Journal of neurosurgery. Spine最新文献

{"title":"Incidence of and risk factors for revision surgery due to acute proximal junctional failure after anterior column realignment for adult spinal deformity.","authors":"Jin-Sung Park, Se-Jun Park, Dong-Ho Kang, Chong-Suh Lee, Hyun-Jun Kim, Kyunghun Jung, Minwook Kang","doi":"10.3171/2026.3.SPINE25135","DOIUrl":"10.3171/2026.3.SPINE25135","url":null,"abstract":"<p><strong>Objective: </strong>The association between the anterior column realignment (ACR) technique and acute proximal junctional failure (APJF) in adult spinal deformity (ASD) has not been thoroughly evaluated, and risk factors for revision surgery following APJF remain unclear. Therefore, this study was performed to determine the incidence of and the risk factors for revision surgery in APJF following ACR for ASD.</p><p><strong>Methods: </strong>Patients eligible for the study were those with severe degenerative sagittal imbalance who underwent deformity correction using ACR at 1 or more levels between 2020 and 2023. APJF was defined as proximal junctional failure occurring within 6 months postoperatively. Cases requiring revision surgery were classified as bony or soft tissue failures. Patient characteristics, surgical factors, and radiographic features were compared to identify risk factors for revision surgery. Univariate and multivariate logistic regression analyses were used to determine independent risk factors.</p><p><strong>Results: </strong>The study included 114 patients (mean age 70.7 ± 5.3 years) with a mean fusion length of 7.2 ± 1.9 levels. APJF occurred in 36 patients (31.6%), with 24 cases of bony failure and 12 cases of soft tissue failure. Revision surgery was performed in 14 patients (38.9% of APJF cases, 12.3% of the study cohort) at a mean of 156.6 ± 76.2 days postoperatively. Among those revisions, 12 cases were due to bony failure and 2 to soft tissue failure. Univariate analysis identified a cranial screw angle at the upper instrumented vertebra (UIV), preoperative thoracic kyphosis (TK), postoperative TK, and proximal junctional angle (PJA) as significant risk factors for revision. Multivariate analysis revealed several independent risk factors for revision surgery: cranial screw angle at UIV (HR 21.578, p < 0.001), preoperative TK (HR 1.049, p = 0.034), and postoperative PJA (HR 1.125, p = 0.046).</p><p><strong>Conclusions: </strong>The incidence of revision surgery due to APJF following ACR for ASD was 12.3% overall. Key risk factors included a cranial UIV screw angle, greater preoperative TK, and increased postoperative PJA.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"527-535"},"PeriodicalIF":3.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689363","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":"Perioperative shear wave elastography for the evaluation of spinal cord release in pediatric dysraphism: first experience in 21 patients.","authors":"Mathilde Gaume, Lou Richard, Claudio Vergari, Eleonore Blondiaux, Marius Buffard, Raphael Vialle, Timothée de Saint-Denis","doi":"10.3171/2026.2.SPINE251716","DOIUrl":"10.3171/2026.2.SPINE251716","url":null,"abstract":"<p><strong>Objective: </strong>Shear wave elastography (SWE) is a recent method for evaluating soft tissue stiffness. Its application to the spinal cord is limited by the ultrasound bone barrier. Spinal dysraphism can cause neurological symptoms impairing bladder, bowel, and lower limb function due to a mechanical stress known as tethered cord syndrome. Detethering of the spinal cord is a part of surgical treatment. This study aimed to assess the feasibility of intraoperative elastography to guide surgery in patients with spinal dysraphism involving traction of the spinal cord.</p><p><strong>Methods: </strong>This single-center retrospective study included all patients who underwent surgery for spinal dysraphism between November 2023 and July 2024. SWE was performed under general anesthesia with the patient in the prone position before and after spinal cord detethering. All SWE measurements were performed using the Aixplorer system. Demographic, clinical, and radiological data (age at surgery, neurological status, and MRI findings) were collected.</p><p><strong>Results: </strong>Twenty-one patients with a mean ± SD (range) age of 3.7 ± 5.3 (0-17.5) years were included. Etiologies included open saccular dysraphism (n = 3), spinal cord conus lipoma (n = 6), limited dorsal myeloschisis (n = 3), and fibrolipomatous filum (n = 9). In 85% of patients, at least 1 clip was of sufficient quality for analysis both before and after release. The mean ± SD (range) spinal cord stiffness at the beginning of surgery was 25.2 ± 9.2 (12.3-39.1) kPa and 11.2 ± 3.8 (6.2-16.5) kPa at the end of release, with a significant stiffness decrease (p = 0.018). No complications attributable to SWE were observed.</p><p><strong>Conclusions: </strong>SWE of the spinal cord in patients with spinal dysraphism is a safe and feasible imaging method. This technique may assist in assessing the adequacy of untethering during surgery. However, no established normative SWE values for the pediatric spinal cord currently exist. Until it does, the intraoperative interpretability and clinical utility of this technique remain limited.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"536-542"},"PeriodicalIF":3.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689359","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":"Prolonged postoperative dysphagia reduces return to work and physical activity after cervical spine surgery.","authors":"Nathan J Kussow, Nicholas P Tippins, Anne M Foreit, Catherine M Milne, Arya M Narayanan, Matthew R Neely, Jake T Reasoner, Kathleen M Hannon, Aidan C Rezner, Vincent J Alentado, Erica F Bisson, Ken Porche, Kevin T Foley, Eric A Potts","doi":"10.3171/2026.3.SPINE251536","DOIUrl":"10.3171/2026.3.SPINE251536","url":null,"abstract":"<p><strong>Objective: </strong>Dysphagia has been shown to have an adverse effect on patient quality of life following cervical spine surgery, but its impact on patients' ability to return to work (RTW) and return to physical activities (RTA) has never been investigated. This study aimed to evaluate the impact of postoperative dysphagia on patients' ability to RTW and RTA after surgery.</p><p><strong>Methods: </strong>A prospectively maintained multi-institutional spine registry of patients who underwent cervical spine surgery between 2016 and 2023 was retrospectively reviewed. An Eating Assessment Tool-10 (EAT-10) score ≥ 3 was used to quantify preoperative and 12-month postoperative dysphagia. Prolonged dysphagia was defined as new dysphagia present at 12 months among patients without baseline dysphagia. RTW and RTA were assessed at baseline and 12 months postoperatively. Mixed-effects logistic regressions were used to evaluate the effect of dysphagia on RTW and RTA.</p><p><strong>Results: </strong>Of the 1208 patients meeting inclusion criteria, 240 (20%) experienced prolonged dysphagia, of whom 208 (87%) underwent anterior surgery. Preoperatively, 709 (59%) patients were fully employed or on short-term leave, 307 (25%) were retired, and 191 (16%) were otherwise unemployed. At the 12-month follow-up, RTW and RTA status were collected for 629 (95%) of the 664 employed patients who planned to RTW after surgery and 1127 (93%) of the total cohort, respectively. Significantly lower rates of RTW (86% vs 96%, p < 0.001) and RTA (62% vs 79%, p < 0.001) were observed in patients with prolonged dysphagia. Multivariable analysis identified dysphagia as being independently associated with lower odds of RTW (OR 0.35, 95% CI 0.14-0.86; p = 0.022) and RTA (OR 0.44, 95% CI 0.31-0.63; p < 0.001).</p><p><strong>Conclusions: </strong>Prolonged postoperative dysphagia-defined as a new EAT-10 score ≥ 3 at 12 months-was associated with substantially lower odds of returning to work and physical activities after cervical spine surgery, underscoring the importance of dysphagia prevention and management in postoperative care.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"632-642"},"PeriodicalIF":3.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689350","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 predictive utility of preoperative canal diameter, foraminal stenosis, and cord-lamina angle for postoperative C5 palsy: a matched cohort validation study.","authors":"Gregory R Toci, Jonathan Dalton, Rachel Huang, William A Green, Mitchell K Ng, Michael Carter, Aditya S Mazmudar, Robert J Oris, Joshua Mathew, Gregorio Baek, Rajkishen Narayanan, Andrew Kim, Sebastian Fras, Marco Goldberg, Evgeniy Uvarov, Mark F Kurd, Ian David Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.3171/2026.2.SPINE251113","DOIUrl":"10.3171/2026.2.SPINE251113","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative C5 palsy is a debilitating complication of cervical spine surgery with unclear etiology. A previous study of 12 patients proposed a three-variable model to predict postoperative C5 palsy based on MRI measurements of the anteroposterior diameter of the spinal canal (APD), foraminal diameter (FD), and cord-lamina angle (CLA). The initial paper reported an area under the receiver operating characteristic (ROC) curve (AUC) of 0.97, with a sensitivity of 91% and specificity of 100%. This study aimed to validate the three-variable model and its individual components in a larger patient cohort.</p><p><strong>Methods: </strong>Adult patients who underwent anterior or posterior cervical discectomy and fusion at C4-5 with subsequent C5 palsy were retrospectively identified (2010-2023). Postoperative C5 palsy was defined as a new or increased deltoid/biceps weakness on manual motor testing. Patients with C5 palsy were propensity score-matched 1 to 3 to a control group based on age, sex, Charlson Comorbidity Index score, procedure type, and levels fused. A biostatistician used the APD, FD, and CLA MRI measurements to calculate ROC curves, sensitivities, and specificities for single- and three-variable predictive models of postoperative C5 palsy.</p><p><strong>Results: </strong>A total of 42 patients with C5 palsy were matched to 126 controls. There were no significant differences in preoperative APD (mean 9.20 vs 9.45 mm, p = 0.426), minimum FD (mean 1.82 vs 1.90 mm, p = 0.609), or maximum CLA (mean 38.8° vs 38.5°, p = 0.867) between the C5 palsy and control groups. The APD had an AUC of 0.455, sensitivity of 0.912, and specificity of 0.148. The minimum FD had an AUC of 0.501, sensitivity of 0.765, and specificity of 0.330. The maximum CLA had an AUC of 0.513, sensitivity of 0.765, and specificity of 0.348. When applied collectively, the three-variable predictive model performed similarly to chance, yielding an AUC of 0.519 (95% CI 0.410-0.628), sensitivity of 0.676, and specificity of 0.452.</p><p><strong>Conclusions: </strong>In a large, well-matched validation cohort, the preoperative MRI parameters of the APD, FD, and CLA were not predictive of postoperative C5 palsy, both individually and as a three-variable model. The etiology of C5 palsy remains poorly understood and reliable preoperative predictors have yet to be identified. The previously proposed three-variable model demonstrated inconsistent predictive utility for postoperative C5 palsy, and the model should be interpreted with caution before more rigorous external validation.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"653-659"},"PeriodicalIF":3.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648735","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":"Paraspinal muscle flap advancement to reduce wound complications following posterior cervical decompression and fusion.","authors":"Samuel Adida, Samuel H Wakelin, Regan M Shanahan, Pooja D Reddy, Victoria Crall, Hansen Deng, Andrew D Legarreta, Joseph S Hudson, D Kojo Hamilton, Nitin Agarwal","doi":"10.3171/2026.2.SPINE251002","DOIUrl":"10.3171/2026.2.SPINE251002","url":null,"abstract":"<p><strong>Objective: </strong>Paraspinal muscle flaps have been used for complex wound reconstruction. Given the higher rates of wound complications associated with closure following posterior cervical decompression and fusion (PCDF), this study evaluated the use of paraspinal muscle flap advancement to mitigate this recognized risk.</p><p><strong>Methods: </strong>A retrospective cohort of patients who underwent PCDF with conventional closure at an academic quaternary center between 2011 and 2022 was identified. Postoperative outcomes were compared with those of a prospectively maintained cohort of patients who underwent PCDF with paraspinal muscle flap advancement performed between 2023 and 2025. Exclusion criteria included active local or systemic infection and less than 3 months of follow-up.</p><p><strong>Results: </strong>A total of 380 patients underwent conventional closure, and 128 patients underwent closure with muscle flap advancement. Baseline characteristics were similar across cohorts, including BMI (p = 0.466) and the prevalence of diabetes mellitus (p = 0.597) and osteoporosis (p = 0.256). The muscle flap cohort was older (p = 0.004) and had higher rates of tobacco use (p = 0.002). There were no differences in preoperative prealbumin (p = 0.427) or albumin (p = 0.527). Operative indications (p = 0.568), revision surgeries (p > 0.999), estimated blood loss (p = 0.465), and number of spinal levels fused (p = 0.067) were not significantly different between the cohorts. Rates of wound complications were comparable between the conventional and muscle flap cohorts, including infection (8% vs 3%, p = 0.132), wound dehiscence (12% vs 11%, p = 0.670), hematoma (1% vs 0%, p = 0.576), and seroma (5% vs 9%, p = 0.429). Wound-related reoperation occurred less frequently following muscle flap closure (12% vs 7%, p = 0.021). On multivariable logistic regression analysis, muscle flap closure was associated with reduced odds of infection (p = 0.005; OR 0.275, 95% CI 0.085-0.702) and wound-related reoperation (p = 0.026; OR 0.445, 95% CI 0.198-0.912).</p><p><strong>Conclusions: </strong>Paraspinal muscle flap advancement following PCDF was associated with reduced odds of infection and wound-related reoperation after adjustment of preoperative and operative factors.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"660-667"},"PeriodicalIF":3.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648815","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":"Cervical myelopathy responses to extracts derived from combustible cigarettes and heated tobacco products: in vivo and in vitro evidence.","authors":"Yuto Kobayashi, Koji Tamai, Masayoshi Iwamae, Kazuya Nishino, Kumi Orita, Yuki Kinoshita, Masataka Miura, Yuki Nagashima, Takeo Furuya, Seiji Ohtori, Hiroaki Nakamura, Hidetomi Terai","doi":"10.3171/2026.2.SPINE251111","DOIUrl":"10.3171/2026.2.SPINE251111","url":null,"abstract":"<p><strong>Objective: </strong>Degenerative cervical myelopathy (DCM) is a progressive spinal cord disorder, yet modifiable risk factors that accelerate its progression remain poorly understood. While cigarette smoking worsens surgical outcomes, its influence on disease progression under conservative management is unclear. Heated tobacco products (HTPs) are increasingly used worldwide, but their neurological effects remain unexamined. Authors of this study analyzed the effects of extracts derived from combustible cigarettes and HTPs on the progression of cervical myelopathy and determined whether combustible cigarettes and HTPs exert similar effects.</p><p><strong>Methods: </strong>Male Sprague Dawley rats (8 weeks old) underwent laminectomy only (sham group) or cervical spinal cord compression surgery and received intraperitoneal injections of saline (compression model [CM] group), cigarette smoke extract (CSE; compression model based on combustible cigarettes [cCM group]) or HTP extract (compression model based on heated tobacco products [hCM group]) every 5 days for 10 weeks. Motor and sensory function were assessed using the Basso, Beattie, Bresnahan (BBB) Locomotor Rating Scale and the von Frey test, respectively. Histological evaluation was performed postmortem. In vitro, differentiated rat pheochromocytoma (PC12) cells were exposed to CSEs prepared from combustible cigarettes (cCSE) or HTPs (hCSE), and neurite length, cell viability, and apoptosis rates were assessed after 24 hours.</p><p><strong>Results: </strong>The median BBB scale scores at 10 weeks postoperatively were significantly lower in the cCM (median 11 [IQR 11-11], p < 0.01) and hCM (11 [10-11], p < 0.01) groups than in the CM group (13 [13-15]). Hind paw withdrawal thresholds were higher in the cCM (median 26.0 g [IQR 26.0-60.0 g], p < 0.001) and hCM (26.0 g [26.0-60.0 g], p < 0.001) groups than in the CM group (15.0 g [10.0-15.0 g]). Histological analysis revealed increased neuronal loss, gray matter cavitation, and white matter demyelination. In PC12 cells, both extracts reduced neurite length (cCSE 13.4 ± 1.1 μm or hCSE 23.7 ± 11.4 μm vs untreated control 38.2 ± 15.4 μm, p < 0.001 for both), decreased viability (cCSE 0.041 ± 0.007 or hCSE 0.047 ± 0.007 vs untreated control 0.070 ± 0.015, p < 0.01 for both), and increased apoptosis (cCSE 53.6% ± 0.8% or hCSE 52.5% ± 1.2% vs untreated control 6.1% ± 1.0%, p < 0.01 for both).</p><p><strong>Conclusions: </strong>Both combustible cigarette and HTP extracts exacerbated neurological deterioration in a cervical myelopathy model. HTPs, despite their perceived safety, exhibited detrimental effects comparable to those from combustible cigarettes. These findings highlight the need to address all forms of tobacco use in patients with DCM treated conservatively.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"686-696"},"PeriodicalIF":3.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of lesion size on outcomes following stereotactic body radiotherapy for spinal metastases.","authors":"Daniel T Lilly, Herika Negri Brito, Wei Wei, Anthony Magnelli, Samuel T Chao, John H Suh, Ehsan H Balagamwala, Lilyana Angelov","doi":"10.3171/2026.2.SPINE251402","DOIUrl":"10.3171/2026.2.SPINE251402","url":null,"abstract":"<p><strong>Objective: </strong>Stereotactic body radiotherapy (SBRT) for metastatic spinal disease provides effective local control (LC). However, there are limited data evaluating how the pretreatment volume or number of affected vertebral levels impacts treatment effect. Therefore, this study compared the efficacy of spine SBRT treatment on LC, distant progression (DP), and overall survival (OS) between patients with limited spinal disease (≤ 2 vertebral segments or < 50 cm3 pretreatment volume) to those with more widespread spine metastases.</p><p><strong>Methods: </strong>All patients with metastatic spinal disease treated with SBRT over a 7-year interval at a single institution were retrospectively reviewed. Baseline demographic characteristics, primary tumor histology, anatomical distribution of metastases, and radiation dosing parameters and toxicity were recorded. LC (absence of recurrent disease at an SBRT-treated segment), DP (progressive disease in a new/untreated segment), and OS were measured. Cox proportional hazards models were used to identify patient and lesion characteristics associated with LC, DP, and OS.</p><p><strong>Results: </strong>In total, 375 patients were treated with spine SBRT (465 isocenters). Median minimum and maximum target doses were 9.98 and 17.73 Gy, respectively. Overall, 10.1% of patients developed distant DP, while 11.2% of lesions recurred. New or worsening compression fracture occurred in 5.6% of lesions following SBRT, with 1.9% of radiated lesions requiring surgical management of a postradiation compression fracture. Neither radioresistant pathologies nor dose above or below 14 Gy were associated with differences in LC, DP, or OS. Multivariate regression revealed that OS was significantly worse with baseline Karnofsky Performance Status < 80 (HR 1.33, p = 0.030), lesion volume ≥ 50 cm3 (HR 1.37, p = 0.011), or treatment at ≥ 3 vertebral levels (HR 1.42, p = 0.013). DP was significantly worse with lesion volume ≥ 50 cm3 (HR 2.14, p = 0.0229) but was unaffected by number of vertebral segments treated. Notably, however, LC was not significantly associated with high lesion volume or the number of vertebral segments affected.</p><p><strong>Conclusions: </strong>Lesion size did not impact the recurrence rates following SBRT for spine metastases in this series, with similar excellent local disease control (> 88%) for patients with ≥ 3 vertebral segments involved or ≥ 50 cm3 pretreatment tumor volume compared to patients with less disease burden. Shorter time to DP and worse OS were both associated with high index lesion volume.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"579-588"},"PeriodicalIF":3.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648821","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":"Recovery rates of postoperative dysphagia following cervical spine surgery.","authors":"Matthew R Neely, Nicholas P Tippins, Anne M Foreit, Vincent J Alentado, Catherine M Milne, Nathan J Kussow, Arya M Narayanan, Aidan C Rezner, Kathleen M Hannon, Erica F Bisson, Ken Porche, Kevin T Foley, Eric A Potts","doi":"10.3171/2026.2.SPINE251597","DOIUrl":"10.3171/2026.2.SPINE251597","url":null,"abstract":"<p><strong>Objective: </strong>This study examines the recovery rates of patients who experience postoperative dysphagia within 1 month following cervical spine surgery.</p><p><strong>Methods: </strong>Data from a prospectively maintained multi-institutional quality registry were retrospectively analyzed. Eating Assessment Tool-10 (EAT-10) questionnaire scores were collected at baseline and 1, 3, and 12 months postoperatively, with total scores ≥ 3 indicating dysphagia. Patients were grouped by whether they reported baseline dysphagia to assess the impact of baseline dysphagia on recovery. Recovery was defined as resolution of postoperative dysphagia and not reporting the condition at any follow-up time point. Patients were excluded from the recovery model if they did not report dysphagia within 1 month of surgery. Recovery to baseline was defined as reporting a postoperative EAT-10 score equal to or less than the baseline score at subsequent time points. Patients were excluded from the recovery-to-baseline model if they did not report EAT-10 scores within 1 month of surgery that were worse than their baseline score. Survival curves were generated for both models.</p><p><strong>Results: </strong>Of the 2003 patients in the registry, 627 met inclusion criteria for the recovery curve and 714 for the recovery-to-baseline curve. Of the patients without baseline dysphagia, 498 developed new postoperative dysphagia within 1 month, with cumulative recovery probabilities of 39.5% by 3 months and 59.1% by 12 months after cervical spine surgery. Furthermore, of the patients without baseline dysphagia, 73.5% (175/238) who reported no dysphagia at 3 months and 32.5% (68/209) who reported no dysphagia at 12 months experienced long-term recovery. Eighty patients with baseline dysphagia reported worse EAT-10 scores within 1 month, with cumulative probabilities of improvement to baseline or below of 37.7% by 3 months and 54.1% by 12 months. Patients with baseline dysphagia were significantly less likely to recover than patients without baseline dysphagia (hazard ratio [HR] 0.37, 95% CI 0.26-0.53; p < 0.001) but significantly more likely to recover to baseline (HR 1.45, 95% CI 1.05-2.00; p = 0.025).</p><p><strong>Conclusions: </strong>Patients who develop postoperative dysphagia within 1 month of cervical spine surgery generally see symptomatic improvement over time. This analysis may aid in clinical decision-making when informing patients about the risk of developing postoperative dysphagia and the recovery rate of this surgical complication.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"643-652"},"PeriodicalIF":3.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648788","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":"Investigating the relationship between low-density lipoprotein cholesterol and lumbar spinal fusion outcomes amongst statin users: a propensity score-matched analysis.","authors":"Kyle Stump, Henry Morar, Ashley Salimbangon, Stephan Aynaszyan, Dhara Patel, Theresa Pazionis","doi":"10.3171/2026.2.SPINE26188","DOIUrl":"https://doi.org/10.3171/2026.2.SPINE26188","url":null,"abstract":"<p><strong>Objective: </strong>Recent evidence suggests that elevated low-density lipoprotein cholesterol (LDL-C) is associated with an increased risk of nonunion following spinal fusion. However, these studies may be confounded by discrepant rates of statin use that exert their own pleotropic effects on bone metabolism. The aim of this study was to evaluate the association between preoperative LDL-C levels and nonunion among statin-exposed patients undergoing single-level lumbar fusion.</p><p><strong>Methods: </strong>The TriNetX Research Network was queried for adult patients who underwent single-level lumbar fusion between September 17, 2003, and September 17, 2023. Patients with a statin prescription within 6 months before or after surgery were identified. In this subset, high and low LDL-C were defined as 1 standard deviation above and below the mean, respectively. A secondary analysis compared patients with and without perioperative statin use. Propensity score matching was performed 1:1 based on demographics and comorbidities. Diagnosis of nonunion was assessed at 6 months, 1 year, and 2 years using risk ratios with 95% confidence intervals.</p><p><strong>Results: </strong>The primary analysis included 849 matched pairs. No differences in risk of nonunion between statin users with high and low LDL-C were observed. Conversely, statin use was associated with a significantly reduced risk of nonunion at all time intervals assessed (all p < 0.001).</p><p><strong>Conclusions: </strong>Among statin-exposed patients undergoing single-level lumbar fusion, LDL-C levels were not associated with nonunion; however, perioperative statin use was independently associated with reduced nonunion risk. These findings suggest that previously reported associations between elevated LDL-C and pseudarthrosis may be partially confounded by differences in statin utilization rather than LDL-C levels themselves.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-7"},"PeriodicalIF":3.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648708","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 neurological deficits and recurrence in sporadic and syndrome-associated spinal nerve sheath tumors.","authors":"Jack Horan, Vincent Healy, James Clerkin, Muhammad Khizar Hayat, Mohamed Abdelsadig, Deirdre Nolan, Paula Corr, Donncha F O'Brien, David O'Brien, Catherine Moran, Ciaran Bolger, Mohammed Ben Husien","doi":"10.3171/2026.2.SPINE251713","DOIUrl":"10.3171/2026.2.SPINE251713","url":null,"abstract":"<p><strong>Objective: </strong>Spinal nerve sheath tumors (SNSTs) are most commonly benign tumors that present with pain. The aim of the study was to assess factors associated with new neurological deficits and recurrence in surgically treated SNSTs.</p><p><strong>Methods: </strong>All surgically treated SNSTs at a single institution over a 10-year period (2014-2023) were identified by searching the institution's histopathological database and neuro-oncology multidisciplinary team conference. Patient demographics, presenting symptoms, tumor characteristics, surgical procedures, use of intraoperative monitoring, neurofibromatosis (NF) status, neurological outcomes, and complications were recorded.</p><p><strong>Results: </strong>There were 169 tumors in 165 patients (52.7% female, mean age 48.6 years) included in this analysis. The median duration of symptoms was 8.5 months (range 0.5-120 months). Presenting symptoms were pain (71.6%), motor deficit (26.6%), sensory deficit (22.5%), and bladder incontinence (5.9%), with incidental findings in 7.7% of cases. The median tumor diameter was 2.5 cm (range 0.6-21 cm). The gross-total resection rate was 63.9% and subtotal resection (STR) rate was 36.1%. Intraoperative neurophysiological monitoring (IONM) was used in 21.9% of cases. NF (NF type 1, NF type 2, or schwannomatosis) was present in 18.9%. Schwannoma was the most common diagnosis (82.8%, 140/169), followed by neurofibroma (13.6%, 23/169) and malignant peripheral nerve sheath tumor (MPNST) (3.6%, 6/169). Four of 6 cases (66.6%) of MPNST were concurrent with NF. The overall complication rate was 22.5% (38/169). New motor weaknesses were seen in 5.3% of cases and were associated with larger tumors (p = 0.007). Nerve root sacrifice of motor nerves produced new motor deficit in 14.3% of cases that were intact preoperatively. The rate of new sensory deficit was 3.6% (6/169). Tumor recurrence occurred in 7.1% (12/169) of cases and was associated with female sex, STR, MPNST, and NF. The median time to recurrence was 22 months (range 1-48 months). IONM use was not associated with fewer complications.</p><p><strong>Conclusions: </strong>These findings suggest that surgical treatment of SNST is a safe and effective procedure. There was low risk of new motor weakness, with or without nerve root sacrifice, following surgery. Recurrence rates were low; however, the risk was increased for patients with STR, NF, MPNST, or neurofibroma. MPNST and SNST in NF are complex and difficult to manage, behaving differently than benign and sporadic nerve sheath tumors.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"611-621"},"PeriodicalIF":3.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648818","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}