Journal of Korean Neurosurgical Society最新文献

{"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}

{"title":"An Integrated Paradigm for Brainstem Cavernoma Surgery : Combining Defined Surgical Timing with Diffusion Tensor Imaging-Guided Tractography.","authors":"Liang He, Zongyu Xiao, Ke Xu, Zhengyang Lu, Chenlong Wang, Yulun Huang","doi":"10.3340/jkns.2026.0032","DOIUrl":"https://doi.org/10.3340/jkns.2026.0032","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate a surgical strategy for hemorrhagic brainstem cavernous malformations by assessing 1) the impact of surgical timing (hemorrhage-to-surgery interval), and 2) the utility of preoperative diffusion tensor imaging (DTI) tractography for corticospinal tract (CST) preservation.</p><p><strong>Methods: </strong>In a retrospective cohort of 41 consecutive patients, the hemorrhage-to-surgery interval was stratified into acute (<3 weeks), subacute (3-8 weeks), and delayed (>8 weeks). Preoperative DTI tractography for CST mapping was utilized in 24 patients (DTI group) and not in 17 (non-DTI group); assignment was determined by magnetic resonance imaging scanner availability rather than clinical selection. The primary outcome was unfavorable functional status (modified Rankin scale score >2) at final follow-up.</p><p><strong>Results: </strong>The median hemorrhage-to-surgery interval was 53.0 days. Delayed surgery independently predicted unfavorable outcome at discharge (adjusted odds ratio, 9.03; 95% confidence interval, 1.10-73.94; p=0.04). Preoperative DTI was associated with a significantly lower rate of postoperative motor deterioration at discharge (12.5% vs. 47.1%; p=0.04). Subgroup analysis showed that the protective effect of DTI was significant only in the delayed surgery group (p=0.04), whereas among patients operated within 8 weeks, motor deterioration rates were low regardless of DTI use (16.7% vs. 16.7%; p=1.00). Persistent postoperative motor deficit was the strongest determinant of long-term disability (44.4% vs. 3.1%; p=0.006).</p><p><strong>Conclusion: </strong>A hemorrhage-to-surgery interval exceeding 8 weeks independently predicts poorer early functional recovery. Preoperative DTI tractography reduces postoperative motor deficits-the key driver of long-term disability-with its benefit most pronounced in the delayed surgery setting. We propose a risk-stratified, dual-emphasis strategy : timely intervention within 8 weeks when feasible, complemented by DTI tractography, which is particularly valuable in mitigating the increased risks of delayed surgery. This framework offers a practical, evidence-informed approach for optimizing functional outcomes.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678813","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":"Red Blood Cell Distribution Width-to-Albumin Ratio as a Predictor of 28-Day Mortality in Patients with Traumatic Brain Injury : A Retrospective Cohort Study Based on the MIMIC-IV Database.","authors":"Ting Pan, Wei Sun, Qihui Huang, Zeting Qiu","doi":"10.3340/jkns.2026.0178","DOIUrl":"https://doi.org/10.3340/jkns.2026.0178","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic brain injury (TBI) remains one of the leading causes of mortality and disability worldwide. Early identification of high‑risk patients is essential for improving clinical outcomes. The red blood cell distribution width‑to‑albumin ratio (RAR) has emerged as a novel biomarker integrating systemic inflammation and nutritional status. This study aimed to evaluate the prognostic value of RAR for predicting 28‑day mortality in critically ill patients with TBI.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted using data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Adult TBI patients admitted to the intensive care unit (ICU) were included. RAR was calculated based on red blood cell distribution width (RDW) and serum albumin levels measured within the first 24 hours of ICU admission. The primary endpoint was 28-day all-cause mortality. Kaplan-Meier survival analysis, Cox proportional hazards models, restricted cubic spline (RCS) analysis, and subgroup analyses were performed. Furthermore, 1:1 propensity score matching (PSM) was conducted to minimize potential confounding bias and validate the robustness of the prognostic association.</p><p><strong>Results: </strong>A total of 465 TBI patients were included, among whom 83 (17.8%) died within 28 days of ICU admission. RAR levels were significantly higher in non-survivors compared to survivors (4.18±0.48 vs 3.56±0.44, p < 0.001). Kaplan-Meier analysis indicated a significantly higher mortality rate in the high RAR group (Log-rank test p < 0.001). Cox regression analysis showed that after adjusting for confounding factors, a high RAR level was an independent risk factor for 28-day mortality in TBI patients (HR = 1.840, 95% CI 1.053-3.214, p = 0.032). This association remained robust in the PSM cohort (HR = 2.928, 95% CI: 1.456-5.886, p = 0.003). RCS analysis demonstrated an increasing hazard ratio trend as RAR rose, plateauing after a threshold of 3.579. Subgroup analysis suggested that the predictive value of RAR was more pronounced in patients with lower disease severity (SOFA score <5).</p><p><strong>Conclusion: </strong>RAR is an independent predictor of 28-day mortality in critically ill patients with TBI. As a simple, inexpensive, and readily available biomarker integrating inflammatory and nutritional status, RAR may serve as a useful tool for early risk stratification in patients with TBI.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630723","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":"Accuracy of Pedicle Screw Placement at the Cervicothoracic Junction (C7-T2) : A Comparative Study of O-arm Navigation versus C-arm Fluoroscopy.","authors":"Jun Seok Lee, Su Hun Lee, Dong Wuk Son, Soon Ki Sung, Chi Hyung Lee, Sang Hwa Kim, Chang Hyeun Kim, Sang Weon Lee","doi":"10.3340/jkns.2026.0147","DOIUrl":"https://doi.org/10.3340/jkns.2026.0147","url":null,"abstract":"<p><strong>Objective: </strong>To compare pedicle screw accuracy at the cervicothoracic junction (CTJ; C7-T2) between O-arm navigation and C-arm fluoroscopy and identify level-specific malposition mechanisms through quantitative trajectory analysis.</p><p><strong>Methods: </strong>We retrospectively reviewed 187 screws in 50 patients (C-arm: 82 screws; O-arm: 105 screws) who underwent CTJ fixation between 2018 and 2024. Accuracy was graded using the modified Gertzbein-Robbins classification. Axial trajectory parameters, including insertion angle (IA) and entry point (EP) deviation, were measured relative to the mid-pedicle reference line.</p><p><strong>Results: </strong>The overall Grade A accuracy did not differ significantly between the C-arm (84.1%) and O-arm (78.1%) groups (p=0.555). While accuracy was comparable at C7 and T1, the Grade A accuracy at T2 was significantly lower in the O-arm group (50.0% vs. 83.3%; p=0.025). The O-arm+T2 combination was associated with a markedly higher malposition risk (OR=7.62; p=0.004). In the C-arm group, failure mechanisms were diverse. Conversely, the predominant failure pattern in the O-arm group at T2 was lateral EP shift combined with insufficient convergence, with sagittal plane mismatch in a subset of cases.</p><p><strong>Conclusion: </strong>O-arm navigation confers no overall accuracy advantage at the CTJ and carries a nearly eightfold malposition risk at T2. Careful preoperative anatomical assessment and intraoperative attention to convergence angle are essential at this level, regardless of the imaging modality used.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630771","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":"Pain and Functional Outcome of Supraclavicular Decompression of the Brachial Plexus for Neurogenic Thoracic Outlet Syndrome.","authors":"Byung-Chul Son","doi":"10.3340/jkns.2026.0135","DOIUrl":"https://doi.org/10.3340/jkns.2026.0135","url":null,"abstract":"","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604217","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":"Predictors of Mechanical Failure Following Lateral Access Corpecto-my: The Impact of Posterior Fixation Range.","authors":"Jae Wook Yu, Jun Seok Lee, Su Hun Lee, Dong Wuk Son, Soon Ki Sung, Kang Hoon Lee, Sang Hwa Kim, Chang Hyeun Kim, Sang Weon Lee","doi":"10.3340/jkns.2026.0157","DOIUrl":"https://doi.org/10.3340/jkns.2026.0157","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the radiologic outcomes of lateral access corpectomy to identify perioperative predictors associated with mechanical failure.</p><p><strong>Methods: </strong>We retrospectively reviewed 42 patients who underwent single-level lateral access corpectomy with posterior instrumentation between January 2019 and July 2024. Clinical indications included osteoporotic vertebral fractures (n = 23), spinal metastases (n = 10), and destructive spondylitis (n = 9). Radiologic parameters including total interbody height (TIH) and local segmental angle (SA) were assessed at each time point. Univariate and logistic regression analyses were performed to identify risk factors for mechanical failure.</p><p><strong>Results: </strong>Postoperatively, the mean TIH gain was 8.42 mm and the mean kyphosis correction was 9.85°. Mechanical failure occurred in 6 cases (14.3%), including pedicle screw pullout (n = 3), rod fracture (n = 1), and severe endplate destruction (n = 2). Logistic regression analysis identified short-segment fixation as a significant risk factor for mechanical failure (OR 8.00, 95% CI 1.19-53.93, p = 0.033). All mechanical failure cases occurred in patients with expandable cages. While expandable cages achieved greater initial TIH gain and kyphosis correction compared with mesh cages, they also demonstrated a greater degree of correction loss at final follow-up (TIH loss 6.62 mm vs. 3.93 mm, p = 0.061).</p><p><strong>Conclusion: </strong>Among patients undergoing lateral access corpectomy, short-segment fixation was the only factor significantly associated with mechanical failure, and its combination with an expandable cage carried the highest failure rate. Given the small number of failure events, these findings are hypothesis-generating and suggest that long-segment fixation should be prioritized whenever clinically feasible.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591970","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":"Dural Entrapment by Facet Joint after Unilateral Biportal Endoscopic Lumbar Decompression Surgery : Incidence, Risk Factors, and Biomechanical Considerations.","authors":"Sang-Woo Lee, JinWoo Jung, Sang-Kyu Son, Dae-Chul Cho, Young San Ko, Man-Kyu Park","doi":"10.3340/jkns.2026.0109","DOIUrl":"https://doi.org/10.3340/jkns.2026.0109","url":null,"abstract":"<p><strong>Objective: </strong>Dural entrapment by the facet joint is an uncommon but potentially symptomatic finding following unilateral biportal endoscopic (UBE) lumbar decompression. Its incidence, associated factors, and underlying mechanisms remain poorly defined. This study aimed to investigate the incidence, clinical course, and anatomical and geometric factors associated with dural entrapment following UBE lumbar decompression.</p><p><strong>Methods: </strong>This retrospective cohort study included 181 patients (257 spinal segments) who underwent UBE lumbar decompression at a single institution between January 2023 and January 2024. Patients with prior lumbar surgery, deformity, severe instability, or incomplete imaging were excluded. Clinical and radiological parameters, including facet joint gap, facet joint angle, facetectomy ratio and dural sac-to-canal ratio, were evaluated. Because of the limited number of events, Firth's penalized logistic regression was applied using two complementary models - a preoperative susceptibility model and a postoperative geometric association model - with receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>Dural entrapment occurred in 15 of 257 segments (5.8%), of which 13 (86.7%) were ipsilateral. Symptomatic entrapment was observed in 2 cases (0.8%), one requiring revision surgery, while most followed a benign radiological course. In the preoperative susceptibility model, degenerative spondylolisthesis (DS; adjusted OR 49.14, p<0.001) and preoperative ipsilateral facet joint gap (adjusted OR 4.77, p=0.007) were independently associated with entrapment (combined AUC 0.875). In the postoperative geometric association model, DS (adjusted OR 34.87, p<0.001) and postoperative ipsilateral facet joint gap (adjusted OR 4.12, p=0.001) showed independent associations (combined AUC 0.897). The facetectomy ratio was not associated with entrapment (p=0.222).</p><p><strong>Conclusion: </strong>Dural entrapment after UBE lumbar decompression is uncommon and usually follows a benign course, although symptomatic cases may occur. DS and the ipsilateral facet joint gap were the principal associated factors, with the absolute facet gap width - rather than the relative extent of bone resection - being the more relevant determinant. These findings, together with the marked ipsilateral predominance, support a geometric basis for this phenomenon and may inform preoperative risk assessment.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455975","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":"Determinants of Out-of-Region Healthcare Use and Patient Experiences in Brain Disorders in Gyeongsangnam-Do : An Andersen's Behavioral Model Approach.","authors":"Kyeong-O Go, Kihwan Hwang, Jung Ho Han, Chae-Yong Kim, Sung-Hyo Seo, Mi-Ji Kim, Joo Hyun Sung","doi":"10.3340/jkns.2026.0128","DOIUrl":"https://doi.org/10.3340/jkns.2026.0128","url":null,"abstract":"<p><strong>Objective: </strong>Healthcare utilization in South Korea is disproportionately concentrated in the capital area, raising substantial concerns about equity and system efficiency, particularly for patients with neurosurgical brain disorders residing outside the capital region. This study applied Andersen's Behavioral Model to identify the determinants of out-of-region (capital-area) healthcare utilization.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted (November 2023-January 2024) among 363 adults aged≥18 years attending neurosurgery outpatient clinics at one non-capital tertiary hospital (n=181) and one capital-area tertiary hospital (n=182). Structured questionnaires assessed predisposing (e.g., education, behaviors), enabling (e.g., income, caregiver location), and need factors (e.g., disease history). Multivariable logistic regression estimated associations with out-of-region utilization as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Out-of-region utilization was associated with education (middle/high school: aOR 3.22, 95% CI 1.20-8.67; college or higher: aOR 3.27, 95% CI 1.04-10.29), regular health checkups (aOR 3.28, 95% CI 1.23-8.79), caregiver outside region (aOR 6.05, 95% CI 2.47-14.85), higher income (3-5 million KRW: aOR 7.06, 95% CI 3.28-15.22, over 5 million KRW: aOR 17.52, 95% CI 7.3-42.06), no cerebrovascular disease history (aOR 0.18, 95% CI 0.08-0.41), and prior brain surgery/procedure (aOR 2.71, 95% CI 1.31-5.62). The model explained 57.8% of the variance.</p><p><strong>Conclusion: </strong>Guided by Andersen's model, tailored interventions addressing predisposing, enabling, and need-related factors are needed to reduce potentially avoidable capital-region utilization among patients with brain disorders in Gyeongsangnam-do and improve regional equity. Further multicenter longitudinal studies should validate causality and intervention efficacy.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430605","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":"GAN-Augmented Radiomics and Machine Learning for Post-Therapy GBM Progression Assessment.","authors":"Dev Deveswar Rana, Sanjay Saxena, Navneet Kumar Dubey, Hemang Chaturvedi, Jiann-Her Lin, Yi-Shan Yang","doi":"10.3340/jkns.2026.0075","DOIUrl":"https://doi.org/10.3340/jkns.2026.0075","url":null,"abstract":"<p><strong>Objective: </strong>Differentiating true progression (TP) from pseudoprogression (PsP) in post-therapy of glioblastoma multiforme (GBM) remains a critical challenge in neuro-oncology, due to their overlapping radiological characteristics. Consequently, an accurate, non-invasive differentiation between PsP and TP is vital for informing treatment decisions and improving patient outcomes. Therefore, we aimed to present a comprehensive AI-driven framework integrating handcrafted radiomics, deep learning features, and generative modelling to enhance diagnostic precision.</p><p><strong>Methods: </strong>Multiparametric MRI data (T1, T2, FLAIR, T1GD) from 58 GBM patients (41 TP, 17 PsP) were analysed using three feature extraction strategies: handcrafted radiomics, Vision Transformer (ViT)-based deep features, and a hybrid combination of both. To address class imbalance, synthetic samples were generated using a Conditional Tabular Generative Adversarial Network (CT-GAN). Feature dimensionality was reduced through a two-stage pipeline comprising a Variational Autoencoder (VAE) followed by Principal Component Analysis (PCA), preserving 95% variance. Classifiers, including Support Vector Machine (SVM), Random Forest, XGBoost, and Multi-Layer Perceptron (MLP), were trained and validated via stratified 5-fold cross-validation.</p><p><strong>Results: </strong>The radiomics-based SVM model yielded the best performance with an accuracy of 91.84% ± 3.59 (95% CI - 0.841 to 0.989) and an AUC of 0.9667 ± 0.0378 (95% CI - 0.920 to 0.998), demonstrating promising performance within the studied dataset and highlighting potential for clinical application, subject to further external validation.</p><p><strong>Conclusion: </strong>Our demonstrated CT-GAN-augmented hybrid radiomics framework offers a robust, non-invasive, and promising solution for reliably distinguishing PsP from TP. It shows promising performance within the studied dataset, with potential for future clinical translation subject to external validation.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391050","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":"Anterior versus Posterior Surgery for Single-Level Metastatic Cervical Spinal Tumors : Comparative Analysis of Sagittal Alignment and Kyphotic Progression.","authors":"Subum Lee, Seung Jun Ryu, Sang Hoon Hwang, Min Han Kim, Danbi Park, Chong Man Kim, Sun Woo Jang, Jin Hoon Park","doi":"10.3340/jkns.2026.0138","DOIUrl":"https://doi.org/10.3340/jkns.2026.0138","url":null,"abstract":"<p><strong>Objective: </strong>To compare clinical and radiological outcomes of anterior (ACSS) and posterior cervical spine surgery (PCSS) in patients with single-level metastatic cervical spinal tumor (MCST).</p><p><strong>Methods: </strong>We retrospectively reviewed 27 patients with single-level MCST treated at a single institution between January 2001 and February 2024, categorized into ACSS (n = 16) and PCSS (n = 11) groups. Clinical outcomes were assessed using the Eastern Cooperative Oncology Group (ECOG) performance status, Nurick scale, and visual analog scale (VAS) for neck pain. Radiological parameters-C2-C7 cervical lordosis, sagittal vertical axis, T1 slope, neck tilt, and segmental Cobb angle (SCA)-were evaluated preoperatively, at 1 month postoperatively, and at final follow-up. Baseline bone quality (adjacent vertebral Hounsfield units), bone-modifying agent use, and adjuvant radiotherapy/systemic therapy were also assessed. Index vertebral collapse was defined as a decrease in SCA exceeding 10° from 1 month postoperatively to final follow-up. Time to kyphotic progression was compared using Kaplan-Meier and Cox proportional hazards analyses.</p><p><strong>Results: </strong>Short-term clinical outcomes did not differ between groups, and both groups achieved comparable kyphosis correction at 1 month postoperatively. However, from 1 month to final follow-up, SCA loss was significantly greater in ACSS (-15.6° ± 7.8° vs -5.5° ± 4.5°; p < 0.001), and index vertebral collapse occurred more frequently in ACSS (81.3% vs 18.1%; p = 0.003). Compensatory changes in T1 slope and neck tilt were significantly greater in ACSS, suggesting greater cranio-cervical adaptation. The median time to SCA decrease exceeding 10° was shorter in ACSS (0.4 vs 2.0 years; log-rank p = 0.0018), and multivariate Cox analysis confirmed a significantly lower hazard of kyphotic progression in PCSS. Operative time was shorter in PCSS (199.1 ± 17.6 vs 245.8 ± 22.5 minutes; p < 0.001). Adjacent vertebral bone density and adjuvant therapy were balanced between groups, although all PCSS cases were performed in the recent era.</p><p><strong>Conclusion: </strong>While short-term clinical outcomes were comparable, PCSS was associated with slower kyphotic progression and a lower rate of index vertebral collapse, suggesting more durable radiographic stability that warrants confirmation in larger prospective studies.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391101","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}