North American Spine Society Journal最新文献

{"title":"Impact of enhanced hospital infection prevention measures during-COVID-19 pandemic on the incidence of surgical site infections following spinal instrumentation surgery for lumbar spinal stenosis: A nationwide database study","authors":"Daiyang Yu MD ,&nbsp;Yuri Miyakoshi MD ,&nbsp;Tomoyuki Tanaka MD, PhD ,&nbsp;Kunihiko Takahashi PhD ,&nbsp;Tetsuya Jinno MD, PhD ,&nbsp;Toshitaka Yoshii MD, PhD ,&nbsp;Kiyohide Fushimi MD, PhD ,&nbsp;Hiroyuki Inose MD, PhD","doi":"10.1016/j.xnsj.2025.100810","DOIUrl":"10.1016/j.xnsj.2025.100810","url":null,"abstract":"<div><h3>Background context</h3><div>Despite the implementation of stringent infection control measures during the COVID-19 pandemic, the impact of these interventions on surgical site infection (SSI) rates in spinal instrumentation surgery remains unclear. This study aimed to compare the incidence of SSIs after spinal instrumentation surgeries for lumbar spinal canal stenosis (LCS) before and during the COVID-19 pandemic and to assess the impact of the COVID-19 pandemic, including enhanced hospital infection prevention measures implemented during-pandemic, on the incidence of SSIs following spinal instrumented surgery for LCS.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study using the Diagnosis Procedure Combination database, a Japanese national database. We analyzed 42,890 patients who underwent instrumentation surgery for LCS during the prepandemic (2017–2018) and during-pandemic (2020–2021) periods. The primary outcome was the occurrence of postoperative SSIs during hospitalization. We used propensity score (PS) matching to compare SSI rates and conducted multivariate logistic regression analysis to assess the pandemic’s impact after adjusting for confounding variables</div></div><div><h3>Results</h3><div>Results showed a significant increase in SSI rates during-pandemic, from 1.83% to 2.53% (p&lt;.01). After PS matching, the during-pandemic group continued to show a higher SSI rate (2.44%) compared to the prepandemic group (1.84%, p=.01). Multiple logistic regression analysis demonstrated that the association between the COVID-19 period (prepandemic versus during-pandemic) and SSI incidence remained statistically significant after adjusting for potential confounding variables (p=.01, OR=1.26).</div></div><div><h3>Conclusions</h3><div>These findings suggest that SSIs following instrumented spinal surgeries for LCS in Japan increased during-pandemic, even with matched patient characteristics. Future research should focus on identifying specific elements of perioperative care that may have been compromised during the pandemic and developing targeted interventions to address these gaps in surgical infection prevention.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100810"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466437","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":"Reoperation risk by subtype in proximal junctional kyphosis and the impact of osteoporosis treatment in adult spinal deformity surgery","authors":"Tetsuro Ohba MD, PhD,&nbsp;Nobuki Tanaka MD, PhD,&nbsp;Kotaro Oda MD, PhD,&nbsp;Hayato Takei MD,&nbsp;Goto Go MD,&nbsp;Hirotaka Haro MD, PhD","doi":"10.1016/j.xnsj.2025.100821","DOIUrl":"10.1016/j.xnsj.2025.100821","url":null,"abstract":"<div><h3>Background</h3><div>Mechanical complications after long-segment fusion for adult spinal deformity (ASD) remain a major driver of reoperation. Proximal junctional kyphosis (PJK) comprises heterogeneous morphologic subtypes with potentially distinct clinical courses, yet how subtype relates to reoperation risk and whether bone quality or osteoporosis medications mitigate that risk are not fully defined.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective cohort study of consecutive older adults undergoing posterior instrumented fusion for ASD. Patients were classified by PJK subtype and grade using standardized radiographic criteria, and followed longitudinally for the occurrence and timing of reoperation. Bone quality surrogates and osteoporosis therapies, including preoperative teriparatide, were recorded. Multivariable models adjusted for demographic, surgical, and spinopelvic parameters were used to assess associations between subtype, bone quality, medication exposure, and reoperation.</div></div><div><h3>Results</h3><div>Reoperation clustered within specific PJK subtypes, with higher-grade deformity demonstrating a disproportionately greater need for revision. Subtypes characterized by structural failure and junctional collapse showed the strongest association with reoperation compared with alignment-predominant patterns. Lower bone quality correlated with more severe PJK and reoperation, whereas exposure to osteoporosis medication—particularly preoperative teriparatide—was associated with a lower likelihood of reoperation and delayed time to reintervention. Sensitivity analyses yielded consistent effect directions across age, sagittal alignment, and construct length strata.</div></div><div><h3>Conclusions</h3><div>PJK subtype meaningfully stratifies reoperation risk after ASD surgery. Integrating subtype with bone quality assessment can refine perioperative decision-making, identify patients who may benefit from intensified junctional protection, and inform surveillance. Preoperative anabolic therapy emerges as a potentially modifiable factor linked with reduced reoperation, warranting prospective evaluation. These findings support a practical, subtype-guided strategy that couples surgical planning with bone health optimization to reduce failure and reoperation burden.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100821"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614554","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":"Not all Parkinsons patients with thoracolumbar spinal fusion are created equal: Highlighting the difference between long and short fusions","authors":"Matthew Lindsey MD ,&nbsp;Hannah Levy MD ,&nbsp;Tyler Allen MD ,&nbsp;Andrew Pumford BA ,&nbsp;Abdelrahman Hamouda BS ,&nbsp;Brian Kelley BS ,&nbsp;Brian Goh MD, PhD ,&nbsp;Brett Freedman MD ,&nbsp;Arjun Sebastian MD ,&nbsp;Ahmad Nassr MD","doi":"10.1016/j.xnsj.2025.100808","DOIUrl":"10.1016/j.xnsj.2025.100808","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Parkinsons disease (PD) is a devastating neuromuscular disease that has several distinct spinal syndromes in addition to common degenerative spinal disorders. Multiple studies have concluded that patients with Parkinson's disease are at increased risk for perioperative medical complications and poor surgical outcomes such as failure of hardware and reoperation. PD patients exist in a spectrum of spinal disease with presentations, indications and surgical paradigms varying widely, yet the literature tends to treat them as a homogenous group. A more nuanced investigation and comparison of PD patients undergoing TL fusion will yield important differences in presentation, indication and outcomes. There is scant evidence on the most appropriate fusion paradigm for treating Parkinson's patients. We set out to compare patients who had short or long (&gt;3 levels) thoracolumbar fusions to contrast the rate of surgical failure, and complications between each surgical approach and identify any patient, surgical, or disease risk factors for poor outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This retrospective cohort study of a single center experience with spinal fusion patients with concomitant Parkinson's disease at the time of spinal surgery. We included adult patients who underwent thoracolumbar spinal fusion and had a concomitant diagnosis of PD at an academic center between 2017 and 2022. Revision, oncologic and infection cases were excluded. Primary outcome measures were radiographic (stenosis, listhesis, hardware, fracture) evidence of failure, and morbidity. Secondarily, a multivariate regression was performed to identify patient risk factors for failure. We extracted and analyzed demographic information, Parkinson's specific metrics, in and out of hospital complications, surgical data, and radiologic outcomes and compared patients who underwent either short or long fusion constructs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;92 patients were identified after inclusion and exclusion. 63 (68%) underwent short fusion and 29 (32%) had long fusion constructs. Short fusion constructs were more strongly indicated for radiculopathy 51% vs. 21% p=.01) while extended fusions had a higher indication of spinal deformity (41%vs. 10% p=.001) or fracture (34%vs. 8% p=.004) and were more likely to have decreased mobility prior to surgery (79.7%vs. 53.9%; P&lt;.001). Short constructs had a higher rate of listhesis (20%vs. 0% p=.01) or stenosis (34.5%vs. 4% p=.008) at the level above the upper instrumented level, proximal screw loosening (13%vs. 0% p=.009), proximal junctional complications (53%vs. 12% p=.001) and proximal junctional failures (37%vs. 8% p=.02). In hospital complications, 90 day and 1 year mortality, reoperation rate, infection rate, progressive neurologic decline, and fusion rates were statistically similar between groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;How to approach surgical treatment of PD patients remains a c","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100808"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466438","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":"Ligamentum flavum: changes in vascular density, physical and histopathobiochemical properties in lumbar spine based on anatomical localization, spinal segment levels, and presence of lumbar spinal stenosis","authors":"Jakub Jezek MD, PhD ,&nbsp;Josef Sepitka MS, PhD ,&nbsp;Petr Kujal MD, PhD ,&nbsp;Petr Waldauf MD, PhD ,&nbsp;Jan Svec MD ,&nbsp;Vojtech Cerny MS ,&nbsp;Filip Samal MD, PhD ,&nbsp;Jiri Skala-Rosenbaum MD, PhD","doi":"10.1016/j.xnsj.2025.100782","DOIUrl":"10.1016/j.xnsj.2025.100782","url":null,"abstract":"<div><h3>Background</h3><div>Hypertrophy of the ligamentum flavum (LF) contributes significantly to the development of lumbar spinal stenosis (LSS), a serious and often disabling disease predominantly affecting the aging population. Histologic changes in the ligament and the tissue mediators that drive these alterations have been described, but their spatial distribution within the ligament remains unclear. Understanding these changes may enable future interventions to slow ligament degeneration and disease progression. To date, no study has comprehensively described the distribution of pathological changes within individual ligaments.</div></div><div><h3>Methods</h3><div>This study combined histopathobiochemical analysis and micromechanical mapping of healthy and degenerated human LF specimens obtained perioperatively from 57 patients undergoing lumbar spine surgery (38 with LSS and 19 controls). Ligament samples were analyzed histologically for vascular density, presence of inflammatory infiltrates, and chondroid metaplasia using morphometric software and immunohistochemical staining. Mechanical properties, including stiffness (Young’s modulus) and contact pressure, were measured via nanoindentation using the Hysitron BioSoft In-Situ Indenter system. Samples were spatially mapped across 9 anatomical zones of the LF to investigate regional variation. Statistical analyses compared these parameters between spinal segments (L3/4, L4/5, L5/S1), between LSS and control groups, and evaluated age-related trends.</div></div><div><h3>Results</h3><div>The central region of the LF exhibited significantly higher vascularity and stiffness compared to peripheral regions. Areas showing chondroid metaplasia and inflammation demonstrated increased vascularization, characteristic of LSS pathology. Although vascular density and mechanical stiffness were elevated in LSS patients versus controls, these differences did not reach statistical significance. Age-related trends differed between groups: stiffness increased with age in controls but decreased in LSS patients.</div></div><div><h3>Conclusions</h3><div>The greatest changes in vascularization and stiffness occur in the central region of ligamentum flavum. Understanding these localized alterations may support future development of targeted therapies to slow or prevent disease progression.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100782"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046901","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":"Non-tobacco nicotine dependence increases risk of complications following lumbar spine decompression and fusion","authors":"Courtney Spitzer BA,&nbsp;Melissa Romoff BA,&nbsp;Madison Brunette BA,&nbsp;Melanie K Peterson MD,&nbsp;Andy Ton MD,&nbsp;Ryan Le MD,&nbsp;Abhinav Sharma MD,&nbsp;Justin P Chan MD,&nbsp;Hao-Hua Wu MD,&nbsp;Sohaib Hashmi MD,&nbsp;Michael S Kim MD","doi":"10.1016/j.xnsj.2025.100790","DOIUrl":"10.1016/j.xnsj.2025.100790","url":null,"abstract":"<div><h3>Background</h3><div>Non-tobacco nicotine products (eg, e-cigarettes, nicotine pouches) are increasingly used by cigarette smokers and prior nonsmokers. While the detrimental effects of cigarette dependence (CD) on healing and surgical recovery are well documented, the impact of non-tobacco nicotine dependence (NTND) on outcomes after lumbar spine surgery remains poorly characterized.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the TriNetX database. Patients undergoing lumbar spine decompression and fusion were divided into 3 cohorts: NTND, CD, and controls (no documented nicotine dependence). Propensity score matching was performed 1:1 based on demographic and clinical characteristics. Complication rates were assessed at 90 days and 3 years postoperatively. Outcomes included anemia, deep vein thrombosis (DVT), myocardial infarction (MI), pneumonia, renal failure, pulmonary embolism (PE), sepsis, stroke, opioid abuse, pseudoarthrosis, and lumbar fracture.</div></div><div><h3>Results</h3><div>A total of 39,195 matched NTND and control patients were analyzed. NTND was associated with increased 90-day risks of anemia, DVT, MI, pneumonia, renal failure, sepsis, stroke, and opioid abuse, as well as higher 3-year risks of pseudoarthrosis and lumbar fracture (p &lt; .05). In a comparison of 36, 877 matched NTND and CD patients, NTND showed higher anemia risk but lower risks of MI, PE, renal failure, sepsis, stroke, and opioid abuse at 90 days. At 3 years, NTND carried a higher pseudoarthrosis risk but lower lumbar fracture risk relative to CD (p &lt; .0001). When NTND and CD patients were combined (<em>n</em> = 102,720 total), both groups demonstrated significantly higher complications risks compared with controls at both 90 days and 3 years (p &lt; .0001).</div></div><div><h3>Conclusions</h3><div>NTND is associated with increased perioperative and long-term complications following lumbar spine surgery, including higher rates of infection, opioid abuse, pseudoarthrosis, and lumbar fracture. NTND demonstrates a distinct complication profile compared to CD, underscoring the need for further research on the impact of non-tobacco nicotine exposure on spinal fusion outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100790"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221067","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":"The future of intraoperative neuromonitoring (IONM) in spinal surgery1","authors":"W. Bryan Wilent PhD, DABNM ,&nbsp;Marcia-Ruth Ndege BS, CNIM ,&nbsp;Adam Doan DC, DABNM","doi":"10.1016/j.xnsj.2025.100777","DOIUrl":"10.1016/j.xnsj.2025.100777","url":null,"abstract":"<div><h3>Preface</h3><div>On behalf of the NASS section on intraoperative neuromonitoring (IONM), we present a narrative perspective exploring the future of IONM in spine surgery in the US, drawing on current evidence and future projections.</div></div><div><h3>Present state</h3><div>IONM is used during hundreds of thousands of spinal procedures each year to enhance patient safety via real-time neurodiagnostic feedback. The most common service model is an in-room technologist and a remote supervising professional who interprets the neurophysiological data. The primary goal of IONM is to: (1) detect significant signal changes from baseline, (2) identify the cause—whether technical, positional, anesthetic, or iatrogenic, and (3) pinpoint the site of injury. This diagnostic process is time-sensitive, complex, and dependent on both the signal pattern change and patient and procedural factors that are dynamically variable.</div></div><div><h3>Future: integrating and advancing technology</h3><div>Artificial intelligence (AI) and machine learning (ML) hold promise to enhance the accuracy in detecting and interpreting signal changes for IONM clinicians and be integrated into surgeon-directed software platforms. However, widespread AI/ML adoption depends on the availability of large, validated IONM datasets—currently hindered by practice variation, inconsistent perioperative documentation, and unharmonized IONM, anesthetic, surgical, and patient medical records.</div></div><div><h3>Future: maturation in Profession</h3><div>IONM can improve in the consistency in which optimal IONM is delivered, how IONM is utilized with evidence-based planning for alerts, and the collection of harmonized and complete signal and clinical records. Most publications have focused on the diagnostic accuracy of IONM in predicting deficits, but more emphasis is needed on demonstrating the therapeutic impact of interventions to alerts and their role in preventing new deficits.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100777"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221066","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 “impact of transversus abdominis plane block on length of stay and postoperative opioid use in anterior lumbar interbody fusions”","authors":"Annie L. McDonald BA,&nbsp;Jonathan N. Grauer MD","doi":"10.1016/j.xnsj.2025.100824","DOIUrl":"10.1016/j.xnsj.2025.100824","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100824"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736470","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":"The future is now: How AI is reshaping spine care","authors":"Eric J. Muelbauer ,&nbsp;Mohammed Ali Alvi MD, MS ,&nbsp;David J. Kennedy ,&nbsp;Michael G. Fehlings MD, PhD","doi":"10.1016/j.xnsj.2025.100825","DOIUrl":"10.1016/j.xnsj.2025.100825","url":null,"abstract":"<div><h3>Introduction</h3><div>Artificial intelligence (AI) is rapidly reshaping spinal care, transitioning from experimental algorithms to operational tools embedded in clinical workflows. This narrative review explores the evolving role of AI across the spine care continuum, including diagnostic imaging, surgical planning, intraoperative navigation, predictive analytics, and digital therapeutics.</div></div><div><h3>Methods</h3><div>Using a mixed-methods approach, we synthesized insights from peer-reviewed literature, regulatory documents, press releases, and grey sources published between 2017 and 2025.</div></div><div><h3>Results</h3><div>AI-enabled imaging platforms now assist in detecting spinal pathologies and extracting quantitative metrics such as disc heights and Cobb angles, improving diagnostic consistency and reducing inter-rater variability. In surgical planning, decision-support systems and robotics-integrated platforms offer personalized guidance and enhanced precision. Intraoperative tools using 2D–3D fusion and volumetric reconstruction are enabling hardware-light navigation, particularly in ambulatory settings. Predictive models for survival, reoperation risk, and patient-reported outcomes are emerging, though external validation remains limited.</div><div>Digital therapeutics and wearable technologies are expanding the reach of spine care beyond the clinic, offering scalable solutions for rehabilitation and postoperative monitoring. Meanwhile, regulatory and legal frameworks are evolving to address transparency, data governance, and intellectual property concerns. Recent FDA guidance and landmark legal cases underscore the need for disciplined collaboration and responsible deployment.</div></div><div><h3>Conclusions</h3><div>AI in spine care is no longer theoretical and is operational. Its integration promises enhanced precision, efficiency, and personalization, but also demands rigorous validation and ethical oversight. This review highlights the multifaceted impact of AI and calls for continued alignment between clinicians, developers, and regulators to ensure safe, equitable, and sustainable innovation.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100825"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736471","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 intraoperative hypotension and motor evoked potential change in ossification of posterior longitudinal ligament and/or ossification of ligamentum flavum surgery","authors":"Tun Liu MD, PhD ,&nbsp;Wentao Wang MD, PhD ,&nbsp;Huaguang Qi MD ,&nbsp;Jia Li MD, PhD ,&nbsp;Bin Guo MD ,&nbsp;Kuo Jiang MD, PhD ,&nbsp;Songchuan Zhao MD ,&nbsp;Ruiguo Wang MD, PhD ,&nbsp;Jitao Zhang MD ,&nbsp;Gang Wu MD, PhD ,&nbsp;Gang Wang MD, PhD","doi":"10.1016/j.xnsj.2025.100820","DOIUrl":"10.1016/j.xnsj.2025.100820","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative hypotension (IOH) is a recognized contributor to changes in motor evoked potential (MEP) during spinal surgeries. Additionally, it is essential to precisely define IOH across different surgical phases. However, there is limited data on optimal IOH thresholds for predicting MEP changes in thoracic ossification of the posterior longitudinal ligament (OPLL) and/or ossification of the ligamentum flavum (OLF) surgery. We aim to determine the IOH thresholds for predicting MEP changes during surgical treatment for OPLL and/or OLF based on different surgical phase.</div></div><div><h3>Methods</h3><div>Data collected included demographic information, surgical details, mean arterial pressure (MAP) values, and MEP signals. A receiver operating characteristic (ROC) curve was employed to determine the MAP thresholds. A comparative analysis was performed to evaluate IOH episodes occurring during predecompression versus postdecompression surgical phases, specifically in the early and later stages. Additionally, a multivariate logistic regression analysis was conducted to assess the association between surgical variables and MEP change.</div></div><div><h3>Results</h3><div>The MAP thresholds for predicting changes in MEP at the early surgical stage were determined as follows: 70 mmHg for patients with combined OPLL and OLF, 66 mmHg for OPLL patients, and 65 mmHg for OLF patients. However, it is recommended that MAP at the later surgical stage should be elevated to exceed 75 mmHg, 73 mmHg, and 71 mmHg in patients diagnosed with combined OPLL and OLF, OPLL, and OLF, respectively. A stronger correlation was observed between MAP variability ratio and MEP amplitude reduction ratio (ARR) during postdecompression surgical phase. At the early surgical stage, the administration of ephedrine bolus was identified as a risk factor for predicting MEP change (odds ratio [OR]=1.13, p&lt;.01). At the later stage, the risk-factors included ephedrine bolus (OR=1.09, p&lt;.01), estimated blood loss (per 100 mL) (OR=1.23, p=.02), and patients with combined OPLL and OLF (OR=12.12, p&lt;.01).</div></div><div><h3>Conclusions</h3><div>We determined cutoff values for MAP to predict changes in MEP in patients undergoing surgical treatment for OPLL and/or OLF based on different surgical phases. Compared to the early surgical stage, patients exhibit less tolerance to IOH at the later surgical stage. A stronger correlation was observed between the MAP variability ratio and MEP ARR at the later surgical stage. Additionally, we identified surgical factors that are associated with a higher probability of MEP change.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100820"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681368","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 systematic review on frailty indices utilized in oncologic surgery and radiotherapy for metastatic spine disease: A critical appraisal of components and performance","authors":"Ali Haider Bangash MBBS ,&nbsp;Rose Fluss MD ,&nbsp;Sertac Kirnaz MD ,&nbsp;Jason D. Nosrati MD ,&nbsp;Byung-Han Rhieu MD ,&nbsp;Justin Tang MD, MS ,&nbsp;Madhur K. Garg MBA, MD ,&nbsp;Saikiran G. Murthy DO ,&nbsp;Yaroslav Gelfand MD ,&nbsp;Reza Yassari MD ,&nbsp;Rafael De la Garza Ramos MD","doi":"10.1016/j.xnsj.2025.100794","DOIUrl":"10.1016/j.xnsj.2025.100794","url":null,"abstract":"<div><h3>Background</h3><div>Frailty assessment is becoming increasingly important for risk stratification in metastatic spine disease (MSD) management. However, the optimal frailty assessment tool for this population remains undefined. The aim of this systematic review was to critically evaluate frailty indices utilized in surgical and radiotherapeutic management of MSD by appraising their components and predictive performance.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Cochrane, and Epistemonikos from inception until November 13, 2024 for studies exploring frailty indices in MSD management. Methodological quality assessment was undertaken using the Methodological index for nonrandomized studies (MINORS) and Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tools. We evaluated indices for comprehensiveness by assessing if they included measures across 8 dimensions (comorbidity burden, mobility, cognition, mood, social vulnerability, nutrition, energy, and function). We also assessed their predictive utility for mortality and complications.</div></div><div><h3>Results</h3><div>Out of a total of 42 studies, 15 studies reporting on 61,663 patients (Mean age: 63 years; 44% female) met the inclusion criteria. All studies were of moderate quality based on MINORS analysis. Six frailty indices were identified, with all including comorbidities while none incorporating energy measures. The Hospital Frailty Risk Score was the most comprehensive (75% of frailty spectrum). Predictive performance varied considerably across studies, with inconsistent associations with complications and mortality after both: surgical and radiotherapeutic interventions.</div></div><div><h3>Conclusions</h3><div>Contemporary frailty indices showed substantial heterogeneity in both composition and predictive performance for MSD outcomes. The inconsistent performance and incomplete capture of frailty dimensions underscored the need for developing a novel frailty index that incorporates oncologic factors and balances comprehensive evaluation with clinical feasibility to help guide treatment decisions between surgery and radiotherapy for patients with MSD.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100794"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268455","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}