Spine[JOURNAL]
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200 papers
A Novel Radiomics-Based Bone Quality Assessment for Early Prediction of Proximal Junctional Kyphosis in Patients with Adult Spinal Deformity.
Wang D, Liu L, Kong C … +6 more , Wang Q, Fan Z, Wang Y, Wang W, Chen X, Lu S
Spine (Phila Pa 1976) · 2026 Apr · PMID 41944816 · Publisher ↗
STUDY DESIGN: A retrospective analysis. OBJECTIVE: To explore the potential of radiomics as a novel bone assessment tool for early prediction of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD). BACKGRO...
STUDY DESIGN: A retrospective analysis. OBJECTIVE: To explore the potential of radiomics as a novel bone assessment tool for early prediction of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD). BACKGROUND: PJK is a prevalent complication following ASD surgery. Since impaired bone quality is a major risk factor, accurate preoperative bone assessment is crucial for early identification of high-risk patients. However, conventional metrics such as T-score, Hounsfield unit (HU) value, and vertebral bone quality (VBQ) score exhibit limitations in accuracy and reliability. METHODS: A total of 358 ASD patients were analyzed and randomly assigned to training and test sets (7:3). Radiomic features were extracted from lumbar CT and MRI scans to construct CT and MRI radiomics scores (CTRS/MRIRS). In parallel, T-score, HU value, and VBQ score were also evaluated. Univariable prediction models were first developed for each of the five bone metrics. Subsequently, multimodal models were constructed using the best-performing bone metric as the core variable, with additional selected clinical and radiographic parameters incorporated to further enhance predictive performance. Model performance was evaluated using AUROC, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS: Among univariable models, CTRS (AUROC=0.780) and T-score (AUROC=0.793) exhibited superior predictive performance compared to MRIRS (AUROC=0.694), HU value (AUROC=0.713), and VBQ score (AUROC=0.658). Multimodal models significantly outperformed their univariable counterparts (CTRS/T-score multimodal AUROC=0.880/0.885), with improved reclassification ability (CTRS univariable vs. multimodal: IDI=-0.2; T-score univariable vs. multimodal: NRI=-0.332, IDI=-0.247; all P <0.001). CONCLUSIONS: The CT-based radiomics score presents a promising alternative to conventional bone quality metrics for early prediction of PJK after ASD surgery. Integrating CTRS with clinical and radiographic factors further enhances predictive accuracy, providing a valuable framework for preoperative risk stratification. LEVEL OF EVIDENCE: III.
Precocious Puberty as a Significant Risk Factor for Scoliosis: A Retrospective Cohort Study Demonstrating Synergistic Effects of GnRHa Therapy and Protective Role of Vitamin D.
Zhang S, Li X, Wu Y … +4 more , Chen Y, Jin S, Huang C, Wang X
Spine (Phila Pa 1976) · 2026 Apr · PMID 41944804 · Publisher ↗
STUDY DESIGN: Cross-sectional and retrospective cohort study. OBJECTIVE: This study aimed to investigate the impact of precocious puberty (PP) on scoliosis development and to evaluate the effects of gonadotropin-releasin...
STUDY DESIGN: Cross-sectional and retrospective cohort study. OBJECTIVE: This study aimed to investigate the impact of precocious puberty (PP) on scoliosis development and to evaluate the effects of gonadotropin-releasing hormone agonist (GnRHa) therapy and vitamin D (VitD) supplementation. SUMMARY OF BACKGROUND DATA: The effects of precocious puberty, GnRHa therapy, and VitD supplementation on scoliosis remain unclear. METHODS: The cross-sectional analysis included 5605 participants, while the retrospective cohort comprised 1575 individuals. Data on PP diagnosis, GnRHa therapy, VitD supplementation were obtained from medical records. Scoliosis was radiographically defined as a Cobb angle ≥10°. Logistic and Cox regression models were used in cross-sectional and cohort analyses, respectively, to assess the associations of PP and GnRHa therapy with scoliosis incidence. RESULTS: In the cross-sectional study, scoliosis prevalence was higher in the PP group compared with controls (19.2% vs. 5.6%, P <0.001), yielding an adjusted odds ratio (OR) of 3.92. Vitamin D deficiency further increased scoliosis risk (HR=2.04, P =0.003). In the longitudinal cohort, PP was associated with a 5.44-fold elevated risk of de novo scoliosis. GnRHa therapy independently increased scoliosis risk (HR=1.99, P =0.004). Conversely, VitD supplementation reduced scoliosis incidence by 51.5% among GnRHa-treated patients (HR=0.43, P <0.001). A U-shaped biphasic association was observed between estradiol levels and scoliosis risk (non-linear P <0.05). CONCLUSION: PP and GnRHa therapy synergistically increase scoliosis risk, whereas VitD co-therapy mitigates this effect. Baseline spinal surveillance and VitD supplementation are recommended for PP patients initiating GnRHa therapy. LEVEL OF EVIDENCE: 3.
Establishing Minimal Important Change After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures.
Sørensen SW, Pedersen CF, Andresen AK … +3 more , Hansen KH, Andersen MØ, Carreon LY
Spine (Phila Pa 1976) · 2026 Apr · PMID 41944792 · Publisher ↗
STUDY DESIGN: Observational longitudinal cohort study. OBJECTIVE: The aim of this study was to establish the minimal important change (MIC) for patients with osteoporotic vertebral compression fractures (OVCFs) treated w...
STUDY DESIGN: Observational longitudinal cohort study. OBJECTIVE: The aim of this study was to establish the minimal important change (MIC) for patients with osteoporotic vertebral compression fractures (OVCFs) treated with percutaneous vertebroplasty (PVP). SUMMARY OF BACKGROUND DATA: MIC thresholds have been established for several surgically treated spine diseases but not for OVCFs after PVP. This lack of relevant MIC thresholds for OVCFs has led to the use of threshold values derived from non-specific low back pain cohorts that may not accurately represent the experience of patients with OVCFs treated with PVP. METHODS: Five hundred and four patients with OVCFs reported their health status before and after PVP using Visual Analog Scale (VAS) for back pain, the Oswestry Disability Index (ODI) and the EuroQOL-5D (EQ-5D). Net change, percent change and follow up scores were calculated for each patient reported outcome measure. An anchor-based receiver operating characteristic curve analysis was used to develop MIC thresholds using the Health Transition Item of the Short Form 36 as the anchor. RESULTS: The following MIC thresholds were optimized for their ability to discriminate improved from unchanged patients: VAS for back pain: 30.5 mm net change, 39% change, follow up score less than 44.5; ODI 17.5 net change, 35% change, follow up score less than 33.5; EQ-5D: 0.4 net change, follow up score less than 0.70. VAS and ODI thresholds outperformed EQ-5D, where discrimination was poor. CONCLUSION: VAS back pain and ODI had a greater ability to discriminate between improved and unchanged patients compared to EQ-5D. Patients with OVCF undergoing vertebroplasty require larger change scores of back pain and disability to experience improvement than other spinal surgery populations.
Flowchart and checklist for transcranial motor evoked potential alarm for reducing true-positive and false-positive cases: a prospective multicenter study.
Shigematsu H, Yoshida G, Ushirozako H … +24 more , Kurosu K, Segi N, Ando M, Hashimoto J, Kawabata S, Morito S, Yamada K, Kanchiku T, Fujiwara Y, Taniguchi S, Iwasaki H, Tadokoro N, Takahashi M, Wada K, Yamamoto N, Funaba M, Yasuda A, Kobayashi K, Nakanishi K, Takatani T, Matsuyama Y, Tanaka Y, Imagama S, Takeshita K
J Neurosurg Spine · 2026 Apr · PMID 41931846 · Publisher ↗
OBJECTIVE: Intraoperative neurophysiological monitoring (IONM) is essential for detecting neurological dysfunction, facilitating timely intervention and potential reversal of neurological deficits before they become perm...
OBJECTIVE: Intraoperative neurophysiological monitoring (IONM) is essential for detecting neurological dysfunction, facilitating timely intervention and potential reversal of neurological deficits before they become permanent. Transcranial electrical stimulation of motor evoked potential (Tc-MEP) is the IONM modality used for monitoring pyramidal tract function. The authors believe that a multidisciplinary team approach in response to a Tc-MEP alarm is crucial for optimal outcomes. To this end, the authors developed a flowchart and checklist to guide the response to Tc-MEP alarms. They aimed to clarify the utility of these tools through a prospective multicenter study. METHODS: Data from 9495 patients who underwent various spinal surgical procedures with an adequate number of Tc-MEP recordings from 2017 to 2023 were collected. Patients from the first 3 years served as the control group (n = 3598) without flowchart and checklist implementation, while those from the last 3 years formed the study group (n = 5897) as flowchart and checklist were implemented. A 70% amplitude reduction was used as the Tc-MEP alarm threshold. Postoperative neurological outcomes were categorized as true-positive (TP), false-positive (FP), and rescue cases on the basis of postoperative assessments. RESULTS: The incidence of TP cases decreased significantly from 93/3598 (2.6%) in the control group to 91/5897 (1.5%) in the study group (p < 0.01). FP cases also decreased significantly from 352/3598 (9.8%) in the control group to 413/5897 (7.0%) in the study group (p < 0.01). Notably, rescue cases increased significantly from 41/486 (8.4%) in the control group to 92/596 (15.4%) in the study group (p < 0.01), among Tc-MEP alarm cases. CONCLUSIONS: Applying a flowchart and checklist improved intraoperative responses to Tc-MEP alarms by facilitating early identification of surgery- and nonsurgery-related factors and guiding appropriate interventions. Using these tools led to a significant reduction in TP and FP cases and increased rescue cases, ultimately enhancing the safety and reliability of spine surgeries.
Comparing risk stratification indices in predicting perioperative adverse events following posterior atlantoaxial and occipitocervical fusion.
Bakare AA, Pertsch N, Kim D … +6 more , Ditzel R, Deutsch H, O'Toole JE, Fontes RBV, Fessler RG, Traynelis VC
J Neurosurg Spine · 2026 Apr · PMID 41931845 · Publisher ↗
OBJECTIVE: Craniocervical instability often requires surgical stabilization through atlantoaxial fusion (AAF) or occipitocervical fusion (OCF), procedures commonly performed in older adults and/or patients with poor func...
OBJECTIVE: Craniocervical instability often requires surgical stabilization through atlantoaxial fusion (AAF) or occipitocervical fusion (OCF), procedures commonly performed in older adults and/or patients with poor functional status and multiple comorbidities. Despite the high-risk nature of this patient population, there are limited data on perioperative risk stratification. Thus, authors of this study aim to assess the ability of an 11-item modified frailty index (mFI-11) and the Charlson Comorbidity Index (CCI) to predict adverse events (AEs) following AAF and OCF. METHODS: Adult patients without prior surgery who underwent AAF or OCF between 2009 and 2023 were eligible for inclusion in this retrospective study. The perioperative AEs analyzed were major complications, nonhome discharge, and prolonged length of stay (LOS). Univariable and multivariable logistic regression analyses, as well as receiver operating characteristic curve analysis, were used to determine which index best predicted these AEs. RESULTS: Among the 219 patients included in this study, most of whom were female (60.7%), the median age was 71.5 years, and 45.2% of patients were 60-69 years old. The median LOS was 6 days, with 27.4% of patients staying ≥ 10 days. Major complications occurred in 16.9% of patients, and 37.4% of the patients were not discharged to home. The median mFI-11 was 1, and the most frequent score was 1 (32.4% of patients). The median CCI was 4, and the most frequent score was ≥ 5 (38.4% of patients). In the multivariable analysis, neither risk index was independently associated with a major complication or prolonged LOS; however, the mFI-11 score was associated with increased odds of predicting a nonhome discharge (OR 1.8, p = 0.003). ROC curve analysis revealed that both the mFI-11 and CCI showed modest but similar discriminative ability in predicting major complications (area under the curve [AUC] 0.633 vs 0.636, respectively). For nonhome discharge, the mFI-11 had slightly stronger discriminative ability (AUC 0.645 vs 0.602, respectively). Neither index had strong discriminative ability in predicting prolonged LOS (AUC 0.576 vs 0.597, respectively). CONCLUSIONS: The mFI-11 demonstrated a slight advantage over the CCI in identifying AEs according to ROC analysis, yet neither index independently predicted major complications or prolonged LOS in the multivariable analysis. However, a higher mFI-11 score was associated with increased odds of predicting a nonhome discharge. While the mFI-11 may offer slightly greater clinical utility in predicting AEs following AAF and/or OCF, neither index alone is sufficient to determine surgical candidacy.
Disparities in quality of life and health literacy among patients with degenerative cervical myelopathy: the influence of racial and ethnic factors in the All of Us Research Program.
Yakdan S, Joseph K, Poulin N … +12 more , Arkam F, Moniz Garcia D, Cadieux M, Neuman B, Goodin BR, Godzik J, Steinmetz MP, Bydon M, Ghogawala Z, Hafez D, Ray WZ, Greenberg JK
J Neurosurg Spine · 2026 Apr · PMID 41931843 · Full text
OBJECTIVE: Degenerative cervical myelopathy (DCM) is a progressive condition that results in significant neurological decline and disability. Racial and ethnic disparities in healthcare access and outcomes are well docum...
OBJECTIVE: Degenerative cervical myelopathy (DCM) is a progressive condition that results in significant neurological decline and disability. Racial and ethnic disparities in healthcare access and outcomes are well documented, yet their impact on DCM patients remains insufficiently explored. This study aimed to investigate racial and ethnic disparities in self-reported health status and quality of life (QOL), health literacy, and healthcare access among individuals with DCM using data from the All of Us Research Program (AoURP). METHODS: In this retrospective study, the authors analyzed the data of AoURP participants with a diagnosis of DCM based on ICD-9 and ICD-10 codes. Race and ethnicity were categorized as White/Caucasian (WC), Black/African American (BAA), and non-White Hispanic (NWH). Participants' demographic characteristics, socioeconomic status (SES), self-reported health status and QOL, health literacy, and healthcare utilization patterns were assessed through survey responses. To assess whether SES mediates the association between race and ethnicity and outcomes, a causal mediation analysis was conducted, operationalizing SES as a composite of standardized income, education, and employment measures. Statistical analyses were conducted using chi-square and independent t-tests to compare categorical and continuous variables, respectively. RESULTS: Among 3092 DCM patients, 26% identified as BAA, 64% as WC, and 10% as NWH. Significant socioeconomic disparities were observed, with WC participants reporting higher educational attainment, income, and homeownership rates (p < 0.001). Healthcare access varied substantially, with BAA and/or NWH participants reporting lower rates of insurance coverage, specialist consultations, and primary care access compared to WC participants (p ≤ 0.05). Financial and transportation barriers to care access were more frequently reported among minority groups. BAA and NWH participants also had lower health literacy, reporting greater difficulty in understanding medical information and completing medical forms and requiring assistance with health materials (p < 0.001). Furthermore, both BAA and NWH groups reported poorer self-perceived health and QOL and higher pain levels (p < 0.001). Causal mediation analysis demonstrated that SES partially mediated the relationship between race and ethnicity and key outcomes, including health literacy, healthcare access, and self-perceived health, indicating that socioeconomic disadvantage explains much, but not all, of the observed disparities. CONCLUSIONS: This study highlights substantial racial and ethnic disparities in healthcare access, health literacy, and self-reported health status and QOL among DCM patients, which are partially mediated by socioeconomic factors. Recognizing and addressing these disparities is essential to improving DCM outcomes and ensuring equitable care.
Differences in the rate of distal junctional problems between L3 and L4 pedicle subtraction osteotomy.
Ambati VS, Shabani S, Mummaneni PV … +19 more , Chryssikos T, Patel A, Ravikumar C, Dada A, Rechav Ben-Natan A, Huang J, Jamieson A, Park K, Macki M, Tawil ME, Guinn J, Wu HH, Wang M, Duan PG, Xi Z, Burch S, Berven S, Chou D, Tan LA
J Neurosurg Spine · 2026 Apr · PMID 41931838 · Publisher ↗
OBJECTIVE: Pedicle subtraction osteotomy (PSO) is a powerful technique for sagittal plane deformity correction. The authors aimed to investigate the differences in radiographic outcomes and rates of distal junctional pro...
OBJECTIVE: Pedicle subtraction osteotomy (PSO) is a powerful technique for sagittal plane deformity correction. The authors aimed to investigate the differences in radiographic outcomes and rates of distal junctional problems (DJPs) between L3 and L4 PSOs. METHODS: Patients who underwent L3 or L4 PSO at a quaternary care center between 2005 and 2021 were retrospectively identified. DJPs were defined as either hardware failure or pseudarthrosis distal to the PSO level. RESULTS: In total, 116 patients were included: 86 (74.1%) underwent L3 PSO and 30 (25.9%) underwent L4 PSO. The mean imaging follow-up was 4.1 (range 1.0-10.9) years. There were no statistically significant differences in age, sex, BMI, operative time, and estimated blood loss. Preoperatively, there were no significant differences in mean sacral Hounsfield units and spinopelvic parameters, with the exception of pelvic incidence (PI; L3: 51.1° ± 11.2° vs L4: 57.9° ± 14.1°, p = 0.012) and the L1 pelvic angle (L3: 23.6° ± 10.1° vs L4: 34.8° ± 13.5°, p < 0.001). Postoperatively, there were no statistically significant differences in primary rod type, 2-rod versus multirod constructs, unilateral versus bilateral iliac fixation, number of levels fused, graft material, L5-S1 interbody fusion approach, and PI-lumbar lordosis mismatch. There were no significant differences between the cohorts in uni- versus bilateral pelvic fixation or type of fixation (iliac vs S2AI); however, patients who underwent L4 PSO had, on average, more pelvic screws placed (mean 1.9 ± 0.7 vs 1.5 ± 0.6, p = 0.002). L4 PSO resulted in larger postoperative L4-S1 segmental lordosis (37.2° ± 13.3° vs 21.4° ± 11.4°, p < 0.001) and reduced rates of postoperative low lordosis distribution index (20.0% vs 60.0%, p < 0.001). There were no significant differences in postoperative complication rates including CSF leak, iatrogenic dorsiflexion weakness, and 30- or 90-day readmissions. The L4 PSO cohort experienced lower DJP rates (6.7% vs 29.1%, p = 0.012), including hardware failure (3.3% vs 20.9%, p = 0.024) and pseudarthrosis (3.3% vs 25.6%, p = 0.008). Multivariate analysis found that multirod construct versus dual-rod configuration (OR 0.31, 95% CI 0.09-0.96) and L4 PSO (OR 0.18, 95% CI 0.02-0.80) were independently associated with decreased DJP rates. Age was also a risk factor for DJPs. The number of pelvic screws and pelvic screw fixation type did not predict DJPs. CONCLUSIONS: In addition to multirod configurations, L4 PSO resulted in a lower rate of DJPs compared with L3 PSO. This result might be due to a more physiological distribution of lumbar lordosis with L4 PSO.
Local Tumor Necrosis Factor Alpha Exposure Inhibits Posterolateral Fusion Rates in a Rat Model.
Ng MK, Koerner JD, Dalton J … +7 more , Eichbaum YK, Venkatesh D, Garcia M, Giakas A, Vaccaro AR, Markova DZ, Kepler CK
Spine (Phila Pa 1976) · 2026 Apr · PMID 41930935 · Publisher ↗
STUDY DESIGN: Randomized, preclinical animal study. OBJECTIVE: To determine whether exposure to TNF-α levels affects Mesenchymal stem cell (MSC) osteogenic differentiation and if brief, localized TNF-α at the fusion site...
STUDY DESIGN: Randomized, preclinical animal study. OBJECTIVE: To determine whether exposure to TNF-α levels affects Mesenchymal stem cell (MSC) osteogenic differentiation and if brief, localized TNF-α at the fusion site affects posterolateral arthrodesis in a rat model. SUMMARY OF BACKGROUND DATA: Elevated tumor necrosis factor-α (TNF-α) has been shown in degenerative spine pathology, pseudarthrosis, and systemic inflammation. Yet the effect of local localized TNF-α exposure on subsequent arthrodesis remains incompletely understood. METHODS: MSCs were examined in vitro with TNF-α exposure. Bilateral posterolateral fusions at L4-L5 were performed on 35 Wistar Kyoto male rats. Demineralized bone matrix (DBM) was used for fusion in both groups, but the treatment group also received a low dose of TNF-α (20 uL of 50 ng/mL) on an absorbable collagen sponge. Animals sacrificed at day 2 and day 4 had the local fusion mass harvested and processed for cytokine analysis with ELISA. Serum was also collected by cardiac puncture. Animals sacrificed at 4 weeks were assessed by manual palpation and microCT for fusion, as well as serum cytokine levels with ELISA. RESULTS: TNF-α suppressed MSC osteogenesis in a dose-dependent manner, starting at 0.1 ng/mL. TNF-α protein rose within the fusion mass at postoperative day (POD) 2 in the treatment group compared to controls (P <0.05), while IL-1β levels remained unchanged. At 4 weeks, manual palpation demonstrated fusion in 4/5 control animals, and no fusion in any TNF-α-treated animal (P=0.048). Micro-CT and histological analysis revealed bilateral fusion in 4/5 controls compared with 1/5 TNF-α animals, with the remainder showing unilateral or no fusion (P = 0.286). CONCLUSIONS: A brief, localized increase in TNF-α levels after surgery significantly impairs posterolateral fusion in rats. Limiting early TNF-α activity at the fusion site may improve arthrodesis outcomes, particularly in patients with elevated inflammatory profiles.
Letter to the Editor "Pelvic Incidence Changes in Patients With Adult Spinal Deformity Following S2AI Fixation: Is the Hip Joint Involved?".
Kocak S
Spine (Phila Pa 1976) · 2026 Jun · PMID 41912263 · Publisher ↗
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Shifting Single-level Anterior and Lateral Lumbar Interbody Fusion to the Ambulatory Setting: Comparative Outcomes from a Large Matched Cohort Analysis.
Green CK, Wang JE, Novicoff W … +1 more , Lockey SD
Spine (Phila Pa 1976) · 2026 Mar · PMID 41912254 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare outcomes and healthcare utilization between single-level anterior lumbar interbody fusion (ALIF) or lateral lumbar interbody fusion (LLIF) performed in inpa...
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare outcomes and healthcare utilization between single-level anterior lumbar interbody fusion (ALIF) or lateral lumbar interbody fusion (LLIF) performed in inpatient and outpatient settings. SUMMARY OF BACKGROUND DATA: As healthcare costs continue to rise, there has been a corresponding increase in the number of spine surgeries performed in ambulatory surgery centers. ALIF/LLIF are among the most commonly performed minimally invasive lumbar spine procedures. Large-scale data reporting on outcomes following outpatient ALIF/LLIF remains limited. METHODS: A retrospective review of the PearlDiver database was conducted, querying for single-level ALIF/LLIF from 2010 to 2022 stratified by service location. Inpatient and outpatient cohorts were matched 1:1 on age range, gender, and the Elixhauser Comorbidity Index (ECI). Outcomes assessed included intraoperative complications, 90-day medical and surgical complications, 30-day and 90-day emergency department (ED) visits and inpatient readmissions, day-of-surgery and 90-day global reimbursements, and five-year revision-free survival. RESULTS: A total of 8,342 patients who underwent outpatient ALIF/LLIF were matched to 8,342 patients who underwent inpatient procedures. Inpatient ALIF/LLIFs were associated with significantly higher rates of intraoperative and 90-day postoperative complications. Patients in the outpatient group were less likely to present to the ED or require hospital readmission at both 30 and 90 days postoperatively (P<0.001 for all) and demonstrated higher revision-free survival at 5 years (log-rank P=0.007). Outpatient procedures were associated with significantly lower reimbursements on the day of surgery (Median [IQR]: $3,199 [$1,270-$6,402] vs. $3,942 [$1,694-$9,433], P<0.001) and within 90 days postoperatively (Median [IQR]: $5,169 [$2,535-$9,480] vs. $6,779 [$3,407-$15,034], P<0.001)). CONCLUSION: Outpatient ALIF/LLIF procedures are associated with significantly lower rates of postoperative ED visits, hospital readmissions, and total reimbursements compared to inpatient ALIF/LLIF, without an increased risk of complications. These findings support the safety and cost-efficiency of outpatient ALIF/LLIF in appropriately selected patients.
Vancomycin Effectiveness in Reducing Surgical Site Infection in Posterior Spinal Fusion Surgery: A Retrospective Data Analysis of the STRIVE Trial.
Joshi A, Schiedo RM, Bronheim RS … +4 more , Helbing J, Jain A, Kebaish KM, Hassanzadeh H
Spine (Phila Pa 1976) · 2026 Feb · PMID 41902726 · Publisher ↗
STUDY DESIGN: Retrospective analysis of prospectively collected data. OBJECTIVE: To reevaluate vancomycin as a preventive measure for surgical site infection (SSI). SUMMARY OF BACKGROUND DATA: Intrawound vancomycin powde...
STUDY DESIGN: Retrospective analysis of prospectively collected data. OBJECTIVE: To reevaluate vancomycin as a preventive measure for surgical site infection (SSI). SUMMARY OF BACKGROUND DATA: Intrawound vancomycin powder is used to prevent SSIs in spinal surgery. Prior studies, often limited to single institutions or small samples, have shown mixed efficacy and potential increases in non-S. aureus and gram-negative infections. We hypothesized that SSIs rates would be similar with and without intrawound vancomycin in posterior spinal fusion (PSF) surgery. METHODS: Prospectively collected data from the 3,595 patients in the STaphylococcus aureus suRgical Inpatient Vaccine Efficacy (STRIVE) trial were stratified by intrawound antibiotic usage. Multivariate logistic regression assessed the effect of vancomycin use on SSI, adjusting for patient demographics and SSI-associated risk factors. Secondary outcomes included critical care stay, reoperation, sepsis, and hospital readmission. RESULTS: Of 3,311 patients who underwent surgery, 847 (26%) received only intrawound vancomycin and 1,534 (46%) received no intrawound antibiotics. Sixty (8%) patients developed postoperative SSI, of whom 20 (33%) had received intrawound vancomycin. Receiving intrawound vancomycin was not associated with SSI incidence versus no intrawound antibiotics (odds ratio [OR] = 0.77; 95% confidence interval [CI] 0.42-1.42), critical care stay (OR = 0.94; 95% CI 0.78-1.12), or sepsis (OR 2.04; 95% CI 0.62-6.73). However, intrawound vancomycin was associated with increased odds of hospital readmission (OR 1.82; 95% CI 1.28-2.6; P < .001) and reoperation (OR 1.75; 95% CI 1.18-2.6; P = .005). Factors significantly associated with intrawound vancomycin use included intraoperative antibiotic readministration (OR 2.97; 95% CI 1.36-6.5; P=.006) and hospital location, lower odds in Europe (OR 0.13; 95% CI 0.06-0.29; P < .001) or Asia (OR: 0.02; 95% CI 0-0.08; P < .001) versus North America. CONCLUSION: Intraoperative vancomycin use was not associated with reduced SSI incidence compared to no intrawound antibiotics following PSF surgery. Level of Evidence: 2.
Letter to the Editor. Vertebral bone quality score and secondary fracture risk after vertebroplasty.
Wang Y, Cheng C
J Neurosurg Spine · 2026 Mar · PMID 41894811 · Publisher ↗
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Opioid use and complications following short-segment fusions in patients with psychiatric disorders.
Khalid SI, Wang R, Abou-Mrad T … +8 more , Tiefenbach J, Massaad E, Elsamadicy AA, Arena JD, Ghenbot Y, Golubovsky JL, Ozturk AK, Shin JH
J Neurosurg Spine · 2026 Mar · PMID 41894810 · Publisher ↗
OBJECTIVE: The rising prevalence of psychiatric disorders significantly impacts surgical outcomes. These conditions can adversely affect pain perception and recovery trajectories following lumbar spine procedures. The ai...
OBJECTIVE: The rising prevalence of psychiatric disorders significantly impacts surgical outcomes. These conditions can adversely affect pain perception and recovery trajectories following lumbar spine procedures. The aim of this study was to investigate the association between specific psychiatric disorders and postoperative opioid use, complications, and 30-day readmission rates after transforaminal lumbar interbody fusion (TLIF). METHODS: A retrospective matched cohort study using a national administrative database included patients with and those without psychiatric diagnoses who underwent short-segment TLIF (≤ 3 levels) between January 2018 and April 2022. Patients were exactly matched 1:1 based on demographics and comorbidities. Psychiatric conditions assessed were anxiety disorders, behavioral disorders, depression, impulse control disorders, and schizophrenia. Outcomes measured included postoperative opioid use beyond 30 days, mean morphine milligram equivalents (MME) per day, 30-day readmission rates, and incidences of medical and surgical complications. Multivariate logistic regression was used to delineate independent effects on outcome variables. RESULTS: Patients with psychiatric comorbidities had significantly greater opioid use beyond 30 days postoperatively (90.94% vs 79.48%; OR 2.59, 95% CI 2.48-2.71; p < 0.001) and greater mean MME per day (50.68 ± 50.97 mg vs 46.10 ± 46.99 mg; p < 0.001). Specific psychiatric conditions linked to increased opioid requirements included anxiety disorders (OR 1.26, 95% CI 1.16-1.36; p < 0.001), depression (OR 1.52, 95% CI 1.40-1.64; p < 0.001), behavioral disorders (OR 1.46, 95% CI 1.16-1.86; p = 0.002), and impulse control disorders (OR 4.88, 95% CI 1.54-29.62; p = 0.027). The 30-day readmission rate was higher in patients with psychiatric comorbidities (2.25% vs 1.88%; OR 1.20, 95% CI 1.08-1.34; p < 0.001). Depression (OR 1.15, 95% CI 0.99-1.34; p = 0.057) and schizophrenia (OR 1.83, 95% CI 1.35-2.48; p < 0.001) were associated with increased readmission rates. Patients with psychiatric diagnoses had higher incidences of composite medical complications (15.49% vs 5.20%; OR 3.34, 95% CI 3.16-3.53; p < 0.001) and surgical complications (4.07% vs 2.39%; OR 1.73, 95% CI 1.58-1.89; p < 0.001). CONCLUSIONS: Psychiatric comorbidities are associated with increased postoperative opioid requirements, higher complication rates, and greater 30-day readmissions following TLIF. Preoperative identification and personalized management of psychiatric conditions might improve postoperative outcomes and optimize healthcare resource utilization.
Letter to the Editor. Do fracture morphology and disability trajectories truly diverge in thoracolumbar burst injuries?
Sah SS, Kumbhalwar A
J Neurosurg Spine · 2026 Mar · PMID 41894807 · Publisher ↗
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Letter to the Editor. Minimally invasive versus open decompression for lumbar spinal stenosis.
Shahi P, Basu A
J Neurosurg Spine · 2026 Mar · PMID 41894805 · Publisher ↗
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A novel interpretable classification of lumbar spinal stenosis using a cascade deep learning approach and T2-weighted MRI.
Tabarestani M, Delfan N, Khoshnevisan M … +5 more , Hatam Parikhan J, Bahri A, Hessam A, Nabiuni M, Moshiri B
J Neurosurg Spine · 2026 Mar · PMID 41894804 · Publisher ↗
OBJECTIVE: Lumbar spinal stenosis (LSS) is a degenerative spinal condition characterized by the narrowing of the lumbar spinal canal, leading to back pain and disability. MRI remains the gold standard for LSS diagnosis,...
OBJECTIVE: Lumbar spinal stenosis (LSS) is a degenerative spinal condition characterized by the narrowing of the lumbar spinal canal, leading to back pain and disability. MRI remains the gold standard for LSS diagnosis, but diagnostic variability arises due to the lack of standardized imaging criteria. Recent advancements in artificial intelligence, particularly convolutional neural networks (CNNs), offer promising potential for automating LSS detection and classification. The aim of this study was to propose a novel 3-stage deep learning pipeline for automated LSS identification, classification, and grading using lumbar MRI, aiming to enhance diagnostic accuracy and consistency. METHODS: Two datasets were used. The first dataset consisted of 17,440 MRI slices obtained in 640 patients (mean patient age 57.58 ± 12.47 years) and was used for model training. The second dataset consisted of 8000 slices and was used only as the external validation set. The proposed framework consists of 1) classification of images into sacral, lumbar, and thoracic regions; 2) region of interest detection; and 3) LSS grading (binary and multiclass). The 10-fold cross-validation method was used to avoid overfitting and improve generalization of the model. RESULTS: The proposed model achieved an accuracy of 97.87% for binary classification and 95.52% for multiclass grading of LSS, outperforming state-of-the-art models. To validate the clinical relevance of the model's decision-making, gradient-weighted class activation mapping was used to visualize the key focus areas. CONCLUSIONS: The proposed framework offers a reliable, interpretable, and effective tool for automated LSS detection and grading, with the potential for future improvements in underdiagnosis and multilevel spine disease analysis.
Is the chin-brow vertical angle always a reliable parameter for surgical planning in the correction of thoracolumbar kyphosis secondary to ankylosing spondylitis?
Chang MH, Qian BP, Qiu Y … +1 more , Bao HD
J Neurosurg Spine · 2026 Mar · PMID 41894803 · Publisher ↗
OBJECTIVE: The aim of this retrospective study was to investigate the correlation between chin-brow vertical angle (CBVA) and osteotomized vertebra angle (OVA) across diverse cervical ranges of motion (CROMs) and to exam...
OBJECTIVE: The aim of this retrospective study was to investigate the correlation between chin-brow vertical angle (CBVA) and osteotomized vertebra angle (OVA) across diverse cervical ranges of motion (CROMs) and to examine the reliability of CBVA in surgical correction design. METHODS: The authors analyzed all ankylosing spondylitis (AS) patients with thoracolumbar kyphosis who had undergone single-level lumbar or thoracic pedicle subtraction osteotomy between January 2015 and December 2019 and had at least 2 years of follow-up. The patients were categorized into 3 groups based on their CROM: group A, CROM ≤ 10°; group B, 10° < CROM ≤ 20°; and group C, CROM > 20°. The correlation between ΔCBVA (change in CBVA from preoperatively to immediately postoperatively) and ΔOVA (change in the Cobb angle of the osteotomized vertebra from preoperatively to immediately postoperatively) was evaluated across the 3 CROM groups, identifying the subgroups as the cervical ankylosis (CA) group and cervical nonankylosis (CNA) group. The Cobb angle from C2 to C7, CBVA, Cobb angle from C0 to C7, global kyphosis, sagittal vertical axis C7-S1, and pelvic tilt were measured to enable comprehensive intergroup and intragroup comparisons of preoperative and postoperative parameters. RESULTS: Among the 64 patients included in this study, a significant correlation between ΔCBVA and OVA was observed in patients from group A (p < 0.001) and group B (p < 0.001); however, no correlation was evident in group C (p = 0.31). Consequently, patients from groups A and B were amalgamated into the CA group, whereas those from group C were classified into the CNA group. Both subgroups attained satisfactory orthopedic outcomes following the surgical intervention. Notably, postoperative evaluations revealed significant kyphosis changes in the cervical spine in the CNA group (change 20.25°) compared to those in the CA group (change 4.97°). CONCLUSIONS: For AS patients with thoracolumbar kyphosis, CBVA is not consistently reliable for determining the OVA necessary for deformity correction, with its reliability closely linked to CROM. When the CROM is extensive (CROM > 20°) in patients with AS, the CBVA is not recommended as a reliable parameter for guiding the design of the OVA.
Proposal of a Cervical Sagittal Classification System to Guide Surgical Treatment for Adult Cervical Deformity: A MEANS Cohort Analysis.
Sardar ZM, Miller R, Reyes JL … +11 more , Dionne AC, Coury JR, Hassan FM, Le Huec JC, Bourret S, Hasegawa K, Wong HK, Liu G, Dennis Hey HW, Kelly MP, Lenke LG
Spine (Phila Pa 1976) · 2026 Jun · PMID 41887753 · Publisher ↗
STUDY DESIGN: Retrospective analysis. OBJECTIVE: To describe normative cervical sagittal alignment and to propose a classification system to guide clinical assessment and surgical planning. BACKGROUND CONTEXT: Optimizing...
STUDY DESIGN: Retrospective analysis. OBJECTIVE: To describe normative cervical sagittal alignment and to propose a classification system to guide clinical assessment and surgical planning. BACKGROUND CONTEXT: Optimizing alignment is a key goal of adult cervical deformity (ACD) surgery. The purpose of this study was to understand normative alignment utilizing an asymptomatic adult cohort and to formulate a classification system that would help identify the spinal regions contributing to the cervical deformity. MATERIALS AND METHODS: A total of 468 asymptomatic adults (18-80 yr) from five countries (USA, France, Japan, Singapore, and Tunisia) formed the Multi-Ethnic Alignment Normative Study (MEANS). The C2-C7 sagittal vertical axis (cSVA), T1 slope (T1S), and C2-C7 cervical sagittal angle (CSA; positive=kyphosis, negative=lordosis), and other sagittal parameters were measured. Linear regression was utilized to correlate the C2-C7 CSA to the T1 slope. Thresholds for the C2-C7 sagittal vertical axis and T1 slope were defined as mean+2 SD. Groups were compared using ANOVA with a Tukey post hoc test. χ 2 analysis was used for categorical comparisons. RESULTS: Mean values for C2-C7 cervical sagittal angle were -0.4° (12.7°), T1 slope was 23.0° (7.9°), C2-C7 sagittal vertical axis was 19.1 (9.8). The highest mean segmental Cobb angle was 3.2° (4.8), which was at the C4-C5 segment. The T1S-CSA mismatch was 22.6 (9.4) with an interquartile range of 9.5 to 35.7. Linear regression yielded a formula CSA=-1.1(T1S) + 24.5 ( R2 =0.45, P <.0001) which was simplified to CSA=25-T1S. Four alignment types (1A/1B/2/4) were observed in the MEANS cohort. Type 3 alignment was absent. Types 1A, 1B, 2, and 4 alignment showed significant differences across cervical, thoracic, and global sagittal parameters. CONCLUSION: We define normative cervical alignment utilizing the MEANS cohort and propose a classification system to identify the spinal region driving the cervical deformity. Types 1A-B represent well-compensated alignment. Types 2 and 3 were considered to have deformities in the cervical spine and thoracolumbar spine, respectively. Type 4 spines have a combined deformity. This can help guide surgeons to determine the appropriate region that should be addressed with surgery.
Iatrogenic Anteverted Pelvis After Adult Spinal Deformity Surgery: Is It a Risk Factor for Postoperative Mechanical Complications in a Young Adult Population or a Physiological Variant?
Roscop C, Bourghli A, Baroncini A … +9 more , Alanay A, Pellise F, Kleinstueck F, Pizones J, Charles YP, Larrieu D, Boissière L, Obeid I, European Spine Study Group (ESSG)
Spine (Phila Pa 1976) · 2026 Mar · PMID 41887717 · Publisher ↗
STUDY DESIGN: Retrospective cohort study based on a multicenter prospectively collected database. OBJECTIVE: To determine whether postoperative anteverted pelvis (AP) in patients with preoperative normo- or retroverted p...
STUDY DESIGN: Retrospective cohort study based on a multicenter prospectively collected database. OBJECTIVE: To determine whether postoperative anteverted pelvis (AP) in patients with preoperative normo- or retroverted pelvis (NRP) is associated with increased risk of mechanical or clinical complications after adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Pelvic anteversion is a rare spinopelvic morphology, typically considered physiological in young patients with low pelvic incidence. However, its occurrence after ASD correction-especially in patients with initially normo- or retroverted pelvic orientation-raises concerns about its potential impact on postoperative outcomes. METHODS: From a database of 2043 surgically treated ASD patients, 84 patients with postoperative AP were identified. Based on preoperative pelvic version, patients were categorized into two groups: preoperative AP (n=38) and preoperative NRP converted to postoperative AP (n=46). Demographic, surgical, radiographic, and health-related quality of life (HRQoL) parameters were analyzed at baseline and at 2-year follow-up. RESULTS: There were no significant differences in age, BMI, or baseline HRQoL between groups. Both groups underwent similar surgical procedures, although the NRP group required more frequent decompression and pelvic fixation. At 2 years, both groups showed significant improvement in ODI and SRS-22 scores. Mechanical complication rates were not significantly different (10.5% in AP vs. 23.9% in NRP, P=0.154). Radiographic analysis showed that postoperative AP patients maintained a lumbar lordosis >60°, despite low or normal pelvic incidence. NRP patients exhibited greater changes in spinopelvic parameters postoperatively. CONCLUSIONS: Postoperative AP does not appear to be associated with increased mechanical complications, even in patients who were normo- or retroverted preoperatively. These findings suggest that iatrogenic AP may represent a physiological adaptation rather than a pathologic outcome, particularly in younger patients without hip or neuromuscular comorbidities. Pelvic fixation is not necessary in cases of isolated AP when global sagittal balance is restored.
Does Preoperative Spinal Alignment Influence Surgical Outcomes When Postoperative Alignment and Fixation Strategies Are Matched in ASD Correction?
Huang D, Wang Z, Jian-Wen Chen M … +14 more , Bay A, Uzzo RN, Dykhouse G, Durbas A, Pezzi A, Owusu-Sarpong S, Colon LF, Araghi K, Singleton Q, Musharbash F, Halayqeh S, Cunningham ME, Kim HJ, Lovecchio FC
Spine (Phila Pa 1976) · 2026 Jun · PMID 41887713 · Publisher ↗
STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate whether the extent of correction influences outcomes following adult spinal deformity (ASD) surgery using a matched-pair analysis. SUMMARY OF BACKGROUND DATA: Ali...
STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate whether the extent of correction influences outcomes following adult spinal deformity (ASD) surgery using a matched-pair analysis. SUMMARY OF BACKGROUND DATA: Alignment targets are often based on achieving absolute values. However, the amount of correction may also influence outcomes. Existing studies are limited by methodological flaws, including multicollinearity and oversimplified modeling of correction. METHODS: We included ASD patients who underwent fusion (≥5 levels) with a UIV between T1 and L1 at a single center (2013-2023), with ≥1-year follow-up. Clinical, radiographic, and surgical outcome data were collected. Patients were 1:1 matched based on T4-L1PA mismatch and L1PA offset (±3°), UIV region (upper vs . lower thoracic), and pelvic fixation status (yes/no). Collected variables were then transformed into within-pair differences (Δ) (absolute value) (for continuous/ordinal variables) or classified as concordant/discordant (for binary variables). Outcomes were analyzed as within-pair Δ or concordance using linear or logistic regression, respectively, with within-pair Δpreoperative alignment as the main predictor and clinical covariates adjusted. RESULTS: A total of 114 patients were matched for similar postoperative sagittal alignment and fixation strategy, forming 57 pairs. Among matched pairs, the average within-pair Δpreoperative alignment (reflecting correction magnitude) was as follows: Δmax Cobb 24.2±18.2°, ΔSVA 76.6±53.2 mm, median ΔL1PA offset 5.0° (IQR 2.3-8.2°), and ΔT4-L1PA 6.9±4.7°. No significant associations were observed between within-pair Δpreoperative alignment and ΔODI, Δlength of stay, or Δoperative time. Similarly, within-pair Δpreoperative alignment did not influence binary outcomes including PJK, PJF, reoperation, complications, or discharge disposition. CONCLUSION: In patients who achieved similar postoperative alignment and fixation strategies, the baseline deformity (or the amount of correction) did not independently affect postoperative outcomes. Achieving target postoperative alignment rather than the extent of correction should remain the primary focus of surgical planning to optimize recovery and reduce complication risk. LEVEL OF EVIDENCE: Level III.
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