Spine Journal最新文献

{"title":"Costs and outcomes of recombinant human bone morphogenetic protein-2 usage in single-level posterior or transforaminal lumbar interbody fusion in a propensity score-matched national, retrospective cohort.","authors":"Austin R Chen, Jacob W McDevitt, Parth N Desai, Cade F Bennett, Andrew Trice Pickens, Theodore A Joaquin, Kranti C Rumalla, Mark A Plantz, Tyler M Compton, Aaron K Hoyt, Matthew W Colman, Wellington K Hsu, Alpesh A Patel, Srikanth N Divi","doi":"10.1016/j.spinee.2026.09.007","DOIUrl":"10.1016/j.spinee.2026.09.007","url":null,"abstract":"<p><strong>Background context: </strong>Recombinant human bone morphogenetic protein-2 (rhBMP-2) is widely used in posterior or transforaminal lumbar interbody fusion (P/TLIF). While rhBMP-2 demonstrates comparable fusion rates to autologous iliac crest bone graft, its high cost brings into question its long-term cost-effectiveness. This question is particularly pertinent in single-level P/TLIF where autologous iliac crest bone graft achieves excellent fusion rates.</p><p><strong>Purpose: </strong>To evaluate the costs associated with and clinical outcomes of rhBMP-2 versus non-rhBMP-2 usage in single-level P/TLIF using a propensity score-matched national sample.</p><p><strong>Study design/setting: </strong>Retrospective propensity score-matched cohort study using the Premier Healthcare claims database (2016-2022).</p><p><strong>Patient sample: </strong>National sample of 9,457 patients who underwent single-level P/TLIF with rhBMP-2 utilization who were one-to-one matched with 9,457 P/TLIF patients without rhBMP-2 based on demographics, Elixhauser comorbidities, and surgical indications.</p><p><strong>Outcome measures: </strong>Primary economic outcomes were index encounter costs by category and 2-year cumulative postdischarge costs. Primary clinical outcomes were 90-day readmission and 2-year revision fusion incidence. Secondary clinical outcomes were 2-year revision decompression incidence, pseudoarthrosis, seroma, infection, and implant complications.</p><p><strong>Methods: </strong>Single-level P/TLIF procedures were identified via billing codes for the procedure. rhBMP-2 usage was identified via identification in the itemized billing for each procedure. Propensity scores were estimated from a multivariate logit model and matched using K-nearest neighbors. Itemized costs were categorized using Premier Healthcare's chargemaster. Survival analysis for clinical outcomes used Kaplan-Meier curves with log-rank test and Cox proportional hazard models. A Bonferroni correction was established of p<.0035714 for 14 total clinical hypotheses tested.</p><p><strong>Results and conclusions: </strong>Total initial encounter costs were 14% higher in the rhBMP-2 group, primarily driven by rhBMP-2 usage ($4,543.51). Ninety-day spine-related readmission rates (1.25% vs. 1.39%, log-rank p=.447), 2-year revision fusion rates (2.7% vs. 3.2%, log-rank p=.055), and 2-year revision decompression rates (0.29% vs. 0.53%, log-rank p=.008) were not statistically significant after Bonferroni correction. Cox proportional hazards modeling also showed no significant protective effect of rhBMP-2 against any adverse outcome after Bonferroni correction. In addition, 2-year cumulative postdischarge costs were not significantly different between groups (p=.558). This may be explained by significantly higher median revision fusion costs in the rhBMP-2 group.</p><p><strong>Conclusions: </strong>These findings suggest broad usage of rhBMP-2 may not be necessary outside of select hig","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":"148956728","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":"Incidental cervical spine stenosis by race and ethnicity among trauma patients: a retrospective cross-sectional clinical study.","authors":"Benoit Kindo, Jacob Welch, David Zurita, Jacob Rumley, David Gemmel, Kene T Ugokwe","doi":"10.1016/j.spinee.2026.09.002","DOIUrl":"10.1016/j.spinee.2026.09.002","url":null,"abstract":"<p><strong>Background: </strong>Congenital cervical spine stenosis is an anatomical narrowing of the cervical spine canal, an aberrant anatomy, which can predispose patients to a wide variety of spinal injuries in undiagnosed individuals, even in the setting of minor trauma. Life-threatening injuries with premature career endings are not uncommon among athletes with undiagnosed congenital cervical stenosis sustaining cervical trauma and are well reported in many news outlets. Unfortunately, no clear consensus regarding diagnostic workup and universal guidelines regarding return to play exist. A similar imbroglio exists overcriteria and parameters used to screen and diagnose the condition, as well as the demographics and epidemiology of congenital cervical spine stenosis due to limited evidence.</p><p><strong>Purpose: </strong>The goal of this retrospective study is to investigate the prevalence of congenital cervical spine stenosis by race.</p><p><strong>Study design: </strong>Large level 1 trauma center retrospective cross-sectional study.</p><p><strong>Patient sample: </strong>A total of 381 trauma patients with unremarkable cervical spine CAT scans from 01/01/2013 to 12/31/2023.</p><p><strong>Outcome measures: </strong>The mid-sagittal canal diameter (SCD) and the interpedicular distance (IPD) were measured from C3-T1 using criteria established by Bajwa, SCD<13 mm and IPD<23 mm as cut points for cervical spine stenosis, with sensitivity and specificity of 88%-100% at each cervical vertebral body.</p><p><strong>Methods: </strong>A total of 797 patients were reported in the registry; 416 met exclusion criteria. Demographic variables, such as age, gender and race, were collected. All patients with a history of cervical spine injury, previous surgeries, and pre-existing anomalies, including lesions, mass, deformity and technical artifact, were excluded. The mid-SCD and the IPD were measured from C3-T1.</p><p><strong>Results: </strong>Three hundred and eighty-one (381) patients met inclusion criteria: 306 (81%) were White, 70 (19%) were Black, 3 (0.78) identified as Asian, and 2 (0.52) were American Indian. In the Asian and American Indian groups, no cervical level met the criteria of stenosis as defined by an SCD<13 mm and IPD<23 mm. For both the White and Black participant groups, C3-C4 was found to have the narrowest canal diameter with an average SCD of 13.57±1.63 and IPD 21.83±1.53. The White participant group prevalence was 15.4% at C3-C4, compared to 21.4% among the Black participant group.</p><p><strong>Conclusions: </strong>This study revealed a high prevalence of congenital cervical stenosis within a trauma population, with a higher prevalence within the Black participant group. Additionally, C3-C4 was found the most commonly affected level, as opposed to previous reports at C5. Providers must remain vigilant for stenosis in at-risk populations.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946093","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":"Introduction to the special issue on Medicare's Transforming Episode Accountability Model: a mandatory bundled payment model that includes spinal fusion.","authors":"Brook I Martin, Grace X Xiong, Christopher M Bono","doi":"10.1016/j.spinee.2026.09.001","DOIUrl":"10.1016/j.spinee.2026.09.001","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946088","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 GLP-1 dose intensity on perioperative and long-term fusion outcomes following ACDF.","authors":"Collin Stirpe, Brandon Lee, Monish Lavu, Idy Ding, Christopher Furey, Christina W Cheng","doi":"10.1016/j.spinee.2026.08.009","DOIUrl":"10.1016/j.spinee.2026.08.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;High-dose glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for obesity management, but their perioperative safety and potential effects on fusion-related outcomes after anterior cervical discectomy and fusion (ACDF) remain unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare short-term postoperative outcomes and longer-term fusion-related outcomes after ACDF among patients receiving high-dose versus standard-dose GLP-1 RA therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective cohort study using the TriNetX Research Network.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Adult patients undergoing ACDF were identified within TriNetX and stratified into 3 pairwise comparison groups: standard-dose GLP-1 RA versus no GLP-1 exposure, high-dose GLP-1 RA versus no GLP-1 exposure, and high-dose versus standard-dose GLP-1 RA use. A total of 112,065 patients met inclusion criteria across all 3 comparisons. In the primary dose-intensity comparison, 921 patients remained in each cohort after 1:1 propensity score matching.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Outcomes included 90-day healthcare utilization (readmission, emergency department visits, outpatient visits, physical therapy utilization), 90-day medical and acute postoperative complications, 90-day opioid exposure, and long-term fusion-related outcomes from 180 to 720 days, including pseudarthrosis and posterior cervical fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were queried on March 9, 2026. Adults undergoing ACDF were identified and stratified by preoperative GLP-1 RA dose intensity. Exposure was defined by recorded GLP-1 RA prescription strength from 1 year to 1 week before the index ACDF procedure. Separate 1:1 propensity score matching was performed for each pairwise comparison. Outcomes were evaluated at 1-90 days for healthcare utilization, short-term complications, and opioid exposure, and at 180-720 days for long-term fusion-related outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the primary high-dose versus standard-dose comparison, 90-day healthcare utilization was similar, including readmission (11.4% vs. 10.0%; p=.327), emergency department visits (11.4% vs. 12.3%; p=.564), outpatient visits (49.8% vs. 52.1%; p=.328), and physical therapy utilization (42.0% vs. 44.0%; p=.397). Short-term complications were also similar, including composite medical complications (9.6% vs. 8.9%; p=.629), dysphagia (10.6% vs. 11.2%; p=.709), hematoma (6.8% vs. 6.3%; p=.638), dysphonia (1.8% vs. 1.6%; p=.721), and acute respiratory failure (2.3% vs. 1.7%; p=.406). Opioid exposure did not differ between cohorts (85.2% vs. 83.1%; p=.202). Long-term outcomes were likewise similar, including pseudarthrosis (4.0% vs. 3.8%; p=.822) and posterior cervical fusion (3.0% vs. 3.7%; p=.398). Compared with matched nonusers, both standard-dose and high-dose GLP-1 RA users had lower pseudarthrosis rates, although no additional long-term benefit was o","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907733","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":"Risk factors for cervical hematoma requiring surgical evacuation after anterior cervical discectomy and fusion and cervical disc replacement: a retrospective analysis of 6,084 cases.","authors":"Gregory S Kazarian, Jung K Mok, Mihir Dekhne, Stephane Owusu-Sarpong, Takashi Hirase, James Farmer, Russel C Huang, Han Jo Kim, Sravisht Iyer, James E Dowdell, Todd J Albert, Ellen M Soffin, James D Beckman, Oliver P F Panzer, Douglas S Wetmore, Sheeraz A Qureshi, Kyle W Morse","doi":"10.1016/j.spinee.2026.08.014","DOIUrl":"10.1016/j.spinee.2026.08.014","url":null,"abstract":"<p><strong>Background context: </strong>Postoperative cervical hematoma requiring surgical evacuation after anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) is rare but life-threatening. Data on incidence and risk factors is limited, inconsistent, and largely derived from heterogeneous administrative databases.</p><p><strong>Purpose: </strong>To characterize the incidence and independent risk factors for postoperative cervical hematoma in a large single-institution consecutive series, as well as to evaluate the roles of Ear/Nose/Throat surgeon (ENT) involvement and drain use/type.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>A total of 6,084 consecutive ACDF/CDR patients at a single academic institution.</p><p><strong>Outcome measures: </strong>Cervical hematoma requiring surgical evacuation.</p><p><strong>Methods: </strong>Univariate and multivariable logistic regression, 1:1 propensity score matching without replacement to assess the impact of ENT involvement and drain type.</p><p><strong>Results: </strong>Incidence was 0.41% (25/6,084). On univariate analysis, male sex (80.0% vs. 56.6%, p=.024), clotting disorder (OR 3.78, p=.017), postoperative antihypertensive use (OR 2.36, p=.042), and ≥4 surgical levels (OR 4.19, p=.022) were associated with increased risk. On multivariable analysis, male sex (aOR 2.99, p=.029) and ≥4 surgical levels (aOR 3.20, p=.037) were independent predictors. Surgical approach by ENT showed no association after propensity matching (OR 1.00, p=1.000). Penrose drains were associated with higher rates than closed-suction drains (OR 6.08, p=.001) or no drain (OR 9.15, p<.001).</p><p><strong>Conclusions: </strong>Cervical hematoma after ACDF/CDR occurred in 0.41% of cases and was independently predicted by male sex and ≥4 surgical levels. ENT approach did not affect risk after matching. Penrose drains were associated with higher hematoma rates than closed-suction or no drain. These findings inform perioperative risk stratification and surgical decision-making.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892828","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":"Return to sport and functional outcomes following spine surgery in hockey players: a scoping review.","authors":"Kenneth T Nguyen, Siddharth Patel, Sydney Pattison, Kento Yamanouchi, Venu M Nemani, Philip K Louie, Aiyush Bansal, Kari Odland","doi":"10.1016/j.spinee.2026.08.005","DOIUrl":"10.1016/j.spinee.2026.08.005","url":null,"abstract":"<p><strong>Background context: </strong>Ice hockey is a high-velocity collision sport associated with substantial axial loading, repetitive flexion-extension, and rotational forces across the spinal column, making spine injuries that require surgical intervention potentially career-altering. Despite this, hockey-specific postoperative outcome data remain fragmented and are often extrapolated from mixed-sport cohorts.</p><p><strong>Purpose: </strong>To synthesize available literature evaluating return-to-sport rates, timing of return, functional recovery, performance outcomes, and career durability following spine surgery in ice hockey players.</p><p><strong>Study design: </strong>Scoping Review.</p><p><strong>Patient sample: </strong>Electronic database searches identified studies reporting postoperative outcomes following spine surgery in hockey athletes.</p><p><strong>Outcome measures: </strong>Extracted variables included: return-to-sport rates, time to return, performance outcomes, functional recovery metrics, surgical characteristics, complications, and career longevity.</p><p><strong>Methods: </strong>PRISMA guidelines to synthesize available literature.</p><p><strong>Results: </strong>Among 441 hockey athletes, return-to-sport rates following spine surgery ranged from 75% to 90% across cervical and lumbar procedures. Lumbar microdiscectomy permitted earlier return compared with fusion procedures, whereas anterior cervical discectomy and fusion demonstrated return timelines approaching 9-12 months. Despite high return participation rates, several studies demonstrated postoperative declines in games played, scoring productivity, and performance indices. Career longevity following lumbar pathology averaged approximately 3-4 years, while cervical-specific longevity data remain limited, with mixed-sport cohorts suggesting similar durations.</p><p><strong>Conclusion: </strong>Overall, available evidence suggests that lumbar and cervical spine surgery can permit return to hockey participation in a majority of athletes; however, existing data are predominantly retrospective and frequently derived from mixed-sport cohorts. Performance decline and variable recovery timelines are commonly observed, and standardized criteria guiding return-to-play clearance, particularly following spinal fusion, are poorly defined and inconsistently reported. Prospective, sport-specific investigations incorporating standardized functional, radiographic, and performance metrics are needed to better guide surgical decision-making and postoperative rehabilitation.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892834","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":"Evaluation of 2D and 3D measurements of cervical sarcopenia and outcomes in patients with acute type II odontoid fractures: a single-institution retrospective cohort analysis.","authors":"Joshua L Golubovsky, Akshath Rajan, Elie Massaad, Ben J Gu, George A Crabill, Yohannes Ghenbot, John D Arena, Dmitriy Petrov, Zarina S Ali, Ali K Ozturk, John H Shin, James M Schuster, Berje Shammassian","doi":"10.1016/j.spinee.2026.08.003","DOIUrl":"10.1016/j.spinee.2026.08.003","url":null,"abstract":"<p><strong>Background context: </strong>Due to an aging population, incidences of Anderson Type 2 Odontoid fractures (T2OF), a type of spinal fragility fracture, are increasing. Elderly populations have high rates of sarcopenia, an age-related condition characterized by loss of muscle mass and function, which has been tied to outcomes after spine surgery and has been related to worse functional status and worse fracture healing.</p><p><strong>Purpose: </strong>No prior studies have explored the relationship between cervical sarcopenia and outcomes following T2OF, which may aid with surgical decision-making in this complex patient population.</p><p><strong>Study design: </strong>This study was a retrospective single-center cohort analysis.</p><p><strong>Patient sample: </strong>Adult patients presenting with acute T2OF after trauma from 2013 to 2025 were included.</p><p><strong>Outcome measures: </strong>Demographics, comorbidities, surgical data, and clinical outcome and imaging data were collected. Cervical skeletal muscle measurements were performed both 2-dimensionally at the C3 level, which was then converted to lumbar skeletal muscle index and then stratified as sarcopenic or nonsarcopenic, and 3-dimentionally via skeletal volume measurements from the top of C1 to the bottom of C7 (cSMV).</p><p><strong>Methods: </strong>Univariable analyses were performed using χ² or Fisher exact tests for categorical variables and analysis of variance or Kruskal-Wallis tests for continuous variables, and multivariable outcomes were assessed using Cox proportional hazards regression models and survival functions by the Kaplan-Meier method.</p><p><strong>Results: </strong>Sarcopenic patients were significantly older, more likely to be female, had lower BMI, were more likely to have T2OF from a fall, and had significantly lower cSMV. Patients with sarcopenia and lower cSMV were less likely to fail nonoperative management, and we did not detect an association between sarcopenia and cSMV and 1-year mortality.</p><p><strong>Conclusions: </strong>Sarcopenia and cSMV both seem to carry valuable prognostic information regarding success of nonoperative management of T2OF, encoding information about patient frailty and functional status beyond age and comorbidity burden. This warrants further exploration in larger multicenter cohorts.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889218","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":"Erector spinae plane block in lumbar spine surgery: dual network meta-analysis of comparative effectiveness and delivery modality.","authors":"Eslam Abourisha, Tanmay Jitendra Talavia, Leicester Spine Group, Sheweidin Aziz","doi":"10.1016/j.spinee.2026.08.015","DOIUrl":"10.1016/j.spinee.2026.08.015","url":null,"abstract":"<p><strong>Background: </strong>Erector spinae plane block (ESPB) is increasingly used to improve perioperative analgesia after lumbar spine surgery, but its comparative effectiveness vs alternative strategies and different delivery modalities remains uncertain.</p><p><strong>Purpose: </strong>To compare ESPB with analgesic comparators evaluated in eligible ESPB-containing studies and to assess whether analgesic efficacy differs by ESPB delivery modality.</p><p><strong>Study design: </strong>Systematic review and dual network meta-analysis.</p><p><strong>Patient sample: </strong>Adults undergoing lumbar spine surgery receiving ESPB, modified thoracolumbar interfascial plane block (mTLIP), wound infiltration, sham ESPB, or control/usual care.</p><p><strong>Outcome measures: </strong>Primary outcomes were 0 to 24 h opioid consumption (intravenous morphine equivalents), 24 h postoperative pain scores, and postoperative nausea/vomiting (PONV); secondary comparisons evaluated ultrasound-guided, fluoroscopy-guided, and freehand ESPB techniques.</p><p><strong>Methods: </strong>Electronic databases were searched for eligible trials and two complementary network meta-analyses were performed: a treatment-comparison network including ESPB, mTLIP, wound infiltration, sham, and control, and a modality-comparison network contrasting ultrasound-guided, fluoroscopy-guided, and freehand ESPB with sham, wound infiltration, and control. Random-effects models generated comparative treatment effects alongside frequentist network estimates and Bayesian ranking metrics.</p><p><strong>Results: </strong>ESPB reduced 0 to 24 h opioid consumption vs control/usual care and was superior to wound infiltration and sham. Modified thoracolumbar interfascial plane block (mTLIP) often ranked highest for opioid sparing, although inferences were limited by sparse direct evidence. ESPB showed favorable effects on 24 h pain and reduced PONV vs control, with no clear differences vs mTLIP or sham for PONV. Modality analyses indicated broadly similar reductions in opioid use and pain with ultrasound- and fluoroscopy-guided ESPB.</p><p><strong>Conclusions: </strong>ESPB is an effective opioid-sparing adjunct after lumbar spine surgery and appears superior to sham and wound infiltration for several outcomes, while apparent advantages of mTLIP require cautious interpretation; ultrasound- and fluoroscopy-guided ESPB demonstrate comparable analgesic performance, supporting modality choice based on local expertise and resources.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889249","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":"3D-printed guides, navigation, and robotic assistance in spinal instrumentation: a network meta-analysis of pedicle screw accuracy and clinical outcomes.","authors":"Shehab Eid, Navid Ghaderi, Robert Koucheki, Dharsan Ravindran, Stephen Lewis, Albert Yee, Han Jo Kim, Jay Toor, Aazad Abbas","doi":"10.1016/j.spinee.2026.08.010","DOIUrl":"10.1016/j.spinee.2026.08.010","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Accurate pedicle screw placement is essential to prevent neurovascular injury, revision surgery, and excess healthcare costs. While navigation and robotic systems enhance accuracy over freehand or fluoroscopic techniques, they remain limited by high cost and patient radiation exposure. Three-dimensional printed (3DP) patient-specific guides offer comparable accuracy with potentially reduced intraoperative time and radiation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the accuracy, safety, and operative efficiency of 3DP- guides (3DPG) with navigation (NAV) and robotic-assisted (RA) platforms for pedicle screw placement using network meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review and network meta-analysis of published clinical studies (randomized control studies, prospective and retrospective cohort studies).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A total of 133 studies encompassing 15,946 adults (aged 18+) undergoing pedicle screw placement were included. PHYSIOLOGIC OUTCOME MEASURES: pedicle screw breach rates, estimated blood loss, operative time, radiation exposure, and complications. FUNCTIONAL OUTCOME MEASURES: postoperative pain (Visual Analog Scale) and functional outcomes (Oswestry Disability Index).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search of PubMed, MEDLINE, Embase and Cochrane was performed on September 27, 2025, comparing 3D-printed guides, computer navigation systems, and robotic-assisted platforms against conventional techniques (freehand or fluoroscopy-guided). Primary outcomes included pedicle screw breach rates, total operative time, estimated blood loss, overall and neurological complications, and pain and functionality scores. Binary outcomes were pooled as odds ratios (ORs) and continuous outcomes as mean differences (MDs), each with 95% confidence intervals. Radiation exposure, reported using heterogeneous metrics, was synthesized as ratios of means (RoM). Random-effects models were used throughout to account for between-study heterogeneity, with statistical significance set at p&lt;.05. Risk of bias was assessed using ROBINS-I and RoB.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared with conventional techniques, 3DPG achieved the lowest overall breach risk (OR 0.21, 95% CI: 0.16-0.28, p&lt;.001) and outperformed both RA and NAV. All advanced methods reduced odds of a major breach compared to the conventional method with no differences between them (p&gt;.2). 3DPG placement produced the lowest blood loss (mean difference (MD) -79.6 mL, 95% CI: -101.1, -58.1, p&lt;.001). Operative time was shortest with 3DPG with RA (+32.4 min, 95% CI: 28.3-36.5, p&lt;.001) and NAV (+34.8 min, 95% CI: 30.5-39.1, p&lt;.001) procedures taking significantly longer than 3DPG. Moreover, patient radiation exposure was significantly reduced compared to NAV and RA (ROM 0.21, 95% CI: 0.08-0.50, p&lt;.01 and ROM 0.35, 95% CI: 0.15-0.82, p&lt;.05, respectively). No significant differences were observed in postoperative ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882438","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":"Longitudinal trends in U.S. Medicare physician reimbursement for common lumbar spine surgery CPT codes: a systematic review.","authors":"Amaar Alwani, Ramana Kolady, Paul G Mastrokostas, Afshin E Razi, Daniel R Fassett, Andrew P Alvarez, Nicholas U Ahn, Arya G Varthi, Alan S Hilibrand, Christopher K Kepler, Gregory D Schroeder, Alexander R Vaccaro, Mitchell K Ng","doi":"10.1016/j.spinee.2026.08.008","DOIUrl":"10.1016/j.spinee.2026.08.008","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Medicare physician reimbursement, even while adjusting for inflation, for lumbar spine surgery has decreased over the past two decades. No systematic review has measured these declines or separated out their differences by procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This review's main question asked how inflation-adjusted U.S. Medicare physician reimbursement for common lumbar spine surgery CPT codes changed over time. Secondary questions explored how these changes differed across procedure categories and their relationship to surgical volume.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Systematic review following PRISMA 2020 guidelines. The protocol was put together prior to beginning the search but was not registered; no quantitative meta-analysis was performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Eleven retrospective studies (published between 2018 and 2026) were selected. These studies looked at Medicare physician reimbursement for lumbar spine surgery from 2000 to 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary variable this review was focused on was the Compound Annual Growth Rate (CAGR) of Medicare physician reimbursement adjusted for inflation. Secondary outcomes were nominal reimbursement, work relative value unit trends, and procedure volume.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched PubMed/MEDLINE, Scopus, and Web of Science from January 2014 to March 2026. Supplemental citation chaining was also done on included studies. Studies were eligible if they reported Medicare physician reimbursement for at least one of 15 lumbar CPT codes (6 decompression, 5 fusion, 4 instrumentation), with at least 3 years of data including one year inside our required range. Risk of bias was measured using the JBI Critical Appraisal Checklist with two review-specific items. Findings were combined as a narrative synthesis. We verified reported estimates by directly analyzing Physician Fee Schedule payment data for all 15 codes (2017-2025). This review received no specific grant funding. Records were screened in duplicate by two independent reviewers. No investigational drug or device was evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The 11 included studies used data from Physician Fee Schedule look-up tools (n=5), Medicare claims (n=5), and a surgical registry (n=1). Six studies were rated low risk of bias, four moderate, and one high. The median study-level CAGR was -2.00% per year (interquartile range, -2.62% to -1.27%; range, +0.38% to -2.77%). Cumulative declines approached 33% over two decades. In our fee schedule analysis, inflation-adjusted payment for all 15 codes declined from 2017 to 2025, showing a median regression slope of -4.62% per year, with every 95% confidence interval remaining below zero. Decompression codes declined most sharply on average. Among fusion codes, anterior lumbar interbody fusion declined the most (CAGR -2.26% to -2.47%), while posterior lumbar interbody fusion was essentially stable (C","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882410","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}