Spine Journal最新文献

{"title":"Machine learning-based identification of distinct risk factors for moderate versus severe proximal junctional kyphosis after adult spinal deformity surgery.","authors":"Dong-Ho Kang, Jin-Sung Park, Chong-Suh Lee, Se-Jun Park","doi":"10.1016/j.spinee.2026.04.030","DOIUrl":"10.1016/j.spinee.2026.04.030","url":null,"abstract":"<p><strong>Background context: </strong>Proximal junctional kyphosis (PJK) is a well-recognized complication of adult spinal deformity surgery. However, traditional proximal junctional angle (PJA) thresholds (15°) and revision-predictive thresholds (28°) may represent distinct clinical entities with unique etiologies.</p><p><strong>Purpose: </strong>To analyze and compare predictive risk factors for moderate (PJA≥15°) and severe (PJA≥28°) PJK using machine learning.</p><p><strong>Study design/setting: </strong>Retrospective study.</p><p><strong>Patient sample: </strong>A total of 374 patients who underwent adult spinal deformity surgery with a minimum 2-year follow-up.</p><p><strong>Outcome measures: </strong>Development of moderate (PJA≥15°) and severe (PJA≥28°) PJK.</p><p><strong>Methods: </strong>Five machine learning algorithms (logistic regression, support vector machine, random forest, extreme gradient boosting, AutoGluon) were trained to predict moderate and severe PJK. Feature stability analysis identified robust predictors across models, and SHAP analysis elucidated the feature directionality.</p><p><strong>Results: </strong>The incidence of moderate and severe PJK was 17.4% (65 patients) and 11.0% (41 patients), respectively. Body mass index and L1 tilt were universally selected for moderate PJK. SHAP analysis showed that high relative lumbar lordosis (relative hyperlordosis) and L1 tilt were associated with increased predicted risk, whereas iliac screws were protective. The maldistributed lordosis distribution index and number of rods were consensus predictors of severe PJK. SHAP associated maldistributed lordosis distribution index, excessive postoperative lumbar lordosis, and high cement volume with an increased predicted risk of severe PJK.</p><p><strong>Conclusions: </strong>Moderate PJK appears to be driven by geometric stress concentration (eg, L1 tilt and relative hyperlordosis), whereas severe PJK stems from structural/distributional mismatch (eg, lordosis maldistribution and construct rigidity). Prevention strategies should be stratified according to these distinct mechanisms.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273549","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":"When aging becomes degeneration: evidence from metabolomics of healthy age-stratified organ-donor and degenerated lumbar discs.","authors":"Shanmuganathan Rajasekaran, Chitraa Tangavel, Divya Arunachalam, Gnanaprakash Gurusamy, Sharon Miracle Nayagam, Arun Meena Sivasubramanian, Sri Vijay Anand","doi":"10.1016/j.spinee.2026.05.010","DOIUrl":"10.1016/j.spinee.2026.05.010","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Aging and degeneration are biologically distinct processes in intervertebral discs, but are difficult to differentiate radiologically. Metabolomics reflects real-time biochemical activity, and age-stratified metabolomic profiling of normal and degenerated discs may identify preclinical degeneration and reveal molecular signatures distinguishing normal aging from degeneration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To characterize the metabolomic changes in the MRI-normal healthy lumbar intervertebral disc and compare them with degenerated discs to identify metabolomic signatures that differentiate normal aging from degeneration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design and setting: &lt;/strong&gt;Comparative metabolomics study using human nucleus pulposus tissue from organ donors and surgical specimens, conducted at a tertiary spine care center and an affiliated research laboratory.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Nucleus pulposus tissue from 21 healthy organ donors (Pfirrmann grade I) was stratified by age: young (20-30 years), middle-aged (31-50 years), and old (&gt;50 years), and compared with 40 degenerated discs (grades III-V) from surgical specimens.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Primary outcome measures included differential metabolite abundance (metabolites with [VIP] Variable Importance in Projection scores&gt;1), pathway enrichment profiles, and identification of age-specific versus degeneration-specific metabolic signatures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Untargeted ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) was performed in both positive and negative ionization modes. Metabolites were identified using Compound Discoverer v3.7, with reference to Human Metabolome Database (HMDB) and Kyoto Genome Encyclopedia (KEGG). Statistical and pathway enrichment analyses were performed using MetaboAnalyst 6.0.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Untargeted UHPLC-MS/MS analysis revealed 831 significant metabolites (VIP&gt;1), contributing to group separation in the partial least squares discriminant analysis (PLS-DA) model. Lipids and lipid-like molecules, especially sphingolipids, fatty acyls, and steroids, constituted 39%. MRI normal organ donor discs in progressive age periods demonstrated 4 distinct metabolic trends: (i) progressive decline of antioxidants (ubiquinone, glutathione, N-acetyl seretonin); (ii) increased oxidative/inflammatory markers (4-HNE, prostaglandin E₂ ethanolamide, N1-acetylspermidine); (iii) transient midlife antioxidant elevation; (4OH benozoic acid, 4OH phenylpyruvic acid); (iv) partial recovery in older discs (Hypoxanthine, Paraxanthine, CerP(d18:1/18:0)). In old-aged discs, accumulation of sphingolipids (sphingosine, ceramides) and redox drift indicated enhanced senescence and energy imbalance. Degenerated discs exhibited a different profile, characterized by the suppression of bioactive lipids, particularly resolvins, PGE2, and SOFAs, accompanied by disrupted sphingol","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213089","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":"Paraspinal musculature and adjacent segment disease after lumbar fusion: a systematic review and meta-analysis of fusion with and without posterior instrumentation.","authors":"Conor McNamee, Andrew Kelly, Salman Keraidi, Richard N Storey, Jake M McDonnell, Stacey Darwish, Joseph S Butler","doi":"10.1016/j.spinee.2026.05.008","DOIUrl":"10.1016/j.spinee.2026.05.008","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Adjacent segment disease (ASD) is the principal long-term complication following lumbar fusion, contributing to pain, disability, and the need for revision surgery. While biomechanical and patient-related factors have been proposed, iatrogenic injury to the paraspinal musculature during posterior exposure may also promote ASD. Minimally invasive anterior, oblique, and lateral approaches, which avoid posterior dissection, may mitigate this risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare rates of radiographic (rASD) and symptomatic ASD, ASD-related reoperation, and secondary outcomes including fusion success, cage subsidence, and patient-reported outcomes between standalone anterior, oblique, or lateral lumbar interbody fusion (ALIF, OLIF, LLIF/XLIF) and fusion procedures involving posterior dissection and pedicle screw placement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review and Bayesian meta-analysis of comparative studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Adults (≥18 years) undergoing lumbar fusion for degenerative pathologies including spondylolisthesis, stenosis, and degenerative disc disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Primary outcomes were diagnosis of rASD, reoperation due to ASD and all cause reoperations. Secondary outcomes included fusion success, cage subsidence, perioperative complications, and patient-reported outcomes (Oswestry Disability Index, VAS back and leg).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed, Embase, and Scopus were searched (09/09/2025) without date restriction per PRISMA guidelines (PROSPERO CRD420251115394). Comparative studies of standalone vs posteriorly instrumented fusion were included. Data extraction and ROBINS-I bias assessment were performed independently by 2 reviewers. Bayesian random-effects models were used for all outcomes. Binary outcomes were analyzed with binomial models; continuous outcomes used normal likelihoods. Analyses were conducted in Python.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-seven studies (4,388 patients: 1,877 no posterior instrumentation; 2,511 posterior instrumented) met inclusion criteria. All were rated at serious risk of bias. Standalone fusion was most commonly ALIF (8 studies), followed by OLIF (6) and LLIF/XLIF (4). Fusion without posterior instrumentation was associated with a significantly lower odds of rASD (OR 0.51, 95% CI: 0.28-0.96) and reoperation for ASD (OR 0.58, 95% CI: 0.33; 0.86). There was no difference in all-cause reoperation (OR 0.84, 95% CI: 0.55-1.30), fusion success (OR 1.33, 95% CI: 0.91; 1.98), or perioperative complications (OR 0.99, 95% CI: 0.71-1.31). Standalone fusion had higher odds of cage subsidence (OR 1.99, 95% CI: 1.22; 3.12). ODI scores were significantly lower (MD: -1.37, 95% CI: -2.76; -0.03), while VAS back and leg scores did not differ significantly between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Standalone anterior, oblique, and lateral lumbar fusions, which avoid posterio","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165267","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":"Real-world implementation strategies and preparation for transforming episode accountability model (TEAM): academic, community hospital-employed, and private practice perspectives.","authors":"Iyan Younus, Philip K Louie, Rajiv K Sethi","doi":"10.1016/j.spinee.2026.04.022","DOIUrl":"10.1016/j.spinee.2026.04.022","url":null,"abstract":"<p><strong>Background context: </strong>The Centers for Medicare & Medicaid Services (CMS) Transforming Episode Accountability Model (TEAM) is the largest mandatory bundled payment program in Medicare history. The program covers 5 high-cost surgical episode categories across 188 selected Core-Based Statistical Areas (CBSAs) from January 1, 2026 through December 31, 2030. Spinal fusion is among the most clinically heterogeneous and financially consequential of the 5 TEAM episode types, subject to a 2.0% mandatory discount factor and a 30-day post-discharge episode window.</p><p><strong>Purpose: </strong>This manuscript reviews current CMS policy guidance and available evidence to provide setting-specific implementation strategies that include: cost containment, care coordination, outpatient episode migration, post-acute network development, and surgeon engagement.</p><p><strong>Study design: </strong>Review.</p><p><strong>Methods: </strong>Literature review performed to comprehensively describe how the implementation strategy for TEAM will vary by practice model to account for financial risk while also preserving patient care and access.</p><p><strong>Results: </strong>While TEAM establishes a unified policy framework, real-world implementation will vary substantially across academic medical centers, community hospital-employed practices, and private practice environments, each of which faces distinct operational constraints, incentive structures, and levels of financial risk exposure.</p><p><strong>Conclusion: </strong>Spine surgeons who engage proactively through formal collaborator agreements, hospital governance participation, and pathway development will be best positioned to preserve clinical autonomy, maintain access for complex patients, and deliver high-quality, equitable care within the value-based landscape that TEAM now mandates.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730492","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":"Complications of spinal fusion: comparing Medicare transforming episode accountability (TEAM) hospitals to control hospitals.","authors":"Brook I Martin, Sohail K Mirza, Hyunkyu Ko, Brian Karamian","doi":"10.1016/j.spinee.2026.03.009","DOIUrl":"10.1016/j.spinee.2026.03.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Medicare's Transforming Episode Accountability Model (TEAM) holds hospitals accountable for 30-day postoperative complications across 18 categories of spinal fusion bundles, yet baseline differences in complication rates between participant and nonparticipant hospitals may confound policy evaluation and performance under this model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;We compared complication rates for 18 TEAM-defined categories of fusion between participant and nonparticipant hospitals, and characterized patient- and hospital-level factors contributing to variation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective cohort study of Medicare beneficiaries undergoing inpatient or hospital outpatient lumbar and cervical fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Fee-for-service Medicare beneficiaries undergoing spinal fusion (2016-2021) were included. Excluded were 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).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Thirty day postdischarge: all-cause readmission and postoperative complications (cardiac, vascular, infection, thromboembolic, cerebrovascular and device-related).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We linked hospital TEAM participants to fee-for-service Medicare fusion claims and calculated 30-day complications by fusion category. Complication rates were estimated using multilevel logistic regression with a hospital-level random effects, adjusting for TEAM-specified covariates: fusion type, stratification, year, age, dual eligibility, social disability insurance, grouped total and select Hierarchical Conditions Classification comorbidity, bundled payment participation history, and the Census Division. An expanded model added patient- and hospital-level factors. Variation was quantified using hospital variance, intraclass correlation coefficients (ICC), and Coefficient of Variation (CV).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;TEAM participant and nonparticipant hospitals had similar 30-day readmission rates for inpatient (8.9%; OR: 1.01; 95% CI: 0.97-1.06; p=.517) and outpatient (5.7%; OR: 0.87; 95% CI: 0.75-1.00; p=.049) fusions, with comparable inpatient (28.2%; OR: 0.97; 95% CI: 0.92-1.03; p=.367) and outpatient (10.4%; OR: 0.97; 95% CI: 0.86-1.10; p=.645) composite complication rates. For readmission the hospital-level ICC was 1.06%, with TEAM adjusters explaining 61.6% of hospital variance, and reducing the CV from 27.6% to 17.1%. The composite complications, the ICC was 3.61%, with TEAM adjusters explaining 36.6% of variance, reducing the CV from 31.6% to 25.2%. Expanded covariates provided minimal incremental variance explanation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Postoperative complication rates were similar between TEAM participant and nonparticipant hospitals, and additional adjustments for surgical inv","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700566","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":"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":"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":"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}

{"title":"NG2 glia promote injured spinal cord repair through neuronal transdifferentiation and keratins expression in juvenile mice","authors":"Qing Zhao MD, PhD ,&nbsp;Pianpian Fan MD, PhD ,&nbsp;Qie Gu MD ,&nbsp;Haoran Yang MD ,&nbsp;Yongxu Xie MD ,&nbsp;Shuaishuai Xia MD ,&nbsp;Mingyu Lv MD ,&nbsp;Xuemei Tan MD ,&nbsp;Xiang Zhou MD, PhD ,&nbsp;Qingchu Li MD, PhD","doi":"10.1016/j.spinee.2025.07.028","DOIUrl":"10.1016/j.spinee.2025.07.028","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Spinal cord injury (SCI) causes severe nerve damage, and there are still considerable challenges in treatment due to its complex pathological mechanisms. Juvenile mice are characterized by robust regenerative and reparative abilities. Specifically, neonatal mice can attain scar-free healing subsequent to SCI. Nevertheless, mature neurons, astrocytes, ependymal cells and microglia possess restricted neuronal regenerative potential. Therefore, the cellular origin of cells that facilitate neuronal regeneration following SCI in neonatal mice or juvenile mice remains elusive.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;NG2 glia could proliferate, migrate, and differentiate into mature oligodendrocytes. NG2 glia are also considered multipotent neural progenitor cells capable of differentiating into neurons. We previously found that NG2 glia upregulated the expression of neuronal markers following SCI. Thus, our study aimed to determine that whether NG2 glia are responsible for neuroregeneration in juvenile mice following SCI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;Primary NG2 glia were obtained from the cerebral cortices of postnatal day 1–2 (P1-2) Sprague Dawley rats, OLN-93 cells (rat NG2 glia) and MO3.13 cells (human NG2 glia) were used to detect the transdifferentiation of NG2 glia via immunofluorescence. Juvenile C57BL/6J mice aged 1 to 2 weeks and 8-week-old C57BL/6J female mice were subjected to spinal cord crush injury.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;By integrating cell culture, immunofluorescence staining, transcriptome RNA sequencing, and molecular experiments, we investigated the role and underlying mechanism of NG2 glia in neuroregeneration and repair subsequent to SCI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;We discovered that NG2 glia are capable of forming oligospheres and transdifferentiating into neuron-like cells both in vitro and in vivo. We observed that juvenile mice aged 1 to 2 weeks can spontaneously repair their injured spinal cords and significantly contribute to neuroregeneration and repair following SCI. NG2 glia migrated from the white matter of spinal cord to the injury area. Their numbers increased significantly on the first day after SCI, reached a peak on day 3, and gradually declined after the repair process. Additionally, we revealed that keratinization-related signals were significantly activated in juvenile mice after SCI. During the self-repair process, the expression of keratins in NG2 glia at the injury site was significantly upregulated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;In conclusion, NG2 glia play a crucial role in neuroregeneration and repair after SCI through transdifferentiating into neuron-like cells and expressing keratins.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CLINICAL SIGNIFICANCE&lt;/h3&gt;&lt;div&gt;Keratin biomaterials have been shown to support locomotor functional recovery and may modify the acute inflammatory response after SCI. Thus, targeting NG2 glia may be a vital strategy for prom","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 622-632"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668849","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}