Journal of spine surgery最新文献

{"title":"Long-term patient-reported outcomes and mechanical complications following spinal fusion in patients with surgical site infection managed with retained instrumentation versus non-infected patients: a systematic review and meta-analysis.","authors":"Sadegh Bagherzadeh, Mohsen Rostami, Negin Safari Dehnavi, Faramarz Roohollahi, Ramin Kordi, Morteza Faghih-Jouybari, Puya Alikhani","doi":"10.21037/jss-2026-0132","DOIUrl":"10.21037/jss-2026-0132","url":null,"abstract":"<p><strong>Background: </strong>Spinal fusion is frequently performed for degenerative and deformity spinal disorders, and surgical site infection (SSI) is one of its most consequential postoperative complications. Although implant retention is often pursued to preserve spinal stability and alignment, the impact of SSI on patient-reported outcome measure (PROM) and mechanical complications compared with non-infected patients is incompletely explored. This study aims to compare pain, disability, and mechanical outcomes between adult spinal fusion patients with SSI managed by retained instrumentation and non-infected controls.</p><p><strong>Methods: </strong>This systematic review and meta-analysis were registered in PROSPERO. PubMed, Embase, Scopus, and Web of Science were searched from inception through December 2025. Eligible studies included adult cohorts undergoing instrumented spinal fusion with SSI treated by implant retention and a non-infected comparison group. Primary outcomes were changes in Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI), representing PROM. Secondary outcomes included unplanned readmission, revision surgery excluding debridement, pseudarthrosis, and proximal junctional kyphosis (PJK). Random-effects models were used to calculate standardized mean differences and odds ratios (ORs).</p><p><strong>Results: </strong>Eleven studies comprising 2,681 patients were included, with mean follow-up of 33.9 months (range, 22-70.7 months). Improvements in back pain VAS, leg pain VAS, and ODI did not differ significantly between SSI and non-SSI groups, showing comparable long-term functional recovery. In contrast, SSI managed with retained instrumentation was associated with significantly increased odds of unplanned readmission, revision surgery excluding debridement, and pseudarthrosis. No significant difference was observed in PJK. Substantial heterogeneity was present for several mechanical outcomes.</p><p><strong>Conclusions: </strong>In adult spinal fusion, patients with SSI managed with retained instrumentation demonstrated patient-reported outcomes comparable to non-infected controls. However, SSI is associated with increased mechanical complications and healthcare utilization. These findings support intensified surveillance, risk-adjusted counseling, and standardized outcome reporting for patients experiencing SSI after spinal fusion.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 9","pages":"143"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039513","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":"Comparing match outcomes of international medical graduates (IMGs), U.S. allopathic (MDs), and osteopathic graduates (DOs) into orthopaedic spine surgery fellowship programs from 2019-2024.","authors":"Anisha Prakash, Aadarsh Tyagi, Anisha Tyagi, Matthew Johnson, Paul Mastrokostas, Jorden Xavier, Jacob Budin, Arie Monas, Suleiman Sudah, Afshin Razi","doi":"10.21037/jss-2026-0110","DOIUrl":"10.21037/jss-2026-0110","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;International medical graduates (IMGs) play a vital role in the U.S. healthcare system, particularly in addressing workforce shortages and serving underserved populations. Despite their substantial contributions, IMGs remain underrepresented in surgical subspecialties, including orthopaedic surgery, where they comprise a small proportion of the workforce. Spine surgery is a highly competitive orthopaedic subspecialty with limited growth in fellowship positions and low match rates. While trends in IMG representation have been described in residency training, data on IMG match outcomes in orthopaedic subspecialty fellowships, particularly spine surgery, remain limited. The aim of this study was to evaluate U.S. orthopaedic spine fellowship match outcomes among IMGs and to compare these outcomes with those of U.S. allopathic (MD) and osteopathic (DO) graduates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective analysis of applicants to U.S. orthopaedic spine surgery fellowship programs using San Francisco Match (SF Match) data from 2019 to 2024. This study period was selected because these years contained the most complete and consistently collected applicant-level data for the variables of interest. Applicants included MD, DO, and IMGs. Variables analyzed included United States Medical Licensing Examination (USMLE) step 1 and step 2 scores, number of applications submitted, interview invitation rates, number of contiguous ranks, applicant and program rank positions, and match outcomes. Descriptive statistics, analysis of variance, and linear regression were used to assess differences among groups, with statistical significance defined as P&lt;0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1,054 applicants were included (674 MD, 72 DO, 308 IMG). IMG applicants originated from 45 countries/regions, most commonly India, Egypt, Jordan, and Canada. Compared with MD and DO applicants, IMGs had significantly lower USMLE step 1 and step 2 scores, lower interview invitation rates, and fewer contiguous ranks (P&lt;0.0001 for all). IMGs submitted more applications on average but had markedly lower interview yield (9%) compared with MD (50%) and DO (29%) applicants. Among IMGs, matched applicants demonstrated significantly higher USMLE scores, interview rates, and rank list lengths than unmatched applicants (P&lt;0.01 for all). Additionally, applicant rank outcomes differed significantly among groups (P&lt;0.01); 10% of IMGs matched at their first-choice program compared with 15% of MD applicants and 6% of DO applicants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;IMG applicants to orthopaedic spine surgery fellowships demonstrate differences from MD and DO applicants across multiple domains of the application process, including standardized test performance, interview invitation rates, and match outcomes. Even among those who successfully match, IMGs were more likely to be ranked lower by the programs where they ultimately matched. Th","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"128"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919964","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":"Anatomical and biological reconstruction of traumatic complete burst fractures of the thoracolumbar vertebrae using pedicle fixation combined with stent-armed kyphoplasty and intracorporeal bone grafting: technique rationale, 7-year experience and clinical, imaging, and histological outcomes.","authors":"Diogo Lino Moura, Carlos Jardim","doi":"10.21037/jss-2026-0154","DOIUrl":"10.21037/jss-2026-0154","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The optimal management of thoracolumbar burst fractures remains controversial. Growing evidence suggests that anatomical vertebral body restoration may be important for restoring structural integrity, load-bearing capacity, and spinal function. The objective of this study was to evaluate the clinical, imaging, and histological outcomes of novel surgical technique for anatomical and biological vertebral body reconstruction in acute traumatic complete burst thoracolumbar fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective study included 32 patients with acute traumatic thoracolumbar complete burst fractures without neurological deficits treated using a novel vertebral body reconstruction technique combining pedicle fixation, stent-armed kyphoplasty, and intracorporeal allogeneic bone grafting. Clinical outcomes [Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Patient Global Impression of Change (PGIC)] and imaging parameters (vertebral body heights, sagittal alignment, and posterior wall retropulsion) were evaluated. In addition, intra-stent bone biopsies were performed in 23 patients to assess allograft incorporation and healing prior to removal of the posterior instrumentation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean follow-up was 4.39±1.46 years (range, 2-7 years). There was a statistically significant improvement in all clinical and functional parameters evaluated between preoperative period and the final follow-up. All vertebral height parameters increased postoperatively, with partial loss of correction over time. At end of follow-up, a statistically significant difference compared with preoperative values was observed for posterior sagittal and left coronal heights; a trend toward significance was noted for anterior sagittal and median coronal heights, and no significant difference was found for median sagittal and right coronal heights. Regarding posterior wall retropulsion, a statistically significant decrease was observed throughout follow-up. Regarding both sagittal angles, a marked postoperative correction was achieved, followed by progressive loss of correction over time. Computed tomography demonstrated imaging signs of vertebral body healing in all patients, while histological analysis demonstrated viable incorporated allograft in 22 of 23 biopsied patients, characterized by trabecular bone containing osteocytes within lacunae and cellular bone marrow with identifiable sinusoids and erythrocyte-containing capillaries. Greater anterior sagittal, median sagittal, and median coronal vertebral body heights were negatively correlated with VAS and ODI scores at different time points.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The favorable clinical, imaging and histological outcomes observed at mid-term follow-up, support the feasibility of this percutaneous transpedicular circumferential stabilization technique for traumatic complete thoracolumbar burst fractures, demonstrating encouraging res","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"131"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919945","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":"Technical considerations for time-efficient four-level biportal endoscopic lumbar interbody fusion in a frail elderly patient with severe lumbar deformity: a case report.","authors":"Yong-Ho Lee","doi":"10.21037/jss-2026-0146","DOIUrl":"10.21037/jss-2026-0146","url":null,"abstract":"<p><strong>Background: </strong>Biportal endoscopic lumbar interbody fusion (BE-LIF) has recently emerged as a minimally invasive alternative to conventional open lumbar fusion surgery. However, long-segment endoscopic fusion for multilevel degenerative lumbar stenosis with associated degenerative scoliosis remains technically challenging because prolonged operative time and perioperative morbidity may substantially increase in frail elderly patients.</p><p><strong>Case description: </strong>An 86-year-old man presented with severe back pain, bilateral radiating leg pain, progressive bilateral lower-extremity weakness, and left foot drop, progressing from one-cane ambulation to wheelchair dependence. Radiologic evaluation demonstrated severe multilevel lumbar spinal stenosis with degenerative scoliosis from L2 to S1, accompanied by severe foraminal stenosis, asymmetric disc collapse, and rotational deformity. Because the patient's symptoms and neurologic deficits could not be attributed to a single level, the deterioration was considered multifactorial, resulting from combined multilevel central, lateral recess, and foraminal neural compression. Given the patient's advanced age, frailty, cardiovascular comorbidity, continued aspirin therapy, and the high risk associated with conventional open deformity correction, four-level BE-LIF from L2 to S1 was performed using a workflow-oriented strategy to minimize operative burden. Osteotome-assisted facetectomy facilitated rapid exposure of the ligamentum flavum and disc space. Rather than extensive bilateral posterior decompression, restoration of disc and foraminal height through cage insertion was prioritized to achieve neural decompression while minimizing operative burden. Total skin-to-skin operative time was 265 minutes. No intraoperative dural tear, neurologic deterioration, cage migration, or conversion to open surgery occurred. At 1-month follow-up, visual analog scale scores for back and leg pain improved from 7 to 2 and from 8 to 2, respectively.</p><p><strong>Conclusions: </strong>Four-level BE-LIF may represent a feasible minimally invasive alternative for carefully selected elderly patients with multilevel lumbar degenerative deformity who are poor candidates for conventional open deformity correction. A workflow-oriented strategy incorporating unilateral posterior decompression, early cage insertion, and individualized pedicle screw fixation may improve operative efficiency while preserving the posterior ligamentous complex.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"140"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920060","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":"Augmented reality-enabled image-guided surgical navigation in minimally invasive spine surgery: application beyond screw placement in prone lateral transpsoas interbody fusion-a cadaveric surgical technique study.","authors":"Abdulrahman Abuhaimed, Austin Q Nguyen, Stuart J Corr, Mark L Prasarn","doi":"10.21037/jss-2026-0084","DOIUrl":"10.21037/jss-2026-0084","url":null,"abstract":"<p><p>Augmented reality-enabled image-guided surgical navigation (ARE-IGSN) has demonstrated high accuracy for pedicle screw placement in spine surgery, but its application to interbody phases of minimally invasive fusion remains largely unexplored. Interbody work typically requires repeated fluoroscopic confirmation, increasing radiation exposure and forcing frequent gaze shifts away from the operative field. This study aims to evaluate the feasibility and accuracy of ARE-IGSN for key interbody steps in prone lateral transpsoas interbody fusion, including skin marking, corridor selection, disc preparation, evaluation of endplate integrity, and cage trajectory and depth control. A fresh frozen cadaver specimen was positioned in a prone lateral configuration with pelvic reference frame registration to a preprocedural computed tomography (CT) scan. An ARE-IGSN platform was used to provide in-field navigation overlays throughout the procedure. The workflow included navigated skin marking, docking, disc preparation using calibrated instruments, and interbody cage placement. Primary endpoints were technical feasibility, implant placement accuracy assessed by comparison of ARE-IGSN data with postprocedural CT imaging, and endplate integrity. Secondary endpoints included fluoroscopy utilization and qualitative ergonomic assessment. ARE-IGSN guidance was used throughout the procedure for skin marking, corridor selection, docking, disc preparation, endplate evaluation, trialing, and cage placement. The procedure was completed without the use of procedural fluoroscopy following system registration. Postprocedural CT demonstrated close agreement between the implant position displayed by the ARE-IGSN system and the final implant position. Retrospective comparison of measurements obtained from the saved ARE-IGSN data and postprocedural CT imaging demonstrated less than 1 mm difference across all assessed parameters, with no evidence of endplate violation. Visualization of navigational information was provided directly through the headset display throughout the procedure. This cadaveric study demonstrates the technical feasibility of applying ARE-IGSN guidance to multiple phases of prone lateral transpsoas interbody fusion beyond pedicle screw placement. Retrospective comparison of saved ARE-IGSN navigational data with postprocedural CT imaging demonstrated close agreement between the implant position displayed by the system and the final implant position. These findings support further prospective clinical investigation of implant placement accuracy, workflow integration, radiation utilization, and ergonomic outcomes.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"135"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919888","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":"Stand-alone prone lateral interbody fusion: a retrospective case series.","authors":"Michael J Patetta, Arnav Sharma, Tristen McGee James, Drew Millar, Muhammad M Abd-El-Barr","doi":"10.21037/jss-2026-0101","DOIUrl":"10.21037/jss-2026-0101","url":null,"abstract":"<p><strong>Background: </strong>Prone lateral spine surgery has gained traction as a single-position approach due to advantages including reduced operative time, and improved lordosis restoration compared with traditional decubitus lateral approaches. Stand-alone anterior lumbar interbody fusion (ALIF) and direct lateral fusion (DLF) techniques have demonstrated reduced operative time, blood loss, length of stay, and cost compared with posteriorly instrumented constructs, though with higher reported rates of subsidence. While stand-alone instrumentation has been described for ALIF and DLF, its use in the prone lateral transpsoas approach has not previously been reported. This study presents a retrospective case series evaluating the feasibility, perioperative outcomes, and radiographic characteristics of stand-alone prone lateral lumbar interbody fusion.</p><p><strong>Case description: </strong>Eight adult patients underwent elective, single-level stand-alone prone lateral lumbar interbody fusion performed by a single surgeon at a large academic institution between May 2020 and September 2025. All patients had prior multilevel lumbar fusion and American Society of Anesthesiologists (ASA) classifications of 2 to 3. Static and expandable cages with integrated lateral plating were utilized. Operative time ranged from 80 to 194 minutes (median 112 minutes), estimated blood loss ranged from 5 to 50 mL (median 50 mL), and length of hospital stay ranged from 1 to 3 days (median 2 days). Three of eight patients required revision surgery (37.5%); one experienced postoperative numbness due to inadequate decompression and two required revision due to subsidence. Radiographic analysis demonstrated median increases in anterior disc height (6.54 mm), posterior disc height (2.75 mm), and foraminal height (2.0 mm). Median change in lumbar lordosis on both immediate postoperative and long-term imaging was ten degrees and seven degrees, respectively. Median change in segmental lordosis on immediate and long-term postoperative imaging was ten degrees and five degrees respectively.</p><p><strong>Conclusions: </strong>This case series of stand-alone prone lateral interbody fusion demonstrates the technical feasibility in select patients. While outcomes pertaining to disc height and lordotic restoration were favorable, surgeons considering this technique should be aware of the complications and revisions observed in this series. Further studies with larger cohorts and longer follow-up are needed to better define the influence of bone quality, indications, radiographic durability, and long-term outcomes of this approach.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"136"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920107","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":"Postoperative outcomes of multilevel versus single-level anterior cervical discectomy and fusion in patients with sarcopenia: a matched cohort study.","authors":"Roma Fe Mabanag, Nikhil Maddina, Ali Rteil, Farid Amirouche","doi":"10.21037/jss-2026-0140","DOIUrl":"10.21037/jss-2026-0140","url":null,"abstract":"<p><strong>Background: </strong>Anterior cervical discectomy and fusion (ACDF) remains an effective treatment for cervical degenerative pathology. However, postoperative outcomes among patients with sarcopenia following multilevel versus single-level ACDF remain poorly understood. This study compared postoperative outcomes and complications between multilevel and single-level ACDF in patients with sarcopenia.</p><p><strong>Methods: </strong>A retrospective propensity-matched cohort study was conducted using the TriNetX database, including 2,873 patients with sarcopenia identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) diagnostic codes who underwent single-level or multilevel ACDF between 2006 and 2026. One-to-one exact matching was done to control variables across multi-level ACDF and single-level ACDF cohorts. Short-term outcomes were assessed at 3 and 6 months, while long-term outcomes were evaluated at 1 and 2 years. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Independent t-tests and Chi-squared analyses were performed to compare continuous and categorical variables, respectively.</p><p><strong>Results: </strong>Sarcopenic multilevel ACDF patients demonstrated significantly higher rates of rehabilitation utilization, opioid use, and pseudoarthrosis during short-term follow-up, with persistent higher rates of pseudoarthrosis during long-term follow-up. At 3 months, multilevel ACDF patients demonstrated higher rehabilitation utilization (51.1% <i>vs.</i> 45.5%, OR 1.25, P=0.006), opioid use (88.7% <i>vs.</i> 82.6%, OR 1.65, P<0.001), and pseudoarthrosis (9.3% <i>vs.</i> 6.7%, OR 1.42, P=0.02). At 6 months, multilevel ACDF patients continued to demonstrate higher rehabilitation utilization (54.6% <i>vs.</i> 48.4%, OR 1.28, P=0.003), opioid use (88.8% <i>vs.</i> 82.6%, OR 1.67, P<0.001), and pseudoarthrosis (10.7% <i>vs.</i> 7.9%, OR 1.40, P=0.02). At 1-year, multilevel ACDF patients demonstrated higher pseudoarthrosis (12.1% <i>vs.</i> 9.2%, OR 1.36, P=0.02) and new postoperative dysphagia (13.7% <i>vs.</i> 10.2%, OR 1.41, P=0.02).</p><p><strong>Conclusions: </strong>Sarcopenic patients undergoing multilevel ACDF demonstrated higher rates of postoperative opioid use, rehabilitation utilization, pseudoarthrosis, and new postoperative dysphagia compared with those undergoing single-level ACDF. These findings should be considered for careful preoperative risk assessment, patient counseling, and postoperative monitoring.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"129"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920112","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":"Retropharyngeal hematoma following anterior cervical spine surgery: a narrative review.","authors":"Gino Lombardo, Travis Washington, Phillip Anderson, Benoit Kindo","doi":"10.21037/jss-2026-0137","DOIUrl":"10.21037/jss-2026-0137","url":null,"abstract":"<p><strong>Background and objective: </strong>Anterior cervical spine surgery (ACSS) is commonly performed for degenerative, traumatic, infectious, and neoplastic conditions of the cervical spine and is generally associated with favorable outcomes and low complication rates. However, postoperative retropharyngeal hematoma is a rare but potentially catastrophic complication due to the risk of rapid airway compromise. This narrative review summarizes the anatomy, pathophysiology, incidence, risk factors, clinical presentation, management, and outcomes of retropharyngeal hematoma following ACSS.</p><p><strong>Methods: </strong>A narrative review was performed using PubMed/MEDLINE, Google Scholar, and manual reference review. Search terms included \"anterior cervical spine surgery\", \"anterior cervical discectomy and fusion\", \"retropharyngeal hematoma\", \"postoperative cervical hematoma\", and \"airway compromise\". English-language human studies, including retrospective cohorts, case series, case reports, and relevant reviews, were included. Given the heterogeneity of available data, no formal quality scoring or meta-analysis was performed.</p><p><strong>Key content and findings: </strong>Retropharyngeal hematoma most commonly occurs within the first 24 hours after surgery, but delayed presentations after discharge have been reported. Presenting symptoms may include progressive dysphagia, hoarseness, neck swelling, stridor, dyspnea, and respiratory distress. Airway compromise primarily results from mechanical compression of the pharynx and larynx by an expanding hematoma, often with secondary soft tissue edema. Reported risk factors include multilevel surgery, coagulopathy or anticoagulation, poor perioperative blood pressure control, male sex, advanced age, medical comorbidity, ossification of the posterior longitudinal ligament (OPLL), and difficult airway morphology. Potential bleeding sources include vascular or soft-tissue oozing, as well as exposed cancellous bony endplates when open interbody cages are inadequately packed. Early recognition, airway control, emergent wound decompression when indicated, and surgical evacuation are central to management.</p><p><strong>Conclusions: </strong>Although uncommon, retropharyngeal hematoma following ACSS requires a high index of suspicion because deterioration can be rapid. Awareness of risk factors, meticulous hemostasis including bony endplate hemostasis, early postoperative monitoring, and prompt multidisciplinary airway management are essential. Prospective studies are needed to better define monitoring strategies and risk stratification models.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"137"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920069","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":"Incidence of asymptomatic early postoperative epidural hematoma in minimally invasive lumbar fusions: an exploratory prospective observational study.","authors":"Ascher B Kaufmann, Evan J Lytle, Daniel W Griepp, Chad F Claus, James Dragonette, Hepzibha Alexander, Nicole Podczervinski, Amanda Murdoch, Boyd F Richards, Lisa Govila, Daniel A Carr","doi":"10.21037/jss-2026-0150","DOIUrl":"10.21037/jss-2026-0150","url":null,"abstract":"<p><strong>Background: </strong>The incidence of all postoperative spinal epidural hematomas (SEH) following open lumbar decompression and fusions reportedly ranges from 58% to 89%. However, the incidence of asymptomatic SEH and the radiographic parameters predicting symptomatic SEH have not been established. The objective was to determine the incidence of SEH and the radiologic parameters that predict SEH becoming symptomatic following minimally invasive transforaminal lumbar interbody fusions (MiTLIF).</p><p><strong>Methods: </strong>Between January 2017 and January 2018, we prospectively studied a series of consecutive patients without new neurologic symptoms following MiTLIFs. The enrolled patients underwent gratis magnetic resonance imaging (MRI) of the lumbar spine. An additional consecutive series of patients who developed symptomatic SEH, confirmed on MRI, were retrospectively analyzed as a control. Using Merge, we measured the level of maximal compression (MC): dural sac-to-spinal canal diameter, length of MC, the volume of the thecal sac, and the ratio of preoperative/postoperative dural-sac cross-sectional area [critical ratio (CR)]. Univariate analyses compared patient hematoma risk factors between asymptomatic and symptomatic patients, radiographic parameters between asymptomatic and symptomatic compressions, and between symptomatic and asymptomatic hematomas. P<0.05 was considered significant.</p><p><strong>Results: </strong>Twelve patients developed symptomatic SEH, while 4 demonstrated asymptomatic SEH, and 26 were without hematoma. The incidence of asymptomatic SEH rate was 13.3% [95% confidence interval (CI): 3.8-30.7%] for MiTLIFs. SEH cross-sectional area was significantly larger in symptomatic than asymptomatic SEH (1.88±0.70 <i>vs.</i> 1.04±0.19, P=0.002). Between the cohorts, post-operative thecal sac cross-sectional area was significantly larger in the no hematoma group than asymptomatic or symptomatic groups (1.22±0.6 <i>vs.</i> 0.80±0.22 <i>vs.</i> 0.62±0.28, P=0.008), and CR was greatest (1.24±0.55 <i>vs.</i> 0.70±0.13 <i>vs.</i> 0.57±0.20, P<0.001), respectively.</p><p><strong>Conclusions: </strong>The incidence of SEH in asymptomatic patients following MiTLIF was lower than previously described for open surgeries. The CR may aid in determining if compression is causing symptoms.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"130"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920150","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":"Clinical burden and treatment pathways of early deep surgical site infection after lumbar spine surgery: a Vietnamese single-center descriptive study.","authors":"Vu Hoang Nguyen, Ngoc Quyen Nguyen","doi":"10.21037/jss-2026-0129","DOIUrl":"10.21037/jss-2026-0129","url":null,"abstract":"<p><strong>Background: </strong>Early deep surgical site infection (SSI) after lumbar spine surgery is uncommon, but management may require repeated surgery, negative-pressure wound therapy, prolonged antimicrobial treatment, and complex implant-related decisions. We aimed to characterize the clinical course, treatment pathways, and major treatment-burden events among affected patients.</p><p><strong>Methods: </strong>This retrospective descriptive study screened 1,923 patients who underwent primary lumbar spine surgery at a single tertiary center between October 2018 and October 2023. Sixteen patients met an operational definition adapted from Centers for Disease Control and Prevention/National Healthcare Safety Network criteria for early deep incisional or organ/space SSI within 90 days. Analyses were descriptive; an exploratory comparison of cumulative infection-related inpatient days was summarized without predictive inference.</p><p><strong>Results: </strong>Sixteen early deep SSIs were identified [crude institutional incidence, 0.83%; 95% confidence interval (CI), 0.48-1.35%]. Diagnosis occurred a median of 14.5 days after surgery [interquartile range (IQR), 6.8-20.8; range, 4-70]. Fourteen patients underwent 52 spinal reoperations; 10 required vacuum-assisted closure with 37 foam changes. Two required intensive care, two were readmitted, and no deaths occurred. Cultures yielded methicillin-susceptible Staphylococcus aureus (n=6), methicillin-resistant S. aureus (n=2), Escherichia coli (n=3), Enterococcus faecium (n=1), and Enterobacter cloacae (n=1); one culture was negative and two patients were not cultured. Eight patients experienced a major treatment-burden event: infection-related adverse outcomes (n=4), an unplanned small-bowel injury during revision (n=1), or implant-removal source-control procedures (n=3). Median cumulative infection-related inpatient duration was 46.5 days with an event and 23.0 days without an event.</p><p><strong>Conclusions: </strong>Early deep SSI was uncommon in this single-center series but imposed considerable procedural and inpatient burden among affected patients. The findings support early recognition, microbiological confirmation when feasible, careful revision planning, and coordinated multidisciplinary infection management, while avoiding causal or predictive conclusions from this small descriptive cohort.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"132"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919933","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}