Spine Journal最新文献

{"title":"Widening gaps in episode of care markers between Medicare managed care and Medicare fee-for-service in spinal fusion.","authors":"Alexa K Pius, Henry Wong, Jayme C B Koltsov, Serena S Hu, Andrew J Schoenfeld, Grace X Xiong","doi":"10.1016/j.spinee.2026.01.022","DOIUrl":"10.1016/j.spinee.2026.01.022","url":null,"abstract":"<p><strong>Background context: </strong>Failure to accurately predict length of stay (LOS) and discharge disposition in the setting of spine fusion episodes of care can have substantial impact on patient care and resource allocation. Mandatory upcoming bundled payment models for spinal fusion will focus solely on traditional Medicare (TM) beneficiaries; however, less is known about episode of care metrics in this subgroup compared with patients in other insurance classes.</p><p><strong>Purpose: </strong>We sought to compare time-based trends among TM and Medicare Advantage (MA) in (1) LOS and home discharge, (2) readmission and emergency department visits, and (3) prevalence of medical comorbidities and social vulnerability.</p><p><strong>Study design/setting: </strong>The Epic Cosmos dataset (comprising longitudinal records for over 300 million patients from over 1,700 hospitals) was used for this retrospective cohort study.</p><p><strong>Patient sample: </strong>Episodes of care containing single-level lumbar fusions performed in adults between January 1st, 2016, to December 31st, 2024.</p><p><strong>Outcome measures: </strong>The primary outcome was LOS in days. Secondary outcomes included rates of discharge home, 30-day readmission rates, and 30-day emergency department visits.</p><p><strong>Methods: </strong>Time-based trends and differences among primary insurance classes in LOS were assessed via a negative binomial regression model that included a 2-way interaction between primary insurance class and time, with adjustment for sociodemographic, clinical, and institutional covariates. Primary insurance classes included TM, MA, Commercial, and Medicaid. Post-hoc tests were adjusted for multiple comparisons via the Holm-Bonferroni method.</p><p><strong>Results: </strong>Among 126,304 spinal fusion episodes, LOS for TM patients decreased at an adjusted rate of 1.1% ([95% CI 0.4, 1.7], p<.001) faster per year compared with MA (TM: 2016-2024 unadjusted LOS 3.37-2.54; MA 3.53-3.12 days). Between 2016 and 2024, TM and MA both saw increases in home discharge, however by 2024 MA had higher adjusted rates of home discharge (unadjusted 2016-2024 raw rates TM 77.2%-86.8%; MA 76.0%-87.9%; adjusted 2024 rate 33% higher than TM [95% CI 18%, 51%, p<.001]). Over the study period, the MA cohort changed to become the group with the greatest number of Hierarchical Conditional Categories (2016 to 2024, 0.45-0.77; 15% increase compared to TM [10%, 22%, p<.001]). At the end of the study period, TM and Commercial had similar social vulnerability index (SVI) (unadjusted 50th vs. 50th percentile, adjusted p>.05) and MA and Medicaid had similar SVI (unadjusted 56th and 63rd percentile, adjusted p>.05). There were no differences in time-based trends between groups for readmission rates and emergency department visits.</p><p><strong>Conclusions: </strong>We observed longer LOS and increased home discharge rates with MA compared to TM over time without apparent improveme","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120660","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":"Corrigendum to “Integrating a randomized controlled trial with a parallel observational cohort study in cervical spine surgery insights from the foraminotomy ACDF cost-effectiveness trial (FACET)” [Spine J 25 (2025) 2014–2025]","authors":"Nádia F. Simões de Souza MD , Anne E.H. Broekema MD, PhD , Remko Soer PhD , Katalin Tamási PhD , Antoinette D.I. van Asselt PhD , Michiel F. Reneman PhD , J. Marc C. van Dijk MD, PhD , Jos M.A. Kuijlen MD, PhD , FACET Investigator group","doi":"10.1016/j.spinee.2025.10.034","DOIUrl":"10.1016/j.spinee.2025.10.034","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 434-435"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589932","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":"Paraspinal sarcopenia independently predicts patient-reported outcomes following open but not minimally invasive single-level lumbar decompression","authors":"Robert J. Oris BS , Rushmin Khazanchi BA , Jacob R. Staub BS , Jonathan Dalton MD , Anitesh Bajaj BA , Jeremy Marx MD , Tyler Compton MD , Jae Jang BS , Shyam Chandrasekar BS , Alpesh A. Patel MD, MBA , Wellington K. Hsu MD , Srikanth N. Divi MD","doi":"10.1016/j.spinee.2025.07.012","DOIUrl":"10.1016/j.spinee.2025.07.012","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Sarcopenia is a known risk factor for inferior outcomes following spine surgery. However, few studies have investigated the optimal method or cutoff to quantify paraspinal sarcopenia on MRI for outcome prediction. Furthermore, no studies have compared the impact of paraspinal sarcopenia on outcomes after minimally invasive versus open decompression surgery.</div></div><div><h3>PURPOSE</h3><div>The objectives of this study were 1) to quantitatively measure sarcopenia of the lumbar paraspinal muscles on MRI to determine the impact on patient-reported outcomes (PROs) following minimally invasive surgery (MIS) versus open single-level lumbar decompression, and 2) to calculate an optimal cutoff for measurements of paraspinal sarcopenia that is predictive of achieving a minimum clinically important difference (MCID) in PROs.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients undergoing single-level lumbar decompression with MIS or open technique at an academic institution with a lumbar MRI within 1 year prior to surgery were identified.</div></div><div><h3>OUTCOME MEASURES</h3><div>Whether or not a minimum clinically important difference (MCID) was achieved 1 year postoperatively for Patient-Reported Outcome Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) scores.</div></div><div><h3>METHODS</h3><div>Demographic variables including age, sex, BMI, 5-factor modified frailty index (mFI-5), and operative level and length were collected. Measurements of the lumbar paraspinal muscles (eg, multifidus, psoas, and erector spinae) included the cross-sectional area (CSA) and fatty infiltration (FI). Demographic characteristics and paraspinal morphology were compared on bivariable and multivariable analyses between patients who met versus failed to meet an MCID of 8 on PROMIS-PF and -PI scores.</div></div><div><h3>RESULTS</h3><div>A total of 152 patients met the inclusion criteria for this study: 99 with MIS and 53 with an open surgical approach. For the MIS cohort, higher psoas FI was associated with less common achievement of MCID for PROMIS-PF (8.60%±4.31 vs 7.17%±5.08, <em>p</em>=.042) and -PI (8.74%±4.43 vs 7.23%±4.97, <em>p</em>=.038), and greater multifidus FI was associated with less common PROMIS-PF MCID achievement (28.2%±14.5 vs 21.1%±11.9, <em>p</em>=.010). However, these relationships did not persist after controlling for confounding variables. In the open laminectomy cohort, higher multifidus FI (32.8%±18.5 vs 22.4%±12.3, <em>p</em>=.040) and CSA (271mm<sup>2</sup>/m<sup>2</sup>±59.1 vs 234 mm<sup>2</sup>/m<sup>2</sup>±53.2, <em>p</em>=.041) and higher erector spinae (ES) FI (31.7%±15.5 vs 20.9%±10.5, <em>p</em>=.017) and CSA (850mm<sup>2</sup>/m<sup>2</sup>±184 vs 703mm<sup>2</sup>/m<sup>2</sup>±116, <em>p</em>=.008) were associated with less common achievement of MCID for PROMIS-PI. However, multivariable analy","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 310-320"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating predictive performance and generalizability of traditional and artificial intelligence models in predicting surgical site infections postspinal surgery: a systematic review","authors":"Laura C.M. Ndjonko , Aritra Chakraborty BS , Francesco Petri MD , Seyed Mohammad Amin Alavi MD , Takahiro Matsuo MD , Fabio Borgonovo MD , Isin Y. Comba MD , Mohammad H. Murad MD , Ahmad Nassr MD , Said El-Zein MD , Elie F. Berbari MD, MBA","doi":"10.1016/j.spinee.2025.07.032","DOIUrl":"10.1016/j.spinee.2025.07.032","url":null,"abstract":"<div><h3>Background Context</h3><div>Surgical site infections (SSIs) are a significant complication following spinal surgery. These infections contribute to increased morbidity, prolonged hospital stays, and substantial healthcare costs. Traditional statistical models have been widely used to predict SSI risk, but artificial intelligence (AI) and its machine learning (ML) methods have also been used for SSI prediction.</div></div><div><h3>Purpose</h3><div>This systematic review aims to evaluate the predictive accuracy of AI models versus traditional statistical models in assessing SSI risk following spinal surgery.</div></div><div><h3>Study Design/Setting</h3><div>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</div></div><div><h3>Methods</h3><div>We searched Medline, Embase, Scopus, Web of Science, and ClinicalTrials.gov. Studies were included if they developed predictive models for SSI following spinal surgery using either AI or traditional statistical approaches. Risk of Bias for all studies was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Predictive model performance was compared using metrics such as the C-statistic and Area under the Receiver Operating Characteristic curve (AUC-ROC).</div></div><div><h3>Results</h3><div>A total of 51 studies were included. Among these, 42 studies used traditional statistical methods, while 9 used AI / ML models. Logistic regression was the most common method among traditional models (95.2%). Across the ML studies, all of which used supervised models trained on tabular data, decision‑tree–based and linear algorithms (n=7, 77.8% each) were the most common, followed by neural networks and support vector machines (n=4, 44.4% each). Traditional models achieved a C-statistic between 0.7 and 0.8 in 40.5% of cases (n=17), with only 4.8% (n=2) exceeding 0.9. AI models showed a C-statistic of 0.9 or higher in 44.4% of cases (n=4). However, 77.8% of those ML-based models (n=7) performed an internal cross validation and only 33.3% reported calibration data (n=3), and none of the studies are externally validated, which raises important concerns about their current clinical applicability and generalizability.</div></div><div><h3>Conclusions</h3><div>This systematic review, the first of its kind, observed that studies utilizing the AI models reported a potential for excellent classification accuracy in predicting SSI following spinal surgery. However, the current shortcomings in methodology limit their generalizability and immediate clinical implementation. For existing models, most AI studies remain in the early stages of development and its findings in excellent performance should be taken with caution. This review highlights the need for standardized model benchmarking and employing external validation to reliably assess generalizability. Furthermore, advancing beyond conventional tabular data by incor","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 280-291"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and surgical outcomes of spinal infection caused by methicillin-resistant staphylococcus aureus","authors":"Mitsuhiro Nishizawa MD ,&nbsp;Mladen Djurasovic MD ,&nbsp;Steven D. Glassman MD ,&nbsp;Charles H. Crawford III MD ,&nbsp;John R. Dimar II MD ,&nbsp;R. Kirk Owens II MD ,&nbsp;Justin Mathew MD ,&nbsp;Benjamin Kostic BS ,&nbsp;Leah Y. Carreon MD, MSc","doi":"10.1016/j.spinee.2025.07.029","DOIUrl":"10.1016/j.spinee.2025.07.029","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) is one of the major causative organisms of spinal infections, and its incidence of spinal infection caused by MRSA has been increasing in recent years. However, limited studies have assessed surgical outcomes and complications focusing specifically on MRSA spinal infections.</div></div><div><h3>PURPOSE</h3><div>To evaluate the characteristics, surgical outcomes, and complications of spinal infection caused by MRSA.</div></div><div><h3>STUDY DESIGN</h3><div>Retrospective observational cohort.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients who underwent surgery for spinal infection, including discitis, osteomyelitis, epidural abscess, and/or septic facet arthritis. Patients with a history of spine surgery within the preceding 90 days or culture-negative spondylodiscitis were excluded.</div></div><div><h3>OUTCOME MEASURES</h3><div>Recurrence and postoperative complications within 1 year.</div></div><div><h3>METHODS</h3><div>We retrospectively reviewed 205 patients who underwent surgery for spinal infection. Clinical characteristics and postoperative complications within 1 year were compared between patients with spinal infection caused by MRSA (MRSA) and those with infections caused by other organisms (Non-MRSA). Multiple logistic analysis was performed to determine independent factors associated with recurrence.</div></div><div><h3>RESULTS</h3><div>MRSA was identified in 89 patients (43%). Compared to Non-MRSA patients, MRSA patients had a significantly higher incidence of current smoking (57% vs 40%, p=.021), intravenous drug use (49% vs 33%, p=.021), thoracic spine involvement (43% vs 28%, p=.039), epidural abscess (65% vs 45%, p=.005), concomitant bone and joint infections (30% vs 16%, p=.027), and positive blood culture (63% vs 46%, p=.017). They also had significantly higher rates of readmission after 30 days postoperatively (48% vs 34%, p=.044) and recurrence (20% vs 7.8%, p=.012). MRSA was an independent risk factor for recurrence following surgical treatment of spinal infection (MRSA: OR 2.60, 95% CI 1.10–6.52, p=.033).</div></div><div><h3>CONCLUSION</h3><div>Spinal infections caused by MRSA were associated with a higher prevalence of current smoking, intravenous drug use, thoracic spine involvement, epidural abscesses, concomitant bone or joint infections, and bacteremia. Moreover, MRSA was identified as an independent risk factor for recurrence following surgical treatment of spinal infection.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 272-279"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in NIH funding for acute traumatic and chronic nontraumatic spinal cord injury: a 10-year national analysis","authors":"Parker Dhillon BS ,&nbsp;Brian Fabian Saway MD ,&nbsp;Audrey Galimba BS ,&nbsp;Kyle Stegmann MSc ,&nbsp;Noah Nawabi BS ,&nbsp;Yi Lu MD, PhD ,&nbsp;Rajiv Saigal MD, PhD, FAANS ,&nbsp;Konstantinos Margetis MD, PhD ,&nbsp;Michael Fehlings MD, PhD ,&nbsp;Jamie RF Wilson MD, MSc","doi":"10.1016/j.spinee.2025.10.030","DOIUrl":"10.1016/j.spinee.2025.10.030","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 232-238"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145394683","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":"Posterior reduction and temporary fixation for odontoid fractures: an intermuscular dissection approach versus a midline standard muscle stripping approach","authors":"Zhenji Xu MD ,&nbsp;Wenqing Wang MD ,&nbsp;Ji Wu MD ,&nbsp;Wenwen Wang MD ,&nbsp;Dongqing Zhu MD ,&nbsp;Qunfeng Guo MD","doi":"10.1016/j.spinee.2025.08.337","DOIUrl":"10.1016/j.spinee.2025.08.337","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Both the intermuscular dissection approach and the midline, standard muscle stripping approach in posterior reduction and temporary fixation (PRTF) technique can effectively avoid the loss of atlantoaxial motion function caused by posterior atlantoaxial fusion. The intermuscular dissection approach demonstrates superior paravertebral muscles integrity preservation. Therefore, we hypothesize that the range of motion (ROM) in rotation of C1–C2 after instrumentation removal would be superior in patients undergoing PRTF through the intermuscular dissection approach compared to the muscle stripping approach.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;The primary objective of this study was to evaluate the treatment efficacy of PRTF for odontoid fractures, with a secondary comparative analysis of the intermuscular dissection approach versus the muscle stripping approach.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;A retrospective study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLES&lt;/h3&gt;&lt;div&gt;From January 2020 to June 2022, clinical data of 58 patients with acute odontoid fractures who underwent PRTF technique were retrospectively reviewed from the hospital’s internal database. The cohort comprised 2 matched groups: 29 patients treated with the intermuscular dissection approach PRTF technique and 29 patients treated with the muscle stripping approach PRTF technique.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;The degree of paravertebral tissue edema in the short-term postoperatively was assessed using the edema coefficient. The operative time, intraoperative blood loss, postoperative paravertebral tissue edema, pain, and supplementary use of narcotics were recorded and compared between the 2 groups. Fracture healing was evaluated using computed tomography and 3-dimensional reconstruction. Instrumentation was removed after fracture healing, and the outcome assessments included American Spinal Injury Association scoring grade, Visual Analog Scale Score for Neck Pain, and Neck Disability Index. Dynamic rotational computed tomography examination of the C1–C2 was performed to compare the ROM in rotation of C1–C2 between the 2 groups at 3 months after instrumentation removal.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;A total of 58 cases with odontoid fractures who underwent PRTF technique were reviewed. The patients’ general information, clinical outcomes, and radiographic outcomes were collected. Subsequently, to test our hypothesis, the patients were divided into 2 groups based on the different techniques of surgical exposure. Clinical data were analyzed between the 2 groups for differences.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 58 patients were included in the study, with a mean age of 46.9±12.0 years old. Fracture healing was achieved in all patients in this study, and all patients in this study chose to remove the instrumentation after fracture healing. All patients returned to their preoperative work. There were no significant d","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 221-231"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976258","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":"Analyzing the relationship between the social vulnerability index and 90-day elective lumbar fusion outcomes","authors":"Vahe Yacoubian MD, MPH ,&nbsp;Andrew Cabrera MD ,&nbsp;Adelin Tulcan BS ,&nbsp;David Shin BS ,&nbsp;David Cheng BS, MPH ,&nbsp;Jairo Campos BS ,&nbsp;Gideon Harianja MD ,&nbsp;Ethan Vyhmeister BS ,&nbsp;Udochukwu Oyoyo MPH ,&nbsp;Wayne Cheng MD ,&nbsp;Melissa Erickson MD ,&nbsp;Olumide Danisa MD","doi":"10.1016/j.spinee.2025.07.023","DOIUrl":"10.1016/j.spinee.2025.07.023","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;The social vulnerability index (SVI) is a centers for disease control and prevention (CDC) census data tool to identify populations that are susceptible to hazards and health emergencies. Higher scores indicate more socioeconomic vulnerability. There is a scarcity of studies investigating the relationship of SVI on spine surgery outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To determine an association between overall SVI scores and postoperative outcomes with elective lumbar fusions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;Retrospective review.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A total of 1,064 adults aged 18 to 85 years who underwent elective lumbar fusion surgery between January 1, 2013, and June 30, 2023, at a Level 1 trauma center in Southern California. Patients were categorized into low, moderate, and high social vulnerability groups based on their SVI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Ninety-day outcome measures were categorized by systemic outcomes, infectious complications, pulmonary complications, and cardiac complications. Systemic outcomes measured were length of stay and readmission. Infectious complications measured were sepsis, urinary tract infection, and surgical site infection. Pulmonary complications measured were mechanical ventilation, respiratory failure, and pneumonia. Cardiac complications measured were cardiac arrest, cerebrovascular event, deep vein thrombosis, hemodynamic instability, and need for transfusion.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Demographic and clinical outcomes were obtained and reviewed by an analytics team utilizing CPT/ICD codes corresponding to diagnoses or outcomes found in each patient’s chart. SVI was obtained using the CDC census tract data available on the CDC website. Patients were categorized into 3 cohorts based on their overall SVI scores—Low (&lt;16th percentile), Moderate (16th to 84th percentile), and High (&gt;84th percentile). Statistical analyses across the 3 SVI cohorts were conducted using chi-square and Fisher’s exact tests for categorical variables and Kruskal-Wallis test for continuous variables. Posthoc, inter-SVI group statistics were run with Dunn’s test with Bonferroni correction for continuous variables and pairwise Chi-square tests with Bonferroni correction for categorical variables.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 1,064 patients were included for analysis. Demographically, White or Caucasian ethnicity (p=.004) is correlated with the lower SVI group, while Hispanic ethnicity is correlated with higher SVI scores (p&lt;.001). Alcohol use was associated with lower SVI (p=.015), while drug use trended with higher SVI, but was not significant (p=.071). Clinically, patients in the high SVI group had significantly longer lengths of stay (p=.001), and potentially higher rates of respiratory failure (p=.011), and more cardiac arrests (p=.011). Compared to the medium SVI group, the high SVI grou","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 262-271"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585413","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":"Prognostic outcomes of spinal metastasis: timing of metastasis presentation matters","authors":"Shan-Lun Tsao BS ,&nbsp;Chang-Wei Tsou BS ,&nbsp;Yu-Ting Pan MD ,&nbsp;Hung-Kuan Yen MD ,&nbsp;Hao-Chen Lin MD ,&nbsp;Jen-Hao Liu BS ,&nbsp;Fon-Yih Tsuang MD, PhD ,&nbsp;Ue-Cheung Ho MD ,&nbsp;Wei-Hsin Lin MD, PhD ,&nbsp;Ming-Hsiao Hu MD, PhD ,&nbsp;Paul Ogink MD, PhD ,&nbsp;Olivier Q. Groot MD, PhD","doi":"10.1016/j.spinee.2025.09.002","DOIUrl":"10.1016/j.spinee.2025.09.002","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Spinal metastasis (SM), though typically associated with late-stage disease, can manifest at any point in the disease process as a synchronous spinal metastasis (SSM) or metachronous spinal metastasis (MSM). The timing of SM presentation can influence the complexity of treatment approaches. Therefore, investigating the clinical and prognostic distinctions between SSM and MSM is vital for enhancing patient management strategies.</div></div><div><h3>PURPOSE</h3><div>This study investigates the incidence, prognosis, and primary malignancies differences between SSM and MSM, aiming to improve clinical practice through inclusion of both surgical and/or radiotherapy cases.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A retrospective study at a single tertiary care center in Taiwan.</div></div><div><h3>PATIENT SAMPLE</h3><div>About 4,269 patients aged 18 or older who received surgery and/or radiotherapy for image-confirmed spinal metastasis at a tertiary medical center in Taipei from 2010 to 2022.</div></div><div><h3>OUTCOME MEASURES</h3><div>The primary outcome was the incidence of SSM among patients with SM requiring local treatment. Secondary outcomes included survival differences and primary malignancy distributions between SSM and MSM.</div></div><div><h3>METHODS</h3><div>SSM was defined as SM diagnosed within 31 days of initial cancer diagnosis; MSM was diagnosed later. Missing data was handled with multiple imputation using chained equations. Prognostic differences were analyzed using univariate and multivariate Cox proportional hazards models, and survival outcomes were compared with Kaplan-Meier and log-rank tests. Differences in primary malignancy types and growth rates were evaluated using Chi-square test or Fisher’s exact test.</div></div><div><h3>RESULTS</h3><div>SSM was identified in 19.6% (838/4,269) and MSM in 80.4% (3,431/4,269). SSM patients had a longer median survival than MSM (17.4 months, interquartile ranges [IQR] 5.6–49.0 vs 7.5 months, IQR 3.0–20.9; p&lt;.001). Lung cancer was the most common primary malignancy, comprising nearly half of SSM cases. Patients with SSM had a more favorable prognosis than MSM (HR=0.74; p&lt;.001).</div></div><div><h3>CONCLUSION</h3><div>One-fifth of the patients were diagnosed with SM before the primary tumor was identified. These SSM patients exhibit distinct clinical and prognostic profiles compared to MSM patients, often showing a survival advantage likely due to their treatment-naïve status and lower tumor burden at time of presentation. These differences suggest that patients with SSM may benefit from tailored treatment approaches, such as more durable surgical stabilization or consideration of higher radiation doses, given their comparatively favorable survival outlook. Future studies should recognize SSM as a unique clinical entity to refine prognostic models and optimize therapeutic approaches.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 374-385"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114773","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":"L4-S1 ALIF restores and maintains lordosis while minimizing adjacent segment disease compared to L4-S1 TLIF","authors":"Yi Zhang MD ,&nbsp;Ved A. Vengsarkar BS ,&nbsp;Jialun Chi BS ,&nbsp;Hanzhi Yang BS ,&nbsp;Ariaz Goudarzi BS ,&nbsp;Mia Shen ,&nbsp;Li Jin PhD ,&nbsp;Samuel K. Cho MD ,&nbsp;S. Tim Yoon MD, PhD ,&nbsp;Xudong Li MD, PhD","doi":"10.1016/j.spinee.2025.06.001","DOIUrl":"10.1016/j.spinee.2025.06.001","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>The L4-S1 region contributes the most to lumbar lordosis<span>, and adjacent segment disease (ASD) is a common complication following lumbar interbody fusion. To date, no study has directly compared sagittal alignment parameters and incidence of ASD between ALIF and TLIF for the treatment of L4-S1 degenerative disc disease.</span></div></div><div><h3>PURPOSE</h3><div>This study aims to evaluate and compare the efficacy of anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) in restoring L4-S1 lordosis and the impact on the development of ASD.</div></div><div><h3>STUDY DESIGN</h3><div>A retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 102 TLIF patients and 53 ALIF patients were identified from a single-center database.</div></div><div><h3>OUTCOME MEASURES</h3><div>Complications, revisions, and radiological sagittal parameters.</div></div><div><h3>METHODS</h3><div>We conducted a retrospective study involving patients who underwent L4-S1 fusion for degenerative lumbar disease from January 2017 to December 2021. Patients were categorized into TLIF and ALIF groups, with demographic, surgical, and radiographic data collected. Radiographic parameters were assessed preoperatively, postoperatively, and at final follow-up (45.8 ± 13.2 months).</div></div><div><h3>RESULTS</h3><div><span>A total of 155 patients were analyzed (102 TLIFs and 53 ALIFs). Both groups exhibited significant changes in L4-S1 lordosis<span> postoperatively; however, ALIF resulted in a more pronounced increase in L4-S1 lordosis (6.5° vs 1.3°) and reduced compensatory changes at L3/4 compared with TLIF (−2.4° vs 0.2°). ALIF also maintained 72% of the lordosis restoration over time. Moreover, ALIF had lower incidences of ASD (3.8% vs 15.7%, p=.034) and significantly fewer </span></span>reoperations<span> (7.5% vs 25.5%, p=.009). A binary logistic regression analysis revealed that an increase in postoperative L4-S1 lordosis (OR 0.903 [95% CI: 0.820–0.994]) and a decrease in delta L3/4 (OR 0.757 [95% CI: 0.597–0.961]) were significantly associated with the reduced risk of ASD.</span></div></div><div><h3>CONCLUSIONS</h3><div>ALIF demonstrated superior effectiveness compared to TLIF in restoring and maintaining L4-S1 lordosis, mitigating compensatory lordosis, and decreasing the incidence of ASD.</div></div><div><h3>LEVEL OF EVIDENCE</h3><div>III.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 292-300"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250548","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}