Spine Journal最新文献

{"title":"Full-endoscopic lumbar spine discectomy: are we finally there? A meta-analysis of its effectiveness against nonmicroscopic discectomy, microdiscectomy and tubular discectomy","authors":"Kajetan Latka PhD ,&nbsp;Klaudia Kozlowska PhD ,&nbsp;Kacper Domisiewicz MD ,&nbsp;Tomasz Klepinowski PhD ,&nbsp;Dariusz Latka MD","doi":"10.1016/j.spinee.2025.02.006","DOIUrl":"10.1016/j.spinee.2025.02.006","url":null,"abstract":"<div><h3>Background Context</h3><div><span>Full-endoscopic lumbar discectomy (FELD) has gained increasing attention as a minimally invasive alternative to conventional </span>microdiscectomy<span> (MD), tubular discectomy (MED), and open nonmicroscopic discectomy (OD) Despite significant technological advancements in endoscopic techniques over the past decade, it is not yet clear whether FELD offers a definitive advantage over traditional methods.</span></div></div><div><h3>Purpose</h3><div>This study aims to perform a meta-analysis of available publications to assess whether the superiority of endoscopic treatment over traditional open and minimally invasive endoscopic surgical techniques can be more conclusively established. The central question driving this meta-analysis was: Are we finally there?</div></div><div><h3>Study Design/Setting</h3><div>Meta-analysis study included adult patients (≥18 years old) with symptomatic lumbar disc herniation<span> (LDH) without concurrent lumbar spinal stenosis.</span></div></div><div><h3>Methods</h3><div><span>A systematic review was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for randomized or nonrandomized controlled trials published between 2013 and 2024. The quality of </span>randomized controlled trials<span><span> and cohort studies was assessed using the Revised Cochrane risk-of-bias tool and Newcastle-Ottawa Scale, respectively. Included studies reported on at least one of the following outcomes: (1) </span>adverse effects, (2) operative parameters, (3) bed and hospital stay, and (4) clinical indices (postoperative values). Mean differences (MDs) or odds ratios (ORs) were used to compare treatment effects between FELD and MD, MED, or OD.</span></div></div><div><h3>Results</h3><div>FELD demonstrated several advantages, particularly in short-term pain (within 6 months postoperatively) relief and faster patient (length of bed stay 1–2 days) mobilization, while maintaining comparable risks of recurrence, reoperation, and complications relative to traditional techniques. However, there is substantial heterogeneity in the data and a limited number of prospective trials.</div></div><div><h3>Conclusions</h3><div>More well-designed, prospective randomized trials are necessary, with a focus on radiological outcomes and comprehensive cost analyses including societal costs. Only through such robust data can we determine whether FELD truly represents a new gold standard for lumbar discectomy. Are we finally there? We are certainly closer, but much remains to be addressed.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 479-497"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537842","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":"What is endoscopic spine surgery? An introduction to a special issue","authors":"Charla R. Fischer MD","doi":"10.1016/j.spinee.2025.12.009","DOIUrl":"10.1016/j.spinee.2025.12.009","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Page 437"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145758270","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":"What is the learning curve for endoscopic spine surgery? A comprehensive systematic review","authors":"Justin P. Chan MD ,&nbsp;Thomas Olson MD ,&nbsp;Beshoy Gabriel BS ,&nbsp;Sohaib Hashmi MD ,&nbsp;Hao-Hua Wu MD ,&nbsp;Hansen Bow MD ,&nbsp;Yu-Po Lee MD ,&nbsp;Nitin Bhatia MD ,&nbsp;Michael Oh MD ,&nbsp;Don Y Park MD","doi":"10.1016/j.spinee.2025.01.004","DOIUrl":"10.1016/j.spinee.2025.01.004","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Endoscopic spine surgery (ESS) is rapidly emerging as a viable minimally invasive technique to successfully treat symptomatic degenerative spinal conditions. Widespread adoption has been limited in part due to the learning curve.</div></div><div><h3>PURPOSE</h3><div>To systematically review the learning curve for uniportal and biportal ESS and compare the 2 techniques.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A systematic review based on PRISMA guidelines.</div></div><div><h3>PATIENT SAMPLE</h3><div>About 29 studies were included with 18 studies investigating uniportal learning curves and 11 biportal studies. There were 1,493 patients across all uniportal studies. There was a total of 1,005 patients across all biportal studies.</div></div><div><h3>OUTCOME MEASURES</h3><div>Number of patients, technique type, patient reported outcomes, complications, operative time before the learning curve threshold, operative time after learning curve threshold, number of cases required to meet threshold, number of surgeons in the study, and cases per surgeon were collected and analyzed.</div></div><div><h3>METHODS</h3><div>A comprehensive literature search was conducted using PubMed, Medline, and Embase from 2000 to present date. Data was extracted by 3 independent reviewers.</div></div><div><h3>RESULTS</h3><div>The learning curve studies were reviewed and summarized. The overall median number of cases to reach the learning curve threshold was significantly less in uniportal vs biportal studies (20 vs 37.5, p=.0463). When stratifying by various procedures, there was no significant difference between the techniques with number of cases required or improvement of operative time. Operative time for biportal discectomies decreased by a significantly greater amount vs uniportal (44.5% vs 21.4%, p=.0332).</div></div><div><h3>CONCLUSIONS</h3><div>The learning curve literature for ESS was systematically reviewed and ways to overcome the learning curve were discussed. The overall median number of cases for the learning curve was significantly fewer in uniportal vs biportal but the improvement in operative time was significantly greater with biportal discectomies, typically the entry level procedure by novice surgeons. Overcoming the learning curve for ESS is a critical factor to widespread adoption and understanding it may aid surgeons in progressing to proficiency while mitigating the risk of complications.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 438-449"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069166","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":"Advances in endoscopic lumbar spine surgery: a comprehensive review of the techniques used for the treatment of lumbar disc herniations and spinal stenosis and lumbar spinal fusion","authors":"Brian Kwon MD ,&nbsp;Andrew Moon MD","doi":"10.1016/j.spinee.2025.06.004","DOIUrl":"10.1016/j.spinee.2025.06.004","url":null,"abstract":"<div><div>Endoscopic lumbar spine surgery has been practiced for decades but has recently gained popularity as a minimally invasive technique for treating the most common spinal pathologies treated by spine surgeons. These include lumbar disc herniations, spinal stenosis, and lumbar spinal fusion. This review provides comprehensive, up-to-date analyses of the 2 main approaches—uniportal and biportal endoscopy—utilized for discectomy, foraminotomy, laminectomy, and interbody fusion. The key advantages of endoscopic spine surgery include smaller incisions, less soft tissue disruption, reduced blood loss, shorter hospital stays, and faster recovery times, all of which collectively contribute to positive patient outcomes. Advances in visualization and instrumentation as well as surgeon training and experience have expanded the indications for endoscopic spine surgery beyond herniated discs, allowing its application in more complex conditions, such as highly migrated disc herniations, spinal tumors, and trauma. Moreover, endoscopic surgery has shown promising results in special populations, such as obese patients, where traditional open approaches can be challenging. Despite its advantages, adopting endoscopic spine surgery poses several challenges: particularly a steep learning curve related to issues with depth perception, maneuvering instruments in narrow spaces, and managing technical pitfalls like dural tears and hemostasis. There are also limitations with endoscopic interbody fusions, in particular the use of smaller cages that have a limited fusion surface area and sagittal alignment; newer expandable cages may circumvent these shortcomings, however. As the body of literature demonstrates comparable, if not superior, outcomes to traditional open surgery, the adoption of endoscopic techniques is expected to increase. Continued innovation, surgeon education and experience, and most important, patient demand are driving the growth of this technique. It is the authors’ opinions that in the near future, endoscopic spine surgery will become a fundamental approach utilized in the treatment of degenerative lumbar spine conditions.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 457-466"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512640","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":"Fulfillment of patient expectations after surgery for degenerative cervical myelopathy. A retrospective analysis of prospectively collected data from the multicenter Canadian Surgical Spine Registry (CSORN)","authors":"Julien Francisco Zaldivar-Jolissaint MD ,&nbsp;Nathan Evaniew MD, PhD, FRCSC ,&nbsp;Nicolas Dea MD, MSc, FRCSC ,&nbsp;W. Bradley Jacobs MD, FRCSC ,&nbsp;Jérome Paquet MD, FRCSC ,&nbsp;Jefferson R Wilson MD, PhD, FRCSC ,&nbsp;Hamilton Hall MD, FRCSC ,&nbsp;Supriya Singh MD, FRCSC ,&nbsp;Michael H. Weber MD, PhD, FRCSC ,&nbsp;Andrew Nataraj MD, MSc, FRCSC ,&nbsp;Najmedden Attabib MD, MBBCH, FRCSC ,&nbsp;David W. Cadotte MD, PhD, FRCSC ,&nbsp;Y. Raja Rampersaud MD, FRCSC ,&nbsp;Philippe Phan MD, PhD, FRCSC ,&nbsp;Sean D. Christie MD, FRCSC ,&nbsp;Charles G. Fisher MD, MHSC, FRCSC ,&nbsp;Christopher Small MD, FRCSC ,&nbsp;Alex Soroceanu MD, MPH, FRCSC ,&nbsp;Christopher S. Bailey MD, FRCSC ,&nbsp;Kenneth Thomas MD, MHSC, FRCSC ,&nbsp;Raphaële Charest-Morin MD, FRCSC","doi":"10.1016/j.spinee.2025.11.001","DOIUrl":"10.1016/j.spinee.2025.11.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;While abundant literature supports the clinical benefits of surgery for degenerative cervical myelopathy (DCM), limited evidence exists regarding the extent to which patients' preoperative expectations are met postoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;This study primarily aimed to report the fulfillment of preoperative expectations 12 months postsurgery. Secondary objectives included identifying predictors of expectation fulfillment and overall patient satisfaction following surgical intervention for DCM.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;We conducted a multicenter analysis of spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN)-DCM prospective cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;Patients who underwent surgical treatment for DCM between April 2015 and September 2022 were included.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Patients completed a preoperative 11-domain expectation questionnaire, quantifying their expected clinical changes in each domain. At 12 months postoperatively, patients reported the extent to which their preoperative expectations were met in each domain, as well as their overall satisfaction with surgical outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Multivariable logistic regression models were employed to identify and validate variables associated with expectation fulfillment and satisfaction.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Among the 490 patients included, 49.2% had all their expectations met and 3.7% had none of their expectations met. The expectations that were most frequently met were prevention of neurological decline (87.5%) and maintaining of independence (86.7%). There were 83% of patients who were satisfied at 12 months. Multivariable logistic regression identified preoperative variables (not smoking, not using pain medication presurgery, having lower levels of depressive symptoms (PHQ-8)), surgical variables (anterior and posterior nonfusion approaches), the absence of peri‑operative adverse events and improvement in pain and Health-Related Quality of life scores at 12 months (NRS neck-pain, SF12 PCS and SF-12 MCS scores) as predictors of expectation fulfillment. Improvement in the mJOA score was not a predictor of expectation fulfillment. Having preoperative expectations met was a strong predictor of being satisfied with the surgery (p&lt;.01).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;The majority of patients undergoing surgery for degenerative cervical myelopathy (DCM) reported satisfaction with their outcomes, with nearly half experiencing complete fulfillment of their preoperative expectations. Importantly, we identified 9 independent predictors of expectation fulfillment, which in turn emerged as a strong determinant of overall patient satisfaction. These findings highlight the critical role of personalized preoperative counseling in optimizing surgical outcomes. By aligning patients","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 548-557"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534925","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":"Shifts in diversity along the spine surgery training pathway: racial, ethnic, and gender representation from medical school to fellowship","authors":"Jason Silvestre MD ,&nbsp;Jaslyn A. Hernandez ,&nbsp;Robert A. Ravinsky MD ,&nbsp;James D. Kang MD ,&nbsp;Hao Hua Wu MD ,&nbsp;Charles A. Reitman MD ,&nbsp;James P. Lawrence MD","doi":"10.1016/j.spinee.2025.08.332","DOIUrl":"10.1016/j.spinee.2025.08.332","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Racial and ethnic minorities are underrepresented among healthcare providers in the United States (US).</div></div><div><h3>PURPOSE</h3><div>This study analyzed the training pathway of underrepresented groups in spine surgery relative to earlier stages of training and the US population.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This was a cross-sectional analysis of medical students, orthopedic surgery residents, and spine surgery fellows at accredited training programs (2014–2024).</div></div><div><h3>PATIENT SAMPLE</h3><div>N/A.</div></div><div><h3>OUTCOME MEASURES</h3><div>Representation (%) and participation-to-prevalence ratios (PPRs) defined as the participation of demographic groups in spine surgery training over their prevalence in earlier stages of training cohorts. PPRs &lt;0.80 were classified as underrepresented and PPRs&gt;1.2 were classified as overrepresented.</div></div><div><h3>METHODS</h3><div>Self-reported demographics were compared between the US population, medical students, orthopedic surgery residents, and spine surgery fellows.</div></div><div><h3>RESULTS</h3><div>There were demographic disparities between medical students, orthopedic surgery residents, and spine surgery fellows including female (48.7% vs 16.7% vs 6.6%, p&lt;.001), White (54.7% vs 73.1% vs 52.6%, p&lt;.001), Black (6.1% vs 4.4% vs 8.4%, p&lt;.001), Native Hawaiian/Pacific Islander (0.04% vs 0.08% vs 0.70%, p&lt;.001), and Asian (21.3% vs 13.0% vs 17.1%, p&lt;.001) trainees. There were no significant disparities among Hispanic (5.4% vs 5.3% vs 7.7%, p=.292) and American Indian/Alaska Native (0.15% vs 0.13% vs 0.35%, p=.888) trainees. Relative to the US population, female (PPR=0.13), Hispanic (PPR=0.41), American Indian/Alaska Native (PPR=0.64), and Black (PPR=0.68) trainees were underrepresented in spine surgery. In contrast, Asian (PPR=2.85), male (PPR=1.89), Native Hawaiian/Pacific Islander (PPR=1.75) were overrepresented in accredited spine surgery training relative to the US population.</div></div><div><h3>CONCLUSIONS</h3><div>Diversity by gender, race, and ethnicity in accredited spine surgery training is limited relative to the US population. There may be opportunities to recruit underrepresented groups during earlier stages of medical training to promote diversity, equity, and inclusion in the emerging spine surgery workforce.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 612-621"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976322","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":"Passive neck stiffness and range of motion for males and females from early to late adulthood","authors":"Mingyue Liu PhD ,&nbsp;Ryan D. Quarrington PhD ,&nbsp;William S.P. Robertson PhD ,&nbsp;Baptiste Sandoz PhD ,&nbsp;Claire F. Jones PhD","doi":"10.1016/j.spinee.2025.08.331","DOIUrl":"10.1016/j.spinee.2025.08.331","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Understanding human passive neck range of motion (ROM) and stiffness, and their association with age and sex, can be beneficial for clinical assessment, and surrogate and computational modelling.</div></div><div><h3>PURPOSE</h3><div>To assess passive head-neck ROM and stiffness, and to investigate association with age and sex, in flexion, extension, left and right lateral bending, and axial rotation.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>In-vivo human participant testing.</div></div><div><h3>METHODS</h3><div>A total of 80 participants aged 20 to 79 years (nearly even distribution), who self-reported no history of significant health conditions and with no neck pain, were recruited. Two custom apparatus were used to support participants in relaxed lying. Their head was rotated to maximum ROM; applied moment and head-torso motion were recorded. Muscle activation was monitored in real-time to ensure electromyographic signals from agonist muscles remained below a passive threshold. Stiffness was determined from the moment-angle data within each of three zones, with zone boundaries delineated to maximize moment-angle linearity within each zone. The age and sex effects on passive stiffness and ROM were assessed using generalized linear models for flexion and extension, and linear mixed models for lateral bending and axial rotation.</div></div><div><h3>RESULTS</h3><div>Passive neck ROM decreased by 0.2° per year of age in lateral bending and axial rotation for males and females, and extension ROM for males was 5.8° lower than for females. Passive stiffness in lateral bending (zone 1 and 2: 0.9 and 3.5 Nmm/°/year; zone 3: 3%), axial rotation (zone 1 and 2: 1%; zone 3 for males and females: 1.9 and 0.9 Nmm/°/year) and some zones in extension (zone 2: 0.8 Nmm/°/year; males in zone 3: 2.7 Nmm/°/year) increased with age, and males had higher stiffness than females in lateral bending (zone 1 and 2: 22.3 and 43.9 Nmm/°; zone 3: 35%) and axial rotation (zone 1 and 2: 49% and 35%).</div></div><div><h3>CONCLUSIONS</h3><div>Passive neck ROM decreased with age in lateral bending and axial rotation, while passive neck stiffness tended to increase with age in all motions but flexion. Extension ROM was higher for females, and lateral bending and axial rotation stiffness at lower angles were higher for males.</div></div><div><h3>CLINICAL SIGNIFICANCE</h3><div>The neck ROM, stiffness, and moment-angle corridors developed in this study provide benchmarks for clinical assessment of cervical spine function, and can assist the development of surrogate and computational models incorporating minimal muscle activation, for injury simulation and clinical skill training.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 633-641"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976326","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":"Postoperative adverse events following 2-level hybrid cervical construct relative to 2-level anterior cervical discectomy","authors":"Philip P. Ratnasamy BS,&nbsp;Sahir S. Jabbouri MD,&nbsp;Michael J. Gouzoulis BS,&nbsp;Arya G. Varthi MD,&nbsp;Jonathan N. Grauer MD","doi":"10.1016/j.spinee.2025.07.026","DOIUrl":"10.1016/j.spinee.2025.07.026","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>ACDF has been the mainstay for managing degenerative cervical spine pathology and CDA has emerged as a possible alternative. Limited research exists comparing postoperative adverse events between 2-level hybrid constructs and 2-level ACDF.</div></div><div><h3>PURPOSE</h3><div>To evaluate postoperative adverse events, readmissions, and 5-year survival to reoperation for patients undergoing 2-level cervical hybrid construct (anterior cervical discectomy at 1 level and fusion [ACDF] and cervical disc arthroplasty [CDA] at an adjacent level) relative to 2-level ACDF.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective database study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients undergoing 2-level cervical hybrid constructs or 2-level ACDF were isolated from the PearlDiver M165Ortho 2010–2021 database, a large national billing claims database containing deidentified health information across all payer types and sites of care in the US.</div></div><div><h3>OUTCOME MEASURES</h3><div>Incidence of 90-day postoperative adverse events in 2-level cervical hybrid construct patients and 2-level ACDF patients. Relative odds of 90-day adverse events for hybrid construct patients relative to ACDF patients. 5-year survival to reoperation.</div></div><div><h3>METHODS</h3><div>Two-level cervical hybrid construct and 2-level ACDF patients were matched 1:4 based on age, sex, and Elixhauser Comorbidity Index (ECI) scores. Odds of 90-day postoperative adverse events were compared between the 2 groups using multivariable analysis. Five-year survival to cervical spine reoperation was then assessed.</div></div><div><h3>RESULTS</h3><div>After matching, there were 1,417 patients in the hybrid construct group and 5,664 in the ACDF group. No significant differences were identified for 90-day individual adverse events, aggregated any adverse events, or readmissions. Further, no significant difference was identified for 5-year survival to reoperation.</div></div><div><h3>CONCLUSIONS</h3><div>While consideration may be given to 2-level cervical hybrid constructs or 2-level ACDF, the current large-cohort comparison study could not determine differences in 90-day complications or 5-year reoperations between these surgical options to support 1 procedure over the other.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 498-503"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620943","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":"History of endoscopic spine surgery: where did it all begin? Development of indications and techniques","authors":"Dong Hwa Heo MD, PhD ,&nbsp;Hyeun Sung Kim MD, PhD ,&nbsp;Yoon Ha Whang MD ,&nbsp;Dong Chan Lee MD ,&nbsp;Kangtaek Lim MD","doi":"10.1016/j.spinee.2025.07.031","DOIUrl":"10.1016/j.spinee.2025.07.031","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Endoscopic spine surgery began as a minimally invasive treatment for lumbar disc herniation. Over time, significant advances in optical technology, surgical instruments, and imaging systems have expanded its applications to a wide spectrum of spinal diseases, including stenosis, instability, and deformities across the lumbar, cervical, and thoracic regions.</div></div><div><h3>PURPOSE</h3><div>This review aims to summarize the historical evolution, technical development, and expanding indications of endoscopic spine surgery, focusing on both full endoscopic (uniportal) and biportal approaches.</div></div><div><h3>STUDY DESIGN</h3><div>A narrative literature review.</div></div><div><h3>METHODS</h3><div>The authors performed an extensive review of historical and recent literature on endoscopic spine surgery, covering major milestones in technique development, key innovations in instrumentation, and published outcomes of different endoscopic approaches. The review systematically categorizes the evolution of full endoscopic transforaminal and interlaminar procedures, endoscopic lumbar interbody fusion, cervical and thoracic techniques, and the development of biportal endoscopic spine surgery, including its generational progression and safety considerations.</div></div><div><h3>RESULTS</h3><div>Full endoscopic techniques have progressed from early transforaminal discectomy to interlaminar decompression and lumbar interbody fusion. In cervical and thoracic spine, endoscopic posterior foraminotomy and laminotomy have shown promising results. Biportal endoscopic spine surgery, developed primarily in South Korea, has gained popularity due to its similarity to arthroscopic and microsurgical procedures. It allows clear visualization and handling of conventional instruments while maintaining minimally invasive principles. Biportal techniques have been successfully applied to decompression, interbody fusion, and complex cervical and thoracic conditions. Furthermore, recent innovations such as large working channels, expandable cages, and 3D endoscopy have enhanced surgical precision and expanded indications. Studies indicate that with proper technique and low-pressure saline irrigation, biportal endoscopy is safe, including the use of radiofrequency devices.</div></div><div><h3>CONCLUSIONS</h3><div>Endoscopic spine surgery has evolved into a versatile and effective approach for treating various spinal disorders. Continuous refinement of tools, visualization technologies, and operative methods will further improve outcomes and broaden clinical applications. Understanding this historical development is essential for appreciating current practices and guiding future advances in minimally invasive spine surgery.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 467-478"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627554","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":"Staged short-term modified halo-pelvic traction and posterior spinal fusion versus posterior vertebral column resection for severe rigid kyphoscoliosis: a multicenter comparative study","authors":"Yiwei Zhao MD ,&nbsp;You Du MD ,&nbsp;Yang Yang MD ,&nbsp;Zheping Zhang MD ,&nbsp;Guanfeng Lin MD ,&nbsp;Chenkai Li MD ,&nbsp;Xiaohan Ye MD ,&nbsp;Dihan Sun BS ,&nbsp;Yu Wang MD ,&nbsp;Jianguo Zhang MD ,&nbsp;Shengru Wang MD","doi":"10.1016/j.spinee.2025.10.024","DOIUrl":"10.1016/j.spinee.2025.10.024","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Surgical correction of severe rigid kyphoscoliosis remains technically challenging and is associated with high complication rates. Posterior vertebral column resection (pVCR) is often required for satisfactory correction but entails substantial surgical risks. Halo-pelvic traction (HPT) has been proposed as a safer alternative that may reduce the need for high-grade osteotomy by partially correcting the deformity preoperatively.</div></div><div><h3>PURPOSE</h3><div>To compare the clinical outcomes of HPT combined with posterior spinal fusion (HPT+PSF) versus pVCR for severe rigid kyphoscoliosis, focusing on deformity correction, surgical morbidity, pulmonary function, and complication profiles.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective comparative effectiveness study conducted at 2 public tertiary referral hospitals in Beijing, China.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 82 patients (41 per group) with severe rigid kyphoscoliosis (defined as coronal and/or sagittal Cobb angle &gt;90° and flexibility &lt;30%) treated between March 2016 and April 2023, with a minimum follow-up of 2 years.</div></div><div><h3>OUTCOME MEASURES</h3><div>Primary outcomes included deformity correction, intraoperative variables, pulmonary function, and surgery-related complications. Secondary outcomes for the HPT+PSF group included traction duration, traction efficacy, and traction-related complications.</div></div><div><h3>METHODS</h3><div>Patients received either HPT+PSF or pVCR based on surgical decision-making. Radiographic measurements were performed independently by 2 blinded observers. Comparative analyses of radiological and clinical outcomes were performed between groups.</div></div><div><h3>RESULTS</h3><div>The mean duration of HPT was 4.7±1.4 weeks. The traction correction rates in the coronal and sagittal planes were 43%±10% and 39%±14%, respectively. 34% (14/41) of the patients experienced traction-related complications. The total correction rates in the coronal and sagittal planes were comparable between the HPT+PSF and pVCR groups. No significant difference between the groups at baseline or at the latest follow-up in terms of the pulmonary function indices. Compared to the pVCR group, the HPT+PSF group demonstrated significantly shorter surgical time, reduced estimated blood loss, lower incidence of intraoperative neurological monitoring alerts, and fewer surgery-related complications.</div></div><div><h3>CONCLUSION</h3><div>HPT+PSF provides deformity correction comparable to that of pVCR while significantly reducing surgical morbidity. It represents a viable and potentially safer alternative for patients with severe rigid kyphoscoliosis. However, the risk of traction-related complications and psychological stress necessitates further refinement of HPT protocols.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 602-611"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313753","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}