Spine Journal最新文献

{"title":"Outcomes after Posterior Cervical Spine Surgery: A Matched Cohort Analysis and Comparison of GLP-1 Receptor Agonist Use and Bariatric Surgery in Patients with Type 2 Diabetes.","authors":"Nicole Rivera, Taylor Bradley, K A Crowell, C Rory Goodwin, Melissa Erickson","doi":"10.1016/j.spinee.2026.10.020","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.020","url":null,"abstract":"<p><strong>Background context: </strong>Obesity and diabetes can increase perioperative risk, especially in posterior cervical spine surgery. Bariatric surgery provides durable weight loss but carries surgical and nutritional risks, while glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are non-surgical alternatives that may optimize weight and metabolic status preoperatively. Evidence evaluating GLP-1 therapy in spine surgery is limited.</p><p><strong>Purpose: </strong>To evaluate associations between preoperative GLP-1 RA use and perioperative, short-term, and long-term complications following posterior cervical spine surgery in patients with type 2 diabetes, including comparisons to matched controls and patients with prior bariatric surgery.</p><p><strong>Study design: </strong>Retrospective database analysis.</p><p><strong>Patient sample: </strong>Patients with type 2 diabetes treated with metformin undergoing posterior cervical spine surgery between 2010 and 2023 were identified in the PearlDiver Mariner database. Patients were stratified into GLP-1 users, non-GLP-1 controls, and patients with prior bariatric surgery.</p><p><strong>Outcome measures: </strong>Physiologic measures included perioperative outcomes and postoperative complications assessed at 90 days and 2 years, including pneumonitis, surgical site infection, revision surgery, readmission, nutritional deficiency, and other medical and surgical complications.</p><p><strong>Methods: </strong>The PearlDiver Mariner database was queried for eligible patients. Propensity-score matching adjusted for baseline cohort differences. Outcomes included perioperative, 90-day, and 2-year complications, with BMI-stratified analyses conducted within the matched GLP-1 and control cohort. Benjamini-Hochberg false discovery rate correction was applied for multiple comparisons.</p><p><strong>Results: </strong>GLP-1 users demonstrated lower odds of perioperative complications, including pneumonitis (OR 0.57; 95% CI 0.43-0.75; p <0.001). At 90 days, GLP-1 users experienced reduced odds of surgical site infection (OR 0.72; 95% CI 0.65-0.80; p <0.001), revision surgery (OR 0.33; 95% CI 0.29-0.36; p <0.001), readmission (OR 0.82; 95% CI 0.76-0.90; p <0.001), and other complications. At 2 years, GLP-1 users had lower odds of revision surgery (OR 0.31; 95% CI 0.28-0.34; p <0.001), nutritional deficiency (OR 0.62; 95% CI 0.59-0.66; p <0.001), and other complications. Exploratory BMI-stratified analyses suggested similar directional trends across overweight and obese patients. Comparisons to prior bariatric surgery patients showed no significant differences.</p><p><strong>Conclusions: </strong>Preoperative GLP-1 RA use was associated with reduced perioperative, short-term, and long-term complications following posterior cervical spine surgery in patients with type 2 diabetes. When compared with a matched bariatric surgery cohort, no significant differences in postoperative outcomes were observed. These f","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between the Bone-cutting Width-to-facet Distance Ratio and Neurological Recovery After Cervical Laminoplasty.","authors":"Kihyun Kwon, Sung Tan Cho, Sehan Park, Chang Hyun Doh, Jae Hwan Cho, Chang Ju Hwang, Dong-Ho Lee","doi":"10.1016/j.spinee.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.009","url":null,"abstract":"<p><strong>Background: </strong>In open-door cervical laminoplasty, gutter position sets the bone-cutting width and canal expansion. Whether a wider opening adds benefit, or a conservative opening with residual dural contact suffices, remains unclear.</p><p><strong>Purpose: </strong>To evaluate whether the laminoplasty width-to-facet distance ratio (LP/Facet percentage) is associated with neurological recovery.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>108 patients who underwent open-door laminoplasty for cervical myelopathy (2017-2024); 75 with preoperative JOA <15 formed the recovery cohort.</p><p><strong>Outcome measures: </strong>JOA recovery rate at postoperative one year.</p><p><strong>Methods: </strong>LP/Facet percentage, open-door angle, and canal area were measured. Associations were examined with Spearman correlation, group comparisons with Benjamini-Hochberg FDR adjustment, and multivariable linear regression of the 1-year postoperative JOA score. The authors report no study-specific funding or conflicts of interest.</p><p><strong>Results: </strong>The LP/Facet percentage was not associated with JOA recovery (ρ = -0.017, P = 0.888) and this remained unchanged after adjustment for the preoperative JOA score, age, OPLL, operated levels, and cervical alignment (B = -0.031, P = 0.260). Greater width correlated with canal enlargement (ρ = +0.305, P = 0.008), but the canal area did not predict recovery (ρ = -0.056, P = 0.632). Patients with dural contact (32/103) showed similar recovery to those without contact (P = 0.387). Patients with neurological worsening had a higher LP/Facet percentage in unadjusted comparison (P = 0.013), although this did not persist after FDR correction (adjusted P = 0.079).</p><p><strong>Conclusion: </strong>Within the range of decompression achieved in this cohort, relative bone-cutting width was not associated with neurological recovery. Wider cutting enlarged the canal but did not improve JOA recovery, and dural contact was not associated with worse recovery. Although these findings do not establish equivalence between narrower and wider decompression, they suggest that routinely maximizing bone-cutting width may offer limited additional neurological benefit.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240143","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 and radiographic factors associated with residual low back pain after single-level decompression for lumbar spinal stenosis: a multicenter retrospective cohort study.","authors":"Yudai Kumanomido, Koji Nakajima, Yutaro Oba, Naoto Komatsu, Hiroyasu Kodama, Michita Noma, Hiroyuki Nakarai, Ryuji Sakamoto, Junya Miyahara, Hideki Nakamoto, So Kato, Yuki Taniguchi, Naohiro Kawamura, Akiro Higashikawa, Yujiro Takeshita, Masayoshi Fukushima, Nobuhiro Hara, Sakae Tanaka, Yasushi Oshima","doi":"10.1016/j.spinee.2026.10.014","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.014","url":null,"abstract":"<p><strong>Background context: </strong>Residual low back pain (LBP) after decompression for lumbar spinal stenosis (LSS) varies considerably and is likely multifactorial. It remains unclear how residual LBP differs by preoperative severity and which factors are independently associated with it.</p><p><strong>Purpose: </strong>To examine how postoperative LBP improves across preoperative severity groups and to identify clinical and radiographic factors independently associated with residual LBP.</p><p><strong>Study design/setting: </strong>Multicenter retrospective cohort study.</p><p><strong>Patient sample: </strong>A total of 450 patients undergoing primary single-level posterior decompression for LSS at six institutions (2017-2023).</p><p><strong>Outcome measures: </strong>The primary outcome was the 1-year postoperative numerical rating scale (NRS) score for LBP. Secondary outcomes were buttock and leg pain NRS, Oswestry Disability Index, EuroQol 5-Dimension, and postoperative satisfaction.</p><p><strong>Methods: </strong>Patients were stratified into three predefined preoperative LBP severity groups (Mild 0-3, Moderate 4-7, Severe 8-10). Inverse probability weighting (IPW) was applied for three-group comparisons. Unweighted multivariable linear regression for postoperative LBP NRS included preoperative LBP NRS together with patient, surgical, and radiographic factors as covariates. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors report no study-specific conflicts of interest.</p><p><strong>Results: </strong>The IPW-adjusted Severe group showed the largest LBP NRS improvement (4.5 points) but the highest residual LBP NRS (4.1). Dissatisfaction did not differ across groups (p=.244). Factors independently associated with residual LBP were preoperative LBP NRS (B=0.381, p<.001), pelvic incidence-lumbar lordosis (PI-LL) >20° (B=0.681, p=.024), and American Society of Anesthesiologists Physical Status (ASA-PS) ≥3 (B=1.298, p=.017).</p><p><strong>Conclusions: </strong>Greater preoperative LBP severity was associated with both larger improvement and higher residual LBP. Preoperative LBP severity, PI-LL >20°, and ASA-PS ≥3 were independent factors for residual LBP.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Spinal Epidural Lipomatosis With Systemic Lipid Metabolism in Patients With Lumbar Spinal Stenosis: A Propensity Score-Matched Study.","authors":"Bolu Zhang, Qingshuang Zhou, Chao Zhong, Sinian Wang, Qinghua Zhao, Zongshan Hu, Bin Wang, Yong Qiu, Zezhang Zhu, Xu Sun","doi":"10.1016/j.spinee.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.005","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Spinal epidural lipomatosis (SEL) is often regarded as a local consequence of obesity, yet its relationship with systemic lipid metabolism and symptom severity in lumbar spinal stenosis remains unclear. Apolipoprotein B (ApoB) is central to atherogenic lipid transport and ectopic fat deposition. Examining the association between systemic lipid metabolic abnormalities, including elevated ApoB levels, and epidural fat accumulation may provide insights into the metabolic pathogenesis and clinical relevance of SEL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To determine whether SEL is associated with systemic lipid metabolic abnormalities and greater preoperative symptom burden in patients undergoing surgery for lumbar spinal stenosis (LSS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective, propensity score-matched cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A consecutive series of 1,145 patients who underwent posterior decompression for symptomatic LSS between December 2023 and December 2025. After 1:1 propensity score matching, 90 patients with SEL were compared with 90 patients without SEL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Serum lipid and other biochemical markers, epidural fat/spinal canal (EF/SpC) index on lumbar magnetic resonance imaging, Oswestry Disability Index (ODI), and visual analog scale (VAS) scores for leg and back pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;SEL was diagnosed and graded on preoperative lumbar MRI according to the Borré classification, using the epidural fat/spinal canal index. Propensity score matching was performed for age, sex, body mass index (BMI), smoking history, drinking history, hypertension, and diabetes. Biochemical variables and preoperative clinical scores were compared between matched SEL and non-SEL patients. Conditional logistic regression was used to identify factors associated with SEL. BMI-adjusted partial Spearman correlation analyses were performed to evaluate associations between the EF/SpC index and biochemical markers. Regression-based trend analyses were conducted to assess changes in lipid-related markers across increasing SEL severity grades.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 1,145 patients with LSS, 105 (9.2%) met the diagnostic criteria for SEL. After matching, 90 patients with SEL were compared with 90 non-SEL controls. The SEL group had higher apolipoprotein B (ApoB) levels than controls, as well as higher low-density lipoprotein cholesterol, triglycerides, and total cholesterol. ApoB remained independently associated with SEL in conditional logistic regression (odds ratio per 0.1 g/L, 1.141; 95% confidence interval, 1.019-1.277; P=0.022). Within the SEL group, the EF/SpC index correlated positively with triglycerides (ρ=0.43, q&lt;0.001) and ApoB (ρ=0.40, q=0.002), while atherogenic lipid markers increased progressively with SEL severity. Patients with SEL also showed higher Oswestry Disability Index and leg-pain visual analog scale scores, wher","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229047","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":"Postembolization CT Digital Subtraction Angiography for Assessing Spinal Tumor Devascularization: Concordance With Catheter Angiography and Association With Surgical Blood Loss.","authors":"Yen-Heng Lin, Yu-Cheng Huang, Ting-Wei Liao, Fon-Yih Tsuang, Chung-Wei Lee","doi":"10.1016/j.spinee.2026.10.021","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.021","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;The adequacy of preoperative embolization for spinal tumors is commonly assessed using selective catheter angiography, but standardized criteria remain lacking. Postembolization CT digital subtraction angiography (CT-DSA) may provide complementary whole-tumor assessment of residual enhancement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate concordance between postembolization CT-DSA and catheter angiography, examine associations between CT-DSA findings and surgical blood loss, and identify factors associated with less favorable CT-DSA findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective single-center observational cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Seventy-two adults who underwent preoperative embolization and postembolization CT-DSA before spinal tumor surgery, including 62 patients with metastatic tumors and 10 with primary spinal neoplasms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Concordance between CT-DSA and catheter angiographic devascularization categories, estimated blood loss (EBL), quantitative CT-DSA peak enhancement index, and factors associated with less favorable CT-DSA categories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Postembolization devascularization was classified as complete, subtotal, or partial using modality-specific criteria. Concordance was evaluated using cross-classification and linearly weighted κ. Associations between CT-DSA findings and EBL were analyzed in patients with metastatic tumors using multivariable regression adjusted for surgical invasiveness and baseline angiographic hypervascularity. Proportional-odds ordinal regression was used to explore factors associated with less favorable CT-DSA categories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;CT-DSA and catheter angiography assigned the same devascularization category in 39 of 72 patients (54.2%), with moderate weighted concordance (κ=0.423; 95% confidence interval [CI], 0.265-0.580). Among patients with metastatic tumors, median EBL was 1,000 mL for complete, 1,650 mL for subtotal, and 1,975 mL for partial devascularization (P=.214). The adjusted overall association between CT-DSA category and EBL was not statistically significant (P=.167). Compared with complete devascularization, partial devascularization showed a directionally higher but imprecise EBL estimate (adjusted EBL ratio, 1.582; 95% CI, 0.861-2.907; P=.139). The quantitative peak enhancement index was not associated with EBL. Greater baseline angiographic hypervascularity (adjusted odds ratio [OR] per grade, 3.243; 95% CI, 1.782-5.902) and a same-level spinal artery (adjusted OR, 10.236; 95% CI, 2.477-42.293) were associated with less favorable CT-DSA categories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Postembolization CT-DSA showed moderate concordance with catheter angiography and may complement selective angiographic assessment by depicting residual enhancement throughout the tumor. Partial devascularization showed a directionally higher but imprecise asso","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225382","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":"Predicting Failure to Rescue After Surgery for Degenerative Cervical Myelopathy: An ACS-NSQIP Analysis (2015-2020).","authors":"Sean T Kelleher, Jerick Kim, Shubhang Bhalla, Austin M Tang, Christian A Bowers, Brandon Lucke-Wold, Michael Karsy","doi":"10.1016/j.spinee.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Failure to rescue (FTR), defined as 30-day mortality among patients who experienced a major complication, has emerged as a quality metric in spine surgery. Recent FTR analyses report high discrimination using prediction models combining pre- and postoperative variables into a single model. Whether this performance reflects true preoperative risk stratification or the inclusion of peri-mortality events as predictors remains unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To identify predictors of FTR in patients undergoing surgery for degenerative cervical myelopathy (DCM) and compare the discrimination of preoperative-only versus combined preoperative-postoperative models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2015-2020.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;19,108 adult patients undergoing cervical decompression and/or fusion for DCM. 938 (4.9%) experienced a major complication and formed the FTR cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;FTR, defined as 30-day all-cause mortality among patients who experienced a major complication within 30 days of surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two multivariable logistic regression models predicted FTR in the complicated cohort: Model A (preoperative variables only) and Model B (preoperative variables plus composite postoperative complication categories: cardiopulmonary, septic/wound, and other). Internal validation used 1,000 bootstrap iterations with optimism correction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 19,108 DCM surgical patients, 938 had a major postoperative complication, and 48 (5.1%) experienced FTR. FTR patients demonstrated higher Risk Analysis Index (RAI) scores (median 25 in FTR vs. 22 in rescued; p=0.005), diabetes prevalence (54.2% vs. 32.4%; p=0.003), and preoperative septic shock (12.5% vs. 3.3%; p=0.004). Model A identified RAI (OR 1.07 per point; 95% CI 1.03-1.12), diabetes (OR 2.18; 95% CI 1.18-4.01), and preoperative septic shock (OR 3.22; 95% CI 1.21-8.56) as independent predictors (corrected C-statistic 0.670). Model B identified cardiopulmonary complications as the strongest predictor (OR 35.4; 95% CI 8.27-151.6), while RAI (OR 1.06; 95% CI 1.02-1.10; p=0.003) and diabetes (OR 2.01; 95% CI 1.08-3.72; p=0.027) remained independent predictors. Model B significantly outperformed Model A (corrected C-statistic 0.816; bootstrap ΔC 0.119, 95% CI 0.042-0.189; DeLong p&lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Among DCM patients who experienced a major complication, frailty, diabetes, and preoperative septic shock were associated with FTR with modest discrimination. Discrimination improved significantly with the addition of postoperative complications, particularly cardiopulmonary events. These findings support frailty-based preoperative risk stratification and identify cardiopulmonary surveillance as a key ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225368","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":"Comparison of Lateral Decubitus versus Prone Lateral Lumbar Interbody Fusion Using Impact Scores: A Method to Quantify Intraoperative Supply Cost and Variability in Surgery.","authors":"Emaad Lala, Kenneth Nguyen, Kento Yamanouchi, Rafael Garcia de Oliveira, Mir Amaan Ali, Iyan Younus, Venu M Nemani, Jean-Christophe Leveque, Philip K Louie, Aiyush Bansal","doi":"10.1016/j.spinee.2026.10.008","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.008","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Surgical value metrics report intraoperative supply costs as aggregate institutional dollars, which do not identify which supply categories drive cost.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To introduce the Impact Score, each supply category's percentage share of total intraoperative supply cost, as a descriptive framework and, using lateral decubitus (LD-LIF) versus prone lateral (PL-LIF) lateral lumbar interbody fusion as a proof of concept, to determine whether impact scores differ by supply category and align with median-cost rankings, whether exploratory outcome-based value metrics differ between approaches, and whether meaningful inter-surgeon variability exists.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective single-center cohort study at a tertiary center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Seventy-eight single-level L4-5 lateral lumbar interbody fusion cases performed from 2021 to 2026 (32 LD-LIF, 46 PL-LIF).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Category-level impact score (percentage of total intraoperative supply cost), supply and total intraoperative cost, exploratory value metrics based on the Oswestry Disability Index and PROMIS-10-derived quality-adjusted life years (including the operative value index and unit price per outcome), and 90-day readmission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Itemized intraoperative supply records were mapped to 33 standardized categories, and each category's impact score was computed as its percentage of total intraoperative supply cost. Time-driven activity-based costing provided staff costs. Category-level impact scores and costs were compared with unadjusted Wilcoxon rank-sum tests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Impact-score and median-cost rankings were broadly concordant. LD-LIF showed higher impact for interbody, screw, biologic, and retractor/dilator, and PL-LIF for neuromonitoring and positioning (all p &lt; 0.01). Navigation and rod did not differ. Total intraoperative cost did not differ between approaches (PL-LIF $17,206 vs LD-LIF $16,404, p = 0.462), nor did staff cost (p = 0.607), and exploratory value metrics did not establish a cost-effectiveness difference, whereas the impact score localized the between-approach difference to supply composition. Biologic impact varied most, with a more than two-fold range among the three surgeons (median approximately 5% to 19%) and higher biologic impact in LD-LIF within individual surgeons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The impact score describes how intraoperative supply costs are distributed across categories. In this single-center, three-surgeon cohort, it identified a potentially modifiable cost driver that neither total cost nor exploratory value metrics revealed. Its use for cross-institutional benchmarking will require a multicenter study of how impact scores vary between institutions with differing vendor pricing and contracting. Because it reflects only the intraoperative phase, it compl","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221031","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":"Development of a Natural Language Processing Algorithm to Aid Creation of a Surgical Spine Database.","authors":"Henry J Wong, Melissa Song, Sarah L Miller, Eshan B Damle, Richard Muniz, Sanket Mehta, Kelly McFarlane, Ari Berg, Yun-Da Li, Jayme C B Koltsov, Grace X Xiong","doi":"10.1016/j.spinee.2026.10.012","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.012","url":null,"abstract":"<p><strong>Background: </strong>Manual effort required for feature extraction from operative reports can be time-intensive, inaccurate, and costly.</p><p><strong>Purpose: </strong>Develop a natural language processing (NLP) algorithm for surgical spine database creation and validate performance against human reviewers with varying clinical experience.</p><p><strong>Design/setting: </strong>Retrospective study at a tertiary academic institution from 2008-2024.</p><p><strong>Patient sample: </strong>Operative spinal cases on adult patients from 22,951 spinal operative reports.</p><p><strong>Outcome measures: </strong>Primary outcome was accuracy in operated spinal level classification. Secondary outcomes include clinical diagnoses, operative procedures, and additional surgical detail classification.</p><p><strong>Methods: </strong>A rule-based NLP algorithm was developed and validated on a random sample of 100 operative reports. Performance of the NLP algorithm and human reviewers was assessed against a reference standard. An a priori acceptability threshold was set at 0.90 for agreement, kappa, and F1. Time required for chart review/processing were also assessed for the NLP algorithm and human reviewers.</p><p><strong>Results: </strong>The NLP algorithm matched the reference standard on operated spinal levels (Percent Agreement=93%; Kappa=0.98; F1=0.98), which outperformed human reviewers in clinical training. Performance on procedural and diagnostic feature extraction did not meet the accepted threshold but largely outperformed human validators in clinical training. NLP algorithm computation time averaged speed of 1,039 reports per minute, compared to the fastest median time of 1 minute per operative report for human chart reviewers.</p><p><strong>Conclusions: </strong>The NLP algorithm can accurately and reliably extract operated spinal levels from high volumes of operative reports. However, classification of diagnosis, operative procedures, and additional surgical procedures were not sufficient for practical implementation.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221081","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 scoliosis screening on surgical threshold attainment: a 30-year population-based longitudinal cohort study.","authors":"Erica Yan Ping Po, Jason Pui Yin Cheung, Kenny Yat Hong Kwan, Alec Lik Hang Hung, Tsz Ping Lam, Jack Chun Yiu Cheng, Teng Zhang, Graham Ka Hon Shea, Kenneth Man Chee Cheung, Yik Chung Wu, Daniel Yee Tak Fong","doi":"10.1016/j.spinee.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.006","url":null,"abstract":"<p><strong>Background: </strong>The United States Preventive Services Task Force cites insufficient evidence that treating screen-detected AIS improves long-term health outcomes, questioning the value of screening.</p><p><strong>Purpose: </strong>To assess the association between a 30-year sustained territory-wide scoliosis screening program and long-term trends in surgical threshold attainment for AIS following the Scoliosis Research Society's criteria.</p><p><strong>Study design/setting: </strong>Population-based longitudinal cohort study PATIENT SAMPLE: We included adolescents aged 10-19 years with AIS and Cobb angle ≥ 20° between 1995 and 2024 from the two tertiary referral scoliosis clinics.</p><p><strong>Outcome measures: </strong>Trends in surgical threshold attainment for AIS.</p><p><strong>Methods: </strong>Age-period-cohort (APC) analysis assessed temporal trends associated with the screening program, with Kaplan-Meier and adjusted Cox modelling as sensitivity analyses.</p><p><strong>Results: </strong>With an overall screening rate of 90.3%, representing 30,818 adolescents, 26,232 (76.9%) females were identified; 2,563 reached surgical threshold (2,011 [78.5%] females). APC analyses showed a pronounced decline in surgical threshold attainment (RR: 1.00 to 0.18) with significant period and cohort effects (p<0.001). Kaplan-Meier and Cox analyses demonstrated improved surgical threshold-free survival (χ² = 93.8, p<0.001) and lower hazards of surgical threshold attainment associated with screening (HR: 0.29; 95% CI, 0.27- 0.32; p<0.001). Concurrently, AIS prevalence with Cobb angle ≥ 20° increased from 0.02% (95% CI, 0.01% - 0.02%) in 1995 to 1.59% (95% CI, 1.56% - 1.62%) in 2019.</p><p><strong>Conclusions: </strong>This 30-year population-based study provides evidence that screening, by enabling earlier detection, is associated with substantial and sustained decline in surgical threshold attainment. This decline was likely multifactorial, reflecting concurrent advances in conservative management and clinical care. These findings provide important longitudinal evidence to inform scoliosis screening recommendations.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221089","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":"Management Strategies and Clinical Outcomes of Methicillin Resistant Staphylococcus Aureus Native Vertebral Osteomyelitis: A Systematic Review and Meta-Analysis.","authors":"Farzad Pourghazi, Seyed Mohammad Amin Alavi, Georges Baaklini, Ahmad Nassr, Brett A Freedman, Takahiro Matsuo, Aaron J Tande, Elie F Berbari","doi":"10.1016/j.spinee.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.007","url":null,"abstract":"<p><strong>Background context: </strong>Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of native vertebral osteomyelitis (NVO) and is associated with persistent infection, complications, prolonged hospitalization, and increased mortality.</p><p><strong>Purpose: </strong>We conducted this systematic review and meta-analysis to evaluate the antimicrobial and surgical approaches used for MRSA NVO and their associated clinical outcomes.</p><p><strong>Study setting: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>A systematic literature search of MEDLINE, Scopus, and Web of Science was conducted on November 27, 2025. Studies were eligible if they included adults with MRSA NVO, evaluated medical or surgical treatment strategies, reported clinical outcomes, and included at least five patients. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using the Newcastle-Ottawa Scale and the Murad et al. tool. Random-effects models were used to pool proportions of treatment success, reinfection, and mortality.</p><p><strong>Results: </strong>Thirty studies including 677 patients were included. Treatment strategies were heterogeneous and included prolonged anti-MRSA antimicrobial therapy and surgical approaches ranging from debridement and drainage to decompression and spinal stabilization or fusion. Vancomycin-based regimens were the most frequently reported antimicrobial strategy. Among studies reporting treatment duration, intravenous therapy commonly ranged from 4 to 8 weeks, with some patients receiving oral step-down or suppressive therapy. The pooled treatment success rate was 84.9% (95% CI, 76.7%-90.7%), pooled reinfection rate was 15.3% (95% CI, 9.5%-23.6%), and pooled mortality rate was 3.1% (95% CI, 0.8%-10.8%). Subgroup analyses were not feasible because treatment-specific data were limited and inconsistently reported.</p><p><strong>Conclusions: </strong>Management of MRSA NVO varied substantially across studies, with vancomycin-based antimicrobial therapy and diverse surgical strategies commonly reported. Pooled outcomes showed high treatment success with lower rates of reinfection and mortality. The substantial clinical and methodological heterogeneity of the available evidence highlights the need for prospective studies with standardized treatment and outcome reporting.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221111","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}