North American Spine Society Journal最新文献

{"title":"Lateral lumbar interbody fusion versus single position prone transpsoas approach: A comprehensive bibliometric analysis","authors":"Meriem Boukhiam MD ,&nbsp;Abdulwhab Alotaibi MD ,&nbsp;Omid Yousefi MD ,&nbsp;Gilberto Perez Rodriguez Garcia MD ,&nbsp;Ataollah Shahbandi MD ,&nbsp;Saman Shabani MD ,&nbsp;Muhammad M. Abd-El-Barr MD, PhD ,&nbsp;Mohamad Bakhaidar MD","doi":"10.1016/j.xnsj.2025.100837","DOIUrl":"10.1016/j.xnsj.2025.100837","url":null,"abstract":"<div><h3>Background</h3><div>Lateral lumbar interbody fusion (LLIF) and single position prone lateral (PTP) approaches represent significant advances in minimally invasive spine surgery, yet comprehensive comparative analysis of their research trajectories remains limited.</div></div><div><h3>Purpose</h3><div>This bibliometric analysis aims to comprehensively compare the scientific landscapes surrounding LLIF and PTP approaches by examining publication trends, citation patterns, authorship networks, and thematic evolution.</div></div><div><h3>Methods</h3><div>We systematically searched Scopus, PubMed and Google Scholar from inception through September 2025 for articles addressing LLIF and single position prone lateral approaches. Bibliometrix package in R was used to complete the bibliometric analysis. We included the following parameters: publication output, citation metrics, journal distribution, author productivity, international collaboration networks, keyword co-occurrence, and thematic mapping in the analysis.</div></div><div><h3>Results</h3><div>We identified 823 LLIF publications and 107 single position prone lateral publications. LLIF accounted for 20,707 total citations with an h-index of 70 and a mean of 31.93 citations per document, whereas PTP accumulated 915 citations with an h-index of 17 and a mean of 8.44 citations per document. Although LLIF has a larger volume of publications, PTP has progressed more rapidly, showing annual growth rates of 44% compared with 30% for LLIF during comparable developmental periods. The United States contributed 45.6% of LLIF and 71.8% of PTP publications, with LLIF research spanning 42 countries and PTP 16 countries. Core research themes for both techniques evolved from technical descriptions to comparative effectiveness studies, and the substantial overlap in authors and institutions indicates complementary rather than competitive research trajectories.</div></div><div><h3>Conclusions</h3><div>LLIF represents a mature surgical approach with a strong evidence base while PTP demonstrates accelerating research interest, with growth trajectories exceeding those of LLIF during comparable developmental stages. Based on current publication trends and thematic evolution, future research on PTP should prioritize rigorous comparative studies, long-term outcome evaluations, cost-effectiveness analyses, and patient-centered outcome research to strengthen the evidence base and guide clinical adoption.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100837"},"PeriodicalIF":2.5,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977246","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":"Performance of ChatGPT versus spine surgeons as an emergency department spine call consultant","authors":"Taha M. Taka MD ,&nbsp;Seena Sebt BA ,&nbsp;Sarah Meng BS ,&nbsp;Andrew Cabrera MD ,&nbsp;David Shin BS ,&nbsp;Vahe Yacoubian MD, MPH ,&nbsp;Weyjuin Chao MD ,&nbsp;Daniel Rossie MD ,&nbsp;Zhengle Xu MD ,&nbsp;Melissa Erickson MD ,&nbsp;Brett Rocos MD ,&nbsp;Khoi Than MD ,&nbsp;Elizabeth Yu MD ,&nbsp;Nicholas Ahn MD ,&nbsp;Christopher Bono MD ,&nbsp;Wayne Cheng MD ,&nbsp;Olumide Danisa MD","doi":"10.1016/j.xnsj.2025.100836","DOIUrl":"10.1016/j.xnsj.2025.100836","url":null,"abstract":"<div><h3>Background</h3><div>Large language models (LLMs) like ChatGPT are increasingly being recognized as credible tools for use across diverse healthcare settings. While artificial intelligence (AI) use has previously been evaluated in emergency medicine, its use in subspecialty care - particularly spine surgery - remains underexplored. This study evaluates the clinical accuracy, management appropriateness, completeness, helpfulness, and overall quality of ChatGPT responses compared to those of board-certified, spine surgeons in response to common emergency department (ED) consultations.</div></div><div><h3>Methods</h3><div>A 7-part questionnaire was developed based on common ED spine consultations (eg, Cauda Equina Syndrome, compression fracture in elderly patients, purulent drainage from surgical wound, acute lumbar disc herniation, incomplete spinal cord injury, epidural abscess, and metastatic spine disease). Each case included 3–4 questions pertaining to examination, diagnosis, management, and counseling. Responses from ChatGPT and 7 board-certified spine surgeons were restricted to 3–4 sentences per question. Three emergency medicine physicians rated each de-identified questionnaire response using a 5-point Likert scale. Statistical analysis was conducted using a 2-sample T-test with unequal variance. Inter-rater reliability was assessed using pairwise weighted Cohen’s kappa coefficient (κ).</div></div><div><h3>Results</h3><div>When comparing AI responses versus spine surgeon responses to proposed ED consultations, AI responses were rated to be superior across all 5 metrics of clinical accuracy, management appropriateness, completeness, helpfulness, and overall quality (p&lt;.05). Inter-rater reliability was assessed using the average pairwise weighted Cohen’s kappa coefficient which showed substantial agreement (κ=0.76).</div></div><div><h3>Conclusions</h3><div>ChatGPT responses to emergency department spine consultations were rated as significantly higher compared to board-certified spine surgeons by emergency medicine providers. Though further improvement and validation is warranted, these findings suggest that ChatGPT can be a useful clinical adjunct for spine-related emergency department consultations.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100836"},"PeriodicalIF":2.5,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925985","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":"Do GLP-1 agonists affect perioperative risk in spine surgery? A systematic review and meta-analysis","authors":"Favour C Ononogbu-Uche BA ,&nbsp;Felix Toussaint MD ,&nbsp;Abdullah W Saleh BS ,&nbsp;Afnan Hassab E Siddig MD ,&nbsp;Ramzy Ahmed BS ,&nbsp;Karim Akl BS ,&nbsp;Mostafa H Algabri MD ,&nbsp;Mohamed Alwadai MD ,&nbsp;Lauren Corliss BA ,&nbsp;Norah Foster MD ,&nbsp;Muhammad M Abd-El-Barr MD,PhD","doi":"10.1016/j.xnsj.2025.100835","DOIUrl":"10.1016/j.xnsj.2025.100835","url":null,"abstract":"<div><h3>Background</h3><div>Use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is increasing among patients presenting for spine surgery, but their perioperative safety and impact on surgical outcomes, particularly pseudoarthrosis, remain uncertain.</div></div><div><h3>Methods</h3><div>We conducted a PRISMA-compliant systematic review and meta-analysis (PROSPERO CRD420251111692) of comparative studies enrolling adults undergoing any spine surgery, comparing perioperative GLP-1 RA use with no GLP-1 RA. PubMed, Embase, Web of Science, and EBSCO were searched through August 1, 2025. Two reviewers independently screened, extracted data, and assessed risk of bias with ROBINS-I. Random-effects models were used for dichotomous outcomes, reported as odds ratios (OR) with 95% confidence intervals (CI). Meta-analyses were performed when at least 3 studies reported a given outcome, and outlier studies were excluded from sensitivity analyses.</div></div><div><h3>Results</h3><div>Thirteen retrospective cohort studies were included. Across cohorts, baseline characteristics were broadly similar between GLP-1 users (<em>n</em> = 13,754) and controls (<em>n</em> = 17,591): weighted mean age approximately 61 years, weighted mean BMI in the low-to-mid 30 s, and high prevalence of type 2 diabetes and hypertension. Seven studies evaluating pseudarthrosis showed much heterogeneity, but there was a lower risk with GLP-1 RA use (OR 0.74; 95% CI: 0.55–1.00; <em>p</em> = .049; I² = 91.7%). This finding was heterogeneous but represented sensitivity analysis (OR 0.64; 95% CI: 0.57–0.73; <em>p</em> &lt; .001; I² = 45.3%). Pooled analyses found no significant differences for other surgical and nonsurgical outcome measures. There was a nonsignificant trend toward higher nerve injury with GLP-1 exposure (OR 1.57; 95% CI: 0.99–2.48; <em>p</em> = .056; I² = 42.4%). Heterogeneity varied by outcome and was highest for reoperation and utilization endpoints.</div></div><div><h3>Conclusions</h3><div>In adults undergoing spine surgery, perioperative GLP-1 RA use appears safe and is associated with a nonrobust, lower risk of pseudarthrosis, with no consistent differences in infection, wound, neurologic, thromboembolic, pulmonary, or utilization outcomes. Given confounders and retrospective designs, prospective, agent-specific studies are needed to validate fusion benefits and refine perioperative management.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100835"},"PeriodicalIF":2.5,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926568","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":"Following posterior spinal fusion for adolescent idiopathic scoliosis, patients with asthma are at increased odds of pulmonary adverse events","authors":"Lucas Y Kim BS,&nbsp;Julian Smith-Voudouris MSc,&nbsp;Scott J Halperin MD MHS,&nbsp;Dominick Tuason MD,&nbsp;Jonathan N Grauer MD","doi":"10.1016/j.xnsj.2025.100833","DOIUrl":"10.1016/j.xnsj.2025.100833","url":null,"abstract":"<div><h3>Background</h3><div>Posterior spinal fusion (PSF) is a highly successful treatment for adolescent idiopathic scoliosis (AIS). Asthma is one of the most common illnesses affecting young patients and has been shown to affect outcomes in orthopedic procedures. The correlation of asthma and postoperative adverse outcomes following PSF had not been well characterized.</div></div><div><h3>Methods</h3><div>Adolescent patients undergoing PSF for AIS between 2015 and 2023 were identified using the national administrative PearlDiver M165 database. Those with versus without asthma were matched 1:4 based on demographic and comorbid factors and compared for incidence of 90-day postoperative adverse events using multivariable logistic regression. Revision surgery within 5 years was compared using Kaplan–Meier analysis and the log-rank test.</div><div>Secondary multivariable analysis was performed comparing odds of 90-day postoperative adverse events for different levels of asthma severity (mild intermittent, mild persistent, moderate/severe) relative to non-asthma patients.</div></div><div><h3>Results</h3><div>Of 10,196 PSF patients meeting study criteria, asthma was noted for 1,616 (15.8%). After matching, those with asthma were at higher odds of respiratory failure (odds ratio [OR] 1.98, p &lt; .001), pneumonia (OR 1.72, p = .004), and atelectasis (OR 1.52, p = .002), as well as emergency department visit (OR 1.66, p &lt; .001) and readmissions (OR 1.58, p &lt; .001). Differences were not identified for non-pulmonary adverse events. As asthma severity increased from mild intermittent, to mild persistent, to moderate/severe, odds ratios incrementally increased pneumonia (OR not significant, not significant, 4.52, respectively), respiratory failure and atelectasis (OR not significant, not significant, 2.38, respectively) (p &lt; .05 for each listed).</div></div><div><h3>Conclusion</h3><div>Overall, asthma is a common comorbidity for adolescent patients undergoing PSF for AIS and is associated with higher odds of postoperative pneumonia, respiratory failure, and atelectasis. These adverse outcomes increase with increased asthma severity. These findings may help in patient counselling and expectations for postoperative management.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100833"},"PeriodicalIF":2.5,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885140","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":"Analysis of National Institutes of Health funding for back pain research in the United States","authors":"Jason Silvestre MD,&nbsp;John C. Martin BS,&nbsp;Robert J. Ferdon MS,&nbsp;Warren Roth MD,&nbsp;James P. Lawrence MD,&nbsp;Kelley Banagan MD,&nbsp;Charles A. Reitman MD,&nbsp;Robert A. Ravinsky MDCM, MPH","doi":"10.1016/j.xnsj.2025.100832","DOIUrl":"10.1016/j.xnsj.2025.100832","url":null,"abstract":"<div><h3>Background</h3><div>There is a paucity of studies investigating the National Institutes of Health (NIH) funding priorities for back pain research. This study analyzed the portfolio of NIH research grants awarded for back pain in the United States.</div></div><div><h3>Methods</h3><div>NIH grant data were collected from the NIH RePORTER database (2016–2023). Principal investigator (PI) characteristics were collected from academic websites including sex, graduate degree, and academic rank. NIH funding was analyzed for twenty clinical areas and compound annual growth rates (CAGRs) were calculated over the study period. Nonparametric tests were used to compare NIH funding totals by PI characteristics.</div></div><div><h3>Results</h3><div>From 2016 to 2023, the NIH research budget increased from $31.5 to $45.0 billion (CAGR 5.2%). Annual NIH funding for back pain research increased from $23.3 to $69.0 million (CAGR 17.0%) and totaled $523 million over the study period. Dementia ($19.7 billion, CAGR 19.2%) and diabetes ($8.9 billion, CAGR 1.3%) had the most NIH funding. The National Institute of Neurological Disorders and Stroke (45.0%) was the top funding institute and the R01 was the top funded grant mechanism (32.8%). The clinical areas receiving the most NIH funding for back pain research were pathophysiology (20.2%), social determinants (19.6%), and clinical trial networks (16.3%). Several PI characteristics were associated with higher NIH funding totals for back pain research including PhD degree and full professor rank (p&lt;.001).</div></div><div><h3>Conclusions</h3><div>Annual NIH funding for back pain research increased over the study period yet remains superseded by other clinical areas. Future coordinated efforts may be needed to stimulate NIH grant funding for back pain research.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100832"},"PeriodicalIF":2.5,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037743","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":"Bed break-induced attenuation of downside leg sciatic nerve sensory and motor evoked potentials during lateral lumbar interbody (LLIF) fusion surgery","authors":"David W Allison PhD, CNIM ,&nbsp;Amit Verma MD ,&nbsp;Anthony R Cockrell CNIM ,&nbsp;Todd Trask MD ,&nbsp;William J Steele MD ,&nbsp;Loyola V Gressot MD ,&nbsp;Suraj Sulhan MD ,&nbsp;Ryan P Cantrell BS ,&nbsp;Jaime R Guerrero MD ,&nbsp;Brandy B Ma MD ,&nbsp;Amir H Faraji MD, PhD ,&nbsp;Mark L Prasarn MD ,&nbsp;Adam Green MD ,&nbsp;Comron Saifi MD ,&nbsp;Sean M Barber MD ,&nbsp;Meng Huang MD ,&nbsp;Paul Holman MD","doi":"10.1016/j.xnsj.2025.100831","DOIUrl":"10.1016/j.xnsj.2025.100831","url":null,"abstract":"<div><h3>Background</h3><div>Multimodality intraoperative neuromonitoring (IONM) is used to map and monitor the femoral plexus during transpsoas lateral lumbar interbody fusion (LLIF) surgery. Approach side LLIF IONM alerts that portend a femoral plexopathy have been well-studied, but downside sciatic nerve distribution alerts have not been reported. The breaking of the bed to obtain better access to the disc space can cause attenuation of downside leg sciatic nerve distribution somatosensory, transcranial, and transabdominal motor evoked potentials (SSEPs, TcMEPs, and TaMEPs) and appears most common in females with a BMI ≥ 30. We evaluated the propensity and cause of downside leg sciatic nerve distribution SSEP, TcMEP, and TaMEP alerts during LLIF surgery.</div></div><div><h3>Methods</h3><div>A single-center 30-month retrospective examined the frequency of downside leg sciatic nerve distribution IONM alerts for 692 patients, 380 female (55%) and 312 male (45%), having LLIF spine surgery utilizing IONM consisting of SSEPs, TcMEPs, TaMEPs, electromyography (EMG) and electroencephalography (EEG). Downside leg IONM alerts were analyzed for correlation to patient BMI, sex, age, as well as the recovery of IONM signals to the length of time the bed remained broken. IONM data was correlated to immediate postoperative neurological evaluations and chart reviews.</div></div><div><h3>Results</h3><div>Of 692 LLIF surgeries, 18 (2.6%) downside leg sciatic nerve distribution SSEP, TcMEP, and TaMEP alerts were observed. No cases detected concomitant IONM changes involving downside-leg femoral nerve distribution. The attenuation and recovery of the downside leg sciatic nerve distribution IONM responses during these alerts appeared to correlate to the breaking and unbreaking of the bed. Of the 18 alerts, 17 occurred in females, 12 in females with BMI ≥ 30, and 16 in patients aged 60 or older. Chi-square analysis points to sex (female) and obesity (BMI ≥ 30) as characteristics that correlate to this phenomenon. Interestingly, none of the 18 patients, including the 2 where IONM responses did not return to baseline, suffered postoperative downside leg sciatic distribution motor or sensory deficits.</div></div><div><h3>Conclusions</h3><div>The possible mechanism of these downside leg alerts is compression or stretch of the sciatic nerve at the level of the pelvis, not leg ischemia. While none of the 18 alert case patients suffered postoperative deficits, best practice would be to partially or completely unbreak the bed as soon as feasible when the downside sciatic nerve distribution IONM signals are attenuated.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100831"},"PeriodicalIF":2.5,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925986","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":"Does psoas size predict postoperative thigh pain in extreme lateral interbody fusion?","authors":"Najim Yusof MBBS, MRCS,&nbsp;Chang Yi Woon MBBS,&nbsp;Han Xinyun Audrey MBBS, MRCS, MMed Ortho, FRCS,&nbsp;Soh Chee Cheong Reuben MBBS, MRCS, MMed Ortho, FRCS","doi":"10.1016/j.xnsj.2025.100783","DOIUrl":"10.1016/j.xnsj.2025.100783","url":null,"abstract":"<div><h3>Background</h3><div>Lateral lumbar interbody fusion via a transpsoas approach is designed to reduce the morbidity of open spinal surgeries and achieve lordosis targets in fusion. A common postoperative finding is thigh dysesthesia and weakness. However, there has not been much research into factors contributing to the thigh dysesthesia and weakness. This study aims to assess the association between psoas size and postoperative thigh and/or groin pain.</div></div><div><h3>Methods</h3><div>A prospectively collected retrospectively analyzed database of patients who had degenerative lumbar spinal stenosis who underwent transpsoas lumbar interbody fusion at a single institution was evaluated. We included patients who had XLIF to either L3/4 and/or L4/5 and excluded patients who did not have preoperative MR imaging scans available in our electronic health records. Patients with previous lumbar surgeries and history of infection to the lumbar spine and psoas were excluded. 80 patients met the inclusion criteria. We tested the association between the presence of postoperative thigh and/or groin pain with the following factors: psoas muscle dimension, gender, age, BMI and length of psoas retraction time using One-way ANOVA or Chi-square test or Fisher Exact test where appropriate.</div></div><div><h3>Results</h3><div>A total of 80 patients met the inclusion criteria. Anterior-posterior diameter of the psoas (p = .011–.013) was found to have a statistically significant relationship with postoperative thigh and/or groin pain for patients who underwent transpsoas lumbar interbody fusion at multiple levels.</div></div><div><h3>Conclusions</h3><div>When considering patients for multilevel lateral lumbar spine surgery, MRI evaluation of anterior-posterior diameter of psoas size and gender of patient is helpful in predicting cases with higher risk of developing postoperative thigh pain. When anterior-posterior psoas diameter is more than 49.51 mm (for multiple level surgeries), consideration to approach via an anterior to psoas lateral approach or greater discussion with postoperative expectation would be warranted.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100783"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614553","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":"Reoperation risk by subtype in proximal junctional kyphosis and the impact of osteoporosis treatment in adult spinal deformity surgery","authors":"Tetsuro Ohba MD, PhD,&nbsp;Nobuki Tanaka MD, PhD,&nbsp;Kotaro Oda MD, PhD,&nbsp;Hayato Takei MD,&nbsp;Goto Go MD,&nbsp;Hirotaka Haro MD, PhD","doi":"10.1016/j.xnsj.2025.100821","DOIUrl":"10.1016/j.xnsj.2025.100821","url":null,"abstract":"<div><h3>Background</h3><div>Mechanical complications after long-segment fusion for adult spinal deformity (ASD) remain a major driver of reoperation. Proximal junctional kyphosis (PJK) comprises heterogeneous morphologic subtypes with potentially distinct clinical courses, yet how subtype relates to reoperation risk and whether bone quality or osteoporosis medications mitigate that risk are not fully defined.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective cohort study of consecutive older adults undergoing posterior instrumented fusion for ASD. Patients were classified by PJK subtype and grade using standardized radiographic criteria, and followed longitudinally for the occurrence and timing of reoperation. Bone quality surrogates and osteoporosis therapies, including preoperative teriparatide, were recorded. Multivariable models adjusted for demographic, surgical, and spinopelvic parameters were used to assess associations between subtype, bone quality, medication exposure, and reoperation.</div></div><div><h3>Results</h3><div>Reoperation clustered within specific PJK subtypes, with higher-grade deformity demonstrating a disproportionately greater need for revision. Subtypes characterized by structural failure and junctional collapse showed the strongest association with reoperation compared with alignment-predominant patterns. Lower bone quality correlated with more severe PJK and reoperation, whereas exposure to osteoporosis medication—particularly preoperative teriparatide—was associated with a lower likelihood of reoperation and delayed time to reintervention. Sensitivity analyses yielded consistent effect directions across age, sagittal alignment, and construct length strata.</div></div><div><h3>Conclusions</h3><div>PJK subtype meaningfully stratifies reoperation risk after ASD surgery. Integrating subtype with bone quality assessment can refine perioperative decision-making, identify patients who may benefit from intensified junctional protection, and inform surveillance. Preoperative anabolic therapy emerges as a potentially modifiable factor linked with reduced reoperation, warranting prospective evaluation. These findings support a practical, subtype-guided strategy that couples surgical planning with bone health optimization to reduce failure and reoperation burden.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100821"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614554","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":"Guest editors introduction of the North American spine society section reports: state of the art and future directions in spine surgery/care","authors":"Rajiv Saigal MD, PhD ,&nbsp;Zorica Buser PhD, MBA ,&nbsp;Michael G. Fehlings MD, PhD","doi":"10.1016/j.xnsj.2025.100826","DOIUrl":"10.1016/j.xnsj.2025.100826","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100826"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789902","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 “impact of transversus abdominis plane block on length of stay and postoperative opioid use in anterior lumbar interbody fusions”","authors":"Annie L. McDonald BA,&nbsp;Jonathan N. Grauer MD","doi":"10.1016/j.xnsj.2025.100824","DOIUrl":"10.1016/j.xnsj.2025.100824","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100824"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736470","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}