Spine Surgery and Related Research最新文献

{"title":"A Rare Case of Conus Medullaris Mature Teratoma Initially Considered a Different Spinal Cord Tumor Due to Intramedullary Hemorrhage.","authors":"Shimpei Kawaharada, Toshiki Okubo, Narihito Nagoshi, Naoto Kubota, Yohei Masugi, Takahito Iga, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Kota Watanabe, Masaya Nakamura","doi":"10.22603/ssrr.2025-0409","DOIUrl":"10.22603/ssrr.2025-0409","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"520-524"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253365","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":"Vertebral Body-Level Increased Signal Intensity in Cervical Ossification of the Posterior Longitudinal Ligament: Association with Segmental Hypermobility and Surgical Outcomes.","authors":"Yuta Yamamoto, Takuhei Kozaki, Yasutsugu Yukawa, Hiroshi Iwasaki, Shunji Tsutsui, Masanari Takami, Keiji Nagata, Yuyu Ishimoto, Masatoshi Teraguchi, Shizumasa Murata, Ryuichiro Nakanishi, Takahiro Kozaki, Hiroshi Hashizume, Hiroshi Yamada","doi":"10.22603/ssrr.2025-0357","DOIUrl":"10.22603/ssrr.2025-0357","url":null,"abstract":"<p><strong>Introduction: </strong>Increased signal intensity (ISI) on T2-weighted magnetic resonance imaging at the vertebral body level in cervical ossification of the posterior longitudinal ligament (OPLL) may reflect dynamic cord compression. This study investigated the prevalence, radiographic characteristics, and surgical outcomes associated with vertebral body-level ISI in patients with OPLL.</p><p><strong>Methods: </strong>This retrospective study analyzed 95 patients with cervical OPLL who underwent surgery between 2013 and 2022. Patients were categorized on the basis of ISI location: group D (disc level, n=52) and group B (vertebral body level, n=23). Radiographic parameters including cervical alignment, range of motion (ROM), and K-line status were evaluated. Clinical outcomes were assessed using Japanese Orthopaedic Association (JOA) scores at 2-year follow-up.</p><p><strong>Results: </strong>Vertebral body-level ISI was observed in 24.2% of the entire cohort, accounting for 30.7% of patients with ISI. Group B indicated significantly greater local ROM (10.3±2.2° vs 5.8±2.6°, p<0.0001) and more pronounced flexion kyphosis than did group D, and predominantly anterior cord compression compared with group D. In group B, fusion surgery yielded superior outcomes to decompression alone (JOA recovery rate: 59.9±21.7% vs 18.7±20.9%, p=0.0061), despite most patients being K-line (+).</p><p><strong>Conclusions: </strong>Vertebral body-level ISI in cervical OPLL is associated with increased segmental mobility and flexion-related dynamic compression. These exploratory findings suggest that vertebral body-level ISI may warrant consideration of fusion surgery, even in K-line (+) cases. Prospective validation in larger cohorts is needed.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"539-547"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763698","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":"Chronic Corticosteroid Use Is Associated with Increased Postoperative Complications Following Lumbar Microdiscectomy.","authors":"Levi M Travis, Solomon G Jackson, Aneesh V Samineni, William A Marmor, Danny Lee, Anil Sedani, Emmanuel N Menga","doi":"10.22603/ssrr.2025-0245","DOIUrl":"10.22603/ssrr.2025-0245","url":null,"abstract":"<p><strong>Introduction: </strong>Lumbar microdiscectomy (MLD) is a safe and effective treatment for lumbar disc herniation with low complication rates. However, short-term perioperative complications remain a concern for at-risk patients. Chronic corticosteroid use has been linked to impaired healing and infection in other spinal procedures, yet its impact in MLD remains poorly defined. This study aimed to evaluate the association between chronic corticosteroid use and 30-day complications following elective lumbar MLD.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2016 to 2023. Data were collected from adult patients (≥18 years) undergoing microdiscectomy. Patients with fusion procedures or systemic illnesses were excluded. Corticosteroid use was defined according to the NSQIP variable as systemic use within 30 days prior to surgery. A 3:1 nearest-neighbor propensity score matching was performed on key covariates. Multivariable logistic regression was adjusted for race, ethnicity, operative year, and inpatient status.</p><p><strong>Results: </strong>Of 64,380 eligible patients, 2,439 (3.8%) used chronic steroids. Post-matching yielded a cohort of 9,648 patients with well-balanced characteristics. Chronic steroid users had significantly higher odds of 30-day readmission (odds ratio [OR]=1.41; 95% confidence interval [CI]: 1.12-1.77; p=0.003), pneumonia (OR=2.21; 95% CI: 1.08-4.44; p=0.026), deep vein thrombosis (OR=2.04; 95% CI: 1.00-4.08; p=0.046), and sepsis (OR=3.18; 95% CI: 1.60-6.37; p<0.001). Operative time, transfusion rates, and length of stay were similar. Most patients were discharged home, with no differences in disposition between groups.</p><p><strong>Conclusions: </strong>Chronic corticosteroid use is independently associated with increased risks of postoperative sepsis, deep vein thrombosis, pneumonia, and readmission following lumbar microdiscectomy. These findings highlight the importance of perioperative risk stratification and surveillance in this subgroup. Surgeons should consider proactive risk mitigation strategies, such as perioperative infection prophylaxis, pulmonary hygiene, and enhanced thromboprophylaxis, when managing these patients. Further prospective studies are warranted to enhance outcomes in this population.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"476-485"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253363","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":"Externally validating the Mortality In Spinal Infection-20 score: A retrospective cohort study in New Zealand.","authors":"Eamon P G Walsh, Greg Gamble, Joseph F Baker","doi":"10.22603/ssrr.2025-0333","DOIUrl":"10.22603/ssrr.2025-0333","url":null,"abstract":"<p><strong>Introduction: </strong>There have been several prognostic tools proposed for determining spinal epidural abscess patient outcomes. One such method is the \"mortality in spinal infection\" scoring system. In this study, we aim to externally validate this score within the New Zealand population.</p><p><strong>Methods: </strong>We identified all patients who were admitted to a tertiary referral centre with a diagnosis of spinal epidural abscess between February 2009 and January 2022. The mortality in spinal infection score was calculated for all patients. We developed a receiver operating characteristic curve and a calibration plot to externally validate the score.</p><p><strong>Results: </strong>A total of 140 patients with spinal epidural abscesses met the criteria for inclusion in our study. Within the one-year follow-up period, 18 patients died while 122 survived. In total, 105 patients underwent surgical intervention, while 35 patients were managed nonoperatively. In total, 5/15 (33%) of patients with scores ≥11 died compared with 13/125 (10%) of those with scores <11 (odds ratio 4.3, 95% confidence interval [CI] 1.3-14.6, p=0.03). This threshold had high specificity (0.92) and negative predictive value (0.90) but lower sensitivity (0.28) and positive predictive value (0.33). The area under the curve of the receiver operating characteristics plot for mortality in spinal infection scoring and death (0.67, 95% CI 0.57-0.79) did not meet the prespecified criterion of an area under the curve >0.80 for acceptable prediction.</p><p><strong>Conclusions: </strong>In this cohort, the mortality in spinal infection-20 score demonstrated limited ability to discriminate between those patients who died vs those who survived at one year post follow-up. Prospective multicentre data collection may improve the development of predictive tools.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"409-416"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253188","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":"Predictive Clinical and Imaging Factors for Conservative versus Operative Management of Spinal Schwannomas and Meningiomas: A Retrospective Study.","authors":"Momotaro Kawai, Narihito Nagoshi, Toshiki Okubo, Masahiro Ozaki, Satoshi Suzuki, Kazuki Takeda, Takahito Iga, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.22603/ssrr.2025-0260","DOIUrl":"10.22603/ssrr.2025-0260","url":null,"abstract":"<p><strong>Introduction: </strong>The paucity of research concerning the conservative management of spinal cord and cauda equina schwannomas and meningiomas complicates the determination of surgical necessity and its optimal timing. This study aimed to elucidate the clinical and imaging characteristics of schwannomas and meningiomas in the thoracolumbar and lumbar spine that support long-term conservative management strategies.</p><p><strong>Methods: </strong>A retrospective case series of 159 patients with magnetic resonance imaging-confirmed schwannomas or meningiomas was conducted. Patients were categorized into operative (n=125) and conservative (n=34) groups based on whether surgery was performed within one year of diagnosis. Tumor characteristics, clinical symptoms, and imaging data were systematically analyzed. Tumor occupancy was modeled using an ellipsoidal formula to estimate spinal canal involvement. A receiver operating characteristic curve analysis determined the optimal cutoff for predicting treatment decisions. Multivariate logistic regression was employed to identify factors influencing treatment choice.</p><p><strong>Results: </strong>Tumor occupancy emerged as a critical determinant, with a cutoff of 0.42 predicting treatment choice with a sensitivity of 0.79 and a specificity of 0.89 (area under the curve=0.87). Logistic regression analysis revealed significant associations for tumor occupancy (adjusted odds ratio [OR]=9.6×10^-5; 95% confidence interval [CI]=6.2×10^-7-5.3×10^-3; p<0.001), presence of numbness or leg pain (OR=0.022; 95% CI=9.8×10^-4-0.18; p=0.002), and male gender (OR=0.19; 95% CI=0.038-0.83; p=0.037). No significant associations were observed for age, decreased manual muscle testing, or imaging heterogeneity.</p><p><strong>Conclusions: </strong>Prolonged conservative management is feasible for female patients who do not have leg pain or numbness and tumors with low occupancy. A tumor occupancy threshold of 0.42 may serve as a valuable clinical indicator to guide treatment decisions, promoting individualized, symptom-driven management strategies tailored to patient characteristics.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"448-455"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253299","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":"Establishment and Preliminary Outcomes of a Nationwide Spine and Spinal Cord Surgery Registry in Japan: Analysis of 158,263 Cases in 2022.","authors":"Hideyuki Arima, Chie Shimmura, Yosuke Shibata, Toshimi Aizawa, Nobuyuki Fujita, Takanori Fujita, Naobumi Hosogane, Shota Ikegami, Shiro Imagama, Gen Inoue, Ken Ishii, Yukihiro Nakagawa, Hiroaki Nakashima, Seiji Ohtori, Haruki Ueda, Kei Watanabe, Mitsuru Yagi, Koji Yamada, Toshitaka Yoshii, Hirotaka Chikuda, Hirotaka Haro, Yukihiro Matsuyama, Masaya Nakamura, Hiroshi Taneichi, Tokumi Kanemura","doi":"10.22603/ssrr.2025-0254","DOIUrl":"10.22603/ssrr.2025-0254","url":null,"abstract":"<p><strong>Introduction: </strong>The Japanese Society for Spine Surgery and Related Research (JSSR) developed a national web-based registry system, integrating it with the Japanese Orthopaedic Association National Registry (JOANR/JSSR-DB) to systematically collect data on spinal and spinal cord surgeries and complications. This study aimed to report on the establishment of JOANR/JSSR-DB, and evaluate the epidemiology of spinal and spinal cord surgery in Japan, in addition to the frequency and characteristics of perioperative complications, on the basis of data from JOANR/JSSR-DB 2022.</p><p><strong>Methods: </strong>This registry-based study analyzed prospectively collected data in all patients who underwent spinal surgery at JSSR-certified institutions between April 1, 2022 and March 31, 2023. A total of 158,263 cases (89,358 men and 68,905 women; mean age 66.6 years) from 1,032 facilities were included. Data included demographics, diagnoses, surgical procedures, use of intraoperative supportive technologies, intraoperative and 30-day postoperative complications, and systemic complications.</p><p><strong>Results: </strong>Of the total patients, 143,085 (90.4%) underwent initial surgery, 3,712 (2.3%) staged surgery, and 11,301 (7.1%) reoperation/additional surgery. The most prevalent diagnoses were lumbar spinal canal stenosis (51,472, 32.5%), lumbar disc herniation (26,256, 16.6%), and cervical spondylotic myelopathy (15,394, 9.7%). The most common surgical procedures were posterior lumbar interbody fusion (10,910, 6.9%), posterior spinal fusion (10,826, 6.8%), and balloon kyphoplasty (8,274, 5.2%). The frequencies of intraoperative, postoperative, and systemic complications were 2.6% (4,107 patients), 2.7% (4,316 patients), and 1.8% (2,782 patients), respectively. Overall, the complication frequency was 6.5% (10,313 patients).</p><p><strong>Conclusions: </strong>A comprehensive spine and spinal cord surgery registry was established in Japan, and a comprehensive study was conducted on diseases, surgeries, and complications related to spinal surgeries performed in 2022 in Japan. Ongoing registry-based studies are expected to enhance evidence-based practices, reduce complications, and maintain high medical care standards.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"393-408"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253146","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":"Anterior versus Posterior Fusion Surgery for Cervical Ossification of the Posterior Longitudinal Ligament: A Systematic Review and Meta-Analysis.","authors":"Narihito Nagoshi, Takashi Hirai, Hiroshi Takahashi, Kanji Mori, Kanichiro Wada, Satoshi Maki, Yasushi Oshima, Go Yoshida, Shiro Imagama, Masahiko Takahata, Hirotaka Chikuda, Masahiro Yoshida, Masao Koda, Motoki Iwasaki, Yoshiharu Kawaguchi, Masashi Yamazaki, Toshitaka Yoshii","doi":"10.22603/ssrr.2025-0399","DOIUrl":"10.22603/ssrr.2025-0399","url":null,"abstract":"<p><strong>Background: </strong>Cervical ossification of the posterior longitudinal ligament (OPLL) often requires surgical decompression with fusion. Both anterior decompression and fusion (ADF) and posterior decompression and fusion (PDF) are used; however, comparative evidence regarding their clinical outcomes remains limited and inconsistent. This study aimed to systematically review and synthesize evidence comparing ADF and PDF in patients with cervical OPLL.</p><p><strong>Methods: </strong>A systematic search of Embase, the Cochrane Library, and MEDLINE was conducted from database inception to November 30, 2024. Randomized controlled trials and cohort studies directly comparing ADF and PDF were included. Outcomes of interest included neurological recovery based on the Japanese Orthopaedic Association score or recovery rate, complication rates, radiographic parameters, pain, reoperation, patient-reported outcome measures (PROMs), and healthcare costs. Pooled analyses were performed using weighted mean differences or odds ratios with 95% confidence intervals. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework.</p><p><strong>Results: </strong>Eleven studies met the inclusion criteria. The overall certainty of evidence was rated as very low. Pooled point estimates favored ADF for neurological recovery compared with PDF, although differences did not reach statistical significance. Similar findings were observed in subgroup analyses of patients with K-line (-) status or high canal-occupying ratios (≥50% to 60%). Perioperative complications were more frequent after ADF, whereas neurological complications occurred more often after PDF; however, neither comparison showed statistically significant differences. No significant differences were identified in pain reduction, radiographic outcomes, reoperation rates, or PROMs. One study reported higher healthcare costs in the PDF group. Substantial heterogeneity was present across most analyses.</p><p><strong>Conclusions: </strong>Current evidence does not demonstrate a clear advantage of either anterior or posterior fusion strategies for cervical OPLL. Given the substantial heterogeneity and very low certainty of evidence, differences between approaches should be interpreted with caution. Further well-designed comparative studies are required to determine the optimal fusion strategy.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"548-557"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760410","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":"Anatomical and Clinical Validation of a Novel Ultrasound-Guided Approach to Lumbar Transforaminal Epidural Injection \"Lambda Sign over Horizontal Line\".","authors":"Sachiko Kawasaki, Manabu Maeda, Nana Maeda, Takamasa Shimizu, Naoki Minami, Yurito Ueda, Kenji Kawamura","doi":"10.22603/ssrr.2025-0385","DOIUrl":"10.22603/ssrr.2025-0385","url":null,"abstract":"<p><strong>Introduction: </strong>Transforaminal epidural injection (EI) is an effective treatment for lumbar disorders. We used a novel ultrasound (US)-guided approach to identify the lumbar transforaminal epidural space without radiation or electrical stimulation. This technique shows a characteristic \"Lambda sign over Horizontal Line (LHL)\" view focused on the pars interarticularis. Therefore, we aimed to determine the anatomical background of the intervertebral foramen and clinical outcomes of this technique.</p><p><strong>Methods: </strong>In one cadaver, indigo carmine was injected into the sacral hiatus, and the L3 vertebra was removed with the L3/4 facet joint. The specimens were sectioned longitudinally along the L3 spinal nerve and examined using hematoxylin-eosin staining. For clinical analysis, 18 individuals with lower limb pain underwent our novel US-guided lumbar transforaminal EI. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was assessed before and at one, two, and four weeks after the first intervention, and scores for three visual analog scales (VASs) and five domains were compared between baseline and 4 weeks. Additionally, patients were divided into two groups based on the number of injections (single-trial versus multiple-trial), and baseline demographic data were compared between them.</p><p><strong>Results: </strong>Histological sections revealed oblique ligamentous tissue on the laterodorsal edge of the pars interarticularis, with the epidural space extending laterally. Among 15 complete follow-up cases, VAS scores for low back pain, lower limb pain, and all JOABPEQ domains except mental health improved significantly. Only the diagnosis differed significantly between the single-trial and multiple-trial groups.</p><p><strong>Conclusions: </strong>Our novel US-guided transforaminal EI approach (\"LHL\") may improve pain and quality of life. However, multiple trials are required for cases of bony stenosis.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"577-584"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763614","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":"Rheumatoid Arthritis in the Cervical Spine: An Updated Review of Epidemiology, Imaging, and Surgical Indications.","authors":"Junho Song, Eric Mai, Joshua Zhang, Manjot Singh, Omri Maayan, Tariq Z Issa, Samuel K Cho, Sheeraz A Qureshi, Andrew C Hecht","doi":"10.22603/ssrr.2025-0423","DOIUrl":"10.22603/ssrr.2025-0423","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid cervical spondylitis (RCS) is a potentially devastating manifestation of rheumatoid arthritis (RA), typically presenting as atlantoaxial instability, basilar invagination, and/or subaxial subluxation. Despite modern disease-modifying antirheumatic drugs and biologics, established cervical instability often progresses and may result in myelopathy, brainstem compression, vertebrobasilar insufficiency, or sudden death. Many patients remain minimally symptomatic until late, emphasizing the need for structured surveillance and timely surgical referral. This review aimed to synthesize contemporary evidence on the epidemiology, imaging evaluation, risk stratification, and management of RCS and outline a pragmatic screening and treatment framework in the biologic era.</p><p><strong>Methods: </strong>We performed a narrative review of the English-language literature using PubMed and major rheumatology and spine journals. Topics included the prevalence and natural history of cervical involvement in RA, mechanisms of instability, radiographic assessment (anterior/posterior atlantodental interval, Ranawat and Redlund-Johnell indices, cervicomedullary angle), clinical predictors of neurological decline, and outcomes of contemporary medical and surgical strategies.</p><p><strong>Results: </strong>Cervical involvement remains common in RA, with atlantoaxial instability, basilar invagination, and subaxial subluxation often coexisting and following a characteristic progression. Many patients demonstrate radiographic instability without neurologic deficit, whereas a subset develops myelopathy or catastrophic injury. Radiographic parameters and clinical grading systems correlate with neurological status and recovery and inform timing of surgery. Modern disease-modifying antirheumatic drugs/biologic regimens reduce but do not abolish RCS progression. Pattern-specific stabilization procedures, including C1-C2 fusion, occipitocervical fusion, and subaxial instrumentation, generally yield pain relief, neurologic improvement, and durable fusion but carry meaningful perioperative risk.</p><p><strong>Conclusions: </strong>RCS remains an important cause of preventable myelopathy and mortality in RA. Routine cervical screening of high-risk patients, appropriate advanced imaging, and early referral for stabilization before fixed deficits are critical to optimizing outcomes.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"331-342"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253262","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":"Efficacy of Neurotropin for Chronic Low Back Pain: A Retrospective Observational Study.","authors":"Kazuhide Inage, Geundong Kim, Noriyasu Toshi, Hiromitsu Takaoka, Tomohito Mukaihata, Noritaka Suzuki, Yawara Eguchi, Miyako Suzuki-Narita, Yasuhiro Shiga, Masahiro Inoue, Takahisa Hishiya, Shuhei Ohyama, Kosuke Takeda, Masaya Mizutani, Susumu Tashiro, Akihiro Iida, Yu Otake, Seiji Ohtori, Sumihisa Orita","doi":"10.22603/ssrr.2025-0289","DOIUrl":"10.22603/ssrr.2025-0289","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate pain outcomes after Neurotropin initiation in individuals with chronic low back pain (CLBP) and to explore factors associated with treatment response.</p><p><strong>Methods: </strong>This multicenter retrospective observational study included patients with CLBP (duration ≥3 months) who received oral Neurotropin therapy (4 tablets daily) from May 2024 to May 2025. The primary outcome was pain intensity, measured using a visual analog scale (VAS) at baseline and at 2, 4, 8, and 12 weeks. The secondary outcomes were patient characteristics, pain features, simplified Spine painDETECT questionnaire scores, and Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP) scores. Statistical analyses were conducted using paired t-tests with Bonferroni correction, repeated-measures analysis of variance, and multivariate regression.</p><p><strong>Results: </strong>A total of 106 patients (46 males, 60 females; mean age: 66.5±15.8 years) were included. The baseline VAS score was 6.74±1.12. Neurotropin was associated with significant pain reduction over 12 weeks, with VAS scores decreasing to 5.40±1.42 at 2 weeks, 5.15±1.39 at 4 weeks, 4.95±1.38 at 8 weeks, and 4.73±1.48 at 12 weeks (p<0.01 for all). The mean VAS score improvement was 2.14 points (95% confidence interval: 1.76-2.52) at 12 weeks. The minimal clinically important difference (≥1.5 points) was achieved by 62.3% (66/106) of patients. A BS-POP score ≥11 (indicating psychiatric problems) was significantly associated with reduced treatment response (VAS score improvement: 1.45±1.22 vs. 2.38±1.18 points, p=0.001). Pain duration was negatively correlated with treatment response (r=-0.26, p=0.049). No adverse events were reported.</p><p><strong>Conclusions: </strong>Neurotropin was associated with significant pain reduction in CLBP in this retrospective observational study, with an excellent safety profile. Psychiatric comorbidities and longer pain duration were associated with reduced treatment response. Neurotropin may be a beneficial therapeutic option for CLBP, particularly in patients considered unsuitable for long-term non-steroidal anti-inflammatory drug therapy, although these findings require confirmation in randomized controlled trials.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"627-633"},"PeriodicalIF":1.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761037","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}