North American Spine Society Journal最新文献

{"title":"Rib construct for severe spinal deformity in young children: a 3-part investigation of biomechanical, animal, and clinical case data","authors":"Daniel J. Bonthius MD, PhD ,&nbsp;Richard H. Gross MD ,&nbsp;Mohammed A. Alshareef MD ,&nbsp;Gregory J. Wright PhD ,&nbsp;Shuchun Sun PhD ,&nbsp;Yongren Wu PhD ,&nbsp;Hai Yao PhD","doi":"10.1016/j.xnsj.2025.100776","DOIUrl":"10.1016/j.xnsj.2025.100776","url":null,"abstract":"<div><h3>Background</h3><div>Early-onset spinal deformity (EOSD), occurring before age 10, requires surgical techniques that accommodate spinal growth. Traditional intra-spinal methods like growing rods have high complication rates. The rib construct is an alternative technique that uses rib-based fixation for correcting EOSD. The objective of this study is to evaluate its performance.</div></div><div><h3>Methods</h3><div>Biomechanical bending and torsional tests on 20 harvested pig spines compared the pull-out and twisting forces between the rib construct and pedicle screw. For the animal study, hyperkyphosis was induced in 6 immature pigs and subsequently corrected using the rib construct; radiographic and histological evaluations assessed the correction outcomes. Retrospective clinical data on 14 patients (8 male, 6 female) treated with the rib construct for severe nonidiopathic spinal deformity were studied including diagnosis, age at index surgery, length of follow-up, T-score bone density, complication rates, procedure time, operative blood loss, and radiographic outcomes.</div></div><div><h3>Results</h3><div>Biomechanical testing studies demonstrated that the rib construct was less prone to proximal fixation failure and less stiff compared to pedicle screws. Animal model studies demonstrated improvement in spinal alignment in hyperkyphotic pigs instrumented with the rib construct. Finally, clinical study outcomes demonstrated excellent deformity correction with the rib construct and a reduction in serious complications compared to other techniques.</div></div><div><h3>Conclusions</h3><div>The rib construct effectively corrects spinal deformity through growth modulation while supporting spinal growth and pulmonary development. It substantially reduces the incidence of severe complications commonly associated with EOSD treatments and is particularly beneficial in cases involving hyperkyphosis and/or osteoporosis.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100776"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932146","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":"Implementation of artificial intelligence (AI) in ASD treatment1","authors":"Kyriakos D. Chatzis BS,&nbsp;Peter Tretiakov BS,&nbsp;Peter G. Passias MD","doi":"10.1016/j.xnsj.2025.100787","DOIUrl":"10.1016/j.xnsj.2025.100787","url":null,"abstract":"<div><h3>Background</h3><div>Adult spinal deformity (ASD) surgery remains one of the most complex and complication-prone areas of spine care, with significant variability in outcomes and high complication rates. Recent advances in artificial intelligence (AI) have shown to be promising tools to address these challenges by improving planning, prediction, and personalization. This narrative review explores the role of AI across the surgical workflow for ASD, from preoperative decision-making to intraoperative execution and postoperative care.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive narrative review of current literature and technologies related to AI in ASD surgery. Focus areas included evidence synthesis, predictive analytics, automated radiographic assessment, intraoperative navigation, patient-specific implants, and digital patient engagement. We also present a representative case example of AI-assisted deformity correction to illustrate practical clinical application.</div></div><div><h3>Results</h3><div>AI tools have demonstrated strong potential in improving accuracy and efficiency across various domains. Machine learning algorithms outperform traditional statistical models in predicting complications, length of stay, and functional outcomes. Automated radiographic platforms reliably reproduce spinal alignment measurements and support surgical planning. Personalized instrumentation has been associated with improved alignment fidelity. Lastly, Intraoperative AR/VR platforms and AI-enhanced robotics are helping to standardize execution and reduce variability.</div></div><div><h3>Conclusions</h3><div>AI is redefining the landscape of ASD surgery through its ability to enhance decision-making, reduce variability, and enable personalized, data-driven care. While widespread adoption requires ongoing validation and integration, current evidence supports the clinical utility of AI-assisted strategies in improving alignment outcomes and surgical safety. This review highlights the growing potential of AI to serve as a cornerstone of precision spine surgery.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100787"},"PeriodicalIF":2.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325761","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":"Identifying patients at risk for a facility discharge following elective one or two level lumbar fusion","authors":"Matthew J. Solomito PhD ,&nbsp;Heeren Makanji MD ,&nbsp;Jesse Eisler MD","doi":"10.1016/j.xnsj.2025.100786","DOIUrl":"10.1016/j.xnsj.2025.100786","url":null,"abstract":"<div><h3>Background</h3><div>Spine procedures are becoming increasingly common and costly in the United States, thus managing fiscal responsibility with surgical outcomes is increasingly important. Reducing facility discharges following a lumbar fusion would not only reduce complications but could provide significant cost savings. Therefore, the purpose of this study is to identify both clinical factors (i.e. demographics, medical history factors) and patient reported outcome scores that were associated with an increased risk of a facility-based discharge following an elective 1 or 2 level lumbar fusion.</div></div><div><h3>Methods</h3><div>A total of 513 patients that underwent a 1- or 2-level lumbar fusion between June 2021 and June 2023 were included in this retrospective study. All patients completed their preoperative PROs and completed their medical history and physical prior to surgery. Using logistic regressions, independent variables associated with postoperative discharge to a skilled nursing facility were identified. Subsequent receiver operator curve analysis helped determine cut point values associated with a facility discharge.</div></div><div><h3>Results</h3><div>A total of 41 patients (7.9%) were discharged to a facility. Regression analysis identified 6 factors associated with a facility discharge. Three factors were related to clinical outcomes while the other 3 factors were obtained from patient reported outcomes measures. More specifically, PROMIS-10 Global physical (OR:0.17,95% CI 0.04–0.62, AUC:0.701) and mental health (OR:0.89,95% CI 0.83–0.95, AUC:0.813) T-scores below 40, and RAPT scores below 9 (OR:0.60,95% CI 0.48–0.74, AUC:0.814) were associated with facility-based discharges.</div></div><div><h3>Conclusions</h3><div>Patient reported outcomes measures provide significant discriminatory ability in combination with standard clinical metrics to identify patients at risk for a facility discharge following elective lumbar fusions. The results suggested that patient reported information concerning preoperative mobility, mental wellbeing, and support at home were more discriminatory than clinical metrics.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100786"},"PeriodicalIF":2.5,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145097249","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 impact of metabolic syndrome on one-year patient-reported outcomes after lumbar fusion surgery","authors":"Jack Parker BS,&nbsp;Jane C. Brennan MS,&nbsp;Andrea H. Johnson MSN, CRNP,&nbsp;Chad M. Patton MD, MS,&nbsp;Justin J. Turcotte PhD, MBA","doi":"10.1016/j.xnsj.2025.100785","DOIUrl":"10.1016/j.xnsj.2025.100785","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence of Metabolic Syndrome (MetS) is increasing and negatively impacts a variety of surgeries. In lumbar fusions, MetS is associated with an increased risk of complications, however no studies have focused on patient-reported outcome measures (PROMs). The aim of this study was to explore the relationship between MetS and 1-year PROMs in lumbar fusion patients using the Patient-Reported Outcomes Measurement Information System (PROMIS).</div></div><div><h3>Methods</h3><div>Retrospective review of 212 patients who underwent 1- to 3-level lumbar fusion for degenerative pathologies between March 2021 and December 2023 from a single institution was performed. Patients were categorized based on the presence of MetS, defined as having 3 or more qualifying metabolic conditions, and assessed using PROMIS surveys (Physical Function [PF], Mental Health, and Pain Interference) preoperatively and at 1-year postoperatively. Univariate and multivariate analyses were performed to evaluate the impact of MetS on PROMIS improvement.</div></div><div><h3>Results</h3><div>Patients with MetS (<em>n</em>=64, 30.2%) had a longer length of stay, were more likely to be discharged to a skilled nursing facility, and experienced higher rates of 1-year complications (37.5vs. 20.9%, p=.016). After risk-adjustment, MetS patients had lower odds of achieving clinically significant improvement in PROMIS-PF (OR: 0.46, p=.020). In obese patients, the presence of MetS was associated with less improvement (β: -3.22, p=.049) and lower odds of clinically significant improvement in PROMIS-PF (OR: 0.34, p=.017). No significant associations between MetS and mental health or pain interference scores were observed in the overall population or obese patients.</div></div><div><h3>Conclusions</h3><div>MetS negatively impacts outcomes following lumbar fusion, and this difference in outcomes is not solely explained by obesity. Patients should be encouraged to modify their lifestyle to reduce the adverse effects of MetS on outcomes, and surgeons should consider the impact of MetS on outcomes following lumbar fusion and communicate these expectations with patients.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100785"},"PeriodicalIF":2.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145097248","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":"Identifying preoperative radiographic metrics to guide surgical selection in lumbar spondylolisthesis and stenosis","authors":"John A. Hipp PhD ,&nbsp;Bradford L. Currier MD ,&nbsp;Trevor F. Grieco PhD ,&nbsp;Job L.C. Van Susante MD","doi":"10.1016/j.xnsj.2025.100784","DOIUrl":"10.1016/j.xnsj.2025.100784","url":null,"abstract":"<div><h3>Background Context</h3><div>“Instability” often drives the decision to add fusion to decompression, yet most instability criteria lean solely on sagittal translation and have never been rigorously validated. The potential of a metric for sagittal plane translation to help decide whether fusion should be added to decompression surgery for symptomatic lumbar stenosis with spondylolisthesis was recently reported. Building on imaging and outcomes from that study, we investigated whether other motion metrics may help to predict postoperative disability and patient‐reported outcomes in lumbar stenosis with spondylolisthesis.</div></div><div><h3>Methods</h3><div>Radiographic metrics were retrospectively calculated from the prospectively collected flexion-extension radiographs of 61 patients with lumbar spinal stenosis and spondylolisthesis. A threshold-limit graphical approach was used to identify metrics and thresholds predictive of the Oswestry Disability Index, leg/buttock pain, and patient satisfaction. Outcomes were compared across groups defined by these threshold levels using statistical analysis.</div></div><div><h3>Results</h3><div>Decompression-only surgery was associated with poorer outcomes in patients exhibiting vertical instability or significant spondylolisthesis changes between flexion and extension. Conversely, decompression-plus-fusion surgery yielded worse outcomes in cases without substantial dynamic spondylolisthesis.</div></div><div><h3>Conclusions</h3><div>A broader definition of spinal instability may be needed when deciding whether to include fusion in treating lumbar stenosis with spondylolisthesis. Preoperative vertical instability and dynamic slip may be important in addition to translational instability. Larger prospective studies are warranted, but these metrics could help guide the decision on whether fusion is necessary and likely to improve outcomes for a common spinal disorder.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100784"},"PeriodicalIF":2.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110031","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":"Ligamentum flavum: changes in vascular density, physical and histopathobiochemical properties in lumbar spine based on anatomical localization, spinal segment levels, and presence of lumbar spinal stenosis","authors":"Jakub Jezek MD, PhD ,&nbsp;Josef Sepitka MS, PhD ,&nbsp;Petr Kujal MD, PhD ,&nbsp;Petr Waldauf MD, PhD ,&nbsp;Jan Svec MD ,&nbsp;Vojtech Cerny MS ,&nbsp;Filip Samal MD, PhD ,&nbsp;Jiri Skala-Rosenbaum MD, PhD","doi":"10.1016/j.xnsj.2025.100782","DOIUrl":"10.1016/j.xnsj.2025.100782","url":null,"abstract":"<div><h3>Background</h3><div>Hypertrophy of the ligamentum flavum (LF) contributes significantly to the development of lumbar spinal stenosis (LSS), a serious and often disabling disease predominantly affecting the aging population. Histologic changes in the ligament and the tissue mediators that drive these alterations have been described, but their spatial distribution within the ligament remains unclear. Understanding these changes may enable future interventions to slow ligament degeneration and disease progression. To date, no study has comprehensively described the distribution of pathological changes within individual ligaments.</div></div><div><h3>Methods</h3><div>This study combined histopathobiochemical analysis and micromechanical mapping of healthy and degenerated human LF specimens obtained perioperatively from 57 patients undergoing lumbar spine surgery (38 with LSS and 19 controls). Ligament samples were analyzed histologically for vascular density, presence of inflammatory infiltrates, and chondroid metaplasia using morphometric software and immunohistochemical staining. Mechanical properties, including stiffness (Young’s modulus) and contact pressure, were measured via nanoindentation using the Hysitron BioSoft In-Situ Indenter system. Samples were spatially mapped across 9 anatomical zones of the LF to investigate regional variation. Statistical analyses compared these parameters between spinal segments (L3/4, L4/5, L5/S1), between LSS and control groups, and evaluated age-related trends.</div></div><div><h3>Results</h3><div>The central region of the LF exhibited significantly higher vascularity and stiffness compared to peripheral regions. Areas showing chondroid metaplasia and inflammation demonstrated increased vascularization, characteristic of LSS pathology. Although vascular density and mechanical stiffness were elevated in LSS patients versus controls, these differences did not reach statistical significance. Age-related trends differed between groups: stiffness increased with age in controls but decreased in LSS patients.</div></div><div><h3>Conclusions</h3><div>The greatest changes in vascularization and stiffness occur in the central region of ligamentum flavum. Understanding these localized alterations may support future development of targeted therapies to slow or prevent disease progression.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100782"},"PeriodicalIF":2.5,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046901","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":"Comparative analysis of acute postoperative pain and opioid use between lateral transpsoas, anterior, and transforaminal lumbar interbody fusions","authors":"Ekrem M. Ayhan BS ,&nbsp;Thomas Giannasca BS ,&nbsp;Jake Laverdiere BS ,&nbsp;Laura Sanzari MS ,&nbsp;Gina Panek BS ,&nbsp;Aris Yannopoulos MD","doi":"10.1016/j.xnsj.2025.100781","DOIUrl":"10.1016/j.xnsj.2025.100781","url":null,"abstract":"<div><h3>Background</h3><div>The lateral transpsoas lumbar interbody fusion is associated with transient postoperative anterior thigh and inguinal dysesthesias and hip flexor weakness from manipulation of the psoas and interposed lumbar plexus. However, it remains unclear whether this translates to higher pain scores and opioid requirements.</div></div><div><h3>Methods</h3><div>Patients who had undergone one- or two-level extreme/direct (XLIF/DLIF), anterior (ALIF), or transforaminal lumbar interbody fusion (TLIF) between January 2018 and December 2023 for degenerative spinal pathology were included. All cases were further classified as standalone or pedicle screw-fixated, and pedicle screw-fixated was included as a covariate. Outcomes were assessed using multivariable linear or binary logistic regression and included length of stay (LOS), inpatient daily maximum pain scores, inpatient morphine-equivalent daily dosage, and total inpatient morphine milligram equivalents, 30- and 90-day complications, emergency department visits, return to operating room, and readmission, and 90-day and 1-year Oswestry Disability Index (ODI) and EuroQuol-5 Dimension (EQ5D).</div></div><div><h3>Results</h3><div>A total of 936 patients were assessed, including 90 (9.6%) XLIF/DLIFs, 587 (62.7%) TLIFs, and 259 (27.6%) ALIFs. Pedicle screw fixation differed significantly between approaches (TLIF: 100%, ALIF: 51.0%, XLIF/DLIF: 51.1%; p&lt;.001). The XLIF/DLIF approach had the shortest operative time compared to ALIF and TLIF (p&lt;.003). Furthermore, XLIF/DLIF approach was associated with lower 90-day ODI than TLIF (<em>β</em>=–21.185; p=.002) and ALIF (<em>β</em>=–9.275; p=.043), higher 90-day EQ5D than TLIF (<em>β</em>=+27.389; p&lt;.001) and ALIF (<em>β</em>=+13.897; p=.001), higher morphine-equivalent daily dosage than TLIF (<em>β</em>=+29.115; p&lt;.001) and ALIF (<em>β</em>=+11.959; p=.006), and shorter LOS than TLIF (<em>β</em>=–45.500 hours; p=.014) and ALIF (<em>β</em>=–24.447 hours; p=.049). No significant differences were observed in maximum pain scores, total inpatient morphine milligram equivalents, complications, readmissions, or return to operating room.</div></div><div><h3>Conclusions</h3><div>Despite a shorter operative time, shorter LOS, and better 90-day ODI and EQ5D, the lateral transpsoas lumbar interbody fusion is associated with higher postoperative inpatient opioid consumption than TLIF and ALIF.</div></div><div><h3>Level of Evidence</h3><div>III</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100781"},"PeriodicalIF":2.5,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908613","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":"Corrigendum to ``P72. Change of spinal cord alignment within one week after cervical laminoplasty'' [North American Spine Society Journal (NASSJ) 18S (2024) 100476]","authors":"Tatsuya Shibata MD ,&nbsp;Yoshikuni Kida MD, PhD ,&nbsp;Jun Tanaka MD, PhD ,&nbsp;Hideki Ota MD ,&nbsp;Yohei Iguchi MD ,&nbsp;Teruaki Shiokawa MD ,&nbsp;Kyoichi Sanada MD ,&nbsp;Shusuke Hagihara MD ,&nbsp;Sota Sasaki MD ,&nbsp;Akitaka Yoshimura MD ,&nbsp;Takuaki Yamamoto MD, PhD","doi":"10.1016/j.xnsj.2025.100772","DOIUrl":"10.1016/j.xnsj.2025.100772","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100772"},"PeriodicalIF":2.5,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779434","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 kiva system versus balloon kyphoplasty for vertebral compression fracture: a meta-analysis of randomized control trials","authors":"Humaid Al Farii MD,&nbsp;Nikhil Gattu MD,&nbsp;Caleb M. Yeung MD,&nbsp;Christopher A. Alvarez-Breckenridge MD,&nbsp;Robert Y. North MD,&nbsp;Claudio E. Tatsui MD,&nbsp;Laurence D. Rhines MD,&nbsp;Valerae O. Lewis MD,&nbsp;Justin E. Bird,&nbsp;Shalin S. Patel","doi":"10.1016/j.xnsj.2025.100778","DOIUrl":"10.1016/j.xnsj.2025.100778","url":null,"abstract":"<div><h3>Background</h3><div>Vertebral compression fractures (VCFs) are the most common type of vertebral body fracture. The Kiva VCF Treatment System is a relatively novel technique to manage VCFs. The aim of this study was to compare the efficacy of Kiva versus standard Balloon Kyphoplasty (BK) through evaluation of published randomized controlled trials (RCTs).</div></div><div><h3>Methods</h3><div>This study was performed following the guidelines for PRISMA. We performed a systematic literature search using PubMed and MEDLINE in June 2023. The search keywords were “Kiva” and “Kyphoplasty” which yielded a total of 112 articles. Outcome measures included pain, measured through the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), and cement leakage rates.</div></div><div><h3>Results</h3><div>Three RCTs were included in this meta-analysis. A total of 468 patients (Kiva=232 patients and BK=236 patients) and 694 fractures (351 treated with Kiva and 343 treated with BK) were included after fulfilling the inclusion criteria. The VAS score in both the Kiva and BK group improved significantly. There was no difference in VAS improvement between the 2 groups (p-value=.84). Of the 694 fractures that were treated procedurally, the Kiva system had significantly less cement leakage than BK (95% CI [-0.89, -0.22], p-value=.00). However, and collectively out of those who had cement leakage, there was only 2 patients (2.1%) developed adverse events of acute paraplegia required reoperation.</div></div><div><h3>Conclusions</h3><div>This meta-analysis demonstrates that the Kiva system and balloon kyphoplasty are both strong treatment options for the purpose of reducing pain associated with VCFs, whether osteoporotic or metastatic in etiology. However, Kiva system was favorable over balloon kyphoplasty in terms of rates of cement leakage.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100778"},"PeriodicalIF":2.5,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046902","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 future of intraoperative neuromonitoring (IONM) in spinal surgery1","authors":"W. Bryan Wilent PhD, DABNM ,&nbsp;Marcia-Ruth Ndege BS, CNIM ,&nbsp;Adam Doan DC, DABNM","doi":"10.1016/j.xnsj.2025.100777","DOIUrl":"10.1016/j.xnsj.2025.100777","url":null,"abstract":"<div><h3>Preface</h3><div>On behalf of the NASS section on intraoperative neuromonitoring (IONM), we present a narrative perspective exploring the future of IONM in spine surgery in the US, drawing on current evidence and future projections.</div></div><div><h3>Present state</h3><div>IONM is used during hundreds of thousands of spinal procedures each year to enhance patient safety via real-time neurodiagnostic feedback. The most common service model is an in-room technologist and a remote supervising professional who interprets the neurophysiological data. The primary goal of IONM is to: (1) detect significant signal changes from baseline, (2) identify the cause—whether technical, positional, anesthetic, or iatrogenic, and (3) pinpoint the site of injury. This diagnostic process is time-sensitive, complex, and dependent on both the signal pattern change and patient and procedural factors that are dynamically variable.</div></div><div><h3>Future: integrating and advancing technology</h3><div>Artificial intelligence (AI) and machine learning (ML) hold promise to enhance the accuracy in detecting and interpreting signal changes for IONM clinicians and be integrated into surgeon-directed software platforms. However, widespread AI/ML adoption depends on the availability of large, validated IONM datasets—currently hindered by practice variation, inconsistent perioperative documentation, and unharmonized IONM, anesthetic, surgical, and patient medical records.</div></div><div><h3>Future: maturation in Profession</h3><div>IONM can improve in the consistency in which optimal IONM is delivered, how IONM is utilized with evidence-based planning for alerts, and the collection of harmonized and complete signal and clinical records. Most publications have focused on the diagnostic accuracy of IONM in predicting deficits, but more emphasis is needed on demonstrating the therapeutic impact of interventions to alerts and their role in preventing new deficits.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100777"},"PeriodicalIF":2.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221066","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}