Journal of Craniovertebral Junction and Spine最新文献

{"title":"Crosslink augmentation in posterior fixation of unstable thoracic and thoracolumbar fractures: A comparative cohort study of mechanical failure and sagittal alignment.","authors":"Jorge Tabilo, Filadelfo Feliciano Norambuena, Cristian Valdez, César Padilla, Alejandro Barria, Cristobal Bravo, Marcos Diaz, Andrei Fernandes Joaquim","doi":"10.4103/jcvjs.jcvjs_155_26","DOIUrl":"10.4103/jcvjs.jcvjs_155_26","url":null,"abstract":"<p><strong>Background: </strong>The value of crosslink augmentation in posterior thoracolumbar instrumentation for traumatic fractures remains uncertain. Although biomechanical studies suggest improved rotational stability, clinical evidence is limited.</p><p><strong>Objective: </strong>To compare mechanical failure and sagittal alignment in posterior pedicle-screw constructs with and without crosslink augmentation for traumatic thoracic, thoracolumbar, and lumbar fractures.</p><p><strong>Methods: </strong>A retrospective single-center comparative cohort study included patients treated between January 2018 and March 2026 for traumatic thoracic, thoracolumbar, or lumbar fractures. Patients were grouped according to crosslink use. The primary outcome was construct-related mechanical failure, including rod fracture, screw loosening, implant disconnection, crosslink failure, progressive loss of correction, or revision for deformity. Local kyphosis was measured preoperatively, postoperatively, and at final follow-up.</p><p><strong>Results: </strong>Twenty-eight patients were analyzed: 13 with crosslink augmentation and 15 without crosslinks. Crosslink constructs were longer, with more instrumented levels (4.9 vs. 3.9; <i>P</i> = 0.008) and screws (8.2 vs. 6.7; <i>P</i> = 0.013). Index-level screw omission was more frequent with crosslinks (61.5% vs. 20.0%; <i>P</i> = 0.051), as was neurological deficit (84.6% vs. 0%; <i>P</i> < 0.001). AO type B/C morphology and confirmed or suspected posterior ligamentous complex injury were similarly distributed. No mechanical failures occurred in the crosslink group, whereas one noncrosslink patient developed screw loosening associated with chronic infection/fistula. Sagittal differences were not statistically significant, although final kyphosis and late kyphotic progression numerically favored crosslink augmentation.</p><p><strong>Conclusion: </strong>Crosslink-augmented constructs showed no mechanical failures despite greater baseline complexity. These findings suggest potential mechanical benefit, but larger studies are required.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"519-529"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management and outcomes analysis of lower lumbar (L3-L5) burst fractures: A single-center experience and meta-analysis.","authors":"Sandeep Mishra, Nidhisha Sadhwani, Abhishek Kumar, Kanwaljeet Garg, Deepak Agrawal, Pankaj Kumar Singh, G D Satyarthee, Deepak Gupta, P Sarat Chandra","doi":"10.4103/jcvjs.jcvjs_208_26","DOIUrl":"10.4103/jcvjs.jcvjs_208_26","url":null,"abstract":"<p><strong>Background: </strong>Lower lumbar (L3-L5) burst fractures are uncommon injuries with distinct clinical and biomechanical characteristics. We evaluated injury patterns, surgical management, and outcomes in patients treated at a single center and performed a systematic review and meta-analysis to assess neurological and functional outcomes reported in the literature.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed surgically treated L3-L5 burst fractures between January 2015 and July 2022. A Preferred Reporting Items for Systematic Reviews and Meta-analyses-compliant systematic review of studies published from January 1993 to January 2026 was conducted using PubMed, Google Scholar, and the Cochrane Library.</p><p><strong>Results: </strong>Eighteen patients (mean age: 28.1 ± 9.1 years; 77.8% male) were included. Falls from height were the most common mechanism (61.1%), with L4 most frequently involved (61.1%). All fractures were AO Spine Type A (61.1% A3; 38.9% A4); 50% had posterior column injury, and 61.1% had Thoracolumbar Injury Classification and Severity Score ≥5. Preoperatively, 55.5% had neurological deficits and 27.8% had bowel/bladder dysfunction. All underwent posterior spinal instrumentation and fixation; 66.7% received long-segment fixation, 33.3% short-segment fixation, and 27.8% corpectomy with anterior column reconstruction. Surgery significantly improved vertebral body height, sagittal alignment, and canal diameter. At a mean follow-up of 3.8 years, 66.7% achieved ASIA Grade E, with no neurological deterioration. Complications occurred in 11.1% and 94.4% reported minimal disability (Oswestry Disability Index). Meta-analysis of 16 studies (248 patients) demonstrated pooled neurological improvement of 53% (95% confidence interval [CI], 0.25-0.79) and return-to-work (RTW) of 85% (95% CI, 0.76-0.91).</p><p><strong>Conclusion: </strong>Surgical treatment produced favorable radiological and functional outcomes, with neurological improvement in 53% of patients and an 85% RTW rate.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"560-569"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction: The omohyoid muscle in anterior cervical approaches: Forgotten anatomy with surgical and functional implications.","authors":"","doi":"10.4103/jcvjs.jcvjs_242_26","DOIUrl":"10.4103/jcvjs.jcvjs_242_26","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.4103/jcvjs.jcvjs_196_25.].</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"574"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Medicare trends in navigation-assisted spine surgery: A temporal and geographic analysis.","authors":"Bhavjeet S Sanghera, Muneeb K Mohiuddin, Khushi H Shah, Malachi Peterson-Hester, Adonicah Cummings, Emily L Errante, Adam S Levy, Adham M Khalafallah, S Shelby Burks","doi":"10.4103/jcvjs.jcvjs_147_26","DOIUrl":"10.4103/jcvjs.jcvjs_147_26","url":null,"abstract":"<p><strong>Background: </strong>Although initially utilized for pedicle screw placement, indications for navigation assistance in spine surgery have expanded over the past several years. While existing studies have evaluated safety, efficacy, and outcomes from navigation assistance, national reimbursement, and utilization patterns remain poorly characterized. This study aims to quantify temporal, geographic, and provider-level trends in navigation-assisted spine surgery among Medicare beneficiaries.</p><p><strong>Materials and methods: </strong>The Medicare Part B National Summary Data Files were queried for national utilization and reimbursements for Current Procedural Terminology (CPT) 61783 (add-on code for navigation-assisted spine surgery) from 2011 to 2024. Additional Medicare databases were queried for geographic- and physician-level trends in navigation assistance utilization from 2013 to 2023. Linear regression was performed on national utilization trends.</p><p><strong>Results: </strong>From 2011 to 2024, allowed services for navigation-assisted spine surgery grew 917.41%, from 3447 in 2011 to 35,070 in 2024. Adjusting for growth in the number of Medicare Part B beneficiaries, this represents a 637.03% increase. In 2023, most physicians performing navigation-assisted spine surgery were neurosurgeons and practiced in urban metropolitan settings. Between 2013 and 2023, all 50 states observed an increase in utilization rate for navigation-assisted spine surgeries. From 2011 to 2024, reimbursements for this add-on code steadily declined by 31.78%, from $334.88 to $228.45.</p><p><strong>Conclusions: </strong>As indications have expanded, utilization of the navigation-assisted spine surgery CPT code has increased sixfold from its introduction in 2011 to 2024. Simultaneously, reimbursements have declined by 31.78%, raising important concerns about misalignment between the clinical value and financial support for navigation-assisted spine surgery.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"553-559"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative step count as a predictor of early postoperative mobility and patient-reported outcomes following lumbar spine surgery.","authors":"Junho Song, Austen D Katz, Timothy Hoang, Ryan Hoang, Alex Ngan, Joshua Zhang, John J Corvi, Nikan K Namiri, Samuel K Cho, Andrew C Hecht, Sheeraz A Qureshi, Sohrab Virk, David Essig","doi":"10.4103/jcvjs.jcvjs_43_26","DOIUrl":"10.4103/jcvjs.jcvjs_43_26","url":null,"abstract":"<p><strong>Objectives: </strong>Objective activity monitoring may provide scalable, real-world functional data in lumbar spine surgery patients. We evaluated whether preoperative daily step count predicts early postoperative ambulation and patient-reported outcomes (PROs).</p><p><strong>Materials and methods: </strong>We performed a retrospective cohort study of adults undergoing elective lumbar decompression, discectomy, or fusion with remote monitoring of daily step counts (preoperative days 7-1 and postoperative days [PODs] 1-28) and longitudinal PROs (Patient-Reported Outcomes Measurement Information System [PROMIS] - Pain/Physical/Mental and Oswestry Disability Index [ODI] at baseline, 6 weeks, 12 weeks, 6 months, and 1 year). Patients were stratified by mean preoperative step count into low activity (<2500 steps/day) versus normal activity (≥2500 steps/day). Between-group comparisons used the Chi-square tests for categorical variables and independent t-tests for continuous variables (<i>P</i> < 0.05).</p><p><strong>Results: </strong>Forty-seven patients were included (mean age: 51.8 ± 13.7 years; body mass index: 29.85 ± 5.00), including 21 (44.7%) low-activity and 26 (55.3%) normal-activity patients. Preoperative steps were lower in the low-activity group (1354 ± 639 vs. 5148 ± 2399; <i>P</i> < 0.001). Postoperative step counts did not differ during POD 1-7 (717 ± 857 vs. 1342 ± 1468; <i>P</i> = 0.091) but were higher in the normal-activity group during POD 8-14 (1515 ± 2048 vs. 2863 ± 2288; <i>P</i> = 0.044) and cumulatively through POD 28 (POD 1-28: 1360 ± 1584 vs. 2784 ± 1978; <i>P</i> = 0.010). By POD 8-14, 53.8% of normal-activity patients achieved ≥2500 steps/day versus 14.3% of low-activity patients (<i>P</i> = 0.005). Normal-activity patients reported lower PROMIS Pain at 6 weeks (2.9 ± 2.4 vs. 4.8 ± 2.1; <i>P</i> = 0.011) and 12 weeks (2.4 ± 2.2 vs. 4.0 ± 2.5; <i>P</i> = 0.029) and lower ODI at 12 weeks (17.4 ± 14.7 vs. 29.5 ± 17.7; <i>P</i> = 0.018).</p><p><strong>Conclusions: </strong>Preoperative step count stratifies early postoperative mobility and short-term pain/disability trajectories after lumbar spine surgery. Objective activity monitoring may support perioperative risk stratification and targeted prehabilitation.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"500-504"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted facet joint surface remodeling for lumbar facet syndrome: A retrospective case series.","authors":"Nikou Nikmaram, Keyvan Mostofi","doi":"10.4103/jcvjs.jcvjs_14_26","DOIUrl":"10.4103/jcvjs.jcvjs_14_26","url":null,"abstract":"<p><strong>Background: </strong>Lumbar facet joint syndrome is a common cause of chronic axial low back pain. Current interventional treatments such as medial branch radiofrequency denervation may provide temporary relief, with frequent symptom recurrence. Direct surgical treatment of the facet joint surface itself has rarely been reported.</p><p><strong>Objective: </strong>To evaluate the clinical outcomes of targeted facet joint surface remodeling in patients with lumbar facet joint syndrome.</p><p><strong>Materials and methods: </strong>This retrospective monocentric case series included 32 patients treated between January 2022 and March 2025. All patients presented with chronic axial low back pain and a positive response to diagnostic facet joint injection. The surgical procedure consisted of targeted facet joint surface shaving and selective osteophyte removal, performed through an open or endoscopic approach, without decompression or fusion. Pain and functional outcomes were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) preoperatively, and at 1, 3, 6, and 9 months postoperatively.</p><p><strong>Results: </strong>The cohort included 18 women and 14 men, with ages ranging from 39 to 69 years. Mean preoperative VAS was 7.34 and improved to 4.12 at 1 month, 3.99 at 3 months, 3.95 at 6 months, and 3.92 at 9 months postoperatively. Mean ODI decreased from 39 preoperatively to 24 at 1 month, 21 at 3 months, 20 at 6 months, and 19 at 9 months. No intraoperative or postoperative complications were observed.</p><p><strong>Conclusion: </strong>Targeted facet joint surface remodeling appears to be a safe and effective motion-preserving surgical option for carefully selected patients with lumbar facet joint syndrome. This proof-of-concept study demonstrates encouraging short-to mid-term clinical outcomes and supports further prospective evaluation.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"542-546"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial hemorrhage following spinal interventions: A comparison between major surgical procedures versus minimally invasive procedures.","authors":"Yahya Al-Kindi, Khalid Al-Balushi, Al-Yaqadhan Al-Kindi, Firas Al Rashdi, Tariq Al-Saadi","doi":"10.4103/jcvjs.jcvjs_70_26","DOIUrl":"10.4103/jcvjs.jcvjs_70_26","url":null,"abstract":"<p><p>This study systematically reviews the incidence, types, and management of intracranial hemorrhage (ICH) following major and minor spinal procedures, highlighting demographic trends, risk factors, and treatment outcomes to standardize clinical practices and improve patient safety. ICH following spine procedures, both major and minimally invasive, remains a rare but severe complication. The exact etiological factors are yet to be fully identified, though cerebrospinal fluid (CSF) leakage and decreased intracranial pressure are significant contributors. A comprehensive literature search identified 114 studies reporting ICH cases from minor post-spinal procedures. A total of 138 patients were included. Data were extracted on demographics, types of spinal procedures, ICH, and management strategies. A database from a previously published paper, which included 109 patients postmajor spinal procedures, was incorporated for comparative analysis to identify patterns and differences. Our study analyzed 138 cases of ICH following minimally invasive spinal procedures, compared to 109 postmajor cases. Females predominated in the minimally invasive group (88.7%). Subdural hematoma was significantly higher in minor procedures (90%), while cerebellar hemorrhage occurred only in major procedures (56.9%). Needle sizes varied, with 18 Gauge needles used in 17% of cases and 66.1% reported as \"Others.\" Mortality rates were comparable between major (3.7%) and minor (5.7%) procedures, indicating similar risk levels. ICH following spinal procedures, particularly minor ones, presents a significant clinical challenge. The findings underscore the need for customized treatment strategies and vigilant monitoring, especially in younger, healthier populations. Study limitations include potential publication bias and heterogeneity, highlighting the need for further research with more extensive, diverse samples to validate these findings.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"464-472"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct spinal cord injury during cervical epidural and nerve root blocks: A case series and pathophysiological reevaluation.","authors":"Sung Jin Kim, Young Jin Kim, In Ho Jung","doi":"10.4103/jcvjs.jcvjs_92_26","DOIUrl":"10.4103/jcvjs.jcvjs_92_26","url":null,"abstract":"<p><p>Cervical epidural and nerve root blocks effectively manage radicular pain but pose risks of severe neurologic complications, including acute myelopathy. Although vascular embolization of particulate steroids is often implicated in these events, direct mechanical spinal cord injury remains an underrecognized etiology. Identifying the true pathophysiologic mechanism is essential to prevent permanent neurological deficits. We retrospectively reviewed four patients who developed acute spinal cord injuries immediately following cervical nerve blocks or targeted acupuncture. We analyzed clinical presentations, intraprocedural events, and longitudinal magnetic resonance imaging (MRI) findings to elucidate the underlying mechanism of injury. All patients reported an instantaneous, excruciating \"electric shock-like\" sensation during needle insertion, followed immediately by severe motor weakness and paresthesia. MRI consistently revealed focal, central T2-weighted high signal intensities strictly localized within the spinal cord parenchyma. Unlike typical vascular infarctions following specific arterial territories, these findings strongly correlate with the physical trajectory of a direct needle puncture. The pathognomonic intraprocedural electric shock sensation and the central localization of MRI lesions strongly suggest direct mechanical needle injury as a primary cause of these catastrophic complications. Immediate cessation of needle advancement upon patient report of a shock-like sensation is critical to prevent irreversible spinal cord damage.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"570-573"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression and psychotic disorders elevate inpatient burden after posterior cervical decompression and fusion: Prioritizing screening and targeted discharge planning.","authors":"Leonidas E Mastrokostas, Paul G Mastrokostas, Daniel Yusupov, Abigail Razi, Aaron B Lavi, Luke B Schwartz, Sean Inzerillo, Mohamed Said, Alexander Kucherina, Pemla Jagtiani, Arie Monas, John K Houten, Christopher K Kepler, Jad Bou Monsef, Afshin E Razi, Mitchell K Ng","doi":"10.4103/jcvjs.jcvjs_95_26","DOIUrl":"10.4103/jcvjs.jcvjs_95_26","url":null,"abstract":"<p><strong>Context: </strong>Psychiatric comorbidity has been associated with worse perioperative outcomes and greater healthcare utilization after spine surgery.</p><p><strong>Aims: </strong>This study compared complications and healthcare utilization among posterior cervical decompression and fusion (PCDF) patients with depression, psychotic disorders, or no mental-health diagnosis.</p><p><strong>Settings and design: </strong>Retrospective cohort analysis of the National Inpatient Sample from 2016 to 2022.</p><p><strong>Materials and methods: </strong>The database was queried for elective adult PCDF encounters. Mental-health exposures were defined using Elixhauser indicators for depression and psychoses. Outcomes included medical complications, non-routine discharge, inpatient mortality, length of stay (LOS), and costs.</p><p><strong>Statistical analysis used: </strong>Chi-square and multivariate logistic regression analyses were performed. Significance was set at the <i>P</i> < 0.05 level.</p><p><strong>Results: </strong>We identified 167,480 weighted admissions: 129,205 with no mental-health diagnosis, 32,500 with depression, and 5,775 with psychotic disorders. Depression was associated with higher odds of cardiovascular complications (odds ratio [OR]: 1.20, <i>P</i> < 0.001), mechanical complications (OR: 1.24, <i>P</i> < 0.001), a composite adverse-event outcome (OR: 1.17, <i>P</i> < 0.001), and nonroutine discharge (OR: 1.12, <i>P</i> < 0.001). Psychotic disorders were associated with higher odds of mechanical complications (OR: 1.44, <i>P</i> = 0.002), nonroutine discharge (OR: 1.32, <i>P</i> < 0.001), and inpatient mortality (OR: 2.33, <i>P</i> = 0.043). Costs were higher with depression and highest with psychotic disorders ($39,564 vs. $40,787 vs. $42,362; <i>P</i> < 0.001). LOS was higher with depression and highest with psychotic disorders (4.10 vs. 4.36 vs. 4.81 days; <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>Depression and psychotic disorders are common in PCDF and are linked to worse outcomes and higher resource use.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 4","pages":"434-440"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myelomalacia severity on preoperative magnetic resonance imaging does not predict patient-reported outcomes after anterior cervical discectomy and fusion.","authors":"Mitchell K Ng, Joshua Mathew, Robert J Oris, Yulia Lee, Jonathan Dalton, Gregorio Baek, Ashley Thommana, William Green, Yasmine Eichbaum, Morgan Hitchner, Brandon Martinazzi, Ali Farooqi, Alec Giakas, Paul Gunter, Vinay Bijoor, Andrew Vanchikorn, John J Mangan, David I Kaye, Mark F Kurd, Thomas D Cha, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.4103/jcvjs.jcvjs_106_26","DOIUrl":"10.4103/jcvjs.jcvjs_106_26","url":null,"abstract":"<p><strong>Study design/setting: </strong>Retrospective cohort study.</p><p><strong>Background: </strong>Signal changes within the spinal cord on magnetic resonance imaging (MRI) or myelomalacia, are frequently seen in patients with cervical myelopathy. While often assumed to predict the outcomes, their prognostic value remains uncertain. Therefore, this study aimed to: (1) describe the clinical characteristics of patients with myelomalacia undergoing Anterior cervical discectomy and fusion (ACDF); (2) evaluate whether MRI findings correlate with patient-reported outcomes (PROMs); and (3) determine whether morphology predict recovery.</p><p><strong>Methods: </strong>A retrospective review at a single tertiary care center was performed (2014-2021). Patients were included if they underwent a primary elective ACDF with an available preoperative MRI. PROMs were collected preoperatively and postoperatively. Sagittal MRI assessment included Yukawa T2 hyperintensity grade, T1 signal change, morphology subtype, canal diameter, and K-line. Axial MRI was used to assess cord compression. Spearman correlation assessed the relationships between MRI measurements and PROMs.</p><p><strong>Results: </strong>Sixty-two patients were included. Bright T2 hyperintensity was observed in 61%, T1 hypointensity in 75%, and fusiform morphology in 53%; 79% were K-line positive. No consistent correlations were identified between MRI severity and PROMs. Yukawa T2 grading, T1 hypointensity, and morphology demonstrated negligible associations with postoperative outcomes. Weak associations were seen between K-line positivity and both 12-month SF-12 MCS (r = 0.34) and change in 6-month VAS neck (r = -0.39), but these were not clinically significant.</p><p><strong>Conclusion: </strong>Preoperative MRI severity and morphology of myelomalacia did not predict postoperative improvement after ACDF. These findings suggest that myelomalacia is best used as a diagnostic marker of spinal cord injury rather than a prognostic marker of recovery.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 4","pages":"415-422"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}