North American Spine Society Journal最新文献

{"title":"Depression among lumbar spine surgery patients: Uncovering the untold story","authors":"Aboubacar Wague BA ,&nbsp;Jennifer M. O’Donnell MD ,&nbsp;Nesa Milan MD ,&nbsp;Alex Youn BA ,&nbsp;Gurbinder Singh BS ,&nbsp;Anna Filley MD ,&nbsp;Avionna Baldwin MD ,&nbsp;Zodina Beine MD ,&nbsp;Aesha Ajose BS ,&nbsp;Ashraf N. El Naga MD ,&nbsp;David Gendelberg MD ,&nbsp;Sigurd Berven MD","doi":"10.1016/j.xnsj.2025.100846","DOIUrl":"10.1016/j.xnsj.2025.100846","url":null,"abstract":"<div><h3>Background</h3><div>Depression is highly prevalent among patients with lumbar degenerative disease and is associated with worse postoperative outcomes. However, a significant proportion of affected individuals remain undiagnosed. We aimed to evaluate the utility of PROMIS Depression scores in identifying patients with undiagnosed depression undergoing lumbar spine surgery and to characterize their clinical outcomes relative to patients with diagnosed and no depression.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients undergoing 1- or 2-level lumbar decompression or fusion between March 2019 and November 2021. Patients were stratified into three cohorts: diagnosed depression (PDD), no depression (NDD), and at-risk for undiagnosed depression (ARUD), defined as PROMIS Depression ≥55 without an ICD-10 diagnosis. Patient-reported outcomes were assessed preoperatively and at 6, 12, and 24 months postoperatively. Between group comparisons and baseline-adjusted ANCOVA models were performed, including subgroup analyses by procedure type (fusion vs. decompression) and revision status.</div></div><div><h3>Results</h3><div>Of 286 ICD-10-negative patients, 24.1% (n=69) met criteria for ARUD. Patient-reported outcome scores across all domains in the ARUD cohort mirrored those of the PDD group and were significantly worse than those of the NDD cohort at all timepoints (p&lt;.001). PROMIS Depression showed a strong correlation with Anxiety (ρ&gt;0.77) and moderate correlations with other domains. No significant difference was observed in outcomes between treated and untreated PDD patients. Older age was associated with reduced likelihood of diagnosis, while substance abuse history, pain clinic enrollment, and retired status predicted higher risk of undiagnosed depression.</div></div><div><h3>Conclusions</h3><div>PROMIS Depression scores can identify patients with undiagnosed depression who experience similar impairments and postoperative outcomes as those with diagnosed depression. These findings support the routine use of PROMIS Depression as a screening tool to enhance preoperative psychiatric assessment in spine surgery patients.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100846"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portal message utilization in orthopedic spine surgery: patterns, predictors, and financial implications","authors":"Sydney Rucker BA ,&nbsp;Michal C Williams BS ,&nbsp;Robert J. Ferdon MS ,&nbsp;Jason Silvestre MD ,&nbsp;Charles Reitman MD ,&nbsp;Robert Ravinsky MDCM, MPH, FRCSC","doi":"10.1016/j.xnsj.2025.100845","DOIUrl":"10.1016/j.xnsj.2025.100845","url":null,"abstract":"<div><h3>Background</h3><div>Electronic patient portals (EPPs) facilitate communication between patients and providers, but their utilization and impact in orthopedic spine surgery are poorly defined. This study aims to quantify portal message volume and content, identified demographic predictors of high utilization, and estimated the associated administrative and financial burden.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of 833 new patients presenting to a single tertiary-care orthopedic spine practice over 6 months (April 2–October 31, 2024). Portal messages were categorized by timeframe and subject matter. Patients were classified as low- or high-volume (HV) users, with HV defined as ≥4 messages. Demographic predictors were assessed using independent t-tests and chi-square analyses. Messages meeting Centers for Medicare and Medicaid Services (CMS) criteria for billable Evaluation and Management (E/M) services were identified and assigned reimbursement values. A Monte Carlo simulation (100,000 iterations; R v4.5.1) estimated lost revenue from unbilled encounters.</div></div><div><h3>Results</h3><div>A total of 548 portal messages were sent (median 0 messages per patient; IQR 0–1). Common message topics included appointment scheduling (<em>n</em>=97), imaging-related concerns (<em>n</em>=94), postoperative issues (<em>n</em>=79), pain management (<em>n</em>=70), and third-party requests (<em>n</em>=59). High-volume utilization occurred in 43 patients (5.2%), with a mean of 5.19 messages per patient (range 3–18). Age was not associated with portal use (p=.276). Race was the only significant predictor of HV utilization (χ²=6.172, p=.046), with White/Caucasian patients overrepresented and Black/African American patients underrepresented. Only 25 messages (4.6%) met CMS billing criteria, primarily Level III E/M encounters (72%). Estimated median lost billable revenue was $7,501 (95% CI $3,845–$12,539).</div></div><div><h3>Conclusions</h3><div>Electronic patient portal (EPP) use in orthopedic spine surgery is highly skewed, with a small subset of patients generating disproportionate message volume. Despite limited billable encounters, portal messaging represents a growing administrative burden. Observed racial disparities highlight the need to further evaluate equity in digital patient engagement.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100845"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of sarcopenia and multifidus atrophy on outcomes from minimally invasive decompression surgery for lumbar spinal stenosis","authors":"Gilad J. Regev MD ,&nbsp;Uri Hochberg MD ,&nbsp;Dror Ofir MD ,&nbsp;Khalil Salame MD ,&nbsp;Zvi Lidar MD ,&nbsp;Morsi Khashan MD","doi":"10.1016/j.xnsj.2025.100828","DOIUrl":"10.1016/j.xnsj.2025.100828","url":null,"abstract":"<div><h3>Background</h3><div>In order to improve outcomes for patients with lumbar spinal stenosis, identification of better prognostic factors is necessary to guide patient selection for surgery. The purpose of this study was to investigate the prognostic value of multifidus atrophy and sarcopenia on postoperative pain and disability following minimally invasive decompression for lumbar spinal stenosis.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed medical records and imaging studies for patients with lumbar spinal stenosis who underwent minimally invasive tubular decompression. Multifidus total cross sectional area (tCSA), multifidus functional cross sectional area (fnCSA), multifidus fatty infiltration (FI), psoas tCSA, and psoas relative cross sectional area (rCSA) were evaluated by univariable and multivariable regression to identify predictors of postoperative improvement in visual analogue scores for back pain (VASB) and leg pain (VASL) and Oswestry disability index (ODI) scores for disability.</div></div><div><h3>Results</h3><div>Minimally invasive decompression was performed at 75 spinal levels in 64 patients with an average age of 70.1±10.0 years. In multivariable analysis, lower multifidus FI was significantly associated with 5 point improvement in ODI (p=.002), 10 point improvement in ODI (p=.017), and 17 point improvement in ODI (p=.044). Only male gender (p=.030), lower preoperative VASB (p=.001), and lower preoperative VASL (p=.015) were independently predictive of postoperative deterioration in ODI, VASB, and VASL, respectively.</div></div><div><h3>Conclusions</h3><div>Multifidus FI predicts postoperative improvement in disability following minimally invasive decompression for lumbar spinal stenosis with high accuracy. Minimally invasive decompression surgery is effective for elderly patients and sarcopenic patients, who are not at risk for poorer postoperative outcomes. Male gender and lower preoperative pain or disability are risk factors for postoperative deterioration in patient-reported outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100828"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between novel unilateral uniportal endoscopic lumbar interbody fusion and conventional transforaminal lumbar interbody fusion for lumbar degenerative disease with bilateral symptoms: A 1-year follow-up retrospective cohort study","authors":"Kai-Ting Chien MD ,&nbsp;Ping-Chi Tsai MD ,&nbsp;Jian-You Li PhD ,&nbsp;Yueh-Ching Liu MD ,&nbsp;Lei-Po Chen MD, PhD ,&nbsp;Yu-Ching Huang MD, PhD ,&nbsp;Yan-Shiang Lian MD ,&nbsp;Ting-Kuo Chang MD, PhD","doi":"10.1016/j.xnsj.2026.100849","DOIUrl":"10.1016/j.xnsj.2026.100849","url":null,"abstract":"<div><h3>Background Context</h3><div>Full endoscopic lumbar interbody fusion (FELIF) is a minimally invasive alternative to open transforaminal lumbar interbody fusion (open-TLIF) for lumbar degenerative disease (LDD). This study aimed to compare 1-year outcomes of a modified trans-Kambin FELIF, termed Kambin Torpedo FELIF (KT-FELIF), with those of conventional open-TLIF.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, 76 patients with single-level LDD and bilateral symptoms underwent KT-FELIF (n=30) or open-TLIF (n=46) between January 2020 and January 2024. Patients with prior spinal surgery, multilevel disease, or incomplete follow-up imaging were excluded. Perioperative data, pain scores [visual analog scale (VAS)], radiologic outcomes, and complications were compared at ≥12-month follow-up.</div></div><div><h3>Results</h3><div>KT-FELIF showed significantly lower blood loss (72.00±62.00 mL vs. 173.91±134.37 mL, p&lt;.01) and faster ambulation (1.37±0.49 vs. 2.30±0.81 days, p&lt;.01) than conventional open-TLIF. Both groups showed significant VAS score improvement, but KT-FELIF offered better early pain relief (2 weeks and 6 months, p&lt;.01). Fusion rates were similar (97% vs. 91%, p=.654), though open-TLIF had larger fusion mass (p=.005). KT-FELIF led to greater lumbar lordosis (p=.038) and spinal canal area gains (p=.002), while open-TLIF improved foraminal height more. Complication rates were comparable.</div></div><div><h3>Conclusions</h3><div>KT-FELIF is a safe, effective, and less invasive alternative to open-TLIF for LDD with bilateral symptoms, offering benefits in blood loss, recovery time, and early pain relief, with comparable fusion and radiologic outcomes. Further long-term multicenter studies are warranted.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100849"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on “Identifying patients at risk for a facility discharge following elective one or two level lumbar fusion”","authors":"Emma Portnoy,&nbsp;Jonathan N. Grauer MD","doi":"10.1016/j.xnsj.2026.100869","DOIUrl":"10.1016/j.xnsj.2026.100869","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100869"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A call for dynamic guidelines: Incorporating AI ethics into social media best practices for spine professionals","authors":"Zubayer Shams MD ,&nbsp;Nicola Montemurro MD, PhD, MBA, MSc, FACS ,&nbsp;Bipin Chaurasia MS","doi":"10.1016/j.xnsj.2026.100853","DOIUrl":"10.1016/j.xnsj.2026.100853","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100853"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147537952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stem cell therapy for degenerative disc disease: A systematic review of preclinical evidence, clinical translation, and future directions","authors":"Vinicius Ricieri Ferraz MD ,&nbsp;Carlos R. Goulart MD ,&nbsp;Maria Fernanda Ricieri Ferraz Franco de Souza MD ,&nbsp;Marcelo Ochoa Coelho de Souza Furlan MD ,&nbsp;Philippe Mercier MD, PhD ,&nbsp;Tobias A. Mattei MD, FACS","doi":"10.1016/j.xnsj.2025.100841","DOIUrl":"10.1016/j.xnsj.2025.100841","url":null,"abstract":"<div><h3>Background</h3><div>Degenerative disc disease (DDD) is a leading contributor to chronic low back pain and global disability. Existing therapies, from conservative management to spinal fusion, do not reverse the underlying molecular degeneration, leaving a critical treatment gap. Given its regenerative capabilities the advent of stem-cell therapy may constitute an ideal solution to fulfill such a therapeutic gap.</div></div><div><h3>Methods</h3><div>This PRISMA-compliant systematic review evaluates stem cell–based strategies for intervertebral disc regeneration by examining preclinical evidence, clinical translation, and future directions. Searches of PubMed, Scopus, Web of Science, and related databases (from January 2000–May 2025) identified studies reporting on pain (Visual Analogue Scale), function (Oswestry Disability Index), and structural outcomes (MRI).</div></div><div><h3>Results</h3><div>Preclinical models uniformly demonstrate meaningful regeneration, including restoration of disc height and extracellular matrix. Clinical evidence, however, is limited: thirteen low to moderate-quality trials show modest, albeit statistically significant, improvements in pain and disability, without compelling imaging proof of biological repair. Short to mid-term safety appears acceptable.</div></div><div><h3>Conclusions</h3><div>The use of stem-cell therapy for treatment of degenerative disc disease is constrained by the somewhat hostile and avascular microenvironment of the intervertebral disc. Existing trials exhibit significant methodological weaknesses which substantially impair their application to the daily clinical practice. Future progress will likely depend on incorporating biomaterial-assisted delivery systems, cell-free exosome approaches, biological scaffolds and gene-editing technologies aimed at engineering the disc niche rather than simply focusing on cell replacement.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100841"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PMMA-augmentation of the spinous process as an enhancing-protective measure against bone failure in “through the spinous process-vertebropexy”","authors":"Alexandros Tsolakidis MD ,&nbsp;Marie-Rosa Fasser PhD ,&nbsp;Oliver Wigger ,&nbsp;Mazda Farshad MD ,&nbsp;Jonas Widmer PhD","doi":"10.1016/j.xnsj.2025.100842","DOIUrl":"10.1016/j.xnsj.2025.100842","url":null,"abstract":"<div><h3>Background</h3><div>Vertebropexy, a semi-rigid spinal stabilization technique, utilizes the spinous process(SP) as an anchor point for stabilizing tendon-grafts or flexible cerclages. In its primary form, it entailed drilling into the bone of 2 adjacent SPs and threading the materials through the holes. Biomechanical studies have identified the SP as the weakest part of the vertebrae, while cadaveric studies have demonstrated a higher bone failure rate with osteoporosis. We investigated whether cement augmentation of the SP could enhance the biomechanical strength and reduce the fracture-risk in the setting of first-generation Vertebropexy.</div></div><div><h3>Methods</h3><div>Following computed tomographic analysis and measurement of the bone mineral density, 12 lumbar segments were divided in 2 groups (Osteoporotic/ Nonosteoporotic) and then fixed in custom-made 3D-printed clamps. The SPs of 6 segments underwent cement augmentation (PMMA-Group), and a CT scan confirmed adequate augmentation. The other 6 segments remained uncemented. (Native-Group). Posterior decompression, drilling, and instrumentation with bovine tendons were then conducted. Torque-to-failure stress tests were performed on a biaxial static testing machine.</div></div><div><h3>Results</h3><div>The cement-augmentation of the SP significantly increases the torque-to-failure in flexion (p=.00037/ Median &amp; IQR: 13.0 &amp; 5.2 Nm in the Native-Group vs. 26.5 &amp; 11.1 Nm in the PMMA-Group), regardless of the bone quality (p=.008). A statistically significant difference in torque-to-failure between Osteoporotic and NonOsteoporotic groups inside the PMMA and Native groups was determined (p=.015 and p=.025, respectively). A statistically significant correlation between bone density and failure torque was not detected in this cohort, possibly due to the limited sample size (Spearman 0.276, p=.192). A comparison between the torque-to-failure of the Native-NonOsteoporotic SPs and that of the PMMA-Osteoporotic showed no statistical significance (p=.240).</div></div><div><h3>Conclusions</h3><div>Based on the findings of this small-sample cadaveric study, cement-augmentation of the spinous processes can multiply the torque-to-failure/fracture in both osteoporotic and nonosteoporotic conditions and may be used as a salvage technique in first-generation vertebropexy procedures that compromise the spinous process.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100842"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traditional pedicle screw versus cortical bone trajectory in the upper thoracic spine: A technical description and retrospective comparative review","authors":"Matthew J. Coyle MD, MSc ,&nbsp;Alexandra Bunting MD ,&nbsp;Eve Tsai MD, PhD ,&nbsp;Alexandra Stratton MD, MSc ,&nbsp;Phillipe Phan MD, PhD ,&nbsp;Stephen Kingwell MD, MSc ,&nbsp;Julia Brillinger MSc ,&nbsp;Eugene K. Wai MD, MSc","doi":"10.1016/j.xnsj.2026.100859","DOIUrl":"10.1016/j.xnsj.2026.100859","url":null,"abstract":"<div><h3>Background</h3><div>The cortical bone trajectory (CBT) screw is a relatively new vertebral fixation technique described for use in the lumbar spine by Santoni and Hynes et al. It has been shown to have advantageous biomechanical properties with respect to torsional and pullout strength. The evaluation of CBT in cervical-thoracic fixation has been quite limited. The primary objective of the current study was to determine the mid to long term results of CBT over traditional pedicle screw fixation in the upper thoracic spine.</div></div><div><h3>Methods</h3><div>The current study completed a retrospective chart review of consecutive patients undergoing posterior cervical thoracic fixation in the setting of degenerative, trauma, infection and oncologic etiologies at a single academic centre. Patients with a greater than 1 year radiological follow up were included in the research study. Data was collected by an independent observer, which included patient demographics, complications. Preserved immediate postoperative sagittal alignment at 1 year was considered the primary outcome of this study.</div></div><div><h3>Results</h3><div>Of the 47 patients who met the inclusion criteria, 18 had undergone upper thoracic spine instrumentation with CBT and 28 had TPS trajectories. The operative time was found to be significantly lower in the CBT group (p&lt;.01). The complication rates were similar between groups with the TPS group having an infection rate of 10.7% while the CBT group had a rate of 4.7%. CBT had a higher rate of preservation of post operative alignment at greater than 1 year follow up (p&lt;.05).</div></div><div><h3>Conclusions</h3><div>Patients who underwent CBT fixation had preserved cervical spine alignment at their final postoperative visit. The use of CBT led to a reduction in total length of OR and trended towards a lower complication rate. Given the early findings of our study and others it is likely that CBT screws in the upper thoracic spine will become much more common place at the end of both cervical-thoracic and thoraco-lumbar fusion constructs given their demonstrated benefits.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100859"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between self-reported mental health and resource utilization in patients undergoing elective lumbar fusion","authors":"Matthew J. Solomito PhD ,&nbsp;Heeren Makanji MD","doi":"10.1016/j.xnsj.2026.100851","DOIUrl":"10.1016/j.xnsj.2026.100851","url":null,"abstract":"<div><h3>Background</h3><div>Mental health concerns are increasingly common in patients undergoing lumbar spine fusion. Recent studies have suggested that poor mental health leads to a greater risk of suboptimal recovery. However, few studies have investigated cost and resource allocation associated with patients with poor mental health. Therefore, this study was designed to understand how self-reported mental health, assessed by the PROMIS-10 Global Mental Health T-score (MHT), was associated with both hospital costs and post discharge resource utilization.</div></div><div><h3>Methods</h3><div>A total of 1,211 patients that underwent 1- or 2-level elective lumbar fusion between June 2021 and June 2024, and completed a preoperative PROMIS-10 Global assessment were analyzed for this retrospective review. Patients were grouped based on their MHT: MHT &gt;50 was considered above average (AA), MHT scores between 40 and 50 were average (A), and MHT &lt;40 was considered below average (BA). Multivariate regressions were used to investigate the associations between the MHT score, cost and postdischarge resource utilization.</div></div><div><h3>Results</h3><div>A total of 41.7% of the study cohort was in the A-MHT group, 31.5% was in the AA-MHT group, and 26.8% was in the BA-MHT group. There were no demographic differences among study groups. The AA-MHT group utilized significantly less resources than both the BA-MHT and A-MHT groups. Neither the MHT group nor diagnosed mental illness, were independently associated with cost (p=.572 and p=.646 respectively).</div></div><div><h3>Conclusions</h3><div>The findings of this study demonstrated that patients with below average mental health (MHT scores &lt;40) may not be a risk for increased resource utilization or cost. However, the study results did suggest that patients with above average mental health (MHT scores &gt;50) have better outcomes, and cost less than other groups during the initial recovery phase following elective lumbar fusions.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100851"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}