Spine Journal最新文献

{"title":"National trends in lumbar facet cyst surgical management: Rising fusion utilization without improved five-year outcomes over decompression alone.","authors":"Joshua G Sanchez, Julian Smith-Voudouris, Katie M Zehner, Anthony E Seddio, Scott J Halperin, Sahir S Jabbouri, Jeremy K Ansah-Twum, Raj Gala, Jonathan N Grauer","doi":"10.1016/j.spinee.2026.04.021","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.021","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar facet cysts can contribute to lumbar radiculopathy and stenosis. Certain patients with lumbar facet cysts may be considered for surgical intervention, which can include decompression (D) alone or decompression with fusion (D+F). However, the use of one modality versus the other remains a topic of discussion.</p><p><strong>Purpose: </strong>The current study utilized a large, national dataset to characterize yearly rates of D versus D+F utilization, identify factors independently associated with D+F relative to D, compare 90-day overall costs (measured by insurer-payments), and analyze 5-year survival to lumbar reoperation.</p><p><strong>Study design/setting: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>The 2010 to 2022 PearlDiver M170 database was queried for adult patients (>17 years of age) who underwent D or D+F with a same-day diagnosis of a lumbar facet synovial cyst. Exclusion criteria included multilevel fusion, coded infection, trauma, or neoplasm related to the spine within 90 days prior to surgery, and database inactivity within 90 days following surgery.</p><p><strong>Outcome measures: </strong>Calendar year incidence rates of D and D+F, independent predictors of D+F relative to D, 90-day postoperative insurer-payments, and 5-year survival to lumbar reoperation.</p><p><strong>Methods: </strong>Calendar year incidence rates for both cohorts were trended with linear regression. Multivariable logistic regression was conducted to identify independent predictors of D+F relative to D. Ninety-day postoperative insurer-payments were compared with a Wilcoxon rank sum test. To determine 5-year survival to subsequent lumbar reoperations, a 1:1 match controlling for age, sex, Elixhauser comorbidity index (ECI), spondylolisthesis, and preoperative nicotine or tobacco use was completed for the two groups. Kaplan-Meier curves for matched cohorts were created and compared with log-rank test (Mantel-Cox). Significance was defined as P < 0.0045, per Bonferroni correction.</p><p><strong>Results: </strong>A total of 45,380 patients with surgically managed lumbar facet cysts were identified, of which D alone was performed for 33,988 (74.9%) and D+F for 11,392 (25.1%). The relative incidence of decompression with fusion increased at a greater rate than D alone, such that D+F rose from 22.9% in 2010 to 29.4% in 2022 (β, slope = 0.58% per year, P < 0.0001). Multivariable analysis found D+F to be independently more likely for those with younger age (odds ratio [OR] 1.20, per decade decrease), female sex (OR 1.18), higher ECI (OR 1.06, per 2-point increase), spondylolisthesis (OR 5.04), and treatment by an orthopaedic surgeon (OR 1.29, relative to neurosurgeon) (P < 0.0001 for all). Ninety-day overall insurer-payments were greater for D+F relative to D (median: $7,744 versus $3,731, P < 0.0001). Five-year reoperation-free survival was not significantly different after matching between","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":"147693291","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 Preoperative Central Sensitization and Novel Mitigation Strategies on Outcomes Following Spinal Surgery: A Comprehensive Narrative Review.","authors":"Mohsen Karami, Hagay Amster Kahn, Mina Fakhrzadegan, Amir Abdul-Jabbar, Rod Oskouian, Jens Chapman","doi":"10.1016/j.spinee.2026.04.006","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.006","url":null,"abstract":"<p><p>Central sensitization (CS) is heightened central nervous system responsiveness to nociceptive input and contributes to the transition from acute to chronic pain. Although increasingly recognized as a predictor of suboptimal outcomes after spinal surgery, no prior review has been synthesized the associations between preoperative CS, underlying mechanisms, and potential perioperative mitigation strategies in spine surgery. This narrative review searched PubMed, Embase, Ovid, the Cochrane Library, and Google Scholar through September 2025 for studies examining preoperative CS-primarily diagnosed using the Central Sensitization Inventory (CSI), Quantitative Sensory Testing (QST), or related tools-in adults undergoing elective spinal surgery. Eleven studies met inclusion criteria, spanning from lumbar disk herniation to cervical myelopathy. Higher preoperative CSI scores (especially ≥40) and abnormal QST findings (reduced pressure pain thresholds, increased temporal summation, impaired conditioned pain modulation) were consistently associated with worse postoperative outcomes, including greater pain intensity, increased disability, poorer quality of life, elevated depressive symptoms, and longer hospital stays. However, leg pain relief after decompression appeared less influenced by CS status in some cohorts. CS prevalence ranged from 10-20% in preoperative populations, with risk factors including prolonged symptom duration, visceral adiposity, pain catastrophizing, and revision surgery. Persistent nociceptive input from degenerative pathology promotes neuroplastic amplification and impaired descending inhibition. Emerging evidence suggests CS may be modifiable: perioperative pain neuroscience education (PPNE) improves CS scores-particularly in high kinesiophobia subgroups-and animal models indicate that intraoperative neuromodulation may decrease postoperative CS development. Preoperative CS screening (e.g., CSI ≥40) should be included into surgical risk assessment . Targeted prehabilitation (PPNE plus exercise), weight optimization, multimodal analgesia, and exploration of intraoperative neuromodulation are promising strategies to mitigate CS related adverse outcomes.</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":"147693296","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":"Postoperative Muscle Loss and Preoperative Sarcopenia Predict Survival and Morbidity After Surgical Stabilization for Spinal Metastases: A Longitudinal CT-Morphometric Analysis of 285 Patients.","authors":"Julian Kylies, Leon-Gordian Leonhardt, Moritz Lenz, Elias Brauneck, Malte Schroeder, Markus Schomacher, Marc Dreimann, Peter Obid, Lennart Viezens","doi":"10.1016/j.spinee.2026.04.019","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.019","url":null,"abstract":"<p><strong>Background context: </strong>Sarcopenia is associated with adverse outcomes in oncologic populations, yet the postoperative trajectory of skeletal muscle following spine surgery for metastatic disease remains poorly characterized.</p><p><strong>Purpose: </strong>To quantify postoperative changes in CT-based body composition after surgical stabilization for spinal metastases and to evaluate the prognostic impact of preoperative sarcopenia and postoperative muscle decline.</p><p><strong>Study design/setting: </strong>Retrospective cohort study at a tertiary spine center (2016-2024).</p><p><strong>Patient sample: </strong>285 adults undergoing surgical stabilization for spinal metastases with preoperative CT (tCT1) and routine follow-up CT at approximately 9 months (tCT2).</p><p><strong>Outcome measures: </strong>Overall survival, length of stay, postoperative complications, ECOG performance status, and CT-based morphometric parameters at L3 (SMI, PSMI, PMI, VAT, SMD).</p><p><strong>Methods: </strong>CT morphometry was performed using standardized protocols. Preoperative sarcopenia was defined using validated sex-specific SMI thresholds. ROC analysis identified ≥15% postoperative SMI decline as the optimal survival-related cutoff. Multivariable Cox models adjusted for clinical and oncologic covariates. A non-oncologic fracture cohort undergoing lumbar stabilization was included to differentiate surgery-related muscle loss from cancer-related systemic catabolism.</p><p><strong>Results: </strong>Skeletal muscle mass and quality declined substantially after surgery, particularly following lumbar stabilization. Minimally invasive procedures were associated with significantly less muscle loss than open approaches (SMI decline -24% vs. -40%, p<0.0001). Compared with fracture controls, metastatic patients demonstrated markedly greater losses in muscle indices and a distinct pattern of visceral fat depletion. An SMI decline ≥15% independently predicted reduced survival (median 284 vs. 730 days; HR 4.78) and poorer functional status. Preoperative sarcopenia, present in one-third of patients, also independently predicted mortality (HR 4.01), prolonged hospitalization, and higher complication rates.</p><p><strong>Conclusions: </strong>Postoperative skeletal muscle loss after stabilization for spinal metastases is frequent and clinically meaningful. Both preoperative sarcopenia and postoperative SMI decline independently predict survival, supporting routine morphometric assessment and the adoption of muscle-sparing surgical and rehabilitation strategies.</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":"147693270","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 Symptom Duration and Lesion Severity at Diagnosis in Symptomatic Adolescents with Lumbar Spondylolysis.","authors":"Yoshiaki Hiranaka, Shingo Miyazaki, Kohei Kuroshima, Takahiro Kitano, Masao Ryu, Shinichi Inoue, Takashi Yurube, Ko Tadokoro","doi":"10.1016/j.spinee.2026.04.005","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.005","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar spondylolysis (LS) is a fatigue-related fracture commonly seen in adolescents. Progressive-stage lesions at diagnosis have been associated with poorer prognosis, including lower bone union rates and a longer time to return to sport.</p><p><strong>Purpose: </strong>To clarify the association between symptom duration, lesion stage at diagnosis, and bilateral involvement in symptomatic adolescents with LS, and to determine the optimal symptom duration cutoff for predicting the presence of a progressive-stage lesion at diagnosis.</p><p><strong>Study design: </strong>Retrospective cross-sectional study.</p><p><strong>Patient sample: </strong>A total of 652 symptomatic adolescent patients with LS managed conservatively using a uniform treatment protocol at one hospital and four affiliated clinics between 2015 and 2023.</p><p><strong>Outcome measures: </strong>Outcome measures included lesion stage based on computed tomography (CT) findings, lesion laterality (unilateral vs. bilateral).</p><p><strong>Methods: </strong>Symptom duration was defined as the interval from onset of low back pain to MRI-confirmed diagnosis of fresh LS. Patients were classified into three stages (very early, early, and progressive) based on CT findings. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal symptom duration cutoff for predicting the presence of a progressive-stage lesion at diagnosis.</p><p><strong>Results: </strong>Median symptom duration was 1.1 weeks for the very early stage, 2.1 weeks for the early stage, and 5.7 weeks for the progressive stage. Patients with progressive-stage LS had significantly longer symptom duration than those with very early or early-stage lesions (both p < 0.001). Symptom duration was also significantly longer in patients with bilateral LS than in those with unilateral LS (3.9 vs. 2.0 weeks, p < 0.001). ROC analysis identified a symptom duration cutoff of 3.0 weeks for patients whose main lesion was classified as progressive (AUC = 0.775, 95% CI: 0.729-0.821).</p><p><strong>Conclusions: </strong>Longer symptom duration was associated with a more advanced lesion stage at diagnosis and bilateral involvement in adolescent LS. Early diagnostic interventions within 3-4 weeks of symptom onset may be critical for preventing stage progression and optimizing clinical outcomes.</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":"147693132","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":"Increasing Levels of Craniocervical Junction Fusion Increase Cervical Annulus Stress and Facet Joint Forces While Decreasing Cervical Motion.","authors":"James M Anderson, Ellie Karren, Andrew T Dailey, Douglas L Brockmeyer, Benjamin J Ellis","doi":"10.1016/j.spinee.2026.04.015","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.015","url":null,"abstract":"<p><strong>Background context: </strong>Preventing cervical adjacent segment disease (ASD) is a priority in spine surgery, because its onset can result in recurrent symptoms and undermine the durability of surgical intervention. However, the biomechanical effects of craniocervical junction (CCJ) fusion on the adjacent annulus and facet joint forces that contribute to the risk of ASD after surgery are poorly understood.</p><p><strong>Purpose: </strong>To elucidate the biomechanical effects of facet joint forces and annulus fibrosus stresses on the subaxial cervical spine caused by fusion in the CCJ.</p><p><strong>Study design/setting: </strong>A finite element (FE) analysis of the adult cervical spine.</p><p><strong>Patient sample: </strong>Three patient-specific FE models developed from a 26-year-old woman, a 59-year-old woman, and a 64-year-old woman.</p><p><strong>Outcome measures: </strong>Subaxial annulus fibrosus stresses, facet joint forces, and total cervical range of motion were analyzed.</p><p><strong>Methods: </strong>The previously validated FE models from occiput to C7 were modified to simulate four fusion constructs: unfused, atlantoaxial fusion (AAF, C1-C2), occipitocervical fusion (OCF, occiput-C2), and extended OCF (eOCF, occiput-C5). Each model was loaded with physiological torques and applied motions in flexion/extension and right/left axial rotation. Results were collated via data clustering, and multilevel linear regression was used for analysis.</p><p><strong>Results: </strong>FE analysis demonstrated that forces measured in adjacent and unfused facet joints significantly increased with fusion length by 606±429%, 1772±1449%, and 24,722±21,729% in the AAF, OCF, and eOCF constructs, respectively. Annulus fibrosus stress also increased significantly by 161±93%, 408±211%, and 1833±1398% in the AAF, OCF, and eOCF constructs, respectively. Differences in annulus fibrosus stress and facet joint force were significant among all fusion levels (p<.0005) and were seen regardless of load direction or distance from fusion. Range of motion significantly decreased (p<.0005) as the fusion length increased, with mean ranges of motion of 46.9±5.0, 32.1±4.2, 24.0±3.4, and 10.2±1.0 degrees in the AAF, OCF, and eOCF models, respectively.</p><p><strong>Conclusions: </strong>Our findings indicate a clear connection between the length of CCJ fusion and factors that have been linked to ASD development. Furthermore, our evidence shows that each additional joint fused significantly limits cervical range of motion. We recommend caution to avoid extending CCJ fusions beyond necessity.</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":"147693140","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":"Local wound anesthesia in spine surgery - a randomized, double-blind, controlled trial.","authors":"Samuel Haupt, Christoph Johannes Laux, Steven Mark Maurer, Farah Selman, Alexander Lebeda, Stefani Dossi, Tobias Götschi, Sabrina Catanzaro, Hagen Bomberg, Urs Eichenberger, Mazda Farshad","doi":"10.1016/j.spinee.2026.04.012","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.012","url":null,"abstract":"<p><strong>Background: </strong>Effective postoperative pain control remains a major challenge in spine surgery. Local wound infiltration with anesthetics is a simple component of multimodal analgesia, yet high-quality comparative data between different infiltration regimens are limited.</p><p><strong>Purpose: </strong>To evaluate the analgesic efficacy and safety of ropivacaine and levobupivacaine/tramadol wound infiltration compared with placebo in lumbar spine surgery.</p><p><strong>Study design/setting: </strong>Prospective, randomized, double-blind, controlled clinical trial.</p><p><strong>Patient sample: </strong>125 patients undergoing elective primary or revision lumbar spine surgery.</p><p><strong>Outcome measures: </strong>Postoperative pain intensity (VAS 2-12 h), opioid consumption (24 h), length of hospital stay, sick leave, and adverse events.</p><p><strong>Methods: </strong>Patients were randomized to receive intraoperative epifascial and subcutaneous wound infiltration with either 0.9% saline (placebo), 0.75% ropivacaine, or 0.5% levobupivacaine + tramadol (100 mg). Outcomes were analyzed using mixed-effects linear models and non-parametric tests.</p><p><strong>Results: </strong>There were no significant differences in postoperative pain scores or opioid consumption between treatment groups at any time point. Hospital stay and functional recovery were comparable. Sick leave duration was shorter in the ropivacaine group compared with placebo (p = 0.021). No infiltration-related adverse events occurred.</p><p><strong>Conclusions: </strong>Local wound infiltration with ropivacaine or levobupivacaine/tramadol is safe but does not provide a clinically meaningful benefit in early postoperative pain control or opioid reduction after lumbar spine surgery. Broader multimodal strategies may be required to achieve optimal postoperative recovery.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, NCT05693454.</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":"147693257","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":"TELD vs. IELD for Lumbar Disc Herniations: A Prospective Multicenter Study of Recovery Trajectories Using High-Frequency PROMs.","authors":"Paula K Krause, Jannik Leyendecker, Cathryn Payne, Nguyen T Tran, Albert Teilfeian, Peter B Derman, John Ogunlade, Saqib Hasan, Sanjay Konakondla, Meng Huang, Raymond Joseph Gardocki, Mark Mahan, Imad Khan, Anubhav Amin, Jan Bredow, Christoph P Hofstetter","doi":"10.1016/j.spinee.2026.04.008","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.008","url":null,"abstract":"<p><strong>Background context: </strong>Full-endoscopic lumbar discectomy can be performed via transforaminal (TELD) or interlaminar (IELD) routes, yet comparative evidence on early recovery trajectories remains limited.</p><p><strong>Purpose: </strong>To evaluate postoperative pain and disability patterns after TELD and IELD and identify approach-specific recovery characteristics and predictors.</p><p><strong>Study design/setting: </strong>Prospective multicenter cohort study.</p><p><strong>Patient sample: </strong>573 patients undergoing ambulatory full-endoscopic lumbar discectomy (351 TELD, 222 IELD).</p><p><strong>Outcome measures: </strong>VAS back pain, ipsilateral leg pain, and Oswestry Disability Index (ODI).</p><p><strong>Methods: </strong>Patient-reported outcomes were collected via the SpineHealthie platform daily during week 1 and at 2 weeks, 1, 3, 6, and 12 months. Linear mixed-effects ANCOVA models adjusted for baseline PROMs, age, BMI, disc morphology, and L5/S1-level were used to compare trajectories.</p><p><strong>Results: </strong>Both techniques yielded rapid, durable reductions in pain and disability. IELD demonstrated faster and more pronounced early recovery. Adjusted mean differences favored IELD at 2 weeks for back pain (-0.77; P = .014) and ODI (-2.50; P = .042), peaking at 6 months (back pain -1.27; ODI -6.14; both P <.001). Differences converged by 12 months for ODI. Surgical approach accounted for 2-3% of variance (η² = 0.02-0.03), while disc morphology (η² = 0.04) and BMI (η² = 0.06) emerged as independent predictors. Age had no effect.</p><p><strong>Conclusions: </strong>TELD and IELD are safe, effective techniques. IELD enables faster recovery and greater short-term functional improvement, whereas TELD provides durable long-term benefit, especially for foraminal and upper lumbar pathology. Outcomes depend on surgical exposure, disc morphology, and body habitus, supporting an anatomy-guided, individualized approach.</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":"147693318","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":"Timing of Thromboprophylaxis in Acute Spinal Cord Injury Patients: A TQIP Study in 15,960 Patients.","authors":"Aazad Abbas, Robert Koucheki, Jay Toor, Robert Fowler, Avery B Nathens, Albert Yee, Stephen Lewis, Jefferson R Wilson, Christopher D Witiw, Michael G Fehlings, Cari Whyne, Jetan Badhiwala","doi":"10.1016/j.spinee.2026.04.017","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.017","url":null,"abstract":"<p><strong>Background context: </strong>Optimal timing of pharmacologic thromboprophylaxis in patients with acute traumatic spinal cord injury (SCI) is unclear. Most guideline recommendations are consensus-based and lacking in primary large-scale data. This study evaluated an ideal timeframe for delivery of thromboprophylaxis in acute SCI.</p><p><strong>Purpose: </strong>Determine the ideal timeframe for initiation of chemical thromboprophylaxis in the setting of acute SCI.</p><p><strong>Study design/setting: </strong>Retrospective cohort study. North American trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program (2017-2022).</p><p><strong>Patient sample: </strong>Adults (≥ 16 years) with acute SCI secondary to blunt trauma who underwent surgical decompression within 24 hours.</p><p><strong>Outcome measures: </strong>Primary: in-hospital venous thromboembolism. Secondary: in-hospital return to the operating room, death during admission and length of stay.</p><p><strong>Methods: </strong>Restricted cubic splines identified an inflection point defining early versus late thromboprophylaxis initiation, which was used for propensity score-matched comparisons. Covariates for propensity matching included patient, injury, treatment, and hospital characteristics. Effect size was calculated using risk difference (RDs) and odds ratio (OR) for dichotomous outcomes and mean difference (MD) for linear outcomes with associated 95% confidence interval (CI).</p><p><strong>Results: </strong>15,960 patients across 511 trauma centres were included. Spline analysis indicated increasing risk after 24-48 hours from surgery. In propensity-matched cohorts for postoperative day 1 (i.e. early <48 hours; late ≥48 hours) (N=6,867 per group), early thromboprophylaxis was associated with lower VTE rates (4.7% vs 5.9%; P=0.002; OR 1.26 [95%CI: 1.09, 1.46]), fewer returns to operating room overall (2.2% vs 2.9%; P=0.004; OR 1.38 [95%CI 1.11, 1.71]), no difference in return to operating room for same-level spine procedure (0.7% vs 1.0%; P=0.07; OR 1.4 [95%CI 0.98, 2.02]), lower mortality (4.0% vs 4.9%; P=0.003; OR 1.28 [95%CI: 1.09, 1.51]), and shorter length of stay (15.8 vs 16.9 days; P<0.001; MD 1.06 days [95%CI: 0.47, 1.65]).</p><p><strong>Conclusions: </strong>Thromboprophylaxis by postoperative day 1 after was associated with a decreased risk of venous thromboembolism, decreased returns to the operating room, no increased return to the operating room for related spine procedure, decreased risk of death, and decreased length of stay. Administration of thromboprophylaxis by postoperative day 1 for acute SCI patients may represent a new clinical standard for optimal patient outcomes.</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":"147693276","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":"Pain and Paresthesia Patterns in Degenerative Cervical Myelopathy: Neuropathic Sensory Features and Postoperative Transitions in a Prospective Cohort.","authors":"Yasushi Oshima, Masahiko Sumitani, Yoshitaka Matsubayashi, Hideki Nakamoto, Hiroyuki Nakarai, Hiroyasu Kodama, Tomohiko Shirokoshi, Yudai Kumanomido, Yoshiki Shimokawa, Daiki Urayama, Atsushi Yoshida, Yoshisato Toriyama, So Kato, Yuki Taniguchi, Sakae Tanaka","doi":"10.1016/j.spinee.2026.04.016","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.016","url":null,"abstract":"<p><strong>Background context: </strong>Pain and paresthesia are common in degenerative cervical myelopathy (DCM), yet their relationship and postoperative course remain uncertain.</p><p><strong>Purpose: </strong>To categorize patients undergoing surgery for DCM using preoperative pain and paresthesia severity, characterize neuropathic sensory signatures, and quantify postoperative transitions among groups.</p><p><strong>Study design/setting: </strong>Prospective cohort study at a single academic institution.</p><p><strong>Patient sample: </strong>Of 408 eligible surgical DCM cases, 306 with complete preoperative and 1-year postoperative datasets were analyzed.</p><p><strong>Outcome measures: </strong>NRS for hand pain and hand paresthesia; EuroQol 5-Dimension (EQ-5D); the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ); Neuropathic Pain Symptom Inventory (NPSI); and painDETECT questionnaire (PDQ).</p><p><strong>Methods: </strong>Using an NRS threshold of 7 to define \"high\" symptoms, patients were classified as Group A (low pain/low paresthesia), Group B (low pain/high paresthesia), and Group C (high pain/high paresthesia). High pain/low paresthesia was rare (n=2, 0.6%) and excluded. Group differences were assessed using parametric/nonparametric tests with multiplicity-adjusted post hoc comparisons. Associations between NRS pain/paresthesia and NPSI items were assessed by Spearman correlation. Postoperative transitions were summarized using a transition matrix and tested for asymmetry.</p><p><strong>Results: </strong>Preoperatively, 159 (51.9%) patients were Group A, 85 (27.8%) Group B, and 60 (19.6%) Group C. Groups B and C had worse preoperative EQ-5D and JOACMEQ scores than Group A, whereas Groups B and C did not differ. At 1 year, EQ-5D and JOACMEQ improved and converged across preoperative groups, despite residual pain/paresthesia in a subset. Paresthesia NRS correlated most closely with NPSI tingling, whereas pain NRS showed higher scores across multiple NPSI domains. Groups B and C shared prominent tingling, but Group C showed broader NPSI elevation and higher PDQ scores. Postoperative transition analysis showed net movement toward Group A, with Group B reaching Group A more frequently than Group C.</p><p><strong>Conclusions: </strong>We investigated pain-paresthesia patterns in DCM patients. Among patients with severe paresthesia, concomitant severe pain was associated with broader neuropathic sensory signatures. Although EQ-5D and JOACMEQ converged after surgery, the likelihood of reaching the low pain/low paresthesia state differed between groups.</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":"147693303","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":"Deep Learning Magnetic Resonance Imaging Algorithm for Differentiating Metastatic Vertebral Fractures.","authors":"Joonghyun Ahn, Young-Hoon Kim, Sang-Il Kim, Jun-Seok Lee, Hyung-Youl Park, Ji-Hyun Ryu, Chungwon Bang, Kee-Won Rhyu, Jae-Hyuk Shin, Youjin Shin, June Lee, Seung Jae Moon, Jae Chul Lee","doi":"10.1016/j.spinee.2026.04.010","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.04.010","url":null,"abstract":"<p><strong>Background context: </strong>Distinguishing malignant metastatic lesions from benign osteoporotic vertebral compression fractures (VCFs) is a major diagnostic challenge in spine practice; delays or errors can lead to inappropriate management and missed opportunities for timely oncologic intervention.</p><p><strong>Purpose: </strong>To develop and validate a deep learning-based object detection algorithm using routine MRI sequences to differentiate malignant metastatic lesions from benign VCFs.</p><p><strong>Study design/setting: </strong>Retrospective multicenter study conducted across six tertiary hospitals.</p><p><strong>Patient sample: </strong>A total of 2,165 patients with either VCFs or spinal metastases were included, encompassing 27,543 vertebral levels. Sagittal T1- and T2-weighted MRI series were available for all participants and were annotated by spine specialists.</p><p><strong>Outcome measures: </strong>Primary outcome: vertebral-level detection/classification performance measured by mean Average Precision across intersection over union thresholds (mAP50-95).</p><p><strong>Secondary outcomes: </strong>Precision, Recall, and F1-score; qualitative error analysis METHODS: : Four object detection models (YOLOv5, YOLOv8, YOLOv11, DETR) were trained and validated on annotated sagittal T1- and T2-weighted images. The dataset was split into training, validation, and test images. Model performance was evaluated using mAP50-95, Precision, Recall, and F1-score on the test set, with qualitative review of misclassifications. Ground-truth was defined by finalized radiology reports and clinical diagnoses; annotators were blinded to model outputs.</p><p><strong>Results: </strong>YOLOv11 with a ResNet-101 backbone achieved the best overall performance (Precision 91.2%, Recall 92.5%, F1-score 91.9%, mAP50-95 80.2%). YOLOv8 showed the highest Recall (93.3%), supporting potential use for screening, whereas YOLOv11 balanced Precision and Recall, minimizing false negatives. Qualitative analysis demonstrated robust detection in difficult scenarios, including multiple concurrent lesions and coexisting benign and malignant fractures. Misclassifications were uncommon and predominantly involved intravertebral vacuum cleft signs that were not explicitly modeled as a class.</p><p><strong>Conclusions: </strong>A deep learning-based object detection approach can accurately distinguish malignant metastatic lesions from benign VCFs on routine MRI. In this large multicenter study, YOLOv11 showed the most balanced performance and may serve as a practical decision-support tool to expedite oncologic referral, improve diagnostic accuracy, and optimize treatment strategies.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693130","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}