Spine Journal最新文献

{"title":"MRI-defined erector spinae fatty infiltration predicts progression of sagittal spinal malalignment: a population-based longitudinal cohort study.","authors":"Keiji Nagata, Hiroshi Hashizume, Shizumasa Murata, Yoshiki Asai, Hiroyuki Oka, Shigeyuki Muraki, Masatoshi Teraguchi, Hiroki Iwahashi, Takahide Sasaki, Toshiko Iidaka, Munehito Yoshida, Sakae Tanaka, Noriko Yoshimura, Hiroshi Yamada","doi":"10.1016/j.spinee.2026.08.006","DOIUrl":"10.1016/j.spinee.2026.08.006","url":null,"abstract":"<p><strong>Background context: </strong>Sagittal malalignment in adult spinal deformity (ASD) is associated with disability and reduced quality of life. Although paraspinal muscle degeneration has been implicated in spinal alignment changes, longitudinal predictors of ASD progression remain unclear.</p><p><strong>Purpose: </strong>To determine whether MRI-defined erector spinae fatty infiltration and pelvic tilt (PT) predict sagittal malalignment progression in a population-based cohort.</p><p><strong>Study design/setting: </strong>Prospective longitudinal cohort study.</p><p><strong>Patient sample: </strong>A total of 533 community-dwelling adults from the Wakayama Spine Study with baseline whole-spine MRI and 6-year radiographic follow-up.</p><p><strong>Outcome measures: </strong>Progression of sagittal malalignment defined as an increase in C7 sagittal vertical axis (SVA)≥50 mm over 6 years.</p><p><strong>Methods: </strong>Fatty infiltration ratio (FIR) of the erector spinae and multifidus was quantified on MRI. Multivariable logistic regression models were constructed, adjusting for age, sex, body mass index, and baseline C7 SVA. FIR was expressed per 5% increase to improve clinical interpretability.</p><p><strong>Results: </strong>Sagittal malalignment progression occurred in 56 participants (10.5%). In univariable analysis, baseline C7 SVA did not differ significantly between groups, whereas PT was significantly higher in the progression group. In multivariable models, PT independently predicted progression (odds ratio [OR] 1.13 per 1° increase, 95% confidence interval [CI] 1.08-1.18, p<.001). Fatty infiltration of the erector spinae at T12/L1 was also an independent predictor (OR 2.01 per 5% increase, 95% CI 1.40-3.05, p<.001), whereas multifidus fatty infiltration was not statistically significant after adjustment. Baseline C7 SVA was inversely associated with progression (OR 0.82 per 10 mm increase, 95% CI 0.81-1.00, p=.0085). In model discrimination analysis, the AUC improved from 0.700 in the base model to 0.806 after adding PT and erector spinae FIR.</p><p><strong>Conclusions: </strong>MRI-defined fatty infiltration of the erector spinae was independently associated with sagittal malalignment progression in the general population. Increased PT and lower baseline SVA may reflect a compensated state prone to subsequent decompensation. These findings highlight the importance of early identification of latent sagittal imbalance and suggest that paraspinal muscle quality may serve as a target for preventive strategies in ASD.</p>","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":"148882403","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":"Epidemiology and mechanisms of cervical spine injuries caused by nontraditional vehicles in the united states: an analysis of national emergency department data.","authors":"Hagop Klachian, Abhishek Srivastava, Rami Taha, Jenna Taha, Madison McDonald, Michael Megafu, Andrew Hecht, James Lin, Robert L Parisien","doi":"10.1016/j.spinee.2026.08.007","DOIUrl":"10.1016/j.spinee.2026.08.007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Cervical spine injuries related to nontraditional modes of transportation represent an emerging source of morbidity in the United States, particularly among younger populations. Although cervical spine trauma has been extensively studied in traditional motor vehicle crashes, epidemiologic data regarding injuries associated with nontraditional vehicles remain limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To characterize the epidemiology, mechanisms, demographics, and temporal trends of cervical spine injuries associated with nontraditional vehicles presenting to United States emergency departments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Descriptive epidemiological study utilizing the National Electronic Injury Surveillance System (NEISS), a nationally representative database of emergency department visits in the United States.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A total of 1,410 sampled NEISS records representing approximately 66,750 estimated emergency department visits for cervical spine injuries associated with nontraditional vehicles between January 1, 2015, and December 31, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Primary outcomes included injury diagnosis, mechanism of injury, patient demographics, vehicle type, injury location, disposition, and temporal trends in annual injury estimates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The NEISS database was queried for cervical spine injuries occurring between 2015 and 2024. Cases were identified using the neck body-part code and relevant diagnosis codes in combination with product codes for all-terrain vehicles (ATVs), dirt bikes, electric bicycles, go-carts, mopeds, minibikes, power-assisted cycles, and utility vehicles. Injury narratives were reviewed to confirm cervical spine involvement and classify mechanisms. National estimates and weighted percentages were calculated by summing the sampling weights provided for eligible NEISS records. No funds were received in support of this work ($0), and no study-specific conflicts of interest were identified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The 1,410 sampled NEISS records represented approximately 66,750 estimated emergency department visits nationally. Cervical strain or sprain was the most common diagnosis (45.7% of the weighted national estimate), followed by cervical fracture (21.4%). Males accounted for 62.4% of the weighted estimate. Four-wheel off-road ATVs were the most frequently involved vehicle type (30.6%), followed by two-wheeled powered off-road vehicles (17.7%). Patients aged 11 to 20 years represented the largest age group (25.7%). Weighted annual estimates increased significantly during the study period, with an average increase of 564 visits per year (p=.011). Noncontact mechanisms, including loss of control, rollover events, and falls from vehicles, predominated across age and sex groups. Most estimated visits resulted in treatment and release from the emergency department (76.0%).&lt;/p&gt;&lt;p&gt;&lt;stro","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876398","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 recovery: long-term multidomain disability and the satisfaction paradox in cauda equina syndrome.","authors":"Elie Najjar, Michael Walsh, Shahbaz Khan, Alice Carlin, Michelle Emsley, Rawan Masarwa, Daniel D'Aquino, Khalid Salem, Nasir Quraishi, Michael Grevitt","doi":"10.1016/j.spinee.2026.08.012","DOIUrl":"10.1016/j.spinee.2026.08.012","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Long-term outcomes after cauda equina syndrome (CES) are commonly reported using isolated endpoints such as bladder recovery, which may underestimate the true burden of disease. CES affects multiple functional domains, yet its cumulative long-term impact remains poorly characterised.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate long-term outcomes after CES using a multidomain framework, quantify cumulative functional burden, examine discordance between residual deficits and patient-perceived recovery, and identify factors associated with adverse outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective cohort study with prospective long-term follow-up conducted at a tertiary spinal referral centre.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Seventy-two patients with degenerative CES confirmed by multidisciplinary team consensus and clinical-radiological correlation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Long-term patient-reported outcomes across seven domains: bladder, bowel, sexual function, mobility, pain, mental health, and activities of daily living. An unweighted multidomain burden score was constructed from 0 to 7, with extensive burden defined as four or more affected domains. Global outcomes included perceived symptomatic improvement, satisfaction, and willingness to undergo surgery again.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with confirmed degenerative CES were identified from a tertiary spinal centre cohort and contacted for structured long-term follow-up. Outcomes were assessed using a domain-based patient-reported questionnaire. Residual dysfunction was recorded across seven functional domains and combined into a multidomain burden score. Comparative analyses were performed between clinically relevant subgroups, including CES-retention vs CES-incomplete status and presence vs absence of persistent bladder dysfunction. Exploratory regression analyses were performed to identify predictors of high multidomain burden and persistent bladder dysfunction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seventy-two patients were included, with a mean age of 49.3±14.8 years and median follow-up of 5.2 years (IQR: 2.9-7.2). Residual dysfunction was common: bladder dysfunction persisted in 51.4%, bowel dysfunction in 37.5%, sexual dysfunction in 54.2%, and mobility limitation in 58.3%. Overall, 90.3% of patients had impairment in at least one domain, 72.2% in three or more domains, and 61.1% demonstrated extensive multidomain burden. Despite this, 79.2% reported symptomatic improvement, 86.1% would choose surgery again, and 70.8% reported high satisfaction, demonstrating discordance between persistent deficits and perceived benefit. Persistent bladder dysfunction was associated with more extensive multidomain burden compared with no bladder dysfunction (5.65±1.32 vs 2.37±1.75, p&lt;.001) and greater functional limitation. CES-retention vs CES-incomplete status did not significantly differentiate long-term outcome","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876419","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":"Unsupervised identification of population clusters with distinct low back pain profiles.","authors":"Francisco Andrés Fernández Schlein, María-Jesús Lira Salas, José-Miguel Lira Salas, Mauricio Campos Daziano","doi":"10.1016/j.spinee.2026.08.004","DOIUrl":"10.1016/j.spinee.2026.08.004","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Low back pain (LBP) is a leading cause of disability worldwide, yet population-level stratification of LBP risk remains limited. Unsupervised machine learning offers a data-driven approach to identify latent subgroups with distinct biopsychosocial profiles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To identify population groups within a nationally representative survey using machine learning-based clustering algorithms and describe their LBP prevalence and associated factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Cross-sectional secondary analysis of the Chilean National Health Survey 2016-2017 (ENS 2016-2017).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A total of 6,233 individuals aged 15 years and older completed the main forms, and 5,520 of these individuals also completed laboratory measurements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Weighted means and prevalence of LBP, sociodemographic characteristics, psychosocial factors (depression suspicion), and clinical biomarkers (metabolic, cardiovascular, and musculoskeletal profiles). Feature importance was assessed to determine the primary drivers of cluster assignment and LBP risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A machine learning pipeline was applied, using the K-prototypes clustering algorithm for mixed-type variables. The optimal number of clusters was determined using the elbow method and silhouette score. Cluster interpretability and feature importance were assessed using SHAP (SHapley Additive explanations) values analysis. Weighted prevalence estimates and descriptive comparisons were calculated across clusters using survey expansion factors. One-way ANOVA and Chi-square tests were conducted to identify differences among clusters (p=.05), and Odds Ratios (ORs) were calculated and adjusted for age and sex.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three clusters emerged: (A) healthy young adults, (B) middle-aged adults with higher depressive symptom burden, and (C) socioeconomically disadvantaged older adults with multimorbidity. Cluster B exhibited the highest weighted prevalence of LBP (26.86%; 95% confidence interval [CI], 24.77 to 29.06), followed by Cluster C (24.38%; 95% CI, 22.32 to 26.56) and Cluster A (10.78%; 95% CI, 9.72 to 11.93) (p&lt;.001). Pain intensity (mean [SD], 7.1 (1.97); 95% CI, 6.97 to 7.23) and depressive symptoms (37.48%, 95% CI, 35.03 to 40.00) were key differentiators for Cluster B, while Cluster C showed increased cardiometabolic risk (High CV risk, 60.53%; 95% CI, 57.41 to 63.57), the longest pain exposure (103.74 months [191.89]; 95% CI, 89.64 to 117.84) and highest multisite pain burden (2.47 sites [1.61]; 95% CI 2.34 to 2.60).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Unsupervised learning identified distinct subgroups within the population with heterogeneous LBP patterns. These findings contribute to a stratified understanding of population-level patterns of low back pain, highlighting the relevance of psychosocial and metabolic factors.&lt;/","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876396","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":"Familial risks of hospital-treated spinal stenosis in first-, second-, and third-degree relatives: a nationwide family study.","authors":"Christian Anker-Hansen, MirNabi Pirouzifard, Jan Sundquist, Kristina Sundquist, Bengt Zöller","doi":"10.1016/j.spinee.2026.08.017","DOIUrl":"10.1016/j.spinee.2026.08.017","url":null,"abstract":"<p><strong>Background context: </strong>Spinal stenosis (SS) has a multifactorial background.</p><p><strong>Purpose: </strong>This nationwide study aimed to determine the familial risks of hospital-treated SS in first-, second-, and third-degree relatives in Sweden.</p><p><strong>Study design: </strong>The Swedish Multigeneration Register was linked to the National Patient Register to investigate the heredity of hospital-treated SS between 1997 and 2018.</p><p><strong>Patient sample: </strong>Offspring born to Swedish-born parents were included.</p><p><strong>Outcome measures: </strong>Familial hazard ratios for SS were calculated for relatives of individuals who had a diagnosis of SS compared with relatives of individuals unaffected by SS as the reference group. The adjusted familial hazard ratios with 95% confidence interval (CI) were determined for SS among pairs of twins, full-siblings, half-siblings, and cousins.</p><p><strong>Methods: </strong>Adjustments were made for birth year, sex, education, occupation, and comorbidities, including amyloidosis.</p><p><strong>Results: </strong>A total of 6,548,565 individuals (48.77% women) were included with a mean age of 41 years (range 0-87 years) at the end of follow-up. A total of 36,958 (0.56%) individuals were affected with hospital-treated SS. The afHR for SS were for twins 5.12 (95% CI 3.33-7.89), siblings 2.47 (95% CI 2.35-2.60), half-siblings 1.49 (95% CI 1.28-1.73), and cousins 1.10 (95% CI 0.85-1.43). Among full-siblings, adjusted familial hazard ratios were 5.38 (95% CI 2.02-14.33) for cervical SS and 3.01 (95% CI 2.69-3.67) for lumbar SS. A total of 0.27% SS patients had amyloidosis. Patients with amyloidosis had an adjusted hazard ratio of 2.03 (95% CI 1.67-2.48) for SS.</p><p><strong>Conclusions: </strong>Heredity is associated with higher risk of hospital-treated SS in the Swedish population.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876427","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":"Analysis of commercially negotiated hospital prices for spinal deformity surgery in the United States.","authors":"Jonathan Wang, Rodrigo Saad Berreta, Eric Mao, Ge Bai, Amit Jain","doi":"10.1016/j.spinee.2026.08.016","DOIUrl":"10.1016/j.spinee.2026.08.016","url":null,"abstract":"<p><strong>Background context: </strong>Spinal deformity surgery is among the most resource-intensive inpatient procedures in the United States. Despite increased transparency in commercial pricing, the structural drivers of cost variation for complex spine surgery remain unclear.</p><p><strong>Purpose: </strong>To characterize hospital-, market-, and community-level factors associated with variation in commercially negotiated prices for thoracolumbar spinal deformity surgery.</p><p><strong>Study design/setting: </strong>Cross-sectional analysis.</p><p><strong>Patient sample: </strong>A total of 6,253 commercially negotiated prices for surgical thoracolumbar spinal deformity treatment (MS-DRG 456-458) were analyzed from 2,449 US hospitals across five major commercial payers.</p><p><strong>Outcome measures (functional measures): </strong>The primary outcome measure was the log-transformed commercially negotiated price for thoracolumbar spinal deformity surgery.</p><p><strong>Methods: </strong>Hospital-level variables included bed size, teaching status, ownership, Case-Mix Index (CMI), and system affiliation. Market-level variables included wage index and concentration (Herfindahl-Hirschman Index). Community-level variables encompassed uninsured rate, Social Deprivation Index, racial composition, and population health metrics. Prices were log-transformed to address skewness. Multivariable linear regression utilized a hospital-payer-DRG contract-level dataset (n=6,253 contracts from 2,449 hospitals), reflecting 30.5% attrition from the initial 3,526 hospitals due to complete-case exclusion for missing covariates (eg, wage index and CMI).</p><p><strong>Results: </strong>The fully specified model, inclusive of state and insurer fixed effects (adjusted R²=0.244), revealed that system affiliation was the strongest predictor of higher prices, with affiliated hospitals charging 21.1% to 41.8% more (p<.001). Larger bed count (p=.008) and higher CMI (p=.015) were also associated with higher prices, whereas nonteaching hospitals (p=.042) had lower prices. Higher labor costs (p<.001) and lower market competition (7.5%-7.8% higher prices, p<.05) were each associated with higher prices. At the community level, higher uninsured rates (+13.4% per SD, p=.020) correlated with higher prices, whereas poorer health (-6.9% per SD, p=.045) and lower Social Deprivation Index (-4.1% per SD, p=.048) were linked to lower prices.</p><p><strong>Conclusions: </strong>Hospital system size, labor costs, market concentration, and community context were associated with substantial variation in negotiated prices for surgical spinal deformity treatment.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876370","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 management failure following incidental durotomy: insights from 24,438 consecutive spinal surgeries.","authors":"Hyun-Jun Jang, Jiwon Woo, Dong-Kyu Kim, Bong-Ju Moon, Jeong-Yoon Park, Sung-Uk Kuh, Dong-Kyu Chin, Keun-Su Kim, Yong-Eun Cho, Kyung-Hyun Kim","doi":"10.1016/j.spinee.2026.08.018","DOIUrl":"10.1016/j.spinee.2026.08.018","url":null,"abstract":"<p><strong>Background context: </strong>Incidental durotomy (IDT) is a frequent intraoperative complication in spine surgery. While most cases are managed successfully with primary repair, management failure leads to persistent symptoms and necessitates secondary intervention, resulting in significantly poorer clinical outcomes.</p><p><strong>Purpose: </strong>To identify independent risk factors for management failure following IDT through a comprehensive analysis of patient demographics, pathological conditions, and surgical approaches.</p><p><strong>Study design/setting: </strong>A retrospective cohort study at a single tertiary institution.</p><p><strong>Patient sample: </strong>A total of 1,180 patients with confirmed IDT, identified from a continuous series of 24,438 spinal procedures performed between 2011 and 2024.</p><p><strong>Outcome measures: </strong>The incidence of IDT and the rate of management failure, defined as the requirement for secondary surgical intervention.</p><p><strong>Methods: </strong>To evaluate factors contributing to IDT management failure, the cohort was categorized into three distinct surgical subgroups based on the surgical approach used: anterior cervical, posterior thoracic OPLL (ossification of the posterior longitudinal ligament)/OLF (ossification of the ligamentum flavum), and general posterior approaches. A comparative evaluation of clinical, anatomical, and operative variables was performed between the success and failure groups to derive independent predictors of surgical failure.</p><p><strong>Results: </strong>The overall incidence of IDT was 4.8% (1,180/24,438), with a management failure rate of 3.22% (38/1,180). Failure rates varied by procedure, peaking in anterior cervical corpectomy and fusion (13.3%) and posterior thoracic OPLL/OLF surgery (9.5%). In the thoracic OPLL/OLF subgroup, revision surgery (42.9% vs 5.4%, p=.015) and a higher OPLL occupying ratio (55.9% vs 16.3%, p<.001) were significantly associated with management failure. In minimally invasive procedures, 74.7% of IDTs were successfully managed without primary sutures. In the general posterior approach subgroup, multivariate analysis identified radiotherapy history (OR 14.82, 95% CI 3.12-70.45, p<.001), dural patch use (OR 5.32, 95% CI 2.05-13.84, p<.001), long-segment surgery (≥ 4 levels) (OR 3.12, 95% CI 1.28-7.62, p=.012), and higher body weight (OR 1.04, p=.019) as independent predictors of failure.</p><p><strong>Conclusions: </strong>Management failure after IDT is driven by patient-specific and anatomical factors. High-risk scenarios-specifically previous radiotherapy, revision thoracic procedures, and severe OPLL-starkly increase this risk, necessitating proactive surgical strategies. To prevent secondary interventions, surgeons must move beyond primary repair alone, optimizing the local environment by obliterating anatomical dead space and ensuring adequate extrinsic tamponade.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867550","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":"Variation in outcomes following ACDF performed by orthopedic and neurosurgery-trained surgeons: a propensity score-matched single-institution analysis.","authors":"Anoop Sunkara, Jacob W McDevitt, Connor P McCloskey, Theodore A Joaquin, Andre C Ferreira, Arun Movva, Wellington K Hsu, Matthew W Colman, Srikanth N Divi, Alpesh A Patel","doi":"10.1016/j.spinee.2026.08.013","DOIUrl":"10.1016/j.spinee.2026.08.013","url":null,"abstract":"<p><strong>Background context: </strong>ACDF is performed by both orthopedic and neurosurgery-trained surgeons, but prior studies comparing outcomes across specialties are limited to 30-day endpoints and multi-institution databases.</p><p><strong>Purpose: </strong>To compare outcomes between orthopedic and neurosurgery-performed ACDF at a single institution.</p><p><strong>Design: </strong>Retrospective propensity score-matched cohort study.</p><p><strong>Patient sample: </strong>Total of 662 pairs (n=1,324) undergoing ACDF at a single academic medical center from 2016 to 2023.</p><p><strong>Outcome measures: </strong>Operative and hospital course duration, 30- and 90-day readmission, 90-day complications, opioid fills at 31-180 days, and one-year complications.</p><p><strong>Methods: </strong>Adults undergoing ACDF (CPT 22551) were identified from an institutional database. Surgeons below the 50th percentile of annual volume (<5.2 cases/year) were excluded. Matching (1:1) incorporated age, sex, BMI, ASA class, Van Walraven Elixhauser comorbidity score, procedure setting, insurance type, fusion levels, myelopathy, and surgeon volume.</p><p><strong>Results: </strong>Neurosurgery cases had longer surgery duration (3.38 vs 2.71 h) and anesthesia time (4.22 vs 3.40 h; both p<.001). Length of stay was longer in neurosurgery (2.84 vs 2.05 days; p<.001), as 30-day (9.8% vs 5.9%; p=.008) and 90-day (13.7% vs 8.6%; p=.003) postoperative readmission rates were greater. The 90-day complication rate was higher in neurosurgery (22.1% vs 16.9%; p=.018). Neurosurgery cases had higher opioid fill rates at 31-90 days (25.8% vs 19.6%; p=.007) and 91-180 days (19.6% vs 14.2%; p=.008) postoperatively.</p><p><strong>Conclusions: </strong>The pattern of short-term differences and long-term convergence suggests differences in perioperative management instead of surgical proficiency. Hospitals performing ACDF across both specialties should standardize perioperative protocols.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867515","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":"Two-year cost-effectiveness analysis of alternate-level instrumentation in open-door cervical laminoplasty: secondary analysis of a randomized controlled trial.","authors":"Masashi Tsujino, Koji Tamai, Masaki Terakawa, Shinji Takahashi, Yuto Kobayashi, Masayuki Umano, Masatoshi Hoshino, Akinobu Suzuki, Tadao Tsujio, Hiroyuki Yasuda, Masayoshi Iwamae, Hiromitsu Toyoda, Makoto Oka, Hiroaki Nakamura, Hidetomi Terai","doi":"10.1016/j.spinee.2026.08.019","DOIUrl":"10.1016/j.spinee.2026.08.019","url":null,"abstract":"<p><strong>Background context: </strong>The optimal number of fixation levels in cervical open-door laminoplasty remains controversial. A recent randomized controlled trial (RCT) demonstrated that alternate-level instrumentation (skip-fixation) achieved noninferior improvement in the Japanese Orthopaedic Association (JOA) score compared with instrumentation at every level (all-fixation). Skip-fixation requires instrumentation at approximately half of the laminar levels and may therefore theoretically reduce implant-related costs. However, the economic impact of fixation strategy has not been formally evaluated.</p><p><strong>Purpose: </strong>To evaluate the cost-effectiveness of skip-fixation compared with all-fixation using two-year direct medical costs and health-related quality-of-life (HRQoL) data within the Japanese public health insurance system.</p><p><strong>Study design/setting: </strong>A secondary cost-effectiveness analysis conducted alongside a prospective, multicenter randomized controlled trial at four hospitals in Japan.</p><p><strong>Patient sample: </strong>Patients aged ≥60 years who underwent C3-C6 open-door cervical laminoplasty for degenerative cervical myelopathy in a multicenter randomized controlled trial.</p><p><strong>Outcome measures: </strong>Two-year cumulative direct medical costs, including surgery-related inpatient costs, postoperative outpatient costs, and costs associated with complications or reoperations, were evaluated from the payer's perspective. HRQoL was measured using the EQ-5D-5L at baseline and at 3, 12, and 24 months postoperatively, and quality-adjusted life-years (QALYs) were calculated.</p><p><strong>Methods: </strong>Incremental net monetary benefit (INMB) was calculated at a willingness-to-pay (WTP) threshold of JPY 5,000,000 (USD 45,900) per QALY. Uncertainty was assessed using 10,000 bootstrap replications to generate cost-effectiveness planes and acceptability curves.</p><p><strong>Results: </strong>A total of 129 patients with complete two-year cost and utility data were analyzed (66 skip-fixation; 63 all-fixation). No statistically significant difference in two-year QALYs was observed between groups (ΔQALY = 0.035; 95% CI, -0.083 to 0.152). Mean two-year total direct medical costs were lower in the skip-fixation group (ΔCost = USD -1,460; 95% CI, -2,834 to -173). At the WTP threshold of USD 45,900, the mean INMB was USD 3,061 (95% CI, -2,481 to 8,569). The probability that skip-fixation was cost-effective was 86.3%. Scenario analyses demonstrated greater economic advantage when higher-cost plate fixation was assumed.</p><p><strong>Conclusions: </strong>Skip-fixation was cost-effective compared with all-fixation in cervical open-door laminoplasty over a two-year period. This economic advantage was more pronounced when high-cost implants were used.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867473","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":"Evolution of generative artificial intelligence in clinical practice: comparative performance of OpenEvidence 2.0 and ChatGPT-4o.","authors":"Fedan Avrumova, Michael Dd Cesar, Giuseppe Loggia, Klemenz Strebel, Franziska Cs Altorfer, Rafael I Castro, Jiaqi Zhu, Celeste Abjornson, Christopher M Bono, Darren R Lebl","doi":"10.1016/j.spinee.2026.08.002","DOIUrl":"10.1016/j.spinee.2026.08.002","url":null,"abstract":"<p><strong>Background context: </strong>Generative artificial intelligence (AI) is increasingly used in spine care; however, concerns remain regarding citation hallucinations and reliability. ChatGPT may generate inaccurate or fabricated references, whereas OpenEvidence (OE) prioritizes verified, peer-reviewed literature. This is the first study comparing OE and ChatGPT using cervical spine clinical guideline (CSCG) queries.</p><p><strong>Purpose: </strong>To compare guideline alignment, citation validity, sourcing, and prompt-engineering effects between OE and ChatGPT using CSCGs.</p><p><strong>Study design/setting: </strong>Cross-sectional comparative analysis.</p><p><strong>Patient sample: </strong>No patient population was included.</p><p><strong>Outcome measures: </strong>Primary outcomes were guideline alignment score and citation validity (fully correct, partially hallucinated, or fully hallucinated). Secondary outcomes included source type, publication year, proportion published after CSCG release, and prompt-engineering effects.</p><p><strong>Methods: </strong>A total of 110 evidence-based clinical questions derived from 10 CSCGs authored by 6 academic societies were submitted to OE (v2.0) and ChatGPT-4o from June 1 to July15, 2025. A subset of prompts was repeated to evaluate prompt-engineering effects.</p><p><strong>Results: </strong>OE generated 999 citations with 100% accuracy, whereas only 184/393 (46.8%) ChatGPT citations met accuracy criteria (p<.001). OE demonstrated higher guideline alignment than ChatGPT (4.6±0.8 vs 4.1±0.7; p=.03), with almost perfect interrater agreement (weighted Cohen's κ = 0.88; 95% CI, 0.80-0.97). ChatGPT produced 88 partially hallucinated citations (22.4%), most commonly due to incorrect hyperlinks, author names, or publication years. OE cited more peer-reviewed literature (79.8% vs 60.1%; p<.001) and more recent studies (2018±5.6 vs 2012±7.4; p<.001). Prompt-engineering analysis showed OE maintained higher citation validity and fewer hallucinations, although accuracy declined when outputs were reformatted through ChatGPT, suggesting cross-model contamination.</p><p><strong>Conclusion: </strong>OE demonstrated superior CSCG concordance and substantially lower susceptibility to hallucinations than ChatGPT. Nonetheless, physician oversight remains essential for safe AI integration into clinical practice.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867498","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}