Journal of neurosurgery. Spine最新文献

{"title":"Survival disparities in primary malignant spine tumors: a national analysis of academic and community hospital care.","authors":"Kameron M Willis, Tiffany Chu, Hasan Radwan, Clarence Julian Clark, Rafael De la Garza Ramos, Byron Stephens, Ian A Buchanan, Kingsley Abode-Iyamah, Ziya L Gokaslan, Peter Rose, Mohamad Bydon, Oluwaseun O Akinduro","doi":"10.3171/2026.2.SPINE25907","DOIUrl":"https://doi.org/10.3171/2026.2.SPINE25907","url":null,"abstract":"<p><strong>Objective: </strong>Primary malignant osseous tumors of the mobile spine are rare and require complex, multidisciplinary care. Treatment outcomes may differ between academic and community hospitals due to variations in resources, expertise, and infrastructure. This study evaluates demographics, care delivery patterns, and clinical outcomes, including both short- and long-term survival, for patients treated at academic versus community cancer programs using the National Cancer Database.</p><p><strong>Methods: </strong>A retrospective analysis of a prospectively maintained database was performed. Nine hundred forty-three patients diagnosed with primary malignant osseous tumors of the mobile spine between 2004 and 2017 were identified. Patients were stratified by facility type: there were 601 patients treated at academic comprehensive cancer programs (ACADs) and 342 treated at comprehensive community cancer programs (CCCPs). Demographic, treatment, and clinical data were compared using descriptive statistics. Outcomes included inpatient length of stay, time to treatment, 30- and 90-day mortality, vital status at last contact, and overall survival. A multivariable Cox proportional hazards model assessed factors associated with overall survival.</p><p><strong>Results: </strong>Patients at ACADs were significantly younger and more likely to have private insurance. The size and histopathological composition of the tumors did not differ significantly between facility types. ACAD patients experienced significantly longer inpatient stays and longer time to radiation initiation among patients receiving radiation with documented start dates. Time to chemotherapy did not significantly differ (p = 0.91). Thirty- and 90-day mortality were comparable between facility types among eligible surgical cases. At last follow-up, a significantly greater proportion of ACAD patients were alive (50.2% vs 38.3%, p < 0.001), and the median time from diagnosis to last contact or death was longer at ACADs (40.8 vs 33.2 months, p = 0.001). In the primary multivariable Cox model, treatment at an academic facility was associated with improved overall survival (hazard ratio [HR] 0.766, 95% CI 0.627-0.937; p = 0.009). In a sensitivity model adjusting for histopathology rather than grade, this association was attenuated and no longer statistically significant (CCCP vs ACAD, HR 1.19, p = 0.081).</p><p><strong>Conclusions: </strong>Patients treated at academic centers had longer inpatient stays and longer time to radiation initiation, yet academic facility treatment was associated with improved overall survival in the primary multivariable model. After accounting for histopathological subtype in sensitivity analysis, the facility-type association was attenuated, suggesting survival differences reflect both tumor biology and system-level care pathways.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mind the gap: discrepancies between planned and achieved screw trajectories in 3D-navigated spine surgery.","authors":"Ulf Bertram, Laure Weis, Tobias P Schmidt, Alexander Romagna, Miguel Pishnamaz, Hans Clusmann, Christian Blume, Christian-Andreas Mueller","doi":"10.3171/2026.5.SPINE2699","DOIUrl":"https://doi.org/10.3171/2026.5.SPINE2699","url":null,"abstract":"<p><strong>Objective: </strong>Intraoperative 3D image-guided navigation has improved the accuracy of posterior screw placement in spine surgery. However, discrepancies between planned and achieved screw trajectories remain underexplored. In this study, authors assessed these deviations across spinal regions and their potential correlation with screw misplacement.</p><p><strong>Methods: </strong>They prospectively analyzed patients undergoing posterior instrumented fusion surgery between 2021 and 2023. Screw placement accuracy was graded using the 2-mm increment basis of the Gertzbein and Robbins (GR) classification. Additionally, angulation discrepancies between planned and achieved trajectories were measured in the axial and sagittal planes. Statistical analyses included Kruskal-Wallis, Dunn's post hoc, and Spearman correlation tests.</p><p><strong>Results: </strong>The study included 725 pedicle and lateral mass screw trajectories in 121 patients. Overall, 95.0% of screws were placed with acceptable accuracy (cervical spine: GR grade A and B; all other spine regions: GR grade A-C). Axial screw trajectory divergence was highest in the subaxial cervical spine (4.2° ± 3.0°), significantly exceeding those in the atlantoaxial (2.6° ± 2.1°), thoracic (2.6° ± 2.2°), and lumbar (2.9° ± 3.2°) regions (p < 0.01). Sagittal divergence was greater in the subaxial cervical spine (4.1° ± 4.0°) than in the thoracic spine (2.8° ± 2.7°; p < 0.001). The correlation between trajectory deviations and screw misplacement was weak or absent.</p><p><strong>Conclusions: </strong>Screw trajectory deviations vary by spinal region, with the greatest axial discrepancies observed in the subaxial cervical spine. These findings highlight the importance of recognizing intraoperative navigation limitations and refining surgical techniques to optimize accuracy. Monitoring screw trajectories may enhance training and improve patient safety.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of spinal and sacral osteosarcoma: a retrospective single-institution case series.","authors":"Taha Khalilullah, Yuanxuan Xia, Tej D Azad, Joseph M Dardick, Andrew M Hersh, Nicholas Theodore, Sang-Hun Lee, Jean-Paul Wolinsky, Daniel Lubelski","doi":"10.3171/2026.5.SPINE251796","DOIUrl":"https://doi.org/10.3171/2026.5.SPINE251796","url":null,"abstract":"<p><strong>Objective: </strong>Primary osteosarcoma of the mobile spine and sacrum is a rare and aggressive tumor pathology, accounting for 3%-5% of osteosarcomas and approximately 10% of primary spinal tumors. Limited evidence based on case series is present to guide clinical treatment based on current advances in Enneking-appropriate (EA) resection and multimodal techniques. This study updates the authors' institutional experience, characterizing current management strategies and outcomes in spinal and sacral osteosarcomas.</p><p><strong>Methods: </strong>The authors retrospectively reviewed the medical records of all patients treated surgically for primary spinal and sacral osteosarcoma at a tertiary spine care center from 2015 to 2025. Preoperative demographic characteristics, tumor characteristics, surgical variables, and neoadjuvant/adjuvant therapies were collected. Resections were classified as EA or Enneking-inappropriate (EI). Neurological and oncological outcomes were assessed at short-term (≤ 4 months), intermediate (4-12 months), and long-term or last (> 12 months) follow-up. Primary endpoints were local recurrence-free survival (LRFS) and overall survival (OS).</p><p><strong>Results: </strong>Twenty-two patients underwent resection. Wide or marginal resection was achieved in 15 patients (68%). Neoadjuvant chemotherapy and radiotherapy were administered to 82% and 27% of patients, respectively. At a median (range) follow-up of 9.1 (0.9-191.0) months, 12 patients (54.5%) had died. Local recurrence occurred in 40.9% of patients and distant metastasis in 31.8%. Multivariable analyses showed significantly higher OS after EA resection (p = 0.026). Additionally, older age, other histological subtypes, and mobile spine locations were independently associated with worse OS.</p><p><strong>Conclusions: </strong>Despite aggressive multimodal therapy, spinal and sacral osteosarcomas carry high rates of recurrence and mortality. EA resection improved survival in univariate and multivariable models, reflecting the influence of surgical margins on improved prognosis. These findings support pursuing wide resection when feasible while underscoring the need for multicenter collaborations to refine prognostic models and explore novel systemic therapies.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-13"},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of nonambulatory patients caused by ossification of the ligamentum flavum in the thoracic spine.","authors":"Juncai Lei, Panpan Hu, Xiao Liu, Hua Zhou, Yanchao Tang, Ben Wang, Yan Li, Fengliang Wu, Liang Jiang, Lei Dang, Zhongjun Liu, Feng Wei, Xiaoguang Liu","doi":"10.3171/2026.4.SPINE251040","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE251040","url":null,"abstract":"<p><strong>Objective: </strong>Thoracic ossification of the ligamentum flavum (T-OLF) may lead to severe thoracic myelopathy and loss of ambulation. Limited data are available regarding surgical outcomes in patients who are nonambulatory preoperatively. This study aimed to evaluate the surgical outcomes of posterior decompression in nonambulatory patients with T-OLF and to identify factors associated with failure to regain ambulation.</p><p><strong>Methods: </strong>This retrospective study included consecutive patients with T-OLF who were nonambulatory before surgery and underwent posterior decompression with fusion (PDF) between July 2010 and July 2023. Preoperative nonambulatory status was defined as complete loss of walking ability, including inability to walk with assistive devices. Neurological function was assessed using the thoracic-adapted modified Japanese Orthopaedic Association (mJOA) score (maximum 11 points). Postoperative ambulation was defined as the ability to walk independently or with assistive devices. Patients were divided into ambulatory and nonambulatory groups based on walking status at the final follow-up. Multivariable logistic regression was performed to identify predictors associated with persistent nonambulation after surgery.</p><p><strong>Results: </strong>A total of 72 patients with a minimum 2-year follow-up were included. At final follow-up, 58 patients (80.6%) regained ambulatory function, whereas 14 patients (19.4%) remained nonambulatory. The mean mJOA score improved significantly after surgery (p < 0.001), with a median recovery rate of 47.2%. Female sex (OR 4.51, p = 0.032) and lower preoperative mJOA score (OR 0.46, p = 0.006) were independently associated with failure to regain ambulation after surgery.</p><p><strong>Conclusions: </strong>In patients with T-OLF who were nonambulatory preoperatively, PDF resulted in recovery of ambulation in the majority of cases. Female sex and lower preoperative neurological function were associated with reduced likelihood of regaining ambulation. Even in severe thoracic myelopathy, meaningful functional improvement remains achievable following surgical decompression.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-7"},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and internal validation of a conditional failure-to-rescue prediction model after surgery for metastatic spine disease.","authors":"Esli Nájera Samaniego, Ali Haider Bangash, Victoria Cao, Alexander Alexandrov, Liza Belman, Temitope Adegbenro, Saikiran Murthy, Yaroslav Gelfand, Reza Yassari, Rafael De la Garza Ramos","doi":"10.3171/2026.4.SPINE26196","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26196","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to develop and internally validate an optimal patient-level prediction model for conditional failure to rescue (cFTR) after surgery for spinal metastases.</p><p><strong>Methods: </strong>The authors performed a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2018 to 2023. The primary endpoint was cFTR, defined as 30-day postoperative mortality among patients who experienced at least 1 major complication following surgery for metastatic spinal tumors. Uni- and multivariable logistic regression models were constructed to predict cFTR. Model performance was assessed using discrimination (area under the receiver operating characteristic curve [AUC]), calibration, and information criteria (Akaike and Bayesian). Penalized regression (least absolute shrinkage and selection operator, and elastic net) was performed to evaluate robustness. Internal validation was conducted using 5-fold cross-validation and bootstrap resampling. Reporting of model development followed the TRIPOD statement.</p><p><strong>Results: </strong>Among 338 patients who experienced at least 1 major postoperative complication, 71 (21%) died within 30 days. Emergency surgery was found to be the strongest predictor of cFTR. In the final 6-predictor clinical model, emergency surgery, current smoking, higher preoperative white blood cell count, lower serum albumin, and functional dependence were associated with increased odds of cFTR. The model demonstrated good discrimination (AUC = 0.740) and acceptable calibration, with minimal optimism on internal validation (cross-validated AUC = 0.713, bootstrap mean AUC = 0.743). Penalized regression models demonstrated slightly higher discrimination but offered limited incremental benefit over the clinical mode. Secondary analyses showed that nonsurvivors experienced a higher burden of complications and disproportionately severe cardiopulmonary and infectious events.</p><p><strong>Conclusions: </strong>Among patients with metastatic spinal tumors who experienced major postoperative complications, cFTR remained common and was largely driven by patient-level vulnerability. Conditioning on the occurrence of complications highlighted emergency presentation, impaired physiological reserve, systemic inflammation, and functional dependence as key determinants of mortality. This internally validated model provides a transparent framework for risk stratification after complications and identified potentially modifiable targets for perioperative optimization. External validation is needed to establish generalizability and clinical utility.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial. Does community hospital care of patients with primary osseous malignant spinal tumors lag behind academic hospitals?","authors":"Geoffrey R O'Malley, Eric A Potts","doi":"10.3171/2026.4.SPINE26298","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26298","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-3"},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypermobile cervical disc arthroplasty: clinical and radiological outcomes at minimum 2-year follow-up.","authors":"Tsung-Hsi Tu, Yi-Hsuan Kuo, Ching-Lan Wu, Chu-Yi Lee, Chao-Hung Kuo, Hsuan-Kan Chang, Chih-Chang Chang, Wen-Cheng Huang, Jau-Ching Wu","doi":"10.3171/2026.4.SPINE2688","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE2688","url":null,"abstract":"<p><strong>Objective: </strong>Cervical disc arthroplasty (CDA) plays a pivotal role in preserving segmental motion at the index level to mitigate adjacent segment degeneration (ASD) and maintain neck mobility. The long-term results of US Investigational Device Exemption trials spanning a decade have consistently shown positive clinical outcomes and notable motion preservation. However, it remains uncertain whether patients with greater postoperative range of motion (ROM) experience different outcomes compared with those with normal ROM. The aim of this study was to evaluate whether postoperative hypermobility affects clinical outcomes and complication rates after CDA.</p><p><strong>Methods: </strong>A retrospective analysis of consecutive patients who underwent single-level CDA at C5-6 with ProDisc-C devices was conducted. Surgical indications included medically refractory cervical radiculopathy and/or myelopathy caused by degenerative disc disease or spondylosis. Patients were categorized based on postoperative segmental ROM as having hypermobility (ROM ≥ 15°) or normal mobility (ROM < 15°). Clinical outcomes were assessed using the visual analog scale (VAS) scores for neck and arm pain, Neck Disability Index (NDI), and modified Japanese Orthopaedic Association (mJOA) scale. Radiological outcomes included heterotopic ossification and ASD. The minimum follow-up was 24 months.</p><p><strong>Results: </strong>Of 114 patients (63 female, mean age 48 years) analyzed, 33 (28.9%) were classified as having hypermobility (mean postoperative ROM 17.8° ± 2.1°) and 81 (71.1%) as having normal mobility (mean ROM 9.3° ± 4.0°). The two groups were similar demographically, except for the slightly younger age in the hypermobility group (mean 45.1 ± 9.5 years vs 49.5 ± 10.6 years, p = 0.045). Both groups demonstrated significant improvements in all clinical parameters postoperatively (p < 0.05 for the Nurick grade and mJOA, VAS neck, VAS arm, and NDI scores), with no statistically significant differences observed between groups at the final follow-up. Complication rates were similar, including heterotopic ossification (12.1% vs 19.6%, p = 0.331) and ASD (3.0% vs 12.3%, p = 0.127). No device dislodgement or implant failure occurred in either group.</p><p><strong>Conclusions: </strong>Postoperative segmental hypermobility following CDA did not compromise clinical outcomes or increase complication rates. The safety profile of hypermobile segments was comparable with that of discs with normal mobility, with no instances of device failure or dislodgement. These findings support the safety and efficacy of CDA regardless of postoperative ROM, suggesting that values above the typical range do not adversely affect outcomes. These results contribute to the growing body of evidence supporting the effectiveness and safety of CDA across a wide spectrum of postoperative segmental ROMs.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrity of artificial intelligence and machine learning evidence in spine surgery: a critical appraisal of systematic reviews.","authors":"Kenneth T Nguyen, Sydney Pattison, Isabel Iral-Dragich, Madison Alessi, Mir Amaan Ali, Kento Yamanouchi, Renzo Laynes, Philip K Louie","doi":"10.3171/2026.4.SPINE251808","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE251808","url":null,"abstract":"<p><strong>Objective: </strong>Artificial intelligence (AI) and machine learning (ML) are increasingly integrated into spine surgery across diagnostic, perioperative, and predictive applications, driven by their potential to enhance accuracy, efficiency, and patient safety. As this literature on AI and ML in spine surgery rapidly expands, concerns have emerged regarding selective reporting and overemphasis on algorithmic performance without adequate attention to transparency, bias, or clinical applicability. Such practices raise the risk of reporting spin, particularly within systematic reviews and meta-analyses, which strongly influences clinical interpretation. This study aimed to evaluate the prevalence and types of reporting bias (spin) in systematic reviews and meta-analyses on AI and ML in spine surgery, and to assess their overall methodological and reporting quality.</p><p><strong>Methods: </strong>Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors searched the PubMed, Scopus, and Embase databases using the terms \"spine surgery\" AND (\"artificial intelligence\" OR \"machine learning\") AND (\"systematic review\" OR \"meta-analysis\"). Eligible peer-reviewed reviews were evaluated for 15 types of spin, and methodological quality was assessed using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). Study characteristics included PRISMA adherence, publication year, and level of evidence. Associations with spin prevalence were examined using chi-square, Mann-Whitney U, and Kruskal-Wallis tests and Spearman's rank correlation.</p><p><strong>Results: </strong>The search identified 273 studies; after removing 90 duplicates and 124 ineligible titles/abstracts, an additional 22 studies were excluded to reach the 37 total. Spin was present in 32 of 37 (86.5%) abstracts. All spin types were observed, with the most common being type 3 (18/37, 48.65%), type 9 (18/37, 48.65%), and type 5 (19/37, 51.35%). Lower journal impact factors and reduced AMSTAR 2 confidence ratings were significantly associated with spin (p < 0.05).</p><p><strong>Conclusions: </strong>Systematic reviews and meta-analyses of AI and ML in spine surgery demonstrate a high prevalence of spin (86.5%), most often overstating conclusions, selectively reporting outcomes, and making inappropriate generalizations. Spin was significantly associated with lower journal impact factors and weaker methodological quality, raising important concerns regarding the reliability and clinical interpretability of the existing evidence base. These findings highlight the need for greater transparency, adherence to reporting standards, and methodological rigor to ensure accurate communication of AI and ML applications. Addressing these biases is critical for reliable evidence synthesis and informed clinical decision-making in spine surgery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":3.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes after MI-TLIF without bone morphogenetic protein: a retrospective study.","authors":"Emmanuel O Mensah, Joshua I Chalif, Felipe Ramirez-Velandia, John L Kilgallon, Ruchit V Patel, Mohit Manchella, Julian Lopez, David D Liu, John H Chi","doi":"10.3171/2026.4.SPINE2679","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE2679","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is widely used to treat degenerative lumbar spine conditions, offering reduced tissue trauma, faster recovery, and lower complication rates compared to those with open TLIF. Recombinant human bone morphogenetic protein 2 (rhBMP-2) can enhance fusion and is often used in the interbody space in minimally invasive fusions because of the limited posterolateral surface area for arthrodesis, but it is associated with higher costs and an increased risk of complications. Authors of this study evaluated the outcomes of MI-TLIF performed without bone morphogenetic protein (BMP), focusing on fusion and complication rates.</p><p><strong>Methods: </strong>The authors retrospectively reviewed the records of patients who underwent MI-TLIF without BMP at a single academic center between January 2012 and August 2023. Eligible patients were those with degenerative disc disease, lumbar stenosis spondylolisthesis, recurrent disc herniation, or pars defect at 1-2 lumbosacral levels that had been refractory to standard nonsurgical therapy. Demographic, surgical, and clinical data as well as perioperative, radiographic, and patient-reported outcomes were analyzed.</p><p><strong>Results: </strong>Three hundred eight patients, 54.5% male, with a median age of 65 years were included in the study. Most procedures were single-level MI-TLIF, primarily at L4-5. The median operative time was 160.5 minutes, estimated blood loss was 50 mL, and hospital stay was 3 days. At a median follow-up of 56.2 months, the radiographic fusion rate was 91.9%. Adjacent segment disease occurred in 6.2% of patients. Patient-Reported Outcome Measurement Information System (PROMIS) short form scores demonstrated clinically meaningful early and midterm improvement across all domains. Physical Function scores increased from baseline (35.12 ± 5.92) to a peak at 12 months (43.15 ± 7.67, p < 0.001) and remained above baseline at the long-term follow-up (39.51 ± 5.41 at 60 months, p = 0.0074). Pain Intensity and Pain Interference scores showed similar substantial early improvements, peaking at 3-12 months. Although some decline occurred over 5 years, long-term scores remained comparable or slightly better than preoperative levels, consistent with expected progression of degenerative spine disease.</p><p><strong>Conclusions: </strong>MI-TLIF without BMP demonstrates high fusion rates, durable clinical improvement, and low reoperation rates, supporting its use as a safe and cost-effective alternative to BMP-augmented fusion. Larger prospective studies are warranted to validate long-term durability and refine patient selection.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of neighborhood deprivation with pain, function, and disability recovery trajectories following cervical spine surgery.","authors":"Yifei Sun, Sasha Howell, Nicholas M B Laskay, Jovanna Tracz, Anil Mahavadi, James Mooney, Jakub Godzik","doi":"10.3171/2026.4.SPINE26111","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26111","url":null,"abstract":"<p><strong>Objective: </strong>Although neighborhood deprivation has been shown to predict complications and readmissions, its association with pain, disability, and function in degenerative cervical spine disease has not been demonstrated. The aim of this study was to investigate the association between the Area Deprivation Index (ADI) and patient-reported outcome measures (PROMs) preoperatively and 3, 6, and 12 months postoperatively.</p><p><strong>Methods: </strong>This was a secondary analysis of a single-center prospectively collected database of patients who underwent elective cervical spine surgery from January 2021 to September 2024. PROMs included the Patient-Reported Outcomes Measurement Information System (PROMIS)-10 Global Health physical and mental health domains, Neck Disability Index (NDI), and numeric rating scale (NRS) for neck pain and arm pain. Neighborhood disadvantage was assessed via the ADI, with higher values indicating greater deprivation. Outcomes were assessed at preoperative and 3-, 6-, and 12-month postoperative time points. The minimal clinically important difference (MCID) was assessed at each time point. Missing data were handled with imputation. Unadjusted comparisons and 1-way ANOVA were used to evaluate differences in PROMs across ADI quartiles, and multivariable adjusted linear regression models were used to evaluate the association between ADI and PROMs.</p><p><strong>Results: </strong>There were 449 patients (mean age 57.9 years) included in this analysis. Patients in higher ADI quartiles of deprivation reported significantly worse preoperative pain, disability, and health-related quality of life, with higher NRS neck and arm pain scores and NDI scores, and lower PROMIS physical and mental health domain scores (p ≤ 0.005). These disparities persisted at 3 and 6 months postoperatively, with patients in the highest deprivation quartile demonstrating worse pain, disability, and PROMIS outcomes compared with those in lower quartiles (p < 0.01). However, this difference was no longer seen by 12 months. In the multivariable regression analysis, high deprivation independently predicted worse baseline PROMs and reduced improvement in pain, disability, and PROMIS physical function at 3 and 6 months after surgery, although this association did not persist at 12 months. Deprivation was inconsistently associated with achieving the MCID, with lower odds for the NDI, NRS for arm pain, and PROMIS domains at early time points but without persisting disadvantage at 12 months.</p><p><strong>Conclusions: </strong>Higher levels of deprivation according to the ADI were associated with worse preoperative disease severity and worse quality of life and function during early recovery, but with improvements at later time points. Patients with greater socioeconomic deprivation can derive significant benefit from surgical intervention for degenerative cervical spine conditions.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-13"},"PeriodicalIF":3.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}