Clinical Spine Surgery最新文献

{"title":"Cervical Spine Oncology: Perioperative Management and Complications.","authors":"Hania Shahzad, Reginald Chinweze, Richard Price, Hai V Le, Wyatt Vander Voort, Safdar N Khan","doi":"10.1097/BSD.0000000000002189","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002189","url":null,"abstract":"<p><strong>Study design: </strong>Narrative review.</p><p><strong>Objective: </strong>To synthesize contemporary evidence on perioperative complications in primary and metastatic cervical spine tumor surgery and to provide an evidence-informed framework for their prevention and management.</p><p><strong>Summary of background data: </strong>Cervical spine tumor surgery converges dense neurovascular and aerodigestive anatomy with a medically fragile, frequently irradiated patient population. Although cervical metastases represent only about 8-20% of spinal metastatic disease, their mismanagement carries disproportionately severe consequences, ranging from disabling pain to high-level paralysis and death. Cervical-specific risk-stratification tools are lacking, and most available evidence is extrapolated from degenerative anterior cervical cohorts.</p><p><strong>Methods: </strong>This is a narrative review of perioperative complications in cervical spine oncology. PubMed/MEDLINE and Google Scholar were searched for English-language articles published through May 2026, prioritizing literature from the past 5 years while including seminal earlier references where foundational, using combinations of the terms \"cervical spine,\" \"spinal metastasis,\" \"spinal tumor,\" \"perioperative complications,\" \"airway,\" \"vertebral artery,\" \"wound,\" \"dysphagia,\" \"venous thromboembolism,\" and \"hardware failure.\" Reference lists of included articles were hand-searched for additional sources. Studies were selected by author consensus for relevance to the complication domains discussed; formal risk-of-bias assessment and quantitative pooling were not performed, consistent with a narrative design. Because oncology-specific evidence is limited, data derived from degenerative cervical cohorts are identified as such throughout.</p><p><strong>Results: </strong>Major complication domains include airway compromise (highest with multilevel corpectomy, combined approaches, and cervicothoracic constructs), vascular and neurologic injury, CSF leak, wound failure and infection in irradiated fields, hardware failure, venous thromboembolism, and dysphagia.</p><p><strong>Conclusions: </strong>Outcomes depend on preoperative risk stratification, multidisciplinary coordination, and individualized postoperative care rather than any single intraoperative maneuver. Because the evidence base remains largely Level III-IV without validated cervical oncology-specific tools, described practices should be regarded as reasonable, evidence-informed considerations rather than standards of care.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Indications and Planning in Cervical Spine Oncology: A NOMS-Informed Framework for Metastatic and Primary Tumors of the Cervical Spine.","authors":"Graham M Winston, David Sykes, William C Newman, Mark Bilsky","doi":"10.1097/BSD.0000000000002192","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002192","url":null,"abstract":"<p><strong>Study design: </strong>Narrative review of contemporary literature alongside institutional experience applying the NOMS framework to cervical spine tumors.</p><p><strong>Objective: </strong>To supplement the NOMS framework with cervical spine-specific considerations: summary of background data.The NOMS framework provides a widely applicable approach to spinal oncology based on neurological, oncologic, mechanical, and systemic factors.</p><p><strong>Methods: </strong>Contemporary literature and published institutional experience addressing cervical spine tumors were reviewed.</p><p><strong>Results: </strong>Cervical spine tumors require region-specific modification of conventional NOMS decision-making. Mechanical considerations are particularly important at the occipitocervical and cervicothoracic junctions, where tumor-related or iatrogenic instability may necessitate extended constructs and careful fixation strategies.Systemic factors, including frailty, malnutrition, prior radiation, active therapy, and prognosis, remain critical determinants of surgical candidacy. Complex cases may require multidisciplinary planning.</p><p><strong>Conclusions: </strong>NOMS remains a useful foundation for cervical spine oncology but should be supplemented by region-specific anatomic and biomechanical considerations.Treatment should be individualized according to neurological compromise, tumor biology, mechanical stability, systemic disease, and surgical morbidity. As radiation and systemic therapies advance, surgery should primarily address decompression, stabilization, and tissue diagnosis rather than serve as a stand-alone modality for local control.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Decompression for Lateral Recess Stenosis Due to Vertebral Compression Fracture: A Case Report.","authors":"Ahmed Yasin Yavuz, Francisco Zarra, Harendra Kumar, Ismail Bozkurt, Salim Senturk","doi":"10.1097/BSD.0000000000002180","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002180","url":null,"abstract":"<p><strong>Study design: </strong>Case presentation.</p><p><strong>Objective: </strong>The interlaminar endoscopic lateral recess decompression (IE-LRD) represents a novel surgical alternative to consider in carefully selected cases, particularly when patients do not respond to conservative treatment.</p><p><strong>Background: </strong>Lumbar spinal stenosis (LSS) constitutes one of the most prevalent spinal conditions in the elderly population around the world. A myriad of causes have been elucidated, and although infrequent, vertebral compression fractures (VCF) may also cause LSS. Conservative treatment might be the first option; however, patients often require surgery.</p><p><strong>Methods: </strong>A 76-year-old woman with a medical history of dementia consulted for radicular pain in her left leg during the past 6 months, without any favorable response to conservative treatment. Neurological examination revealed a positive straight leg raising test on the left. A spine MRI revealed a VCF in L5, linked with spondylolisthesis (grade I) at L5-S1. An IE-LRD was planned, as the patient did not consent to a classical open surgery. The incision was placed over the inferior medial edge of the left L4 lamina. Following sequential dilatators, the working channel was located on the inferomedial edge of the left L4 lamina. Lateral fluoroscopy (LF) guided the entire procedure. During the procedure, laminotomy was extended cranially and caudally to ensure sufficient vertebral decompression.</p><p><strong>Results: </strong>After surgery, the patient was mobilized in the first 6 hours and discharged in the next 24 hours. Her lower back pain score improved significantly to 2-3, while her leg VAS pain improved to 0-1. After a follow-up for 18 months, the patient did not manifest complications or recurrences, and no additional treatment was carried out.</p><p><strong>Conclusion: </strong>(1) IE-LRD might be a useful and safe surgical procedure for the surgical management of LSS caused by VCF. (2) Consider this surgical alternative for elderly patients without a previous response to conservative medical treatment.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is There an Association Between Preoperative PONV Prophylaxis With Dexamethasone and Incidence of Wound Revisions in the Surgical Treatment of Pediatric Secondary Scoliosis? A Retrospective Cross-Sectional Study in 162 Patients.","authors":"Nima Taheri, Zhao Li, Zhen Wang, Konstantin Cloeren, Antonia Koch, Serafeim Tsitsilonis, Friederike Schömig, Michael Putzier, Matthias Pumberger, Paul Köhli","doi":"10.1097/BSD.0000000000002186","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002186","url":null,"abstract":"<p><strong>Background data: </strong>Pediatric patients undergoing surgery for secondary scoliosis are at special risk for surgical site infections (SSIs). The application of dexamethasone (Dexa) for perioperative prophylaxis of postoperative nausea and vomiting is an established method. Despite the benefits, there is still concern regarding an increased risk for SSI.</p><p><strong>Objective: </strong>This study aimed to evaluate the association between perioperative Dexa administration for PONV prophylaxis and the occurrence of SSI requiring surgical revision in pediatric patients undergoing surgery for secondary scoliosis.</p><p><strong>Study design: </strong>Single-center retrospective cohort study.</p><p><strong>Methods: </strong>Patients younger than 18 years undergoing surgical treatment for secondary scoliosis between January 2017 and December 2021 were included. Demographic and surgical data were extracted from medical records and discharge summaries. SSI requiring surgical reintervention was the primary outcome. Statistical analysis was conducted using the Mann-Whitney U test, Fisher exact test, and Fisher-Freeman-Halton test, univariable and bivariable logistic regression.</p><p><strong>Results: </strong>One hundred sixty-two patients were included (Dexa: n=30, control: n=132). There were no significant differences considering demographics (P>0.05). Patients receiving Dexa underwent undergoing revision surgery more often or had meningomyelocele (MMC). The overall incidence of infection was 11/162. Patients receiving Dexa showed a higher incidence of SSI requiring surgical reintervention (6/30 vs. 5/132, P=0.01) and were at higher Odds for SSI (OR: 5.25, 95% CI: 1.53-18.15, P=0.007), which remained significant after adjusting for confounders (MMC: OR: 3.97, 95% CI: 1.08-14.38, P=0.033; revision surgery: OR: 3.97, 95% CI: 1.08-14.38, P=0.033).</p><p><strong>Conclusions: </strong>This study observed an association between the preoperative application of Dexa for PONV prophylaxis in secondary scoliosis surgery and an increased risk of SSI. Our results give reason for a more thoughtful application of Dexa-based PONV prophylaxes in the perioperative therapy of a population of high-risk children for SSI with secondary scoliosis.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Bone Loss After 2-Level Cervical Disc Arthroplasty With Baguera C Discs.","authors":"Chia-Ning Chang, Wen-Hsien Chen, Hsi-Kai Tsou, Chung-Yuh Tzeng, Yen-Po Lai, Ting-Hsien Kao, Chih-Wei Huang, Jun-Peng Chen, Tse-Yu Chen","doi":"10.1097/BSD.0000000000002181","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002181","url":null,"abstract":"<p><strong>Study design: </strong>Clinical original research.</p><p><strong>Objectives: </strong>The objectives of this study were to identify the risk factors and incidence of anterior bone loss (ABL) after 2-level Baguera C cervical disc arthroplasty (CDA), as well as the impact of hybrid surgery on ABL.</p><p><strong>Background: </strong>ABL commonly occurs after CDA. Despite recent research on ABL, data on its incidence after 2-level CDA remain limited.</p><p><strong>Methods: </strong>In this retrospective cohort study, we reviewed patients who underwent 2-level Baguera C CDA in a medical center. We recorded the extent of ABL and radiologic parameters, including the segmental and global alignment angles, lordotic angle (or functional spinal unit angle), shell angle, global range of motion (ROM), and ROM of the index level.</p><p><strong>Results: </strong>We found that all patients had at least grade 1 ABL in 1 or 2 surgical segments. Of the 216 surgical segments analyzed, 66 (30.5%) had grade 2 ABL, 141 (65.3%) had grade 1 ABL, and only 9 (4.2%) had no bone loss at all. Patients with grade 2 ABL tended to have larger segmental and global alignment angles, and shell angle during extension than did those with grade 1 or grade 0 ABL.</p><p><strong>Conclusions: </strong>ABL is a common phenomenon found in essentially all patients receiving 2-level CDA. The extent and prevalence of ABL were greater in 2-level CDA than in 1-level CDA. Larger segmental and global alignment angles, and shell angle during extension were associated with grade 2 ABL, which is extensive bone loss with implant exposure. The exact mechanism of ABL remains to be elucidated.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiotherapy Advances for Cervical Spine Tumors: Conventional Versus Stereotactic Body Radiotherapy (SBRT).","authors":"Daniel T Lilly, Samuel T Chao, Lilyana Angelov","doi":"10.1097/BSD.0000000000002188","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002188","url":null,"abstract":"<p><strong>Study design: </strong>Narrative review.</p><p><strong>Objectives: </strong>To evaluate the current data related to radiation treatment for cervical spine tumors and how this impacts surgical strategies, emerging technologies, and the effect of advancements in systemic therapies.</p><p><strong>Summary of background data: </strong>Cervical spine tumors are most commonly metastatic in origin, with primary malignancies and benign pathologies also possible. Unique treatment challenges for these tumors exist, and a multidisciplinary approach is often required.</p><p><strong>Methods: </strong>A review was performed synthesizing the existing literature regarding radiation therapies in the management of cervical spine tumors.</p><p><strong>Results: </strong>Both spine stereotactic body radiotherapy (SBRT) and conventional external beam radiotherapy (cEBRT) remain frequently utilized for the treatment of spinal metastases, with randomized data supporting higher rates of complete pain relief and improved local control with SBRT. Particle therapies have demonstrated promise in scenarios requiring dose escalation, but access and costs remain barriers to widespread adoption. Targeted systemic therapies provide significant survival benefits, but their efficacy and safety for spinal metastases remain an active area of investigation.</p><p><strong>Conclusions: </strong>Advances in radiation delivery technologies, minimally invasive hybrid approaches, and the rapid growth of systemic treatment options are transforming the management of cervical spine tumors while allowing for continued development of personalized treatment approaches.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and Oncologic Patterns of Cervical Spine Metastases and Primary Tumors.","authors":"Samuel W Rice, William A Lambert, Ryan M Schiedo, Thomas A Pieters, Michael P Stauff","doi":"10.1097/BSD.0000000000002183","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002183","url":null,"abstract":"<p><strong>Study design: </strong>Narrative review.</p><p><strong>Objective: </strong>To summarize the epidemiology and oncologic patterns of metastatic and primary cervical spine tumors and evaluate the classification systems, instability assessments, cord compression frameworks, and prognostic tools used in their management.</p><p><strong>Summary of background data: </strong>Although relatively uncommon, cervical spine tumors carry disproportionate clinical consequences. Epidural spinal cord compression can cause quadriplegia and respiratory failure, while the region's distinctive anatomy and biomechanics complicate oncologic decision-making.</p><p><strong>Methods: </strong>A narrative review of the literature was performed, focusing on the epidemiology, primary tumor origins, biologic behavior, classification, spinal instability, epidural spinal cord compression, and survival prediction relevant to metastatic and primary cervical spine tumors.</p><p><strong>Results: </strong>Metastatic neoplasms constitute most cervical spine tumors and most commonly arise from lung, breast, and prostate cancers. Primary cervical spine tumors account for ∼5-10% of spinal neoplasms and encompass diverse pathologies with distinct biologic behavior and management implications. Existing classification systems, instability assessments, cord compression frameworks, and prognostic scores support multidisciplinary decision-making but incompletely reflect cervical anatomic and biomechanical complexity. Furthermore, survival prediction models may underestimate prognosis in the era of modern systemic therapy and spinal stereotactic radiosurgery.</p><p><strong>Conclusions: </strong>Cervical spine tumors require individualized, multidisciplinary evaluation that integrates tumor biology, neurologic status, mechanical stability, anatomic level, systemic disease burden, and anticipated survival. Current frameworks remain clinically useful adjuncts but should not replace comprehensive clinical judgment, particularly as oncologic and radiation treatments continue to improve.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Transforaminal Lumbar Interbody Fusion (TLIF) the Optimal Choice in the Treatment of Low-Grade Degenerative Spondylolisthesis When Compared With Posterolateral Decompression and Fusion (PLDF).","authors":"Lauren M Boden, William Sheppard, Taylor Paziuk","doi":"10.1097/BSD.0000000000002193","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002193","url":null,"abstract":"","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Management of Direct Oral Anticoagulants After Elective Spine Surgery: When Can These Drugs be Safely Resumed?","authors":"Maroun Rizkallah, Elias Melhem, Pierre-Emmanuel Moreau, Stephane Wolff, Guillaume Riouallon","doi":"10.1097/BSD.0000000000002169","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002169","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective monocentric study.</p><p><strong>Objectives: </strong>To determine a safe interval for the resumption of DOACs based on the risk of postoperative surgical reoperation in the month following spine surgery.</p><p><strong>Summary of background data: </strong>More patients scheduled for spine surgeries are being treated with direct oral anticoagulants (DOACs). Scientific society guidelines recommend the resumption of DOACs 2-3 days postoperatively. However, spine surgeries could be associated with an increased risk of complications warranting urgent surgical revision. Early resumption of DOACs imposes a 3-5-day delay before any possible intervention, raising challenges for the surgeon.</p><p><strong>Methods: </strong>All patients who had spine surgery between 2006 and 2020 were included. Data on the occurrence of reoperation, age, sex, duration of surgery, surgeon's experience, year, and type of surgery were collected. The main outcome was the occurrence of reoperation and the time to reoperation.</p><p><strong>Results: </strong>In total, 2540 patients, who underwent 3109 spine surgeries, were included. There were 260 reoperations that occurred in the month following the index surgery, of which 230 (7.39%) were due to complications requiring urgent revision surgery. More than 80% of the revision surgeries occurred within the 15 days following the index surgery, with half occurring after postoperative day 5. A longer duration of the surgery, nighttime surgery, and the type of surgery (multilevel fusions, surgery for surgical site infection) were associated with a significantly increased risk of revision within the month following the surgery.</p><p><strong>Conclusions: </strong>Although the resumption of DOACs 2-3 days postoperatively is safe in terms of bleeding risk, we believe that this interval is short considering the risk of revision during the first month after surgery. Timing of DOACs' resumption should be tailored to the patient's comorbidities and to the surgical characteristics; it should sometimes involve a multidisciplinary discussion.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Cervical MRI Findings Can Tell About ACDF Outcomes and Risks of ASD.","authors":"Olga Leonova, Evgenii Baykov, Aleksandr Krutko","doi":"10.1097/BSD.0000000000001881","DOIUrl":"10.1097/BSD.0000000000001881","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective analysis of data on patients with cervical degenerative disc disease who underwent single-level anterior cervical discectomy and fusion (ACDF).</p><p><strong>Objective: </strong>To determine the association between preoperative cervical MRI parameters and surgical outcomes, and their role in the adjacent segment disease (ASD).</p><p><strong>Summary of background data: </strong>There is no evidence on what preoperative findings are related to ACDF outcomes, and the progression of postoperative degenerative changes at the adjacent levels has not been found yet.</p><p><strong>Methods: </strong>The patients' demographic data, cervical MRI findings at all cervical levels and clinical data were collected preoperatively and postoperatively. A comparative analysis of MRIs of the levels adjacent and nondjacent to ACDF was performed to find out whether or not they were undergoing accelerated degeneration. A regression analysis was carried out for the identification of predictors of fusion rates and implant subsidence.</p><p><strong>Results: </strong>The study included 121 patients at visit 1 and 83 at visit 2. The median follow-up duration was 26.5 [18.9; 33.1] months. Complete fusions were observed in 85.5% of the patients (71/83), and implant subsidence was observed in 40% of the patients (33/83). Neither failed fusions nor implant subsidence were significant to clinical data ( P >0.05). Significant changes in the Modic changes ratio of type 1 to type 2 were observed 1 or 2 segments above ACDF ( P >0.05), along with an increase in the endplate damage there ( P <0.001). Endplate defects grade are a strong and independent predictor of implant subsidence at the same level (OR=1.3-12.94, P <0.05).</p><p><strong>Conclusions: </strong>At the levels adjacent to and above the ACDF segment, there is a change in the Modic change type-to-type ratio and an increase in the endplate damage. However, these changes in MRI parameters cannot be regarded as evidence for accelerated segment degeneration due to ACDF. Endplate defects revealed on preoperative MRI scans are predictors of implant subsidence at the same level.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E415-E420"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}