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Socioeconomic Implications of Recurrent Lumbar Disc Herniation: A Narrative Review
Neurospine. 2026;23(1):94-108.   Published online January 31, 2026
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Socioeconomic Implications of Recurrent Lumbar Disc Herniation: A Narrative Review
Neurospine. 2026;23(1):94-108.   Published online January 31, 2026
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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.

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  • Efficacy and safety of unilateral biportal endoscopy for recurrent lumbar disc herniation: A quantitative analysis of 7 cohort studies involving 409 patients
    Mingjiang Luo, Jinkai He, Wei Li, Yingting Tian, Xiao Liu, Weijian Li, Pinyi Liang, Yuxiao Zhou, Zhangchi Liu, Ziliang Zhao, Zhihong Xiao
    Neurosurgical Review.2026;[Epub]     CrossRef
  • 2,036 View
  • 50 Download
  • 1 Web of Science
  • 1 Crossref

Original Articles

Minimally Invasive Spine Surgery

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Transforaminal Lumbar Endoscopic Discectomy: A Novel Alternative for Management of Lumbar Disc Herniation in Patients With Rheumatoid Arthritis?
Neurospine. 2024;21(4):1210-1218.   Published online December 31, 2024
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Transforaminal Lumbar Endoscopic Discectomy: A Novel Alternative for Management of Lumbar Disc Herniation in Patients With Rheumatoid Arthritis?
Neurospine. 2024;21(4):1210-1218.   Published online December 31, 2024
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Objective
Lumbar disc herniation (LDH) represents an increasingly encountered condition in patients with rheumatoid arthritis (RA). The aim of the present study is to assess the progress of health-related quality of life following transforaminal endoscopic lumbar discectomy (TELD) for LDH in patients suffering from RA.
Methods
Seventy-four patients, scheduled to undergo elective TELD for LDH, were prospectively enrolled in the study. Group A included 36 otherwise healthy individuals and group B 38 patients complementarily diagnosed with RA according to the 2010 ACR/EULAR (American College of Rheumatology/European League Against Rheumatism) criteria. The Medical Outcomes Study 36-item Short Form health survey (SF-36) was selected for the outcome assessment at baseline and postoperatively, at selected intervals at 6 weeks, 3, 6, and 12 months postoperatively.
Results
Group A presented statistically significantly higher scores in all SF-36 domains and all selected intervals (p<0.001), except for mental health parameter. All aspects of SF-36 questionnaire significantly improved postoperatively (p<0.001) and in each group independently. Nevertheless, the absolute improvement between consecutive time intervals did not differ significantly between the 2 groups.
Conclusion
Patients diagnosed with RA who undergo TELD for LDH demonstrate statistically significant improvement in their health status, as measured by SF-36 questionnaire, one year after the procedure. This improvement is comparable with normal individuals.

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  • Full-Endoscopic Lumbar Discectomy: A Review of the Surgical Techniques, Indications and Anatomical Considerations
    Stylianos Kapetanakis, Mikail Chatzivasiliadis, Nikolaos Gkantsinikoudis, Konstantinos Pazarlis
    Journal of Clinical Medicine.2025; 14(24): 8961.     CrossRef
  • 3,608 View
  • 97 Download
  • 1 Web of Science
  • 1 Crossref

Regular Issue

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Clinical Characteristics, Surgical Outcomes, and Risk Factors for Emergency Surgery in Patients With Spinal Metastases: A Prospective Cohort Study
Neurospine. 2024;21(1):314-327.   Published online February 1, 2024
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Clinical Characteristics, Surgical Outcomes, and Risk Factors for Emergency Surgery in Patients With Spinal Metastases: A Prospective Cohort Study
Neurospine. 2024;21(1):314-327.   Published online February 1, 2024
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Objective
To elucidate the patient characteristics and outcomes of emergency surgery for spinal metastases and identify risk factors for emergency surgery.
Methods
We prospectively analyzed 216 patients with spinal metastases who underwent palliative surgery from 2015 to 2020. The Eastern Cooperative Oncology Group performance status, Barthel index, EuroQol-5 dimension (EQ5D), and neurological function were assessed at surgery and at 1, 3, and 6 months postoperatively. Multivariate analysis was performed to identify risk factors for emergency surgery.
Results
In total, 146 patients underwent nonemergency surgery and 70 patients underwent emergency surgery within 48 hours of diagnosis of a surgical indication. After propensity score matching, we compared 61 patients each who underwent nonemergency and emergency surgery. Regardless of matching, the median performance status and the mean Barthel index and EQ5D score showed a tendency toward worse outcomes in the emergency than nonemergency group both preoperatively and 1 month postoperatively, although the surgery greatly improved these values in both groups. The median survival time tended to be shorter in the emergency than nonemergency group. The multivariate analysis showed that lesions located at T3–10 (p = 0.002; odds ratio [OR], 2.92; 95% confidence interval [CI], 1.48–5.75) and Frankel grades A–C (p < 0.001; OR, 4.91; 95% CI, 2.45–9.86) were independent risk factors for emergency surgery.
Conclusion
Among patients with spinal metastases, preoperative and postoperative subjective health values and postoperative survival are poorer in emergency than nonemergency surgery. Close attention to patients with T3–10 metastases is required to avoid poor outcomes after emergency surgery.

Citations

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  • Diagnostic errors in spinal metastases: a systematic review of contributing clinical and systemic factors
    Kyron Wicker, Robert Tran, Robert Ablove
    European Spine Journal.2026; 35(2): 732.     CrossRef
  • The role of surgical timing in survival of patients with spinal metastases
    Miklós Kopa, Ádám Kővári, Lukács Németh, János Báskay, Péter Pollner, Zoltán Nagy, Péter Banczerowski, Tamás Mezei
    International Journal of Clinical Oncology.2026;[Epub]     CrossRef
  • Health- related quality of life after surgery for spinal metastases
    Silvia Terzi, Cristiana Griffoni, Simona Rosa, Chiara Cini, Emanuela Asunis, Chiara Alcherigi, Federica Trentin, Stefano Bandiera, Riccardo Ghermandi, Giuseppe Tedesco, Gisberto Evangelisti, Marco Girolami, Valerio Pipola, Giovanni Barbanti Brodano, Aless
    Journal of Bone Oncology.2025; 52: 100675.     CrossRef
  • Short-Term Outcomes in Planned Versus Unplanned Surgery for Spinal Metastases
    Ali Haider Bangash, Sertac Kirnaz, Rose Fluss, Victoria Cao, Alexander Alexandrov, Liza Belman, Yaroslav Gelfand, Saikiran G. Murthy, Reza Yassari, Rafael De la Garza Ramos
    Cancers.2025; 17(14): 2403.     CrossRef
  • One-Year Survival Following Surgical Management of Spinal Metastases
    Andrey Švec, Martin Bibza, Peter Tisovský, Veronika Boleková, Boris Šteňo
    Bratislava Medical Journal.2025; 126(12): 3600.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the March 2024 Issue
    Inbo Han
    Neurospine.2024; 21(1): 1.     CrossRef
  • Commentary on “Clinical Characteristics, Surgical Outcomes, and Risk Factors for Emergency Surgery in Patients With Spinal Metastases: A Prospective Cohort Study”
    John H. Chi
    Neurospine.2024; 21(1): 328.     CrossRef
  • Determinants of Overall and Readmission-Free Survival in Patients with Metastatic Epidural Spinal Cord Compression
    Mirza Pojskić, Benjamin Saß, Miriam H. A. Bopp, Sebastian Wilke, Christopher Nimsky
    Cancers.2024; 16(24): 4248.     CrossRef
  • 6,957 View
  • 125 Download
  • 8 Web of Science
  • 8 Crossref

Regular Issue

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Multilevel Pedicle Subtraction Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis: Clinical Effect and Biomechanical Evaluation
Neurospine. 2024;21(1):231-243.   Published online January 31, 2024
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Multilevel Pedicle Subtraction Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis: Clinical Effect and Biomechanical Evaluation
Neurospine. 2024;21(1):231-243.   Published online January 31, 2024
Close
Objective
To compare the clinical outcomes and biomechanical characteristics of 1-, 2-, and 3-level pedicle subtraction osteotomy (PSO), and establish selection criteria based on preoperative radiographic parameters.
Methods
Patients undergone PSO to treat ankylosing spondylitis from February 2009 to May 2019 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled. According to the quantity of osteotomy performed, the participants were divided into group A (1-level PSO, n = 24), group B (2-level PSO, n = 19), and group C (3-level PSO, n = 11). Clinical outcomes were assessed before surgery and at the final follow-up. Comparisons of the radiographic parameters and quality-of-life indicators were performed among and within these groups, and the selection criteria were established by regression. Finite element analysis was conducted to compare the biomechanical characteristics of the spine treated with different quantity of osteotomies under different working conditions.
Results
Three-level PSO improved the sagittal parameters more significantly, but resulted in longer operative time and greater blood loss (p < 0.05). Greater stress was found in the proximal screws and proximal junction area of the vertebra in the model simulating 1-level PSO. Larger stress of screws and vertebra was observed at the distal end in the model simulating 3-level PSO.
Conclusion
Multilevel PSO works better for larger deformity correction than single-level PSO by allowing greater sagittal parameter correction and obtaining a better distribution of stress in the hardware construct, although with longer operation time and greater blood loss. Three-level osteotomy is recommended for the patients with preoperative of global kyphosis > 85.95°, T1 pelvic angle > 62.3°, sagittal vertical alignment > 299.55 mm, and pelvic tilt+ chin-brow vertical angle > 109.6°.

Citations

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  • Optimizing osteotomy in ankylosing spondylitis-induced kyphosis: anatomical insights and novel instrumentation
    Jiabao Liu, Qiwei Wang, Ziliang Zeng, Xumin Hu, Yelidana Nuertai, Zhihao Huang, Xin Lv, Liangbin Gao
    BMC Musculoskeletal Disorders.2026;[Epub]     CrossRef
  • A novel pre-contoured V-shaped rod in one-level pedicle subtraction osteotomy for the treatment of rigid lumbar kyphosis caused by ankylosing spondylitis: technical note and case series
    Hongtao Ding, Cheng Zeng, Andrew Y. Xu, Audrey Y. Su, Jeffrey J. Yeung, Xin Chen, Huadong Wang, Yanbin Zhang, Kai Yan, Yonggang Xing, Da He, Bin Xiao
    BMC Musculoskeletal Disorders.2025;[Epub]     CrossRef
  • Advances in Molecular Research on Hip Joint Impingement—A Vascular Perspective
    Riana Maria Huzum, Marius Valeriu Hînganu, Bogdan Huzum, Delia Hînganu
    Biomolecules.2024; 14(7): 784.     CrossRef
  • 7,697 View
  • 146 Download
  • 3 Web of Science
  • 3 Crossref

Review Article

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Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets
Neurospine. 2023;20(4):1246-1255.   Published online December 31, 2023
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Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets
Neurospine. 2023;20(4):1246-1255.   Published online December 31, 2023
Close
Cervical spinal deformity (CSD) is a complex condition characterized by abnormal curvature and cervical spine alignment. It can lead to a multitude of symptoms, including chronic pain, neurological deficits, and functional impairments, severely impacting an individual’s health-related quality of life (HRQoL). Surgical intervention is often necessary to address the deformity and alleviate symptoms, but optimal surgical strategies remain a topic of ongoing research and debate. This narrative review aims to provide an in-depth overview of the surgical management of CSD, focusing on optimizing patient outcomes and enhancing readers’ understanding of the complexities involved. We begin by discussing the importance of preoperative assessment, including comprehensive radiographic evaluation and careful consideration of the global spinal alignment. The relationship between the cervical spine and the reciprocal changes that occur are explored to guide surgeons in their decision-making process. Furthermore, we delve into the selection of fusion levels, emphasizing the significance of identifying the primary driver of deformity. We review the current literature on optimal alignment targets and strategies to optimize surgical planning. By providing a comprehensive analysis of the surgical management of CSD, this review aims to enhance the readers’ knowledge and assist surgeons in making informed decisions when planning and executing surgical interventions. Understanding the intricacies of CSD correction and the latest advancements in the field can ultimately improve patient outcomes and enhance HRQoL for individuals suffering from this challenging condition.

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  • A systematic review and meta-analysis of sagittal cervical spine parameters: Normative values, correlation with quality of life, and biomechanical modeling
    Vinicius Ricieri Ferraz, Carlos R. Goulart, Tobias Alecio Mattei
    North American Spine Society Journal (NASSJ).2026; 25: 100819.     CrossRef
  • Lordosis Distribution Index in an Asymptomatic Elderly Population : The Role of Lower and Upper Lumbar Lordosis According to Individual Pelvic Incidence and Roussouly Type
    Seung-Jae Hyun, Sanghyun Han, Youngbae B. Kim
    Journal of Korean Neurosurgical Society.2026; 69(1): 92.     CrossRef
  • Impact of T1 Slope as a Predictor of Loss of Cervical Lordosis and Health-Related Quality of Life after Laminoplasty in Patients with Ossification of the Posterior Longitudinal Ligament : A Retrospective Cohort Study
    Ji-Ho Jung, Jong-Hoon Jeong, Jong-Hwan Hong, Moon-Soo Han, Jung-Kil Lee
    Journal of Korean Neurosurgical Society.2026; 69(1): 124.     CrossRef
  • C2 Slope as an Independent Predictor of Cervical Lordosis Loss Following Laminoplasty
    Bin Zheng, Panfeng Yu, Zhenqi Zhu, Yan Liang, Haiying Liu
    Orthopaedic Surgery.2026; 18(3): 569.     CrossRef
  • Does Higher T1 Slope Predict Poor Outcomes Following Posterior Cervical Fusion for Degenerative Pathology?
    Harsh Jain, Sameer Sundrani, Iyan Younus, Nick De Oliveira, Omar Zakieh, Maryam Jawid, Naadir Jamal, Hani Chanbour, Tyler Zeoli, Ranbir Ahluwalia, Mitchell Bowers, Raymond J. Gardocki, Amir M. Abtahi, Byron F. Stephens, Scott L. Zuckerman
    World Neurosurgery.2026; 209: 124920.     CrossRef
  • Sagittal balance of the cervical spine in adults: a non-systematic literature review
    R. S. Chernyshyov, V. B. Lebedev, B. R. Kinzyagulov, A. A. Zuev
    Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika).2026; 23(1): 92.     CrossRef
  • Investigation of spinopelvic sagittal alignment and its correlations in asymptomatic pediatric populations
    Hao Qi, ZengHui Zhao, Feiyu Zu, Chenchen Wang, Chenxi Wang, Zuzhuo Zhang, Jianhua Ren, Rui Xue, Zhaoxuan Wang, Zhiyong Hou, Wei Chen, Di Zhang
    Scientific Reports.2025;[Epub]     CrossRef
  • Cervical Sagittal Alignment Revisited on the Path to Personalized Spine Surgery: A Big Picture Perspective Through Bibliometric Analysis and Visualization
    Luke L. Jouppi, Clifford Pierre, Anna Gorbacheva, Julius Gerstmeyer, Colin Gold, Cameron Hogsett, Nicholas Minissale, Mark Kraemer, Stephen Lockey, Amir Abdul-Jabbar, Rod J. Oskouian, Jens R. Chapman
    World Neurosurgery.2025; 202: 124387.     CrossRef
  • 5,724 View
  • 285 Download
  • 7 Web of Science
  • 8 Crossref

Original Articles

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The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries
Neurospine. 2023;20(2):608-619.   Published online June 30, 2023
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The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries
Neurospine. 2023;20(2):608-619.   Published online June 30, 2023
Close
Objective
We aim to report the outcomes and feasibility of endoscopic spine surgery used to treat symptomatic spinal metastases patients. This is the most extensive series of spinal metastases patients who underwent endoscopic spine surgery.
Methods
A worldwide collaborative network group of endoscopic spine surgeons, named ‘ESSSORG,’ was established. Patients diagnosed with spinal metastases who underwent endoscopic spine surgery from 2012 to 2022 were retrospectively reviewed. All related patient data and clinical outcomes were gathered and analyzed before the surgery and the followtime period of 2 weeks, 1 month, 3 months, and 6 months.
Results
A total of 29 patients from South Korea, Thailand, Taiwan, Mexico, Brazil, Argentina, Chile, and India, were included. The mean age was 59.59 years, and 11 of them were female. The total number of decompressed levels was 40. The technique was relatively equal (15 uniportal; 14 biportal). The average length of admission was 4.41 days. Of all patients with an American Spinal Injury Association Impairment Scale of D or lower before surgery, 62.06% reported having at least one recovery grade after the surgery. Almost all clinical outcomes parameters statistically significantly improved and maintained from 2 weeks to 6 months after the surgery. Few surgical-related complications (4 cases) were reported.
Conclusion
Endoscopic spine surgery is a valid option for treating spinal metastases patients as it could yield comparable results to other minimally invasive spine surgery techniques. As the aim is to improve the quality of life, this procedure is valuable and holds value in palliative oncologic spine surgery.

Citations

Citations to this article as recorded by  Crossref logo
  • Endoscopic resection of lumbar intradural spinal tumors: A case series on feasibility, safety, and preliminary outcomes
    Facundo Van Isseldyk, Vincent Hagel
    Brain and Spine.2026; 6: 106040.     CrossRef
  • Biportal Endoscopic Spine Surgery for Epidural Metastatic Tumors: A Surgical Technical Note With a Case Series
    Chan Yang Noh, Il Choi, Junsoo Jang
    Journal of Minimally Invasive Spine Surgery and Technique.2026; 11(1): 140.     CrossRef
  • Technical Feasibility and Safety of Transpedicular Thoracic Partial Corpectomy Using Biportal Endoscopic Technique: A Novel Approach for Separation Surgery in Spinal Metastatic Disease
    Yohannes Ghenbot, Joshua Golubovsky, Hasan S. Ahmad, John D. Arena, Gabrielle Santangelo, Connor Wathen, Rahwa Ghenbot, Mert Marcel Dagli, Daksh Chauhan, Emily Ling-Lin Pai, Jang W. Yoon
    World Neurosurgery.2025; 194: 123582.     CrossRef
  • Applications of endoscopic techniques in spinal oncology: A systematic review of the contemporary literature
    Saarang Patel, Mohammad Faizan Khan, Ryan Gensler, Nolan J. Brown, Marcos Real, Zach Pennington, Mohammad Zoha Khan, Julian Gendreau, Ronald Sahyouni, Martin H. Pham
    Journal of Clinical Neuroscience.2025; 136: 111232.     CrossRef
  • Advancements in Spinal Endoscopic Surgery: Comprehensive Techniques and Pathologies Addressed by Full Endoscopy Beyond Lumbar Disc Herniation
    Jad El Choueiri, Francesca Pellicanò, Edoardo Caimi, Francesco Laurelli, Leonardo Di Cosmo, Ali Darwiche Rada, Daniel Cernigoi, Arosh S. Perera Molligoda Arachchige, Giorgio Cracchiolo, Donato Creatura, Ali Baram, Carlo Brembilla, Gabriele Capo
    Journal of Clinical Medicine.2025; 14(11): 3685.     CrossRef
  • Thoracic spine metastases from lung cancer with incomplete paralysis treated by endoscopic spinal surgery: a case report
    Ningdao Li, Runhan Zhao, Jun Zhang, Xiaoji Luo, Xifeng Zhang
    European Spine Journal.2025; 34(8): 3549.     CrossRef
  • Extensive thoracic vertebral and chest wall metastases as the initial presentation of breast cancer: a case report and literature review
    Yergen N. Kenzhegulov, Daniyar K. Zhamoldin, Victor G. Aleinikov, Talgat T. Kerimbayev, Berik Zhetpisbaev, Serik Akshulakov
    Frontiers in Oncology.2025;[Epub]     CrossRef
  • Spine endoscopic surgery establishment for disc disease (Neurocore-SENSED): an open and decentralized consensus
    Mejdeddine Al Barajraji, Sami Barrit, Adam Boukind, Albert E. Telfeian, Javier Quillo-Olvera, Mehdi Afathi, Frank Hassel, Peter B. Derman, Maxime Challali, Alexandre Simonin, Antoine Devalckeneer, Ryoji Tominaga, Jean-Charles Le Huec, Xavier A. Santander,
    Brain and Spine.2025; 5: 105604.     CrossRef
  • Endoscopie rachidienne : techniques, indications et limites
    Benjamin Bouyer, Henri d’Astorg
    Revue de Chirurgie Orthopédique et Traumatologique.2025; 111(6): 663.     CrossRef
  • Full-endoscopic-assisted retroperitoneal approach for the devastating spondylodiscitis with psoas abscess
    Siravich Suvithayasiri, Chan-Woong Park, Yanting Liu, Khanathip Jitpakdee, Akaworn Mahatthanatrakul, Jin-Sung Kim
    Brain and Spine.2025; 5: 105881.     CrossRef
  • Full-Endoscopic Resection of a Lumbar Intradural Tumor (Schwannoma): Video Case Report and Description of the Surgical Technique
    Vincent Hagel, Facundo Van Isseldyk
    Neurospine.2024; 21(4): 1096.     CrossRef
  • Commentary on “The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries”
    Wongthawat Liawrungrueang, Vit Kotheeranurak
    Neurospine.2023; 20(2): 620.     CrossRef
  • Future of Endoscopic Spine Surgery: Insights from Cutting-Edge Technology in the Industrial Field
    Woon-Tak Yuh, You-Sang Lee, Il Choi
    Bioengineering.2023; 10(12): 1363.     CrossRef
  • Near infrared imaging system for preventing blood vision obstruction in endoscopy
    Meng-Huang Wu, Jason C. Hsu, Jin-Sung Kim, Tsung-Jen Huang, Yi-Hung Huang, Hon Pan Yiu, Ching-Yu Lee, Jowy Tani, Cheng-Chun Chang
    Optics Express.2023; 31(26): 43877.     CrossRef
  • 9,281 View
  • 278 Download
  • 16 Web of Science
  • 14 Crossref

CSRS Special Issue

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Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery
Neurospine. 2022;19(4):912-920.   Published online December 31, 2022
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Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery
Neurospine. 2022;19(4):912-920.   Published online December 31, 2022
Close
Objective
C2 slope (C2S), a cervical parameter mathematically approximated as T1 slope minus cervical lordosis (T1S–CL), predicts functional improvement in cervical deformity patients. Nonetheless, C2S is a positional parameter based only on the horizontal axis. The current study aims to introduce novel odontoid parameters and establish their relationships with patient-reported health-related quality of life (HRQoL).
Methods
Lateral plain radiographs of 32 adults who underwent multilevel posterior cervical fusion were analyzed. The odontoid parameters included odontoid incidence (OI), C2S, odontoid tilt (OT), and gravity line-C2 distance (GL-C2), while the cervical parameters were the Cobb angle at C0–1, C1–2, C0–2, C2–7, C2–7 sagittal vertical axis (cSVA), T1 slope, and T1S–CL. The range of motion (ROM) of the occipito-atlantoaxial complex was measured in flexion and extension plain radiographs. Scores on the Neck Disability Index (NDI) and visual analogue scale (VAS) for axial neck (VASn) and arm pain were measured.
Results
Compared to asymptomatic subjects, patients had larger C2S, cSVA, and T1S–CL, and smaller OT. Preoperatively, OI was significantly correlated with the ROM of C1–2 (r = 0.37, p < 0.05) and C0–2 (r = 0.46, p < 0.01). OT and C2S had significant correlations with the C0–1, C1–2, and C0–2 angles, GL-C2, and T1S–CL. Postoperative NDI scores were significantly correlated with OI (r = -0.40, p < 0.05) and OT (ρ = -0.37, p < 0.05). VASn was significantly correlated with GL-C2 (r = -0.35, p < 0.05).
Conclusion
The odontoid parameters were significantly correlated with established cervical parameters and HRQoL measures. OI is a constant parameter representing the individual's compensatory reservoir at the upper cervical spine.

Citations

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  • Odontoid Parameters in Adolescent Idiopathic Scoliosis Patients
    Qiong-run Xiao, Long-ao Huang, Ke-lin Li, Yu-wang Du, Xiao Liang, Chong-yang Wang, Hua Jiang
    Clinical Spine Surgery.2026; 39(2): E74.     CrossRef
  • The effect of cervical spine flexion-extension motion on odontoid parameters
    Longao Huang, Dun Liu, Hongyuan Xu, Junfei Feng, Tao Kang, Shengwang Wei, Hua Jiang
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Correlation analysis between preoperative odontoid incidence and clinical outcomes 2 years after anterior cervical discectomy and fusion
    Yan Gong, Hao Liu, Yanchi Gan, Jiahui He, Zelin Zhou, Hang Zhuo, Yu Liu, De Liang, Hui Ren, Xiaobing Jiang, Zhaojun Cheng
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Lower C2 slope and milder uncovertebral joint degeneration are risk factors for pseudarthrosis after single-level anterior cervical corpectomy and fusion (ACCF): retrospective study of 102 patients with minimum 2-year follow-up
    Haoxiang Wang, Tian Xia, Ruomu Qu, Hanbo Geng, Yu Sun, Fengshan Zhang, Shengfa Pan, Xin Chen, Yanbin Zhao, Feifei Zhou
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Impact of anterior controllable antedisplacement and fusion (ACAF) on cervical lordosis and sagittal alignment in OPLL: A comparative radiographic analysis
    Shunmin Wang, Dong Liu, Jincui Li, Jingchuan Sun, Tiefeng Li, Jiangang Shi
    Journal of Orthopaedics.2025; 70: 158.     CrossRef
  • Odontoid parameters in subjects with and without degenerative cervical spondylosis
    Tao Kang, Weiyou Chen, Longao Huang, Hongyuan Xu, Hua Jiang
    BMC Musculoskeletal Disorders.2025;[Epub]     CrossRef
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    Catriona M. Steele, Makaya O' Grady, Sima Farpour, Melanie Peladeau‐Pigeon, Sophia Werden Abrams, Maureen Folsom, Emily K. Plowman, Ashwini M. Namasivayam‐MacDonald
    Laryngoscope Investigative Otolaryngology.2025;[Epub]     CrossRef
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    Hongyu Qin, Weiyou Chen, Longao Huang, Xin Xiao, Qinghua Yang, Hua Jiang
    Global Spine Journal.2024; 14(8): 2374.     CrossRef
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    Yuwang Du, Weiyou Chen, Hongyuan Xu, Xiao Liang, Chongyang Wang, Hongyu Qin, Hua Jiang
    World Neurosurgery.2024; 190: e496.     CrossRef
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    Junho Mun, Seung-Jae Hyun, Jae-Koo Lee, Sungjae An, Ki-Jeong Kim
    Neurospine.2023; 20(3): 981.     CrossRef
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    Seung-Ho Seo, Seung-Jae Hyun, Jae-Koo Lee, Yong Jae Cho, Dae Jean Jo, Jin Hoon Park, Ki-Jeong Kim
    Neurospine.2023; 20(3): 799.     CrossRef
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    Jae-Koo Lee, Seung-Jae Hyun, Ki-Jeong Kim
    Neurospine.2023; 20(4): 1246.     CrossRef
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    Sang Hun Lee
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    Atul Goel
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Psychometric Properties of the Scoliosis Research Society Questionnaire (Version 22r) Domains Among Adults With Spinal Deformity: A Rasch Measurement Theory Analysis
Neurospine. 2022;19(2):422-433.   Published online May 15, 2022
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Psychometric Properties of the Scoliosis Research Society Questionnaire (Version 22r) Domains Among Adults With Spinal Deformity: A Rasch Measurement Theory Analysis
Neurospine. 2022;19(2):422-433.   Published online May 15, 2022
Close
Objective
Adult spinal deformity (ASD) have lower health-related quality of life (HRQoL) compared to the general population. Applying Rasch measurement theory (RMT), this study tested the revised Scoliosis Research Society-22 (SRS-22r) HRQoL instrument among symptomatic adult patients with degenerative spinal disorders and varying degrees of ASD.
Methods
SRS-22r data from 637 outpatient spine clinic patients with degenerative spine conditions were investigated for unidimensionality, item/scale fit, differential item functioning (DIF), scale coverage/targeting, and person separation index (PSI) using RMT.
Results
Unidimensionality of the SRS-22r was not supported for either the total score or for 3 of its 5 domains. Item fit was acceptable for 11/22 items. The individual domains showed good coverage despite the degree of structural disorders. Ordered thresholds were achieved by merging response categories in some of the items. DIF towards age or sex was found in 11/22 items and in some domain items. The PSI exceeded 0.7 for the SRS-22r total score.
Conclusion
The individual domain scores of the SRS-22r perform better than the total score providing good coverage and targeting among patients with ASD. Refinements of items and domains may improve the structural validity of the instrument to meet the criteria for measuring ASD patients, even when multidimensionality persists.

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  • Beyond the curve: The impact of trunk and shoulder symmetry on self-image and mental health in adolescent idiopathic scoliosis
    A. Shiju Majeed, B.P. Vinodkumar, N. Ajina
    Journal of Orthopaedic Reports.2026; : 100897.     CrossRef
  • Course and Predictors of Adult Spinal Sagittal Disorders
    Heidi Mannström, Juhani Multanen, Jari Ylinen, Arto Hautala, Arttu Peuna, Lauri Karttunen, Liisa Pekkanen, Kati Kyrölä
    Spine.2025; 50(8): 522.     CrossRef
  • Validation of the Oswestry Disability Index in Adult Spinal Deformity
    Omid Jalali, Justin S. Smith, Shay Bess, Richard Hostin, Renaud Lafage, Virginie Lafage, Christopher I. Shaffrey, Christopher P. Ames, Lawrence G. Lenke, Michael P. Kelly
    Spine.2024; 49(10): 682.     CrossRef
  • Development and Preliminary Testing of the Staffordshire Questionnaire for Adolescent Idiopathic Scoliosis (SQ‐AIS): Content and Face Validity
    Enza Leone, Nachiappan Chockalingam, Robert Needham, Aoife Healy, Nicola Eddison, Nikola Jevtic, Vinay Jasani
    Health Science Reports.2024;[Epub]     CrossRef
  • 9,646 View
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  • 4 Web of Science
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Cost-Utility Analysis Compared Between Radiotherapy Alone and Combined Surgery and Radiotherapy for Symptomatic Spinal Metastases in Thailand
Neurospine. 2022;19(2):334-347.   Published online May 12, 2022
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Cost-Utility Analysis Compared Between Radiotherapy Alone and Combined Surgery and Radiotherapy for Symptomatic Spinal Metastases in Thailand
Neurospine. 2022;19(2):334-347.   Published online May 12, 2022
Close
Objective
To investigate the patient quality of life and cost-utility compared between radiotherapy alone and combined surgery and radiotherapy for spinal metastasis (SM) in Thailand.
Methods
Patients with SM with an indication for surgery during 2018–2020 were prospectively recruited. Patients were assigned to either the combination surgery and radiotherapy group or the radiotherapy alone group. Quality of life was assessed by EuroQol-5D-5L (EQ-5D-5L) questionnaire, and relevant healthcare costs were collected pretreatment, and at 3-month and 6-month posttreatment. Total lifetime cost and quality-adjusted life-years (QALYs) were estimated for each group.
Results
Twenty-four SM patients (18 females, 6 males) were included. Of those, 12 patients underwent combination treatment, and 12 underwent radiotherapy alone. At 6-month posttreatment, 10 patients in the surgery group, and 11 patients in the nonsurgery group remained alive for a survival rate of 83.3% and 91.7%, retrospectively. At 6-month posttreatment, the mean utility in the combination treatment group was significantly better than in the radiotherapy alone group (0.804 ± 0.264 vs. 0.518 ± 0.282, respectively; p = 0.011). Total lifetime costs were 59,863.14 United States dollar (USD) in the combination treatment group and 24,526.97 USD in the radiation-only group. The incremental cost-effectiveness ratio using 6-month follow-up data was 57,074.01 USD per QALY gained.
Conclusion
Surgical treatment combined with radiotherapy to treat SM significantly improved patient quality of life compared to radiotherapy alone during the 6-month posttreatment period. However, combination treatment was found not to be cost-effective compared to radiotherapy alone for SM at the Thailand willingness-to-pay threshold of 5,113 USD/QALY.

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    Lu Sun, Fan Luo, Yajuan Zhou, Xiyou Liu, Pingping Zhang, Dan Li, Yi Peng
    Cancer Reports.2026;[Epub]     CrossRef
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    Kenneth Nguyen, Emaad Lala, Kento Yamanouchi, Sydney Pattison, Aiyush Bansal, Abhinav Balu, Mir Amaan Ali, Philip K. Louie
    Journal of Surgical Research.2026; 325: 32.     CrossRef
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    Yoontae Hong, Yeon-koo Kang, Eun Bi Park, Min-Sung Kim, Yunhee Choi, Siyoung Lee, Chang-Hyun Lee, Jun-Hoe Kim, Miso Kim, Jin Chul Paeng, Chi Heon Kim
    The Spine Journal.2025; 25(2): 306.     CrossRef
  • The role of combination surgery and radiotherapy in patients with metastatic spinal cord compression: What are the remaining grey areas? A systematic review
    Carly Weber-Levine, Kelly Jiang, Abdel-Hameed Al-Mistarehi, Jeremy Welland, Andrew M. Hersh, Melanie Alfonzo Horowitz, A. Daniel Davidar, Shahab Aldin Sattari, Kristin J. Redmond, Sang H. Lee, Nicholas Theodore, Daniel Lubelski
    Clinical Neurology and Neurosurgery.2025; 248: 108632.     CrossRef
  • Cost-Effectiveness of Surgery for Spinal Metastasis
    Philip Heesen, Emil O.R. Nordin, Vivek Sanker, María J. Cavagnaro, Corinna C. Zygourakis, John Ratliff, Atman M. Desai
    Spine.2025; 50(24): 1779.     CrossRef
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    Christopher Alvarez-Breckenridge, Romulo de Almeida, Ali Haider, Matthew Muir, Justin Bird, Robert North, Laurence Rhines, Claudio Tatsui
    Neurospine.2023; 20(1): 317.     CrossRef
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    Neurospine.2023; 20(2): 608.     CrossRef
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Clinical, Radiographic, and Genetic Analyses in a Population-Based Cohort of Adult Spinal Deformity in the Older Population
Neurospine. 2021;18(3):608-617.   Published online September 30, 2021
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Clinical, Radiographic, and Genetic Analyses in a Population-Based Cohort of Adult Spinal Deformity in the Older Population
Neurospine. 2021;18(3):608-617.   Published online September 30, 2021
Close
Objective
This study aimed to identify the sagittal parameters associated with health-related quality of life and genetic variations that increase the risk of adult spinal deformity (ASD) onset in the older population.
Methods
We recruited 120 participants who had a sagittal vertical axis > 50 mm in a sagittal imbalance study. Sagittal radiographic parameters, cross-sectional area, and intramuscular fatty infiltration using the Goutallier classification in the paraspinal lumbar muscles were evaluated. Functional scales included the self-reported Oswestry Disability Index (ODI), 36-item Short Form Health Survey (SF-36), and visual analogue scales (VAS) for back and leg pain. We performed whole-exome sequencing and an exome-wide association study using the 100 control subjects and 63 individuals with severe phenotypes of sagittal imbalance.
Results
Pelvic incidence minus lumbar lordosis (PI–LL) mismatch was negatively associated with the SF-36 and positively correlated with ODI and VAS for back and leg pain. PI–LL was related to the quality and size of the paraspinal muscles, especially the multifidus muscle. We identified common individual variants that reached exome-wide significance using single-variant analysis. The most significant single-nucleotide polymorphism was rs78773460, situated in an exon of the SVIL gene (odds ratio, 9.61; p = 1.15 × 10-9).
Conclusion
Older age, higher body mass index, and a more significant PI–LL mismatch were associated with unfavorable results on functional scales. We found a genetic variation in the SVIL gene, which has been associated with the integrity of the cytoskeleton and the development of skeletal muscles, in severe ASD phenotypes. Our results help to elucidate the pathogenesis of ASD.

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    Donghua Huang, Austin C. Kaidi, Zhan Wang, Ning Zhang, Robert N. Uzzo, Michael Mazzucco, Andrea Pezzi, Atahan Durbas, Gabrielle Dykhouse, Tejas Subramanian, Luis Felipe Colon, Stephane Owusu-Sarpong, Han Jo Kim, Francis C. Lovecchio
    Global Spine Journal.2026; 16(2): 1165.     CrossRef
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    Takumi Nakanishi, Akito Kataoka, Singo Mitamura, Hideki Warashina
    Gait & Posture.2025; 117: 317.     CrossRef
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    Jun Ouchida, Yoshinori Morita, Sadayuki Ito, Naoki Segi, Ippei Yamauchi, Tokumi Kanemura, Tetsuya Ohara, Taichi Tsuji, Ryuichi Shinjyo, Shiro Imagama, Hiroaki Nakashima
    Neurospine.2025; 22(1): 30.     CrossRef
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    Donghua Huang, Zhan Wang, Mihir Dekhne, Atahan Durbas, Tejas Subramanian, Gabrielle Dykhouse, Robert N. Uzzo, Luis Felipe Colón, Stephane Owusu-Sarpong, Han Jo Kim, Francis Lovecchio
    Journal of Clinical Medicine.2025; 14(10): 3293.     CrossRef
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    Yalçın Yaman, Ramazan Aymaz, Murat Keleş, Yiğit Emir Kişi, Ecem Hatipoğlu, Arzu Özdemir, Elif Çetinkaya
    BMC Veterinary Research.2025;[Epub]     CrossRef
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    Fangda Si, Aobo Wang, Ying Chen, Ning Fan, Tianyi Wang
    BMC Musculoskeletal Disorders.2025;[Epub]     CrossRef
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    Hyeun Sung Kim, Pang Hung Wu
    Seminars in Spine Surgery.2024; 36(1): 101081.     CrossRef
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    Sungjae An, Seung-Jae Hyun, Jae-Koo Lee, Seung Heon Yang, Ki-Jeong Kim
    Neurosurgery.2023; 92(5): 998.     CrossRef
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    Pang Hung Wu, Hyeun Sung Kim, Jin Woo An, Myeonghun Kim, Inkyung Lee, Jong Seon Park, Jun Hyoung Lee, Sangsoo Kang, Jeongshik Lee, Yeonjin Yi, Jun Hyung Lee, Jun Hwan Park, Jae Hyeon Lim, Il-Tae Jang
    Asian Spine Journal.2023; 17(2): 373.     CrossRef
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    Mingoo Cho, Jun-Sang Han, Sungwook Kang, Chang-Hwan Ahn, Dong-Hee Kim, Chul-Hyun Kim, Kyoung-Tae Kim, Ae-Ryoung Kim, Jong-Moon Hwang
    Bioengineering.2023; 10(9): 1051.     CrossRef
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    Jinyoung Park, Yong Eun Cho, Kyung Hyun Kim, Sanghoon Shin, Sungjun Kim, Chae Hwan Lim, Seok Young Chung, Yoon Ghil Park
    Neurospine.2023; 20(3): 921.     CrossRef
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    Young Il Won, Chang-Hyun Lee, Woon Tak Yuh, Shin Won Kwon, Chi Heon Kim, Chun Kee Chung
    Neurospine.2022; 19(2): 299.     CrossRef
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    Journal of X-Ray Science and Technology.2022; 30(6): 1099.     CrossRef
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  • 149 Download
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Thoracolumbar Slope Is Useful Parameter for Evaluating HealthRelated Quality of Life and Sagittal Imbalance Aggravation in Adult Spinal Deformity: A Prospective Observational Cohort Study
Neurospine. 2021;18(3):467-474.   Published online September 30, 2021
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Thoracolumbar Slope Is Useful Parameter for Evaluating HealthRelated Quality of Life and Sagittal Imbalance Aggravation in Adult Spinal Deformity: A Prospective Observational Cohort Study
Neurospine. 2021;18(3):467-474.   Published online September 30, 2021
Close
Objective
The purpose of the present study was to evaluate the natural course of primary degenerative sagittal imbalance (PDSI), its aggravating factors, and health-related quality of life (HRQoL) associated with various spinal alignment parameters (SAPs) in patients with PDSI who have not undergone surgery.
Methods
One hundred three participants volunteered to participate. The SAPs, including T1 pelvic angle (T1PA), thoracolumbar tilt, and thoracolumbar slope (TLS), were measured on whole-spine standing radiographs. The back and lumbar muscle volumes were measured. To determine HRQoL at baseline and at 2-year follow-up, face-to-face questionnaires were administered, which included visual analogue scale of the back and leg, physical component summary/mental component summary of 36-item Short Form Health Survey, Oswestry Disability Index (ODI), and Mini-Mental State Examination.
Results
Overall HRQoL measures had improved after 2 years of follow-up compared to baseline. PDSI aggravation was observed in 18 participants (26.1%). TLS, sagittal vertical axis (SVA), and T1PA were strongly correlated with each other. TLS, SVA, and T1PA were correlated with ODI score. Among them, TLS was most highly correlated with ODI score. TLS greater than -3.5° was a predicting factor for PDSI aggravation (p = 0.034; 95% confidence interval, 1.173–63.61; odds ratio, 8.636).
Conclusion
The present study implied that PDSI does not necessarily worsen with aging. TLS is an appropriate parameter for assessing the clinical situation in patients with PDSI. Furthermore, a TLS greater than -3.5° predicts PDSI aggravation; thus, TLS may be a useful parameter for predicting prognosis in PDSI.

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  • Normal Functional Local Alignment and Segmental Motion at the Thoracolumbar Junction: A Cross-Sectional Study of Healthy Subjects
    Moon-Soo Han, Jong-Hwan Hong, Ji-Ho Jung, Jung-Kil Lee
    World Neurosurgery.2024; 186: e713.     CrossRef
  • Crossing the Bridge From Degeneration to Deformity: When Does Sagittal Correction Impact Outcomes in Adult Spinal Deformity Surgery?
    Tyler K. Williamson, Oscar Krol, Peter Tretiakov, Rachel Joujon-Roche, Bailey Imbo, Salman Ahmad, Stephane Owusu-Sarpong, Jordan Lebovic, Rivka Ihejirika-Lomedico, Michael Dinizo, Shaleen Vira, Ekamjeet Dhillon, Brooke O’Connell, Constance Maglaras, Andre
    Spine.2023; 48(3): E25.     CrossRef
  • Relationships Between Skeletal Muscle Mass, Lumbar Lordosis, and Chronic Low Back Pain in the Elderly
    Myung Woo Park, Sang Jun Park, Sun Gun Chung
    Neurospine.2023; 20(3): 959.     CrossRef
  • Introduction of a New Radiographic Parameter to Predict Proximal Junctional Kyphosis in Adult Spinal Deformity: UIVPTA (Uppermost Instrumented Vertebra-Pelvic Tilt Angle)
    Se-Jun Park, Chong-Suh Lee, Jin-Sung Park, Tae Soo Shin
    Neurospine.2023; 20(3): 969.     CrossRef
  • Reciprocal Changes in the Whole-Body Following Realignment Surgery in Adult Spinal Deformity
    Jae-Koo Lee, Seung-Jae Hyun, Ki-Jeong Kim
    Asian Spine Journal.2022; 16(6): 958.     CrossRef
  • 7,985 View
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Incidence of Chronic Periscapular Pain After Adult Thoracolumbar Deformity Correction and Impact on Outcomes
Neurospine. 2021;18(3):515-523.   Published online September 30, 2021
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Incidence of Chronic Periscapular Pain After Adult Thoracolumbar Deformity Correction and Impact on Outcomes
Neurospine. 2021;18(3):515-523.   Published online September 30, 2021
Close
Objective
Extension of the posterior upper-most instrumented vertebra (UIV) into the upper thoracic (UT) spine allows for greater deformity correction and reduced incidence of proximal junction kyphosis (PJK) in adult spinal deformity (ASD) patients. However, it may be associated with chronic postoperative scapular pain (POSP). The goal of this study was to assess the relationship between UT UIV and persistent POSP, describe the pain, and assess its impact on patient disability.
Methods
ASD patients who underwent multilevel posterior fusion were retrospectively identified then administered a survey regarding scapular pain and the Oswestry Disability Index (ODI), by telephone. Univariate and multivariate analysis were utilized.
Results
A total of 74 ASD patients were included in the study: 37 patients with chronic POSP and 37 without scapular pain. The mean age was 70.5 years, and 63.9% were women. There were no significant differences in clinical characteristics, including mechanical complications (PJK, pseudarthrosis, and rod fracture) or reoperation between groups. Patients with persistent POSP were more likely to have a UT than a lower thoracic UIV (p = 0.018). UT UIV was independently associated with chronic POSP on multivariate analysis (p = 0.022). ODI score was significantly higher in patients with scapular pain (p = 0.001). Chronic POSP (p = 0.001) and prior spine surgery (p = 0.037) were independently associated with ODI on multivariate analysis.
Conclusion
A UT UIV is independently associated with increased odds of chronic POSP, and this pain is associated with significant increases in patient disability. It is a significant clinical problem despite solid radiographic fusion and the absence of PJK.
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Association of Spinal Alignment Correction With Patient-Reported Outcomes in Adult Cervical Deformity: Review of the Literature
Neurospine. 2021;18(3):533-542.   Published online May 18, 2021
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Association of Spinal Alignment Correction With Patient-Reported Outcomes in Adult Cervical Deformity: Review of the Literature
Neurospine. 2021;18(3):533-542.   Published online May 18, 2021
Close
Objective
Adult cervical deformity (ACD) is a debilitating spinal condition that causes significant pain, neurologic dysfunction, and functional impairment. Surgery is often performed to correct cervical alignment, but the optimal amount of correction required to improve patient-reported outcomes (PROs) are not yet well-defined.
Methods
A review of the literature was performed and Fisher z-transformation (Zr) was used to pool the correlation coefficients between alignment parameters and PROs. The strength of correlation was defined according to the following: poor (0 < r ≤ 0.3), fair (0.3 < r ≤ 0.5), moderate (0.5 < r ≤ 0.8), and strong (0.8 < r ≤ 1).
Results
Increased C2–7 sagittal vertical axis was fairly associated with increased Neck Disability Index (NDI) (pooled Zr = 0.31; 95% confidence interval [CI], -0.03 to 0.58). Changes in T1 slope minus cervical lordosis poorly correlated with NDI (pooled Zr = -0.04; 95% CI, -0.23 to 0.30). Increased C7–S1 was poorly associated with worse EuroQoL 5-Dimension (pooled Zr = -0.22; 95% CI, -0.36 to -0.06). Correction of horizontal gaze did not correlate with legacy metrics. Modified Japanese Orthopedic Association correlated with C2-slope, C7–S1, and C2–S1.
Conclusion
Spinal alignment parameters variably correlated with improved health-related quality of life and myelopathy after corrective surgery for ACD. Further studies evaluating legacy PROs, Patient-Reported Outcomes Measurement System, and ACD specific instruments are needed for further validation.

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    Zeeshan M. Sardar, Justin L. Reyes, Josephine R. Coury, K. Daniel Riew
    Journal of the American Academy of Orthopaedic Surgeons.2026; 34(2): e176.     CrossRef
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    Dewa Gde Prema Ananda, Ida Bagus Sutha Dwipajaya, Ida Bagus Artha Vijaya Antara, Nia Irayati, Asra Al Fauzi
    Spine Surgery and Related Research.2026; 10(1): 11.     CrossRef
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    Alexandra C. Dionne, Prakash Gorroochurn, Roy Miller, Prerana Katiyar, Samuel Bennion, Lisa Bonsignore-Opp, Josephine R. Coury, Fthimnir M. Hassan, Joseph M. Lombardi, Lawrence G. Lenke, Justin L. Reyes, Zeeshan M. Sardar
    Spine Open.2026;[Epub]     CrossRef
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    Ahmed Mohammed Ragab, Mahmoud M. Taha, Mansour Abdel Mageed Makkia, Ayman M. Ismail
    Scientific Reports.2026;[Epub]     CrossRef
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    Masayuki Ohashi, Kei Watanabe, Toru Hirano, Kazuhiro Hasegawa, Hideki Tashi, Tatsuo Makino, Keitaro Minato, Masayuki Sato, Hiroyuki Kawashima
    European Spine Journal.2024; 33(6): 2522.     CrossRef
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    Danbi Park, Sang Hyub Lee, Subum Lee, Jemin Park, Hyeon Gyu Yang, Chongman Kim, Jin Hoon Park
    Neurospine.2024; 21(1): 352.     CrossRef
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    Renzo A. Laynes, Christopher J. Kleck
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Unilateral Posterior Surgery for Severe Osteoporotic Vertebrae Fractures’ Sequelae in Geriatric Population: Minimum 5-Year Results of 109 Patients
Neurospine. 2021;18(2):319-327.   Published online March 4, 2021
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Unilateral Posterior Surgery for Severe Osteoporotic Vertebrae Fractures’ Sequelae in Geriatric Population: Minimum 5-Year Results of 109 Patients
Neurospine. 2021;18(2):319-327.   Published online March 4, 2021
Close
Objective
This study aimed to evaluate the efficacy and safety of modified posterior vertebral column resection (PVCR) combined with anterior column restoration in elderly patients presenting with thoracic or thoracolumbar osteoporotic fractures with spinal cord compression and severe pain.
Methods
One hundred nine patients with one level thoracolumbar osteoporotic fracture and at least 5 years of follow-up were included. They underwent posterior instrumentation performed with polymethymetachrylate augmented pedicle screws. A modified PVCR (unilateral costotransversectomy+hemilaminectomy) combined with the insertion of an expandable titanium cage for anterior column restoration was undertaken. Patients were evaluated clinically and radiographically.
Results
Patients had a mean age of 74.1 and a follow-up duration of 92.3 months. Mean duration of operations, hospital stays, and mean loss of blood were 172.3 minutes, 4.3 days, and 205.4 mL. All of the patients were mobilized immediately after surgery. The mean preoperative local kyphosis angle improved from 39.3° to 4.7° at the last follow-up (p = 0.003). Patients preoperative mean visual analogue score, Japanese Orthopaedic Association, and Oswestry Disability Index scores improved from 7.7/8.6/76.3 to 1.6/26.1/17.4 (p < 0.001 for all), respectively. The average 36-item Short-Form survey physical component summary/mental component summary scores at the last follow-up were 55.1/56.8. A dural tear was detected intraoperatively in 1 patient and repaired immediately.
Conclusion
Subtotal PVCR combined with the insertion of an expandable titanium cage was detected as a safe and effective method for osteoporotic vertebrae fractures’ sequelae in the older population involving spinal cord compression by enabling the decompression of the spinal canal and reconstruction of the resected segment, resulting in significant improvement in clinical and radiographic outcomes.

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  • 7,744 View
  • 173 Download
  • 9 Web of Science
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Surgical Impact on Global Sagittal Alignment and Health-Related Quality of Life Following Cervical Kyphosis Correction Surgery: Systematic Review
Neurospine. 2020;17(3):497-504.   Published online September 30, 2020
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Surgical Impact on Global Sagittal Alignment and Health-Related Quality of Life Following Cervical Kyphosis Correction Surgery: Systematic Review
Neurospine. 2020;17(3):497-504.   Published online September 30, 2020
Close
When spinal imbalance occurs, the human body reacts through various compensatory mechanisms to maintain the head over the pelvis and to retain a horizontal gaze. These compensations occur through mobile spine segments as well as pelvic tilt and lower extremities. The purpose of this review was to understand the surgical impact on global sagittal alignment and health-related quality of life (HRQoL) following cervical kyphosis correction surgery. The cervical kyphosis correction surgery induces reciprocal changes in craniocervical and thoracolumbar alignment. Successful cervical deformity correction needs to focus not only on restoring proper cervical lordosis, but also on achieving global balance of the cervical spine with other parts of the spine. The goal of the surgery is to achieve occiputtrunk (OT) concordance (the center of gravity-C7 sagittal vertical axis < 30 mm) and cervical sagittal balance. Once OT-concordance is achieved, subsequent thoracolumbar alignment changes occur as needed to harmonize global spinal alignment. Reciprocal changes after surgery exhibit different patterns depending on whether patients have compensation ability in their thoracolumbar spine or not. C2–7 sagittal vertical axis and sagittal morphotype of the cervical kyphosis are correlated with HRQoL. Changes in cervical lordosis minus T1 slope correlate to HRQoL improvements.

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