. METHODS: This study was a retrospective cohort study at a single surgical center affiliated with an academic practice. All patients undergoing single-level lumbar discectomy between 2021 and 2024 were retrospectively identified and stratified into cohorts by approach taken (open or endoscopic). Baseline comorbidities and postsurgical outcomes were collected from the medical record, and opioid use data were retrieved from the state Prescription Drug Monitoring Program. Clinical outcomes, postoperative opioid usage by time, and cumulative opioid usage by morphine milligram equivalents (MME) between the two cohorts were compared using the 2-sided t-test for continuous variables and the chi-square test of independence for categorical variables. RESULTS: One hundred ninety-one patients met the criteria for analysis, of whom 91 (47.6%) underwent endoscopic and 100 (52.4%) underwent open procedures. Patients who underwent endoscopic procedures experienced lower rates of persistent opioid use at postoperative week 6 compared with those who underwent open procedures (8.8% vs 21.0%; relative risk 0.47, p = 0.035) as well as lower average cumulative opioid use by MME (264.7 vs 340.5, p = 0.017). Rates and the amount of opioid usage beyond 6 weeks were not significantly different between groups. Similarly, rates of outcomes such as reduction in leg pain, reoperation, durotomy, and operative time were similar between the groups. CONCLUSIONS: In this retrospective analysis, endoscopic lumbar discectomy was associated with lower short-term postoperative opioid utilization while conferring clinical outcomes similar to those of traditional open microdiscectomy. These results are limited by individual variation in opioid-prescribing practices by individual center, and future studies with standardized opioid-prescription protocols will improve the external validity of these findings.
Treatment of extramedullary tumors: morbidity and long-term results.
Klekamp J
J Neurosurg Spine · 2026 Apr · PMID 41962167 · Publisher ↗
OBJECTIVE: Surgery on extramedullary tumors has a place among the most gratifying operations in neurosurgery. However, little data exist on permanent morbidity and long-term results. This paper provides these data and an...
OBJECTIVE: Surgery on extramedullary tumors has a place among the most gratifying operations in neurosurgery. However, little data exist on permanent morbidity and long-term results. This paper provides these data and analyzes which factors influence them and how they can be managed. METHODS: Among 2081 patients with tumors of the spinal canal presenting between 1991 and 2024, 605 patients were identified with intradural extramedullary tumors, of whom 500 patients underwent 570 operations. Multiple regression was used to identify factors influencing resection and morbidity rates. Short-term results were analyzed according to a neurological scoring system for individual symptoms, while long-term results were determined calculating recurrence-free outcome rates with Kaplan-Meier statistics. RESULTS: The mean age for operated patients was 49.8 ± 18 years, presenting after a mean history of 21.2 ± 42 months. They were followed up by outpatient visits and questionnaires for up to 34 years (mean 43.3 ± 64 months). Overall, 87.4% of tumors were resected completely, while 11.2% underwent partial resection and 1.4% biopsy. Transient postoperative deteriorations were observed in 15.1% of surgeries. Permanent surgical morbidity occurred in 7.1%, that is, 4.8% for first surgeries and 18.4% for recurrent tumors (p < 0.0001). With complete resection, recurrence-free outcome rates of 80.5% and 77% after 5 and 10 years, respectively, were obtained, while partial resection reduced these rates to 40.0% and 36.4% after 5 and 10 years, respectively (p < 0.0001). Surgeons with > 100 operations achieved significantly higher recurrence-free outcome rates compared to surgeons with less experience at each postoperative time point. Schwannomas, meningiomas, ependymomas of the filum terminale, and hamartomas represented 89.8% of all pathologies and were analyzed separately. The best results for resection rates, permanent morbidity, and recurrence-free outcomes were observed for schwannomas. The highest morbidity rates were determined for ependymomas and hamartomas. Complete resection resulted in recurrence-free outcome rates of around 90% after 10 years for each histological group with the exception of meningiomas (73.3%). CONCLUSIONS: Whenever an extramedullary tumor is completely resected, rates for surgical morbidity and 10-year recurrence-free outcomes are favorable. In contrast, with arachnoid adhesions, as in recurrent tumors and some hamartomas, complete resection rates decline, morbidity rates rise, and long-term results become less satisfactory. This emphasizes the importance of achieving complete resection, particularly in the first operation. Surgeons dedicated to spinal cord pathologies can expect to achieve superior long-term results.
The association between intraoperative ketamine administration and reduced postoperative opioid consumption among chronic opioid users after multilevel lumbar fusion.
Diltz Z, Nguyen AQ, Wang C … +4 more , Liu J, Sullivan T, Lambert B, Saifi C
J Neurosurg Spine · 2026 Apr · PMID 41962165 · Publisher ↗
OBJECTIVE: Achieving postoperative pain control while minimizing opioid dependence is a challenge in surgery. Intraoperative ketamine administration in patients undergoing surgery has been associated with decreased posto...
OBJECTIVE: Achieving postoperative pain control while minimizing opioid dependence is a challenge in surgery. Intraoperative ketamine administration in patients undergoing surgery has been associated with decreased postoperative opioid consumption. This study aimed to determine postoperative opioid consumption after multilevel lumbar spine fusion in patients who received intraoperative ketamine compared to those who did not. METHODS: A retrospective observational study was performed for 434 participants who underwent a ≥ 2-level lumbar spine fusion surgery. Propensity score weighting was used to evaluate the association between ketamine administration and net outpatient opioid consumption at 1, 3, 6, and 12 months postoperatively. Patients were stratified into subgroups based on chronicity and magnitude of preoperative opioid exposure. The association between intraoperative ketamine and postoperative opioid consumption was examined in all subgroups. RESULTS: Compared to the control group, patients who received intraoperative ketamine presented with a significantly higher number of readmissions (mean 0.291 [SD 0.75] vs 0.475 [SD 0.874], p = 0.045) and higher mean opioid usage in the year prior to surgery (5089 [SD 16,813] vs 11,801 [SD 28,043] morphine milligram equivalents [MMEs]; p = 0.016). Among patients with long-term preoperative opioid use, those who received ketamine consumed 41% fewer total MMEs (1470 MMEs) than the control group (2308 MMEs; p = 0.011) at 1 month postoperatively. There was no significant change in opioid use at 1, 3, 6, or 12 months postoperatively in the two groups. There was no difference in the incidence of long-term postoperative opioid use, visual analog scale (VAS) score at discharge, VAS pain scores, and length of stay. CONCLUSIONS: In patients with chronic opioid use, intraoperative ketamine administration was associated with decreased opioid use at 1 month postoperatively following multilevel lumbar spine fusion. Ketamine should be considered an important adjuvant treatment for intraoperative pain management in patients with long-term opioid use. However, ketamine should be used with caution in opioid-naive patients as there was an increased incidence of long-term postoperative opioid use in this group.
Costs associated with delirium among older patients undergoing complex spine surgeries.
Barreto Chang OL, Pawar N, Brown RT … +6 more , Theologis AA, Patel A, Mummaneni PV, Miller B, Maze M, Possin KL
J Neurosurg Spine · 2026 Apr · PMID 41962161 · Full text
OBJECTIVE: As the number of older adults undergoing spine surgery grows, it is important to better understand the risks of this procedure, including associated costs. The authors recently reported that undergoing more co...
OBJECTIVE: As the number of older adults undergoing spine surgery grows, it is important to better understand the risks of this procedure, including associated costs. The authors recently reported that undergoing more complex spine surgeries is strongly associated with postoperative delirium (POD). The goal of this study was to examine the costs associated with POD among patients undergoing spine surgeries of varying complexity. METHODS: Data from a prospective observational cohort study of 256 adults aged ≥ 65 years who underwent spine surgery were analyzed. Preoperative, intraoperative, and postoperative variables were collected. The primary outcome of POD was defined as a positive score on any of three measures (Confusion Assessment Method for the Intensive Care Unit, Nursing Delirium Screening Scale, and chart review). The authors conducted univariable and multivariable analyses to examine factors associated with POD and estimated costs of POD stratified by tier of surgery. RESULTS: Risk factors associated with POD included age, lower education level, baseline cognitive impairment, American Society of Anesthesiologists class ≥ III, tier 4 surgery, high estimated blood loss, intensive care unit admission, postoperative complications, and hospital length of stay. In multivariable analyses, age, baseline cognitive impairment, postoperative complications, and length of hospitalization remained significantly associated with POD. The mean total costs were significantly higher in the group with delirium versus without delirium ($99,543 vs $67,892). Additionally, more patients who developed delirium required discharge to an acute rehabilitation facility (47.0% vs 21.5%, p < 0.001). In analyses stratified by tier of surgery, the greatest difference in mean costs between those with delirium versus without delirium was observed in tier 4 ($164,902 vs $116,579, p < 0.001). CONCLUSIONS: Spine surgeries with greater complexity are associated with an increased risk of POD, with higher costs and rates of intensive care unit admissions, more postoperative complications, and discharge to acute rehabilitation facilities. Delirium prevention interventions targeted to older adults at high risk for POD have the potential to optimize outcomes and decrease healthcare costs.
Creating sustainability in centers performing high-volume adult spinal deformity surgery: evaluation of the Maryland all-payer model.
Kim AH, Raad M, Hostin RA … +21 more , Bess S, Gum JL, Line BG, Nayak P, Lafage V, Lafage R, Hamilton DK, Passias PG, Protopsaltis TS, Lenke LG, Smith JS, Ames CP, Diebo BG, Klineberg EO, Daniels AH, Kim HJ, Gupta MC, Schwab FJ, Shaffrey CI, Burton DC, Kebaish KM
J Neurosurg Spine · 2026 Apr · PMID 41962158 · Publisher ↗
OBJECTIVE: The all-payer model is a healthcare payment system unique to the state of Maryland, while the Medicare Severity-Diagnosis-Related Group (MS-DRG) model is used by all other states. The purpose of this study was...
OBJECTIVE: The all-payer model is a healthcare payment system unique to the state of Maryland, while the Medicare Severity-Diagnosis-Related Group (MS-DRG) model is used by all other states. The purpose of this study was to investigate differences in reimbursement and inpatient length of stay (LOS) in adult spinal deformity (ASD) surgery between the all-payer and MS-DRG models. METHODS: MS-DRG reimbursements were calculated using the Centers for Medicare & Medicaid Services Web Pricer tool; reimbursements for the all-payer model were compiled from a single institution in the state of Maryland. Payments for the most frequently occurring ASD MS-DRGs (codes 453, 454, 455, 456, 457, 458, and 460) were analyzed for fiscal years 2018-2023. The mean inpatient LOS was calculated for each MS-DRG code and reimbursement model. RESULTS: When comparing 416 MS-DRG and 1783 all-payer model accounts, the overall mean reimbursements for ASD surgery were significantly lower under the MS-DRG model ($59,199 vs $77,246, p < 0.001). The mean reimbursement payments for MS-DRG codes 453, 454, 455, 456, 457, and 460 were significantly higher under the Maryland all-payer model (p < 0.001). The mean LOS was significantly shorter in the all-payer model for MS-DRG code 453 (p = 0.046) and longer for code 457 (p < 0.001). For all other codes, no significant differences in LOS were observed. CONCLUSIONS: ASD surgery reimbursements are higher overall under the Maryland all-payer model compared with the MS-DRG model. The mean inpatient LOS did not differ significantly across most MS-DRG codes, highlighting the financial viability of an all-payer model in a healthcare system.
Diabetes as a significant risk factor for postoperative dysphagia following cervical spine surgery.
Milne CM, Tippins NP, Foreit AM … +5 more , Alentado VJ, Bisson EF, Porche K, Foley KT, Potts EA
J Neurosurg Spine · 2026 Apr · PMID 41962152 · Publisher ↗
OBJECTIVE: This study investigated the relationship between diabetes and the incidence of postoperative dysphagia following cervical spine surgery (CSS). METHODS: A prospectively collected multi-institutional quality reg...
OBJECTIVE: This study investigated the relationship between diabetes and the incidence of postoperative dysphagia following cervical spine surgery (CSS). METHODS: A prospectively collected multi-institutional quality registry was retrospectively reviewed. Patients who underwent CSS were categorized on the basis of diabetes status, and correlations with preoperative and postoperative Eating Assessment Tool-10 (EAT-10) dysphagia questionnaire scores were assessed. Mixed-effects logistic regressions were performed to examine the impact of preoperative diabetes on postoperative dysphagia. RESULTS: Of the 2001 patients who met the inclusion criteria, 400 (20%) had diabetes. Baseline dysphagia rates were not significantly different between groups (18% vs 14%, p = 0.08). Patients with diabetes had a significantly higher incidence of dysphagia at 1 month (66% vs 54%, p = 0.002), 3 months (39% vs 26%, p < 0.001), and 12 months (33% vs 24%, p = 0.004) after surgery compared to patients without diabetes. Including baseline dysphagia as a fixed effect, multivariable analysis indicated that diabetes was a significant predictor of postoperative dysphagia at 1 month (OR 1.46, p = 0.041) and 3 months (OR 1.63, p = 0.001) but not at 12 months (OR 1.21, p = 0.3). In patients with no baseline dysphagia, those with diabetes (329 of 400 [82.3%]) had a significantly higher incidence of new dysphagia than nondiabetics at 1 month (62% vs 50%, p = 0.003), 3 months (34% vs 21%, p < 0.001), and 12 months (27% vs 18%, p = 0.001). The mean change in EAT-10 scores between baseline and 12 months was significantly worse in patients with preoperative diabetes (2.440 ± 5.013 vs 1.688 ± 4.139, p = 0.025). Multivariable analysis indicated that diabetes was a significant predictor of new postoperative dysphagia at 1 month (OR 1.49, p = 0.040) and 3 months (OR 1.81, p < 0.001) but not at 12 months (OR 1.31, p = 0.2). CONCLUSIONS: Diabetes is a significant risk factor for experiencing postoperative dysphagia following CSS. Diabetes correlated with higher incidence of dysphagia at all postoperative time points and was a strong independent predictor of postoperative dysphagia at 1 and 3 months.
Adjacent segment disease treated with stand-alone lateral lumbar interbody fusion: an analysis of domino adjacent segment revisions.
Burkhard MD, Stepan T, Rojas DG … +9 more , Guven AE, Mielke AM, Verna B, Loggia G, Shue J, Girardi FP, Cammisa FP, Sama AA, Hughes AP
J Neurosurg Spine · 2026 Apr · PMID 41962149 · Publisher ↗
OBJECTIVE: The aim of this study was to assess whether stand-alone lateral lumbar interbody fusion (LLIF) is a durable revision strategy for adjacent segment disease (ASD) in terms of risk for subsequent ASD revision sur...
OBJECTIVE: The aim of this study was to assess whether stand-alone lateral lumbar interbody fusion (LLIF) is a durable revision strategy for adjacent segment disease (ASD) in terms of risk for subsequent ASD revision surgery (i.e., domino ASD revision) compared with circumferential LLIF with posterior extension of fusion. METHODS: This was a single-center retrospective cohort study of patients who underwent revision and extension of fusion for ASD using either stand-alone LLIF or circumferential LLIF with posterior pedicle screw instrumentation between January 2008 and August 2023. Patients were included if they had undergone previous posterior lumbosacral fusion. Patients undergoing instrumentation across the thoracolumbar junction and those with incomplete radiographic data were excluded. Preoperative radiographs and MR images were reviewed to control for alignment and stenosis severity. The primary outcome was domino ASD revision. Secondary outcomes included cage subsidence and radiographic alignment, measured 1 year postoperatively. Kaplan-Meier survival analysis and multivariable Cox regression were performed. RESULTS: Of the 236 patients included, the mean age was 63.5 years, the mean BMI was 29.6 kg/m2, and 47.5% of patients were female. Baseline demographics, comorbidities, and spinal levels treated were similar to those treated with stand-alone LLIF (n = 131) and those treated with circumferential LLIF (n = 105). The median number of previous segments fused was 2 (IQR 2-3), and the median number of segments extended with LLIF was 1 (IQR 1-2). Stand-alone LLIF was associated with a significantly lower 5-year incidence of domino ASD revision (13.7% vs 28.6%, p = 0.005). On multivariable Cox regression analysis adjusting for preoperative alignment, stenosis severity, and the number of segments fused, stand-alone LLIF remained independently associated with fewer domino ASD revisions (HR 0.43, 95% CI 0.23-0.79, p = 0.007). Radiographic alignment was comparable between the groups. Cage subsidence occurred more frequently after stand-alone LLIF compared with circumferential LLIF (Marchi grade ≥ II: 22.9% vs 9.5%, p = 0.019) but was not associated with increased revision risk. Operative time and hospital stay were significantly shorter in the stand-alone LLIF group. CONCLUSIONS: The findings of this study support the use of stand-alone LLIF as a treatment option for ASD after previous posterior fusion. Compared with those treated with circumferential LLIF and posterior extension of fusion, patients treated with stand-alone LLIF had less domino ASD revision surgery, spent less time in the operating room, and had shorter hospital stays, with comparable radiographic outcomes except for a higher rate of cage subsidence.
Redefining Mental Health Assessment in Adolescent Idiopathic Scoliosis using PROMIS Psychological Well-Being Measures.
Catanzano AA, Virk U, Ribet J … +4 more , Sachs E, Poehlein E, Green CL, Lark RK
Spine (Phila Pa 1976) · 2026 Apr · PMID 41955012 · Publisher ↗
STUDY DESIGN: Prospective. OBJECTIVE: To evaluate the construct validity of PROMIS Positive Affect (PA), Life Satisfaction (LS), and Meaning & Purpose (MP) measures compared to the SRS-22 in AIS patients and determine wh...
STUDY DESIGN: Prospective. OBJECTIVE: To evaluate the construct validity of PROMIS Positive Affect (PA), Life Satisfaction (LS), and Meaning & Purpose (MP) measures compared to the SRS-22 in AIS patients and determine whether these measures capture distinct aspects of mental health not adequately assessed by traditional instruments. SUMMARY OF BACKGROUND DATA: Traditional AIS mental health assessment focuses on psychopathology, but optimal well-being requires positive psychological functioning too. PROMIS PA, LS, and MP measures need validation in AIS populations and may capture patients who can benefit from interventions prior to AIS treatment to optimize outcomes. METHODS: This prospective cohort study enrolled 93 AIS patients (mean age 13.8±1.8 years, 78.5% female) at a single institution. Patients completed PROMIS PA, LS, MP, Anxiety, and Depression measures alongside the SRS-22 questionnaire at baseline. Construct validity was assessed using Spearman correlations. Agreement between PROMIS measures (threshold t-score <45 for LS, MP, and PA and >55 for depression and anxiety) and SRS-22 Mental Health domain (threshold <3.5) for detecting suboptimal well-being was evaluated using Cohen's kappa (κ) and logistic regression. RESULTS: PROMIS measures demonstrated moderate-to-strong correlation with SRS-22 Mental Health (|ρ| = 0.53-0.79) but weak correlation with other SRS-22 domains. Between 14-40% of patients with suboptimal PROMIS well-being scores had SRS-22 Mental Health scores indicating low depression risk. Agreement between measures was moderate (κ=0.47-0.77), with no measure significantly more likely to identify suboptimal mental health compared to the SRS-22. Among bracing patients, those with curves ≤30° had MP scores 10.9 (95% CI: 2.2-19.7) points higher than those with curves >50° (P=0.039). CONCLUSION: PROMIS well-being measures demonstrate acceptable construct validity in AIS patients while capturing unique variance not assessed by the SRS-22, identifying vulnerable patients with suboptimal positive functioning despite low psychopathology risk. LEVEL OF EVIDENCE: 2.
Opioid and Neuropathic Pain Medication use After ACDF for Degenerative Cervical Spine Disease - Nationwide FinSpine Register Study.
Klimko N, Danner N, Schildt L … +3 more , Salo H, Leinonen V, Huttunen J
Spine (Phila Pa 1976) · 2026 Apr · PMID 41954970 · Publisher ↗
STUDY DESIGN: Longitudinal nationwide register study. OBJECTIVE: To examine use of opioids and neuropathic pain medications after primary anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine dis...
STUDY DESIGN: Longitudinal nationwide register study. OBJECTIVE: To examine use of opioids and neuropathic pain medications after primary anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease (DCSD), and to identify independent factors associated with postoperative use. SUMMARY OF BACKGROUND DATA: ACDF is used for cervical radiculopathy and myelopathy, yet many patients continue analgesic use postoperatively. Prolonged opioid use is associated with dependence, poorer clinical outcomes, and reduced return-to-work rates. Evidence on postoperative medication trajectories and their predictors in population-based cohorts remains limited. METHODS: Data were obtained from the nationwide FinSpine register and the Finnish prescription database, which records all outpatient prescription drug purchases. Consecutive patients undergoing primary ACDF for DCSD between 2017 and 2022 were included. Repeated purchases were defined as at least two purchases of the same drug during months 2-12 postoperatively. New strong-opioid users were defined as patients who were strong-opioid naïve six months preceding surgery and met the repeated postoperative purchase criterion. Multivariable logistic regression was used to identify independently associated covariates. RESULTS: The cohort included 4366 patients. Preoperatively, 41.9% (n=1830) purchased opioids and 41.2% (n=1798) gabapentinoids. Repeated postoperative purchases were observed in 16.5% for opioids and 15.6% for gabapentinoids. Among preoperative opioid and gabapentinoid users, cessation rates were 69.5% and 70.9%, respectively. In previously strong-opioid naïve patients, the incidence of new repeated strong-opioid purchases was 2.2% after ACDF. Independent predictors of repeated postoperative purchases included preoperative pain duration of more than one year, smoking, higher baseline NDI, central canal stenosis, adverse working status, and preoperative purchases of the same drug class. CONCLUSION: A considerable proportion of patients continued to purchase opioids and gabapentinoids during the first postoperative year after ACDF. New strong-opioid initiation postoperatively was uncommon. Nationwide prescription data offer an objective and complete measure of postoperative medication dispensing for outcome assessment.
Functional Outcomes Between Surgical and Nonsurgical Treatment for Neurologically Intact Patients With Thoracolumbar Burst Fractures as Measured by the AO Spine PROST.
Sadiqi S, Dandurand C, Muijs SPJ … +8 more , Bransford RJ, Joaquim AF, Benneker LM, Tee JW, Spiegel U, Vaccaro AR, Oner FC, AO Spine Knowledge Forum Trauma & Infection
Spine (Phila Pa 1976) · 2026 Apr · PMID 41954890 · Publisher ↗
STUDY DESIGN: Prospective observational multicenter cohort study. OBJECTIVE: To evaluate and compare functional outcomes, as measured by AO Spine Patient Reported Outcome Spine Trauma (PROST), in neurologically intact pa...
STUDY DESIGN: Prospective observational multicenter cohort study. OBJECTIVE: To evaluate and compare functional outcomes, as measured by AO Spine Patient Reported Outcome Spine Trauma (PROST), in neurologically intact patients with thoracolumbar (TL) burst fractures treated operatively or nonoperatively. SUMMARY OF BACKGROUND DATA: The optimal management of these patients remains debated. METHODS: This investigation was part of a prospective observational international multicenter cohort study. Neurologically intact adults (18-65 y) with acute (≤10 d) TL burst fractures were included from various sites across the world. Provided treatment was determined by the local standard of care. PROST was administered at multiple prospective timepoints from baseline up to 2-years post-injury. Descriptive statistics were used to analyze patient and clinical characteristics. Multivariable mixed models for repeated measures were used to assess differences in treatment groups and between the fracture types. RESULTS: A total of 93 patients were included (mean age 41 y, 57% male). Most sustained high-energy trauma (73.1%) and had type A3 fractures (63.4%), with 61.3% treated nonoperatively. Both nonsurgical (34.2 to 86.0) and surgical (39.9 to 85.6), as well as fracture types (A4: 38.4 to 85.6; A3: 36.4 to 87.3) demonstrated significant improvements in PROST scores over time (P<0.001). No statistically significant differences in PROST scores were found between treatment groups or fracture types. Although, surgically treated patients showed higher PROST scores within the first 3 months, and nonsurgical patients had marginally higher scores hereafter, these differences were not statistically significant and converged by 2 years. CONCLUSION: Both surgical and nonsurgical treatment of neurologically intact TL burst fracture patients resulted in comparable long-term functional outcomes as measured by AO Spine PROST. A descriptive trend was observed with surgically treated patients showing higher mean PROST scores up to 3 months post-treatment, however, between-group differences were not statistically significant and equalized by two years.
Letter to the Editor regarding "The Impact of Teaching Hospital Status on Postoperative Outcomes Among Adults Undergoing Short-Segment Lumbar Instrumentation".
Wang J
Spine (Phila Pa 1976) · 2026 Jul · PMID 41945688 · Publisher ↗
Abstract loading — click title to view on PubMed.
Vertebral-Pelvic Angle Settling: Quantifying T4-L1-Hip Axis Changes Between Intraoperative and Postoperative Alignment for Adult Spinal Deformity.
Yahanda AT, Joseph K, Bui TT … +9 more , Vogl S, Gupta VP, Pallotta NA, Neuman BJ, Hills J, Kelly MP, Ray WZ, Gupta MC, Molina CA
Spine (Phila Pa 1976) · 2026 Apr · PMID 41945674 · Publisher ↗
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To evaluate changes in vertebral-pelvic angles (VPAs) between intraoperative and 6-week postoperative radiographs after fusions for adult spinal deformity (ASD). SUMMARY OF...
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To evaluate changes in vertebral-pelvic angles (VPAs) between intraoperative and 6-week postoperative radiographs after fusions for adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: VPAs are measures of sagittal balance that are independent of posture. Their magnitude is expected to remain relatively fixed within spinal constructs between intraoperative and postoperative alignment. However, no studies have examined VPA fidelity between intraoperative prone and postoperative standing radiographs or analyzed potential factors influencing VPA shifts. METHODS: We analyzed data for patients receiving spinopelvic fusions for ASD from at least L2-pelvis. Pre- and 6-week postoperative VPAs were measured on standing radiographs. Intraoperative VPAs were measured on prone radiographs obtained after screw tightening. Primary VPAs were L1-pelvic angle (L1PA) and T4-pelvic angle (T4PA). Uni- and multivariable regressions were performed to assess variables that may be associated with intra-to-postoperative VPA changes. Analyses were stratified by whether constructs controlled L1PA only (L1C; UIV: L2-T6) or T4PA+L1PA (T4L1C; UIV: T5 and above). RESULTS: 216 patients were analyzed (mean age 64.9±10.7 y, 68% female). 80 patients were L1C and 136 patients were T4L1C. Regardless of UIV, both L1PA (p≤0.0001) and T4PA (P<0.0001) increased on postoperative radiographs. L1PA changed by 2.94±2.5° and 3.43±2.5° for L1C and T4L1C, respectively. T4PA changed by 4.62±2.8° and 4.23±2.9° for L1C and T4L1C, respectively. T4PA-L1PA concordance similarly worsened (p≤0.007 for LIC and T4L1C). Multivariable analyses identified preoperative C2PA, 3-column osteotomy, rod material, rod diameter, rod number, and lumbar interbody use as significantly associated with ΔL1PA or ΔT4PA. CONCLUSIONS: L1PA, T4PA, and T4PA-L1PA mismatch increased with upright posture postoperatively, even when stratifying by fusion length. Several variables were potentially related to these changes. These data support the notion of "VPA settling" whereby the realigned spine and construct cannot counteract some amount of reversion towards preoperative alignment. Anticipating these changes could have implications for intraoperative decision-making and alignment goals. LEVEL OF EVIDENCE: III.
Nonoperative Management is Associated With Similar Long-Term Patient-Reported Outcomes Compared With Surgery for Cervical Radiculopathy: A Systematic Review and Meta-analysis.
Kale KM, Chai YH, Patel S … +2 more , Nischal SA, Wilson JRF
Spine (Phila Pa 1976) · 2026 Apr · PMID 41945632 · Publisher ↗
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To compare long-term patient-reported outcomes between surgical and nonoperative management for cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Cervical r...
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To compare long-term patient-reported outcomes between surgical and nonoperative management for cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Cervical radiculopathy is a common condition associated with substantial morbidity. While both surgical and nonoperative approaches are effective, it remains unclear which patients benefit most from each strategy and whether earlier operative intervention confers meaningful long-term advantage. MATERIALS AND METHODS: PubMed, Embase, and the Cochrane Library were searched from inception to January 2026 for randomized and observational studies comparing surgical and nonoperative management for cervical radiculopathy. Primary outcomes included visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), and overall clinical success. Secondary outcomes included analgesia use and sick leave. Random-effects meta-analyses were performed using restricted maximum likelihood estimation. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence using GRADE. RESULTS: Eleven studies comprising 1154 patients (surgical: 522; nonoperative: 632) were included. Surgery was not associated with superior outcomes in VAS for arm pain (MD: -0.67, 95% CI: -1.59 to 0.26, P =0.12), VAS for neck pain (MD: -0.50, 95% CI: -1.38 to 0.38; P =0.19), or NDI (MD: -3.69, 95% CI: -9.63 to 2.25, P =0.16) after 12 months of treatment, nor in overall success (RR: 1.11, 95% CI: 0.93-1.34, P =0.21). No significant differences were observed in analgesia use ( P =0.54) or sick leave ( P =0.48) at last follow-up. Most studies were rated serious risk of bias and overall certainty of evidence was moderate. CONCLUSION: Evidence from this pooled analysis suggests that long-term pain, disability, and functional outcomes are comparable between patients selected for nonoperative management and those selected for surgery. These findings reflect outcomes within selected cohorts and should not be interpreted as evidence of therapeutic equivalence. LEVEL OF EVIDENCE: Level II.
Age-Stratified Analysis of Posterior Lumbar Fusion Surgeries: Revealing Unique Surgical Patterns and Outcomes in an Aging Population.
Dalton J, Tomlak A, Ng M … +19 more , Mathew J, Giakas A, Oris RJ, Alexander T, Narayanan R, Pohl NB, Green WA, Schoenberg M, Gaccione L, Syed A, Mula M, Kurd MF, Kaye ID, Rihn JA, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD
Spine (Phila Pa 1976) · 2026 Apr · PMID 41945607 · Publisher ↗
STUDY DESIGN: Retrospective Cohort. OBJECTIVE: Compare surgical characteristics, complications, and patient-reported outcome measures (PROMs) by clinically relevant and easily applicable age-decade groups after posterior...
STUDY DESIGN: Retrospective Cohort. OBJECTIVE: Compare surgical characteristics, complications, and patient-reported outcome measures (PROMs) by clinically relevant and easily applicable age-decade groups after posterior lumbar decompression and fusion surgery (PLDF). SUMMARY OF BACKGROUND DATA: Due to an aging population and an increased utilization of spine surgery, spine surgeons must increasingly consider age as a variable that affects surgical risk and outcomes. METHODS: Patients undergoing primary/elective PLDF at one tertiary center (2017-2021) were included. Outcomes included rates of in-hospital and 30-day mortality, 90-day readmission, 1-year revision, and PROMs- Oswestry Disability Index, SF-12 Physical (PCS) and Mental Component Summary (MCS), and Visual Analog Scale (VAS): Back and Leg. Patients were stratified and compared by age decade. RESULTS: 1100 patients were included (Age: <50-N=90, 50-59-N=212, 60-69-N=385, 70-79-N=334, ≥80-N=79). Increasing age decade was associated with lower BMI. Comorbidities, levels decompressed and fused increased with age decade until 70 then slightly decreased. Patients ≥80 predominantly received PLDF, while those <50 predominantly received TLIF/PLDF. Decade groups were similar regarding rates of in-hospital/30-day mortality, 90-day readmission, 1-year revision, and all PROMs except 6-month and 1-year postoperative MCS. Patients aged 70-79 displayed the best 6-month and 1-year postoperative MCS scores. On multivariable regression, age ≥80 best predicted increased LOS (β=0.89; P<0.001) and non-home discharge (β=3.05; OR=21.17; P<0.001) after accounting for sex, BMI, Charlson Comorbidity Index, operative time, and number of levels fused; age 60-79 showed weaker prediction. CONCLUSION: Following PLDF, older patients had similar postoperative mortality, readmission, revision, and PROM improvement; however increasing age predicted increased LOS and non-home discharge. These results suggest that patients in advanced age decades derive similar benefits to their younger counterparts, while maintaining an appropriate safety profile. Future studies should further elucidate age-related outcome differences to improve risk stratification and patient counseling.
"Surgical Outcomes After Preoperative Embolization in Hypervascular Spinal Metastases: A Propensity Scored Study of 191 Patients" by Pierik et al.
Matsuo R, Toda Y, Inoue F … +4 more , Hirata H, Yoshihara T, Tsukamoto M, Morimoto T
Spine (Phila Pa 1976) · 2026 Jun · PMID 41945471 · Publisher ↗
Abstract loading — click title to view on PubMed.
Assessing the Clinical Usefulness and Transparency of Adult Spinal Deformity Randomized Controlled Trials: A Systematic Review Using the Van't Hooft Framework.
Achilova F, Nassar JE, Daher M … +5 more , Sahhar M, Farias MJ, Carayannopoulos NL, Diebo BG, Daniels AH
Spine (Phila Pa 1976) · 2026 Apr · PMID 41945399 · Publisher ↗
STUDY DESIGN: Systematic review and regression analysis of randomized controlled trials. OBJECTIVE: To assess the clinical usefulness of randomized controlled trials (RCTs) in adult spinal deformity (ASD) using the van't...
STUDY DESIGN: Systematic review and regression analysis of randomized controlled trials. OBJECTIVE: To assess the clinical usefulness of randomized controlled trials (RCTs) in adult spinal deformity (ASD) using the van't Hooft framework. SUMMARY OF BACKGROUND DATA: ASD surgery is increasingly performed and associated with substantial clinical risk and economic burden. Although RCTs are essential for guiding surgical decision-making, the extent to which ASD RCTs provide clinically useful, real-world evidence remains unclear. METHODS: RCTs evaluating ASD interventions published between 2001 and 2025 were systematically identified through PubMed, Cochrane, and Embase. Clinical usefulness was assessed using the 13-item van't Hooft framework, encompassing clinical utility and transparency domains. Descriptive analyses summarized trial characteristics and usefulness criteria. Internal consistency was evaluated using Cronbach's alpha. Linear and multivariable ordinary least squares regression analyses examined associations between usefulness scores and trial characteristics, including funding, trial registration, journal category, and publication year. RESULTS: Twenty-six ASD RCTs met inclusion criteria. All addressed a relevant clinical problem, and 96.2% appropriately contextualized findings within existing literature. Pragmatism was limited, with only 23.1% fully meeting pragmatism criteria, and value-for-money analyses were largely absent. Transparency varied widely: 38.5% of trials were preregistered, 7.7% provided a publicly available protocol, and none shared raw data. Overall usefulness scores increased over time (β=0.24, P=0.032), driven primarily by improvements in transparency (β=0.18, P=0.031), while clinical utility showed no meaningful temporal change. Self-funded trials demonstrated significantly lower transparency and usefulness. CONCLUSIONS: Despite methodological rigor, many ASD RCTs exhibit limited real-world applicability and incomplete transparency Improvements in reporting over time have not translated into gains in core clinical utility. Clinicians should therefore interpret current randomized evidence in the context of patient complexity and practice variation, recognizing that many trials establish procedural efficacy under controlled conditions rather than effectiveness across heterogeneous ASD populations.
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