Journal of spine surgery最新文献

{"title":"Should venous thromboembolism chemoprophylaxis be utilized following spinal fusions?-a systematic review and literature-based decision analysis.","authors":"Sofia A Perez, Owen W Dean, Jackson G Pophal, Jack T Eichman, Emmanuel Fatodu, Ilyas Syed Aleem","doi":"10.21037/jss-2026-0125","DOIUrl":"10.21037/jss-2026-0125","url":null,"abstract":"<p><strong>Background: </strong>Venous thromboembolism (VTE) is a potentially life-threatening complication of spinal fusion. The balance of benefits and harms associated with chemoprophylaxis (CPX) remains uncertain in traditional studies. This study aimed to consolidate the available evidence and develop an exploratory model to quantify these competing outcomes.</p><p><strong>Methods: </strong>A thorough literature search was conducted across multiple databases, with study selection criteria including outcomes of interest for model parameters. Abstracts and full texts were screened independently by five reviewers, with data extracted to derive event probabilities and health utility values. Probabilities of outcomes included occurrence of post-operative VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), and epidural hematoma. Utility assignments were derived from the literature with senior author review to ensure alignment.</p><p><strong>Results: </strong>A total of six studies with 2,023 patients were included in the final analysis. A clinical decision tree was generated using weighted averages of each outcome's probability and their corresponding utility values. We integrated branch-specific probabilities and utilities from the terminal nodes through each chance and decision node in a rollback analysis to calculate the overall expected utility for each strategy. The base-case analysis demonstrated that VTE CPX (n=1,049) yielded an expected utility of 0.79 compared to 0.88 for no VTE CPX (n=974). This pattern persisted across tested probability ranges (0.78-0.79 <i>vs.</i> 0.85-0.94) and tested utility ranges for 'epidural hematoma' and 'VTE without epidural hematoma' (0.78-0.79 <i>vs.</i> 0.87-0.89). However, varying the utility of 'no epidural hematoma and no VTE' produced overlapping ranges (0.40-0.97 <i>vs.</i> 0.45-0.97) and changed the preferred strategy at 0.8 and 0.9 utility values, respectively.</p><p><strong>Conclusions: </strong>Based on heterogeneous outcome and health-utility estimates from the available literature, our exploratory decision-tree analysis found limited evidence of incremental benefit from VTE CPX after spinal fusion. This finding is sensitive to the model assumptions and should not be interpreted as definitive guidance for clinical practice.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 9","pages":"146"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039536","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":"Revision surgical technique for laterally placed MinuteMan^® interspinous devices using a novel VertiFix^® removal system through a spinous process-preserving midline approach with InSpan fusion.","authors":"Sandra Thompson, Vito Lore, Erik Spayde, Taylor Headley, Jordan Acosta, Hope Estevez, Sukanya Chebrolu, Jason A Seale, Kingsley R Chin","doi":"10.21037/jss-2026-0148","DOIUrl":"10.21037/jss-2026-0148","url":null,"abstract":"<p><p>The MinuteMan^® interspinous fixation device (IFD) is a titanium implant designed for percutaneous lateral placement to provide interspinous distraction and stabilization in the treatment of lumbar spinal stenosis and interspinous fusion when combined with bone graft. With increasing use by interventional pain management physicians, standardized techniques for revision of failed lateral interspinous implants are needed. Revision is technically challenging due to dense scar tissue formation and limited access to the implant, particularly when preservation of the spinous processes is required to allow reinstrumentation. To our knowledge, there are no prior reports describing removal of a laterally placed IFD with revision using a midline interlaminar IFD. We describe a spinous process-preserving open midline surgical technique using the VertiFix^® interspinous removal system for removal of a laterally placed IFD, followed by reinstrumentation with a midline interlaminar IFD (InSpan^®) to facilitate interspinous fusion. The technique involves circumferential scar tissue release, controlled implant removal, decompression, and revision implant placement. Patients demonstrated 60% and 70% reductions in pain at three months. Revision was associated with implant size increases from 8 to 14 mm and 16 mm, with restoration of interspinous height. Postoperative imaging confirmed stable implant positioning without complications. This two-case technical report describes a feasible posterior midline revision approach for selected failed laterally placed IFDs. The technique may allow controlled implant removal and interspinous reinstrumentation when the posterior elements remain suitable; however, larger studies with longer follow-up and radiographic fusion assessment are needed to evaluate reproducibility, fusion, durability, and long-term clinical outcomes.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 9","pages":"149"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039455","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":"ABM/P-15-enhanced bone graft in oncologic cervical spine reconstruction: two case reports and narrative discussion.","authors":"Henrique Ribeiro Rodrigues Neto, Federico Cardahi, Kaveh Mozafari-Lorestani, William Kubik, Julien Montreuil, Anthony Bozzo, Ahmed Aoude","doi":"10.21037/jss-2026-0119","DOIUrl":"10.21037/jss-2026-0119","url":null,"abstract":"<p><strong>Background: </strong>Bone consolidation in musculoskeletal oncology is challenging after pathological fracture, radiotherapy, repeated surgery, extensive reconstruction, or compromised vascularity. Successful healing also requires segmental mechanical stability. Anorganic bone mineral/P-15 (ABM/P-15) bone grafts provide an osteoconductive mineral scaffold with a synthetic collagen-mimetic peptide surface, but their use in oncologic cervical spine reconstruction remains sparsely described.</p><p><strong>Case description: </strong>At the McGill University Health Centre, a tertiary referral center, we report two complex cervical oncologic reconstructions in which ABM/P-15 was used as one component of multicomponent fusion constructs. A young adult male with metastatic solitary fibrous tumor, prior radiotherapy, upper cervical nonunion, and pathologic fracture underwent revision occiput-to-T2 fusion with local autograft and ABM/P-15. A young adult female with recurrent cervical chordoma after prior resection and proton-beam radiotherapy underwent combined anterior and posterior tumor resection, instrumentation, and fibular graft reconstruction augmented with ABM/P-15. In both cases, rigid reconstruction plus adjunctive grafting was followed by CT and radiographic evidence of bridging bone or host-graft incorporation without implant loosening or pseudoarthrosis at approximately 12 months. Standardized Visual Analog Scale (VAS)/Numeric Rating Scale (NRS) and Neck Disability Index (NDI) scores were not collected.</p><p><strong>Conclusions: </strong>These two cases document radiographic fusion after complex oncologic cervical reconstructions in which ABM/P-15 was used as an adjunct. The perceived rationale was to provide an osteoconductive, collagen-mimetic surface in compromised host biology, but these cases do not establish that ABM/P-15 independently caused fusion or improved oncologic safety. The findings should be interpreted as descriptive and hypothesis-generating.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 9","pages":"152"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039510","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":"Single-position lateral anterior lumbar interbody fusion: anatomic considerations, workflow optimization, and technical nuances.","authors":"Timour Al-Khindi, Jawad Khalifeh, Liam P Hughes, Louis Chang","doi":"10.21037/jss-2026-0139","DOIUrl":"10.21037/jss-2026-0139","url":null,"abstract":"<p><p>In recent years, the single-position combined anterior-posterior approach has emerged as an increasingly utilized technique in lumbar fusion surgery. The approach combining posterior pedicle screw fixation with anterior lumbar interbody fusion (ALIF) performed in the lateral decubitus position is referred to as the lateral ALIF. Compared to traditional approaches that involve flipping the patient mid-surgery or staging the surgery at multiple time points, single-position lateral ALIF has been associated with shorter operative times, reduced estimated blood loss (EBL), shorter hospital length of stay, and lower rates of postoperative ileus, while maintaining comparable rates of fusion, complications, and reoperation. The lateral position also facilitates access to the retroperitoneal space through gravitational displacement of the abdominal contents and can permit simultaneous anterior and posterior surgical exposure. However, safe and effective execution of this approach requires familiarity with the unique anatomic, vascular, and workflow considerations associated with lateral positioning. The purpose of this review is to describe the technical details of single-position lateral ALIF surgery, focusing on surgical anatomy, indications and patient selection, surgical technique, workflow optimization, integration of navigation technologies, and perioperative, radiographic, and clinical outcomes. Preoperative assessment of spinopelvic alignment, vascular anatomy, psoas morphology, and prior abdominal surgery is essential. Intraoperatively, coordinated positioning, simultaneous anterior and posterior exposure, and integration of fluoroscopy, navigation, or robotic assistance can facilitate efficient and accurate placement of instrumentation. Current evidence suggests that single-position lateral ALIF provides comparable radiographic and clinical outcomes to traditional dual-position approaches; however, existing studies are predominantly retrospective and heterogeneous, and long-term clinical outcomes remain incompletely characterized. This review provides a practical framework for surgeons seeking to incorporate single-position lateral ALIF into their practice.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 9","pages":"148"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039539","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":"Medial-caudal first access strategy for safe disc-side corridor creation in unilateral biportal endoscopic surgery for lateral lumbar disc herniation.","authors":"Shinya Arataki, Akiyoshi Miyamoto, Tadashi Komatsubara, Masato Tanaka","doi":"10.21037/jss-2026-0173","DOIUrl":"10.21037/jss-2026-0173","url":null,"abstract":"<p><p>Lateral lumbar disc herniation presents a technical challenge because the herniated fragment may elevate the exiting nerve root and dorsal root ganglion within the narrow foraminal-extraforaminal corridor. During unilateral biportal endoscopy (UBE), limited depth perception in the early stages of decompression may increase the risk of premature neural contact and postoperative dysesthesia. We developed a medial-caudal first access strategy supported by O-arm navigation to establish a safe disc-side working corridor before direct neural exposure. Four patients with symptomatic lateral lumbar disc herniation underwent decompression using an anatomy-based strategy. Preoperative computed tomography/magnetic resonance imaging fusion imaging was used to identify a reproducible medial-caudal disc-side corridor according to the anatomical relationship between the disc fragment, pedicle, facet complex, iliac crest, and exiting nerve root. Portal placement was planned to reproduce this corridor, and O-arm navigation was used as an adjunct to facilitate the reproduction of the planned trajectory and portal geometry during surgery. The planned medial-caudal corridor was successfully reproduced in all four patients. Sufficient disc-side working space was established before direct exposure of the exiting nerve root, allowing gradual cranial and lateral decompression under continuous endoscopic observation. Adequate decompression was achieved without neurological complications, postoperative dysesthesia, or conversion to open surgery. Postoperative imaging confirmed sufficient decompression with limited medial bone removal. The proposed strategy may provide a practical and reproducible workflow for UBE treatment of lateral lumbar disc herniation. By prioritizing the creation of a limited disc-side working corridor before neural exposure, this technique may improve early depth control, reduce unnecessary neural manipulation, and preserve the surrounding bony structures. O-arm navigation serves as an adjunct to reproduce the preplanned surgical corridor, rather than as the primary objective of the procedure.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 9","pages":"150"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039528","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":"Continuous local antibiotic perfusion for spinal infection: a systematic review of reported cases.","authors":"Fumihiro Inoue, Hirohito Hirata, Norio Yamamoto, Tatsuhiko Nanri, Ryota Kimura, Tadatsugu Morimoto","doi":"10.21037/jss-2026-0156","DOIUrl":"10.21037/jss-2026-0156","url":null,"abstract":"<p><strong>Background: </strong>Spinal infections are difficult to cure, especially when implants are present, because implant removal can destabilize the spine. Continuous local antibiotic perfusion (CLAP) delivers high-concentration antibiotic directly to the infected site. We systematically reviewed and descriptively synthesized the reported cases of CLAP for spinal infection.</p><p><strong>Methods: </strong>MEDLINE, Embase, CENTRAL, International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov were searched from inception through October 1, 2025. Case reports and case series using CLAP for spinal infection were included. The primary outcome was the reoperation- and mortality-free proportion after CLAP, a pragmatic composite surrogate that does not equate to microbiological or clinical cure. Secondary outcomes included time to reported clinical stabilization, recurrence, high-concentration-antibiotic toxicity (renal and hepatic dysfunction), device-related events, and reoperation.</p><p><strong>Results: </strong>Nine studies with 48 patients were included, and most had a surgical site infection (SSI) with instrumentation. A reoperation- and mortality-free course was recorded in 36 patients (75.0%). However, the mean follow-up was only 7.5±4.3 months, and this surrogate may misclassify unresolved or non-operatively managed infection, or patients lost to follow-up, as successes; the estimate should be interpreted with caution. Complete implant retention was reported in 51.1% of patients, while 35.6% required removal. CLAP was given for a mean of 16.1±9.3 days, and reoperation after CLAP occurred in 25.0%. No treatment-related toxicity or device-related problems were reported.</p><p><strong>Conclusions: </strong>Across the reported cases, CLAP was used as one component of multimodal management-with systemic antibiotics, surgical source control, and, in nearly all cases, negative-pressure wound therapy (NPWT)-rather than as a stand-alone therapy. Because the evidence is uncontrolled and dominated by a single cohort, this review can describe how CLAP has been applied and what outcomes were reported, but cannot establish its independent effectiveness or safety; controlled prospective studies are needed. The protocol was registered on the Open Science Framework (OSF; https://osf.io/rk4g6/).</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 9","pages":"147"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039503","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":"Occipital plate-assisted posterior reduction for tumor-related severe atlantoaxial dislocation: a single-case surgical technique.","authors":"Guojun Li, Juncai Lei, Yanchao Tang, Zhongjun Liu, Rongjin Feng, Feng Wei, Hua Zhou","doi":"10.21037/jss-2026-0162","DOIUrl":"10.21037/jss-2026-0162","url":null,"abstract":"<p><p>Tumor-related severe atlantoaxial dislocation is rare but may rapidly endanger the cervicomedullary junction when axis destruction, pathological fracture, and craniovertebral instability coexist. This single-case technical note describes a posterior-only occipital plate-assisted reduction technique for a selected patient with severe but reducible tumor-related atlantoaxial dislocation in whom the atlas and axis could not be used as reliable reduction anchors. Conventional reduction strategies for congenital, inflammatory, traumatic, or degenerative atlantoaxial dislocation commonly depend on traction, atlantoaxial joint release, direct C1-C2 manipulation, or C1/C2 screw-based reduction. These maneuvers may be unsafe when the atlas has translated anteriorly beyond the axis body or when osteolysis structurally compromises the axis. The operative principle is to use the occipital plate as an active proximal reduction handle and the subaxial cervical spine as a reliable distal fixation base. After neutral Mayfield positioning, posterior exposure, decompression when indicated, and distal cervical screw placement, a precontoured rod is locked to the distal anchors. The occipital plate is connected to the proximal rod while maintaining a deliberate plate-to-skull step-off. The plate is then compressed to the occipital surface and fixed with occipital screws; release of compression allows the skull-occiput complex to settle into the rod-defined alignment, indirectly reducing the atlantoaxial dislocation without lifting the tumor-involved C1-C2 segment. The illustrative case demonstrates immediate radiographic correction and decompression through a single posterior approach, with quantitative radiographic and clinical outcomes reported in tabular form. As the evidence is limited to one patient, the technique should be considered hypothesis-generating and requires larger clinical series and biomechanical validation before broader adoption.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 9","pages":"151"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039541","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":"Comparison of recurrence and postoperative outcomes after endoscopic versus microsurgical sequestrectomy for lumbar disc herniation: 5-year experience.","authors":"Iván N Camal Ruggieri, Daniel Staribacher, Guenther C Feigl, Dzmitry Kuzmin","doi":"10.21037/jss-2026-0147","DOIUrl":"10.21037/jss-2026-0147","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Endoscopic spinal surgery has expanded beyond standard lumbar procedures to include increasingly complex interventions. Nevertheless, limitations remain, particularly regarding recurrence after lumbar disc surgery. While percutaneous endoscopic and open microsurgical techniques are widely performed, evidence comparing recurrence rates and influencing factors between both approaches remains limited and controversial. This study aimed to compare recurrence rates, perioperative outcomes, and factors associated with recurrence between percutaneous endoscopic sequestrectomy (PES) and open microsurgical sequestrectomy (OMS) in patients undergoing surgery for lumbar disc herniation at follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was performed of 187 consecutive patients treated for lumbar disc herniation (LDH) between September 2019 and November 2022 (PES: n=47; OMS: n=140). OMS was performed via laminotomy or hemilaminectomy; PES was performed via transforaminal percutaneous endoscopic sequestrectomy (TPES) or interlaminar percutaneous endoscopic sequestrectomy (IPES) access according to case-specific considerations. Recurrence was defined as a new ipsilateral LDH at the same level after initial postoperative relief; all recurrences requiring surgery were classified as recurrence requiring reoperation (RrR). Baseline clinical variables, operative time, intraoperative events, length of stay, complications, and recurrence-related reoperations were collected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients in the PES group were younger [47.15±14.12 &lt;i&gt;vs.&lt;/i&gt; 53.03±14.31 years; mean difference (MD) -5.88, 95% confidence interval (CI): -10.63 to -1.13; P=0.02] and more often had symptom duration &lt;3 months [95.7% &lt;i&gt;vs.&lt;/i&gt; 80.7%; risk difference (RD) 15.0%, 95% CI: -0.6 to 25.4; P=0.01]. Postoperative symptom reduction was high in both groups but slightly lower after PES (93.6% &lt;i&gt;vs.&lt;/i&gt; 99.3%; RD -5.7%, 95% CI: -17.0 to 1.7; P=0.050). Operative time was significantly shorter in PES (84.74±37.16 &lt;i&gt;vs.&lt;/i&gt; 122.89±41.39 minutes; MD -38.15, 95% CI: -50.97 to -25.33; P&lt;0.001), whereas length of stay was comparable (4.34±1.88 &lt;i&gt;vs.&lt;/i&gt; 4.65±2.02 days; MD -0.31, 95% CI: -0.95 to 0.33; P=0.34). Overall complication rates did not differ significantly (21.3% &lt;i&gt;vs.&lt;/i&gt; 12.1%; RD 9.1%, 95% CI: -6.6 to 27.2; P=0.15). Recurrence rates were numerically higher after PES (12.8% &lt;i&gt;vs.&lt;/i&gt; 7.1%; RD 5.6%, 95% CI: -6.7 to 21.2; P=0.24), and all RrR. Neuropathic pain was more frequent after PES (8.5% &lt;i&gt;vs.&lt;/i&gt; 1.4%; RD 7.1%, 95% CI: -1.7 to 19.5; P=0.04). Kaplan-Meier analysis showed no significant difference in recurrence-free survival between PES and OMS (log-rank χ&lt;sup&gt;2&lt;/sup&gt;=1.36, P=0.24). In exploratory multivariable Cox regression, PES was associated with a numerically higher but statistically nonsignificant hazard of recurrence [hazard ratio (HR) 1.98, 95% CI: 0.65-5.98; P=0.23]. Follow-up duration was comparable (5","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 9","pages":"144"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039485","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":"Early mechanical outcomes of two expandable interbody cages in minimally invasive TLIF: a comparative single-surgeon study.","authors":"Lali H S Sekhon, Milin Singh Sekhon, Curt Erickson, Gregory Graves","doi":"10.21037/jss-2026-0135","DOIUrl":"10.21037/jss-2026-0135","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Expandable transforaminal lumbar interbody fusion (TLIF) cages permit low-profile insertion followed by in situ restoration of disc height and segmental lordosis. Mechanical failure, including secondary collapse of the expansion mechanism and endplate subsidence, has been reported with some expandable designs. We compared early secondary cage collapse and, secondarily, subsidence between the Catalyft PL and X-PAC expandable TLIF cages in a consecutive single-surgeon minimally invasive surgery (MIS) cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively reviewed 168 consecutive patients (224 cages) undergoing one- or two-level MIS TLIF: 112 patients (144 cages) received Catalyft PL and 56 patients (80 cages) received X-PAC during sequential, non-overlapping periods. Surgical technique, disc preparation, grafting, and pedicle screw-rod instrumentation were comparable between cohorts. Standing lateral radiographs obtained postoperatively and during follow-up were independently reviewed by three reviewers, with discrepancies resolved by consensus. The primary endpoint was patient-level secondary cage collapse, defined as &gt;2 mm loss of implant height relative to baseline imaging. Cage-level analyses were supportive; clustered generalized estimating equation (GEE) models accounted for within-patient correlation. Fisher's exact test was used for categorical comparisons, with a Bonferroni-corrected threshold of α=0.008 across six pre-specified comparisons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Secondary collapse occurred in 23/112 Catalyft PL patients (20.5%, 95% CI: 14.1-28.9%) versus 1/56 X-PAC patients [1.8%, 95% confidence interval (CI): 0.3-9.4%] (relative risk 11.5, 95% CI: 1.6-83.0; P=0.001), remaining significant after Bonferroni correction. At the cage level, collapse occurred in 24/144 Catalyft PL cages (16.7%) versus 1/80 X-PAC cages (1.2%) (P&lt;0.001); clustered GEE analysis was consistent with this association (odds ratio 15.2, 95% CI: 2.0-116.0). Subsidence was more frequent with Catalyft PL at both the patient level (32.1% &lt;i&gt;vs.&lt;/i&gt; 14.3%) and cage level (28.5% &lt;i&gt;vs.&lt;/i&gt; 10.0%), but the patient-level comparison did not survive Bonferroni correction (P=0.02). The cohorts also differed substantially in cage footprint (approximately 273 &lt;i&gt;vs.&lt;/i&gt; 384 mm²) and multilevel proportion (28.6% &lt;i&gt;vs.&lt;/i&gt; 42.9%); subsidence is therefore considered exploratory. Pseudarthrosis occurred in 2 Catalyft PL patients (1.8%) and no X-PAC patients (P=0.55), an underpowered comparison.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this single-surgeon MIS TLIF series, Catalyft PL was associated with a significantly higher rate of early secondary collapse than X-PAC. Because the cohorts were treated sequentially and differed in cage geometry, these findings demonstrate association rather than a causal effect of expansion mechanism. The collapse findings are consistent in direction and magnitude with an independent published series and wit","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 9","pages":"145"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039501","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":"AI cannot synthesise what has never been reported: the future of the spine journal.","authors":"Ralph J Mobbs","doi":"10.21037/jss-20262-05","DOIUrl":"10.21037/jss-20262-05","url":null,"abstract":"","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 9","pages":"142"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039479","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}