Spine Journal最新文献

{"title":"\"It's Such a Small World!\"-For Some, But Not Others: Think Outside Your Circles to Make It a Fair-Sized World For All.","authors":"","doi":"10.1016/j.spinee.2025.07.033","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.033","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NG2 glia promote injured spinal cord repair through neuronal transdifferentiation and keratins expression in juvenile mice.","authors":"Qing Zhao, Pianpian Fan, Qie Gu, Haoran Yang, Yongxu Xie, Shuaishuai Xia, Mingyu Lv, Xuemei Tan, Xiang Zhou, Qingchu Li","doi":"10.1016/j.spinee.2025.07.028","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.028","url":null,"abstract":"<p><strong>Background context: </strong>Spinal cord injury (SCI) causes severe nerve damage, and there are still considerable challenges in treatment due to its complex pathological mechanisms. Juvenile mice are characterized by robust regenerative and reparative abilities. Specifically, neonatal mice can attain scar-free healing subsequent to SCI. Nevertheless, mature neurons, astrocytes, ependymal cells and microglia possess restricted neuronal regenerative potential. Therefore, the cellular origin of cells that facilitate neuronal regeneration following SCI in neonatal mice or juvenile mice remains elusive.</p><p><strong>Purpose: </strong>NG2 glia could proliferate, migrate, and differentiate into mature oligodendrocytes. NG2 glia are also considered multipotent neural progenitor cells capable of differentiating into neurons. We previously found that NG2 glia upregulated the expression of neuronal markers following SCI. Thus, our study aimed to determine that whether NG2 glia are responsible for neuroregeneration in juvenile mice following SCI.</p><p><strong>Study design: </strong>Primary NG2 glia were obtained from the cerebral cortices of postnatal day 1-2 (P1-2) Sprague Dawley rats, OLN-93 cells (rat NG2 glia) and MO3.13 cells (human NG2 glia) were used to detect the transdifferentiation of NG2 glia via immunofluorescence. Juvenile C57BL/6J mice aged 1 to 2 weeks and 8-week-old C57BL/6J female mice were subjected to spinal cord crush injury.</p><p><strong>Methods: </strong>By integrating cell culture, immunofluorescence staining, transcriptome RNA sequencing, and molecular experiments, we investigated the role and underlying mechanism of NG2 glia in neuroregeneration and repair subsequent to SCI.</p><p><strong>Results: </strong>We discovered that NG2 glia are capable of forming oligospheres and transdifferentiating into neuron-like cells both in vitro and in vivo. We observed that juvenile mice aged 1 to 2 weeks can spontaneously repair their injured spinal cords and significantly contribute to neuroregeneration and repair following SCI. NG2 glia migrated from the white matter of spinal cord to the injury area. Their numbers increased significantly on the first day after SCI, reached a peak on day 3, and gradually declined after the repair process. Additionally, we revealed that keratinization-related signals were significantly activated in juvenile mice after SCI. During the self - repair process, the expression of keratins in NG2 glia at the injury site was significantly upregulated.</p><p><strong>Conclusions: </strong>In conclusion, NG2 glia play a crucial role in neuroregeneration and repair after SCI through transdifferentiating into neuron-like cells and expressing keratins.</p><p><strong>Clinical significance: </strong>Keratin biomaterials have been shown to support locomotor functional recovery and may modify the acute inflammatory response after SCI. Thus, targeting NG2 glia may be a vital strategy for promoting spinal cord healing","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding, “Multisociety response to The BMJ publications on interventional spine procedures for chronic back and neck pain,” by Rittenberg","authors":"Xiaoqin Wang PhD , Liang Yao PhD , Stéphane Genevay MD, PhD , Gordon H. Guyatt MD, PhD , Thomas Agoritsas MD, PhD , Jason W. Busse MD, PhD , Review and Rapid Recommendation authors.","doi":"10.1016/j.spinee.2025.05.008","DOIUrl":"10.1016/j.spinee.2025.05.008","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 8","pages":"Pages 1853-1854"},"PeriodicalIF":4.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Predictive Performance and Generalizability of Traditional and Artificial Intelligence Models in Predicting Surgical Site Infections Post-Spinal Surgery: A Systematic Review.","authors":"Laura C M Ndjonko, Aritra Chakraborty, Francesco Petri, Seyed Mohammad Amin Alavi, Takahiro Matsuo, Fabio Borgonovo, Isin Y Comba, Mohammad H Murad, Ahmad Nassr, Said El-Zein, Elie F Berbari","doi":"10.1016/j.spinee.2025.07.032","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.032","url":null,"abstract":"<p><strong>Background context: </strong>Surgical site infections (SSIs) are a significant complication following spinal surgery. These infections contribute to increased morbidity, prolonged hospital stays, and substantial healthcare costs. Traditional statistical models have been widely used to predict SSI risk, but artificial intelligence (AI) and its machine learning (ML) methods have also been used for SSI prediction.</p><p><strong>Purpose: </strong>This systematic review aims to evaluate the predictive accuracy of AI models versus traditional statistical models in assessing SSI risk following spinal surgery.</p><p><strong>Study design/setting: </strong>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</p><p><strong>Methods: </strong>We searched Medline, Embase, Scopus, Web of Science, and ClinicalTrials.gov. Studies were included if they developed predictive models for SSI following spinal surgery using either AI or traditional statistical approaches. Risk of Bias for all studies was assessed using the Prediction model Risk of Bias Assessment Tool (PROBAST). Predictive model performance was compared using metrics such as the C-statistic and Area under the Receiver Operating Characteristic curve (AUC-ROC).</p><p><strong>Results: </strong>A total of 51 studies were included. Among these, 42 studies used traditional statistical methods, while 9 used AI / ML models. Logistic regression was the most common method among traditional models (95.2%). Across the ML studies, all of which used supervised models trained on tabular data, decision‑tree-based and linear algorithms (n=7, 77.8% each) were the most common, followed by neural networks and support vector machines (n = 4, 44.4% each). Traditional models achieved a C-statistic between 0.7 and 0.8 in 40.5% of cases (n = 17), with only 4.8% (n = 2) exceeding 0.9. AI models showed a C-statistic of 0.9 or higher in 44.4% of cases (n = 4). However, 77.8% of those ML-based models (n = 7) performed an internal cross validation and only 33.3% reported calibration data (n = 3), and none of the studies are externally validated, which raises important concerns about their current clinical applicability and generalizability.</p><p><strong>Conclusions: </strong>This systematic review, the first of its kind, observed that studies utilizing the ML models reported a potential for excellent classification accuracy in predicting SSI following spinal surgery. However, the current shortcomings in methodology limit their generalizability and immediate clinical implementation. For existing models, most ML studies remain in the early stages of development and its findings in excellent performance should be taken with caution. This review highlights the need for standardized model benchmarking and employing external validation to reliably assess generalizability. Furthermore, advancing beyond conventional tabular data by incorporating s","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors for bladder function recovery following cervical OPLL surgery: a comprehensive analysis.","authors":"Yusuke Setojima, Kengo Fujii, Toru Funayama, Toshitaka Yoshii, Satoru Egawa, Takashi Hirai, Hiroshi Takahashi, Masashi Yamazaki, Masao Koda","doi":"10.1016/j.spinee.2025.07.027","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.027","url":null,"abstract":"<p><strong>Background context: </strong>Neurogenic bladder dysfunction, a condition affecting both bladder storage and voiding function, remains a primary source of morbidity in patients with cervical ossification of posterior longitudinal ligaments (OPLL). Prognosticating the functional outcomes of bladder function postoperatively in patients with cervical OPLL is crucial for patient counseling, rehabilitation planning, and discharge protocols. However, a validated prediction model for bladder function outcomes is currently unavailable. The Japanese Orthopaedic Association (JOA) score, a comprehensive assessment tool for cervical compressive myelopathy, comprises six domains: upper extremity motor function, lower extremity motor function, upper extremity sensory function, trunk sensory function, lower extremity sensory function, and bladder function. The total score ranges from -2 to 17.</p><p><strong>Purpose: </strong>To determine the correlation between postoperative bladder function outcomes and preoperative parameters, including the JOA score, with an aim to identify independent prognostic factors for bladder function recovery one year postoperatively in patients with OPLL.</p><p><strong>Study design/setting: </strong>Retrospective review of prospectively collected data across multiple institutions.</p><p><strong>Patient sample: </strong>Data were collected from 477 patients who underwent surgical intervention for cervical OPLL. After applying the exclusion criteria, data from 192 patients were included in the final analysis. The following variables were examined at the initial presentation: age, sex, body mass index (BMI), comorbidities, preoperative JOA score, OPLL occupation ratio, K-line, surgical approach, spinal fusion, and number of vertebral levels involved.</p><p><strong>Outcome measures: </strong>Postoperative bladder function outcomes one year after surgery.</p><p><strong>Methods: </strong>Univariable and multivariable analyses were performed utilizing the Cox proportional hazards regression model. This study was funded by the Japan Agency for Medical Research and Development (grant number 23ek0109541h0003; total amount: $85,000). All authors have disclosed financial relationships in accordance with ICMJE guidelines.</p><p><strong>Results: </strong>Multivariable analyses revealed that age (p=.003), preoperative JOA lower extremity motor function score (p<.001), and preoperative JOA trunk sensory function score significantly influenced bladder function recovery. Receiver operating characteristic (ROC) curve analysis revealed that preoperative JOA scores of 1.5 points for both lower extremity motor function and trunk sensory function were the optimal thresholds for predicting complete bladder function recovery (p<.001).</p><p><strong>Conclusion: </strong>Age, preoperative JOA lower extremity motor function score, and JOA trunk sensory function score were identified as significant predictors of bladder function recovery following cer","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Surgical Outcomes of Spinal Infection Caused by Methicillin-resistant Staphylococcus aureus.","authors":"Mitsuhiro Nishizawa, Mladen Djurasovic, Steven D Glassman, Charles H Crawford, John R Dimar, R Kirk Owens, Justin Mathew, Benjamin Kostic, Leah Y Carreon","doi":"10.1016/j.spinee.2025.07.029","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.029","url":null,"abstract":"<p><strong>Background context: </strong>Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major causative organisms of spinal infections, and its incidence of spinal infection caused by MRSA has been increasing in recent years. However, limited studies have assessed surgical outcomes and complications focusing specifically on MRSA spinal infections.</p><p><strong>Purpose: </strong>To evaluate the characteristics, surgical outcomes, and complications of spinal infection caused by MRSA.</p><p><strong>Study design: </strong>Retrospective observational cohort.</p><p><strong>Patient sample: </strong>Patients who underwent surgery for spinal infection, including discitis, osteomyelitis, epidural abscess, and/or septic facet arthritis. Patients with a history of spine surgery within the preceding 90 days or culture-negative spondylodiscitis were excluded.</p><p><strong>Outcome measures: </strong>Recurrence and postoperative complications within one year METHODS: We retrospectively reviewed 205 patients who underwent surgery for spinal infection. Clinical characteristics and postoperative complications within one year were compared between patients with spinal infection caused by MRSA (MRSA) and those with infections caused by other organisms (Non-MRSA). Multiple logistic analysis was performed to determine independent factors associated with recurrence.</p><p><strong>Results: </strong>MRSA was identified in 89 patients (43%). Compared to Non-MRSA patients, MRSA patients had a significantly higher incidence of current smoking (57% vs 40%, p=0.021), intravenous drug use (49% vs 33%, p=0.021), thoracic spine involvement (43% vs 28%, p=0.039), epidural abscess (65% vs 45%, p=0.005), concomitant bone and joint infections (30% vs 16%, p=0.027), and positive blood culture (63% vs 46%, p=0.017). They also had significantly higher rates of readmission after 30 days postoperatively (48% vs 34%, p=0.044) and recurrence (20% vs. 7.8%, p=0.012). MRSA was an independent risk factor for recurrence following surgical treatment of spinal infection (MRSA: OR 2.60, 95% CI 1.10-6.52, p =0.033).</p><p><strong>Conclusion: </strong>Spinal infections caused by MRSA were associated with a higher prevalence of current smoking, intravenous drug use, thoracic spine involvement, epidural abscesses, concomitant bone or joint infections, and bacteremia. Moreover, MRSA was identified as an independent risk factor for recurrence following surgical treatment of spinal infection.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot randomized control trial comparing posterior paramedian versus midline incisions for interbody fusions of the lumbar spine.","authors":"Christiaan C Sonke, Cynthia E Dunning, Emma Jones, Caroline E King, William M Oxner, R Andrew Glennie","doi":"10.1016/j.spinee.2025.07.009","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;The midline posterior approach to the lumbar spine remains the most commonly used approach for lumbar spine fusion. This approach, however, is not without downfalls and complications, most notably the risk of infection. The paramedian approach offers potential advantages but literature comparing these approaches is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This pilot feasibility study is needed to establish the protocol and data necessary to determine the sample size required for a well-powered randomized control trial (RCT) to directly compare the midline and paramedian approaches to the lumbar spine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;This was a single-centered, prospective, pilot randomized control trial conducted in Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;All consecutive patients deemed appropriate surgical candidates with single- or two-level degenerative conditions of the lumbar spine were approached for participation in the trial between December 2017 and November 2024. Inclusion criteria were a clinical history of buttock and/or leg pain, with symptoms for greater than three months, and failed conservative care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary clinical outcome measure was deep infection rate within 3 months of surgery, and the second outcome was re-operation at any time during follow up. Other clinical and safety outcomes include intra-operative factors (length of operation, estimated blood loss, length of stay), inpatient and outpatient adverse events, and patient reported outcomes (i.e. ODI, SF-12, VAS for back pain, leg pain, and overall health score, PHQ-9, and EQ-5D) recorded pre-operatively and at 6-18 week and one-year follow-ups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients underwent a one or two-level lumbar instrumented fusion with interbody device, with the surgery being randomized to either a posterior midline or posterior paramedian approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 112 participants were assessed for eligibility in the trial of which 11 were excluded. Fifty-one patients were randomized to the midline group, and 50 to the paramedian group. Five patients (9.6%; 95% CI: 3.1-21.0%) in the midline group were diagnosed with a deep infection and two patients (4.1%; 95% 95% CI: 0.4-14.0%) in the paramedian group. A total of 13 (25%; 95% CI: 14.0-38.9%) patients underwent a revision procedure in the midline group, with a further three requiring a third procedure, while three revision procedures (6.1%; 95% CI: 1.2-16.9%) were performed in the paramedian group. The ODI, SF-12, VAS, and EQ-5D all showed improvement from pre-operative to one year post-operative in both the paramedian and midline groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The current pilot RCT demonstrates potential differences in post-operative deep wound infection at 3-months as well as different rates of re-operation between the midline and paramedian approach. Patient reported o","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"History of endoscopic spine surgery: where did it all begin? Development of indications and techniques.","authors":"Dong Hwa Heo, Hyeun Sung Kim, Yoon Ha Whang, Dong Chan Lee, Kangtaek Lim","doi":"10.1016/j.spinee.2025.07.031","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.031","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic spine surgery began as a minimally invasive treatment for lumbar disc herniation. Over time, significant advances in optical technology, surgical instruments, and imaging systems have expanded its applications to a wide spectrum of spinal diseases, including stenosis, instability, and deformities across the lumbar, cervical, and thoracic regions.</p><p><strong>Purpose: </strong>This review aims to summarize the historical evolution, technical development, and expanding indications of endoscopic spine surgery, focusing on both full endoscopic (uniportal) and biportal approaches.</p><p><strong>Study design: </strong>A narrative literature review METHODS: The authors performed an extensive review of historical and recent literature on endoscopic spine surgery, covering major milestones in technique development, key innovations in instrumentation, and published outcomes of different endoscopic approaches. The review systematically categorizes the evolution of full endoscopic transforaminal and interlaminar procedures, endoscopic lumbar interbody fusion, cervical and thoracic techniques, and the development of biportal endoscopic spine surgery, including its generational progression and safety considerations.</p><p><strong>Results: </strong>Full endoscopic techniques have progressed from early transforaminal discectomy to interlaminar decompression and lumbar interbody fusion. In cervical and thoracic spine, endoscopic posterior foraminotomy and laminotomy have shown promising results. Biportal endoscopic spine surgery, developed primarily in South Korea, has gained popularity due to its similarity to arthroscopic and microsurgical procedures. It allows clear visualization and handling of conventional instruments while maintaining minimally invasive principles. Biportal techniques have been successfully applied to decompression, interbody fusion, and complex cervical and thoracic conditions. Furthermore, recent innovations such as large working channels, expandable cages, and 3D endoscopy have enhanced surgical precision and expanded indications. Studies indicate that with proper technique and low-pressure saline irrigation, biportal endoscopy is safe, including the use of radiofrequency devices.</p><p><strong>Conclusions: </strong>Endoscopic spine surgery has evolved into a versatile and effective approach for treating various spinal disorders. Continuous refinement of tools, visualization technologies, and operative methods will further improve outcomes and broaden clinical applications. Understanding this historical development is essential for appreciating current practices and guiding future advances in minimally invasive spine surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of the Iron-Chelating Agent Deferoxamine in Spinal Cord Injury: A Systematic Review and Meta-Analysis of Preclinical Studies.","authors":"Mehrnaz Moradi, Amirhossein Najibi, Reza Moshfeghinia, Afshin Heidarian, Mehrpour Moradi, Michael G Fehlings","doi":"10.1016/j.spinee.2025.07.030","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.030","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Despite advances in the medical, surgical and rehabilitation treatment of spinal cord injury (SCI), there is a need to develop therapeutic strategies to address mechanisms of secondary injury. Numerous preclinical studies investigated deferoxamine efficacy, an iron chelating agent, in improving functional outcome in SCI models. They proposed anti-inflammatory, anti-ferroptosis, and lipoperoxidation inhibitory mechanisms as the underlying mechanism of action.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Considering preclinical studies are the gate to translational medicine, we present a quantitative synthesis of the existing literature to shed light on gaps and guide future research in neuroprotection for SCI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This is a meta-analysis of preclinical studies involving the use of deferoxamine in in-vivo models of traumatic SCI, regardless of level of injury and/or animal species.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a comprehensive search in 3 databases (PubMed, Web of Science, Scopus) in accordance with PRISMA guidelines. Our review protocol was preregistered (PROSPERO registration ID: CRD420251007113). Ten preclinical studies that investigated deferoxamine administration in functional outcome of animals were chosen. We performed a meta-analysis, using a random effects approach, comparing normalized mean differences in deferoxamine-treated and control group. To minimize heterogeneity, subgroup analysis and meta regression were conducted. We utilized the CAMARADES checklist for quality assessment of the included studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 157 articles, 10 were included for final analysis. Our results revealed that deferoxamine can improve functional scores in animal models of thoracic traumatic SCI (NMD=35.74% [18.74, 52.75]; p&lt;0.001). The funnel plot was symmetric and no publication bias was noted. Heterogeneity was high among included studies (I²: 95.98). The median score for CAMARADES was 5 (IQR range: 4-6), indicating moderate overall quality of include studies. Sample size calculation and allocation concealment were lacking in included studies. Meta regression was significant for assessment time (Coefficient: -0.574 [-0.905, -0.242]) and route of administration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We demonstrated that deferoxamine improves hindlimb motor function in animal models of SCI. Potential knowledge gaps exist, necessitating future animal studies across a more diverse range of injury level and function assessment tools before moving on to conducting clinical trials. Assessment time may play a critical role in preclinical models and needs to be adjusted to clinically plausible time points in future studies. More inter-species preclinical research, especially in non-human primates, is encouraged to foster generalizability and clinical applicability of the models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical significance: &lt;/strong&gt;Approved medical interventions for neurop","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Successful Early Discharge in Revision Lumbar Fusion.","authors":"Omar H Tarawneh, Rajkishen Narayanan, Jonathan Dalton, Robert J Oris, Mark Miller, Matthew Meade, Jarod Olson, Nicholas B Pohl, Tariq Z Issa, Olivia A Opara, Emily Berthiaume, Gokul Karthikeyan, Logan Witt, Aayush Mehta, Barrett I Woods, Mark F Kurd, I David Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1016/j.spinee.2025.07.024","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.024","url":null,"abstract":"<p><strong>Background context: </strong>Reducing length of hospital stay (LOS) and establishing earlier discharge goals are critically important in terms of improving patient satisfaction and maximizing value in spine surgery. Revision lumbar fusion is associated with higher costs and longer inpatient stays compared to primary surgery. Identifying factors that correlate with safe early discharge in this population can inform efforts to improve the value of care.</p><p><strong>Purpose: </strong>This study aims to evaluate predictors of successful early discharge following revision lumbar fusion.</p><p><strong>Study design/setting: </strong>Retrospective Cohort PATIENT SAMPLE: Patients who underwent 1-2 level revision lumbar fusion from 2011 to 2022 were included.</p><p><strong>Outcome measures: </strong>Emergency department (ED) visits within 30 days postoperatively and readmissions within 30- and 90-days were recorded. Sub-analyses of patient-reported outcome measures (PROMs) and postoperative opioid use were performed.</p><p><strong>Methods: </strong>Patients were stratified as early and late discharge, with those in the lowest 25% of LOS classified as achieving early discharge. Early and late discharge groups were compared for outcome measures on bivariate and multivariate analyses.</p><p><strong>Results: </strong>Of the 479 patients included, 150 were in the early discharge group (LOS 1.85 vs 4.37 days, p<0.001). Male sex was an independent predictor of early discharge (OR: 1.82, P=0.010), while higher BMI (OR=0.95, P=0.010), index procedure being a fusion (OR: 0.57, P=0.022), nonunion (OR=0.27, P=0.014) as the revision indication, and increased surgical duration (OR: 0.995, P=0.019) demonstrated decreased odds of early discharge. Early discharge patients experienced greater VAS-back (-4.04 vs -2.58, p= 0.031), and VAS-leg (-4.32 vs -2.14, p=0.008) improvement at 90 days. ED visits (7.33% vs 3.34%, p=0.080) and 90-day readmissions (4.00% vs. 5.17%, p=0.746) were similar between groups.</p><p><strong>Conclusions: </strong>Elevated BMI, fusion as the index procedure, revisions due to non-union, and longer operative time independently reduced the likelihood of early discharge. VAS scores for back and leg pain, were significantly better in the early DC group. No differences existed in postoperative ED visits or readmissions, highlighting the potential for safe, early discharges in the appropriately selected patient.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}