Spine[JOURNAL]
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200 papers
Multilevel stand-alone lateral lumbar interbody fusion: radiographic and clinical outcomes.
Lee KE, Farber SH, Cheung ATM … +11 more , Katsevman GA, Alan N, Zhou JJ, Dugan RK, Giraldo JP, Cho SS, White MD, Lee JJ, O'Neill LK, Turner JD, Uribe JS
J Neurosurg Spine · 2026 Jul · PMID 42398117 · Publisher ↗
OBJECTIVE: Stand-alone lateral lumbar interbody fusion (SA-LLIF) without posterior instrumentation is increasingly being performed for various spine pathologies. There are few studies regarding clinical and radiographic...
OBJECTIVE: Stand-alone lateral lumbar interbody fusion (SA-LLIF) without posterior instrumentation is increasingly being performed for various spine pathologies. There are few studies regarding clinical and radiographic outcomes in patients who underwent multilevel SA-LLIF. In this study, the authors aimed to explore these outcomes. METHODS: This is a retrospective review of patients who underwent multilevel SA-LLIF without posterior instrumentation between August 2017 and October 2021. Demographic information, comorbidities, and complications were collected. Clinical outcomes were measured using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Spinopelvic parameters, subsidence rates, and repeat operations were recorded. RESULTS: Forty-three patients met the inclusion criteria. The mean age was 70.1 years, and 31 (72.1%) patients were male. The mean BMI was 28.2. Patients often had multiple indications for surgery, with 39 (90.7%), 28 (65.1%), and 9 (20.9%) patients undergoing surgery for adult spinal deformity, degenerative disc disease, and adjacent segment disease, respectively. The mean number of levels treated was 2.42 (range 2-4 levels, total 104 levels treated). The mean time to follow-up imaging was 2.01 years (range 30 days-4.95 years). There were significant differences in pre- and postoperative lumbar lordosis (LL) (+4.9°, p = 0.001), pelvic incidence-LL mismatch (-4.5°, p = 0.003), and segmental LL at treated levels (+4.0°, p = 0.002). Fifteen (35%) patients had coronal Cobb angles > 20° preoperatively; 11 (73%) showed improvement in Cobb angle postoperatively (mean change -5.4°, p = 0.02). Fifteen (35%) patients experienced grade 1 or higher subsidence at 23 of 104 (22%) levels. Five (12%) patients required repeat operations for failure of indirect decompression, progressive deformity, symptomatic subsidence, or a combination thereof. Three (7%) of these patients had symptomatic subsidence. Subsidence was more common in patients with polyetheretherketone implants (n = 13) versus titanium implants (n = 2) (p = 0.002). Significant improvements were seen in median (IQR) pre- and postoperative ODI (38 [28-48.5] vs 25 [17.5-38.5], p = 0.001), VAS back (7.0 [4.8-8.0] vs 3.5 [0.8-6.2], p = 0.002), and VAS leg (6.0 [2.5-8.0] vs 0.0 [0.0-4.2], p = 0.001) scores. CONCLUSIONS: In this small cohort, multilevel SA-LLIF was a safe and clinically effective surgical option for patients who required a shorter operative duration. Multilevel SA-LLIF had good clinical and radiographic outcomes but had a 7% reoperation rate for symptomatic subsidence. Further studies with longer clinical and radiographic follow-up are necessary to determine the durability of multilevel SA-LLIF.
Is cervicothoracic ossification of the posterior longitudinal ligament a distinct clinicoradiological variant? A critical analysis of neurological recovery predictors.
Shetty AP, Ramachandran K, Iyer PR … +3 more , Paramasivam D, Kanna RM, Rajasekaran S
J Neurosurg Spine · 2026 Jul · PMID 42398103 · Publisher ↗
OBJECTIVE: Ossification of the posterior longitudinal ligament (OPLL) extending to the cervicothoracic junction presents unique surgical challenges since it represents a transitional zone between the changes in the mobil...
OBJECTIVE: Ossification of the posterior longitudinal ligament (OPLL) extending to the cervicothoracic junction presents unique surgical challenges since it represents a transitional zone between the changes in the mobile lordotic cervical spine and a relatively stiff thoracic spine. The literature on cervicothoracic OPLL is limited, and it is unclear whether it differs from subaxial OPLL in terms of radiological characteristics and postoperative outcomes. In this study, the authors aimed to analyze clinicoradiological outcomes and factors predicting neurological recovery in patients who underwent surgery for symptomatic cervicothoracic OPLL. METHODS: This retrospective study included patients with symptomatic cervicothoracic OPLL who underwent posterior instrumented laminectomy from April 2017 to April 2022 with a minimum follow-up of 2 years. Preoperative imaging included CT-based axial morphology classification (hill, mushroom, plateau), canal occupying ratio (COR), and MRI evaluation of cord signal changes. Clinical parameters, including the modified Japanese Orthopaedic Association score, Nurick grade, hand myelopathy signs, and bladder dysfunction, were recorded. The recovery rate (RR) was calculated using Hirabayashi's formula. RESULTS: Of 53 patients, most were male (81.1%), with a mean age of 55.2 years at presentation. Nurick grade 5 was the most common grade observed, accounting for 34.0% of patients. Hand myelopathy signs were absent in 30.2% of patients. Overall, 28 patients experienced poor recovery (RR < 50%) and 25 had good recovery (RR ≥ 50%). Hill-type morphology was significantly linked to poor outcomes (p = 0.022), and the mean COR was higher in the poor recovery group (67.54 ± 9.74 vs 55.32 ± 11.94, p = 0.001). Univariate analysis identified ossification type, morphology, and COR as significant predictors of RR, while multivariate regression confirmed COR as the only independent predictor (p = 0.006, OR 1.097). Receiver operating characteristic curve analysis indicated that COR had good predictive accuracy (area under the curve 0.777), with a 65% cutoff, providing 68% specificity and 60.71% sensitivity. CONCLUSIONS: Cervicothoracic OPLL is a distinct clinicoradiological variant of OPLL, usually associated with severe myelopathy characterized by predominant lower limb symptoms. COR > 65% and axial morphology are key predictors of poor recovery, emphasizing the importance of detailed preoperative imaging and risk assessment.
Pseudoarthrosis After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Multicenter Analysis of Revision Strategies and Outcomes.
La Poche A, Benes G, Hariharan A … +8 more , Jain A, Samdani A, Vorhies J, Gabos P, Newton PO, Yaszay B, Louer C, Harms Study Group
Spine (Phila Pa 1976) · 2026 Jul · PMID 42397799 · Publisher ↗
STUDY DESIGN: Retrospective analysis of a prospectively maintained multicenter pediatric spine registry. OBJECTIVE: To characterize clinical presentation, revision strategies, bone graft utilization, and short-term outco...
STUDY DESIGN: Retrospective analysis of a prospectively maintained multicenter pediatric spine registry. OBJECTIVE: To characterize clinical presentation, revision strategies, bone graft utilization, and short-term outcomes in adolescent idiopathic scoliosis (AIS) patients undergoing revision for pseudoarthrosis. SUMMARY OF BACKGROUND DATA: Pseudoarthrosis following posterior spinal fusion (PSF) for AIS is rare but clinically significant, often presenting with pain or implant failure. Contemporary, diagnosis-specific data describing revision strategies and outcomes remain limited. METHODS: A multicenter registry was queried for AIS patients undergoing PSF with ≥2 years follow-up. Potential pseudoarthrosis cases were identified using complication codes and confirmed through review of radiographs, operative reports, and clinical documentation, defined as failed arthrodesis >6 months post-index fusion, excluding infection. Demographics, revision techniques, graft selection, and outcomes were analyzed descriptively. RESULTS: Among 3,532 eligible AIS patients, 22 had confirmed pseudoarthrosis requiring revision. Median time to revision was 2.5 years. Twelve patients (55%) presented with pain and 10 (45%) were identified radiographically. Implant failure most commonly involved the distal construct (17/22, 77%), with screw loosening in 9 (41%), rod fracture in 7 (32%), and screw breakage in 6 (27%). All revisions were posterior-only; 16 patients (73%) preserved index fusion levels and 5 (23%) required extension for junctional deformity. Revision was tailored to failure patterns, including focal screw revision and rod exchange, with partial rod revision used in 8 of 18 rod failures (44%). Graft use was heterogeneous, most commonly allograft (68%) and local autograft (46%). Post-revision complications occurred in 2 patients (9%), both surgical site infections, with one reoperation (5%). At median 1.2-year follow-up, no recurrent pseudoarthrosis was observed. CONCLUSION: Pseudoarthrosis after AIS PSF most commonly presents as distal mechanical failure. Posterior-only, failure-pattern-directed revision, typically preserving fusion levels with selective extension for junctional deformity, achieves favorable short-term outcomes. These findings provide multicenter, diagnosis-specific guidance for management of this rare complication. LEVEL OF EVIDENCE: Level IV.
To the Editor "Low-Density Lipoprotein Cholesterol and Statin Usage Are Associated With Rates of Pseudarthrosis Following Single-Level Posterior Lumbar Interbody Fusion" by Lavu et al.
Stump K, Morar H, Aynaszyan S … +2 more , Patel D, Pazionis T
Spine (Phila Pa 1976) · 2026 Jun · PMID 42391337 · Publisher ↗
Abstract loading — click title to view on PubMed.
Sarcopenia Increases Adjacent Segment Degeneration Risk within 3 Years of Anterior Cervical Discectomy and Fusion.
Wilkinson BM, Polavarapu H, Bashir R … +3 more , Maloney B, Kedra J, Hazama A
Spine (Phila Pa 1976) · 2026 Jun · PMID 42391334 · Publisher ↗
STUDY DESIGN: Exploratory retrospective cohort. OBJECTIVE: To determine the impact of sarcopenia on adjacent segment degeneration (ASD) following anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA...
STUDY DESIGN: Exploratory retrospective cohort. OBJECTIVE: To determine the impact of sarcopenia on adjacent segment degeneration (ASD) following anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: Sarcopenia has been shown to worsen sagittal alignment, reduce patient reported outcomes measures postoperatively, and predict early ASD following lumbar fusion. METHODS: Retrospective data was collected from 333 adult patients who underwent elective ACDF from 2012-2022. Cases of trauma, central nervous system infection or neoplasm, those with prior cervical spine surgery, or those who additionally underwent posterior cervical surgery were excluded. The primary outcome was radiographic ASD development within 3 years of index surgery. Cross-sectional muscle and vertebral body measurements were recorded at the C4 mid-vertebral body level from the most recent preoperative MRI. Odds ratios were calculated with logistic regression analyses. Sarcopenia was characterized as having combined extensor muscle:vertebral body ratio (EM:VBR) ≥1 SD below gender mean (T-score -1). RESULTS: Of 333 patients undergoing elective ACDF, 77 (23.12%) developed radiographic ASD within 3 years. Sarcopenia was the strongest predictor of early ASD (OR 7.225, 95% CI 3.816, 13.682, P<0.0001), with increased muscle fat infiltration significantly increasing ASD risk. Of 60 sarcopenic patients, 33 (55%) developed ASD within 3 years vs 44 of 273 (16.12%) non-sarcopenic patients (P<0.0001). Female gender, vitamin D deficiency, pre-existing adjacent level degenerative changes, and increased T1 slope (T1S) - cervical lordosis (CL) mismatch also increased ASD risk. The use of anterior plating was associated with decreased ASD risk on bivariate (P=0.0259) but not multivariable analysis. CONCLUSIONS: Sarcopenia significantly predicted ASD development within 3 years of ACDF. This information can potentially be used to counsel patients on risk of reoperation and tailor treatments pre- and postoperatively, including physical therapy and correction of vitamin D deficiency.
Two-Year Cervical Alignment Trajectories and Associated Radiographic Factors after Posterior Spinal Fusion for Lenke Type 1 Adolescent Idiopathic Scoliosis.
Watanabe K, Suzuki S, Takeda K … +6 more , Iga T, Okubo T, Ozaki M, Nagoshi N, Matsumoto M, Nakamura M
Spine (Phila Pa 1976) · 2026 Jun · PMID 42391234 · Publisher ↗
STUDY DESIGN: Retrospective analysis of a prospectively collected cohort. OBJECTIVE: To describe 2-year cervical alignment trajectories after posterior spinal fusion (PSF) for Lenke type 1 adolescent idiopathic scoliosis...
STUDY DESIGN: Retrospective analysis of a prospectively collected cohort. OBJECTIVE: To describe 2-year cervical alignment trajectories after posterior spinal fusion (PSF) for Lenke type 1 adolescent idiopathic scoliosis (AIS) and identify factors associated with absence of lordotic change. SUMMARY OF BACKGROUND DATA: Postoperative cervical alignment after AIS correction is variable, and factors associated with trajectory remain unclear. METHODS: We analyzed 189 patients with Lenke type 1 AIS who had radiographs obtained preoperatively, within 1 month postoperatively, and at 2-year follow-up. Preoperative cervical kyphotic alignment (C2-7 angle <0°) was present in 122 patients (64.6%). A subgroup of 74 patients had preoperative cervical kyphotic alignment and early postoperative T5-12 kyphosis gain (ΔT5-12 >0°). Lordotic change was defined as an increase in the C2-7 angle at 2 years; absence of lordotic change was defined as ΔC2-7 angle ≤0°. Multivariable logistic regression identified associated factors. RESULTS: Among the 122 patients with preoperative cervical kyphotic alignment, 97 (79.5%) remained kyphotic at 2 years. Among the 74 patients with preoperative cervical kyphotic alignment and early postoperative T5-12 kyphosis gain, 25 (33.8%) showed absence of lordotic change. Absence of lordotic change was associated with higher preoperative pelvic tilt (adjusted OR 2.12 per 5°, P=0.007), lower attained early postoperative T5-12 kyphosis (adjusted OR 0.49 per 5°, P=0.012), and preoperative |T1 tilt| ≥5° (adjusted OR 6.31, P=0.030). Greater magnitude of preoperative kyphotic C2-7 angle was associated with a lower likelihood of absence of lordotic change (adjusted OR 0.31 per 5°, P<0.001). CONCLUSION: Kyphotic cervical alignment remained common 2 years after PSF for Lenke type 1 AIS. Early postoperative T5-12 kyphosis gain alone did not fully distinguish later cervical alignment trajectories. Absence of lordotic change was associated with higher pelvic tilt, lower attained early postoperative T5-12 kyphosis, and greater T1 tilt magnitude. The clinical significance of these radiographic trajectories remains uncertain, as SRS-22 scores did not differ significantly across 2-year alignment categories. LEVEL OF EVIDENCE: Level III.
Association of C7 Laminoplasty and Decompression Construct Length With Postoperative Axial Symptoms After Cervical Expansive Unilateral Open-door Laminoplasty.
Fan Z, Huang K, Teng Y … +3 more , Deng Q, Xu D, Teng H
Spine (Phila Pa 1976) · 2026 Jul · PMID 42391020 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate whether C7 laminoplasty and decompression construct length were associated with postoperative axial symptoms after expansive unilateral open-door laminopla...
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate whether C7 laminoplasty and decompression construct length were associated with postoperative axial symptoms after expansive unilateral open-door laminoplasty (ELAP) for cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: Postoperative axial symptoms remain a common source of dissatisfaction after cervical laminoplasty. Although prior studies have examined patient-related risk factors, the association between observed operative patterns and postoperative pain burden remains clinically relevant. METHODS: Adults undergoing ELAP for CSM between April 2016 and April 2024 were retrospectively reviewed. Patients with preoperative axial symptoms, cervical deformity, trauma-related cervical spinal cord injury, neurologic disorders affecting outcome assessment, incomplete data, or follow-up shorter than 1 year were excluded. The primary outcome was new-onset postoperative axial symptoms at 12 months. The main operative variables were C7 laminoplasty versus C7 preservation and longer- versus shorter-segment ELAP. Multivariable logistic regression, descriptive joint operative-pattern analyses, longitudinal mixed-effects models, and sensitivity analyses were performed. RESULTS: Among 865 patients, crude axial symptom rates differed across the four joint operative-pattern groups: 1.4%, 27.6%, 22.7%, and 69.4%. Exploratory logistic-regression, Firth-penalized, and propensity score analyses were directionally consistent with these absolute event-rate patterns, but the OR magnitudes should be interpreted cautiously because of nonrandom operative selection, clinical coupling between operative variables, residual confounding, and sparse reference-group events. VAS trajectories differed across groups, whereas JOA trajectories and complication rates were broadly similar. CONCLUSION: C7 laminoplasty and longer-segment ELAP were associated with greater postoperative axial symptom burden, and the C7-preserving/shorter-segment group had the lowest observed pain burden. These findings should be considered hypothesis-generating and should not be interpreted as evidence of operative superiority or causal surgical effects because of the observational design, nonrandom operative selection, clinical coupling between operative variables, and residual confounding.
Functional Assessment of Dysphagia and Dysphonia Following C3-C4 Anterior Spine Surgery: A Prospective Comparison Between Simplified Retropharyngeal and Anterolateral Approaches.
De Bonis P, Giannini S, Moldovan RA … +6 more , Bortolotti S, Mantovani G, Cavallo MA, Scerrati A, Lofrese G, Andreella N
Spine (Phila Pa 1976) · 2026 Jun · PMID 42390991 · Publisher ↗
STUDY DESIGN: Single-center prospective cohort study. OBJECTIVE: To prospectively evaluate postoperative dysphagia and dysphonia in patients undergoing C3-C4 anterior cervical discectomy and fusion (ACDF) with the Simpli...
STUDY DESIGN: Single-center prospective cohort study. OBJECTIVE: To prospectively evaluate postoperative dysphagia and dysphonia in patients undergoing C3-C4 anterior cervical discectomy and fusion (ACDF) with the Simplified Retropharyngeal (SR) approach and the standard anterolateral (AL) approach. SUMMARY OF BACKGROUND DATA: The C3-C4 level lies adjacent to the pharyngolaryngeal complex and represents a transition zone between the SR and AL approaches. In this region, modest retraction can translate into clinically relevant dysphagia and dysphonia. Currently, no prospective study has directly evaluated and compared functional swallowing and voice outcomes between these two techniques. METHODS: Consecutive adult patients undergoing primary C3-C4 ACDF were prospectively enrolled. Patients were matched 1:2 (SR:AL) based on sex, age, and BMI, resulting in 75 total patients (25 SR, 50 AL). Patient-reported outcome measures (DHI, VHI) and clinician-rated outcomes (DOSS, GRBAS Grade) were collected preoperatively and at multiple postoperative timepoints up to 180 days. Outcomes were analyzed using mixed-effects models. RESULTS: Baseline characteristics and operative times were comparable between groups, with no adverse events recorded. Early postoperative patient-reported symptoms were common (mean DHI 9.1 vs 8.9 for SR vs AL at ≤24 hours) but improved to near-zero by 90 days and resolved by 180 days. Adjusted models revealed no significant differences in DHI or VHI between approaches at any visit. Clinician-rated impairment was uncommon, improved rapidly, and showed no significant between-approach differences. CONCLUSION: This study found that early postoperative patient-reported swallowing and voice symptoms were common but improved rapidly, completely resolving by the last follow-up. Clinician-rated dysphagia and dysphonia were infrequent and returned to normal by 30 days with both approaches, with no statistically significant differences. LEVEL OF EVIDENCE: III.
Pulsed Electromagnetic Field Bone Growth Stimulation Improves Union Outcomes in Type II Odontoid Fractures: Insights from a Multicenter Propensity-Matched Pilot Study.
Enriquez-Marulanda A, Sakthiyendran NA, Gonzalez-Salido J … +15 more , Perkins T, Sconzo D, Ramirez-Velandia F, Berube M, Avery MA, Powers AY, Im J, Yazdanian F, Alwakaa O, Terry-Escalante F, Syed BA, Stippler M, Papavassiliou E, Moses ZB, Binello E
Spine (Phila Pa 1976) · 2026 Jun · PMID 42390981 · Publisher ↗
STUDY DESIGN: Retrospective multicenter cohort study. BACKGROUND: Type II odontoid fractures (TTOFs) are common in older adults. Surgical fixation increases union but carries surgical risk, while external immobilization...
STUDY DESIGN: Retrospective multicenter cohort study. BACKGROUND: Type II odontoid fractures (TTOFs) are common in older adults. Surgical fixation increases union but carries surgical risk, while external immobilization avoids surgical risk but has variable union rates. Pulsed electromagnetic field-based bone growth stimulation (Bone-Stim) is a noninvasive and collar compatible adjunct that has not previously been tested in patients with TTOFs. OBJECTIVE: To compare radiographic and clinical outcomes of TTOF patients treated with and without adjunct Bone-Stim. METHODS: A retrospective cohort of adult patients with TTOFs at two centers (2014-2024) was studied. Patients with pathologic fractures, prior C1-2 union, emergent stabilization, in-hospital death before follow-up imaging, or no post-index imaging were excluded. Primary outcome of interest was radiographic fracture union. Secondary outcomes included pain, modified Rankin Scale score, complications, and mortality. Propensity-score matching (up-to 2:1, nearest neighbor, no replacement) balanced multiple factors, including age, gender, smoking, frailty, osteoporosis, and fracture displacement. RESULTS: Among 321 patients (median age 80; 51.7% women), 281 (87.5%) were managed with external immobilization and 40 (12.5%) underwent surgical fixation. Bone-stim was used in 20 patients (6.2%), including 19 managed with external immobilization and 1 treated with surgical fixation. In the unmatched cohort, fracture union was higher with vs without Bone-Stim (65% vs. 13.7%; P<0.01). In the matched cohort (n=48; 19 with and 29 without Bone-stim), union remained higher with Bone-Stim (68.4% vs. 13%; P<0.01). Delayed conversion to surgery occurred only without Bone-Stim (3 cases). Pain, mRS, complications, and mortality did not differ significantly in the cohorts. CONCLUSIONS: In patients with TTOFs, adjunct Bone-Stim was associated with higher radiographic union without worse symptoms or complications, while retaining mobility. A larger prospective, adherence-tracked study with standardized follow-up is needed to validate efficacy, refine patient selection, and optimize treatment protocols.
The Importance of Surgeon Dashboarding for Comparative Quality and Safety Outcomes when Adopting Robotics in Practice.
Bosco AP, Welch NW, Sullivan ML … +4 more , Petcharaporn M, Marks MC, De Silva S, Hedequist DJ
Spine (Phila Pa 1976) · 2026 Jun · PMID 42384782 · Publisher ↗
STUDY DESIGN: Retrospective Cohort Study. OBJECTIVE: To characterize the utility and value of surgical dashboarding when adopting robotic technology into surgical practice. SUMMARY OF BACKGROUND DATA: The adoption of rob...
STUDY DESIGN: Retrospective Cohort Study. OBJECTIVE: To characterize the utility and value of surgical dashboarding when adopting robotic technology into surgical practice. SUMMARY OF BACKGROUND DATA: The adoption of robotics assisted with navigation (RAN) for pedicle screw placement in adolescent idiopathic scoliosis (AIS) has shown similar intraoperative performance and safety profile when compared to freehand (FH) technique. Prospectively enrolling patients in the Surgeon Performance Program (SPP) Quality Improvement Registry allows surgeons to identify areas for improvement and analyze performance individually or compared to peers. This study employs SPP dashboarding metrics to compare quality and safety outcomes using RAN versus FH in AIS surgery in AIS patients who underwent posterior spinal fusion by a single surgeon from 2016-2022. METHODS: Demographics and radiographs were summarized with descriptive statistics. Surgical measures, radiographic outcomes, and complications from the SPP were compared between RAN and FH groups and against national means using t-tests, Wilcoxon tests, Fisher's exact tests, and chi-squared tests as appropriate. RESULTS: The cohort included 215 patients (121 FH, 94 RAN), had a mean age of 15.3 years and was mostly female (82%). Demographics and preoperative radiographic measures did not differ between groups. Dashboarding revealed RAN had significantly longer mean surgical time (240 mins vs. 192 mins; P<0.001) and higher curve correction (70% vs. 60%; P=0.003) than FH patients. There were no differences in complication rates (P=0.3) or EBL (P=0.4) found between RAN and FH. Compared to national averages, quartiles for surgical time, EBL, and complications were the same for each group. There were no deep infections, neurologic deficits, or return to OR for malpositioned screws in either group. CONCLUSIONS: SPP dashboarding results effectively compared RAN and FH techniques in spinal surgery, revealing increased surgical time but higher curve correction in RAN patients, but comparable EBL and safety profiles across groups.
Estimated Three-Dimensional Thoracic Kyphosis Supplements Radiographic Bone Age in Predicting Adolescent Idiopathic Scoliosis Curve Progression.
McCoy L, Tang N, Kelly BA … +2 more , Brouillet K, Luhmann SJ
Spine (Phila Pa 1976) · 2026 Jun · PMID 42384701 · Publisher ↗
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate whether estimated 3-dimensional thoracic kyphosis (e3DTK) adds predictive value to radiographic bone age in identifying adolescent idiopathic scoliosis (AI...
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate whether estimated 3-dimensional thoracic kyphosis (e3DTK) adds predictive value to radiographic bone age in identifying adolescent idiopathic scoliosis (AIS) patients at risk for curve progression. SUMMARY OF BACKGROUND DATA: Accurate prediction of curve progression in AIS remains challenging. Radiographic bone age is commonly used for risk stratification; however, three-dimensional spinal morphology may better reflect biomechanical factors influencing progression. METHODS: AIS patients were retrospectively identified at a single tertiary pediatric center. Progression was defined as a ≥6° increase in Cobb angle or progression to ≥50°. e3DTK was estimated from standard radiographs using a validated equation. Predictive performance was assessed using ROC analysis, DeLong testing, and likelihood ratio comparisons. Patients were additionally stratified by Sanders score and e3DTK risk category to evaluate subgroup progression rates. RESULTS: A total of 126 patients were included (79.4% female; 109 braced). e3DTK (r=0.25, P=0.005) and Sanders score (r=-0.33, P<0.001) were both correlated with curve magnitude change. Sanders score demonstrated strong predictive performance (AUC=0.80). Adding e3DTK to Sanders did not improve model performance (AUC=0.69; P=0.15). e3DTK alone showed good discrimination for progression (AUC=0.89) with an optimal threshold of 22.7°. However, this did not outperform Sanders-based prediction or improve combined models. Stratified analyses showed higher progression rates in high-risk e3DTK groups across Sanders stages (P=0.022), suggesting within-stratum risk differentiation. CONCLUSION: e3DTK is associated with AIS curve progression and demonstrates discriminatory ability in univariate analysis; however, it does not improve predictive performance beyond Sanders skeletal maturity staging. While it may help characterize risk heterogeneity within maturity strata, its role appears complementary rather than independently additive in AIS progression prediction.
Does preoperative depression predict return to sport and exercise after degenerative spine surgery?
Sarikonda A, Jain H, Tang AR … +8 more , Younus I, Ahluwalia R, Zeoli T, Jonzzon S, Chanbour H, Abtahi AM, Stephens BF, Zuckerman SL
J Neurosurg Spine · 2026 Jun · PMID 42361383 · Publisher ↗
OBJECTIVE: Predicting postoperative return to sport (RTS)/return to exercise (RTE) is challenging, particularly given the unclear impact of preexisting mood conditions. In sport/exercise participants who underwent spine...
OBJECTIVE: Predicting postoperative return to sport (RTS)/return to exercise (RTE) is challenging, particularly given the unclear impact of preexisting mood conditions. In sport/exercise participants who underwent spine surgery, the authors sought to evaluate the relationship between preoperative depression and postoperative sport/exercise participation and establish a threshold depression score predictive of RTS/RTE. METHODS: A retrospective cohort study (2011-2022) was conducted of sport/exercise participants who underwent degenerative spine surgery. Moderate/severe depression was defined as a score ≥ 10 on the Patient Health Questionnaire-9 (PHQ-9). Primary outcomes were 1) RTS/RTE (yes/no), time to return (months), frequency of participation (hours and days per week); and 2) optimal PHQ-9 score predicting RTS/RTE. Secondary outcomes were patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI) and Neck Disability Index (NDI). Multivariable regression controlled for age, sex, BMI, use of narcotics, surgical procedure, and preoperative PROM scores. RESULTS: Of 737 patients surveyed on sports/exercise participation, 150 (20.4%) reported preoperative sport/exercise. The mean patient age was 56.3 ± 13.8 years, and the mean follow-up was 6.0 ± 2.1 years. Thirty-four (22.7%) patients had moderate/severe depression. Common sports/exercises were hiking (55.3%), weight lifting (46.0%), and running/jogging (40.7%). Of the 150 patients, 127 (84.7%; 64.7% depressed vs 90.5% nondepressed, p < 0.001) returned to sport/exercise within 8.9 ± 3.7 months (13.0 ± 19.3 vs 8.1 ± 12.2 months, p = 0.147) postoperatively. Compared with their presymptom baseline, depressed patients engaged in fewer days (2.5 ± 1.9 vs 4.2 ± 1.4 days, p = 0.011) and hours (5.1 ± 4.8 vs 10.1 ± 7.3 hours, p = 0.047) of sport/exercise weekly, compared with their presymptom baseline. Preoperative depression predicted longer time to RTS/RTE (HR 0.6, 95% CI 0.4-1.0; p = 0.043). A PHQ-9 score of 7.2 (AUC 0.71, p = 0.001) predicted failure to RTS/RTE. Preoperative depression predicted worse long-term ODI (β 15.0, 95% CI 4.2-25.8; p = 0.007) and NDI (β 17.3, 95% CI 0.94-33.7; p = 0.039) scores. CONCLUSIONS: Sport/exercise participants undergoing degenerative spine surgery with moderate/severe depression were less likely to return to sport/return to exercise, returned later, and failed to regain presymptom levels of participation. Even mild depression (PHQ-9 score 7-9) predicted failure to return to sport/return to exercise. To facilitate successful return to sport/return to exercise, surgeons should screen all patients for depression and consider referring those with even mild depression for preoperative psychiatric optimization.
Photodynamic diagnosis using 5-aminolevulinic acid in surgery for spinal cord astrocytic tumors: a propensity score-matched comparison with brain tumors.
Kashiwagi H, Fujikawa Y, Fukumura M … +9 more , Yagi R, Hiramatsu R, Kameda M, Nonoguchi N, Furuse M, Kawabata S, Yasuda E, Takami T, Wanibuchi M
J Neurosurg Spine · 2026 Jun · PMID 42361382 · Publisher ↗
OBJECTIVE: Photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) has proven to be an effective method for visualizing the tumor during surgery. The purpose of this study was to verify the practicality of PDD i...
OBJECTIVE: Photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) has proven to be an effective method for visualizing the tumor during surgery. The purpose of this study was to verify the practicality of PDD in the surgery of astrocytic tumors of the spinal cord, with particular emphasis on comparison with astrocytic tumors of the brain. METHODS: This retrospective study included the cases of astrocytic tumors of the spinal cord and brain that were treated with initial surgery at the authors' institution between April 2023 and March 2025. The PDD and pathological characteristics were compared between spinal cord and brain tumors. A propensity score-matched analysis was performed to reduce covariate bias between the cohorts. RESULTS: There were 13 cases of astrocytic tumors in the spinal cord and 43 cases of those in the brain; 5-ALA-induced protoporphyrin IX (PpIX) fluorescence was observed considerably less frequently in spinal cord astrocytic tumors (15.4%) than in those in the brain (69.8%). Pathological analysis revealed a tendency for the malignant form to be more prevalent in the brain. A notable finding was that all 13 cases of spinal cord tumors were found to be the isocitrate dehydrogenase 1 (IDH1) wildtype. The propensity score-matched analysis suggested that the detection of PpIX fluorescence was found to be significantly less prevalent in the spinal cord. CONCLUSIONS: The findings of this study suggest that PDD may be less effective in the surgery of astrocytic tumors of the spinal cord compared with those of the brain. Verifying the molecular differences of astrocytic tumors between the spinal cord and brain in a large number of cases will be necessary in future studies.
Editorial. Rethinking spinal cord gliomas: beyond the intracranial paradigm.
Ryu S, Ha Y
J Neurosurg Spine · 2026 Jun · PMID 42361380 · Publisher ↗
Abstract loading — click title to view on PubMed.
Oncological and neurological outcomes after parent rootlet resection in functionally critical spinal schwannomas: a retrospective multicenter comparative study.
Galeano Zapata JC, Maragno E, Gallus M … +28 more , Spille D, Stengel FC, Yarkin A, Rodrigo-Paradells V, Butenschoen VM, Hubertus V, Onken JS, von Bronewski E, Demetz M, Freyschlag C, Schär RT, Petutschnigg T, Bschorer M, Mohme M, Zoia C, Solou M, Lenschow M, Latifi C, Molliqaj G, Romero-López C, Lepić M, Kaprovoy S, Gandia-Gonzalez ML, Bartek J, Peul W, Stummer W, Stienen MN, Schwake M
J Neurosurg Spine · 2026 Jun · PMID 42361373 · Publisher ↗
OBJECTIVE: Resection of spinal schwannomas remains a clinical and technical challenge, particularly in cases involving functionally critical spinal segments where management of the parent nerve rootlet is critical. Altho...
OBJECTIVE: Resection of spinal schwannomas remains a clinical and technical challenge, particularly in cases involving functionally critical spinal segments where management of the parent nerve rootlet is critical. Although sacrificing the involved rootlet may enable gross-total resection (GTR), it carries a significant risk of postoperative neurological deficits. This study aimed to evaluate the extent of tumor resection and the incidence of new deficits associated with rootlet resection in the cervical and lumbosacral spine. METHODS: In this European multicenter cohort study, the authors retrospectively analyzed patients diagnosed with spinal schwannomas located between segments C3-T1 (cervical) and L1-S2 (lumbosacral). Patients were stratified into 2 cohorts based on intraoperative management of the parent rootlet: rootlet resection versus rootlet preservation. Primary outcomes were GTR and the incidence of new neurological deficits. RESULTS: Of the 232 spinal schwannomas in the database, 190 (81.9%) were classified as arising in functionally critical segments. The parent rootlet was resected in 94 cases (49.5%) and preserved in 96 (50.5%). The rate of GTR was significantly higher in the rootlet resection cohort (n = 88, 93.6%) than in the rootlet preservation cohort (n = 72, 75.0%; p = 0.008). The OR for incomplete resection in the rootlet resection group was 0.205 (95% CI 0.09-0.56, p < 0.001), with a number needed to treat of 5.4 (95% CI 3.5-12.1) to achieve 1 additional GTR. New neurological deficits occurred in 5 patients (5.3%) after rootlet resection and in 7 patients (7.3%) after preservation (p = 0.767). Perioperative parameters, complications, and functional recovery at 3 months were comparable between the groups, with both cohorts showing significant improvement over baseline. With a mean follow-up of 33.1 ± 28.2 months (± SD), the mean progression-free survival was 121.4 months in the GTR cohort and 89.1 months in the non-GTR cohort (p < 0.001). CONCLUSIONS: Parent rootlet resection was associated with higher rates of GTR without an increased risk of new postoperative deficits. These findings require confirmation in prospective studies.
Risk factors for elevated endotracheal tube cuff pressure in anterior cervical spine surgery.
Goulazian J, Raman A, Abdul-Rahman NH … +6 more , Affolter K, Niksic A, Gerszten PC, Agarwal N, Hamilton DK, Snyderman C
J Neurosurg Spine · 2026 Jun · PMID 42361370 · Publisher ↗
OBJECTIVE: Dysphonia resulting from injury to the recurrent laryngeal nerve (RLN) is a known risk of anterior cervical spine surgery (ACSS). While the main mechanism underlying this injury is unclear, high endotracheal t...
OBJECTIVE: Dysphonia resulting from injury to the recurrent laryngeal nerve (RLN) is a known risk of anterior cervical spine surgery (ACSS). While the main mechanism underlying this injury is unclear, high endotracheal tube (ETT) cuff pressures have been linked to postoperative dysphonia. This study was performed to assess intraoperative ETT cuff pressures and how patient and surgical variables influence them. METHODS: A retrospective observational study was conducted using intraoperative cuff pressures collected from patients who underwent ACSS from January 2024 to March 2025 at a single institution. ETT cuff pressure was measured after intubation, manual adjustment, and, finally, placement of cervical retractors. Data for 3 months after surgery were collected via retrospective chart review. Additionally, 5 cadaveric specimens were obtained for experimentation. After intubation of a specimen, cuff pressure was set to 20-30 cm H2O and remeasured following cervical retraction. RESULTS: Among the 39 patients included in the study, ETT cuff pressures at the start of surgery often exceeded safe levels, with a mean pressure of 72.6 ± 37.7 cm H2O (IQR 81). These elevated levels were significantly associated with obesity and female sex. Despite manual adjustment, ETT cuff pressures were again elevated following airway retraction, with a mean of 50.5 ± 19.9 cm H2O (IQR 31.5). Cuff pressures were also increased with caudal surgery and an advanced age. A cadaveric model demonstrated that caudal cervical approaches, as compared to rostral ones, yielded a significantly greater increase in ETT cuff pressure following retraction (p < 0.0001). The side of approach was not a significant determinant of pressure elevation at either cervical level of approach. CONCLUSIONS: Retraction of cervical tissues during ACSS significantly increases ETT cuff pressure to unsafe levels, increasing the risk of RLN injury. Frequent ETT cuff pressure monitoring and adjustment are necessary to reduce RLN exposure to elevated pressures and potentially reduce the risk of dysphonia after ACSS.
Does postoperative gabapentinoid prescription reduce chronic opioid use following short-segment lumbar instrumentation?
Karnati J, Wu A, Kaghazchi A … +9 more , Ashraf A, Jelkin G, Ranganathan S, Abid S, Lunasco L, Shankar S, Wallace M, Cheng J, Adogwa O
J Neurosurg Spine · 2026 Jun · PMID 42361366 · Publisher ↗
OBJECTIVE: The aim of this study was to evaluate the impact of initial postoperative gabapentinoid prescription on chronic postoperative opioid use in patients who underwent short-segment lumbar instrumentation by using...
OBJECTIVE: The aim of this study was to evaluate the impact of initial postoperative gabapentinoid prescription on chronic postoperative opioid use in patients who underwent short-segment lumbar instrumentation by using a large multicenter electronic health record database. METHODS: A retrospective cohort study was conducted using the TriNetX research network, encompassing adult patients who underwent short-segment posterior lumbar instrumentation between January 1, 2010, and December 31, 2022. Inclusion criteria were limited to patients with preoperative diagnoses of lumbar spinal stenosis, spondylolisthesis, radiculopathy, or scoliosis. Patients were stratified based on whether they were prescribed a gabapentinoid medication (gabapentin or pregabalin) within 30 days following the index procedure. To reduce confounders, 1:1 propensity score matching was performed based on age, sex, race, comorbidities, and preoperative opioid and gabapentinoid prescriptions. Postoperative opioid prescribing patterns were assessed at 3-6 months, 6-12 months, and 12-24 months postoperatively. Medications were identified via RxNorm codes and classified as codeine-based (oxycodone, hydrocodone, codeine, and tramadol) or noncodeine-based (fentanyl, morphine, and hydromorphone). Agents were further stratified by morphine milligram equivalent (MME) potency: strong (MME > 1), moderate (MME = 1), or weak (MME < 1). RESULTS: Among 27,165 eligible patients (mean age 59.5 ± 13.3 years), 11,528 received a gabapentinoid prescription within 30 days postoperatively, while 15,637 did not. After matching, each group consisted of 1893 patients with comparable baseline characteristics. At 3-6 months postoperatively, gabapentinoid recipients had significantly lower odds of being prescribed codeine-based (OR 0.743), noncodeine-based (OR 0.602), and strong (OR 0.574) opioids. No significant difference was observed for weak opioids. At 6-12 months, this association persisted for codeine-based (OR 0.778), noncodeine-based (OR 0.564), and strong (OR 0.589) opioids. At 12-24 months, the gabapentinoid group continued to demonstrate lower odds of noncodeine-based (OR 0.523) and strong (OR 0.612) opioid prescriptions, although differences in codeine-based, moderate, and weak opioids were not significant. CONCLUSIONS: Postoperative gabapentinoid prescription within 30 days of short-segment lumbar instrumentation was associated with significantly lower odds of chronic postoperative opioid use, particularly for strong and noncodeine-based agents. These findings support gabapentinoids as a beneficial adjunct in multimodal postoperative pain management.
Full-Body Radiographic Imaging-Based Thigh Muscle Measurement for Sarcopenia: Association with Functional Assessments and Sagittal Alignment in Adult Spinal Deformity Patients.
Nassar JE, Farias MJ, Hostin R … +21 more , Gupta MC, Klineberg EO, Mundis GM, Okonkwo DO, Hamilton KD, Passias PG, Protopsaltis TS, Kim HJ, Gum JL, Smith JS, Raad M, Kebaish KM, Lenke LG, Shaffrey CI, Bess S, Schwab FJ, Lafage R, Lafage V, Daniels AH, Diebo BG, International Spine Study Group
Spine (Phila Pa 1976) · 2026 Jun · PMID 42348845 · Publisher ↗
STUDY DESIGN: Multicenter retrospective cohort study of prospectively collected data. OBJECTIVE: Evaluate the impact of EOS-derived thigh muscle measurements as indicators of sarcopenia and their effect on compensatory m...
STUDY DESIGN: Multicenter retrospective cohort study of prospectively collected data. OBJECTIVE: Evaluate the impact of EOS-derived thigh muscle measurements as indicators of sarcopenia and their effect on compensatory mechanisms in adult spinal deformity (ASD) patients. SUMMARY OF BACKGROUND DATA: ASD patients frequently present with sarcopenia, the progressive loss of muscle strength and mass associated with worse postoperative outcomes. Routine EOS full-body radiographs allow opportunistic thigh muscle measurement without added cost or radiation. This study evaluated EOS-derived thigh and quadriceps thickness against clinical indicators of sarcopenia and their impact on compensatory mechanisms in ASD. METHODS: We retrospectively analyzed prospectively collected data from 24 U.S. and Canadian spine centers(2019-2024). Sarcopenia was defined using validated sex-specific EOS cutoffs. Patients were classified as sarcopenic only when both AP thigh and LAT quadriceps measurements fell below threshold. Clinical frailty scores, grip strength, 3-meter timed up and go(TUG), and epigenetic age were compared between sarcopenic(SARCO) and non-sarcopenic(NON-SARCO) patients. Multivariate regressions assessed associations between thigh measurements, sarcopenia status, and compensatory radiographic parameters. RESULTS: Among 540 ASD patients (mean age 60, 71% female), 61 (11.3%) were SARCO. SARCO patients had lower BMI(23.6 vs. 27.3 kg/m²), higher clinical frailty scores (3.4 vs. 3.0), and slower TUG (12.2 vs. 10.5s) (all P<0.05). Multivariate analyses showed smaller thigh and quadriceps thickness and sarcopenia status correlated with higher frailty, weaker grip, slower TUG, and older epigenetic age (all P<0.05). Sarcopenia was also associated with greater thoracic kyphosis (β=6.87, P<0.01), cervical lordosis (β=5.84, P=0.01), sagittal vertical axis (β=13.17, P=0.04), and knee flexion angle (β=2.29, P=0.04), but not pelvic tilt, shift, or sacro-femoral angle (all P>0.05). CONCLUSIONS: Full-body radiographic derived thigh measurements significantly correlate with frailty, grip strength, TUG, and epigenetic age. Sarcopenic ASD patients demonstrate impaired proximal and increased distal compensations. Incorporating thigh and quadriceps muscle thickness measurements into preoperative assessment may improve surgical planning and patient management in ASD. LEVEL OF EVIDENCE: Prognostic Level III.
Biomechanical Effects of A Unilateral Transforaminal Endoscopic Approach for Lumbar Decompression: A Cadaveric Study.
Elhamdani SM, Copinga AK, Corcoran OG … +8 more , Vyas PS, Aslami J, Woodhouse CJ, Kramer DE, Walker CT, Sauber RD, Yu AK, Cheng BC
Spine (Phila Pa 1976) · 2026 Jun · PMID 42348832 · Publisher ↗
STUDY DESIGN: Cadaveric biomechanics study. OBJECTIVE: This study characterizes biomechanical changes in spinal kinematics for varying degrees of unilateral resection of the superior articular process by way of a transfo...
STUDY DESIGN: Cadaveric biomechanics study. OBJECTIVE: This study characterizes biomechanical changes in spinal kinematics for varying degrees of unilateral resection of the superior articular process by way of a transforaminal endoscopic approach. SUMMARY OF BACKGROUND DATA: Transforaminal endoscopic approaches for decompression of the lumbar spine have emerged as a desirable alternative to posterior decompression because they are assumed to be less destabilizing, if at all, to the spine. However, while general clinical outcomes are well-supported, there is limited evidence explicitly quantifying the effect of a step-wise approach on postoperative segmental stability, and even fewer biomechanical studies. METHODS: Six lumbar cadaveric specimens were tested biomechanically for range of motion (ROM) in flexion/extension (FE), lateral bending (LB), and axial torsion (AT). Between flexibility tests, a measured section of the left superior articular process (SAP) of the inferior vertebrae was removed in four increments (passes). Collected outcome measures were ROM, neutral zone (NZ), and neutral zone stiffness (NZ stiffness) in both directions of loading. RESULTS: Average ROM for intact specimens was 9.1°±1.0° in FE, 9.1°±1.4° in LB, and 3.0°±0.6° in AT. A one-way ANOVA revealed significance in ROM for LB, NZ in all three directions, and NZ stiffness at both loading modes in FE and LB. Post-hoc analysis showed that significant increases in LB ROM and significant decreases in stiffness occurred as early as the first pass. NZ in FE had significant increases at second and fourth passes. CONCLUSION: Significant increases in ROM in LB and decreases in NZ stiffness in both LB and FE with even minimal resection of the superior articulating process suggest changes in spine kinematics. While the magnitude of changes may not be clinically meaningful in general, this cadaveric model represents a worst case for biomechanical changes.
Reply to the Letter to the Editor: "Low-Density Lipoprotein Cholesterol and Statin Usage Are Associated With Rates of Pseudarthrosis Following Single-Level Posterior Lumbar Interbody Fusion".
Lavu MS, Eghrari NB, Makineni PS … +3 more , Kaelber DC, Savage JW, Pelle DW
Spine (Phila Pa 1976) · 2026 Jun · PMID 42348827 · Publisher ↗
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