Spine[JOURNAL]
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200 papers
Impact of Operative Order on Postoperative Outcomes in Patients Undergoing Lumbar Fusion and Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.
Al-Saidi N, Al-Saidi N, Nguyen R … +4 more , Dominari A, Reilly A, Mohammed D, Bydon M
Spine (Phila Pa 1976) · 2026 Jun · PMID 41887675 · Publisher ↗
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To assess how operative order affects clinical outcomes and complications in patients with concomitant lumbar spinal and hip pathologies. SUMMARY OF BACKGROUN...
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To assess how operative order affects clinical outcomes and complications in patients with concomitant lumbar spinal and hip pathologies. SUMMARY OF BACKGROUND DATA: Concomitant lumbar spinal and hip pathologies are becoming increasingly prevalent in the growing population. Determining the optimal operative order for surgical treatment remains challenging, particularly when comparing spine arthrodesis followed by hip arthroplasty (SAHA) with hip arthroplasty followed by spine arthrodesis (HASA). Prior studies report conflicting results regarding outcomes and complications. METHODS: A comprehensive literature search was performed to identify studies reporting on postoperative outcomes and complications in patients with concomitant lumbar spinal and hip pathologies. Random-effects model meta-analysis of pooled outcomes was performed comparing operative order groups (SAHA and HASA), with postoperative complications and revisions being our primary endpoints. RESULTS: A total of 22 studies, yielding 161,326 patients who received surgical treatment for concomitant lumbar spinal and hip pathologies, were included. The majority of patients underwent SAHA (pooled estimate: 88.4%, 95% CI: 76.9-96.3%, P =0.01). Females comprised 56.1% (95% CI: 49.2-62.8%) of the study population. The mean age was 70.6±6.4 years, and the mean follow-up duration was 2.6±2.1 years. The mean number of treated levels was 2.1±1.4. No significant differences were noted between the SAHA and HASA groups with respect to complications, including hip dislocation ( P =0.7), mechanical loosening ( P =0.8), periprosthetic fractures ( P =0.7), deep venous thrombosis (DVT) ( P =0.8), and infection ( P =0.9). Revisions were required in 3.6% of patients in the SAHA group (95% CI: 2.5-4.9%) and 2.6% of patients in the HASA group (95% CI: 0.5-6.2%, P =0.5). CONCLUSION: Among patients surgically treated for concomitant lumbar spinal and hip pathologies, SAHA was significantly more commonly performed than HASA. Our analysis shows that postoperative complications and revisions did not significantly differ depending on operative order.
Cost-Effectiveness of Acupuncture for Chronic Low Back Pain: Sensitivity to Outliers and the Need for Clear Decision Context.
Shiraishi K
Spine (Phila Pa 1976) · 2026 Mar · PMID 41887673 · Publisher ↗
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Patient Specific Finite Element Modelling Outputs Outperform Clinical Metrics in Predicting Fusion Cage Subsidence.
Lali F, Raftery K, Levy H … +2 more , Freedman B, Newell N
Spine (Phila Pa 1976) · 2026 Mar · PMID 41887667 · Full text
STUDY DESIGN: Finite element (FE) analysis of retrospective clinical cohort. OBJECTIVE: To determine whether preoperative CT-derived FE model outputs can improve subsidence prediction compared to conventional clinical me...
STUDY DESIGN: Finite element (FE) analysis of retrospective clinical cohort. OBJECTIVE: To determine whether preoperative CT-derived FE model outputs can improve subsidence prediction compared to conventional clinical measurements alone in patients undergoing transforaminal lumbar interbody fusion (TLIF). SUMMARY OF BACKGROUND DATA: Cage subsidence occurs in approximately 20% of spinal fusion patients and can lead to complications requiring reoperation. While individual risk factors are known, no validated tool integrates patient anatomy, bone quality, and implant characteristics to predict subsidence. Finite element models have been hypothesized to predict subsidence but lack clinical validation. METHODS: Patient-specific FE models were created from preoperative CT scans of 42 TLIF patients: N=22 Severe subsidence (≥4 mm); N=20 Non-severe subsidence (<4 mm). Vertebral geometries were segmented, and bone material properties were assigned based on Hounsfield units (HU). Cage positions from postoperative scans were registered to preoperative anatomy. Endplate and trabecular stresses and strains from FE models were compared to clinical measures using receiver operating characteristic analysis. RESULTS: 15 Principal stresses and strains of the FE simulations showed significantly higher values in severely subsided patients compared to the Non-Severe group. Average trabecular intermediate strain achieved the highest area under curve score (AUC=0.809), outperforming all clinical metrics. Peak endplate minimum principal stress (AUC=0.775) was the second-best FE classifier. Traditional clinical measures showed lower discriminative ability: cage length (AUC=0.797), cage width (AUC=0.750), and cage height (AUC=0.698). CONCLUSION: Patient-specific FE model outputs significantly correlate with clinical subsidence outcomes and outperform several traditional metrics in classifying severe subsidence. Both endplate and trabecular stresses and strains are important predictors, with average values showing comparable or superior performance to peak values. Integration of FE models into the clinical workflow could provide a comprehensive preoperative subsidence prediction tool.
A Logical Rubric for Adjudicating Spinal Injuries and Chronic Pain Conditions Occurring as the Result of Traumatic Injury.
Schoenfeld AJ, Schoenfeld AL
Spine (Phila Pa 1976) · 2026 Apr · PMID 41886644 · Publisher ↗
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Erratum. Incomplete (A3) versus complete (A4) thoracolumbar burst fractures: results from a prospective international multicenter cohort study.
Tee JW
J Neurosurg Spine · 2026 Mar · PMID 41871434 · Publisher ↗
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Intrathecal baclofen pump complications in adults: rates, risk factors, and spinal cord injury insights from a longitudinal cohort study.
García-Rudolph A, Mendez JM, Ledesma L … +3 more , Del Arco A, Benito-Penalva J, Vidal J
J Neurosurg Spine · 2026 Mar · PMID 41871433 · Publisher ↗
OBJECTIVE: This study analyzed a cohort of adult patients who underwent intrathecal baclofen (ITB) pump and catheter implantation at a large tertiary neurorehabilitation center. The objectives were 1) to describe the rat...
OBJECTIVE: This study analyzed a cohort of adult patients who underwent intrathecal baclofen (ITB) pump and catheter implantation at a large tertiary neurorehabilitation center. The objectives were 1) to describe the rate and types of ITB-associated complications in patients with diverse neurological conditions, 2) to compare baseline clinical and demographic characteristics between patients with spinal cord injury (SCI) who experienced a complication and those who did not, and 3) to identify potential risk factors associated with the occurrence of complications in patients with SCI. METHODS: This retrospective cohort study included patients who underwent ITB implantation at a single center (1989-2025). Patients with SCI who had complications were compared with those without complications across multiple baseline variables, including age, sex, ambulation status, BMI, diabetes status, neurological level of injury, American Spinal Injury Association Impairment Scale (AIS) grade, and motor Functional Independence Measure (FIM). Cox proportional hazards models were used to assess the association between patient-related factors and the risk of experiencing a first complication event. RESULTS: Among 281 patients (205 male, mean age 43.1 years) who underwent ITB pump implantation, the most prevalent conditions were SCI (203/281, 72.2%), multiple sclerosis (29/281, 10.3%), and cerebrovascular accident (16/281, 5.7%). Overall, 22.4% of patients experienced an ITB-related complication. Complications included device erosion (20/281, 7.1%), catheter malfunction (16/281, 5.7%), infection (14/281, 5.0%), CSF leakage (10/281, 3.6%), and pump malfunction (8/281, 2.8%). Additionally, 28 patients (10.0%) had "other" complications, which included a range of issues (e.g., seromas and hematomas). Among the patients with SCI, those with a complication (25.1%) were significantly younger at the time of implantation (mean age 38.1, SD 14.4, years) compared with those without a complication (mean age 45.3, SD 15.7, years; p = 0.004). No significant differences were observed between groups in terms of AIS grade, ambulation, diabetes, BMI, or neurological level. Patients who developed complications had a higher motor FIM score at baseline (mean 51.3 [SD 24.9] vs 44.4 [SD 25.0]), although this difference did not reach statistical significance (p = 0.056). Multivariable Cox proportional hazards analysis identified younger age at implantation as the only significant predictor of complication risk (HR 0.97 [95% CI 0.95-0.99], p = 0.013; C-index = 0.714). CONCLUSIONS: One in four patients with SCI had complications, half of which occurred within the first year. Younger patients were at higher risk, likely due to increased activity, emphasizing the need for early monitoring and targeted prevention strategies.
The posterior approach for removal of all thoracic disc herniations: a single-surgeon experience using the partial transpedicular approach with ultrasonic bone aspiration and ultrasound guidance in 108 consecutive patients.
Saway BF, Dhillon P, Suresh R … +10 more , Nawabi NLA, Pereira MP, Eckert T, Cunningham C, Rafka HE, Isidor J, Abo Kasem R, Sowlat M, Weber A, Kalhorn SP
J Neurosurg Spine · 2026 Mar · PMID 41871428 · Publisher ↗
OBJECTIVE: Thoracic disc herniation (TDH) remains a complex surgical challenge due to its ventral location, frequent calcification, and potential for severe neurological compromise. Anterior and lateral approaches, thoug...
OBJECTIVE: Thoracic disc herniation (TDH) remains a complex surgical challenge due to its ventral location, frequent calcification, and potential for severe neurological compromise. Anterior and lateral approaches, though effective, are associated with significant morbidity and technical demands. Posterior approaches offer a familiar alternative but have historically been limited in access and safety. The integration of intraoperative ultrasound (IOUS) and ultrasonic aspiration (UA) may enhance the safety and efficacy of posterior decompression techniques. The objective of this study was to evaluate the safety, efficacy, and versatility of a posterior partial transpedicular approach using IOUS and UA for symptomatic TDH in a large single-surgeon cohort. METHODS: A retrospective review was performed on 108 consecutive patients (137 TDHs) who underwent posterior partial transpedicular discectomy using IOUS and UA by a single surgeon between 2012 and 2024. Clinical, radiographic, and operative data were collected. Frankel grades were assessed preoperatively, at 3-6 months, and at final follow-up. Multivariate regression was used to identify predictors of neurological improvement. RESULTS: The mean ± SD age was 58.6 ± 13.8 years, and 54.7% of patients were female. Most patients presented with myelopathy (86.1%) and giant disc herniations (> 40% stenosis) (68.6%). IOUS and UA facilitated safe decompression in all cases. The mean Frankel grade improved from 3.77 preoperatively to 4.54 at last follow-up (p < 0.001), with 61.1% of patients improving by at least 1 grade. The complication rate requiring reoperation was 9.3%. Comorbidities such as diabetes and obesity were associated with less neurological improvement. CONCLUSIONS: This large single-surgeon series demonstrated that the posterior partial transpedicular approach augmented with IOUS and UA is a safe, effective, and widely applicable technique for TDH, including large and calcified lesions. The method provides significant neurological improvement with an acceptable complication profile and can be readily adopted by general spine surgeons.
Same-day spine surgery at an ambulatory surgical center versus hospital outpatient department: a propensity-matched analysis of complications and patient-reported outcomes using the Michigan Spine Surgery Improvement Collaborative Registry.
Gandhi SD, Park DK, Hu J … +12 more , Zakko P, Tong D, Schultz L, Chang V, Nerenz DR, Aleem I, Kazemi N, Taliaferro K, Abdulhak M, Easton R, Perez-Cruet M, Khalil JG
J Neurosurg Spine · 2026 Mar · PMID 41871411 · Publisher ↗
OBJECTIVE: Although many authors have shown the safety of outpatient spine surgery, few have compared same-day spine surgery in the ambulatory surgical center (ASC) versus the hospital outpatient department (HOPD). The p...
OBJECTIVE: Although many authors have shown the safety of outpatient spine surgery, few have compared same-day spine surgery in the ambulatory surgical center (ASC) versus the hospital outpatient department (HOPD). The purpose of this study was to compare the safety of anterior cervical arthrodesis/arthroplasty or lumbar decompression with same-day discharge performed at the ASC versus HOPD. METHODS: After IRB approval, a retrospective, propensity-matched, comparative cohort analysis of a statewide, prospective, multicenter, spine-specific database (Michigan Spine Surgery Improvement Collaborative [MSSIC]) was undertaken. Patients who underwent lumbar decompression or anterior cervical arthrodesis/arthroplasty (1 or 2 levels) with same-day discharge from January 1, 2021, to June 30, 2023, were reviewed. The HOPD/ASC matched cohorts were created at a ratio of 4:1 based on BMI, American Society of Anesthesiologists physical status class (ASA), and operative levels. The primary outcome variables investigated included any complication, return to operating room (OR) within 90 days, and emergency department (ED) visit or readmission within 30 and 90 days. Secondary outcome measures investigated included patient-reported outcome (PRO) measures at 90 days and 1 year and return to work at 90 days and 1 year. Differences between HOPD and ASC patients were tested using univariate comparisons for both the anterior cervical and lumbar decompression cohorts. Multivariate analysis was performed for the lumbar decompression group. RESULTS: After matching, 3351 patients who underwent outpatient lumbar decompression (2679 HOPD and 672 ASC) and 806 patients who underwent anterior cervical arthrodesis/arthroplasty (644 HOPD and 162 ASC) were included in the analysis. In the univariate analysis for anterior cervical arthrodesis/arthroplasty, there were no differences between HOPD and ASC groups in terms of any complication, PROs at 90 days or 1 year, and return to work at 90 days and 1 year (p > 0.05). In the univariate analysis of the lumbar decompression group, there were higher rates of complications and return to the OR for the ASC group compared to the HOPD group (8% vs 5.5% [p = 0.01] and 4.9% vs 2.1% [p < 0.001], respectively), which remained in the multivariate analysis (incidence rate ratio [IRR] 1.5 [p = 0.001] and IRR 2.3 [p < 0.001], respectively). There were no differences between the groups in terms of PROs at 90 days and 1 year. CONCLUSIONS: Although both outpatient anterior cervical surgery and lumbar decompression can be performed safely and effectively in ASC and HOPD, there is a slightly higher risk of return to the OR for patients who undergo lumbar decompression in the ASC. Given similar outcomes, future studies should focus on patient and payer cost differences between ASC and HOPD.
Risk factors for nonresolving neurological deficits after spinal meningioma surgery: an integrated clinical and volumetric analysis of 202 patients.
Alhalabi OT, Mahmutoglu MA, Abouarab AG … +14 more , Mitschang D, Freist D, Ismail-Zade E, Mironov K, Klein L, Heene S, Jungwirth G, Landré V, Bendszus M, Herold-Mende C, Zweckberger K, Krieg SM, Unterberg AW, Younsi A
J Neurosurg Spine · 2026 Mar · PMID 41871409 · Publisher ↗
OBJECTIVE: Functional outcome after resection of spinal meningiomas (SMs) is mostly considered satisfactory. However, patients with nonresolving neurological symptoms show a reduced quality of life. This study examined f...
OBJECTIVE: Functional outcome after resection of spinal meningiomas (SMs) is mostly considered satisfactory. However, patients with nonresolving neurological symptoms show a reduced quality of life. This study examined factors that determine full neurological recovery after resection of SMs. METHODS: A single-center retrospective analysis of consecutive patients undergoing surgery on SM between 2007 and 2022 integrated clinical and surgical data with MRI-based automated volumetric tumor analyses. Patients with a favorable outcome (Frankel grade E) were compared to patients with nonresolving neurological symptoms (Frankel grade A-D) at final follow-up. RESULTS: A total of 202 patients with a histologically diagnosed SM were included. The cohort consisted of 159 females (78.7%) and had a median age of 65 (interquartile range [IQR] 55-74) years. Upon admission, clinical examination in 97 patients (48.0%) revealed a Frankel grade of A-D. Gross-total resection was achieved in 193 patients (95.5%) with a surgical complication rate of 8.9% (n = 18). After a median follow-up of 479 (IQR 193-1049) days, 135 patients (66.8%) showed intact neurological function (Frankel grade E). A univariate analysis revealed an overrepresentation of advanced age (OR for age ≤ 60 years = 0.14, p < 0.0001) and higher rates of preoperative neurological deficits (OR 7.39, p < 0.0001) in patients without complete recovery. No significant differences were noted in tumor volume between both groups (mean 2.34 [SD 1.69] vs 2.36 [SD 1.75] cm3, p = 0.962). In a multivariate analysis, age > 60 years, preoperative Frankel grade A-D, and Ki-67/MIB-1 index < 5% were significantly associated with nonresolving deficits at the final follow-up. CONCLUSIONS: This volumetry-informed series of patients with SM revealed older age and a low Ki-67 index, along with preoperative neurological deficits, constitute a higher risk of nonresolving neurological symptoms after resection. An early surgical intervention in oligosymptomatic young patients could therefore help preserve excellent long-term neurological function.
The role of spinal stereotactic radiosurgery in the treatment of renal cell carcinoma spinal metastases.
Bhatia S, Taori S, Adida S … +8 more , Kann MR, Rajan A, Burton SA, Flickinger JC, Bayley JC, Zinn PO, Sefcik RK, Gerszten PC
J Neurosurg Spine · 2026 Mar · PMID 41871408 · Publisher ↗
OBJECTIVE: Renal cell carcinoma (RCC) spinal metastases can lead to intractable pain and neurological deficits and are traditionally considered radioresistant to conventional radiotherapy. Spinal stereotactic radiosurger...
OBJECTIVE: Renal cell carcinoma (RCC) spinal metastases can lead to intractable pain and neurological deficits and are traditionally considered radioresistant to conventional radiotherapy. Spinal stereotactic radiosurgery (SRS) has emerged as a minimally invasive management modality to deliver high doses of conformal radiation while sparing critical structures to overcome radioresistance. The aim of this large, single-institution study was to evaluate outcomes following SRS for patients with RCC spinal metastases. METHODS: Eighty-one patients who underwent SRS for 152 primary RCC spinal metastases met inclusion criteria. The primary outcome was local control (LC). Secondary outcomes were overall survival (OS), pain palliation, and adverse radiation effects (AREs). Univariable and multivariable Cox proportional hazards regression analyses were conducted to assess prognostic factors related to study outcomes. RESULTS: At a median follow-up of 10 (range 1-125) months, 40 lesions (26%) demonstrated radiographic progression. The median time to progression was 9 (range 3-60) months. Following SRS, the 6-month, 1-year, and 2-year crude LC rates were 91%, 78%, and 65%, respectively. The median OS was 15 (range 1-129) months, with rates of 6-month, 1-year, and 2-year OS of 84%, 57%, and 39%, respectively. Tumors with extension into the paraspinal musculature (HR 2.70, 95% CI 1.17-6.26; p = 0.020) and those causing radiographic spinal misalignment (HR 3.79, 95% CI 1.43-10.06; p = 0.008) were associated with worsened LC. No predictors were found for OS. Clinical improvement or stability in pain was observed in 97%, 88%, and 81% of lesions at 1, 3, and 6 months after SRS, respectively. Twenty-six AREs (17%) were observed, including 14 vertebral compression fractures (VCFs, 9%). Baseline VCF at the irradiated level (HR 6.00, 95% CI 1.29-27.87; p = 0.023) was significantly associated with VCF following SRS. CONCLUSIONS: Spinal SRS is a safe and effective treatment modality that confers high rates of tumor control and symptomatic pain relief for patients with RCC spinal metastases.
Growth Guidance Surgery: Factors Associated With Complications.
ElNemer W, Elsabbagh Z, Cha MJ … +7 more , Andras L, Akbarnia BA, Bumpass DB, Luhmann SJ, McCarthy RE, Sponseller PD, Pediatric Spine Study Group
Spine (Phila Pa 1976) · 2026 Jun · PMID 41871188 · Publisher ↗
STUDY DESIGN: Retrospective, multicenter cohort study. SUMMARY OF BACKGROUND DATA: Growth guidance surgery (GGS) has lower reoperation rates and fewer episodes of care than other growth-sparing methods but is associated...
STUDY DESIGN: Retrospective, multicenter cohort study. SUMMARY OF BACKGROUND DATA: Growth guidance surgery (GGS) has lower reoperation rates and fewer episodes of care than other growth-sparing methods but is associated with instrumentation complications. This study aimed to characterize factors associated with implant complications in GGS. METHODS: A multicenter early-onset scoliosis database was analyzed for patients who underwent GGS. Radiographs, complication reports, and reoperation notes were evaluated for instances of rod breakage, screw pullout, instrumentation prominence, skin breakdown over implants, patients outgrowing implants, and deep wound infection. Descriptive statistics, χ 2 test, and Cox proportional-hazards models were utilized to detect differences in complications. RESULTS: One hundred eighteen patients [7±2 y old; 69 (58%) female] were included. Mean follow-up was 5 (±3) years. The 173 instances of instrumentation complications comprised 55 (32%) broken rods, 46 (27%) screw pullouts, 33 (19%) prominences, seven (4%) skin breakdown over implant, and 32 (18%) outgrowing the rods. There was a 2.46-fold ( P =0.039) increased risk of rod breakage for rod diameter ≤4.5 versus >4.5 mm. For lighter patients, odds were greater for screw pullout by 2.0-fold, for prominence by 3.1-fold, for skin breakdown over implant by 7.7-fold, and for deep wound infection by 3.6-fold compared with heavier patients (all P <0.05). Broken rods more often occurred within two vertebrae of the apex of deformity; screw pullouts near the upper or lowest instrumented vertebrae. CONCLUSIONS: Most instrumentation failures were broken rods and screw pullouts. Breakage was largely confined to the deformity apex and was mitigated by rods >4.5 mm; pullouts clustered at construct ends. Lighter ( i.e. mostly younger) patients faced higher risks of infection, prominence, and skin compromise. Using larger-diameter rods, ensuring robust proximal-distal fixation, and maximizing the muscle envelope may meaningfully reduce these complications and, thus, reoperations. LEVEL OF EVIDENCE: Level III.
Frailty-Modulated Outcomes After Microscopic Versus Unilateral Biportal Endoscopic Decompression for Degenerative Lumbar Spinal Stenosis Without Instability.
Pür B, Yılar S, Dağ İ … +1 more , Kaya S
Spine (Phila Pa 1976) · 2026 Mar · PMID 41861038 · Publisher ↗
STUDY DESIGN: Retrospective observational cohort study. OBJECTIVE: To compare clinical outcomes and paraspinal muscle preservation between microscopic decompression and unilateral laminotomy for bilateral decompression (...
STUDY DESIGN: Retrospective observational cohort study. OBJECTIVE: To compare clinical outcomes and paraspinal muscle preservation between microscopic decompression and unilateral laminotomy for bilateral decompression (ULBD) using unilateral biportal endoscopy (UBE) in degenerative lumbar spinal stenosis (DLSS) without instability, and to assess the influence of frailty. SUMMARY OF BACKGROUND DATA: Both microscopic decompression and UBE-assisted ULBD are commonly used for DLSS, but comparative data addressing frailty and muscle preservation are limited. METHODS: A total of 180 patients with 1-2 level DLSS without instability were retrospectively analyzed and assigned to microscopic decompression (n=90) or UBE-assisted ULBD (n=90). Frailty was assessed using the modified Frailty Index-11. Outcomes included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores for back and leg pain, evaluated preoperatively and at 12 months. Clinical success was defined as meaningful improvement in ODI. Paraspinal muscle injury was assessed on MRI by multifidus muscle atrophy and fatty infiltration. Inverse probability of treatment weighting was used for adjustment. RESULTS: Both techniques significantly improved ODI and VAS scores at 12 months (P<0.001). ODI improvement and clinical success were higher in the UBE group (92.2% vs. 78.9%; P=0.012). MRI demonstrated less multifidus atrophy and fatty infiltration after UBE. Frailty was negatively associated with functional improvement, with a significant interaction favoring UBE in frailer patients (P=0.018). CONCLUSIONS: Both techniques are safe and effective for DLSS without instability. However, UBE-assisted decompression provides superior functional outcomes and better paraspinal muscle preservation, particularly in frail patients.
Longitudinal Investigation of Postural Strategies Associated with Improvement in Gait Speed Following Adult Spinal Deformity Surgery using Machine Learning.
Mano N, Mori K, Konishi T … +5 more , Kuramoto J, Ito S, Kuwabara T, Ushikubo T, Hase K
Spine (Phila Pa 1976) · 2026 Mar · PMID 41860195 · Publisher ↗
STUDY DESIGN: Retrospective longitudinal cohort study. OBJECTIVE: To identify postural strategies associated with improvement in gait speed following spinal fixation from thoracic vertebrae to pelvis using machine learni...
STUDY DESIGN: Retrospective longitudinal cohort study. OBJECTIVE: To identify postural strategies associated with improvement in gait speed following spinal fixation from thoracic vertebrae to pelvis using machine learning. SUMMARY OF BACKGROUND DATA: Although the spinal fixation for adult spinal deformity (ASD) is effective in improving radiographic parameters and quality of life, improvement in gait function is more challenging. The underlying reason has not been elucidated due to the lack of longitudinal gait analysis research focusing on change in speed and posture. METHODS: Three-dimensional gait analysis was performed before and 6 months following the surgery to investigate the gait speed and anteroposterior distance from center of mass to center of pressure in trailing limb (COM-COP distance). The relationship between COM-COP distance and gait speed were demonstrated. Postoperative gait patterns were categorized through k-means clustering, and the disease-specific gait characteristics associated with COM-COP distance were extracted. RESULTS: Eighty-nine patients (mean age: 73.4 years) with ASD were included. Changes in gait speed between pre- and post-surgery were associated with changes in COM-COP distance (r=0.607, P<0.001). Postoperative gait speed was associated with COM-COP distance (r=0.873, P<0.001). The COM-COP distance comprised the hip sagittal angle, power, and ankle plantarflexion moment (R2=0.793, P<0.001). Two clusters A (n=37) and B (n=52) were identified. The postoperative COM-COP distance was significantly associated with hip sagittal power on terminal stance (r=-0.487, P<0.001) in the younger cluster A and maximum ankle plantarflexion moment (r=0.576, r<0.001) in the older cluster B. Cluster A significantly improved gait speed but cluster B did not improve gait speed and COM-COP distance following the surgery. CONCLUSIONS: The COM-COP distance composed of hip and ankle movement was associated with the improvement in gait speed. These findings imply the new rehabilitation strategies to improve gait speed. LEVEL OF EVIDENCE: Ⅲ.
Idiopathic Thoracolumbar Scoliosis Treated at Adult Age: Timing of Surgery and Quality of Life.
Lamotte-Paulet P, Gourinchat M, Aleman C … +14 more , Severac F, Núñez-Pereira S, Haddad S, Pupak A, Pellisé F, Obeid I, Boissière L, Roscop C, Alanay A, Kleinstück F, Loibl M, Pizones J, Charles YP, European Spine Study Group (ESSG)
Spine (Phila Pa 1976) · 2026 Mar · PMID 41860167 · Publisher ↗
STUDY DESIGN: Retrospective register study. OBJECTIVE: Determine when preoperative Quality of Life (QoL) declines in adult Thoracolumbar/Lumbar Adolescent Idiopathic Scoliosis (TL/L-AIS) patients, to analyze postoperativ...
STUDY DESIGN: Retrospective register study. OBJECTIVE: Determine when preoperative Quality of Life (QoL) declines in adult Thoracolumbar/Lumbar Adolescent Idiopathic Scoliosis (TL/L-AIS) patients, to analyze postoperative age-related changes. Analyze the influence of preoperative sagittal alignment and Lowest Instrumented Vertebra (LIV) on QoL. SUMMARY OF BACKGROUND DATA: The effect of surgery on self-image, function and pain may vary depending on age, alignment and fusion length. METHODS: 310 patients were analyzed preoperatively and postoperatively until 2-year follow-up. Scoliosis Research Society-22 (SRS-22) and Short Form-36 (SF-36) scores were collected. Relative Spinopelvic Alignment (RSA), T4 and L1 Pelvic Angles (T4PA-L1PA), LIV were determined on radiographs. Linear mixed-effect regression models were used including group, time, and interaction. RESULTS: The phase 30-42 years represented an inflexion point in preoperative SRS-22 total scores, after which scores were unlikely to reach postoperative levels of younger patients. All age groups improved postoperatively. The SRS-22 total score difference at 2 years was -0.48 between 40-60 and <40-year groups (P<0.001), -0.50 between >60 and <40-year groups (P<0.001). Self-image improved in all groups: +1.16 in <40 years, +1.08 in 40-60 years, and +1.14 in >60 years. Pain improved in patients 40-60 years +0.75 and >60 years +1.07. The SF-36 Physical Component Summary improvement was larger in patients 40-60 years +6.76 (P<0.001) and >60 years +8.74 (P<0.001) versus <40 years. Preoperatively severely malaligned patients had lowest SRS-22 and largest postoperative improvement. Patients with LIV S1/iliac had lower SRS-22 than LIV L2/L3 or L4/L5 at 2-year follow-up. CONCLUSION: In adult TL/L-AIS patients QoL declined around the fourth life decade, postoperative recovery patterns differed. All age groups improved QoL postoperatively. Self-image improved most. Pain and the physical component improved most in patients >40 years. Preoperative sagittal malalignment and the LIV influenced QoL.
Differentiating Spinal Deformity Versus Leg Length Discrepancy in Patients With Pelvic Obliquity : Systematic Review of Diagnostic Methods, Imaging, and Clinical Management.
Truumees E, Akkihal K, Griffin J … +4 more , Singh D, Geck M, Stokes J, Mayer R
Spine (Phila Pa 1976) · 2026 Jun · PMID 41855582 · Publisher ↗
STUDY DESIGN: Systematic review, PROSPERO ID: (CRD42023112392). OBJECTIVE: We aim to provide physicians with an evidence-based stepwise approach to distinguishing the primary cause of plane pelvic obliquity (PO) to guide...
STUDY DESIGN: Systematic review, PROSPERO ID: (CRD42023112392). OBJECTIVE: We aim to provide physicians with an evidence-based stepwise approach to distinguishing the primary cause of plane pelvic obliquity (PO) to guide treatment. SUMMARY OF BACKGROUND DATA: PO is a frequent clinical finding in both spinal deformity (SD) and leg length discrepancy (LLD) but distinguishing between these etiologies remains challenging due to overlapping clinical and radiographic features and potential multifactorial origins. Misdiagnosis may delay care and worsen patient outcomes. MATERIALS AND METHODS: PubMed, Embase, Scopus, and Web of Science were searched from inception to July 2025 for English-language studies evaluating coronal PO in the context of LLD and/or SD that explicitly compared or differentiated limb-origin from spine-origin obliquity using radiographic, advanced imaging, or validated clinical assessments and reported diagnostic accuracy, discriminative features, or management impact. Two reviewers independently screened studies, extracted data, and performed ROBINS-I risk assessment and Newcastle-Ottawa Scale quality assessment. Owing to marked heterogeneity in populations, measurement protocols, and thresholds, findings were synthesized qualitatively with stratification by age group where possible. RESULTS: Of 436 records, 24 cohort studies met the inclusion criteria. Standing anteroposterior (AP) radiographs reliably quantified both LLD and PO, while advanced imaging provided high reproducibility for subtle or ambiguous cases. Radiographic block or shoe lift correction tests distinguished limb-origin and spine-origin PO through immediate postural correction. Key discriminators included a lumbar curve or PO resolving with block/lift correction suggesting LLD, versus persistent deformity despite correction suggesting spinal etiology. Difficulty remains in diagnosing and treating mixed etiology patients. CONCLUSION: Accurate differentiation of spinal versus limb-driven PO begins with a structured diagnostic approach. AP radiographs, followed by functional block tests, and advanced imaging, may increase diagnostic confidence and decrease unnecessary interventions. Particularly in patients with both LLD and coronal plane SD, prospective studies are required to standardize measurement protocols and improve long-term outcomes. LEVEL OF EVIDENCE: Level IV.
Incidental Durotomies do not Impact Long-term Neurologic Function After Adult Spinal Deformity Surgery.
Sulieman A, Sahhar M, Beeram I … +32 more , Diebo BG, Lafage V, Lafage R, Line BG, Hamilton DK, Hostin R, Passias PG, Klineberg EO, Smith JS, Gum JL, Mullin J, Buell TJ, Soroceanu A, Kim HJ, Eastlack RK, Daniels AH, Mundis GM, Protopsaltis TS, Gupta MC, Anand N, Okonkwo DO, Turner JD, Schwab FJ, Shaffrey CI, Lewis SJ, Mummaneni PV, Ames CP, Lenke LG, Bess S, Lee SH, Kebaish KM, International Spine Study Group
Spine (Phila Pa 1976) · 2026 Mar · PMID 41844195 · Publisher ↗
STUDY DESIGN: Retrospective review of multicenter data. OBJECTIVE: To compare long-term neurologic recovery in patients with and without incidental durotomy (hereafter, "durotomy") after adult spinal deformity surgery. S...
STUDY DESIGN: Retrospective review of multicenter data. OBJECTIVE: To compare long-term neurologic recovery in patients with and without incidental durotomy (hereafter, "durotomy") after adult spinal deformity surgery. SUMMARY OF BACKGROUND DATA: Durotomy is a common complication of adult spinal deformity surgery and is typically associated with technical challenges during the procedure. METHODS: Using a prospectively collected database, we included 1452 patients (73% female; mean age, 60±14 y) who underwent adult spinal deformity surgery from 2008-2020 at 22 US centers. We compared patients with and without durotomy with respect to demographic characteristics, surgical variables, and neurologic outcomes at baseline and at 1 and 2 years postoperatively. Multivariate analysis compared neurologic complications and length of stay (LOS) between the groups. P<.05 was considered significant. RESULTS: Durotomy occurred in 121 patients (8.3%). Patients with durotomy were more likely to have undergone revision surgery (P<.001) and had higher Charlson Comorbidity Index values (P=.029) than those who did not. Patients with durotomy had higher estimated blood loss, longer operative time, more frequent 3-column osteotomies, and longer LOS (all, P<.001). Lower-extremity motor scores did not differ between patients with durotomy and those without at 1 and 2 years postoperatively. The incidence of neurologic, medical, and surgical complications did not differ significantly between the 2 groups. Patients with durotomy had a higher rate of inpatient return to the operating room (5.0%) than those without (2.0%) (P=.04). On multivariate analysis, there were no differences between groups in lower-extremity motor scores, neurologic complications, or LOS. CONCLUSIONS: Incidental durotomy during adult spinal deformity surgery was associated with greater intraoperative complexity and transient sensory symptoms but did not adversely affect long-term motor recovery, neurologic complications, or patient-reported outcomes. These findings suggest durotomy is a manageable complication without lasting functional consequences.
Sagittal Spinal Alignment 2 Years After Vertebral Body Tethering.
Ouchida J, Schupper A, Pahys J … +6 more , Samdani A, Hwang S, Upasani VV, Newton PO, Gholami P, Kelly MP
Spine (Phila Pa 1976) · 2026 Mar · PMID 41844176 · Publisher ↗
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To investigate the change of sagittal spinal alignment after anterior vertebral body tethering (VBT) in skeletally immature patients with idiopathic scoliosis using pelvic i...
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To investigate the change of sagittal spinal alignment after anterior vertebral body tethering (VBT) in skeletally immature patients with idiopathic scoliosis using pelvic incidence-based measures of alignment. SUMMARY OF BACKGROUND DATA: VBT is a non-fusion option for the treatment of idiopathic scoliosis, though concern exists for derangement of the sagittal plane with skeletal growth. METHODS: A retrospective analysis was conducted on 87 patients with thoracic idiopathic scoliosis who underwent VBT. Preoperative and 2-year postoperative radiographs were reviewed, recording coronal radiographic measures, sagittal pelvic parameters, and vertebral pelvic angles (VPA) at T4 and L1. Linear regression modeled T4PA and L1PA by pelvic incidence and the coefficient of determinations assessed model fit. The difference between T4PA and L1PA (T4-L1 mismatch) was modeled by pelvic incidence and compared with normal, healthy adults. RESULTS: After VBT, the thoracic main scoliotic curve significantly improved from 49 degrees (43-56) to 23 degrees (17-34) (P <.01). Accompanying growth-related pelvic parameter changes, T4PA increased from 3 (1, 8) to 6 (1, 11) degrees (P <0.01) and L1PA from 5 (2, 11) to 8 (3, 13) degrees (P <0.01). T4-L1 mismatch by PI showed significant correlation postoperatively (R²=0.11, P <0.01), with cases within the adult 80% prediction interval increasing from 56.3% to 70.1%. CONCLUSION: Patients who underwent VBT maintained sagittal alignment when measured by VPA while achieving coronal plane correction. These data offer evidence against concerns for sagittal plane malalignment with VBT.
Height, Not Weight, is an Independent Predictor of Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery.
Sulieman A, Sahhar M, Beeram I … +32 more , Diebo BG, Lafage V, Lafage R, Line BG, Hamilton DK, Hostin R, Passias PG, Klineberg EO, Smith JS, Gum JL, Mullin J, Buell TJ, Soroceanu A, Kim HJ, Eastlack RK, Daniels AH, Mundis GM, Protopsaltis TS, Gupta MC, Anand N, Okonkwo DO, Turner JD, Schwab FJ, Shaffrey CI, Lewis SJ, Mummaneni PV, Ames CP, Lenke LG, Bess S, Lee SH, Kebaish KM, International Spine Study Group
Spine (Phila Pa 1976) · 2026 Mar · PMID 41844174 · Publisher ↗
STUDY DESIGN: Retrospective review of prospectively collected, multicenter data. OBJECTIVE: To assess associations between patient height and weight independently and interactively with the incidence of proximal junction...
STUDY DESIGN: Retrospective review of prospectively collected, multicenter data. OBJECTIVE: To assess associations between patient height and weight independently and interactively with the incidence of proximal junctional kyphosis (PJK) after surgical treatment of adult spine deformity. SUMMARY OF BACKGROUND DATA: Body mass index has traditionally been used to assess the influence of body composition on surgical outcomes, but the individual effects of height and weight have not been studied in relation to PJK. METHODS: We compared baseline demographic characteristics, radiographic measurements, and perioperative variables between patients who developed PJK after adult spinal deformity surgery between 2008 and 2020 and those who did not. Using a generalized additive model with a logistic link function, we modeled height and weight and their interaction as smooth terms to capture potential nonlinear effects on PJK risk. Multivariate analysis was adjusted for age, history of osteoporosis, upper instrumented vertebra, number of levels fused, and postoperative pelvic incidence minus lumbar lordosis and T1 pelvic angle. RESULTS: Of 904 included patients, the median age was 65 years (interquartile range: 58-71), and 76% were female. PJK developed in 131 patients (14%). Baseline characteristics, including frailty, comorbidities, and radiographic measures, did not differ significantly between the PJK and non-PJK groups. Taller height was a predictor of PJK (P=.03). In contrast, weight was not an independent predictor, and there was no significant interaction between height and weight. The incidence of PJK peaked at a height of approximately 179 cm before plateauing. CONCLUSIONS: Taller height, but not weight, was associated with developing PJK after adult spinal deformity surgery. These findings underscore the importance of considering patient height during surgical planning.
The pattern and chronology of symptom development in degenerative cervical myelopathy: a clinical study.
Ortuno O, Soufi K, Castillo JA … +12 more , Simões de Souza NF, Chu T, Ghabussi G, Harris A, Kim KD, Price R, Javidan Y, Le HV, Roberto RF, Khan S, Klineberg EO, Martin AR
J Neurosurg Spine · 2026 Mar · PMID 41825083 · Publisher ↗
OBJECTIVE: Degenerative cervical myelopathy (DCM) is a common condition caused by cervical spinal cord compression and produces diverse symptoms and neurological deficits. Diagnosis is clinical and corroborated by imagin...
OBJECTIVE: Degenerative cervical myelopathy (DCM) is a common condition caused by cervical spinal cord compression and produces diverse symptoms and neurological deficits. Diagnosis is clinical and corroborated by imaging, yet formal diagnostic criteria and consensus on relevant symptoms are lacking. The aim of this study was to describe the onset and chronology of early symptoms in patients who were already diagnosed with DCM to improve understanding and inform future development of diagnostic criteria. METHODS: The authors conducted a prospective cross-sectional study of consecutive patients with DCM at their initial spine surgery visit. They recorded detailed histories of headache, neck and back pain, hand incoordination, gait imbalance, urinary and fecal dysfunction, saddle numbness, sexual dysfunction, and upper extremity (UE) and lower extremity (LE) pain, weakness, and numbness. For each symptom, they captured duration, severity, frequency (days/week), laterality, pattern, progression, and order of onset. The authors assessed Pearson correlations between symptom duration or severity and modified Japanese Orthopaedic Association (mJOA) score. RESULTS: A total of 138 patients were included in the study. The most common symptoms were neck pain (84.1%), back pain (72.5%), UE numbness (66.7%), gait imbalance (58.0%), and UE incoordination (57.2%). Symptoms most frequently recalled as first were back pain (40.6%), neck pain (31.9%), UE numbness (19.6%), and UE pain (15.2%). The longest mean ± SD pain durations were back pain (8.6 ± 11.7 years), LE pain (6.6 ± 10.9 years), neck pain (6.3 ± 9.5 years), and UE pain (6.2 ± 8.6 years). The most bothersome symptoms were saddle numbness (5.8/10), UE pain (5.2/10), UE weakness (5.1/10), and back pain (5.1/10). Most symptoms occurred frequently (approximately 6 days/week). Common co-occurrences were neck and back pain (65.2%), neck pain and UE numbness (57.2%), and neck pain and gait imbalance (50.7%). CONCLUSIONS: DCM frequently presents with a prodrome of pain before neurological symptoms, with neck and back pain representing the most common and earliest symptoms, while arm pain, leg pain, and headache are also common. Further research is needed to understand the importance of these nonspecific symptoms, which could be early clues that help achieve earlier diagnosis of DCM.
Erratum. Cervical spine chordomas: surgical outcome assessment in a multicenter cohort from the Primary Tumor Research and Outcomes Network.
Dea N
J Neurosurg Spine · 2026 Mar · PMID 41825072 · Publisher ↗
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