Journal of neurosurgery. Spine最新文献

{"title":"Diagnostic selective nerve root block in degenerative lumbar spine radiculopathy: a systematic review and meta-analysis.","authors":"David Kocemba, Søren Ørskov, Jakob Gram Carlsen, Mette Katrine Schulz, Bent Uhrbrand, Hanne Dinesen, Ronni Mikkelsen, Mathias Møller Thygesen, Mikkel Mylius Rasmussen","doi":"10.3171/2026.4.SPINE251222","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE251222","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to estimate the diagnostic accuracy of selective nerve root blocks (SNRBs) in patients with lumbar radiculopathy undergoing surgery.</p><p><strong>Methods: </strong>The authors searched major medical databases (PubMed, Embase, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Cochrane Library, Web of Science, Google Scholar, and Scopus) and trial registries (ClinicalTrials.gov, ICTRP [International Clinical Trials Registry Program], CENTRAL [Cochrane Central Register of Controlled Trials]). They included studies that 1) investigated foraminal or transforaminal SNRB in adults with degenerative lumbar conditions and radiculopathy; 2) utilized local anesthetics, steroids, or both; 3) performed SNRB under fluoroscopic or CT guidance; and 4) reported SNRB response and postoperative outcomes. Two independent reviewers screened the studies, assessed the risk of bias using QUADAS (Quality Assessment of Diagnostic Accuracy Studies)-2, and evaluated the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Diagnostic accuracy was evaluated using a random-effects model to calculate summary estimates for sensitivity and specificity.</p><p><strong>Results: </strong>The authors identified 11,723 studies, of which 134 were selected for full-text review. Of these, 25 met the inclusion criteria for the systematic review and 7 for the meta-analysis. Summary estimates for sensitivity of 0.88 (95% CI 0.80-0.92) and specificity of 0.57 (95% CI 0.27-0.83), I2 = 24.7%, were obtained. The certainty of evidence was rated moderate for sensitivity and very low for specificity.</p><p><strong>Conclusions: </strong>This is the first meta-analysis to evaluate the sensitivity, specificity, and certainty of evidence for SNRB. The diagnostic utility depends highly on the pretest probability of a favorable surgical outcome. Clinicians should interpret SNRB findings within the context of clinical and imaging findings.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-14"},"PeriodicalIF":3.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147823","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":"Long-term dysphagia after multilevel anterior decompressive surgery for cervical myelopathy: findings from the phase III CSM-Protect trial.","authors":"Alex B Bak, Karlo M Pedro, Ali Moghaddamjou, Michael G Fehlings","doi":"10.3171/2026.4.SPINE26260","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26260","url":null,"abstract":"<p><strong>Objective: </strong>Dysphagia is a common early complication after anterior cervical spine surgery, yet its long-term natural history and risk factors remain incompletely understood, particularly in multilevel procedures for degenerative cervical myelopathy (DCM). This study aimed to characterize the natural history of postoperative dysphagia and identify predictors of persistent dysphagia at 12 months.</p><p><strong>Methods: </strong>Adult patients who received anterior decompression for DCM between 2012 and 2017 and were prospectively enrolled as part of the CSM-Protect trial were retrospectively reviewed. Presence and severity of dysphagia were assessed with the Bazaz scale (none, mild, moderate, or severe) at baseline and 35, 180, and 365 days postoperatively. Multivariable logistic regression controlling for study randomization and site were used to identify risk factors for dysphagia at 365 days.</p><p><strong>Results: </strong>From a total of 290 patients, 132 subjects met the eligibility criteria. Preoperatively, 11.4% of patients had moderate dysphagia. Dysphagia peaked at 35 days with 68.6% of all patients (14% severe) before declining to 47% at 180 days and 36.4% at 365 days. At 1 year, 10.6% had moderate dysphagia and 3.0% severe. Multivariable analysis demonstrated that anterior surgery at the C5 level (OR 4.52, 95% CI 1.16-19.4, p = 0.034), baseline dysphagia (OR 4.56, 95% CI 1.74-12.9, p = 0.003), and shorter duration of myelopathic symptoms (OR 0.98 per month, 95% CI 0.97-0.98, p = 0.027) were independently associated with persistent dysphagia.</p><p><strong>Conclusions: </strong>In this cohort of primarily multilevel anterior cervical surgical procedures, postoperative dysphagia peaked early but remained common at 1 year. Baseline dysphagia, C5-level involvement, and shorter symptom duration were key predictors of long-term dysphagia.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":3.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148456","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":"Rethinking sagittal alignment: the value of evaluating spinal shape in conjunction with T4-L1 pelvic angle measurement to prevent proximal junctional failure.","authors":"Renaud Lafage, Fares Ani, Themistocles Protopsaltis, Max Kohn, Shay Bess, Alan H Daniels, Bassel G Diebo, Robert K Eastlack, Munish C Gupta, Richard Hostin, Khaled M Kebaish, Eric O Klineberg, Gregory M Mundis, David O Okonkwo, Peter G Passias, Christopher P Ames, Frank Schwab, Christopher I Shaffrey, Justin S Smith, Virginie Lafage","doi":"10.3171/2026.4.SPINE251528","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE251528","url":null,"abstract":"<p><strong>Objective: </strong>The T4-L1 pelvic angle (T4-L1PA) has been proposed as a novel alignment target associated with mechanical complications in long-segment adult spinal deformity (ASD) surgery. However, its relationship to proximal junctional failure (PJF) and its relevance in shorter thoracolumbar constructs remain unclear. The aim of this study was to evaluate whether T4-L1PA and L1 pelvic angle (L1PA) guidelines predict PJF in ASD surgery and to examine how early proximal reciprocal changes influence this relationship.</p><p><strong>Methods: </strong>A prospective ASD database was reviewed for patients who underwent fusion from the ilium to the thoracic spine with a minimum follow-up of 2 years. Postoperative PJF was defined as 1) revision surgery requiring proximal extension or 2) severe radiographic proximal junctional kyphosis (PJK) (proximal junctional angle [PJA] > 28° and ΔPJA > 22°). Patients were categorized based on adherence to L1PA (0.5 × PI -19 ± 2°) and T4-L1PA (from -3° to 1°) guidelines, stratified by upper instrumented vertebra position (upper thoracic [UT], T2-4; lower thoracic, T9-11). Simulated postoperative alignment was used to assess the effect of the PJA on guideline adherence and failure risk.</p><p><strong>Results: </strong>Among 661 patients (78% female, mean age 65 ± 9 years, mean BMI 28.3 ± 5.7), 17.9% experienced PJF at 2 years (8.3% with revision, 10.4% with severe PJK). Patients with UT UIVs had higher failure rates when L1PA was overcorrected (25.6%) versus matching (12.9%) or undercorrected (11.1%, p = 0.029). In contrast, failure rates across T4-L1PA groups were not different (p = 0.094). The lowest failure rate was identified for either L1PA undercorrected and T4 aligned or L1PA aligned but T4 ventral to L1. For short fusion, no significant differences were found across L1PA guidelines (p = 0.132), and the significant difference in T4-L1PA was not maintained after adjusting for PJA influence on early postoperative alignment (p = 0.148). Similarly, no significant differences were found across the 9 combinations after controlling for PJA influence.</p><p><strong>Conclusions: </strong>The T4-L1PA concept demonstrated some association with PJF alone in the setting of long fusions, although adjusting L1PA thresholds toward less correction might further improve outcomes. Unfortunately, current targets seem inappropriate for short fusions, and a different framework might be required.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148921","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":"Intrawound antibiotic use and postoperative surgical site infection in instrumented spine surgery: a statewide registry analysis of 24,015 patients from the Spine Care Outcomes Assessment Program.","authors":"Renzo Laynes, Aiyush Bansal, Kenneth Nguyen, Rafael Garcia de Oliveira, Philip K Louie, Nicholas J Kassebaum, Jean-Christophe Leveque, Vickie A Kolios-Morris","doi":"10.3171/2026.4.SPINE251431","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE251431","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the association between intrawound antibiotic use and postoperative surgical site infection (SSI) following instrumented spine surgery in a large statewide registry.</p><p><strong>Methods: </strong>The authors performed a retrospective cohort study using prospectively collected data from the Spine Care Outcomes Assessment Program (COAP) in Washington State. Adult patients undergoing instrumented cervical or lumbar spine surgery between July 2011 and January 2024 were included. Patients were stratified by intrawound antibiotic use at wound closure. The primary outcome was postoperative SSI. Univariate robust Poisson regression was used to estimate risk ratios (RRs). Multivariable robust Poisson regression was performed to identify independent predictors of SSI while adjusting for demographic, clinical, and operative variables.</p><p><strong>Results: </strong>Among 24,015 patients, 256 (1.1%) developed SSI. On univariate analysis, obesity (BMI ≥ 40), open surgical approach, lumbar procedures, diabetes, higher American Society of Anesthesiologists class, greater comorbidity burden, and higher Enhanced Recovery After Surgery score were associated with increased SSI risk, whereas higher serum albumin, minimally invasive surgery, and cervical procedures were associated with reduced risk. In multivariable analysis, open surgical approach (RR 4.94, 95% CI 2.26-10.79) and lumbar procedures (RR 2.33, 95% CI 1.45-3.75) were independently associated with increased SSI risk. Higher serum albumin was independently protective (RR 0.35, 95% CI 0.24-0.51). Intrawound antibiotic use was not associated with SSI on univariate analysis (RR 0.90, 95% CI 0.70-1.16) and was not an independent predictor after adjustment.</p><p><strong>Conclusions: </strong>In this large statewide cohort of instrumented spine procedures, surgical approach, anatomical region, and preoperative nutritional status were the strongest independent predictors of SSI. Intrawound antibiotic use was not associated with reduced infection risk. These findings underscore the multifactorial nature of postoperative infection risk in spine surgery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111102","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":"Linking the Scoliosis Research Society-22 domains to the PROMIS domains in adult symptomatic lumbar scoliosis.","authors":"Michael P Kelly, Maxwell Mansolf, Justin S Smith, Elizabeth L Yanik, Emily H Ho, Michelle M Langer, Keith H Bridwell","doi":"10.3171/2026.4.SPINE251628","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE251628","url":null,"abstract":"<p><strong>Objective: </strong>The Scoliosis Research Society-22 (SRS-22) is a legacy measure used to assess patient-reported outcomes of disease-related disability in adult spinal deformity (ASD), while the Patient-Reported Outcomes Measurement Information System (PROMIS) collects health domain scores (for example, Function) and offers a score relative to population norms. The authors sought to create linkage tables to allow comparison of prior outcomes research in ASD with the SRS-22 to more recent studies using PROMIS.</p><p><strong>Methods: </strong>Patients with symptomatic lumbar scoliosis were enrolled and treated in a combined randomized and observational study and completed SRS-22 and PROMIS Function, Pain Interference, Anxiety, and Depression questionnaires at visits 2 to 8 years after enrollment. Correlations between the SRS-22 and PROMIS domains identified the most appropriate PROMIS domains for each of 3 SRS-22 subscales (Pain, Function, and Mental Health); equipercentile linking constructed linkages. Linkages were evaluated on the basis of bias, error, and criterion-related validity with other patient-reported outcome measures (PROMs), demographic characteristics, and treatment arm.</p><p><strong>Results: </strong>PROMIS Physical Function linked with SRS-22 Function (r = 0.80, 95% CI 0.75-0.84), PROMIS Pain Interference with SRS-22 Pain (r = -0.75, 95% CI -0.80 to -0.69), and PROMIS Anxiety with SRS-22 Mental Health (r = -0.71, 95% CI -0.79 to -0.62). Smoothing the linking functions yielded little difference in performance (bias, linking error); thus, smoothing was used to construct more continuous crosswalk tables linking the measures. Linking error was modest, suggesting linked scores are most useful for group mean, rather than individual, comparisons. Linkages are useful for yielding comparable scores to compare demographic groups (sex, age) and treatment arms (operative, nonoperative) in clinical research, but scores are not comparable in their relationships with related PROMs.</p><p><strong>Conclusions: </strong>Linkages between SRS-22 and PROMIS domains allow data harmonization for comparing results of clinical and epidemiological research. Neither sex, age, nor treatment arm affected the interchangeability of the linked scores. There is a need for a PROMIS Self-Image instrument.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-14"},"PeriodicalIF":3.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111073","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":"Spinal meningiomas: higher incidence of atypical pathology in symptomatic lumbar lesions.","authors":"Anthony Marincovich, Clayton Rosinski, Kareem Shoukih, Pujit Mekala, Satoka Shidoh, Satoshi Yamaguchi","doi":"10.3171/2026.4.SPINE251406","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE251406","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to assess differences in incidence, demographics, pathology, management, and functional outcomes between lumbar and cervicothoracic spinal meningiomas (SMs).</p><p><strong>Methods: </strong>A retrospective review of patients undergoing resection of SMs at an academic tertiary care hospital between January 2013 and December 2024 was performed after approval from the IRB. Seventy-three consecutive patients who underwent resection of SMs were identified and included for analysis. The patients' electronic medical records were reviewed to collect data on demographics, clinical presentation, radiographic findings, surgical details, pathology reports, and long-term functional outcomes.</p><p><strong>Results: </strong>A majority of patients were female (84.9%). The median overall age was 65 years and the median age for patients with lumbar meningiomas trended lower (44 years) compared with cervical (66 years) and thoracic (65 years) meningiomas, although this difference was not statistically significant. The most common presenting symptom for lumbar meningiomas was pain (88.9%) followed by weakness (11.1%), with weakness being a more common presenting symptom in the cervical (38.9%) and thoracic (41.3%) spine. WHO grade 2 tumors were present significantly more often in the lumbar spine (55.6%) compared with the cervical (0%) or thoracic (1%) spine (p < 0.001) and were commonly clear cell subtype (44.4%). Patients with lumbar meningioma required significantly more surgeries for the meningioma than those with cervical and thoracic meningiomas (p < 0.001) but were not more likely to require adjuvant medical or radiation therapy. There were no significant differences by region in outcome regarding pain control and neurological function.</p><p><strong>Conclusions: </strong>Symptomatic SMs of the lumbar spine were more likely to be malignant than those in the cervical or thoracic spine and more likely to require multiple surgeries. Resection of SMs in any location generally resulted in symptom improvement or resolution correlating with current standard of practice.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":3.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111025","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":"Endoscopic repair of spontaneous ventral spinal cerebrospinal fluid leaks after failed open intradural surgery, and vice versa.","authors":"Wouter I Schievink, Corey T Walker","doi":"10.3171/2026.4.SPINE26331","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26331","url":null,"abstract":"<p><strong>Objective: </strong>Ventral spinal CSF leaks are a common cause of spontaneous intracranial hypotension (SIH) and may require surgical repair. Open intradural and endoscopic transforaminal extradural approaches may be considered for treatment of these ventral spinal lesions. The authors report their experience using complementary surgical techniques for patients with persistent ventral spinal CSF leaks after prior unsuccessful surgery with the other approach.</p><p><strong>Methods: </strong>The authors present a series of patients from their prospectively maintained registry of patients with SIH evaluated at their institution. Inclusion criteria were 1) diagnosis of SIH based on modified International Classification of Headache Disorders, 3rd edition criteria, 2) thoracic ventral spinal CSF leak, 3) at least 1 prior failed surgical repair with either an open transdural or endoscopic transforaminal approach. Disability was assessed pre- and posttreatment using the SIH Disability Assessment Score (SIHDAS). Surgical outcome was determined by symptom improvement and resolution of extradural CSF collection on postoperative imaging.</p><p><strong>Results: </strong>Ten patients (7 males, 3 females; mean age 49.8 years) met inclusion criteria. Six patients underwent endoscopic extradural repair following failed open intradural repair, and 4 underwent open intradural repair after failed endoscopic extradural repair (1 after 2 prior endoscopic attempts). The mean interval between surgeries was 13.5 months. No operative complications occurred with either approach. Persistent ventral dural defects were identified intraoperatively in all cases. Postoperative imaging demonstrated complete resolution of the extradural CSF collection in 8 of 10 patients (4 of 6 after salvage endoscopic repair; 4 of 4 after salvage open intradural repair). All patients had acceptable clinical SIHDAS scores of I or II (no or mild disability) at the final follow-up.</p><p><strong>Conclusions: </strong>This study suggests that using complementary surgical techniques provides an effective strategy for managing persistent postoperative ventral spinal CSF leaks. Employing the alternative approach avoids prior surgical corridors and associated scar tissue and may reduce risk while improving effectiveness. Both endoscopic extradural and open intradural techniques can be performed safely in revision settings, and selective use of the alternative approach may optimize outcomes in treating this challenging pathology.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":3.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111090","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":"Factors associated with gait recovery following surgery for degenerative cervical myelopathy.","authors":"Hassan Darabi, Harshit Arora, Jared T Wilcox, John C Gensel, Ajit M W Chaudhari, Arnaud Gouelle, Francis Farhadi","doi":"10.3171/2026.4.SPINE2610","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE2610","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to quantify perioperative gait spatiotemporal parameters (STPs) in patients with degenerative cervical myelopathy (DCM) and to identify baseline predictors of gait recovery.</p><p><strong>Methods: </strong>This study evaluated a prospective observational cohort at a single academic center. Participants with DCM (n = 59) and non-DCM controls with cervical radiculopathy (n = 13) completed GAITRite walkway assessments at baseline, 6 months, and 12 months after standard-of-care treatments including surgery. STPs included gait speed, step/stride length, cadence, double support time, stride width, and Enhanced Gait Variability Index (eGVI). Relationships between STPs and common clinical scales, including the modified Japanese Orthopaedic Association lower extremity (mJOA-LE) subscore, Nurick grade, and Neck Disability Index (NDI), were evaluated with the Spearman ρ test. The Welch/Wilcoxon tests and linear mixed-effects models were used for between-group and longitudinal comparisons, respectively. Multivariable linear regression modeling was performed to evaluate independent predictors of gait recovery at last follow-up, including age, baseline STPs, mJOA-LE score, and Nurick grade.</p><p><strong>Results: </strong>At baseline, subjects with DCM demonstrated a distinct gait phenotype as compared to controls, characterized by significantly reduced gait speed (median [IQR] 83.1 [50.4-101.4] vs 105.1 [91.0-118.1] cm/sec, p = 0.003), shorter step length (51.7 [37.8-60.5] vs 59.1 [56.4-65.4] cm, p = 0.007), and shorter stride length (103.5 [75.1-120.3] vs 118.4 [113.0-130.4] cm, p = 0.006). Subjects with DCM also exhibited greater double support time (36.8% [32.7%-47.1%] vs 34.1% [30.8%-36.1%], p = 0.040) and lower cadence (95.1 [76.7-104.7] vs 103.7 [98.0-114.7] steps/min, p = 0.014). In contrast to NDI, mJOA-LE and Nurick scores showed significant correlations with STPs. After surgery, most STPs improved at 6 months and largely plateaued by 12 months. In multivariable models, the baseline value of each STP was the strongest predictor of change at last follow-up (all p < 0.01), with poorer baseline spatiotemporal performance predictive of greater interval recovery. Older age independently attenuated gains in gait speed and step/stride length (p ≤ 0.04). Baseline mJOA-LE and Nurick scores were not independent predictors of recovery after adjustment.</p><p><strong>Conclusions: </strong>DCM is characterized by a slower and unstable gait with shorter stride lengths that significantly improves by 6 months after surgery and then plateaus. Baseline STPs track disease severity and postoperative gait recovery. Recovery magnitude depends primarily on baseline spatiotemporal performance and is attenuated by age, supporting the use of STPs and age-based stratification for prognostication.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-12"},"PeriodicalIF":3.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111018","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":"Predicting tracheostomy after operative cervical spine trauma: development and internal validation of the Tracheostomy Likelihood Score.","authors":"Nick De Oliveira, Harsh Jain, Clayton R Baker, Emma Ye, Jordan Vanleuven, Alexander T Lyons, Tyler Zeoli, Hani Chanbour, Amir M Abtahi, Byron F Stephens, Bayard Wilson, Scott L Zuckerman","doi":"10.3171/2026.4.SPINE2630","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE2630","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Tracheostomy decisions after operative cervical spine trauma vary widely, and existing prediction tools were developed in heterogeneous populations that included nonoperative patients or rely on variables not consistently available early after injury. No validated score exists specifically for surgically managed cervical trauma patients. The authors sought to develop and internally validate a practical risk score to estimate tracheostomy risk after operative cervical spine trauma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The authors performed a retrospective cohort study of adults (≥ 18 years) who underwent operative management for traumatic cervical spine injury at a single level I trauma center (2017-2021). The primary outcome was postoperative tracheostomy during the index hospitalization. Candidate predictors available at or shortly after admission were selected a priori based on clinical plausibility and prior literature, then evaluated using multivariable logistic regression with a parsimonious model-building strategy. Model discrimination, calibration, and accuracy were internally validated using repeated stratified 10-fold cross-validation (10 repeats, 100 total fits) and bootstrap validation with optimism correction. Regression coefficients were converted into an integer Tracheostomy Likelihood Score (TLS) for bedside risk stratification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 515 patients (66 tracheostomies [12.8%]), 461 with assessable admission American Spinal Injury Association Impairment Scale (AIS) examinations comprised the primary modeling cohort (47 tracheostomies [10.2%]). The final 6-variable model included admission AIS grade, clinically significant traumatic brain injury, number of cervical fracture levels, thoracic injury, nonspine injuries requiring surgery, and intubation on admission. Admission AIS grade (OR 2.27 per grade, p &lt; 0.001) and intubation on admission (OR 6.54, p &lt; 0.001) were the strongest independent predictors. The model demonstrated excellent discrimination (apparent area under the receiver operating characteristic curve [AUC] 0.903 [95% CI 0.858-0.945]) with preserved performance after repeated cross-validation (AUC 0.883 [95% CI 0.830-0.933]) and minimal overfitting (bootstrap optimism 1.5%). The TLS preserved nearly all the model's performance (AUC 0.897 [95% CI 0.849-0.943]) and stratified observed tracheostomy risk from 1.7% (TLS 0-5) to 10.7% (TLS 6-10) and 61.2% (TLS &gt; 10), representing an approximately 36-fold gradient. On sensitivity analyses reincorporating patients with untestable AIS examinations, discrimination remained excellent (AUC 0.883-0.891).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The 6-variable TLS accurately stratifies tracheostomy risk after operative cervical spine trauma using early clinical and imaging data, including in patients whose neurological status cannot be formally assessed. This simple bedside tool may support more consistent airway planning, facilitate mul","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111044","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":"Mechanical complication patterns following cervical and cervicothoracic junction en bloc spondylectomy of primary spinal tumors: a single-institution decade of experience.","authors":"Taha Khalilullah, Tej D Azad, Vikas N Vattipally, Patrick Kramer, Michael Mugerwa, Wesley M Durand, Yuanxuan Xia, Amit Jain, Sang Hun Lee, Khaled M Kebaish, Sheng-Fu Larry Lo, Nicholas Theodore, Ziya L Gokaslan, Jean-Paul Wolinsky, Daniel M Sciubba, Daniel Lubelski","doi":"10.3171/2026.3.SPINE251795","DOIUrl":"https://doi.org/10.3171/2026.3.SPINE251795","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to characterize reconstruction strategies, mechanical failure modes, and risk signals after cervical/cervicothoracic junction (CTJ) en bloc spondylectomy at a high-volume tumor center.</p><p><strong>Methods: </strong>A single-institution retrospective cohort (2015-2025) of consecutive cervical/CTJ primary tumors treated with en bloc spondylectomy and circumferential reconstruction was performed. Demographics, pathology, construct details, bone quality by Hounsfield units (HUs), and oncological therapies were abstracted. The primary endpoint was instrumentation failure, including any mechanical event prompting or necessitating revision. Univariate analysis was conducted.</p><p><strong>Results: </strong>Twenty patients (mean age 49.1 ± 15.3 years; 55% male) were included; 50% of tumors were chordomas, 15% were chondrosarcomas, and 35% were other tumors. Anterior column reconstruction was performed using a titanium cage in 85% of patients; posterior reconstruction was performed using 2 rods in 75% of patients (3.5-mm rods in 65% patients). Cobalt-chromium rods were used in 5% of patients. Instrumentation failure occurred in 3 (15%) of the 20 patients at 4-44 months (median nonfailure follow-up 30 months, range 1-96 months; failure follow-up 60 months, range 44-94 months). Two of the failures were anterior column events (cage migration or delayed visceral erosion) and one was a posterior rod fracture. Patients with failure more often had smaller (3.5 mm) 2-rod constructs and fewer levels instrumented above the resection; cobalt-chromium rod use was more common among failures (33.3% vs 0%, p = 0.015). Thirty-day readmission was higher in patients with failure (100% vs 17.6%, p = 0.004). HU values trended toward lower rates of failures.</p><p><strong>Conclusions: </strong>Mechanical complications occurred in 15% of cervical/CTJ spondylectomies, with a notable proportion involving anterior column failure. Although underpowered for definitive predictors, this exploratory analysis identified several risk signals: limited proximal fixation, small-diameter 2-rod constructs, and cobalt-chromium rod usage that may inform CTJ-specific reconstruction strategies. These findings support exploring the impact of robust proximal fixation, biologically supported anterior reconstruction, bone-health optimization, and long-term surveillance on mechanical complications in CTJ en bloc spondylectomy of primary spinal tumors.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":3.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061490","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}