Spine Journal最新文献

{"title":"The Gut-Spine Axis in Lumbar Intervertebral Disc Degeneration: Microbial and Inflammatory Signatures.","authors":"Ratnadeep Das, Kavya Varshni, Mrutyunjay Mohanty, Urmi Chakraborty, Arunkumar Sekar, Priyanka Mishra, Rishikesh Dash, Mantu Jain, Gurudip Das, Balamurugan Ramadass","doi":"10.1016/j.spinee.2026.10.016","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.016","url":null,"abstract":"<p><strong>Background context: </strong>Intervertebral disc degeneration (IDD) is commonly found in patients with chronic low back pain. Traditionally viewed as a biomechanical failure, emerging evidence implicates systemic inflammation in IDD pathogenesis. The proposed \"gut-spine axis,\" in which gut dysbiosis may promote inflammation and, potentially, disc colonization, represents a paradigm shift. To bridge gaps in human data, we present the first multi-compartment (gut-blood-disc) study profiling paired microbiomes alongside systemic inflammatory biomarkers.</p><p><strong>Purpose: </strong>To investigate the role of the gut-spine axis in intervertebral disc degeneration (IDD) by characterizing gut microbiome dysbiosis, its association with systemic inflammation, and the presence of distinct microbial signatures in degenerated disc tissue.</p><p><strong>Study design/setting: </strong>Prospective clinical case-control study conducted at a tertiary care center.</p><p><strong>Patient sample: </strong>Twenty adult patients (aged 18-65 years) undergoing surgical discectomy for symptomatic lumbar IDD (Pfirrmann grade ≥3) and twenty age-matched healthy controls without low back pain or radiographic evidence of IDD.</p><p><strong>Outcome measures: </strong>Primary outcomes included gut and disc microbial diversity (alpha diversity indices: Shannon, Simpson, observed genera; beta diversity: Bray Curtis dissimilarity), genus level relative abundance of key microbial organisms, and systemic inflammatory status assessed using the neutrophil-to-lymphocyte ratio (NLR). Secondary outcomes included associations between microbial organisms and systemic inflammation.</p><p><strong>Methods: </strong>We prospectively analyzed patients undergoing lumbar IDD surgery alongside matched healthy controls. Paired fecal and surgically excised disc samples underwent 16S rRNA sequencing. Systemic inflammation was quantified via the peripheral neutrophil-to-lymphocyte ratio (NLR). We evaluated alpha- and beta-diversity and employed linear regression to assess functional associations between microbial abundance and NLR RESULTS: Patients with symptomatic IDD exhibited significant gut dysbiosis, including elevated Streptococcus and a 7-fold enrichment of Collinsella (10% in IDD vs. 1.5% in controls). Fecal Acinetobacter positively correlated with systemic inflammation (NLR; R²=0.326, p=0.009), whereas beneficial Dorea negatively correlated (R²=0.230, p=0.032). Locally, degenerated discs harbored a unique, low-diversity microbiome (Simpson index p=0.038) dominated by the facultative anaerobes Acinetobacter and Stenotrophomonas (32% relative abundance vs. <1% in gut). Beta-diversity confirmed disc and gut communities are statistically distinct (PERMANOVA R²=0.451, p=0.001), a pattern more consistent with compartment-specific microbial communities than with surgical contamination.</p><p><strong>Conclusions: </strong>This study provides preliminary evidence for a potential function","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149276413","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":"Outcomes Analysis of Low Back Pain Patients Managed Through a Spine Center Clinical Care Redesign Pathway: An Initial Retrospective Cohort Study.","authors":"Isabel Nip, Jonathan Sylvain, Jyoti Chhabra, Subramani Seetharama","doi":"10.1016/j.spinee.2026.10.011","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.011","url":null,"abstract":"<p><strong>Background context: </strong>Back pain affects a large portion of the U.S. population, and delivering care in an efficient manner without compromising outcomes is of utmost importance for quality of life. One potential approach is to reinvent clinical pathways to streamline care and reduce the gaps evident between recommendation and actual practice, such as high uses of surgery and imaging.</p><p><strong>Purpose: </strong>To compare outcomes of acute or acute-on-chronic low back pain patients treated through a value-based structured clinical care redesign spine pathway at The Hospital of Central Connecticut (THOCC) Spine Center versus patients treated by Hartford HealthCare (HHC) ambulatory care providers/clinics that did not participate in the clinical care redesign spine pathway.</p><p><strong>Study design/setting: </strong>Retrospective cohort study in the setting of ambulatory care referrals from primary care or community providers, urgent care, emergency department, walk-ins, or self-referral within HHC.</p><p><strong>Patient sample: </strong>Acute or acute-on-chronic lumbar pain patients conservatively treated with at least three physical therapy (PT) visits OUTCOME MEASURES: Initial and follow-up Modified Oswestry Low Back Pain Disability Questionnaire (MDQ) and numeric pain rating scale scores; days of first provider to first PT visit, first provider visit to completion of the acute care episode; number of provider, PT, and outside specialist visits (orthopedics, neurosurgery, neurology), and imaging studies (x-rays) METHODS: Patients were identified by querying the rehabilitation outcomes management system (ROMS) database. Variables were collected via chart and ROMS database review. Mann-Whitney-U tests with α set at 0.05 were performed. Differences in dichotomous data between the two groups were analyzed with contingency Chi-square tests or Fisher's Exact tests. Because this was a retrospective analysis of an existing cohort, no a priori sample-size calculation was performed. The final sample represents all available patients meeting the prespecified eligibility criteria during the study period.</p><p><strong>Results: </strong>There were no statistically significant differences between the 41 patients treated through the THOCC clinical care redesign spine pathway and the 33 patients treated in the standard non-spine care pathway regarding sex, race, ethnicity, diagnosis, initial pain or disability score, or Subgroups for Targeted Treatment (STarT) Back Tool risk category. Spine Center participants were significantly older than controls (median age 52 vs 43 years, p=0.0004, effect size 0.414). Compared with controls, Spine Center patients demonstrated significantly shorter median time from first provider visit to PT (2.5 days [IQR 1-6.5] vs. 19 days [IQR 8-39], z=-4.98, p<0.0001, effect size 0.591), shorter median episode duration (70 days [IQR 47.5-93.75] vs. 132 days [IQR 71-311], z=-3.04, p=0.0023, effect size 0.361), great","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149276469","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 Age-Adjusted Pelvic Tilt Correction After Long-Segment Adult Spinal Deformity Correction.","authors":"Blake Holthaus, Nathan Ritchey, Joshua H Weinberg, Santino Cua, Eashwar Kantemneni, Kevin Agner, Luke Comisford, Heema Vyas, Yamenah Ambreen, Katelyn Sette, Witty Kwok, Abdul Karim Ghaith, Bryan Ladd, Siri Khalsa, David Xu, Stephanus Viljoen, Andrew Grossbach","doi":"10.1016/j.spinee.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.010","url":null,"abstract":"<p><strong>Background context: </strong>Pelvic tilt (PT) reflects sagittal alignment compensation in adult spinal deformity and is associated with postoperative outcomes. Achievement of age-adjusted PT after long segment fusion demonstrates substantial improvements in health-related quality of life and a reduction of complications. However, many patients fail to normalize PT and predictors remain incompletely defined.</p><p><strong>Purpose: </strong>This study aims to identify preoperative and surgical predictors of PT correction using age-adjusted thresholds in patients undergoing long-segment thoracolumbar fusion with pelvic fixation.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Adult spinal deformity (ASD) patients undergoing long-segment thoracolumbar fusion with pelvic fixation with preoperative PT above age-adjusted targets (n=129).</p><p><strong>Outcome measures: </strong>Primary outcome was achievement of age-adjusted PT at 12 months postoperative. Radiographic parameters included pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), T1 pelvic angle (T1PA), and proportional correction measures normalized to PI.</p><p><strong>Methods: </strong>Patients were dichotomized based on PT normalization at 12 months. Extent of spinopelvic correction and deviation from ideal was calculated and normalized by PI. Mixed-effects multivariable logistic regression controlled for confounding variables. Univariate area under curve (AUC) assessed predictive performance.</p><p><strong>Results: </strong>Patients who normalized PT at 12 months had lower baseline PI, PT, SS, and LL. When normalized to PI, these associations became stronger. T1PA deviation ratio, ΔLL/PI, and PI were identified as independent predictors of PT normalization. T1PA had the highest discriminatory ability (AUC=0.803), while PI was the strongest negative predictor (AUC=0.745).</p><p><strong>Conclusion: </strong>PT correction depends on both baseline alignment and extent of surgical correction. Greater correction of LL and T1PA proportional to PI, were independently associated with PT normalization.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247306","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":"Rod Geometry and Material Characteristics as Risk Factors for Rod Breakage After Adult Spinal Deformity Surgery: A Multicenter Cohort Study with Five-Year Follow-up.","authors":"Alice Baroncini, Daniel Larrieu, Louis Boissiere, Cecile Roscop, Ferran Pellisé, Ahmet Alanay, Frank Kleinstueck, Javier Pizones, Yann Philippe Charles, Anouar Bourghli, Ibrahim Obeid","doi":"10.1016/j.spinee.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.004","url":null,"abstract":"<p><p>Background Context Rod breakage is a frequent and clinically important late complication after adult spine deformity (ASD) surgery, yet most research has focused on patient and alignment factors rather than implant geometry. Purpose This study aimed to investigate the rod-related characteristics independently associated with rod breakage following ASD surgery, with particular focus on quantitative measures of rod material, rod shape and its postoperative evolution. Design Retrospective analysis of prospectively collected, six-center data. Patient Sample ASD patients, who underwent long posterior fusion to the pelvis with available serial full-length lateral radiographs at 6 weeks, 6 months, 1 year, and 2 years were included; patients with multiple-rod constructs were excluded. Minimum two-year follow-up. Outcome Measures Rod breakage (defined radiographically), time to rod breakage, and discrimination performance of a multivariable predictive model based on patient and rod characteristics. Methods Rod curvature was quantified at L1-S1 and L4-S1 and the maximum positive increase in L1-S1 curvature between consecutive postoperative timepoints was derived. Time-to-breakage was analyzed using Kaplan-Meier and Cox proportional hazards models, with data-driven thresholds defining high-risk geometry. Model discrimination was assessed using the concordance index. Results Eighty-three patients (mean follow-up 60.0 ± 23.0 months) were analyzed; 30 developed rod breakage at a mean 41.7 ± 22.2 months. L4-S1 rod curvature ≥33° at 6 weeks was associated with higher risk of breakage (HR 2.25; 95% CI 1.06-4.77; p = 0.036), as was a maximum L1-S1 curvature increase≤4° (HR 3.33; 95% CI 1.25-8.84; p = 0.016). Titanium rods had lower risk compared with cobalt-chromium (HR for titanium 0.50; p = 0.02), and diameter >5.5 mm was associated with increased risk (HR 1.90; p = 0.02). A multivariable patient-level model incorporating rod geometry showed improved discrimination (C-index 0.74). Conclusions Specific rod geometry characteristics-particularly early lower lumbar curvature and limited postoperative curvature increase-were independently associated with rod breakage after ASD surgery. Integrating rod shape into risk models may support implant selection, surgical planning, and postoperative monitoring. Level of Evidence Level III, retrospective cohort study.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247356","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":"Objective Functional Phenotyping in Spine Surgery: A Translational Framework for Quantifying Disability, Guiding Clinical Decision-Making, and Monitoring Recovery.","authors":"Ram Haddas, Joshua M Coan, Ye Shu, Paul Rubery, Varun Puvanesarajah, Ashley Rogerson","doi":"10.1016/j.spinee.2026.10.019","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.019","url":null,"abstract":"<p><p>Imaging, physical examination, and patient-reported outcome measures (PROMs) remain central to spine care but incompletely characterize how spinal disease affects physical performance and how function changes following treatment. Objective assessment of gait, balance, functional transitions, lifting, and neuromuscular control provides complementary information regarding movement impairment, compensation, and recovery. This narrative review synthesizes current evidence supporting objective functional assessment in spine care and proposes Disability and Functional Outcome Measures (DFOMs) as a translational framework for organizing these measurements into clinically interpretable functional domains. DFOMs are not presented as a new measurement instrument or independently validated composite outcome; rather, the framework integrates established and emerging objective functional measures acquired through motion analysis, force platforms, electromyography, wearable sensors, and markerless technologies. Evidence supporting individual measures varies substantially with respect to validity, reliability, responsiveness, normative reference values, and clinical utility. Laboratory-based gait and balance assessment currently have the strongest evidence base, whereas multidomain composite scoring, markerless assessment, wearable-derived biomarkers, and artificial intelligence-enabled phenotyping remain at earlier stages of clinical translation. Objective functional phenotyping may ultimately complement structural and patient-reported assessment by providing a multidimensional characterization of disability and recovery. However, standardized protocols, multicenter validation, clinically meaningful thresholds, implementation studies, and evidence of incremental clinical utility are required before widespread adoption in routine spine care.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247269","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":"Long-term cervical sagittal balance after single-level anterior cervical discectomy with or without fusion or arthroplasty: sex-specific changes in cervical alignment over 5 years.","authors":"Floor E de Vries, Kwint J Schut, Niels Pacheco-Barrios, Caroline M W Goedmakers, Carmen L A Vleggeert-Lankamp","doi":"10.1016/j.spinee.2026.10.015","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.015","url":null,"abstract":"<p><strong>Background context: </strong>Cervical sagittal balance influences spinal biomechanics and may be affected by anterior cervical discectomy (ACD), potentially affecting clinical outcomes.</p><p><strong>Purpose: </strong>To evaluate longitudinal changes in cervical sagittal alignment over 5 years following single-level ACD with or without fusion or arthroplasty and assess associations with clinical outcomes.</p><p><strong>Study design: </strong>Post hoc analysis of the Netherlands Cervical Kinematics (NECK) trial (NTR1289).</p><p><strong>Patient sample: </strong>Patients undergoing single-level ACD with or without fusion or arthroplasty for cervical radiculopathy were evaluated at baseline, 1-, 2-, and 5-years follow-up.</p><p><strong>Outcome measures: </strong>C0-C2 angle, C2-C7 Cobb angle, segmental Cobb angle, C7 angle, T1 angle, T1-CL (T1 angle minus C2-C7 lordosis) and C2-C7 sagittal vertical axis (SVA) were measured on lateral radiographs. Clinical outcomes included the Neck Disability Index (NDI) and Visual Analog Scale (VAS) for arm and neck pain.</p><p><strong>Methods: </strong>Linear mixed models assessed longitudinal changes, corrected for potential confounders. Linear regression evaluated associations between alignment and clinical outcomes.</p><p><strong>Results: </strong>Out of 109 enrolled patients, 81 patients had a lateral X-ray available at baseline. C2-C7 Cobb angle increased from 9.0° at baseline to 13.8°, 12.3°, and 13.6° at 1-, 2-, and 5-year follow-up (p<0.001). T1-CL decreased from 12.5° to 4.7°, 6.4°, and 6.8° (p<0.05). SVA decreased from 16.1 mm to 10.5 and 10.7 mm at 1 and 2 years (p<0.05), returning to 14.8 mm at 5 years. C0-C2 angle increased from 19.4° at 1 year to 23.1° at 5 years (p<0.005). Men showed greater subaxial lordosis; women greater upper cervical lordosis. At 1 year, a more positive segmental Cobb angle was associated with lower arm pain (B=-1.99, p=0.02) and higher SVA with increased arm pain (B=0.48, p=0.04).</p><p><strong>Conclusions: </strong>Single-level ACD with or without fusion or arthroplasty is associated with long-term increases in cervical lordosis with sex-specific compensatory patterns. Alignment-outcome cross-sectional associations were limited to early follow-up, suggesting that restoring adequate segmental lordosis at surgery may reduce early postoperative arm pain.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247315","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 Outcomes and Factors Associated with Radiological Resorption in Symptomatic Extruded or Sequestrated Lumbar Disc Herniation: A Retrospective Cohort Study.","authors":"Zhenyu Tang, Xiaorong Li, Chengpeng Gong, Zihang Li, Kaiyang Xu, Zhijia Ma, Yan Gong, Hongda Zhou, Xiaochun Li, Zhiqiang Wang, Yucheng Wang, Hong Jiang, Yuxiang Dai, Pengfei Yu, Jintao Liu","doi":"10.1016/j.spinee.2026.10.013","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.013","url":null,"abstract":"<p><strong>Background: </strong>The relationship between resorption and long-term outcomes in extruded or sequestrated lumbar disc herniation (LDH) remains uncertain.</p><p><strong>Purpose: </strong>To evaluate the clinical significance of resorption and factors associated with resorption timing.</p><p><strong>Study design: </strong>Single-center retrospective cohort study.</p><p><strong>Patient sample: </strong>578 patients with symptomatic extruded or sequestrated LDH were managed nonsurgically and followed for ≥ 24 months.</p><p><strong>Outcome measures: </strong>Surgery, symptomatic episodes, Oswestry Disability Index (ODI), visual analog scale (VAS), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A).</p><p><strong>Methods: </strong>Radiological resorption was defined as ≥30% volume reduction, representing at least partial resorption. Generalized estimating equations assessed longitudinal outcomes; time-dependent Cox and landmark analyses assessed surgery; and an interval-censored model assessed resorption timing. Governmental and institutional grants provided US$100,001-500,000. No conflict-of-interest bias was identified.</p><p><strong>Results: </strong>Resorption was documented in 256 patients (44.3%; median, 8.2 months). Surgery occurred in 0.8% versus 24.0%; resorption was associated with lower surgical risk (adjusted HR, 0.067; 95% CI, 0.015-0.292), with consistent landmark findings. The resorption group had fewer symptomatic episodes. ODI and VAS improvement was similar through 6 months but greater thereafter; HADS-A improvement was greater throughout. Komori type III (HR, 6.07; 95% CI, 3.58-10.29) and Modic type I (HR, 2.65; 95% CI, 1.25-5.60) were associated with earlier resorption. Resorption magnitude showed no consistent association with outcomes.</p><p><strong>Conclusions: </strong>Resorption was associated with a more favorable clinical course, but improvement also occurred without resorption. Komori type III and Modic type I were associated with earlier documented resorption; resorption magnitude showed no consistent outcome association.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247261","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":"2026 North American Spine Society Patient Safety Position Statement on Education, Training, and Competency for Spine Interventions.","authors":"Brian W Su, Karin R Swartz, Pierce D Nunley, Christopher P Kauffman, Edward J Dohring, Alan S Hilibrand, Kevin E Macadaeg, Heidi M Hullinger, D J Kennedy, Zoher Ghogawala, William Mitchell","doi":"10.1016/j.spinee.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.003","url":null,"abstract":"<p><p>The rapid expansion of minimally invasive, endoscopic, percutaneous, and implant-based spine interventions has outpaced standardized training requirements. This statement provides recommendations based on current training pathways, contemporary practice, and expert consensus, with patient safety as the guiding principle. These recommendations are not intended to define or restrict scope of practice; credentialing decisions remain the responsibility of institutions and governing bodies. Formal surgical spine training currently occurs through orthopaedic surgery residency with spine fellowship or neurological surgery residency with or without spine fellowship. These pathways include substantial supervised operative experience and ACGME residency case minimums. Anesthesiology, physical medicine and rehabilitation, radiology, and pain medicine pathways provide procedural training but do not include operative spine training, and nationally recognized training pathways for these specialties do not have minimum required case volumes across the spectrum of advanced spine interventions. Minimum case numbers, where established, are only one component of competency and should be considered alongside appropriate education, supervised experience, and demonstrated competency. Training and credentialing should reflect procedural complexity, anatomy at risk, biomechanical alteration, and potential complications. A surgical intervention treats structural spinal anatomy and meaningfully alters biomechanics or directly visualizes and decompresses the spinal cord and/or nerve roots. Based on current training pathways, spinal fusion or permanent stabilization, direct spinal cord and/or nerve root decompression, lateral sacroiliac fusion, vertebral augmentation with structural vertebral implants beyond cement or bone graft, and spinal cord stimulation paddle lead placement should be performed by physicians with formal surgical spine training. Other non-structural interventions, including basivertebral nerve ablation, percutaneous neuromodulation, cement or bone-graft vertebral augmentation, and endoscopic branch neurectomy, should require structured procedure-specific education, supervised experience, appropriate minimum case numbers, and competency assessment. Educational courses should complement rather than replace structured clinical experience. This statement encourages prospective registries for emerging technologies to evaluate outcomes, complications, reinterventions, durability, subsequent surgical consequences, and inform training standards. Transparent informed consent and documented complication-management arrangements established before the procedure in every practice setting, including physician offices, are essential.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240204","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":"Longitudinal Discordance Between Functional Recovery and Patient Satisfaction After Lumbar Spine Surgery: A 2-Year Registry Study.","authors":"Xun Li, Alex Quok An Teo, Jiong Hao Jonathan Tan, Calvin Wei Jie Chern, Wenru Wang, Nan Luo, Hwee Weng Dennis Hey, Ling Jie Cheng","doi":"10.1016/j.spinee.2026.10.017","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.017","url":null,"abstract":"<p><strong>Background context: </strong>Patient-reported outcome measures (PROMs) and satisfaction are used after lumbar spine surgery but capture distinct constructs.</p><p><strong>Purpose: </strong>To characterise 2-year trajectories of disability, health status, improvement, PROM-satisfaction concordance, and associated factors.</p><p><strong>Study design/setting: </strong>Registry-based longitudinal cohort study at a tertiary referral centre in Singapore.</p><p><strong>Patient sample: </strong>748 adults undergoing primary elective lumbar surgery for degenerative disease with at least 1 postoperative satisfaction assessment.</p><p><strong>Outcome measures: </strong>Oswestry Disability Index (ODI; primary), EQ-5D-5L crosswalk index, EQ VAS, satisfaction, minimum important difference (MID), and ODI patient acceptable symptom state (PASS).</p><p><strong>Methods: </strong>PROMs were assessed at baseline and follow-up; satisfaction at 3-6 months, 1 year, and 2 years. Linear mixed-effects models assessed PROM trajectories; logistic mixed-effects models assessed MID and PASS achievement; ordered logistic mixed-effects models assessed satisfaction; and multinomial regression assessed ODI MID-satisfaction concordance. No study-specific funding or conflicts of interest were reported.</p><p><strong>Results: </strong>ODI improved through 1 year then remained stable, whereas EQ-5D plateaued after 3-6 months. Satisfaction remained approximately 84%. ODI MID-satisfaction discordance decreased from 33.8% to 24.2%; at 2 years, discordance was 28.7% for EQ-5D and 57.0% for EQ VAS. Higher baseline ODI increased the odds of MID achievement but decreased the odds of PASS achievement. Sensitivity analyses supported these trajectories despite attrition. Greater ODI and EQ-5D improvements were associated with greater satisfaction; satisfaction without MID achievement was more common among patients with lower baseline disability.</p><p><strong>Conclusions: </strong>Disability, health status, and satisfaction followed different trajectories. Change-based thresholds, acceptable states, and satisfaction are complementary, not interchangeable, outcomes.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240125","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":"Outcomes after Posterior Cervical Spine Surgery: A Matched Cohort Analysis and Comparison of GLP-1 Receptor Agonist Use and Bariatric Surgery in Patients with Type 2 Diabetes.","authors":"Nicole Rivera, Taylor Bradley, K A Crowell, C Rory Goodwin, Melissa Erickson","doi":"10.1016/j.spinee.2026.10.020","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.020","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Obesity and diabetes can increase perioperative risk, especially in posterior cervical spine surgery. Bariatric surgery provides durable weight loss but carries surgical and nutritional risks, while glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are non-surgical alternatives that may optimize weight and metabolic status preoperatively. Evidence evaluating GLP-1 therapy in spine surgery is limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate associations between preoperative GLP-1 RA use and perioperative, short-term, and long-term complications following posterior cervical spine surgery in patients with type 2 diabetes, including comparisons to matched controls and patients with prior bariatric surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective database analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients with type 2 diabetes treated with metformin undergoing posterior cervical spine surgery between 2010 and 2023 were identified in the PearlDiver Mariner database. Patients were stratified into GLP-1 users, non-GLP-1 controls, and patients with prior bariatric surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Physiologic measures included perioperative outcomes and postoperative complications assessed at 90 days and 2 years, including pneumonitis, surgical site infection, revision surgery, readmission, nutritional deficiency, and other medical and surgical complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The PearlDiver Mariner database was queried for eligible patients. Propensity-score matching adjusted for baseline cohort differences. Outcomes included perioperative, 90-day, and 2-year complications, with BMI-stratified analyses conducted within the matched GLP-1 and control cohort. Benjamini-Hochberg false discovery rate correction was applied for multiple comparisons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;GLP-1 users demonstrated lower odds of perioperative complications, including pneumonitis (OR 0.57; 95% CI 0.43-0.75; p &lt;0.001). At 90 days, GLP-1 users experienced reduced odds of surgical site infection (OR 0.72; 95% CI 0.65-0.80; p &lt;0.001), revision surgery (OR 0.33; 95% CI 0.29-0.36; p &lt;0.001), readmission (OR 0.82; 95% CI 0.76-0.90; p &lt;0.001), and other complications. At 2 years, GLP-1 users had lower odds of revision surgery (OR 0.31; 95% CI 0.28-0.34; p &lt;0.001), nutritional deficiency (OR 0.62; 95% CI 0.59-0.66; p &lt;0.001), and other complications. Exploratory BMI-stratified analyses suggested similar directional trends across overweight and obese patients. Comparisons to prior bariatric surgery patients showed no significant differences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Preoperative GLP-1 RA use was associated with reduced perioperative, short-term, and long-term complications following posterior cervical spine surgery in patients with type 2 diabetes. When compared with a matched bariatric surgery cohort, no significant differences in postoperative outcomes were observed. These f","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240127","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}