Journal of Korean Neurosurgical Society最新文献

{"title":"Intraoperative Corticocortical Evoked Potential Monitoring for Language Preservation during Glioblastoma Surgery under General Anesthesia.","authors":"Nam Sik Oh, Yu Kyeng Byeon, Gung Ju Kim, Se Keun Oh, Yong Seo Koo, Sang Joon Chong, Young Hoon Kim, Young Hyun Cho, Chang Ki Hong, Seok Ho Hong, Jeong Hoon Kim, Sang Woo Song","doi":"10.3340/jkns.2026.0126","DOIUrl":"https://doi.org/10.3340/jkns.2026.0126","url":null,"abstract":"<p><strong>Objective: </strong>Intraoperative language mapping under general anesthesia plays an important role in brain tumor surgery, particularly when awake surgery cannot be performed. Corticocortical evoked potential (CCEP) monitoring is considered a valuable method for localizing functional language regions and evaluating neuronal connectivity. The present study aimed to assess the clinical usefulness of intraoperative CCEP monitoring in preserving language function during glioma surgery.</p><p><strong>Methods: </strong>A total of 18 consecutive patients with glioblastoma located in the left language-dominant hemisphere underwent CCEP-guided tumor resection under general anesthesia between January 2022 and December 2024. Subdural electrodes were positioned over the presumed anterior and posterior perisylvian language cortices, and bidirectional single-pulse CCEP stimulation was used to evaluate connectivity between these regions and to localize the arcuate fasciculus. The primary monitoring pathway was selected according to the most robust and stable CCEP response, and tumor resection was performed while preserving the mapped language network. Language function was assessed clinically before surgery, immediately after surgery, and again at 3-6 months after surgery using a 4-level ordinal scale.</p><p><strong>Results: </strong>Language-related CCEP monitoring was feasible in 15 of 18 patients. Among these, intraoperative CCEP signals remained stable in 9 patients, transiently decreased with recovery in 2 patients, and persistently decreased by the end of surgery in 4 patients. Unfavorable language outcomes were observed in 1 of 11 patients (9.1%) in the preserved/recovered group and in 1 of 4 patients (25.0%) in the persistent-decrease group. A single patient showed an unfavorable language outcome despite stable intraoperative CCEP findings.</p><p><strong>Conclusion: </strong>Intraoperative CCEP monitoring under general anesthesia may provide clinically useful information for language preservation during glioblastoma surgery when awake mapping is not feasible. Although further investigation is required to define a solid threshold for intraoperative CCEP deterioration, qualitative CCEP changes may be clinically informative and helpful in guiding surgical strategy.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Knee Osteoarthritis on Compensatory Mechanisms Post-Spinal Deformity Correction.","authors":"Yoon Ha Hwang, Dongkyu Kim, Hyun-Jun Jang, Bong Ju Moon, Jeong-Yoon Park, Kyung-Hyun Kim","doi":"10.3340/jkns.2025.0225","DOIUrl":"10.3340/jkns.2025.0225","url":null,"abstract":"<p><strong>Objective: </strong>We investigated the relationship among regional alignments, the chronological sequence of compensatory mechanism changes, restoration of sagittal malalignment, and the effect of knee osteoarthritis (KOA) on resolution of compensatory mechanisms and clinical outcomes in deformity correction surgery.</p><p><strong>Methods: </strong>We reviewed medical records and images of 75 patients with adult spinal deformity undergoing thoracolumbar fusion, with a minimum of 2 years of postoperative follow-up. Data collection focused on changes in various spinal and lower extremity alignments, including global angle, pelvic shift, knee angles (KAs), and ankle angles (AAs). We conducted propensity-matched comparisons to elucidate the impact of OA on resolution of compensatory mechanisms between the KOA group and the non-KOA (NKOA) group based on the Kellgren-Lawrence grading (KLG). Additionally, the study assessed patient-reported outcome measures.</p><p><strong>Results: </strong>A significant linear correlation was observed between the change in T1 pelvic angle and the changes in various spinal and lower extremity parameters during follow-ups. Statistically significant correlation coefficients for thoracic kyphosis, sacro-femoral angle, and AA, initially not observed, were observed during the final follow-up. The KOA group exhibited limited restorative changes in compensatory spinal and lower extremities (KA : 1.1±5.5 vs. 7.1±9.3; p=0.015). Clinical outcomes showed improvement in both groups, with the NKOA group demonstrating more significant progress in 36-Item Short Form Health Survey (p<0.05).</p><p><strong>Conclusion: </strong>Restoring sagittal alignment leads to the disappearance of compensatory mechanisms in a temporal pattern, with lower extremity improvements continuing for years. Severe KOA over KLG 3 impedes this restoration and results in poorer clinical outcomes.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"744-756"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Middle Meningeal Artery Embolization for Recurrent Chronic Subdural Hematoma.","authors":"Bae Jae Kim, Gyojun Hwang, Hyun-Gon Kim, Jae Seong Kang, Jong-Hyeok Park, Sung Han Oh, Mi-Kyung Kim, Bong Sub Chung","doi":"10.3340/jkns.2025.0259","DOIUrl":"10.3340/jkns.2025.0259","url":null,"abstract":"<p><strong>Objective: </strong>Repeating surgical treatment remains the main option for recurrent chronic subdural hematoma, but a second recurrence frequently occurs. We employed middle meningeal artery embolization as an alternative treatment for recurrent hematoma. This study aimed to evaluate the effect and safety of middle meningeal artery embolization compared with conventional retreatment.</p><p><strong>Methods: </strong>We retrospectively reviewed 1162 patients who underwent management for chronic subdural hematoma between May 1998 and March 2025 and included 142 patients with recurrent hematoma (middle meningeal artery embolization in 46 and conventional retreatment in 96) in this study. The primary outcome was second recurrence, defined as a composite of imaging (recurrent or residual hematoma >10 mm in thickness) and clinical (development or aggravation of symptoms, or second re-operation) events. Secondary outcomes included complications (any adverse events or death) and neurological recovery (return of the modified Rankin scale score to the level before initial hematoma development). Outcomes during treatment and 6-month follow-up were compared between the two study groups using logistic regression analysis, adjusted for variables showing baseline group differences with a p-value <0.2.</p><p><strong>Results: </strong>The second recurrence rate was significantly lower in patients receiving middle meningeal artery embolization than in those receiving conventional retreatment (1/46 [2.2%] vs. 32/96 [33.3%]; adjusted odds ratio [OR], 0.056; 95% confidence interval [CI], 0.003-0.164; P=0.001). Complication rates did not differ significantly (1/46 [2.2%] vs. 10/96 [10.4%]; adjusted OR, 0.203; 95% CI, 0.019-1.221; P=0.103), but neurological recovery was more frequent in patients receiving middle meningeal artery embolization (32/46 [69.6%] vs. 46/96 [47.9%]; adjusted OR, 3.147; 95% CI, 1.198-8.268; P=0.020).</p><p><strong>Conclusion: </strong>Middle meningeal artery embolization for recurrent chronic subdural hematoma prevented second recurrence and improved neurological recovery compared with conventional retreatment, without increasing the complication rate. These findings suggest that middle meningeal artery embolization could be considered an effective and safe retreatment option for recurrent chronic subdural hematoma.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"717-724"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Brain Injury and Risk of Intracranial Meningioma : A Systematic Review and Meta-Analysis.","authors":"Ahood Mahjari, Abdullah Alyazidi, Khaled El-Sayed, Abdullah Alqarni, Afrah A Alharthi, Amjad Alshahrani, Nouf Al-Salaman, Amjad Majrashi, Fatimah Alqahtani, Shooq Al-Shahrani, Muhannad Al-Obaiyah, Renad Al-Obaiyah, Ziyad Aldossari, Abdulsalam Alfaifi, Mona Alfaifi","doi":"10.3340/jkns.2026.0061","DOIUrl":"10.3340/jkns.2026.0061","url":null,"abstract":"<p><p>Meningiomas are the most common primary intracranial tumors, but the role of traumatic brain injury (TBI) as a risk factor remains unclear. This study aimed to systematically review and quantitatively synthesize the available observational evidence on the association between TBI and subsequent meningioma risk. We conducted a systematic review and meta-analysis of observational studies following PRISMA guidelines. PubMed, Scopus, Web of Science, and Cochrane databases were searched through December 5, 2025. Studies comparing meningioma incidence in individuals with and without a history of TBI were included. Risk of bias was assessed using the Newcastle-Ottawa scale. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects models. Heterogeneity and sensitivity analyses were performed. In results, 10 observational studies (seven case-control and three cohort studies) were included in the systematic review, with eight contributing to the quantitative synthesis. The pooled analysis demonstrated a statistically significant association between TBI and meningioma (OR, 1.96; 95% CI, 1.31 to 2.95; p=0.0012) with moderate heterogeneity (I2=65.6%). Sensitivity analyses confirmed the robustness of the findings, although funnel plot asymmetry suggested potential publication bias. We concluded that although a statistical association between prior TBI and meningioma diagnosis was observed, the current evidence does not support a clear causal relationship. The pooled effect appears to be driven mainly by retrospective case-control studies, which are particularly vulnerable to recall and detection bias, whereas cohort studies provide less consistent support for a direct etiological link. Further largescale prospective studies with long-term follow-up are needed to clarify this relationship.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"695-703"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Language Models in Spine Surgery : A Narrative Review of Performance Paradox and Clinical Integration Challenges.","authors":"Sung Bum Kim, Il-Tae Jang, YooKyung Lee, Yoon Gyo Jung, Sangsoo Choi, Jun-Yong Cha","doi":"10.3340/jkns.2026.0057","DOIUrl":"10.3340/jkns.2026.0057","url":null,"abstract":"<p><p>To provide a narrative synthesis of the performance paradox in large language model (LLM) applications for spine surgery, examining the disparity between technical metrics and clinical utility. A narrative review was conducted examining literature from January 2023 to February 2026 across PubMed, EMBASE, and Google Scholar. Studies evaluating LLM applications in spine surgery were included, with emphasis on newer models (GPT-4o, GPT-5, Claude, Gemini variants, DeepSeek). Studies were thematically analyzed across clinical documentation, patient communication, and surgical decision-making domains. Analysis of 42 studies revealed a consistent pattern across applications. LLMs performed strongly in structured documentation tasks, including current procedural terminology coding (area under the receiver operating characteristic curve, 0.87) and surgical classification (91% accuracy), and improved readability in patientfacing materials. Patient communication achieved high satisfaction rates but demonstrated limited emotional intelligence. In contrast, decision-making performance was more variable: in small vignette-based comparisons, LLMs showed lower raw accuracy than attending spine surgeons in complex scenarios, and guideline concordance ranged from 33% to 88% across models. Emerging evidence with nextgeneration models suggests incremental gains, but procedure-level agreement remains limited (κ=0.415 and 0.587 in minimally invasive spine surgery triage). Image-based tasks, such as Cobb angle measurement, remain particularly challenging, with all tested models failing to meet the ≤10° clinical threshold. LLMs show near-term utility in standardized text-based tasks, but current evidence does not support autonomous use in complex clinical decision-making or image-based spinal assessment. Staged implementation with mandatory human oversight remains necessary.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"674-682"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolution and Global Impact of Uniportal Endoscopic Spine Surgery : A Korean Perspective and Historical Legacy.","authors":"Jin-Sung Kim","doi":"10.3340/jkns.2026.0214","DOIUrl":"https://doi.org/10.3340/jkns.2026.0214","url":null,"abstract":"<p><p>Uniportal full-endoscopic spine surgery (FESS) has expanded over three decades from percutaneous discectomy to include multilevel decompression, endoscopic interbody fusion (Endo-LIF), spinal infection management, and tumor surgery. The Republic of Korea is a leading contributor to this field: across bibliometric analyses, six of the world's top ten contributing authors and three of the top five contributing institutions are Korean. This article provides a Korea-centered critical appraisal of uniportal FESS, integrating five domains: Korean academic contributions, Level-I evidence by spinal region, expansion of indications, integration of next-generation technologies (navigation, augmented reality, artificial intelligence, robotics), and structural barriers in health policy and reimbursement. Level-I randomized evidence supports clinical equivalence to microscopic surgery for lumbar disc herniation and lumbar spinal stenosis, with cost-utility data from the Korean National Health Insurance Service showing a cost-per-quality-adjusted-life-year of approximately USD 5,241-well below conventional willingness-to-pay thresholds. Cervical FESS evidence remains limited to two single-center RCTs from 2008-2009, and thoracic FESS data derive from non-randomized multicenter case series showing large perioperative advantages over open surgery. Despite the maturity of the evidence, Korean reimbursement codes have not been updated to reflect modern uniportal techniques, Endo-LIF lacks dedicated coding, and the radiofrequency-related fee schedule still uses 1990s-era valuations. We propose a tiered policy roadmap-short-term code differentiation, mid-term Endo-LIF and navigation-track integration, and long-term registry-based credentialing-to align Korean reimbursement infrastructure with the country's established academic and clinical leadership in this field.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Prehospital Stroke Triage : Commentary on Emergency Medical Services Assessment Tools.","authors":"Muhammad Dawood, Nawal Mahmood","doi":"10.3340/jkns.2026.0051","DOIUrl":"10.3340/jkns.2026.0051","url":null,"abstract":"","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"829-830"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editors' Pick in September 2026.","authors":"Hee-Jin Yang","doi":"10.3340/jkns.2026.0246","DOIUrl":"10.3340/jkns.2026.0246","url":null,"abstract":"","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":"69 5","pages":"667-669"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decompressive Craniectomy for Intracranial Pathologies in the Intensive Care Unit : Effects on Mortality and Clinical Course.","authors":"Ahmet Sari, Osman Ekinci, Selen Bozdemir, Recep Balık, Ahmet Sait Bulut, Süheyla Abitağaoğlu, Fatih Kılıç, Saliha Erkan, Fethi Gül, Burçin Doruk Oktay, Yelda Balık, Feyza Kargın, Kemal Tolga Saraçoğlu","doi":"10.3340/jkns.2025.0234","DOIUrl":"10.3340/jkns.2025.0234","url":null,"abstract":"<p><strong>Objective: </strong>Decompressive craniectomy (DC) is a surgical procedure in which a portion of the skull overlying edematous and vulnerable brain tissue is removed to reduce intracranial pressure. In cases where all other treatment modalities fail, DC can be life-saving. However, this procedure is not a \"panacea;\" it can prolong the death process and condemn the patient to a life in need of care, with severe neurological sequelae.</p><p><strong>Methods: </strong>This multicenter, retrospective study recorded patients' comorbidities, Glasgow coma scale (GCS), Acute physiology and chronic health evaluation II (APACHE II) and Sequential organ failure assessment (SOFA) scores, as well as relevant laboratory parameters. Patients were categorized into three groups according to the Glasgow outcome scale.</p><p><strong>Results: </strong>Among 201 patients, 41.3% expired, 33.8% survived with severe vegetative sequelae, and 24.9% had mild to moderate sequelae. Non-survivors had significantly lower preoperative and postoperative GCS scores (median 7 vs. 9, p=0.010; 3 vs. 10, p<0.001) and higher 24-hour peak glucose levels (186 vs. 164 mg/dL, p=0.009). Steroid therapy was ineffective. Preoperative GCS scores were significantly lower in patients who later developed severe sequelae compared to those with better outcomes (median 8 vs. 11, p<0.001). Postoperative GCS scores were also lower in this group (8 vs. 13, p<0.001).Additionally, APACHE II (22 vs. 18, p=0.002) and SOFA scores (4 vs. 3, p<0.001) were higher, indicating greater disease severity.</p><p><strong>Conclusion: </strong>DC can be a lifesaving procedure in selected patients with appropriate indications and appropriate timing. However, the possibility of this procedure resulting in high mortality and severe sequelae cannot be ignored. Therefore, the clinical outcomes that the patient and their families would find acceptable should be carefully considered.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"779-788"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracolumbar Trauma in the Aging Spine : Limitations of Conventional Classification Systems and an Integrated Frailty-Based Treatment Framework.","authors":"Seung Hoon Lee, Matthew W Scarsbrook, Joonho Byun, Seung Jin Choi, Chang Hwa Ham, Eun-Sang Kim, Joo Han Kim, Myeong Jin Ko, Subum Lee, Byung-Jou Lee, Suk-Hyung Kang, Je Hoon Jeong, Jong Hyun Kim, Woo-Keun Kwon","doi":"10.3340/jkns.2026.0195","DOIUrl":"https://doi.org/10.3340/jkns.2026.0195","url":null,"abstract":"<p><p>Thoracolumbar trauma in elderly patients has become increasingly important as population aging has reshaped the epidemiology of spinal injury. In the aging spine, low-energy trauma can produce clinically significant or unstable fractures because osteoporosis, degenerative stiffness, and rigid spine disorders alter mechanical behavior. Conventional classification systems and guideline-based algorithms remain useful for describing fracture morphology, neurological status, and structural instability. However, their applicability in elderly patients is limited because treatment decisions must account for frailty-related vulnerability and the functional consequences of immobilization. This review summarizes the distinctive features of thoracolumbar trauma in the aging spine and proposes an integrated framework that combines structural injury severity with frailty-based assessment of treatment tolerance. Frailty reduces physiologic reserve and limits the ability to tolerate treatment and recover after injury, while poor bone quality and spinal rigidity increase the risk of structural failure even with guideline-concordant care. Treatment should aim to restore stability, preserve neurological function, control pain, and enable early mobilization while minimizing physiologic burden. Depending on structural demand, treatment may range from non-operative care or vertebral augmentation in appropriate patients to definitive fixation, with selection guided by bone quality, frailty, and expected functional benefit. Thoracolumbar trauma in the aging spine should be managed as a distinct clinical entity for which an integrated frailty-based framework may better support practical, patient-centered decision-making.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}