Spine Journal最新文献

{"title":"Spilling the tea in Transforming Episode Accountability Model: unanticipated consequences of Medicare's Transforming Episode Accountability Model.","authors":"Jonathan F Gong, Grace X Xiong","doi":"10.1016/j.spinee.2026.03.008","DOIUrl":"10.1016/j.spinee.2026.03.008","url":null,"abstract":"<p><p>The Transforming Episode Accountability Model (TEAM), implemented in January 2026, represents Medicare's most expansive bundled payment model for surgical services, extending mandatory 30-day episode-based accountability to spinal fusion. While prior bundled payment initiatives demonstrated improved efficiency for more standardized procedures such as lower extremity joint replacement, their effects in more heterogenous fields have been mixed. Spine surgery, characterized by substantial variation in pathology, operative strategy, implant utilization, and postoperative care, presents distinct challenges for uniform episode-based reimbursement. This review examines potential unintended consequences of TEAM in spine surgery, drawing on evidence from predecessor bundled payment models. Three domains are emphasized: patient selection, shifts within and across bundles, and site-of-service impacts. As TEAM is implemented, ongoing evaluation will be essential to ensure that bundled payment reform promotes efficiency while preserving equity, clinical discretion, and long-term value in spine care.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655225","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 nomogram prediction model for lumbar disc herniation recurrence after percutaneous endoscopic lumbar discectomy: a multicenter retrospective study.","authors":"Kaiyuan Lin, Junsong Yang, Tuanjiang Liu, Jianmin Wei, Bo Zhang, Lei Chu, Yutong Gu, Haimiti Abudouaini","doi":"10.1016/j.spinee.2026.03.007","DOIUrl":"10.1016/j.spinee.2026.03.007","url":null,"abstract":"<p><strong>Background context: </strong>Recurrent lumbar disc herniation (rLDH) is a common postoperative complication after percutaneous endoscopic lumbar discectomy (PELD), with recurrence rates reported between 5% and 21%. Identifying patients at risk remains a critical clinical need, yet few predictive models exist to guide prevention.</p><p><strong>Purpose: </strong>To develop and externally validate a predictive nomogram model for rLDH following PELD, based on preoperative clinical and imaging parameters.</p><p><strong>Study design/setting: </strong>A multicenter retrospective cohort study using data from 4 hospitals in China.</p><p><strong>Patient sample: </strong>A total of 3,610 patients who underwent PELD for L4-L5 or L5-S1 disc herniation were included. The training cohort comprised 2,436 patients from 2 centers between January 2012 and December 2021. The external validation cohort included 1,174 patients from 2 additional centers between January 2012 and December 2021.</p><p><strong>Outcome measures: </strong>The primary outcome was the occurrence of rLDH, defined as symptom recurrence at the operated level after a pain-free interval of at least 2 weeks. Predictive accuracy was assessed using area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis.</p><p><strong>Methods: </strong>Independent risk factors for rLDH were identified using multivariate logistic regression after variable selection with the Least Absolute Shrinkage and Selection Operator algorithm. A nomogram was constructed based on the final model. Internal validation was performed using bootstrap resampling. External validation was conducted in a separate patient cohort. This study received no external funding. The authors declare that no financial support was obtained for the research, authorship, and/or publication of this article.</p><p><strong>Results: </strong>Younger age (OR per year increase 0.972, 95% CI 0.956-0.988), Modic type I (OR 1.650, 95% CI 1.075-2.607) and type II (OR 5.755, 95% CI 3.702-9.202) changes, smaller multifidus cross-sectional area (OR 0.900, 95% CI 0.864-0.937), excessive lumbar lordosis (OR 1.033, 95% CI 1.019-1.049), and larger facet joint orientation (OR 1.047, 95% CI 1.031-1.064) were independent predictors of rLDH. The nomogram demonstrated good discriminative ability in both the training cohort (AUC=0.755) and validation cohort (AUC=0.831), with satisfactory calibration and clinical utility supported by decision curve analysis.</p><p><strong>Conclusions: </strong>We developed and externally validated a nomogram model to predict rLDH after PELD using readily available preoperative variables. This tool may assist spine surgeons in early risk stratification and tailored postoperative management; however, as this was a retrospective study, prospective validation and inclusion of intraoperative variables are still needed.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595756","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":"Hospital characteristics and episode cost differences between participant and nonparticipant hospitals in Medicare's Transforming Episode Accountability Model (TEAM) bundle payment program.","authors":"Brook I Martin, Sohail K Mirza, Hyunkyu Ko, Brian Karamian","doi":"10.1016/j.spinee.2026.03.006","DOIUrl":"10.1016/j.spinee.2026.03.006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Medicare's Transforming Episode Accountability Model (TEAM) is a mandatory 30-day bundled payment model intended to improve care coordination and cost reduction for specific surgical episodes, including 18 categories of inpatient and hospital outpatient spinal fusion procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare characteristics and episode costs of TEAM participant hospitals to nonparticipants, and to describe variation in hospital-specific episode costs for fusion procedures relative to their regional target prices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Cross sectional analysis of hospital characteristics, and retrospective cohort analysis of episode costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Medicare beneficiaries undergoing fusion procedures from 2016 to 2021 based on TEAM, which excludes 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). To emulate TEAM design, we retained patients with dual eligibility and Social Security Disability Insurance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Thirty-day episode reimbursement for all inpatient, hospital outpatient, skilled nursing, home health agency, provider care (Part B), and durable medical equipment services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The 2023 American Hospital Association (AHA) Annual Survey was linked to Medicare's publicly available list of TEAM hospital participants. Differences in characteristics between TEAM participant and nonparticipant hospitals were reported using t-tests for continuous variables and chi-square for categorical variables. Medicare fee-for-service claims were used to summarize 30-day episode costs for each type of fusion procedure. A generalized linear regression (gamma distribution, log link) with a hospital-specific random effect parameter compared differences in mean episode costs between participant and nonparticipant hospitals, adjusting for fusion type, stratification, patient age, sex, race, year, comorbidity based on grouped total and select Hierarchical Condition Classifications (HCC), dual eligibility, social security disability entitlement, osteoporosis, osteoarthritis, surgical indication, and hospital characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At its launch, TEAM included 726 hospitals, including 10 voluntary participants. TEAM hospitals were significantly larger in terms of bed count, total admissions, Medicare discharges and total expenses, and were more likely to be Level I trauma centers, not-for-profit hospitals, teaching/academic affiliated, and to provide orthopedic services. Relative to nonparticipants, adjusted 30-day episode costs for TEAM participants were $1,590 greater (95%CI $682; $2,500; p=.001) combining all types of inpatient fusion (nonparticipant=$41,289; participant=$42,880). Relative to nonparticipants, TEAM participant co","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464111","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 association between teaching hospital status and postoperative outcomes among adults undergoing long-segment posterior lumbar instrumentation.","authors":"Janesh Karnati, Aydin Kaghazchi, Ahmed Ashraf, Leina Lunasco, Gabriel Jelkin, Shameel Abid, Andrew Wu, Sruthi Ranganathan, Mikayla Wallace, Mir Ashraf, Joseph Cheng, Owoicho Adogwa","doi":"10.1016/j.spinee.2026.03.005","DOIUrl":"10.1016/j.spinee.2026.03.005","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Long-segment lumbar spine fusions (LSLF) are widely performed in the United States to address degenerative conditions, instability, and deformities but carry substantial risks of surgical and medical complications. With demand expected to rise alongside an aging population, understanding factors that influence outcomes is critical. Hospital teaching status may play a role, as academic centers offer multidisciplinary resources and trainee involvement, whereas nonacademic hospitals may prioritize efficiency and patient flow. Prior studies across surgical disciplines, including spine surgery, have reported inconsistent findings, and few have comprehensively examined complication profiles after LSLF. This study evaluates the association between hospital teaching status and surgical, mechanical, and medical complications following LSLF, with readmission risk assessed as an exploratory outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate the association between hospital teaching status and short- and long-term outcomes following long-segment posterior lumbar spine procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective study utilizing the TriNetX Research Network.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients who underwent posterior lumbar instrumentation spanning 3 to 12 vertebral segments for lumbar spinal stenosis, spondylolisthesis, or scoliosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Primary outcomes included surgical complications (wound dehiscence, infection, reoperation) at 30 and 90 days postoperatively. Secondary outcomes assessed medical complications at 30 and 90 days, and pseudoarthrosis or mechanical failure at one and two years postoperatively. Exploratory outcomes were readmission rates at 30 and 90 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The TriNetX Research Network was queried from January 1, 2010, to December 31, 2022. Patients were categorized by academic or nonacademic treatment centers. Propensity score matching was used to control for age, gender, race, and comorbidities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Initially, 39,582 patients (8,506 nonacademic, 31,076 academic) met criteria. Following 1:1 propensity score matching, each cohort consisted of 6,548 patients. No significant difference in surgical complication rates between academic and nonacademic centers was observed at 30 days (OR=0.950, 95% CI [0.823-1.097]) or 90 days (OR=0.971, 95% CI [0.866-1.089]). Medical complication rates were similar at 30 days (OR=1.022, 95% CI [0.897-1.165]) and 90 days (OR=1.015, 95% CI [0.907-1.136]). At one year, patients at nonacademic centers exhibited significantly higher odds of pseudoarthrosis or mechanical failure (OR=1.314, 95% CI [1.213-1.423]), which persisted at two years postoperatively (OR=1.265, 95% CI [1.171-1.367]). Exploratory analyses revealed significantly higher odds of readmission at both 30 days (OR=2.211, 95% CI [2.044-2.390]) and 90 days (OR=1.920, 95% CI [1.781-2.066]) for p","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391475","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 dedicated spine team is more efficient and improves perioperative outcomes in idiopathic scoliosis surgery: a propensity score-matched study.","authors":"Sin Ying Lee, Masayoshi Iwamae, Chee Kidd Chiu, Amanda Weng Yee Leong, Hui Chin Ting, Shinji Takahashi, Hidetomi Terai, Mohd Shahnaz Hasan, Chris Yin Wei Chan, Mun Keong Kwan","doi":"10.1016/j.spinee.2026.03.004","DOIUrl":"10.1016/j.spinee.2026.03.004","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Operating theatre (OT) inefficiency often leads to unnecessary healthcare expenditure. A dedicated spine team (DST) approach may enhance OT efficiency in scoliosis surgeries. However, its adoption remains debatable, as some believe it may require significant investment in training and expertise, pose potential administrative challenges, and question whether the perceived impact on perioperative outcomes justifies these efforts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to evaluate the OT efficiency and perioperative outcomes of the DST approach compared with the nondedicated spine team (NDST) approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;This study initially identified 235 patients with idiopathic scoliosis (IS) who underwent posterior spinal fusion (PSF) using either the DST or NDST approach between 2022 and 2024. Patients were divided into two groups: DST (180 cases) and NDST (55 cases). Following propensity score matching (PSM), 74 patients were included in the final analysis, with 37 cases matched to each group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Primary outcomes included OT efficiency (represented by preoperative time, operative time, postoperative time, and total OT time), total blood loss and salvaged blood volume, perioperative complications, postoperative major Cobb angle, hemoglobin (Hb) level, blood transfusion requirement, postoperative patient-controlled analgesia (PCA) morphine usage, and length of hospital stay. Operative time was subdivided into four stages (Stage 1: exposure, Stage 2: screw insertion, Stage 3: correction and balancing, and Stage 4: corticotomies, bone grafting, and closure).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The DST comprised three senior spine consultants who operated using a dual attending surgeon strategy, supported by a dedicated anesthetic consultant, and a consistent OT team, including orthopedic scrub nurses, anesthetic nurses, radiographers, and neuromonitoring technicians. The NDST comprised one attending surgeon (from the DST), one spine surgery fellow as the second surgeon, as well as anesthetic and OT staff assigned according to the OT roster. The intraoperative team size was identical between the two groups. PSM was performed using nearest-neighbor matching with a match tolerance of 0.05. Multiple linear regression analysis was performed to identify factors influencing the outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Following PSM, 37 cases were included in each group. There were significant differences between the DST and NDST in preoperative time (38.1±4.5 minutes vs. 75.1±19.1 minutes), operative time (138.5±35.1 minutes vs. 206.2±44.4 minutes), and postoperative time (13.8±4.4 minutes vs. 35.0±25.8 minutes) (p&lt;.001). The DST had significantly shorter duration in Stage 1 (exposure), Stage 2 (screw insertion), and Stage 4 (corticotomies, bone grafting, and closure) as compared to the NDST (p","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379284","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":"Predictors of insurance denial with and without prior authorization in patients undergoing spine surgery: A year-long, single-center cohort analysis.","authors":"Long Di, Solomon Jackson, Seth Tigchelaar, Tyler Cardinal, Adam Levy, Adham M Khalafallah, Lauren Tierney, Andrew Sasser, Michael Y Wang, Allan D Levi, Gregory Basil","doi":"10.1016/j.spinee.2026.03.002","DOIUrl":"10.1016/j.spinee.2026.03.002","url":null,"abstract":"<p><strong>Background context: </strong>Insurance prior authorization (PA), initially intended to curb healthcare costs and wasteful spending, has become a growing regulatory barrier to timely spine surgery. Yet, the process of PA and drivers of coverage denials remain elusive.</p><p><strong>Purpose: </strong>We present a one-year review of insurance referrals for spine surgery at a single academic, tertiary care center to identify predictors of PA and ultimately coverage approval and denial.</p><p><strong>Study design: </strong>We retrospectively reviewed 740 adult patients referred for spine surgery between June 2023 and March 2025 at our single academic medical center in Florida.</p><p><strong>Methods: </strong>Data analyzed included demographics, insurance type (private vs. public), insurance provider, clinical severity (eg, myelopathy, cord compression), and authorization outcomes. Univariate and Multivariate statistical analysis identified predictors of denial both with and without PA.</p><p><strong>Results: </strong>Mean patient age was 66.8 years (54% male) with 40.4% of patients having public (Medicare) and 59.6% having private insurance. A majority of patients required PA (499, 67.4%). Of the total cohort, 45 (6.1%) of patients were ultimately denied coverage. Presence of neurologic deficit, myelopathic signs, cord compression or cord signal change on imaging, and prior trial of conservative management did not significantly predict need for PA or insurance coverage. Payor type (public vs. private and type of private insurer) was significantly associated with need for PA and insurance outcome. Need for PA resulted in an average 14-day delay to final insurance decision and 11-day delay to spine surgery compared to patients who did not require PA (p<.001).</p><p><strong>Conclusion: </strong>This single institution study suggests there may be other factors payors consider when making insurance decisions that are not directly tied to traditional clinical indicators of surgical necessity. Public versus private insurance as well as type of payor amongst patients with private insurance appear to be correlated with need for PA and insurance denial. Need for PA does significantly increase time to surgery for patients who must first undergo that process.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373417","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":"Progression of lumbar disc degeneration: a 26-year follow-up study of healthy individuals from childhood to adulthood.","authors":"Teija Lund, Anni Aavikko, Leena Ristolainen, Hannu Kautiainen, Martina Lohman, Dietrich Schlenzka","doi":"10.1016/j.spinee.2026.03.001","DOIUrl":"10.1016/j.spinee.2026.03.001","url":null,"abstract":"<p><strong>Background context: </strong>Imaging signs of disc degeneration (DD) are common in both symptomatic and asymptomatic individuals and increase with age. In adults, DD progression typically peaks before age 50 and is strongly influenced by genetic factors at younger ages. However, longitudinal data describing DD progression from childhood through adulthood remain limited.</p><p><strong>Purpose: </strong>To characterize individual DD progression and examine the relationship between DD and lifetime low back pain (LBP) in a cohort of healthy volunteers followed from childhood into adulthood.</p><p><strong>Study design: </strong>Prospective longitudinal cohort study.</p><p><strong>Patient sample: </strong>Healthy children originally examined at ages 8 (n=94), 11(n=81) and 19 (n=71), with long-term follow-up at age 34 (n=48). The present analysis included 40 individuals with complete data (structured interview, clinical examination, lumbar spine MRI) at all 4 time points.</p><p><strong>Outcome measures: </strong>Annual rate of DD progression, level-specific disc changes, and the association between DD and self-reported lifetime LBP.</p><p><strong>Methods: </strong>Mid-sagittal T2-weighted MR images (L1/L2 to L5/S1) were graded using the 5-level Pfirrmann classification. A Pfirrmann Summary Score (PSS; range 5-25) was calculated as the sum of all lumbar disc grades. DD progression was defined as an increase in PSS compared with the previous assessment. Lifetime LBP unrelated to trauma was assessed through standardized interviews. Generalized Estimating Equation (GEE) models estimated annual changes in PSS. Participants were further categorized according to the presence or absence of at least one lumbar disc graded Pfirrmann ≥ 3 or according to lifetime LBP at age 34. Covariates included sex, BMI, smoking, and physical activity when appropriate.</p><p><strong>Results: </strong>Forty participants completed all 4 assessments. The proportion of participants with at least one disc graded Pfirrmann ≥ 3 increased from 5% at age 8 to 12% at age 11, 48% at age 19 and 72% at age 34. PSS increased significantly over time in all participants. The annual increase in PSS was significantly greater between ages 11 and 19 (0.55; 95% CI: 0.48 to 0.63) than between ages 19 and 34 (0.08; 95% CI: 0.05 to 0.11). Participants reporting lifetime LBP at age 34 had more widespread or severe disc changes at age 19 compared to their asymptomatic peers, independent of covariates.</p><p><strong>Conclusions: </strong>DD progression appears strongly age-dependent, with the pubertal growth spurt representing a period of accelerated structural change. Progression slowed substantially after age 19. In this cohort, more widespread or severe degeneration at age 19 was associated with lifetime LBP at age 34. These findings highlight adolescence as a potentially critical period in the natural history of DD.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366988","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 association of operative versus nonoperative treatment for lumbar spondylolisthesis and stenosis with future metabolic conditions and allostatic burden: an emulated target trial.","authors":"Muhammad Talal Ibrahim, Nicolas Kuttner, Roman J Schoenfeld, Paul Alvarez, Venkat Kavuri, Varun Kumar Singh, Andrew J Schoenfeld, Elizabeth Yu","doi":"10.1016/j.spinee.2026.03.003","DOIUrl":"10.1016/j.spinee.2026.03.003","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar spinal stenosis adversely impacts mobility and function. Persistent lack of exercise and ambulatory capacity may contribute to the development of metabolic conditions.</p><p><strong>Purpose: </strong>To determine the effect of surgical intervention, as compared to non-operative treatment, on the development of metabolic conditions, chronic pain, frailty, and allostatic load (AL).</p><p><strong>Study design: </strong>Retrospective emulation target trial.</p><p><strong>Patient sample: </strong>A total of 2,521,827 patients were included, of which 329,314 (13.1%) underwent surgery.</p><p><strong>Outcome measures: </strong>Development of metabolic conditions, chronic pain, frailty, and allostatic load (AL).</p><p><strong>Methods: </strong>Data was sourced from EPIC COSMOS. We conducted a clone analysis using inverse probability censoring weights and inverse probability of treatment weights that accounted for confounders. Risk ratios (RR) were calculated at 1- and 3-years post-index diagnosis for post-operative metabolic burden and frailty, and at 1 and 2 years for active opioid prescription, using weighted pooled logistic regression. Generalized Estimating Equation was used to determine the mean difference in AL at 1 and 3 years.</p><p><strong>Results: </strong>Surgery within 12 months of index diagnosis demonstrated a significantly lower risk of metabolic burden (1-year RR [95% confidence interval (CI)]: 0.98 [0.98 to 0.98]; 3-year: 0.98 [0.98 to 0.98]) and frailty (1-year: 0.98 [0.98 to 0.99]; 3-year: 0.99 [0.98 to 0.99]). The risk of metabolic burden was lowest if surgery occurred within 6 months (1-year RR [95% CI]: 0.93 [0.93 to 0.94]; 3-year RR [95% CI]: 0.94 [0.94 to 0.95]). No significant difference in AL was noted at 1-year, and the difference was negligible at 3-years. The surgery cohort had a higher risk of active opioid prescription at 1-year (RR [95% CI]: 1.04 [1.04 to 1.04]) and 3-year (RR [95% CI]: 1.19 [1.17 to 1.20]) follow-up.</p><p><strong>Conclusions: </strong>We found that surgical intervention was associated with greater reductions in metabolic burden and frailty up to 3 years following the procedure. We also found evidence of a time-dependent effect such that maximal benefit was appreciated when surgery was performed within 6-months of presentation.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367077","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":"Does age-adjusted pelvic incidence minus lumbar lordosis overcorrection truly increase the risk of proximal junctional failure? A confounder-adjusted multivariate analysis in adult spinal deformity","authors":"Se-Jun Park MD, PhD ,&nbsp;Jin-Sung Park MD, PhD ,&nbsp;Dong-Ho Kang MD ,&nbsp;Chong-Suh Lee MD, PhD","doi":"10.1016/j.spinee.2025.10.033","DOIUrl":"10.1016/j.spinee.2025.10.033","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Correction beyond age-adjusted pelvic incidence minus lumbar lordosis (PI–LL) targets (age-adjusted PI-LL overcorrection) is believed to increase the risk of proximal junctional failure (PJF) in adult spinal deformity (ASD) surgery. However, this association has not been analyzed after adjusting for confounding variables.</div></div><div><h3>PURPOSE</h3><div>To investigate whether age-adjusted PI–LL overcorrection independently increases the risk of PJF after accounting for potential confounders.</div></div><div><h3>STUDY DESIGN</h3><div>Retrospective cohort study using prospectively collected data from a single tertiary spine center.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 177 patients who underwent lower thoracic (T8–T10) to sacropelvic fusion for ASD between 2015 and 2022, with a 2-year follow-up.</div></div><div><h3>OUTCOME MEASURES</h3><div>PJF, defined as structural failure including proximal junctional angle ≥20°, vertebral fracture, fixation failure, myelopathy, or revision surgery.</div></div><div><h3>METHODS</h3><div>Patients were grouped by 6-week postoperative PI–LL status into under-, matched-, and over-correction groups based on age-adjusted PI–LL targets. Unadjusted and confounder-adjusted logistic regression analyses were conducted to evaluate the association between PI–LL correction and PJF. Confounding variables were those predictive of PJF and significantly imbalanced across correction groups.</div></div><div><h3>RESULTS</h3><div>The unadjusted analysis showed a significantly higher PJF incidence in the overcorrection group compared to the matched correction group (47.2% vs 27.1%, p=.004). However, after adjustment, age-adjusted PI–LL correction was no longer associated with PJF risk. Advanced age (odds ratio [OR]=1.075, p=.048), lack of transverse process hook fixation (OR=5.225, p=.001), and high preoperative thoracic kyphosis (OR=1.046, p=.003) were independent risk factors for PJF.</div></div><div><h3>CONCLUSIONS</h3><div>Overcorrection relative to age-adjusted PI-LL target does not independently increase PJF risk when key confounders are considered. Surgeons should focus on individual patient and surgical factors—particularly age, thoracic alignment, and prophylactic strategies—rather than relying solely on PI–LL correction thresholds in ASD surgical planning.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 586-593"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410498","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":"Radiomics-powered radiographic image analysis for enhanced mechanical complications prediction and surgical planning in adult spine deformity","authors":"Ferran Pellisé MD, PhD ,&nbsp;Sleiman Haddad MD, PhD, FRCS ,&nbsp;Susana Núñez-Pereira MD, PhD ,&nbsp;Caglar Yilgor MD ,&nbsp;Anika Pupak PhD ,&nbsp;Manuel Ramírez-Valencia MD ,&nbsp;Javier Pizones MD, PhD ,&nbsp;Ahmet Alanay MD ,&nbsp;Ibrahim Obeid MD ,&nbsp;Frank S. Kleinstueck MD ,&nbsp;Fabio Galbusera PhD ,&nbsp;Oleguer Sagarra PhD ,&nbsp;European Spine Study Group","doi":"10.1016/j.spinee.2025.10.011","DOIUrl":"10.1016/j.spinee.2025.10.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Radiomics, a technique employing machine learning (ML) to extract quantitative features from processed radiographic images, holds promise for improving clinical prediction models. It offers the potential to comprehensively characterize spinal shape and alignment. We hypothesized that processed image (PrIm) algorithms outperform traditional radiographic measurements (TRM) and scores in predicting postoperative mechanical complications (MC) in adult spinal deformity (ASD).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;The aim was to compare the performance of PrIm algorithms to TRM-GAP score in the prediction of MC in ASD patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;An AI-leveraged retrospective analysis was conducted using data from a prospective international multicenter database dedicated to ASD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;The study focused on ASD patients aged 18 or older who were surgically treated and who had a minimum follow-up period of two years, with complete preoperative, 6-week and 2-year follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Major mechanical complications such as rod fractures, pseudarthrosis, or junctional kyphosis or failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Processed full-spine standing radiographic images were analyzed using an automatic vertebral centroid generation algorithm to map posteroanterior (PA) and lateral spinal shape. Distances and angles between each vertebra and the pelvic centroid were automatically obtained. Machine learning models were constructed using Catboost, combining nonradiographic variables (Non-R: demographic, PROMS, surgical), TRM + GAP score, and PrIm features. AUC-ROC, sensitivity, specificity, and Brier score (0= perfectly calibrated / 1=poor) were used to evaluate prediction accuracy. SHapley Additive exPlanations (SHAP) values were employed to assess variable contributions and address overfitting/noise.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 690 patients (81% female, 52±19 years, 9.7±3.9 levels, 18.6% 3CO, 43.5% pelvic fixation, 37.5% MC) were analyzed. The Non-R + PrIm model outperformed the present “Gold Standard” model (Non-R + TRM-GAP): AUC-ROC 0.75 vs 0.71 (p=.009), accuracy 0.72 vs 0.62 (p&lt;.001), specificity 0.79 vs 0.60 (p&lt;.001), sensitivity 0.52 vs 0.70 (p&lt;.001), and Brier score 0.17 vs 0.22 (p&lt;.001). Adding TRM and GAP score to Non-R + PrIm model did not improve model estimates. SHAP adjusted models summed 35 variables and revealed PrIm's superior predictive importance, contributing 65.7% to the model compared to Non-R (Surgical factors 16.1%, PROMS 11.3% and demographics 6.9%). Personalized SHAP decision plots identified the most critical vertebral centroids associated with MC risk both globally and individually.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;Radiomics powered by full-spine processed radiographic images enable the most accurate predictive models for MC in ASD. This novel approac","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 578-585"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276406","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}