European Spine Journal最新文献

{"title":"Are pain intensity measures interchangeable? agreement among ODI, SRS-22, and COMI in chronic low back pain with and without scoliosis.","authors":"Carmelo Pulici, Tito Bassani, René Marten Castelein, Antonio Pizzicato, Silvano Ferrari, Stefano Negrini, Fabio Zaina","doi":"10.1007/s00586-026-10420-6","DOIUrl":"https://doi.org/10.1007/s00586-026-10420-6","url":null,"abstract":"<p><strong>Purpose: </strong>Pain intensity in chronic low back pain (CLBP) is often assessed using pain items embedded in multidimensional patient-reported outcome measures (PROMs), but differences in scale format and recall period may limit score interchangeability. The purpose of this study was to evaluate the association and agreement among three commonly used pain intensity items derived from ODI, SRS-22, and COMI in adults with CLBP, with and without scoliosis.</p><p><strong>Methods: </strong>Secondary cross-sectional analysis of an observational cohort. From 1,092 eligible subjects (552 scoliosis-associated LBP; 540 non-scoliosis LBP), we included participants with complete pain items: ODI Item 1 (pain \"at the moment\", 1-6), SRS-22 pain item (past month, 1-5), and COMI pain (maximum of back/leg pain over the past week, 0-10). Agreement was assessed using Spearman's rho, Kendall's W, and intraclass correlation coefficients (ICC), overall and by pathology group and sex.</p><p><strong>Results: </strong>The final sample included 417 adults (88% female; mean age 65 ± 10 years): 319 SLBP and 98 LBP. Across all subjects, correlations were moderate to strong (rho 0.50-0.70) with substantial ordinal agreement (W = 0.74) but only moderate quantitative concordance (ICC = 0.45). Estimates were similar in SLBP and LBP (rho 0.49-0.70; W 0.74-0.79; ICC 0.43-0.53) and did not differ by sex.</p><p><strong>Conclusions: </strong>Pain items from ODI, SRS-22, and COMI rank patients similarly but yield non-interchangeable absolute scores in CLBP, irrespective of scoliosis. Consistent instrument selection is recommended when comparing or pooling pain outcomes.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106433","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":"Predictors of postoperative shoulder imbalance in adolescent idiopathic scoliosis: a retrospective cohort of 468 patients.","authors":"Anas Al Abdallat, Radwan Abu Romman, Mohammad Obeidallah, Shojaa Aljarajreh, Mutaz Aljaloudi, Faris Alzuheir, Yazan Alomari","doi":"10.1007/s00586-026-10386-5","DOIUrl":"https://doi.org/10.1007/s00586-026-10386-5","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>To determine the independent risk factors associated with postoperative shoulder imbalance (PSI) in adolescent idiopathic scoliosis (AIS) patients after posterior spinal fusion.</p><p><strong>Background: </strong>Postoperative shoulder imbalance is one of the most frequent complications following surgery in cases of adolescent idiopathic scoliosis (AIS). Quantitative Radiographic parameters that can be used for the preoperative planning of surgery are not clearly identified. The purpose of this study was to determine independent predictors of postoperative shoulder imbalance and to examine the correction PT/MT ratio as a quantitative radiographic predictor.</p><p><strong>Methods: </strong>For this study, 468 consecutive AIS patients subjected to posterior spinal fusion surgery, during January 2018 through December 2025 have been reviewed retrospectively. Data for this study were collected from the Hakeem electronic medical records system while radiographic measurements were obtained from the Picture Archiving and Communication System (PACS). PT and MT Cobb angles, T1 inclination, clavicle angle, radiographic shoulder height (RSH), and number of fusion segments were some of the radiographic measurements taken. PSI was diagnosed as RSH ≥ 15 mm after at least 24 months of follow up period. Independent predictors of PSI were found using multivariate logistic.</p><p><strong>Results: </strong>Female patients comprised 82%, while the mean age was 14.7 ± 1.9 years. PSI occurred 20.9% (n = 98). In comparison to the non-PSI group, the PSI group had low levels of UIV (below T3, p = 0.003), high preoperative left shoulder elevation, large PT Cobb angles (p < 0.001), and low PT correction rate (p < 0.001). Univariate analysis showed that residual proximal thoracic curvature ≥ 15° (OR 3.1, 95% CI 1.8-5.4, p < 0.001), UIV below T3 (OR 2.8, 95% CI 1.6-4.9, p = 0.001), preoperative left shoulder elevation, and PT/MT correction ratio below 0.59 (r=-0.53, p < 0.001) were independent factors of postoperative shoulder imbalance. The ROC curve analysis revealed an optimal PT/MT correction ratio threshold of 0.59.</p><p><strong>Conclusions: </strong>Residual proximal thoracic deformity and UIV lower than T3 were significant independent risk factors for shoulder imbalance. A PT/MT correction ratio less than 0.59 was an independent risk factor and might serve as a quantifiable radiographic criterion for surgical planning. These findings require prospective external validation before routine clinical implementation.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106506","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":"Adherence to home-based exercise therapy in adults with non-specific chronic low back pain: a cross-sectional study of 491 participants of the ComPaRE cLBP e-cohort (ADHERE II).","authors":"Julien Giraudo-Guglielmi, Leslie Toko Kamga, Marie-Ombeline Chagnas-Martin, Emmanuel Coudeyre, Camille Daste, Mathieu de Sèze, Arnaud Dupeyron, Quentin Kirren, Marie-Martine Lefèvre-Colau, Vanina Nicol, Isabelle Pane, François Rannou, Alexandra Rören, Viet-Thi Tran, Christelle Nguyen","doi":"10.1007/s00586-026-10413-5","DOIUrl":"https://doi.org/10.1007/s00586-026-10413-5","url":null,"abstract":"<p><strong>Background: </strong>Exercise therapy is part of the core treatment of non-specific chronic low back pain (cLBP) and is usually first delivered under the supervision of a health care provider, then home-based. Adherence to home-based exercise therapy is a key contributor to clinical response. However, reproducible standardized measure of adherence is lacking and determinants of adherence, especially the role of supervision, have not been fully explored. We aimed: 1/ to report adherence to exercise therapy in adults with non-specific cLBP, 2/ to assess whether supervision could influence adherence, and 3/ to identify contributors to adherence.</p><p><strong>Methods: </strong>We assessed adherence to exercise therapy in a sample of participants from the ComPaRe cLBP French e-cohort using the Exercise Adherence Rating Scale (EARS). Adherence to home-based exercise therapy was defined as a score ≥ 3/4 on the first item of the EARS. We compared modalities of supervision between adherent and non-adherent participants. Finally, we performed logistic regression to identify independent contributors to adherence.</p><p><strong>Findings: </strong>Overall, 491 adults with non-specific cLBP were included in the analysis. Adherence to home-based exercise therapy was 45%. Bivariate analysis showed that adherent participants more often received supervised sessions within the last 6 months. Multivariate analysis showed that higher levels of physical activity before the onset of cLBP, lower intensity of cLBP and lower burden of treatment were associated with a higher adherence to home-based exercise therapy (odds ratio [95% confidence interval]: 2.66 [1.77; 4.00], 1.01 [1.00; 1.02] and 0.95 [0.94; 0.96], respectively).</p><p><strong>Conclusions: </strong>We found that 45% of adults with non-specific cLBP were adherent to home-based exercise therapy. We were unable to demonstrate a significant influence of supervision on adherence.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106491","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":"Study of the consolidation of type B thoracolumbar fractures treated by monosegmental percutaneous osteosynthesis in patients with an ankylosed spine.","authors":"Elise Caron, Insafe Mezjan, Nacer Mansouri, David Masson","doi":"10.1007/s00586-026-10389-2","DOIUrl":"https://doi.org/10.1007/s00586-026-10389-2","url":null,"abstract":"<p><strong>Purpose: </strong>The objective is to study the rate of fusion of type B thoracolumbar fractures occurring in patients with an ankylosed spine and treated by monosegmental percutaneous osteosynthesis.</p><p><strong>Methods: </strong>We report 43 patients who underwent a mono-segmental screw fixation in this indication, between January 1, 2018, and December 31, 2023, at the University Hospital of Nancy, with follow up at 3, 6, 9 and 12 months. A CT scan was done at each post operative control and fusion was evaluated.</p><p><strong>Results: </strong>Of the 43 included patients, 41 had complete fusion at 12 months (95%) and 2 (5%) had fractures that did not consolidate. We had not any displacement of screws or rods. 29 men (67%) and 14 women (33%). The average age was 70.6 ± 11.5 years. Hospitalization duration averaged 10.7 ± 9.4 days (range 2-49), with a median of 7 days. Ten patients had medical complications during hospitalization stay (23%).</p><p><strong>Conclusion: </strong>Mono-segmental percutaneous osteosynthesis could enable fracture consolidation at 12 months in patients with thoracolumbar type B fractures and had ankylosed spine.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106475","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":"Radiographic and perceptual outcomes of shoulder imbalance in AIS: bracing alone versus bracing with Schroth methods.","authors":"Lijuan Ren, Qiuya Li, Prudence Wing Hang Cheung, Jason Pui Yin Cheung","doi":"10.1007/s00586-026-10398-1","DOIUrl":"https://doi.org/10.1007/s00586-026-10398-1","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effectiveness of underarm bracing alone versus combined underarm bracing with Schroth methods for radiographic shoulder imbalance in adolescent idiopathic scoliosis (AIS) patients and whether radiographic changes translate into patient-perceived changes.</p><p><strong>Methods: </strong>This retrospective study included moderate AIS patients with radiographic shoulder imbalance, categorized into brace-alone and combined (brace with Schroth methods) groups. Shoulder balance was assessed using standardized radiographs at baseline, first follow-up, and final follow-up. Primary outcomes were changes in T1 tilt (medial) and clavicle angle (lateral); secondary outcomes included additional radiographic measures. Associations between changes in primary radiographic parameters and patient-reported shoulder appearance were evaluated using the revised 22-item Scoliosis Research Society questionnaire appearance domain. Between-group differences were analyzed using analysis of covariance, with linear mixed-effects models for supplementary analyses; correlations were assessed using Pearson's or Spearman's coefficients.</p><p><strong>Results: </strong>A total of 54 patients were included, with 25 in the combined group and 29 in the brace-alone group. The combined group showed greater improvement in lateral shoulder balance, with larger ΔCA from baseline to final follow-up (1.04°, p = 0.026) and a significant group × time interaction (p = 0.041). Medial shoulder changes were comparable between groups. T1 tilt changes correlated with patient-reported appearance overall (r = 0.698, p = 0.037) and in the combined group (r = 0.917, p = 0.029), whereas clavicle angle changes did not.</p><p><strong>Conclusions: </strong>Combined bracing with Schroth methods improves lateral but not medial shoulder imbalance. Medial shoulder changes, not lateral, relate to patient-perceived appearance, highlighting the multidimensional nature of shoulder imbalance.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106487","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":"Machine learning-assisted osteoporosis detection using radiographic canal bone ratio (CBR-7) and demographic features.","authors":"Akihiko Hiyama, Daisuke Sakai, Hiroyuki Katoh, Masato Sato, Masahiko Watanabe","doi":"10.1007/s00586-026-10382-9","DOIUrl":"https://doi.org/10.1007/s00586-026-10382-9","url":null,"abstract":"<p><strong>Purpose: </strong>Osteoporosis remains underdiagnosed in aging populations due to its asymptomatic nature and limited access to diagnostic imaging. The Canal Bone Ratio measured 7 cm distal to the lesser trochanter (CBR-7), obtainable from standard full-length spinal radiographs, has emerged as a potential surrogate marker for bone quality. This study investigates the utility of CBR-7 in combination with machine learning (ML) models for opportunistic osteoporosis screening.</p><p><strong>Methods: </strong>We retrospectively analyzed 162 patients (mean age, 73.3 years) who underwent DXA and standing full-length spinal radiography before lumbar spine surgery. Osteoporosis was defined as the lower of the lumbar spine and femoral neck T-scores being ≤ -2.5. Six regression models were evaluated using nested five-fold cross-validation to estimate the CBR-7 value corresponding to this diagnostic threshold. Separately, a logistic regression model incorporating CBR-7, age, sex, and BMI was evaluated using stratified five-fold cross-validation to classify DXA-defined osteoporosis.</p><p><strong>Results: </strong>Of the 162 patients, 63 (38.9%) met the DXA-based definition of osteoporosis. CBR-7 was significantly higher in the osteoporosis group than in the non-osteoporosis group (0.517 ± 0.062 vs. 0.468 ± 0.058, p < 0.001). In the threshold-estimation analysis, Linear Regression showed the lowest cross-validated prediction error (MSE = 0.0033 ± 0.0006; R² = 0.181 ± 0.117) and estimated a CBR-7 value of 0.499 ± 0.001 corresponding to a Low T-score of -2.5. The logistic regression model combining CBR-7, age, sex, and BMI achieved an out-of-fold AUC of 0.778. At the Youden-derived probability threshold of 0.317, sensitivity was 82.5%, specificity was 57.6%, accuracy was 67.3%, precision was 55.3%, and the F1 score was 0.662.</p><p><strong>Conclusions: </strong>CBR-7 was associated with DXA-defined osteoporosis and may serve as a preliminary radiographic marker for identifying patients who warrant further assessment with DXA. The simple linear model provided a stable estimate of the CBR-7 value corresponding to the diagnostic T-score threshold, whereas the classification model demonstrated moderate discrimination. External validation in independent cohorts, together with prospective multicenter validation, is required before clinical implementation.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106467","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":"Association of a polyester mesh-containing tissue adhesive system with early postoperative inflammatory biomarker profiles following instrumented thoracolumbar and lumbar fusion.","authors":"Yoon Jae Cho, Han Sol Kim, Kihun Kim, Jae Young Kim, Tae Sik Goh, Jung Sub Lee","doi":"10.1007/s00586-026-10405-5","DOIUrl":"https://doi.org/10.1007/s00586-026-10405-5","url":null,"abstract":"<p><strong>Purpose: </strong>Polyester mesh-containing 2-octyl cyanoacrylate systems are increasingly used for skin closure after spinal surgery and can simplify postoperative wound care. However, whether their use is associated with a distinct early systemic inflammatory biomarker profile following instrumented fusion remains unclear. This study compared postoperative clinical events and early CRP and CRP-to-albumin ratio (CAR) profiles between a polyester mesh-containing tissue adhesive system and conventional closure.</p><p><strong>Methods: </strong>This retrospective cohort study included 256 patients who underwent posterior instrumented thoracolumbar or lumbar fusion between January 2021 and July 2026. Conventional closure was used until May 2024 (n = 194), after which the tissue adhesive system was routinely adopted for eligible patients (n = 62). CRP, albumin, and CAR were assessed immediately postoperatively and at postoperative days (POD) 3 and 7. The full cohort was used for the primary analysis. Multivariable regression adjusted for demographic factors, major comorbidities, underlying diagnosis, and number of fused levels. A sensitivity analysis excluded patients with postoperative readmission and/or irrigation and debridement (I&D), and the relative reduction in CRP and CAR from POD 3 to POD 7 was evaluated.</p><p><strong>Results: </strong>Postoperative readmission and reoperation requiring I&D did not differ significantly between groups, although event counts were low. Immediate postoperative CRP and CAR were comparable. At POD 3 and POD 7, the Tissue Adhesive Group had lower CRP (6.51 vs. 11.23 mg/dL and 3.21 vs. 6.05 mg/dL, respectively) and lower CAR (all P < 0.001). These associations remained significant after multivariable adjustment (POD 3 CRP adjusted mean difference, -4.29 mg/dL; 95% CI, -5.61 to -2.97; P < 0.001) and in the sensitivity analysis. In contrast, the percentage reduction from POD 3 to POD 7 did not differ significantly between groups for CRP (P = 0.655) or CAR (P = 0.516).</p><p><strong>Conclusions: </strong>Use of the polyester mesh-containing tissue adhesive system was associated with lower absolute CRP and CAR levels during the early postoperative period, but not with a faster relative decline from POD 3 to POD 7. These findings support an association with a lower early postoperative inflammatory biomarker profile; the clinical significance of this difference requires further prospective evaluation.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106418","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":"Comparison of navigation and fluoroscopic assisted posterior spinal fusion in adolescent idiopathic scoliosis surgery.","authors":"Michael Sarter, Carolin Bay, Maximilian Lenz, Nikolaus Kernich, Krishnan Sircar, Peer Eysel, Stavros Oikonomidis","doi":"10.1007/s00586-026-10393-6","DOIUrl":"https://doi.org/10.1007/s00586-026-10393-6","url":null,"abstract":"<p><strong>Purpose: </strong>Intraoperative navigation is increasingly used in spinal deformity surgery. However, evidence comparing navigated and conventional fluoroscopic-assisted posterior fusion in adolescent idiopathic scoliosis is still heterogeneous and often lacks comprehensive perioperative and recovery data. The aim of this study was to retrospectively compare clinical, radiographic, and perioperative outcomes between CT-navigated and fluoroscopic-assisted posterior spinal fusion in adolescent idiopathic scoliosis (AIS).</p><p><strong>Methods: </strong>We analyzed 71 patients (54 female, 17 male) with AIS treated between 2011 and 2018. Surgical indication was a structural curve with a Cobb angle ≥ 45-50°. 37 patients underwent navigated fusion (Nav+), and 34 had conventional fluoroscopic-assisted fusion (Nav-). Outcome parameters included Cobb angle correction, operative time, intraoperative blood loss, fluoroscopy time, surgical complications, need for intensive care, hospital stay, and revision rates. Statistical analyses used nonparametric (Mann-Whitney, Chi-square) tests, with significance at p < 0.05.</p><p><strong>Results: </strong>Preoperative Cobb angle was 70.27° (SD 18.84°, range 45-120°) in Nav + and 68.24° (SD 20.88°, range 45-118°) in Nav-. Mean number of fused segments was higher in Nav+ (10.24 ± 1.77; range 7-14) compared to Nav- (9.26 ± 2.67; range 4-14). Cobb correction did not differ significantly (24.5° vs. 24.7°, p = 0.85). Operative time was longer in Nav+ (230 vs. 175 min, p = 0.0006). ICU admission was more frequent in Nav+ (73% vs. 32.4%, p = 0.0006). Hospital stay was shorter in Nav+ (10 vs. 13 days, p < 0.00001).</p><p><strong>Conclusion: </strong>CT-navigation did not improve radiographic correction in AIS. CT-based navigation achieved radiographic correction comparable to fluoroscopic-assisted posterior spinal fusion in AIS. Navigation was associated with longer operative time. Differences in ICU utilization and hospital stay should be interpreted cautiously because they may reflect institutional practice patterns, temporal changes during the study period, surgeon-dependent treatment allocation, and differences in surgical complexity.</p><p><strong>Level of evidence: </strong>III, retrospective study.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106508","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":"Clinical outcomes of the LORDS strategy for thoracolumbar spinal metastases: a retrospective cohort study.","authors":"Zhilong Shen, Yuechao Zhao, Pengru Wang, Shangbin Zhou, Hao Yuan, Danyang Bai, Gan Xu, Jianru Xiao, Wei Xu","doi":"10.1007/s00586-026-10392-7","DOIUrl":"https://doi.org/10.1007/s00586-026-10392-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare surgical outcomes between patients with spinal metastases who received surgical treatment concordant with the LORDS (life expectancy, operability, responsible segment, decompression, and stabilization) strategy and those who did not.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Neurologic, Oncologic, Mechanical, and Systemic (NOMS) framework is widely used to guide decision-making in spinal metastases. With advances in targeted therapy, immunotherapy, and surgical techniques, more patients are now candidates for anterior column resection. However, a balanced surgical strategy that is compatible with NOMS framework and surgery remains lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We included 238 adult patients (≥18 years) with spinal metastases who underwent surgery between January 2018 and December 2022. Patients were categorized into the LORDS-concordant group (n = 129) and the non-concordant group (n = 109). The non-concordant group was further subdivided based on decompression extent into de-escalated (n = 37) and escalated (n = 72) subgroups. Surgical outcomes included blood loss, duration of surgery, change in Frankel grade, postoperative systemic therapy (chemotherapy, targeted therapy, immunotherapy, bone-modifying agents), radiotherapy, length of hospitalization, reoperation, complications, overall survival (OS), and local progression-free survival (LPFS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients who underwent surgery in accordance with the LORDS strategy exhibited a higher proportion of both radioresistant and radiosensitive individuals, while the proportion of patients with undefined radiosensitivity was lower (p = 0.030). However, this baseline difference did not reach statistical significance in subgroup analysis (p = 0.102). Furthermore, the LORDS-concordant group experienced a shorter length of hospitalization compared to the non-concordant group (p = 0.004), with subgroup analysis confirming consistent results (p &lt; 0.001). Regarding survival outcomes, patients in the LORDS-concordant group demonstrated significantly improved OS (802.00 [95% CI: 544.00; 1332.00] days) and LPFS (530.00 [95% CI: 364.00; 980.00] days) compared to the non-concordant group (OS: 590.00 [95% CI: 283.00; 844.00] days, LPFS: 376.00 [95% CI: 234.00; 711.00] days) (p &lt; 0.001 for OS and p = 0.008 for LPFS). Subgroup analysis further revealed longer OS and LPFS in the LORDS-concordant group compared to both the de-escalated (OS: 590.00 [95% CI: 303.00; 1179.00] days, LPFS: 280.00 [95% CI: 185.00; 759.00] days) and escalated groups (OS: 587.50 [95% CI: 275.50; 817.75] days, LPFS: 423.50 [95% CI: 240.00; 710.25] days) (p &lt; 0.001 for OS and p = 0.008 for LPFS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The LORDS strategy represents an exploratory surgical framework that integrates key clinical considerations while remaining compatible with the NOMS framework. It may offer a balanced and individualized approach to surgical decision-making in ","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106430","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":"Symptom relief does not fully reflect functional adaptation after lumbar decompression: longitudinal changes in lifting biomechanics following surgery for degenerative lumbar stenosis.","authors":"Ram Haddas, Ye Shu, Mark Lawlor, Alexander Akoto, Ashley Rogerson, Andrew Megas, Paul Rubery, Varun Puvanesarajah","doi":"10.1007/s00586-026-10343-2","DOIUrl":"https://doi.org/10.1007/s00586-026-10343-2","url":null,"abstract":"<p><strong>Purpose: </strong>Lumbar decompression effectively reduces pain and disability in patients with degenerative lumbar stenosis (DLS); however, it remains unclear whether symptomatic improvement is accompanied by restoration of functional movement during activities of daily living. This study evaluated longitudinal changes in lifting biomechanics and neuromuscular activation following lumbar decompression.</p><p><strong>Methods: </strong>Thirty-eight patients with symptomatic DLS underwent three-dimensional motion analysis and synchronized surface electromyography during a standardized symmetric lifting task approximately one week before surgery and again at 3 and 6 months postoperatively. Patient-reported outcome measures (ODI and PROMIS) were collected at each visit. Mixed-effects linear regression models evaluated longitudinal changes in kinematics and muscle activation.</p><p><strong>Results: </strong>Lumbar decompression produced significant improvements in disability, physical function, pain interference, and mood within three months that were maintained at six months. Despite these improvements, objective movement patterns continued to change through six months, with persistent biomechanical and neuromuscular adaptations. Postoperatively, patients demonstrated greater trunk and lumbar flexion, reduced frontal and transverse plane lower-extremity motion, and altered neuromuscular activation characterized by increased external oblique activity and shorter activation durations of the rectus femoris and gluteus maximus, whereas persistent adaptations remained in the tibialis anterior and erector spinae. Patients lifted heavier loads after surgery without significant changes in task completion time, indicating improved quality of movement rather than faster task performance.</p><p><strong>Conclusions: </strong>Following lumbar decompression, improvements in patient-reported pain and disability were accompanied by longitudinal changes in lifting biomechanics and neuromuscular control; however, these objective adaptations remained evident through six months. These findings suggest that symptomatic improvement and objective functional adaptation represent complementary but distinct dimensions of postoperative recovery. Objective biomechanical assessment may therefore provide clinically relevant information beyond PROMs by characterizing how patients adapt movement strategies during recovery.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105535","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}