Spine最新文献

{"title":"Efficacy of Liposomal Bupivacaine for Pain Control in Pediatric Patients With Adolescent Idiopathic Scoliosis Undergoing Instrumented Posterior Spinal Fusion.","authors":"Vishal Sarwahi, Alexander Morledge, Anabelle Cohen, Katherine Eigo, Effat Rahman, Sarah Trent, Swara Kalva, Viraaj Sarwahi, Jon-Paul DiMauro, Jeremy Nikfarjam, Yungtai Lo, Terry Amaral","doi":"10.1097/BRS.0000000000005548","DOIUrl":"10.1097/BRS.0000000000005548","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>This study aimed to compare perioperative pain outcomes in adolescent idiopathic scoliosis (AIS) patients who either did or did not receive a liposomal bupivacaine (LB) injection during their posterior spinal fusion (PSF).</p><p><strong>Summary of background data: </strong>Liposomal bupivacaine (LB) has been promoted for its apparent long-lasting effects on pain management when compared with standard formulations. Many studies in adult spine populations have been carried out with varying results but few studies have investigated LB's effect in the pediatric population.</p><p><strong>Methods: </strong>Four hundred seventy-two pediatric patients with spine deformity undergoing posterior spinal fusion (PSF) between 2018 and 2024 were included. Starting early 2018, patients began receiving peri-incisional injections of LB by plastic surgeons during PSF closure (LB group). These patients were compared with those that did not receive any injections [Non-LB [N-LB] group]. Pain scores, opioid consumption (MME), time to ambulation (out-of-bed/OOB), length of stay (LOS), narcotic refills, and 90-day complications were analyzed. Differences between the LB and N-LB groups were assessed using the Wilcoxon rank-sum test for continuous variables and either the χ 2 test or Fisher exact test for categorical variables, as appropriate. A nonparametric analysis of covariance (ANCOVA) was conducted to compare pain scores at rest on POD1 and POD2, as well as morphine consumption during the first 24 hours and total morphine consumption.</p><p><strong>Results: </strong>Two hundred ninety-five patients were in the LB Group, and 177 patients were N-LB. No differences were noted in demographics. Pain scores at rest were significantly lower on POD 1, POD 2, and overall ( P <0.05) in LB patients. LOS was significantly shorter in LB patients ( P <0.001). Significantly more patients were out of bed by POD 0 (59.9% vs. 38.0%, P <0.001) in the LB group. LB patients consumed significantly less opioids in 0 to 24 hours postop and during their total hospital stay ( P <0.001 and P =0.032, respectively).</p><p><strong>Conclusions: </strong>Patients who received liposomal bupivacaine had lower VAS pain scores at rest, opioid consumption, and length of stay with no increase in complications. This suggests that a long-acting local anesthetic formulation may offer superior pain management.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1511-1517"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145393135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Declining Reimbursement, Shifting Surgical Workforce, and Geographic Disparities in Lumbar Laminectomy: A Medicare Analysis, 2013 to 2023.","authors":"Arjun Dinesh, Ankit Hirpara, Christina W Cheng, Christopher G Furey, Prashant V Rajan","doi":"10.1097/BRS.0000000000005823","DOIUrl":"10.1097/BRS.0000000000005823","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective database study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate national and regional trends in lumbar laminectomy [Current Procedural Terminology (CPT) 63047] reimbursement, utilization, and patient population characteristics among Medicare fee-for-service beneficiaries from 2013 to 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary of background data: &lt;/strong&gt;Lumbar laminectomy is among the most commonly performed spinal decompression procedures in the United States. Despite its prevalence in the Medicare population, national trends in surgeon reimbursement, utilization, and patient characteristics across geographic areas and surgeon specialties have not been comprehensively characterized over the past decade.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The CMS \"Medicare Physician and Other Practitioners\" database was queried for all billing episodes of lumbar laminectomy (CPT 63047) from 2013 to 2023 among neurosurgeons and orthopedic surgeons. Population-based utilization rates were calculated using CMS Monthly Enrollment data. Inflation-adjusted reimbursement, procedural volume, and patient characteristics were extracted and stratified by US Census region and rural-urban commuting area (RUCA) codes. The Kruskal-Wallis tests, Wilcoxon rank-sum tests, and linear regression analyses were performed. As this analysis was restricted to fee-for-service (FFS) claims, the reported trends reflect changes within the FFS-billed population and do not capture procedures performed on Medicare Advantage beneficiaries, whose enrollment grew substantially over the study period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Population-based utilization declined 18.1% [24.14-19.78 per 10,000 Medicare fee-for-service (FFS) beneficiaries], and inflation-adjusted surgeon reimbursement declined 17.0% ($783-$649). The number of performing surgeons declined 16.6% (3184-2657). Between 2019 and 2020, national lumbar laminectomy volume fell 21.1%, reflecting the impact of the COVID-19 pandemic. In 2023, the South demonstrated the highest utilization (21.48 per 10,000 FFS beneficiaries), and reimbursement did not differ significantly across Census regions ( P =0.067) or RUCA categories ( P =0.531). Orthopedic surgeons performed the majority of procedures by 2023 (51.5%), up from 46.0% in 2013. Surgeon specialty was the only significant predictor of reimbursement on regression analysis ( P =0.021).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Lumbar laminectomy utilization and surgeon reimbursement declined substantially among Medicare FFS beneficiaries from 2013 to 2023, and geographic disparities in utilization persisted throughout the study period. These findings highlight ongoing workforce and access concerns in lumbar spine surgery. However, these findings reflect trends specific to the fee-for-service Medicare population and should not be interpreted as a decline in access to lumbar decompression among all Medicare beneficiaries, given the concurrent expansion of Medicare Advan","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E558-E567"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recovery Trajectories After Anterior Cervical Discectomy and Fusion.","authors":"Tomoyuki Asada, Eric R Zhao, Adin M Ehrlich, Sereen Halayqeh, Adrian T H Lui, Kasra Araghi, Olivia C Tuma, Andrea Pezzi, Tarek Harhash, Sophie Kush, Courtney Harris, Amy Z Lu, Harvinder S Sandhu, Todd J Albert, Han Jo Kim, James C Farmer, Russel C Huang, Matthew E Cunningham, Francis C Lovecchio, Kyle W Morse, James E Dowdell, Evan D Sheha, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.1097/BRS.0000000000005582","DOIUrl":"10.1097/BRS.0000000000005582","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Objective: </strong>To characterize the recovery trajectory after anterior cervical discectomy and fusion (ACDF) by identifying recovery phases and their inflection timepoints.</p><p><strong>Summary of background context: </strong>Understanding how the number of fused levels influences recovery is essential for tailoring surgical decisions and postoperative management.</p><p><strong>Materials and methods: </strong>This study included patients who underwent primary ACDF for degenerative cervical disease. Outcome measures included the Neck Disability Index (NDI), and numeric rating scale (NRS) for neck and arm pain, collected longitudinally. Segmented regression modeling was used to predict recovery trajectories by phase-specific slopes and inflection timepoints between phases.</p><p><strong>Results: </strong>A total of 290 patients were included. Segmented regression identified three improvement phases of NDI: early improvement phase (EIP), late improvement phase (LIP), and plateau phase (PP), with two inflection timepoints between phases (EIP to LIP: day 43.4±6.7; LIP to PP: day 100.7±13.1). During EIP, the one-level group demonstrated significantly steeper improvement slopes (-0.44 points/d in NDI) compared with ≥2-level (-0.35 points/d; P  = 0.001). The models for NRS for neck and arm pain detected two phases: the improvement phase and PP. Neck pain improved until day 24.1±2.6, while arm pain improved until day 10.6±2.0. Level-specific model showed that the breakpoint for NRS neck occurred faster in one-level compared with ≥2-level (18.0±3.0 vs . 28.2±4.0 d; P  = 0.042).</p><p><strong>Conclusion: </strong>The recovery trajectory of disability following ACDF was characterized by three phases: rapid improvement until four to six weeks, slower improvement until three to four months, followed by symptom plateau after four months. A greater number of fused levels slows early disability recovery and delays neck‑pain relief. These findings are informative to tailor perioperative expectations and rehabilitation protocols to fusion length.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1503-1510"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Regarding \"Discharge Hemoglobin Impacts Functional Recovery After Lumbar Fusion\".","authors":"Mitsuhiro Nishizawa, Steven D Glassman, Leah Y Carreon","doi":"10.1097/BRS.0000000000005832","DOIUrl":"10.1097/BRS.0000000000005832","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E569"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased 90-Day Episode-of-Care Costs Associated With Severe Obesity in Lumbar Decompression Surgery.","authors":"Katharine P Playter, Hannah I Travers, Sophia M Ly, Mikhail Kuznetsov, Ruijia Niu, Graham S Goh, Brian Hollenbeck, David H Kim, Raymond W Hwang","doi":"10.1097/BRS.0000000000005573","DOIUrl":"10.1097/BRS.0000000000005573","url":null,"abstract":"<p><strong>Study design: </strong>A national retrospective observational cohort study was conducted using the MarketScan Commercial Claims and Encounters and MarketScan Medicare Supplemental and Coordination of Benefits databases (Merative).</p><p><strong>Objective: </strong>This study aimed to compare 90-day episode-of-care costs and outcomes between patients with and without severe obesity undergoing lumbar decompression (LD).</p><p><strong>Summary of background data: </strong>Severe obesity is associated with longer hospital stays and increased postoperative complications after lumbar spine surgery; however, its impact on episode-of-care costs remains underexplored.</p><p><strong>Methods: </strong>Patients who underwent single-level LD between January 2018 and October 2023 were identified. Patients were stratified by a severe obesity diagnosis. The primary outcome was the cost for the day of surgery, 30-day, and 90-day episodes of care. Secondary outcomes included complication, readmission, and reoperation rates.</p><p><strong>Results: </strong>A total of 56,897 patients undergoing LD were included, of which 5.6% were diagnosed with severe obesity. These patients demonstrated higher rates of readmission, emergency department visits, 30-day and 90-day complications, and reoperation (P < 0.001). Day-of-surgery costs were higher in these patients ($26,993 vs. $22,279; P = 0.001), as were total 30-day and 90-day episode-of-care costs ($30,316 vs. $24,551 and $34,569 vs. $27,816 for 30 d and 90 d, respectively, P < 0.001). On multivariable analysis, severe obesity independently predicted increased day-of-surgery (P = 0.013), 30-day (P < 0.001), and 90-day total costs (P < 0.001), as well as higher rates of any complication (OR=1.65, 95% CI=1.39-1.95), wound infection (OR=1.90, 95% CI=1.58-2.27), and wound disruption (OR=2.08, 95% CI=1.57-2.73).</p><p><strong>Conclusions: </strong>Severe obesity is associated with higher 30-day and 90-day episode-of-care costs following lumbar decompression surgery, driven by increased postoperative complications, readmissions, and reoperations. These findings highlight the need for both tailored management and adjusted reimbursement in this population, particularly in the setting of value-based care models.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"51 21","pages":"1518-1523"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Multicenter Analysis of Iliac Crest Bone Graft or Cage in Anterior Cervical Discectomy and Fusion Surgery.","authors":"Sachiko Kawasaki, Paul Gerdhem, Ryo Fujita, Anna MacDowall","doi":"10.1097/BRS.0000000000005620","DOIUrl":"10.1097/BRS.0000000000005620","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study design on prospectively collected registry data.</p><p><strong>Objective: </strong>To compare clinical outcomes and complication rates between anterior cervical discectomy and fusion (ACDF) using iliac crest bone graft with plate or cage with plate.</p><p><strong>Summary of background data: </strong>ACDF is an effective surgical treatment for cervical degenerative radiculopathy. Restoring the disk space with iliac crest bone graft yields good outcomes; however, it is associated with donor site pain and complications. The alternative, using an interbody cage, may delay bony union.</p><p><strong>Material and methods: </strong>Patients who underwent ACDF for cervical degenerative radiculopathy using either iliac crest bone graft with plate or cage with plate were identified in the Swedish Spine Registry. Patient-reported outcome measures (PROMs) included the neck disability index (NDI), quality of life, and numeric pain rating scale scores. PROM improvements after two years of follow-up as well as postoperative complications and reoperations, were compared between the iliac crest bone graft and cage groups. Multivariable mixed-effects regression analyses were used to analyze factors associated with NDI improvement, complications, and reoperations while accounting for inter-facility variability.</p><p><strong>Results: </strong>Included participants were 225 in the iliac crest group and 1288 in the cage group. Both groups achieved comparable postoperative PROMs, with a median NDI improvement of -20 (iliac crest) and -18 (cage) points, respectively. The rate of late reoperations (after 30 d) was significantly lower in the cage group than in the iliac crest group (odds ratio: 0.19, 95% CI: 0.05-0.76, P =0.02).</p><p><strong>Conclusions: </strong>At two years of follow-up, ACDF with a cage and plate achieved postoperative outcomes comparable to those of with an iliac crest bone graft and plate. Moreover, the study findings suggest that the cage represents a safer alternative to the iliac crest bone graft.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E540-E547"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Regarding \"Discharge Hemoglobin Impacts Functional Recovery After Lumbar Fusion\".","authors":"Rui Terada, Aki Kondo","doi":"10.1097/BRS.0000000000005827","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005827","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":"51 21","pages":"E568"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concordance Between Patients' and Surgeons' Expectations of Cervical Spine Surgery.","authors":"Carol A Mancuso, Roland Duculan, Frank P Cammisa, Andrew A Sama, Alexander P Hughes, Darren R Lebl, Federico P Girardi","doi":"10.1097/BRS.0000000000005569","DOIUrl":"10.1097/BRS.0000000000005569","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study of patient-surgeon preoperative expectations of cervical surgery.</p><p><strong>Objective: </strong>To measure concordance (agreement) between patient-surgeon expectations, to measure associations between expectations and demographic/clinical variables.</p><p><strong>Background: </strong>Agreement about expectations should be ensured during preoperative patient-surgeon discussions.</p><p><strong>Methods: </strong>Preoperatively patients completed the 20-item Cervical Spine Surgery Expectations Survey measuring expected improvement for symptoms, function, and psychological well-being. Response options range from complete to a little improvement; overall score ranges from 0 to 100 (higher=greater expectations). Surgeons completed an identical surgeons' version of the survey for each patient. Demographic/clinical variables were obtained from patients and medical records. Patient-surgeon agreement was measured for each item with weighted kappa statistics and for overall score with intraclass correlation coefficients (ICC), possible range 0 to 1.0, (higher=more agreement). Associations with demographic/clinical variables were assessed with multivariable models.</p><p><strong>Results: </strong>For 321 patient-surgeon pairs (mean patient age 58, 51% men, 50% radiculopathy, 34% myelopathy), mean patient and surgeon survey scores were 66±21 and 54±18 (patient score greater for 73%). In multivariable analysis, greater patient expectations were associated with younger age, more arm pain, more neck disability, no prior surgery, decreased muscle power, and absent Hoffman sign ( P ≤0.01). Greater surgeon expectations were associated with younger age, more arm pain, more neck disability, no prior surgery, more depressive symptoms, absent Hoffman sign, and present Spurling sign ( P ≤0.04). Regarding patient-surgeon agreement, weighted kappa values were poor (14% items), fair (19%), moderate (57%), and good (10%). ICC value for the overall score was 0.50 (moderate agreement) and varied for demographic/clinical variables, for example, myelopathy/radiculopathy (0.51/0.44), less/more (0.60/0.18) neck-related disability. In multivariable analysis, less agreement was associated with extent of surgery and extent of disease on physical examination.</p><p><strong>Conclusions: </strong>Using paired methodology and multiple-item surveys there was moderate patient-surgeon agreement for cervical spine surgery expectations. These results support enhanced patient-surgeon discussions of expectations during preoperative consultations.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1552-1559"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145605684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Two Distinct Functional Lordoses of the Lumbar Spine.","authors":"David Gadoin, Claudio Vergari, Ayman Assi, Anaïs Venard, Pierre Guigui, Olivier Gille, Wafa Skalli, Virginie Lafage, Emmanuelle Ferrero, Marc Khalifé","doi":"10.1097/BRS.0000000000005788","DOIUrl":"10.1097/BRS.0000000000005788","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective radiographic study of a multicentric prospective database.</p><p><strong>Objective: </strong>This study aimed to analyze the relationships between lumbar lordosis (LL) proximal and distal arcs and spinopelvic parameters, and to determine how their distribution varies with pelvic incidence (PI).</p><p><strong>Summary of background data: </strong>LL is a key component of sagittal spinal alignment, yet its definition and assessment remain debated. Recent evidence suggests LL is not a uniform curvature but rather a complex structure, with proximal and distal arcs that may exhibit distinct biomechanical roles.</p><p><strong>Methods: </strong>This study included 642 healthy volunteers (mean age: 37.6±16.3) with full-body stereoradiographs, without spinal deformities. Maximum LL was assessed (LLmax), measured between the thoracolumbar inflection vertebra upper endplate and the sacral plateau. Correlations between proximal lordosis (LLprox, measured between the thoracolumbar inflection vertebra upper endplate and the lumbar apex upper endplate), distal lordosis (LLdist, measured between the lumbar apex upper endplate and the sacral plateau), and spinopelvic parameters were sought. Subjects were stratified into five PI groups to assess variation in lordosis distribution with PI in terms of angle and the number of vertebrae included in the curvature.</p><p><strong>Results: </strong>LLdist strongly correlated with pelvic parameters, particularly sacral slope (SS, r =-0.83, P <0.001) and PI ( r =-0.54, P <0.001), but not with thoracic alignment. LLprox correlated with both pelvic and thoracic parameters, including SS ( r =-0.31, P <0.001) and thoracic kyphosis ( r =-0.35, P <0.001). As PI increased, the contribution of LLdist to LLmax rose from 55±12% to 66±8% ( P <0.001), while the number of vertebrae in the distal arc increased from 1.52±0.50 to 2.32±0.59 ( P <0.001). Consequently, LLprox's proportional contribution to LLmax decreased, despite a stable vertebral extent.</p><p><strong>Conclusion: </strong>LL comprises two functionally distinct arcs: a pelvic-driven distal arc and a proximal arc influenced by overlying alignment and pelvic parameters. As PI increases, the LL distal arc becomes preponderant. These findings advocate for a segmental approach in clinical assessment and surgical planning, emphasizing the need to consider both arcs independently.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1560-1567"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of Augmented Reality Navigation Versus Freehand Pedicle Screw Placement.","authors":"Giuseppe Loggia, Aron Alakmeh, Fedan Avrumova, Franziska C S Altorfer, Jiaqi Zhu, Frank P Cammisa, Andrew Sama, Mazda Farshad, Darren R Lebl","doi":"10.1097/BRS.0000000000005594","DOIUrl":"10.1097/BRS.0000000000005594","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To compare the accuracy of augmented reality (AR)-guided and freehand (FH) pedicle screw placement in the lumbosacral spine using computed tomography (CT)-based Gertzbein-Robbins (GRS) grading, and to assess demographic and surgical factors associated with accuracy.</p><p><strong>Background: </strong>Accurate pedicle screw placement is essential for safe and effective spinal fusion. AR navigation has emerged as an alternative to conventional FH techniques, with potential advantages in accuracy, efficiency, and ergonomics.</p><p><strong>Materials and methods: </strong>All patients who underwent pedicle screws placement from L1 to S1 using either AR navigation or conventional FH technique, with available postoperative CT imaging for screw accuracy assessment, were analyzed. Demographic and surgical characteristics were compared between both cohorts.</p><p><strong>Results: </strong>A total of 202 patients were analyzed, comprising 1109 pedicle screws placed (AR: n = 548; FH: n = 561). The proportion of clinically acceptable screws (GRS grade A or B) was significantly higher in the AR group compared with the FH group (99.3% vs . 96.4%; P = 0.013). The rate of clinically unacceptable breaches (GRS grade C-E) was significantly lower in the AR group than in the FH group (0.7% vs . 3.6%; P = 0.013). Level-specific directional summary showed that the highest number of breaches in the AR group occurred at L4, predominantly lateral (n = 24), while in the FH group, breaches were most common at L5 and primarily medial (n = 22). Demographic and surgical characteristics demonstrated no significant differences between the cohorts.</p><p><strong>Conclusions: </strong>AR-guided navigation was associated with significantly higher pedicle screw placement accuracy compared with conventional FH technique. As the largest study to date directly comparing these approaches, this analysis reinforces the notion that AR may offer more consistent accuracy in screw placement. Further prospective studies are needed to determine its long-term clinical implications.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1524-1532"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}