European Spine Journal最新文献

{"title":"Prognostic Factors for Neurological Outcome After Surgery for Idiopathic Spinal Cord Herniation: A Systematic Review and Published Individual Patient Data Analysis.","authors":"Giuseppe Corazzelli, Sergio Corvino, Valentina Cioffi, Maria Rosaria Scala, Ciro Mastantuoni, Fabrizio Giaculli, Oreste de Divitiis, Maria Sacco, Giuseppe Catapano, Vincenzo Esposito, Salvatore Di Colandrea, Luigi Sigona, Raffaele de Falco, Antonio Bocchetti","doi":"10.1007/s00586-026-10440-2","DOIUrl":"https://doi.org/10.1007/s00586-026-10440-2","url":null,"abstract":"<p><strong>Objective: </strong>Idiopathic spinal cord herniation (ISCH) is a rare cause of progressive thoracic myelopathy, for which surgical management is widely accepted for symptomatic patients, but prognostic determinants remain poorly defined. This study aimed to synthesize the available surgical literature on ISCH, through a systematic review of published individual patient data (IPD), and to identify clinical, anatomical, and intraoperative factors associated with postoperative motor and sensory outcomes.</p><p><strong>Methods: </strong>A systematic review of the literature was performed in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD420251273863). Studies reporting surgically treated cases of ISCH were identified, from database inception to December 2024. Stringent inclusion criteria were applied. For the enrolled patients, demographic, clinical, radiological, surgical, and postoperative outcome variables were harmonized. Postoperative motor and sensory outcomes were dichotomized as improved versus stable or worsened. Associations were explored using univariate and multivariable logistic regression models to identify factors independently associated with neurological outcomes.</p><p><strong>Results: </strong>A total of 154 studies were included, providing published IPD for 285 surgically treated patients. The cohort consisted predominantly of middle-aged individuals with a slight female predominance, and Brown-Séquard syndrome represented the most frequent neurological presentation. Dural patch reconstruction and primary dural closure were adopted in 68.8% and 31.2% of patients, respectively. Overall, postoperative motor and sensory improvement were observed in 79.2% and 63% of patients, respectively. No significant association was found between dural patch adoption and postoperative motor or sensory improvement. Multivariable logistic regression identified preoperative paraparesis/plegia as independently associated with both motor and sensory stableness or worsened function (p = 0.041; p = 0.014, respectively). The presence of a posterior arachnoid cyst was independently associated with a higher probability of stable/worsened motor outcome (p = 0.033). Duplication of dura mater was associated with a lower probability of stable/worsened sensory outcome (p = 0.036), while dural patch reconstruction was associated with a higher probability of stable/worsened sensory outcome (p = 0.015). Intraoperative neurophysiological monitoring showed significant associations in both motor (p = 0.020) and sensory (p = 0.007).</p><p><strong>Conclusions: </strong>Surgical treatment of ISCH resulted in neurological improvement in a substantial proportion of patients. This IPD analysis identified preoperative neurological impairment and specific anatomical characteristics as factors associated with postoperative recovery, suggesting that advanced neurological deterioration may reduce the probability of functional improveme","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statistical fragility of significant outcomes in spine surgery randomized controlled trials: a systematic review of binary and continuous outcomes.","authors":"Vitaliy Voznyy, Mouad Elganga, Leya Tawfik, Dharsan Ravindran, Robert Koucheki, Jacob Greenberg, Zoher Ghogawala, Michael P Steinmetz, Jefferson R Wilson, Michael G Fehlings, Jay Toor, Jetan Badhiwala, Aazad Abbas","doi":"10.1007/s00586-026-10439-9","DOIUrl":"https://doi.org/10.1007/s00586-026-10439-9","url":null,"abstract":"<p><strong>Purpose: </strong>Spinal disorders are a major cause of disability worldwide, and the increasing use of spine surgery has been accompanied by a growing body of randomized controlled trials (RCTs). However, statistical significance based on P-values alone may not adequately capture the robustness of trial findings. The Fragility Index (FI) is a complementary measure of evidence stability, quantifying how easily statistical significance can be reversed. Previous spine-specific fragility analyses have demonstrated that statistically significant dichotomous outcomes are frequently fragile, but continuous outcomes have not been comprehensively evaluated. Accordingly, a systematic review and fragility analysis was performed to evaluate the robustness of statistically significant outcomes in spine surgery RCTs across both dichotomous and continuous outcomes.</p><p><strong>Methods: </strong>Embase, MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to January 14, 2026 for RCTs in spine surgery reporting significant primary outcomes. Studies were screened and extracted in duplicate, and the risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool; fragility was evaluated using the FI for binary outcomes and the Continuous Fragility Index (CFI) for continuous outcomes, where lower values indicate that statistical significance would be lost with fewer outcome changes, with results summarized descriptively and across predefined subgroup analyses.</p><p><strong>Results: </strong>A total of 265 RCTs comprising 24,083 patients were included; 43 (16.2%) reported binary outcomes and 222 (83.8%) reported continuous outcomes. Overall median fragility was 10.5 (interquartile range (IQR) 5.0 to 18.7), with median values of 4.0 for binary outcomes (IQR 2.0 to 5.0) and 12.2 for continuous outcomes (IQR 7.4 to 21.0). Notably, 76.7% of binary outcomes had an FI ≤ 5, and fragility did not differ significantly by risk-of-bias category. Fragility also differed significantly by reported P-value category, with more strongly significant outcomes generally showing greater robustness.</p><p><strong>Conclusion: </strong>In recent spine surgery RCTs with statistically significant primary outcomes, findings were often statistically fragile. For binary outcomes, reversal of statistical significance required a change in outcome status for a median of only 4 patients, with more than three-quarters of outcomes having an FI ≤ 5. Continuous outcomes also showed measurable fragility, with reversal requiring reallocation of a median of 12.2 patients. These results suggest that a substantial proportion of statistically significant findings in contemporary spine surgery RCTs may be less robust than conventional P-values alone imply. Fragility analysis may therefore serve as a useful complement to conventional significance testing when interpreting statistically significant findings in spine surgery","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avoidance of vascular injury during trans-psoas approaches; awareness of venous anatomy on MRI.","authors":"Naomi Winn, David Jaffray, Birender Balain, Matthew Ockendon","doi":"10.1007/s00586-026-10434-0","DOIUrl":"https://doi.org/10.1007/s00586-026-10434-0","url":null,"abstract":"<p><strong>Purpose: </strong>Iliolumbar venous anatomy shows many variations between individuals, which can potentially be hazardous during lumbar spine surgery. The iliolumbar veins and any large variants can be observed on routine pre-operative lumbar spine MRI. Knowledge of the venous anatomy is important during lumbar spinal surgery, to avoid any potential haemorrhagic complications. This is particularly relevant for anterior lumbar surgery and lateral trans-psoas surgery.</p><p><strong>Methods: </strong>In this study, we assessed the venous anatomy on the pre-operative MRI of 144 patients who underwent trans-psoas lateral access surgery over the past 15 years. Any surgical complications were also analysed.</p><p><strong>Results: </strong>The iliolumbar vein was visible in 113 patients. The iliolumbar vein was seen at L5-S1 level in 78 patients, reaching to L4- 5 in 32 patients and extending up to L3-4 in 3 patients. Only one patient had a large variant left sided ascending lumbar vein visible on the pre-operative MRI and this patient had a haemorrhagic complication during the lateral trans-psoas surgical approach. None of the other patients had any significant haemorrhagic complications.</p><p><strong>Conclusion: </strong>The vascular anatomy is readily identified on the pre-operative MRI. Veins considered to be large enough to present a surgical hazard, at levels proximal to the L4-5 disc, have a diameter greater than the exiting nerve root at the same level. Review of the vascular anatomy should be performed during the surgical planning to avoid any potential haemorrhagic complications.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foot drop secondary to lumbar degenerative disease: a scoping review of recovery patterns, predictors, and research gaps.","authors":"Dana Saleh, Ahmad Zayd Alkadri, Gilberto Perez Rodriguez Garcia, Nikhil Dholaria, James Kelbert, Salma Bakr, Giovanni Barbagli, Sohail Daulat, Zach Wetsel, Sananthan Sivakanthan, Joseph Georges, Michael Prim, Ali A Baaj","doi":"10.1007/s00586-026-10447-9","DOIUrl":"https://doi.org/10.1007/s00586-026-10447-9","url":null,"abstract":"<p><strong>Background: </strong>Foot drop (FD) secondary to lumbar degenerative disease is common and disabling, but reported recovery rates and predictors after surgical decompression vary widely, and prior reviews have not clarified how much of this variability reflects true clinical heterogeneity versus inconsistent methodology.</p><p><strong>Objective: </strong>To map the available evidence on recovery from FD following lumbar decompression, characterize methodological and definitional heterogeneity, synthesize reported predictors and recovery timelines, and identify gaps to guide future research.</p><p><strong>Methods: </strong>A PubMed search using MeSH and free-text terms yielded 1,195 records; after deduplication, 1,068 records were screened, and 22 studies met inclusion criteria. Data were extracted on study characteristics, recovery outcomes, predictors, timeline, and definitional consistency; findings were synthesized narratively, consistent with scoping review methodology.</p><p><strong>Results: </strong>Twenty-two studies (1994-2025; 1,882 patients), predominantly retrospective cohorts (17 of 22), met inclusion criteria. Substantial heterogeneity existed in FD and recovery definitions, with at least four outcome-grading frameworks in use. Recovery rates ranged 55-100% (any improvement, 13 studies), 15.6-100% (functional recovery, MMT/MRC ≥ 4, 11 studies), and 5.9-93% (complete recovery, MMT/MRC 5/5, 14 studies). Shorter symptom duration and higher preoperative strength were the most consistent significant predictors (62% and 59% of studies testing them, respectively), though \"early surgery\" thresholds varied from ≤ 48 h to ≤ 3 months. Other predictors were tested in fewer than half of studies. Recovery plateaus ranged from 6 weeks to 2 years. No study used electrodiagnostic confirmation of the deficit, and the deficit was graded from tibialis anterior strength alone in 19 of 22 studies.</p><p><strong>Conclusions: </strong>Shorter symptom duration and greater preoperative strength are the most consistently reported predictors of recovery from FD after lumbar decompression, but the certainty of this evidence is low: the underlying studies are predominantly retrospective and single-predictor in design, use incompatible definitions of both FD and recovery, vary in follow-up, and report an effect estimate with a confidence interval in only 8 of 22 cases. The universal absence of electrodiagnostic testing further means that no included study could exclude a coexisting peripheral entrapment contributing to the deficit. These limitations currently preclude meaningful quantitative pooling of recovery rates. We propose a minimum reporting set intended to make future primary studies mutually poolable, and identify standardized definitions, fixed follow-up windows, and baseline electrodiagnostic assessment as prerequisites for a reliable meta-analysis.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of general-purpose large language models (LLMS) in interpreting adolescent idiopathic scoliosis radiographs: a comparative study with experienced spine surgeons.","authors":"İdris Avcı, Salih Batuhan Kartal, Ahmed Yasin Yavuz, Kemal Paksoy, Onur Yaman","doi":"10.1007/s00586-026-10443-z","DOIUrl":"https://doi.org/10.1007/s00586-026-10443-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates the accuracy of general-purpose, vision-capable large language models (LLMs) in interpreting adolescent idiopathic scoliosis (AIS) radiographs and compares their outputs with an expert surgeon consensus reference standard.</p><p><strong>Methods: </strong>This retrospective comparative diagnostic accuracy study analyzed 128 anonymized AIS radiographic case sets from 128 different patients, including standing coronal and sagittal radiographs and lateral bending films. ChatGPT GPT-5.2 Instant, Gemini 3 Flash, and Grok 4.1 were evaluated through their official web interfaces in January 2026 using the original standardized prompt based on the Lenke classification system. Model inputs were de-identified raw radiographs without measurement lines, Cobb values, vertebral labels, or Surgimap overlays. Three spine surgeons with more than 10 years of deformity surgery experience independently assessed all cases using Surgimap. Surgeon consensus was the reference standard. Cobb angle (CA) accuracy was assessed using mean absolute error and agreement within ± 5°; categorical variables were assessed by exact agreement with 95% confidence intervals.</p><p><strong>Results: </strong>ChatGPT achieved 94.5% agreement within ± 5° of surgeon consensus, with a mean absolute CA error of 2.4°. Gemini achieved 92.2% agreement with a mean absolute error of 2.7°, and Grok achieved 90.6% agreement with a mean absolute error of 3.1°. Exact agreement was substantially lower for Lenke classification, lumbar and sagittal modifiers, neutral vertebra, and stable vertebra identification. Inter-rater reliability among surgeons was high for CA and categorical parameters. No formal inferential ranking between LLMs was performed.</p><p><strong>Conclusion: </strong>The tested general-purpose LLM versions showed limited reliability for comprehensive AIS radiographic interpretation. Their performance was substantially weaker for Lenke classification, modifiers, and fusion-level-related landmarks than for CA estimation. The findings do not support independent use of these systems for scoliosis measurement, education, or surgical planning. At present, these tools should be regarded as supervised documentation or teaching aids rather than measurement or decision-making systems.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MR spectroscopy in the diagnosis of lumbar discogenic pain.","authors":"John Sutcliffe, Simon Blease, Oakley Hill-Smith","doi":"10.1007/s00586-026-10319-2","DOIUrl":"https://doi.org/10.1007/s00586-026-10319-2","url":null,"abstract":"<p><strong>Purpose: </strong>to determine whether magnetic resonance spectroscopy (MRS) provides similar clinical data to low pressure provocative discography (PD).</p><p><strong>Methods: </strong>Twenty patients suffering from axial lower back pain underwent both MRS and PD concurrently. MRS was performed on a Siemens 3T scanner* of the lower three lumbar discs, where possible. Collapsed discs could not be assessed. Low pressure PD was performed on at least the lower three discs, by the author with considerable experience of the technique.</p><p><strong>Results: </strong>MRS agreed with PD findings in 70-87% of 55 discs tested, depending on the agreement level set. Of the non-agreements, 10/17 were under-calls, 3 were overcalls and 4 were indeterminate.</p><p><strong>Conclusion: </strong>MRS of lumbar discs may become a viable alternative to PD, as our experience and the technique evolves.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate in-brace correction and 1-year radiographic stability after a hybrid textile brace for adolescent idiopathic scoliosis: a retrospective cohort study.","authors":"Sangwon Hwang, Chung Hwan Choi, Chanwoong Jang, Jung Hyun Park","doi":"10.1007/s00586-026-10428-y","DOIUrl":"https://doi.org/10.1007/s00586-026-10428-y","url":null,"abstract":"<p><strong>Purpose: </strong>The Spinamic^® brace (VNTC, Seoul, Republic of Korea) is a hybrid spinal orthosis designed to prevent curve progression in adolescent idiopathic scoliosis (AIS). Given that AIS often involves both structural deformity and flexibility-dependent components, evaluating brace effects requires assessing curve flexibility in addition to Cobb angle magnitude. This study examined the immediate in-brace correction and its long-term follow-up outcomes.</p><p><strong>Methods: </strong>This retrospective study analyzed data from participants aged 9-17 years, diagnosed with AIS. Pre-brace standing and supine radiographs were used to assess curve flexibility. In-brace standing radiographs were taken on the day of application. Follow-ups at 6 months and 1 year recorded Cobb angles.</p><p><strong>Results: </strong>Among 108 patients (82 girls and 26 boys), 75 were followed for 6 months and 58 for 1 year. The mean age at brace application was 13.4 ± 1.7 years, and the mean Risser grade was 2.8 ± 1.5. The mean Cobb angles of the primary curve were 24.7 ± 9.6° (supine) and 32.7 ± 10.3° (standing), indicating a degree of flexibility component averaging 8.1 ± 4.8°, corresponding to 25.4 ± 14.3% of standing scoliosis angle. Immediate correction of the flexible component averaged 68.6 ± 34.7%. At 6 months, 14.7% showed improvement, 69.3% stabilization, and 16.0% progression. At 1 year, 17.2% of evaluable patients showed improvement and 51.7% stabilization, while 31.0% demonstrated progression exceeding 5°. Flexibility was significantly associated with immediate in-brace correction (r = 0.39, p < 0.001).</p><p><strong>Conclusion: </strong>The hybrid textile brace was associated with significant immediate radiographic correction, particularly in flexible curves. Baseline flexibility is informative in anticipating the immediate corrective response, whereas the uncontrolled design precludes conclusions regarding long-term clinical effectiveness.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subarachnoid-subarachnoid bypass versus extradural decompression for adhesive syringomyelia: experimental and early clinical evaluation.","authors":"Can Zhang, Chenghua Yuan, Jun Bai, Shengyu Cui, Jinze Li, Sumei Liu, Nanding Li, Kang Li, Fan Yuan, Xiaoli Sun, Honglei Liu, Jian Guan, Fengzeng Jian","doi":"10.1007/s00586-026-10431-3","DOIUrl":"https://doi.org/10.1007/s00586-026-10431-3","url":null,"abstract":"<p><strong>Background: </strong>Adhesive syringomyelia (SM) is associated with cerebrospinal fluid (CSF) obstruction in the spinal subarachnoid space (SAS). Recurrent obstruction after decompression or arachnoidolysis may limit surgical efficacy, making the durable surgical management of adhesive SM an important challenge in neurosurgery.</p><p><strong>Methods: </strong>Rats with MRI-confirmed SM were allocated to S-S bypass, extradural decompression, or vehicle treatment; sham-operated rats served as additional controls. Outcomes included MRI, blinded behavioral assessment, histology, and CT and fluorescent tracer studies. A prospective uncontrolled series of 14 selected patients evaluated technical feasibility, short-term safety, and clinical and radiological changes.</p><p><strong>Results: </strong>In the rat model, S-S bypass was associated with greater syrinx regression and more favorable behavioral and histological outcomes than extradural decompression. Distal tracer passage was also improved, whereas scar-associated tissue and recurrent SAS narrowing were observed after extradural decompression. Clinically, all 14 procedures were completed without major complications. At final follow-up, 13 patients were descriptively classified as improved and one as stable, accompanied by modest increases in ASIA sensory and motor scores.</p><p><strong>Conclusions: </strong>In this rat model, S-S bypass produced more favorable structural and functional outcomes than extradural decompression by providing an alternative pathway across the obstructed segment. The preliminary clinical series supports the technical feasibility and short-term safety of the procedure, but its clinical effectiveness requires confirmation in larger controlled studies.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-media spinal endoscopy versus unilateral biportal endoscopy for single-level degenerative lumbar spinal stenosis: a comparative study of mid-term outcomes.","authors":"Ruixiong Du, Taotao Lin, Xianfeng Lin, Yu Lin, Jing Wang, Hailin Lin, Yuhang Chen, Wenge Liu, Zhenyu Wang","doi":"10.1007/s00586-026-10435-z","DOIUrl":"https://doi.org/10.1007/s00586-026-10435-z","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the clinical and radiographic outcomes of dual-media spinal endoscopy (DMSE), a single-portal endoscopic system allowing flexible air-water switching, with unilateral biportal endoscopy (UBE) in the treatment of single-level degenerative lumbar spinal stenosis (DLSS).</p><p><strong>Methods: </strong>A retrospective analysis was performed on 105 patients diagnosed with single-level DLSS who underwent either DMSE (n = 48) or UBE (n = 57) between January 2023 and June 2024. Visual Analogue Scale (VAS) scores for back and leg pain and Japanese Orthopaedic Association (JOA) scores were recorded preoperatively and at 3 days, 1, 3, 6, and 12 months postoperatively. Radiographic parameters included facet resection rate, dural sac expansion, and decompression ratio. Serum creatine kinase (CK) changes and perioperative complications were also evaluated.</p><p><strong>Results: </strong>Both groups demonstrated significant improvements in low-back pain, leg pain, and JOA scores from 1 month through 12 months postoperatively (all p < 0.001). Unadjusted between-group differences in back-pain VAS (p = 0.034) and leg-pain VAS (p = 0.023) at 12 months did not remain statistically significant after Holm adjustment (adjusted p = 0.170 and 0.115, respectively).The fluoroscopy frequency was significantly lower in the DMSE group than in the UBE group(4 vs. 8 ; p < 0.001). The facet resection rate was significantly higher in DMSE (28.6 ± 13.7%) than in UBE (20.3 ± 12.1%; p = 0.001), and postoperative serum CK elevation was greater in DMSE (p = 0.010). Complication rates did not differ significantly between groups (2.1% vs. 1.8%; p > 0.05).</p><p><strong>Conclusions: </strong>Both DMSE and UBE appear to be safe and effective minimally invasive procedures for patients with single-level DLSS, with generally comparable short- to mid-term clinical outcomes. DMSE was associated with lower fluoroscopy frequency but greater facet resection, whereas UBE showed lower early postoperative CK elevation. These findings suggest different perioperative and technical profiles rather than clear overall superiority of either technique.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of intraoperative bulbocavernosus reflex monitoring for postoperative voiding dysfunction after lumbosacral spine surgery: a systematic review and meta-analysis.","authors":"Abdulrahim Saleh Alrasheed, Hanan Aljedani, Fatma Esam Nasraldin, Abdulmalek Mamdouh Baajajah, Lina A Justenia, Mohammad Salem Alqahtani, Faisal Rashed Almatrafi","doi":"10.1007/s00586-026-10411-7","DOIUrl":"https://doi.org/10.1007/s00586-026-10411-7","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative voiding dysfunction (POVD) is a significant complication of spinal dysraphism and lumbosacral spinal tumor resection. Conventional intraoperative neurophysiological monitoring modalities primarily assess the descending motor pathway and may not fully evaluate the integrity of the sacral reflex pathway. Intraoperative bulbocavernosus reflex (BCR) monitoring provides a real-time assessment of the sacral reflex arc's afferent and efferent pathways and may predict postoperative urinary function. However, its diagnostic performance and clinical utility remain incompletely defined. Therefore, this study aimed to evaluate the predictive value and diagnostic accuracy of intraoperative BCR monitoring for POVD in patients undergoing lumbosacral spine surgery.</p><p><strong>Methods: </strong>PubMed, Medline, Scopus, and Web of Science were searched comprehensively through March 2026. Random-effects models were used to pool BCR feasibility, diagnostic performance (sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV)), and the association between end-of-surgery BCR status and POVD. Leave-one-out sensitivity analyses and meta-regression were conducted to explore potential sources of heterogeneity.</p><p><strong>Results: </strong>Intraoperative BCR monitoring was feasible with a success rate of 94%. BCR demonstrated moderate sensitivity of 62% (95% CI: 0.38-0.81) and high specificity of 99% (95% CI: 0.95-1.00) for predicting POVD. The pooled PPV, NPV, and accuracy were 93% (95% CI: 0.63-0.99), 94% (CI: 0.88-0.97), and 93% (CI: 0.87-0.96), respectively. End-of-surgery BCR maintenance was significantly associated with lower likelihood of POVD (OR: 0.02; 95% CI: 0.00-0.32; P = 0.0019). Conversely, BCR disappearance showed an imprecise trend towards higher likelihood of POVD (OR: 6.91; 95% CI: 0.87- 54.85; P = 0.0642).</p><p><strong>Conclusion: </strong>Intraoperative BCR monitoring is feasible and may provide clinically useful predictive information for POVD after lumbosacral spine surgery. Its high specificity and NPV support its use as a part of a multimodal neuromonitoring protocol for assessing sacral pathway integrity. Further prospective studies are needed to validate its predictive performance and standardize monitoring protocols and outcome definitions.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}