Journal of neurosurgery. Spine最新文献

{"title":"Does postoperative gabapentinoid prescription reduce chronic opioid use following short-segment lumbar instrumentation?","authors":"Janesh Karnati, Andrew Wu, Aydin Kaghazchi, Ahmed Ashraf, Gabriel Jelkin, Sruthi Ranganathan, Shameel Abid, Leina Lunasco, Sachin Shankar, Mikayla Wallace, Joseph Cheng, Owoicho Adogwa","doi":"10.3171/2026.2.SPINE25802","DOIUrl":"10.3171/2026.2.SPINE25802","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the impact of initial postoperative gabapentinoid prescription on chronic postoperative opioid use in patients who underwent short-segment lumbar instrumentation by using a large multicenter electronic health record database.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the TriNetX research network, encompassing adult patients who underwent short-segment posterior lumbar instrumentation between January 1, 2010, and December 31, 2022. Inclusion criteria were limited to patients with preoperative diagnoses of lumbar spinal stenosis, spondylolisthesis, radiculopathy, or scoliosis. Patients were stratified based on whether they were prescribed a gabapentinoid medication (gabapentin or pregabalin) within 30 days following the index procedure. To reduce confounders, 1:1 propensity score matching was performed based on age, sex, race, comorbidities, and preoperative opioid and gabapentinoid prescriptions. Postoperative opioid prescribing patterns were assessed at 3-6 months, 6-12 months, and 12-24 months postoperatively. Medications were identified via RxNorm codes and classified as codeine-based (oxycodone, hydrocodone, codeine, and tramadol) or noncodeine-based (fentanyl, morphine, and hydromorphone). Agents were further stratified by morphine milligram equivalent (MME) potency: strong (MME > 1), moderate (MME = 1), or weak (MME < 1).</p><p><strong>Results: </strong>Among 27,165 eligible patients (mean age 59.5 ± 13.3 years), 11,528 received a gabapentinoid prescription within 30 days postoperatively, while 15,637 did not. After matching, each group consisted of 1893 patients with comparable baseline characteristics. At 3-6 months postoperatively, gabapentinoid recipients had significantly lower odds of being prescribed codeine-based (OR 0.743), noncodeine-based (OR 0.602), and strong (OR 0.574) opioids. No significant difference was observed for weak opioids. At 6-12 months, this association persisted for codeine-based (OR 0.778), noncodeine-based (OR 0.564), and strong (OR 0.589) opioids. At 12-24 months, the gabapentinoid group continued to demonstrate lower odds of noncodeine-based (OR 0.523) and strong (OR 0.612) opioid prescriptions, although differences in codeine-based, moderate, and weak opioids were not significant.</p><p><strong>Conclusions: </strong>Postoperative gabapentinoid prescription within 30 days of short-segment lumbar instrumentation was associated with significantly lower odds of chronic postoperative opioid use, particularly for strong and noncodeine-based agents. These findings support gabapentinoids as a beneficial adjunct in multimodal postoperative pain management.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"413-422"},"PeriodicalIF":3.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339006","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. Rethinking spinal cord gliomas: beyond the intracranial paradigm.","authors":"Seongjun Ryu, Yoon Ha","doi":"10.3171/2026.2.SPINE26137","DOIUrl":"10.3171/2026.2.SPINE26137","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"437-439"},"PeriodicalIF":3.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338797","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":"Outside-in foraminal access for cervical dumbbell tumors: a surgical paradigm shift with technical insights and clinical outcomes.","authors":"Hao Yan, Yun Liu, Han Lin, Long Wang, Bo Han, Li Yu, Xiao Wu, Ruichao Chai, Hui Qiao, Wenqing Jia, Yongzhi Wang","doi":"10.3171/2026.1.SPINE25944","DOIUrl":"10.3171/2026.1.SPINE25944","url":null,"abstract":"<p><strong>Objective: </strong>Cervical dumbbell tumors present surgical challenges due to their proximity to critical structures, including the facet joints and vertebral artery (VA). Conventional posterior approaches often require facet joint resection and fusion, risking spinal instability. This study summarizes the authors' experience with a lateral foraminal approach that preserves facet integrity through a minimally invasive corridor.</p><p><strong>Methods: </strong>The lateral foraminal approach begins with an incision along the lateral border of the sternocleidomastoid, proceeding obliquely \"outside-in\" through the interscalene space between the scalene muscles. Depending on the specific spinal level and corresponding orientation of the intervertebral foramen, this surgical concept incorporates both the anterolateral approach (C2-3 to C7-T1) and the posterolateral approach (C1-2 and occasionally C2-3).</p><p><strong>Results: </strong>The study comprised 30 males and 25 females with a median (range) age of 45 (11-69) years. The tumors were located from C1-2 to C7-T1 intervertebral foramina. Gross-total resection with preserved facet joint integrity was achieved in all cases, with visualization safeguarding brachial plexus and VA integrity during resection. Surgery resulted in significant improvements in neurological function and pain, with mean Japanese Orthopaedic Association (JOA) scores increasing from 13.3 to 15.1 (p < 0.001) and mean visual analog scale (VAS) scores decreasing from 4.3 to 2.4 (p < 0.001).</p><p><strong>Conclusions: </strong>The lateral foraminal approach is a minimally invasive technique for resecting cervical dumbbell tumors via an anatomical corridor. It preserves the facet joint entirely, eliminating the need for internal fixation or fusion. Under direct visualization, the brachial plexus and VA are microsurgically protected throughout dissection.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"448-456"},"PeriodicalIF":3.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283739","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":"Risk factors for unplanned reoperation after the treatment of early-onset scoliosis with traditional dual growing rods combined with apical control techniques.","authors":"Chenkai Li, Bingtai Han, Bingxu Li, Yang Yang, Guanfeng Lin, You Du, Yiwei Zhao, Haoran Zhang, Xiaohan Ye, Jianguo Zhang, Shengru Wang","doi":"10.3171/2026.1.SPINE251209","DOIUrl":"10.3171/2026.1.SPINE251209","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify the incidence of and potential risk factors for unplanned reoperations following traditional dual growing rods (TDGRs) combined with apical control techniques (ACTs; TDGRs+ACTs).</p><p><strong>Methods: </strong>A retrospective study of patients with early-onset scoliosis treated with TDGRs+ACTs from June 2006 to November 2022 was conducted. The patients were grouped based on the occurrence of unplanned reoperations. Demographic characteristics, surgery-related data, radiographic parameters, complications, unplanned reoperations, and clinical outcomes were collected. Univariate and multivariate analyses were conducted to identify potential risk factors for unplanned reoperation following TDGR+ACT treatment. Receiver operating characteristic (ROC) curve analysis was used to identify the cutoff values.</p><p><strong>Results: </strong>A total of 60 patients were enrolled. The mean age at initial surgery was 7.2 years, with a mean follow-up duration of 6.5 years. Eleven patients (18.3%) underwent 14 unplanned reoperations by the final follow-up. Logistic regression analysis revealed that the 1-year progression rate of global kyphosis (GK; OR 1.211, p = 0.018) was a significant independent risk factor for unplanned reoperation. ROC analysis revealed that the 1-year progression rate of GK had good discriminatory ability (area under the curve 0.855, 95% CI 0.743-0.966), and the cutoff value was 12.5°/year. At the last follow-up, the mean emotion score in the reoperation group was significantly lower than that in the nonreoperation group (63.18 ± 20.16 vs 76.54 ± 18.90, p = 0.042).</p><p><strong>Conclusions: </strong>The unplanned reoperation rate of TDGR+ACT treatment was 18.3%. The 1-year progression rate of GK was an independent risk factor for unplanned reoperation after TDGR+ACT, with the incidence of unplanned reoperation significantly increasing when the 1-year progression rate exceeded 12.5°/year. Unplanned reoperations not only affect the physical health of patients but also impose a heavy burden on their mental health.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"429-436"},"PeriodicalIF":3.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283715","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":"Physical activity and patient-reported outcomes after decompressive endoscopic lumbar spine surgery.","authors":"Sama Noroozi Gilandehi, Loay Shoubash, Jannik Leyendecker, Sanjay Konakondla, Osama Kashlan, Peter Derman, Albert E Telfeian, Christoph P Hofstetter, Mark A Mahan","doi":"10.3171/2026.1.SPINE25926","DOIUrl":"10.3171/2026.1.SPINE25926","url":null,"abstract":"<p><strong>Objective: </strong>Although patients often report improvements in pain and functional capacity after endoscopic lumbar spine surgery, objectively measured real-life physical activity may differ from that reported. This multicenter prospective study aimed to assess the correlations between physical activity and patient-reported outcomes (PROs).</p><p><strong>Methods: </strong>All adult patients undergoing endoscopic lumbar spine surgery were offered enrollment in the SPINEhealthie smartphone app to assess physical activity. Estimated daily step counts (SCs) and serial PROs, including visual analog scale (VAS) leg pain, VAS back pain, and Oswestry Disability Index (ODI) scores, were collected.</p><p><strong>Results: </strong>Of the 289 patients with pre- and postoperative SC data (mean follow-up 11.4 months), > 70% of patients achieved minimal clinically important difference (MCID) for VAS back and leg pain at 2 weeks and remained stable at 1 year (p < 0.05). Although patients demonstrated substantial improvement in VAS leg (-3.4, p < 0.001) and VAS back (-3.1, p < 0.001) pain scores at 2 weeks, the mean SC decreased significantly at 2 weeks (-632.4, p < 0.001). SC began to increase at 3 months (+265.7, p = 0.004). VAS scores demonstrated minimal further improvement beyond 2 weeks, but SCs continued to improve at all subsequent time points (p < 0.001), as did ODI (-12.2 at 3 months and -13.6 at 1 year, p < 0.001 for both). Preoperative SC was highly predictive of 1-year SC (r = 0.86, p < 0.001) and mildly predictive of ODI at 1 year (r = -0.31, p = 0.006). No preoperative PRO was correlated with PROs or SC at 1 year (r ≤ 0.10, p > 0.2 for all). Quartile analysis of SC revealed that pain scores did not correlate with functional measures. The patient quartiles' recovery patterns remained distinct (p < 0.05 between quartiles at 1 year). ODI improvement was greater in patients with higher baseline SCs (-15.6 vs -13.8 in the lowest quartile at 1 year, p = 0.047). Stratification of patients by baseline scores did not distinguish improvement in SC, or ODI, VAS leg pain, or VAS back pain (p > 0.05 for all) scores, indicative that baseline scores did not predict outcomes.</p><p><strong>Conclusions: </strong>Patients demonstrated immediate reduction in pain but delayed improvement in SC and ODI score. Among preoperative assessments, only SCs were predictive of postoperative outcomes. Furthermore, pain scores did not correlate with disability or activity. SC demonstrated interquartile stability, suggesting that SC may provide a reliable and independent perspective and may be predictive of outcomes.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"393-403"},"PeriodicalIF":3.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283755","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":"Can patient-specific precontoured rod instrumentation reduce the rate of proximal junctional kyphosis for adult spinal deformity? A propensity score-matched analysis.","authors":"Michael W Fields, Joseph M Lombardi, Nathan J Lee, Gabriella Greisberg, Justin L Reyes, Mark M Herbert, Matan S Malka, Cole Morrissette, Zeeshan M Sardar, Lawrence G Lenke, Ronald A Lehman","doi":"10.3171/2026.1.SPINE251110","DOIUrl":"10.3171/2026.1.SPINE251110","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to determine whether patient-specific precontoured rod (PCR) instrumentation is associated with lower rates of proximal junctional kyphosis (PJK) compared with manually contoured conventional rods (CRs) in adult spinal deformity (ASD) surgery.</p><p><strong>Methods: </strong>The data of ASD patients (age ≥ 18 years) undergoing posterior spinal instrumentation and fusion of a minimum of 5 levels were consecutively reviewed from 2016 to 2021. A propensity score-matching algorithm was used to match patients undergoing instrumentation with PCRs (n = 80) to those treated with CRs (n = 210). The primary outcome was the rate of radiographic PJK at a minimum follow-up of 1 year. PJK was defined by two criteria: a postoperative proximal junctional sagittal angle (PJA) 1) ≥ 10° and 2) at least 10° greater than the preoperative measurement.</p><p><strong>Results: </strong>Following propensity score matching, 160 patients were included in the study (80 per group). Patients demonstrated similar preoperative baseline characteristics and preoperative radiographic alignment. Preoperatively, the mean PJAs measured 9.24° ± 6.8° and 8.8° ± 7.3° for the PCR and CR groups, respectively (p = 0.751). At the most recent follow-up, the PCR and CR groups demonstrated mean PJAs of 11.6° ± 9.1° and 10.8° ± 8.3°, respectively (p = 0.545). Ten (12.5%) patients experienced PJK in the PCR group compared to 16 (20%) patients in the CR group (p = 0.199). In patients with upper instrumented vertebrae in the lower thoracic region, 5 (11.1%) patients in the PCR group experienced PJK versus 12 (26.7%) patients in the CR group (p = 0.059). Furthermore, 7 (10.9%) patients in the PCR group experienced PJK compared to 14 (21.5%) patients in the CR group after including patients with fusion to the sacrum/pelvis (p = 0.103).</p><p><strong>Conclusions: </strong>Lower rates of PJK were observed in the PCR group when compared to the CR cohort. However, this relationship was not statistically significant. Future studies with longer-term follow-up and larger sample sizes are warranted to investigate the relationship between PCR instrumentation and PJK prophylaxis. While PCR technology alone is likely not a definitive solution for preventing PJK, its strength lies in enabling rigorous preoperative planning and thoughtful deformity correction strategies. When integrated into a comprehensive approach to patient optimization, alignment, and junctional control, PCRs may serve as a useful adjunct in mitigating PJK risk.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"423-428"},"PeriodicalIF":3.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283772","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":"Subaxial cervical spine fractures in ankylosing spondylitis: management and outcomes from a 10-year population-based cohort.","authors":"Pål Nicolay Fougner Rydning, Hege Linnerud, Jalal Mirzamohammadi, Tor Brommeland, Magnus Evjensvold, Vidar Stenset, Dag Ferner Netteland, Eirik Helseth, Markus K H Wiedmann","doi":"10.3171/2026.1.SPINE251637","DOIUrl":"10.3171/2026.1.SPINE251637","url":null,"abstract":"<p><strong>Objective: </strong>Patients with ankylosing spondylitis (AS) are predisposed to unstable cervical spine fractures with a high risk of cervical spinal cord injury (cSCI). Evidence regarding optimal management and outcomes in this population remains limited. This study aimed to describe treatment strategies and short-term outcomes in a prospectively collected, population-based cohort.</p><p><strong>Methods: </strong>This 10-year (2015-2024) population-based study included all traumatic subaxial cervical spine fractures in patients with AS treated at Oslo University Hospital, the sole neurotrauma center serving Southeast Norway. Data were prospectively collected and analyzed for fracture morphology, management approach, surgical technique, complications, and 90-day mortality.</p><p><strong>Results: </strong>A total of 132 fractures occurred in 127 patients (median age 70 years, 88% male). Most injuries (86%) resulted from low-energy falls. AO Spine type B or C fractures accounted for 94% of the fractures, and 20% were associated with cSCI. Primary management was surgical in 67% and conservative in 33%. Posterior fixation was the predominant surgical approach (77%). Among patients initially managed conservatively, 14% required delayed surgery. Revision surgery was performed in 9%, most commonly for implant failure after anterior-only fixation or deep infection. The 90-day mortality rate was 16% and was independently associated with advanced age, higher American Society of Anesthesiologists class, and in-hospital pneumonia, but not with cSCI, functional status, or treatment modality.</p><p><strong>Conclusions: </strong>Most AS-related subaxial cervical spine fractures are highly unstable and benefit from early surgical stabilization. Conservative management carries a substantial risk of failure. The high short-term mortality rate reflects patient frailty rather than treatment strategy. Multidisciplinary evaluation and close follow-up are essential, particularly for patients managed nonoperatively.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"347-356"},"PeriodicalIF":3.9,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239458","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":"A novel fully visualized transparent channel in posterior uniportal endoscopic spine surgery: a paradigm shift for nerve root exposure and decompression under direct visualization.","authors":"Maji Sun, Syed Ahmad Ali Shah, Junwei Zhang, Shuo Feng, Yang Sun, Bin Pan, Feng Yuan","doi":"10.3171/2026.1.SPINE251142","DOIUrl":"10.3171/2026.1.SPINE251142","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to explore the technical advantages and clinical efficacy of the fully visualized transparent channel in posterior uniportal endoscopic spine surgery for direct nerve root exposure.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 120 patients with lumbar spinal stenosis who underwent posterior uniportal endoscopic spine surgery between January 2022 and December 2023. Patients were divided into a transparent channel group (60 cases) and a metal channel group (60 cases). A polypropylene/polyamide 6 nanocomposite transparent channel system was used in the transparent channel group, whereas a traditional titanium alloy channel was used in the metal channel group. The two groups were compared in terms of surgical field coverage (structural similarity index measure [SSIM]), nerve root traction time, intraoperative blood loss, operation time, postoperative complications, and follow-up outcomes (visual analog scale, Oswestry Disability Index, and Macnab scores).</p><p><strong>Results: </strong>The surgical field coverage in the transparent channel group was significantly higher than that in the metal channel group (SSIM 0.89 ± 0.05 vs 0.52 ± 0.08, p < 0.001). Nerve root traction time (2.3 ± 0.6 minutes vs 4.1 ± 1.1 minutes, p < 0.01) and intraoperative blood loss (18.5 ± 3.2 mL vs 24.7 ± 4.5 mL, p < 0.05) were significantly reduced. The incidence of postoperative nerve irritation signs was 0% in the transparent channel group and 10% in the metal channel group (p < 0.01). The excellent/good rates of Macnab scores at 1 year postoperatively were 96.7% versus 88.3% (p < 0.05).</p><p><strong>Conclusions: </strong>The fully visualized transparent channel significantly improves surgical field clarity and operational safety, providing a more surgically aligned minimally invasive solution for posterior endoscopic spine surgery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"330-338"},"PeriodicalIF":3.9,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239460","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 \"one-and-a-half\" minimally invasive transforaminal lumbar interbody fusion: a single-center retrospective case series.","authors":"Minaam Farooq, Ahmet Kartal, Chibuikem A Ikwuegbuenyi, Mousa K Hamad, Anthony Robayo, Evan Wang, Noel F Manalil, Noah Willett, Andreas Kramer, Rodolfo Villalobos-Díaz, Ibrahim Hussain, Roger Härtl","doi":"10.3171/2026.1.SPINE251181","DOIUrl":"10.3171/2026.1.SPINE251181","url":null,"abstract":"<p><strong>Objective: </strong>Symptomatic lumbar spondylolisthesis with multilevel spinal stenosis poses a complex surgical challenge, often managed through multilevel decompression and fusion. There is a hybrid surgical approach, termed \"one-and-a-half,\" that combines minimally invasive transforaminal lumbar interbody fusion (mTLIF) at the unstable segment with unilateral laminotomy for bilateral decompression (ULBD) at an adjacent stenotic level without fusion. The aim of this study was to assess the reoperation rate, specifically fusion extension to adjacent decompressed segments, in patients who underwent the one-and-a-half mTLIF technique.</p><p><strong>Methods: </strong>This retrospective analysis reviewed patients who underwent one-and-a-half mTLIF performed by a single surgeon between January 2016 and February 2023 at a single institution. The revision surgery rate, as well as radiographic and clinical outcomes, was assessed.</p><p><strong>Results: </strong>Thirty-three patients (57.6% male, mean age 67.9 years) who underwent one-and-a-half mTLIF were included, with a median follow-up of 26 months. Fusion was achieved in 96.2% (25/26) of patients. The reoperation rate was 9.1% (3/33); 2 patients (6.1%) required subsequent fusion at the previously decompressed (ULBD-treated) level and 1 patient (3.0%) at the index level. The perioperative complication rate was 12.1% (4/33), and neurological complications were not observed.</p><p><strong>Conclusions: </strong>The one-and-a-half mTLIF technique is a promising alternative to traditional multilevel fusion in patients with lumbar spondylolisthesis and concurrent multilevel stenosis. This hybrid approach offers a biomechanically stable alternative to multilevel fusion by selectively fusing the unstable segment while preserving spinal motion through decompression alone at the adjacent stenotic level. This study highlights its long-term effectiveness in reducing the necessity for reoperation and fusion extension, suggesting one-and-a-half mTLIF as a less invasive yet durable solution for managing complex lumbar spine pathology with promising radiographic and clinical outcomes.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"339-346"},"PeriodicalIF":3.9,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239533","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. Podium to press: what counts as progress?","authors":"Jakub Godzik","doi":"10.3171/2026.1.SPINE251658","DOIUrl":"10.3171/2026.1.SPINE251658","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"313-314"},"PeriodicalIF":3.9,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175824","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}