Journal of spine surgery最新文献

{"title":"Sacral chordomas: surgical management, reconstruction, and translational advances: a systematic review.","authors":"Vivek Sanker, Sawsane Ghaddar, Anam Sayed Mushir Ali, Gokulesh D Gurumurthy, Malavika Jayan, Mahin Qudeer Sheikh, Linda Liverani, Gayathri Sunil, Sunil Kumar, Maria Jose Cavagnaro, Ravi Medikonda, John Ratliff, Atman Desai","doi":"10.21037/jss-25-180","DOIUrl":"https://doi.org/10.21037/jss-25-180","url":null,"abstract":"<p><strong>Background: </strong>Sacral chordomas are rare malignant tumors arising from notochordal remnants that present unique surgical challenges due to their indolent growth, locally aggressive behavior, and high recurrence rates despite treatment. This review synthesizes current evidence on surgical management, reconstruction techniques, adjuvant therapies, and translational advances for sacral chordomas.</p><p><strong>Methods: </strong>This systematic review synthesizes current evidence on surgical management, reconstruction techniques, adjuvant therapies, and translational advances through analysis of PubMed, Scopus, and Web of Science databases [2023-2025].</p><p><strong>Results: </strong><i>En bloc</i> resection with wide negative margins remains the cornerstone of treatment, achieving optimal local control but often at the cost of significant neurological and functional morbidity. Modern reconstruction techniques, including vascularized grafts and three-dimensional (3D)-printed prostheses, have improved spinopelvic stability and postoperative outcomes. Adjuvant particle beam radiotherapy, particularly proton and carbon ion therapy, demonstrates superior 5-year local control rates of 77-89% compared to 10-30% with conventional photon therapy, while stereotactic radiosurgery achieves 81% local control. Systemic therapies remain limited, though targeted inhibitors of platelet-derived growth factor receptor (PDGFR), epidermal growth factor receptor (EGFR), and the PI3K/AKT/mTOR pathway show modest activity with disease stabilization in 60-70% of cases. Novel immunotherapeutic approaches, including Brachyury-targeted vaccines and checkpoint blockade, are under investigation. Molecular insights have identified key drivers, including Brachyury [T-box transcription factor T (TBXT)], receptor tyrosine kinases, and emerging biomarkers that may guide future therapeutic selection.</p><p><strong>Conclusions: </strong>Integrated multimodal care is critical for improving survival and function in patients with sacral chordomas.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 3","pages":"36"},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674609","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":"The role of intracorporeal cancellous bone grafting in the biological augmentation of vertebral body fractures: a literature review, historical perspective, and update on imaging and bone healing outcomes.","authors":"Diogo Lino Moura","doi":"10.21037/jss-2025-1-222","DOIUrl":"https://doi.org/10.21037/jss-2025-1-222","url":null,"abstract":"<p><strong>Background and objective: </strong>Interior vertebral body augmentation enables minimally invasive reconstruction from within by filling the void created by trabecular collapse, restoring endplate alignment, and supporting the anterior and middle columns. Although traditional intracorporeal cancellous bone grafting has been associated with unfavorable outcomes due to insufficient early stability, its use in combination with modern stabilization techniques may represent an effective strategy for biological vertebral body repair. This study aims to provide an updated review of the scientific literature on the role of intracorporeal cancellous bone grafting in the augmentation of vertebral body fractures.</p><p><strong>Methods: </strong>A literature review of the PubMed/MEDLINE database was performed focusing on imaging outcomes and bone healing findings in clinical studies evaluating intracorporeal cancellous bone grafting for vertebral body fractures.</p><p><strong>Key content and findings: </strong>Fifty-five studies were included, addressing acute traumatic or osteoporotic thoracolumbar fractures and post-traumatic vertebral necrosis (Kümmell's disease). The literature was categorized into three sections: grafting alone (2 studies), grafting combined with fixation of adjacent vertebrae (35 studies, ranging from early techniques to modern pedicle screw constructs), and grafting combined with intravertebral stabilization (intermediate pedicle screws, 5 studies; static cages, 9; expandable implants, 4). Imaging and bone healing outcomes were heterogeneous, yet most studies reported favorable imaging, bone union, and clinical results, underscoring the benefits of combining supplemental stabilization methods with intracorporeal bone grafting in biological vertebral augmentation. Less favorable outcomes were observed in only 9 studies (16.36%), primarily involving stand-alone grafting or grafting combined with adjacent pedicle fixation, and were characterized by vertebral height loss, segmental angle reduction, necrosis, and graft resorption.</p><p><strong>Conclusions: </strong>Based on heterogeneous, low-level evidence, this narrative review suggests that less favorable outcomes with intracorporeal bone grafting were mainly due to insufficient vertebral stability, suboptimal grafting, and disc injury with consequent segmental kyphosis. Outcomes appear influenced by the type of additional stabilization used alongside grafting. In selected studies using modern stabilization-such as pedicle screws or intravertebral augmentation-acceptable short- to mid-term bone healing and imaging outcomes were reported. However, effect size and consistency vary, and further prospective, comparative, subgroup-specific studies are needed to confirm effectiveness.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 3","pages":"38"},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674646","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":"Zero-profile interbody fusion in single and two-level anterior cervical discectomy and fusion: a novel surgical system and its indications.","authors":"Mitchell K Ng, Paul G Mastrokostas, Ahmed K Emara, Ian Tafel, Paul R Krafft, Afshin E Razi","doi":"10.21037/jss-2025-aw-212","DOIUrl":"https://doi.org/10.21037/jss-2025-aw-212","url":null,"abstract":"<p><p>Anterior cervical discectomy and fusion (ACDF) is considered gold standard for anterior management of cervical degenerative disease, yet traditional interbody and plate constructs often require substantial soft-tissue exposure and may be associated with increased postoperative morbidity and dysphagia/prevertebral swelling. Moreover, anterior plate prominence and prolonged retraction have been implicated in postoperative dysphagia and prevertebral soft-tissue irritation, motivating interest in low-profile fixation strategies. The goal of this paper is to introduce a novel zero-profile interbody fusion technology and describe its clinical application in the context of 1- and 2-level ACDF. Specifically, this paper aims to: (I) define indications for use of this novel zero-profile interbody fixation system; (II) detail the step-by-step surgical technique with tips/tricks and other technical pearls; and (III) discuss advantages of this system relative to traditional interbody devices and plate-based constructs. Overall, this novel implant combines a biocompatible polymer interbody spacer with integrated titanium fixation, enabling stable anterior column support and an all-in-one construct designed to remain fully contained within the disc space footprint while maintaining construct stability and arthrodesis principles. Overall, this novel technique enables efficient intraoperative implantation, reduced soft-tissue retraction, especially in revision cases that conventionally necessitate plate removal or in adjacent-segment settings where prior anterior hardware may complicate exposure. Because this report is intended as a surgical technique description rather than a clinical outcomes study, any proposed benefits related to dysphagia, operative time, or fusion should be interpreted cautiously and warrant prospective comparative evaluation. Overall, it represents a safer, quicker and easy-to-adopt advancement in anterior cervical fusion technology that may streamline workflow while minimizing anterior profile.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 3","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674179","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":"The renewed role of interspinous devices: the InSpan system-a narrative review on surgical indications.","authors":"Mario Cahueque, Enrique Azmitia, Miguel Guerra, Santiago Montenegro","doi":"10.21037/jss-2025-1-232","DOIUrl":"https://doi.org/10.21037/jss-2025-1-232","url":null,"abstract":"<p><strong>Background and objective: </strong>Interspinous devices have evolved from simple distraction spacers to interlaminar fixation systems capable of promoting fusion and stability. Early distraction-only implants were associated with high failure and reoperation rates, leading surgeons to abandon this technology. The InSpan system represents a new generation of posterior, interlaminar fixation devices designed to provide indirect decompression and interlaminar fusion. The goal of this review is to define practical, evidence-based indications and contraindications for the InSpan system within the context of interlaminar fixation, and to position this strategy among decompression alone and pedicle-based fusions.</p><p><strong>Methods: </strong>This narrative review synthesizes evidence on interspinous and interlaminar fixation devices, with focus on the InSpan system. A search of PubMed/MEDLINE, Embase, and Cochrane Library databases up to November 2025 using the MeSH terms \"interspinous device\", \"interlaminar fixation\", \"InSpan\", \"lumbar spinal stenosis\", \"spondylolisthesis\", and \"disc herniation\" identified studies evaluating device design, kinematic behavior, clinical outcomes, and complications. Emphasis was placed on data informing practical surgical indications, contraindications, and patient selection criteria for InSpan.</p><p><strong>Key content and findings: </strong>Available biomechanical studies suggest that InSpan provides meaningful flexion-extension control and serves as an effective scaffold for interlaminar fusion, while avoiding pedicle violation and preserving the posterior structures. Clinical series report sustained improvements in pain and disability scores, low revision and complication rates, and radiographic evidence of fusion in selected patients. The most promising indications include: (I) recurrent lumbar disc herniation after microdiscectomy with segmental micromotion or disc height loss; (II) single-level lumbar spinal stenosis with low-grade spondylolisthesis or mild instability in patients at elevated risk for pedicle-screw fusion; and (III) foraminal or far-lateral stenosis where preservation of foraminal height is critical. Severe instability, high-grade spondylolisthesis, deformity, and multilevel disease remain better suited to conventional fusion constructs.</p><p><strong>Conclusions: </strong>Interlaminar fixation devices appear to occupy a valuable niche between decompression alone and pedicle-based fusion, particularly in single-level degenerative pathology and fragile patients. When combined with decompression, InSpan can provide indirect decompression and interlaminar fusion with reduced surgical morbidity. Nevertheless, current evidence is largely limited, and high-quality randomized and long-term studies are needed to refine indications, durability, and cost-effectiveness.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 3","pages":"37"},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674589","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-incision four-level oblique lateral interbody fusion and cement-augmented fixation in a severely osteoporotic lumbar spine: a case report.","authors":"Talgat Kerimbayev, Daryn Borangaliyev, Nurzhan Abishev, Galymzhan Kadirbekov, Zhandos Tuigynov, Meirzhan Oshayev, Yermek Urunbayev, Yergen Kenzhegulov, Viktor Aleinikov, Serik Akshulakov","doi":"10.21037/jss-25-124","DOIUrl":"https://doi.org/10.21037/jss-25-124","url":null,"abstract":"<p><strong>Background: </strong>Multilevel degenerative lumbar instability in patients with severe osteoporosis presents considerable surgical challenges due to compromised bone quality and increased risk of instrumentation failure. Oblique lateral interbody fusion (OLIF) offers a minimally invasive corridor for interbody fusion and deformity correction, typically enabling access to up to three adjacent disc levels through a single incision using the \"sliding window\" technique. Extension of OLIF to four levels via a single approach is rarely reported, particularly in the osteoporotic population, due to anatomical limitations and concerns about fixation stability.</p><p><strong>Case description: </strong>We report the case of a 67-year-old woman with advanced osteoporosis who presented with severe low back pain, neurogenic claudication, and progressive lower limb weakness. Radiographs and magnetic resonance imaging (MRI) revealed degenerative lumbar scoliosis, multilevel vacuum disc phenomena, Meyerding grade I-II spondylolistheses, and severe foraminal stenosis from L2 to S1. After preoperative optimization with teriparatide therapy, a two-stage surgical strategy was implemented. The first stage involved a single-access, four-level OLIF (L2-S1) using the sliding window technique to restore disc height and alignment. The second stage consisted of percutaneous pedicle screw fixation from L2 to S1 with polymethylmethacrylate (PMMA) cement augmentation to enhance screw stability in the osteoporotic vertebrae. Both stages were completed without complications. The patient experienced significant postoperative improvement, including pain reduction and restoration of independent ambulation.</p><p><strong>Conclusions: </strong>This case demonstrates that four-level OLIF can be safely performed through a single incision even in patients with severe osteoporosis when using a staged surgical approach and cement-augmented fixation. This combined strategy offers a viable, minimally invasive solution for complex multilevel lumbar instability in high-risk patients, providing substantial symptom relief and functional recovery.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 3","pages":"40"},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674643","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":"Three-stage anterior lumbar interbody fusion revision surgery for transforaminal lumbar interbody fusion cage retrieval: surgical steps and preliminary results.","authors":"Francesco Caiazzo, Daniel Alveal-Mellado, Lucas Capo, Paula Lavezzolo, Judith Salat-Batlle, Beatriz Iguácel-Duarte, Juan Bago","doi":"10.21037/jss-25-160","DOIUrl":"https://doi.org/10.21037/jss-25-160","url":null,"abstract":"<p><p>Revising failed transforaminal lumbar interbody fusion (TLIF) presents significant surgical challenges, primarily due to the presence of dense scar tissue and pre-existing cage placement. While anterior surgical approaches offer superior visualization for cage retrieval, existing posterior instrumentation often complicates adequate intervertebral distraction, which is crucial for both comprehensive cage removal and effective deformity correction. Here, we detail a three-stage surgical strategy (back-front-back) adopted in Instituto Quirúrgico Spanò to overcome these inherent limitations. Stage 1 involves the careful removal of existing posterior rods and release of the posterior tension band to re-establish segmental mobility. Stage 2 proceeds with an anterior approach to facilitate the precise removal of the failed interbody cage, meticulous preparation of the endplates, and the subsequent implantation of a new, hyperlordotic anterior lumbar interbody fusion (ALIF) cage, essential for optimal restoration of sagittal alignment. Finally, stage 3 focuses on definitive posterior stabilization using new pedicle screws and rods. To assess the safety and efficacy of this technique, we conducted a retrospective review of 11 consecutive patients who underwent revision surgery, presenting with conditions such as pseudarthrosis, cage subsidence, or sagittal malalignment. The three-stage procedure was technically successful in all 11 patients, with no major complications reported at the one-year follow-up. The mean surgical time recorded was 258 minutes, with an average estimated blood loss of 493 mL. Postoperative imaging studies consistently confirmed satisfactory cage placement in all treated cases, demonstrating the viability and promising outcomes of this comprehensive surgical approach.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 3","pages":"33"},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674604","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":"Correction of deformity from convexity in adolescent idiopathic scoliosis.","authors":"José María Hernández Mateo, Jaime Flores Gallardo, Oscar Riquelme García, Azucena García Martín, Cristina Igualada Blázquez, Tania Quevedo Narciso, María Del Coro Solans López, Laura Muñoz Núñez, Luis Alejandro Esparragoza Cabrera","doi":"10.21037/jss-25-166","DOIUrl":"https://doi.org/10.21037/jss-25-166","url":null,"abstract":"<p><strong>Background: </strong>Correction of scoliosis deformity from the convexity of the curve reduces the theoretical risk of neurovascular injury, a fact to be considered, especially in the paediatric population. Our aim is to evaluate the efficacy of this technique in patients with adolescent idiopathic scoliosis (AIS).</p><p><strong>Methods: </strong>This is a retrospective study, in which 50 patients with AIS were included. The minimum required follow-up was 24 months. After open posterior approach and flexibilisation of the deformity by facetectomies, pedicle screws were inserted 'free-hand' in the convexity and at the extremes of the assembly at the concavity level, with intraoperative neurophysiological monitoring. <i>In situ</i> moulding maneuvers, segmental correction of the curve by compression-distraction and direct vertebral derrotation from the convexity were performed, using another chromium-cobalt rod on the concave side. General demographic and deformity data were collected, as well as radiological variables.</p><p><strong>Results: </strong>Fifty patients with AIS underwent surgery. The mean operative time was 251±50 min. Mean blood loss was 4.3±0.3 g/dL Hb. The mean postoperative stay was 6.3±0.3 days. A reduction of the Cobb angle was achieved in primary curve by 64.4% (from 53.0°±12.6° to 18.9°±9.5°; P<0.001) and in secondary curve by 47% (from 33.3°±11.4° to 17.5°±9.5°; P=0.005). Coronal balance changed from 3.6±1.9 to 2.3±4.2 mm (P=0.59) and sagittal vertical axis (SVA) changed from -14.7±40 to -6.1±28.9 mm (P=0.10). There were no vascular complications. A single intraoperative neurophysiological event was recorded, requiring screw repositioning. Two wound infections were recorded.</p><p><strong>Conclusions: </strong>Correction of the deformity from the convexity using low-density constructs with pedicle screws, achieves similar results to other techniques.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 3","pages":"31"},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674606","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":"Full-endoscopic rhizotomy for degenerative lumbar facet joint syndrome: a systematic review and meta-analysis.","authors":"Wongthawat Liawrungrueang, Sompoom Sunpaweravong, Pakawat Chongsathidkiet, Watcharaporn Cholamjiak, Meng-Huang Wu, Don Young Park, Peem Sarasombath","doi":"10.21037/jss-2025-aw-199","DOIUrl":"https://doi.org/10.21037/jss-2025-aw-199","url":null,"abstract":"<p><strong>Background: </strong>Degenerative changes, such as osteoarthritis, often lead to facet joint syndrome (FJS). Standard treatments include physical therapy, nerve blocks, and radiofrequency rhizotomy. Full-endoscopic lumbar rhizotomy enables direct visualization and precise ablation of the medial branch nerves. Recent studies have shown significant reductions in pain and disability. This study aimed to evaluate the efficacy and safety of full-endoscopic rhizotomy in patients with degenerative lumbar FJS, using pooled data from clinical studies reporting postoperative outcomes.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed and Scopus databases between January 2000 and March 2025, following PRISMA guidelines. Studies reporting preoperative and postoperative outcomes of full-endoscopic rhizotomy in adult patients (18 years of age or older) with lumbar FJS were included. Both randomized controlled trials (RCTs) and observational studies were considered. Risk of bias was assessed using the Cochrane RoB 2 tool for RCTs and Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) for non-randomized studies. Primary outcomes included changes in pain and disability scores measured by the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Meta-analyses were performed using pooled mean differences with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Fourteen studies involving a total of 1,467 patients were included. The pooled mean improvement in VAS was -4.36 (95% CI: -4.42 to -4.31), and the mean improvement in ODI was -32.32 (95% CI: -32.84 to -31.80), indicating significant pain and functional improvement after endoscopic rhizotomy. No study reported any severe or permanent complications. Minor complications included transient skin numbness, intraoperative discomfort, and failed sutures. Endoscopic techniques demonstrated lower complication rates (6.67% <i>vs.</i> 30%, P<0.05), although associated with a longer operative time than fluoroscopic-guided percutaneous rhizotomy.</p><p><strong>Conclusions: </strong>Full-endoscopic rhizotomy is a safe and effective treatment for degenerative lumbar FJS, offering significant and sustained improvements in pain and disability. While it requires a longer operative time than conventional techniques, its satisfactory clinical outcomes and low complication rates support its use as a minimally invasive alternative. Further high-quality comparative studies are recommended to validate long-term benefits.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 3","pages":"32"},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13066666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674617","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":"Disease-modifying anti-rheumatic drugs are associated with increased readmission and reoperation rates following anterior cervical discectomy and fusion: a propensity-matched cohort study.","authors":"Muhammad Waheed, Malik Al-Jamal, Ashar Ahmed, Abdelrahman Diab, Omar Diab, Ali Elaydi, Rahul Vaidya","doi":"10.21037/jss-25-134","DOIUrl":"https://doi.org/10.21037/jss-25-134","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that compromises joint integrity, often necessitating surgical interventions such as anterior cervical discectomy and fusion (ACDF). However, the impact of disease-modifying anti-rheumatic drug (DMARD) therapy on ACDF outcomes remains unclear, particularly with respect to short-term and long-term postoperative complications.</p><p><strong>Methods: </strong>This retrospective propensity-matched cohort study utilized the TriNetX research network to identify adult patients with RA who underwent primary ACDF within the past 20 years. Patients were divided into two cohorts based on perioperative DMARD use. Two matched cohorts of 507 patients each were analyzed (mean age 60 years; 70% female in the DMARD group and 68% female in the non-DMARD group). Primary outcomes included medical complications at 90 days and surgical site and implant-related complications at both 90 days and 2 years postoperatively, including readmission and reoperation rates. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Kaplan-Meier survival analysis was performed to evaluate reoperation-free survival, with statistical significance set at P<0.05.</p><p><strong>Results: </strong>RA patients on DMARD therapy experienced significantly higher rates of 90-day readmission (4.3% <i>vs</i>. 2.0%; P=0.03) and reoperation (4.1% <i>vs</i>. 2.0%; P=0.045) compared to matched controls. At 2-year follow-up, reoperation rates remained higher in the DMARD cohort (8.3% <i>vs</i>. 4.1%; P=0.006). Kaplan-Meier analysis demonstrated significantly reduced reoperation-free survival among patients receiving DMARD therapy (P=0.008).</p><p><strong>Conclusions: </strong>DMARD therapy in RA patients undergoing ACDF is associated with increased risks of readmission and reoperation. These findings suggest that while DMARDs provide symptomatic and disease-modifying benefits in RA, their perioperative use may adversely affect surgical durability. Careful consideration of these risks and benefits is warranted when managing RA patients undergoing ACDF.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 3","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674573","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":"Demonstrating the feasibility of facet arthroplasty using the Total Posterior Spine System (TOPS) in the ambulatory surgery center (the TOPS outpatient experience).","authors":"Jared D Ament, Jack Petros, Cooper Gardner, Etai A Bergman, Amir Vokshoor","doi":"10.21037/jss-2025-aw-214","DOIUrl":"https://doi.org/10.21037/jss-2025-aw-214","url":null,"abstract":"<p><strong>Background: </strong>The transition to the outpatient/ambulatory setting is especially important within value-based care system. While some procedures are well supported, posterior motion-preserving technologies, such as Total Posterior Spine System (TOPS), a novel artificial facet replacement, have yet to be evaluated in an ambulatory surgery center (ASC) setting. The objective of this study is to assess the feasibility, safety and early outcomes of the TOPS device in an ASC setting.</p><p><strong>Methods: </strong>In this retrospective case series, we reviewed 30 consecutive patients who underwent TOPS implantation at a free-standing ASC between September 2023 and December 2025. Demographics, intra-operative metrics, discharge data, 90-day events and patient-reported outcome measures (PROMs) were collected from operative/anesthesia reports and the electronic medical record.</p><p><strong>Results: </strong>Thirty patients were included; 14 males and 16 females, with a mean age and body mass index (BMI) of 62 years and 27±5 kg/m², respectively. Mean estimated blood loss was 278±65.2 mL and mean operative time was 206±52 minutes. All patients were discharged the same day; 63% home, 37% to an after-care facility. There were no hospital admissions. Within 90 days three revision surgeries (10%) occurred for device malposition (n=2) and seroma drainage (n=1). By six months, mean visual analog scale (VAS) back pain decreased by 67.3%, right leg VAS by 93.8%, left leg VAS by 98.6%. Oswestry Disability Index (ODI) improved by 71.5%, and patient-reported outcome measurement information system (PROMIS) physical increased by 27.6%, and PROMIS mental by 13.8%. Mean patient satisfaction rose from 7.1/10 at six months to 9.8/10 at twelve months.</p><p><strong>Conclusions: </strong>This series demonstrates that TOPS facet arthroplasty can be safely and effectively performed in a free-standing ASC.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 3","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674575","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}