Brain & spine最新文献

{"title":"Minimally invasive tubular resection of spinal arachnoid webs.","authors":"Florian Volz, Jürgen Beck, Ulrich Hubbe, Amir El Rahal, Christoph Scholz, Marc Hohenhaus, Ralf Watzlawick, Marco Bissolo, Lucas Becker, Marius Schwabenland, Jan-Helge Klingler","doi":"10.1016/j.bas.2026.106079","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106079","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal arachnoid webs (SAWs) are rare intradural extramedullary lesions causing progressive myelopathy. For surgical resection, minimally invasive approaches, especially using tubular retractors, remain underreported.</p><p><strong>Research question: </strong>This study presents a series of minimally invasive SAW resections performed through expandable and non-expandable tubular retractors.</p><p><strong>Material and methods: </strong>This retrospective monocentric cohort study included patients with minimally invasive tubular resection of SAWs between July 2017 and December 2025. Preoperative and postoperative status was assessed using the modified McCormick grading scale, surgical details were descriptively analyzed.</p><p><strong>Results: </strong>The cohort comprised 5 male and 7 female patients (mean age 61.1 ± 8.8 years). All patients presented with progressive myelopathy. All lesions were located in the upper thoracic spine, with T2-3 being most common. All patients demonstrated the pathognomonic scalpel sign on preoperative MRI, two patients (17%) had associated syringomyelia. Surgical technique involved expandable (3/12) and non-expandable tubular retractors (20 mm diameter, 9/12). Mean operative time was 110 ± 30 min with minimal blood loss in all cases. Two patients required revision surgery. No permanent neurological deficits occurred, and all patients maintained stable or improved neurological function postoperatively.</p><p><strong>Discussion and conclusion: </strong>This series represents the largest experience with tubular resection of SAWs using non-expandable retractor systems with 20 mm diameter access corridors. The revision rate aligns with the published literature and reflects the technical challenges rather than a limitation of the approach. This truly minimally invasive approach is safe and effective in appropriately selected patients and in experienced centers.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106079"},"PeriodicalIF":2.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846294","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 hemangioblastomas in children: Clinical-radiological characteristics, microsurgical strategy, and long-term outcomes in a 10-year single-center cohort.","authors":"Qishuai Yu, Desheng Kong, Liang Zhang","doi":"10.1016/j.bas.2026.106085","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106085","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial hemangioblastomas (HBs) are exceedingly rare in the pediatric population, and their clinical-radiological features, optimal treatment modalities, and long-term prognosis remain inadequately defined.</p><p><strong>Research question: </strong>We sought to characterize the clinical-radiological characteristics, treatment modalities and clarify the surgical outcomes for pediatric patients with brain HBs.</p><p><strong>Material and methods: </strong>Consecutive patients aged ≤18 years who underwent resection for intracranial HBs between 2011 and 2021 were retrospectively reviewed. Epidemiologic, clinical, neuroimaging, treatment modalities, and follow-up data were integrated and reviewed.</p><p><strong>Results: </strong>Thirty-three patients (male:female = 1.2:1; mean age 14.9 ± 2.8 years) were identified. Eighteen cases (54.5%) were sporadic, 15 (45.5%) were von Hippel-Lindau (VHL)-associated. Presenting manifestations mainly reflected posterior-fossa hypertension and cerebellar dysfunction: headache (n = 21, 63.6%), vomiting (n = 13, 39.4%), and gait instability (n = 9, 27.3%). Neuroimaging revealed a predominant cerebellar location (n = 30, 76.9%); most (n = 29, 74.4%) exhibited the classic cyst-with-enhancing-nodule architecture. VHL-associated HBs were smaller (p = 0.039) and more frequently multi-focal. Gross-total resection (GTR) achieved in 94.9% lesions. At follow-up, all recurrences (n = 4, 12.1%) occurred in the VHL cohort, yielding a 5-year progression-free survival (PFS) of 87.9% for the entire series but only 73.3% for VHL patients. Multi-focal central nervous system (CNS) and extra-CNS VHL lesions necessitated additional interventions in 53.3% of VHL cases.</p><p><strong>Discussion and conclusion: </strong>Pediatric intracranial HBs demonstrate unique features, including a higher rate of VHL association. Early surgical intervention remains the main treatment methods, ensuring favorable outcomes when performed properly. Life-long follow-up is essential, particularly for those with VHL-associated tumors, due to their higher recurrence risk.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106085"},"PeriodicalIF":2.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846272","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":"Trans orbital eyebrow approach for selective resections in mesial temporal lobe epilepsy: Technical aspects and preliminary case series.","authors":"Sébastien Froelich, Emmanuel Mandonnet, Yohan Caudron, Tingting Jiang, Arianna Fava, Thibault Passeri, Agathe Laurent, Adrien Zanin, Bertrand Devaux, Francine Chassoux","doi":"10.1016/j.bas.2026.106075","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106075","url":null,"abstract":"<p><strong>Introduction: </strong>Selective amygdalo-hippocampectomy (SAH) is commonly performed in drug-resistant mesial temporal lobe epilepsy (MTLE) with seizure-free outcome in 70-80% of patients, however cognitive risks with respect to surgical approaches remain debated.</p><p><strong>Research question: </strong>The preliminary experience of a new surgical route through the orbit are evaluated with the aim to improve the benefits/risks of SAH.</p><p><strong>Methods: </strong>Patients were recruited among a cohort of 100 patients investigated in the Epilepsy Unit of the department of Neurosurgery, between 2022 and 2024. A SAH through a transorbital approach with an eyebrow incision was performed in 3 patients (2 males, 22-51 years) after investigation for pure MTLE (right side in 2, non-lesional in 1).Surgical outcome was assessed with respect to seizures according to the International League Against Epilepsy (ILAE) classification.</p><p><strong>Results: </strong>No local or general complications occurred postoperatively except a transient diplopia due to ocular oedema. Mean volume of resection was of 9.2 cc, and virtual dissection of tractograms demonstrated that the resection cavity spared the optic, uncinate and inferior longitudinal pathways in all cases.With a 12 to 31 month-follow-up (mean 22 months), seizure-free outcome (ILAE class 1) was obtained in all patients. Neuropsychological evaluation showed increased or stable cognitive and memory performances, with an improvement of quality of life (QOL) in all. Aesthetical results were excellent.</p><p><strong>Conclusion: </strong>Transorbital eyebrow approach is safe and effective for SAH, with a positive impact on cognitive functions and QOL. Although preliminary, these findings suggest that it may be an option in patients with pure MTLE.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106075"},"PeriodicalIF":2.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846846","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":"Transforaminal lumbar interbody fusion (TLIF) with or without anterior release (TFAR) using expandable interbody spacers - comparative cohort study.","authors":"Martin N Stienen, Laurin Feuerstein, Felix C Stengel, Lorenzo Bertulli, Linda Bättig, Yesim Yildiz, Gregor Fischer, Francis Kissling, Thomas Schöfl, Nader Hejrati, Daniele Gianoli, Stefan Motov, Benjamin Martens","doi":"10.1016/j.bas.2026.106069","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106069","url":null,"abstract":"<p><strong>Introduction: </strong>Transforaminal lumbar interbody fusion (TLIF) can be extended by transforaminal anterior release (TFAR), to open and distract degenerated segments and increase segmental lordosis (SL).</p><p><strong>Research question: </strong>To analyze the rate, type and severity of adverse events (AEs), as well as spinopelvic parameters and clinical outcomes.</p><p><strong>Material and methods: </strong>We reviewed consecutive patients treated with TLIF with expandable interbody spacers. TFAR patients were matched 1:5 to a control group (conventional TLIF).</p><p><strong>Results: </strong>We identified n = 435 patients (541 TLIF levels; mean age 65.2 years; 55.7% female), of which n = 30 patients (39 levels) were assigned to the TFAR group and n = 149 (247 TLIF levels) to the control group. TFAR procedures took longer (mean difference (MD) 86min, p = 0.004) and had a higher blood loss (MD 463 ml, p = 0.022). In multivariable analysis, TFAR patients were more likely to experience intraoperative AEs (OR 3.49, 95% CI 1.47 - 8.31, p = 0.005) and early postoperative AEs (OR 2.39, 95% CI 0.99 - 5.76, p = 0.051), while the risk for further AEs at 90 days and 12 months was similar. Patients in the TFAR group were more likely to achieve a favorable 12-month outcome (OR 2.71, 95% CI 1.13 - 6.51, p = 0.025). TFAR patients had consistently more SL during follow-up (12 month: 24.9° vs. 18.9°, p < 0.001) and the pelvic incidence (PI)-LL mismatch was lower (0.4° vs. 7.2°, p = 0.020).</p><p><strong>Discussion and conclusion: </strong>We found a 3-fold increase in intraoperative and early postoperative AEs in TFAR patients, while the mid- and longer-term outcomes were similar or even slightly better than in patients undergoing conventional TLIF.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106069"},"PeriodicalIF":2.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846823","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":"Secondary changes in sagittal alignment after instrumented surgery with and without corpectomy for pyogenic spondylodiscitis.","authors":"B Younes, B Schatlo, P Melich, D Mielke, V Rohde, T Abboud","doi":"10.1016/j.bas.2026.106066","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106066","url":null,"abstract":"<p><strong>Objective: </strong>Pyogenic spondylodiscitis is associated with substantial morbidity and mortality, and vertebral body destruction may lead to secondary spinal deformity. However, there is no consensus regarding the indication for 360° fusion compared with stand-alone posterior instrumentation. This study evaluated postoperative changes in sagittal alignment and compared radiological outcomes between these surgical strategies.</p><p><strong>Methods: </strong>Data from 90 patients who underwent instrumented surgery for pyogenic spondylodiscitis between 2013 and 2020 were retrospectively analyzed. The primary radiological endpoint was the Cobb angle at the last radiological follow-up (12 months), compared with preoperative and immediate postoperative measurements. Continuous variables are presented as mean ± standard deviation. Univariate and multivariable regression analyses were performed to identify factors associated with alignment changes.</p><p><strong>Results: </strong>Posterior instrumentation was performed in 65 lumbar and 25 thoracic cases; 360° fusion was performed in 9 lumbar and 11 thoracic cases. The mean clinical follow-up duration was 24 ± 3 months. In lumbar cases, mean Cobb angles were 26.4 ± 15.8° preoperatively, 28.9 ± 16° postoperatively, and 24.7 ± 14.2° at follow-up. Lordosis increased after surgery but decreased at follow-up (P = 0.034 and P = 0.001, respectively). In thoracic cases, mean Cobb angles were -12.3 ± 6.7°, -11.1 ± 7.1°, and -16.3 ± 9.1°, respectively, with no postoperative improvement and significant kyphosis progression at follow-up (P = 0.211 and P = 0.001, respectively). In lumbar cases, 360° fusion was associated with better sagittal alignment at last follow-up (p = 0.045) and remained an independent predictor in multivariable analysis (p = 0.038). In thoracic cases, the number of operated levels was associated with improved alignment (p = 0.048).</p><p><strong>Conclusion: </strong>Secondary changes in sagittal alignment may occur after surgery for pyogenic spondylodiscitis. A 360° fusion may provide greater long-term sagittal stability in the lumbar spine, while posterior instrumentation alone appears sufficient in the thoracic spine.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106066"},"PeriodicalIF":2.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846549","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":"Comparing the intra- and inter-rater reliability of two outcomes, two software platforms, and three levels of surgical experience for radiographic measurements of surgically treated osteoporotic vertebral compression fractures.","authors":"Andreas Tsoupras, Anne Tabard-Fougère, Khalid Al Taha, Pietro Feltri, Sana Boudabbous, Dennis E Dominguez, Nicolas Lauper","doi":"10.1016/j.bas.2026.106070","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106070","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoporotic vertebral compression fractures (OVCFs) present diagnostic challenges, especially in elderly patients with low bone density. Radiographic measurement is key to surgical decision-making, but their reliability in these patients with lower radiological density is questionable.</p><p><strong>Research question: </strong>What is the intra- and inter-rater reliability and responsiveness to the measurement of two commonly used radiographic parameters-vertebral kyphotic angle (VKA) and vertebral body height (VBH)-using two different DICOM software platforms for patients undergoing surgical treatment for OVCFs?</p><p><strong>Material and methods: </strong>Patients treated surgically for OVCFs were randomly extracted. Sagittal vertebral body deformity was evaluated using the VKA and the VBH (pre-operative, post-operative and change over time). One operator repeated measurements with one-month interval (intra-rater reliability), using two software platforms (OsiriX MD and Weasis). Three randomly assigned surgeons per platform performed blindly measurements (inter-rater). Reliability was assessed using intraclass correlation coefficients (ICC).</p><p><strong>Results: </strong>Thirty-four patients (71% females; mean age 75.3 ± 9.4 years) were included. Intra-rater and inter-rater reliability were reported as good-to-excellent (ICC: 0.75-0.90) for VKA, and good-to-moderate (ICC: 0.50-0.75) for VBH. Reliability for measuring post-operative change was moderate for both outcomes. Both software platforms perform comparably with good agreement.</p><p><strong>Discussion and conclusions: </strong>This was the first study to assess the reliability and responsiveness of postoperative radiographic changes in OVCF surgery across two different software platforms. VKA is a more reliable measurement than VBH. These findings support using VKA to guide treatment and monitoring recovery, although measurement error remain important considerations in elderly patients with low bone density.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106070"},"PeriodicalIF":2.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846938","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":"Psoas muscle attenuation on preoperative CT predicts 30-day complications after lateral lumbar interbody fusion.","authors":"Julien N Jost, Kristina Catalano, Pascal Luterbacher, Jaqueline Lattmann, Debora Cipriani, Lukas Andereggen, Gerrit A Schubert, Markus Bruder","doi":"10.1016/j.bas.2026.106063","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106063","url":null,"abstract":"<p><strong>Introduction: </strong>Computed tomography (CT)-derived mean psoas muscle attenuation (P-HU) reflects myosteatosis and has been associated with frailty-related outcomes. Whether it predicts early postoperative complications after lateral lumbar interbody fusion (LLIF) remains unclear.</p><p><strong>Research question: </strong>Does preoperative P-HU predict 30-day postoperative complications, prolonged hospitalization, and approach-related hip flexion weakness after LLIF?</p><p><strong>Material and methods: </strong>We retrospectively analyzed 60 adults undergoing LLIF. Mean bilateral P-HU was measured at mid-L3 on routine preoperative CT. The primary endpoint was any 30-day postoperative complication classified according to Clavien-Dindo (CD ≥ I); clinically relevant complications (CD ≥ II) were evaluated in sensitivity analyses. Multivariable Firth logistic regression adjusted for age, ASA classification, and body mass index. Interobserver reliability was assessed in a subset of 36 patients.</p><p><strong>Results: </strong>Sixteen patients (26.7%) developed 30-day postoperative complications. P-HU was significantly lower in patients with complications than in those without (35.1 ± 6.0 vs 44.4 ± 7.3 HU; p < 0.001). Each 10-HU increase in P-HU was independently associated with lower odds of complications (OR 0.20; p = 0.002). Discrimination was high (AUC 0.87). Higher P-HU was also associated with shorter hospital stay but not with postoperative hip flexion weakness.</p><p><strong>Discussion and conclusion: </strong>Lower preoperative P-HU was independently associated with postoperative complications and prolonged hospitalization after LLIF, but not with approach-related hip flexion weakness. Opportunistic CT-based muscle assessment may represent a simple imaging biomarker for perioperative risk stratification.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106063"},"PeriodicalIF":2.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824023","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":"Upright supine imaging can detect clinically relevant occult instability in degenerative lumbar spondylolisthesis - A two-year PROM based comparison with flexion extension radiographs.","authors":"Tom Folkerts, Julia Wimmer, Lukas Schönnagel, Anna-Maria Mielke, Bruno Verna, Pedro Rocha Torres, Paul Köhli, Jiaqi Zhu, Jennifer Shue, Rolando Duculan, Andrew A Sama, Federico P Girardi, Frank P Cammisa, Carol A Mancuso, Marco D Burkhard, Alexander P Hughes","doi":"10.1016/j.bas.2026.106064","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106064","url":null,"abstract":"<p><strong>Introduction: </strong>Flexion-extension radiographs (FER) are widely used to assess segmental instability in degenerative lumbar spondylolisthesis (DLS) and guide surgical decision-making, as dynamic instability may be associated with suboptimal outcomes after decompression only. However, FER rely on patient effort, and pain or limited mobility can reduce reproducibility and underestimate instability. Upright-supine imaging (USI), comparing upright radiographs with supine MRI, may better capture slip dynamics, but its clinical value remains undefined.</p><p><strong>Research question: </strong>To evaluate whether USI-derived segmental instability provides additional prognostic information beyond FER for predicting postoperative improvement in disability and low back pain (LBP) following decompression-only surgery for DLS.</p><p><strong>Material and methods: </strong>This retrospective analysis of prospectively collected data included 92 DLS patients undergoing decompression-only surgery. Slip dynamics were quantified as between-position difference in relative translation (ΔRT) on FER and USI. Multivariable regression assessed associations between ΔRT and two-year outcomes (Oswestry Disability Index [ODI], LBP numeric rating scale). ROC analyses determined optimal ΔRT_USI cutoffs.</p><p><strong>Results: </strong>ΔRT_USI independently predicted postoperative improvement in ODI (p < 0.001) and LBP (p < 0.001), whereas ΔRT_FER was not associated with outcomes. ROC analysis identified a ΔRT_USI threshold of 7.9% as optimal (ODI: AUC = 0.87, sensitivity = 0.86, specificity = 0.81; LBP: AUC = 0.62, sensitivity = 0.9, specificity = 0.48). USI identified instability in 22.8% of patients, uncovering occult instability that FER missed. USI-unstable patients showed significantly less postoperative improvement (p < 0.001).</p><p><strong>Discussion and conclusion: </strong>USI detects clinically relevant occult instability missed by FER and independently predicts outcomes after decompression-only surgery. A ΔRT_USI threshold of approximately 8% serves as a quantitative marker supporting USI for preoperative assessment in DLS.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106064"},"PeriodicalIF":2.5,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824029","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":"Evaluation of bony fusion after posterior lumbar interbody fusion: a systematic review and meta-analysis.","authors":"Luc W F van Haaster, Rania A Mekary, Carmen L A Vleggeert-Lankamp","doi":"10.1016/j.bas.2026.106067","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106067","url":null,"abstract":"<p><strong>Introduction: </strong>Posterior lumbar interbody fusion (PLIF) is a common surgical procedure for degenerative lumbar conditions, aiming to decompress neural tissue and stabilize the spine. Bony fusion is essential for long-term success, but inconsistent radiological criteria lead to variable reported fusion rates. This systematic review and meta-analysis evaluated quantitative criteria for assessing bony fusion and their impact on fusion rates over time.</p><p><strong>Research question: </strong>What quantitative criteria are used to assess bony fusion after PLIF, and how do these criteria affect fusion rates at different postoperative time points?</p><p><strong>Material and methods: </strong>PubMed, MEDLINE, Embase, Web of Science, Cochrane Library, and CINAHL were searched through November 6, 2025, for studies assessing bony fusion after PLIF using quantitative criteria on dynamic X-ray or CT. Pooled fusion rates were calculated at different postoperative time points, including additional analyses for cage material, smoking, and segmental motion cut-offs.</p><p><strong>Results: </strong>Seventeen studies including 1390 patients were analyzed. Fusion was assessed quantitatively exclusively by dynamic X-ray. Pooled fusion rates increased over time: 76.0% at 6 months, 86.4% at 12 months, 90.2% at 24 months, and 93.4% at 48 months. Optimal cut-off values for segmental motion of ≤3° and ≤4° were chosen due to similar heterogeneity, which was the lowest at 24 months.</p><p><strong>Discussion and conclusion: </strong>Fusion rates reach approximately 90% 24 months after PLIF and show minimal increase thereafter. Evaluating segmental motion with a ≤3°- or ≤4° cut-off provides the most reliable assessment of bony fusion.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106067"},"PeriodicalIF":2.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846867","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":"Clinical impact and predictive value of patient specific pre-bent rods in spinal deformity surgery: A comparative analysis of preoperative planned and postoperative outcomes.","authors":"Zimo Lu, Jun Ao, Alexander Hammer, Denis Rappert, Olga Cheremina, Thomas Tischer, Christoph Lutter, Klaus John Schnake","doi":"10.1016/j.bas.2026.106068","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106068","url":null,"abstract":"<p><strong>Introduction: </strong>Patient-specific rods (PSRs) represent an emerging technology for spinal deformity correction, offering personalized surgical planning based on individual anatomy.</p><p><strong>Research question: </strong>How accurately do PSRs achieve planned sagittal alignment corrections, and what factors influence surgical outcomes and complications?</p><p><strong>Material and methods: </strong>Twenty-two consecutive patients underwent spinal deformity correction using UNiD™ PSRs. Two novel metrics were developed: Correction Achievement Ratio (CAR) and Correction Maintenance Index (CMI). Radiographic parameters were measured preoperatively, postoperatively, and at one-year follow-up.</p><p><strong>Results: </strong>Twenty patients (91%) completed follow-up. PI-LL mismatch (CAR = 102.8%) and TPA (CAR = 91.9%) achieved near-perfect correction. PT (CAR = 149.2%) and SS (CAR = 123.5%) showed overcorrection. Learning curve analysis revealed improved accuracy after case 8. Overcorrection significantly increased complication risk (PT>120%: OR = 3.41, p = 0.025; PI-LL>120%: OR = 4.25, p = 0.007).</p><p><strong>Discussion and conclusion: </strong>PSRs effectively achieve planned sagittal corrections with high initial accuracy. However, maintaining correction remains challenging, and overcorrection increases complication risk. Surgical precision improves with experience. While promising for reducing mechanical complications, the technology requires further refinement for optimal outcomes.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106068"},"PeriodicalIF":2.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846930","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}