Spine最新文献

{"title":"Single-Level versus Two-Level Decompression for Adjacent Segment Spinal Stenosis: A Spinal Canal Area Matched Comparative Study.","authors":"Josh Zhang, Tomoyuki Asada, Felipe Colon, Sereen Halayqeh, Adrian T H Lui, Andrea Pezzi, Olivia C Tuma, Nicholas Giattino, Anthony Lewis, James E Dowdell, Sravisht Iyer, Sheeraz A Qureshi","doi":"10.1097/BRS.0000000000005540","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005540","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To investigate clinical outcomes between lumbar decompression without fusion by matching canal area between the adjacent level in one-level decompression and the upper level in two-level decompression procedures.</p><p><strong>Summary of background data: </strong>In patients with multi-level lumbar stenosis, surgeons face the dilemma of whether to decompress only the symptomatic level or to prophylactically include adjacent stenotic segments. Current literature shows little consensus on this decision, with comparative studies indicating that single-level and two-level decompressions yield similar pain relief, functional outcomes, and reoperation rates. Furthermore, no comparison has been made between decompression groups that accounts for the severity of stenosis at the upper adjacent level.</p><p><strong>Material and methods: </strong>Preoperative imaging was evaluated for dural sac cross-sectional area (DSCSA) and spinopelvic parameters. A 1:2 propensity score-matched analysis was performed using age, sex, comorbidity, and DSCSA to compare reoperation rates and patient-reported outcome measures (PROMs).</p><p><strong>Results: </strong>A total of 351 patients were included in the matching process. In matched cohort, overall reoperation rates were similar between groups (21.2% vs. 21.2%). However, reoperation at the upper adjacent level showed a trend toward higher rates in the single-level group (16.7% vs. 3.0%; P=0.057; Number Needed to Treat [NNT] = 8), though this did not reach statistical significance. Both groups exhibited similar improvements in PROMs and recovery patterns.</p><p><strong>Conclusion: </strong>Single- and two-level decompression groups exhibited similar clinical outcomes in patients with symptomatic stenosis at one level and radiographic stenosis at the upper adjacent level. The two-level decompression group may be associated with a relatively lower reoperation rate at the upper adjacent level, suggesting possible benefit of two-level decompression.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303495","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":"Lateral Decubitus Anterior Lumbar Interbody Fusion at the L4-5 Level is a Safe Alternative to Lateral Lumbar Interbody Fusion in 1-2 Level Lateral Decubitus Single Position Surgery.","authors":"Nam V Huynh, J Alex Thomas, Brett A Braly, Cristiano M Menezes, Domenic Robinson, Emily Oettinger, Hannah Herrick, Aaron J Buckland","doi":"10.1097/BRS.0000000000005542","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005542","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of prospectively, consecutively enrolled patients.</p><p><strong>Objective: </strong>To assess differences in safety, efficiency and alignment between L-ALIF and LLIF at the L4-5 level in lateral single position surgery (L-SPS).</p><p><strong>Summary of background data: </strong>The safety of L4-5 access in lateral lumbar interbody fusion (LLIF) may be limited by psoas, iliac crest and vascular anatomy. Alternatively, lateral decubitus anterior lumbar interbody fusion (L-ALIF) can be used at the L4-5 level during L-SPS.</p><p><strong>Methods: </strong>Patients who underwent 1-2 level L-SPS patients including L4-5 were analysed from 7 institutions across 3 countries (Australia, Brazil, USA). Patients were grouped by the L4-5 interbody fusion technique: L-ALIF or LLIF. Demographics, procedural characteristics, complications and sagittal alignment were analysed.</p><p><strong>Results: </strong>Of 511 patients, 72 underwent L4-5 L-ALIF and 439 L4-5 LLIF. L-ALIF patients had more levels fused (1.65 vs.1.25, P<0.001), longer operative time (115.78 vs. 89.08 min, P<0.001) and length of stay (LOS) (2.41 vs. 1.71 d, P<0.001).Propensity matching for demographics and levels fused (72 per group), demonstrated similar operative time (115.78 vs. 115.77 min, P=0.998), LOS (2.41 vs. 1.98 d, P=0.069) and blood loss (138.68 vs. 165.00 mL, P=0.408).L-ALIF patients had less postoperative (4.2% vs. 21.6%, P<0.001) and minor complications (1.4% vs. 15.0%, P=0.001), mainly attributable to less transient thigh dysaesthesia (0.0% vs. 6.4%, P=0.028). Intraoperative complications (2.8% vs. 2.5%, P=0.892), major postoperative complications (2.8% vs. 8.9%, P=0.077), reoperations within 90-days (2.8% vs. 7.1%, P=0.170) and cage revisions (1.4% vs. 1.6%, P=0.896) were similar.L-ALIF more accurately restored L4-S1 regional lordosis (36.1° vs. 29.7°, P=0.017) postoperatively, and enabled larger improvement in L4-5 segmental lordosis (change of 6.8° vs. 1.8°, P<0.001).</p><p><strong>Conclusion: </strong>L-ALIF at L4-5 is a safe alternative to LLIF in L-SPS. Additionally, L4-5 L-ALIF enables more accurate restoration of L4-S1 lordosis and effectively improves L4-5 segmental lordosis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303501","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":"Lower Bone Mineral Density is Associated with Severity of Deformity in Adolescent Idiopathic Scoliosis.","authors":"Takahiro Shibata, Kazuki Takeda, Satoshi Suzuki, Takahito Iga, Toshiki Okubo, Masahiro Ozaki, Osahiko Tsuji, Narihito Nagoshi, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.1097/BRS.0000000000005538","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005538","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To investigate the association between preoperative bone mineral density (BMD) and both physical and radiographic parameters in adolescent idiopathic scoliosis (AIS) patients undergoing correction and fusion surgery.</p><p><strong>Summary of background: </strong>AIS is a multifactorial condition with a suspected polygenic basis. Osteopenia has been proposed as a contributing factor to curve progression, but the relationship between scoliosis severity and BMD remains unclear.</p><p><strong>Methods: </strong>We retrospectively reviewed 348 AIS patients who had reached Risser sign grade 4 or 5 and underwent surgery. Preoperative total proximal femur BMD was measured and used to categorize patients into two groups: normal BMD (N group; Z-score > -1, n=242) and low BMD (L group; Z-score ≤ -1, n=106). Preoperative radiographic parameters were compared between the two groups. Correlation analysis was performed to assess the relationship between the Z-score of BMD, BMI, and Cobb angle. Multiple regression analysis was conducted to identify independent risk factors for Cobb angle.</p><p><strong>Results: </strong>BMI was significantly lower in the L group (17.9±1.9 kg/m2) compared to the N group (19.6±2.3 kg/m2). The Cobb angle was significantly larger in the L group (59.3±11.8°) compared to the N group (51.4±9.1°). A significant positive correlation was observed between the Z-score of BMD and BMI (r=0.36, P<0.01), while a significant negative correlation was found between the Z-score of BMD and Cobb angle (r=-0.37, P<0.01). Multiple regression analysis revealed that the Z-score of BMD was an independent factor associated with Cobb angle.</p><p><strong>Conclusion: </strong>AIS patient with lower BMD exhibited significantly larger Cobb angles, indicating the potential role of low BMD in curve progression. These findings suggest that addressing bone health in AIS patients could offer new strategies for mitigating curve severely.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303536","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":"Patient Financial Burden in Surgical Treatment of Adolescent and Adult Spinal Deformity in the United States.","authors":"Wesley M Durand, Alekos A Theologis, Gabriel I Nazario-Ferrer, Elyette Lugo, Miguel A Cartagena-Reyes, Richard L Skolasky, Hamid Hassanzadeh, Khaled Kebaish, Paul D Sponseller, Amit Jain","doi":"10.1097/BRS.0000000000005544","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005544","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To quantify out-of-pocket costs (OOPC) for surgical treatment of adolescent idiopathic scoliosis (AIS) and adult spinal deformity (ASD) in commercially insured patients between 2015 and 2020.</p><p><strong>Summary of background data: </strong>OOPC related to spinal deformity surgery can present a significant financial burden on patients. Previous studies have explored surgical costs, but few have examined OOPC specifically for AIS and ASD in commercially insured populations. This study provides an analysis of OOPC and insurance payments.</p><p><strong>Methods: </strong>We utilized a large commercial insurance claims database to identify patients undergoing surgery for AIS (ages 10-25) and ASD (≥40 y) from 2015 to 2020. The surgical care episode was defined from 180 days pre-operative to 30 days post-operative. OOPC and total net payments from insurance were calculated and adjusted to 2020 dollars.</p><p><strong>Results: </strong>A total of 2,869 AIS and 1,528 ASD patients were included. Median ages were 15.0±2.5 years (AIS) and 58.0±6.2 years (ASD). The median OOPC for AIS surgery was $3,231 (SD 2,615), representing 2.6% of total net payments, while ASD surgery had a median OOPC of $2,559 (SD 2,803), representing 1.8%. HDHP patients faced the highest OOPC. The total net payments from commercial insurance were $119,493 (SD 71,480) for AIS and $140,822 (SD 112,060) for ASD. OOPC and total net payments did not significantly increase from 2015 to 2020 (P>0.1).</p><p><strong>Conclusion: </strong>OOPC for AIS and ASD surgeries remain substantial, particularly for patients with HDHPs. High OOPC may contribute to delays in care or deferral of surgery. Financial counseling, cost transparency, and policy efforts aimed at mitigating OOP burden are important steps to improve timely access to spine surgery and reduce the risk of financial strain for patients.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303561","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":"Three-Level Anterior Cervical Discectomy and Fusion (ACDF) is Associated with Higher Rates of Instrumentation Failure and Shorter Time to Reoperation Than One-Level or Two Level ACDF.","authors":"Manjot Singh, Alejandro Perez-Albea, Ishan Shah, Maria Jensen, Alan H Daniels, Bryce A Basques","doi":"10.1097/BRS.0000000000005543","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005543","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Evaluate the impact of increasing levels of cervical fusion on alignment and outcomes.</p><p><strong>Background: </strong>One-level anterior cervical discectomy and fusion (ACDF) adequately restores cervical alignment and offers favorable postoperative outcomes. However, comparative studies following increasing levels of fusion are lacking.</p><p><strong>Methods: </strong>Patients who underwent one- to three-level ACDFs were identified. Demographics, spinopelvic alignment, and clinical outcomes were compared up to one-year postoperatively. Multivariate regressions, accounting for age, gender, Charlson Comorbidity Index (CCI), osteoporosis, and baseline cervical deformity were performed to examine the association between levels of ACDF and postoperative outcomes. Cox regression analysis was also performed to evaluate the association between levels of ACDF and time to reoperation.</p><p><strong>Results: </strong>Among 279 patients (mean age 54.1years, 49% female, mean CCI 0.6), 110 had one-level, 137 had two-level, and 32 had three-level ACDFs. Perioperatively, estimated blood loss (19.1 vs 25.3 vs 33.8 mL) was comparable and procedure time (131.2 vs 167.9 vs 225.9 mL) increased with increasing levels of ACDF, with regression analysis revealing higher odds of both in three-level ACDFs (P<0.05). Postoperatively, instrument failure (1% vs 4% vs 13%, P=0.008) and cage subsidence (15% vs 28% vs 44%, P=0.001) rates increased with increasing levels of ACDF, with regression analysis showing higher odds of both in three-level ACDFs (P<0.05). Cox regression revealed a hazards ratio of 1.2 (95%CI=0.5-3.3) for two-level ACDF and 25.9 (95%CI=2.8-239.8) for three-level ACDF in predicting time to reoperation relative to one-level ACDF. Lordotic correction and improvement in PROMs were comparable across cohorts (P>0.05).</p><p><strong>Conclusion: </strong>Multi-level ACDF yielded comparable improvements in sagittal cervical alignment and PROMs, but was associated with worse in-hospital and out-of-hospital outcomes than single-level ACDF. In addition, it lowered the time to reoperation following the initial procedure. Surgeons should, thus, carefully select operative levels based on clinical and radiographic factors.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303487","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":"Diagnostic Accuracy of the Head Elevation Test: A Novel Physical Examination for Vertebral Compression Fractures in Older Adults with Back Pain.","authors":"Takeshi Ueda","doi":"10.1097/BRS.0000000000005545","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005545","url":null,"abstract":"<p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Objective: </strong>To evaluate the diagnostic accuracy of the head elevation test (HET), a novel bedside physical examination maneuver, for identifying vertebral compression fractures (VCFs) in older adults with acute or subacute back pain.</p><p><strong>Summary of background data: </strong>VCFs are a common cause of acute back pain in older adults but are frequently underdiagnosed, especially in emergency and outpatient settings where MRI is not always immediately available. Existing physical examination signs, such as the closed-fist percussion test (CFPT) and supine sign, have limited validation in prospective studies.</p><p><strong>Methods: </strong>We prospectively and consecutively enrolled 311 adults presenting with acute or subacute back pain. Two bedside physical examination maneuvers were evaluated: the HET and the CFPT. A positive HET was defined as severe midline spinal pain induced before 60° of head elevation. Imaging-based diagnoses served as the reference standard. Sensitivity, specificity, and likelihood ratios were calculated, including an MRI-confirmed subgroup analysis.</p><p><strong>Results: </strong>The HET demonstrated a sensitivity of 92.2% and specificity of 85.9% for VCFs, outperforming the CFPT (sensitivity 75.6%, specificity 82.4%). Combining both maneuvers yielded a sensitivity of 96.6%. The HET was especially effective for fractures at the thoracolumbar junction.</p><p><strong>Conclusion: </strong>The head elevation test demonstrated high diagnostic accuracy for vertebral compression fractures and represents a novel, simple bedside examination to rapidly screen older adults with back pain in both emergency and outpatient settings.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303556","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 and Value of Time-resolved MRA for Spinal Vascular Malformations.","authors":"Xiao-Er Wei, Jin-Yu Zhu, Ming-Hua Li, Jianyong Wei, Liming Wei, Yueqi Zhu, Yuehua Li","doi":"10.1097/BRS.0000000000005233","DOIUrl":"10.1097/BRS.0000000000005233","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective.</p><p><strong>Objective: </strong>To explore the value of time-resolved CE-MRA in evaluating and locating the SVM before digital subtraction angiography (DSA).</p><p><strong>Summary of background data: </strong>Spinal vascular malformations (SVM) can be detected with time-resolved contrast-enhanced MRA (CE-MRA).</p><p><strong>Materials and methods: </strong>One hundred seventy-eight patients with suspected SVM who underwent time-resolved CE-MRA examination and DSA were included in this study. DSA served as the reference standard. The type of SVM, feeding arteries, fistula/nidus, and proximal segment of draining veins were evaluated on time-resolved CE-MRA. The diagnostic performance and classification performance of time-resolved CE-MRA in the diagnosis of SVM is summarized in terms of overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The difference in catheterized vessels during spinal vascular DSA between the actual and estimated number was also analyzed.</p><p><strong>Results: </strong>One hundred forty-seven patients were diagnosed with SVM (20 cervical, 118 thoracolumbar, and 9 deep lumbosacral), and 31 patients were diagnosed with non-SVM, according to DSA findings. The diagnostic sensitivity, specificity, PPV, NPV, and accuracy of time-resolved CE-MRA for a subtype of SVM were 0.961, 0.961, 0.993, 0.806, and 0.961, respectively. The overall accuracy of time-resolved CE-MRA for the diagnosis of SVM was 0.821 and 0.783, 0.793, and 0.778 for cervical, thoracolumbar, and deep lumbosacral SVM, respectively. The actual number of catheterized vessels during spinal vascular DSA with time-resolved CE-MRA as the reference was lower than the estimated number of catheterized vessels in both SVM and non-SVM patients ( P <0.001).</p><p><strong>Conclusions: </strong>Time-resolved CE-MRA could accurately evaluate SVM and reduce the number of catheterized vessels during spinal vascular DSA.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E422-E428"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772462","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 on \"Dual Sustained-Release BMP7-Nanoparticle Hydrogel Scaffolds for Enhanced BMSC Neuronal Differentiation and Spinal Cord Injury Repair\".","authors":"Long Yu, Qingyu Xu","doi":"10.1097/BRS.0000000000005371","DOIUrl":"10.1097/BRS.0000000000005371","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E429"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015222","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":"Risk Factors Associated With Revision Microdiscectomy or Subsequent Spinal Fusion Within Two Years of Index Lumbar Microdiscectomy.","authors":"Dallas E Kramer, Tyson S Barrett, Charlotte Drury-Gworek, Keith LeJeune, Boyle C Cheng, Praveer Vyas, Kevin Walsh, Edward Richard Prostko, Daniel T Altman, Lara Massie","doi":"10.1097/BRS.0000000000005302","DOIUrl":"10.1097/BRS.0000000000005302","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of insurance claims and electronic medical records of a major blended health organization in the eastern United States.</p><p><strong>Objective: </strong>Primary objective was to report rates of revision microdiscectomy and fusion within two years of index lumbar microdiscectomy. Secondary objectives were to identify patient characteristics and comorbidities predictive for revision surgeries.</p><p><strong>Summary of background information: </strong>Incidence of disc reherniation after lumbar microdiscectomy ranges from 3% to 18%. Although rates of revision microdiscectomy are well reported, rates of fusion after index microdiscectomy and risk factors for subsequent fusion beyond history of prior discectomy warrants further investigation.</p><p><strong>Methods: </strong>Retrospective review of health insurance claims data for index lumbar microdiscectomy between January 2016, and December 2019. Rates of revision microdiscectomy and fusion within two years were reported, and cohort demographics and Charlson Comorbidity Index (CCI) comorbidities were analyzed using Pearson χ 2 analyses and Fisher exact tests. Time-to-event modeling and multivariate Cox proportional hazards regression assessed for predictors of revision surgery.</p><p><strong>Results: </strong>The full sample consisted of 8158 members. The rate of revision microdiscectomy was 3.5% within one year and 5.5% within two years of index surgery. The rate of fusion was 2.9% within one year and 6.6% within two years of index surgery. Age 40 to 59 ( P <0.001), female sex ( P =0.024), and presence of ≥1 CCI comorbidities ( P <0.001) were significantly associated with time-to-fusion but not revision microdiscectomy. Increasing CCI score was associated with a significantly greater likelihood of need for fusion (CCI=1, HR 1.35, P =0.045; CCI=2, HR 1.85, P <0.001; CCI ≥ 3, HR 2.47, P <0.001).</p><p><strong>Conclusion: </strong>Rates of revision microdiscectomy and fusion within two years of index lumbar microdiscectomy were 5.5% and 6.6%, respectively. Age 40 to 59 years, female sex, and having ≥1 CCI comorbidity, were significantly predictive of time-to-fusion but not revision microdiscectomy. Having at least one comorbidity increased the likelihood of fusion by 80%.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1392-1399"},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047924","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":"An Overview of this Special Issue on Spinal Deformity.","authors":"Peter G Passias, Virginie Lafage, Shay Bess","doi":"10.1097/BRS.0000000000005541","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005541","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303540","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}