Spine Journal最新文献

{"title":"The destabilizing effect of cervical foraminotomy - an ex vivo biomechanical study.","authors":"Anna-Katharina Calek, Alexandra Stauffer, Marie-Rosa Fasser, Jana F Schader, Anna M Schuler, Alexandra Grob, Mazda Farshad, Jonas Widmer, José M Spirig","doi":"10.1016/j.spinee.2026.10.001","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.10.001","url":null,"abstract":"<p><p>Background Context Posterior cervical foraminotomy is a minimally invasive, motion-preserving treatment for cervical radiculopathy. However, surgeons still rely on the traditional \"50% rule\" for facet resection despite limited biomechanical evidence supporting this threshold. Purpose To evaluate the biomechanical effects of graded unilateral facet joint resection (10%, 25%, 50%, 75%, 100%) compared with the native state. Study Design Cadaveric biomechanical study Methods Nine cervical segments from five fresh-frozen cadavers were tested under load control. Segmental ROM was assessed in the native state and after 10%, 25%, 50%, 75%, and 100% facet resection in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anteroposterior shear (AS), and axial rotation (AR). Results ROM increased in all directions with progressive facet (and adjacent capsular) resection. Significant changes were observed at 25% resection (native vs. 25%): AR, 1.8° vs. 2.7°; FE, 7.1° vs. 8.6°; and LS, 0.6 mm vs. 0.6 mm (all p<0.05). Beyond 50% resection, FE, LS, and AS largely plateaued. AR showed the greatest increase in ROM, reaching 45% and 71% above the native condition after 75% and 100% resection, respectively (p<0.05). Conclusion Unilateral cervical foraminotomy caused progressive, motion-specific destabilization, most pronounced in AR, followed by LB. Significant changes occurred within the first 25% of resection. Beyond 50%, FE, LS, and AS plateaued, whereas AR continued to increase without a discrete threshold. Clinical significance: These findings support minimizing facet and capsular disruption and challenge the 50% rule as a universal biomechanical safety threshold.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128993","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":"Teriparatide attenuates vertebral destruction and modulates bone remodeling in a rat model of pyogenic spondylodiscitis.","authors":"Yo Morishita, Yuji Kasukawa, Michio Hongo, Koji Nozaka, Hiroyuki Tsuchie, Yuichi Ono, Manabu Akagawa, Kento Okamoto, Kenta Tominaga, Yasuhito Asaka, Manami Nakanishi, Yuki Ishigaki, Akari Hisada, Genki Tojo, Takashi Ebihara, Naohisa Miyakoshi","doi":"10.1016/j.spinee.2026.09.012","DOIUrl":"10.1016/j.spinee.2026.09.012","url":null,"abstract":"<p><strong>Background context: </strong>Pyogenic spondylodiscitis can lead to progressive vertebral destruction and structural failure despite adequate infection control. However, pharmacologic strategies that preserve vertebral structure and support reparative bone remodeling in infected vertebrae remain insufficiently investigated.</p><p><strong>Purpose: </strong>This study investigated whether teriparatide (TPTD) attenuates vertebral destruction and modulates bone remodeling in a rat model of pyogenic spondylodiscitis.</p><p><strong>Study design: </strong>Preclinical in vivo animal study.</p><p><strong>Methods: </strong>Pyogenic spondylodiscitis was induced in 12-week-old male Sprague-Dawley rats by percutaneous inoculation of methicillin-susceptible Staphylococcus aureus into the Co6/7 intervertebral disc space. Rats were assigned to vehicle control or TPTD treatment (n=9-10 per group) and evaluated at 2 or 6 weeks. Vertebral destruction, disc height, cancellous radiodensity, and trabecular microarchitecture were assessed by microcomputed tomography. Bone histomorphometry and bone-corrected interleukin (IL)-6-positive area were also evaluated. This study was supported by Departmental Research Funds ($10,000-$50,000); the authors identified no study-specific conflict of interest-associated biases.</p><p><strong>Results: </strong>At 2 weeks, most outcomes did not differ significantly between groups. At 6 weeks, the TPTD group showed a significantly lower vertebral destruction rate and higher cancellous radiodensity than the Control group. The vertebral destruction rate increased significantly from 2 to 6 weeks in the Control group, whereas no significant progression was observed in the TPTD group. Disc height ratio did not differ between groups at either time point. TPTD also increased BV/TV and Tb.Th and decreased Tb.Sp, with higher Conn.D observed at both 2 and 6 weeks. Histomorphometric analysis at 6 weeks demonstrated lower Oc.S/BS and higher Ob.S/BS in the TPTD group. In addition, bone-corrected IL-6-positive area was significantly lower in the TPTD group at 6 weeks.</p><p><strong>Conclusions: </strong>TPTD attenuated progression of vertebral destruction and improved trabecular microarchitecture in infected vertebrae. These changes were accompanied by a shift toward reparative bone remodeling and a reduction in bone-corrected IL-6-positive area.</p><p><strong>Clinical significance: </strong>These preclinical findings raise the possibility that TPTD could be evaluated as an adjunct to standard management of pyogenic spondylodiscitis, particularly in patients with coexisting osteoporosis. Further studies incorporating antibiotic treatment and models of persistent infection are needed to clarify its translational relevance and potential clinical applicability.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082612","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":"High psychosocial impact of complications, suboptimal coping strategies, and burnout among spine surgeons.","authors":"Rishi M Kanna, Gnanaprakash Gurusamy, Ajoy P Shetty, Shanmuganathan Rajasekaran","doi":"10.1016/j.spinee.2026.09.011","DOIUrl":"10.1016/j.spinee.2026.09.011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Complications in spine surgery are unavoidable. Apart from the patients' suffering, complications can profoundly affect surgeons' emotional well-being. Though medical literature discusses extensively about handling the medical aspect of complications, the real psychological impact of complications on spine surgeons is less discussed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate the emotional burden of complications, psychological impact, coping strategies, and burnout among spine surgeons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cross-sectional survey-based study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Total of 50 practicing spine surgeons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An anonymous cross-sectional survey including 35 questions covering seven psychological domains was shared with 50 spine surgeons. The structured questionnaire explored demographics, surgical experience, complication rates, psychosocial domains, coping mechanisms, financial concessions, institutional support, and burnout. Descriptive statistics were applied. A five-point criterion was used for defining a serious surgical complication (SSC). Categorical variables were summarized as proportions. Unadjusted and adjusted Firth penalized logistic regression was conducted to identify factors associated with burnout.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Prevalence of emotional burden and burnout RESULTS: Participants were predominantly orthopaedic surgeons (96%), with 86% being fellowship trained. Most practiced in private corporate hospitals (74%). Nearly all (96%) reported psychological suffering after a SSC, with guilt (42%), depression (38%), anxiety (36%), and irritability (30%) frequently cited. Almost all faculties of psyche were affected: general well-being (78%), sleep (80%), driving ability (54%), appetite (60%), and sex life (56%). Multiple domains were affected in 86%. It also interfered with personal relationships with friends (46%), family (62%), colleagues (56%), and other patients (64%). Coping strategies included peer (74%) and mentor support (52%), family engagement (54%), and self-acceptance (64%). Unfortunately, standard coping mechanisms during distress, including music or sports, were inadequate (34% each), while substance use was reported by 34%. Two-thirds (66%) reduced professional fees or institutional charges for affected patients. The availability of emotional support from the family and friends (84%) and absent punitive response from institutions was impressive. Burnout-domain symptoms was common with moderate-to-severe exhaustion in 44%, depersonalization in 40%, and poor professional accomplishment in 48%. In adjusted regression, anxiety after a complication was associated with higher burnout symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Spine surgeons experience high psychological burden from surgical complications, with widespread burnout symptoms, and reliance on varied, often inadequate and inappropriate coping s","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065610","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":"Preoperative versus postoperative MRI comparisons after the MILD procedure versus open decompression for lumbar spinal stenosis: multicenter cohort study.","authors":"Mark R Jones, Luis M Fandos, Jonathan S Daitch, Sandra Thompson, Douglas P Beall, Ajay Yeddu, Paul Pannozzo, Rajmani Krishnan, Sunil D Albert, Daniel J Kohane, Yeshvant A Navalgund, Hasan Abed, Soubrata V Raikar, Erik Spayde, William M Costigan, Vito Lore, Matthew Lazzari, Sukanya Chebrolu, Hope Estevez, Chukwunonso C Ilogu, Jason A Seale, Kingsley R Chin","doi":"10.1016/j.spinee.2026.09.010","DOIUrl":"10.1016/j.spinee.2026.09.010","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;The minimally invasive lumbar decompression (MILD) procedure, introduced in 2005, is a percutaneous fluoroscopy-guided technique designed as an alternative to open decompression for patients with lumbar spinal stenosis (LSS) causing neurogenic claudication. MILD specifically targets hypertrophied ligamentum flavum, allowing for expansion of the dural sac to relieve central stenosis, but it is not intended to treat lateral recess or foraminal stenosis. While published studies have reported symptomatic improvement, no study has evaluated pre and postoperative MRI to assess its effectiveness in achieving anatomical decompression and improving nerve root sedimentation sign (SedSign).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare pre and postoperative MRI findings in patients undergoing MILD versus open decompression, specifically evaluating changes in SedSign and anatomical decompression for LSS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Multicenter cohort study conducted at 7 centers between 2019 and 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A total of 182 patients with LSS and a positive SedSign on preoperative MRI underwent either MILD (n=162) by interventional pain management (IPM) physicians or open decompression (n=20) by an orthopedic spine surgeon. All patients received postoperative MRI for assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Measures included pre and postoperative MRI assessments evaluating SedSign improvements, decrease in ligamentum flavum thickness, presence of a lamina defect and multifidus muscle scar signal changes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients were assigned to treatment based on the specialty of the consulting physician: IPM physicians performed MILD (Group 1), and an orthopedic spine surgeon performed open decompression (Group 2). Blinded radiologists reviewed pre and postoperative MRI scans to assess SedSign and anatomical changes. Interobserver and intraobserver reliability were analyzed using Cohen kappa statistics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Group 1 demonstrated no SedSign improvement or anatomical changes. Group 2 achieved 100% SedSign reversal, &gt;90% ligamentum flavum removal, 100% lamina defect and multifidus muscle scar signal changes postoperatively. No complications were reported in either group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The MILD procedure did not produce anatomical decompression or SedSign reversal on MRI, whereas open decompression reliably achieved both. Secondary anatomical changes, such as scar tissue and muscle signal alterations, were observed only in the open surgery group. These findings suggest that while MILD is tissue-sparing, it may be insufficient for achieving anatomical goals in patients with central LSS. Future percutaneous strategies should aim to combine the anatomical effectiveness of open decompression with the reduced tissue disruption characteristic of less exposure approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: 3: &lt;/","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065620","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":"Beyond anatomical resectability: a hypermetabolic and highly aggressive subtype of spinal chordoma associated with cancer-specific progression.","authors":"Zelin Yun, Yanchao Tang, Le Song, Shaomin Yang, Ben Wang, Panpan Hu, Yan Li, Xiao Liu, Fengliang Wu, Hua Zhou, Zhongjun Liu, Xiaoguang Liu, Feng Wei","doi":"10.1016/j.spinee.2026.09.009","DOIUrl":"10.1016/j.spinee.2026.09.009","url":null,"abstract":"<p><strong>Background context: </strong>Spinal chordoma demonstrates substantial biological heterogeneity, with a subset exhibiting highly aggressive behavior. However, existing isolated prognostic factors remain insufficient for reliable preoperative risk stratification.</p><p><strong>Purpose: </strong>To characterize a metabolically aggressive phenotype (MAP) of spinal chordoma associated with malignant events (MEs) and to develop a preliminary preoperative prognostic stratification score.</p><p><strong>Study design: </strong>Retrospective single-center cohort study.</p><p><strong>Patient sample: </strong>A total of 36 patients with newly diagnosed spinal chordoma who underwent preoperative PET/CT examination and comprehensive clinical, radiological, and pathological evaluation were finally included. The median follow-up was 78.5 months.</p><p><strong>Outcome measures: </strong>Primary outcomes were recurrence, metastasis, and cancer-specific death. The composite MEs endpoint comprised recurrence, metastasis, and cancer-specific death.</p><p><strong>Methods: </strong>PET/CT-derived metabolic parameters together with clinical, imaging, pathological, and laboratory variables were analyzed to identify patients at increased risk of MEs. Model performance was evaluated using time-dependent receiver operating characteristic curves, calibration curves, decision curve analysis, and bootstrap validation.</p><p><strong>Results: </strong>Across analyses of the individual outcomes, higher PET/CT-derived metabolic tumor volume (MTV), total lesion glycolysis, Spinal Instability Neoplastic Score >10, Enneking stage of IIB, elevated C-reactive protein levels, and hemorrhagic-necrotic pathology emerged as significant adverse features. In multivariable analysis, Spinal Instability Neoplastic Score >10 (hazard ratio [HR]=4.685, p=.026) and Enneking stage of IIB (HR=4.647, p=.014) were significantly associated with MEs, whereas MTV>35 cm³ showed a borderline association (HR=2.242, p=.053). The model demonstrated a C-index of 0.812 (bootstrap-corrected: 0.782), and time-dependent AUCs of 0.706, 0.899, and 0.918 at 12, 36, and 60 months. A preliminary MAP-associated MEs score was developed to stratify patients into low-, intermediate-, or high-risk groups.</p><p><strong>Conclusions: </strong>The MAP in spinal chordoma is characterized by a triad of elevated PET/CT-derived MTV and/or total lesion glycolysis, hemorrhagic-necrotic pathology, and increased inflammatory activity. MAP is associated with MEs and demonstrates concordance with clinical and radiological indicators. The MAP-associated MEs score provides a biologically interpretable framework for risk stratification and may support individualized multidisciplinary treatment planning.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002853","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":"Superior articular process-endplate angle is associated with postoperative contralateral symptoms after unilateral transforaminal lumbar interbody fusion.","authors":"Yiting Tu, Sunlong Li, Shuqing Jin, Zhouwei Wu, Shu Yang, Morgan E B Jones, Kenny Yat Hong Kwan, Haiming Jin, Xiangyang Wang","doi":"10.1016/j.spinee.2026.09.004","DOIUrl":"10.1016/j.spinee.2026.09.004","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;New-onset contralateral symptoms after unilateral transforaminal lumbar interbody fusion (TLIF) are clinically important, but simple preoperative predictors are limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To characterize sagittal superior articular process-endplate (SAP-E) angle distribution and evaluate its association with postoperative contralateral symptoms after unilateral open L4/5 TLIF in L4 degenerative lumbar spondylolisthesis (DLS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective observational imaging and clinical cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;The study included 111 normal individuals and 296 patients with L4 DLS who underwent unilateral open L4/5 TLIF. Among the DLS patients, 15 developed postoperative contralateral symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Radiographic measures included SAP-E angles at L3-L5 in normal individuals and the preoperative L5 SAP-E angle in patients with DLS. The primary clinical outcome was new-onset contralateral symptoms after unilateral open L4/5 TLIF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;SAP-E angles at L3-L5 were measured in normal individuals to evaluate lower lumbar distribution. In patients with DLS, the preoperative L5 SAP-E angle was compared between symptomatic and asymptomatic groups. Measurement reliability was assessed using intraclass correlation coefficients. Repeated-measures analysis of variance, Welch t tests, Fisher exact tests, Firth logistic regression, receiver operating characteristic analyses, and bootstrap internal validation were performed. This study was supported by the Zhejiang Provincial Health Science and Technology Program (financial support amount, USD 100,001-500,000; paid to the institution). The funder had no role in the conduct or reporting of the study. The authors report no study-specific conflicts of interest or associated sources of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In normal individuals, the SAP-E angle decreased from L3 to L5 (125.58±8.62°, 123.13±7.39°, and 118.43±7.28°; p&lt;.001). L5 SAP-E angle was smaller in DLS patients than in controls (109.45±16.05° vs 118.43±7.28°, p&lt;.001). Symptomatic DLS patients had markedly smaller L5 SAP-E angles than asymptomatic patients (77.21±7.80° vs 111.06±14.72°, p&lt;.001). In Firth logistic regression, a smaller L5 SAP-E angle was significantly associated with postoperative contralateral symptoms (odds ratio per 1° increase, 0.89; 95% CI, 0.848-0.924; p&lt;.001). Receiver operating characteristic analysis showed apparent discrimination (area under the curve, 0.961); an exploratory 92.13° cutoff yielded 100.0% sensitivity, 89.3% specificity, 33.3% positive predictive value, and 100.0% negative predictive value.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The SAP-E angle shows a level-dependent decrease in normal lower lumbar spines and is reduced in DLS patients. A smaller preoperative L5 SAP-E angle was associated with contralateral symptoms after unilateral open","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972130","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 surgical planning status on survival, complications, resource utilization, and functional outcomes of metastatic spine tumor surgery: systematic review.","authors":"Ali Haider Bangash, Jayden Boafo, Michelle Lee, Keyvan Ghadimi, Victoria Cao, Alexander Alexandrov, Liza Belman, Sertac Kirnaz, Rose Fluss, Saikiran G Murthy, Yaroslav Gelfand, Reza Yassari, Rafael De la Garza Ramos","doi":"10.1016/j.spinee.2026.09.003","DOIUrl":"10.1016/j.spinee.2026.09.003","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Metastatic spine disease presents complex surgical decision-making challenges, where patients may undergo either planned or unplanned intervention depending on clinical presentation and system-level factors. Unplanned surgery appears to be associated with more advanced disease at presentation, including neurological compromise, yet its impact on short- and long-term outcomes remains incompletely understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To synthesize the available evidence on the association between surgical planning status and outcomes in metastatic spine tumor surgery (MSTS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Systematic review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients managed with MSTS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;We analyzed survival, perioperative complications, resource utilization metrics (length of stay, discharge disposition, healthcare costs), functional recovery, patient-reported outcomes, reoperation rates, and pain-related measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive search was conducted across PubMed/Medline, Cochrane Database of Systematic Reviews, and Epistemonikos from inception to May 14, 2025 for studies reporting outcomes by surgical planning status in MSTS. Surgical planning status was defined as planned (elective) vs unplanned (urgent/emergent) procedures. Study quality was assessed using the Methodological index for nonrandomized studies (MINORS) tool. Short-term outcomes were defined as events occurring within 30 days postoperatively. The impact of surgical planning status on outcomes was systematically synthesized. Meta-analysis feasibility was assessed based on consistency in operational definitions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 1,279 articles, twenty-eight studies comprising 76,291 patients (mean age 62 years, 43% female) met inclusion criteria. The MINORS analysis yielded 79% of studies to be of \"moderate\" methodological quality. Meta-analysis was not undertaken due to substantial heterogeneity in surgical planning definitions, with timing cutoffs ranging from 4 to 48 hours. Patients undergoing unplanned surgery more frequently presented with nonambulatory status (41% vs 6%) and neurological compromise, suggesting more advanced disease at presentation. Unplanned surgery was associated with worse short-term outcomes, including reduced survival (67% of reporting studies) and higher complication rates (57% of reporting studies). However, these differences diminished over time, with only 31% of reporting studies demonstrating long-term survival benefits for planned surgery. Patient-reported outcomes converged beyond three months postoperatively. In contrast, resource utilization consistently favored planned surgery, with prolonged hospitalization reported in 88% of reporting studies and increased costs associated with unplanned procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients requiring unplanned MSTS have worse short-term ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956725","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":"Multifaceted infection prevention protocol is associated with reduced surgical site infection after spinal fusion: a before-and-after study.","authors":"Hyuk-Joon Sohn, Jae Hwan Cho, Dong-Ho Lee, Chang Ju Hwang, Sehan Park","doi":"10.1016/j.spinee.2026.09.005","DOIUrl":"10.1016/j.spinee.2026.09.005","url":null,"abstract":"<p><strong>Background context: </strong>Surgical site infection (SSI) after spinal instrumentation surgery is a serious complication with substantial clinical and economic consequences, and evidence on multifaceted prevention protocols in spine surgery remains limited.</p><p><strong>Purpose: </strong>To evaluate the effectiveness of a multifaceted SSI prevention protocol after spinal fusion surgery.</p><p><strong>Study design: </strong>Retrospective single-center before-and-after intervention study.</p><p><strong>Patient sample: </strong>A total of 631 consecutive patients who underwent spinal instrumentation surgery (NHSN procedure code FUSN) between April 2023 and October 2024 (preintervention, n=377; postintervention, n=254).</p><p><strong>Outcome measures: </strong>Incidence of SSI within 3 months after surgery, defined according to the CDC/NHSN surveillance criteria.</p><p><strong>Methods: </strong>The protocol, implemented in December 2023, comprised (1) universal preoperative povidone-iodine nasal decolonization, (2) chlorhexidine gluconate bathing, (3) enhanced perioperative glycemic control, and (4) reinforced intraoperative aseptic techniques. Demographics, surgical variables, and SSI rates were compared between groups, and multivariate logistic regression was performed.</p><p><strong>Results: </strong>The SSI rate decreased from 2.9% (11/377) to 0.4% (1/254) after implementation (absolute risk reduction 2.5%, 95% confidence interval 0.7%-4.4%; p=.033). Groups were comparable in sex, body mass index, smoking status, normothermia, ASA classification, operative time, NNIS risk index, and number of fused levels, although the postintervention group was younger (median 65.5 vs. 68 years; p=.006). The protocol was an independent protective factor against SSI (Firth-penalized adjusted odds ratio 0.18; 95% confidence interval 0.02-0.76; p=.017).</p><p><strong>Conclusions: </strong>A multifaceted SSI prevention protocol was associated with a significant reduction in SSI after spinal instrumentation surgery, supporting the adoption of standardized, multitarget prevention strategies.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956713","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":"Trends in vertebral augmentation in South Korea (2010-2024): a nationwide population-based study with international comparison.","authors":"Dong-Ju Lim","doi":"10.1016/j.spinee.2026.09.008","DOIUrl":"10.1016/j.spinee.2026.09.008","url":null,"abstract":"<p><strong>Background context: </strong>Vertebral augmentation (VA)-vertebroplasty (VP) and balloon kyphoplasty (BKP)-treats painful osteoporotic vertebral compression fractures refractory to conservative care. After 2009 sham-controlled trials, US VA use declined and shifted toward BKP; long-term Korean trends are less defined.</p><p><strong>Purpose: </strong>To evaluate national VA utilization in South Korea from 2010 through 2024 and compare it with international patterns.</p><p><strong>Study design/setting: </strong>Nationwide serial cross-sectional study of public HIRA aggregate statistics (2010-2024).</p><p><strong>Patient sample: </strong>Annual N0471 (VP) and N0473 (BKP) code-specific patient counts; the 15-year cumulative sum was 643,255. Counts could not be deduplicated across years or procedure categories.</p><p><strong>Outcome measures: </strong>Annual procedure, sex, age, regional, average annual percent change (AAPC), and nominal claim-amount trends.</p><p><strong>Methods: </strong>Descriptive summaries and log-linear regression were used; international comparisons were narrative. Funding was US$0; relevant financial relationships were US$0, and no study-specific conflict-of-interest-associated bias was identified.</p><p><strong>Results: </strong>The national annual count increased from 30,190 to 59,556 (+97.3%; AAPC +4.4%; p<.001). VP rose from 24,165 to 54,364 (AAPC +5.2%; p<.001), and its share increased from 80.0% to 91.3%. BKP ended 13.8% lower (6,025 to 5,192), with a nonsignificant trend (AAPC -0.7%; p=.260). Females comprised 80.6%-82.6% of annual counts. The group aged 80 years or older reached 54.3% of counts in 2024 (AAPC +9.8%; p<.001). Nominal HIRA-adjudicated claim amounts increased from KRW 9.679 billion to KRW 19.041 billion (+96.7%; AAPC +4.6%; p<.001).</p><p><strong>Conclusions: </strong>South Korea showed sustained VP-predominant growth, unlike US practice, and a marked shift toward patients aged 80 years or older, with planning implications in a superaged society.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946044","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":"Cutibacterium acnes in elective spine surgery:a 24-year characterization of treated and untreated culture-positive patients.","authors":"Lukas F Panzenböck, Raphael Scheuer, Matthias Pallamar, Philipp Scheider, Petra Krepler","doi":"10.1016/j.spinee.2026.09.006","DOIUrl":"10.1016/j.spinee.2026.09.006","url":null,"abstract":"<p><strong>Background context: </strong>Cutibacterium acnes is a frequent culture from spinal surgical-site infection (SSI), but as a ubiquitous skin commensal a positive culture is of uncertain significance, and no accepted definition of low-grade spinal implant infection exists.</p><p><strong>Purpose: </strong>To characterize all C. acnes-positive spinal SSI episodes over a 24-year period and to describe how episodes the treating team elected to treat differ from those left untreated.</p><p><strong>Study design / setting: </strong>Retrospective single-center cohort of consecutive elective spinal procedures at a tertiary spine center, 2002-2025.</p><p><strong>Patient sample: </strong>All 164 C. acnes-positive spinal SSI episodes identified by structured manual review of an institutional database (92 treated, 72 untreated). Primary spinal infections were excluded.</p><p><strong>Outcome measures: </strong>Polymicrobial co-isolation, time-to-positivity (TTP), semiquantitative bacterial load, number of C. acnes-positive specimens, peak C-reactive protein (CRP) and white blood cell count (WBC), wound complications, antimicrobial susceptibility and subsequent same-region surgery.</p><p><strong>Methods: </strong>Groups were compared by the Mann-Whitney U and Fisher exact tests. A logistic-regression model with the treatment decision as the outcome, evaluated by leave-one-out cross-validation, described factors associated with treatment.</p><p><strong>Results: </strong>Treated episodes were more often polymicrobial (41.3% vs 6.9%, p<.001), grew faster (TTP 6 vs 9 days, p<.001), more often yielded two or more positive specimens (58% vs 14%, p<.001) and grew at higher load. Peak CRP was higher in treated episodes (90 vs 52 mg/L, p=.012) and wound complications more frequent (40% vs 17%, p=.001). WBC did not differ. Treated episodes were sampled more intensively (3.5 vs 1 cultures, p<.001). Susceptibility to amoxicillin, imipenem, linezolid and vancomycin exceeded 99%. Clindamycin resistance was 3.8%.</p><p><strong>Conclusions: </strong>Treated and untreated episodes differed across every culture-derived measure and in CRP and wound complications, whereas demographics and onset category were similar. Because the treating team's decision drove both the extent of sampling and the treatment itself, these features describe that decision rather than a proven infection status. Polymicrobial growth, a short TTP, more positive specimens and a higher CRP were each independently associated with the decision and remained so when sampling intensity was accounted for. They are candidate features for classifying a C. acnes-positive culture and require prospective validation against an accepted definition of low-grade spinal infection.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956786","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}