Journal of neurosurgery. Spine最新文献

{"title":"An intraoperatively guided posterior decompression with fusion-first strategy for nonambulatory patients with beak-type thoracic ossification of the posterior longitudinal ligament.","authors":"Juncai Lei, Panpan Hu, Hua Zhou, Zhongjun Liu, Feng Wei, Xiaoguang Liu","doi":"10.3171/2026.2.SPINE251204","DOIUrl":"10.3171/2026.2.SPINE251204","url":null,"abstract":"<p><strong>Objective: </strong>Surgical management of nonambulatory patients with beak-type thoracic ossification of the posterior longitudinal ligament (T-OPLL) remains challenging, and the optimal extent of decompression is unexplored. This study aimed to evaluate neurological outcomes and perioperative characteristics of a selective posterior decompression with fusion (PDF)-first strategy, with circumferential decompression (CD) performed only when indirect decompression was deemed insufficient based on intraoperative assessment.</p><p><strong>Methods: </strong>Nonambulatory patients with beak-type T-OPLL who underwent thoracic spine surgery between September 2012 and July 2022 were retrospectively reviewed. All patients initially underwent PDF. Conversion to CD via a posterior approach was performed intraoperatively when persistent ventral spinal cord compression was identified based on dural sac refilling, spinal cord pulsation, and findings on intraoperative ultrasonography and neurophysiological monitoring. Neurological outcomes were assessed using the modified Japanese Orthopaedic Association (mJOA) score, recovery rate, ambulation status, and health-related quality of life (EQ-5D-5L score). Perioperative parameters and complications were recorded.</p><p><strong>Results: </strong>A total of 31 patients met the inclusion criteria, including 19 treated with PDF alone and 12 who required additional CD. At final follow-up, significant neurological improvement was observed in the overall cohort, with 93.6% of patients regaining ambulatory ability. Both groups demonstrated significant postoperative improvements in mJOA and EQ-5D-5L scores compared with baseline. Patients who underwent CD had significantly longer operative times and greater estimated blood loss. The incidence of cerebrospinal fluid leakage was high but was successfully managed without permanent neurological sequelae.</p><p><strong>Conclusions: </strong>In nonambulatory patients with beak-type T-OPLL, a selective PDF-first surgical strategy resulted in favorable neurological recovery in the majority of patients. CD served as an effective adjunct when intraoperative findings indicated inadequate indirect decompression. These findings support an individualized, intraoperatively guided approach rather than the routine use of CD in this high-risk population.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"495-503"},"PeriodicalIF":3.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421886","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":"Benchmarking risk prediction tools in spine surgery: a national registry analysis of albumin, frailty, and surgical calculators.","authors":"Michael Farid, Nicolai Blasdel, Justin Wang, Blake Perdikis, Sean O'Leary, Kwadwo Darko, Umaru Barrie, Hammad A Khan, Darryl Lau","doi":"10.3171/2026.2.SPINE251657","DOIUrl":"10.3171/2026.2.SPINE251657","url":null,"abstract":"<p><strong>Objective: </strong>Preoperative risk-stratification tools, including frailty, nutritional, and surgical risk metrics, are used to predict complications after spine surgery. The relative performance of these tools across complication types and surgical subgroups is not well characterized. This study aimed to compare the predictive performance of 5 risk metrics, American College of Surgeons Surgical Risk Calculator (ACS SRC), serum albumin, Risk Analysis Index (RAI), modified 5-item frailty index (mFI-5), and Geriatric Nutritional Risk Index (GNRI), for perioperative complications.</p><p><strong>Methods: </strong>The authors analyzed 362,145 adult spine surgery patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2017 to 2022. Adjusted odds ratios were estimated via multivariable logistic regression, controlling for age, sex, urgency, and procedure type (defined by Current Procedural Terminology [CPT] codes). Subgroup analyses were stratified by ICD-10 diagnosis category, including degenerative disease, tumor, trauma, infection, and spinal deformity. Discrimination for predicting complications was assessed using C-statistics and DeLong's test.</p><p><strong>Results: </strong>Across all endpoints, ACS SRC had the best predictive accuracy: mortality C-statistic (95% CI) 0.908 (0.900-0.916), Clavien-Dindo grade IV (CD-IV) 0.823 (0.816-0.830), and major complications 0.749 (0.745-0.752). Serum albumin, despite being a single laboratory value, ranked second with mortality C-statistic (95% CI) 0.820 (0.807-0.833), CD-IV 0.734, and major complications 0.682 and showed strong discrimination for infectious complications (e.g., sepsis, septic shock, surgical site infection, and urinary tract infection), as well as for hospital length of stay and nonhome discharge. Compared to frailty-based metrics, albumin showed significantly better predictive value (p < 0.001 for pairwise comparisons) and maintained its advantages across all subgroups, including high-risk groups such as infection, trauma, and tumor cases. RAI provided moderate mortality prediction (C-statistic 0.807) and was most effective for predicting cardiovascular events, while both GNRI (0.753) and mFI-5 (0.647) were less consistent and demonstrated weaker associations with adverse outcomes. Multivariable regression confirmed that lower preoperative albumin and higher ACS SRC predictions were robust, independent predictors of increased risk for major complications, CD-IV events, and mortality. These performance patterns remained stable across surgical indications and in subgroup analyses.</p><p><strong>Conclusions: </strong>ACS SRC remains among the comprehensive tools for risk stratification in spine surgery. Serum albumin offers strong, consistent predictive value, especially for infectious, respiratory, and life-threatening complications, and may be a valuable alternative when calculator inputs are incomplete.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"467-481"},"PeriodicalIF":3.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421822","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":"Can clinical scores substitute for objective walking capacity tests? A prospective study of subjective, functional, and radiographic correlates in lumbar spinal stenosis.","authors":"Wenyang Fu, Rongkun Xu, Yonghao Tian, Fangze Qi, Xing Chen, Shangye Li, Yuchen Zhang, Suomao Yuan, Xinyu Liu, Lianlei Wang","doi":"10.3171/2026.2.SPINE25887","DOIUrl":"10.3171/2026.2.SPINE25887","url":null,"abstract":"<p><strong>Objective: </strong>This prospective study aimed to determine the correlation between the objective 6-minute walk test (6MWT) and key patient-reported outcomes, clinician-reported outcomes, and radiographic parameters in patients with lumbar spinal stenosis (LSS) to evaluate whether clinical scores can substitute for objective walking capacity assessment.</p><p><strong>Methods: </strong>The 6MWT was conducted in strict accordance with established guidelines. Japanese Orthopaedic Association (JOA) scale scores were assessed by two experienced spine surgeons, while a visual analog scale for pain or numbness, the Oswestry Disability Index (ODI), the Back Disability Index (BDI), and the Swiss Spinal Stenosis (SSS) scores were collected in the form of questionnaires. Independent-samples t-tests, paired t-tests, Pearson's correlation analysis, and multiple regression analysis were applied for data analysis. To confirm the accuracy of the results of the multiple regression analysis, an additional 40 patients with LSS were included and assessed for model evaluation.</p><p><strong>Results: </strong>The postoperative 6-minute walking distance (6MWD) increased significantly (mean 209.68 [SD 146.33] vs 399.42 [SD 66.15] m, p < 0.001) but remained lower than that of the control group (mean 460.30 [SD 54.60] m, p = 0.006). The SSS-Physical Function (SSS-PF), ODI, and BDI scores were strongly correlated with the preoperative 6MWD (r > 0.7). Among these scores, the SSS-PF score had the strongest correlation with the preoperative 6MWD in patients with LSS (r = -0.836, p < 0.001). Postoperative SSS-PF scores also demonstrated an excellent correlation with the 6MWD (r = -0.807). The preoperative dural sac area was significantly larger in patients with a 6MWD ≥ 100 m (mean 67.49 [SD 19.76] mm2) than in patients with a 6MWD < 100 m (56.65 [SD 7.80] mm2; p = 0.010).</p><p><strong>Conclusions: </strong>Walking ability can be effectively assessed by the SSS-PF, ODI, BDI, and JOA scale scores. The SSS-PF scale demonstrated an excellent correlation with 6MWD and showed promise as the best patient-reported assessment tool for walking ability in LSS, particularly in clinical settings where objective testing is not feasible.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"554-562"},"PeriodicalIF":3.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421879","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. Interpreting matched outcome equivalence after spinal fracture surgery in ASD.","authors":"Dandan Jiang, Xiaoying Lin, Ting Wang","doi":"10.3171/2026.2.SPINE26230","DOIUrl":"10.3171/2026.2.SPINE26230","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"490-491"},"PeriodicalIF":3.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421891","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":"Is cervicothoracic ossification of the posterior longitudinal ligament a distinct clinicoradiological variant? A critical analysis of neurological recovery predictors.","authors":"Ajoy Prasad Shetty, Karthik Ramachandran, Praveen R Iyer, Deva Paramasivam, Rishi Mugesh Kanna, Shanmuganathan Rajasekaran","doi":"10.3171/2026.2.SPINE251529","DOIUrl":"10.3171/2026.2.SPINE251529","url":null,"abstract":"<p><strong>Objective: </strong>Ossification of the posterior longitudinal ligament (OPLL) extending to the cervicothoracic junction presents unique surgical challenges since it represents a transitional zone between the changes in the mobile lordotic cervical spine and a relatively stiff thoracic spine. The literature on cervicothoracic OPLL is limited, and it is unclear whether it differs from subaxial OPLL in terms of radiological characteristics and postoperative outcomes. In this study, the authors aimed to analyze clinicoradiological outcomes and factors predicting neurological recovery in patients who underwent surgery for symptomatic cervicothoracic OPLL.</p><p><strong>Methods: </strong>This retrospective study included patients with symptomatic cervicothoracic OPLL who underwent posterior instrumented laminectomy from April 2017 to April 2022 with a minimum follow-up of 2 years. Preoperative imaging included CT-based axial morphology classification (hill, mushroom, plateau), canal occupying ratio (COR), and MRI evaluation of cord signal changes. Clinical parameters, including the modified Japanese Orthopaedic Association score, Nurick grade, hand myelopathy signs, and bladder dysfunction, were recorded. The recovery rate (RR) was calculated using Hirabayashi's formula.</p><p><strong>Results: </strong>Of 53 patients, most were male (81.1%), with a mean age of 55.2 years at presentation. Nurick grade 5 was the most common grade observed, accounting for 34.0% of patients. Hand myelopathy signs were absent in 30.2% of patients. Overall, 28 patients experienced poor recovery (RR < 50%) and 25 had good recovery (RR ≥ 50%). Hill-type morphology was significantly linked to poor outcomes (p = 0.022), and the mean COR was higher in the poor recovery group (67.54 ± 9.74 vs 55.32 ± 11.94, p = 0.001). Univariate analysis identified ossification type, morphology, and COR as significant predictors of RR, while multivariate regression confirmed COR as the only independent predictor (p = 0.006, OR 1.097). Receiver operating characteristic curve analysis indicated that COR had good predictive accuracy (area under the curve 0.777), with a 65% cutoff, providing 68% specificity and 60.71% sensitivity.</p><p><strong>Conclusions: </strong>Cervicothoracic OPLL is a distinct clinicoradiological variant of OPLL, usually associated with severe myelopathy characterized by predominant lower limb symptoms. COR > 65% and axial morphology are key predictors of poor recovery, emphasizing the importance of detailed preoperative imaging and risk assessment.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"357-366"},"PeriodicalIF":3.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382205","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":"Multilevel stand-alone lateral lumbar interbody fusion: radiographic and clinical outcomes.","authors":"Katriel E Lee, S Harrison Farber, Alexander T M Cheung, Gennadiy A Katsevman, Nima Alan, James J Zhou, Robert K Dugan, Juan P Giraldo, Steve S Cho, Michael D White, Jonathan J Lee, Luke K O'Neill, Jay D Turner, Juan S Uribe","doi":"10.3171/2026.2.SPINE25811","DOIUrl":"10.3171/2026.2.SPINE25811","url":null,"abstract":"<p><strong>Objective: </strong>Stand-alone lateral lumbar interbody fusion (SA-LLIF) without posterior instrumentation is increasingly being performed for various spine pathologies. There are few studies regarding clinical and radiographic outcomes in patients who underwent multilevel SA-LLIF. In this study, the authors aimed to explore these outcomes.</p><p><strong>Methods: </strong>This is a retrospective review of patients who underwent multilevel SA-LLIF without posterior instrumentation between August 2017 and October 2021. Demographic information, comorbidities, and complications were collected. Clinical outcomes were measured using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Spinopelvic parameters, subsidence rates, and repeat operations were recorded.</p><p><strong>Results: </strong>Forty-three patients met the inclusion criteria. The mean age was 70.1 years, and 31 (72.1%) patients were male. The mean BMI was 28.2. Patients often had multiple indications for surgery, with 39 (90.7%), 28 (65.1%), and 9 (20.9%) patients undergoing surgery for adult spinal deformity, degenerative disc disease, and adjacent segment disease, respectively. The mean number of levels treated was 2.42 (range 2-4 levels, total 104 levels treated). The mean time to follow-up imaging was 2.01 years (range 30 days-4.95 years). There were significant differences in pre- and postoperative lumbar lordosis (LL) (+4.9°, p = 0.001), pelvic incidence-LL mismatch (-4.5°, p = 0.003), and segmental LL at treated levels (+4.0°, p = 0.002). Fifteen (35%) patients had coronal Cobb angles > 20° preoperatively; 11 (73%) showed improvement in Cobb angle postoperatively (mean change -5.4°, p = 0.02). Fifteen (35%) patients experienced grade 1 or higher subsidence at 23 of 104 (22%) levels. Five (12%) patients required repeat operations for failure of indirect decompression, progressive deformity, symptomatic subsidence, or a combination thereof. Three (7%) of these patients had symptomatic subsidence. Subsidence was more common in patients with polyetheretherketone implants (n = 13) versus titanium implants (n = 2) (p = 0.002). Significant improvements were seen in median (IQR) pre- and postoperative ODI (38 [28-48.5] vs 25 [17.5-38.5], p = 0.001), VAS back (7.0 [4.8-8.0] vs 3.5 [0.8-6.2], p = 0.002), and VAS leg (6.0 [2.5-8.0] vs 0.0 [0.0-4.2], p = 0.001) scores.</p><p><strong>Conclusions: </strong>In this small cohort, multilevel SA-LLIF was a safe and clinically effective surgical option for patients who required a shorter operative duration. Multilevel SA-LLIF had good clinical and radiographic outcomes but had a 7% reoperation rate for symptomatic subsidence. Further studies with longer clinical and radiographic follow-up are necessary to determine the durability of multilevel SA-LLIF.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"404-412"},"PeriodicalIF":3.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382202","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":"Oncological and neurological outcomes after parent rootlet resection in functionally critical spinal schwannomas: a retrospective multicenter comparative study.","authors":"Juan Carlos Galeano Zapata, Emanuele Maragno, Marco Gallus, Dorothee Spille, Felix C Stengel, Aziz Yarkin, Victor Rodrigo-Paradells, Vicki M Butenschoen, Vanessa Hubertus, Julia Sophie Onken, Emily von Bronewski, Matthias Demetz, Christian Freyschlag, Ralph T Schär, Thomas Petutschnigg, Maximilian Bschorer, Malte Mohme, Cesare Zoia, Mary Solou, Moritz Lenschow, Cyrus Latifi, Granit Molliqaj, Cristina Romero-López, Milan Lepić, Stanislav Kaprovoy, María L Gandia-Gonzalez, Jiri Bartek, Wilco Peul, Walter Stummer, Martin N Stienen, Michael Schwake","doi":"10.3171/2026.2.SPINE251487","DOIUrl":"10.3171/2026.2.SPINE251487","url":null,"abstract":"<p><strong>Objective: </strong>Resection of spinal schwannomas remains a clinical and technical challenge, particularly in cases involving functionally critical spinal segments where management of the parent nerve rootlet is critical. Although sacrificing the involved rootlet may enable gross-total resection (GTR), it carries a significant risk of postoperative neurological deficits. This study aimed to evaluate the extent of tumor resection and the incidence of new deficits associated with rootlet resection in the cervical and lumbosacral spine.</p><p><strong>Methods: </strong>In this European multicenter cohort study, the authors retrospectively analyzed patients diagnosed with spinal schwannomas located between segments C3-T1 (cervical) and L1-S2 (lumbosacral). Patients were stratified into 2 cohorts based on intraoperative management of the parent rootlet: rootlet resection versus rootlet preservation. Primary outcomes were GTR and the incidence of new neurological deficits.</p><p><strong>Results: </strong>Of the 232 spinal schwannomas in the database, 190 (81.9%) were classified as arising in functionally critical segments. The parent rootlet was resected in 94 cases (49.5%) and preserved in 96 (50.5%). The rate of GTR was significantly higher in the rootlet resection cohort (n = 88, 93.6%) than in the rootlet preservation cohort (n = 72, 75.0%; p = 0.008). The OR for incomplete resection in the rootlet resection group was 0.205 (95% CI 0.09-0.56, p < 0.001), with a number needed to treat of 5.4 (95% CI 3.5-12.1) to achieve 1 additional GTR. New neurological deficits occurred in 5 patients (5.3%) after rootlet resection and in 7 patients (7.3%) after preservation (p = 0.767). Perioperative parameters, complications, and functional recovery at 3 months were comparable between the groups, with both cohorts showing significant improvement over baseline. With a mean follow-up of 33.1 ± 28.2 months (± SD), the mean progression-free survival was 121.4 months in the GTR cohort and 89.1 months in the non-GTR cohort (p < 0.001).</p><p><strong>Conclusions: </strong>Parent rootlet resection was associated with higher rates of GTR without an increased risk of new postoperative deficits. These findings require confirmation in prospective studies.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"457-466"},"PeriodicalIF":3.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338809","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":"Does preoperative depression predict return to sport and exercise after degenerative spine surgery?","authors":"Advith Sarikonda, Harsh Jain, Alan R Tang, Iyan Younus, Ranbir Ahluwalia, Tyler Zeoli, Soren Jonzzon, Hani Chanbour, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman","doi":"10.3171/2026.1.SPINE251522","DOIUrl":"10.3171/2026.1.SPINE251522","url":null,"abstract":"<p><strong>Objective: </strong>Predicting postoperative return to sport (RTS)/return to exercise (RTE) is challenging, particularly given the unclear impact of preexisting mood conditions. In sport/exercise participants who underwent spine surgery, the authors sought to evaluate the relationship between preoperative depression and postoperative sport/exercise participation and establish a threshold depression score predictive of RTS/RTE.</p><p><strong>Methods: </strong>A retrospective cohort study (2011-2022) was conducted of sport/exercise participants who underwent degenerative spine surgery. Moderate/severe depression was defined as a score ≥ 10 on the Patient Health Questionnaire-9 (PHQ-9). Primary outcomes were 1) RTS/RTE (yes/no), time to return (months), frequency of participation (hours and days per week); and 2) optimal PHQ-9 score predicting RTS/RTE. Secondary outcomes were patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI) and Neck Disability Index (NDI). Multivariable regression controlled for age, sex, BMI, use of narcotics, surgical procedure, and preoperative PROM scores.</p><p><strong>Results: </strong>Of 737 patients surveyed on sports/exercise participation, 150 (20.4%) reported preoperative sport/exercise. The mean patient age was 56.3 ± 13.8 years, and the mean follow-up was 6.0 ± 2.1 years. Thirty-four (22.7%) patients had moderate/severe depression. Common sports/exercises were hiking (55.3%), weight lifting (46.0%), and running/jogging (40.7%). Of the 150 patients, 127 (84.7%; 64.7% depressed vs 90.5% nondepressed, p < 0.001) returned to sport/exercise within 8.9 ± 3.7 months (13.0 ± 19.3 vs 8.1 ± 12.2 months, p = 0.147) postoperatively. Compared with their presymptom baseline, depressed patients engaged in fewer days (2.5 ± 1.9 vs 4.2 ± 1.4 days, p = 0.011) and hours (5.1 ± 4.8 vs 10.1 ± 7.3 hours, p = 0.047) of sport/exercise weekly, compared with their presymptom baseline. Preoperative depression predicted longer time to RTS/RTE (HR 0.6, 95% CI 0.4-1.0; p = 0.043). A PHQ-9 score of 7.2 (AUC 0.71, p = 0.001) predicted failure to RTS/RTE. Preoperative depression predicted worse long-term ODI (β 15.0, 95% CI 4.2-25.8; p = 0.007) and NDI (β 17.3, 95% CI 0.94-33.7; p = 0.039) scores.</p><p><strong>Conclusions: </strong>Sport/exercise participants undergoing degenerative spine surgery with moderate/severe depression were less likely to return to sport/return to exercise, returned later, and failed to regain presymptom levels of participation. Even mild depression (PHQ-9 score 7-9) predicted failure to return to sport/return to exercise. To facilitate successful return to sport/return to exercise, surgeons should screen all patients for depression and consider referring those with even mild depression for preoperative psychiatric optimization.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"382-392"},"PeriodicalIF":3.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337721","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 elevated endotracheal tube cuff pressure in anterior cervical spine surgery.","authors":"Jonathan Goulazian, Akshaya Raman, Nana-Hawwa Abdul-Rahman, Kyle Affolter, Amila Niksic, Peter C Gerszten, Nitin Agarwal, D Kojo Hamilton, Carl Snyderman","doi":"10.3171/2026.2.SPINE251178","DOIUrl":"10.3171/2026.2.SPINE251178","url":null,"abstract":"<p><strong>Objective: </strong>Dysphonia resulting from injury to the recurrent laryngeal nerve (RLN) is a known risk of anterior cervical spine surgery (ACSS). While the main mechanism underlying this injury is unclear, high endotracheal tube (ETT) cuff pressures have been linked to postoperative dysphonia. This study was performed to assess intraoperative ETT cuff pressures and how patient and surgical variables influence them.</p><p><strong>Methods: </strong>A retrospective observational study was conducted using intraoperative cuff pressures collected from patients who underwent ACSS from January 2024 to March 2025 at a single institution. ETT cuff pressure was measured after intubation, manual adjustment, and, finally, placement of cervical retractors. Data for 3 months after surgery were collected via retrospective chart review. Additionally, 5 cadaveric specimens were obtained for experimentation. After intubation of a specimen, cuff pressure was set to 20-30 cm H2O and remeasured following cervical retraction.</p><p><strong>Results: </strong>Among the 39 patients included in the study, ETT cuff pressures at the start of surgery often exceeded safe levels, with a mean pressure of 72.6 ± 37.7 cm H2O (IQR 81). These elevated levels were significantly associated with obesity and female sex. Despite manual adjustment, ETT cuff pressures were again elevated following airway retraction, with a mean of 50.5 ± 19.9 cm H2O (IQR 31.5). Cuff pressures were also increased with caudal surgery and an advanced age. A cadaveric model demonstrated that caudal cervical approaches, as compared to rostral ones, yielded a significantly greater increase in ETT cuff pressure following retraction (p < 0.0001). The side of approach was not a significant determinant of pressure elevation at either cervical level of approach.</p><p><strong>Conclusions: </strong>Retraction of cervical tissues during ACSS significantly increases ETT cuff pressure to unsafe levels, increasing the risk of RLN injury. Frequent ETT cuff pressure monitoring and adjustment are necessary to reduce RLN exposure to elevated pressures and potentially reduce the risk of dysphonia after ACSS.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"367-373"},"PeriodicalIF":3.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338883","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":"Photodynamic diagnosis using 5-aminolevulinic acid in surgery for spinal cord astrocytic tumors: a propensity score-matched comparison with brain tumors.","authors":"Hideki Kashiwagi, Yoshiki Fujikawa, Masao Fukumura, Ryokichi Yagi, Ryo Hiramatsu, Masahiro Kameda, Naosuke Nonoguchi, Motomasa Furuse, Shinji Kawabata, Emi Yasuda, Toshihiro Takami, Masahiko Wanibuchi","doi":"10.3171/2026.1.SPINE251659","DOIUrl":"10.3171/2026.1.SPINE251659","url":null,"abstract":"<p><strong>Objective: </strong>Photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) has proven to be an effective method for visualizing the tumor during surgery. The purpose of this study was to verify the practicality of PDD in the surgery of astrocytic tumors of the spinal cord, with particular emphasis on comparison with astrocytic tumors of the brain.</p><p><strong>Methods: </strong>This retrospective study included the cases of astrocytic tumors of the spinal cord and brain that were treated with initial surgery at the authors' institution between April 2023 and March 2025. The PDD and pathological characteristics were compared between spinal cord and brain tumors. A propensity score-matched analysis was performed to reduce covariate bias between the cohorts.</p><p><strong>Results: </strong>There were 13 cases of astrocytic tumors in the spinal cord and 43 cases of those in the brain; 5-ALA-induced protoporphyrin IX (PpIX) fluorescence was observed considerably less frequently in spinal cord astrocytic tumors (15.4%) than in those in the brain (69.8%). Pathological analysis revealed a tendency for the malignant form to be more prevalent in the brain. A notable finding was that all 13 cases of spinal cord tumors were found to be the isocitrate dehydrogenase 1 (IDH1) wildtype. The propensity score-matched analysis suggested that the detection of PpIX fluorescence was found to be significantly less prevalent in the spinal cord.</p><p><strong>Conclusions: </strong>The findings of this study suggest that PDD may be less effective in the surgery of astrocytic tumors of the spinal cord compared with those of the brain. Verifying the molecular differences of astrocytic tumors between the spinal cord and brain in a large number of cases will be necessary in future studies.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"440-447"},"PeriodicalIF":3.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338836","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}