From the Editor-in-Chief: Featured Articles in the September 2025 Issue

Inbo Han

doi:10.14245/ns.2551310.655

In this editorial, we highlight the most noteworthy articles featured in the September 2025 issue of Neurospine. This issue comprises one paper from the Neurospinal Society of Japan special issue and four articles from our regular submissions.

Article 1: “Long-term Outcomes of Multilevel Anterior Cervical Osteotomy and Posterior Instrumentation for OPLL-Induced Myelopathy With Cervical Kyphosis”

This comprehensive study [1] evaluated the long-term clinical and radiological outcomes of multilevel anterior osteotomy with posterior instrumentation in patients with ossification of the posterior longitudinal ligament (OPLL)-induced myelopathy and cervical kyphosis. Twenty-eight patients with a minimum of 5-year follow-up were analyzed. Clinical outcomes (C-JOA [Japanese Orthopaedic Association score system for cervical myelopathy], 12-item Short Form health survey, Neck Disability Index) and radiological parameters (C2–7 lordosis, center of gravity of the head [CGH]–C7 sagittal vertical axis [SVA], T1 slope) were assessed preoperatively, immediately postoperatively, and at final follow-up. All clinical scores demonstrated significant improvement (p<0.001). C2–7 lordosis increased postoperatively and was largely maintained, while T1 slope and CGH–C7 SVA increased over time. These findings demonstrate that this surgical approach represents a safe and effective option for correcting kyphotic cervical alignment in OPLL-related myelopathy, although the observed progressive forward tilting warrants further investigation.

Article 2: “Atlantoaxial Reconstruction: The Artful Evolution of Craniovertebral Junctional Spine Surgery” - The Neurospinal Society of Japan Special Issue

This comprehensive review [2] traces the evolution of posterior fusion techniques at the atlantoaxial joint (C1–2), which remains one of the most technically challenging regions in cervical spine surgery due to its complex anatomy and proximity to critical neurovascular structures. A systematic search identified 61 studies; 41 were narratively reviewed to outline historical development, while 20 post-2000 studies were systematically analyzed for technical details and outcomes. Surgical techniques have progressed from Gallie’s posterior wiring with autologous grafts to rigid screw-based fixation, yielding higher fusion rates and improved outcomes. The incorporation of concurrent interarticular fusion has enhanced biomechanical stability and biological healing. Future advances will require patient-specific surgical planning and integration of advanced intraoperative imaging to improve screw placement accuracy, minimize complications, and optimize fusion success.

Article 3: “The Role of D-Wave Monitoring in Motor-Evoked Potential Loss During Intramedullary Spinal Cord Tumors Resection”

This important study [3] assessed the role of D-wave monitoring in guiding continued resection following motor-evoked potential (MEP) loss during intramedullary spinal cord tumor surgery. Thirty-seven adults with ependymoma (EPN), cavernous angioma, or subependymoma who experienced MEP loss were retrospectively analyzed; 9 underwent continued resection under D-wave guidance while 28 did not. Functional improvement at the last follow-up was significantly greater with D-wave guidance (66.7% vs. 17.9%, p=0.011), particularly in EPN cases (74.4% vs. 9.1%, p=0.003). While early postoperative weakness was more frequent, this difference was not statistically significant, and long-term ambulation, extent of resection, complications, and recurrence rates were similar between groups. These findings suggest that D-wave-guided surgery may facilitate safe tumor removal following MEP loss while preserving long-term motor function.

Article 4: “Efficacy of Proximal Junctional Tethering in Spinal Fusion Surgery for Preventing Proximal Junctional Kyphosis and Proximal Junctional Failure: A Meta-analysis”

This rigorous meta-analysis [4] evaluated the effectiveness of proximal junctional tethering (PJT) in preventing proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following spinal fusion surgery for adult spinal deformities. A systematic search of PubMed, Embase, and the Cochrane Library identified 11 studies (8 retrospective cohorts and 3 propensity-score–matched analyses) encompassing 1,424 patients. Compared to controls, PJT significantly reduced the risk of PJK (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.27–0.71) and PJF (OR, 0.36; 95% CI, 0.19–0.69). These findings indicate that PJT is an effective strategy for reducing the incidence of PJK and PJF in adult spinal fusion surgery.

Article 5: “The Contribution of Paraspinal Sarcopenia on Sagittal Imbalance in Degenerative Kyphosis”

This insightful study [5] investigated the relationship between paraspinal sarcopenia (PS) and sagittal imbalance (SI) in degenerative kyphosis (DK), while also examining how paraspinal muscle (PSM) dysfunction relates to morphological changes. A total of 138 DK patients and 204 controls with lumbar spinal stenosis were analyzed. DK patients were stratified into sagittal balance (SVA≤5 cm) and SI (SVA>5 cm) groups. The SI group exhibited significantly lower endurance time (ET), maximal voluntary exertion (MVE), and relative cross-sectional area (rCSA), along with higher fat infiltration (rFI%) compared to other groups. ET<15.5 seconds, MVE<1.3 N/kg, and rCSA atrophy were identified as independent risk factors for SI. These findings suggest that PS contributes to the progression of SI, highlighting emphasizing the clinical importance of combined functional and morphological PSM evaluation