Journal of neurosurgery. Spine最新文献

{"title":"Utility of direct wave intraoperative neuromonitoring for intramedullary spinal cord tumor resection.","authors":"Kelly Jiang, Abdel-Hameed Al-Mistarehi, Khaled J Zaitoun, Carly Weber-Levine, Yuanxuan Xia, Benjamin Z Mendelson, Noa L Ksabi, Pritika Papali, Sushanth Neerumalla, Albert Antar, Andrew M Hersh, A Daniel Davidar, Zach Pennington, Ziya L Gokaslan, Michael Lim, Shih-Chun Lin, Sheng-Fu Larry Lo, Timothy Witham, Daniel M Sciubba, George Jallo, Jean-Paul Wolinsky, Jon Weingart, Nicholas Theodore, Daniel Lubelski","doi":"10.3171/2025.11.SPINE25124","DOIUrl":"https://doi.org/10.3171/2025.11.SPINE25124","url":null,"abstract":"<p><strong>Objective: </strong>Intramedullary spinal cord tumors (IMSCTs) are typically treated with maximal safe resection, during which neurosurgeons often monitor for neurological injury using muscle motor evoked potential (mMEP) and direct wave (D-wave) neuromonitoring. The predictive value of changes in D-waves for identifying motor outcomes is underexplored. This study evaluated the utility of D-waves for predicting postoperative motor deficits.</p><p><strong>Methods: </strong>Patients who underwent resection of a primary IMSCT with mMEP neuromonitoring from 2003 to 2023 at a tertiary care hospital were identified. Patients who underwent D-wave monitoring in addition to mMEP monitoring were compared to those who underwent mMEP monitoring alone using the Mann-Whitney U-test, chi-square test, and Fisher's exact test. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of D-wave and mMEP monitoring for identifying new neurological deficits immediately postoperatively and at 1 month, 6 months, and last follow-up were calculated.</p><p><strong>Results: </strong>After matching, 125 patients were included (median age 42.0 years; 57.6% male; median follow-up 34.0 months), of whom 88 had both mMEP and D-wave data. The most common pathologies were ependymoma (64.0%) and astrocytoma (17.6%). Patients who did and did not undergo D-wave neuromonitoring had similar preoperative neurological function, primary pathology, tumor grade, and tumor location. D-wave use was associated with increased gross-total resection (88.6% vs 64.9%, p = 0.002) and reduced mortality (5.7% vs 24.3%, p = 0.007), length of stay (5.0 vs 6.0 days, p = 0.033), and 30-day readmission (2.3% vs 13.5%, p = 0.013) and reoperation (1.1% vs 10.8%, p = 0.012). At the 6-month follow-up, D-wave monitoring alone was superior to mMEP and combination monitoring for detecting new motor deficits. D-wave monitoring had peak sensitivity (77.8%) and NPV (96.5%) at 6 months and peak specificity (95.8%) and PPV (76.9%) in the immediate postoperative period.</p><p><strong>Conclusions: </strong>D-wave monitoring was associated with reduced mortality and was more accurate than mMEP monitoring alone or combination monitoring for detecting new postoperative neurological deficits. Further prospective studies are needed to validate these results.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774143","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. Intraoperative neuromonitoring for intramedullary spinal cord tumors: are we asking the right questions?","authors":"Christopher S Lozano, Jefferson R Wilson","doi":"10.3171/2025.12.SPINE251601","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE251601","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-4"},"PeriodicalIF":3.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774054","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 evolving landscape of spinal cord injury: a tale of 3 decades.","authors":"Ayesha I Quddusi, Jetan H Badhiwala, Jefferson R Wilson, Julio C Furlan, Karlo M Pedro, Mohammed Ali Alvi, Michael G Fehlings","doi":"10.3171/2025.12.SPINE251083","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE251083","url":null,"abstract":"<p><strong>Objective: </strong>Considerable advances in the prevention and treatment of traumatic spinal cord injury (SCI) have been made in the last 3 decades; hence, it can be assumed that the groups at risk, etiology, and characteristics of SCI have evolved in tandem. The objective of this study was to analyze SCI data to discern changes in patient demographics, etiology, and characteristics of injury over the last 3 decades.</p><p><strong>Methods: </strong>Data from 5 multicenter, prospective sources were combined to create a dataset representing the period from 1991 to 2020. The data were divided into 3 decades; 1991-1999, 2000-2009, and 2010-2020. The analyzed variables included patient age, sex, etiology, baseline injury severity based on the American Spinal Injury Association Impairment Scale (AIS), surgery, and timing of surgery. One-way ANOVA was performed to examine the association between patient age and decade, whereas chi-square tests were used to assess the association of sex, etiology, surgery, timing of surgery, and baseline severity with decade. Further analyses were done using univariate and multivariate regression to evaluate the relationship between age and sex, etiology, and decade.</p><p><strong>Results: </strong>The overall dataset included 2642 patients. From the 1990s to the 2010s, the mean age increased independent of changes in etiology (p < 0.001), the frequency of injuries related to falls increased from 20.6% to 42.1% (p < 0.0001), and the frequency of SCIs related to motor vehicle collision decreased from 50.4% to 39.1% (p < 0.0001). Significant changes were observed when examining injury severity between the 1990s and 2010s: the percentage of complete SCI (AIS grade A) decreased from 58.3% to 49.8%, the percentage of incomplete SCI (AIS grades B, C, and D) increased from 41.7% to 50.2%, and the percentage of central cord syndrome increased from 33.7% to 54.7%. The percentage of patients undergoing surgical treatment increased from 73.8% to 96.8% (p < 0.0001), and the proportion that underwent early surgery increased from 20.6% to 43.9% (p < 0.0001).</p><p><strong>Conclusions: </strong>The changes in the demographics, etiology, and characteristics of SCI reflect a combination of an aging population, an increased public awareness of neurotrauma, and enhanced clinical management of older patients. These findings have implications for further research and the optimization of primary and secondary injury prevention strategies.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774089","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":"Understanding femoral nerve injuries during extreme lateral lumbar interbody fusion using transabdominal muscle action potential and an event-based protocol.","authors":"Ashish Patel, Michael R McDermott, Alfred-John Bayaton, Michael Rogers, J Blake Boyett, Andre M Jakoi, Michael R Conti Mica","doi":"10.3171/2025.12.SPINE25372","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE25372","url":null,"abstract":"<p><strong>Objective: </strong>Extreme lateral lumbar interbody fusion (XLIF) carries a significant risk of femoral nerve injury, particularly at L4-5, where neural structures are close to the transpsoas corridor. While neuromonitoring techniques such as triggered electromyography and somatosensory evoked potentials are widely used, they lack the real-time sensitivity and specificity necessary for reliably detecting nerve compromise. The absence of real-time neuromonitoring data in XLIF has limited the understanding of when and how femoral nerve injuries occur, leaving surgeons without a clear strategy to mitigate these injuries intraoperatively. The aim of this study was to evaluate the reliability of detecting nerve injury during XLIF using transabdominal muscle action potential (TMAP) monitoring with an event-based protocol.</p><p><strong>Methods: </strong>A retrospective analysis of consecutive patients who underwent single-position prone XLIF from 2020 to 2024 was conducted. Patients with lateral implants placed in the femoral nerve distribution (L2-5) were included. TMAP monitoring was performed intraoperatively at predefined procedural steps to monitor nerve integrity. TMAP changes were correlated with postoperative quadriceps motor deficits to determine the timing of injury. Sensitivity, specificity, and predictive thresholds of TMAP were also analyzed.</p><p><strong>Results: </strong>One hundred sixty-one patients (mean age 67.9 ± 9.8 years, BMI 30.7 ± 5.6 kg/m2) were included; 63.4% of patients were female, and 82.6% underwent XLIF at L4-5. Uninterrupted TMAP monitoring was achieved in all cases. Postoperative quadriceps muscle weakness (≤ 3/5 strength) occurred in 4 patients (2.5%), with no significant difference in retractor times between injured and uninjured patients. TMAP monitoring detected all injuries intraoperatively, demonstrating 100% sensitivity. Threshold analysis identified a change in TMAPs of 400-500 mA as clinically significant for the development of a postoperative neurological change (p < 0.01). Specificity at this threshold change ranged from 83.4% to 89.8% while maintaining 100% sensitivity. The event-based protocol revealed that injuries were linked to specific procedural steps, with the docking phase posing a high risk for femoral nerve injury.</p><p><strong>Conclusions: </strong>This study provides new insights into femoral nerve injuries incurred during XLIF, demonstrating that nerve compromise is more strongly associated with specific procedural steps rather than prolonged retractor time. TMAP monitoring, integrated with an event-based protocol, enabled real-time identification of nerve compromise, revealing that direct mechanical trauma was the primary mechanism of femoral nerve injury in XLIF.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717065","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. Respecting pelvic morphology: low pelvic incidence demands precision to minimize proximal junctional failure.","authors":"Danielle Nieto, Niall Buckley, Lee A Tan","doi":"10.3171/2025.12.SPINE251602","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE251602","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-2"},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717107","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":"Staphylococcus aureus colonization before elective posterior spine surgery: is it associated with postoperative S. aureus infections?","authors":"Aditya S Joshi, Rachel S Bronheim, Ryan M Schiedo, Jordan A Helbing, Paul Botolin, Amit Jain, Khaled M Kebaish, Hamid Hassanzadeh","doi":"10.3171/2025.12.SPINE25788","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE25788","url":null,"abstract":"<p><strong>Objective: </strong>Evidence suggests that preoperative Staphylococcus aureus colonization predicts postoperative superficial surgical site infection (SSI). However, it is unclear how preoperative colonization is related to deep surgical site, organ space, and bloodstream infections after spine surgery. Therefore, the objective of this study was to investigate associations between preoperative S. aureus colonization and S. aureus infections following elective, instrumented posterior spine surgery.</p><p><strong>Methods: </strong>The authors retrospectively analyzed international trial data from 3311 participants who underwent open, instrumented, multilevel posterior spine surgery from 2015 to 2019. Multivariate logistic regression was used to determine associations between preoperative S. aureus colonization and postoperative S. aureus infection.</p><p><strong>Results: </strong>Thirty-five percent of participants (n = 1148) had preoperative S. aureus colonization in the nose or throat. Within 3 months after surgery, 68 of all participants (2%) developed S. aureus infections. Preoperative colonization was associated with greater odds of superficial SSI (OR 1.7, 95% CI 1.2-2.3; p = 0.004) and bloodstream infection (OR 1.8, 95% CI 1.1-4.2; p = 0.017). Other factors associated with postoperative infection included nasal (relative to throat) colonization (OR 1.03, 95% CI 1.01-1.1; p = 0.038), number of vertebrae fused (OR 1.2, 95% CI 1.1-1.2; p < 0.001), and BMI (OR 1.1, 95% CI 1.03-1.1; p < 0.001). Prophylactic decolonization was associated with lower odds of infection (OR 0.6, 95% CI 0.42-0.84; p = 0.003). Specifically, the odds were lower for participants treated with chlorhexidine wash (OR 0.4, 95% CI 0.25-0.64; p < 0.001), intranasal mupirocin (OR 0.13, 95% CI 0.02-0.98; p = 0.048), or both (OR 0.56, 95% CI 0.33-0.98; p = 0.041).</p><p><strong>Conclusions: </strong>Preoperative S. aureus colonization was associated with superficial SSI and bloodstream S. aureus infections after elective spine surgery. Prophylactic decolonization measures were associated with lower odds of postoperative infection. Future analysis should explore optimal decolonization regimens for at-risk individuals.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717047","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":"Use of pelvic incidence to predict proximal junctional failure in long-segment spinal fusion.","authors":"Nathan P Ritchey, Joshua H Weinberg, Kevin E Agner, Eashwar Kantemneni, Blake Holthaus, Witty Kwok, Abdul Karim Ghaith, Luke Comisford, Yamenah Ambreen, Katelyn Sette, Bryan Ladd, Siri Khalsa, David Xu, Stephanus Viljoen, Andrew Grossbach","doi":"10.3171/2025.11.SPINE251010","DOIUrl":"https://doi.org/10.3171/2025.11.SPINE251010","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the impact of pelvic incidence (PI) on spinopelvic correction and complication rates following surgical correction of adult spinal deformity.</p><p><strong>Methods: </strong>The authors conducted a retrospective analysis of a prospectively maintained database and identified 204 patients who underwent long-segment thoracolumbar fusions with pelvic fixation and a minimum of 1-year follow-up for deformity correction defined by the Scoliosis Research Society (SRS)-Schwab criteria. Patients were dichotomized into lower (108 patients) and higher (96 patients) PI groups on the basis of the mean value of 55°. Patient demographic characteristics, spinopelvic parameters, and complications were compared using univariate, multivariate, and mixed-effect analyses.</p><p><strong>Results: </strong>Patients with higher PI demonstrated significantly lower rates of proximal junctional failure (PJF) than the lower PI group (9% vs 21%, p = 0.019). In particular, lower rates of PJF were found in patients with an upper thoracic upper instrumented vertebra (UIV) (0% vs 15%, p = 0.014). Multivariate analysis revealed that lower PI (OR 4.3, 95% CI 1.5-15.4, p = 0.006), lower thoracic UIV (OR 6.5, 95% CI 1.8-24.0, p = 0.005), and reoperation status (OR 23.8, 95% CI 5.8-97.8, p = 0.001) independently predicted PJF while controlling for significant differences. Bayesian mixed-effects modeling confirmed lower PI (OR 6.25, 95% credible interval [CrI] 1.52-50.0, posterior probability = 0.996) and lower thoracic UIV (OR 7.03, 95% CrI 1.6-76.0, posterior probability = 0.997) as significant predictors of PJF while controlling for random effects between patients.</p><p><strong>Conclusions: </strong>Patients with lower PI are at an increased risk of PJF following long-segment fusion. Preoperative PI morphology may be used to inform surgical planning and reduce the risk of junctional pathologies.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717024","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":"Postoperative opioid utilization following uniportal endoscopic versus open microscopic lumbar discectomy.","authors":"Darius Ansari, Jacob A Bethel, Ahmed Elbayomy, Garret P Greeneway, Jonathan E Bryan, Grace Talbot, Nathaniel P Brooks","doi":"10.3171/2025.11.SPINE251226","DOIUrl":"https://doi.org/10.3171/2025.11.SPINE251226","url":null,"abstract":"<p><strong>Objective: </strong>Symptomatic lumbar disc herniation refractory to nonoperative management may be treated by traditional open lumbar microdiscectomy or by emerging alternative approaches such as endoscopic discectomy. Although the smaller incision and lesser degree of iatrogenic tissue disruption afforded by endoscopy are hypothesized to minimize postoperative pain, there is a paucity of studies that have evaluated this outcome.</p><p><strong>Methods: </strong>This study was a retrospective cohort study at a single surgical center affiliated with an academic practice. All patients undergoing single-level lumbar discectomy between 2021 and 2024 were retrospectively identified and stratified into cohorts by approach taken (open or endoscopic). Baseline comorbidities and postsurgical outcomes were collected from the medical record, and opioid use data were retrieved from the state Prescription Drug Monitoring Program. Clinical outcomes, postoperative opioid usage by time, and cumulative opioid usage by morphine milligram equivalents (MME) between the two cohorts were compared using the 2-sided t-test for continuous variables and the chi-square test of independence for categorical variables.</p><p><strong>Results: </strong>One hundred ninety-one patients met the criteria for analysis, of whom 91 (47.6%) underwent endoscopic and 100 (52.4%) underwent open procedures. Patients who underwent endoscopic procedures experienced lower rates of persistent opioid use at postoperative week 6 compared with those who underwent open procedures (8.8% vs 21.0%; relative risk 0.47, p = 0.035) as well as lower average cumulative opioid use by MME (264.7 vs 340.5, p = 0.017). Rates and the amount of opioid usage beyond 6 weeks were not significantly different between groups. Similarly, rates of outcomes such as reduction in leg pain, reoperation, durotomy, and operative time were similar between the groups.</p><p><strong>Conclusions: </strong>In this retrospective analysis, endoscopic lumbar discectomy was associated with lower short-term postoperative opioid utilization while conferring clinical outcomes similar to those of traditional open microdiscectomy. These results are limited by individual variation in opioid-prescribing practices by individual center, and future studies with standardized opioid-prescription protocols will improve the external validity of these findings.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717087","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 intraoperative ketamine administration and reduced postoperative opioid consumption among chronic opioid users after multilevel lumbar fusion.","authors":"Zachary Diltz, Austin Q Nguyen, Carol Wang, Jennifer Liu, Thomas Sullivan, Bradley Lambert, Comron Saifi","doi":"10.3171/2025.12.SPINE25700","DOIUrl":"https://doi.org/10.3171/2025.12.SPINE25700","url":null,"abstract":"<p><strong>Objective: </strong>Achieving postoperative pain control while minimizing opioid dependence is a challenge in surgery. Intraoperative ketamine administration in patients undergoing surgery has been associated with decreased postoperative opioid consumption. This study aimed to determine postoperative opioid consumption after multilevel lumbar spine fusion in patients who received intraoperative ketamine compared to those who did not.</p><p><strong>Methods: </strong>A retrospective observational study was performed for 434 participants who underwent a ≥ 2-level lumbar spine fusion surgery. Propensity score weighting was used to evaluate the association between ketamine administration and net outpatient opioid consumption at 1, 3, 6, and 12 months postoperatively. Patients were stratified into subgroups based on chronicity and magnitude of preoperative opioid exposure. The association between intraoperative ketamine and postoperative opioid consumption was examined in all subgroups.</p><p><strong>Results: </strong>Compared to the control group, patients who received intraoperative ketamine presented with a significantly higher number of readmissions (mean 0.291 [SD 0.75] vs 0.475 [SD 0.874], p = 0.045) and higher mean opioid usage in the year prior to surgery (5089 [SD 16,813] vs 11,801 [SD 28,043] morphine milligram equivalents [MMEs]; p = 0.016). Among patients with long-term preoperative opioid use, those who received ketamine consumed 41% fewer total MMEs (1470 MMEs) than the control group (2308 MMEs; p = 0.011) at 1 month postoperatively. There was no significant change in opioid use at 1, 3, 6, or 12 months postoperatively in the two groups. There was no difference in the incidence of long-term postoperative opioid use, visual analog scale (VAS) score at discharge, VAS pain scores, and length of stay.</p><p><strong>Conclusions: </strong>In patients with chronic opioid use, intraoperative ketamine administration was associated with decreased opioid use at 1 month postoperatively following multilevel lumbar spine fusion. Ketamine should be considered an important adjuvant treatment for intraoperative pain management in patients with long-term opioid use. However, ketamine should be used with caution in opioid-naive patients as there was an increased incidence of long-term postoperative opioid use in this group.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-7"},"PeriodicalIF":3.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654148","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":"Costs associated with delirium among older patients undergoing complex spine surgeries.","authors":"Odmara L Barreto Chang, Niti Pawar, Rebecca T Brown, Alekos A Theologis, Arati Patel, Praveen V Mummaneni, Bruce Miller, Mervyn Maze, Katherine L Possin","doi":"10.3171/2025.11.SPINE25221","DOIUrl":"https://doi.org/10.3171/2025.11.SPINE25221","url":null,"abstract":"<p><strong>Objective: </strong>As the number of older adults undergoing spine surgery grows, it is important to better understand the risks of this procedure, including associated costs. The authors recently reported that undergoing more complex spine surgeries is strongly associated with postoperative delirium (POD). The goal of this study was to examine the costs associated with POD among patients undergoing spine surgeries of varying complexity.</p><p><strong>Methods: </strong>Data from a prospective observational cohort study of 256 adults aged ≥ 65 years who underwent spine surgery were analyzed. Preoperative, intraoperative, and postoperative variables were collected. The primary outcome of POD was defined as a positive score on any of three measures (Confusion Assessment Method for the Intensive Care Unit, Nursing Delirium Screening Scale, and chart review). The authors conducted univariable and multivariable analyses to examine factors associated with POD and estimated costs of POD stratified by tier of surgery.</p><p><strong>Results: </strong>Risk factors associated with POD included age, lower education level, baseline cognitive impairment, American Society of Anesthesiologists class ≥ III, tier 4 surgery, high estimated blood loss, intensive care unit admission, postoperative complications, and hospital length of stay. In multivariable analyses, age, baseline cognitive impairment, postoperative complications, and length of hospitalization remained significantly associated with POD. The mean total costs were significantly higher in the group with delirium versus without delirium ($99,543 vs $67,892). Additionally, more patients who developed delirium required discharge to an acute rehabilitation facility (47.0% vs 21.5%, p < 0.001). In analyses stratified by tier of surgery, the greatest difference in mean costs between those with delirium versus without delirium was observed in tier 4 ($164,902 vs $116,579, p < 0.001).</p><p><strong>Conclusions: </strong>Spine surgeries with greater complexity are associated with an increased risk of POD, with higher costs and rates of intensive care unit admissions, more postoperative complications, and discharge to acute rehabilitation facilities. Delirium prevention interventions targeted to older adults at high risk for POD have the potential to optimize outcomes and decrease healthcare costs.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":3.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654186","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}