Journal of neurosurgery. Spine最新文献

{"title":"GLP-1 agonist use and lower rates of pseudarthrosis and dysphagia following anterior cervical discectomy and fusion surgery, with time-dependent effects.","authors":"Manaav K S Mehta, Abhinav K Sharma, Vishaal Mehta, Ryan M Schiedo, Michael Kim, Melissa Romoff, Emily S Mills, Hao-Hua Wu, Sohaib Hashmi, Yu-Po Lee, Nitin Bhatia, Don Young Park, Michael P Stauff","doi":"10.3171/2026.4.SPINE26216","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26216","url":null,"abstract":"<p><strong>Objective: </strong>Anterior cervical discectomy and fusion (ACDF) is among the most frequently performed spinal procedures in the US. Despite high success rates, complications such as pseudarthrosis, dysphagia, and revision surgery remain clinically significant, particularly in patients with diabetes mellitus (DM) and obesity. Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have demonstrated anti-inflammatory and bone-modulating properties in existing clinical and laboratory orthopedic research, yet their relationship to cervical fusion outcomes remains unclear, especially regarding therapy timing. The aim of this study was to evaluate the association between GLP-1 RA use and pseudarthrosis, dysphagia, and revision surgery, as well as perioperative complications, following ACDF surgery.</p><p><strong>Methods: </strong>TriNetX, a global health research network, was queried (2014-2024) for patients undergoing ACDF surgery (CPT code 22551) with GLP-1 RA exposure. Subcohort analyses were conducted based on overall therapy timing (preoperative, perioperative, and postoperative) and further stratified by initiation and discontinuation timing. Postoperative initiators were analyzed using a landmark approach to mitigate immortal time bias. Each subcohort was 1:1 propensity score-matched to controls by age, sex, race, smoking, DM, BMI, and uremia. Ninety-day outcomes included deep vein thrombosis, pulmonary embolism, emergency department visit, inpatient hospitalization, sepsis, surgical site infection, and wound disruption. Two-year outcomes included pseudarthrosis, dysphagia, and revision surgery. Odds ratios with 95% confidence intervals were calculated using chi-square analysis.</p><p><strong>Results: </strong>Among 2345 patients with GLP-1 RA exposure within 2 years after undergoing ACDF, overall use was associated with reduced pseudarthrosis and dysphagia, but not revision surgery. Preoperative GLP-1 RA use was associated with increased odds of dysphagia when discontinued > 12 months before surgery. Continuous perioperative use was associated with increased odds of dysphagia and revision surgery, as well as reduced odds of sepsis. Postoperative initiation was associated with reduced odds of pseudarthrosis and dysphagia in the overall subcohort, reduced odds of pseudarthrosis in patients with DM, and increased odds of dysphagia in those with multilevel fusion surgeries.</p><p><strong>Conclusions: </strong>GLP-1 RA use demonstrated timing-dependent associations with outcomes following ACDF surgery. Postoperative initiation of therapy was associated with reduced pseudarthrosis, particularly in patients with DM, and dysphagia, while continuous perioperative exposure increased the risk of dysphagia and revision. These findings suggest a potential role for temporally targeted GLP-1 RA therapy during postoperative healing. Prospective studies are required for validation and to determine causal relationships.</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":"148850810","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":"Do outcomes diverge over time? A 5-year Spine CORe™ Quality Outcomes Database study comparing patient-reported outcomes after minimally invasive versus open surgery for degenerative grade 1 lumbar spondylolisthesis.","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":"10.3171/2026.4.SPINE26180","DOIUrl":"https://doi.org/10.3171/2026.4.SPINE26180","url":null,"abstract":"<p><strong>Objective: </strong>Both open and minimally invasive surgery (MIS) approaches for degenerative low-grade lumbar spondylolisthesis have been shown to improve patient-reported outcomes (PROs). Recent studies, however, have suggested that MIS may offer superior, more durable benefits due to less soft tissue dissection and expedited recovery. Unfortunately, data demonstrating whether or when such divergences in long-term PROs may arise are limited.</p><p><strong>Methods: </strong>The authors utilized the prospective multicenter Spine CORe™ Quality Outcomes Database grade 1 lumbar spondylolisthesis dataset to evaluate longitudinal outcomes over 60 months. PROs included Oswestry Disability Index (ODI), EuroQol-5D, and numeric rating scale for back pain and leg pain scores. Outcomes were compared between MIS and open approaches using univariate and multivariable analyses. Minimal clinically important differences (MCIDs) were assessed using established thresholds.</p><p><strong>Results: </strong>Of 608 patients, 265 (43.6%) underwent MIS while 343 (56.4%) underwent open surgery. MIS patients were older (64.1 ± 11.6 vs 60.7 ± 12.2 years, p < 0.001) and had lower BMI (29.7 ± 5.8 vs 30.9 ± 6.7 kg/m2, p = 0.0180). Overall, 72.8% of MIS and 80.2% of open patients underwent arthrodesis (p = 0.0330). Other variables, including baseline PROs, were similar. After surgery, MIS was associated with less blood loss (104.2 ± 100.4 vs 249.1 ± 233.3 mL, p < 0.001) and shorter length of stay (2.3 ± 1.9 vs 3.1 ± 1.7 days, p < 0.001); there were no differences in readmission, complication, or 60-month related reoperation rates. In univariate analyses, at the 3-month and 12-month follow-ups, there were no differences in magnitude of change or MCID achievement for any PRO. MIS, however, demonstrated superior improvements in ODI score at 24 months (-25.8 ± 20.6 vs -20.9 ± 20.0, p = 0.0116) and 60 months (-24.4 ± 20.9 vs -19.8 ± 21.1, p = 0.0162), with greater MCID rates (24 months: 72.8% vs 61.1%, p = 0.0090; 60 months: 68.1% vs 58.8%, p = 0.0363). After multivariable analysis, these significant differences in ODI score persisted (24-month change: β = -6.2, p = 0.0014; 60-month change: β = -4.6, p = 0.0216; 24-month MCID: OR 2.0, p = 0.0022; 60-month MCID: OR 1.6, p = 0.0302). After stratification, these multivariable results were consistent in patients undergoing arthrodesis but not in those undergoing decompression alone.</p><p><strong>Conclusions: </strong>In this prospective multicenter study, there were no differences in early disability or quality of life outcomes between MIS and open surgery for low-grade spondylolisthesis. By 24 months, trajectories diverged: MIS yielded greater improvements in ODI score that persisted at the 60-month follow-up, especially with arthrodesis. While open surgery remains essential in many contexts, MIS may offer more meaningful long-term improvement in appropriately selected 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":"148850865","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 effects of postoperative neurological deficits on overall survival in patients with malignant peripheral nerve sheath tumors.","authors":"Melanie Alfonzo Horowitz, Jawad M Khalifeh, Xinlan Yang, Oishika Das, Omar Selim, Taha Khalilullah, Landon J Hansen, A Karim Ahmed, Stavriani C Makri, Lindy Zhang, Sahaja Acharya, Jordina Rincon-Torroella, Nicholas Theodore, Sang Hun Lee, John M Gross, Carlos G Romo, Christian F Meyer, Christine A Pratilas, Jaishri O Blakeley, Allan J Belzberg, Daniel Lubelski","doi":"10.3171/2026.3.SPINE251085","DOIUrl":"https://doi.org/10.3171/2026.3.SPINE251085","url":null,"abstract":"<p><strong>Objective: </strong>Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive sarcomas with peripheral nerve differentiation. Surgical management of MPNSTs entails wide resection with negative margins, although the extent of resection required to achieve oncological control may result in postoperative neurological morbidity. The association between postoperative neurological deficits and survival outcomes in patients with MPNSTs remains poorly defined. In this study, the authors evaluated the association between new or worsening postoperative neurological deficits and overall survival (OS) following resection for MPNSTs.</p><p><strong>Methods: </strong>A retrospective review of all patients who underwent resection for MPNSTs at Johns Hopkins Hospital between 2010 and 2024 was performed. Postoperative neurological deficits were defined as new or worsened motor or sensory impairment documented on postoperative examination compared with preoperative baseline. Deficits were classified as transient if they resolved within 3 months or permanent if they persisted beyond 3 months. OS was assessed using Kaplan-Meier analysis. Uni- and multivariable Cox proportional hazards models were used to evaluate the association between postoperative neurological deficits and OS, adjusting for tumor characteristics and extent of resection.</p><p><strong>Results: </strong>A total of 116 patients underwent resection during the study period, 49 (42.2%) of whom developed a postoperative neurological deficit. The median overall follow-up duration was 20.6 (interquartile range 8.6-56.2) months. Permanent neurological deficits were more common among patients with spinal tumors (35.3% vs 11.9%, p = 0.046). The presence of a permanent deficit was associated with worse OS (hazard ratio [HR] 3.64, 95% CI 1.97-6.72) compared with transient or no deficits. When stratified by extent of resection, patients who underwent gross-total resection (GTR) without a neurological deficit demonstrated the longest OS, followed by GTR with a deficit, subtotal resection (STR) without a deficit, and STR with a deficit. On multivariable analysis, the development of a permanent postoperative neurological deficit remained independently associated with worse OS (HR 8.50, 95% CI 2.77-14.59).</p><p><strong>Conclusions: </strong>In patients undergoing resection for MPNSTs, the development of a permanent postoperative neurological deficit was independently associated with decreased OS. These findings underscore the importance of balancing maximal oncological resection with preservation of neurological function to optimize long-term outcomes in patients with MPNSTs.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":3.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the predictive roles of CT- and MRI-based endplate regional osteoporosis status measurements for cage subsidence after posterior lumbar interbody fusion.","authors":"Peng Du, Minghui Liang, Ruiyuan Chen, Congying Zou, Tianyi Wang, Ning Fan, Shuo Yuan, Aobo Wang, Ziqian Ma, Yu Xi, Lei Zang","doi":"10.3171/2026.2.SPINE251506","DOIUrl":"https://doi.org/10.3171/2026.2.SPINE251506","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the efficacy of endplate Hounsfield unit (HU) values and endplate bone quality (EBQ) scores in predicting cage subsidence (CS) after posterior lumbar interbody fusion (PLIF) in older patients and identify the most discriminative bone mineral density (BMD) assessment indicator.</p><p><strong>Methods: </strong>This retrospective analysis included consecutive patients who underwent PLIF at the authors' institution between January 2016 and February 2024. Clinical data were collected for all patients. Propensity scores were used to match patients with and without CS, and the matched cohort was subjected to conditional logistic regression to investigate the association between radiographic factors and CS. L1 and endplate HU values were derived from CT scans, whereas vertebral bone quality (VBQ) and EBQ scores were derived from MR images. Receiver operating characteristic curve analysis was conducted to assess the predictive value of endplate HU values and EBQ scores for CS and further compare their predictive value with that of L1 HU values and VBQ scores.</p><p><strong>Results: </strong>This study included 130 matched patients. The CS group demonstrated lower L1 (p < 0.001) and endplate HU (p < 0.001) values and higher VBQ (p = 0.002) and EBQ (p < 0.001) scores compared with the non-CS group. The conditional logistic regression analysis identified L1 HU value (OR 0.99, 95% CI 0.97-0.99; p = 0.036), endplate HU value (OR 0.99, 95% CI 0.98-0.99; p = 0.044), VBQ score (OR 2.40, 95% CI 1.34-4.32; p = 0.038), and EBQ score (OR 4.46, 95% CI 2.16-9.18; p = 0.003) as independent predictors of CS, demonstrating areas under the curve of 0.722, 0.815, 0.648, and 0.782, respectively. The optimal cutoff for the endplate HU value in predicting CS was 262.11 (sensitivity 83.08%, specificity 73.85%).</p><p><strong>Conclusions: </strong>Endplate HU values indicated a relatively higher predictive performance for CS compared with EBQ scores and served as the most discriminative BMD indicator in patients who underwent PLIF. Measuring the endplate HU value preoperatively helps surgeons select a more appropriate surgical plan and is expected to improve patient outcomes.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794466","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":"Assessing the association between revision anterior cervical spine surgery for adjacent segment disease and postoperative dysphagia.","authors":"Kathleen M Hannon, Nicholas P Tippins, Aidan C Rezner, Shaira S Patel, Jake T Reasoner, Adison M Steinke, Camden A Cooper, Ryan D Harmelink, Alexander J Potts, Vincent J Alentado, Eric A Potts","doi":"10.3171/2026.3.SPINE251527","DOIUrl":"https://doi.org/10.3171/2026.3.SPINE251527","url":null,"abstract":"<p><strong>Objective: </strong>Revision surgery is a known risk factor for postoperative dysphagia. This study aimed to assess the association of revision surgeries indicated to treat adjacent segment disease (ASD) with pre- and postoperative dysphagia rates.</p><p><strong>Methods: </strong>A prospectively collected quality registry for anterior cervical spine surgery was retrospectively reviewed. Eating Assessment Tool-10 (EAT-10) dysphagia questionnaire responses were collected at baseline and at 1, 3, and 12 months postoperatively, using scores ≥ 3 to represent dysphagia. Revision surgeries indicated for ASD were compared against primary surgeries, and univariate analysis assessed differences in patient demographics, surgical information, and patient-reported outcome measures. Fixed-effects logistic regressions were performed to assess the independent impact of ASD on postoperative dysphagia and to identify risk factors within revision surgery.</p><p><strong>Results: </strong>Of the 1713 patients in the cervical spine registry meeting the inclusion criteria, 279 (16.3%) had preoperative ASD while 1434 (83.7%) were primary surgeries. ASD was associated with a higher incidence of dysphagia at 1 (65% vs 57%, p = 0.024), 3 (43% vs 30%, p < 0.001), and 12 months (35% vs 26%, p = 0.018), but not at baseline (15% vs 12%, p = 0.11). Among patients without baseline dysphagia, patients with ASD were significantly more likely to report new dysphagia at 3 months (38% vs 26%, p < 0.001) but not at 1 (59% vs 54%, p = 0.2) or 12 months (26% vs 21%, p = 0.2). Among patients with baseline dysphagia, the average EAT-10 score improved from baseline to 12 months postoperatively, but patients with ASD experienced significantly less improvement (-1.414 [SD 8.399] vs -5.793 [SD 9.217], p = 0.011). In the multivariable analyses of all patients, ASD was an independent predictor of dysphagia at 3 months (OR 1.11, p < 0.001) but not at 1 (OR 1.03, p = 0.4) or 12 months (OR 1.05, p = 0.2). Among patients with ASD, 3-month dysphagia was independently predicted by baseline dysphagia (OR 1.42, p < 0.001), C3-4 exposure (OR 1.27, p = 0.004), and re-exposure of prior levels (OR 1.16, p = 0.024), while an otolaryngologist-assisted approach predicted a lower risk (OR 0.77, p = 0.022).</p><p><strong>Conclusions: </strong>ASD did not significantly impact baseline dysphagia rates, but revision surgery for ASD was a significant independent risk factor for delayed recovery from initial postoperative dysphagia beyond 3 months following anterior cervical spine surgery. Exposure-related variables further stratified risk within ASD revision surgery. Preoperative patient counseling should manage patient expectations accordingly.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-14"},"PeriodicalIF":3.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794533","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":"Risk factors for mechanical failure involving the cervicothoracic junction following posterior cervical instrumentation.","authors":"Samuel H Wakelin, Ayesha Akbar Waheed, Ben Carnovale, Regan M Shanahan, Samuel Adida, Andrew D Legarreta, Joseph S Hudson, Hansen Deng, Nitin Agarwal, D Kojo Hamilton","doi":"10.3171/2026.3.SPINE251587","DOIUrl":"10.3171/2026.3.SPINE251587","url":null,"abstract":"<p><strong>Objective: </strong>The risk profile of posterior cervical decompression and fusion (PCDF), particularly at the cervicothoracic junction (CTJ), remains a topic of ongoing investigation. The goal of this study was to determine whether construct-specific factors affect mechanical failure in patients undergoing PCDF at or beyond the CTJ.</p><p><strong>Methods: </strong>A retrospective chart review was conducted at a single quaternary care center from 2011 to 2023. Patients undergoing PCDF with 3 or more operative levels, long-term follow-up, and lowest instrumented vertebra (LIV) at C7, T1, or T2 were included. Demographic information, surgery indication, instrumentation characteristics, and secondary surgical outcomes were evaluated. Statistical analysis was performed in Python.</p><p><strong>Results: </strong>In total, 485 patients were included. The mean age for the cohort was 62.2 (SD 12.1) years, 296 patients (61.0%) were male, and the mean BMI was 30.0 (SD 7.4). Regarding comorbidities, 24.5% of patients had diabetes, 23.9% had heart disease, and 4.5% had osteoporosis. The most common upper instrumented vertebra (UIV) was C2 (58.1%) and the most common LIV was T2 (55.9%). Nineteen patients (3.9%) experienced mechanical failure. On multivariate analysis, a UIV at C2 was associated with decreased odds of mechanical failure compared with C3-4 (OR 0.08, 95% CI 0.02-0.24; p < 0.001). Furthermore, pedicle screw placement at C7 was associated with significantly decreased odds of mechanical failure (OR 0.23, 95% CI 0.02-0.79; p = 0.02). Additionally, compared to an LIV at C7, an LIV at T2 significantly decreased the odds of mechanical failure (OR 0.17, 95% CI 0.04-0.55; p < 0.001). A C7 pedicle screw remained protective in this regression, with significantly decreased odds of mechanical failure (OR 0.22, 95% CI 0.04-0.90; p = 0.03). In a subgroup of patients with 2-year follow-up, a C2 UIV (OR 0.07, 95% CI 0.01-0.32; p < 0.001) and C7 pedicle screw placement (OR 0.06, 95% CI 0.001-0.51; p = 0.01) remained associated with decreased odds of mechanical failure.</p><p><strong>Conclusions: </strong>In the largest single-institution experience to date, this study identified construct-specific factors, including the UIV, LIV, and C7 pedicle screw placement, as independent predictors of mechanical failure in patients undergoing PCDF with constructs ending at or beyond the CTJ.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"678-685"},"PeriodicalIF":3.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764941","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":"Impact of oncological biomarkers and clinical factors on survival outcomes in renal cell carcinoma with spinal metastasis: a retrospective analysis.","authors":"Joseph Rajasekaran, Xinlan Yang, Abdul Karim Ghaith, Zhehao Zhang, Abdel-Hameed Al-Mistarehi, Taha Khalilullah, Avi N Albert, Kristin J Redmond, Nicholas Theodore, Daniel Lubelski","doi":"10.3171/2026.3.SPINE251351","DOIUrl":"10.3171/2026.3.SPINE251351","url":null,"abstract":"<p><strong>Objective: </strong>Renal cell carcinoma (RCC) is a common malignancy that metastasizes to the spine, leading to complex treatment challenges and reduced survival. The aim of this study was to evaluate the prevalence of oncological biomarkers in patients with RCC spinal metastasis and analyze how these biomarkers, along with clinical factors, impact survival outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with RCC spinal metastasis who were treated surgically at a single academic center between 2013 and 2024. Clinical, surgical, and treatment data were collected. Immunohistochemical analysis of the 10 most prevalent biomarkers was performed on spinal tumor specimens. Predictive modeling of overall mortality was conducted using multivariate logistic regression, decision tree, and random forest algorithms. Model performance was assessed using the area under the curve, and key interactions were identified through interaction depth analysis. Unsupervised clustering was used to stratify patients into biomarker-defined risk groups.</p><p><strong>Results: </strong>Thirty-six patients (mean age 60 years) were included in the analysis. The overall mortality rate was 61.1%, with a mean follow-up duration after diagnosis of spinal metastasis of 16.1 months. CK7 and AE1/AE3 were the most significant predictors of mortality, with CK7-positive and AE1/AE3-negative patients having an 80% mortality rate versus 25% in AE1/AE3-positive patients (p < 0.01). CAM5.2 and KRAS expression were associated with 100% and 80% mortality, respectively. Patients with EGFR positivity and CK7 negativity had 0% mortality (p = 0.01). Decision tree analysis identified CAM5.2, CK7, and AE1/AE3 as key hierarchical classifiers. In the random forest analysis, CK7 and AE1/AE3 (mean minimal depths of 2.04 and 2.34, respectively) had the highest variable importance scores (Gini p < 0.01) (area under the curve: logistic regression = 0.74; decision tree = 0.72; random forest = 0.81). Unsupervised clustering stratified patients into three molecular subgroups with distinct mortality risks: cluster 1 (61.5%), cluster 2 (50.0%), and cluster 3 (66.7%).</p><p><strong>Conclusions: </strong>Immunohistochemical biomarkers, particularly CK7, AE1/AE3, CAM5.2, and EGFR, hold significant prognostic value in RCC spinal metastasis and can help stratify patients into high- and low-risk groups. The integration of these biomarkers into tree-based machine learning models provides interpretable data-driven decision tools to support personalized surgical and systemic treatment planning. These findings warrant validation in larger multi-institutional prospective cohorts and further analysis of biomarker interactions.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"600-610"},"PeriodicalIF":3.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760859","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 utility of the Risk Assessment and Prediction Tool in predicting discharge disposition, length of stay, and readmissions in patients undergoing transforaminal lumbar interbody fusion.","authors":"Gabriel A Gonzalez, Caden R Moenning, Aaron Davidson, Michael J Farias, Joseph E Nassar, Nicolas L Carayannopoulos, Zvipo Chisango, Catherine B Hurley, Andrew J Chi, Christy C Ciesla, Eren O Kuris, Bryce A Basques, Bassel G Diebo, Alan H Daniels","doi":"10.3171/2026.3.SPINE251683","DOIUrl":"10.3171/2026.3.SPINE251683","url":null,"abstract":"<p><strong>Objective: </strong>The Risk Assessment and Prediction Tool (RAPT) has been utilized to anticipate discharge needs after procedures such as total joint arthroplasty. Its usefulness for spine patients, particularly those undergoing transforaminal lumbar interbody fusion (TLIF), has not been clearly established. This study evaluated the relationship between the preoperative RAPT score and 3 postoperative outcomes: discharge destination, hospital length of stay (LOS), and 30-day readmission.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted of adults who underwent elective TLIF with a recorded preoperative RAPT score. RAPT was analyzed as a continuous variable. Home discharge and 30-day readmission were modeled with logistic regression, and LOS with linear regression. Multivariable models adjusted for age, sex, Charlson Comorbidity Index (CCI), and insurance type. Discrimination for facility discharge was assessed by receiver operating characteristic (ROC) analysis at literature-aligned thresholds (RAPT scores 9.5 and 8.5: balanced and conservative, respectively).</p><p><strong>Results: </strong>Among 116 patients, the mean age was 62.2 years and 50.9% of patients were female; the mean BMI was 29.9, and the mean CCI was 5.64. The mean RAPT score was 9.65, and the mean LOS was 3.14 days. Discharge to a skilled nursing or rehabilitation facility occurred in 6.9% of patients, and 30-day readmission occurred in 6.0%. Each 1-point increase in the RAPT score was associated with higher odds of home discharge (univariate: OR 1.74, 95% CI 1.11-2.73, p = 0.016; multivariable: OR 2.17, 95% CI 1.24-3.80, p = 0.007) and a shorter LOS (β = -0.38 days, 95% CI -0.71 to -0.05, p = 0.025; adjusted β = -0.39, bootstrap 95% CI -0.76 to -0.10, p = 0.038). The RAPT score was not associated with 30-day readmission (adjusted OR 0.93, 95% CI 0.52-1.65; p = 0.798). ROC analysis for predicting facility discharge showed moderate discrimination with an area under the curve of 0.709 (95% CI 0.543-0.876, p = 0.049), with sensitivity 63% and specificity 62% at 9.5, and sensitivity 38% and specificity 82% at 8.5. Youden's index revealed an optimal cutoff of 10.5, with sensitivity 100% and specificity 29.6%.</p><p><strong>Conclusions: </strong>In patients undergoing TLIF, higher preoperative RAPT scores were associated with greater odds of home discharge and shorter LOS. RAPT may serve as a practical preoperative tool to support discharge planning and resource allocation in spine surgery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"563-569"},"PeriodicalIF":3.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764973","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":"What predicts prolonged length of stay after surgery for cervical spondylotic myelopathy? A QOD CSM study.","authors":"Harrison J Howell, Evan F Joiner, Praveen V Mummaneni, Dean Chou, Erica F Bisson, Mohamad Bydon, Anthony L Asher, Domagoj Coric, Paul K Kim, Matthew J McGirt, Eric A Potts, Kevin T Foley, Paul Park, Michael Y Wang, Kai-Ming G Fu, Michael S Virk, Christopher I Shaffrey, Oren N Gottfried, John J Knightly, Scott A Meyer, Cheerag D Upadhyaya, Chun-Po Yen, Luis M Tumialán, Juan S Uribe, Jay D Turner, Regis W Haid, Andrew K Chan","doi":"10.3171/2026.3.SPINE251066","DOIUrl":"10.3171/2026.3.SPINE251066","url":null,"abstract":"<p><strong>Objective: </strong>Cervical spondylotic myelopathy (CSM) is a leading cause of spinal cord dysfunction requiring surgical intervention. Prolonged length of stay (LOS) after CSM surgery is associated with worse outcomes, increased complications, greater financial burden, and inefficient resource utilization. This study aimed to develop machine learning models to predict prolonged LOS after CSM surgery and to improve patient counseling, perioperative optimization, and discharge planning.</p><p><strong>Methods: </strong>The authors analyzed prospectively collected data from 14 high-accruing Spine CORe™ sites in the Quality Outcomes Database (QOD) of adult patients who underwent elective surgery for CSM. Patients with missing data were excluded. Machine learning models were trained to predict prolonged LOS, defined as ≥ 3 days. Models incorporated a wide range of preoperative demographic, clinical, and surgical variables. Model performance was evaluated using area under the receiver operating characteristic curve (AUROC) analysis, and significant predictors were extracted from the logistic regression model.</p><p><strong>Results: </strong>Of the 1141 patients identified as having undergone elective surgery for CSM, 1020 were included. Logistic regression, XGBoost, and random forest models demonstrated excellent performance with mean ± standard deviation AUROC values of 0.88 ± 0.02, 0.89 ± 0.02, and 0.89 ± 0.02, respectively. Prior shoulder surgery (OR 2.33, 95% CI 2.16-2.51, p = 0.04), greater total fused levels (OR 1.89, 95% CI 1.83-1.95, p < 0.001), and diabetes (OR 1.75, 95% CI 1.66-1.83, p = 0.049) were predictors of prolonged LOS. In contrast, anterior surgical approach (OR 0.14, 95% CI 0.12-0.17, p < 0.001), radicular motor deficit (OR 0.49, 95% CI 0.45-0.54, p = 0.030), and greater baseline modified Japanese Orthopaedic Association (mJOA) score (OR 0.87, 95% CI 0.86-0.88, p = 0.007) were associated with a lower likelihood of prolonged LOS. Subgroup analyses revealed that patients with radicular motor deficit and prior shoulder surgery differed demographically, clinically, and surgically compared to those without.</p><p><strong>Conclusions: </strong>In this large cohort of patients operated on for CSM, prior shoulder surgery, greater number of levels fused, and diabetes were significant positive predictors of prolonged LOS, while anterior approach surgery, radicular motor deficit, and higher baseline mJOA scores were predictive of a shorter inpatient stay. Patients with prior shoulder surgery and those with radicular motor deficit may represent distinct and clinically important subgroups within the broader CSM population. Machine learning models demonstrated excellent performance for predicting prolonged LOS from purely preoperative variables. The findings of this study may help enhance preoperative counseling, perioperative care, and resource utilization for CSM surgery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"668-677"},"PeriodicalIF":3.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766580","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":"Early perioperative outcomes after spinal cord injury due to low-energy fall: a retrospective comparative study of 78 patients with rigid versus 183 patients with nonrigid spine.","authors":"Alexander Zorzi, Andréane Richard-Denis, Manuel Jaramillo Jiménez, Jean-Marc Mac-Thiong","doi":"10.3171/2026.3.SPINE251199","DOIUrl":"10.3171/2026.3.SPINE251199","url":null,"abstract":"<p><strong>Objective: </strong>The number of patients with a rigid spine (e.g., due to ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, or ossification of the posterior longitudinal ligament) requiring surgery after spinal cord injury (SCI) is rising. However, the impact of an underlying rigid spine on perioperative outcomes remains unclear. Therefore, the aim of this study was to compare the characteristics and perioperative outcomes of patients with rigid spine with that of patients without rigid spine after SCI due to a low-energy fall.</p><p><strong>Methods: </strong>This retrospective analysis of prospectively collected data included a cohort of 261 adults who underwent surgery for acute SCI due to a low-energy fall at a single institution (April 2010-May 2024). Radiological studies were used to identify the presence or absence of an underlying rigid spine. Multivariable analysis was performed to determine associations between the presence of rigid spine and perioperative outcomes (neurological improvement, complications, and hospital length of stay [LOS]) while accounting for covariables.</p><p><strong>Results: </strong>Although the baseline SCI severity was similar, patients with rigid spine (n = 78) were older, had higher BMI, more comorbidities, and a longer surgery duration than those without rigid spine. In addition, patients with rigid spine had increased LOS (mean 39.2 ± 36.2 vs 26.4 ± 17.1, p = 0.004), rate of pneumonia (28.2% vs 13.7%, p = 0.005), and rate of urinary tract infection (30.8% vs 15.8%, p = 0.006). Multivariable analysis confirmed that having a rigid spine was associated with increased LOS and increased likelihood of pneumonia.</p><p><strong>Conclusions: </strong>Following SCI due to a low-energy fall, patients with rigid spine had an increased hospital LOS and complication rate after surgery. Clinicians should rapidly identify the presence of rigid spine in patients after SCI, considering the higher risk of poor perioperative outcomes.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"504-512"},"PeriodicalIF":3.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689415","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}