Journal of spine surgery最新文献

{"title":"Tumor occupancy ratio as a predictor of neurological recovery after hemilaminectomy for intradural spinal tumors.","authors":"Anusorn Mungmee, Prachya Punyarat","doi":"10.21037/jss-2026-0128","DOIUrl":"10.21037/jss-2026-0128","url":null,"abstract":"<p><strong>Background: </strong>Hemilaminectomy is increasingly used as a less invasive alternative to conventional laminectomy for resection of intradural spinal tumors. This study aimed to evaluate whether the tumor occupancy ratio on preoperative axial magnetic resonance imaging (MRI) was associated with postoperative neurological improvement after hemilaminectomy for selected intradural spinal tumors and to describe the surgical outcomes of this approach.</p><p><strong>Methods: </strong>We retrospectively reviewed adult patients who underwent hemilaminectomy for intradural spinal tumors between 2018 and 2024 at a single institution and had at least 6 months of follow-up. Neurological status was assessed preoperatively and at the last follow-up using the modified McCormick scale (MMS). Clinical, radiographic, and operative variables, including tumor occupancy ratio on axial MRI, were analyzed using univariate tests and multivariable logistic regression.</p><p><strong>Results: </strong>Forty-six patients were included (mean age 56.3±14.0 years; 78% female). Gross total resection was achieved in 44 of 46 patients (96%). The mean hemilaminectomy corridor ratio, measured as the hemilaminectomy width divided by the interpedicular distance, was 0.55±0.12. At the last follow-up (median 27 months), 37 patients (80.4%) showed neurological improvement. Two patients (4.3%) developed postoperative neurological deterioration. On univariate analysis, sagittal tumor extent, operative time, blood loss, and tumor occupancy ratio were associated with MMS improvement. On multivariable analysis, tumor occupancy ratio was the only variable independently associated with postoperative neurological non-improvement [odds ratio (OR) 1.31, 95% confidence interval (CI): 1.02-1.68; P=0.03].</p><p><strong>Conclusions: </strong>Hemilaminectomy achieved a high rate of gross total resection with favorable neurological outcomes in selected patients with solid intradural spinal tumors. Tumor occupancy ratio was associated with postoperative neurological outcome and may be useful as a preoperative prognostic imaging marker, although further validation is required.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"133"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920117","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 radiculopathy following the use of a flowable gelatin-based hemostatic matrix in endoscopic lumbar spine surgery: two case reports of uniportal and biportal decompression procedures.","authors":"Ramon Guerra Barbosa, Adam Li, Benjamin Mingzheng Yu, Newton Pimenta","doi":"10.21037/jss-2026-0136","DOIUrl":"10.21037/jss-2026-0136","url":null,"abstract":"<p><strong>Background: </strong>Hemostatic matrices such as SURGIFLO are widely used in spine surgery because they provide rapid and effective hemostasis. Although these agents are generally considered safe, rare cases of postoperative neural compression secondary to their expansion have been reported in open spine surgery, but such complications in endoscopic lumbar decompression procedures remain poorly described. We report two cases of delayed postoperative radiculopathy associated with expanded SURGIFLO following uniportal and biportal endoscopic lumbar decompression.</p><p><strong>Case description: </strong>Case 1 involved a 61-year-old woman with severe L4-L5 lumbar spinal stenosis who underwent biportal endoscopic unilateral laminotomy for bilateral decompression (ULBD) and was discharged home the same day with improvement of her symptoms. Seven days postoperatively, she developed progressive bilateral lower extremity pain and impaired mobilization. The magnetic resonance imaging demonstrated a compressive epidural collection at L4-L5. Surgical exploration revealed that the expanded hemostatic matrix caused compression of the dural sac and nerve roots. Endoscopic removal of the material resulted in complete neurologic recovery. Case 2 involved an 82-year-old man with single level L4-L5 symptomatic lumbar stenosis who underwent uniportal endoscopic ULBD. One month postoperatively, he presented severe recurrent lumbar radiculopathy and inability to ambulate. Revision surgery demonstrated the expanded gelatin matrix compressing the neural structures. Removal of the compressive material led to symptom resolution.</p><p><strong>Conclusions: </strong>These cases demonstrate that postoperative expansion of SURGIFLO may cause delayed neural compression following endoscopic decompression. We recommend using a minimal amount of such agent and washing it out once hemostasis is achieved. Endoscopic revision seems to be a safe approach to remove compressive SURGIFLO to resolve the postoperative radiculopathy.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"139"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI parameters for enhancing spine surgery outcomes: a narrative review.","authors":"Jaden Wise, Isabella Merem, Justin Gumbs, Zachary Comella, Angela Rodio, Victoria Lin, Victoria Verrengia, Rudy Paul, Min Shi, Maohua Lin, Frank D Vrionis","doi":"10.21037/jss-2026-0130","DOIUrl":"10.21037/jss-2026-0130","url":null,"abstract":"<p><strong>Background and objective: </strong>Artificial intelligence (AI) is increasingly applied in spine surgery for diagnosis, operative planning, intraoperative guidance, and outcome prediction. However, reported technical performance does not always translate into clinical reliability. This narrative review evaluates how parameter-level decisions influence the reliability and clinical translation of AI models in spine surgery.</p><p><strong>Methods: </strong>A structured literature search of PubMed, Scopus, and Google Scholar was performed for English-language studies published from January 2015 through March 2025. Search terms combined spine surgery concepts with AI, machine learning, deep learning, hyperparameters, learning rate, feature selection, regularization, model validation, and training strategy. Studies were synthesized narratively according to recurring parameter domains and clinical implementation context.</p><p><strong>Key content and findings: </strong>Across preoperative, intraoperative, and postoperative applications, learning rate, feature selection, regularization, model architecture, optimization strategy, and evaluation metrics shaped convergence behavior, overfitting risk, interpretability, calibration, and external validity. Reported performance varied substantially by task, dataset, outcome definition, and validation strategy. Common limitations included retrospective single-center datasets, inconsistent parameter reporting, limited external validation, and challenges related to bias, interpretability, workflow integration, and model drift.</p><p><strong>Conclusions: </strong>AI reliability in spine surgery depends on parameter-level development choices rather than algorithm selection alone. More standardized reporting, calibration assessment, prospective validation, and lifecycle monitoring are needed before AI tools can be integrated safely into spine surgery workflows.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"138"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919752","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: Real-world outcomes of minimally invasive posterior thoracic and lumbar spine fusion surgery versus open surgery in the Finnish Spine Registry.","authors":"","doi":"10.21037/jss-20262-02","DOIUrl":"10.21037/jss-20262-02","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.21037/jss-2026-1-0025.].</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"141"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920073","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":"Pedicle subtraction osteotomy using ultrasonic bone curette yields fewer durotomies, decreased blood loss: a single surgeon's retrospective experience.","authors":"Benjamin S Succop, Elias Mohammad, Stephen M Bergin, Andrew Abumoussa, Aaron Gelinne, Brett Rocos, Muhammad M Abd-El-Barr, Deb Bhowmick","doi":"10.21037/jss-2026-1-0020","DOIUrl":"10.21037/jss-2026-1-0020","url":null,"abstract":"<p><strong>Background: </strong>Pedicle subtraction osteotomy (PSO) is a three column deformity correction technique that can achieve 30 to 40 degrees of correction and is best used for patients with severe rigid sagittal imbalances. Patients report a high degree of satisfaction with quality of life outcomes as a consequence of undergoing PSO. However, complications range between 12% and 40%, including dural tears or neurovascular injuries causing neurological deficit occurring as a consequence of high speed drilling or traction from the spooned retractors used to facilitate exposure. Ultrasonic bone curettes may provide a safer alternative to the drill and retractor approach. The purpose of this retrospective study was to compare outcomes between newer spoonless ultrasonic bone curettage and traditional high speed drilling with paravertebral spoon retractors for pedicle subtraction osteotomies.</p><p><strong>Methods: </strong>All patients undergoing PSO with a single surgeon across two academic health institutions in the past eight years were reviewed. Preoperative variables obtained were demographics, prior spine surgeries, and etiology, while intraoperative predictor variables were ultrasonic bone curettage use and number of fused levels. The principal outcomes were surgical: duration of surgery, estimated blood loss (EBL), incidence of durotomies, and neurovascular injury. Secondary outcomes were postoperative: length of stay, need for revision surgery, minor complications, and major complications. Multiple logistic regression was used to evaluate associations with binary outcomes, while multiple linear regression evaluated correlations with continuous outcomes.</p><p><strong>Results: </strong>Overall, 175 patients were reviewed. In this sample, 89 (51%) had prior surgeries, and 45 (26%) were treated with the ultrasonic bone curettage. Intraoperatively, the mean EBL was 1,105 mL (range, 350-3,000 mL), 29 (17%) of participants sustained durotomies, 14 (8%) experienced neurovascular injury, and the mean duration of surgery was 401 mins (range, 135-695 mins). Postoperatively, 35 (20%) experienced minor complications, 25 (14%) experienced major complications, and mean length of stay was 11 days (range, 2-80 days). Ultrasonic bone curettage use correlated with decreased blood loss (β =-270 mL, P=0.004) and was associated with decreased incidence of durotomy [odds ratio (OR) =0.29, P=0.042].</p><p><strong>Conclusions: </strong>Use of spoonless ultrasonic bone curettage in PSO was associated with significantly less blood loss and fewer durotomies compared to traditional drilling in this single surgeon's multi-institutional experience.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 8","pages":"134"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920109","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":"Intraoperative three-dimensional imaging-guided vertebral body stenting for cleft-associated very severe osteoporotic vertebral compression fractures: a surgical technique case series.","authors":"Hiroki Eguchi, Yosuke Nakayama, Eitaro Okumura, Ryo Hashimoto, Motoo Kubota, Shigekuni Tachibana","doi":"10.21037/jss-2026-0124","DOIUrl":"10.21037/jss-2026-0124","url":null,"abstract":"<p><p>Very severe osteoporotic vertebral compression fractures (vsOVCF) associated with intravertebral clefts represent a technically challenging subgroup of vertebral augmentation because of severe vertebral collapse, distorted intravertebral anatomy, and increased risk of cement leakage. Conventional fluoroscopy alone may be insufficient for accurate device positioning in these cases. We describe the surgical technique and technical utility of intraoperative three-dimensional (3D) imaging during vertebral body stenting (VBS) in three consecutive patients with cleft-associated vsOVCF without neurological deficits. All patients demonstrated intravertebral clefts on preoperative imaging. The procedure was performed using a bilateral transpedicular approach under biplanar fluoroscopy with adjunctive intraoperative 3D rotational imaging. Intraoperative 3D imaging enabled confirmation of balloon and stent positioning within residual cancellous bone rather than within the cleft cavity. Vertebral height restoration ranged from 9% to 18%, and all patients experienced marked pain relief, with mean Numerical Rating Scale scores improving from 8.0 preoperatively to 1.0 postoperatively. Cement leakage into the adjacent disc occurred in two cases, although no spinal canal leakage or symptomatic complications were observed. Postoperative computed tomography at 3 and 6 months demonstrated maintained vertebral height without recollapse, osteonecrosis, or implant-related complications. Intraoperative 3D imaging may serve as a useful technical adjunct for safer and more controlled VBS in anatomically complex fractures.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"121"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

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

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

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