Global Spine Journal最新文献

{"title":"Temporary Occiput-C2 Fixation for Unstable Atlas Fractures: A Reliable Alternative to Halo-Vest? Minimum Two-Year Clinical Outcomes.","authors":"Abdülhalim Akar, Muhammed Fatih Serttaş, Tuna Pehli̇vanoğlu, Uğur Özdemi̇r, Mehmet Aydoğan","doi":"10.1177/21925682261419050","DOIUrl":"10.1177/21925682261419050","url":null,"abstract":"<p><p>Study DesignRetrospective study.ObjectivesThis study aimed to assess clinical and radiological outcomes of temporary occiput-C2 fixation(TOC2F) as an alternative to halo-vest immobilization in unstable atlas fractures.MethodsAfter ethics approval, 43 patients treated for C1 fractures between 2011-2018 were reviewed.Inclusion criteria were acute traumatic C1 fractures managed with TOC2F and at least two years of follow-up after implant removal. Exclusion criteria were polytrauma affecting follow-up, pathological fractures, prior cervical surgery, congenital anomalies, and incomplete data. Preoperative imaging included MRI, CT, MR angiography, and X-ray. Union was evaluated with CT at 3 and 6 months. Functional outcomes were assessed using NDI, SF-36 (MCS/PCS), and goniometric cervical rotation.ResultsThe cohort consisted of 23 patients(16 male,7 female).According to Landells classification,78.2% had type II and 21.7% type III fractures. Radiological union was achieved in all patients by 6 months, with hardware removal at a mean of 6.3 months. Cervical rotation significantly improved from 103.78° ± 12.02 at day 4 to 153.78° ± 9.29 at two years(<i>P</i> < .05).NDI scores improved from 12.21 ± 3.66 to 2.14 ± 0.94(<i>P</i> < .05).Final SF-36 MCS/PCS scores were favorable 56.33/56.09).No neurological deterioration occurred; one superficial wound complication was documented.ConclusionTOC2F demonstrates potential as a viable and effective alternative for the management of unstable C1 burst fractures.This technique provides immediate postoperative stability, facilitates reliable fracture union, and allows restoration of physiological cervical motion following implant removal.The favorable functional outcomes, low complication rate, and preserved long-term mobility observed in this study suggest that temporary fixation may offer substantial advantages over halo-vest immobilization and permanent fusion in appropriately selected patients.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"2966-2974"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12812063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to \"Laminoplasty Versus Laminectomy and Fusion in the Treatment of Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis of Cost and Patient-Centered Outcomes in the United States\".","authors":"Ahmad Shafi Antar","doi":"10.1177/21925682261422212","DOIUrl":"10.1177/21925682261422212","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3701"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral Bone Mineral Density Shows Stronger Correlation With Pedicle Screw Insertional Torque than Lumbar Bone Mineral Density or Hounsfield Units: A Retrospective in Vivo Study.","authors":"Yoji Ogura, Taisei Kato, Yuichiro Nishiyama, Keisuke Otsuka, Kenta Fujimura, Arya Varthi, Yoshihisa Suzuki","doi":"10.1177/21925682251415346","DOIUrl":"10.1177/21925682251415346","url":null,"abstract":"<p><p>ObjectivesInstrumentation failure remains a significant complication in spinal surgery. Preoperative bone health assessment is critical prior to spinal fusion surgery. Currently, bone mineral density (BMD) and Hounsfield Unit (HU) are common preoperative assessments, although it remains unclear which is more predictive of screw fixation strength. We aimed to identify the most reliable preoperative evaluation method for predicting screw insertional torque in patients undergoing lumbar fusion surgery.MethodsPatients who underwent lumbar fusion surgery utilizing pedicle screws between 2021 and 2023, were prospectively registered in our database. All participants underwent preoperative lumbar CT and Dual-Energy X-ray Absorptiometry (DEXA) scans. We analyzed data from 109 patients who underwent lumbar fusion surgery with 6.5 mm pedicle screws. Preoperative BMD was measured via DEXA (lumbar spine and femur), and HU values were obtained from preoperative lumbar CT scans. Insertional torque of the screws was measured intraoperatively using a calibrated torque wrench. Correlations between insertional torque and BMD/HU as well as patients' demographic/lab data were analyzed.ResultsA total of 335 pedicle screws were analyzed. Femoral BMD exhibited the strongest correlation with insertional torque (r = 0.557, <i>P</i> < 0.001), compared with lumbar BMD and HU. Age, ASA grade, BMI, serum calcium, and albumin showed weak correlations.ConclusionsFemoral BMD demonstrated the strongest, although still moderate, association with intraoperative insertional torque among all preoperative bone quality measures evaluated, suggesting that it may offer a more informative estimate of underlying bone strength in patients undergoing lumbar fusion.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"2846-2854"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12764419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145896483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality After Operatively Treated Cervical Spine Fractures - A National FinSpine Register Study.","authors":"Nils Danner, Nikolai Klimko, Henri Salo, Ville Leinonen, Jukka Huttunen","doi":"10.1177/21925682261442458","DOIUrl":"10.1177/21925682261442458","url":null,"abstract":"<p><p>Study DesignNationwide register study.ObjectiveThe incidence of cervical spine fractures and related surgeries are increasing in the ageing population, yet population-based outcome data remain limited. This study aimed to identify factors associated with mortality and to analyze causes of death following surgical treatment for cervical spine fractures in a nationwide cohort.MethodsA cohort of 979 patients undergoing surgery for cervical spine fractures (2017-2024) was identified from the nationwide FinSpine register. Independent risk factors for mortality were identified with Cox proportional hazards models. Patient data were linked with national records on mortality and causes-of-death. Standardized mortality ratios (SMRs) were calculated for comparison with the age- and sex-matched general population.ResultsThe 1-year mortality rate was 11.8%, increasing with age from 3.9% in patients younger than 65 years to 24.9% in those aged 85 years or older. Increasing age (HR 1.06 per year) and spinal cord injury (HR 1.71) predicted mortality. Compared with the general population, mortality was significantly elevated across all age groups, with highest standardized mortality ratio in patients younger than 65 years (SMR 8.3) and lowest for patients aged ≥85 years (SMR 2.0). External causes (accidents and violence) were the leading causes of death and highly over-represented (SMR 22.7) in the patients.ConclusionsIncreasing age and spinal cord injury predict mortality after surgery for cervical spine fractures. The low relative excess mortality in elderly patients, compared to the general population, supports the potential role of operative management with careful patient selection even in advanced age.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3560-3568"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13083284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147689822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinopelvic-Hip Harmony [PFA-(PI-LL)] as a Radiographic Indicator of Hip Extension Compensatory Reserve in Kyphotic Adult Spinal Deformity: A Multicenter Study.","authors":"Keisuke Ishikawa, Kohei Takahashi, Ko Hashimoto, Kenichiro Yahata, Kazuyoshi Baba, Takahiro Onoki, Ryo Fujita, Junya Kusakabe, Tomonori Kawaharada, Michiyoshi Sato, Takeshi Nakamura, Ryo Sugawara, Kyoichi Handa, Haruo Kanno, Hiroshi Ozawa, Yasuhisa Tanaka, Toshimi Aizawa","doi":"10.1177/21925682261438473","DOIUrl":"10.1177/21925682261438473","url":null,"abstract":"<p><p>Study DesignRetrospective multicenter observational study.ObjectivesIn kyphotic adult spinal deformity (ASD), hip extension, assessed by pelvic femoral angle (PFA), compensates for sagittal malalignment, but no radiographic measure quantifies residual \"hip extension reserve.\" When hip compensation fails, knee flexion, assessed by femoral inclination (FI), is recruited and forward trunk inclination, assessed by sagittal vertical axis (SVA), worsens. We aimed to identify which sagittal radiographic parameter best explains FI, SVA, and health-related quality of life (HRQOL), and to evaluate whether spinopelvic-hip harmony, defined as PFA minus spinopelvic mismatch [PFA-(PI-LL)], reflects hip extension reserve.MethodsWe included 115 kyphotic ASD patients from three spine centers. Spinopelvic parameters, PFA, and FI were measured; PI-LL and PFA-(PI-LL) were calculated. HRQOL was assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). We performed Spearman correlations and hierarchical linear regression (baseline: age, sex, and body mass index), adding each radiographic parameter individually and comparing ΔR² and the corrected Akaike information criterion (AICc) (complexity-penalized fit).ResultsPFA-(PI-LL) correlated with FI (ρ = -0.71) and SVA (ρ = -0.73). After adjustment, PFA-(PI-LL) yielded the greatest incremental explanatory power for FI (ΔR² = 0.43) and SVA (ΔR² = 0.56), with ΔAICc >10 vs the others. PFA-(PI-LL) was also associated with JOABPEQ lumbar function and walking ability. ROC analyses showed PFA-(PI-LL) cutoffs for FI >10° and SVA >95 mm were around 160°.ConclusionsIn kyphotic ASD, PFA-(PI-LL) best explained both knee flexion recruitment and forward trunk inclination and may indicate hip extension reserve.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3469-3481"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147511615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Recovery After Lumbar Fusion Surgery: An International Survey on Current Practice.","authors":"Hein R Jonkman, Floris R van Tol, Tim M Govers, Silje A C A Debets, Thomas W Wainwright, Bertrand Debono, Michael M H Yang, Hans D de Boer, Maroeska M Rovers, Jorrit-Jan Verlaan","doi":"10.1177/21925682261434216","DOIUrl":"10.1177/21925682261434216","url":null,"abstract":"<p><p>Study DesignCross-sectional, web-based international survey study.ObjectivesTo assess spine surgeons' perspectives on the importance of Enhanced Recovery After Surgery (ERAS) components and barriers to implementing ERAS programs in degenerative lumbar fusion.MethodsIn May 2024, a web-based survey was distributed to AOSpine members. The survey covered eight ERAS components derived from the 2021 consensus statement for perioperative care in lumbar fusion. Respondents selected up to three components with the biggest perceived impact on recovery and up to three with the greatest room for improvement. Responses were summarized in a priority matrix. Demographics, perceived barriers, and implementation support needs were analyzed using descriptive statistics.ResultsThe survey was accessed by 400 individuals, yielding 322 responses (80.5%) and a 76.7% completion rate. Respondents represented academic (50.6%), private (28.9%), and local/community hospitals (20.5%) worldwide. ERAS components perceived to have the biggest impact on recovery were multimodal opioid-sparing analgesia (73.3%), early mobilization (63.8%), and preoperative education & counselling (58.6%), which were also identified as having the greatest room for improvement (39.4%, 41.4%, and 62.6%, respectively). Key barriers were the absence of clear protocols and guidelines (56.2%), staff shortages (53.8%), and difficulties coordinating implementation and adherence (43.0%).ConclusionMultimodal opioid-sparing analgesia, early mobilization, and preoperative education & counselling were identified as ERAS components with the biggest perceived impact on patient recovery and the greatest room for improvement. Targeted efforts in these domains may represent an important opportunity to enhance perioperative care and support the implementation of ERAS programs in lumbar spinal fusion.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3369-3378"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147432403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Consensus on the Management of Spinal Infections: Recommendations From International Consensus Meeting 2025.","authors":"Shanmuganathan Rajasekaran, Javad Parvizi","doi":"10.1177/21925682261427448","DOIUrl":"10.1177/21925682261427448","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":"16 3_suppl","pages":"5S-6S"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of Adult Cervical Spinous Processes to Vertebral Midline for Cervical Disc Replacement.","authors":"Kevin G Liu, Jacob T Wechsler, Daniel Rusu, Aidan Lindgren, Marc A Abdou, Jeffrey C Wang, Raymond J Hah, Ram K Alluri","doi":"10.1177/21925682261486413","DOIUrl":"10.1177/21925682261486413","url":null,"abstract":"<p><p>Study DesignRetrospective Cohort.ObjectivesAccurate, midline artificial disc placement is crucial when performing cervical disc replacement (CDR). Although cervical spinous processes (SPs) are considered midline structures, clinical experience has often shown noticeable deviation at times. This study aims to quantitatively characterize this known observation to better understand the utility of SPs as midline indicators during CDR.MethodsPatients who underwent anterior cervical discectomy and fusion with preoperative cervical spine computerized tomography (CT) scans were retrospectively identified, excluding those with previously surgically altered spines. Angular and lateral SP deviations from C3-C7 were collected from these CTs. Statistical analysis was conducted using one-way ANOVA with post-hoc testing using Tukey's test.ResultsThe average angular SP deviations at C3-C7 were 2.94 ± 2.06 degrees, 3.52 ± 2.19 degrees, 3.50 ± 2.13 degrees, 4.31 ± 2.15 degrees, and 3.53 ± 2.86 degrees, respectively. The average lateral SP deviations at C3-C7 relative to vertebral body widths were 5.43%, 6.10%, 6.14%, 8.17%, and 7.52%, respectively. Angular deviation at C6 was greater than C3 (p = 0.009). Relative lateral deviation at C6 was greater than at C3 (p = 0.027). Neither angular nor lateral deviation differed by sex at any level (p > 0.05 for all).ConclusionsGiven significant variation in cervical SP deviation between patients and by level, surgeons should hesitate to solely rely on them for determining vertebral midline during CDR. The C6 and C7 SPs especially should be used cautiously as they show relatively higher magnitudes and variations of deviation. However, the C3-C5 SPs may be of use if viewed in conjunction with other radiographic landmarks, such as the uncinate processes or medial borders of the pedicles.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261486413"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative GLP-1 Receptor Agonist Use is Associated With Reduced Revisions and Complications Following ACDF: A Propensity-Matched Analysis.","authors":"Matthew T Kim, Seungjun Lee, Graham S Goh, K Daniel Riew","doi":"10.1177/21925682261419753","DOIUrl":"10.1177/21925682261419753","url":null,"abstract":"<p><p>Study DesignRetrospective cohort study.ObjectivesGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are prescribed for obesity and type 2 diabetes mellitus (T2DM) and exhibit anti-inflammatory and osteogenic effects which may influence fusion outcomes. This study evaluated the association between preoperative GLP-1RA use and perioperative complications, resource utilization, and revision rates after anterior cervical discectomy and fusion (ACDF) in patients with T2DM.MethodsThe TriNetX Global Network was queried for patients with T2DM undergoing single-level or multi-level ACDF. GLP-1RA users were defined by prescriptions within 6 months before and after surgery. Propensity score matching controlled for demographics, comorbidities, and socioeconomic factors. Outcomes included medical and surgical complications, revision rates, and healthcare utilization at 90 days, 6 months, and 1 year.Results608 single-level and 639 multi-level GLP-1RA users were compared with matched nonusers. GLP-1RA use was associated with lower revision rates after single-level ACDF at 90 days (OR:0.445, <i>P</i> = 0.032) and 6 months (OR:0.489, <i>P</i> = 0.034). Pseudarthrosis risk was reduced across all timepoints for both single-level and multi-level ACDF (OR:0.296-0.608, all <i>P</i> ≤ 0.008). GLP-1RA users also had lower dysphagia risk following single-level ACDF across all timepoints (OR:0.506-0.661, all <i>P</i> ≤ 0.030). Resource utilization was decreased, with fewer readmissions (single-level: OR:0.401-0.634; multi-level: OR:0.418-0.593, all <i>P</i> ≤ 0.003) and ED visits (single-level: OR:0.563-0.697, all <i>P</i> ≤ 0.007) across all timepoints. On multivariate Cox regression, GLP-1RA use independently predicted reduced pseudarthrosis at 1 year (HR:0.665, 95% CI:0.570-0.775, <i>P</i> = 0.005).ConclusionPerioperative GLP-1RA therapy was associated with reduced rates of pseudarthrosis, revision, dysphagia, and healthcare utilization following ACDF without increased adverse events.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"2975-2984"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Hospital Mortality After Lumbar Fusion is Rare But Occurs Early: A Nationwide Analysis of Risk Factors, 2016-2022.","authors":"Mitchell K Ng, Leonidas E Mastrokostas, Paul G Mastrokostas, Anton J Cristofoli, Matthew W Xie, Gregorio Baek, Sean Inzerillo, Luke B Schwartz, Rajendra Singh, Mohamed Said, Matthew Meade, Afshin E Razi, Andrew P Alvarez, Jeffrey A Rihn, Mark F Kurd, Ian David Kaye, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler, Thomas D Cha","doi":"10.1177/21925682261423475","DOIUrl":"10.1177/21925682261423475","url":null,"abstract":"<p><p>Study DesignRetrospective cohort study.ObjectivesTo update national estimates of in-hospital mortality after lumbar fusion, characterize when deaths occur during hospitalization, and identify independent predictors of mortality.MethodsAdult (≥18 years) lumbar fusion hospitalizations in the National Inpatient Sample (NIS) from 2016 to 2022 were analyzed. The primary outcome was in-hospital mortality. Secondary outcomes included hospital-day timing of death and survivor-decedent comparisons of comorbidity and perioperative complication profiles. Multivariable logistic regression identified independent predictors (<i>P</i> < 0.05).ResultsAmong 1,181,465 weighted admissions, mortality was 0.11% (1290 deaths) and occurred early (approximately 50% within 7 days; >90% by ∼ 30 days). Decedents more often underwent multilevel fusion (67.8% vs 38.8%, <i>P</i> < 0.001), were aged ≥75 years (41.5% vs 16.5%, <i>P</i> < 0.001), and had higher comorbidity burden (mean Elixhauser count 3.92 vs 2.15, <i>P</i> < 0.001). Independent predictors included age ≥75 years (OR 4.49, <i>P</i> = 0.003), multilevel fusion (OR 2.09, <i>P</i> < 0.001), congestive heart failure (OR 4.46, <i>P</i> < 0.001), coagulopathy (OR 3.44, <i>P</i> < 0.001), neurologic disorders (OR 9.27, <i>P</i> < 0.001), peripheral vascular disease (OR 1.61, <i>P</i> = 0.031), and higher comorbidity count (per-point OR 1.16, <i>P</i> = 0.010). Female sex (OR 0.72, <i>P</i> = 0.022) and highest income quartile (OR 0.58, <i>P</i> = 0.009) were protective.ConclusionsIn-hospital mortality after lumbar fusion is uncommon but concentrates early and disproportionately affects older, medically complex patients undergoing multilevel procedures, supporting preoperative counseling, front-loaded perioperative risk stratification, and heightened early postoperative vigilance.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3129-3138"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}