European Spine Journal最新文献

{"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":"<p><strong>Objective: </strong>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.</p><p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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 < 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 < 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 < 0.001 for OS and p = 0.008 for LPFS).</p><p><strong>Conclusion: </strong>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}

{"title":"Successful execution of preoperative lumbar alignment planning: reliability of the L5-S1 anterior lumbar interbody fusion (ALIF).","authors":"Alan Daniels, Manjot Singh, Ashley Knebel, Michael Farias, Joseph Nassar, Jinseong Kim, Todd Stafford, Bassel Diebo","doi":"10.1007/s00586-026-10403-7","DOIUrl":"https://doi.org/10.1007/s00586-026-10403-7","url":null,"abstract":"<p><strong>Purpose: </strong>Preoperative planning for lumbar fusion involves careful consideration of segmental and regional spinopelvic alignment. However, whether anterior lumbar interbody fusion (ALIF) reliably delivers planned lordosis is incompletely understood. The purpose of this study was to evaluate the ability of L5-S1 ALIF to restore regional L4-S1 and segmental L5-S1 lordosis according to preoperative plan.</p><p><strong>Methods: </strong>Adult patients who underwent L5-S1 ALIF with posterior fusion by a single surgeon, had a documented preoperative plan, and received UNiD patient-specific rods were included. Demographics, preoperative and 3-month postoperative spinopelvic alignment, and deviation from ideal postoperative alignment were assessed. Two one-sample t-tests (TOST) were performed to evaluate equivalence of planned and postoperative lordosis. Sub-analysis by L4-L5 correction status (no fusion, screws, interbody) was also performed.</p><p><strong>Results: </strong>Among 102 patients, mean age was 61.2 years, 45% were female, mean levels fused were 4.5. Preoperatively, mean PI-LL was 10.8°, SVA was 61.6 mm, L4-S1 was 29.8°, L5-S1 was 11.2°, and L4-S1 LDI was 63%. Postoperatively, mean PI-LL was corrected to 6.4°, SVA to 33.5 mm, L4-S1 to 38.3°, L5-S1 to 20.7°, and L4-S1 LDI to 79%, and reciprocal TK change was 8.3° (all p < 0.05). Mean L4-S1 lordosis was 1.1° below plan and L5-S1 lordosis was 0.8° above plan (p > 0.05). TOST testing revealed that mean plan-achieved difference for L4-S1 and L5-S1 lordosis were statistically equivalent within the predefined equivalence margin of ± 2.5° (p < 0.05). In total, 76% and 95% of ideally planned patients achieved at least 35° L4-S1 lordosis and 50% L4-S1 LDI postoperatively, respectively. Fusion approach at L4-L5 was not associated with postoperative L4-S1 lordosis or plan success (p > 0.05).</p><p><strong>Conclusion: </strong>L5-S1 ALIF delivers reliable early correction of regional L4-S1 and segmental L5-S1 lordosis that closely matches preoperative planning parameters, regardless of fusion technique at L4-L5. The reliability of other fusion techniques at L4-S1 to achieve planned lordosis should be similarly examined.</p><p><strong>Level of evidence: </strong>IV.</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":"149106428","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":"Posterior spinal fusion with pedicle screw-based constructs in osteogenesis imperfecta: a systematic review of surgical and radiographic outcomes.","authors":"Paolo Brigato, Camilla Ravaioli, Leonardo Oggiano, Sergio De Salvatore, Davide Palombi, Pier Francesco Costici, Lisbet Haglund, Neil Saran, Jean Albert Ouellet","doi":"10.1007/s00586-026-09861-w","DOIUrl":"10.1007/s00586-026-09861-w","url":null,"abstract":"<p><strong>Background: </strong>Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by bone fragility and severe spinal deformities, with scoliosis affecting up to 80% of patients and often progressing despite bracing. Surgical management is challenging due to poor bone quality and high complication risk. Advances in pedicle screw-based constructs and multimodal strategies, including traction and bisphosphonates, have improved outcomes and enabled the successful correction of deformities. This review analyzes radiographic and surgical results of modern posterior spinal fusion (PSF) in OI-associated spinal deformity.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus, Embase, Cochrane Library, and Google Scholar (inception to May 2025) was performed using search terms such as \"osteogenesis imperfecta\", \"brittle bone disease\", \"posterior spinal fusion\", \"spinal arthrodesis\", \"scoliosis\" and \"spinal deformity\". Extracted data covered demographics, OI type, traction techniques, instrumentation, radiographic and surgical outcomes, complications, and patient-reported outcome measures (PROMs). The risk of bias was assessed using the MINORS tool, and reporting followed PRISMA guidelines.</p><p><strong>Results: </strong>The initial search identified 264 articles, of which 8 met the inclusion criteria, including 149 patients with OI (mean age 15.5 years). All studies were retrospective case series (level IV evidence). Cement augmentation was used in 31.5% of cases and apical osteotomies in 37.5%. Preoperative main curves ranged from 75.5° to 96°, with a mean correction rate of 49.5% after PSF. Both coronal and sagittal radiographic parameters improved postoperatively. The mean operative time was 410.6 minutes, blood loss averaged 1,375 mL, and hospital stay was 7.9 days. The overall complication rate was 27.5%, with 10.7% requiring unplanned reoperation.</p><p><strong>Conclusion: </strong>Modern pedicle screw-based constructs appear to provide more consistent radiographic correction in OI-associated scoliosis compared to earlier in situ fusion techniques. Although these procedures still entail significant blood loss and long operative times, their complication rates remain acceptable given patient complexity. Future multicenter high-quality studies should focus on optimizing implant density, screw augmentation, rod material, osteotomies, and integrating navigation and new biomaterials to standardize treatment strategies.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"5869-5883"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147485390","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":"Long-term clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) compared with open TLIF(O-TLIF): A retrospective cohort study for at least 5 years.","authors":"Fengzhao Zhu, Ya Ning, Xue Leng, Changqing Li, Bo Huang","doi":"10.1007/s00586-026-09824-1","DOIUrl":"10.1007/s00586-026-09824-1","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"6109-6118"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147276275","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":"Finite element validation and short-term clinical outcomes of robot-assisted percutaneous microwave ablation plus cement augmentation and sacroiliac screw fixation for upper sacral (S1-S2) metastases.","authors":"Jianping Hu, Jiazhuang Zhu, Xingkai Wang, Kunpeng Zhu, Xiaolong Ma, Chunlin Zhang, Tiantian Gao","doi":"10.1007/s00586-026-09842-z","DOIUrl":"10.1007/s00586-026-09842-z","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"6330-6338"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147289144","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":"Impact of vertebrae shape variation on lumbar spine loading: an image-based computational modeling study.","authors":"Gregory G Knapik, Ehud Mendel, Eric Bourekas, William S Marras","doi":"10.1007/s00586-026-09804-5","DOIUrl":"10.1007/s00586-026-09804-5","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"6507-6521"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146212779","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":"Early postoperative recovery of gait efficiency after lumbar decompression: three-month quantitative biomarker assessment.","authors":"Ram Haddas, Prasanth Romiyo, Ye Shu, Paul Rubery, Ashley Rogerson, Varun Puvanesarajah","doi":"10.1007/s00586-026-09808-1","DOIUrl":"10.1007/s00586-026-09808-1","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"6218-6230"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147325146","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":"Using ultrasound to assess connective tissue quality in spine surgery: cutoffs and predictive value for adjacent segment disease.","authors":"Erika Chiapparelli, Ali E Guven, Jiaqi Zhu, Marco D Burkhard, Krizia Amoroso, Bruno Verna, Anna-Maria Mielke, Jennifer Shue, Frank P Cammisa, Federico P Girardi, Andrew A Sama, Alexander P Hughes","doi":"10.1007/s00586-025-09730-y","DOIUrl":"10.1007/s00586-025-09730-y","url":null,"abstract":"<p><strong>Purpose: </strong>Collagen integrity is essential for connective tissue maintenance, and its deterioration may contribute to postoperative complications. Dermal ultrasound (US) echogenicity has been associated with collagen quality, with changes in echogenicity reflecting alterations in collagen composition. These changes may indicate increased susceptibility to revision surgery in lumbar fusion patients, particularly due to adjacent segment disease (ASD). However, no study has established a specific cutoff value for skin US echogenicity to predict the need for ASD-related revision surgery. This single-center prospective cohort study aimed to evaluate the association between dermal echogenicity and ASD revision, and to determine echogenicity cutoff values that could help identify patients at higher risk of requiring revision surgery.</p><p><strong>Methods: </strong>Patients undergoing posterior lumbar fusion from 2014 to 2023 were included. US measurements were conducted at two standardized locations on the lumbar back. Echogenicity values for the average dermal (AD), upper dermal (UD), and lower dermal (LD) layers were calculated using our institution's PACS imaging software. Statistical significance set at p < 0.05.</p><p><strong>Results: </strong>Among 383 patients (51% female, median age 63), those undergoing ASD revision were significantly older (median age 66.8 vs. 62 years, p = 0.012). Higher echogenicity in the LD (OR = 1.03, p = 0.008), UD (OR = 1.03, p = 0.027), and AD (OR = 1.03, p = 0.005) layers was associated with increased ASD risk. The optimal LD echogenicity cutoff was 124.3 (AUC = 0.654, sensitivity = 0.6, specificity = 0.69).</p><p><strong>Conclusion: </strong>We identify echogenicity cutoff values that correlate with an increased risk of revision surgery for ASD. Higher dermal US echogenicity may reflect alterations in collagen, contributing to poorer tissue quality. These findings support the use of dermal US parameters as a potential biomarker for high-risk lumbar fusion patients.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"6423-6429"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029016","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":"Quantifying gait and mobility in severe idiopathic scoliosis with inertial measurement technology.","authors":"Pablo Ulldemolins, Jorge Mario Morales, Pedro Rubio, Silvia Pérez, Miquel Bovea, Jose Luis Bas, Paloma Bas, Teresa Bas, Javier Martínez-Gramage","doi":"10.1007/s00586-026-09890-5","DOIUrl":"10.1007/s00586-026-09890-5","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"5974-5983"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622225","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}