Global Spine Journal最新文献

{"title":"Preoperative Thoracic Compensation is Associated With a Lower Risk of Proximal Junctional Kyphosis After Lower Thoracic Fusion for Adult Spinal Deformity.","authors":"Tae Soo Shin, Jin-Sung Park, Dong-Ho Kang, Jun-Seok Oh, Joon Young Jung, Jae-Won Hur, Se-Jun Park","doi":"10.1177/21925682261496815","DOIUrl":"https://doi.org/10.1177/21925682261496815","url":null,"abstract":"<p><p>Study DesignRetrospective cohort study.ObjectivesTo determine whether thoracic compensation (TC) assessed against the deformity burden is associated with proximal junctional kyphosis (PJK) after lower thoracic fusion for adult spinal deformity (ASD).MethodsWe reviewed 343 patients fused from T9-L1 to the sacrum or pelvis with a pelvic incidence (PI) minus lumbar lordosis (LL) mismatch above 20°. Expected thoracic kyphosis (TK) was derived from the PI-LL mismatch using published equations, and a measured TK below it defined TC. PJK was defined as a proximal junctional angle of 20° or more, or revision, within two years. Multivariable logistic regression adjusted for patient, operative, and radiographic covariates including two measures of correction adequacy.ResultsPJK occurred in 60 of 124 patients (48.4%) without TC and 68 of 219 (31.1%) with TC (P = 0.002). Correction was equivalent for PI-LL, the L1 pelvic angle (L1PA), and pelvic tilt, yet the TC present group restored more TK (19.1° vs. 11.0°) while reaching a lower postoperative value (21.5° vs. 33.7°, both P < 0.001). TC remained associated with a lower risk of PJK after adjustment (odds ratio 0.431, 95% CI 0.261-0.713, P = 0.001), consistently across eight prespecified subgroups. Relative to TC without overcorrection, the odds ratio reached 3.41 (95% CI 1.37-8.46) when TC was absent and the L1PA offset indicated overcorrection.ConclusionsTC assessed against the deformity burden was associated with a lower risk of PJK despite a larger reciprocal increase in TK. Risk was highest when TC was absent and lordosis overcorrected.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261496815"},"PeriodicalIF":3.1,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166601","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":"Evaluation, Management, and Return-To-Sport Guidelines for Cervical Spine Injuries in Athletes: A Narrative Review.","authors":"Firas Batrash, Nicolas L Carayannopoulos, Puru Sadh, Yasmeen Saeed, Michael J Farias, Joseph E Nassar, Jinseong Kim, Eren O Kuris, Stephen E Marcaccio, Nicholas Lemme, Brett Owens, Bryce A Basques, Alan H Daniels","doi":"10.1177/21925682261495104","DOIUrl":"10.1177/21925682261495104","url":null,"abstract":"<p><p>Study DesignNarrative review.ObjectivesTo synthesize current evidence on the epidemiology, pathophysiology, classification, evaluation, and imaging of cervical spine injuries (CSI) in athletes and propose a practical framework for return-to-sport (RTS) decision-making.MethodsA review of the most recent and relevant published studies and consensus statements was performed, focusing on athletic cervical spine pathology. Key domains included on-field assessment, imaging modalities, clinical clearance criteria, and sport-specific risk considerations. All literature published in reputable journals, preferably available through well-regarded databases such as Scopus and PubMed, was eligible for inclusion, with preference given to the most recent publications related to any given topic.ResultsThe reviewed literature supports that RTS across CSI types requires resolution of symptoms, normal neurologic examination, restoration of painless cervical range of motion and strength, and radiographic evidence of healing or stability. MRI is consistently recommended for identifying high-risk features such as canal stenosis, cord signal change, or ligamentous disruption. Sport-specific risk stratification is supported by data showing higher reinjury rates in collision sports. Evidence remains heterogeneous, with substantial variation in specialist recommendations.ConclusionsSafe RTS after CSI requires comprehensive clinical and imaging assessment, recognition of sport-specific risks, and shared decision-making to prioritize athlete safety while avoiding unnecessary restrictions.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261495104"},"PeriodicalIF":3.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136274","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":"Timing Matters: Preoperative Lumbar Epidural Steroid Injection and Long-Term Outcomes Following Single-Level Posterior Lumbar Fusion.","authors":"Mark Miller, John Pignataro, Matthew Meade, Omar Sbaih, Ruchir Nanavati, Nithin Gupta, William DiCiurcio, Gregory Schroeder, Alexander R Vaccaro, Christopher Kepler, Barrett Woods","doi":"10.1177/21925682261493045","DOIUrl":"10.1177/21925682261493045","url":null,"abstract":"<p><p>Study DesignRetrospective Cohort Analysis.ObjectiveCESIs are a mainstay of nonoperative treatment for degenerative lumbar spine disease. As increasing numbers of patients undergo sPLF after receiving CESIs, understanding their impact on surgical outcomes is essential. The objective of the present investigation was to evaluate the association between preoperative corticosteroid epidural spinal injections (CESI) and postoperative outcomes following single-level posterior lumbar fusion (sPLF).MethodsA retrospective cohort study was performed using the TriNetX database. Patients undergoing sPLF were stratified by preoperative CESI exposure within 3 months of surgery. After 1:1 propensity score matching, 3,804 patients remained in each cohort. Outcomes included surgical site infection (SSI), pseudoarthrosis, and reoperation. Risk ratios (RR), 95% confidence intervals (CI), and Kaplan-Meier analyses were performed.ResultsPreoperative CESI was not associated with an increased risk of 90-day SSI (1.06% vs. 1.01%; RR 1.05, 95% CI 0.68-1.64; p=0.82). However, pseudoarthrosis occurred more frequently in the CESI cohort at 1 year (9.58% vs. 6.54%; RR 1.47; p<0.001), 3 years (11.20% vs. 7.55%; RR 1.48; p<0.001), and 5 years (11.81% vs. 8.10%; RR 1.46; p<0.001). Reoperation rates were not significantly different at 5 years (7.81% vs. 7.25%; RR 1.08; p=0.36). Kaplan-Meier analysis demonstrated earlier and sustained pseudoarthrosis following preoperative CESI. The number needed to harm was 33.ConclusionsPreoperative CESI within 3 months of sPLF was associated with increased long-term pseudoarthrosis, without increasing postoperative SSI and reoperation rates.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261493045"},"PeriodicalIF":3.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148221","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":"Investigating the Relationship Between Estrogen Replacement Therapy and Postoperative Complications Following Single-Level Lumbar Fusion: A Propensity Matched Analysis.","authors":"Kyle B Stump, Alec M Giakas, Gregorio Baek, Mitchell K Ng, Andrew P Alvarez, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.1177/21925682261494600","DOIUrl":"10.1177/21925682261494600","url":null,"abstract":"<p><p>Study DesignRetrospective Cohort.ObjectivesThe objective of this study was to investigate the relationship between preoperative estrogen replacement therapy and postoperative complications following single level lumbar fusion.MethodsThe TriNetX Research Network was queried for menopausal patients aged ≥ 50 years who underwent single level lumbar fusion. Patients issued ERT within the 12-month preoperative period were separated from patients with no documented ERT use. Propensity score matching was performed 1:1 based upon demographic characteristics and medical comorbidities. Rates of medical complications were assessed within 90 days postoperatively. Secondary outcomes include pseudarthrosis and revision surgery, which were evaluated within one and two years postoperatively. P < 0.05 indicates statistical significance.ResultsA total of 1,570 matched pairs were included. The incidence of PE was more than doubled in the ERT-positive cohort (RR 2.167, 95% CI 1.097 - 4.279, <i>P</i>=0.022). Rates of pseudarthrosis were elevated in the ERT-positive cohort within one (12.9% versus 9.9%, RR 1.303, 95% CI 1.070 - 1.587, <i>P</i>=0.008) and two years postoperatively (14.8% versus 11.6%, RR 1.275, 95% CI 1.064 - 1.528, <i>P</i>=0.008); reoperation rates were similar at both intervals. ERT use was also associated with increased rates of ED utilization within 90 days postoperatively (15.4% versus 11.1%, RR 1.377, 95% CI 1.148 - 1.651, <i>P</i>=0.001).ConclusionsPatients on preoperative ERT may represent a higher-risk cohort amongst single-level lumbar fusion candidates. Further studies are warranted to explore causality and the potential mechanistic underpinnings between ERT and unsuccessful bone healing and thromboembolic complications.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261494600"},"PeriodicalIF":3.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127066","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":"Regarding: \"The Longitudinal Changes of Cervical Sagittal Alignment in a Non-Surgical Cohort: A 12-Year Longitudinal Study\".","authors":"Xiaoxiong Yang, Wu Haosen, Hanbo Geng, Feifei Zhou","doi":"10.1177/21925682261493869","DOIUrl":"10.1177/21925682261493869","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261493869"},"PeriodicalIF":3.1,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108517","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":"Thoracic Ossification of the Posterior Longitudinal Ligament: Thickness Changes After Posterior Decompression and Corrective Fusion in a Longitudinal Study With up to 10-Year Follow-up.","authors":"Maiweilan Maihemuti, Go Yoshida, Tomohiko Hasegawa, Tomohiro Banno, Tomohiro Yamada, Hideyuki Arima, Hirotaka Ogi, Hiroki Ushirozako, Alex Quok An Teo, Shin Oe, Shuyun Jiang, Koichiro Ide, Yukihiro Matsuyama, Yu Yamato","doi":"10.1177/21925682261495062","DOIUrl":"https://doi.org/10.1177/21925682261495062","url":null,"abstract":"<p><p>Study DesignRetrospective cohort study.ObjectivesThoracic ossification of the posterior longitudinal ligament (OPLL) is traditionally considered progressive, raising concern that the ossified mass left after posterior decompression and instrumented fusion (PDF) may enlarge. We characterized long-term CT-based changes in focal OPLL thickness after PDF and assessed whether the residual mass continued to enlarge.MethodsWe reviewed all consecutive adult patients who underwent PDF for thoracic OPLL (2009-2023) with ≥2 years of follow-up. Maximum OPLL thickness was measured on axial CT and tracked longitudinally; a predefined 2-mm threshold, prespecified as the minimal clinically important difference, classified change. Thoracic kyphosis (TK) and modified Japanese Orthopaedic Association (mJOA) scores were also assessed.ResultsTwenty-six patients (mean age 49.5 ± 12.4 years; 15 men) were followed 5.4 ± 2.7 years (range 2-11). Mean axial OPLL thickness changed from 7.02 ± 1.58 to 6.90 ± 2.01 mm (Δ -0.12 ± 1.03 mm). By the 2-mm threshold, 92.3% were stable, 3.8% decreased, and 3.8% increased; directional decreases occurred in 69.2% and increased with longer follow-up (37.5%, 77.8%, 88.9%; p = 0.023). TK increased (+6.2°, p < 0.001) but was uncorrelated with thickness change (r = 0.250). mJOA improved from 7.3 to 8.7 (p = 0.0001; recovery rate 34.9%; excellent/good 53.8%). The mean change was equivalent to zero within ±2 mm (two one-sided tests p < 0.001).ConclusionsFocal thoracic OPLL thickness remained predominantly stable after PDF, with threshold-level progression infrequent and neurological improvement maintained. Focal radiographic stability, rather than continued enlargement of the residual mass, was the predominant postoperative course after PDF.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261495062"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108556","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":"Postoperative Airway Compromise After Anterior Cervical Spine Surgery: Hematoma, Edema, or Both?","authors":"Akio Kawamoto, Takumi Kajitani, Yuma Hiratsuka","doi":"10.1177/21925682261496267","DOIUrl":"https://doi.org/10.1177/21925682261496267","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261496267"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108544","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":"National Inpatient Burden, Treatment Patterns, and In-Hospital Mortality of Spinal Tuberculosis in Germany Amid Demographic Change: A Population-Based DRG Study, 2019-2025.","authors":"Siegmund Lang, Josina Straub, Jonas Krückel, Marcin T Czyz, Julian Scherer","doi":"10.1177/21925682261491253","DOIUrl":"https://doi.org/10.1177/21925682261491253","url":null,"abstract":"<p><p>Study DesignPopulation-based ecological study.ObjectivesTo quantify the national inpatient burden, treatment patterns, and in-hospital mortality of spinal tuberculosis (STB) in Germany, and to test whether demographic change is associated with STB hospitalisation rates.MethodsThe German InEK DRG browser was analysed for inpatient STB episodes (ICD-10-GM A18.0 as principal diagnosis with a secondary diagnosis from category M49.0-; n = 671; case years 2019-2025), integrated with national TB hospitalisation data (2015-2024), population statistics by nationality, and migration data. Joinpoint regression, Poisson and negative binomial (NB) modelling with population offset, age-standardized rates (ESP2013), and Kitagawa decomposition were applied, with sensitivity analyses including lagged migration denominators and COVID-period exclusion.ResultsSTB hospitalisation rates remained stable (ASR 0.11-0.14/100,000; annual percent change -3.1%, P = .14), while total TB declined 29% (joinpoint 2022, P = .022). Patients were predominantly male (70.3%) and aged 18-39 years (56%-69%). In-hospital case fatality was below 0.5%. Surgical DRG assignment varied from 13.5% to 42.2%. The temporal trend was flat (IRR 0.97 per year, 95% CI 0.92-1.02). Despite a 43% increase in the foreign-national population (P < .001), no increase in STB episodes was detectable, whether the population was modelled alongside calendar year (IRR 1.03 per million, 95% CI 0.55-1.92) or without it (IRR 0.93, 95% CI 0.84-1.04). Kitagawa decomposition (2019→2024) attributed the rate component to -10.5 episodes versus +0.5 from population growth. All sensitivity analyses confirmed these null findings.ConclusionsThe national inpatient STB burden is low but stable and decoupled from overall TB hospitalisation trends. No increase in STB hospitalisations was detectable during the observed demographic change, although individual-level associations with migration could not be assessed. Very low in-hospital mortality contrasts with pyogenic spondylodiscitis. Marked variation in surgical DRG assignment warrants standardized care pathways at specialized centers.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261491253"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108522","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":"CYP2D6 Metabolizer Phenotype and New Persistent Opioid Use After Spine Surgery.","authors":"Samer G Salman, Rohan A Phadke, Krishna K Anand, Joseph W Guarnieri, Ethan Waisberg, James Rizkalla, Nathan J Lee","doi":"10.1177/21925682261495118","DOIUrl":"10.1177/21925682261495118","url":null,"abstract":"<p><p>Study DesignRetrospective Cohort Study.ObjectivesTo determine whether cytochrome P450 2D6 (CYP2D6) metabolizer phenotype is associated with new persistent opioid use after cervical, thoracic, or lumbar spine surgery among opioid-naive adults.MethodsAdults with whole-genome sequencing data who underwent cervical, thoracic, or lumbar fusion or decompression between May 2018 and January 1, 2025, were identified in the All of Us Research Program. Participants had 365 days of baseline observation, 180 days of postoperative follow-up, and no opioid fills from 365 to 30 days before surgery. CYP2D6 phenotype was categorized as poor, intermediate, normal, or ultrarapid metabolizer. New persistent opioid use required a perioperative opioid fill and another fill 90 to 180 days postoperatively. Associations were estimated using Firth-penalized logistic regression adjusted for ancestry principal components and clinical covariates.ResultsAmong 3,820 participants, 460 (12.0%) developed new persistent opioid use. The overall association across CYP2D6 phenotypes was significant (χ² = 15.30; <i>P</i> = .002). Compared with normal metabolizers, adjusted odds ratios were 1.48 (95% CI, 1.00-2.18) for poor, 1.05 (95% CI, 0.85-1.30) for intermediate, and 1.50 (95% CI, 0.89-2.54) for ultrarapid metabolizers. Poor metabolizers receiving hydrocodone had higher odds of persistent use (OR, 2.15; 95% CI, 1.07-4.32).ConclusionsCYP2D6 phenotype was associated with new persistent opioid use after spine surgery, with higher risk estimates at the metabolic extremes. Extreme-phenotype estimates were reportable only in European-ancestry participants, so risk in other ancestry groups remains unknown. Medication-specific replication in larger, ancestry-diverse cohorts is needed before clinical implementation.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261495118"},"PeriodicalIF":3.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080708","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":"Response to Letter to the Editor for \"Impact of Concomitant Grade I Degenerative Spondylolisthesis on Clinical and Radiographic Outcomes Following Biportal Endoscopic Versus Microscopic Laminectomy for Lumbar Spinal Stenosis: A Post Hoc Analysis of a Multicenter Randomized Clinical Trial\".","authors":"Hyun-Jin Park, Min-Seok Kang, Kwang-Sup Song, Dae-Woong Ham, Ho-Joong Kim, Ki-Han You, Seung-Yeon Jeong, Jin-Sung Kim, Sang-Min Park","doi":"10.1177/21925682261495508","DOIUrl":"10.1177/21925682261495508","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261495508"},"PeriodicalIF":3.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074273","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}