Global Spine Journal最新文献

{"title":"National Utilization of Navigation and Robotics in Inpatient Spinal Fusion Remains Low but is Increasing, 2016-2022.","authors":"Mitchell K Ng, Leonidas E Mastrokostas, Paul G Mastrokostas, Gregorio Baek, Matthew Meade, Mohamed Said, Pemla Jagtiani, Jad Bou Monsef, Afshin E Razi, Barrett Woods, Mark F Kurd, Ian David Kaye, Zachary Wilt, Thomas D Cha, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler, Andrew P Alvarez","doi":"10.1177/21925682261490446","DOIUrl":"10.1177/21925682261490446","url":null,"abstract":"<p><p>Study DesignRetrospective cohort study.ObjectivesAdoption patterns in spinal fusion remain poorly defined at the national level. This study aimed to evaluate national adoption trends of navigation and robotics in spine fusion from 2016 to 2022.MethodsThe National Inpatient Sample was queried for adult spinal fusion hospitalizations between 2016 and 2022. Procedures were categorized as navigation-assisted, robotic-assisted, or conventional. Outcomes included frequency of utilization, complications, and discharge disposition. National estimates were generated using survey weights, and outcomes were compared across groups.ResultsOf 2,057,450 inpatient spinal fusions from 2016 to 2022, 152,155 (7.4%) incorporated technology-120,525 (5.9%) navigation and 31,630 (1.5%) robotics. Technology utilization increased from 2.7% in 2016 to 13.3% in 2022 (navigation 2.30% to 10.39%; robotics 0.36% to 2.90%). Mean unadjusted complication rates were 20.9% for conventional cases, 25.6% for navigation-assisted cases, and 22.4% for robotic-assisted cases, with non-routine discharge also varying across cohorts and spinal regions. However, these findings should be interpreted cautiously, as selection bias and unmeasured differences in case complexity likely influenced technology use and associated outcomes. Further study with more granular clinical data is needed to better define the relationship between these technologies and perioperative outcomes.ConclusionsThis national study characterized trends in navigation/robotic-assisted spinal fusion. Although adoption remained modest, robotics expanded at a steeper trajectory than navigation. Despite observed differences in unadjusted complication profiles across cohorts, these findings should be interpreted cautiously given likely selection bias and unmeasured case complexity, and prospective studies are needed to determine long-term outcomes.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261490446"},"PeriodicalIF":3.1,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955312","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":"Lumbar Decompression is Associated With Changes in Functional Transition Biomechanics and Neuromuscular Control During Sit-to-Stand in Degenerative Lumbar Stenosis.","authors":"Ye Shu, Prasanth Romiyo, Andrew Gansas, Paul Rubery, Mark Lawlor, Ashley Rogerson, Andrew Megas, Varun Puvanesarajah, Ram Haddas","doi":"10.1177/21925682261489579","DOIUrl":"10.1177/21925682261489579","url":null,"abstract":"<p><p>Study DesignProspective cohort study.ObjectivesTo compare sit-to-stand (STS) movement patterns and characterize neuromuscular activation and compensatory strategies in patients with degenerative lumbar stenosis (DLS) before and after lumbar decompression, relative to healthy controls.MethodsThirty-five DLS patients undergoing central decompression and sixteen healthy controls were included in the study. Patients were evaluated one week preoperatively and three months postoperatively; controls were tested once. STS kinematics and muscle activation were quantified using three-dimensional motion capture and surface EMG across three trials without upper-extremity assistance. Outcomes were analyzed using linear mixed-effects regression models adjusted for age and body mass index, with subject-level random intercepts.ResultsAt peak trunk forward lean, postoperative patients shifted toward a lower-extremity-driven strategy, with greater knee flexion, reduced pelvic anterior tilt, and reduced thoracic flexion (25.9° vs 30.4°, <i>p</i> < 0.001). Neuromuscular coordination improved postoperatively. Normalized EMG findings reflect relative activation patterns and should not be interpreted as absolute muscle effort. Tibialis anterior activation occurred earlier (4.6% vs 10.1%, <i>p</i> = 0.002) with lower mean activity, suggesting improved anticipatory ankle control. Gluteus maximus showed earlier onset (2.9% vs 9.0%, <i>p</i> = 0.018), longer activation duration (<i>p</i> = 0.001), and lower mean amplitude (0.9 vs 1.8, <i>p</i> = 0.002), reflecting more efficient hip extension. Erector spinae activation was delayed (9.3% vs 4.3%, <i>p</i> = 0.031) with reduced duration (<i>p</i> = 0.003), indicating decreased reliance on protective trunk co-contraction. Patient-reported outcomes improved significantly, including disability (ODI: 24.8 vs 44.4), fear of movement (TSK: 36.2 vs 43.4), physical function (PROMIS PF: 42.3 vs 35.1), and pain interference (PROMIS PI: 57.3 vs 66.2) (all <i>p</i> < 0.001).ConclusionLumbar decompression was associated with measurable changes in functional transition biomechanics and neuromuscular coordination during sit-to-stand. Postoperatively, patients demonstrated reduced reliance on trunk-dominant compensatory strategies and protective extensor co-contraction, with greater lower-extremity contribution and improved anticipatory neuromuscular control. Importantly, these objective recovery signatures were detected despite minimal differences in task completion time, suggesting that conventional time-based assessments may underestimate meaningful postoperative functional recovery. Objective biomechanical assessment of activities of daily living may provide a sensitive measure of recovery following lumbar decompression and may help guide postoperative rehabilitation and functional optimization in patients with degenerative lumbar stenosis.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261489579"},"PeriodicalIF":3.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148943999","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":"Fusion Assessment, Reoperation Rates, and Imaging Modality Agreement after Four-Level Anterior Cervical Discectomy and Fusion: A Retrospective Single-Center Study.","authors":"Bruno Verna, Pedro Rocha Torres, Tom Folkerts, Julia Wimmer, Anna-Maria Mielke, Steven M Maurer, Jiaqi Zhu, Jennifer Shue, Marco D Burkhard, Andrew A Sama, Frank P Cammisa, Alexander P Hughes, Federico P Girardi","doi":"10.1177/21925682261488752","DOIUrl":"10.1177/21925682261488752","url":null,"abstract":"<p><p>Study DesignRetrospective single-center cohort study.ObjectiveTo evaluate fusion and reoperation rates after four-level anterior cervical discectomy and fusion (ACDF) using a hierarchical imaging strategy, and to assess agreement between imaging modalities.MethodsPatients undergoing primary four-level ACDF with postoperative imaging for fusion assessment and ≥2-year follow-up were included. Fusion status by ≥12 months was determined using a hierarchical imaging strategy, with computed tomography (CT) prioritized, followed by dynamic flexion-extension (F-E) radiographs and plain radiographs. Early fusion (6-12 months) was analyzed separately. Reoperation within 24 months was recorded. Agreement between imaging modalities was assessed using Fleiss' kappa for tri-modality comparison and Cohen's kappa for pairwise analyses.ResultA total of 152 patients had imaging available for fusion assessment; 140 had ≥12-month follow-up. Fusion by 12 months was observed in 81.4% (114/140). Early fusion occurred in 70.1% (101/144). Nonunion most commonly involved a single level, predominantly at C6-7. Within 24 months, reoperation occurred in 7.7% of patients with nonunion and 2.6% of fused patients. In a tri-modality subset, overall agreement was high (κ=0.823), with near-perfect agreement between CT and F-E radiographs (κ=0.938).ConclusionFour-level ACDF demonstrated high fusion rates and low reoperation rates in one of the largest single-center cohorts reported to date. CT and F-E radiographs showed strong agreement, while plain radiographs tended to overestimate fusion. These findings suggest that acceptable outcomes may be achieved in appropriately selected patients and that construct length alone should not preclude consideration of an anterior-only approach.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261488752"},"PeriodicalIF":3.1,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911814","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":"Comment on: \"The Longitudinal Changes of Cervical Sagittal Alignment in a Non-Surgical Cohort: A 12-Year Longitudinal Study\".","authors":"Sharath Raj, Vijay Goni","doi":"10.1177/21925682261489587","DOIUrl":"10.1177/21925682261489587","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261489587"},"PeriodicalIF":3.1,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906089","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 and Regional Patterns of Drug Resistance and Treatment Regimens in Spinal Tuberculosis: A Systematic Review and Meta-Analysis.","authors":"Shanmuganathan Rajasekaran, Gnanaprakash Gurusamy, Ajoy Prasad Shetty, Rishi Mugesh Kanna, Abhishek Uday Bicholkar, Nadipalli Sathwik, Nalabothu Bindu Vasanthi, S P Gogul, Aravind P Gandhi, Gokul Vv, Mogan Kaviprawin","doi":"10.1177/21925682261488395","DOIUrl":"10.1177/21925682261488395","url":null,"abstract":"<p><p>Study DesignSystematic review and meta-analysis.ObjectiveTo evaluate the prevalence, patterns, diagnosis, and management of drug-resistant spinal tuberculosis (TB).MethodsWe systematically searched PubMed, Embase, Scopus, Web of Science, and the Cochrane database from database inception to 14 February 2026, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Observational and experimental studies reporting drug resistance among patients with spinal TB were included. A random-effects meta-analysis was performed to estimate pooled proportions with 95% confidence intervals (CI). Risk of bias was assessed using the Joanna Briggs Institute checklist.ResultsNineteen studies involving 5,475 patients with spinal TB were included. The pooled prevalence of multidrug-resistant (MDR)-TB among spinal TB was 4.69% (95% CI: 3.03-7.20%; 16 studies). Rifampicin resistance was noted in 13.84% (95% CI: 3.07-44.90%; 6 studies). Drug susceptibility testing was most commonly performed after clinical or radiological non-response rather than as routine practice. Treatment approaches were heterogeneous, with MDR spinal TB typically managed using individualized second-line anti-TB regimens, frequently combined with surgical intervention. Low risk of bias was documented in 47.4% of studies.ConclusionsThe prevalence of MDR-TB among spinal tuberculosis was 4.69%. Considerable heterogeneity exists in drug susceptibility testing, diagnosis, medical treatment, and surgical management. The available evidence remains limited, underscoring the need for prospective studies evaluating the effectiveness of anti-TB regimens in MDR spinal tuberculosis.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261488395"},"PeriodicalIF":3.1,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911900","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":"Interval-Based International Multicenter Validation of the Distal Radius and Ulna Classification for Growth Velocity and Curve Progression in Adolescent Idiopathic Scoliosis.","authors":"Hideyuki Arima, Yu Yamato, Chris Yin Wei Chan, Chee Kidd Chiu, Mun Keong Kwan, Shinji Takahashi, Yusuke Hori, Hideki Sudo, Katsuhisa Yamada, Shu-Hua Yang, Ming-Hsiao Hu, Chih-Wei Chen, Jason Pui Yin Cheung, Prudence Wing Hang Cheung, Sophia Sze, Yat Wa Wong, Keith Dip Kei Luk, Daisuke Sakai, Daisuke Kudo, Wataru Saito, Gabriel Liu, Leok Lim Lau, Ajoy Shetty, Hideki Shigematsu","doi":"10.1177/21925682261486377","DOIUrl":"10.1177/21925682261486377","url":null,"abstract":"<p><p>Study DesignProspective international multicenter observational cohort study.ObjectiveTo evaluate the relationships among distal radius and ulna (DRU) classification, growth velocity, and scoliosis progression patterns in adolescent idiopathic scoliosis (AIS) using longitudinal interval-based analyses in a multinational Asian cohort.MethodsPatients aged 10-18 years with AIS were prospectively enrolled from multiple Asian centers. DRU classification, Sanders classification, Risser stage, standing height, and Cobb angle were assessed at approximately 4-6-month intervals. Only observations obtained before brace treatment or surgery were included. Height velocity and Cobb progression velocity were calculated between consecutive visits. Stage-specific patterns were evaluated using boxplots, nonparametric analyses, and mixed-effects models adjusted for age, sex, and baseline Cobb angle.ResultsAmong 329 enrolled patients, 236 patients contributing 618 longitudinal intervals met eligibility criteria. Mean age was 13.5 years, and mean baseline Cobb angle was 24.0°. Height velocity peaked at Radius stage 6 (0.62 cm/month) and Ulnar stage 5 (0.68 cm/month). Cobb progression velocity was greatest at Radius stage 6 (0.31°/month); among adequately represented Ulnar stages, progression velocity was greatest at stage 5 (0.27°/month). Spearman analyses showed only very weak correlations between skeletal maturity stage and Cobb progression velocity. Mixed-effects analyses suggested nonlinear progression patterns, with increased progression velocity at earlier to intermediate maturity stages.ConclusionsDRU classification demonstrated stage-dependent progression patterns, with peak scoliosis progression generally occurring approximately one DRU stage after peak height velocity. These findings suggest that DRU classification may help identify skeletal maturity phases associated with accelerated scoliosis progression in AIS.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261486377"},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906054","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 the Editor: Clinical Outcomes and Mechanical Complications After Adult Spinal Deformity Surgery in Patients Aged 80 Years or Older: A Propensity Score-Matched Comparative Study.","authors":"Lingyu Wang","doi":"10.1177/21925682261489234","DOIUrl":"10.1177/21925682261489234","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261489234"},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906077","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":"Toward a More Clinically Actionable Strategy for Surgical Site Infection After Posterior Cervical Fusion.","authors":"Jiajun Deng, Yongchun Xiao, Hongsheng Lin","doi":"10.1177/21925682261488859","DOIUrl":"10.1177/21925682261488859","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261488859"},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906093","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":"Longitudinal Evidence on Natural History, Nonoperative Management, and Multimodal Surveillance in Mild to Moderate Degenerative Cervical Myelopathy: A Scoping Review.","authors":"Bo Xu, Dong-Sheng Yuan, Ya-Ling Gao, Guo-Liang Ma, Zhi-Zhuang Wang, Yan-Zhen Zhang, Xin Chen, Bo-Wen Yang, Xiao-Kuan Qin, Peng-Hui Li, Ke-Xin Yang, Jie Yu, Li-Guo Zhu, Min-Shan Feng, He Yin","doi":"10.1177/21925682261474151","DOIUrl":"10.1177/21925682261474151","url":null,"abstract":"<p><p>Study DesignScoping review.ObjectivesTo map longitudinal evidence on natural history, nonoperative management, progression definitions, clinical decision variables, and multimodal surveillance in mild to moderate degenerative cervical myelopathy (DCM), while distinguishing the treatment implications of mild and moderate disease.MethodsPubMed/MEDLINE, Embase, Web of Science Core Collection, Scopus, and the Cochrane Library were searched from inception to March 22, 2026. The review followed PRISMA-ScR. Eligible studies were adult longitudinal reports of mild or moderate DCM/cervical spondylotic myelopathy, extractable mild/moderate subgroups, or clinically relevant progression-surveillance evidence. Data were charted for design, population, management, follow-up, endpoints, progression definitions, examination findings, imaging variables, CT-relevant pathology, and alignment or motion factors.ResultsOf 6,193 records, 4,137 remained after deduplication and 766 underwent full-text consideration. Thirty-two reports underwent final eligibility assessment; 28 were retained, including 13 main analytic studies, 7 supplementary or conditional studies, and 8 adjunct multimodal narrative studies. Evidence was heterogeneous in severity thresholds, progression definitions, endpoints, and follow-up schedules. Nonoperative and natural-history cohorts showed that mild to moderate disease is not uniformly stable; some patients remained stable, whereas others deteriorated or crossed over to surgery. Objective function, quantitative MRI, electrophysiology, and selected structural measures may detect change more sensitively than symptom scales or conventional MRI alone.ConclusionsMild to moderate DCM represents a surveillance population, but mild and moderate disease should not be treated as having identical indications. Nonoperative cohorts help define progression and escalation risk, and multimodal follow-up appears more informative than single-scale monitoring.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261474151"},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906063","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":"Interlaminar Contralateral Endoscopic Foraminotomy Reduces Postoperative Dysesthesia in Patients With Degenerative Lumbar Deformity: A Multicenter Comparative Cohort Study.","authors":"Facundo Van Isseldyk, Rodrigo Borges, Julio Bassani, Lisandro Rodriguez Sattler, Alejandro Betemps, Jefferson Leal, Cristian Correa Valencia, Alberto Gotfryd, Jeronimo Milano, Alfredo Guiroy, Diego Ponte, Marco Moscatelli, Cristiano Menezes, Nelson Astur","doi":"10.1177/21925682261488412","DOIUrl":"10.1177/21925682261488412","url":null,"abstract":"<p><p>Study DesignRetrospective-prospective multicenter comparative cohort study.ObjectivesPostoperative dysesthesia (POD) is a recognized complication of transforaminal endoscopic lumbar surgery, with reported rates up to 21.5%. Degenerative lumbar deformity may amplify this risk through vertebral rotation displacing the dorsal root ganglion into the transforaminal trajectory. This study compares POD rates and functional outcomes between transforaminal endoscopic lumbar foraminotomy (TELF) and interlaminar contralateral endoscopic lumbar foraminotomy (ICELF) in degenerative lumbar deformity, and explores vertebral rotation as a mechanistic basis for approach selection.MethodsOne hundred patients with degenerative lumbar deformity (Cobb ≥10°) and foraminal stenosis underwent single-level endoscopic foraminotomy across 6 centers in Latin America: a retrospective cohort of 46 patients treated with TELF (2021-2023) and a prospective cohort of 54 patients treated with ICELF (2023-2025). Vertebral rotation was measured by CT using the Aaro-Dahlbornmethod. Primary outcome was POD occurrence; secondary outcomes included VAS, ODI, and modified MacNab criteria at 12 months.ResultsPOD occurred in 8/46 TELF patients (17.4%) versus 1/54 ICELF patients (1.9%; p=0.011, OR=11.16), corresponding to an 89% relative risk reduction (NNT=6.4). Functional outcomes were equivalent at 12 months (MacNab excellent+good: 67.4% vs 70.4%, p=0.376). Within the TELF group, vertebral rotation was significantly higher in POD patients (19.2°±4.7° vs 12.2°±4.3°, p=0.001). ROC analysis identified a 15° threshold (AUC=0.870, sensitivity 88%, specificity 74%).ConclusionsICELF is associated with substantially lower POD rates compared to TELF in degenerative lumbar deformity, with equivalent functional outcomes. Vertebral rotation appears to be a specific, measurable risk modifier for POD in the transforaminal approach, suggesting its role in approach selection.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261488412"},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906061","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}