Journal of neurosurgery. Spine最新文献

{"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}

{"title":"Hypotension during adult spinal deformity surgery: a risk factor for postoperative complications?","authors":"Harsh Jain, Duby D Okonkwo, Advith Sarikonda, Omar Zakieh, Sakshi Krishna, Nick De Oliveira, Ranbir Ahluwalia, Austin Montgomery, Walter Navid, Iyan Younus, Hani Chanbour, Bayard Wilson, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman","doi":"10.3171/2026.4.SPINE26173","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26173","url":null,"abstract":"<p><strong>Objective: </strong>Intraoperative hypotension is common during adult spinal deformity (ASD) surgery, occurring because of blood loss and sometimes requested by surgeons during exposure, but its impact on postoperative complications is unclear. In patients who underwent ASD surgery, the authors sought to evaluate the relationships between intraoperative hypotension and 1) medical complications, 2) length of hospital stay (LOS), 3) discharge disposition, or 4) reoperation.</p><p><strong>Methods: </strong>The authors performed a retrospective cohort study of patients who underwent ASD surgery from 2009 to 2023 and had a 2-year follow-up. The primary exposure variable was intraoperative hypotension, defined as mean arterial pressure (MAP) < 65 mm Hg for at least 30 minutes. The primary outcomes were 1) complications, 2) reoperation, 3) LOS, and 4) discharge disposition. Multivariable logistic regression controlled for age, sex, BMI, comorbidities, and operative time.</p><p><strong>Results: </strong>Among 277 patients who underwent ASD surgery, 70 (25%) were males and the mean age was 62.5 ± 17.5 years. Intraoperative hypotension was observed in 122 patients (44%) for a mean duration of 45.4 ± 47.6 minutes, with most of these patients (66%) having hypotension in the second half of surgery. Patients with intraoperative hypotension had a greater incidence of postoperative medical complications (28% vs 17%, p = 0.026), including pulmonary complications (12% vs 3%, p = 0.003), yet no difference was seen in reoperation rates (39% vs 32%, p = 0.278). Neither was there a difference in LOS (7 ± 7 vs 7 ± 12 days, respectively, p = 0.814) or home discharge (p = 0.097) between groups. On multivariable logistic regression, intraoperative hypotension was an independent risk factor for any medical complications (OR 2.0, 95% CI 1.0-3.9, p = 0.047), especially pulmonary complications (OR 5.1, 95% CI 1.5-17.0, p = 0.008).</p><p><strong>Conclusions: </strong>In ASD surgery, intraoperative hypotension (MAP < 65 mm Hg for ≥ 30 minutes) was independently associated with medical complications, particularly pulmonary complications. These findings highlight the importance of avoiding prolonged hypotension in ASD surgery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850797","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":"Combining universal access with high precision for revolutionary osteoporosis screening: CT-based 3D-HU volumetric bone density.","authors":"Rongkun Chang, Jinxin Gu, Yumei Ding, Lei Liang, Chunlin Qu, Yang You, Jie Cheng, Zhen Geng, Xiaohong Chang, Jizhe Zhang, Feng Chang, Lijun Cai, Zhuo Zhang","doi":"10.3171/2026.3.SPINE251518","DOIUrl":"https://doi.org/10.3171/2026.3.SPINE251518","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop a novel 3D Hounsfield unit (HU) technique for assessing volumetric bone mineral density (vBMD) using routine preoperative CT scans. It was designed to enable opportunistic osteoporosis screening by leveraging existing imaging data. The diagnostic accuracy of this approach was rigorously evaluated against quantitative CT (QCT).</p><p><strong>Methods: </strong>The authors retrospectively analyzed the records of spine surgery patients who underwent both spinal CT and QCT within a 1-week period. Patients were divided into 3 groups (osteoporosis, osteopenia, and normal bone mineral density [BMD]) based on QCT-vBMD. Baseline characteristics and radiological parameters were compared among the 3 groups. Three-dimensional HU measurements were obtained from lumbar CT scans. Multivariable logistic regression, Pearson correlation analysis, and receiver operating characteristic (ROC) analysis were used to assess the relationships between vBMD and 3D-HU. To evaluate interscanner reliability, a subset of patients received additional CT scanning using both GE and Philips systems. Bland-Altman analysis was used to assess agreement between 3D-HU measurements from different scanner platforms.</p><p><strong>Results: </strong>Among 264 enrolled patients, 94 were classified as osteoporotic, 114 as osteopenic, and 56 as having normal BMD. Multivariable logistic regression analyses identified lower 3D-HU as an independent predictor of both osteoporosis (OR 0.723, 95% CI 0.618-0.806; p < 0.0001) and osteopenia (OR 0.698, 95% CI 0.564-0.799; p < 0.0001). Three-dimensional HU demonstrated a strong correlation with QCT-vBMD (T12, r = 0.979; L1, r = 0.968; L2, r = 0.962). ROC analysis demonstrated that 3D-HU achieved diagnostic accuracy comparable to QCT for both osteoporosis and osteopenia. Specifically, for osteoporosis, the area under the ROC curve (AUC) was 99.1% (sensitivity 94.7%, specificity 98.3%); for osteopenia, the AUC was 98.5% (sensitivity 93.9%, specificity 94.6%). Bland-Altman analysis demonstrated excellent interscanner agreement (mean difference 0.13; 95% limits of agreement -8.23 to 8.50), with only 2% of measurements falling outside the agreement limits.</p><p><strong>Conclusions: </strong>Three-dimensional HU represents a novel vBMD assessment methodology that achieves diagnostic parity with QCT. Crucially, this precision is attained using conventional CT scanners without extra radiation exposure or specialized equipment. This study demonstrated that precise, universally accessible osteoporosis screening is now achievable, promising a transformative advance in public bone health.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850778","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":"Are we achieving what the algorithm tells us? Analysis of lumbar pedicle subtraction osteotomies with pre-bent rods.","authors":"Renzo Laynes, Rafael Garcia de Oliveira, Kenneth Nguyen, Kento Yamanouchi, Takeshi Fujii, Iyan Younus, Aiyush Bansal, Jean-Christophe Leveque, Philip K Louie, Rajiv K Sethi, Venu M Nemani","doi":"10.3171/2026.4.SPINE26171","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26171","url":null,"abstract":"<p><strong>Objective: </strong>Precise restoration of sagittal balance is a critical goal in adult spinal deformity surgery. Computer-assisted planning allows for patient-specific alignment targets and rod pre-bending, theoretically improving the accuracy of surgical correction. However, the correlation between planned and achieved alignment goals using pre-bent rods remains unclear. The aim of this study was to evaluate the accuracy of alignment correction in patients undergoing lumbar pedicle subtraction osteotomy (PSO) using UNiD-derived pre-bent rods, and to compare software-generated preoperative alignment targets with actual postoperative radiographic parameters.</p><p><strong>Methods: </strong>A retrospective cohort study was performed of adults who underwent lumbar PSO with long-segment thoracolumbar fusion (≥ 6 levels) at a single academic center between 2018 and 2022. Inclusion criteria required UNiD preoperative planning, PSO performed at the planned level, use of patient-specific pre-bent rods, and complete radiographic data. Planned alignment targets were obtained from the UNiD platform and compared with immediate postoperative standing lateral radiographs. Absolute differences between preoperative-to-planned and preoperative-to-postoperative values were compared using paired t-tests. Effect sizes (Cohen's d) were calculated and post hoc power analysis was performed, with primary focus on pelvic incidence (PI), sagittal vertical axis, pelvic tilt, and PI minus lumbar lordosis (PI-LL).</p><p><strong>Results: </strong>Twenty patients (60% female, median age 66.8 years) were included. The planned PSO angle closely matched the achieved correction (mean -24.2° planned vs -24.02° ± 7.31° postoperative, p = 0.94). Lumbar lordosis and L4-S1 lordosis exceeded planned correction, with a significant but modest increase at L4-S1 (p = 0.03). Pelvic parameters demonstrated the largest deviations from plan. Pelvic tilt correction exceeded predictions by a mean of 8.97° ± 7.10° (p < 0.01); the sagittal vertical axis was undercorrected by a mean of 36.37 ± 48.30 mm (p < 0.01); and PI changed more than anticipated (p = 0.01). PI-LL improved substantially from a mean of 29.73° ± 15.76° preoperatively to -3.23° ± 10.95° postoperatively (p < 0.001). The planned and achieved L1 pelvic angle did not differ significantly.</p><p><strong>Conclusions: </strong>Computer-assisted planning with patient-specific rods accurately reproduced the intended PSO and segmental lumbar correction but did not reliably predict global sagittal parameters. These findings suggest that current planning tools might require refinement to improve the accuracy of predicted postoperative alignment using pre-bent rods and to minimize the risk of suboptimal outcomes.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between direct admission to level I trauma centers and lower in-hospital mortality in operative spine trauma.","authors":"Mitchell K Ng, Leonidas E Mastrokostas, Paul G Mastrokostas, Sean Inzerillo, Jad Bou Monsef, Afshin E Razi, Nicholas U Ahn, Zachary Wilt, Mark F Kurd, Ian David Kaye, Barrett Woods, Daniel R Fassett, Andrew P Alvarez, Jose A Canseco, Thomas D Cha, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.3171/2026.4.SPINE26178","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26178","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate whether trauma center level is associated with in-hospital mortality among patients undergoing operative management for spine trauma and to determine whether this relationship differs according to triage pathway.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using the 2023 National Trauma Data Bank. Adult patients undergoing operative treatment for spine trauma at American College of Surgeons-verified level I or level II trauma centers were identified. Patients with polytrauma or incomplete clinical data were excluded. Demographics, injury characteristics, comorbidities, arrival physiology, and hospital factors were compared between trauma center levels. Multivariable logistic regression models were constructed to assess the association between trauma center level and in-hospital mortality, stratified by triage pathway (direct admission vs interfacility transfer) and adjusted for demographic, injury severity, physiological, and hospital covariates. Significance was set at the p < 0.05 level.</p><p><strong>Results: </strong>A total of 12,516 operative spine trauma encounters were included, with 8548 treated at level I centers and 3968 at level II centers. Level I centers managed patients with greater injury severity and higher comorbidity burden and received a larger proportion of interfacility transfers. Among directly admitted patients, treatment at a level I trauma center was associated with significantly lower adjusted odds of in-hospital mortality compared with level II centers (adjusted OR 0.62, 95% CI 0.39-0.97; p = 0.037). No significant mortality difference was observed among transferred patients (adjusted OR 0.88, 95% CI 0.47-1.68; p = 0.693).</p><p><strong>Conclusions: </strong>Level I trauma center care was associated with reduced adjusted mortality among directly admitted operative spine trauma patients but not among transferred patients. These findings suggest that early access to specialized multidisciplinary spine trauma care, rather than trauma center designation alone, may drive improved survival and highlight the importance of optimized prehospital triage and direct transport strategies.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-7"},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850806","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 in the distribution of skeletal compensation based on severity and correction in adult spinal deformity patients.","authors":"Oluwatobi O Onafowokan, Mohammad Daher, Renaud Lafage, Virginie Lafage, Justin S Smith, D Kojo Hamilton, Max R Fisher, Bassel G Diebo, Alan H Daniels, Robert Eastlack, Gregory Mundis, Breton G Line, Pierce Nunley, Neel Anand, Themistocles Protopsaltis, David O Okonkwo, Khaled M Kebaish, Justin K Scheer, Praveen V Mummaneni, Dean Chou, Han Jo Kim, Richard Hostin, Munish Gupta, Douglas Burton, Christopher P Ames, Frank Schwab, Christopher I Shaffrey, Shay Bess, Lawrence Lenke, Peter G Passias","doi":"10.3171/2026.3.SPINE251232","DOIUrl":"https://doi.org/10.3171/2026.3.SPINE251232","url":null,"abstract":"<p><strong>Objective: </strong>Adult spinal deformity (ASD) surgery patients maintain upright posture by using numerous compensatory mechanisms. The distribution of this compensation throughout the skeleton has not been fully investigated.</p><p><strong>Methods: </strong>Patients with lumbar deformity curves undergoing fusion from T10 to the pelvis were included. Groups were stratified by Scoliosis Research Society (SRS)-Schwab sagittal deformity severity (mild, moderate, and severe). Compensation was determined based on the published values of asymptomatic individuals by Bao et al. (2018), with patients outside 1 standard deviation of the mean values deemed to be compensating. Adequate deformity correction was determined based on matching published sagittal age-adjusted score (SAAS) criteria. Means comparisons tests assessed differences between cohorts at each time point.</p><p><strong>Results: </strong>In total, 379 ASD patients were included (mean age 66.7 ± 10.2 years, body mass index 28.4 ± 5.4 kg/m2, Charlson Comorbidity Index 1.20 ± 1.73). In total, 23.8% of patients had mild deformity, 19.2% moderate, and 57% severe. The severe deformity cohort generally demonstrated the highest rates of compensation across all regions at different time points. At baseline, the severe and moderate cohorts demonstrated predominantly lower limb-dominant compensation, with the highest frequencies of compensation seen at the knee and pelvis. In the mild cohort, knee compensation was relieved by 1 year when adequate correction was achieved. For the moderate cohort, hip and pelvic compensation were relieved first, with knee compensatory relief occurring by 2 years. For the severe cohort, pelvic compensation was relieved first, with global lower limb and thoracic compensation subsequently occurring.</p><p><strong>Conclusions: </strong>There is notable variation in how ASD patients compensate as the severity of their deformity progresses. There is also variation in how these patterns are altered postoperatively.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850864","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":"Loss of patient-reported outcome benefit over 8-year follow-up for operatively treated adult symptomatic lumbar scoliosis patients who required revision surgery for mechanical complications.","authors":"Justin S Smith, Michael P Kelly, Elizabeth L Yanik, Christine R Baldus, Vy Pham, Hong Joo Moon, Jon D Lurie, Charles Edwards, Steven D Glassman, Lawrence G Lenke, Stefan Parent, Jacob M Buchowski, Leah Y Carreon, Charles H Crawford, Stephen J Lewis, Tyler Koski, Virginie Lafage, Munish C Gupta, Han Jo Kim, Christopher P Ames, Shay Bess, Frank J Schwab, Christopher I Shaffrey, Keith H Bridwell","doi":"10.3171/2026.2.SPINE251451","DOIUrl":"https://doi.org/10.3171/2026.2.SPINE251451","url":null,"abstract":"<p><strong>Objective: </strong>Rates of revision surgery following operative treatment for adult symptomatic lumbar scoliosis (ASLS) are high, mostly due to mechanical complications, including proximal junctional failure (PJF) and pseudarthrosis/rod fracture (RF). How these revisions impact long-term clinical outcomes remains unclear. The aim of this study was to assess revision rates for the two most common mechanical complications (PJF and RF) and the potential impact of these revisions on patient-reported outcome measures over 8 years of follow-up for operatively treated patients with ASLS.</p><p><strong>Methods: </strong>This retrospective review used data from a multicenter prospective ASLS study to assess operative versus nonoperative ASLS treatment. Patients were 40-80 years of age with ASLS (Cobb ≥ 30° and Oswestry Disability Index [ODI] score ≥ 20 or revised Scoliosis Research Society 22-item questionnaire [SRS-22r] score ≤ 4.0 in pain, function/activity, and/or self-image domains). Patients who underwent long-segment posterior fusion (thoracic spine to sacrum) were assessed for the impact of revision due to mechanical complications on outcomes (SRS-22r subscore and ODI score).</p><p><strong>Results: </strong>Overall, 160 patients (141 female, median age 61.31 years) met inclusion criteria. Of these, 53 (33.1%) required revision (71 revisions, 25 for PJF and 46 for RF) for mechanical complications, with 1, 2, and 3 revisions in 39, 10, and 4 patients, respectively. By 8 years of follow-up, patients had a 38% estimated risk of revision for mechanical complications. The mean time to the first and second revisions was 3.0 years (SD 2.1) and 4.8 years (SD 2.3), respectively. In unadjusted analyses, patients with ≥ 1 revision had a significant negative impact on their 8-year ODI score (mean difference 9.40, 95% CI 3.68-15.13; p = 0.0013) and SRS-22r subscore (mean difference -0.27, 95% CI -0.49 to -0.05; p = 0.0141). Patients with ≥ 2 revisions experienced the greatest impact on both their ODI score (mean difference 14.48, 95% CI 4.89-24.07; p = 0.0031) and SRS-22r subscore (mean difference -0.38, 95% CI -0.74 to -0.02; p = 0.0361), with the impact exceeding the minimum detectable measurement difference for the ODI score (7) but not the SRS-22r subscore (0.4). In adjusted analyses, these differences were attenuated for patients with ≥ 2 revisions: ODI score (mean difference 14.14, 95% CI 4.52-23.75; p = 0.0040) and SRS-22r subscore (mean difference -0.30, 95% CI -0.67 to 0.06; p = 0.1001).</p><p><strong>Conclusions: </strong>By the 8-year follow-up, revision surgery for mechanical complications was required in an estimated 38% of operative ASLS patients. Patients who underwent ≥ 1 revision had a significant negative impact on ODI score and SRS-22r subscore, and this impact was greatest with ≥ 2 revisions. These findings emphasize the need for better techniques to reduce mechanical complications in ASLS surgery.</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":"148850827","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":"Association between postoperative ketorolac use and pseudarthrosis following anterior lumbar interbody fusion: retrospective analysis of a multicenter national database.","authors":"Trevor Luck, Coleman Cush, Nigel Wang, Harrison Pajor, Akhil Sharma, Amir Fayyazi, Colin Whitaker","doi":"10.3171/2026.4.SPINE26198","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26198","url":null,"abstract":"<p><strong>Objective: </strong>Use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac (Toradol) after spinal fusion surgery remains controversial due to concerns about increased pseudarthrosis rates. However, no prior studies have specifically examined this outcome in anterior lumbar interbody fusion (ALIF). The aim of this study was to investigate whether postoperative ketorolac is associated with pseudarthrosis after ALIF. The authors hypothesized that short-term ketorolac use does not significantly increase pseudarthrosis risk.</p><p><strong>Methods: </strong>The TriNetX database was queried from 2003 to 2023 for adults (≥ 18 years) undergoing primary ALIF (Current Procedural Terminology code 22558) with ≥ 6 months of follow-up. Patients were grouped by postoperative ketorolac or acetaminophen (control) administration within 48 hours. Propensity score matching controlled for demographics, comorbidities, medication use, and surgical indications. Baseline characteristics were compared using t-tests and chi-square tests as appropriate. Outcomes were assessed using relative risk (RR) with 95% confidence intervals; significance was considered at p < 0.05.</p><p><strong>Results: </strong>There were 2408 patients per cohort who met criteria after matching. After 2 years of follow-up, there was no increase in pseudarthrosis rate with exposure to ketorolac; in fact, ketorolac appeared to have a protective effect on this outcome (3.99% vs 5.44% control; RR 0.733 [95% CI 0.567-0.948], p = 0.017). There was no difference in reoperation rate (4.82% vs 5.31%; RR 0.906 [0.709-1.158], p = 0.430). At 90 days postoperatively, no patients in either group experienced severe postoperative bleeding, postoperative hematoma/seroma, acute surgical site infection, or postoperative ileus. There was no significant difference in bowel regimen utilization. There was no difference in risk of oral opioid prescriptions (21.7% vs 21.8%; RR 0.998 [0.897-1.111], p = 0.972) or in mean narcotic prescription count (mean number of instances at 90 days 0.61 vs 0.62, p = 0.87).</p><p><strong>Conclusions: </strong>Ketorolac is a safe adjunct to pain control following ALIF. Administration was not found to be associated with increased pseudarthrosis or reoperation rates at the 2-year follow-up. There were no significant differences in acute postoperative events at 90 days postoperatively. Further studies are warranted to evaluate the effect of postoperative NSAIDs on outcomes in anterior lumbar fusion surgery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850840","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}