Journal of neurosurgery. Spine最新文献

{"title":"Erratum. Subaxial cervical spine fractures in ankylosing spondylitis: management and outcomes from a 10-year population-based cohort.","authors":"Pål Nicolay Fougner Rydning","doi":"10.3171/2026.8.SPINE251637a","DOIUrl":"https://doi.org/10.3171/2026.8.SPINE251637a","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1"},"PeriodicalIF":3.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061506","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":"Prognostic value of the Epidural Spinal Cord Compression scale, Revised Tokuhashi, and Spine Instability Neoplastic Scores in primary stereotactic body radiotherapy for spinal bone metastases.","authors":"Kuan-Nien Chou, David J Park, Yusuke S Hori, Amit R Persad, Cynthia Chuang, Sara C Emrich, Louisa Ustrzynski, Armine Tayag, Erqi Pollom, Scott G Soltys, Cheng-Hsiang Lo, Steven D Chang","doi":"10.3171/2026.4.SPINE25212","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE25212","url":null,"abstract":"<p><strong>Objective: </strong>Stereotactic body radiotherapy (SBRT) has emerged as a highly effective, noninvasive treatment for spinal bone metastases (SBMs). However, long-term outcomes of primary SBRT and the comparative prognostic performance of commonly used decision-making tools remain incompletely defined. This study evaluated long-term local control (LC) and systematically compared the predictive value of the Epidural Spinal Cord Compression (ESCC) grade, Spine Instability Neoplastic Score (SINS), and revised Tokuhashi score (rTS).</p><p><strong>Methods: </strong>The authors retrospectively analyzed 330 patients with 537 SBMs treated with primary CyberKnife SBRT between 2012 and 2023. SBMs with surgical indications under the NOMS (neurological, oncological, mechanical, and systemic) framework, defined as high-grade epidural compression (ESCC grade 2 or 3) and/or spinal instability (SINS > 12), were excluded. LC was defined as absence of radiographic tumor regrowth ≥ 6 months post-SBRT. Cox proportional hazards models identified independent predictors of local progression (LP). Prognostic discrimination of the ESCC grade, SINS, rTS, and a novel integrated multivariable model was evaluated using receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>The 1- and 2-year LC rates were 86.2% and 75.9%, respectively, with a median time to LP of 12 months. Independent predictors of LP included radioresistant histology, epidural compression, pain, osteolytic destruction, single-fraction equivalent dose < 20 Gy, and repeat SBRT. Even minimal epidural compression was strongly associated with inferior LC (adjusted hazard ratio [aHR] 2.01, p < 0.001). SBMs with SINS 7-12 also demonstrated significantly worse LC compared with SINS < 7 (aHR 1.78, p = 0.002). The prognostic contribution of rTS was largely driven by performance status alone. ROC analysis showed that the integrated model consistently outperformed the ESCC grade, SINS, and rTS at 1, 3, and 5 years (area under the curve 0.72-0.75 vs 0.59-0.65, all p < 0.05). Acute adverse events occurred in 33.9% of treated SBMs, predominantly pain flare (14.2%). Vertebral fractures developed in 17.0%, 24.2% of which were associated with LP.</p><p><strong>Conclusions: </strong>Primary SBRT for SBMs provided durable LC with acceptable toxicity. Although the ESCC grade, SINS, and rTS offered moderate prognostic utility, an integrated multivariable model incorporating tumor, anatomical, and clinical factors demonstrated superior predictive accuracy. Comprehensive risk stratification may refine patient selection and optimize SBRT strategies.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061644","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":"Trends and disparities in spinal cord injury: incidence, prevalence, and disability across the United States from 1990 to 2023.","authors":"Rohin Singh, Omar Sbaih, Nithin Gupta, Aman Singh, Muhammad I Jalal, Mina Botros, Robert Molinari, Jonathan Stone","doi":"10.3171/2026.4.SPINE26156","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26156","url":null,"abstract":"<p><strong>Objective: </strong>Spinal cord injury (SCI) is associated with significant disability and mortality across the United States. Updated epidemiological data is necessary to direct public health efforts and policy development. The aim of this study was to characterize SCI burden in the US from 1990 to 2023 and to evaluate the incidence, prevalence, and years lived with disability (YLDs) across multiple strata, including age, sex, geography, and injury subtype.</p><p><strong>Methods: </strong>Epidemiological data were extracted from the Global Burden of Disease (GBD) database, including rates per 100,000 population of SCI incidence, prevalence, and YLDs. The US was divided into the four Census Bureau regions. State-level 2023 Human Development Index (HDI) values were obtained from the Global Data Lab. The Quality of Care Index, a composite measure derived from GBD outcome ratios, was calculated to assess health system performance by quantifying the discrepancy between SCI burden and disability outcomes. State-level differences in SCI metrics and their correlations with state HDI values were evaluated.</p><p><strong>Results: </strong>In 2023, the national mean incidence of SCI was 26.88 per 100,000, with prevalence of 662.15 and YLDs of 174.93. From 1990 to 2023, incidence increased by 3.43%, while prevalence and YLD decreased by 18.84% and 23.64%, respectively. Cervical injuries consistently demonstrated higher incidence, prevalence, and YLDs than thoracic or lumbar injuries. Adults aged 65-79 years had the greatest prevalence, incidence, and YLDs. Regionally, the West had the highest 2023 incidence (28.89), prevalence (714.16), and YLDs (188.10). Across all regions, males had significantly higher SCI metrics than that of females (all p < 0.001). No significant associations were identified between state-level SCI metrics in 2023 and HDI values. The national Quality of Care Index was 90.3, and showed a moderately positive correlation with state HDI values (R2 = 0.48, p < 0.001).</p><p><strong>Conclusions: </strong>While the US burden of SCI has decreased over the past 34 years, unequal distribution across regions and sexes necessitates targeted prevention and policies to further reduce the SCI burden and improve patient outcomes and quality of life.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001929","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":"Comparison of liposomal bupivacaine and modified cocktail analgesia for postoperative pain control after transforaminal lumbar interbody fusion: a prospective, double-blind, randomized controlled trial.","authors":"Junhu Li, Mei Yao, Jin Chen, Zhiqiang Yang, Shuxin Zheng, Jianzhi Wang, Weinan Zeng, Xi Yang, Lei Wang, Yueming Song","doi":"10.3171/2026.4.SPINE251671","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE251671","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative incisional pain remains a major clinical challenge after transforaminal lumbar interbody fusion (TLIF). Liposomal bupivacaine (LB) and modified cocktail analgesia have shown analgesic efficacy in other surgical settings, but their comparative value in TLIF remains unclear. This study compared the analgesic effectiveness of LB versus a modified cocktail regimen administered via an erector spinae plane block (ESPB) in patients undergoing TLIF.</p><p><strong>Methods: </strong>In this prospective, double-blind, randomized controlled trial, 181 patients were screened and 118 eligible patients were randomized equally to the LB group or the modified cocktail group (n = 59 each). In both groups, the study drug was administered via ESPB at the surgical level. The LB group received 266 mg LB diluted to 80 ml. The modified cocktail group received ropivacaine, epinephrine, dexamethasone, magnesium sulfate, and sodium bicarbonate. All other perioperative management was identical. The primary outcome was total postoperative rescue morphine consumption. Secondary outcomes included time to first rescue analgesia; 24-hour morphine consumption; number of rescue analgesia events; patient-controlled analgesia (PCA) activations and consumption; visual analog scale (VAS) pain scores at rest and during activity at 3, 6, 12, 24, 36, 48, and 72 hours; time to first ambulation; ambulation distance; length of hospital stay; and postoperative complications.</p><p><strong>Results: </strong>The LB group required significantly less total postoperative rescue morphine than the modified cocktail group (mean 16.2 [SD 11.6] vs 22.6 [SD 12.0] mg, p = 0.020). No significant differences were noted in the median time to first rescue analgesia (20.6 [IQR 8.3-36.6] vs 10.0 [IQR 3.2-27.9] hours, p = 0.074), mean morphine consumption within 24 hours (7.1 [SD 2.5] vs 7.2 [SD 2.5] mg, p = 0.894), or mean number of rescue analgesia events (2.4 [SD 1.4] vs 3.3 [SD 2.1] events, p = 0.058). The LB group had markedly fewer PCA activations (mean 7.3 [SD 6.4] vs 17.6 [SD 10.1] activations, p < 0.001) and lower total PCA drug use (mean 33.4 [SD 23.1] vs 62.8 [SD 27.8] ml, p < 0.001). Significant intergroup differences in VAS pain scores appeared only at 24 and 36 hours postoperatively.</p><p><strong>Conclusions: </strong>Both LB and the modified cocktail regimen administered via ESPB effectively reduced early incisional pain after TLIF. The modified cocktail provided satisfactory analgesia within 24 hours at substantially lower cost, whereas LB offered more prolonged analgesia up to 36 hours, with reduced opioid consumption and PCA demand. Chinese Clinical Trial Registry no.: ChiCTR2400089275 (https://www.chictr.org.cn/index.html).</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":3.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002004","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":"Accuracy, complications, and outcomes of dual-pin reference frame placement in navigated minimally invasive transforaminal lumbar interbody fusion.","authors":"Chibuikem A Ikwuegbuenyi, Noah Willett, Mousa Hamad, Andreas Kramer, Rachel Bratescu, Natasha Kharas, Anthony Robayo, Galal Elsayed, Ibrahim Hussain, Osama Kashlan, Roger Härtl","doi":"10.3171/2026.3.SPINE25807","DOIUrl":"https://doi.org/10.3171/2026.3.SPINE25807","url":null,"abstract":"<p><strong>Objective: </strong>Percutaneous dual-pin reference frames (RFs) enable image-guided minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) but carry risks of pin-related morbidity, notably sacroiliac (SI) joint dysfunction. While single-pin systems have been studied, clinical data on dual-pin systems remain limited. The authors report on their experience identifying complications related to dual-pin placement and evaluating their distribution using a three-zone anatomical grading system (green, yellow, red).</p><p><strong>Methods: </strong>This study retrospectively reviewed 133 consecutive patients who underwent MI-TLIF with intraoperative CT-guided dual-pin placement between January 2019 and July 2023, with at least 1 month of clinical follow-up. Pin-related complications assessed included new SI joint pain, persistent pin-site pain, hematoma, infection, fracture, and visceral injury. Two independent, blinded spine surgeons graded 266 total pins into one of three anatomical zones: 1) the green zone, involving the medial posterior superior iliac spine/ilium; 2) the yellow zone, abutting or breaching the SI joint or with inadequate bone purchase; and 3) the red zone, comprising the sacrum, neural foramen, or pelvic cavity. Interrater reliability was calculated using quadratic-weighted Cohen's kappa.</p><p><strong>Results: </strong>Two patients (1.5%) developed new SI joint pain with confirmed SI joint penetration on the symptomatic side, and 1 patient (0.8%) reported persistent pin-site pain. No hematomas, infections, fractures, or vascular or visceral injuries were observed. All complications occurred exclusively in the yellow or red zones. Among the 266 RF frame pins evaluated, 192 (72.2%) were in the green zone, 63 (23.7%) in the yellow zone, and 11 (4.1%) in the red zone. Interrater reliability for zone assignment was excellent (quadratic-weighted Cohen's κ = 0.89 and 0.90 for inferior and superior pins, respectively; p < 0.001).</p><p><strong>Conclusions: </strong>Dual-pin RF placement using an institution-defined three-zone classification showed high interobserver reliability and a low complication rate. Although 72.2% of pins were placed in the green zone, clinically significant SI region dysfunction on the pin side occurred in only 1.5%. These findings support the safety of dual-pin systems while underscoring the need for continued refinement of placement technique and further evaluation of alternative fixation methods.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001933","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. Automating opportunity: AI-driven measurement of vertebral bone quality as a scalable biomarker in preoperative spine risk assessment.","authors":"Jay Kumar, Danielle Nieto, Lee A Tan","doi":"10.3171/2026.4.SPINE26358","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26358","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-2"},"PeriodicalIF":3.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945154","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":"Nicotine replacement therapy and elective spinal fusion eligibility: a national analysis of insurance policy language.","authors":"Joseph Camarano, Jenae' Naquin, Zachary Sorrentino, Meena Vessell, Stephen Pirris, Catherine A Mazzola, Brandon Lucke-Wold, Owoicho Adogwa, Deepak Kumbhare, Bharat Guthikonda","doi":"10.3171/2026.3.SPINE251649","DOIUrl":"https://doi.org/10.3171/2026.3.SPINE251649","url":null,"abstract":"<p><strong>Objective: </strong>Smoking is a well-established risk factor for impaired spinal fusion, leading many insurers to require preoperative abstinence. Nicotine replacement therapy (NRT) supports smoking cessation without consistently demonstrating detrimental effects on spinal fusion outcomes. Nonetheless, many insurance policies for elective spinal fusion surgery treat NRT use as equivalent to active smoking, creating potential barriers for patients attempting evidence-based cessation. This study evaluated the clarity and nicotine specificity of insurer elective spinal fusion policies nationwide and identified factors associated with vague or restrictive language.</p><p><strong>Methods: </strong>Active spinal fusion coverage policies were identified using Policy Reporter. A total of 107 policies from 64 insurers across 49 states were analyzed. Policies were categorized based on clarity of cessation requirements, verification methods, and whether NRT use was distinguished from tobacco use. Insurance market share data were incorporated to estimate potential population-level relevance. Logistic regression and supervised machine learning models were used to identify policy characteristics predictive of vagueness or NRT-unfriendly language.</p><p><strong>Results: </strong>Sixty-six policies (62%) required preoperative cessation, of which 64% were NRT unfriendly and 29% lacked clear cessation timelines. Thirty-two percent of the US insurance market is governed by plans with NRT-unfriendly language, with 24 states having at least one of the top 2 major payers applying such language. Medicare Advantage plans had significantly lower odds of being NRT friendly (OR 0.06, p = 0.001). Machine learning models predicted NRT friendliness with 82.2% accuracy (area under the curve 0.80), with Medicare Advantage status and policy geographic scope among the strongest predictors.</p><p><strong>Conclusions: </strong>A substantial portion of spinal fusion coverage policies either lack clarity or treat NRT use equivalently to smoking, despite limited evidence that therapeutic nicotine exposure adversely affects fusion. These patterns affect a meaningful share of insured patients and may introduce preventable variability in authorization workflows. Clearer, standardized policy language that distinguishes NRT from tobacco use may better reflect emerging evidence, support patient-centered cessation strategies, and promote alignment between insurance criteria and clinical practice.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945203","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 impact of preoperative cervical degeneration on proximal junctional kyphosis in adult spinal deformity surgery with an upper-thoracic upper instrumented vertebra.","authors":"Josephine Coury Whalley, Fthimnir M Hassan, Justin L Reyes, Taylor J Jackson, Andrew S Zhang, Michael J Strong, Joseph Lombardi, Eduardo Beauchamp, Zeeshan Sardar, Ronald Lehman, Lawrence Lenke","doi":"10.3171/2026.5.SPINE26197","DOIUrl":"https://doi.org/10.3171/2026.5.SPINE26197","url":null,"abstract":"<p><strong>Objective: </strong>Preoperative cervical malalignment, including an increased cervical sagittal vertical axis and proximal junctional angle (PJA), has been associated with proximal junctional kyphosis (PJK) following thoracolumbar deformity correction. However, the influence of cervical disc degeneration on PJK risk remains unclear. This study evaluated whether preoperative MRI-based cervical degeneration predicts PJK following thoracolumbar deformity correction in patients with adult spinal deformity (ASD).</p><p><strong>Methods: </strong>One hundred twenty-six patients with ASD and preoperative cervical MRI who underwent thoracolumbar deformity correction with fusion from an upper-thoracic upper instrumented vertebra (UIV; C7-T4) to the S1 vertebra and ilium with at least 2 years of follow-up were included. Cervical degeneration was graded using the MRI-based Miyazaki classification, with grade IV-V discs considered severely degenerated. PJK was defined as a PJA ≥ 10° and ≥ 10° greater than preoperatively.</p><p><strong>Results: </strong>Patients without severe cervical degeneration had no significant increase in PJA and no cases of PJK at 2 years. From preoperatively to 2 years, PJA increased by 2.9° (p = 0.014), 4.0° (p = 0.002), and 4.1° (p = 0.04) in patients with 0, 1-2, and ≥ 3 severely degenerated discs, respectively, with corresponding PJK rates of 0%, 10.3%, and 40.6% (p < 0.0001). The posterior cranial vertical line to UIV screw head distance was greater in patients with minimal degeneration (15.8 mm) than those with 1-2 (2.8 mm) or ≥ 3 discs (6.0 mm; p < 0.0001). After adjusting for confounders, severe cervical degeneration independently predicted PJK (OR 3.01, p = 0.0004; area under the receiver operating characteristic curve = 0.90).</p><p><strong>Conclusions: </strong>Severe cervical degeneration on preoperative MRI strongly predicts PJK after thoracolumbar deformity correction with upper thoracic UIV and fusion to the S1 vertebra and ilium. Preoperative cervical MRI may identify high-risk patients and inform surgical planning for long thoracolumbar constructs.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-14"},"PeriodicalIF":3.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945242","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":"Contemporary science in coverage determination policies for cervical interbody fusion.","authors":"Luis M Tumialán, Joseph S Cheng, John K Ratliff","doi":"10.3171/2026.7.SPINE26627","DOIUrl":"https://doi.org/10.3171/2026.7.SPINE26627","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-3"},"PeriodicalIF":3.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of an AI framework for automated vertebral bone quality assessment of lumbar MRI.","authors":"Christian Quinones, Wesley Jameson, Andrew Schwartz, Bailey Lupo, Joe Wolters, Smith Surendran, Huy Tran, Deepak Kumbhare, Bharat Guthikonda, Stanley Hoang","doi":"10.3171/2026.3.SPINE251469","DOIUrl":"https://doi.org/10.3171/2026.3.SPINE251469","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop and validate a fully automated vertebral bone quality (VBQ) pipeline for lumbar MRI studies and to assess its diagnostic performance with dual-energy x-ray absorptiometry (DXA)-defined osteoporosis.</p><p><strong>Methods: </strong>Lumbar MRI studies from patients being evaluated for low-back pain were collected, deidentified, and assigned to reviewers for manual annotations. Each MRI study was manually annotated by two independent reviewers and by a custom, automated artificial intelligence (AI)-based segmentation algorithm. The measured signal intensity from the regions of interest (ROIs) was then extracted. Agreement between manual and automated methods was assessed using intraclass correlation coefficients (ICCs), root mean square error, and the paired t-test. The automated algorithm was validated on a separate cohort of 100 MRI examinations with paired DXA studies. Diagnostic performance for identifying osteoporosis was evaluated using receiver operating characteristic analysis to calculate the area under the curve (AUC).</p><p><strong>Results: </strong>A total of 1089 patients were included to compare manual and automated VBQ calculations. Correlation between reviewer and automation was strong (r = 0.87, p < 0.001), and agreement was good with an ICC of 0.86 (95% CI 0.81-0.89). Diagnostic capacity was validated in a separate cohort (n = 100) with an AUC of 0.79 (95% CI 0.63-0.92). The Youden-optimized VBQ score of 2.59 increased sensitivity from 0.20-0.50 to 0.66-0.80 while maintaining high specificity at 0.83-0.96.</p><p><strong>Conclusions: </strong>Automated VBQ measurement closely aligns with manual methods. An optimized threshold of 2.59 improved sensitivity for DXA-defined osteoporosis while maintaining high specificity. The automated algorithm may serve as an adjunct screening tool for osteoporosis in clinical practice and as a scalable research application suitable for integration into clinical workflows and large-scale MRI dataset analysis.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":3.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945119","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}