Journal of neurosurgery. Spine最新文献

{"title":"Editorial. Optimization or obstruction? Aligning nicotine policies with evidence in spinal fusion.","authors":"Nicholas M Rabah, Michael J Yang, Jay D Turner","doi":"10.3171/2026.4.SPINE26322","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26322","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":"148945228","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 effect of low-dose ketorolac on minimally invasive transforaminal lumbar interbody fusions: final analysis of a randomized, double-blinded, placebo-controlled trial.","authors":"Chad F Claus, Jeffrey P Turnbull, Bryce K Sarcar, Daniel W Griepp, Gustavo Anton, Michael H Lawless, Heather Lucke, Grace D Brannan, Rabia Ahmed, Andrew Beggs, Karl Kado, Jake M Jasinski, Peter Bono, Daniel A Carr, Prashant S Kelkar, Clifford M Houseman, Boyd F Richards, Heather Heitkotter, Doris Tong, Teck M Soo","doi":"10.3171/2026.5.SPINE26228","DOIUrl":"https://doi.org/10.3171/2026.5.SPINE26228","url":null,"abstract":"<p><strong>Objective: </strong>In this study, the authors aimed to evaluate the safety and efficacy of short-term, low-dose ketorolac following minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) with bone morphogenetic protein (BMP), specifically assessing its impact on fusion rates and postoperative opioid consumption in a randomized, double-blind, placebo-controlled, noninferiority trial.</p><p><strong>Methods: </strong>Adult patients undergoing elective 1- to 3-level MIS TLIF with BMP between October 2017 and April 2024 were randomized to receive perioperative ketorolac or placebo in addition to a standardized multimodal analgesic regimen. The primary outcome was radiographic fusion at 1 year, assessed by independent neuroradiologists using dynamic radiographs and CT scans as needed. A noninferiority margin of -0.15 was prespecified. Secondary outcomes were 48-hour and total in-hospital opioid consumption (intravenous morphine milligram equivalents [MME]) and length of stay (LOS). Patient-reported outcomes (PROs) were collected at baseline and postoperative intervals. Analyses were performed per protocol with significance set at an α value of 0.025.</p><p><strong>Results: </strong>Of 420 randomized patients, 31 in the ketorolac group and 34 in the placebo group were excluded due to surgery cancellation, protocol violations, or withdrawal of consent. One hundred sixty-seven patients remained in the ketorolac group and 188 in the placebo group. The per-protocol analysis included 364 levels (1 year) and 395 levels (2 years) for fusion assessment, and 355 patients for secondary outcomes (MME and LOS). Baseline demographics and intraoperative characteristics were comparable between groups. The fusion rate did not significantly differ at 6 months (Δ = 0.8, 95% CI -5.6 to 7.1; p = 0.51), 1 year (Δ = 2.5, 95% CI -3.4 to 8.2; p = 0.39), or 2 years (Δ = 2.6, 95% CI -2.6 to 7.7; p = 0.49). The lower bounds of the 95% confidence intervals for differences in solid fusion rates did not cross the -0.15 noninferiority margin at any time point, confirming the noninferiority of ketorolac. The mean total in-hospital MME (Δ = 22.65, 95% CI 12.27-33.04; p < 0.001) and 48-hour MME (Δ = 17.19, 95% CI 9.24-25.13; p < 0.001) were significantly reduced in the ketorolac group. Patients receiving ketorolac demonstrated significantly lower mean visual analog scale pain scores over the first 48 hours (Δ = 0.52, 95% CI 0.18-0.86; p = 0.003) and shorter LOS (Δ = 0.73 days, 95% CI 0.39-1.07 days; p < 0.001). There were no significant differences in complications, revision surgery, or PROs.</p><p><strong>Conclusions: </strong>Short-term, low-dose ketorolac following MIS TLIF with BMP maintained noninferior fusion rates while providing significant reductions in opioid requirements, hospital stay, and early postoperative pain. Clinical trial registration no.: NCT03278691 (ClinicalTrials.gov).</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890828","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 the need for syrinx shunting after posterior fossa decompression in Chiari I malformation: a real-world machine learning analysis.","authors":"Rahim Abo Kasem, Nicholas Dietz, Isaac Josh Abecassis, Redi Rahmani, Akshitkumar M Mistry, Brian J Williams, Dale Ding, S Hassan A Akbari, Laila M Mohammad","doi":"10.3171/2026.6.SPINE26351","DOIUrl":"https://doi.org/10.3171/2026.6.SPINE26351","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to develop and validate a machine learning (ML) algorithm to predict the delayed need for syrinx shunt placement following posterior fossa decompression (PFD) for Chiari malformation type I (CM-I) with concurrent syringomyelia.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study utilized the TriNetX network to identify patients undergoing index PFD for CM-I and syringomyelia (2010-2020) with at least 2 years of continuous follow-up. The primary outcome was unplanned syringosubarachnoid, syringopleural, or syringoperitoneal shunt placement. Five supervised ML classifiers were trained on 30 preoperative clinical and demographic variables using the Synthetic Minority Over-Sampling Technique to address class imbalance.</p><p><strong>Results: </strong>Of 3112 patients (62.3% female, median age 28.4 years) with a median follow-up of 5.1 years, 271 (8.7%) experienced refractory syringomyelia requiring a shunt. The CatBoost classifier achieved the highest discriminative performance on the independent validation set, yielding an area under the curve of 0.87, accuracy of 83%, sensitivity of 0.78, and specificity of 0.82. Shapley Additive Explanations analysis identified adolescent idiopathic scoliosis, prolonged symptom duration, age > 40 years, and preoperative opioid dependency as the strongest predictors of delayed shunt placement. Notably, partial dependence analysis revealed that every 1-month delay in surgical intervention increased the absolute probability of shunting by approximately 0.8%-1.0%.</p><p><strong>Conclusions: </strong>The CatBoost ML algorithm accurately predicted the delayed need for syrinx shunting after PFD. The prominent risk associated with concomitant scoliotic deformity and surgical delay provides actionable intelligence, strongly supporting early operative intervention and guiding highly individualized long-term postoperative surveillance.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892050","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":"Incidence and severity of postoperative dysphagia after short-segment anterior cervical fusion, corpectomy, or arthroplasty.","authors":"David Wallace, Mark N Pernik, Erica F Bisson, Eric A Potts, Kevin T Foley, Vincent J Alentado, Olivia Denton, Nicholas Tippins, Ken Porche, Paul Park","doi":"10.3171/2026.4.SPINE26217","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26217","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Postoperative dysphagia occurs frequently after anterior cervical surgery. In this study, dysphagia incidence and duration were assessed in a multicenter cohort of patients who had undergone short-segment anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), or cervical disc arthroplasty (CDA). The authors hypothesized that CDA would demonstrate the lowest dysphagia burden; ACCF, the highest; and ACDF, an intermediate burden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Authors retrospectively analyzed consecutive adult patients who underwent short-segment anterior cervical surgery, including CDA, ACDF, and ACCF, from 2010 to 2020 at three institutions. The 10-item Eating Assessment Tool (EAT-10) was used to assess for the occurrence of dysphagia and its persistence, the primary outcomes. An EAT-10 score ≥ 3 was defined as the threshold for dysphagia. Assessment for predictors of postoperative dysphagia was the secondary outcome. Univariate and regression analyses were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Authors identified 1466 patients who had been treated with 1- or 2-level ACDF (n = 1296), 1-level ACCF (n = 50), or 1- or 2-level CDA (n = 120). Significant differences in age, BMI, race, comorbidities, education level, and surgical characteristics were observed between and among surgical techniques. Preoperatively, the mean EAT-10 score was 1.6 for the whole cohort, increasing to 6.0 at 1 month after surgery and then decreasing to 2.5 and 2.4 at 3 and 12 months, respectively. At 1 month, dysphagia was present in 57% of patients after ACDF, 61% after ACCF, and 42% after CDA; at 12 months, dysphagia rates were 24%, 37%, and 17%, respectively. In patients without preexisting dysphagia (n = 1261), mean EAT-10 scores were 0.1 at baseline, increasing to 5.1 at 1 month and decreasing to 2.0 and 1.8 at 3 and 12 months, respectively. Within this patient subset at 1 month, dysphagia was present in 52% after ACDF, 60% after ACCF, and 39% after CDA; at 12 months, rates were 18%, 36%, and 12%, respectively. Compared to patients without preexisting dysphagia, those with baseline dysphagia had increased risks for postoperative dysphagia at the 1-month (OR 4.53, 95% CI 2.66-7.72), 3-month (OR 4.81, 95% CI 3.31-6.99), and 12-month (OR 6.69, 95% CI 4.40-10.2) follow-ups. At 3 months after surgery, other predictors of dysphagia were ACCF (OR 2.31, 95% CI 1.10-4.85) and diabetes (OR 1.71, 95% CI 1.22-2.41), whereas antithrombotic use indicated lower odds of dysphagia (OR 0.66, 95% CI 0.46-0.93). At the 12-month follow-up, female sex (OR 1.73, 95% CI 1.24-2.43), coronary artery disease (OR 2.25, 95% CI 1.29-3.93), and chronic pulmonary disease (OR 1.83, 95% CI 1.11-3.00) indicated greater odds of dysphagia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although dysphagia resolved in the great majority of patients, a not insignificant portion had residual symptoms at the 12-month follow-up. Various risk factors","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":3.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892052","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":"Implications of asymptomatic radiographic foraminal stenosis: outcomes after single-level minimally invasive decompression.","authors":"Tejas Subramanian, Stephane Owusu-Sarpong, Atahan Durbas, Tomoyuki Asada, Austin C Kaidi, Mihir Dekhne, Gregory S Kazarian, Takashi Hirase, Eric Zhao, Junho Song, Evan Sheha, Kyle Morse, Francis C Lovecchio, James E Dowdell, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.3171/2026.4.SPINE26284","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26284","url":null,"abstract":"<p><strong>Objective: </strong>Foraminal stenosis (FS) is commonly identified in patients undergoing lumbar decompression, but its clinical significance when deemed \"asymptomatic\" remains unclear. Minimally invasive surgery techniques for decompression, including unilateral laminotomy for bilateral decompression, aim to relieve neural compression while preserving soft tissue. However, the impact of preoperative FS on postoperative outcomes following minimally invasive decompression is not well-established. The aim of this study was to evaluate the effect of preoperative FS on patient-reported outcome measures (PROMs) and revision surgery rates following single-level minimally invasive lumbar decompression.</p><p><strong>Methods: </strong>Patients who underwent primary single-level minimally invasive decompression for degenerative lumbar conditions between February 2017 and September 2022 at a single institution were included. Preoperative FS severity was graded from 0 (none) to 3 (severe) on MRI, and patients were stratified into FS+ (any FS ≥ grade 1) and FS- (no FS) groups. Patients in the FS+ and FS- groups were matched 1:1 based on demographic characteristics and preoperative radiographic parameters and compared for all outcome measures. Outcomes included PROMs (Oswestry Disability Index [ODI], visual analog scale [VAS] for back and leg pain, and SF-12 Physical Component Score [PCS]) at short-term and long-term follow-up time points and revision surgery rates. Multivariable logistic regression analysis was conducted for predictors of nonachievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS).</p><p><strong>Results: </strong>Of 320 patients included in the analysis, FS was present in 234 (73.1%, mean age 68.52 years). After matching, the FS+ group (n = 71) and FS- group (n = 71) were compared. Both groups demonstrated significant postoperative improvement in PROMs; however, patients with FS had worse ODI (p = 0.001), VAS-back (p = 0.003), and SF-12 PCS (p = 0.004) outcomes at long-term follow-up. In addition, the FS+ group had higher revision surgery rates at the index level (p = 0.003) and greater likelihood of requiring fusion (p = 0.005). An FS grade of 2 or 3 independently predicted failure to achieve the MCID for ODI, VAS Back, SF-12 PCS and the PASS for ODI.</p><p><strong>Conclusions: </strong>Radiographic FS, even when deemed asymptomatic, was associated with worse long-term functional outcomes and higher revision rates following minimally invasive decompression. These findings underscore the need for careful preoperative assessment and surgical planning, particularly for patients with moderate-to-severe FS, to optimize long-term outcomes.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892082","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":"Posterior vertebral column resection at the apical vertebra versus subapical vertebra for tuberculotic angular kyphosis: 100 patients with a minimum 2-year follow-up.","authors":"Yilin Lu, Zekun Li, Junyu Li, Xiang Zhang, Yongqiang Wang, Weishi Li, Miao Yu","doi":"10.3171/2026.3.SPINE251477","DOIUrl":"https://doi.org/10.3171/2026.3.SPINE251477","url":null,"abstract":"<p><strong>Objective: </strong>The authors of this study aimed to compare the surgical outcomes and complication profiles of posterior vertebral column resection (pVCR) performed at the apical vertebra (AV) versus the subapical vertebra (SAV) in patients with rigid tuberculotic angular kyphosis (TAK). They hypothesized that an SAV resection would reduce the incidence of neurological complications without compromising radiographic correction.</p><p><strong>Methods: </strong>They conducted a retrospective analysis of patients with TAK who underwent single-level pVCR (Schwab grade 5 osteotomy) between June 2010 and June 2023. Patients were divided into 2 groups, an AV group and SAV group. Demographic, surgical, radiographic, and health-related quality of life (HRQOL) data were collected. Radiographic parameters included sagittal Cobb angle, pelvic incidence, lumbar lordosis, and sagittal vertical axis. HRQOL outcomes were assessed using the visual analog scale, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) functional assessment, and SF-36. Complications, including dural tears, intraoperative neuromonitoring (IONM) alerts, neurological deficits, etc., were recorded and compared.</p><p><strong>Results: </strong>One hundred patients were eligible for study inclusion, of whom 65 were included in the AV group and 35 in the SAV group. Both groups attained and maintained significant correction of the sagittal Cobb angle postoperatively, with no significant differences in radiographic outcomes between groups. However, the SAV group demonstrated significantly lower rates of dural tears (11.4% vs 29.2%, p = 0.044), IONM alerts (22.9% vs 44.6%, p = 0.032), and neurological complications (17.1% vs 36.9%, p = 0.040), particularly motor deficits (11.4% vs 29.2%, p = 0.044). HRQOL outcomes showed better ODI and JOA scores in the SAV group at the final follow-up (both p < 0.001).</p><p><strong>Conclusions: </strong>This study provides clinical evidence that the SAV constitutes a safer and more strategic resection site, as it avoids the severely pathological kyphotic apex and facilitates a more physiologically tolerable correction. Therefore, the subapical VCR strategy is recommended as a viable alternative for managing severe TAK, one that prioritizes patient safety without substantially compromising deformity correction.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892121","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":"Cost-effectiveness of minimally invasive surgery for grade 1 lumbar spondylolisthesis: a 5-year Quality Outcomes Database study.","authors":"Farhan A Khan, Peter J Chabot, Dean Chou, Praveen V Mummaneni, Mohamad Bydon, Erica F Bisson, Christopher I Shaffrey, Steven D Glassman, Kevin T Foley, Eric A Potts, Chun-Po Yen, Paul K Kim, John J Knightly, Paul Park, Michael Y Wang, Kai-Ming G Fu, Jonathan R Slotkin, Anthony L Asher, Timothy J Yee, Michael S Virk, Regis W Haid, Andrew K Chan","doi":"10.3171/2026.5.SPINE26177","DOIUrl":"https://doi.org/10.3171/2026.5.SPINE26177","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Minimally invasive surgery (MIS) is a reasonable treatment option for lumbar spondylolisthesis, but its long-term cost-effectiveness is not well established. Herein, the authors describe the 5-year cost-effectiveness of posterior MIS using prospective data from the multicenter Quality Outcomes Database (QOD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients from the Spine COReTM study group's multicenter, prospectively collected QOD grade 1 lumbar spondylolisthesis dataset who had undergone single-stage posterior surgery were included. Gains in quality-adjusted life years (QALYs) were quantified using EQ-5D scores across 60 months. Costs from index surgeries and related reoperations were estimated using Medicare rates for inpatient care and Current Procedural Terminology rates for outpatient care. Validation was achieved via price transparency diagnosis-related group (DRG) charges and charge/cost ratios (CCRs). The cost per QALY gained was ultimately calculated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 608 patients identified as having undergone single- or multiple-stage surgery, 559 underwent single-stage posterior surgery, 242 via MIS (mean age 64.3 ± 11.7 years, 71.1% arthrodesis rate) and 317 via open surgical approaches (mean age 61.3 ± 12.2 years, 78.5% arthrodesis rate). Length of stay (LOS) was 2.3 ± 1.9 days for patients in the MIS group and 3.1 ± 1.7 days for those in the open surgery group (p &lt; 0.0001). Operative duration was similar between the groups (171.7 ± 93.3 vs 174.2 ± 72.3 minutes, p = 0.739), whereas estimated blood loss was 108.3 ± 102.2 mL for the MIS group and 251.9 ± 230.6 mL for the open surgery group (p &lt; 0.0001). Moreover, 6.2% of patients in the MIS group and 7.9% in the open surgery group underwent related reoperations; 5.0% and 7.6% of patients, respectively, had complications. Thirty-day readmission was required in 1.2% of patients in the MIS group and 2.5% in the open surgery group. DRG costs were stable between our model and the CCR-based model, providing external validation. The mean QALY gain was 1.06 (95% CI 0.92-1.20) for MIS and 0.94 (95% CI 0.83-1.05) for open surgery (p = 0.191); the mean QALY gain was 1.09 (95% CI 0.92-1.25) versus 0.95 (95% CI 0.82-1.08), respectively, among those who underwent arthrodesis (p = 0.193) and 0.99 (95% CI 0.71-1.28) versus 0.90 (95% CI 0.64-1.16) among those who underwent decompression only (p = 0.628). The mean cost of MIS was significantly lower ($31,822) than that of open surgery ($39,151; p = 0.001). Among those who underwent arthrodesis, the mean cost was $41,916 for MIS versus $46,626 for open surgery (p = 0.031). Among patients who underwent decompression only, the mean respective cost was $7021 versus $11,780 (p = 0.004). The mean cost per QALY gained was $29,995 for MIS and $41,635 for open surgery (p = 0.0017), $38,501 versus $48,998 among those who underwent arthrodesis (p = 0.0193), and $7073 versus $13,100 among those who underwent decompres","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892133","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":"Introduction. Proceedings of Spine Summit 2026.","authors":"Jeffrey P Mullin, Laura A Snyder, Melissa Erickson, Gregory M Mundis, Daniel M Sciubba, Luis M Tumialán, Erica F Bisson","doi":"10.3171/2026.6.SPINE26770","DOIUrl":"10.3171/2026.6.SPINE26770","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1"},"PeriodicalIF":3.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892042","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":"Mortality risk after traumatic fractures in autofused spines from ankylosing spondylitis or DISH: age may matter more than treatment.","authors":"Abdelrahman M Hamouda, Zach Pennington, Mohamed M El-Gohary, Nikita Lakomkin, Seth Ransom, Stanley Dennison, Derrick Obiri-Yeboah, Michael L Martini, Nicholas Kendall, Orod Gharibi, Virgenal Owens, Michelle J Clarke, William E Krauss, Melvin D Helgeson, Ahmad N Nassr, Arjun S Sebastian, Anthony L Mikula, Jeremy L Fogelson, Brett A Freedman, Benjamin D Elder","doi":"10.3171/2026.4.SPINE251776","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE251776","url":null,"abstract":"<p><strong>Objective: </strong>Multisegmental pathological autofusion is a hallmark feature of ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH), creating a rigid, brittle spine highly susceptible to three-column fractures and devastating neurological injury. This study aimed to evaluate survival outcomes in this patient population and identify clinical and demographic predictors of mortality.</p><p><strong>Methods: </strong>Adults with DISH or AS who sustained a fracture and were admitted to a single tertiary care center for spinal fracture were retrospectively identified using ICD-10 diagnostic codes. Data were extracted on demographics, clinical presentation, fracture characteristics, and details of treatment.</p><p><strong>Results: </strong>A total of 383 patients (median age 78 years, 75.2% male) were included. Over a median follow-up of 17.3 months, overall mortality was 38.1%, in-hospital mortality was 5.2%, 30-day mortality was 5.7%, and 1-year mortality was 18.0%. Initial treatment consisted of external orthosis in 220 (57.4%) and surgery in 144 (37.6%), while 19 (5.0%) were left untreated. Patients who died were older (median 83 vs 74 years, p < 0.001), had a lower BMI (29.4 vs 32.3 kg/m2, p < 0.001), had higher frailty on the 5-item modified frailty index (mFI-5), and more commonly had congestive heart failure (CHF), cancer, functional dependency, and chronic kidney disease (CKD) (all p < 0.01). Mortality was not associated with fracture location, mechanism of injury, fracture number, or the presence of neurological deficits. Univariable time-to-event analysis showed that decreased survival was predicted by older age (HR 1.08, p < 0.0001), lower BMI (HR per kg/m2 0.93, p < 0.0001), functional dependency (HR 2.05, p < 0.001), cancer (HR 1.55 p = 0.01), CKD (HR 1.48, p = 0.019), CHF (HR 2.18, p < 0.001), and higher mFI-5 score (HR per point 1.34, p < 0.001). On multivariable analysis, older age (HR 1.06 per year, p < 0.001), lower BMI (HR per kg/m2 0.95, p < 0.001), and mFI-5 score (HR per patient 1.37, p < 0.001) remained significant independent predictors of mortality. Treatment modality did not predict mortality.</p><p><strong>Conclusions: </strong>AS- or DISH-associated spinal fractures have a high associated mortality, regardless of mechanism or severity. Treatment modality did not affect odds of survival, suggesting that nonoperative management with an external orthosis may be an appropriate option, particularly in older and medically complex patients.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850779","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. Too much or too little: what does mechanical failure in long-segment fusions mean to the patient and surgeon?","authors":"John H Chi","doi":"10.3171/2026.3.SPINE26268","DOIUrl":"https://doi.org/10.3171/2026.3.SPINE26268","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-3"},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850794","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}