Spine最新文献

{"title":"Impact of Nontobacco Nicotine Dependence on Outcomes Following Anterior Lumbar Interbody Fusion.","authors":"Ankit Hirpara, Ansh Shah, Andrew J Moyal, Jeremy M Adelstein, Robert J Burkhart, Collin Stirpe, Christina W Cheng, Zachary L Gordon, Christopher G Furey, Prashant V Rajan","doi":"10.1097/BRS.0000000000005555","DOIUrl":"10.1097/BRS.0000000000005555","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To compare rates of health care utilization, complications, opioid use, and revision surgery following anterior lumbar interbody fusion (ALIF) in patients with versus without nontobacco nicotine dependence (NTND).</p><p><strong>Summary of background data: </strong>The prevalence of NTND is rising in the United States due to products such as nicotine e-cigarettes, pouches, gums, and lozenges. Studies have shown that tobacco use can contribute to adverse outcomes following spinal fusion surgery, including pseudarthrosis. However, literature focusing specifically on NTND is sparse.</p><p><strong>Methods: </strong>The TriNetX database was queried to identify patients over 18 years old who underwent primary ALIF. Patients were stratified into two cohorts based on their history of NTND. Patients underwent propensity score matching in a 1:1 ratio based on demographics and relevant comorbidities. Covariate balance was confirmed by standardized mean differences ≤ 0.1. The following outcomes were collected: (1) medical complications and health care utilization within 90 days, (2) opioid use within 2 years, and (3) surgical complications and revision surgery within 2 years.</p><p><strong>Results: </strong>Within 90 days, patients with NTND (n=2296), compared with those without (n=2296), had higher rates of emergency department visits ( P =0.001), outpatient encounters ( P =0.001), pneumonia ( P =0.007), ventilator support ( P =0.019), and sepsis ( P =0.015). Patients with NTND received significantly more opioid prescriptions at all time points (all P ≤0.001). More patients with NTND were prFescribed opioids at all time points (all P ≤0.001) except at one week. Lastly, patients with NTND had higher rates of postlaminectomy syndrome (all P <0.001), pseudarthrosis (all P <0.001), and revision surgery (all P <0.05) at all time points within 2 years.</p><p><strong>Conclusion: </strong>Patients with NTND have higher rates of health care utilization, complications, opioid use, and revision surgery following ALIF. Patients should be screened and counseled in a multidisciplinary fashion to ensure the best possible outcome after surgery.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1456-1463"},"PeriodicalIF":3.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432262","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 Performance of Prognostic Measures for Survival in Spinal Metastatic Disease in Light of Modern Advancements in Medical and Surgical Management.","authors":"Brendan M Striano, Marco L Ferrone, Kaitlyn E Holly, Christy Zheng, Andrew Nguyen, Joseph Macksood, Amelia Osgood, Joshua M Coan, J Prescott Chan, Patrick K Cronin, Daniel G Tobert, Andrew J Schoenfeld","doi":"10.1097/BRS.0000000000005741","DOIUrl":"10.1097/BRS.0000000000005741","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To compare the performance of four of the most widely used scoring systems for survival in spinal metastatic disease among a representative battery of cases treated in our health system during 2017 to 2022.</p><p><strong>Summary of background data: </strong>None of the popular risk scores in use today effectively account for improved survival due to advancements in immunotherapy, molecular targeted treatment, and surgical techniques.</p><p><strong>Methods: </strong>We assembled a representative battery of 997 patients who underwent operative or nonoperative treatment for spinal metastases (2017-2022). All patients were assigned a Tokuhashi score, Tomita score, Skeletal Oncology Research Group (SORG), and New England Spinal Metastasis Score (NESMS) based on data at initial presentation. The primary outcome was the discriminative capacity of the scoring utilities in predicting one-year mortality. This was evaluated using multivariable logistic regression with all variables included as co-variates. The discriminative capacity for each model was compared using the c-statistic. We also assessed the performance of operative management in conjunction with the survival score.</p><p><strong>Results: </strong>One-year mortality was 54%. The SORG's c-statistic was 0.75 (95% CI: 0.71, 0.78), compared with 0.68 (95% CI: 0.65, 0.71) for the NESMS. The c-statistic for the Tokuhashi score was 0.70 (95% CI: 0.67, 0.73), while that of the Tomita scale was 0.66 (95% CI: 0.63, 0.69). Only the SORG (OR: 0.64; 95% CI: 0.46, 0.90; P =0.01) and NESMS (OR: 0.74; 95% CI: 0.56, 0.97; P =0.03) preserved a significant association between surgical intervention and survival.</p><p><strong>Conclusions: </strong>We found that the performance of all scores was diminished relative to historical reports, but remained adequate for the NESMS and SORG algorithms. In current practice, we believe the optimal approach entails initial use of the NESMS when considering treatment approaches, with the SORG used for recalculating survival if surgical intervention has been selected as a treatment strategy.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1435-1440"},"PeriodicalIF":3.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044010","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":"Nationwide Retrospective Analysis of Early Complications After Adult Spinal Deformity Surgery: Insights From the Japanese Spinal Instrumentation Society Database Registry.","authors":"Junya Katayanagi, Haruki Ueda, Hideyuki Arima, Koji Yamada, Mitsuru Yagi, Kimiaki Yokosuka, Shunsuke Katsumi, Atsushi Tagami, Yusuke Hori, Akira Matsumura, Tokumi Kanemura, Hiroshi Taneichi, Yukihiro Matsuyama","doi":"10.1097/BRS.0000000000005646","DOIUrl":"10.1097/BRS.0000000000005646","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective nationwide registry-based observational study.</p><p><strong>Objective: </strong>To determine the incidence of and factors associated with early complications following surgery for adult spinal deformity (ASD).</p><p><strong>Summary of background data: </strong>Complications after ASD surgery contribute to morbidity, mortality, and health care costs. Prior studies were limited by small sample sizes and incomplete surgical information. The Japanese Spinal Instrumentation Society database (JSIS-DB) includes detailed instrumentation data, enabling a robust secondary analysis of perioperative factors.</p><p><strong>Materials and methods: </strong>We analyzed JSIS-DB data from patients undergoing ASD surgery involving the fusion of three or more vertebrae between 2018 and 2022. Demographics, comorbidities, and surgical variables [fusion length, osteotomy, interbody fusion type, minimally invasive surgery (MIS), staged procedures, navigation, and neuromonitoring] were assessed. The primary endpoint was ultra-early perioperative complications within two weeks, classified as major (mortality, massive bleeding, neurological, cardiopulmonary, or infectious events) or minor (dural injury, delirium, or urinary tract infection). Multivariable logistic regression was used to identify the associated factors.</p><p><strong>Results: </strong>Among 3193 patients (mean age 60.8 yr), the overall complication rate was 28.5%, including 25.4% with major complications and 0.1% with mortality. Increased risk was associated with operative time >5 hours [adjusted odds ratio (aOR) 4.40; 95% CI: 3.60-5.47], fusion >5 levels (aOR: 1.51; 95% CI: 1.20-1.91), posterior/transforaminal interbody fusion (PLIF/TLIF) (aOR: 1.47; 95% CI: 1.20-1.79), and three-column osteotomy (3CO) (aOR: 3.50; 95% CI: 2.21-5.53). Reduced risk was associated with adult idiopathic scoliosis (aOR: 0.48; 95% CI: 0.37-0.63), staged surgery (aOR: 0.24; 95% CI: 0.18-0.32), lateral lumbar interbody fusion (LLIF) (aOR: 0.74; 95% CI: 0.58-0.95), and MIS (aOR: 0.65; 95% CI: 0.49-0.86). Respiratory complications, massive bleeding, neurological deficits, surgical site infections, and proximal junctional kyphosis were associated with prolonged hospitalization (>30 d).</p><p><strong>Conclusions: </strong>This nationwide registry analysis demonstrated that prolonged operative time, long fusion, PLIF/TLIF, and 3CO increase the early complication risk after ASD surgery, whereas staged surgery, LLIF, and MIS are protective.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E519-E529"},"PeriodicalIF":3.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Teaching Hospital Status on Postoperative Outcomes Among Adults Undergoing Short-Segment Lumbar Instrumentation.","authors":"Janesh Karnati, Aydin Kaghazchi, Ahmed Ashraf, Xu Tao, Andrew Wu, Sruthi Ranganathan, Gabriel Jelkin, Shameel Abid, Leina Lunasco, Sachin Shankar, Mir Ashraf, Mikayla Wallace, Joseph Cheng, Owoicho Adogwa","doi":"10.1097/BRS.0000000000005572","DOIUrl":"10.1097/BRS.0000000000005572","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To evaluate the impact of teaching hospital status on short-term and long-term surgical outcomes after single-level lumbar instrumentation.</p><p><strong>Summary of background data: </strong>Teaching hospital status and its effect on surgical outcomes have produced conflicting results, and, in spine surgery, have largely focused on perioperative complications and length of stay. More comprehensive analysis on long-term outcomes has yet to be consistently demonstrated.</p><p><strong>Methods: </strong>The TriNetX Research Network was queried for adult patients who underwent short-segment lumbar fusion between 2010 and 2022 with preoperative diagnoses of lumbar spinal stenosis, spondylolisthesis, radiculopathy, or scoliosis. Patients were categorized based on treatment at academic or non-academic centers. Propensity score matching was used to control for confounders.</p><p><strong>Results: </strong>A total of 38,898 patients met the inclusion criteria, with 8789 patients treated at non-academic centers and 30,109 at academic centers. After propensity score matching, cohorts included 7004 patients each with comparable baseline characteristics. Surgical complications and medical complications showed no significant differences at 30 days (OR=1.120, 95% CI [0.971-1.292]; OR=0.927, 95% CI [0.785-1.095]) or 90 days (OR=1.072, 95% CI [0.949-1.211]; OR=0.988, 95% CI [0.859-1.135]). Non-academic centers had significantly higher odds of pseudoarthrosis or mechanical failure at one year (OR=1.819, 95% CI [1.675-1.975]) and two years (OR=1.732, 95% CI [1.599-1.875]). In addition, readmission rates were significantly higher for non-academic center patients at both 30 days (OR=1.500, 95% CI [1.377-1.633]) and 90 days (OR=1.290, 95% CI [1.191-1.395]).</p><p><strong>Conclusions: </strong>This retrospective analysis using propensity score matching demonstrates that patients undergoing single-level lumbar instrumentation at non-academic hospitals have substantially higher odds of readmission and long-term mechanical failures compared with those treated at academic centers despite having similar rates of short-term medical and surgical complications. These findings highlight the influence of hospital teaching status on postoperative outcomes, potentially informing clinical decisions, referrals, and institutional quality improvement initiatives.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1464-1471"},"PeriodicalIF":3.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145857659","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":"Supine ALIF versus Lateral-Decubitus OLIF for Degenerative Lumbar Disease: A Systematic Review and Meta-Analysis of Comparative Studies.","authors":"Ishan D Shah, Puru Sadh, Vikram Sharma, Tasif Mahmoud, Alan H Daniels, Bryce A Basques","doi":"10.1097/BRS.0000000000005905","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005905","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To compare outcomes between supine anterior lumbar interbody fusion (ALIF) and lateral decubitus oblique lumbar interbody fusion (OLIF).</p><p><strong>Background: </strong>ALIF and OLIF differ in surgical corridor and patient positioning, with their relative advantages remaining debated.</p><p><strong>Methods: </strong>A PRISMA-compliant search of PubMed, Embase, and Google Scholar was performed through April 2026 for studies evaluating anterior versus oblique lumbar interbody fusion. Outcomes included perioperative, complication, patient-reported, and sagittal alignment measures, pooled using fixed- or random-effects models based on heterogeneity (I²>50%).</p><p><strong>Results: </strong>Thirteen studies (1,432 patients; 795 ALIF, 637 OLIF) met inclusion criteria. OLIF was associated with shorter length of stay (-0.87 days [95% CI: -1.47 to -0.26], P=0.005). Leave-one-out analyses demonstrated lower operative time (-39.07 minutes [95% CI: -76.73 to -1.41], P=0.04) and estimated blood loss (-96.32 mL [95% CI: -182.03 to -10.61], P=0.03) favoring OLIF, though substantial heterogeneity persisted. Complications and patient-reported outcomes did not differ. OLIF showed greater reductions in sagittal vertical axis (SVA) immediately postoperatively (-18.32 mm [95% CI: -30.89 to -5.75], P=0.004) and at final follow-up (-9.39 mm [95% CI: -17.83 to -0.96], P=0.03). In a subanalysis of fusions involving the sacrum, OLIF had lower EBL (-182.32 mL [95% CI: -297.38 to -67.27], P=0.002) and shorter LOS (-1.45 days [95% CI: -1.72 to -1.18], P<0.00001), with a similar operative time trend (-72.83 min [95% CI: -147.48 to 1.81], P=0.06).</p><p><strong>Conclusions: </strong>OLIF appears to offer a modest advantage over ALIF, with shorter hospitalization, comparable complications and patient-reported outcomes, and greater SVA correction. These perioperative benefits could potentially be meaningful in patients with higher comorbidity burden and appeared preserved in fusions involving the sacrum. The SVA correction may reflect advantages of single-position lateral surgery for restoring global alignment.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196832","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 \"Proposal of a Cervical Sagittal Classification System to Guide Surgical Treatment for Adult Cervical Deformity: A MEANS Cohort Analysis\".","authors":"Xianghe Wang, Haocheng Xu, Xiaosheng Ma, Feizhou Lyu, Jianyuan Jiang, Hongli Wang","doi":"10.1097/BRS.0000000000005904","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005904","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184491","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":"Surgical and Radiographic Outcomes in Cervical Deformity Patients with High T1 Slope and High C2 Slope (HTHC) Versus Low T1 Slope and High C2 Slope (LTHC): Distinct Phenotypes of Cervical-Only versus Global Spinal Deformity.","authors":"Alexander Kucherina, Zoe Norris, Eaman Balouch, Renaud Lafage, Alexandra Soroceanu, Jeffrey Gum, Justin S Smith, Robert Eastlack, Gregory Mundis, Munish Gupta, Richard Hostin, Eric Klineberg, Lawrence Lenke, Christopher Ames, Christopher Shaffrey, Peter Passias, Sang Lee, David K Hamilton, Virginie Lafage, Frank Schwab, Darryl Lau, Shay Bess, Themistocles S Protopsaltis","doi":"10.1097/BRS.0000000000005902","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005902","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of a prospective multicenter operative cervical deformity (CD) database.</p><p><strong>Objective: </strong>To determine whether T1 slope (T1S) and C2 slope (C2S) together identify distinct CD phenotypes: cervical-only versus global sagittal deformity, and to compare surgical invasiveness, radiographic correction, and patient-reported outcomes.</p><p><strong>Summary of background data: </strong>T1S and C2S mark cervical malalignment, and elevated T1S has been linked to global sagittal malalignment. Combining them may distinguish CD-only from global deformity on cervical imaging alone.</p><p><strong>Methods: </strong>Operative CD patients with ≥2 years follow-up and preoperative C2S >30° were stratified by T1S into low T1S-high C2S (LTHC; ≤30°) and high T1S-high C2S (HTHC; >30°). Multivariable regression assessed group effect on 2-year NDI change, adjusted for age, sex, baseline NDI, and posterior levels fused. NDI MCID was set a priori at ≥7 points per the ISSG threshold.</p><p><strong>Results: </strong>Ninety-two patients met criteria (31 LTHC, 61 HTHC). HTHC patients were older (64.7 vs. 60.0 years; P=0.035) with higher Charlson index (P=0.022). Preoperatively, HTHC had greater thoracic kyphosis, TPA, cSVA, PI-LL mismatch, and C7 SVA (all P≤0.010). HTHC underwent more extensive surgery: more posterior levels fused (10.3 vs. 6.7), more circumferential fusions (66.7% vs. 38.7%), and more caudal LIV (T7 vs. T3) (all P<0.05). At 2 years, HTHC retained higher TK and cSVA despite greater absolute correction. Baseline NDI was similar (P=0.906), but 2-year NDI improvement was smaller in HTHC (-6.2 vs. -14.6 points; P=0.013), and fewer achieved MCID (45.9% vs. 71.0%; P=0.022). HTHC remained an independent predictor of smaller improvement (β=+7.4; P=0.020). Reoperation, DJK, and complication rates did not differ.</p><p><strong>Conclusions: </strong>Among CD patients with elevated C2S, additional elevated T1S identifies a global-deformity phenotype requiring more invasive correction and showing smaller 2-year patient-reported improvement despite comparable complications. T1S and C2S, measurable on cervical imaging alone, screen for which CD patients warrant full-spine imaging.</p><p><strong>Level of evidence: </strong>III (retrospective analysis of prospectively collected multicenter data).</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184449","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":"Complications and Instrumentation Failure After Total En Bloc Spondylectomy: A Systematic Review and Meta-analysis.","authors":"Yeu Chyi Leong, He-Tai Jheng, Jyun-Yuan Huang, Jui-Sheng Chen, Yu-Duan Tsai, Kuo-Wei Wang, Hao-Kuang Wang","doi":"10.1097/BRS.0000000000005903","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005903","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To generate pooled estimates of instrumentation failure (IF), complication, mortality, and local recurrence rates after total en bloc spondylectomy (TES), and to quantify the influence of follow-up duration on reported IF rates.</p><p><strong>Summary of background data: </strong>TES offers margin-free resection for primary spinal malignancies and selected solitary metastases but carries substantial perioperative hazards and a delayed risk of IF. How the duration of postoperative observation shapes reported IF rates has not been formally quantified.</p><p><strong>Methods: </strong>Four databases (PubMed, EMBASE, Cochrane CENTRAL, OVID Medline) were searched from database inception through June 2026 for English-language studies reporting TES outcomes in adults. Event rates were pooled using DerSimonian-Laird random-effects models. Meta-regression tested whether mean follow-up duration explained heterogeneity in IF rates. Methodological quality was graded with MINORS.</p><p><strong>Results: </strong>Twenty-three studies enrolling 1,416 patients were included. IF occurred in 16.8% of patients (95% CI 12.2-22.8%; I²=76.7%); among the 81 failures with a reported failure type (six studies), rod fracture accounted for 84.0%, and the median time to failure was 26.7 months. Each additional 12 months of mean follow-up increased the odds of IF by 24% (OR 1.24; β=0.018; P=0.005), accounting for 35% of between-study variance. Pooled complication rate was 43.8% (95% CI 34.7-53.2%), perioperative mortality 2.7% (95% CI 1.9-4.0%), and local recurrence 13.4% (95% CI 10.6-16.8%). Among patients with confirmed IF, 58.4% (143/245) required reoperation.</p><p><strong>Conclusion: </strong>Roughly one in six patients sustains IF after TES, and recorded failure accumulates with longer observation rather than concentrating early. Postoperative radiographic surveillance should extend to at least five years, and a shared complication taxonomy is needed for cross-institutional comparison.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184421","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":"Early Ambulation Accelerates Time to First Bowel Movement After Separation Surgery for Spinal Tumors.","authors":"Donghua Huang, Yubin Zhao, Nong Lin, Hengyuan Li, Jianbin Xu, Meng Liu, Xiaobo Yan, Xin Huang, Zhaoming Ye","doi":"10.1097/BRS.0000000000005894","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005894","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To identify factors associated with the timing of bowel function recovery after separation surgery for metastatic spinal tumors, while incorporating the temporal dimension of postoperative rehabilitation.</p><p><strong>Summary of background data: </strong>Separation surgery for metastatic spinal tumors is more extensive compared to conventional spinal surgery and carries a higher risk of postoperative ileus (POI). However, the factors influencing bowel recovery following this procedure remain poorly understood. Prior studies on conventional spinal decompression typically characterize bowel outcomes as binary events, neglect temporal recovery kinetics, and may introduce reverse causation bias.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients who underwent separation surgery for metastatic spinal tumors at our institution (2021-2025). Clinical characteristics, postoperative ambulation status (including the status and time to first ambulation), and bowel movement outcomes (comprising the occurrence and postoperative time to first bowel movement) were collected. The primary endpoint was time to first postoperative bowel movement. Univariable and multivariable time-dependent Cox proportional hazards models were performed, with the time to first postoperative bowel movement serving as the primary outcome, and ambulation status modeled as a time-dependent covariate.</p><p><strong>Results: </strong>A total of 153 patients were included (median age 62 years [IQR, 57-69]; 64.7% male). During hospitalization, 134 patients (87.6%) achieved postoperative bowel movement, occurring at a mean of 4.0±1.9 days after surgery. In multivariable Cox regression analysis, postoperative ambulation was independently associated with earlier bowel recovery (HR, 5.69; 95% CI, 3.03-10.69; P<0.001), with the estimated association substantially increasing from HR 1.80 before adjustment for postoperative opioid consumption. Increasing age (per 10-year increase: HR, 0.83; 95% CI, 0.72-0.95; P=0.007) and greater postoperative 24-hour opioid consumption (per 10-MME increase: HR, 0.45; 95% CI, 0.35-0.57; P<0.001) were associated with delayed bowel recovery. Tumor origin, involvement pattern, ESCC grade, pathological fracture, surgical region, fixation levels, and decompression levels were not significantly associated with bowel recovery.</p><p><strong>Conclusion: </strong>Early postoperative ambulation was associated with faster bowel recovery after spinal tumor separation surgery, supporting its incorporation into postoperative rehabilitation strategies. Postoperative opioid management may require balancing adequate analgesia to facilitate mobilization against potential adverse effects on bowel recovery.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171458","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":"Development of a Multivariable Prognostic Model for Risk Stratification in C1 Fractures.","authors":"Patrick K Cronin, Kaitlyn E Holly, Rishi Virani, Malina O Hatton, Michael D Cesar, Christopher Lai, Samy S Gabriel, Brendan M Striano, James D Kang, Andrew J Schoenfeld","doi":"10.1097/BRS.0000000000005897","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005897","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of adult patients with radiographically confirmed C1 fractures treated across a single healthcare system including multiple level 1 trauma centers and multiple community hospitals (2015-22). The primary outcome was instability. Peri-operative outcomes and complications were also considered.</p><p><strong>Objective: </strong>To evaluate radiographic and clinical predictors of instability or surgical management in patients with C1 fractures and to develop a multivariable prognostic model.</p><p><strong>Summary of background data: </strong>Determining instability in C1 fractures remains challenging. Traditional criteria rely heavily on radiographic displacement thresholds, which may not fully capture the multifactorial nature of atlas fracture instability.</p><p><strong>Methods: </strong>Demographic, clinical, and radiographic variables were analyzed including lateral mass displacement, dens fracture, neurologic deficit, age, sex, and body mass index. Multivariable Firth penalized logistic regression was used to adjust for confounders and identify factors significantly associated with instability/operative treatment. Receiver operating characteristic analysis assessed model discrimination. A point-based instability risk score was derived from model coefficients.</p><p><strong>Results: </strong>In adjusted analysis of Two hundred and seventy-nine patients, Lateral mass displacement (OR 1.20 per mm, 95% CI 1.09-1.33, P<0.001), dens fracture (OR 2.67, 95% CI 1.35-5.38, P=0.0047), and neurologic deficit (OR 5.22, 95% CI 1.69-16.1, P=0.0047) were significantly associated with instability or surgical management. The traditional 7-mm displacement threshold performed poorly (AUC 0.64, P=0.012). The multivariable model demonstrated good discrimination (AUC 0.75. Based on the final multivariable regression model, a point-based instability risk score was derived to estimate patient-specific risk with good predictive accuracy.</p><p><strong>Conclusions: </strong>Instability in C1 fractures was significantly associated with several factors including increasing lateral mass displacement, dens fracture, and neurologic deficit. These parameters outperformed legacy assessment tools based on radiographic measurement. Our prognostic utility demonstrated improved predictive performance and may assist clinicians in risk stratification and treatment decision-making.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184471","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}