Spine Journal最新文献

{"title":"Evaluating the Utility of Melatonin in Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.","authors":"Shahabeddin Yazdanpanah, Hana-Joy E Hanks, Sultan Baz, Andy Ton, Anthony N Baumann, Yu-Po Lee, Emily S Mills, Nitin N Bhatia, Don Y Park, Sohaib Z Hashmi, Hao-Hua Wu","doi":"10.1016/j.spinee.2026.04.020","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.020","url":null,"abstract":"<p><strong>Background: </strong>Spine surgery is increasingly performed worldwide, and acute postoperative stressors such as pain and anxiety remain highly prevalent despite historical management with opioids and other pharmacological agents. Recently, interest has emerged in melatonin administration given its endogenous physiological roles, low cost, favorable adverse event profile, and documented benefits throughout surgical literature.</p><p><strong>Purpose: </strong>This study aims to consolidate the existing evidence on melatonin's utility specifically in spine surgery, an area not yet comprehensively evaluated, to inform clinical practice and enhance spine surgeon comprehension.</p><p><strong>Study design/setting: </strong>Pre-registered on PROSPERO, this systematic review queried PubMed/MEDLINE, CINAHL, SPORTDiscus, and Web of Science on November 21^st, 2025, for studies reporting outcomes following melatonin administration in patients undergoing spine surgery.</p><p><strong>Methods: </strong>Study quality was assessed using the Cochrane Risk-of-Bias 2 tool. Extracted variables included demographics, comparator medications, dosages, and other relevant details. Statistical analyses included frequency-weighted means (FWM), associated standard deviations, narrative syntheses, and limited meta-analyses, where appropriate.</p><p><strong>Results: </strong>Six moderate-quality randomized trials were included from 749 screened. Melatonin (3-10mg) was administered to 227 patients (FWM age=43.3±8.6 years; 46.2% male; BMI=26.6±3.2 kg/m²), placebo to 125 patients (age=43.2±10.1 years; 60% male; BMI=28.5±4.3 kg/m²), and active pharmacologic comparators (fentanyl, gabapentin, dexmedetomidine, zolpidem) to 151 patients (age=46.6±8.9 years; 40.5% male; BMI=26.3±3.5 kg/m²). Procedures primarily involved uncomplicated lumbar laminectomies (1-4 levels), with outcomes assessed up to 24 hours postoperatively. Melatonin was associated with significant improvements in early postoperative VAS-pain scores, blood-pressure-related, analgesic-related, and anxiety-related outcomes versus placebo across most reporting studies. Compared with active pharmacologic agents, significant benefits were observed only in select nausea- and anxiety-related instances. Limited meta-analysis (n=2) demonstrated higher 24-hour VAS-pain for melatonin versus gabapentin, though mean difference was near-negligible and harbored extensive heterogeneity.</p><p><strong>Conclusion: </strong>Melatonin demonstrates variable utility following spine surgery, with generally consistent anxiolysis and frequent benefit versus placebo but less consistent and comparatively weaker efficacy relative to active pharmacologic comparators. Future outcome-homogenous studies incorporating more granular, expansive comparator arms and more robust quantitative analyses are needed to further elucidate melatonin's role in advancing spine care.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700569","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":"Reassessing the Clock in Cauda Equina Syndrome: A Systematic Review and Meta-analysis of Surgical Timing and Outcomes.","authors":"Elie Najjar, Chinedu Egu, Hussein Akil, Sam Najjar, Melanie AlAchkar, Rodrigo Muscogliati, Daniel Daquino, Spyridon Komaitis, Michael Grevitt","doi":"10.1016/j.spinee.2026.04.013","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.013","url":null,"abstract":"<p><strong>Background context: </strong>Despite universal advocacy for urgent decompression in cauda equina syndrome (CES), the literature remains inconsistent regarding the optimal surgical timing. Heterogeneous diagnostic criteria, variable timing definitions, and a mix of clinical cohorts and national datasets have contributed to ongoing debate over 24- and 48-hour thresholds.</p><p><strong>Purpose: </strong>To evaluate whether timing of decompression influences urinary, neurological, functional, and inpatient outcomes in CES, and to identify clinically meaningful temporal thresholds.</p><p><strong>Study design/setting: </strong>Systematic review and meta-analysis of comparative cohort studies conducted according to PRISMA 2020 and MOOSE guidelines.</p><p><strong>Patient sample: </strong>Fifteen comparative studies involving 26,627 adults undergoing decompression for degenerative CES.</p><p><strong>Outcome measures: </strong>Urinary and bowel recovery, motor and sensory improvement, pain (VAS), disability (ODI), return to work, complications, in-hospital mortality, length of stay, and discharge disposition.</p><p><strong>Methods: </strong>Five databases were searched from inception through November 2025. Eligible studies compared at least two discrete time-to-surgery intervals. Risk of bias was assessed with ROBINS-I. Random-effects models were used for pooled analyses with prespecified subgroup analyses by CES subtype, timing definition, etiology, and follow-up duration.</p><p><strong>Results: </strong>Across clinical cohorts, decompression within 48 hours of symptom onset significantly improved urinary recovery (pooled OR ≈2.3), motor function, and overall neurological outcomes compared with >48 hours. Incomplete CES showed a strong timing effect, whereas retention-type CES demonstrated no significant timing-related difference. National database studies showed increased mortality, longer length of stay, and worse discharge disposition when surgery was delayed beyond 48 hours. No consistent advantage was observed for <24 hours compared with 24-48 hours across neurological, urinary, functional, or inpatient outcomes. Early timing effects were most pronounced for short-term recovery; at ≥12 months, differences between early and delayed groups attenuated, and baseline bladder status was the dominant prognostic factor.</p><p><strong>Conclusions: </strong>Comparative evidence identifies a clinically meaningful threshold at approximately 48 hours from symptom onset for optimizing early urinary and neurological outcomes in CES, particularly in incomplete presentations. Surgery within the first 24 hours does not consistently outperform surgery performed between 24 and 48 hours. Long-term outcomes are driven primarily by preoperative bladder function rather than surgical timing. Clinical pathways should emphasize expedited diagnosis and decompression within 48 hours, with greatest urgency for patients who retain voluntary voiding.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700612","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":"Complications of Spinal Fusion: Comparing Medicare Transforming Episode Accountability (TEAM) Hospitals to Control Hospitals.","authors":"Brook I Martin, Sohail K Mirza, Hyunkyu Ko, Brian Karamian","doi":"10.1016/j.spinee.2026.03.009","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.03.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Medicare's Transforming Episode Accountability Model (TEAM) holds hospitals accountable for 30-day post-operative complication across 18 categories of spinal fusion bundles, yet baseline differences in complication rates between participant and non-participant hospitals may confound policy evaluation and performance under this model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;We compared complication rates for 18 TEAM-defined categories of fusion between participant and non-participant hospitals, and characterized patient- and hospital-level factors contributing to variation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective cohort study of Medicare beneficiaries undergoing inpatient or hospital outpatient lumbar and cervical fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Fee-for-service Medicare beneficiaries undergoing spinal fusion (2016-2021) were included. Excluded were Medicare Advantage, United Mine Workers, Maryland hospitals, and patients undergoing complex fusions (8+ vertebral levels, or fusion for primary diagnosis of spinal curvature, malignancy, infection).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;THIRTY DAY POST-DISCHARGE: all-cause readmission and post-operative complications (cardiac, vascular, infection, thromboembolic, cerebrovascular and device-related).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We linked hospital TEAM participants to fee-for-service Medicare fusion claims and calculated 30-day complications by fusion category. Complication rates were estimated using multilevel logistic regression with a hospital-level random effects, adjusting for TEAM-specified covariates: fusion type, stratification, year, age, dual eligibility, social disability insurance, grouped total and select Hierarchical Conditions Classification comorbidity, bundled payment participation history, and the Census Division. An expanded model added patient- and hospital-level factors. Variation was quantified using hospital variance, intraclass correlation coefficients (ICC), and Coefficient of Variation (CV).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;TEAM participant and non-participant hospitals had similar 30-day readmission rates for inpatient (8.9%; OR 1.01; 95%CI 0.97-1.06; p=0.517) and outpatient (5.7%; OR 0.87; 95%CI 0.75-1.00; p=0.049) fusions, with comparable inpatient (28.2%; OR 0.97; 95%CI 0.92-1.03; p=0.367) and outpatient (10.4%; OR 0.97; 95%CI 0.86-1.10; p=0.645) composite complication rates. For readmission the hospital-level ICC was 1.06%, with TEAM adjusters explaining 61.6% of hospital variance, and reducing the CV from 27.6% to 17.1%. The composite complications, the ICC was 3.61%, with TEAM adjusters explaining 36.6% of variance, reducing the CV from 31.6% to 25.2%. Expanded covariates provided minimal incremental variance explanation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Postoperative complication rates were similar between TEAM participant and non-participant hospitals, and additional adjustments for surgical invas","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700566","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 impact of structural damage and muscle properties on spinal mobility in axial spondyloarthritis: A sensor-based analysis from the CASTRO registry.","authors":"Diana Maria Margareta Moldovan, Inmaculada Concepción Aranda-Valera, Lourdes Ladehesa-Pineda, María Del Carmen Ábalos-Aguilera, María Ángeles Puche-Larrubia, Alejandro Escudero-Contreras, Cristina González-Navas, Juan Luis Garrido-Castro, Daniela Fodor, Eduardo Collantes-Estévez, Clementina López-Medina","doi":"10.1016/j.spinee.2026.04.003","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.003","url":null,"abstract":"<p><strong>Background context: </strong>The loss of spinal mobility remains one of the most debilitating consequences of axial spondyloarthritis (axSpA). Despite therapeutic advancements, many patients still have limited mobility. Structural damage is a recognized contributor, but the role of paraspinal muscle properties in determining spinal mobility is less studied.</p><p><strong>Purpose: </strong>To evaluate the relative contribution of structural damage and paraspinal muscle mechanical properties to cervical and lumbar spinal mobility in axSpA patients.</p><p><strong>Study design/setting: </strong>Cross-sectional observational study PATIENT SAMPLE: A total of 98 axSpA patients from the Córdoba axSpA Task Force Registry and Outcomes (CASTRO) who met ASAS criteria.</p><p><strong>Outcome measures: </strong>Cervical and lumbar range of motion (ROM); paraspinal muscle stiffness and elasticity parameters.</p><p><strong>Methods: </strong>Spinal mobility in the cervical and lumbar regions was measured in three planes using inertial measurement units (IMUs). Paraspinal muscle stiffness and muscle elasticity (logarithmic decrement) were quantified with the MyotonPRO device. Structural damage was assessed with the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Associations between structural damage, muscle properties, and mobility were explored using generalized linear models (GLMs), adjusted for age, sex, body mass index (BMI), and C-reactive protein (CRP). A sensitivity exploratory analysis was conducted using Gradient Boosting Machine (GBM) models.</p><p><strong>Results: </strong>Structural damage, as quantified by mSASSS, was significantly associated with impaired spinal mobility. In adjusted GLMs, both structural damage and paraspinal muscle properties, including muscle stiffness and reduced elasticity (higher decrement), were independently associated with decreased ROM, most notably in the cervical spine. GBM models supported these findings, with SHAP values consistently identifying mSASSS, stiffness, and elasticity among the top predictors of mobility outcomes.</p><p><strong>Conclusion: </strong>Structural damage and paraspinal muscle properties were independently associated with reduced spinal mobility in axSpA. Digital tools such as IMUs and MyotonPRO may support objective functional assessment and targeted rehabilitation strategies. However, the cross-sectional design limits conclusions regarding temporal relationships.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700649","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":"Extraforaminal versus central lumbar disc herniations: clinical features and surgical outcome comparing data from a national spine registry (NORspine).","authors":"João André Barroso Pereira Roque Dos Reis, Greger Lønne, Oliver Grundnes, Ole Kristian Alhaug","doi":"10.1016/j.spinee.2026.04.009","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Previous studies indicate that extraforaminal disc herniations (EDH) tend to have a more acute onset and more pronounced radicular symptoms. Surgical outcomes for lateral disc herniations remain somewhat heterogeneous in the literature when compared with central disc herniations (CDH).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;We aim to compare clinical features and surgical outcomes between extraforaminal and central disc herniations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective analysis of prospectively collected data from the Norwegian Spine Registry (NORspine) PATIENT SAMPLE: 11,341 patients were registered during the study period. We included 10,288 patients: 10,159 with CDH and 229 with EDH. Propensity score matching resulted in two groups of 214 patients each.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome was the Oswestry Disability Index (ODI) score at three and twelve months postoperatively. Secondary outcomes were success at three and twelve months postoperatively, defined as ODI &lt; 22, a Global Perceived Effect (GPE) rating of \"much improved\" or \"completely recovered\", Numeric Rating Scale (NRS) for back and leg pain (0-10), as well as patient satisfaction, perioperative and postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patient groups were defined based on reported MRI findings, categorising cases as either CDH or EDH. We used Patient-Reported Outcome Measures (PROMs) derived from NORspine, specifically ODI, NRS back and leg pain and GPE, as well as surgical details, and clinical outcomes at 3 and 12 months, and recorded complications. To adjust for baseline differences between the groups, propensity score matching was used.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients in the EDH group were older (57.1 vs. 46.7 years), had higher preoperative ODI scores (49.5 vs. 46.6), and reported higher NRS scores for both leg pain (7.4 vs. 7.1) and back pain (7.0 vs. 6.5). At the three-month follow-up, patients with EDH had higher ODI scores (21.9 vs. 17.1; p &lt; 0.001), higher NRS leg pain (3.1 vs. 2.3; p &lt; 0.001), and higher NRS back pain (3.5 vs. 2.9; p &lt; 0.001). At the 12-month follow-up, group differences had narrowed but remained statistically significant for ODI and NRS leg pain. Following propensity score matching, preoperative PROM differences were no longer statistically significant. NRS leg and back pain remained slightly worse in the EDH group at 3-month follow-up (3.0 vs. 2.3; p = 0.011; 3.5 vs 2.6; p &lt; 0.001). At 12- month follow-up, there was no statistically significant difference in PROMs between groups (ODI 18.9 vs 17.4; NRS leg pain 3.0 vs 2.4; NRS back pain 3.0 vs 3.1). Surgical duration was longer for EDH procedures (75.9 vs. 58.0 minutes), although perioperative complications were less common in the EDH group (0.4% vs. 1.4%). The proportions of patients reporting satisfaction at 3 and 12 months were similar across groups and did not differ significantly.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclu","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693187","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":"Dynamic Slip Comparing Upright and Supine Positions Predicts Reoperation After Lumbar Decompression Surgery for Degenerative Lumbar Disease.","authors":"Shuhei Ohyama, Masahiro Inoue, Masaya Mizutani, Sumihisa Orita, Yawara Eguchi, Kazuhide Inage, Yasuhiro Shiga, Masashi Sato, Tsuyoshi Sakuma, Yasushi Iijima, Noritaka Suzuki, Kosuke Takeda, Akihiro Iida, Yu Otake, Toshiaki Kotani, Shohei Minami, Yasuchika Aoki, Seiji Ohtori","doi":"10.1016/j.spinee.2026.04.004","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.004","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar segmental instability is an important factor in determining surgical strategies for degenerative lumbar spine disorders. Although dynamic slip comparing extension and flexion radiographs (DSEF) is commonly used, dynamic slip comparing upright and supine positions (DSUS) has been proposed as an alternative measure.</p><p><strong>Purpose: </strong>To examine the association between DSUS and postoperative outcomes after lumbar decompression surgery without fusion and to identify a DSUS threshold predictive of reoperation.</p><p><strong>Study design: </strong>Multicenter retrospective cohort study.</p><p><strong>Patient sample: </strong>A total of 188 patients who underwent initial single-level lumbar decompression surgery and were followed for at least three years.</p><p><strong>Outcome measures: </strong>Symptomatic reoperation, Oswestry Disability Index (ODI), visual analogue scale (VAS) scores, and radiographic parameters.</p><p><strong>Methods: </strong>DSUS and DSEF were measured using standing-supine imaging and flexion-extension radiographs. Patients were classified as DSUS-positive (≥3 mm) or DSUS-negative (<3 mm). Clinical and radiographic outcomes were compared longitudinally. Time-to-event outcomes were assessed using Kaplan-Meier and Cox proportional hazards models. Receiver operating characteristic (ROC) analyses were performed.</p><p><strong>Results: </strong>DSUS and DSEF showed moderate correlation (r = 0.37) with frequent discordance. Thirty-three patients (17.6%) were DSUS-positive. DSUS-positive patients had significantly higher reoperation rates, worse postoperative ODI and VAS scores, and greater postoperative slip progression. In Cox models, DSUS independently predicted reoperation after adjustment for key covariates. ROC analysis identified 3.0 mm as the optimal cutoff (area under the curve 0.90).</p><p><strong>Conclusions: </strong>DSUS is associated with poorer postoperative outcomes and increased reoperation risk after lumbar decompression surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693196","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":"Do the waveform transition patterns after intraoperative neurophysiological monitoring alerts indicate the postoperative neurological outcomes after spinal correction surgery?","authors":"Wanyou Liu, Junyin Qiu, Yinkun Li, Saihu Mao, Zhen Liu, Xu Sun, Zezhang Zhu, Yong Qiu, Benlong Shi","doi":"10.1016/j.spinee.2026.04.014","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.014","url":null,"abstract":"<p><strong>Background context: </strong>Intraoperative neurophysiological monitoring (IONM) alerts during spinal deformity surgery require timely intervention, but the prognostic significance of different waveform transition patterns following these alerts remains inadequately characterized.</p><p><strong>Purpose: </strong>This study aimed to classify IONM waveform transition patterns after critical alerts and evaluate their association with immediate and long-term postoperative neurological outcomes.</p><p><strong>Study design: </strong>A single-center retrospective cohort study.</p><p><strong>Patient sample: </strong>Thirty-seven out of 1994 patients (1.9%) who experienced significant IONM alerts during spinal deformity correction surgery between July 2015 and June 2022.</p><p><strong>Outcome measures: </strong>Physiologic Measures: IONM waveform recovery (full, partial, or none). Functional Measures: Neurological status (no deficit, partial deficit, or complete paralysis) assessed immediately postoperation and during 24-month follow-up.</p><p><strong>Methods: </strong>Patients were categorized into five distinct IONM patterns based on waveform recovery dynamics and postoperative neurological status. Demographic, surgical, and radiographic factors were compared across groups. Due to the small sample size, analyses were primarily descriptive. Between-group comparisons were performed using Fisher's exact test for categorical variables..</p><p><strong>Results: </strong>Five waveform patterns were identified: Pattern A (full recovery, no deficits; 21.6%), B1 (partial recovery, no deficits; 13.5%), B2 (partial recovery, partial deficits; 24.3%), C1 (no recovery, partial deficits; 32.4%), and C2 (no recovery, complete paralysis; 8.1%). Exploratory analyses suggested that global kyphosis >90°, alerts during osteotomy, three-column osteotomy, blood loss >3000 mL, and preoperative spinal cord abnormalities were more frequent in patients with irreversible alerts and deficits. At 2-year follow-up, 91.7% of patients with initial neurological deficits showed improvement, suggesting that IONM waveform recovery may be associated with favorable neurological prognosis.</p><p><strong>Conclusions: </strong>IONM waveform transition patterns following critical alerts demonstrate an significant association with postoperative neurological outcomes. Recovery trajectories varied across patterns: all Pattern B2 patients recovered within 6 months, while Pattern C patients showed gradual improvement over 24 months, with 91.7% of affected patients achieving favorable outcomes by 24-month follow-up, underscoring the importance of timely intervention during spinal deformity surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Cohort Analysis Evaluating the Utility of the Spinal Instability Neoplastic Score (SINS) in Screening for Spinal Instability and Vertebral Compression Fracture Risk in Plasma Cell Neoplasm and Lymphoma Lesions.","authors":"Joshua L Golubovsky, George A Crabill, Akshath Rajan, Ian Messing, Elie Massaad, Bonnie Y Hu, Claudia Hejazi-Garcia, Connor A Wathen, Michael Shost, Ali K Ozturk, John H Shin, Cara A Cipriano, Kristy L Weber, Gabrielle W Peters, Anish A Butala, Neil R Malhotra, James M Schuster","doi":"10.1016/j.spinee.2026.04.018","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.018","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Spinal column tumors with Spinal Instability Neoplastic Scores (SINS) suggesting instability often trigger referrals to spine surgeons. Plasma cell lesions and lymphoma are highly radiosensitive histologies, and may re-ossify after radiation therapy. The SINS score, designed to assess the need for surgical stabilization for spinal neoplasms, may therefore overestimate instability in patients with these radiosensitive histologies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Herein we seek to determine if the SINS score is significantly correlated with lesion instability and vertebral compression fracture progression in patients with plasma cell neoplasms or lymphoma of the spine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This was a retrospective single-institution cohort analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients with spinal plasma cell or lymphoma lesions with identifiable primary lesions were found by querying our institutional electronic medical record from 2010-2024. All patients were at least 18 years of age.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Demographics, comorbidities, symptoms, radiation data, surgical data, and imaging data were collected. Outcomes included development of spinal instability, new or progressive vertebral compression fracture, and follow-up neurological status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Multivariable logistic regressions were used to evaluate categorical outcomes, while Kaplan-Meier analysis was utilized to assess time to mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;240 patients were identified with a mean SINS of 9.79. 23 patients had lesions classified as stable (SINS 0-6, 9.8%), 183 had lesions classified as possibly unstable (SINS 7-12, 76.3%), and 34 had lesions classified as unstable (SINS 13-18, 14.2%). 27 patients underwent surgical management (2 SINS stable, 20 possibly unstable, and 5 unstable), with a 90-day reoperation rate of 11.1% and a 90-day readmission rate of 29.6%. At 3-month follow-up, factors associated with development of instability were higher total SINS score (odds ratio (OR) 1.38, p &lt; 0.001), SINS unstable lesions compared with possibly unstable lesions (OR 2.69, p = 0.028), younger age (OR 0.98 per year, p &lt; 0.001), and higher radiation biologically effective dose (OR 1.03, p &lt; 0.001). Meanwhile, factors associated with new or progressive vertebral compression fracture were higher total SINS score (OR 1.45, p &lt; 0.001), SINS unstable lesions compared with possibly unstable (OR 3.59, p = 0.002), possibly unstable lesions compared with stable (OR Stable 0.22, p = 0.029), and increased age (OR 1.01 per year, p &lt; 0.001), while larger baseline VB height (OR 0.91, p &lt; 0.001) and bisphosphonate or RANK-ligand inhibitor use (OR 0.61, p = 0.009) were protective. SINS was not significantly associated with follow-up neurological status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;SINS is a useful prognostic factor for the development of instability and new or progressi","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693142","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":"Patient-Reported Outcomes Decline After Second Revision Lumbar Fusion: A Retrospective Cohort Study.","authors":"Mitchell Ng, Joydeep Baidya, Joshua Mathew, Jonathan Dalton, Gregorio Baek, Yulia Lee, William Green, Ali Farooqi, Alec Giakas, Samuel Alfonsi, Rajkishen Narayanan, Olivia Opara, Matthew Meade, Yunsoo Lee, Teeto Ezeonu, Michael McCurdy, Yashas Reddy, Christian McCormick, Mark F Kurd, Zachary Wilt, Jeffrey A Rihn, Jose Canseco, Alan Hilibrand, Alexander Vaccaro, Christopher Kepler, Gregory Schroeder","doi":"10.1016/j.spinee.2026.04.011","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.011","url":null,"abstract":"<p><strong>Background context: </strong>While lumbar fusion revision is associated with inferior outcomes compared to primary surgery, the impact of undergoing multiple revisions remains unclear.</p><p><strong>Purpose: </strong>To evaluate surgical and patient-reported outcomes (PROMs) after primary, first revision, and second revision lumbar fusion, and to identify characteristics associated with multiple revisions.</p><p><strong>Study design/setting: </strong>Retrospective cohort study at a single academic center (2011-2022).</p><p><strong>Patient sample: </strong>747 patients underwent lumbar fusion: 554 had no revision, 153 underwent one revision, and 40 underwent ≥2 revisions.</p><p><strong>Outcome measures: </strong>Surgical characteristics and PROMs including Oswestry Disability Index (ODI), Visual Analog Scale for back pain (VAS-back), Visual Analog Scale for leg pain (VAS-leg), 12-Item Short Form Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS), assessed preoperatively and at 3 months and 1 year postoperatively.</p><p><strong>Methods: </strong>Patients were stratified by number of surgeries. Delta PROM scores were calculated. Comparisons were made using Analysis of Variance (ANOVA) or Kruskal-Wallis tests.</p><p><strong>Results: </strong>Patients undergoing revision were more often male (67.9 versus 45.5%, P < 0.01) and had higher Charlson Comorbidity Index (CCI) (1.84 versus 0.88, P < 0.001). Those with ≥ 2 revisions had more levels fused (3.05 versus 2.26, P = 0.040) and longer time from index surgery (47.1 versus 31.3 months, P = 0.002). PROMs declined with each revision. At 1 year, ODI scores were 23.2 (no revision), 35.4 (1st revision), and 38.1 (2nd revision) (P < 0.001). PCS-12 delta at 3 months was +4.21, -0.60, and -9.49, respectively (P < 0.001).</p><p><strong>Conclusions: </strong>A single revision may yield clinical improvement, but outcomes significantly decline after a second revision. Patients should be counseled on the limited benefit and higher risk of repeated lumbar fusion.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693315","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":"Inpatient National Trends and Aggregate Costs of Primary and Revision Lumbar Fusion in the United States from 2016 to 2022.","authors":"Mitchell K Ng, Leonidas E Mastrokostas, Paul G Mastrokostas, Yulia Lee, Sean Inzerillo, Jonathan Dalton, Arya Varthi, Jad Bou Monsef, Afshin E Razi, Jose A Canseco, Thomas D Cha, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.1016/j.spinee.2026.04.001","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.001","url":null,"abstract":"<p><strong>Background context: </strong>With increasing utilization of lumbar fusions and a growing emphasis on value-based care, a contemporary understanding of national trends in procedural volume and cost is needed. While prior studies have demonstrated increases in lumbar fusion volume in past decades, they did not include more recent years or provide a granular breakdown distinguishing primary and revision procedures.</p><p><strong>Purpose: </strong>This study aimed to define recent national trends in the utilization, aggregate costs, and revision burden of lumbar fusions in the United States.</p><p><strong>Study design/setting: </strong>Retrospective database analysis of inpatient lumbar fusion procedures captured in the National Inpatient Sample (NIS).</p><p><strong>Patient sample: </strong>Adult patients undergoing elective lumbar fusion between 2016 and 2022 OUTCOME MEASURES: National trends in procedural volume, aggregate hospital costs (inflation-adjusted to 2022), and annual revision burden were analyzed.</p><p><strong>Methods: </strong>Adult patients undergoing elective lumbar fusion were identified from the NIS using ICD-10-PCS codes. Encounters were stratified into primary versus revision procedures; \"revision\" was defined as fusion construct revision/removal. Primary fusions were further categorized by approach (posterolateral fusion [PLF], posterior/transforaminal lumbar interbody fusion [PLIF/TLIF], and anterolateral interbody fusion).</p><p><strong>Results: </strong>The analysis included 1,029,610 primary and 183,110 revision lumbar fusions. Overall primary fusion volume remained stable (compound annual growth rate [CAGR] -0.77%), while aggregate costs continued to rise (CAGR +1.41%). This was driven by a shift in surgical approach, with a decline in PLIF/TLIF procedures (CAGR -2.70%) and a rise in more costly anterolateral interbody fusion procedures (CAGR +5.78%). PLF predominated among patients aged 65 and older. Revision surgeries represented a substantial proportion of all fusions, with a total revision burden of 15.1% over the study period. Revisions were associated with higher mean costs than primary PLF and PLIF/TLIF procedures, accounting for $8.2 billion in aggregate costs.</p><p><strong>Conclusion: </strong>While the rapid growth of inpatient lumbar fusion volume has stabilized, the economic burden continues to increase. This trend is driven by a shift toward more costly surgical techniques and the persistent, high cost of revision surgery. These findings highlight the need for value-based care initiatives to focus on the clinical and economic drivers of procedural choice for both primary and revision fusions.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693246","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}