Journal of spine surgery最新文献

{"title":"Associations between preoperative biomarkers and patient-reported outcomes after single-level lumbar discectomy: a systematic review.","authors":"Shailen G Sampath, Colin J Willoughby, Jay M Iyer, Miles L Botkiss, Christopher Pawul, Harrison J Howell, Pavan S Upadhyayula, Farhan A Khan, Vivian P Le, Nadeen O Chahine, Dean Chou, Andrew K Chan","doi":"10.21037/jss-2026-1-0060","DOIUrl":"10.21037/jss-2026-1-0060","url":null,"abstract":"<p><strong>Background: </strong>Single-level discectomy is among the most frequently performed spine procedures for radiculopathy due to disc herniation. Although most patients improve, a subset experiences suboptimal recovery, disability, or reoperation. Current preoperative risk stratification remains limited, highlighting the need for objective biomarkers that can improve the prediction of postoperative outcomes. The objective of this study is to review the effect of biomarkers on standard patient outcomes, identify consistencies and gaps in the literature, and outline priorities for biomarker panel standardization to support clinically meaningful prediction in discectomy.</p><p><strong>Methods: </strong>We conducted a systematic review in accordance with PRISMA guidelines. PubMed, Embase, and the Cochrane Library were searched from inception to August 27, 2025, using terms for discectomy procedures, serum/tissue biomarkers, and PROs. Eligible studies enrolled adults undergoing single-level discectomy, measured biomarkers pre- or intra-operatively, and reported associations with PROs such as Visual Analog Scale (VAS), Oswestry disability Index (ODI), or EuroQol 5-Dimension Questionnaire (EQ-5D). Three authors independently performed screening, data extraction, and risk-of-bias assessment. Risk of bias was assessed using the Newcastle-Ottawa scale for observational studies.</p><p><strong>Results: </strong>Eight studies met inclusion criteria. Given heterogeneity in biomarkers, assays, and outcome reporting, findings were synthesized narratively by biomarker class; quantitative meta-analysis was not feasible. Across cohorts, pro-inflammatory cytokines consistently predicted worse outcomes: higher preoperative interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) were associated with higher postoperative VAS and ODI scores, and higher preoperative IL-1β was associated with higher postoperative VAS scores. The acute phase reactant C-reactive protein (CRP) was associated with increased VAS scores. In addition, regulatory cytokine transforming growth factor beta 1 (TGF-β1) corresponded to worse postoperative VAS. In contrast, anti-inflammatory/type-2 signaling with higher IL-4 correlated with greater VAS improvement. Brain-derived neurotrophic factor (BDNF) was also inversely correlated with worse VAS scores in specific studies.</p><p><strong>Conclusions: </strong>Preoperative biomarker profiles provide prognostic value for patient outcomes following single-level discectomy. Standardized, prospective studies using multivariable biomarker panels are warranted to validate current findings and establish quantitative prognosis.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"120"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712850","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":"L5-S1 basivertebral nerve ablation for chronic vertebrogenic low back pain following lumbar fusion: a case report.","authors":"Jaimin Shah, Justin Hyun, Nickul S Jain","doi":"10.21037/jss-2026-0097","DOIUrl":"10.21037/jss-2026-0097","url":null,"abstract":"<p><strong>Background: </strong>Basivertebral nerve ablation (BVNA) is an established treatment for vertebrogenic low back pain associated with Modic endplate changes, but trials and current on-label use have excluded patients with prior lumbar fusion. The clinical efficacy of BVNA has been established in the SMART (Surgical Multi-Center Assessment of RF Therapy) and INTRACEPT trials. Patients with prior lumbar fusion with symptomatic vertebrogenic low back pain were excluded from these major trials, but remain a clinically significant subgroup of patients who may benefit from BVNA.</p><p><strong>Case description: </strong>A 55-year-old man presented with severe chronic axial low back pain persisting for more than 5 years after stand-alone L5-S1 interbody fusion performed in 1995. Pain was predominantly midline and mechanical, worsened by sitting, bending, lifting, and driving, and improved with standing or walking. He had failed extensive conservative and interventional therapies including nonsteroidal anti-inflammatory drugs, acetaminophen, epidural steroid injections, facet injections, medial branch blocks, sacroiliac joint injections, radiofrequency ablations, prolotherapy, acupuncture, and chiropractic care. Preoperative visual analog scale (VAS) score was 7/10 and Oswestry Disability Index (ODI) was 48%. Computed tomography showed a stable fusion construct without evidence of pseudoarthrosis or hardware complication. Magnetic resonance imaging demonstrated Modic type 2 endplate changes at L5-S1 adjacent to the fusion cages, supporting a vertebrogenic pain generator. The patient underwent fluoroscopically guided BVNA at L5 and S1 without complication. At 12 months, VAS was 3/10 and ODI 16%, exceeding the minimum clinically important difference (MCID) for spine surgery. The patient reported a 75% subjective improvement and return to unrestricted occupational activity.</p><p><strong>Conclusions: </strong>This case suggests that off-label BVNA may provide meaningful and durable relief in carefully selected post-fusion patients with persistent vertebrogenic pain and persistent Modic changes.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"123"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712378","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":"Erratum: Zero-profile interbody fusion in single and two-level anterior cervical discectomy and fusion: a novel surgical system and its indications.","authors":"","doi":"10.21037/jss-20262-01","DOIUrl":"10.21037/jss-20262-01","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.21037/jss-2025-aw-212.].</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"127"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712918","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":"Improving operating room turnover efficiency with a real-time workflow coordination software in adult degenerative spine surgery.","authors":"Zachary G Brumm, Megha R Aepala, Justin K Gottlieb, Paul D Kim, Evan Nigh, Adam Barrus, Robyn Bowler, Jodi Britton, Sophea R Bergen, Stephanie L Haua, Mary F Makabenta, Sally Pusch, Susie Stephens, Josielyn Fishell, Hiedylyn Iligan, Isabella Airada, Vendellyn J Tegura, Vinalyn Ortega, Kayla Iniguez, Jessica Reyes, Nidya Iribe, Brittany Duda, Maria E Delos Santos, Ramin Raiszadeh","doi":"10.21037/jss-2026-0099","DOIUrl":"10.21037/jss-2026-0099","url":null,"abstract":"<p><strong>Background: </strong>Operating room (OR) efficiency represents a critical determinant of surgical productivity, cost-effectiveness, workforce wellness, and patient access to care. Among its modifiable components, turnover time (TOT), the interval between patient exit and subsequent patient entry, is a key target for operational improvement. This study describes the impact of the S1 Pit Crew™ platform, a real-time, role-based OR workflow coordination software, on TOT using adult degenerative spine surgery as a representative test environment.</p><p><strong>Methods: </strong>This study examined prospectively collected perioperative and turnover workflow data from 51 consecutive elective adult degenerative spine surgery cases performed at a single hospital following S1 Pit Crew™ platform implementation. Baseline TOT was derived from institutional records of cases performed over the year preceding implementation and was used for descriptive comparison. The platform delivered real-time, role-specific task prompts and shared situational awareness across all perioperative team members via synchronized multi-device displays, enabling prospective collection of turnover and perioperative workflow data. A total of 24-time parameters were collected and aggregated into four key time interval durations including Stage 1: perioperative time interval #1 (dressing to wheels-out); Stage 2: turnover time (wheels-out to wheels-in); Stage 3: perioperative time interval #2 (wheels-in to incision); and total elapsed skin-to-skin time. Cases were stratified into initial (N=26) and subsequent (N=25) cohorts to assess efficiency with continued utilization and key time interval durations were also compared across procedure types, surgeon, OR, and case order.</p><p><strong>Results: </strong>Mean TOT was 26.5 minutes following platform implementation, compared with a baseline institutional average of 38.0 minutes, representing a 30.3% descriptive difference. TOT decreased significantly between the initial (28.9±7.7 minutes) and subsequent cohort (23.9±3.7 minutes) (P=0.02). Perioperative time intervals did not differ significantly between initial and subsequent cohorts (P>0.05). All key time interval durations were similar across procedure types, surgeons, ORs, and case order (P>0.05).</p><p><strong>Conclusions: </strong>After implementation of the S1 Pit Crew™ platform, mean TOT was descriptively 30.3% lower than the prior institutional baseline, with improvement observed with continued utilization and similar time durations across procedure types of varying complexity. Through standardizing workflow with real-time, shared task visibility, the platform functions as a behavioral coordination tool while also promoting accountability and enabling identification of inefficiencies. Real-time workflow coordination through the S1 Pit Crew™ platform may represent a scalable approach to improving OR efficiency across surgical environments.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"109"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712879","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-level cervical disc arthroplasty is associated with higher early subsequent surgery rates and similar adjacent segment disease rates compared with anterior cervical discectomy and fusion.","authors":"Muhammad Waheed, Abdul-Lateef Shafau, Sazid Hasan, Alqasim Elnaggar, Tarek Harhash, Kareem Oulabi, Ahmad Almaat, Abdel Kareem Hilo, Syed Kazi, Bashar Jawich, Haytham Alqasmi, Rahul Vaidya","doi":"10.21037/jss-2026-0094","DOIUrl":"10.21037/jss-2026-0094","url":null,"abstract":"<p><strong>Background: </strong>Cervical disc arthroplasty (CDA) is a motion-preserving alternative to anterior cervical discectomy and fusion (ACDF), but its comparative long-term durability remains debated. This study aimed to compare short- and long-term postoperative outcomes following single-level CDA versus ACDF.</p><p><strong>Methods: </strong>A retrospective propensity-matched cohort study was performed using a large national administrative database. Adult patients undergoing single-level CDA or ACDF without prior spine surgery were identified and matched 1:1, yielding 3,138 patients per cohort. Outcomes were assessed at 1, 2, 5, and 10 years postoperatively.</p><p><strong>Results: </strong>At 1 year, CDA was associated with lower rates of pulmonary embolism/deep venous thrombosis (PE/DVT) [0.6% <i>vs.</i> 1.2%; risk ratio (RR) 0.526, P=0.02] and neurovascular injury (0.4% <i>vs</i>. 1.3%; RR 0.333, P<0.001), while other short-term complications were similar. At 2 and 5 years, CDA demonstrated higher rates of subsequent cervical spine surgery (1.5% <i>vs</i>. 0.7%, P=0.003; 1.9% <i>vs</i>. 1.1%, P=0.02), although this difference was no longer significant at 10 years. CDA also showed lower long-term rates of infection, PE/DVT, and nerve injury. No significant differences were observed in adjacent segment disease (ASD) or cervical spondylolisthesis.</p><p><strong>Conclusions: </strong>Single-level CDA was associated with higher early revision and subsequent surgery rates and similar ASD rates compared with ACDF. Although CDA showed lower rates of select complications, these differences may not outweigh the increased intermediate-term reoperation burden.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"110"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712788","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":"Kyphoplasty for vertebral compression fractures: the blue zone effect.","authors":"David Shin, Elijah Haynal, Rekha Isaac, Graydon Dietrich, Hyun Ah Park, Daniel Im, Jeffrey Lubisich, Brandon Edelbach, Othman Bin-Alamer, Rasha Elbadry, Peter Zaki, Namath Hussain","doi":"10.21037/jss-2026-0095","DOIUrl":"10.21037/jss-2026-0095","url":null,"abstract":"<p><strong>Background: </strong>Kyphoplasty effectively treats vertebral compression fractures (VCFs) but carries risks of perioperative complications and readmissions. Blue zones, regions characterized by longevity and reduced chronic disease, provide a unique opportunity to examine how lifestyle factors may influence surgical outcomes. This study investigated how patient demographics, health status, surgical factors, and geographic location, particularly residence in a blue zone, affected kyphoplasty outcomes.</p><p><strong>Methods: </strong>A retrospective cohort review of 372 patients undergoing kyphoplasty for VCFs from January 2009 to May 2025 was conducted at a single, tertiary care institution. Patients were divided into blue zone or non-blue zone by postal codes. 1:3 propensity score matching (PSM) was used to minimize bias and multivariable logistic regression analyzed outcomes. A 10-year Kaplan-Meier survival curve was formulated utilizing a log-rank test.</p><p><strong>Results: </strong>A total of 190 patients (175 non-blue zone and 15 blue zone patients) were available after exclusion. In the unmatched cohort, tobacco usage was associated with higher 30-day readmissions. Increased length of stay (LOS) was associated with higher American Society of Anesthesiologists (ASA) scores, older age, diabetes, mechanical expansion, and greater estimated blood loss (EBL). Thoracolumbar involvement increased neurological complications, while a bilateral approach reduced incidence. Blue zone patients had significantly lower alcohol (0% <i>vs.</i> 34-64%) and tobacco use (7% <i>vs.</i> 43-47%) than non-blue zone patients in both unmatched and 1:3 PSM cohorts. No other significant differences in outcomes were observed.</p><p><strong>Conclusions: </strong>Our findings reinforce the significance of traditional risk factors including age, ASA score, diabetes, and tobacco use, as key indicators of kyphoplasty outcomes. Blue zone kyphoplasty patients demonstrated markedly healthier lifestyles, such as reduced alcohol and tobacco use. The present small-sized matched analyses demonstrated that while lifestyle and environmental factors may delay onset of chronic disease and VCF occurrence, no detectable association was identified between blue zone residence and kyphoplasty outcomes.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"111"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712889","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":"Age predicts long-term functional outcomes following vertebroplasty for osteoporotic vertebral compression fractures: a retrospective cohort study.","authors":"Jeremy Tze En Lim, Yong Ng, Yee Gen Lim, Zhixing Marcus Ling, Reuben Chee Cheong Soh, Lei Jiang, Christian Hwee Yee Heng","doi":"10.21037/jss-2026-0131","DOIUrl":"10.21037/jss-2026-0131","url":null,"abstract":"<p><strong>Background: </strong>Vertebroplasty provides effective pain relief for osteoporotic vertebral compression fractures; however, determinants of long-term functional recovery remain incompletely defined. This study aimed to evaluate baseline predictors of long-term patient-reported outcomes following vertebroplasty.</p><p><strong>Methods: </strong>Ninety-two patients who underwent percutaneous vertebroplasty between 2010 and 2022 with complete patient-reported outcome measures (PROMs) at baseline, 6 months, and 2 years were included. The primary outcome was Short Form-36 (SF-36) Physical Function at 2 years. Multivariable linear regression models adjusted for baseline PROMs were used to evaluate associations with age, sex, vertebral region, and number of treated levels.</p><p><strong>Results: </strong>Mean age was 76.5±8.4 years, and 82.6% were female. Significant improvements were observed in Oswestry Disability Index (ODI) scores (77.3 to 25.3), SF-36 Physical Function (9.2 to 41.8), and visual analogue scale (VAS) back pain scores (8.0 to 1.7) at 2 years (all P<0.001). Increasing age was independently associated with poorer 2-year SF-36 Physical Function [β=-17.45 per 10-year increase; 95% confidence interval (CI): -24.43 to -10.47; P<0.001]. Procedural variables were not associated with postoperative outcomes. Baseline physical function demonstrated moderate correlation with postoperative outcomes (r=0.40-0.44) but was not independently predictive after adjustment.</p><p><strong>Conclusions: </strong>Vertebroplasty was associated with sustained improvement in pain and function. Increasing age was the strongest observed independent predictor of poorer long-term physical function within this cohort, whereas procedural variables were not significantly associated with postoperative outcomes. These findings suggest that long-term functional recovery following vertebroplasty may be associated more strongly with patient-related than procedural factors within this cohort.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"115"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712833","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":"A decade of impact: the <i>Journal of Spine Surgery</i> enters its next phase.","authors":"Ralph J Mobbs","doi":"10.21037/jss-20262-04","DOIUrl":"10.21037/jss-20262-04","url":null,"abstract":"","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"108"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712811","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":"Motion-preserving direct osteosynthesis for a C2 complex fracture involving the vertebral body and posterior elements: a case report.","authors":"Yohei Miyamoto, Ichiro Okano, Yusuke Dodo, Yuta Urabe, Yoshifumi Kudo","doi":"10.21037/jss-2026-0055","DOIUrl":"10.21037/jss-2026-0055","url":null,"abstract":"<p><strong>Background: </strong>Surgical treatment of C2 fractures often involves fixation across C1-2, which restricts atlantoaxial motion. Because the C1-2 segment plays a major role in cervical mobility, motion-preserving strategies may be desirable in selected cases. We report a case of a complex C2 fracture treated with navigation-assisted motion-preserving fixation.</p><p><strong>Case description: </strong>A 54-year-old man sustained multiple injuries in a motor vehicle collision, including a C2 fracture involving the vertebral body and posterior elements. He presented with neck pain but no neurological deficits. Computed tomography (CT) demonstrated a fracture line extending from the left vertebral body to the right lamina with minimal displacement. CT angiography showed no vertebral artery injury. The patient remained hemodynamically stable. Considering his occupational demands and preference for early return to activity, surgical treatment was performed on hospital day 5. Under intraoperative navigation, direct osteosynthesis was achieved. A lag screw was inserted to reduce and compress the displaced laminar component. Bilateral pars screws connected by a rod were placed to augment stability without crossing adjacent motion segments or performing fusion. The postoperative course was uneventful. The patient was mobilized early with a hard cervical collar and discharged on postoperative day 12. At 13 months, CT confirmed solid bony union. The patient remained symptom-free with preserved cervical range of motion.</p><p><strong>Conclusions: </strong>Motion-preserving fixation using navigation-assisted direct osteosynthesis achieved stable union in a complex C2 fracture involving both anterior and posterior elements. In carefully selected patients, this strategy may serve as a viable alternative to C1-2 fusion.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"125"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712664","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 Konakondla-Telfeian-Shen (KTS) Pyramid: a safe entry zone for ventral thoracic pathologies.","authors":"Sanjay Konakondla, Shailen G Sampath, Isaac Lee, Jian Shen, Albert Telfeian","doi":"10.21037/jss-2026-0080","DOIUrl":"10.21037/jss-2026-0080","url":null,"abstract":"<p><strong>Background: </strong>Transforaminal (TF) endoscopic access to the lumbar spine has long relied on Kambin's triangle as a posterolateral safe zone. As endoscopic indications expand, there are fundamental differences in thoracic anatomy that Kambin's triangle does not account for, including smaller foraminal dimensions, the presence of the spinal cord, cranio-caudal pedicle angulation, and the rib head-costovertebral complex. To date, no formal anatomic framework exists to standardize thoracic TF planning. The objective of this study is to define and describe a three-dimensional thoracic TF working corridor, the Konakondla-Telfeian-Shen (KTS) Thoracic Pyramid, and to propose a standardized anatomic language and preoperative planning framework for endoscopic access to ventral thoracic pathology.</p><p><strong>Methods: </strong>The thoracic TF corridor is conceptualized as a six-faced three-dimensional volume. Level-dependent anatomic constraints, including the rib head-costovertebral complex, pedicle morphology, spinal cord position, and segmental vascular anatomy, are incorporated. Variations due to degeneration, fusion, prior surgery, and vascular anatomy are discussed within this geometric framework.</p><p><strong>Results: </strong>The KTS Pyramid defines a reproducible, level-specific posterolateral access corridor to the ventral thoracic canal. The corridor predictably narrows from T12 to T1 as the rib head and costovertebral joint migrate cranially toward the disc plane and pedicle angulation increases. This framework identifies which anatomic \"face\" of the pyramid limits access at each thoracic level.</p><p><strong>Conclusions: </strong>The KTS Pyramid provides a formal geometric and anatomic description of a thoracic TF working corridor. By standardizing thoracic endoscopic planning with level-specific boundaries and terminology, this framework supports safer access to ventral thoracic pathology, shortens the learning curve, and enables consistent communication, training, and future comparative research in thoracic endoscopic spine surgery.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"112"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712806","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}