Spine Surgery and Related Research最新文献

{"title":"Postoperative Risks in Thoracolumbar Fractures Patients with Mental Disorders: A Retrospective Cohort Study Using a Nationwide Inpatient Database.","authors":"Kenta Takakura, Akira Honda, Yusuke Sasabuchi, Eiji Takasawa, Tokue Mieda, Toshiki Tsukui, Tomoki Nakajima, Kazuhiro Inomata, Yuya Kimura, Kiyohide Fushimi, Hideo Yasunaga, Hirotaka Chikuda","doi":"10.22603/ssrr.2025-0411","DOIUrl":"10.22603/ssrr.2025-0411","url":null,"abstract":"<p><strong>Background: </strong>Mental disorders, such as schizophrenia and mood disorders, are associated with spine injuries. However, the relationship between mental disorders and short-term outcomes after surgery for spine injury remains unclear. This study aimed to investigate the association between mental disorders and postoperative outcomes in surgical patients with thoracolumbar fractures.</p><p><strong>Methods: </strong>This retrospective cohort study was performed using a national inpatient database in Japan. Patients who were emergently admitted and underwent spinal fixation surgery for thoracolumbar fractures were categorized into schizophrenia, mood disorder, and control groups. Postoperative outcomes included in-hospital mortality, postoperative complications, and 30-day readmission. Multivariable logistic regression analyses were performed to adjust for patient backgrounds and injury severity.</p><p><strong>Results: </strong>Among 23,148 patients, 1,243 patients had schizophrenia, 1,192 had mood disorder, and the remaining 20,713 patients were classified into the control group. In-hospital mortality was 1.0%, 0.6%, and 1.3%, postoperative complications occurred in 20.7%, 19.2%, and 18.0%, and readmission within 30 days was observed in 2.3%, 3.1%, and 3.2% of patients in the schizophrenia, mood disorder, and control groups, respectively. Compared to the control group, postoperative complications were more likely to occur in the schizophrenia group (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.52-2.06) and the mood disorders group (OR, 1.50; 95% CI, 1.28-1.74). No significant differences were observed in in-hospital mortality or 30-day readmission.</p><p><strong>Conclusions: </strong>Mental disorders were associated with postoperative complications in patients with spinal injuries. Careful perioperative management may be necessary for this population.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"795-801"},"PeriodicalIF":1.6,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Risk of Reoperation after Hybrid Cervical Surgery with One-Level Anterior Cervical Corpectomy and Fusion versus Multilevel Anterior Cervical Discectomy and Fusion: A Retrospective Cohort Study.","authors":"Anthony N Baumann, Robert J Trager, Omkar S Anaspure, Keegan T Conry, Gordon Preston, Jacob C Hoffmann","doi":"10.22603/ssrr.2025-0362","DOIUrl":"10.22603/ssrr.2025-0362","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Introduction: </strong>HCS involving one-level anterior cervical corpectomy and fusion (1L-ACCF) along with ACDF is an alternative technique to the standard of mACDF for DCM, with limited evidence available on postoperative outcomes. The primary objective is to compare 4-year reoperation risk after hybrid cervical surgery (HCS) versus multilevel anterior cervical discectomy and fusion (mACDF) in degenerative cervical myelopathy (DCM). Secondarily, the study evaluates the association of surgical technique with pseudoarthrosis, oral opioid prescriptions, and postoperative dysphagia.</p><p><strong>Methods: </strong>Using TriNetX, we identified adults (≥18 years) with DCM who underwent either HCS with 1L-ACCF or ≥4-level mACDF from 2004 to 2020. Patients were grouped by surgery type, and reoperation risk factors were used for propensity matching. The primary outcome was the risk ratio ([RR], 95% confidence interval [CI]) for reoperation; secondary outcomes included RRs for pseudoarthrosis, oral opioid prescriptions, and postoperative dysphagia, as well as the mean number of oral opioid prescriptions.</p><p><strong>Results: </strong>There were 1,203 patients with DCM per cohort (mean age=56 years) after matching. Within the HCS with 1L-ACCF cohort, compared to the mACDF cohort, there was a statistically significant greater risk of reoperation (10.2% vs 7.6%; RR=1.34 [1.03-1.73]; p=0.0267), yet a significantly lower risk of pseudoarthrosis (22.6% vs 32.3%; RR=0.70 [0.61-0.80]; p<0.001) and dysphagia (12.1% vs 18.8%; RR=0.65 [0.53-0.78]; p<0.001). There was no statistically significant difference in the risk or mean count of oral opioid prescriptions between cohorts (RR=0.96 [0.91-1.01]; 8.4 vs 8.9; p=0.471).</p><p><strong>Conclusions: </strong>There appears to be a higher risk of reoperation after HCS with 1L-ACCF compared to that with mACDF in adult patients with DCM. However, HCS with 1L-ACCF was associated with a lower risk of pseudoarthrosis and dysphagia as compared to that of mACDF, with no difference in oral opioid prescriptions. Surgeons can consider these tradeoffs in the complex decision-making process when recommending a surgical approach for DCM.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"702-709"},"PeriodicalIF":1.6,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advantages of Posterior Harms-Goel C1C3 Fixation over Anterior C2C3 Discectomy and Fusion with Plate and Screws for Highly Unstable Hangman's Fracture: Time to Close the Debate?","authors":"Nathan Beucler","doi":"10.22603/ssrr.2025-0032","DOIUrl":"10.22603/ssrr.2025-0032","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"525-528"},"PeriodicalIF":1.6,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Fibrous Dysplasia Arising in the Lumbar Pedicle Successfully Diagnosed and Treated by Safe Lesion Biopsy Using O-Arm Navigation and Endoscopic Techniques.","authors":"Takashi Dezawa, Katsunori Fukutake, Keiji Hasegawa, Akihito Wada, Daisuke Kamakura, Akinori Tani, Aki Mitsuda, Naobumi Tochigi, Hiroshi Takahashi","doi":"10.22603/ssrr.2026-0058","DOIUrl":"10.22603/ssrr.2026-0058","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"656-659"},"PeriodicalIF":1.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of Differences in the Firing Patterns of Paraspinal Muscle Electromyography in Healthy Subjects.","authors":"Hirokazu Shitogishi, Daisuke Yamabe, Makoto Suzuki, Yusuke Chiba, Hirotaka Yan, Ryo Hatayama, Hideki Murakami, Yasushi Chida, Kenichiro Kakutani, Minoru Doita","doi":"10.22603/ssrr.2026-0033","DOIUrl":"10.22603/ssrr.2026-0033","url":null,"abstract":"<p><strong>Introduction: </strong>Limited data exist regarding the contraction and relaxation patterns of paraspinal muscles (PSMs) during dynamic tasks like gait in healthy individuals. Our preliminary findings, as a cross-sectional study, suggested the existence of distinct, highly individualized activation patterns of PSMs. This study aimed to classify these patterns and to investigate their relationships with functional mobility parameters.</p><p><strong>Methods: </strong>A total of 57 healthy volunteers participated in 10-m gait and Timed-Up-and-Go (TUG) tests. Paraspinal electromyography (EMG), tri-axial acceleration, and angular velocity were simultaneously recorded using wireless sensors at the lumbar region. Participants were classified into four distinct types (Types A, B, C, and D) based on the synchronization of PSMs EMG with vertical acceleration and EMG amplitude during gait. Functional parameters were compared using analysis of variance and Dunnett's post hoc tests (vs. Type A). Logistic regression analysis was performed to assess the predictability of Type C.</p><p><strong>Results: </strong>Type C (n=20), characterized by extremely weak PSMs EMG firing (≤±1300 μV) during gait, showed several functional impairments compared with Type A: significantly longer TUG completion time (p<0.05), and shallower anteroposterior inclination angle and reduced pitch angular velocity during the sit-to-stand transition (both p<0.05). Logistic regression confirmed that Type C could be reliably distinguished from Type A (area under the curve ≤0.973) using a combination of EMG-root mean square (EMG-RMS) and kinematic parameters.</p><p><strong>Conclusions: </strong>Healthy individuals exhibit characteristic individual differences in PSM activation during walking and rising. The group with extremely weak PSM activation (Type C) showed compromised physical function and altered postural control strategies, suggesting that these neuromuscular patterns may reflect subtle functional variations, potentially acting as preclinical indicators of future functional decline.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"787-794"},"PeriodicalIF":1.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Internal Validation of a Simplified Clinical Risk Score for Systemic Complications After Spine Surgery Using a Nationwide Japanese Registry: JOANR/JSSR-DB.","authors":"Shota Ikegami, Hideyuki Arima, Hiroyuki Ishiguro, Shinji Takahashi, Hayato Takei, Satoshi Maki, Chie Shimmura, Gen Inoue, Takashi Kaito, Haruo Kanno, Shota Takenaka, Hiroaki Nakashima, Nobuyuki Fujita, Naobumi Hosogane, Mitsuru Yagi, Kentaro Yamada, Kei Watanabe, Takanori Fujita, Hiroshi Taneichi, Masahiko Watanabe, Katsushi Takeshita, Masaya Nakamura, Yukihiro Matsuyama, Hirotaka Haro, Hirotaka Chikuda, Tokumi Kanemura","doi":"10.22603/ssrr.2026-0113","DOIUrl":"10.22603/ssrr.2026-0113","url":null,"abstract":"<p><strong>Introduction: </strong>We developed a simplified scoring system (JSSR-DB RC3S) to predict systemic complications after spine surgery using data from the nationwide Japanese Society for Spine Surgery and Related Research Database (JSSR-DB).</p><p><strong>Methods: </strong>This retrospective cohort study included 8,930 spine surgery cases registered between January and March 2024. The target outcome was systemic complications occurring intraoperatively or within 30 days postoperatively. Candidate preoperative variables were screened using least absolute shrinkage and selection operator logistic regression with 5-fold cross-validation, and the five dominant predictors were used to construct the JSSR-DB RC3S. Integer points were assigned using a zero-start scoring approach, followed by score-based recalibration. Internal validation used out-of-fold predictions from 5-fold cross-validation.</p><p><strong>Results: </strong>The incidence rate of systemic complications was 1.7% (156/8,930). The five selected predictors were age, performance status, emergency surgery, degenerative disease, and spinal trauma. The final score ranged from 0 to 22 points. Observed incidence rates increased from 0.23% in the low-risk group (0-2 points) to 6.67% in the high-risk group (14-22 points). The model performance was acceptable, with an area under the curve of 0.740, observed-to-expected ratio of 0.997, and Brier score of 0.0167.</p><p><strong>Conclusions: </strong>The JSSR-DB RC3S is a transparent, clinically interpretable, simplified score for predicting systemic complications after spine surgery, derived from Japanese nationwide registry data. It may support perioperative risk communication in daily practice, and may serve as an introductory implementation of the broader JSSR-DB risk calculator framework.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"685-692"},"PeriodicalIF":1.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed-Onset C1 Myelopathy after Cervical Laminoplasty.","authors":"Yuto Kobayashi, Koji Tamai, Minori Kato, Hiromitsu Toyoda, Akinobu Suzuki, Shinji Takahashi, Yuta Sawada, Masayoshi Iwamae, Yuki Okamura, Masato Uematsu, Hiroshi Taniwaki, Ryo Sasaki, Yuki Kinoshita, Maya Suzuki, Masashi Tsujino, Hiroaki Nakamura, Hidetomi Terai","doi":"10.22603/ssrr.2026-0101","DOIUrl":"10.22603/ssrr.2026-0101","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"816-819"},"PeriodicalIF":1.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between Lumbar Spinal Movement and the Location of Type 1 Modic Changes in Elite Athletes.","authors":"Saori Soeda, Masatoshi Morimoto, Takafumi Ohshima, Junzo Fujitani, Takayuki Kitahara, Daiki Nakajima, Naoto Ono, Yuji Nagao, Kosuke Sugiura, Hiroaki Manabe, Fumitake Tezuka, Sudharshan Tripathi, Koichi Sairyo","doi":"10.22603/ssrr.2026-0057","DOIUrl":"10.22603/ssrr.2026-0057","url":null,"abstract":"<p><strong>Introduction: </strong>Type 1 Modic change (MC1) is strongly associated with chronic low back pain, but it is unclear whether its anatomical distribution reflects sport-specific spinal loading in elite athletes.</p><p><strong>Methods: </strong>We retrospectively reviewed elite athletes with chronic low back pain and magnetic resonance imaging (MRI)-confirmed MC1 who had a history of low back pain for >3 months and concordant pain relief after fluoroscopy-guided discography or selective disc block at the MC1 level. Athletes aged >60 years and those with a history of lumbar surgery, scoliosis >10°, or sagittal translation >4 mm were excluded. Three blinded reviewers classified the dominant spinal movement of each athlete during competition (flexion, extension, right/left lateral bending, or axial loading). The distribution pattern of MC1 (anterior, posterior, right, left, or entire) was determined on short-tau inversion recovery MRI scans. Correspondence was assessed only when all reviewers agreed on the dominant movement.</p><p><strong>Results: </strong>Eighteen athletes (19 levels) with a mean age of 34.5 years were included. MC1 (63%) was most frequently observed at L5-S1. MC1 was localized anteriorly in 42%, to the right in 26%, to the left in 16%, and involved the entire endplate in 16%. There were no posterior-only lesions. Rater consensus on the dominant movement was obtained for 10 athletes (involved in seven sports). Nine of these 10 athletes (90%) showed correspondence between the dominant movement and the distribution of MC1, including flexion with anterior MC1 and right lateral bending with right-sided MC1.</p><p><strong>Conclusions: </strong>Sports with a single dominant repetitive spinal movement often showed a match between that movement and the location of MC1. This finding supports a focal, load-related mechanism linking sport-specific spinal loading with MC1 in elite athletes with chronic low back pain.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"741-750"},"PeriodicalIF":1.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S1 Dual Outer Diameter Screws Accelerate Early Fusion Compared with Conventional Pedicle Screws in Posterior Lumbosacral Interbody Fusion.","authors":"Hiroaki Onuma, Takashi Hirai, Kenichiro Sakai, Fujiki Numano, Masaki Tomori, Kyohei Sakaki, Takuya Takahashi, Shunichi Fujii, Yu Matsukura, Kentaro Yamada, Satoru Egawa, Motonori Hashimoto, Toshitaka Yoshii, Yoshiyasu Arai","doi":"10.22603/ssrr.2026-0004","DOIUrl":"10.22603/ssrr.2026-0004","url":null,"abstract":"<p><strong>Introduction: </strong>Achieving successful lumbosacral interbody fusion is challenging due to the unique anatomical characteristics of the sacrum. The predominantly cancellous bone and short pedicles limit screw purchase, which frequently leads to S1 screw loosening and pseudarthrosis, resulting in persistent pain and poor outcomes. Therefore, the S1 Dual Outer Diameter (DOD) screw, featuring a dual-zone thread design with greater thread depth and sharper edges proximally and reduced thread depth with blunter edges distally, was developed to maximize screw purchase in cancellous and cortical bones. This study aimed to compare the clinical and radiological outcomes of DOD and conventional pedicle screws in posterior lumbosacral interbody fusion.</p><p><strong>Methods: </strong>A total of 90 patients (control group, n=51; DOD group, n=39) who underwent lumbosacral fusion (≤2 levels) between 2017 and 2023 were retrospectively reviewed. The outcomes included the Japanese Orthopaedic Association (JOA) score and computed tomography-assessed interbody fusion and S1 screw loosening rates over 2 years.</p><p><strong>Results: </strong>The DOD group demonstrated a significantly higher early fusion rate at six months than the control group (33.3% vs. 9.8%; p=0.006). This early fusion was associated with a significantly higher 6-month JOA recovery rate in the DOD group (59.2%±26.9% vs. 47.8%±22.6%; p=0.029). No significant difference in overall loosening rates was observed between the two groups (20.5% vs. 35.3%; p=0.12). However, patients with one-level fusions in the DOD group showed a significantly lower loosening rate than those in the control group (5.3% vs. 25.8%; p=0.048). A higher preoperative Oswestry Disability Index score, lower lumbar lordosis, and multi-level fusion were risk factors for loosening, even with DOD screws.</p><p><strong>Conclusions: </strong>S1 DOD screws were associated with significantly improved early fusion and functional recovery, as assessed by the JOA score, and with a significantly lower loosening rate in one-level fusion. These findings indicate that DOD screws are an effective option for short-segment lumbosacral fusion.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"751-760"},"PeriodicalIF":1.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compact Navigation-Assisted Transpedicular Approach Using Unilateral Biportal Endoscopy for Caudally Migrated Lumbar Disc Herniation.","authors":"Takeshi Umebayashi, Yasukazu Hijikata, Takaoki Kimura, Nahoko Kikuchi, Takeshi Hara, Keiichi Tsuda, Shinji Kumamoto, Daichi Kawamura","doi":"10.22603/ssrr.2025-0369","DOIUrl":"10.22603/ssrr.2025-0369","url":null,"abstract":"<p><strong>Introduction: </strong>Severely migrated lumbar disc herniations are challenging to access using conventional interlaminar or transforaminal approaches, especially in revision cases. A transpedicular route provides direct access but raises concerns regarding accuracy, safety, and radiation exposure when fluoroscopy is required. In this Technical Note, we describe a transpedicular unilateral biportal endoscopic (UBE) approach assisted by a compact navigation system for a caudally migrated disc herniation, highlighting its feasibility and potential advantages.</p><p><strong>Technical note: </strong>A 73-year-old man with a history of L1/2 fusion and multilevel laminoplasty presented with severe low back pain, radicular leg pain, and weakness. Magnetic resonance imaging demonstrated a left L2/3 disc herniation that had migrated caudally to the lower border of the L3 pedicle. Based on these findings, a transpedicular UBE approach assisted by a compact navigation system was selected. After intraoperative computed tomography (CT) acquisition and automatic registration, real-time navigation accurately localized the left L3 pedicle and displayed the planned entry point and drilling trajectory relative to the patient's anatomy. Using a navigated drill, a pedicle entry point was created, and the transpedicular channel was prepared. Under UBE visualization, the medial pedicle wall was drilled to expose the L3 nerve root, enabling direct removal of the caudally migrated fragment. The procedure was completed safely with minimal blood loss and required only a single intraoperative CT, with no fluoroscopy. Postoperative CT confirmed an approximately 6-mm transpedicular bone window without pedicle fracture. The patient had immediate symptom relief and remained recurrence-free at 6 months.</p><p><strong>Conclusions: </strong>This Technical Note demonstrates the feasibility of a transpedicular UBE approach assisted by compact navigation for complete removal of a severely caudally migrated lumbar disc herniation. The technique allowed accurate instrument guidance, effective decompression, and zero radiation exposure to the surgical team. Future studies are warranted to validate its long-term safety and broader applicability.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"809-815"},"PeriodicalIF":1.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}