Journal of neurosurgery. Spine最新文献

{"title":"Diabetes as a significant risk factor for postoperative dysphagia following cervical spine surgery.","authors":"Catherine M Milne, Nicholas P Tippins, Anne M Foreit, Vincent J Alentado, Erica F Bisson, Ken Porche, Kevin T Foley, Eric A Potts","doi":"10.3171/2025.11.SPINE25838","DOIUrl":"https://doi.org/10.3171/2025.11.SPINE25838","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the relationship between diabetes and the incidence of postoperative dysphagia following cervical spine surgery (CSS).</p><p><strong>Methods: </strong>A prospectively collected multi-institutional quality registry was retrospectively reviewed. Patients who underwent CSS were categorized on the basis of diabetes status, and correlations with preoperative and postoperative Eating Assessment Tool-10 (EAT-10) dysphagia questionnaire scores were assessed. Mixed-effects logistic regressions were performed to examine the impact of preoperative diabetes on postoperative dysphagia.</p><p><strong>Results: </strong>Of the 2001 patients who met the inclusion criteria, 400 (20%) had diabetes. Baseline dysphagia rates were not significantly different between groups (18% vs 14%, p = 0.08). Patients with diabetes had a significantly higher incidence of dysphagia at 1 month (66% vs 54%, p = 0.002), 3 months (39% vs 26%, p < 0.001), and 12 months (33% vs 24%, p = 0.004) after surgery compared to patients without diabetes. Including baseline dysphagia as a fixed effect, multivariable analysis indicated that diabetes was a significant predictor of postoperative dysphagia at 1 month (OR 1.46, p = 0.041) and 3 months (OR 1.63, p = 0.001) but not at 12 months (OR 1.21, p = 0.3). In patients with no baseline dysphagia, those with diabetes (329 of 400 [82.3%]) had a significantly higher incidence of new dysphagia than nondiabetics at 1 month (62% vs 50%, p = 0.003), 3 months (34% vs 21%, p < 0.001), and 12 months (27% vs 18%, p = 0.001). The mean change in EAT-10 scores between baseline and 12 months was significantly worse in patients with preoperative diabetes (2.440 ± 5.013 vs 1.688 ± 4.139, p = 0.025). Multivariable analysis indicated that diabetes was a significant predictor of new postoperative dysphagia at 1 month (OR 1.49, p = 0.040) and 3 months (OR 1.81, p < 0.001) but not at 12 months (OR 1.31, p = 0.2).</p><p><strong>Conclusions: </strong>Diabetes is a significant risk factor for experiencing postoperative dysphagia following CSS. Diabetes correlated with higher incidence of dysphagia at all postoperative time points and was a strong independent predictor of postoperative dysphagia at 1 and 3 months.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":3.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654111","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":"Adjacent segment disease treated with stand-alone lateral lumbar interbody fusion: an analysis of domino adjacent segment revisions.","authors":"Marco D Burkhard, Torben Stepan, David G Rojas, Ali E Guven, Anna-Maria Mielke, Bruno Verna, Giuseppe Loggia, Jennifer Shue, Federico P Girardi, Frank P Cammisa, Andrew A Sama, Alexander P Hughes","doi":"10.3171/2025.11.SPINE251104","DOIUrl":"https://doi.org/10.3171/2025.11.SPINE251104","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to assess whether stand-alone lateral lumbar interbody fusion (LLIF) is a durable revision strategy for adjacent segment disease (ASD) in terms of risk for subsequent ASD revision surgery (i.e., domino ASD revision) compared with circumferential LLIF with posterior extension of fusion.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study of patients who underwent revision and extension of fusion for ASD using either stand-alone LLIF or circumferential LLIF with posterior pedicle screw instrumentation between January 2008 and August 2023. Patients were included if they had undergone previous posterior lumbosacral fusion. Patients undergoing instrumentation across the thoracolumbar junction and those with incomplete radiographic data were excluded. Preoperative radiographs and MR images were reviewed to control for alignment and stenosis severity. The primary outcome was domino ASD revision. Secondary outcomes included cage subsidence and radiographic alignment, measured 1 year postoperatively. Kaplan-Meier survival analysis and multivariable Cox regression were performed.</p><p><strong>Results: </strong>Of the 236 patients included, the mean age was 63.5 years, the mean BMI was 29.6 kg/m2, and 47.5% of patients were female. Baseline demographics, comorbidities, and spinal levels treated were similar to those treated with stand-alone LLIF (n = 131) and those treated with circumferential LLIF (n = 105). The median number of previous segments fused was 2 (IQR 2-3), and the median number of segments extended with LLIF was 1 (IQR 1-2). Stand-alone LLIF was associated with a significantly lower 5-year incidence of domino ASD revision (13.7% vs 28.6%, p = 0.005). On multivariable Cox regression analysis adjusting for preoperative alignment, stenosis severity, and the number of segments fused, stand-alone LLIF remained independently associated with fewer domino ASD revisions (HR 0.43, 95% CI 0.23-0.79, p = 0.007). Radiographic alignment was comparable between the groups. Cage subsidence occurred more frequently after stand-alone LLIF compared with circumferential LLIF (Marchi grade ≥ II: 22.9% vs 9.5%, p = 0.019) but was not associated with increased revision risk. Operative time and hospital stay were significantly shorter in the stand-alone LLIF group.</p><p><strong>Conclusions: </strong>The findings of this study support the use of stand-alone LLIF as a treatment option for ASD after previous posterior fusion. Compared with those treated with circumferential LLIF and posterior extension of fusion, patients treated with stand-alone LLIF had less domino ASD revision surgery, spent less time in the operating room, and had shorter hospital stays, with comparable radiographic outcomes except for a higher rate of cage subsidence.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654105","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":"Creating sustainability in centers performing high-volume adult spinal deformity surgery: evaluation of the Maryland all-payer model.","authors":"Andrew H Kim, Micheal Raad, Richard A Hostin, Shay Bess, Jeffrey L Gum, Breton G Line, Pratibha Nayak, Virginie Lafage, Renaud Lafage, D Kojo Hamilton, Peter G Passias, Themistocles S Protopsaltis, Lawrence G Lenke, Justin S Smith, Christopher P Ames, Bassel G Diebo, Eric O Klineberg, Alan H Daniels, Han Jo Kim, Munish C Gupta, Frank J Schwab, Christopher I Shaffrey, Douglas C Burton, Khaled M Kebaish","doi":"10.3171/2025.11.SPINE25237","DOIUrl":"https://doi.org/10.3171/2025.11.SPINE25237","url":null,"abstract":"<p><strong>Objective: </strong>The all-payer model is a healthcare payment system unique to the state of Maryland, while the Medicare Severity-Diagnosis-Related Group (MS-DRG) model is used by all other states. The purpose of this study was to investigate differences in reimbursement and inpatient length of stay (LOS) in adult spinal deformity (ASD) surgery between the all-payer and MS-DRG models.</p><p><strong>Methods: </strong>MS-DRG reimbursements were calculated using the Centers for Medicare & Medicaid Services Web Pricer tool; reimbursements for the all-payer model were compiled from a single institution in the state of Maryland. Payments for the most frequently occurring ASD MS-DRGs (codes 453, 454, 455, 456, 457, 458, and 460) were analyzed for fiscal years 2018-2023. The mean inpatient LOS was calculated for each MS-DRG code and reimbursement model.</p><p><strong>Results: </strong>When comparing 416 MS-DRG and 1783 all-payer model accounts, the overall mean reimbursements for ASD surgery were significantly lower under the MS-DRG model ($59,199 vs $77,246, p < 0.001). The mean reimbursement payments for MS-DRG codes 453, 454, 455, 456, 457, and 460 were significantly higher under the Maryland all-payer model (p < 0.001). The mean LOS was significantly shorter in the all-payer model for MS-DRG code 453 (p = 0.046) and longer for code 457 (p < 0.001). For all other codes, no significant differences in LOS were observed.</p><p><strong>Conclusions: </strong>ASD surgery reimbursements are higher overall under the Maryland all-payer model compared with the MS-DRG model. The mean inpatient LOS did not differ significantly across most MS-DRG codes, highlighting the financial viability of an all-payer model in a healthcare system.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":3.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654095","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":"Treatment of extramedullary tumors: morbidity and long-term results.","authors":"Jörg Klekamp","doi":"10.3171/2025.11.SPINE251323","DOIUrl":"https://doi.org/10.3171/2025.11.SPINE251323","url":null,"abstract":"<p><strong>Objective: </strong>Surgery on extramedullary tumors has a place among the most gratifying operations in neurosurgery. However, little data exist on permanent morbidity and long-term results. This paper provides these data and analyzes which factors influence them and how they can be managed.</p><p><strong>Methods: </strong>Among 2081 patients with tumors of the spinal canal presenting between 1991 and 2024, 605 patients were identified with intradural extramedullary tumors, of whom 500 patients underwent 570 operations. Multiple regression was used to identify factors influencing resection and morbidity rates. Short-term results were analyzed according to a neurological scoring system for individual symptoms, while long-term results were determined calculating recurrence-free outcome rates with Kaplan-Meier statistics.</p><p><strong>Results: </strong>The mean age for operated patients was 49.8 ± 18 years, presenting after a mean history of 21.2 ± 42 months. They were followed up by outpatient visits and questionnaires for up to 34 years (mean 43.3 ± 64 months). Overall, 87.4% of tumors were resected completely, while 11.2% underwent partial resection and 1.4% biopsy. Transient postoperative deteriorations were observed in 15.1% of surgeries. Permanent surgical morbidity occurred in 7.1%, that is, 4.8% for first surgeries and 18.4% for recurrent tumors (p < 0.0001). With complete resection, recurrence-free outcome rates of 80.5% and 77% after 5 and 10 years, respectively, were obtained, while partial resection reduced these rates to 40.0% and 36.4% after 5 and 10 years, respectively (p < 0.0001). Surgeons with > 100 operations achieved significantly higher recurrence-free outcome rates compared to surgeons with less experience at each postoperative time point. Schwannomas, meningiomas, ependymomas of the filum terminale, and hamartomas represented 89.8% of all pathologies and were analyzed separately. The best results for resection rates, permanent morbidity, and recurrence-free outcomes were observed for schwannomas. The highest morbidity rates were determined for ependymomas and hamartomas. Complete resection resulted in recurrence-free outcome rates of around 90% after 10 years for each histological group with the exception of meningiomas (73.3%).</p><p><strong>Conclusions: </strong>Whenever an extramedullary tumor is completely resected, rates for surgical morbidity and 10-year recurrence-free outcomes are favorable. In contrast, with arachnoid adhesions, as in recurrent tumors and some hamartomas, complete resection rates decline, morbidity rates rise, and long-term results become less satisfactory. This emphasizes the importance of achieving complete resection, particularly in the first operation. Surgeons dedicated to spinal cord pathologies can expect to achieve superior long-term results.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654114","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":"Flowchart and checklist for transcranial motor evoked potential alarm for reducing true-positive and false-positive cases: a prospective multicenter study.","authors":"Hideki Shigematsu, Go Yoshida, Hiroki Ushirozako, Kenta Kurosu, Naoki Segi, Muneharu Ando, Jun Hashimoto, Shigenori Kawabata, Shinji Morito, Kei Yamada, Tsukasa Kanchiku, Yasushi Fujiwara, Shinichirou Taniguchi, Hiroshi Iwasaki, Nobuaki Tadokoro, Masahito Takahashi, Kanichiro Wada, Naoya Yamamoto, Masahiro Funaba, Akimasa Yasuda, Kazuyoshi Kobayashi, Kazuyoshi Nakanishi, Tsunenori Takatani, Yukihiro Matsuyama, Yasuhito Tanaka, Shiro Imagama, Katsushi Takeshita","doi":"10.3171/2025.11.SPINE25175","DOIUrl":"https://doi.org/10.3171/2025.11.SPINE25175","url":null,"abstract":"<p><strong>Objective: </strong>Intraoperative neurophysiological monitoring (IONM) is essential for detecting neurological dysfunction, facilitating timely intervention and potential reversal of neurological deficits before they become permanent. Transcranial electrical stimulation of motor evoked potential (Tc-MEP) is the IONM modality used for monitoring pyramidal tract function. The authors believe that a multidisciplinary team approach in response to a Tc-MEP alarm is crucial for optimal outcomes. To this end, the authors developed a flowchart and checklist to guide the response to Tc-MEP alarms. They aimed to clarify the utility of these tools through a prospective multicenter study.</p><p><strong>Methods: </strong>Data from 9495 patients who underwent various spinal surgical procedures with an adequate number of Tc-MEP recordings from 2017 to 2023 were collected. Patients from the first 3 years served as the control group (n = 3598) without flowchart and checklist implementation, while those from the last 3 years formed the study group (n = 5897) as flowchart and checklist were implemented. A 70% amplitude reduction was used as the Tc-MEP alarm threshold. Postoperative neurological outcomes were categorized as true-positive (TP), false-positive (FP), and rescue cases on the basis of postoperative assessments.</p><p><strong>Results: </strong>The incidence of TP cases decreased significantly from 93/3598 (2.6%) in the control group to 91/5897 (1.5%) in the study group (p < 0.01). FP cases also decreased significantly from 352/3598 (9.8%) in the control group to 413/5897 (7.0%) in the study group (p < 0.01). Notably, rescue cases increased significantly from 41/486 (8.4%) in the control group to 92/596 (15.4%) in the study group (p < 0.01), among Tc-MEP alarm cases.</p><p><strong>Conclusions: </strong>Applying a flowchart and checklist improved intraoperative responses to Tc-MEP alarms by facilitating early identification of surgery- and nonsurgery-related factors and guiding appropriate interventions. Using these tools led to a significant reduction in TP and FP cases and increased rescue cases, ultimately enhancing the safety and reliability of spine surgeries.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":3.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616268","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":"Comparing risk stratification indices in predicting perioperative adverse events following posterior atlantoaxial and occipitocervical fusion.","authors":"Adewale A Bakare, Nathan Pertsch, Dustin Kim, Ricky Ditzel, Harel Deutsch, John E O'Toole, Ricardo B V Fontes, Richard G Fessler, Vincent C Traynelis","doi":"10.3171/2025.11.SPINE25367","DOIUrl":"https://doi.org/10.3171/2025.11.SPINE25367","url":null,"abstract":"<p><strong>Objective: </strong>Craniocervical instability often requires surgical stabilization through atlantoaxial fusion (AAF) or occipitocervical fusion (OCF), procedures commonly performed in older adults and/or patients with poor functional status and multiple comorbidities. Despite the high-risk nature of this patient population, there are limited data on perioperative risk stratification. Thus, authors of this study aim to assess the ability of an 11-item modified frailty index (mFI-11) and the Charlson Comorbidity Index (CCI) to predict adverse events (AEs) following AAF and OCF.</p><p><strong>Methods: </strong>Adult patients without prior surgery who underwent AAF or OCF between 2009 and 2023 were eligible for inclusion in this retrospective study. The perioperative AEs analyzed were major complications, nonhome discharge, and prolonged length of stay (LOS). Univariable and multivariable logistic regression analyses, as well as receiver operating characteristic curve analysis, were used to determine which index best predicted these AEs.</p><p><strong>Results: </strong>Among the 219 patients included in this study, most of whom were female (60.7%), the median age was 71.5 years, and 45.2% of patients were 60-69 years old. The median LOS was 6 days, with 27.4% of patients staying ≥ 10 days. Major complications occurred in 16.9% of patients, and 37.4% of the patients were not discharged to home. The median mFI-11 was 1, and the most frequent score was 1 (32.4% of patients). The median CCI was 4, and the most frequent score was ≥ 5 (38.4% of patients). In the multivariable analysis, neither risk index was independently associated with a major complication or prolonged LOS; however, the mFI-11 score was associated with increased odds of predicting a nonhome discharge (OR 1.8, p = 0.003). ROC curve analysis revealed that both the mFI-11 and CCI showed modest but similar discriminative ability in predicting major complications (area under the curve [AUC] 0.633 vs 0.636, respectively). For nonhome discharge, the mFI-11 had slightly stronger discriminative ability (AUC 0.645 vs 0.602, respectively). Neither index had strong discriminative ability in predicting prolonged LOS (AUC 0.576 vs 0.597, respectively).</p><p><strong>Conclusions: </strong>The mFI-11 demonstrated a slight advantage over the CCI in identifying AEs according to ROC analysis, yet neither index independently predicted major complications or prolonged LOS in the multivariable analysis. However, a higher mFI-11 score was associated with increased odds of predicting a nonhome discharge. While the mFI-11 may offer slightly greater clinical utility in predicting AEs following AAF and/or OCF, neither index alone is sufficient to determine surgical candidacy.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-12"},"PeriodicalIF":3.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616332","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":"Disparities in quality of life and health literacy among patients with degenerative cervical myelopathy: the influence of racial and ethnic factors in the All of Us Research Program.","authors":"Salim Yakdan, Karan Joseph, Noah Poulin, Faraz Arkam, Diogo Moniz Garcia, Magalie Cadieux, Brian Neuman, Burel R Goodin, Jakub Godzik, Michael P Steinmetz, Mohamad Bydon, Zoher Ghogawala, Daniel Hafez, Wilson Z Ray, Jacob K Greenberg","doi":"10.3171/2025.11.SPINE25662","DOIUrl":"10.3171/2025.11.SPINE25662","url":null,"abstract":"<p><strong>Objective: </strong>Degenerative cervical myelopathy (DCM) is a progressive condition that results in significant neurological decline and disability. Racial and ethnic disparities in healthcare access and outcomes are well documented, yet their impact on DCM patients remains insufficiently explored. This study aimed to investigate racial and ethnic disparities in self-reported health status and quality of life (QOL), health literacy, and healthcare access among individuals with DCM using data from the All of Us Research Program (AoURP).</p><p><strong>Methods: </strong>In this retrospective study, the authors analyzed the data of AoURP participants with a diagnosis of DCM based on ICD-9 and ICD-10 codes. Race and ethnicity were categorized as White/Caucasian (WC), Black/African American (BAA), and non-White Hispanic (NWH). Participants' demographic characteristics, socioeconomic status (SES), self-reported health status and QOL, health literacy, and healthcare utilization patterns were assessed through survey responses. To assess whether SES mediates the association between race and ethnicity and outcomes, a causal mediation analysis was conducted, operationalizing SES as a composite of standardized income, education, and employment measures. Statistical analyses were conducted using chi-square and independent t-tests to compare categorical and continuous variables, respectively.</p><p><strong>Results: </strong>Among 3092 DCM patients, 26% identified as BAA, 64% as WC, and 10% as NWH. Significant socioeconomic disparities were observed, with WC participants reporting higher educational attainment, income, and homeownership rates (p < 0.001). Healthcare access varied substantially, with BAA and/or NWH participants reporting lower rates of insurance coverage, specialist consultations, and primary care access compared to WC participants (p ≤ 0.05). Financial and transportation barriers to care access were more frequently reported among minority groups. BAA and NWH participants also had lower health literacy, reporting greater difficulty in understanding medical information and completing medical forms and requiring assistance with health materials (p < 0.001). Furthermore, both BAA and NWH groups reported poorer self-perceived health and QOL and higher pain levels (p < 0.001). Causal mediation analysis demonstrated that SES partially mediated the relationship between race and ethnicity and key outcomes, including health literacy, healthcare access, and self-perceived health, indicating that socioeconomic disadvantage explains much, but not all, of the observed disparities.</p><p><strong>Conclusions: </strong>This study highlights substantial racial and ethnic disparities in healthcare access, health literacy, and self-reported health status and QOL among DCM patients, which are partially mediated by socioeconomic factors. Recognizing and addressing these disparities is essential to improving DCM outcomes and ensuring equitable care.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in the rate of distal junctional problems between L3 and L4 pedicle subtraction osteotomy.","authors":"Vardhaan S Ambati, Saman Shabani, Praveen V Mummaneni, Timothy Chryssikos, Arati Patel, Catherine Ravikumar, Abraham Dada, Alma Rechav Ben-Natan, Jeremy Huang, Alysha Jamieson, Kathryn Park, Mohamed Macki, Michael E Tawil, Jeremy Guinn, Hao-Hua Wu, Minghao Wang, Ping-Guo Duan, Zhuo Xi, Shane Burch, Sigurd Berven, Dean Chou, Lee A Tan","doi":"10.3171/2025.10.SPINE25539","DOIUrl":"https://doi.org/10.3171/2025.10.SPINE25539","url":null,"abstract":"<p><strong>Objective: </strong>Pedicle subtraction osteotomy (PSO) is a powerful technique for sagittal plane deformity correction. The authors aimed to investigate the differences in radiographic outcomes and rates of distal junctional problems (DJPs) between L3 and L4 PSOs.</p><p><strong>Methods: </strong>Patients who underwent L3 or L4 PSO at a quaternary care center between 2005 and 2021 were retrospectively identified. DJPs were defined as either hardware failure or pseudarthrosis distal to the PSO level.</p><p><strong>Results: </strong>In total, 116 patients were included: 86 (74.1%) underwent L3 PSO and 30 (25.9%) underwent L4 PSO. The mean imaging follow-up was 4.1 (range 1.0-10.9) years. There were no statistically significant differences in age, sex, BMI, operative time, and estimated blood loss. Preoperatively, there were no significant differences in mean sacral Hounsfield units and spinopelvic parameters, with the exception of pelvic incidence (PI; L3: 51.1° ± 11.2° vs L4: 57.9° ± 14.1°, p = 0.012) and the L1 pelvic angle (L3: 23.6° ± 10.1° vs L4: 34.8° ± 13.5°, p < 0.001). Postoperatively, there were no statistically significant differences in primary rod type, 2-rod versus multirod constructs, unilateral versus bilateral iliac fixation, number of levels fused, graft material, L5-S1 interbody fusion approach, and PI-lumbar lordosis mismatch. There were no significant differences between the cohorts in uni- versus bilateral pelvic fixation or type of fixation (iliac vs S2AI); however, patients who underwent L4 PSO had, on average, more pelvic screws placed (mean 1.9 ± 0.7 vs 1.5 ± 0.6, p = 0.002). L4 PSO resulted in larger postoperative L4-S1 segmental lordosis (37.2° ± 13.3° vs 21.4° ± 11.4°, p < 0.001) and reduced rates of postoperative low lordosis distribution index (20.0% vs 60.0%, p < 0.001). There were no significant differences in postoperative complication rates including CSF leak, iatrogenic dorsiflexion weakness, and 30- or 90-day readmissions. The L4 PSO cohort experienced lower DJP rates (6.7% vs 29.1%, p = 0.012), including hardware failure (3.3% vs 20.9%, p = 0.024) and pseudarthrosis (3.3% vs 25.6%, p = 0.008). Multivariate analysis found that multirod construct versus dual-rod configuration (OR 0.31, 95% CI 0.09-0.96) and L4 PSO (OR 0.18, 95% CI 0.02-0.80) were independently associated with decreased DJP rates. Age was also a risk factor for DJPs. The number of pelvic screws and pelvic screw fixation type did not predict DJPs.</p><p><strong>Conclusions: </strong>In addition to multirod configurations, L4 PSO resulted in a lower rate of DJPs compared with L3 PSO. This result might be due to a more physiological distribution of lumbar lordosis with L4 PSO.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616278","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 interpretable classification of lumbar spinal stenosis using a cascade deep learning approach and T2-weighted MRI.","authors":"Mohammad Tabarestani, Niloufar Delfan, Mohammad Khoshnevisan, Jaber Hatam Parikhan, Amirmohammad Bahri, Amin Hessam, Mohsen Nabiuni, Behzad Moshiri","doi":"10.3171/2025.10.SPINE25878","DOIUrl":"https://doi.org/10.3171/2025.10.SPINE25878","url":null,"abstract":"<p><strong>Objective: </strong>Lumbar spinal stenosis (LSS) is a degenerative spinal condition characterized by the narrowing of the lumbar spinal canal, leading to back pain and disability. MRI remains the gold standard for LSS diagnosis, but diagnostic variability arises due to the lack of standardized imaging criteria. Recent advancements in artificial intelligence, particularly convolutional neural networks (CNNs), offer promising potential for automating LSS detection and classification. The aim of this study was to propose a novel 3-stage deep learning pipeline for automated LSS identification, classification, and grading using lumbar MRI, aiming to enhance diagnostic accuracy and consistency.</p><p><strong>Methods: </strong>Two datasets were used. The first dataset consisted of 17,440 MRI slices obtained in 640 patients (mean patient age 57.58 ± 12.47 years) and was used for model training. The second dataset consisted of 8000 slices and was used only as the external validation set. The proposed framework consists of 1) classification of images into sacral, lumbar, and thoracic regions; 2) region of interest detection; and 3) LSS grading (binary and multiclass). The 10-fold cross-validation method was used to avoid overfitting and improve generalization of the model.</p><p><strong>Results: </strong>The proposed model achieved an accuracy of 97.87% for binary classification and 95.52% for multiclass grading of LSS, outperforming state-of-the-art models. To validate the clinical relevance of the model's decision-making, gradient-weighted class activation mapping was used to visualize the key focus areas.</p><p><strong>Conclusions: </strong>The proposed framework offers a reliable, interpretable, and effective tool for automated LSS detection and grading, with the potential for future improvements in underdiagnosis and multilevel spine disease analysis.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":3.1,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529927","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":"Letter to the Editor. Minimally invasive versus open decompression for lumbar spinal stenosis.","authors":"Pratyush Shahi, Anindya Basu","doi":"10.3171/2025.11.SPINE251641","DOIUrl":"https://doi.org/10.3171/2025.11.SPINE251641","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-2"},"PeriodicalIF":3.1,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529971","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}