Journal of neurosurgery. Spine最新文献

{"title":"Association between poverty and lack of insurance on mortality rates at 1, 2, and 5 years in patients with breast cancer metastatic to the spine: a propensity score-matched analysis of 854 patients.","authors":"Austin Q Nguyen, Brian M Phelps, Syed Mehdi, Kevin Bondar, Sree M Vemu, Comron Saifi","doi":"10.3171/2026.2.SPINE251182","DOIUrl":"10.3171/2026.2.SPINE251182","url":null,"abstract":"<p><strong>Objective: </strong>Metastatic cancer to the spine presents a growing challenge in the US, with surgery often recommended for stability and palliation. Despite advancements, postoperative complication and mortality rates remain high. In this study, the authors aimed to investigate the impact of poverty and social determinants of health on survival rates among patients with metastatic breast cancer to the spine.</p><p><strong>Methods: </strong>A propensity score-matched retrospective study of patients aged > 18 years receiving a diagnosis of metastatic breast cancer to the spine between 2006 and 2015 was performed using data from the US Surveillance, Epidemiology, and End Results (SEER) sites in the SEER-Medicare database. Poverty census, dual eligibility, race, tumor characteristics (grade, stage, receptor status), community distress score, education level, insurance status at diagnosis, income level, and marital status were evaluated in the model.</p><p><strong>Results: </strong>Of 854 patients, 651 resided in zip codes in which 0% to < 20% of the population lived below the poverty line and 203 patients resided in zip codes in which 20%-100% lived below the poverty line. After propensity score matching, patients living in areas with 20%-100% of the population below the poverty line had worse survival at 1 year (HR 1.43, p = 0.009), 2 years (HR 1.45, p = 0.008) and 5 years (HR 1.5, p = 0.007) after diagnosis. Patients with insurance, both non-Medicaid and Medicaid, respectively, had higher survival at 1 year (HR 0.389, p = 0.009) and (HR 0.429, p = 0.006), at 2 years (HR 0.359, p = 0.003) and (HR 0.444, p = 0.008), and at 5 years (HR 0.446, p = 0.01) and (HR 0.513, p = 0.037) compared with patients with no insurance.</p><p><strong>Conclusions: </strong>This is the first study to demonstrate poverty and insurance status as independent predictors of survival at 1, 2, and 5 years in patients with breast cancer metastatic to the spine.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"589-599"},"PeriodicalIF":3.9,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584399","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":"Detailing long-term functional morbidity after resecting mobile spine chordomas across 35 patients.","authors":"Yuanxuan Xia, Pritika Papali, Abdel-Hameed Al-Mistarehi, Christian Meyer, John Gross, Majid Khan, Chetan Bettegowda, Timothy Witham, Ali Bydon, Nicholas Theodore, Jean-Paul Wolinsky, Ziya L Gokaslan, Sheng-Fu Larry Lo, Daniel Sciubba, Salih Colakoglu, Sang H Lee, Kristin J Redmond, Daniel Lubelski","doi":"10.3171/2026.2.SPINE251166","DOIUrl":"10.3171/2026.2.SPINE251166","url":null,"abstract":"<p><strong>Objective: </strong>Surgery for mobile spine chordomas poses a challenge as en bloc resection often requires nerve root resection. Decision-making is challenging for patients because of this inherent high risk of postoperative deficits, and data demonstrating long-term postoperative functional outcomes are lacking. Here, the authors aimed to show the postoperative functional morbidity of a large series of patients with mobile spine chordomas and detail what was achieved intraoperatively and what nerve root(s) were deemed appropriate for sacrifice in each case.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of all patients who underwent follow-up for mobile spine chordomas at a quaternary spinal oncology center from 2008 to 2023. Data including intraoperative nerve sacrifices, adjuvant treatments, and functional outcomes at last follow-up were collected. Primary outcomes were neck/back pain and all-cause motor weakness and sensory deficits at last follow-up, while secondary outcomes were overall survival and local recurrence.</p><p><strong>Results: </strong>Thirty-five patients were included in this cohort with a median follow-up of 5.4 (IQR 4.9-9.0) years. Resections were Enneking appropriate (EA) in 23 (65.7%) of the 35 patients, with 13 cases involving nerve root sacrifice. Three of the 12 Enneking inappropriate (EI) cases also had nerve root sacrifice. The proportion of patients with long-term postoperative weakness was similar between patients receiving EA and those receiving EI resection (47.8% vs 41.7%, p > 0.99) as were the rates of nerve root sacrifice (56.5% vs 25.0%, p = 0.152). Notably, 36.8% of patients with no nerve root sacrifice developed unplanned long-term weakness, which highlights how causes of long-term weakness are multifactorial. Nerve root sacrifice was more common in the thoracic spine than cervical or lumbar spine, and lesions in areas of the subaxial cervical and lumbar spines with functional nerve roots did receive surgeries with fewer nerve root sacrifices. At the time of census, 7 (20.0%) patients had died and 14 (40.0%) experienced recurrence.</p><p><strong>Conclusions: </strong>Surgeons must consider the costs and benefits of sacrificing nerve roots to achieve en bloc resection for mobile spine chordomas. Here, the authors catalog a series of mobile spine chordoma resections to help illustrate what is considered acceptable functional morbidity to achieve en bloc results at a large quaternary referral center. They demonstrate that EA surgery is not associated with higher rates of motor weakness and has rates of nerve root sacrifice that are similar to those of to EI surgery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"622-631"},"PeriodicalIF":3.9,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584519","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":"Diagnostic utility of dural sac morphology on MRI in tethered cord syndrome: a multicenter study.","authors":"He Wang, Kai Wang, Kun He, Tianyun Zhao, Tzak S Lau, Yaobin Wang, Yuhua Yang, Fan Zhang, Shaocheng Liu, Zhenlei Liu, Lei Zhang, Xiaorong Yan, Hao Wu, Chuan Huang","doi":"10.3171/2026.2.SPINE251037","DOIUrl":"10.3171/2026.2.SPINE251037","url":null,"abstract":"<p><strong>Objective: </strong>Tethered cord syndrome (TCS) results in neurological dysfunction due to spinal cord tethering. Because MRI sensitivity, particularly for occult TCS (OTCS), is limited by variable image quality and anatomy, the authors aimed to develop and externally validate a simple MRI-based diagnostic index derived from dural sac morphology to improve diagnosis across multicenter datasets.</p><p><strong>Methods: </strong>This retrospective multicenter study included 280 participants from 5 hospitals, encompassing patients with simple TCS, complex TCS, and OTCS along with healthy controls. Participants were allocated into training, internal validation, external test, and external OTCS test datasets. Dural sac morphological features were manually measured on axial T2-weighted MRI scans from levels L1-2 through L5-S1. Logistic regression identified key morphological features at L1-2 and L2-3 levels, which were integrated into a diagnostic index incorporating demographic adjustments for age and sex. Model performance was assessed using receiver operating characteristic curve analysis across all datasets.</p><p><strong>Results: </strong>The final diagnostic model demonstrated strong and consistent diagnostic efficacy. In the training dataset, the corrected diagnostic index achieved a sensitivity of 0.921 and specificity of 0.779 (area under the curve 0.930). High sensitivity (≥ 0.9) and satisfactory specificity (≥ 0.7) were reliably maintained across the internal validation, external test, and OTCS datasets.</p><p><strong>Conclusions: </strong>This study establishes a practical MRI-based diagnostic index that leverages dural sac morphological parameters at levels L1-2 and L2-3 to accurately diagnose TCS, including challenging occult cases. The model's reliance on straightforward anatomical measurements and demographic corrections eliminates dependence on advanced imaging protocols or subjective interpretations, presenting a robust imaging biomarker that can significantly improve early detection and clinical management of TCS.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"543-553"},"PeriodicalIF":3.9,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584458","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":"Use of domino connector to improve simultaneous correction of combined sagittal and coronal malalignment in adult spinal deformity surgery.","authors":"Lluís Vila, Anouar Bourghli, Daniel Larrieu, Cécile Roscop, Alice Baroncini, Yann Philippe Charles, Ahmet Alanay, Frank Kleinstück, Ferran Pellisé, Javier Pizones, Louis Boissière, Ibrahim Obeid","doi":"10.3171/2026.1.SPINE251160","DOIUrl":"10.3171/2026.1.SPINE251160","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to compare the radiological and clinical outcomes of two groups of adult spinal deformity (ASD) patients categorized according to the use or not of a side-to-side domino connector (DC) as a corrective tool for malalignment.</p><p><strong>Methods: </strong>This study was a retrospective analysis of a prospective multicentric ASD database. Patients with baseline coronal (C7 to central sacral vertical line [CSVL] > 20 mm) and sagittal (pelvic tilt [PT] > 25°, sagittal vertical axis [SVA] > 5 cm, thoracic kyphosis > 60°, or global tilt [GT] > 25°) malalignment who underwent spinal fusion with pelvic fixation and had at least 2 years of follow-up were included. Patients were classified according to the use of DC. To account for baseline differences, a propensity score-matched (PSM) analysis was conducted, matching patients for preoperative deformity magnitude and surgical invasiveness. Finally, a subanalysis of patients without pedicle subtraction osteotomy (PSO) was performed to evaluate the intrinsic corrective power of the DC. Demographic and surgical data, alignment evolution, complications, and patient-reported outcome measures were compared.</p><p><strong>Results: </strong>Of the 224 patients included, the DC group (n = 81) had significantly worse preoperative biplanar malalignment compared to the no-DC group (n = 143), which led to more frequent use of pedicle subtraction osteotomy (47.7% vs 21.0%, p < 0.001). The DC group achieved significantly greater biplanar correction, including C7-CSVL (29 mm vs 18.7 mm, p = 0.007), GT (22.6° vs 12.0°, p = 0.004), and lumbar lordosis (26° vs 17°, p < 0.05). This translated to superior final sagittal alignment at 2 years, with a lower GT (25.1° vs 29.8°, p = 0.009) and greater L1-S1 lordosis (54.9° vs 48.6°, p < 0.001), while final coronal alignment was comparable between groups. These superior outcomes were confirmed in the PSM analysis, where the DC group retained significantly better postoperative sagittal alignment (p < 0.05). These corrective benefits were also observed in the subgroup of patients who did not undergo 3-column osteotomy, where the DC group maintained significantly greater L1-S1 lordosis (55.5° vs 47.3°, p < 0.001) and thoracic kyphosis (43.1° vs 37.0°, p = 0.032). Despite the greater correction, there was no increase in mechanical complications and patient-reported outcome measures were comparable at the final follow-up.</p><p><strong>Conclusions: </strong>The use of DC is associated with greater radiological correction of complex sagittal and coronal deformities, with no apparent increase in overall complications rates. These findings suggest that DC may represent a powerful and safe tool for optimizing biplanar correction in challenging ASD cases.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"516-526"},"PeriodicalIF":3.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471383","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. Utilization of domino connectors in the pursuit of biplanar harmonious alignment in adult spinal deformity.","authors":"Jay Kumar, Danielle Nieto, Lee A Tan","doi":"10.3171/2026.3.SPINE26138","DOIUrl":"10.3171/2026.3.SPINE26138","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"513-515"},"PeriodicalIF":3.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor. A critical appraisal of TMAP thresholds in XLIF.","authors":"YaoTian Zhang, Zejun Yang","doi":"10.3171/2026.4.SPINE26543","DOIUrl":"10.3171/2026.4.SPINE26543","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"697-698"},"PeriodicalIF":3.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471292","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":"Detection of bacteria in healthy spinal bone during pedicle screw placement: colonization versus evidence for future low-grade infection.","authors":"Vicki M Butenschoen, Julia Pohl, Maximilian Schwendner, Ann-Kathrin Joerger, Victoria Kehl, Nina Wantia, Bernhard Meyer, Sandro M Krieg","doi":"10.3171/2026.2.SPINE251668","DOIUrl":"10.3171/2026.2.SPINE251668","url":null,"abstract":"<p><strong>Objective: </strong>Symptomatic implant failure presents a burdensome complication for patients undergoing spinal instrumentation. The origin of screw loosening remains a question of debate; mechanical load, patient-related factors, and the hypothesis of low-grade infections with biofilm production can contribute to the need for revision surgery. Scientific evidence lacks a prospective investigation of contributing factors. Therefore, the aim of this study was to evaluate the causes of implant loosening, including microbiological analysis of the vertebral bone before instrumentation, using prospectively collected data.</p><p><strong>Methods: </strong>The authors prospectively enrolled patients undergoing spinal instrumentation for degenerative or trauma indications at their tertiary care center between April 2020 and January 2022. Bone meal obtained during the drilling process for pedicle screw placement was microbiologically analyzed for each pilot hole. Clinical prognostic risk factors, including comorbidities, surgical data, and postoperative complications, were assessed. Patients were screened for symptomatic screw loosening over a 2-year period following surgery.</p><p><strong>Results: </strong>In total, 867 pilot holes in 146 patients (79 female, median age 72.5 years) were analyzed. Bacterial presence was detected in 65.4% of the patients (significant amount in 7.3%, sporadic in 21.8%, in enrichment medium in 54.2%, and in a single probe in 20.7%). The most prevalent bacteria identified was Cutibacterium acnes (31.5%), followed by Staphylococcus epidermidis (23.3%), Staphylococcus hominis (14.4%), Staphylococcus capitis (8.2%, significantly more present in spinal revision cases 17.6% vs 3.6%), and Staphylococcus aureus (0.7%). After a 2-year follow-up period, screw loosening was detected in 12.3% of patients. Previous surgery at the same level, an open surgical approach, antiplatelet therapy, and previous steroid injection to the spine were identified as potential risk factors. The presence of Staphylococcus species was significantly associated with future screw loosening, while the presence of C. acnes had no prognostic value.</p><p><strong>Conclusions: </strong>In a large patient cohort, no significant association between C. acnes and screw loosening was found. Meanwhile, low-virulent Staphylococcus species, open surgery, previous surgery, antiplatelet therapy, or infiltration were associated with a higher rate of screw loosening. These findings emphasize the multifactorial nature of implant failure, with several contributing risk factors identified, including revision surgery and open approaches, particularly when combined.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"570-578"},"PeriodicalIF":3.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471208","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":"Different risk factors for early-onset adjacent segment disease at L3-4 and L5-S1 segments after isolated L4-5 lumbar fusion surgery: 2-year follow-up.","authors":"Toshiyuki Kitaori, Masato Ota, Jiro Tamura, Takahiko Saji, Masayuki Ishibashi, Takahiro Maeda, Yoshiyuki Asada","doi":"10.3171/2026.2.SPINE251490","DOIUrl":"10.3171/2026.2.SPINE251490","url":null,"abstract":"<p><strong>Objective: </strong>Posterior or transforaminal lumbar interbody fusion (PLIF/TLIF) has become the standard procedure for treating degenerative lumbar diseases. With the increasing number of surgeries, adjacent segment disease (ASD) is becoming widely known as a postoperative complication. However, the association between lumbosacral sagittal alignment and ASD following L4-5 isolated fusion surgery has not been fully elucidated. The aim of this study was to identify the preoperative radiological risk factors for L3-4 ASD and L5-S1 ASD independently after isolated L4-5 PLIF/TLIF.</p><p><strong>Methods: </strong>The authors retrospectively reviewed the data of 151 patients with degenerative lumbar diseases who underwent isolated L4-5 PLIF/TLIF at their institution between April 2013 and August 2022. L3-4 ASD and L5-S1 ASD were evaluated separately, and these groups were compared with the non-ASD group. Radiological ASD was defined as disc height (DH) loss (> 3 mm), posterior opening (> 5°) on flexion, or progression of slippage (> 3 mm) as observed on plane radiographs. Symptomatic ASD was defined as the presence of symptoms attributable to the adjacent segment that required revision surgery within 2 years. Preoperative lumbosacral parameters, including slippage at L4-5 (Meyerding grade), pelvic tilt, sacral slope, pelvic incidence (PI), lumbar lordosis (LL), PI-LL, L1 sagittal vertical axis (SVA), and L4 SVA, were measured using standing radiographs. Intraoperative distraction at the L4-5 DH, preoperative disc degeneration (Pfirrman grade), vacuum phenomenon, foraminal stenosis, and additional decompression at adjacent segments were also evaluated.</p><p><strong>Results: </strong>Of 151 unique patients, 31 (20.5%) had ASD, with 20 (13.2%) included in the L3-4 ASD group and 13 (8.6%) included in the L5-S1 ASD group (2 patients were included in both groups). Multivariate analysis revealed that additional L3-4 decompression and distraction at L4-5 DH were significantly associated with L3-4 ASD, whereas L1 SVA > L4 SVA (L1 plumb line anterior to the L4 plumb line) was associated with L5-S1 ASD. The risk of L5-S1 ASD increased by a factor of 4.13 (p = 0.004) in patients with sagittal imbalance, as indicated by L1 SVA > L4 SVA.</p><p><strong>Conclusions: </strong>These findings suggest distinct characteristics between L3-4 ASD and L5-S1 ASD. L3-4 ASD was not associated with lumbosacral sagittal imbalance. By contrast, an anterior shift of the lumbar loading axis, as indicated by L1 SVA > L4 SVA, was associated with the development of L5-S1 ASD. Preoperative L1 SVA > L4 SVA might serve as a convenient predictive parameter for L5-S1 ASD after isolated L4-5 fusion surgery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"374-381"},"PeriodicalIF":3.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421868","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. Selective decompression in beak-type thoracic OPLL: decision-making guided by intraoperative ultrasound.","authors":"Jay I Kumar, Danielle Nieto, Lee A Tan","doi":"10.3171/2026.3.SPINE26233","DOIUrl":"10.3171/2026.3.SPINE26233","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"492-494"},"PeriodicalIF":3.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421820","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":"Agreement and reliability analysis of sarcopenia measures based on muscle function, body composition, and imaging in spinal deformity patients.","authors":"Alexa Semonche, Ann A Lazar, Justin K Scheer, Anthony L Mikula, Thomas Wozny, Jaemin Kim, Terry H Nguyen, Vedat Deviren, Aaron J Clark, Christopher P Ames","doi":"10.3171/2026.2.SPINE251093","DOIUrl":"10.3171/2026.2.SPINE251093","url":null,"abstract":"<p><strong>Objective: </strong>There is no gold standard for assessing sarcopenia. The authors aimed to quantify agreement and reliability among common sarcopenia measures based on muscle function, body composition, and imaging characteristics in a cohort of adult spinal deformity (ASD) patients.</p><p><strong>Methods: </strong>This was a cross-sectional study. Preoperative ASD patients at a single tertiary-care center underwent the following sarcopenia assessments: 2 functional muscle assessments (grip strength and gait speed), 3 bioelectrical impedance (BIA) measures (skeletal muscle index [SMI], phase angle, and extracellular water [ECW]/total body water [TBW] ratio), and 2 imaging-based assessments (psoas muscle index [PMI] and total psoas area [TPA]/vertebral body area [VBA] ratio). Spearman's correlation analysis was used to test for associations. Measurements were standardized into sex-specific z-scores. Bland-Altman analysis was used to quantify agreement and Cronbach's alpha analysis was used to quantify reliability between sarcopenia measures.</p><p><strong>Results: </strong>Between 2017 and 2025, 272 ASD patients were enrolled in the study. Of these, 88 ASD patients (59.1% female, median age 67.7 years) completed all sarcopenia assessments and thus were included in the analysis. Most sarcopenia measures were weakly correlated, except for PMI and TPA/VBA, which were moderately correlated (ρ = 0.84, p < 0.001), and phase angle and ECW/TBW (ρ = -0.82, p < 0.001). Bland-Altman analysis demonstrated poor agreement between all pairs of sarcopenia measures. Cronbach's alpha analysis showed poor reliability (α < 0.7) between all pairs of sarcopenia measures except for PMI and TPA/VBA (α = 0.89). These results did not significantly change when all 272 patients with imputed missing data were included.</p><p><strong>Conclusions: </strong>The authors found low agreement and reliability between 7 commonly used sarcopenia measures, except for good reliability between PMI and TPA/VBA. These sarcopenia measures are not interchangeable and may not be measuring the same underlying clinical entity. This is the first study to quantify agreement and reliability between sarcopenia measures. Future studies are needed to determine which sarcopenia measures best predict clinical outcomes in ASD patients.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"482-489"},"PeriodicalIF":3.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421843","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}