Journal of neurosurgery. Spine最新文献

{"title":"Initial follow-up results in patients undergoing uniportal full endoscopic cervical unilateral laminotomy for bilateral decompression.","authors":"Steve S Cho, Yoon Ha Hwang, Mohammed Madi, Dong Hwa Heo, Hyeun Sung Kim","doi":"10.3171/2025.12.SPINE25849","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE25849","url":null,"abstract":"<p><strong>Objective: </strong>Cervical spondylosis affects 5%-20% of the population and is commonly managed with posterior decompression. However, early studies of laminectomy without fusion revealed a significant risk of postoperative kyphosis, leading to the adoption of laminectomy with posterior fixation or laminoplasty as the standard of care. The aim of this study was to assess whether posterior decompression performed via a uniportal full endoscopic approach can achieve adequate decompression of the cervical spinal cord while preserving postoperative alignment.</p><p><strong>Methods: </strong>This single-surgeon single-institution retrospective case series included patients who underwent uniportal full endoscopic cervical unilateral laminotomy for bilateral decompression (UNI-CE-ULBD) between August 2023 and August 2024. Radiography, CT, and MRI performed preoperatively and at 1, 3, 6, and 12 months postoperatively were used to assess canal decompression, cervical alignment, and range of motion (ROM).</p><p><strong>Results: </strong>UNI-CE-ULBD was performed in 42 patients, and 15 patients (10 male, mean age 61.1 ± 9.9 years) who completed ≥ 9 months of follow-up (mean 12.1 ± 3.8 months, range 9.0-18.1) were included in the analysis. The mean canal stenosis improved from 37.2% ± 12.1% preoperatively to 5.2% ± 14.5% 6 months postoperatively (p < 0.0001). No significant change in cervical alignment, segmental angles, or ROM was observed. Four patients exhibited mild reductions in cervical lordosis. Clinically, patients showed significant improvements in neck/arm pain and myelopathy. Of 6 patients with preoperative motor deficits, 4 improved measurably and none experienced new or worsening deficits. The mean modified Japanese Orthopaedic Association score increased from 14.0 ± 1.7 to 15.7 ± 1.0 (p = 0.0001). There were no intraoperative complications, perioperative adverse events, or reoperations.</p><p><strong>Conclusions: </strong>In this retrospective case series, UNI-CE-ULBD achieved effective cervical cord decompression without short-term postoperative malalignment and might offer a minimally invasive alternative to traditional fusion-based posterior approaches in appropriately selected patients.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856476","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. Blurring boundaries: revisiting scope, training, and competency in spine intervention.","authors":"Aaron M Gelinne, Allie Harbert, Eldad Hadar, Cheerag D Upadhyaya","doi":"10.3171/2025.12.SPINE251438","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE251438","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-3"},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856415","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":"Prevalence of interventional spine procedures performed by pain management physicians: blurred boundaries.","authors":"Juan P Giraldo, Gabriella P Williams, Nikhil Dholaria, Brayden Haberman, Katriel E Lee, Jonathan J Lee, Jay D Turner, Juan S Uribe","doi":"10.3171/2025.10.SPINE241562","DOIUrl":"https://doi.org/10.3171/2025.10.SPINE241562","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Interventional pain management physicians (IPMPs) and spine surgeons are allies in treating spinal disorders. In addition to medical management, IPMPs can perform procedures such as epidural injections, rhizotomies, or kyphoplasties to bring relief to patients. However, some IPMPs perform procedures traditionally performed by spine surgeons, such as minimally invasive spine surgery, neural decompression, and spinal fusion. The line between spine procedures performed by spine surgeons and interventional pain management procedures performed by IPMPs has blurred. This study aimed to determine the incidence of IPMPs performing interventional spinal procedures traditionally performed by spine surgeons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;IPMPs were identified through the American Society of Interventional Pain Physicians (ASIPP) DoctorFinder database. Each physician's Scopus profile was evaluated to determine academic productivity. Personal physician websites were queried to determine whether they offered minimally invasive or open spinal procedures. Potential associations and differences among IPMPs performing interventional spinal procedures were analyzed using descriptive statistics, independent-sample t-tests, and chi-square analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After neurosurgeons and orthopedic surgeons were removed from the initial list of 325 registered healthcare providers, 269 providers were included in the analysis (mean [SD] age, 56.3 [9.6] years). Physician degrees included MD (n = 237) and DO (n = 32). Some physicians held an additional degree (MS [n = 4], PhD [n = 4], and unspecified [n = 38]). Of the 269 healthcare providers, 130 had Scopus research profiles (mean publications, 24.2; mean h-index, 6.0; mean citations, 925.6). Seventy-four physicians (27.5%) performed interventional spinal procedures: 35 (13.0%) performed minimally invasive lumbar decompression (mild procedure), 33 (12.3%) performed Superion or Vertiflex interspinous spacer insertion, 18 (6.7%) performed spinal arthrodesis or fusion, 26 (9.7%) performed discectomies, 11 (4.1%) performed Minuteman interspinous-interlaminar fusion, 1 (0.4%) performed disc replacement, and 14 (5.2%) performed other unspecified decompressive spinal procedures. There were no significant differences in age (p = 0.62), publication number (p = 0.19), h-index (p = 0.53), citation count (p = 0.44), and fellowship incidence (p = 0.19) between IPMPs who performed interventional spine procedures and those who did not. No significant associations were found between sex (p = 0.19), medical degree (MD: p = 0.07, DO: p = 0.11), or number of publications (p = 0.38) and whether interventional spinal procedures were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The incidence of invasive spine procedures performed by IPMPs is high. Future studies must analyze patient-reported outcomes, and differences in the training for traditional spine surgery interventions performed by su","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856454","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":"From anticipation to achievement: evaluating the impact of preoperative expectations on postoperative patient satisfaction in lumbar decompression surgeries.","authors":"Kiumars Edalati, Aiyush Bansal, Kenneth T Nguyen, Michael Jeffko, Paul Wilson, Patricia Lipson, Comron Saifi, Philip K Louie","doi":"10.3171/2025.12.SPINE251460","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE251460","url":null,"abstract":"<p><strong>Objective: </strong>Patient expectations significantly influence perceived success and satisfaction following spine surgery. While objective metrics assess outcomes, patient-reported outcomes (PROs) are the gold standard for evaluating subjective outcomes and health-related quality of life. Recent studies highlight the complex relationship between preoperative expectations and postoperative satisfaction in spine surgeries. However, the impact of preoperative expectations on PROs for lumbar decompression remains unexplored. The objective of this study was to examine how preoperative expectations influence postoperative satisfaction following lumbar decompression surgery.</p><p><strong>Methods: </strong>This prospective cohort study included adults undergoing primary or revision 1- to 2-level lumbar laminectomy or discectomy at a single center between July 2023 and August 2024. PRO measures included the Musculoskeletal Outcomes Data Evaluation and Management Systems instrument, Oswestry Disability Index (ODI), SF-36, and satisfaction (scale 0-100) collected before surgery and 6 weeks, 3 months, and 6 months after surgery. Expectation-outcome mismatch was calculated as preoperative expectation minus postoperative outcome. Multivariable linear regression was used to assess the association between mismatch and satisfaction while adjusting for demographic and clinical covariates.</p><p><strong>Results: </strong>Of 104 enrolled patients, 89 (mean age 64.9 years) were included in this analysis. Preoperative expectation for pain relief was high, with 91% of patients anticipating significant improvement, yet this was achieved postoperatively in only 69%-71%. Lumbar decompression produced substantial functional gains, with the mean ODI score improving from 39.9 ± 17.8 preoperatively to 19.7 ± 19.4 at 3 months, and SF-36 scores showing marked improvement. Expectation-outcome mismatch was the strongest predictor of satisfaction at all time points. Each 10-point increase in mismatch was associated with an approximately 8-point decrease in satisfaction postoperatively at 6 weeks, 3 months, and 6 months (all p < 0.001). No demographic or clinical factors predicted satisfaction at 6 months.</p><p><strong>Conclusions: </strong>Expectation-outcome alignment was the primary determinant of postoperative satisfaction following lumbar decompression. Although patients experienced substantial improvements in disability and quality of life, many did not experience the degree of pain relief they anticipated, and unmet expectations were closely associated with lower satisfaction across all recovery stages. These findings highlight the clinical value of structured realistic preoperative counseling focused on anticipated pain relief, functional recovery, and expected recovery timelines. Incorporating expectation management into routine preoperative discussions might reduce mismatch, improve satisfaction, and support more patient-centered perioperative care.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856505","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":"Age-related differences in surgical outcomes for traumatic central cord syndrome: a multi-institutional causal machine learning analysis.","authors":"Carlos A Aude, Vikas N Vattipally, Ritvik Jillala, Jawad Khalifeh, Liam P Hughes, Jacob Jo, James P Byrne, Christopher D Witiw, Timothy Chryssikos, Gary Schwartzbauer, John R Williams, Daniel Lubelski, Ali Bydon, Timothy F Witham, Nicholas Theodore, Tej D Azad","doi":"10.3171/2025.12.SPINE25166","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE25166","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic central cord syndrome (TCCS) is the most common incomplete spinal cord injury, yet the optimal management strategy remains controversial, particularly for older adults who often present with worse outcomes. The authors aimed to determine whether surgical intervention confers different benefits across age groups, focusing on 1-year functional and neurological recovery.</p><p><strong>Methods: </strong>The authors retrospectively analyzed 890 patients with TCCS from the multi-institutional Spinal Cord Injury Model Systems (SCIMS) Database between 2006 and 2021. TCCS was defined as an American Spinal Injury Association (ASIA) Impairment Scale grade C or D cervical injury and at least a 5-point discrepancy favoring lower extremity motor score over upper extremity motor score. Missing admission ASIA data were addressed via validated random forest imputation. The authors compared surgical versus nonsurgical groups using full optimal matching to reduce confounding, achieving balanced cohorts (698 patients in the surgical group vs 179 in the nonsurgical group). The authors then applied a causal forest algorithm to detect heterogeneous treatment effects and used segmented regression to identify age-related inflection points. The primary outcome was the Physical Function Composite Score (PFCS) (range 0-300), which captures physical independence, mobility, and occupational function. Sensitivity analyses further evaluated neurological recovery on the basis of ASIA motor scores and stricter criteria for TCCS identification after the exclusion of imputed data.</p><p><strong>Results: </strong>Across the matched cohort, surgery was associated with mean PFCS improvement of 6.6 points (95% CI -4.5 to 17.8), which did not reach statistical significance. However, subgroup analysis revealed that age was the strongest effect modifier of surgical benefit (relative importance 42.8%, p < 0.001). Segmented regression identified an inflection at approximately 64 years of age. Patients older than 64 years demonstrated a significant improvement of 34.7 points (95% CI 12.2-57.2), whereas younger individuals showed no statistically significant surgical benefit (-4.1 points, 95% CI -16.8 to 8.6). All sensitivity analyses were consistent with the results of our primary findings.</p><p><strong>Conclusions: </strong>The authors' findings suggest that the effectiveness of surgical intervention for TCCS may be influenced by age, with adults older than 64 years experiencing differentially greater functional and neurological benefit. These results may inform patient-specific treatment decisions and clinical guidelines. Prospective research is needed to validate these observations, elucidate underlying mechanisms, and guide evidence-based TCCS management.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856418","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":"Lumbar Spine Research Society 19th Annual Scientific Meeting Abstracts.","authors":"","doi":"10.3171/2026.5.LSRS2025abstracts","DOIUrl":"https://doi.org/10.3171/2026.5.LSRS2025abstracts","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":"44 5","pages":"1-107"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816513","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":"Targeting EGFR with miR-148a-3p: a novel approach to mitigate intervertebral disc degeneration.","authors":"Lei Zhang, Xiaoming Cong, Shaowei Sun, Pengcheng Li, Wei Zhao, Nan Wang, Dewei Shen, Yang Zhang","doi":"10.3171/2025.12.SPINE251314","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE251314","url":null,"abstract":"<p><strong>Objective: </strong>In light of microRNA (miRNA)-targeted therapies in the management of intervertebral disc degeneration (IVDD), this study aimed to elucidate the role and mechanism of miRNA (miR)-148a-3p in the pathogenesis of IVDD.</p><p><strong>Methods: </strong>Human nucleus pulposus (NP) cells treated with interleukin (IL)-1β (10 ng/mL) were used to simulate IVDD in vitro. Gain-of-function experiments were performed by transfecting NP cells with an miR-148a-3p mimic and a pcDNA-epidermal growth factor receptor (EGFR) vector (a mammalian expression encoding EGFR) and evaluated using the CCK-8 assay and TUNEL staining. The target of miR-148a-3p was identified by a dual-luciferase reporter assay. An in vivo IVDD model was established using Sprague-Dawley rats subjected to acupuncture, followed by histological, inflammatory, and expression analyses.</p><p><strong>Results: </strong>Downregulation of miR-148a-3p but upregulation of EGFR was observed in IL-1β-treated NP cells. Increasing miR-148a-3p resulted in elevated cell viability but decreased apoptosis in IL-1β-treated NP cells. Meanwhile, the upregulation of miR-148a-3p effectively counteracted all IL-1β-induced alterations in protein expression, as demonstrated by the enhanced expression of extracellular matrix (ECM)-associated markers, alongside a reduction in autophagy markers such as LC3II/LC3I, Beclin1, and ATG7. MiR-148a-3p was found to exert a negative regulatory effect on EGFR. The overexpression of EGFR negated the alterations induced by the miR-148a-3p mimic. In the IVDD rat model, miR-148a-3p ameliorated histological damage and enhanced ECM marker expression while concurrently reducing the inflammatory response and autophagy markers.</p><p><strong>Conclusions: </strong>The restoration of miR-148a-3p inhibited EGFR, thereby suppressing inflammation, apoptosis, and autophagy but promoting ECM production in IVDD models. Therefore, miR-148a-3p may serve as a potential therapeutic candidate for the management of IVDD.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-12"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816589","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":"Characterizing immune involvement in degenerative cervical myelopathy: a systematic review.","authors":"Peter J Chabot, Nathan J Winans, Joshua S Fuller, Nicholas B Dadario, Travis S CreveCoeur, Nathaniel Rolfe, Harrison J Howell, Shailen G Sampath, Dean Chou, Andrew K Chan","doi":"10.3171/2025.12.SPINE251122","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE251122","url":null,"abstract":"<p><strong>Objective: </strong>Degenerative cervical myelopathy (DCM) is the most common cause of cervical spinal cord impairment in adults. It is described as progressive, age-related spinal cord compression due to degenerative changes in the spinal column. While the mechanical pathology of DCM is well characterized, the immune system's role in the disease's neurological progression and potential as a therapeutic target remains unclear. The authors aimed to comprehensively review the available literature on immunological involvement in DCM pathogenesis. Understanding the interactions between inflammation, apoptosis, and neurodegeneration in DCM may provide insights into novel treatment strategies.</p><p><strong>Methods: </strong>A systematic literature review was conducted in the PubMed database through August 1, 2024, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Papers met inclusion criteria for the review if they reported on molecular, histological, CSF, or peripheral markers of immune involvement or the immune response, causation, or relation to DCM. Systematic reviews, case reports, or animal studies were excluded. Studies were screened by two blinded authors based on relevance and synthesized to assess the immune environment in DCM.</p><p><strong>Results: </strong>A total of 113 studies were identified, with 10 meeting the inclusion criteria. Findings revealed elevated proinflammatory cytokines in the CSF of DCM patients, including interleukin-8 and tumor necrosis factor-α, as well as increased oligoclonal IgG bands and blood-spinal cord barrier disruption. Histological analysis demonstrated apoptosis via Fas-mediated pathways, impaired autophagy, and increased staining for activated myeloid cells in DCM tissue compared to controls. Peripheral immune profiling indicated increased M2 macrophages and activated CD4 T cells in DCM patients. Furthermore, serum S100b postoperative values and perioperative CSF levels of neurofilament light chain and glial fibrillary acidic protein correlated significantly with clinical improvement and favorable outcomes following treatment. This review is limited by the number of eligible studies, causal interpretation and temporal bias, and lack of standardized interstudy biomarker analysis. These findings identify an immune component of DCM neurodegeneration that may influence disease severity and treatment response.</p><p><strong>Conclusions: </strong>There is a significant interplay between immune responses and DCM disease progression, revealing how inflammatory mechanisms can influence clinical outcomes and treatment efficacy. Further studies are warranted to understand the immune component of DCM and pave the way for targeted immunotherapies alongside surgical decompression.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-12"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816477","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 and prognostic factors in patients with spinal dural arteriovenous fistula: a nearly 10-year prospective cohort study.","authors":"Huishen Pang, Chengbin Yang, Zihao Song, Xin Su, Yiguang Chen, Huiwei Liu, Lisong Bian, Peng Hu, Chuan He, Ming Ye, Guilin Li, Tao Hong, Peng Zhang, Hongqi Zhang, Yongjie Ma","doi":"10.3171/2025.12.SPINE25729","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE25729","url":null,"abstract":"<p><strong>Objective: </strong>This prospective cohort study aimed to evaluate the long-term outcomes of patients with spinal dural arteriovenous fistulas (SDAVFs) nearly 10 years after treatment and identify prognostic factors influencing recovery and progression.</p><p><strong>Methods: </strong>Seventy-six patients diagnosed with SDAVF from two centers in China were treated with microsurgery, endovascular therapy, or combined therapy based on angiographic findings. Baseline data collected included age, gender, disease duration, modified Aminoff-Logue Scale (mALS) scores, the presence of numbness and pain (modified Denis Scale [mDS] scores), fistula location, and treatment method. Follow-up evaluations were conducted at 3 months, 6 months, 1 year, 6 years, and nearly 10 years after treatment, in which mALS and mDS scores were recorded.</p><p><strong>Results: </strong>The mean follow-up duration was 121.6 (SD 3.8) months. Fistulas were predominantly in the lower thoracic spine (T7-12, 48.7%), and 82.9% of the patients were male. Improvement was observed in 63.2% of the patients, whereas 55.3% had poor outcomes (mALS score ≥ 4) and 32.9% showed late clinical deterioration. Patient age > 55 years (OR 4.316, 95% CI 1.312-14.196; p = 0.016) and pretreatment disability (moderate: OR 10.160, 95% CI 1.932-53.433, p = 0.006; severe: OR 22.112, 95% CI 2.440-200.344, p = 0.006) were predictors of poor 10-year outcomes. Pretreatment disability (moderate: OR 8.432, 95% CI 1.008-70.512, p = 0.049; severe: OR 12.838, 95% CI 1.231-133.907, p = 0.033) were further associated with late clinical deterioration.</p><p><strong>Conclusions: </strong>Patients with SDAVFs show early functional improvement but progressive decline over time. Older age and moderate to severe pretreatment disability predicted poor outcomes, while moderate to severe pretreatment disability was associated with late clinical deterioration. These findings highlight the need for early intervention and long-term rehabilitation to mitigate functional decline.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816570","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":"The association between lumbopelvic fixation and improved pain and function in patients with unstable pathologic sacral fractures.","authors":"Takashi Hirase, Michael Mazzucco, Max Vaynrub","doi":"10.3171/2025.12.SPINE251346","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE251346","url":null,"abstract":"<p><strong>Objective: </strong>Spinopelvic dissociation from U- or H-type pathologic sacral fractures can be debilitating and often results in chronic pain and functional impairment. In the setting of metastatic disease with prior or planned radiotherapy (RT) and/or chemotherapy, obtaining a successful fracture union is particularly challenging. This study sought to determine the effectiveness of lumbopelvic fixation for the treatment of U- or H-type pathologic sacral fractures.</p><p><strong>Methods: </strong>The authors reviewed data from patients with metastatic disease who presented with U- or H-type pathologic sacral fractures recalcitrant to nonoperative management and were treated with lumbopelvic instrumentation at a single institution between January 2019 and November 2024. Primary outcome measures were pre- and postoperative sacral pain (assessed using a visual analog scale [VAS]), ambulatory status, and opioid use in morphine milligram equivalents (MMEs).</p><p><strong>Results: </strong>Twenty-two patients (mean age 63.4 [SD 12.8] years) met the inclusion criteria and had a mean of 14.5 (SD 9.2) months of follow-up. Seventeen patients (77.3%) underwent RT prior to surgery with a mean biologically effective dose of 59.1 (SD 14.6) Gy. The mean preoperative sacral VAS pain score was 7.5 (SD 2.2), which decreased to 2.2 (SD 2.2) at 3 weeks postoperatively (p < 0.001) and 0.4 (SD 1.1) at final follow-up (p < 0.001). All 22 patients had radicular symptoms preoperatively, compared to 2 patients (9.1%) at final follow-up (p < 0.001). Improvement in ambulatory status relative to preoperative baseline was evident in 15 patients (68.2%) at 3 weeks and in 19 patients (86.4%) at final follow-up. The mean preoperative daily opioid use was 156.1 (SD 154.9) MMEs, which decreased to 77.0 (SD 92.7) MMEs at 6 weeks postoperatively (p = 0.048) and 59.1 (SD 97.5) MMEs at final follow-up (p = 0.018). There was 1 reoperation (4.5%) at the final follow-up for a set-screw disengagement.</p><p><strong>Conclusions: </strong>Patients with metastatic disease who present with spinopelvic dissociation from U- or H-type pathologic sacral fractures use fewer opioid medications for axial and radicular pain and have better ambulatory function following lumbopelvic fixation. Larger, prospective studies are needed to confirm the authors' findings.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":3.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774133","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}