Spine Journal最新文献

{"title":"Expanded Biological Characterization of Autograft-Derived Contributions to Spinal Fusion: Graft-Derived Progenitors Contribute via Endochondral Bone Formation.","authors":"Atsuyuki Kawabata, Duby D Okonkwo, Takuya Oyaizu, Byron F Stephens, Craig R Louer, Stephanie N Moore-Lotridge, Rachel M Mckee, J Court Reese, Satoru Egawa, Toshitaka Yoshii, Jonathan G Schoenecker","doi":"10.1016/j.spinee.2026.04.028","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.028","url":null,"abstract":"<p><strong>Background context: </strong>Autologous bone graft remains the clinical standard in spinal fusion due to its reliable performance. Characterization of the biological mechanism underlying the clinical superiority of autologous bone graft in spinal fusion remains incomplete. The field is divided between \"creeping substitution,\" which posits the graft as a passive scaffold whose cells perish, and the \"cellular hypothesis,\" which argues for an active contribution from viable donor cells.</p><p><strong>Purpose: </strong>This study aimed to build upon prior work by further characterizing graft-derived cell survival after transplantation and identify the biological mechanisms by which these cells may contribute to spinal fusion.</p><p><strong>Study design: </strong>We employed an immunocompetent \"sibling-pair\" murine posterolateral fusion model (L3-L4) of Iliac bone grafting for this study.</p><p><strong>Methods: </strong>Autologous Iliac bone grafts from fluorescent reporter mice were transplanted into non-fluorescent siblings. A panel of inducible Cre-lox reporter lines (CAG, Col1a1, Sox9, and Aggrecan) was used to trace the fate of specific graft-derived cell populations. A pre-grafting induction strategy was used to label mature cells at harvest, while a post-grafting induction strategy identified donor progenitor cells that survived and differentiated in vivo. Fusion masses were analyzed at 2- and 6-weeks following grafting via microCT, histology, and fluorescence microscopy.</p><p><strong>Results: </strong>Pan-cellular (CAG-Cre) tracing suggests robust donor cell survival and integration into the 2 and 6-week fusion masses. In contrast, pre-labeled grafted mature osteoblasts and osteocytes (Col1a1-Cre) were largely absent at all time points, suggesting this population does not meaningfully survive transplantation. Post-grafting induction of Col1a1-Cre mice revealed the emergence of numerous new, donor-derived osteoblasts at 2 and 6 weeks, suggesting their origin from an unlabeled progenitor pool. Additionally, post-grafting induction of chondrocyte-lineage reporters (Sox9-Cre, Aggrecan-Cre) demonstrated the appearance of donor-derived chondrocytes at 2 weeks, which subsequently transitioned into osteocytes within the mature bone by 6 weeks suggesting endochondral ossification.</p><p><strong>Conclusions: </strong>These findings builds on prior work supporting the \"cellular hypothesis\" which argues that autologous bone grafts contribute viable cells. Furthermore, our findings suggest a model of \" Skeletal Stem and Progenitor Cells (SSPC)-driven Adaptation,\" where the ICBG serves as a vehicle for resilient Skeletal Stem and Progenitor Cells (SSPCs). These progenitors, rather than mature osteoblasts, appear to survive transplantation and adapt to the avascular fusion bed by initiating endochondral ossification to form the fusion mass.</p><p><strong>Clinical significance: </strong>This suggests that the clinical focus on mature \"osteogenic\" ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857551","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":"Psychometric Validation and Population-Based Normative Values of the Japanese Oswestry Disability Index Version 2.1a: A Nationally Representative Survey.","authors":"Yuji Endo, Ryoji Tominaga, Noriaki Kurita, Nobuyuki Fujita, Takafumi Wakita, Masao Kobayakawa, Yoshihiro Matsumoto, Seiji Ohtori, Shin-Ichi Konno, Takuya Nikaido","doi":"10.1016/j.spinee.2026.04.024","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.024","url":null,"abstract":"<p><strong>Background context: </strong>The Oswestry Disability Index (ODI) is one of the most widely used instruments for assessing disability related to low back pain (LBP). However, population-based normative values are scarce, and the structural validity of Japanese version of the ODI (version 2.1a) has not been sufficiently evaluated.</p><p><strong>Purpose: </strong>To psychometrically validate the Japanese version of the ODI (version 2.1a) and to establish population-based normative values stratified by age and LBP duration.</p><p><strong>Study design/setting: </strong>Population-based cross-sectional study using a nationwide survey in Japan.</p><p><strong>Patient sample: </strong>A nationally representative sample of community-dwelling adults in Japan selected through a two-stage stratified random sampling design. A total of 5,000 individuals were invited to participate.</p><p><strong>Outcome measures: </strong>Self-report measures: Disability related to low back pain assessed using the Japanese version of the ODI (version 2.1a).</p><p><strong>Methods: </strong>Japan was stratified into 65 strata, from which 250 sampling points were randomly selected, and 20 residents were randomly sampled per point. Psychometric properties of the ODI version 2.1a were evaluated among respondents using factor analyses. Response-adjusted, survey-weighted normative values were estimated for the general population and for individuals with LBP, stratified by age group and pain duration subtype (acute, subacute, and chronic).</p><p><strong>Results: </strong>Of the 5,000 individuals invited, 2,188 responded (response rate 43.8%). Among respondents, 1,270 had complete ODI data and were included in the psychometric analysis, including 173 individuals with LBP. The estimated population prevalence of LBP was 14.7% (95% confidence interval [CI] 13.1-16.4%), comprising acute 2.5% (95% CI 1.9-3.3%), subacute 1.1% (95% CI 0.7-1.7%), and chronic 11.1% (95% CI 9.8-12.5%). Factor analyses demonstrated a unidimensional structure of the ODI version 2.1a. Among individuals with LBP, the survey-weighted mean ODI score was 20.23 (95% CI 18.32-22.13). Normative values varied by pain duration (acute: 12.54 [95% CI 8.87-16.22]; subacute: 13.54 [95% CI 8.78-18.31]; chronic: 22.74 [95% CI 20.56-24.92]) and increased with advancing age.</p><p><strong>Conclusion: </strong>This study provides psychometric validation of the Japanese ODI version 2.1a and establishes age- and pain duration-specific normative values. These findings support the use of ODI version 2.1a as a single total score for profiling disability in everyday life and for evaluating the management of LBP in both clinical practice and research.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822883","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":"Functional evaluation in Adult Spinal Deformity can be reduced to three key kinematic parameters that can sufficiently predict health-related quality of life outcomes: an observational prospective study.","authors":"Elio Mekhael, Rami Rachkidi, Nabil Nassim, Georges El Haddad, Marc Boutros, Maria R Karam, Emmanuelle Wakim, Maria Asmar, Mohamad Karam, Abir Massaad, Ismat Ghanem, Ayman Assi","doi":"10.1016/j.spinee.2026.04.025","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.025","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Recently, functional evaluation using 3D gait analysis (3DGA) proved to predict health-related quality-of-life (HRQOL) scores better than static radiographic evaluation in adult spinal deformity (ASD). However, 3DGA provides multiple parameters that can be a burden to interpret by non-experts. A recent study showed that the dynamic pelvic tilt (dPT), the forward projection of the head and thorax (dODHA) and walking step length (SL) are the most representative gait kinematics in ASD patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To determine whether reducing kinematic parameters to only these 3 key parameters would still predict HRQOL outcomes in ASD based on machine learning (ML) random forest regression model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Single-center prospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;197 patients with ASD and 57 control subjects OUTCOME MEASURES: Self-report measures: SF36 with the physical and mental components (PCS & MCS), Oswetry Disability Index (ODI), Beck's depression inventory (BDI) and Visual analogue scale (VAS) for pain. Physiologic measures: low-dose full-body biplanar Xrays with 3D skeletal reconstructions. Functional measures: full-body 3D gait analysis during walking. Prediction accuracy: random forest regression ML model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All subjects underwent low-dose full-body biplanar Xrays with 3D skeletal reconstructions (with the calculation of spino-pelvic and global alignment parameters), full-body 3DGA during walking (with the calculation of full-body joint kinematic parameters), and completed HRQOL questionnaires: SF36 with the physical and mental components (PCS&MCS), ODI, BDI and VAS for pain. A random forest regression machine learning model was used to predict HRQOL scores in 4 simulations: (Sim-1) X-ray parameters (spinopelvic and global alignment); (Sim-2) Key-kinematic parameters (dPT, dODHA and SL); (Sim-3) X-ray parameters and dPT, dODHA and SL; (Sim-4) All-kinematic parameters. The prediction accuracy and root mean squared error (RMSE) were evaluated using a 10-fold cross-validation and compared between simulations. The same methodology was applied on a subset of 30 ASD patients followed (6 months to 2 years) after medical, orthopedic and surgical treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Simulations 1, 2, 3 and 4 had a median accuracy of 82, 85, 86 and 86%, respectively. Simulations 2, 3 and 4 had comparable accuracies of prediction for all HRQOL scores and higher predictions compared to Simulation 1 (i.e., accuracy for PCS=86±3 vs 90±2, 91±3% and 91±3% for simulations 1, 2, 3 and 4 respectively, p&lt;0.05). Similar results were obtained for the 30 follwed-up ASD patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Head and pelvis kinematics and step length are sufficient to predict HRQOL scores, even postoperatively, with higher accuracies than classic spinopelvic and global alignment parameters. While the latter play an integrating r","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822823","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":"Adult Spinal Deformity with Low Pelvic Incidence: A Challenging Condition Demanding a Tailored Strategy.","authors":"Housen Zhang, Jie Li, Xiaodong Qin, Benlong Shi, Saihu Mao, Zezhang Zhu, Yong Qiu, Zhen Liu","doi":"10.1016/j.spinee.2026.04.029","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.029","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Existing surgical alignment goals derived from populations with a high pelvic incidence (PI) are not applicable for patients with adult spinal deformity (ASD) and a low PI, who account for a high proportion of Asian populations. The surgical treatment for patients with a low PI is challenging because of their limited pelvic compensation capacity and because there are no criteria to guide corrective spinal deformity surgery in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To develop and validate a tailored sagittal correction strategy for patients with ASD and a low PI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Cross-sectional normative analysis and retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Stage I included 852 asymptomatic Chinese adults (age 50-79 years). Stage II included 103 patients with ASD and a PI of ≤41° who underwent posterior long-segment fusion and follow-up evaluation for ≥2 years, stratified by kyphotic apex into a TL group (kyphotic apex at L1 or above; n = 59) and an L group (kyphotic apex at L2 or below; n = 44).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Mechanical complications (MCs) and health-related quality of life (HRQOL), as measured by the Oswestry Disability Index and a visual analog scale for back and leg pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Normative spinopelvic parameters were used to define a low-PI subgroup (PI ≤ 41°) and to derive the sufficient sacral slope-lumbar lordosis matched correction (SSS-LLMC) strategy. The 25th percentile sacral slope (SS) in asymptomatic adults with a low PI (41°) was adopted as the minimal SS target (SS ≥ 21°). Patients with ASD and a low PI were divided into sufficient sacral slope (SSS, postoperative SS ≥ 21°) or an insufficient sacral slope (ISS, postoperative SS &lt; 21°). According to the linear sacral slope-lumbar lordosis (SS-LL) relationship (LL = 1.122 × SS + 10.84) established in asymptomatic adults with a low PI, the group of patients with an SSS was further stratified into lumbar lordosis matched correction (LLMC), lumbar lordosis undercorrection (LLUC), and lumbar lordosis overcorrection (LLOC). MCs and HRQOL over a minimum 2-year follow-up period were compared across these subgroups within the TL and L groups, and multivariate logistic regression identified independent predictors of MCs in the overall and apex-stratified cohorts. In addition, this strategy was compared with conventional alignment goals, such as the Scoliosis Research Society-Schwab modification of the pelvic incidence to lumbar lordosis (PI-LL) mismatch and the global alignment and proportion (GAP) score, to evaluate the ability of these approaches to reduce MCs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A low PI (≤ 41°) accounted for 32.2% (274/852) of the asymptomatic cohort. Among 103 patients with ASD and a low PI, 36 (35.0%) developed MCs. MCs occurred in 56.8% (20/34) of patients with an ISS versus 23.2% (16/69) of patients with a SSS (P &lt; 0.00","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787430","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":"Changes in patient-reported outcome measures are associated with expectation fulfilment following elective lumbar spine surgery: an observational study from the Canadian Spine Outcome Research Network (CSORN).","authors":"Vishwajeet Singh, Raymond Andrew Glennie, Raphaele Charest-Morin, Neil Manson, Sean Comstock, Bernard LaRue, Najmedden Attabib, Christopher Small, Adrienne M Kelly, Renan Rodrigues Fernandes, Daryl Fourney, Jerome Paquet, Andrew Nataraj, Nicolas Dea, Christopher S Bailey, Joel Finkelstein, Y Raja Rampersaud, Charles G Fisher, Jennifer Urquhart, Andrew J Schoenfeld, Kenneth Thomas","doi":"10.1016/j.spinee.2026.04.023","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.023","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Patients' perspectives are central measures of success in healthcare delivery. The association of postoperative changes in patient-reported outcome measures (PROM) and expectation fulfillment is not well established.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study's primary objective was to assess the association between changes in PROMs (e.g., ODI or EQ-5D) and patient multidimensional expectations fulfillment at 1 year following elective lumbar spine surgery. The secondary objectives included measuring changes in PROMs across various levels of expectation fulfillment and identifying the PROM instrument that explains the highest variability in each expectation domain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study from the prospectively collected registry data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Data were obtained from the Canadian Spine Outcome Research Network (CSORN) registry, which prospectively enrolls adults undergoing elective spine surgery in Canada. We included adults who underwent elective lumbar spine surgery between January 2015 and December 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The study's primary outcome was the extent of expectation fulfillment at one-year follow-up in surgical patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Demographic, lifestyle, clinical, and multidimensional expectation data were collected using the North American Spine Society Lumbar Spine Questionnaire. Postoperative changes in PROMs were the primary exposure variables. Baseline sociodemographic and clinical characteristics were summarized descriptively, and ordinal logistic regression was used to examine associations between expectation fulfillment and changes in PROMs, adjusting for confounders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 6,260 patients. Females represented 50% of the study sample, and the median age was 62 years. The median change in postoperative leg pain scores (NRS) was -6 (-8, -4), -3 (-5, -1), and -1 (-2, 1) points for patients whose expectations were completely met, somewhat met, and unmet, respectively. ODI changed by -28 (-40, -16), -15 (-26, -4), and -4 (-4, 4); p&lt;0.001 for those whose expectations were completely met, somewhat met, and unmet, respectively. PCS scores changed by 16.6 (8.6, 24.1), 8.7 (2.2, 15.2), and 2 (-3.7, 8.6); p&lt;0.001 for patients with expectations that were completely met, somewhat met, and unmet, respectively. A similar association was observed between changes in PROMs and expectation fulfillment in other expectation domains. Changes in the leg pain and back pain score were strongly associated with expectation fulfillment regarding reduction in Leg pain and Back pain, respectively. Similarly, changes in ODI, EQ-5D and SF-12 PCS scores were strongly associated with expectation fulfillment for Improvement in General Physical Capacity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Postoperative changes in PROMs are strongly associated with patient expectation f","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787437","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":"Molecular Traces of Microbial Cross-Kingdom Migration: From the Gut Ecosystem to the Intervertebral Disc Microenvironment.","authors":"Hao Liu, Bin Xie, Hang Zhuo, Bowen He, Jiahui Dai, Zelin Zhou, Gengyang Shen, Binwei Chen, Jingjing Tang, Hui Ren, Xiaobing Jiang","doi":"10.1016/j.spinee.2026.04.027","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.027","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Low back pain is a leading cause of disability worldwide, and lumbar intervertebral disc degeneration (IVDD) is strongly associated with its development. Recent studies have shown that the gut microbiota (GM) and its metabolites may be involved in the occurrence and development of IVDD through the gut-disc axis. However, the key microbes mediating this process and their specific molecular mechanisms remain unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to identify the gut microbes that play a key role in the progression of IVDD using multi-omics approaches and clarify the specific mechanisms by which these microbes participate in IVDD by regulating host cell functions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;A single center, prospective cross-sectional study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;We prospectively included 113 patients who underwent surgical treatment for symptomatic lumbar degenerative diseases from May 2022 to May 2023, and their degenerated lumbar intervertebral disc (IVD) tissues as well as paired feces samples were collected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Metagenomic next-generation sequencing (mNGS), modified Pfirrmann typing, Single-cell RNA sequencing (scRNA-seq), Bulk RNA sequencing (Bulk RNA-seq).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Clinical IVD samples and paired fecal samples were prospectively collected and subjected to multi-omics bioinformatics analysis. mNGS was used to analyze the microbial composition in IVD and paired fecal samples. scRNA-seq was employed to resolve the cellular heterogeneity of IVD tissues. Bulk RNA-seq was utilized to identify the characteristics of host response genes related to microbial exposure. Subsequent AUCell scoring was performed to evaluate the abundance of microbes in cell subsets. The CellChat algorithm was applied to analyze the microbe-mediated intercellular communication network of host cells.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The raw detection rate of mNGS in IVD tissues was 100%, with a positive rate of 60.2% (68/113) after excluding background bacteria. A total of 505 genera and 1,528 microbial species were detected, with dominant species including Stutzerimonas stutzeri and Moraxella osloensis. The mNGS detection rate in fecal samples was 100% (322 genera and 789 species), among which Phocaeicola vulgatus (PV) was a dominant species. A total of 7 bacterial species shared by GM and IVD were identified; however, only the relative abundances of PV and Bacteroides thetaiotaomicron (BT) increased gradually with the severity of IVDD. Single-cell RNA-seq identified 10 cell clusters, annotated as chondrocytes, macrophages, fibroblasts, and endothelial cells, with the proportions of the latter three non-chondrocyte populations being significantly higher in the severe IVDD group. Chondrocytes were further divided into subsets. Subsets MDC1 and MDC5 were related to mild degeneration with high expression of ACAN and SOX9, whe","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787452","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":"Environmental Factors Rather Than Genetics Likely Drive Vitamin D Deficiency in Idiopathic Scoliosis.","authors":"I Georgopoulos, T Cheng, D Fell, A Simony, M O Andersen, E Einarsdottir, M K Karlsson, I Bergström, E Diarbakerli, N Schizas, P Gerdhem","doi":"10.1016/j.spinee.2026.04.026","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.026","url":null,"abstract":"<p><strong>Background context: </strong>Low vitamin D levels in individuals with idiopathic scoliosis (IS) have been reported and suggested as a potential contributor to IS. Bone density has also been shown to be lower in individuals with IS.</p><p><strong>Purpose: </strong>To investigate serum levels of vitamin D, parathyroid hormone (PTH), markers of bone metabolism, and the genetic variation associated with vitamin D levels and bone density in individuals with IS and healthy controls.</p><p><strong>Study design/setting: </strong>Case-control study combining Scandinavian serum cohorts and genetic cohorts.</p><p><strong>Patient sample: </strong>Serum analyses: 174 individuals with IS and 153 non-scoliotic controls.</p><p><strong>Genetic analyses: </strong>1,394 individuals with IS and 11,108 controls.</p><p><strong>Outcome measures: </strong>Serum 25-hydroxyvitamin D [25(OH)D)], PTH, C-terminal telopeptide (CTX), osteocalcin, calcium, phosphate, creatinine, albumin, ALP and leptin. Polygenic risk scores (PRS) for 25(OH)D and bone mineral density (BMD).</p><p><strong>Methods: </strong>Serum samples were analyzed using validated clinical laboratory methods. PRS for 25(OH)D and bone mineral density (BMD) were calculated based on previous literature. Statistical analyses were performed using Mann-Whitney U-tests, logistic and linear regression. Mendelian randomization was analyzed using logistic regression and the inverse-variance weighted method.</p><p><strong>Results: </strong>In the serum cohort, median 25(OH)D levels were 54.4 nmol/L in individuals with IS and 67.0 nmol/L in controls. Corresponding PTH levels were 4.0 pmol/L and 3.2 pmol/L. No statistically significant differences were found in CTX, osteocalcin, ALP, or leptin. PRS for 25(OH)D was associated with serum 25(OH)D levels. PRS in individuals with IS and controls were non-significant for 25(OH)D, BMD femoral neck, and BMD lumbar spine. A tendency for lower values for estimated BMD heel was seen in individuals with scoliosis compared to controls.</p><p><strong>Conclusion: </strong>Our findings indicate altered regulation of the vitamin D-PTH axis in idiopathic scoliosis, likely driven by environmental rather than genetic factors. Bone turnover markers were comparable between groups, no clear genetically mediated BMD differences could be observed.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787446","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":"Real-World Implementation Strategies and Preparation for Transforming Episode Accountability Model (TEAM): Academic, Community Hospital-Employed, and Private Practice Perspectives.\"","authors":"Iyan Younus, Philip K Louie, Rajiv K Sethi","doi":"10.1016/j.spinee.2026.04.022","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.022","url":null,"abstract":"<p><strong>Background context: </strong>The Centers for Medicare & Medicaid Services (CMS) Transforming Episode Accountability Model (TEAM) is the largest mandatory bundled payment program in Medicare history. The program covers five high-cost surgical episode categories across 188 selected Core-Based Statistical Areas (CBSAs) from January 1, 2026 through December 31, 2030. Spinal fusion is among the most clinically heterogeneous and financially consequential of the five TEAM episode types, subject to a 2.0% mandatory discount factor and a 30-day post-discharge episode window.</p><p><strong>Purpose: </strong>This manuscript reviews current CMS policy guidance and available evidence to provide setting-specific implementation strategies that include: cost containment, care coordination, outpatient episode migration, post-acute network development, and surgeon engagement.</p><p><strong>Study design: </strong>Review METHODS: Literature review performed to comprehensively describe how the implementation strategy for TEAM will vary by practice model to account for financial risk while also preserving patient care and access.</p><p><strong>Results: </strong>While TEAM establishes a unified policy framework, real-world implementation will vary substantially across academic medical centers, community hospital-employed practices, and private practice environments, each of which faces distinct operational constraints, incentive structures, and levels of financial risk exposure.</p><p><strong>Conclusion: </strong>Spine surgeons who engage proactively through formal collaborator agreements, hospital governance participation, and pathway development will be best positioned to preserve clinical autonomy, maintain access for complex patients, and deliver high-quality, equitable care within the value-based landscape that TEAM now mandates.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730492","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":"Association Between Antidepressant Use and Pseudarthrosis Following Spinal Fusion: A Systematic Review and Meta-Analysis.","authors":"Nicholas Frappa, Morgan Dillon, Danil Chernov, Zachary Troiani, Maxwell M Scott, Christopher Lucasti, Matthew G Alben","doi":"10.1016/j.spinee.2026.04.007","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.007","url":null,"abstract":"<p><strong>Background context: </strong>Pseudarthrosis remains a clinically important complication following spinal fusion. Antidepressants are commonly prescribed among patients undergoing spinal arthrodesis, and serotonergic signaling plays a recognized role in bone metabolism. Whether antidepressant use influences fusion outcomes remains uncertain.</p><p><strong>Purpose: </strong>To evaluate the association between antidepressant use and pseudarthrosis following spinal fusion, with prespecified subgroup analyses of serotonergic antidepressants and by spinal region.</p><p><strong>Study design/setting: </strong>Systematic review and meta-analysis.</p><p><strong>Patient sample: </strong>A total of 37,554 adult patients (≥18 years) undergoing cervical or lumbar spinal fusion across five observational studies.</p><p><strong>Outcome measures: </strong>Physiologic measures-radiographic nonunion, clinically diagnosed pseudarthrosis, or revision surgery for pseudarthrosis.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, and Web of Science was performed from database inception through the final search date. Eligible studies compared antidepressant-exposed patients with unexposed controls and reported pseudarthrosis or nonunion outcomes. Random-effects meta-analyses were conducted to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Prespecified subgroup analyses were performed by spinal region and serotonergic antidepressant exposure.</p><p><strong>Results: </strong>Five studies met inclusion criteria. In the primary analysis including all antidepressant classes, antidepressant use was associated with increased odds of pseudarthrosis (OR 1.53, 95% CI 1.17-2.01; p = 0.002), with substantial heterogeneity (I² = 75.7%). In the serotonergic antidepressant subgroup (n = 8,572), exposure was associated with more than a two-fold increase in odds of pseudarthrosis (OR 2.26, 95% CI 1.18-4.33; p = 0.014). Directionally consistent associations were observed in both cervical and lumbar fusion cohorts.</p><p><strong>Conclusions: </strong>Antidepressant use is associated with increased odds of pseudarthrosis following spinal fusion, with a stronger association observed among serotonergic agents. These findings support incorporating antidepressant exposure into preoperative risk stratification and patient counseling.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724351","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":"Optimization of Frailty Indices in Predicting the Risk of Surgical Outcomes in Patients Undergoing Spine Surgery Under Non-General Anesthesia.","authors":"Xinlan Yang, Abdul Karim Ghaith, Zhehao Zhang, Anthony Davidson, Taha Khalilullah, Tej Azad, Yuanxuan Xia, Jawad Khalifeh, A Karim Ahmed, Daniel Lubelski, Nicholas Theodore","doi":"10.1016/j.spinee.2026.04.002","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Non-general anesthesia (NGA) techniques are increasingly utilized in spine surgery for potential perioperative benefits. However, reliable approaches to risk stratification in this population remain undefined. Frailty indices are widely used across surgical specialties, yet their predictive accuracy and optimal integration within NGA spine cohorts have not been fully established.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate the predictive performance of common frailty indices in adults undergoing spine surgery under NGA, and to determine whether combining frailty measures with perioperative clinical variables (particularly American Society of Anesthesiologists classification [ASA]) improves prediction of short-term postoperative outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2010-2022).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Adult patients undergoing spine surgery under NGA identified in ACS-NSQIP (2010-2022).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Thirty-day postoperative (1) complications, (2) readmission, and (3) reoperation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Frailty was quantified using the 5-Item Modified Frailty Index (mFI-5), 11-Item Modified Frailty Index (mFI-11), and Risk Analysis Index-Administrative (RAI-A). Each index was evaluated independently and in combination with ASA classification and body mass index (BMI). Multivariable logistic regression models were constructed for each outcome. Model performance was assessed using area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI), with 1,000 bootstrap resamples.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 3,019 patients undergoing spine surgery under NGA, 30-day complication, readmission, and reoperation rates were 6.0%, 3.4%, and 1.7%, respectively. The combined mFI-11 + ASA model demonstrated superior discrimination for complications (AUC 0.751 vs 0.578; ΔAUC = 0.172), readmission (AUC 0.660 vs 0.474; ΔAUC = 0.186), and reoperation (AUC 0.618 vs 0.541; ΔAUC = 0.077), with significant IDI and NRI improvement. In multivariable analysis, both mFI-11 and ASA independently predicted complications and readmission, whereas ASA alone was associated with reoperation in a dose-dependent manner.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Perioperative status as reflected by ASA classification is critical for risk assessment in patients undergoing spine surgery under NGA. Integrating ASA into mFI-11 significantly enhances short-term prediction. Higher mFI-11 frailty scores and ASA classes were associated with increased risks of complications and readmissions, underscoring the importance of careful patient selection and preoperative optimization when considering NGA in frail individuals. The proposed risk equation offers a practical appr","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718851","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}