Spine Journal最新文献

{"title":"Re-evaluation of categorial outcomes using common clinically relevant improvement thresholds following bilateral L2 medial branch restorative neurostimulation versus sham.","authors":"Matthew Smuck, Dylan Lukes, Byron Schneider, David J Kennedy, Allen S Chen, Zachary L McCormick","doi":"10.1016/j.spinee.2025.12.002","DOIUrl":"10.1016/j.spinee.2025.12.002","url":null,"abstract":"<p><strong>Background context: </strong>When chronic low back pain (cLBP) persists after conservative management, there are limited treatment options. Increasingly, researchers and clinicians are defining distinct phenotypes within the cLBP population to develop and provide more targeted and effective interventions. One such phenotype involves people with mechanical low back pain and impaired motor control, identified by physical exam or MRI evidence of multifidus dysfunction. An implantable neurostimulation device that delivers an electrical stimulation to the L2 medial branch has been recently FDA-approved, with initially encouraging preliminary results. The pivotal trial demonstrated statistically-significant benefits over sham treatment in all secondary outcomes but not the primary outcome at the 120-day primary endpoint. However, recently published 1- and 5-year studies have shown better outcomes compared to optimal medical management.</p><p><strong>Purpose: </strong>It was our purpose to expand the comparison of clinical outcomes between this neurostimulation treatment and sham by re-evaluating the data from the aforementioned pivotal trial using common clinically-relevant thresholds of treatment success that were not included in the pivotal trial's uncommon composite definition of treatment success or in its analysis of secondary outcomes for Oswestry Disability Index (ODI) and EQ-5D that compared mean improvements instead of categorical responder rates.</p><p><strong>Study design/setting: </strong>Posthoc reanalysis of previously published data from a prospective, randomized, double-blind, multicenter sham-controlled clinical trial.</p><p><strong>Patient sample: </strong>From 26 centers, 204 participants age 46.53±9.38 years (range 22-71) and 53.9% (110/204) female were recruited with mechanical cLBP despite physical therapy and medical management, and a positive prone instability test on physical exam.</p><p><strong>Outcome measures: </strong>Participants completed several patient-reported outcomes at baseline and at the primary endpoint of 120 days following activation of the implanted stimulator or sham, including: visual analog scale, ODI, EQ-5D, and subject global impression of change.</p><p><strong>Methods: </strong>Using a complete-case analysis, we compared differences between the neurostimulation treatment group and the sham-control group. Demographics are expressed using descriptive statistics. Patient-reported outcomes are compared between groups with a categorical analysis, setting responder thresholds at commonly used benchmarks and established minimum clinically important change (MCIC) thresholds. Statistical significance is determined by a two-sided p-value from Fisher's exact test with significance set at p<.05. Potential conflicts of interest directly related to this manuscript include research funding to support MS (level e) and DL (level b). The sponsor funded the original sham-controlled trial and funded this reanalysi","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative weight loss is not beneficial in obese patients undergoing cervical or lumbar fusion-a national cohort study of 57,961 patients.","authors":"Muhammad Talal Ibrahim, James Caid Kirven, Diego Martinez Castaneda, Phillip Glivar, Venkat Kavuri, Varun Kumar Singh, Elizabeth Yu","doi":"10.1016/j.spinee.2025.12.008","DOIUrl":"10.1016/j.spinee.2025.12.008","url":null,"abstract":"<p><strong>Background context: </strong>Morbid obesity is a known risk factor for worse outcomes after spinal fusion. Preoperative weight loss (WL) is routinely advocated for obese spinal fusion candidates based on the assumption that postoperative risk in patients with lower body mass index (BMI), after recent WL, is equivalent to that in weight-stable patients. However, this assumption has not been directly tested in the literature.</p><p><strong>Purpose: </strong>To compare obese patients who lost ≥5% of body weight within 2 years prior to undergoing cervical or lumbar fusion with obese patients who maintained a stable weight prior to surgery.</p><p><strong>Design: </strong>Retrospective cohort study with propensity score matching.</p><p><strong>Patient sample: </strong>Epic Cosmos was used to identify obese patients (BMI 30-50 kg/m<sup>2</sup>) undergoing cervical or lumbar fusion between 2017 and 2023. Patients were divided into two cohorts: (1) WL: patients with 5% to 30% body WL within 2 years preoperatively, (2) no WL (NoWL): controls with stable weight. Patients with pathological WL were excluded.</p><p><strong>Outcome measures: </strong>At 90 days, length of stay, healthcare utilization (HCU), severe adverse events (SAEs), and minor adverse events (MAEs) were assessed. At the 2-year follow-up, surgical failure (SF) was assessed.</p><p><strong>Methods: </strong>Cohorts were matched on demographics, preweight-loss BMI, comorbidities, diagnoses, and operative factors using propensity score matching. Analyses for cervical and lumbar fusions were run independently. Multivariable linear or logistic regression was used to determine the odds ratio of outcomes, adjusting for age, sex, race, preweight-loss BMI, comorbidities, diagnoses, and operative factors. Sensitivity analysis was conducted by excluding myelopathic patients and additionally adjusting the regression models for BMI at surgery.</p><p><strong>Results: </strong>After matching, the cervical fusion groups consisted of 10,201 patients per cohort, with a mean age of 59.4 years, 52.6% females, and 75.3% white patients. The WL cohort had higher rates of HCU (11.5% vs. 8.8%), SAEs (10.7% vs. 9.0%), MAEs (14.0% vs. 10.9%), and SF (11.6% vs. 9.7%). The lumbar fusion groups consisted of 10,755 patients per cohort, with a mean age of 62.4 years, 56.1% female, and 77.7% white patients. The WL cohort also had higher rates of HCU (12.2% vs. 11.6%), SAEs (11.0% vs. 10.0%), MAEs (24.9% vs. 22.8%), and SF (13.8% vs. 12.9%). In multivariable regression analysis, the cervical fusion WL cohort had higher odds of HCU (adjusted odds ratio [aOR]: 1.28, p<.001), MAEs (aOR: 1.26, p<.001), and SF (aOR: 1.20, p<.001), as well as increased length of stay (adjusted beta-coefficient [aβ]: 0.53, p<.001) compared to cervical fusion NoWL cohort. Statistical significance was no longer observed after removing myelopathic patients. In the lumbar fusion cohorts, there were no statistical differences in the outcomes in","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting oxidative stress with amobarbital to prevent intervertebral disc degeneration: part II. Rabbit disc herniation model.","authors":"Venkateswaran Ganesh, Douglas C Fredericks, Mitchell C Coleman, Emily B Petersen, Youssef W Naguib, Jordon D Turner, Jaison Marks, James A Martin, Aliasger K Salem, Tae-Hong Lim, Dongrim Seol","doi":"10.1016/j.spinee.2025.12.003","DOIUrl":"10.1016/j.spinee.2025.12.003","url":null,"abstract":"<p><strong>Background: </strong>Evidence that oxidative stress contributes to the progression of post-traumatic intervertebral disc degeneration suggests targeting oxidant metabolism in disc cells as a strategy to mitigate degeneration in injured discs. We previously identified amobarbital, a drug that suppresses mitochondrial activity in a cell culture model with the chemical induction of oxidative stress, as a promising candidate for this purpose.</p><p><strong>Purpose: </strong>The objective of this study was to investigate the preventive effects of amobarbital on the progression of disc degeneration using a rabbit disc herniation model.</p><p><strong>Study design/setting: </strong>The effects of amobarbital on the prevention of disc degeneration were evaluated in both ex vivo and in vivo herniated discs.</p><p><strong>Methods: </strong>Spine motion segments or animals were randomly assigned for intact control, vehicle control (hydrogel only), and amobarbital. Disc herniation was initiated by puncturing the annulus fibrosus with a needle, and amobarbital was delivered to the nucleus pulposus (NP) in a Pluronic F-127/hyaluronic acid hydrogel. A modified histological classification was applied to evaluate for degenerative cellular and matrix changes in both the annulus fibrosus and NP. Additionally, immunohistochemical staining for apoptosis and oxidative stress response, and radiography for disc height index were examined in the ex vivo and in vivo models, respectively.</p><p><strong>Results: </strong>Amobarbital injection allowed uniform distribution in the whole NP and showed sustained release for 3 to 4 days. In an organ culture model, amobarbital treatment after a discal injury prohibited morphologic changes of notochordal cells, structural changes of extracellular matrix, endplate chondrocyte migration, and cell apoptosis compared with the vehicle control. Similarly, the preventive effects of amobarbital on disc degeneration were confirmed in an animal study, especially at 2 weeks, with maintained disc height.</p><p><strong>Conclusions: </strong>In summary, amobarbital injection loaded in F127/hyaluronic acid hydrogel reduced cellular and structural degenerative changes against herniated discal injuries. Therefore, amobarbital has great potential for treating degenerative disc degeneration.</p><p><strong>Clinical significance: </strong>Amobarbital encapsulated in hydrogel in this model allowed for effective local delivery into the NP and sustained release of amobarbital, which is promising for potential clinical application. Delivering amobarbital in NP cells may be a therapeutic option to retard intervertebral disc degeneration.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the association between insulin resistance and diffuse idiopathic skeletal hyperostosis: a cross-sectional observational study.","authors":"Yu Li, Kairo Wada, Kanichiro Wada, Takaaki Nakano, Gentaro Kumagai, Sho Kaneko, Kazushige Koyama, Sunao Tanaka, Yasuyuki Ishibashi","doi":"10.1016/j.spinee.2025.12.007","DOIUrl":"10.1016/j.spinee.2025.12.007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Diffuse idiopathic skeletal hyperostosis (DISH) is a disorder characterized by the calcification and ossification of ligaments and soft tissues, especially ossification of the anterior longitudinal ligament, resulting in the formation of \"bridging\" osteophytes extending over multiple contiguous segments. The precise etiology of DISH remains unclear; however, metabolic disorders such as diabetes mellitus and hyperlipidemia may be associated with its development. Insulin resistance (IR), a critical component of metabolic syndrome, not only contributes to the dysregulation of blood glucose homeostasis but also influences bone metabolism disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Considering the association between DISH and metabolic disturbances, we aimed to investigate the relationship between IR and DISH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cross-sectional, observational study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;This study was conducted using data from the XXX. After screening, a total of 522 patients (206 males, 316 females) were included in the study cohort (mean age: 62.04±10.68 years).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome measure was the prevalence of DISH, which was diagnosed using the modified Resnick's criteria based on prior studies. The secondary outcome measure was IR, which was quantified using the Homeostatic Model Assessment of IR (HOMA-IR), with the 75th percentile (1.52) used as the cut-off value.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Logistic regression and receiver operating curve analyses were performed between HOMA-IR and the visceral fat area to verify whether the 75th percentile of HOMA-IR could be used as a cut-off for defining IR. Subsequently, χ² tests and logistic regression analyses were conducted to evaluate the association between HOMA-IR and DISH. Covariates included waist circumference, blood pressure, lipid profiles, fasting glucose levels adjusted for International Diabetes Federation metabolic syndrome criteria, and age. The robustness of the study findings was assessed using log-transformed HOMA-IR and internal validation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 522 participants, 40 were diagnosed with DISH. Higher HOMA-IR (≥1.52, 75th percentile) strongly correlated with higher visceral fat area and significantly higher prevalence of DISH (15.1% vs. 5.1%; p&lt;.001). IR was significantly associated with DISH (odds ratio: 3.17; p=.000478). In adjusted models, the HOMA-IR effect was attenuated, whereas systolic blood pressure and waist circumference remained robustly associated. No significant relationship was found between the HOMA-IR and early-phase DISH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this sample, higher HOMA-IR was associated with DISH; however, the association attenuated after adjustment for metabolic syndrome components, suggesting that IR is consistent with shared pathways with central obesity and blood pressure rather than demonstrating an i","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is endoscopic spine surgery? an introduction to a special issue.","authors":"Charla R Fischer","doi":"10.1016/j.spinee.2025.12.009","DOIUrl":"10.1016/j.spinee.2025.12.009","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145758270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presidential address 2025.","authors":"D Scott Kreiner","doi":"10.1016/j.spinee.2025.12.001","DOIUrl":"10.1016/j.spinee.2025.12.001","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter to the Editor regarding “Tri-cortical pedicle screw fixation in the most cranial instrumented segment to prevent proximal junctional kyphosis”","authors":"Zhen Liu MD ,&nbsp;Ziyang Tang PhD ,&nbsp;Jie Li PhD ,&nbsp;Zongshan Hu MD ,&nbsp;Xiaodong Qin MD ,&nbsp;Benlong Shi MD ,&nbsp;Saihu Mao MD ,&nbsp;Yong Qiu MD ,&nbsp;Zezhang Zhu MD","doi":"10.1016/j.spinee.2025.09.001","DOIUrl":"10.1016/j.spinee.2025.09.001","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 1","pages":"Pages 217-218"},"PeriodicalIF":4.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding “Tri-cortical pedicle screw fixation in the most cranial instrumented segment to prevent proximal junctional kyphosis” by Liu et al","authors":"Joshua Mathew BS,&nbsp;Mitchell Ng MD,&nbsp;Jonathan Dalton MD,&nbsp;Yasmine Eichbaum BS,&nbsp;Yulia Lee BS,&nbsp;Alexander R. Vaccaro MD, PhD, MBA","doi":"10.1016/j.spinee.2025.08.339","DOIUrl":"10.1016/j.spinee.2025.08.339","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 1","pages":"Pages 215-216"},"PeriodicalIF":4.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Integrating a randomized controlled trial with a parallel observational cohort study in cervical spine surgery insights from the foraminotomy ACDF cost-effectiveness trial (FACET)” [Spine J 25 (2025) 2014–2025]","authors":"Nádia F. Simões de Souza MD ,&nbsp;Anne E.H. Broekema MD, PhD ,&nbsp;Remko Soer PhD ,&nbsp;Katalin Tamási PhD ,&nbsp;Antoinette D.I. van Asselt PhD ,&nbsp;Michiel F. Reneman PhD ,&nbsp;J. Marc C. van Dijk MD, PhD ,&nbsp;Jos M.A. Kuijlen MD, PhD ,&nbsp;FACET Investigator group","doi":"10.1016/j.spinee.2025.10.034","DOIUrl":"10.1016/j.spinee.2025.10.034","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 434-435"},"PeriodicalIF":4.7,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fulfillment of patient expectations after surgery for degenerative cervical myelopathy. A retrospective analysis of prospectively collected data from the multicenter Canadian Surgical Spine Registry (CSORN).","authors":"Julien Francisco Zaldivar-Jolissaint, Nathan Evaniew, Nicolas Dea, W Bradley Jacobs, Jérome Paquet, Jefferson R Wilson, Hamilton Hall, Supriya Singh, Michael H Weber, Andrew Nataraj, Najmedden Attabib, David W Cadotte, Y Raja Rampersaud, Philippe Phan, Sean D Christie, Charles G Fisher, Christopher Small, Alex Soroceanu, Christopher S Bailey, Kenneth Thomas, Neil Manson, Greg McIntosh, Zhi Wang, Jay Toor, R Andrew Glennie, Raphaële Charest-Morin","doi":"10.1016/j.spinee.2025.11.001","DOIUrl":"10.1016/j.spinee.2025.11.001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;While abundant literature supports the clinical benefits of surgery for degenerative cervical myelopathy (DCM), limited evidence exists regarding the extent to which patients' preoperative expectations are met postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study primarily aimed to report the fulfillment of preoperative expectations 12 months postsurgery. Secondary objectives included identifying predictors of expectation fulfillment and overall patient satisfaction following surgical intervention for DCM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;We conducted a multicenter analysis of spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN)-DCM prospective cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients who underwent surgical treatment for DCM between April 2015 and September 2022 were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Patients completed a preoperative 11-domain expectation questionnaire, quantifying their expected clinical changes in each domain. At 12 months postoperatively, patients reported the extent to which their preoperative expectations were met in each domain, as well as their overall satisfaction with surgical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Multivariable logistic regression models were employed to identify and validate variables associated with expectation fulfillment and satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 490 patients included, 49.2% had all their expectations met and 3.7% had none of their expectations met. The expectations that were most frequently met were prevention of neurological decline (87.5%) and maintaining of independence (86.7%). There were 83% of patients who were satisfied at 12 months. Multivariable logistic regression identified preoperative variables (not smoking, not using pain medication presurgery, having lower levels of depressive symptoms (PHQ-8)), surgical variables (anterior and posterior nonfusion approaches), the absence of peri‑operative adverse events and improvement in pain and Health-Related Quality of life scores at 12 months (NRS neck-pain, SF12 PCS and SF-12 MCS scores) as predictors of expectation fulfillment. Improvement in the mJOA score was not a predictor of expectation fulfillment. Having preoperative expectations met was a strong predictor of being satisfied with the surgery (p&lt;.01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The majority of patients undergoing surgery for degenerative cervical myelopathy (DCM) reported satisfaction with their outcomes, with nearly half experiencing complete fulfillment of their preoperative expectations. Importantly, we identified 9 independent predictors of expectation fulfillment, which in turn emerged as a strong determinant of overall patient satisfaction. These findings highlight the critical role of personalized preoperative counseling in optimizing surgical outcomes. By aligning patients' expectations with realistic goals","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}