Spine最新文献

{"title":"Does T4-L1PA Mismatch Still Matter After Lower Thoracic Fusion for Adult Spinal Deformity? Two-Year Mechanical Failure and Why the Target Is Missed.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Tae Soo Shin, Jun-Seok Oh, Joon Young Jung, Jae-Won Hur, Chong-Suh Lee","doi":"10.1097/BRS.0000000000005900","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005900","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To determine whether a residual positive T4-L1PA mismatch predicts mechanical failure after lower thoracic fusion, and to identify factors associated with failure to achieve the target.</p><p><strong>Summary of background data: </strong>The T4-L1-Hip axis defines sagittal alignment using two vertebral pelvic angles that are fixed or directly modifiable in surgery. When fusion stops in the lower thoracic region, T4 remains above the construct and outside the surgeon's control.</p><p><strong>Methods: </strong>Patients who underwent fusion from T9-L1 to the pelvis between 2015 and 2024 with two-year follow-up were reviewed. Sixteen with a mismatch below -4° were excluded, leaving 357 patients. A mismatch within ±4° was defined as matched and one above +4° as a residual positive mismatch. Proximal junctional kyphosis (PJK), rod fracture, and revision surgery were assessed by Firth penalized logistic regression with covariates specified a priori.</p><p><strong>Results: </strong>A residual positive mismatch was present in 140 patients (39.2%). PJK occurred in 35.0%, rod fracture in 9.2%, and revision in 15.4%. A residual positive mismatch was associated with PJK (odds ratio [OR] 1.83, P=0.011) and revision (OR 2.40, P=0.004) but not rod fracture (OR 1.19, P=0.639). A hyperlordotic lordosis distribution index (LDI) was its strongest determinant for a residual positive T4-L1PA mismatch (OR 5.40, P<0.001). The L1PA offset showed no association (P=0.150); 14 of 19 patients (73.7%) who met the L1PA target with a hyperlordotic LDI still had a residual mismatch. L1 tilt increased across the LDI categories whereas T4 tilt did not.</p><p><strong>Conclusions: </strong>A residual positive T4-L1PA mismatch after lower thoracic fusion was associated with PJK and revision surgery, but not with rod fracture. A hyperlordotic distribution of lordosis, rather than the magnitude of correction, was associated with this residual mismatch.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184437","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":"Unmeasured Biomechanical Confounding and Dichotomization Fallacies in Erector Spinae Degeneration.","authors":"Yang Bai","doi":"10.1097/BRS.0000000000005901","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005901","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166759","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":"Comment on \"Decompression and Dynamic Sagittal Tether Stabilization for Degenerative Spondylolisthesis: Primary Outcomes of a Multicenter FDA IDE Trial\".","authors":"Yuanshuo Niu, Silong Li","doi":"10.1097/BRS.0000000000005899","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005899","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170528","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":"Does Additional Distal S2 Fixation Improve Lumbosacral Stability Compared with Standard L4-S1 Fixation in High-Grade Spondylolisthesis? A Prospective Randomised Comparative Study.","authors":"Morsy Basiony, Moaaz Ali Hamoud","doi":"10.1097/BRS.0000000000005896","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005896","url":null,"abstract":"<p><strong>Study design: </strong>Prospective, randomised, single-centre comparative study.</p><p><strong>Objective: </strong>To compare standard L4-S1 fixation with an identical construct extended by bilateral S2 fixation in patients undergoing posterior lumbar interbody fusion for high-grade L5-S1 spondylolisthesis.</p><p><strong>Summary of background data: </strong>High-grade L5-S1 spondylolisthesis subjects posterior fixation to lumbosacral shear that may exceed the tolerance of a standard L4-S1 construct. Extending fixation distally to S2 - using either a conventional S2 pedicle screw or, where sacral purchase is inadequate, an S2 alar-iliac (S2AI) screw - has been proposed to mitigate this shear, but comparative prospective data remain limited.</p><p><strong>Methods: </strong>Seventy consecutive patients with Meyerding grade III/IV spondylolisthesis undergoing posterior lumbar interbody fusion between May 2020 and November 2022 were randomly allocated 1:1 to standard L4-S1 fixation (Group A, n=35) or bilateral S2 extension (Group B, n=35; conventional S2 pedicle screws in 29, intraoperative conversion to S2-alar-iliac fixation in 6). Co-primary outcomes were the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at 36 months, compared using a Bonferroni-adjusted significance threshold.</p><p><strong>Results: </strong>All 70 patients (100%) completed follow-up. Group B achieved lower VAS (1.9±0.8 vs. 3.1±1.0, P<0.001) and ODI (21.4±5.6 vs. 30.1±6.0, P<0.001). Fusion rate (88.6% vs. 77.1%, P=0.34), pseudarthrosis (11.4% vs. 22.9%, P=0.34), and screw pull-out (2.9% vs. 14.3%, P=0.20) all numerically favoured Group B without reaching statistical significance. S1 screw breakage occurred exclusively in Group A (65.7% vs. 0%, P<0.001).</p><p><strong>Conclusions: </strong>These findings suggest that distal fixation, through S2 or S2AI, may play a substantial role in mitigating the shear stress forces at the lumbosacral junction and the hardware failures commonly seen with S1-only anchorage in this complex pathology. Given the potential for performance bias and technique heterogeneity (conventional S2 vs. S2AI), multicentre randomised trials are warranted to confirm these findings and define which patients benefit most from S2 extension.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114745","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":"Radiographic Muscle Sarcopenia Affects Regional Sagittal Alignment: A Single-Center Radiographic Retrospective Analysis.","authors":"Joyce En-Hua Wang, Ben Setaro, Jestin Williams, Jesse Wang, Yuvraj Sethi, Sarah Kebaish, Wendy Novicoff, Xudong Joshua Li, Steven C Ludwig, Stephen Daniel Lockey","doi":"10.1097/BRS.0000000000005895","DOIUrl":"10.1097/BRS.0000000000005895","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To describe differences in sagittal alignment and compensatory mechanisms in patients with and without sarcopenia.</p><p><strong>Summary of background data: </strong>Sarcopenia refers to the degenerative loss of muscle quantity and quality and impacts the sagittal balance of the spine. Skeletal muscle is essential to maintaining upright posture, and its progressive loss may compromise the compensatory mechanisms that preserve sagittal alignment. Sarcopenia can be diagnosed using thigh muscle thickness measured on a low-dose full-body radiograph.</p><p><strong>Methods: </strong>Full-body standing radiographs from 375 adult patients without prior spine surgery, hip, or knee arthroplasty were analyzed. Spinopelvic parameters, including pelvic tilt, pelvic incidence, lumbar lordosis (L1-S1), PI-LL, L4-S1 lordosis, sagittal vertebral axis (SVA), T1 pelvic angle, cervical SVA, T1 slope, C2-C7 lordosis, thoracic kyphosis (T4-T12), sacral slope, leg length discrepancy, and knee flexion, were generated through a machine-learning-based algorithm. Sarcopenia was defined as anteroposterior thigh muscle thickness <12.47 cm (males) and <10.68 cm (females), and lateral quadriceps thickness <3.23 cm (males) and <2.20 cm (females). Subgroup analyses examined patients with spinopelvic mismatch (108 [28.8%], PI-LL ≥10°) and sagittal imbalance (105 [28.0%], SVA ≥5 cm).</p><p><strong>Results: </strong>Sarcoopenia was prevalent in 12.8% of the study cohort, 13.0% in patients with spinopelvic mismatch, and 15.2% in patients with sagittal imbalance. The sarcopenic group had a higher cervical lordosis (-8.37 vs. -13.29°; P =0.021), T1 slope (33.11 vs. 36.90°; P =0.018), and thoracic kyphosis (39.57 vs. 44.19°; P =0.044). In subgroup analysis of patients with PI-LL mismatch or sagittal imbalance, those with sarcopenia had a higher L4-S1 lordosis.</p><p><strong>Conclusion: </strong>Sarcopenia is associated with altered regional alignment, manifesting as thoracic hyperkyphosis and cervical hyperlordosis. In the presence of sagittal deformity, compensatory mechanisms may differ in the distal and proximal segments of the lumbar spine.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115023","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 One- to Two-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":"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>Materials and methods: </strong>Patients who underwent one to two-level L-SPS patients including L4-5 were analysed from seven institutions across three 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. In addition, 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":"1381-1389"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","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":"Body Mass Index and Surgical Outcomes in Degenerative Cervical Myelopathy: Findings From a Prospective Multicenter Cohort of 935 Patients.","authors":"Toshiki Okubo, Narihito Nagoshi, Junichi Yamane, Takahiro Kitagawa, Kanehiro Fujiyoshi, Tastuya Yamamoto, Kazuya Kitamura, Takeshi Ikegami, Kentaro Ago, Takahito Iga, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.1097/BRS.0000000000005554","DOIUrl":"10.1097/BRS.0000000000005554","url":null,"abstract":"<p><strong>Study design: </strong>Prospective multicenter cohort study.</p><p><strong>Objectives: </strong>To clarify the relationship between body mass index (BMI) and surgical outcomes in degenerative cervical myelopathy (DCM).</p><p><strong>Summary of background data: </strong>Obesity is a growing global health concern and has been implicated in DCM. However, evidence on whether BMI affects postoperative neurological and patient-reported outcomes remains inconsistent, with limited prospective multicenter data.</p><p><strong>Methods: </strong>We prospectively analyzed 935 patients with DCM who underwent surgery at 10 high-volume spine centers in Japan. Patients were categorized as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), or obesity (≥30.0) per World Health Organization criteria. Demographics, comorbidities, radiographic parameters, operative variables, and outcomes-Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) pain scores, Short Form-36 physical (PCS) and mental (MCS) component scores, and Neuropathic Pain Symptom Inventory (NPSI)-were compared across BMI groups over a two-year follow-up.</p><p><strong>Results: </strong>Obese patients were younger (mean: 60.2 y, P <0.001) and had a higher prevalence of OPLL (47.7%, P <0.001). They required longer operative time (128.3 min) and greater blood loss (91.2 mL) (both P <0.001) but did not have higher perioperative complication rates. Obesity was associated with smaller C2 to 7 lordosis and reduced cervical range of motion preoperatively and at two years (both P <0.05). Underweight patients had the largest mean MCS improvement (+6.0), but differences among BMI groups were not statistically significant ( P =0.117). Across all groups, JOA score improvement, recovery rate, PCS change, pain reduction, and NPSI improvement were comparable.</p><p><strong>Conclusions: </strong>Higher BMI in DCM was associated with greater operative demands, higher OPLL prevalence, and persistent postoperative alignment and motion deficits. However, neurological recovery and patient-reported outcomes were comparable across BMI categories. In patients with surgical indications based on symptoms and imaging findings, surgery can be performed appropriately regardless of BMI, with favorable outcomes achievable through thorough preoperative assessment and strategic surgical planning.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1354-1362"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432254","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":"Abdominal Aortic Calcification Is Associated With Degeneration of The Paraspinal Muscles​: A Retrospective Cross-sectional Study.","authors":"Friederike Schömig, Lukas Schönnagel, Jiaqi Zhu, Phillip Suwalski, Paul Köhli, Thomas Caffard, Ali E Guven, Erika Chiapparelli, Artine Arzani, Krizia Amoroso, Jennifer Shue, Andrew A Sama, Frank P Cammisa, Federico P Girardi, Alexander P Hughes","doi":"10.1097/BRS.0000000000005027","DOIUrl":"10.1097/BRS.0000000000005027","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The aim of this study was to analyze the relationship of abdominal aortic calcification (AAC) and a reduction in the cross-sectional area (CSA) and the fatty infiltration (FI) of the paravertebral muscles in patients undergoing lumbar fusion surgery.</p><p><strong>Background: </strong>Both AAC and paraspinal muscle degeneration have been shown to be associated with poorer outcomes after surgical treatment of degenerative diseases of the lumbar spine. However, there is a lack of data on the association between AAC and paraspinal muscle changes in patients undergoing spine surgery.</p><p><strong>Methods: </strong>We retrospectively analyzed patients undergoing lumbar fusion for degenerative spinal pathologies. Muscular and spinal degeneration were measured on magnetic resonance imaging (MRI). AAC was classified on lateral lumbar radiographs. The association of AAC and paraspinal muscle composition was assessed by a multivariate regression analysis adjusted for age, sex, body mass index (BMI), comorbidities, and lumbar degeneration.</p><p><strong>Results: </strong>A total of 301 patients was included. Patients with AAC showed significantly higher degrees of intervertebral disk and facet joint degeneration as well as higher total endplate scores at the L3/L4 level. The univariable regression analysis showed a significant positive correlation between the degree of AAC and the FI of the erector spinae ( b =0.530, P <0.001) and multifidus ( b =0.730, P <0.001). The multivariable regression analysis showed a significant positive correlation between the degree of AAC and the FI of the erector spinae ( b =0.270, P =0.006) and a significant negative correlation between the degree of AAC and the CSA of the psoas muscle ( b =-0.260, P =0.003).</p><p><strong>Conclusions: </strong>This study demonstrates a significant and independent association between AAC and degeneration of the erector spinae and the psoas muscles in patients undergoing lumbar fusion. As both AAC and degeneration of paraspinal muscles impact postoperative outcomes negatively, preoperative assessment of AAC may aid in identifying patients at higher risk after lumbar surgery.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1407-1413"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877398","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":"Nonoperative Management is Associated With Similar Long-Term Patient-Reported Outcomes Compared With Surgery for Cervical Radiculopathy: A Systematic Review and Meta-analysis.","authors":"Kush M Kale, Yi Hein Chai, Shaan Patel, Shiva A Nischal, Jamie R F Wilson","doi":"10.1097/BRS.0000000000005704","DOIUrl":"10.1097/BRS.0000000000005704","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To compare long-term patient-reported outcomes between surgical and nonoperative management for cervical radiculopathy.</p><p><strong>Summary of background data: </strong>Cervical radiculopathy is a common condition associated with substantial morbidity. While both surgical and nonoperative approaches are effective, it remains unclear which patients benefit most from each strategy and whether earlier operative intervention confers meaningful long-term advantage.</p><p><strong>Materials and methods: </strong>PubMed, Embase, and the Cochrane Library were searched from inception to January 2026 for randomized and observational studies comparing surgical and nonoperative management for cervical radiculopathy. Primary outcomes included visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), and overall clinical success. Secondary outcomes included analgesia use and sick leave. Random-effects meta-analyses were performed using restricted maximum likelihood estimation. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence using GRADE.</p><p><strong>Results: </strong>Eleven studies comprising 1154 patients (surgical: 522; nonoperative: 632) were included. Surgery was not associated with superior outcomes in VAS for arm pain (MD: -0.67, 95% CI: -1.59 to 0.26, P =0.12), VAS for neck pain (MD: -0.50, 95% CI: -1.38 to 0.38; P =0.19), or NDI (MD: -3.69, 95% CI: -9.63 to 2.25, P =0.16) after 12 months of treatment, nor in overall success (RR: 1.11, 95% CI: 0.93-1.34, P =0.21). No significant differences were observed in analgesia use ( P =0.54) or sick leave ( P =0.48) at last follow-up. Most studies were rated serious risk of bias and overall certainty of evidence was moderate.</p><p><strong>Conclusion: </strong>Evidence from this pooled analysis suggests that long-term pain, disability, and functional outcomes are comparable between patients selected for nonoperative management and those selected for surgery. These findings reflect outcomes within selected cohorts and should not be interpreted as evidence of therapeutic equivalence.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E487-E499"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634317","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":"Response to Letter to the Editor.","authors":"Patricia M Herman, Sam Mann, Lynn L DeBar","doi":"10.1097/BRS.0000000000005737","DOIUrl":"10.1097/BRS.0000000000005737","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E513"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424349","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}