Spine Journal最新文献

{"title":"Outcomes of retreatment for local recurrence after surgery for metastatic spine cancer: a multicenter study","authors":"Sehan Park MD, PhD ,&nbsp;Dong-Ho Lee MD, PhD ,&nbsp;Chang Ju Hwang MD, PhD ,&nbsp;Bong-Soon Chang MD, PhD ,&nbsp;Hyoungmin Kim MD, PhD ,&nbsp;Sam Yeol Chang MD ,&nbsp;Se-Jun Park MD, PhD ,&nbsp;Jin-Sung Park MD, PhD ,&nbsp;Dong-Ho Kang MD ,&nbsp;Young-Hoon Kim MD, PhD ,&nbsp;Sang-Il Kim MD, PhD ,&nbsp;Chung-Won Bang MD ,&nbsp;Jae Hwan Cho MD, PhD","doi":"10.1016/j.spinee.2025.10.029","DOIUrl":"10.1016/j.spinee.2025.10.029","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Local recurrence (LR) after surgery for metastatic spine cancer (MSC) is a challenging complication, and evidence guiding optimal retreatment strategies remains limited.</div></div><div><h3>PURPOSE</h3><div>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.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A multicenter retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Ninety-nine patients from 4 tertiary hospitals who developed symptomatic LR after surgery for MSC and underwent reoperation or radiation therapy (RT).</div></div><div><h3>OUTCOME MEASURES</h3><div>Motor grade, pain visual analog scale (VAS) score, ambulatory function, retreatment failure rate, and overall survival after LR diagnosis were assessed.</div></div><div><h3>METHODS</h3><div>Patients were grouped based on retreatment modality into reoperation (<em>n</em>=36), RT (<em>n</em>=38), and conservative management (<em>n</em>=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.</div></div><div><h3>RESULTS</h3><div>Reoperation significantly improved motor grade (p=.041) and pain VAS score (p=.002), whereas RT and conservative treatment showed no significant improvement. Ambulatory status decreased significantly in the RT group (p=.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=.414) and was associated with increased pain (p=.042) and reduced ambulation (p=.012). The only significant predictor of retreatment failure was a shorter interval between initial surgery and LR (odds ratio, 0.953; p=.045). A cutoff of 12.5 months was predictive of retreatment failure (area under the curve, 0.713; p=.056).</div></div><div><h3>CONCLUSIONS</h3><div>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.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 400-412"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","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":"Novel risk calculator predicting long-term survival in pediatric versus adult patients diagnosed with spinal low-grade glioma: a nationwide analysis","authors":"Abdul Karim Ghaith MD, PhD ,&nbsp;Xinlan Yang MS ,&nbsp;Abdel-Hameed Al-Mistarehi MD ,&nbsp;Taha Khalilullah BS ,&nbsp;F.N.U. Ruchika MBBS ,&nbsp;Joshua Weinberg MD ,&nbsp;Meghana Bhimreddy BA ,&nbsp;Arjun K. Menta BS ,&nbsp;Khaled Zaitoun MBBS ,&nbsp;Chase Foster MD ,&nbsp;David Xu MD ,&nbsp;Nicholas Theodore MD, MS ,&nbsp;Daniel Lubelski MD","doi":"10.1016/j.spinee.2025.08.335","DOIUrl":"10.1016/j.spinee.2025.08.335","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Spinal low-grade gliomas (SLGGs) are rare, slow-growing central nervous system tumors affecting both pediatric and adult populations. Due to their rarity, their prognosis and optimal treatment strategies remain poorly defined, necessitating further investigation into age-related differences in outcomes and risk factors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;This study aims to evaluate differences in treatment modalities and clinical outcomes between pediatric and adult SLGG patients. Additionally, it seeks to identify risk factors for long-term survival using predictive modeling.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;DESIGN&lt;/h3&gt;&lt;div&gt;A retrospective cohort study using data from the National Cancer Database (NCDB) was conducted. Patients were stratified into pediatric (≤21 years) and adult (&gt;21 years) groups for comparative analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A total of 884 patients diagnosed with SLGGs (Grades I and II) were included: Pediatric patients (≤21 years): 294 (33.3%) and adult patients (&gt;21 years): 590 (66.7%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;The primary outcome was overall survival (OS), analyzed using Kaplan-Meier survival curves and the Log-rank test. Predictive modeling was used to identify significant risk factors associated with mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Patients with SLGGs (Grades I and II) were identified from the National Cancer Database (NCDB) and categorized into pediatric (≤21 years) and adult (&gt;21 years) groups. Demographic, tumor, and treatment characteristics were compared using univariate analysis. Overall survival (OS) was assessed using Kaplan-Meier survival curves and the Log-rank test. Multivariate Cox proportional hazards modeling was performed to identify independent predictors of mortality. Three machine learning models were applied to predict mortality risk, with performance evaluated using the Area Under the Curve (AUC) and Concordance index (C-index). SHapley Additive exPlanations (SHAP) analysis was used to interpret feature importance in the best-performing model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Pediatric patients presented with larger tumors on average but had significantly better OS than adults (long-term mortality: 8.2% vs 36.8%, p&lt;.001). Surgical resection, including gross total resection (GTR) and subtotal resection (STR), was associated with improved OS in both age groups (p=.0015). Adults were more likely to receive radiation therapy (47.8% vs 19.1%, p&lt;.001), while pediatric patients more frequently received chemotherapy (18.4% vs 11.7%, p=.007); however, both treatments were associated with poorer OS (p&lt;.0001). Multivariate Cox regression identified pediatric age (HR=0.26, p&lt;.001) and surgery alone (HR=0.43, p&lt;.001) as protective factors against mortality. The Random Survival Forest model demonstrated the highest predictive performance (AUC=0.74, C-index=0.71), identifying high comorbidity scores, radi","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 361-373"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of the iron-chelating agent deferoxamine in spinal cord injury: a systematic review and meta-analysis of preclinical studies","authors":"Mehrnaz Moradi MD ,&nbsp;Amirhossein Najibi MD ,&nbsp;Reza Moshfeghinia MD ,&nbsp;Afshin Heidarian MD ,&nbsp;Mehrpour Moradi MD ,&nbsp;Michael G. Fehlings MD, PhD","doi":"10.1016/j.spinee.2025.07.030","DOIUrl":"10.1016/j.spinee.2025.07.030","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Despite advances in the medical, surgical and rehabilitation treatment of spinal cord injury (SCI), there remains a need to develop therapeutic strategies to address mechanisms of secondary injury. Numerous preclinical studies have investigated the efficacy of deferoxamine, an iron chelating agent, in improving functional outcomes in SCI models. Anti-inflammatory, antiferroptosis, and lipoperoxidation inhibitory mechanisms have been proposed as the underlying mechanisms of action.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;Considering preclinical studies are the gate to translational medicine, we present a quantitative synthesis of the existing literature to shed light on gaps and guide future research in neuroprotection for SCI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;Meta-analysis of preclinical studies involving the use of deferoxamine in in-vivo models of traumatic SCI, regardless of level of injury and/or animal species.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;We conducted a comprehensive search in 3 databases (PubMed, Web of Science, Scopus) in accordance with PRISMA guidelines. Our review protocol was preregistered (PROSPERO registration ID: CRD420251007113). Ten preclinical studies that investigated deferoxamine administration and functional outcomes in animal models of SCI were chosen. We performed a meta-analysis, using a random effects approach, comparing normalized mean differences in deferoxamine-treated and control groups. To minimize heterogeneity, subgroup analysis and meta regression were conducted. We utilized the CAMARADES checklist for quality assessment of the included studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Out of 157 articles, 10 were included for final analysis. Our results revealed that deferoxamine can improve functional scores in animal models of thoracic traumatic SCI (NMD=35.74% [18.74, 52.75]; p&lt;.001). The funnel plot was symmetric and no publication bias was noted. Heterogeneity was high among included studies (I²: 95.98). The median score for CAMARADES was 5 (IQR range: 4–6), indicating moderate overall quality of include studies. Sample size calculation and allocation concealment were lacking in included studies. Meta regression was significant for assessment time (Coefficient: −0.574 [−0.905, −0.242]) and route of administration.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;We demonstrated that deferoxamine improves hindlimb motor function in animal models of SCI. Potential knowledge gaps exist, necessitating future animal studies across a more diverse range of injury levels and functional assessment tools before moving on to conducting clinical trials. Assessment time may play a critical role in preclinical models and needs to be adjusted to clinically plausible time points in future studies. More inter-species preclinical research, especially in nonhuman primates, is encouraged to foster generalizability and clinical applicability of the models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CLINICAL SIG","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 239-251"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Static versus expandable transforaminal lumbar interbody fusion cages: a meta-analysis of complications, clinical, and radiographic outcomes","authors":"Mohammad Daher MD ,&nbsp;Marven Aoun MD ,&nbsp;Richard K. Hurley MD ,&nbsp;William F. Lavelle MD ,&nbsp;Bassel G. Diebo MD ,&nbsp;Amer Sebaaly MD ,&nbsp;Andrew J. Schoenfeld MD ,&nbsp;Alan H. Daniels MD","doi":"10.1016/j.spinee.2025.07.018","DOIUrl":"10.1016/j.spinee.2025.07.018","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Surgical management of degenerative spinal disorders commonly includes lumbar interbody fusion. Transforaminal lumbar interbody fusion (TLIF) is an approach where the cages may be either static or expandable. However, published studies have reported disparate outcomes based on cage type.</div></div><div><h3>PURPOSE</h3><div>Therefore, this meta-analysis will compare the radiographic outcomes as well as the complications and clinical outcomes between static and expandable TLIF cages.</div></div><div><h3>STUDY DESIGN</h3><div>Meta-analysis.</div></div><div><h3>METHODS</h3><div>Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1-20) were accessed and explored until December 2024. The extracted data consisted of complications (subsidence, radiculitis, adjacent segment disease, pseudoarthrosis, hardware failure, and durotomies), 90-day readmissions, reoperations, patient-reported outcomes measures (PROMs) at ≤3 months and ≥6 months, and improvement in radiographic parameters at ≥6 months. Heterogeneity was evaluated by Q tests and <em>I²</em> statistics. If considerable heterogeneity was identified, a random-effects model was used. Otherwise, fixed-effect models were employed.</div></div><div><h3>RESULTS</h3><div>A total of 15 retrospective articles were included in the meta-analysis, including 2247 patients, with 1359 in the static TLIF group and 888 in the expandable TLIF group. While there was no difference in most of the assessed complications or 90-day readmission, patients in the static TLIF group had a trend towards a lower rate of subsidence (OR=0.50; 95% CI: 0.25–1.00, p=.05) and a higher rate of reoperations (OR=1.96; 95% CI: 1.18–3.25, p=.01). When examining PROMs, there was no significant difference in back or leg pain. However, the static TLIF group had worse ODI at ≥6 months (mean difference=3.77; 95% CI: 0.34–7.19, p=.03). Furthermore, there was no difference in segmental lordosis improvement between the 2 groups. Nevertheless, the static TLIF group had less improvement in disc height (Standardized mean difference = -1.90; 95% CI: -2.98– -0.82, p&lt;.001, p&lt;.001), and foraminal height (Standardized mean difference=-3.76; 95% CI: -6.33– -1.19, p=.004).</div></div><div><h3>CONCLUSION</h3><div>We found limited evidence of superior outcomes for most clinical parameters when comparing expandable to static TLIF. Surgeons should weigh anticipated benefits in case-specific scenarios against associated costs when selecting to use expandable devices.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 329-340"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585424","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 performance status and predictive factors for poor improvement following surgery for spinal metastasis: a nationwide multicenter prospective cohort study","authors":"Akinobu Suzuki MD, PhD ,&nbsp;Koji Tamai MD, PhD ,&nbsp;Shinji Takahashi MD, PhD ,&nbsp;Masayoshi Iwamae MD ,&nbsp;Hiroshi Taniwaki MD ,&nbsp;Yuki Shiratani MD ,&nbsp;Takaki Shimizu MD, PhD ,&nbsp;Kenichiro Kakutani MD, PhD ,&nbsp;Yutaro Kanda MD, PhD ,&nbsp;Hiroyuki Tominaga MD, PhD ,&nbsp;Ichiro Kawamura MD, PhD ,&nbsp;Masayuki Ishihara MD ,&nbsp;Masaaki Paku MD, PhD ,&nbsp;Yohei Takahashi MD, PhD ,&nbsp;Toru Funayama MD, PhD ,&nbsp;Kousei Miura MD, PhD ,&nbsp;Eiki Shirasawa MD ,&nbsp;Hirokazu Inoue MD, PhD ,&nbsp;Atsushi Kimura MD, PhD ,&nbsp;Takuya Iimura MD, PhD ,&nbsp;Takeo Furuya MD, PhD","doi":"10.1016/j.spinee.2025.10.028","DOIUrl":"10.1016/j.spinee.2025.10.028","url":null,"abstract":"<div><h3>Background Context</h3><div>Spinal metastasis affects the activities of daily living (ADL) of patients, and spinal surgery is aimed at improving or maintaining ADL. The Eastern Cooperative Oncology Group Performance status (ECOG-PS) is a measure of ADL, and its change after surgery can influence decisions regarding cancer treatment options. However, few detailed, large-scale studies have examined changes in ECOG-PS after surgery for spinal metastases.</div></div><div><h3>Purpose</h3><div>(1) To investigate the effects of spinal surgery for metastatic spinal tumors on ECOG-PS, and (2) To identify the risk factors for poor postoperative improvement.</div></div><div><h3>Study Design</h3><div>Prospective multicenter cohort study.</div></div><div><h3>Patient Sample</h3><div>A total of 404 symptomatic patients who underwent surgical treatment for metastatic spinal tumors.</div></div><div><h3>Outcome Measures</h3><div>ECOG-PS was designated as the primary outcome and Barthel Index (BI) as the secondary outcome. Both were assessed preoperatively and at 1 and 6 months postsurgery.</div></div><div><h3>Methods</h3><div>Changes in ECOG-PS and BI were analyzed using the Friedman test or a general mixed-effect model. Poor outcomes were defined as a ECOG-PS score of 3, 4, or death. Preoperative factors associated with poor outcomes were analyzed using multivariate logistic regression analyses with complete or multiple imputed datasets.</div></div><div><h3>Results</h3><div>Preoperative ECOG-PS and BI scores improved at 1 and 6 months postoperatively. Patients with a ECOG-PS score of ≤2 at 1 month had significantly higher rates of receiving systemic therapy than those with a ECOG-PS score of ≥3. No use of bone-modifying agents, Frankel grade ≥<em>C</em>, ECOG-PS score of ≥3, or a high C-reactive protein/albumin ratio (CAR) were the preoperative factors associated with poor PS at 1 month, whereas history of systemic therapy, ECOG-PS score of ≥3, primary tumor type, anemia, and high CAR were the preoperative factors associated with poor ECOG-PS at 6 months.</div></div><div><h3>Conclusion</h3><div>Spinal surgery can improve ADL in patients with spinal metastases; however, not all patients experience favorable outcomes. The present findings indicate that the preoperative severity of paralysis and ADL impairment, laboratory data, and treatment history are important for predicting ADL after surgery for spinal metastasis.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 386-399"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313718","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":"Analysis of the efficacy of Endo-TLIF and OLIF-360 assisted by optical navigation in the treatment of degenerative lumbar spondylolisthesis lesions: a retrospective cohort study.","authors":"Qingyu Yao, Yuanrun Wei, Mengxuan Wang, Guantong Sun, Mingzhi Liu, Yichen Jiang, Kunpeng Su, Jae Hyup Lee, Mazda Farshad, Yan Wang, Xuexiao Ma, Chuanli Zhou","doi":"10.1016/j.spinee.2026.01.015","DOIUrl":"10.1016/j.spinee.2026.01.015","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) and oblique lumbar interbody fusion with percutaneous fixation (OLIF-360) are both minimally invasive fusion techniques for degenerative lumbar spondylolisthesis (DLS). Endo-TLIF provides direct decompression under endoscopic visualization, whereas OLIF-360 restores disc height and lumbar lordosis through indirect decompression. However, their relative advantages remain uncertain, particularly regarding perioperative outcomes and radiographic efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the clinical and radiographic outcomes of Endo-TLIF and OLIF-360 assisted by optical navigation in the management of DLS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;One hundred and one patients treated by Endo-TLIF and ninety-three patients treated by OLIF-360.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Clinical records including the visual analog scale (VAS) score of the lower back and leg and the Oswestry disability index (ODI). Radiological records including disk height (DH), lumbar lordosis (LL), segmental lordosis (SL), the cross-sectional area (CSA) of the spinal canal, and fusion rate. Surgical-related information and complications were also recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review was conducted of patients with DLS who underwent surgical treatment between 2020 and 2022 with a minimum follow-up of 2 years. A total of 194 patients were included, comprising 101 cases treated with endoscopic transforaminal lumbar interbody fusion (Endo-TLIF group) and 93 cases treated with oblique lateral interbody fusion combined with percutaneous pedicle screw fixation (OLIF-360 group). Perioperative outcomes, radiographic parameters, and complications were compared to evaluate the relative advantages and limitations of the two approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The Endo-TLIF group had significantly less intraoperative blood loss, shorter incision length, and reduced hospital stay compared with the OLIF-360 group. Clinical scores improved significantly in both groups. The Endo-TLIF group showed better early postoperative mobilization, while functional outcomes were similar between groups at longer-term follow-up. CSA expansion was greater in the Endo-TLIF group, whereas improvements in DH and SL were more pronounced in the OLIF-360 group. Fusion rates at all postoperative time points were comparable between the two groups. The overall complication rates were 4.00% in the Endo-TLIF group and 9.68% in the OLIF-360 group, with Endo-TLIF showing a slightly lower incidence. Most complications in the OLIF-360 group were related to psoas muscle injury and recurrent same-level spinal canal stenosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study demonstrates that both Endo-TLIF and OLIF-360 achieve favorable outcomes in the treatment of DLS. Compared with OLIF-360, Endo-TLIF offers ad","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960540","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":"What functional benefits can older patients expect after adult spinal deformity surgeries? Subanalysis from the Prospective Evaluation of Elderly Deformity Surgery (PEEDS) study with 5 year follow up.","authors":"Aditya Raj, Hananel Shear-Yashuv, Yousef Aljamaal, Colby Oitment, Anna Rienmueller, Yukihiro Matsuyama, Yong Qiu, Juan P Sardi, Benny T Dahl, Maarten Spruit, Marinus de Kleuver, David W Polly, Ferran Pellisé, Kenneth Mc Cheung, Ahmet Alanay, Lawrence G Lenke, Christopher I Shaffrey, Sigurd H Berven, Stephen J Lewis","doi":"10.1016/j.spinee.2026.01.008","DOIUrl":"10.1016/j.spinee.2026.01.008","url":null,"abstract":"<p><strong>Background context: </strong>Increasing number of patients are undergoing surgical treatment for adult spinal deformity (ASD). The main indications are pain, disability and loss of function. Multiple patient- reported health related quality of life (HRQOL) measures are utilized to assess functional status and disability before and after the surgery. Some components of these questionnaires may be more pertinent in the elderly population.</p><p><strong>Purpose: </strong>Primary aim was to assess key functional outcomes were most relevant to elderly patients undergoing multilevel fusion surgery for ASD. Secondary aim was to assess if these functional improvements were maintained over the follow up period.</p><p><strong>Study design/setting: </strong>Post hoc analysis of prospectively collected data from multicenter observational study, where primary outcome was the absolute changes in the SRS-22r total and subtotal scores between baseline and 2-years FU.</p><p><strong>Patient sample: </strong>Two Hundred nineteen patients.</p><p><strong>Outcome measures: </strong>Self-reported and functional measures were included. Function was assessed using the Scoliosis Research Society 22r (SRS-22r) function domain, and the personal care, walking, sitting and standing sections from the Oswestry disability index (ODI) and EuroQol- 5 Dimension (EQ-5D-3L scores).</p><p><strong>Methods: </strong>Patients ≥60 years of age from 12 international centres undergoing spinal fusion of at least 5 levels were included. Follow up visits were performed at 10 weeks, 12 months, 24 months and 60 months.</p><p><strong>Results: </strong>A total of 219 patients (80.4% females) were included with a mean age of 67.5 years. The mean SRS-22r function scores preoperative were 2.70 (CI: 2.60-2.80), which improved to 3.46 (CI: 3.36-3.56) by 2 years postsurgery and were maintained at 5 years (3.39, CI: 3.27-3.51). 44.9% patients were either bedbound or had primarily no activity before the surgery which reduced to 18.3 % at 2 years and 17.4% at 5 years follow up. Similarly, the percentage of patients that could stand >30 minutes improved from 24.5% to 68.6% at 2 years and 59.4% at 5 years. 26% of the patients could walk for a mile or more before surgery which improved to 63.1 % at 2 years and maintained in 58.7% patients at 5 years. 43.1 % had unlimited sitting preoperatively, that improved to 65.3% at 2 years and 64.7% at 5 years. Normal social life was seen in 19.2% of patients at baseline compared to 57.5% at 2 years and 52.7% at 5 years.</p><p><strong>Conclusions: </strong>Elderly patients undergoing multilevel spinal fusions for ASD experienced significant functional improvements, which were maintained at 5 years postoperatively. This practical information can be utilized during patient counselling preoperatively when considering functional outcomes after major ASD surgery in patients over 60 years of age.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949401","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":"Network meta-analysis of antibiotic exposure and holiday duration, biopsy site, imaging guidance, and sampling approach on culture yield in vertebral osteomyelitis.","authors":"Eslam Abourisha, Tanmay Jitendra Talavia, Kristine Logan, Sanjeevi Bharadwaj, Amit Bishnoi, Sriram Harish Srinivasan","doi":"10.1016/j.spinee.2026.01.002","DOIUrl":"10.1016/j.spinee.2026.01.002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Microbiological confirmation in suspected native vertebral osteomyelitis/spondylodiscitis (NVO/SD) guides pathogen-directed therapy, yet culture yields vary and the impact of antecedent antibiotics is disputed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The primary aim of this study was to determine how different factors-such as prior antibiotic use, the length of any antibiotic-free interval before biopsy, biopsy site selection, sampling method, and imaging guidance-affect the chances of obtaining a positive culture in adults suspected of having native vertebral osteomyelitis or spondylodiscitis. The study also explored whether planning a second biopsy after an initial negative attempt could help improve diagnostic confirmation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;27 adult cohort studies were included in this meta-analysis. Each study involved patients being investigated for suspected native vertebral osteomyelitis/spondylodiscitis. A comparative analysis was done. Included studies were both retrospective and prospective and mostly focused on pyogenic cases and some with mycobacterial infections. We excluded pediatric and nonspinal cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome assessed was the rate at which bacterial cultures yielded positive results from sampled material (Biopsy or Aspirate). This was reported across studies and based on laboratory microbiology results. No self- report or functional measures were analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We synthesized comparative evidence from an investigator-assembled corpus supplemented by a reproducible MEDLINE (via PubMed), Embase (via Ovid), and Cochrane CENTRAL search (2000-21 Sept 2025) and reference checking. Eligible adult cohort studies reported arm-level culture positivity for: prior antibiotics exposure, timing of an \"antibiotic holiday,\" biopsy target, guidance modality, open/intraoperative versus percutaneous sampling, and a planned repeat-biopsy strategy. Analyses used MetaInsight (random-effects pairwise/network metanalysis). Effect size was risk ratio (RR) for positive culture (RR&gt;1 favors the listed strategy). Overall, 27 unique studies contributed to ≥1 comparison.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Across 12 cohorts (n=967 biopsy procedures), prior antibiotic exposure was not associated with a statistically significant difference in culture yield (pooled RR 0.86, 95% CI 0.72-1.03). In the 3-arm network (biopsy performed while on antibiotics or within 48 hours of the last dose, 72 hours to 9 days after the last dose, and ≥10 days after the last dose) estimated yields were higher with longer antibiotic-free intervals; however, neither comparison reached statistical significance (72 h-9 days vs. ≤48 h: RR 1.37, 95% CI 0.58-3.24; ≥10 days vs. ≤48 hours: RR 2.53, 95% CI 0.81-7.92). For biopsy target (reference = paravertebral/epidural soft tissue collectio","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949371","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":"Demographic and Socioeconomic Association with Surgical Recommendations in Multidisciplinary Adult Spinal Deformity Conference.","authors":"Kento Yamanouchi, Aiyush Bansal, Patricia Lipson, Takeshi Fujii, Rafael Garcia de Oliveira, Michelle Gilbert, Jesse Shen, Jean-Christophe Leveque, Venu Nemani, Rajiv K Sethi, Philip K Louie","doi":"10.1016/j.spinee.2026.01.012","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.01.012","url":null,"abstract":"<p><strong>Background context: </strong>Surgical treatment for adult spinal deformity (ASD) is associated with high rates of perioperative complications and mortality. To address these complexities, multidisciplinary approaches have emerged as a promising strategy to optimize patient care, enhance surgical outcomes, and mitigate complications.</p><p><strong>Purpose: </strong>This study examines whether a multidisciplinary conference at a quaternary referral center discriminates based on socioeconomic disparities measured by the Area Deprivation Index (ADI).</p><p><strong>Study design/ setting: </strong>Single-center retrospective review.</p><p><strong>Patient sample: </strong>698 patients evaluated in a multidisciplinary conference between August 2015 and March 2025.</p><p><strong>Outcome measures: </strong>The primary outcome was the recommendation for surgery following multidisciplinary conference discussion. ADI scores were compared between patients who were recommended for surgery and those who were not. Secondly outcomes were demographic data, clinical outcomes, comorbidity index (CCI), and socioeconomic factors among these two groups.</p><p><strong>Methods: </strong>Participants were categorized to surgery group (n = 398) and non-surgery group (n = 300).</p><p><strong>Results: </strong>On univariate analysis, patients recommended for surgery were more likely to be White (80.7% vs. 65.3%, p < .001), non-Hispanic (88.4% vs. 73.3%, p < .001), and had greater distance to the hospital (146.7 vs. 91.7 miles, p = .01). In the multivariate model, non-Hispanic ethnicity (OR 2.58, 95% CI 1.69-3.99) and White race (OR 1.60, 95% CI 1.09-2.33) were independently associated with higher odds of surgical recommendation. Other factors, including insurance type, CCI, ADI, and distance to hospital, were not significant predictors in the multivariate model.</p><p><strong>Conclusions: </strong>This study identified that surgical recommendations in a multidisciplinary spine clinic were not associated with socioeconomic factor. Our findings highlight the importance of future efforts on developing strategies to identify and mitigate these persistent individual-level biases.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946625","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":"Stem cell therapy for spinal cord injury: lessons from Japan's experiment in regulatory deregulation.","authors":"Hiroshi Kawaguchi","doi":"10.1016/j.spinee.2026.01.005","DOIUrl":"10.1016/j.spinee.2026.01.005","url":null,"abstract":"<p><p>Stem cell-based therapies for spinal cord injury (SCI) have generated substantial global interest; however, no regenerative treatment has yet demonstrated sufficient efficacy to achieve full regulatory approval in major jurisdictions. In Japan, an expedited regulatory framework enabled the conditional approval of Stemirac, an autologous mesenchymal stem cell therapy for SCI, based on limited and uncontrolled clinical evidence. This Perspective examines the scientific, methodological, and ethical implications of that decision. Focusing on trial design, outcome assessment, extensive public and media attention during the confirmatory trial period, and downstream societal consequences, we explore how premature commercialization under public reimbursement may compromise scientific rigor and erode public trust. The Stemirac case offers important lessons for regulators, clinicians, and researchers worldwide, underscoring the need to balance rapid patient access with robust evidentiary standards in the development of regenerative therapies for SCI.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946706","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}