Clinical Spine Surgery最新文献

{"title":"Delayed Cerebrospinal Fluid Leakage With Central Nervous System Infection Following Posterior Cervical Laminectomy: A Case Report and Review of Literature.","authors":"Dapeng Bi, Jianbang Han, Jiang Jiang, Yingfeng Wang","doi":"10.1097/BSD.0000000000002148","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002148","url":null,"abstract":"<p><strong>Study design: </strong>Case report and literature review.</p><p><strong>Objective: </strong>To report a rare case of delayed cerebrospinal fluid leakage complicated by central nervous system infection following posterior cervical laminectomy, and to elucidate the associated diagnostic and management challenges.</p><p><strong>Background: </strong>Acute cerebrospinal fluid (CSF) leakage is a recognized complication of posterior cervical spine surgery, whereas delayed CSF leakage remains exceedingly rare. When delayed CSF leakage coincides with central nervous system infection, delayed diagnosis may lead to catastrophic outcomes. We describe an unusual case of this complication following a cervical laminectomy.</p><p><strong>Methods: </strong>A 60-year-old male underwent a posterior cervical C3-5 laminectomy and decompression with lateral mass screw-rod fixation for traumatic cervical spinal cord injury and multilevel cervical spinal stenosis. Postoperatively, he developed fever, cervicodorsal pain, and headache. The diagnostic workup consisted of magnetic resonance imaging, cerebrospinal fluid analysis, and microbial culture.</p><p><strong>Results: </strong>Magnetic resonance imaging revealed a fluid collection at the surgical site, and cerebrospinal fluid analysis confirmed bacterial meningitis caused by Enterobacter aerogenes. The patient achieved complete neurological recovery following combined antimicrobial therapy and lumbar cistern drainage.</p><p><strong>Conclusion: </strong>This case highlights that nonspecific symptoms such as orthostatic headache and fever, emerging more than 48 hours postoperatively-even in the absence of an intraoperative dural tear-should raise suspicion for delayed cerebrospinal fluid (CSF) leakage with central nervous system infection. Definitive diagnosis requires prompt magnetic resonance imaging and CSF analysis. Early intervention with targeted antibiotics and lumbar cistern drainage is essential for optimal outcomes.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839396","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":"Comparison of Posterior Instrumentation With and Without Interbody Fusion for Degenerative Spinal Stenosis.","authors":"Çağrı Özcan, Ömer Polat, Halid Şafak, Elif R Cadircibasi, Bahattin Kemah, Serdar K Çepni","doi":"10.1097/BSD.0000000000002150","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002150","url":null,"abstract":"<p><strong>Study design: </strong>This is a retrospective comparative cohort study.</p><p><strong>Objectives: </strong>The aim of this study was to compare the radiologic and functional outcomes of patients undergoing short-segment instrumentation for lumbar spinal stenosis, specifically those treated with posterior instrumentation and decompression alone versus those treated with posterior instrumentation, decompression, and transforaminal lumbar interbody fusion (TLIF).</p><p><strong>Summary of background data: </strong>TLIF is often added to improve stability and fusion in lumbar spinal stenosis surgery. However, the additional clinical benefit of TLIF in short-segment degenerative lumbar stenosis remains controversial due to its association with increased operating time and perioperative morbidity.</p><p><strong>Methods: </strong>Twenty-four underwent TLIF in combination with posterior spinal instrumentation (PSI), whereas 26 received only PSI and decompression. Surgical duration, postoperative complications, symptom duration, intrahospital blood transfusion requirements, complications, radiologic images and fusion levels were retrospectively analyzed. The ODI and VAS scores were evaluated preoperatively and at the final follow-up.</p><p><strong>Results: </strong>There were no statistically significant differences between the groups in terms of age, symptom duration, follow-up, preoperative or postoperative VAS and ODI scores, ASA scores, complication, number of fusions, or length of hospital stay. However, the operative duration was significantly longer and blood transfusion rates were significantly higher in the TLIF group than in the control group (P<0.05).</p><p><strong>Conclusion: </strong>PSI with TLIF provides superior radiologic fusion outcomes in short-segment spinal stenosis surgery but does not offer a clear clinical advantage over PSI with decompression. Furthermore, it may result in longer operative duration, greater intraoperative blood loss, and may contribute to higher hospital costs.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839381","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":"Human Versus Machine: Concordance and Conflict in Spinal Metastasis Management.","authors":"Elie Najjar, Rawan Masarwa, Ahmed A Hassan, Sotiris Karatzoglou, Rodrigo Muscogliati, Khalid Salem, Nasir A Quraishi","doi":"10.1097/BSD.0000000000002135","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002135","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective concordance analysis.</p><p><strong>Objective: </strong>To evaluate the concordance between ChatGPT-4 and a spinal multidisciplinary team (MDT) in management decisions for metastatic spinal disease and to explore the potential role of large language models (LLMs) as decision-support tools in oncologic spine care.</p><p><strong>Summary of background data: </strong>Management of metastatic spinal disease requires multidisciplinary input balancing neurological preservation, mechanical stability, and systemic prognosis. Frameworks such as the Spine Instability Neoplastic Score (SINS) and the NOMS model guide decisions, but variability persists. Artificial intelligence tools like ChatGPT may standardize reasoning, yet their concordance with expert MDTs remains unexplored in this context.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 100 anonymized adult cases referred to a spinal MDT for spinal metastases with suspected instability or metastatic spinal cord compression (MSCC). Ten additional cases were used to calibrate the model input. Each case summary, including demographics, tumor histology, SINS, Karnofsky Performance Scale, and Tokuhashi estimates, was presented identically to ChatGPT-4 (OpenAI, March 2025 snapshot) and the MDT. Management recommendations: surgical versus palliative (noncurative therapy including radiotherapy, systemic treatment, or best supportive care) were compared using Cohen κ, and discordant cases underwent qualitative analysis.</p><p><strong>Results: </strong>ChatGPT and the MDT were concordant in 86% of cases (κ=0.66, P<0.001), indicating substantial agreement. Concordant recommendations included surgery in 26% and palliative care in 60%. Discordance occurred in 14% of cases, typically involving younger patients or rare tumor histologies. ChatGPT emphasized mechanical instability and high SINS scores, whereas the MDT weighted systemic prognosis more heavily.</p><p><strong>Conclusions: </strong>ChatGPT-4 achieved substantial concordance with expert MDT decision-making in metastatic spinal disease. While it aligned well in structurally clear-cut cases, discordance in prognostically complex scenarios underscores the need for prognosis-aware, dynamically validated AI models. These findings support AI as an adjunct-not a replacement-for multidisciplinary clinical workflows.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839403","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 Cervical Discectomy and Fusion Achieves Outcomes Comparable to Laminoplasty in Patients With Spinal Cord-Canal Mismatch.","authors":"Dong-Ho Lee, Sehan Park, Myeong G Song, Chang J Hwang, Jae H Cho","doi":"10.1097/BSD.0000000000002139","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002139","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To compare the clinical and radiographic outcomes of anterior cervical discectomy and fusion (ACDF) and laminoplasty in patients with cervical myelopathy complicated by spinal cord-canal mismatch (SCCM).</p><p><strong>Summary of background data: </strong>SCCM, defined by a high spinal cord occupation ratio (SCOR), represents a congenital or developmental stenosis that may complicate surgical decision-making. Although laminoplasty provides indirect posterior decompression, ACDF offers direct ventral decompression and correction of local alignment. Comparative evidence in patients with SCCM-related myelopathy remains limited.</p><p><strong>Methods: </strong>A retrospective review was conducted of 323 patients who underwent ACDF and 244 who underwent laminoplasty between 2014 and 2020. Patients with SCOR ≥0.7 on magnetic resonance imaging and a minimum 2-year follow-up were included. Clinical outcomes included the Japanese Orthopaedic Association (JOA) score, recovery rate, and Visual Analog Scale (VAS) for neck and arm pain. Radiographic parameters (C2-C7 sagittal vertical axis, cervical lordosis) and incidence of adjacent segment degeneration (ASD) were analyzed.</p><p><strong>Results: </strong>Thirty-nine ACDF and 22 laminoplasty patients met the inclusion criteria. Baseline demographics were comparable, except for a higher prevalence of hypertension and more operated levels in the laminoplasty group. Both procedures significantly improved JOA scores with no difference in recovery rate (P=0.901). Neck and arm pain improved significantly after ACDF but not after laminoplasty, although between-group differences were not significant. Radiographic parameters were similar at follow-up. Symptomatic ASD occurred in 20.5% of patients with ACDF and in none after laminoplasty (P=0.079). Neither SCOR nor surgical approach independently predicted neurological recovery.</p><p><strong>Conclusions: </strong>ACDF and laminoplasty achieved comparable neurological recovery in SCCM-related myelopathy. Laminoplasty may reduce ASD risk, whereas ACDF yields comparable outcomes when decompression is sufficient. SCCM alone should not contraindicate anterior surgery; approach selection should consider alignment, pathology, and symptoms.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817303","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":"Randomized Controlled Trials on Thoracolumbar Burst Fracture Management Are Statistically Fragile: A Systematic Review.","authors":"Junho Song, Julian V Javier, Ramone M Brown, Reginald M Brewster, Avanish Yendluri, Nikan K Namiri, John J Corvi, Samuel K Cho, Saad Chaudhary, Andrew C Hecht","doi":"10.1097/BSD.0000000000002140","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002140","url":null,"abstract":"<p><strong>Study design: </strong>Statistical fragility analysis.</p><p><strong>Objective: </strong>The management of thoracolumbar burst fractures (TLBFs) is challenging, and many surgeons rely on randomized controlled trials (RCTs) to inform decision-making. RCTs often report P-values, which may not fully reflect statistical robustness. This study utilizes fragility statistics to assess the reliability of RCTs evaluating TLBF outcomes.</p><p><strong>Summary of background data: </strong>Thoracolumbar burst fracture management remains controversial. Surgeons often rely on RCTs, though P-values alone may not reflect the reliability of the results. Fragility analysis offers deeper insight into the robustness of reported outcomes, yet its use in TLBF research remains limited.</p><p><strong>Methods: </strong>RCTs assessing TLBF management outcomes (2014-2024) were identified through PubMed, Embase, and Medline. Fragility index (FI) and reverse FI (rFI) were calculated as the number of events required to reverse the significance for significant and nonsignificant outcomes, respectively. Fragility quotient (FQ) was derived by dividing FI by the sample size. Subgroup analyses included pain, function, complications, perioperative metrics, and radiographic outcomes.</p><p><strong>Results: </strong>Of the 1073 studies screened, 22 RCTs were included, yielding 179 outcomes (114 continuous and 65 dichotomous). The median FI was 6 [Interquartile Range (IQR) 3-15], indicating that a median of 6 patient reversals changes statistical significance. The median FQ was 0.13 (IQR=0.08-0.24). Subgroup analyses demonstrated median FQs of 6 for pain (IQR=3-12), 6 for function (IQR=3-9), 4 for postoperative complications (IQR=2.75-6), 7 for intraoperative complications (IQR=7-7), 16 for perioperative metrics (IQR=10-20), and 5 for radiographic outcomes (IQR=2-8).</p><p><strong>Conclusions: </strong>Outcomes reported in RCTs evaluating TLBF management are statistically fragile, with an overall fragility quotient of 0.13. The significance of radiographic outcomes can be altered by as few as 6 event reversals. Reporting fragility metrics alongside P-values is recommended to improve the interpretation of RCT results and enable better-informed surgical decisions.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817445","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":"Quantitative Paraspinal Muscle Morphology and Risk of 90-Day Complications After Lumbar Instrumentation Surgery.","authors":"Mustafa Bulut, Muhammed Furkan Darılmaz, Serkan Güler","doi":"10.1097/BSD.0000000000002143","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002143","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To investigate the association between paraspinal muscle morphology and postoperative complications after lumbar instrumentation surgery for degenerative lumbar spine disease.</p><p><strong>Summary of background data: </strong>Paraspinal muscle degeneration may influence outcomes after lumbar spine surgery; however, quantitative imaging-based predictors of postoperative complications remain limited.</p><p><strong>Methods: </strong>In this retrospective cohort study, 89 patients who underwent lumbar instrumentation surgery were analyzed. Paraspinal muscle cross-sectional areas of the multifidus and erector spinae at the L4-L5 level were measured using a region-of-interest technique on preoperative MRI. Muscle ratios, a composite Paraspinal Muscle Index (SMI), and asymmetry indices were calculated. Logistic regression and receiver operating characteristic (ROC) analyses were used to evaluate associations with 90-day postoperative complications.</p><p><strong>Results: </strong>Postoperative complications occurred in 19 patients (21.3%). Patients with complications demonstrated lower mean multifidus ratio (P=0.005), erector spinae ratio (P=0.010), and SMI (P=0.004), whereas multifidus asymmetry was significantly higher (P=0.012). In multivariable analysis, diabetes mellitus and operative time remained independent predictors. The addition of muscle parameters increased model discrimination from AUC 0.771-0.820; however, this improvement did not reach statistical significance (P=0.150).</p><p><strong>Conclusions: </strong>Reduced paraspinal muscle ratios and increased muscle asymmetry were associated with postoperative complications. Quantitative evaluation of paraspinal muscles on routine MRI may contribute to perioperative risk stratification.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817439","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":"Robotic-Assisted Cervical Pedicle Screw Placement With Uniform 5.5 mm Rods Crossing the Cervicothoracic Junction: Accuracy and Technical Feasibility.","authors":"Vidyadhara Srinivasa, Abhishek Soni, Balamurugan Thirugnanam","doi":"10.1097/BSD.0000000000002142","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002142","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case series.</p><p><strong>Objective: </strong>To evaluate the accuracy and safety of robotic-assisted cervical pedicle screw placement using the SpineVidya C-TEK system with uniform 5.5 mm rods across the cervicothoracic junction.</p><p><strong>Summary of background data: </strong>The cervicothoracic junction (CTJ) represents a biomechanical transition zone where traditional cervical constructs require rod diameter transitions, introducing mechanical weakness. The C-TEK system features an enlarged tulip design accommodating 5.5 mm rods with 4.0 mm diameter cervical pedicle screws, eliminating the need for tapered rods or connectors at the CTJ.</p><p><strong>Methods: </strong>Twenty-six consecutive patients (282 screws) underwent robotic-assisted C-TEK cervical pedicle screw placement crossing the CTJ between April 2024 and June 2025. All procedures utilized the MazorX Stealth Edition robotic system with O-arm intraoperative CT imaging. Two blinded observers assessed screw accuracy using the Gertzbein-Robbins classification. Clinical outcomes and complications were evaluated.</p><p><strong>Results: </strong>Mean age was 54.1 years. In this preliminary series, all 282 screws achieved clinically acceptable placement (grades A-B; 100% in this cohort). Perfect placement (grade A) was achieved in 276 screws (97.9%), with grade B breach in 6 screws (2.1%). No grade C, D, or E breaches occurred. At the cervicothoracic junction levels (C7, T1, T2), 78 screws maintained clinically acceptable accuracy. Interobserver reliability was excellent (κ=0.94). No vertebral artery injuries, permanent neurological deficits, or hardware failures occurred. Illustrative cases demonstrated feasibility across diverse pathologies including dropped head syndrome, dystrophic scoliosis, and revision scenarios.</p><p><strong>Conclusions: </strong>Robotic-assisted C-TEK cervical pedicle screw placement demonstrates high accuracy and technical feasibility for uniform 5.5 mm rod constructs crossing the CTJ without rod diameter transitions or connectors. These preliminary results from a single-center experience support further investigation, including comparative studies with traditional dual-diameter systems.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817490","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":"The Impact of Social Support on Outcomes in Spine Surgery Patients: A Systematic Review and Meta-Analysis.","authors":"Jacqueline M Emerson, Advika Kumar, Cristal Ortiz, Kristina N Schaufele, Dana G Rowe, Antoinette J Charles, Edwin Owolo, Michael H Weber, Raphaele Charest-Morin, Rafael De la Garza Ramos, John H Shin, Ankit I Mehta, Jeremy J Reynolds, Michelle J Clarke, Andrea N Goodwin, Samantha Kaplan, Kerri-Anne Crowell, Melissa M Erickson, C Rory Goodwin","doi":"10.1097/BSD.0000000000002098","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002098","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To perform a systematic review and meta-analysis of the impact of social support on outcomes among adults undergoing nontraumatic/nononcologic spine surgery.</p><p><strong>Summary of background data: </strong>Spine surgery patients experience perioperative physical discomfort and psychological stress linked to negative outcomes like persistent pain, prolonged hospital stays, and re-admission. While social support is known to improve postoperative outcomes, its role within spine surgery remains unclear.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (PubMed), EMBASE (Elsevier), and Scopus (Elsevier) were searched from inception through October 2023. Keywords included adult spine surgery, prognosis, postoperative period, outcomes, and social support. The risk of bias was assessed using the Newcastle-Ottawa Scale. Data regarding social support and outcomes were collected. A meta-analysis was conducted to evaluate the association between social support and postoperative outcomes.</p><p><strong>Results: </strong>In summary, 982 full-text articles were screened, and 22 studies (11,702 patients) met the inclusion criteria. Samples ranged from 19-2070 patients (mean±SD: 532±562). The mean age was 55 years, and 52% were female. Half of the studies reported a significant positive association (P<0.05) between social support (eg, marital status, living environment, and support programs) and a favorable postoperative outcome [readmission rates, pain, mobility, length of stay (LOS), discharge disposition, emergency department visits, and ability to work]. In a meta-analysis (n=5 studies), married individuals had nearly twice the odds of a shorter LOS than nonmarried patients (OR=1.96, 95% CI: 1.28-3.00, I2=57%).</p><p><strong>Conclusions: </strong>Social support is a key predictor of clinical outcomes for spine surgery patients. While the types of social support reported in the literature were highly heterogeneous, patients with social support experienced shorter hospital stays, fewer readmissions, and increased home discharges. Enhancing perioperative resources for patients with limited social support networks may improve outcomes and enhance recovery for spine surgery patients.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817478","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":"Preoperative Depression and Patient-Reported Outcomes Following Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis.","authors":"Alejandro Perez-Albela, Puru Sadh, Mohammad Daher, Charles Furlong, Manjot Singh, Sonia Sheth, Alan H Daniels, Bryce A Basques","doi":"10.1097/BSD.0000000000002137","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002137","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To evaluate whether preoperative depression is associated with differences in improvement of PROs following ACDF by comparing improvement-from-baseline outcomes between depressed and nondepressed patients.</p><p><strong>Background of summary data: </strong>Depression has been associated with worse baseline and postoperative patient-reported outcomes (PROs) following anterior cervical discectomy and fusion (ACDF). However, most studies emphasize absolute postoperative scores rather than improvement from baseline, which more directly reflects the treatment effect.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. MEDLINE, PubMed, Cochrane Library, and Google Scholar were searched for comparative studies evaluating PROs after ACDF in patients with and without preoperative depression. Outcomes included Neck Disability Index (NDI), visual analog scale (VAS) neck pain, VAS arm pain, and SF-12 Physical and Mental Component Scores (PCS, MCS). Mean improvement from preoperative baseline to 6-month and ≥1-year follow-up was analyzed separately for depressed and nondepressed cohorts.</p><p><strong>Results: </strong>A total of 6 studies encompassing 930 patients met inclusion criteria. At baseline and at all postoperative time points, depressed patients demonstrated worse absolute PROs compared with nondepressed patients. However, when improvement from baseline was analyzed, depressed patients demonstrated significantly greater improvement in disability and pain outcomes. Perioperative outcomes, including operative time, blood loss, and length of stay, did not differ between groups.</p><p><strong>Conclusions: </strong>Although patients with preoperative depression experience worse absolute postoperative PROs following ACDF, they demonstrate comparable or greater improvement in disability and pain from baseline. These findings highlight the importance of distinguishing final health status from treatment effect and suggest that depression alone should not be considered a contraindication to surgical intervention but rather a factor for preoperative counseling and expectation management.</p><p><strong>Levels of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788840","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":"Posterior Laminectomy and Lateral Mass Screw Fixation With 1-2 Levels Laminoplasty for the Treatment of Cervical Spondylotic Myelopathy.","authors":"Chuang Li, Jingfeng Li, Qixin Zheng","doi":"10.1097/BSD.0000000000001878","DOIUrl":"10.1097/BSD.0000000000001878","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, observational study.</p><p><strong>Objective: </strong>This study aimed to evaluate the clinical efficacy of cervical posterior laminectomy with lateral mass screw internal fixation combined with 1-2 levels of laminoplasty in patients with severe complex cervical spondylotic myelopathy.</p><p><strong>Summary of background data: </strong>In this single-center retrospective observational study, data collected from 15 patients who underwent modified cervical posterior laminectomy with lateral mass screw internal fixation (modified PLF group) were compared with those from 45 patients who underwent standard cervical posterior laminectomy with lateral mass screw internal fixation (PLF group) during the same period.</p><p><strong>Methods: </strong>The cervical curvature, Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), neck disability index (NDI), Odom's grade, and development of C5 nerve palsy were compared preoperatively and postoperatively. A power analysis was conducted to determine the sample size required to detect clinically significant differences between the groups. Based on an expected effect size of 0.5, a significance level (α) of 0.05, and a power (1-β) of 80%, the analysis indicated that a minimum of 60 patients per group would be needed. The mean follow-up period was 3.5 years.</p><p><strong>Results: </strong>A significant reduction in the extent of cervical kyphosis ( P <0.05) was observed at the last follow-up in both groups. There were no significant differences in the JOA score, VAS, and NDI, all of which significantly improved in both groups. The rates of excellent and good Odom's grading (100% and 88.89% in the modified PLF and PLF groups, respectively) and the incidence of C5 nerve palsy (0% and 11.11% in the modified PLF and PLF groups, respectively) were significantly different between the 2 groups ( P <0.05). The power analysis confirmed that the study was adequately powered to detect significant differences in cervical curvature and clinical outcomes, although the smaller sample size of the modified PLF group (n=15) may have limited the ability to detect smaller but clinically meaningful differences in secondary outcomes.</p><p><strong>Conclusions: </strong>Modified cervical posterior laminectomy with lateral mass screw internal fixation achieved improved clinical outcomes after medium-to-long-term follow-up in patients with severe and complex cervical spondylotic myelopathy. It can stabilize the cervical spine, fully decompress the spinal canal, and prevent excessive backward drifting of the cervical spinal cord, thereby reducing cervical spinal cord injury and C5 nerve palsy.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E367-E374"},"PeriodicalIF":1.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}