Rachel Bratescu, Anthony Robayo, Evan Wang, Chibuikem A. Ikwuegbuenyi, Lawrance K. Chung, Noah Willett, Andreas K. Demetriades, Sun-Ho Lee, Roger Härtl, AO Spine Knowledge Forum Degenerative
Neurospine 2026;23(1):94-108. Published online January 31, 2026
Recurrent lumbar disc herniation (RLDH) is a common complication after discectomy, occurring in 2%–25% of patients and contributing to higher reoperation rates, reduced satisfaction, and substantial direct and indirect costs. This review evaluates the economic consequences of RLDH and the relative cost-effectiveness of available management strategies. A systematic search of OVID, MEDLINE, and the Cochrane Library was performed through August 2025. Peer-reviewed, English-language studies were included if they examined adults (≥18 years) with RLDH and reported economic data. Exclusion criteria were studies limited to primary, cervical, or thoracic herniations; animal or cadaveric models; and abstracts. Extracted variables included study design, sample size, follow-up duration, and cost components. Of 283 records identified, 220 were screened and 35 underwent full-text review. Six studies met inclusion criteria, with 2 added through citation searching. Reported costs varied considerably: repeat discectomy added $6,907 in one analysis, while fusion increased expenses by more than 350%. Across studies, repeat discectomy remained the most cost-efficient option, providing comparable outcomes with reduced perioperative expenditures. Conservative management had the lowest immediate direct costs (≈$2,300) but likely underestimates the overall burden due to unmeasured productivity losses. Annular closure devices demonstrated potential cost savings of $2,000–5,000 over 2–5 years. RLDH imposes a substantial economic burden. Heterogeneity in costing methods remains a major limitation which hinders evidence-based determinations. Greater transparency, methodological standardization, and incorporation of societal perspectives are essential to accurately assess the socioeconomic impact of RLDH.
Luca Ambrosio, Sathish Muthu, Samuel K. Cho, Micheal S. Virk, Juan P. Cabrera, Patrick C. Hsieh, Andreas K. Demetriades, Stipe Ćorluka, S. Tim Yoon, Gianluca Vadalà, AO Spine Knowledge Forum Degenerative
Neurospine 2025;22(1):40-47. Published online March 31, 2025
Objective This study aims to assess global trends in the use of open surgery versus minimally invasive surgery (MIS) for the treatment of single-level L4–5 degenerative lumbar spondylolisthesis (DLS).
Methods A cross-sectional online survey issued by the AO Spine Knowledge Forum Degenerative was conducted among AO Spine members between July and September 2023. Participants were presented with 3 clinical cases of L4–5 grade 1 DLS, each with varying degrees of stenosis and instability. The survey captured surgeon demographics and preferences for open versus MIS approaches. Statistical analysis, including chi-square tests and logistic regression, was performed to explore associations between surgical choices and surgeon demographics.
Results A total of 943 surgeons responded, with 479 completing the survey. Open surgery was the preferred approach in all 3 cases (58.8%, 57.3%, and 42.4%, respectively), particularly in cases involving central and bilateral foraminal stenosis. MIS was the second most common choice, particularly for unilateral foraminal stenosis with mild instability (38.8%). Surgeons’ preferences varied significantly by region, age, and fellowship training, with younger and fellowship-trained surgeons more likely to prefer MIS.
Conclusion The study highlights the continued predominance of open surgery for DLS, especially in complex cases, despite the growing acceptance of MIS. Significant regional and demographic variations in surgical preferences suggest the need for tailored guidelines and standardized training protocols to optimize patient outcomes. Future research should focus on the long-term efficacy of these approaches and the impact of evolving technologies on surgical decision-making.
Citations
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Minimally Invasive Options for Spondylolisthesis Chibuikem A. Ikwuegbuenyi, Mousa Hamad, Ibrahim Hussain, Roger Härtl Neurosurgery Clinics of North America.2026; 37(1): 39. CrossRef
Long-term comparative study of Open-TLIF, MIS-TLIF, and UBE-TLIF in single-level degenerative lumbar spondylolisthesis Jian Luo, Lihua Shen, Changshen Bao, Zhichao Gao European Journal of Medical Research.2026;[Epub] CrossRef
Current Trends and Future Directions in Lumbar Spine Surgery: A Review of Emerging Techniques and Evolving Management Paradigms Gianluca Galieri, Vittorio Orlando, Roberto Altieri, Manlio Barbarisi, Alessandro Olivi, Giovanni Sabatino, Giuseppe La Rocca Journal of Clinical Medicine.2025; 14(10): 3390. CrossRef
Jordan J Levett, Miltiadis Georgiopoulos, Simon Martel, Wissam Al Mugheiry, Nikolaos A. Stavropoulos, Miguel Vega-Arroyo, Carlo Santaguida, Michael H. Weber, Jeff D. Golan, Peter Jarzem, Jean A. Ouellet, Georgios Klironomos, Andreas K. Demetriades
Neurospine 2024;21(2):375-400. Published online June 30, 2024
Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults, representing substantial morbidity and significant financial and resource burdens. Typically, patients with progressive DCM will eventually receive surgical treatment. Nonetheless, despite advancements in pharmacotherapeutics, evidence for pharmacological therapy remains limited. Health professionals from various fields would find interest in pharmacological agents that could benefit patients with mild DCM or enhance surgical outcomes. This review aims to consolidate all clinical and experimental evidence on the pharmacological treatment of DCM. We conducted a comprehensive narrative review that presents all pharmacological agents that have been investigated for DCM treatment in both humans and animal models. Riluzole exhibits effectiveness solely in rat models, but not in treating mild DCM in humans. Cerebrolysin emerges as a potential neuroprotective agent for myelopathy in animals but had contradictory results in clinical trials. Limaprost alfadex demonstrates motor function improvement in animal models and exhibits promising outcomes in a small clinical trial. Glucocorticoids not only fail to provide clinical benefits but may also lead to adverse events. Cilostazol, anti-Fas ligand antibody, and Jingshu Keli display promise in animal studies, while erythropoietin, granulocyte colony-stimulating factor and limaprost alfadex exhibit potential in both animal and human research. Existing evidence mainly rests on weak clinical data and animal experimentation. Current pharmacological efforts target ion channels, stem cell differentiation, inflammatory, vascular, and apoptotic pathways. The inherent nature and pathogenesis of DCM offer substantial prospects for developing neurodegenerative or neuroprotective therapies capable of altering disease progression, potentially delaying surgical intervention, and optimizing outcomes for those undergoing surgical decompression.
Citations
Citations to this article as recorded by
Conservative and newer drug treatment for degenerative cervical myelopathy Osita Ede, Jason Pui Yin Cheung Journal of Clinical Orthopaedics and Trauma.2025; 64: 102972. CrossRef
Revisiting Secondary Dilative Cardiomyopathy Nilima Rajpal Kundnani, Federico Di Luca, Vlad Meche, Abhinav Sharma, Mihaela-Diana Popa, Marioara Nicula-Neagu, Oana Raluca Voinescu, Mihai Iacob, Daniel-Marius Duda-Seiman, Simona Ruxanda Dragan International Journal of Molecular Sciences.2025; 26(9): 4181. CrossRef
Glucocorticoid-induced osteoporosis: novel concepts and clinical implications Lorenz C Hofbauer, Juliet E Compston, Kenneth G Saag, Martina Rauner, Elena Tsourdi The Lancet Diabetes & Endocrinology.2025; 13(11): 964. CrossRef
From the Editor-in-Chief: Featured Articles in the June 2024 Issue Inbo Han Neurospine.2024; 21(2): 373. CrossRef
Neuroprotection and Neuroregeneration of the Injured Spinal Cord: A Focus on Degenerative Cervical Myelopathy – Commentary on “Pharmacological Treatment of Degenerative Cervical Myelopathy: A Critical Review of Current Evidence” Karlo M. Pedro, Michael G. Fehlings Neurospine.2024; 21(2): 401. CrossRef
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