North American Spine Society Journal最新文献

{"title":"A room with a view: Recovery bed environment following pediatric spinal fusion","authors":"Alexa P. Bosco BA ,&nbsp;Margaret L. Sullivan BS ,&nbsp;Daniel Gabriel BA, MBA ,&nbsp;Shanika De Silva PhD ,&nbsp;Daniel Hedequist MD ,&nbsp;Michael T. Hresko MD ,&nbsp;Craig Munro Birch MD ,&nbsp;Grant D. Hogue MD","doi":"10.1016/j.xnsj.2026.100848","DOIUrl":"10.1016/j.xnsj.2026.100848","url":null,"abstract":"<div><h3>Background Context</h3><div>Patients in a double-occupancy room during recovery will have different experiences based on bed location. For instance, patients near a window will have access to natural light while a patient near the door may experience higher noise levels. This study aims to assess the impact of inpatient bed placement on postoperative recovery for adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF).</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 448 AIS patients who underwent PSF from 2011 to 2017 at a single center. Demographics and baseline radiographic measurements were summarized using appropriate statistics. Intraoperative and postoperative outcomes, NRS pain scores and total daily opioid administration were compared across bed types using t-tests, Wilcoxon rank sum tests, chi-squared tests, or Fisher’s exact tests, as appropriate. GEE models were constructed to examine the influence of bed type and days since surgery on outcomes such as postoperative complication, PACU pain levels, length of stay, daily numerical ranking scale (NRS) pain scores and total daily opioid administration.</div></div><div><h3>Results</h3><div>325 (73%) patients in the cohort were assigned to a bed by the window and 123 (27%) were assigned to a bed by the door. The mean age was 15±2 years and 85% of patients were female. Length of hospital stay, complication rates, 2-year outcomes, inpatient pain scores, and daily opioid usage did not significantly differ between bed types (all p&gt;.05). Adjusted GEE models revealed no significant associations between bed type and pain scores (p=.9) or between bed type and total opioid dosage (p=.95).</div></div><div><h3>Conclusions</h3><div>Proximity to a window while recovering from PSF surgery for AIS does not impact inpatient outcomes. When bed space is scarce, usage of all available beds can serve as a relief valve to continue elective practices without compromising postoperative outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100848"},"PeriodicalIF":2.5,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression among lumbar spine surgery patients: Uncovering the untold story","authors":"Aboubacar Wague BA ,&nbsp;Jennifer M. O’Donnell MD ,&nbsp;Nesa Milan MD ,&nbsp;Alex Youn BA ,&nbsp;Gurbinder Singh BS ,&nbsp;Anna Filley MD ,&nbsp;Avionna Baldwin MD ,&nbsp;Zodina Beine MD ,&nbsp;Aesha Ajose BS ,&nbsp;Ashraf N. El Naga MD ,&nbsp;David Gendelberg MD ,&nbsp;Sigurd Berven MD","doi":"10.1016/j.xnsj.2025.100846","DOIUrl":"10.1016/j.xnsj.2025.100846","url":null,"abstract":"<div><h3>Background</h3><div>Depression is highly prevalent among patients with lumbar degenerative disease and is associated with worse postoperative outcomes. However, a significant proportion of affected individuals remain undiagnosed. We aimed to evaluate the utility of PROMIS Depression scores in identifying patients with undiagnosed depression undergoing lumbar spine surgery and to characterize their clinical outcomes relative to patients with diagnosed and no depression.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients undergoing 1- or 2-level lumbar decompression or fusion between March 2019 and November 2021. Patients were stratified into three cohorts: diagnosed depression (PDD), no depression (NDD), and at-risk for undiagnosed depression (ARUD), defined as PROMIS Depression ≥55 without an ICD-10 diagnosis. Patient-reported outcomes were assessed preoperatively and at 6, 12, and 24 months postoperatively. Between group comparisons and baseline-adjusted ANCOVA models were performed, including subgroup analyses by procedure type (fusion vs. decompression) and revision status.</div></div><div><h3>Results</h3><div>Of 286 ICD-10-negative patients, 24.1% (n=69) met criteria for ARUD. Patient-reported outcome scores across all domains in the ARUD cohort mirrored those of the PDD group and were significantly worse than those of the NDD cohort at all timepoints (p&lt;.001). PROMIS Depression showed a strong correlation with Anxiety (ρ&gt;0.77) and moderate correlations with other domains. No significant difference was observed in outcomes between treated and untreated PDD patients. Older age was associated with reduced likelihood of diagnosis, while substance abuse history, pain clinic enrollment, and retired status predicted higher risk of undiagnosed depression.</div></div><div><h3>Conclusions</h3><div>PROMIS Depression scores can identify patients with undiagnosed depression who experience similar impairments and postoperative outcomes as those with diagnosed depression. These findings support the routine use of PROMIS Depression as a screening tool to enhance preoperative psychiatric assessment in spine surgery patients.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100846"},"PeriodicalIF":2.5,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portal message utilization in orthopedic spine surgery: patterns, predictors, and financial implications","authors":"Sydney Rucker BA ,&nbsp;Michal C Williams BS ,&nbsp;Robert J. Ferdon MS ,&nbsp;Jason Silvestre MD ,&nbsp;Charles Reitman MD ,&nbsp;Robert Ravinsky MDCM, MPH, FRCSC","doi":"10.1016/j.xnsj.2025.100845","DOIUrl":"10.1016/j.xnsj.2025.100845","url":null,"abstract":"<div><h3>Background</h3><div>Electronic patient portals (EPPs) facilitate communication between patients and providers, but their utilization and impact in orthopedic spine surgery are poorly defined. This study aims to quantify portal message volume and content, identified demographic predictors of high utilization, and estimated the associated administrative and financial burden.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of 833 new patients presenting to a single tertiary-care orthopedic spine practice over 6 months (April 2–October 31, 2024). Portal messages were categorized by timeframe and subject matter. Patients were classified as low- or high-volume (HV) users, with HV defined as ≥4 messages. Demographic predictors were assessed using independent t-tests and chi-square analyses. Messages meeting Centers for Medicare and Medicaid Services (CMS) criteria for billable Evaluation and Management (E/M) services were identified and assigned reimbursement values. A Monte Carlo simulation (100,000 iterations; R v4.5.1) estimated lost revenue from unbilled encounters.</div></div><div><h3>Results</h3><div>A total of 548 portal messages were sent (median 0 messages per patient; IQR 0–1). Common message topics included appointment scheduling (<em>n</em>=97), imaging-related concerns (<em>n</em>=94), postoperative issues (<em>n</em>=79), pain management (<em>n</em>=70), and third-party requests (<em>n</em>=59). High-volume utilization occurred in 43 patients (5.2%), with a mean of 5.19 messages per patient (range 3–18). Age was not associated with portal use (p=.276). Race was the only significant predictor of HV utilization (χ²=6.172, p=.046), with White/Caucasian patients overrepresented and Black/African American patients underrepresented. Only 25 messages (4.6%) met CMS billing criteria, primarily Level III E/M encounters (72%). Estimated median lost billable revenue was $7,501 (95% CI $3,845–$12,539).</div></div><div><h3>Conclusions</h3><div>Electronic patient portal (EPP) use in orthopedic spine surgery is highly skewed, with a small subset of patients generating disproportionate message volume. Despite limited billable encounters, portal messaging represents a growing administrative burden. Observed racial disparities highlight the need to further evaluate equity in digital patient engagement.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100845"},"PeriodicalIF":2.5,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel carbon fiber pedicle screw system for the treatment of lumbar degenerative disc disease: Results from a prospective, multicenter, FDA investigational device exemption study","authors":"Scot Dean Miller DO, MBA ,&nbsp;Rajiv V. Taliwal MD ,&nbsp;Kathleen Opsitnick MSN, APRN, ACNP-BC ,&nbsp;Brandy Mansfield MSN, APRN, ANP-BC ,&nbsp;Thomas Cha MD ,&nbsp;Mohamad Bydon MD ,&nbsp;Anders Jonathan Cohen MD ,&nbsp;Reuven Gepstein MD ,&nbsp;Itzhak Engel MD ,&nbsp;Joshef Leitner MD ,&nbsp;Ely Ashkenazi MD ,&nbsp;Michael Millgram MD ,&nbsp;Yoram Folman MD ,&nbsp;Carl Lauryssen MD","doi":"10.1016/j.xnsj.2025.100844","DOIUrl":"10.1016/j.xnsj.2025.100844","url":null,"abstract":"<div><h3>Background</h3><div>Standard titanium pedicle screw systems are widely used in spinal fusion but produce imaging artifacts and may have limitations in fatigue resistance. CarboClear carbon fiber-reinforced PEEK (CFR-PEEK) implants offer improved radiolucency and fatigue properties, and negligible artifacts in MRI and CT scans. The purpose of this study was to evaluate the safety and effectiveness of CarboClear CFR-PEEK pedicle screw system for patients with degenerative disc disease (DDD) undergoing 1 level lumbar spinal fusion.</div></div><div><h3>Methods</h3><div>A prospective, multicenter, FDA-regulated Investigational Device Exemption (IDE) clinical trial, including 55 patients with DDD at 1 level (L2 to S1). Patients received the CarboClear System and a PEEK interbody fusion device. They were evaluated preoperatively and postoperatively at 6 weeks, 3, 6, 12, and 24 months, and then annually until the last patient completed 24-month follow-up. Primary outcome measures included self-reporting Visual Analog Scale (VAS) pain scores and Oswestry Disability Index (ODI), radiographic fusion rate, and safety assessments. Secondary measures included self-reporting SF-12 Health Survey (SF-12) scores and patient satisfaction (VAS), and operative parameters. Results were compared to predefined literature control group.</div></div><div><h3>Results</h3><div>At 24 months, 90.0% of the patients had clinically meaningful pain improvement (VAS ≥ 20), and 78.0% had ODI improvement ≥15 points. Rigorously defined fusion was achieved in 85.71% of the patients at 24 months and in 94.59% at 36 months. The neurological success rate was 93.33%. No serious device-related adverse events occurred. The 24-month index-level reoperation rate was 7.14%, including 1 implant removal case (1.79%). Compared to the literature control, CarboClear device demonstrated superior imaging clarity and at least equivalent clinical outcomes.</div></div><div><h3>Conclusions</h3><div>The CarboClear System is a safe and effective alternative to titanium pedicle screws for lumbar fusion, providing improved imaging compatibility and fatigue resistance.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100844"},"PeriodicalIF":2.5,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjacent segment degeneration after superior facet joint violation of the lumbar spine","authors":"Conor McNamee MB, BCh, BAO, MCh ,&nbsp;Bryan Magee BSc ,&nbsp;Richard N. Storey MBChB, FRACS ,&nbsp;Jake M. McDonnell MRCS ,&nbsp;Stacey Darwish MBChB, FRCS ,&nbsp;Joseph S. Butler PhD, FRCS","doi":"10.1016/j.xnsj.2025.100843","DOIUrl":"10.1016/j.xnsj.2025.100843","url":null,"abstract":"<div><h3>Background</h3><div>Facet joint violation (FJV) is a recognized complication of pedicle screw fixation and has been proposed as a driver of adjacent segment disease (ASD). Biomechanical models suggest that FJV may alter segmental kinematics, but its clinical impact on degeneration and reoperation remains uncertain. This work evaluates whether superior FJV is associated with an increased risk of radiographic ASD or reoperation after lumbar fusion.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of patients undergoing lumbar pedicle screw fixation with postoperative CT imaging that captured the instrumentation and the cranial adjacent segment. Superior FJV was graded using an established 3-tier system. Follow-up imaging was assessed for disc height loss, progression of spondylolisthesis, coronal deformity, central stenosis, lateral recess height and a composite degeneration endpoint; reoperations were recorded. Propensity score weighting balanced measured covariates, and a weighted cox regression was used for time-to-event analyses.</div></div><div><h3>Results</h3><div>Seventy-one patients met inclusion criteria, with FJV identified in 35 (49.3%). Weighted analyses demonstrated no significant association between FJV and disc height loss (HR 1.21, 95% CI 0.54–2.72), progression of spondylolisthesis (HR 0.59, 95% CI 0.13–2.65), coronal deformity (HR 2.18, 95% CI 0.48–10.01), central stenosis (HR 1.35, 95% CI 0.21–8.61), composite degeneration (HR 1.76, 95% CI 0.87–3.56), or reoperation (HR 0.44, 95% CI 0.12–1.62). Exploratory subgroup analysis suggested that minor (grade 1) violations may contribute to axial instability, whereas full joint traversal (grade 2) may confer relative stability, though neither reached statistical significance.</div></div><div><h3>Conclusions</h3><div>In this cohort with extended follow-up, superior FJV was not significantly associated with any measure of radiographic degeneration or reoperation. These findings suggest that FJV may not be a major determinant of long-term outcomes after lumbar fusion. Further biomechanical and clinical studies are warranted to clarify whether specific grades of FJV differentially affect cranial segment stability and screw performance.</div></div><div><h3>140 characters</h3><div>Superior FJV on CT didn’t significantly increase hazards of disc height loss, listhesis, stenosis, deformity, or reop after fusion.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100843"},"PeriodicalIF":2.5,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PMMA-augmentation of the spinous process as an enhancing-protective measure against bone failure in “through the spinous process-vertebropexy”","authors":"Alexandros Tsolakidis MD ,&nbsp;Marie-Rosa Fasser PhD ,&nbsp;Oliver Wigger ,&nbsp;Mazda Farshad MD ,&nbsp;Jonas Widmer PhD","doi":"10.1016/j.xnsj.2025.100842","DOIUrl":"10.1016/j.xnsj.2025.100842","url":null,"abstract":"<div><h3>Background</h3><div>Vertebropexy, a semi-rigid spinal stabilization technique, utilizes the spinous process(SP) as an anchor point for stabilizing tendon-grafts or flexible cerclages. In its primary form, it entailed drilling into the bone of 2 adjacent SPs and threading the materials through the holes. Biomechanical studies have identified the SP as the weakest part of the vertebrae, while cadaveric studies have demonstrated a higher bone failure rate with osteoporosis. We investigated whether cement augmentation of the SP could enhance the biomechanical strength and reduce the fracture-risk in the setting of first-generation Vertebropexy.</div></div><div><h3>Methods</h3><div>Following computed tomographic analysis and measurement of the bone mineral density, 12 lumbar segments were divided in 2 groups (Osteoporotic/ Nonosteoporotic) and then fixed in custom-made 3D-printed clamps. The SPs of 6 segments underwent cement augmentation (PMMA-Group), and a CT scan confirmed adequate augmentation. The other 6 segments remained uncemented. (Native-Group). Posterior decompression, drilling, and instrumentation with bovine tendons were then conducted. Torque-to-failure stress tests were performed on a biaxial static testing machine.</div></div><div><h3>Results</h3><div>The cement-augmentation of the SP significantly increases the torque-to-failure in flexion (p=.00037/ Median &amp; IQR: 13.0 &amp; 5.2 Nm in the Native-Group vs. 26.5 &amp; 11.1 Nm in the PMMA-Group), regardless of the bone quality (p=.008). A statistically significant difference in torque-to-failure between Osteoporotic and NonOsteoporotic groups inside the PMMA and Native groups was determined (p=.015 and p=.025, respectively). A statistically significant correlation between bone density and failure torque was not detected in this cohort, possibly due to the limited sample size (Spearman 0.276, p=.192). A comparison between the torque-to-failure of the Native-NonOsteoporotic SPs and that of the PMMA-Osteoporotic showed no statistical significance (p=.240).</div></div><div><h3>Conclusions</h3><div>Based on the findings of this small-sample cadaveric study, cement-augmentation of the spinous processes can multiply the torque-to-failure/fracture in both osteoporotic and nonosteoporotic conditions and may be used as a salvage technique in first-generation vertebropexy procedures that compromise the spinous process.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100842"},"PeriodicalIF":2.5,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnostic value of metagenomic next-generation sequencing versus traditional microbiological testing in native pyogenic spinal infections: A systematic review and meta-analysis","authors":"Othman Ibrahim BS ,&nbsp;Rewa Aboushaala ,&nbsp;Namrah Ahmed MS ,&nbsp;Andrew Savoia BS ,&nbsp;Sloane O. Ward BS ,&nbsp;Shriya N. Patel BS ,&nbsp;Gregory Lopez MD ,&nbsp;Sarah E. Sansom DO, MS ,&nbsp;Brett Williams MD ,&nbsp;Kern Singh MD ,&nbsp;Lena Al-Harthi PhD ,&nbsp;Khaled Aboushaala MD, MS, PhD","doi":"10.1016/j.xnsj.2025.100840","DOIUrl":"10.1016/j.xnsj.2025.100840","url":null,"abstract":"<div><h3>Background</h3><div>Native pyogenic spinal infections (PSIs), including spondylodiscitis and vertebral osteomyelitis, are challenging to diagnose due to low culture sensitivity and delayed results. Metagenomic next-generation sequencing (mNGS) has emerged as a promising diagnostic tool, but its comparative clinical utility remains uncertain. The purpose of this study is to systematically compare the diagnostic performance and clinical impact of mNGS versus conventional microbial culture in detecting pathogens responsible for native PSIs.</div></div><div><h3>Methods</h3><div>The current systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed across 6 major databases. Eligible studies directly compared mNGS with standard culture for native PSIs and reported diagnostic performance metrics. Data were extracted and analyzed using a random-effects model to produce pooled estimates. Study quality was assessed using the Newcastle-Ottawa Scale. Primary outcomes included pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Secondary outcomes assessed diagnostic yield, time to diagnosis, treatment modification, and false-positive or contamination events.</div></div><div><h3>Results</h3><div>A total of 1,227 patients from 12 studies were included, encompassing those with suspected or confirmed native PSIs. Pooled sensitivity and specificity of mNGS were 89.7% (95% CI: 85.6–93.1%) and 86.2% (95% CI: 80.5–91.0%), respectively. mNGS demonstrated a significantly higher diagnostic yield (69–90%) compared to culture (27.2–44.7%) and enabled faster diagnosis (range, 17.7–48 hours). mNGS informed antimicrobial selection in up to 70.3% of cases and detected a broader pathogen spectrum. The incidence of false positives was low (range, 1–5) but non-negligible, emphasizing the need for careful interpretation.</div></div><div><h3>Conclusions</h3><div>mNGS outperforms conventional culture in sensitivity, speed, and breadth of pathogen detection in native PSIs and supports more tailored antimicrobial therapy. However, careful interpretation is necessary due to potential false positives. These findings support the integration of mNGS into clinical workflows, particularly in complex or culture-negative infections.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100840"},"PeriodicalIF":2.5,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stem cell therapy for degenerative disc disease: A systematic review of preclinical evidence, clinical translation, and future directions","authors":"Vinicius Ricieri Ferraz MD ,&nbsp;Carlos R. Goulart MD ,&nbsp;Maria Fernanda Ricieri Ferraz Franco de Souza MD ,&nbsp;Marcelo Ochoa Coelho de Souza Furlan MD ,&nbsp;Philippe Mercier MD, PhD ,&nbsp;Tobias A. Mattei MD, FACS","doi":"10.1016/j.xnsj.2025.100841","DOIUrl":"10.1016/j.xnsj.2025.100841","url":null,"abstract":"<div><h3>Background</h3><div>Degenerative disc disease (DDD) is a leading contributor to chronic low back pain and global disability. Existing therapies, from conservative management to spinal fusion, do not reverse the underlying molecular degeneration, leaving a critical treatment gap. Given its regenerative capabilities the advent of stem-cell therapy may constitute an ideal solution to fulfill such a therapeutic gap.</div></div><div><h3>Methods</h3><div>This PRISMA-compliant systematic review evaluates stem cell–based strategies for intervertebral disc regeneration by examining preclinical evidence, clinical translation, and future directions. Searches of PubMed, Scopus, Web of Science, and related databases (from January 2000–May 2025) identified studies reporting on pain (Visual Analogue Scale), function (Oswestry Disability Index), and structural outcomes (MRI).</div></div><div><h3>Results</h3><div>Preclinical models uniformly demonstrate meaningful regeneration, including restoration of disc height and extracellular matrix. Clinical evidence, however, is limited: thirteen low to moderate-quality trials show modest, albeit statistically significant, improvements in pain and disability, without compelling imaging proof of biological repair. Short to mid-term safety appears acceptable.</div></div><div><h3>Conclusions</h3><div>The use of stem-cell therapy for treatment of degenerative disc disease is constrained by the somewhat hostile and avascular microenvironment of the intervertebral disc. Existing trials exhibit significant methodological weaknesses which substantially impair their application to the daily clinical practice. Future progress will likely depend on incorporating biomaterial-assisted delivery systems, cell-free exosome approaches, biological scaffolds and gene-editing technologies aimed at engineering the disc niche rather than simply focusing on cell replacement.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100841"},"PeriodicalIF":2.5,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on “Undetected low bone mineral density in patients undergoing lumbar fusion surgery: Prevalence and risk factors”","authors":"Melissa Baker MD ,&nbsp;Zorica Buser PhD, MBA","doi":"10.1016/j.xnsj.2025.100839","DOIUrl":"10.1016/j.xnsj.2025.100839","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100839"},"PeriodicalIF":2.5,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative complications after anterior cervical discectomy and fusion in patients with versus without carotid artery stenosis","authors":"Katie M. Zehner BS ,&nbsp;Julian Smith-Voudouris MS ,&nbsp;Joshua G. Sanchez BA ,&nbsp;Sahir S. Jabbouri MD ,&nbsp;Yoji Ogura MD, PhD ,&nbsp;Basar Atalay MD, PhD ,&nbsp;Jonathan N. Grauer MD ,&nbsp;Arya G. Varthi MD","doi":"10.1016/j.xnsj.2025.100838","DOIUrl":"10.1016/j.xnsj.2025.100838","url":null,"abstract":"<div><h3>Background</h3><div>Carotid artery stenosis (CS) may elevate risk of stroke related to anterior cervical discectomy and fusion (ACDF) due to manipulation of the carotid artery and alteration in flow dynamics. Prior studies assessing this potential association are limited by small sample size and assessment of in-hospital stroke only.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted to compare 90-day adverse events following ACDF in patients with versus without CS. Adult patients (age &gt;17 years) without a history of stroke who underwent isolated 1-3 level ACDF were identified in the 2010-2023 PearlDiver M170 database. Patients with CS were matched 1:4 to patients without CS based on age, sex, and Elixhauser comorbidity index (ECI). Adverse outcomes, emergency department (ED) visits, and readmissions in the 90 postoperative days were identified and compared between groups with univariable and multivariable analyses, the latter controlling for age, sex, and ECI. The timing of stroke following surgery was also plotted on a Kaplan-Meier survival curve and compared by log-rank test. A secondary analysis was conducted comparing CS patients with and without a history of revascularization procedure.</div></div><div><h3>Results</h3><div>Among patients in the database undergoing ACDF, 17,772 with and 423,401 without CS were identified. Following matching, final cohorts consisted of 16,888 CS patients and 67,355 matched controls. CS was associated with greater odds of cardiac events (OR=1.74, p&lt;.001) and stroke (OR=1.49, p&lt;.001), but not other assessed adverse outcomes. The incidence of stroke continued to diverge for the 2 groups out to 90-days postoperatively. Of the CS patients, 2.8% had prior carotid revascularization. These patients had no difference in odds of stroke when compared to patients who had not undergone revascularization (p=.522)</div></div><div><h3>Conclusions</h3><div>ACDF patients with CS were found to be at significantly elevated odds of cardiac events and stroke (adverse outcomes associated with atherosclerotic burden), but not other assessed adverse outcomes. Surveillance of related symptoms through the perioperative period is importantly considered.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100838"},"PeriodicalIF":2.5,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}