European Spine Journal最新文献

{"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}

{"title":"Multifactorial prediction of mechanical complications after lumbar fusion using bone quality and turnover markers.","authors":"Yoji Ogura, Taisei Kato, Yuichiro Nishiyama, Arya Varthi, Yoshihisa Suzuki","doi":"10.1007/s00586-026-10424-2","DOIUrl":"https://doi.org/10.1007/s00586-026-10424-2","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the predictive value of preoperative bone health indices including T-score, bone mineral density (BMD), Hounsfield units (HU), and serum bone turnover markers for postoperative mechanical complications following lumbar fusion surgery.</p><p><strong>Methods: </strong>This retrospective study analyzed prospectively collected data from 120 patients who underwent lumbar fusion with pedicle screw instrumentation between August 2021 and June 2024. Preoperative assessments included dual-energy X-ray absorptiometry (DEXA)-derived BMD and T-scores, computed tomography-derived HU values, and serum bone turnover markers including procollagen type I N-terminal propeptide (P1NP) and tartrate-resistant acid phosphatase type 5b (TRACP-5b). Mechanical complications were evaluated radiographically at ≥ 12 months postoperatively. Receiver operating characteristic (ROC) curve analyses were performed for individual parameters, and multivariable logistic regression was used to identify independent predictors.</p><p><strong>Results: </strong>Mechanical complications occurred in 40 patients (33%). In univariate analysis, patients with complications were significantly older and had lower femoral BMD and T-scores and higher P1NP levels (all p < 0.05). ROC analysis demonstrated modest predictive ability for femoral T-score (AUC = 0.688) and BMD (AUC = 0.681). In multivariable logistic regression, TRACP-5b (OR = 1.02, p = 0.042) and the number of fused levels (OR = 5.24, p = 0.001) were associated with complications. A multivariate model combining significant variables yielded an AUC of 0.830, indicating good overall discrimination.</p><p><strong>Conclusions: </strong>Preoperative T-score, BMD, and HU values alone showed limited predictive accuracy for mechanical complications after lumbar fusion. However, integrating serum bone turnover markers and surgical factors substantially improved predictive performance. A multifactorial preoperative assessment incorporating bone density, metabolic, and mechanical parameters may better stratify risk and guide surgical planning in patients with poor bone quality.</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":"149180342","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":"Is time really spine? Early versus delayed surgical decompression in traumatic spinal cord injury: a systematic review and meta-analysis.","authors":"Wilhelm Hansen, Reaz Moolla, Duval Jugganath, Matthew Velcich, Kylen Govender, Kofi Nyarko, Olusegun Ogunbanjo, Badar Munir","doi":"10.1007/s00586-026-10438-w","DOIUrl":"https://doi.org/10.1007/s00586-026-10438-w","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether earlier surgical decompression is associated with improved neurological and clinical outcomes compared with delayed decompression after traumatic spinal cord injury.</p><p><strong>Methods: </strong>MEDLINE, Scopus, Web of Science, CINAHL, the Cochrane Library and Google Scholar were searched from inception to February 2025. Comparative studies of early versus delayed decompression in adult or predominantly adult traumatic spinal cord injury cohorts were included. Three reviewers independently screened studies, extracted data and assessed risk of bias. Random-effects meta-analyses were performed where outcomes were sufficiently comparable. The primary outcomes were improvement of at least one grade and at least two grades on the American Spinal Injury Association (ASIA) Impairment Scale.</p><p><strong>Results: </strong>Seventy-eight studies comprising 31,190 reported participants were included. Surgery within 24 h was the most common definition of early decompression, although thresholds and timing origins varied substantially. Seventeen studies contributed to the analysis of AIS improvement of at least one grade. Early decompression was associated with a greater likelihood of improvement than delayed decompression (risk ratio [RR] 1.46, 95% confidence interval [CI] 1.27-1.68; I² = 48.3%). Eleven studies contributed to the analysis of AIS improvement of at least two grades, which also favoured early decompression (RR 2.18, 95% CI 1.69-2.81; I² = 0.0%). Four studies were pooled for overall complications, with no clear difference between early and delayed decompression (RR 0.97, 95% CI 0.60-1.56; I² = 74.9%). Functional recovery, mortality, length of stay, intensive care, ventilation and cost outcomes were reported inconsistently and were synthesised narratively.</p><p><strong>Conclusion: </strong>Earlier surgical decompression was associated with greater AIS-grade neurological recovery after traumatic spinal cord injury, particularly for improvement of at least two grades. However, most evidence was observational and limited by heterogeneous timing definitions, inconsistent outcome reporting and residual confounding. These findings support timely decompression when medically feasible, but do not establish that surgical timing alone determines neurological recovery.</p><p><strong>Prospero registration: </strong>CRD420251000074.</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":"149180329","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":"Primary spinal bone sarcomas in Japan: a nationwide comparative analysis of demographic and pathologic features, treatment patterns, and survival.","authors":"Yu Toda, Koichi Ogura, Chigusa Morizane, Tomoyuki Satake, Shintaro Iwata, Eisuke Kobayashi, Toshiyuki Takemori, Hiroya Kondo, Shudai Muramatsu, Takahiro Higashi, Akira Kawai","doi":"10.1007/s00586-026-10416-2","DOIUrl":"https://doi.org/10.1007/s00586-026-10416-2","url":null,"abstract":"<p><strong>Purpose: </strong>Primary spinal bone sarcoma (BS) is a rare malignancy accounting for less than 5% of all bone tumors, and direct comparisons between spinal and non-spinal BS remain limited, particularly in Asian populations. We aimed to compare demographic and pathologic characteristics, treatment patterns, and overall survival (OAS) between primary spinal and non-spinal BS, and to identify prognostic factors within the spinal BS cohort.</p><p><strong>Methods: </strong>In this retrospective cohort study based on the Japanese National Cancer Registry (NCR), we identified patients with primary BS diagnosed between 2016 and 2019. Spinal and non-spinal BS were compared for demographic and pathologic characteristics, treatment patterns, and OAS using chi-square tests, Kaplan-Meier analysis, and Cox proportional hazards models.</p><p><strong>Results: </strong>Among 3,755 patients with BS, 356 (9.5%) had spinal tumors. Compared with non-spinal BS, patients with spinal BS were significantly older (P < 0.001), more frequently presented with advanced disease (P < 0.001), and were less often managed at specialist (Japanese Orthopaedic Association-certified) centers (P = 0.002). Surgery was performed less frequently (33% vs. 68%, P < 0.001) and radiotherapy more often (54% vs. 19%, P < 0.001) in the spinal cohort. The 3-year OAS was significantly poorer in the spinal group (45% vs. 69%, P < 0.001). Within the spinal BS cohort, osteosarcoma was associated with significantly worse OAS than chordoma (hazard ratio [HR] 5.98; 95% confidence interval [CI] 1.71-20.96; P = 0.005), and distant disease at diagnosis predicted worse OAS than localized disease (HR 3.54; 95% CI 1.84-6.81; P < 0.001).</p><p><strong>Conclusion: </strong>Primary spinal BS in Japan differs substantially from non-spinal BS in clinical profile, treatment, and prognosis. Histological subtype and disease extent were the strongest independent prognostic factors. These nationwide real-world data offer a benchmark for risk stratification and may inform future treatment strategies for this rare disease.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180515","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":"Longitudinal trajectories and determinants of urinary outcomes after spinal ependymoma surgery.","authors":"Stefano Colonna, Jacopo Talarico, Giada Mai, Luca Ceroni, Alessandro Fiumefreddo, Antonio Melcarne, Diego Garbossa, Fabio Cofano","doi":"10.1007/s00586-026-10378-5","DOIUrl":"https://doi.org/10.1007/s00586-026-10378-5","url":null,"abstract":"<p><strong>Objective: </strong>Urinary dysfunction is an underexplored component of postoperative morbidity in spinal ependymomas. This study aimed to characterize longitudinal urinary and fecal outcomes, bladder-management trajectories, and predictors of early dysfunction and long-term catheter dependency following surgical resection.</p><p><strong>Methods: </strong>A retrospective cohort study of adult patients undergoing resection of spinal ependymomas was performed (2018-2024). Urinary and fecal outcomes were assessed at baseline, discharge, and 12 months. Bladder management was longitudinally assessed at discharge, 3, 6, and 12 months. Univariable logistic regression was used to identify predictors of postoperative urinary dysfunction and catheter dependency.</p><p><strong>Results: </strong>Fifty-five adult patients undergoing surgical resection for spinal ependymoma were included. Urinary dysfunction increased from 1.8% at baseline to 20.0% at discharge, then decreased to 12.7% at 12 months, mainly due to urinary retention. Fecal dysfunction remained uncommon throughout follow-up. Among patients with postoperative urinary retention (n = 10), bladder-management trajectories demonstrated progressive recovery over time, with six patients showing a lower level of catheter dependency at 12 months, four remaining unchanged, and no patients worsening. Most favorable transitions occurred within the first 6 months after surgery. Notably, no patient requiring an indwelling catheter at discharge remained dependent on it at 12-month follow-up. Subtotal resection (OR 6.34, p = 0.012) and intraoperative neurophysiological alterations (SSEP: OR 17.50, p < 0.001; MEP: OR 16.88, p < 0.001) were associated with postoperative urinary dysfunction. Histological subtype and tumor location were not associated with early postoperative urinary dysfunction but showed a descriptive relationship with longitudinal bladder-management outcomes.</p><p><strong>Conclusion: </strong>Urinary dysfunction is common after spinal ependymoma surgery but often improves over time. Early indwelling catheter dependency should not be considered a definitive poor prognostic sign, while extent of resection and intraoperative neurophysiological alterations appear to identify patients at increased risk of early postoperative urinary dysfunction.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180393","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":"Composite inflammatory, immune, and nutritional indices for predicting surgical site infection following spine surgery: a systematic review with narrative synthesis.","authors":"Yanbo Wen, Jing Zhong, Qiyuan Yang, Zhuohua Shi, Jianyuan Ouyang, Bing Tan","doi":"10.1007/s00586-026-10410-8","DOIUrl":"https://doi.org/10.1007/s00586-026-10410-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Surgical site infection (SSI) is an important complication after spine surgery, with a reported incidence of approximately 1%-4% and a substantial associated healthcare burden. Early identification of high-risk patients remains difficult. Composite indices derived from routine laboratory tests that integrate inflammatory, immune, and nutritional parameters may assist perioperative SSI risk stratification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This systematic review with narrative synthesis was conducted in accordance with the PRISMA 2020 statement and was registered in PROSPERO (registration number blinded for peer review). PubMed, Web of Science, and Embase were searched from database inception to May 28, 2026. Non-randomized clinical studies evaluating composite inflammatory, immune, or nutritional indices for predicting SSI after spine surgery were eligible. Two reviewers independently performed study selection, data extraction, and quality assessment. Observational studies were appraised using the Newcastle-Ottawa Scale (NOS), prediction-model studies using PROBAST, and studies reporting diagnostic or discriminative performance using QUADAS-2 as a supplementary tool. Because the included studies differed in surgical procedures, index definitions, sampling time points, thresholds, and statistical methods, the evidence was synthesized narratively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-one retrospective studies comprising 13,853 patients and 763 SSI or SSI-related infectious outcome cases were included. The evaluated indices comprised NLR, PLR, PNI, NRI, AGR, CAR, CLR, SIRI, SII, AISI, CALLY, CONUT, mGPS, and MNA-SF, among others. NLR was the most frequently studied inflammatory index. Postoperative NLR, particularly when measured between postoperative days 3 and 7, showed potential for early SSI detection. Associations with SSI were relatively consistent for CAR and mGPS, whereas findings for PNI and other nutritional indices were more variable. Five studies developed or evaluated prediction models or composite scoring systems. These models often reported higher discrimination than individual markers, but most were derived from retrospective cohorts, with limited external validation and heterogeneous calibration or clinical-utility assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Composite inflammatory, immune, and nutritional indices may assist SSI risk stratification after spine surgery. Postoperative NLR, CAR, mGPS, PNI, and SIRI appear to be clinically relevant adjunctive markers, but current evidence remains limited by retrospective designs, heterogeneous SSI definitions, variable sampling times, and insufficient external validation. Multivariable and machine-learning models have reported high discrimination in some cohorts, but their clinical use remains uncertain without robust calibration, independent validation, and clinical-utility assessment. At present, these measures should support, rather than replace, co","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167882","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}