Spine Journal最新文献

{"title":"Limited cervical laminectomy prevents postoperative delayed motor palsy: an experimental study using a rat model.","authors":"Atsushi Yokota, Masashi Neo, Takashi Fujishiro, Sachio Hayama, Fumiya Adachi, Shuhei Otsuki","doi":"10.1016/j.spinee.2025.10.020","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.10.020","url":null,"abstract":"<p><strong>Background context: </strong>Whether the width of laminectomy is a risk factor for the development of C5 palsy (C5P) remains controversial, partly due to confounding variables inherent in retrospective clinical studies.</p><p><strong>Purpose: </strong>To investigate the relationship between laminectomy width, posterior shift of the spinal cord, and elongation of the anterior rootlets using an animal model.</p><p><strong>Study design: </strong>Basic in vivo experimental study.</p><p><strong>Methods: </strong>Eighteen Sprague-Dawley rats were randomly assigned to three groups: Group L (limited laminectomy, N = 6), Group W (wide laminectomy, N = 6), and Group S (sham surgery, N = 6). Animals were evaluated pre and postoperative days 3, 10, and 14. The widths of the laminectomy, posterior spinal cord shift, and anterior rootlet length were quantified using computed tomography-myelogram images. Motor evoked potentials (MEPs) were recorded from the deltoid (C5-C6 innervated) and triceps brachii (C7-T1 innervated) muscles.</p><p><strong>Results: </strong>Postoperative posterior shift of the cervical cord was observed in both experimental groups. However, Group W showed significantly greater displacement than Group L at the C4-C6 vertebral levels on postoperative days 10 and 14, corresponding to a greater elongation of the C5-C7 anterior rootlets. MEP latency of the deltoid muscle was significantly longer in Group W than in Group L at postoperative days 10 and 14, and significantly longer than in Group S at all postoperative time points. Conversely, no statistically significant differences in MEP latency of the triceps brachii were observed among all groups.</p><p><strong>Conclusions: </strong>Limited laminectomy may prevent C5P by minimizing elongation of the intradural anterior rootlets caused by gradual posterior shift of the cervical spinal cord.</p><p><strong>Clinical significance: </strong>This study provides insights for clinicians regarding C5 palsy prevention. By limiting the width of degree of laminectomy, posterior shift of the spinal cord, and thus elongation of the anterior rootlets, can be reduced. These findings support the hypothesis that root tethering from spinal cord shift is a likely mechanism of C5P.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330786","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":"Donepezil Treatment Does Not Improve Postoperative Delirium, Medical, or Surgical Outcomes Following Lumbar Spine Surgery: A Propensity-Matched Analysis.","authors":"Ahmed Ashraf, Janesh Karnati, Shameel Abid, Xu Tao, Aydin Kaghazchi, Andrew Wu, Sruthi Ranganathan, Leina Lunasco, Gabriel Jelkin, Evan Moon, Mir Ashraf, Sachin Shankar, Harry Hoffman, Mikayla Wallace, Joseph Cheng, Owoicho Adogwa","doi":"10.1016/j.spinee.2025.10.016","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.10.016","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Patients with preoperative cognitive impairment, defined as a diagnosis of dementia or mild cognitive impairment (MCI), have been associated with inferior perioperative lumbar spine surgery outcomes when compared to cognitively normal patients. Donepezil is currently used to improve mentation and memory in patients with cognitive impairment (CI), however there is an absence of literature regarding its impact on postoperative complications following spine surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To assess the impact of Donepezil treatment on postoperative delirium, medical complications, and surgical wound outcomes following lumbar spine surgery in patients with CI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective study utilizing the TriNetX Research Network.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients were sectioned into two groups: (1) those treated with Donepezil and (2) those not treated with any acetylcholinesterase inhibitors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome was 30-day postoperative delirium. The secondary outcome was a composite measure of medical complications including urinary tract infection, pneumonia, deep vein thrombosis, and pulmonary embolism. The exploratory outcomes were emergency department visits and a composite measure of surgical wound complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The TriNetX Research Network was queried to identify patients diagnosed with either dementia or MCI who underwent lumbar spine surgery for treatment of lumbar spondylolisthesis or stenosis. Propensity score matching was performed to adjust for age, race, gender, and comorbidities, thereby controlling for potential confounders. Postoperative outcomes were identified utilizing corresponding diagnostic and procedural codes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Following propensity score matching, a total of 832 patients were included in the final analysis (mean age: 74.2 years; SD: 7.18; 390 [46.9%] male), with 416 patients in both the Donepezil-treated and non-treated cohorts. There were no statistically significant differences between groups in the incidence of postoperative delirium at 15 days (OR: 1.000, 95% CI [0.601-1.665]) 30 days (OR: 0.967, 95% CI [0.583-1.605]) or 90 days (OR: 1.000, 95% CI [0.605-1.653]). Similarly, rates of composite medical complications did not differ at 15 days (OR: 0.954, 95% CI [0.623-1.460]), 30 days (OR:0.979, 95% CI [0.657-1.461]), or 90 days (OR: 0.832, 95% CI [0.581-1.191]). Composite surgical wound complications were also comparable between cohorts at 15 days (OR: 1.000, 95% CI (0.412-2.428]), 30 days (OR: 1.414, 95% CI [0.621-3.220]), and 90 days (OR: 1.131, 95% CI [0.568-2.249]). Further, no differences in emergency department visits were observed at 15 days (OR: 1.223 95% CI [0.656-2.281]), 30 days (OR: 1.123, 95% CI [0.700-1.801]), or 90 days (OR: 0.875, 95%CI [0.596-1.284]) CONCLUSIONS: This large retrospective, propensity score-matched an","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318755","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 of Retreatment for Local Recurrence After Surgery for Metastatic Spine Cancer: A Multicenter Study.","authors":"Sehan Park, Dong-Ho Lee, Chang Ju Hwang, Bong-Soon Chang, Hyoungmin Kim, Sam Yeol Chang, Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Young-Hoon Kim, Sang-Il Kim, Chung-Won Bang, Jae Hwan Cho","doi":"10.1016/j.spinee.2025.10.029","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.10.029","url":null,"abstract":"<p><strong>Background context: </strong>Local recurrence (LR) after surgery for metastatic spine cancer (MSC) is a challenging complication, and evidence guiding optimal retreatment strategies remains limited.</p><p><strong>Purpose: </strong>To evaluate prognosis following retreatment for LR after surgery for MSC, compare treatment outcomes based on retreatment modality, and identify risk factors associated with retreatment failure.</p><p><strong>Study design/setting: </strong>A multicenter retrospective cohort study.</p><p><strong>Patient sample: </strong>Ninety-nine patients from four tertiary hospitals who developed symptomatic LR after surgery for MSC and underwent reoperation or radiation therapy (RT).</p><p><strong>Outcome measures: </strong>Motor grade, pain visual analog scale (VAS) score, ambulatory function, retreatment failure rate, and overall survival after LR diagnosis were assessed.</p><p><strong>Methods: </strong>Patients were grouped based on retreatment modality into reoperation (n=36), RT (n=38), and conservative management (n=25) groups. Conservative management included symptomatic care for LR without surgery or RT, with or without systemic treatments such as chemotherapy or hormonal therapy. Retreatment failure was defined as symptom progression despite treatment or recurrence after initial improvement. Clinical outcomes were compared among the groups, and logistic regression was performed to identify factors associated with retreatment failure.</p><p><strong>Results: </strong>Reoperation significantly improved motor grade (p=0.041) and pain VAS score (p=0.002), whereas RT and conservative treatment showed no significant improvement. Ambulatory status decreased significantly in the RT group (p=0.031) but was preserved in the reoperation group. Retreatment failure occurred in 41.9% of patients (15/36 after reoperation, 16/38 after RT; p=0.414) and was associated with increased pain (p=0.042) and reduced ambulation (p=0.012). The only significant predictor of retreatment failure was a shorter interval between initial surgery and LR (odds ratio, 0.953; p=0.045). A cutoff of 12.5 months was predictive of retreatment failure (area under the curve, 0.713; p=0.056).</p><p><strong>Conclusions: </strong>Only reoperation resulted in significant functional improvement after retreatment for LR. RT was associated with decreased ambulatory function and did not provide significant symptom relief. Retreatment failure was common and associated with increased pain and diminished function. A significant predictor of retreatment failure was a shorter interval-less than 12.5 months-between the initial surgery and LR. These findings highlight the importance of patient selection and the limited utility of retreatment in aggressive or early-recurrent cases.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318786","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":"Diagnosis of spinal infections caused by fastidious bacteria: a multicenter, retrospective observational study.","authors":"Wenqiao Wang, Huafeng Wang, Qiang Zhang, Litao Li, Xiaofeng Lian, Chuqiang Yin, Yuhan Lin, Zhaohui Li, Yuelei Wang, Zengshuai Han, Feng Shen, Xiaotong Chen, Ruifu Sun, Ting Wang","doi":"10.1016/j.spinee.2025.10.019","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.10.019","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Identifying pathogens in pyogenic spinal infections is essential for guiding clinical treatment. However, the fastidious characteristics of certain bacteria often make traditional microbial culture methods ineffective, resulting in diagnostic delays and postponed intervention. In recent years, metagenomic next-generation sequencing (mNGS) has shown strong potential in analyzing complex microbial communities, offering a more advanced strategy for pathogen detection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Evaluating mNGS versus microbial culture for diagnosing fastidious bacteria in pyogenic spinal infections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A multicenter, retrospective observational study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;We retrospectively reviewed clinical data from 553 patients diagnosed with spinal infections across four medical centers between December 2019 and December 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Identification of fastidious bacteria in patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All patients underwent imaging and standard laboratory testing. Specimens from infected sites obtained through puncture or surgery were analyzed using both microbial culture and mNGS. According to predefined diagnostic, inclusion, and exclusion criteria for fastidious bacteria, 49 patients (8.86%, 49/553) were identified with pyogenic spinal infections caused by fastidious organisms. We compared the diagnostic outcomes of mNGS with those of culture-based methods for detecting fastidious bacterial pathogens in spinal infections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 49 patients, mNGS yielded a positive detection rate of 87.76% (43/49), which was significantly higher than that of conventional culture methods at 16.33% (8/49) (χ²=12.683, p &lt; 0.001). Among the 41 culture-negative cases, mNGS successfully identified fastidious bacteria in 37, corresponding to an effective supplementary detection rate of 90.24% (37/41). While culture identified 5 species of fastidious bacteria, mNGS detected 15, giving an effective pathogen supplementation rate of 66.7% (10/15). These 15 bacteria fell into two groups: the first included those that cannot be cultured using routine clinical media (26/43, 60.47%), and the second included those that may sporadically grow in standard cultures but tend to show low positivity (17/43, 39.53%). Out of the total 553 cases, 382 were culture-negative. Among these, 37 (37/382, 9.69%) were identified as fastidious bacteria via mNGS. mNGS yielded results within 48 hours, significantly faster than the 3-7 days typically required by culture methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In cases of pyogenic spinal infections caused by fastidious bacteria, mNGS demonstrated a higher detection rate, wider pathogen range, and significantly shorter turnaround compared to traditional microbial culture. The culture-independent approach of mNGS presents a distinct advantage in identifying fastidious ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318735","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":"Surgical Practice Variation and Outcomes Regarding Single-Level Posterior Approach for Degenerative Lumbar Spondylolisthesis: A Canadian Spine Outcomes Research Network (CSORN) Study.","authors":"F Cardahi, M Georgiopoulos, A Siddique, J Urquhart, G McIntosh, D Fourney, R Charest-Morin, S Al Rawahi, J Couture, N Manson, S Christie, S Paquette, J Paquet, S Singh, A Yee, H Ahn, J Larouche, M H Weber","doi":"10.1016/j.spinee.2025.10.027","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.10.027","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Symptomatic degenerative lumbar spondylolisthesis (DLS) is a common pathology for spinal surgery. Due to the high surgical volume and variability in management approaches, analyzing and understanding practice patterns is essential for improving patient care PURPOSE: To investigate the extent of surgical practice variation in the treatment of Meyerding Grade I DLS among Canadian spine centers and compare outcomes between decompression alone and decompression with instrumented fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;We conducted a multicenter retrospective review of collected data on consecutive spine surgery patients enrolled by the Canadian Spine Outcomes and Research Network (CSORN) between January 2015 to December 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Adults (≥18 years) surgically treated for a primary diagnosis of Grade I DLS presenting with radiculopathy or neurogenic claudication and managed with single-level posterior lumbar decompression, with or without instrumented arthrodesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;significant improvement in all PROMs at 3 months, 12 months and 24 months (p &lt; 0.001). At the 12-month and 24-month mark, the decompression and instrumented arthrodesis group showed a higher EQ-5D score (0.23 vs 0.17, p = 0.119) but not statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients aged 18 or older who were surgically treated for a primary diagnosis of Meyerding Grade I DLS with a chief complaint of radiculopathy or claudication and treated with single-level posterior lumbar spinal decompression with or without instrumented arthrodesis with pedicle screw fixation were included in this study. A total of 548 patients met the inclusion criteria, of which 171 patients (31.2%) underwent decompression alone and 377 patients (68.8%) underwent decompression with instrumented arthrodesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Postoperatively, both groups showed significant improvement in all PROMs at 3 months, 12 months and 24 months (p &lt; 0.001). At the 12-month and 24-month mark, the decompression and instrumented arthrodesis group showed a higher EQ-5D score (0.23 vs 0.17, p = 0.119) but not statistically significant. The decompression and instrumented arthrodesis group showed a higher rate of perioperative AEs (17.1% vs 9.4%, p = 0.029) and had a significantly longer hospital stay (3.68 days vs 1.25 days, p &lt; 0.001). No reoperations were needed after alone decompressions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;There was no significant practice variability between the Canadian Provinces for the surgical treatment of grade I DLS with spine centers in New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta and British Columbia performing decompression and instrumented arthrodesis. Overall, there was no significant difference between centers in the West and in the East (p = 0.262), with both Western and Eastern centers generally performing more decompression and","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318775","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 Systematic Review of the Role of Wearable Devices and Artificial Intelligence Applications in Assessing Functional Outcomes after Lumbar Fusion.","authors":"Sriharsha Sripadrao, Christopher Carr, Muhsin Quraishi, Justin Abes, Mehul Mehra, Kenneth James, Fernando Vale, Michel Pare","doi":"10.1016/j.spinee.2025.10.012","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.10.012","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;As the population ages, rates of lumbar spine disease have risen, and lumbar fusion surgeries have become more prevalent. There has been a corresponding emphasis on value-based cost reductions and outcomes research to identify which patients benefit from fusion. While wearable remote-monitoring devices such as goniometers have been used for some time in other medical fields, these seem to have yet to attain wide usage in spine surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;We aimed to conduct a systematic review of the PubMed database in accordance with PRISMA guidelines to characterize the use of wearable devices to describe functional outcomes before and after lumbar fusion surgery. We discuss the role of artificial intelligence and its applications in terms of predictive analytics incorporated into such portable devices for evaluating outcomes of lumbar fusions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Systematic review of studies evaluating the use of wearable devices for functional outcomes in lumbar fusion surgery. The review was conducted using the PubMed database and followed PRISMA guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We included all relevant articles and excluded lumbar spine surgeries without fusion (i.e. microdiscectomy), review articles and editorials, proof-of-concept studies, biomechanical analyses, and technical notes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our initial search generated 5283 citations, of which 9 articles with 813 patients were ultimately included. 5/9 (55%) studies included steps per day as a primary outcome. All studies were pre-post in design. Data collected included vitals, positional data, step counts, diet and sleep data, incision photos, pain scores, and serial patient reported outcome measure administration. Benefits of wearable devices with and without artificial intelligence/predictive analytics included patient education, reduced ER visits, reduced in-person visits, continuous data collection, earlier identification of complications, and wearable devices that do not require FDA device approval. Drawbacks of wearable devices with and without artificial intelligence/predictive analytics included concerns for data security, uncertain cost-effectiveness, lack of standard protocols, heterogeneity of devices, and susceptibility to placebo effect. Overall, studies including wearable devices with and without artificial intelligence/predictive analytics showed that lumbar fusion patients recovered functionally more slowly (i.e. when compared to discectomy patients) but had good long-term functional outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our review suggests wearable devices enhance post-operative monitoring for lumbar fusion surgery by providing real-time, objective data to optimize rehabilitation and functional recovery. As digital health tools evolve, integrating predictive analytics driven by artificial intelligence and through wearable devices may further refine per","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314082","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":"Infectious Complications of Stereotactic Navigation in Posterior or Posterolateral Thoracic and Lumbar Spinal Fusion and Posterior Lumbar Interbody Fusion for Degenerative Spinal Disease: An ACS-NSQIP Study.","authors":"Christian Rajkovic, Victor Koltenyuk, A Daniel Davidar, Ariel Sacknovitz, Jovanna Tracz, Amar Gopal, Matthew Merckling, Ethan Parisier, Ankita Jain, Eris Spirollari, Bridget Nolan, Mahnoor Shafi, Sabrina L Zeller, John V Wainwright, Timothy F Witham, Merritt D Kinon","doi":"10.1016/j.spinee.2025.10.026","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.10.026","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Intraoperative stereotactic navigation systems are routinely used in thoracic and lumbar spine surgery to enhance precision and improve visualization of relevant anatomy. However, the potential impact of navigation on postoperative infection remains controversial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aims to evaluate the association between stereotactic navigation and postoperative infection following posterior or posterolateral thoracic fusion (PTF), posterior or posterolateral lumbar fusion (PLF), and posterior lumbar interbody fusion (PLIF) for degenerative pathology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective Cohort PATIENT SAMPLE: National Surgical Quality Improvement Program (NSQIP) Database OUTCOME MEASURES: Primary outcomes included database-reported thirty-day reoperation rates, readmission rates, mortality, superficial surgical site infection (SSI), deep SSI, sepsis, septic shock, and wound dehiscence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective analysis of the NSQIP database to investigate patients who received PTF, PLF, or PLIF for degenerative pathology from 2015 to 2020. Patients were divided into two cohorts: those who underwent surgery with stereotactic navigation and those without. Baseline demographics and comorbidities including patient sex, patient age, body mass index (BMI), diabetes mellitus, smoking status, chronic obstructive pulmonary disease, ventilator dependency, congestive heart failure, hypertension, acute renal failure, dialysis status, disseminated cancer, steroid use, and previous wound infection as well as operative time and length of stay (LOS) were collected. Chi-square tests and logistic regression analysis were conducted for univariate and multivariate analysis, respectively, of baseline demographics and primary outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 7,537 patients who received PTF, PLF, or PLIF with stereotactic navigation were identified and compared to 108,033 patients who received these operations without navigation. Mean operative time (235.5 ± 102.4 min vs 181.5 ± 99.9 min, p&lt;0.001) and LOS (3.9 ± 5.1 days vs 2.9 ± 4.8 days, p&lt;0.001) were significantly longer for the navigation cohort than for the non-navigation cohort. Controlling for patient age, LOS, operative time, previous open wound infection, steroid use, smoking status, diabetes mellitus, revision status, and frailty, navigation-assisted PTF, PLF, or PLIF was associated with significantly higher odds of superficial surgical site infection (p=0.046) and all postoperative infection (p=0.045) within 30 days of index procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The use of stereotactic navigation systems in posterior or posterolateral thoracic and lumbar fusion or posterior lumbar interbody fusion procedures is associated with increased odds of postoperative infection. These findings highlight the complex relationship between navigation and surgical outcomes, creat","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313707","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":"Staged short-term modified halo-pelvic traction and posterior spinal fusion versus posterior vertebral column resection for severe rigid kyphoscoliosis: a multicenter comparative study.","authors":"Yiwei Zhao, You Du, YangYang, Zheping Zhang, Guanfeng Lin, Chenkai Li, Xiaohan Ye, Dihan Sun, Yu Wang, Jianguo Zhang, Shengru Wang","doi":"10.1016/j.spinee.2025.10.024","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.10.024","url":null,"abstract":"<p><strong>Background context: </strong>Surgical correction of severe rigid kyphoscoliosis remains technically challenging and is associated with high complication rates. Posterior vertebral column resection (pVCR) is often required for satisfactory correction but entails substantial surgical risks. Halo-pelvic traction (HPT) has been proposed as a safer alternative that may reduce the need for high-grade osteotomy by partially correcting the deformity preoperatively.</p><p><strong>Purpose: </strong>To compare the clinical outcomes of HPT combined with posterior spinal fusion (HPT+PSF) versus pVCR for severe rigid kyphoscoliosis, focusing on deformity correction, surgical morbidity, pulmonary function, and complication profiles.</p><p><strong>Study design/setting: </strong>Retrospective comparative effectiveness study conducted at two public tertiary referral hospitals in Beijing, China.</p><p><strong>Patient sample: </strong>A total of 82 patients (41 per group) with severe rigid kyphoscoliosis (defined as coronal and/or sagittal Cobb angle >90° and flexibility <30%) treated between March 2016 and April 2023, with a minimum follow-up of 2 years.</p><p><strong>Outcome measures: </strong>Primary outcomes included deformity correction, intraoperative variables, pulmonary function, and surgery-related complications. Secondary outcomes for the HPT+PSF group included traction duration, traction efficacy, and traction-related complications.</p><p><strong>Methods: </strong>Patients received either HPT+PSF or pVCR based on surgical decision-making. Radiographic measurements were performed independently by two blinded observers. Comparative analyses of radiological and clinical outcomes were performed between groups.</p><p><strong>Results: </strong>The mean duration of HPT was 4.7±1.4 weeks. The traction correction rates in the coronal and sagittal planes were 43%±10% and 39%±14%, respectively. 34% (14/41) of the patients experienced traction-related complications. The total correction rates in the coronal and sagittal planes were comparable between the HPT+PSF and pVCR groups. No significant difference between the groups at baseline or at the latest follow-up in terms of the pulmonary function indices. Compared to the pVCR group, the HPT+PSF group demonstrated significantly shorter surgical time, reduced estimated blood loss, lower incidence of intraoperative neurological monitoring alerts, and fewer surgery-related complications.</p><p><strong>Conclusion: </strong>HPT+PSF provides deformity correction comparable to that of pVCR while significantly reducing surgical morbidity. It represents a viable and potentially safer alternative for patients with severe rigid kyphoscoliosis. However, the risk of traction-related complications and psychological stress necessitates further refinement of HPT protocols.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313753","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":"Distinct Postoperative Quality of Life Trajectories After Surgery for Degenerative Cervical Myelopathy: A Multicenter Prospective Cohort Study.","authors":"Takahiro Kitagawa, Narihito Nagoshi, Junichi Yamane, Toshiki Okubo, Yasuhiro Kamata, Yosuke Horiuchi, Norihiro Isogai, Hitoshi Kono, Reo Shibata, Yoshiomi Kobayashi, Kanehiro Fujiyoshi, Yoshiyuki Yato, Takahito Iga, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.1016/j.spinee.2025.10.023","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.10.023","url":null,"abstract":"<p><strong>Background context: </strong>Postoperative outcomes in degenerative cervical myelopathy (DCM) vary considerably, yet few studies have characterized the heterogeneous recovery trajectories using longitudinal data.</p><p><strong>Purpose: </strong>To identify distinct postoperative quality of life (QOL) trajectories in DCM patients and determine baseline predictors of recovery patterns.</p><p><strong>Study design/setting: </strong>Prospective multicenter observational study.</p><p><strong>Patient sample: </strong>977 patients undergoing surgery for DCM across 10 high-volume spine centers in Japan.</p><p><strong>Outcome measures: </strong>The QOL outcome measure comprised the Short Form-36 physical component summary (PCS) score. Functional outcomes were specifically captured through Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. Outcomes were measured at baseline, 6, 12 and 24 months postoperatively.</p><p><strong>Methods: </strong>Latent growth mixture modeling was employed to classify patients into distinct postoperative recovery trajectories based on PCS trends. To identify independent predictors of trajectory membership, multinomial logistic regression was performed, with variable selection refined through least absolute shrinkage and selection operator regression (LASSO) regression. Model performance was assessed using area under the receiver operating characteristic curve (AUC) for discrimination and decile-based calibration plots with bootstrap validation.</p><p><strong>Results: </strong>Four distinct PCS recovery trajectories were identified: Low-to-High (L-H, 7.3%), High-to-High (H-H, 44.9%), Low-to-Low (L-L, 37.7%), and Initial-Decline (I-D, 10.1%). Preoperative lower extremity function emerged as the strongest predictor of trajectory class, reflecting the baseline QOL. Additional significant predictors included age, smoking history, symptom duration, and cervical spine function. Particularly, reduced cervical function at baseline was found to be a significant predictor of unfavorable QOL at 24 months. The prediction model demonstrated good discriminatory performance following LASSO regression for common classes (AUCs: H-H = 0.86, L-L = 0.80) and moderate performance for L-H class (AUC = 0.74). However, accuracy was limited for the I-D class (AUC = 0.63), and calibration was compressed in rarer classes due to class imbalance.</p><p><strong>Conclusions: </strong>Distinct patterns of postoperative recovery exist among DCM patients, with baseline physical function and patient characteristics significantly influencing QOL trajectory. While predictive models reliably distinguished major recovery patterns, less frequent trajectories, particularly those involving deterioration, were difficult to forecast. These findings support the utility of trajectory modeling and patient-reported outcome measures to enhance individualized surgical prognostication in DCM.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313729","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":"Impact of posterior cervical spine surgery on neck pain-related driving disability and risk factor analysis of postoperative worsening or poor improvement: A retrospective multicenter cohort study.","authors":"Naoki Okamoto, Hideki Nakamoto, Hiroki Iwai, Naohiro Kawamura, Akiro Higashikawa, Nobuhiro Hara, Yujiro Takeshita, Masayoshi Fukushima, Takashi Ono, Masahito Oshina, Shima Hirai, Kazuhiro Masuda, Shurei Sugita, Sakae Tanaka, Yasushi Oshima","doi":"10.1016/j.spinee.2025.10.025","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.10.025","url":null,"abstract":"<p><strong>Background context: </strong>Previous research has shown the positive effect of 1- and 2-level anterior cervical spine surgery on driving disability; however, the impact of posterior cervical spine surgery, which is usually performed for three or more level pathologies, remains unexplored.</p><p><strong>Purpose: </strong>To investigate the impact of posterior cervical spine surgery on neck pain-related driving disability and identify the risk factors for poor driving outcomes.</p><p><strong>Study design: </strong>A retrospective review of a multicenter prospective database.</p><p><strong>Patient sample: </strong>Patients undergoing posterior cervical spine surgery for degenerative cervical myelopathy.</p><p><strong>Outcome measures: </strong>Data were collected on patient and surgical characteristics and patient-reported outcome measurements (PROMs), including the Neck Disability Index (NDI), Numeric Rating Scale for neck/arm pain, EuroQol 5 Dimension, Japanese Orthopedic Association scores, and postoperative satisfaction.</p><p><strong>Methods: </strong>The NDI driving subscale (0-5) was used to evaluate neck pain-related driving disability at baseline and 24 months postoperatively. Driving severity was categorized as \"non-to-mild\" (score 0, 1, or 2) and \"moderate-to-severe\" (score 3, 4, or 5) and used to determine whether patients experienced postoperative improvement, worsening, or rest. Multivariate analysis was performed to identify clinical and surgical risk factors for deteriorating or persistent driving disability. We analyzed the association between driving outcomes and PROMs.</p><p><strong>Results: </strong>Of the 1067 patients included, 277 (26.0%) reported moderate-to-severe driving disability at baseline. At 24 months, 70.8% of these patients experienced substantial improvement, whereas 29.2% did not. Among the 790 patients with baseline non-to-mild driving disability, 69 (8.7%) experienced significant postoperative deterioration. Multivariate analysis identified older age (odds ratio [OR] 2.6), female sex (OR 2.2), and ≥4-level fusion (OR 2.4) as significant risk factors for postoperative worsening, whereas older age (OR 2.1) was the significant risk factor for poor postoperative improvement. Patients with poor outcomes were less likely to achieve clinically significant improvements in all PROMs.</p><p><strong>Conclusions: </strong>Posterior cervical spine surgery can improve driving disability associated with neck pain. Nevertheless, the potential risk of postoperative deterioration or poor improvement should be considered, particularly among patients who are older, female, or have undergone ≥4-level fusion surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313763","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}