Journal of spine surgery最新文献

{"title":"Intraoperative three-dimensional imaging-guided vertebral body stenting for cleft-associated very severe osteoporotic vertebral compression fractures: a surgical technique case series.","authors":"Hiroki Eguchi, Yosuke Nakayama, Eitaro Okumura, Ryo Hashimoto, Motoo Kubota, Shigekuni Tachibana","doi":"10.21037/jss-2026-0124","DOIUrl":"10.21037/jss-2026-0124","url":null,"abstract":"<p><p>Very severe osteoporotic vertebral compression fractures (vsOVCF) associated with intravertebral clefts represent a technically challenging subgroup of vertebral augmentation because of severe vertebral collapse, distorted intravertebral anatomy, and increased risk of cement leakage. Conventional fluoroscopy alone may be insufficient for accurate device positioning in these cases. We describe the surgical technique and technical utility of intraoperative three-dimensional (3D) imaging during vertebral body stenting (VBS) in three consecutive patients with cleft-associated vsOVCF without neurological deficits. All patients demonstrated intravertebral clefts on preoperative imaging. The procedure was performed using a bilateral transpedicular approach under biplanar fluoroscopy with adjunctive intraoperative 3D rotational imaging. Intraoperative 3D imaging enabled confirmation of balloon and stent positioning within residual cancellous bone rather than within the cleft cavity. Vertebral height restoration ranged from 9% to 18%, and all patients experienced marked pain relief, with mean Numerical Rating Scale scores improving from 8.0 preoperatively to 1.0 postoperatively. Cement leakage into the adjacent disc occurred in two cases, although no spinal canal leakage or symptomatic complications were observed. Postoperative computed tomography at 3 and 6 months demonstrated maintained vertebral height without recollapse, osteonecrosis, or implant-related complications. Intraoperative 3D imaging may serve as a useful technical adjunct for safer and more controlled VBS in anatomically complex fractures.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"121"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does pre-operative psoas muscle cross-sectional area predict post-operative outcomes following lumbar spine fusion surgery?-a systematic review and narrative synthesis.","authors":"Dean T Biddau, Charlie R Faulks, Gregory M Malham, Prashanth J Rao, James McGree, Matthew Bellgard, Simon J Summers","doi":"10.21037/jss-2026-0087","DOIUrl":"10.21037/jss-2026-0087","url":null,"abstract":"<p><strong>Background: </strong>Low back pain remains a leading cause of disability globally, with surgical interventions commonly utilised as treatment. Rates of lumbar fusion surgery continue to rise, but poor outcomes remain common. Preoperative psoas muscle morphology has been proposed as a potential predictor of postoperative success. Evidence supporting a link between psoas morphology and outcomes post-fusion surgery is growing yet remains unclear. This systematic review and narrative synthesis aimed to evaluate whether pre-operative psoas muscle morphology predicts clinical and radiographic outcomes following lumbar fusion surgery.</p><p><strong>Methods: </strong>Five databases (MEDLINE, PubMed, CINAHL, Web of Science, and SportDiscus) were searched from inception to June 2025. Included studies assessed pre-operative psoas morphology [cross-sectional area (CSA), volume] and reported post-operative clinical (pain, disability, quality of life) or radiographic outcomes (fusion rates, alignment, complications). Risk of bias was assessed using Quality in Prognostic Studies (QUIPS), and certainty of evidence evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).</p><p><strong>Results: </strong>Sixteen retrospective cohort studies encompassing 2,250 patients were included. Overall, data indicates that psoas morphology is not a consistent predictor of outcomes following fusion procedures. A limited number of low-quality studies, however, suggest that the surgical approach may influence this relationship. Posterior fusion techniques showed some association where a larger psoas was linked to early improvements in pain and function, while lateral and anterior approaches demonstrated no relationship.</p><p><strong>Conclusions: </strong>Based on very low to low certainty evidence, routine pre-operative psoas assessment is not currently justified for predicting lumbar fusion outcomes. Higher-quality prospective studies are needed to clarify the prognostic value of psoas morphology in spine surgery.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"119"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considering biomechanical environment in the prevention and treatment of ACDF complications.","authors":"Javier Melchor Duart Clemente, María Luisa Gandía-González, Mario Taravilla-Loma, Víctor Rodríguez-Domínguez","doi":"10.21037/jss-2026-0141","DOIUrl":"10.21037/jss-2026-0141","url":null,"abstract":"","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"126"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of autograft <i>vs</i>. synthetic bone graft in spinal fusion: a systematic review and meta-analysis.","authors":"Ahmed Onayzan Alshammari, Saadeldin Ahmed Idris, Turki Alhumaidi Dhawi Alshammari, Refal Mohammed Algahtani, Hatim Salem Alanazi, Thayid Binyah Alshammari, Yousef Hulayyil Alanazi, Obaid Muslm Alrashedi, Rabah Abdulaziz Alshuhail","doi":"10.21037/jss-2026-0072","DOIUrl":"10.21037/jss-2026-0072","url":null,"abstract":"<p><strong>Background: </strong>Autografts are regarded as the gold standard for spinal fusion owing to their capability to promote bone formation. However, synthetic bone grafts are gaining popularity for their consistency and avoidance of donor site complications. This meta-analysis compares the treatment results of autografts and synthetic bone grafts in spinal fusion procedures and evaluates their clinical effectiveness.</p><p><strong>Methods: </strong>The study adhered to PRISMA guidelines and conducted a comprehensive literature search. It compared autografts and synthetic bone grafts in spinal fusion by employing a random-effects model for meta-analysis, assessing publication bias, and evaluating the certainty of evidence using Grading, Reporting, Assessment, Development, and Evaluation (GRADE) guidelines, along with methodological quality through the risk of bias-2.0 (RoB-2.0) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tools.</p><p><strong>Results: </strong>Following a thorough screening, nine studies fulfilled the inclusion criteria. In the subgroup analysis, the pooled effect size for the fusion rate between different types of synthetic bone graft [ceramics, i-Factor, demineralized bone matrix (DBM)] and compared with autograft was 1.24 odds ratio (OR) [95% confidence interval (CI): 0.77-2.02; P=0.38; I²=0%], success rate for ceramics, i-Factor, and bioactive glass was 1.78 OR (95% CI: 1.28-2.48; P=0.0006; I²=0%). The blood loss had an -0.88 standardized mean difference (SMD) (95% CI: -1.90 to 0.15; P=0.09; I²=87%). For reoperation, the effect size was 0.78 (95% CI: 0.37-1.68; P=0.53; I²=0%), and in the complications subgroup analysis (i-Factor, ceramic, bioactive glass), the pooled effect size was 0.82 (95% CI: 0.54-1.24; P=0.35; I²=0%). A funnel plot revealed publication bias, while most studies demonstrated minimal risk of bias. However, the certainty of evidence was low because of this bias and wide variance.</p><p><strong>Conclusions: </strong>Synthetic bone grafts can be a reliable alternative to autografts in spinal fusion, and the recommendation is weak due to low-certainty evidence. Meanwhile, further longitudinal studies are required to validate these findings.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"116"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does adult lumbar scoliosis affect spine T-score accuracy in osteoporosis diagnosis?-a cross-sectional study of adults aged 50 years and older.","authors":"Gabriel Liu, Seth Ian Sim, Bo Xiang Bryan Neo, Chan Yiong Huak, Wong Hee-Kit, Jun-Hao Tan","doi":"10.21037/jss-2026-0071","DOIUrl":"10.21037/jss-2026-0071","url":null,"abstract":"<p><strong>Background: </strong>Dual-energy X-ray absorptiometry (DEXA) is the gold standard for assessing bone mineral density (BMD) and diagnosing osteoporosis (T-score ≤-2.5). Lumbar spine T-scores are often used when hip measurements are unavailable or unreliable. However, degenerative spinal changes can artifactually elevate lumbar spine BMD, leading to discordance between spine and hip T-scores and potential misclassification of osteoporosis. The impact of adult degenerative scoliosis on this discordance remains poorly defined. This study evaluates the association between lumbar scoliosis and spine-hip T-score discordance in adults ≥50 years.</p><p><strong>Methods: </strong>A retrospective cross-sectional study included consecutive adults ≥50 years who underwent DEXA scans over a 4-year period at a university hospital. Patients with secondary causes of osteoporosis were excluded. Participants were grouped by presence or absence of scoliosis. Spine and hip T-scores were recorded and classified as no, minor, or major discordance. No discordance indicated no grade difference between sites. Minor discordance referred to a one-grade difference (normal <i>vs.</i> osteopenia or osteopenia <i>vs.</i> osteoporosis). Major discordance referred to a two-grade difference (normal <i>vs.</i> osteoporosis).</p><p><strong>Results: </strong>A total of 6,969 patients were included; 91.6% were female with a mean age of 60.6 years. Scoliosis was present in 637 patients (9.1%), with a mean Cobb angle of 17° (range, 10-66°). Spine T-scores classified more patients as normal (43.0% <i>vs.</i> 31.1%) and fewer as osteopenic (41.5% <i>vs.</i> 48.9%) or osteoporotic (15.5% <i>vs.</i> 19.1%) compared with hip T-scores. Patients with scoliosis were older (67 <i>vs.</i> 60 years, P<0.001) and more likely female (94% <i>vs.</i> 91%, P<0.001). Spine-hip discordance was more frequent in scoliosis patients, with minor discordance in 44.1% <i>vs.</i> 39.0% and major discordance in 5.0% <i>vs.</i> 2.8% of non-scoliosis patients.</p><p><strong>Conclusions: </strong>Lumbar scoliosis is associated with increased spine-hip T-score discordance, limiting the reliability of lumbar spine measurements in osteoporosis assessment. These effects are more pronounced in older adults and females. Clinicians should interpret spine T-scores cautiously in the presence of scoliosis and prioritise hip measurements when assessing bone health or planning interventions where bone quality is critical.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"114"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare intradural lumbar disc herniation at L1/2: a case report.","authors":"Lucia Ledererová, Peter Hudák, Dana Kuniaková, Ján Kozák, Milan Liška","doi":"10.21037/jss-2026-0106","DOIUrl":"10.21037/jss-2026-0106","url":null,"abstract":"<p><strong>Background: </strong>Intradural disc herniation (IDH) in the lumbar spine is an extremely rare condition, representing only a small percentage of all disc herniations. Despite advanced imaging techniques, IDH is often misdiagnosed as intradural tumor, disc herniation or migrated sequester. Definitive diagnosis is usually established intraoperatively and may be confirmed histologically. This case report describes an L1/2 IDH that was microsurgically removed with the assistance of intraoperative ultrasonography (IOUS) for localization of the lesion. The ventral dural tear, frequently occurring in IDH, was managed using a collagen pad, resulting in an uneventful postoperative course without evidence of cerebrospinal fluid (CSF) leak during follow-up.</p><p><strong>Case description: </strong>We present a 70-year-old female patient with acute back pain, radiating to inner thighs and paraparesis. Magnetic resonance imaging (MRI) showed intervertebral (IV) disc herniation in the L1/2 segment. Subsequent microdiscectomy assisted by IOUS revealed intradurally migrated fragments, which were carefully removed. The ventral dural tear was identified and treated using an absorbable collagen pad. At both 7-week and 18-month follow-up, the patient remained pain-free and showed no new neurological deficits or signs of CSF leakage.</p><p><strong>Conclusions: </strong>Lumbar IDH remains a rare diagnostic challenge, as preoperative imaging is often inconclusive. This case suggests that intraoperative ultrasound may aid localization of intradural pathology, while collagen-pad repair may provide a useful option for managing ventral dural defects when primary closure is technically challenging, although further research is necessary.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"124"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of incidental thoracic spinal stenosis on outcomes following lumbar fusion: propensity score-matched cohort study.","authors":"Jeremy Tze En Lim, Ashton Kai Shun Tan, Shi Ting Chiu, Christian Hwee Yee Heng, Yee Gen Lim, Marcus Zhixing Ling, Reuben Chee Cheong Soh, Lei Jiang","doi":"10.21037/jss-2026-0111","DOIUrl":"10.21037/jss-2026-0111","url":null,"abstract":"<p><strong>Background: </strong>Incidental thoracic spinal stenosis (TSS) is increasingly identified on whole-spine imaging, but its clinical significance in patients undergoing lumbar fusion remains unclear. This study aimed to evaluate whether incidental radiologic TSS is associated with postoperative outcomes following lumbar fusion.</p><p><strong>Methods: </strong>A retrospective propensity score-matched cohort study was conducted using a prospectively maintained registry [2010-2023] at a single tertiary centre. Patients with incidental radiologic TSS were matched 1:4 to controls without TSS based on age, sex, body mass index, and number of fused levels. Outcomes included Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), North American Spine Society (NASS), and 36-Item Short Form Health Survey (SF-36) at baseline, 6 months, and 2 years.</p><p><strong>Results: </strong>Both groups demonstrated meaningful improvements in pain, disability, and quality-of-life outcomes at 6 months and 2 years. No significant between-group differences were observed in pain, disability, or quality-of-life outcomes at 6 months or 2 years (all P>0.05). During follow-up, 9/27 patients (33.3%) with TSS required thoracic surgery, whereas none in the control group did.</p><p><strong>Conclusions: </strong>In this propensity score-matched cohort, no statistically significant differences in lumbar fusion outcomes were detected between patients with and without incidental radiologic TSS at 6 months or 2 years. However, the subsequent thoracic surgery rate of 33.3% suggests that incidental TSS should not be considered clinically benign and may warrant ongoing surveillance for neurological progression.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"113"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of paraspinal muscle quantity and quality with patient-reported outcomes in patients aged ≥85 years undergoing lumbar spine surgery: an exploratory retrospective study.","authors":"Shutaro Yamada, Sadaaki Kanayama, Tsuyoshi Kono, Shota Takenaka","doi":"10.21037/jss-2026-0112","DOIUrl":"10.21037/jss-2026-0112","url":null,"abstract":"<p><strong>Background: </strong>Population aging has driven an increase in lumbar spine surgery among the super-elderly. The associations of preoperative paraspinal muscle quantity and quality with patient-reported outcomes in patients aged ≥85 years undergoing lumbar spine surgery remain unclear. We therefore examined these associations at baseline and 1 year after surgery.</p><p><strong>Methods: </strong>This is a retrospective observational study. Forty-three patients aged ≥85 years undergoing surgery for degenerative lumbar disorders were studied. Preoperative L3 muscle quantity [paraspinal muscle index (PMI)] and quality [computed tomography (CT) attenuation (Hounsfield units, HU); magnetic resonance imaging (MRI)-based Goutallier grading] were assessed. Patient-reported outcome measures (PROMs) were collected preoperatively and at 1 year. Associations at baseline, 1 year, and change from baseline (Δ) were examined using Spearman correlations. Multivariable linear and baseline-adjusted Firth logistic regression assessed the preoperative Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) low back pain score and treatment effectiveness, respectively. An exploratory receiver operating characteristic (ROC) analysis evaluated HU to identify low preoperative JOABPEQ low back pain scores (≤29).</p><p><strong>Results: </strong>PMI showed no statistically detectable association with any PROM in this sample. In separate exploratory multivariable models, HU and Goutallier grade showed nominal associations with the preoperative JOABPEQ low back pain score, whereas no statistically detectable association was observed for PMI; no muscle measure showed a statistically detectable association with treatment effectiveness after baseline adjustment. HU correlated positively with preoperative JOABPEQ low back pain (ρ=0.379, P=0.02), whereas Goutallier grade correlated inversely with the same PROM (ρ=-0.374, P=0.02) and with preoperative 8-Item Short Form Health Survey physical component summary (SF-8 PCS) (ρ=-0.307, P=0.048). In exploratory ROC analysis, HU showed fair discrimination for low JOABPEQ low back pain scores [area under the curve (AUC) =0.740, 95% confidence interval (CI): 0.586-0.893]; the data-derived cutoff of 33.7 HU requires external validation and is not ready for clinical application.</p><p><strong>Conclusions: </strong>In this small, single-center exploratory study, HU and Goutallier grade showed nominal associations with baseline pain-related disability, whereas PMI showed no statistically detectable association. No muscle measure showed a statistically detectable association with treatment effectiveness after baseline adjustment. Given limited power, no multiplicity adjustment, and potential selection bias, these findings require validation and should not guide preoperative decision-making.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"117"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depth-adapted portal design for unilateral biportal endoscopic discectomy in a morbidly obese patient (BMI 41): technical considerations.","authors":"Shinya Arataki, Akiyoshi Miyamoto, Tadashi Komatsubara, Masato Tanaka","doi":"10.21037/jss-2026-0126","DOIUrl":"10.21037/jss-2026-0126","url":null,"abstract":"<p><p>Morbid obesity increases operative depth and soft-tissue thickness in lumbar spine surgery, potentially complicating portal placement and working-corridor stability in unilateral biportal endoscopic (UBE) procedures. Although previous studies have reported acceptable clinical outcomes of UBE in obese patients, technical considerations for depth-adapted portal design and working corridor management at extreme operative depths have not been sufficiently described. A male patient in his late 20s, with a height of 183 cm and body weight of 137 kg (body mass index 41 kg/m2), presented with a large left L5/S1 lumbar disc herniation. Preoperative imaging suggested a deep operative corridor, with the relevant working depth ranging approximately from 80 to 100 mm depending on the laminar working area and the oblique trajectory toward the L5/S1 disc space. Because the skin contours were incompletely visualized on preoperative computed tomography (CT) due to the patient's body habitus, intraoperative O-arm navigation was used as an adjunctive tool to confirm and refine the planned portal trajectories. Two 10-mm longitudinal skin incisions were created approximately 23 mm lateral to the midline, with an interportal distance of 35 mm. Adequate fascial release wider than the skin incisions was performed to reduce soft-tissue constraint at the fascial level. UBE discectomy was completed without dural injury or technical restriction, using standard UBE instruments. Postoperatively, radicular symptoms improved promptly without neurological deficits. This case illustrates depth-dependent amplification of soft-tissue constraints in UBE. As operative depth increases, small restrictions at the fascial level may proportionally narrow the functional working corridor. Adequate fascial release and thoughtful portal spacing may help preserve triangulation and facilitate irrigation outflow in deep operative fields. Rather than proposing a fixed portal template or requiring navigation, this report emphasizes individualized, depth-aware portal planning. Navigation may be useful in selected extreme cases when surface anatomy is difficult to evaluate reliably, but the same planning principles may also be applied using fluoroscopy and careful preoperative CT/MRI assessment. In morbidly obese patients with substantial operative depth, depth-aware portal planning combined with tailored fascial management may improve the reproducibility and technical stability of UBE discectomy. These findings should be interpreted as technical observations from a single case.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"122"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of 3D-printed titanium cages for surgical reconstruction in infectious spondylodiscitis: a systematic review.","authors":"Wentian Li, Akina Li, Gayani Petersingham, Prashanth J Rao","doi":"10.21037/jss-2026-1-0017","DOIUrl":"10.21037/jss-2026-1-0017","url":null,"abstract":"<p><strong>Background: </strong>Infectious spondylodiscitis remains a complex spinal condition that may require surgical debridement and interbody reconstruction in cases of instability, deformity, or failure of medical management. Conventional reconstructive options include titanium mesh cages (TMC) and polyetheretherketone (PEEK) cages; however, three-dimensional printed titanium (3DPT) cages have been increasingly adopted due to their porous architecture and potential to enhance osseointegration. The clinical performance of 3DPT cages in the setting of spinal infection has not been well defined. This study aimed to qualitatively summarise the currently available direct and contextual evidence regarding the use of 3DPT cages for spinal reconstruction in infectious spondylodiscitis.</p><p><strong>Methods: </strong>A systematic literature search of EMBASE, MEDLINE, and Cochrane Library was conducted up to December 2025. Studies reporting outcomes following spinal reconstruction using 3DPT cages in adult patients with infectious spondylodiscitis were included. Surgical parameters, radiological outcomes (including fusion and subsidence), and clinical outcomes were extracted and synthesised qualitatively due to heterogeneity in study design and outcome reporting.</p><p><strong>Results: </strong>A total of seven studies were included in this review. Among these, only one study directly evaluated 3DPT cages specifically in infectious spondylodiscitis, while the remaining studies provided indirect or contextual evidence from mixed-pathology or degenerative spinal cohorts. Overall, the available evidence remains highly limited and heterogeneous, with substantial variability in study design, outcome reporting, and follow-up duration.</p><p><strong>Conclusions: </strong>Only limited direct evidence is currently available regarding the use of 3DPT cages in infectious spondylodiscitis. While early reports suggest that these implants may be feasible for spinal reconstruction, the current evidence base is highly limited, indirect, and heterogeneous, preventing definitive conclusions regarding clinical effectiveness or superiority over conventional interbody devices. Therefore, these findings should be interpreted as hypothesis-generating rather than practice-changing. Future well-designed prospective and comparative studies with standardised outcome measures are required to better define their role and enable meaningful meta-analysis.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"118"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}