Journal of spine surgery最新文献

{"title":"Rare intradural lumbar disc herniation at L1/2: a case report.","authors":"Lucia Ledererová, Peter Hudák, Dana Kuniaková, Ján Kozák, Milan Liška","doi":"10.21037/jss-2026-0106","DOIUrl":"10.21037/jss-2026-0106","url":null,"abstract":"<p><strong>Background: </strong>Intradural disc herniation (IDH) in the lumbar spine is an extremely rare condition, representing only a small percentage of all disc herniations. Despite advanced imaging techniques, IDH is often misdiagnosed as intradural tumor, disc herniation or migrated sequester. Definitive diagnosis is usually established intraoperatively and may be confirmed histologically. This case report describes an L1/2 IDH that was microsurgically removed with the assistance of intraoperative ultrasonography (IOUS) for localization of the lesion. The ventral dural tear, frequently occurring in IDH, was managed using a collagen pad, resulting in an uneventful postoperative course without evidence of cerebrospinal fluid (CSF) leak during follow-up.</p><p><strong>Case description: </strong>We present a 70-year-old female patient with acute back pain, radiating to inner thighs and paraparesis. Magnetic resonance imaging (MRI) showed intervertebral (IV) disc herniation in the L1/2 segment. Subsequent microdiscectomy assisted by IOUS revealed intradurally migrated fragments, which were carefully removed. The ventral dural tear was identified and treated using an absorbable collagen pad. At both 7-week and 18-month follow-up, the patient remained pain-free and showed no new neurological deficits or signs of CSF leakage.</p><p><strong>Conclusions: </strong>Lumbar IDH remains a rare diagnostic challenge, as preoperative imaging is often inconclusive. This case suggests that intraoperative ultrasound may aid localization of intradural pathology, while collagen-pad repair may provide a useful option for managing ventral dural defects when primary closure is technically challenging, although further research is necessary.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"124"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712846","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":"Associations of paraspinal muscle quantity and quality with patient-reported outcomes in patients aged ≥85 years undergoing lumbar spine surgery: an exploratory retrospective study.","authors":"Shutaro Yamada, Sadaaki Kanayama, Tsuyoshi Kono, Shota Takenaka","doi":"10.21037/jss-2026-0112","DOIUrl":"10.21037/jss-2026-0112","url":null,"abstract":"<p><strong>Background: </strong>Population aging has driven an increase in lumbar spine surgery among the super-elderly. The associations of preoperative paraspinal muscle quantity and quality with patient-reported outcomes in patients aged ≥85 years undergoing lumbar spine surgery remain unclear. We therefore examined these associations at baseline and 1 year after surgery.</p><p><strong>Methods: </strong>This is a retrospective observational study. Forty-three patients aged ≥85 years undergoing surgery for degenerative lumbar disorders were studied. Preoperative L3 muscle quantity [paraspinal muscle index (PMI)] and quality [computed tomography (CT) attenuation (Hounsfield units, HU); magnetic resonance imaging (MRI)-based Goutallier grading] were assessed. Patient-reported outcome measures (PROMs) were collected preoperatively and at 1 year. Associations at baseline, 1 year, and change from baseline (Δ) were examined using Spearman correlations. Multivariable linear and baseline-adjusted Firth logistic regression assessed the preoperative Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) low back pain score and treatment effectiveness, respectively. An exploratory receiver operating characteristic (ROC) analysis evaluated HU to identify low preoperative JOABPEQ low back pain scores (≤29).</p><p><strong>Results: </strong>PMI showed no statistically detectable association with any PROM in this sample. In separate exploratory multivariable models, HU and Goutallier grade showed nominal associations with the preoperative JOABPEQ low back pain score, whereas no statistically detectable association was observed for PMI; no muscle measure showed a statistically detectable association with treatment effectiveness after baseline adjustment. HU correlated positively with preoperative JOABPEQ low back pain (ρ=0.379, P=0.02), whereas Goutallier grade correlated inversely with the same PROM (ρ=-0.374, P=0.02) and with preoperative 8-Item Short Form Health Survey physical component summary (SF-8 PCS) (ρ=-0.307, P=0.048). In exploratory ROC analysis, HU showed fair discrimination for low JOABPEQ low back pain scores [area under the curve (AUC) =0.740, 95% confidence interval (CI): 0.586-0.893]; the data-derived cutoff of 33.7 HU requires external validation and is not ready for clinical application.</p><p><strong>Conclusions: </strong>In this small, single-center exploratory study, HU and Goutallier grade showed nominal associations with baseline pain-related disability, whereas PMI showed no statistically detectable association. No muscle measure showed a statistically detectable association with treatment effectiveness after baseline adjustment. Given limited power, no multiplicity adjustment, and potential selection bias, these findings require validation and should not guide preoperative decision-making.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"117"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712809","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":"Impact of incidental thoracic spinal stenosis on outcomes following lumbar fusion: propensity score-matched cohort study.","authors":"Jeremy Tze En Lim, Ashton Kai Shun Tan, Shi Ting Chiu, Christian Hwee Yee Heng, Yee Gen Lim, Marcus Zhixing Ling, Reuben Chee Cheong Soh, Lei Jiang","doi":"10.21037/jss-2026-0111","DOIUrl":"10.21037/jss-2026-0111","url":null,"abstract":"<p><strong>Background: </strong>Incidental thoracic spinal stenosis (TSS) is increasingly identified on whole-spine imaging, but its clinical significance in patients undergoing lumbar fusion remains unclear. This study aimed to evaluate whether incidental radiologic TSS is associated with postoperative outcomes following lumbar fusion.</p><p><strong>Methods: </strong>A retrospective propensity score-matched cohort study was conducted using a prospectively maintained registry [2010-2023] at a single tertiary centre. Patients with incidental radiologic TSS were matched 1:4 to controls without TSS based on age, sex, body mass index, and number of fused levels. Outcomes included Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), North American Spine Society (NASS), and 36-Item Short Form Health Survey (SF-36) at baseline, 6 months, and 2 years.</p><p><strong>Results: </strong>Both groups demonstrated meaningful improvements in pain, disability, and quality-of-life outcomes at 6 months and 2 years. No significant between-group differences were observed in pain, disability, or quality-of-life outcomes at 6 months or 2 years (all P>0.05). During follow-up, 9/27 patients (33.3%) with TSS required thoracic surgery, whereas none in the control group did.</p><p><strong>Conclusions: </strong>In this propensity score-matched cohort, no statistically significant differences in lumbar fusion outcomes were detected between patients with and without incidental radiologic TSS at 6 months or 2 years. However, the subsequent thoracic surgery rate of 33.3% suggests that incidental TSS should not be considered clinically benign and may warrant ongoing surveillance for neurological progression.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"113"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712905","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":"Depth-adapted portal design for unilateral biportal endoscopic discectomy in a morbidly obese patient (BMI 41): technical considerations.","authors":"Shinya Arataki, Akiyoshi Miyamoto, Tadashi Komatsubara, Masato Tanaka","doi":"10.21037/jss-2026-0126","DOIUrl":"10.21037/jss-2026-0126","url":null,"abstract":"<p><p>Morbid obesity increases operative depth and soft-tissue thickness in lumbar spine surgery, potentially complicating portal placement and working-corridor stability in unilateral biportal endoscopic (UBE) procedures. Although previous studies have reported acceptable clinical outcomes of UBE in obese patients, technical considerations for depth-adapted portal design and working corridor management at extreme operative depths have not been sufficiently described. A male patient in his late 20s, with a height of 183 cm and body weight of 137 kg (body mass index 41 kg/m2), presented with a large left L5/S1 lumbar disc herniation. Preoperative imaging suggested a deep operative corridor, with the relevant working depth ranging approximately from 80 to 100 mm depending on the laminar working area and the oblique trajectory toward the L5/S1 disc space. Because the skin contours were incompletely visualized on preoperative computed tomography (CT) due to the patient's body habitus, intraoperative O-arm navigation was used as an adjunctive tool to confirm and refine the planned portal trajectories. Two 10-mm longitudinal skin incisions were created approximately 23 mm lateral to the midline, with an interportal distance of 35 mm. Adequate fascial release wider than the skin incisions was performed to reduce soft-tissue constraint at the fascial level. UBE discectomy was completed without dural injury or technical restriction, using standard UBE instruments. Postoperatively, radicular symptoms improved promptly without neurological deficits. This case illustrates depth-dependent amplification of soft-tissue constraints in UBE. As operative depth increases, small restrictions at the fascial level may proportionally narrow the functional working corridor. Adequate fascial release and thoughtful portal spacing may help preserve triangulation and facilitate irrigation outflow in deep operative fields. Rather than proposing a fixed portal template or requiring navigation, this report emphasizes individualized, depth-aware portal planning. Navigation may be useful in selected extreme cases when surface anatomy is difficult to evaluate reliably, but the same planning principles may also be applied using fluoroscopy and careful preoperative CT/MRI assessment. In morbidly obese patients with substantial operative depth, depth-aware portal planning combined with tailored fascial management may improve the reproducibility and technical stability of UBE discectomy. These findings should be interpreted as technical observations from a single case.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"122"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712783","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":"Outcomes of 3D-printed titanium cages for surgical reconstruction in infectious spondylodiscitis: a systematic review.","authors":"Wentian Li, Akina Li, Gayani Petersingham, Prashanth J Rao","doi":"10.21037/jss-2026-1-0017","DOIUrl":"10.21037/jss-2026-1-0017","url":null,"abstract":"<p><strong>Background: </strong>Infectious spondylodiscitis remains a complex spinal condition that may require surgical debridement and interbody reconstruction in cases of instability, deformity, or failure of medical management. Conventional reconstructive options include titanium mesh cages (TMC) and polyetheretherketone (PEEK) cages; however, three-dimensional printed titanium (3DPT) cages have been increasingly adopted due to their porous architecture and potential to enhance osseointegration. The clinical performance of 3DPT cages in the setting of spinal infection has not been well defined. This study aimed to qualitatively summarise the currently available direct and contextual evidence regarding the use of 3DPT cages for spinal reconstruction in infectious spondylodiscitis.</p><p><strong>Methods: </strong>A systematic literature search of EMBASE, MEDLINE, and Cochrane Library was conducted up to December 2025. Studies reporting outcomes following spinal reconstruction using 3DPT cages in adult patients with infectious spondylodiscitis were included. Surgical parameters, radiological outcomes (including fusion and subsidence), and clinical outcomes were extracted and synthesised qualitatively due to heterogeneity in study design and outcome reporting.</p><p><strong>Results: </strong>A total of seven studies were included in this review. Among these, only one study directly evaluated 3DPT cages specifically in infectious spondylodiscitis, while the remaining studies provided indirect or contextual evidence from mixed-pathology or degenerative spinal cohorts. Overall, the available evidence remains highly limited and heterogeneous, with substantial variability in study design, outcome reporting, and follow-up duration.</p><p><strong>Conclusions: </strong>Only limited direct evidence is currently available regarding the use of 3DPT cages in infectious spondylodiscitis. While early reports suggest that these implants may be feasible for spinal reconstruction, the current evidence base is highly limited, indirect, and heterogeneous, preventing definitive conclusions regarding clinical effectiveness or superiority over conventional interbody devices. Therefore, these findings should be interpreted as hypothesis-generating rather than practice-changing. Future well-designed prospective and comparative studies with standardised outcome measures are required to better define their role and enable meaningful meta-analysis.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"12 7","pages":"118"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712631","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":"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":"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":"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":"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}