This nationwide registry study compared the long-term risk of adjacent segment disease (ASD) requiring reoperation after anterior cervical discectomy and fusion (ACDF) with that after cervical disc arthroplasty (CDA). Using prospectively collected data from Swespine, the authors analyzed 9,338 patients treated from 2006 to 2026 and identified 509 reoperations over 45,666 person-years of follow-up. The cumulative incidence of ASD requiring reoperation was 4.9% at 5 years and 10% at 10 years, lower than many previously reported estimates. After adjustment, CDA was associated with a lower risk of ASD than ACDF, although the absolute difference was small. These findings provide real-world clinical evidence supporting the potential benefit of motion preservation while indicating that the magnitude of this benefit should be interpreted cautiously.
This nationwide propensity-score-matched cohort study evaluated the risk of subsequent lumbar surgery after spinal fusion in patients with Parkinson disease (PD). Using data from the Health Insurance Review & Assessment Service of Korea, the authors matched 2,287 patients with PD to 6,861 patients without PD and followed both groups for up to 7 years. Patients with PD had a 1.6-fold higher risk of subsequent lumbar surgery after fusion, although the time to reoperation did not differ significantly between the groups. The higher reoperation risk may reflect biomechanical challenges associated with PD; flexed posture and neuromuscular dysfunction may compromise long-term fusion durability. The study therefore supports careful patient selection, preoperative optimization, and realistic counseling before lumbar fusion in patients with PD.
This registry-based study examined a practical question in lumbar revision surgery: whether decompression alone or decompression with extended fusion should be performed when clinically evident adjacent-segment pathology develops after a previous fusion. Using Swespine data from 2,521 patients treated from 1997 to 2019, the authors compared subsequent surgery rates between the 2 strategies over a mean follow-up of 6.1 years. The 5-year probability of subsequent surgery was 18% after decompression alone and 25% after extended fusion, and extended fusion was associated with a higher adjusted risk of subsequent surgery. Residual confounding remains likely because information on radiographic instability, deformity, and foraminal stenosis was unavailable; nevertheless, the findings challenge the assumption that extending the fusion necessarily reduces the risk of later reoperation.
In the final featured article, the authors evaluated whether posterior minimally invasive scoliosis surgery (MISS) remains feasible for patients with flexible adolescent idiopathic scoliosis and a Cobb angle exceeding 80°. They compared moderate, severe, and very severe curvature groups among 257 patients. The very severe curvature group had longer operative times, more fused vertebral segments, and more frequent rib resection during thoracoplasty. Correction rates and final thoracic kyphosis were similar among the 3 groups, and overall complication rates did not differ significantly. However, invasive treatment for pleural effusion was more common in the very severe curvature group. These findings suggest that posterior MISS may be a feasible option for carefully selected patients with flexible adolescent idiopathic scoliosis and very severe curvature, provided that the greater operative demands and the possibility of pleural effusion requiring invasive treatment are anticipated.
Together, these 4 studies demonstrate how large-scale realworld data and carefully selected cohorts of surgical patients can improve decision-making processes across the treatment of cervical, lumbar, adult, and pediatric spinal deformities. Furthermore, these studies emphasize the need to consider database limitations, patient-selection criteria, and procedure-specific complexities when interpreting apparent benefits or risks. We hope these articles stimulate future prospective and methodologically rigorous research to improve patient-centered spine care.
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