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"Yoon Ha"

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Clinical Study – Cervical Spine

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Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
Neurospine. 2025;22(4):937-948.   Published online December 31, 2025
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Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
Neurospine. 2025;22(4):937-948.   Published online December 31, 2025
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Objective
To evaluate the clinical significance of a negative K-line in the neck flexion position (FK-line [-]), which indicates that cervical ossification of the posterior longitudinal ligament (OPLL) crosses the K-line during flexion, and to compare surgical outcomes between laminoplasty (LP) and laminectomy with fusion (LF) for multilevel FK-line (-) cervical OPLL.
Methods
A total of 349 patients with multiple cervical OPLL who underwent posterior decompression surgery (LP or LF) with a minimum of 2 years of follow-up were stratified by FK-line status. Clinical and radiological parameters were compared between the FK-line (+) and FK-line (-) groups. Subgroup analysis of FK-line (-) patients evaluated the efficacy of LP versus LF. Multivariate regression identified predictors of neurological recovery.
Results
Patients with FK-line (-) OPLL exhibited a smaller FK-line distance, more kyphotic alignment, greater cervical flexion, and lower recovery ratios compared to those with FK-line (+). In the FK-line (-) subgroup, LF achieved a significantly greater increase in FK-line distance, better correction of the flexion angle, and more neurological recovery than LP. Multivariate analyses identified postoperative FK-line distance, C2–7 flexion angle, and preoperative dynamic extension reserve as independent predictors of neurological outcomes.
Conclusion
FK-line status reflects the sagittal cord position and predicts surgical outcomes in cervical OPLL. In FK-line (-) patients, LF provides better neurological recovery and more effective posterior cord shift and kyphotic alignment correction than LP. Incorporating FK-line assessment to guide surgical planning could improve individualized treatment outcomes for multilevel OPLL.

Citations

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  • A Commentary on “Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion”
    John H. Chi
    Neurospine.2025; 22(4): 951.     CrossRef
  • A Commentary on “Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion”
    Yutaro Kanda
    Neurospine.2025; 22(4): 949.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the December 2025 Issue
    Inbo Han
    Neurospine.2025; 22(4): 877.     CrossRef
  • 1,158 View
  • 69 Download
  • 3 Web of Science
  • 3 Crossref

Cervical Spine

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The Role of K-Line and Canal-Occupying Ratio in Surgical Outcomes for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Multicenter Study
Neurospine. 2025;22(2):337-348.   Published online June 30, 2025
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The Role of K-Line and Canal-Occupying Ratio in Surgical Outcomes for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Multicenter Study
Neurospine. 2025;22(2):337-348.   Published online June 30, 2025
Close
Objective
To evaluate the impact of the K-line and canal-occupying ratio (COR) on surgical outcomes in patients with multilevel cervical ossification of the posterior longitudinal ligament (OPLL).
Methods
Patients with cervical myelopathy due to multilevel OPLL who underwent decompression surgery (anterior or posterior) from 2013 to 2022, with 2-year minimum follow-up, were enrolled. Radiological evaluations included K-line, COR, OPLL type/level, and cervical parameters (C2 slope [C2S], T1 slope [T1S], K-line tilt). Clinical outcomes included Japanese Orthopaedic Association (JOA) score and neck-pain visual analogue scale. Patients were categorized by K-line status (+/-) and COR (<50% or ≥50%).
Results
Among 575 patients, JOA recovery was significantly better in the K-line (+) and in low COR (<50%). In high COR (≥50%), K-line (-) was associated with poorer recovery. In low COR, outcomes were similar regardless of K-line. Anterior decompression with fusion (ADF) yielded the best outcomes. Laminoplasty (LP) was optimal for COR ≥50% and/or K-line (+), while laminectomy with fusion (LF) was better for COR ≥50% and K-line (-). In high COR, K-line was influenced by cervical alignment, C2S, and T1S, while in low COR, it was mainly affected by COR percentage.
Conclusion
Combining K-line and COR is essential for surgical planning in multilevel OPLL. When COR is high, K-line plays a significant role in predicting neurological recovery. ADF led to superior recovery, whereas for patients with K-line (-) and high COR, LF offered better results than LP. Cervical parameters at high COR influence the K-line more.

Citations

Citations to this article as recorded by  Crossref logo
  • Evaluating the demographics and complications of North American surgical patients with ossification of the posterior longitudinal ligament
    Aaron Phung, Justin Hyde, Justin Azmoodeh, Theodore Quan, Lancelot Benn, Christopher P. Bellaire, Oliver Tannous, Joseph Ferguson, Seyed B Kalantar, David Weiner, Andrew Mo, Fred Mo, Sean Bae, Ala Alshomali, Crisanto L. Macaraeg, Kevin Yoon, Jonathan P. J
    Journal of Clinical Neuroscience.2026; 144: 111790.     CrossRef
  • Radiological assessment in cervical spine myelopathy
    Shanmuganathan Rajasekaran, Gnanaprakash Gurusamy, Pushpa Bhari Thippeswamy, Karthik Ramachandran, Stefano Conti
    Journal of Clinical Orthopaedics and Trauma.2026; 72: 103301.     CrossRef
  • C2-Involving Cervical Ossification of the Posterior Longitudinal Ligament (OPLL): Dome-like Laminoplasty Versus Laminectomy With Fusion
    Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Joongkyum Shin, Yoon Ha
    Global Spine Journal.2026;[Epub]     CrossRef
  • Dynamic K-Line Status and Surgical Outcomes in Multilevel Cervical OPLL: A Multicenter Comparative Study
    Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Chang Kyu Lee, Keung Nyun Kim, Tae Woo Kim, Yoon Ha
    Journal of Clinical Medicine.2026; 15(2): 520.     CrossRef
  • A comparative study on surgical management of long-course symptomatic cervical OPLL between anterior en bloc resection and posterior laminectomy with instrumented fusion
    Kefu Chen, Yiwei Lu, Shu Liu, Lianshun Jia, Xingcheng Dong, Tianwen Ye
    BMC Musculoskeletal Disorders.2026;[Epub]     CrossRef
  • Reduction of Spinal Cord Cross-Sectional Area Is Associated With Myelopathy in Severe Cervical Ossification of the Posterior Longitudinal Ligaments
    Hyun-Jun Jang, Dong-Kyu Kim, Bong-Ju Moon, Kyung-Hyun Kim, Jeong-Yoon Park, Sung-Uk Kuh, Keun-Su Kim, Yong-Eun Cho, Dong-Kyu Chin
    Neurosurgery.2026;[Epub]     CrossRef
  • Spinal cord extracellular matrix hydrogel enhances organoid maturation and functional regeneration after spinal cord injury
    Junghoon Kim, Songzi Zhang, Joon-Hyuk Jung, Mi-Jeong Lee, Inbo Han, Seung-Woo Cho
    Materials Today Bio.2026; : 103168.     CrossRef
  • Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
    Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho, Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Joongkyum Shin, Yoon Ha
    Neurospine.2025; 22(4): 937.     CrossRef
  • 8,365 View
  • 239 Download
  • 8 Web of Science
  • 8 Crossref

Deformity

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Application of Transverse Process Hooks at Distal Thoracic Vertebrae in Uppermost Vertebral Instrumentation for Adult Spinal Deformity Surgery: Special Focus on Delayed-Onset Neurologic Deficits
Neurospine. 2024;21(4):1219-1229.   Published online December 31, 2024
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Application of Transverse Process Hooks at Distal Thoracic Vertebrae in Uppermost Vertebral Instrumentation for Adult Spinal Deformity Surgery: Special Focus on Delayed-Onset Neurologic Deficits
Neurospine. 2024;21(4):1219-1229.   Published online December 31, 2024
Close
Objective
We aimed to investigate the incidence of delayed-onset neurological deficits (DONDs), DOND-related reoperation rates following adult spinal deformity (ASD) surgery, and efficacy of transverse process hooks (TPHs) at the uppermost instrumented vertebra (UIV) compared to pedicle screws (PSs).
Methods
We included 90 consecutive patients who underwent instrumented fusion from the sacrum to the distal thoracic spine for ASD, with a minimum follow-up of 24 months. Clinical and radiological outcomes were compared between 33 patients in the TPH group and 57 patients in the PS group, using the Scoliosis Research Society-22 Outcomes questionnaire (SRS-22), Medical Outcomes Study Questionnaire Short-Form 36 (SF-36), and various spinal sagittal parameters.
Results
While absent in the TPH group, myelopathy occurred in 15.8% of the PS group, wherein 15 patients underwent reoperation. The change in the proximal junctional angle, from the pre- to postoperative assessment, was lower in the TPH group than in the PS group (0.2 vs. 6.6, p=0.002). Postoperative facet degeneration in the PS group progressed more significantly than in the TPH group (0.5 vs. 0.1, p=0.002). Surgical outcomes were comparable for both groups, except for the back visual analogue scale (3.5 vs. 4.1, p=0.010) and SRS-22 domains, including pain and satisfaction (3.3 vs. 2.9, p=0.033; 3.7 vs. 3.3, p=0.041). No intergroup difference was observed in SF-36.
Conclusion
Using TPHs at the UIV level can prevent DOND, and thereby prevent postoperative myelopathy that necessitates reoperation; thus, TPHs is preferable over PSs in ASD surgery.

Citations

Citations to this article as recorded by  Crossref logo
  • Clinical and radiological outcomes of transverse process hooks versus pedicle screws at the upper instrumented vertebra in adult spinal deformity patients undergoing three-column osteotomy: A retrospective comparative study
    Mohsen Rostami, Sadegh Bagherzadeh, Navid Moghadam, Faramarz Roohollahi, Cesar Carballo Cuello, Jay Kumar, Mark Greenberg, Puya Alikhani
    Clinical Neurology and Neurosurgery.2026; 261: 109263.     CrossRef
  • Comparison of Hook Fixation and Vertebroplasty for Prevention of Proximal Junctional Failure: A Retrospective Cohort Study
    Sung Tan Cho, Jae Hwan Cho, Dong-Ho Lee, Chang Ju Hwang, Sehan Park, Jin Hwan Kim, Wongthawat Liawrungrueang
    Global Spine Journal.2026;[Epub]     CrossRef
  • Prevalence and Risk Factors for Postoperative Neurological Complications in Spinal Deformity Surgery: A Systematic Review and Proportional Meta-Analysis
    Yam Wa Man, Jedidiah Yui Shing Lui, Chor Yin Lam, Jason Pui Yin Cheung, Prudence Wing Hang Cheung
    Neurospine.2025; 22(1): 243.     CrossRef
  • 3,687 View
  • 126 Download
  • 3 Web of Science
  • 3 Crossref

Regular Issue

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The Clinical Outcomes of Cervical Spine Chordoma: A Nationwide Multicenter Retrospective Study
Neurospine. 2024;21(3):942-953.   Published online September 30, 2024
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The Clinical Outcomes of Cervical Spine Chordoma: A Nationwide Multicenter Retrospective Study
Neurospine. 2024;21(3):942-953.   Published online September 30, 2024
Close
Objective
Chordoma, a rare malignant tumor originating from embryonal notochord remnants, exhibits high resistance to conventional treatments, making surgical resection imperative. However, the factors influencing prognosis specifically for cervical spine chordoma have not been clearly identified. We investigate the prognosis of cervical spine chordoma with factors influential in a nationwide multicenter retrospective study.
Methods
This study included all patients diagnosed with cervical spine chordoma at 7 tertiary referral centers from January 1998 to March 2023, excluding those with clivus and thoracic spine chordomas extending into the cervical spine. Local recurrence (LR) was identified through follow-up magnetic resonance imaging, either as reappearance in completely resected tumors or regrowth in residual tumors. The study assessed LR and overall survival, analyzing factors influencing LR and death.
Results
Forty-five patients with cervical spine chordoma had a mean age of 46.4 years. Over a median follow-up of 52 months, LR and distant metastasis were observed in 21 (46.7%) and 4 patients (8.9%), respectively, and 16 patients (36%) were confirmed dead. The 5-year and 10-year cumulative LR rates were 51.3% and 60%, respectively, while the 5-year and 10-year survival rates were 82% and 53%. Age was the only significant factor affecting mortality (hazard ratio, 1.04; 95% confidence interval, 1.04–1.07; p=0.015). Notably, the degree of resection and adjuvant therapy did not statistically significantly impact local tumor control and mortality.
Conclusion
This study, the largest multicenter retrospective analysis of cervical spine chordoma in Korea, identified age as the only factor significantly affecting patient survival.

Citations

Citations to this article as recorded by  Crossref logo
  • Cervical Vertebral Body Implant Modification Accommodating Vertebral Artery Aneurysm Clips: A Case Report
    Robert Rothrock, Vitaly Siomin, Rupesh Kotecha, Starlie C Belnap, Michael McDermott
    Cureus.2026;[Epub]     CrossRef
  • SURGICAL MANAGEMENT OF ANTERIORLY LOCATED TUMORS AT THE CRANIOVERTEBRAL JUNCTION: ADVANCES AND CHALLENGES
    ANTONIO VINICIUS DA SILVA GONÇALVES DA ROCHA, MARIANA CHANTRE-JUSTINO, OCTAVIO AUGUSTO TOMÉ DA SILVA, DAVI SOÉJIMA CORREIA RAMALHO, ALDERICO GIRÃO CAMPOS DE BARROS, ULLYANOV TOSCANO, LUIS E. CARELLI
    Coluna/Columna.2025;[Epub]     CrossRef
  • Comparative Outcomes of Brachyury Vaccine vs. Imatinib in Advanced Chordoma: A Mayo Clinic Experience
    Juan P. Navarro-Garcia de Llano, Harshvardhan G. Iyer, Harry C. Hoffman, Mahesh Seetharam, Steven Attia, Oluwaseun O. Akinduro
    Cancers.2025; 17(21): 3493.     CrossRef
  • 10,827 View
  • 168 Download
  • 2 Web of Science
  • 3 Crossref

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Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy
Neurospine. 2024;21(2):443-454.   Published online June 30, 2024
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Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy
Neurospine. 2024;21(2):443-454.   Published online June 30, 2024
Close
Objective
The study compared the morphometric changes of the cervical spinal cord using dynamic magnetic resonance imaging (MRI) in patients with cervical spondylotic myelopathy (CSM) and assessed the correlation with kinematic changes, cord cross-sectional area (CSA), and high signal intensity (SI) on T2-weighted imaging (T2WI).
Methods
Patients with CSM were evaluated through dynamic MRI for sagittal and axial CSA changes of the cervical cord, cerebrospinal fluid (CSF) reserve ratio, degree of cord impingement, cord compression rate, range of motion (ROM), and severity of SI on T2WI. The degree of cord impingement was evaluated using the Muhle grading system. Clinical outcomes were assessed using Japanese Orthopaedic Association scoring and Nurick grade.
Results
The study included 191 patients (113 males) with a mean age of 55.34 ± 12.09 years. The lowest sagittal CSF reserve ratio and cord occupation rate were observed during extension. Cord impingement and SI change were more prevalent in extension-positioned MRI. There was no difference between ROM on dynamic radiographs and dynamic MRI. Preoperative cervical ROM was greater in patients with intensely high SI change.
Conclusion
Dynamic MRI is useful for evaluating neck movement. Patients with high SI had greater ROM before surgery but worse outcomes after. Neck extension exacerbated cervical stenosis and cord compression compared to flexion, and cervical spinal motion contributed to the severity of CSM. Cervical spinal motion should be carefully evaluated, particularly in hyperextension, to prevent worsening of CSM.

Citations

Citations to this article as recorded by  Crossref logo
  • Dynamic K-Line Status and Surgical Outcomes in Multilevel Cervical OPLL: A Multicenter Comparative Study
    Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Chang Kyu Lee, Keung Nyun Kim, Tae Woo Kim, Yoon Ha
    Journal of Clinical Medicine.2026; 15(2): 520.     CrossRef
  • Dynamic Cervical Myelopathy Misleading on Neutral Imaging: The Role of Flexion–Extension MRI
    Leonardo Anselmi, Donato Creatura, Mario De Robertis, Ali Baram, Emanuele Stucchi, Gabriele Capo, Jad El Choueiri, Federico Pessina, Maurizio Fornari, Carlo Brembilla
    Journal of Clinical Medicine.2026; 15(4): 1333.     CrossRef
  • Intramedullary Strain During Neck Extension is Associated with Microstructural Spinal Cord Injury in Degenerative Cervical Myelopathy
    Mahmudur Rahman, Karthik Banurekha Devaraj, Balaji Harinathan, Omkar Chauhan, Matthew Budde, Narayan Yoganandan, Aditya Vedantam
    Annals of Biomedical Engineering.2026;[Epub]     CrossRef
  • Predictive factors for outcomes of anterior-only surgery in multilevel pincer-type cervical spondylotic myelopathy: The role of the posterior compression score
    Lin Xie, Wenbo Wu, Kun Wang, Yu Song, Xianlin Zeng, Cao Yang, Xiaobo Feng
    Journal of Orthopaedics.2026; 75: 305.     CrossRef
  • The Role of Dynamic Cervical Magnetic Resonance Imaging in Determining the Level of Posterior Decompression in Cervical Spondylotic Myelopathy
    Luay Şerifoğlu, Abdulmutalip Karaaslanlı
    World Neurosurgery.2025; 195: 123698.     CrossRef
  • T2-weighted MRI high signal in cervical spondylotic myelopathy is associated with dynamic change
    Xiangzhen Kong, Zhenchuan Liu, Kangle Song, Keyu Pan, Yuanqiang Zhang, Jianlu Wei, Lei Cheng
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • X-ray Diagnostics of Degenerative Spinal Canal Stenosis at the Cervical Level (Literature Review)
    V. S. Petrova, P. V. Seliverstov, V. A. Sorokovikov, S. N. Larionov
    Radiology - Practice.2025; (2): 28.     CrossRef
  • Weight-bearing MRI of the cervical spine: A scoping review of clinical utility and emerging applications
    Jonathan Verderame, Muhammad Shakib Arslan, Farhan Mukhtar, Zaheer Abbas
    European Journal of Radiology Open.2025; 15: 100694.     CrossRef
  • Evaluation of Cases Diagnosed with Cervical Myelopathy or Syringomyelia Referred with a Preliminary Diagnosis of Amyotrophic Lateral Sclerosis
    Nimet Ucaroglu Can
    Online Türk Sağlık Bilimleri Dergisi.2025; 10(3): 239.     CrossRef
  • Posture-dependent assessment of whole-spine curvature with a rotatable cryogen-free 1.5T MRI and automated Cobb angle analysis
    Shiying Ke, Hengyuan Guo, Yulin Wang, Jichang Zhang, Pengfei Xu, Jianjun Zheng, Bin Chen, Chendie Yao, Thomas Meersmann, Chengbo Wang
    European Spine Journal.2025;[Epub]     CrossRef
  • Dynamic MRI in Degenerative Cervical Myelopathy: A Systematic Review of Radiological Markers, Correlations, and Outcomes
    Ali Baram, Jad El Choueiri, Carlo Brembilla, Francesca Pellicanò, Lorenzo De Rossi, Leonardo Di Cosmo, Mario De Robertis, Emanuele Stucchi, Donato Creatura, Gabriele Capo, Maurizio Fornari, Marco Riva, Letterio S. Politi, Federico Pessina
    Journal of Clinical Medicine.2025; 15(1): 265.     CrossRef
  • Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
    Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho, Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Joongkyum Shin, Yoon Ha
    Neurospine.2025; 22(4): 937.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the June 2024 Issue
    Inbo Han
    Neurospine.2024; 21(2): 373.     CrossRef
  • Commentary on “Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy”
    Aydin Sinan Apaydin, Khoi Than
    Neurospine.2024; 21(2): 455.     CrossRef
  • 14,700 View
  • 229 Download
  • 12 Web of Science
  • 14 Crossref

Special Issue on AI & Robotics

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A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Methods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques
Neurospine. 2024;21(1):83-94.   Published online March 31, 2024
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A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Methods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques
Neurospine. 2024;21(1):83-94.   Published online March 31, 2024
Close
Objective
This study aimed to compare the accuracy of robotic spine surgery and conventional pedicle screw fixation in lumbar degenerative disease. We evaluated clinical and radiological outcomes to demonstrate the noninferiority of robotic surgery.
Methods
This study employed propensity score matching and included 3 groups: robot-assisted mini-open posterior lumbar interbody fusion (PLIF) (robotic surgery, RS), c-arm guided minimally invasive surgery transforaminal lumbar interbody fusion (C-arm guidance, CG), and freehand open PLIF (free of guidance, FG) (54 patients each). The mean follow-up period was 2.2 years. The preoperative spine condition was considered. Accuracy was evaluated using the Gertzbein-Robbins scale (GRS score) and Babu classification (Babu score). Radiological outcomes included adjacent segmental disease (ASD) and mechanical failure. Clinical outcomes were assessed based on the visual analogue scale, Oswestry Disability Index, 36-item Short Form health survey, and clinical ASD rate.
Results
Accuracy was higher in the RS group (p < 0.01) than in other groups. The GRS score was lower in the CG group, whereas the Babu score was lower in the FG group compared with the RS group. No significant differences were observed in radiological and clinical outcomes among the 3 groups. Regression analysis identified preoperative facet degeneration, GRS and Babu scores as significant variables for radiological and clinical ASD. Mechanical failure was influenced by the GRS score and patients’ age.
Conclusion
This study showed the superior accuracy of robotic spine surgery compared with conventional techniques. When combined with minimally invasive surgery, robotic surgery is advantageous with reduced ligament and muscle damage associated with traditional open procedures.

Citations

Citations to this article as recorded by  Crossref logo
  • Biomechanical stability and pedicle screw loosening
    Chenxi Cui, Haisheng Yang
    Journal of Biomechanics.2026; 197: 113174.     CrossRef
  • L-Point Entry, Juxtapedicular, and Endplate-Parallel Trajectory (L-JET) Screw Fixation: A Novel Technique in Thoracic Spinal Tumor Surgery
    Seunghoon Lee, Young Rak Kim, Chang-Hyun Lee, Jungbo Sim, Woojin Kim, Ho Sung Myeong, Hangeul Park, Jun-Hoe Kim, Chi Heon Kim
    Journal of Minimally Invasive Spine Surgery and Technique.2026; 11(1): 6.     CrossRef
  • Biomechanical Impact of Cement Augmentation on Pedicle Screw Fixation and Adjacent Segment Disease in Multilevel Lumbar Fusion: A Finite Element Analysis
    Min-Young Jo, Sung-Jae Lee, Je-Hoon An, Young-Hoon Kim, Jun-Seok Lee, Hyung-Youl Park
    Neurospine.2025; 22(3): 763.     CrossRef
  • Robot-Assisted Pedicle Screw Insertion in Pediatric Spine Surgery: An Institutional Experience and Meta-Analysis
    Taha Khalilullah, Abdul Karim Ghaith, Xinlan Yang, Linda Tang, Shaan Bhandarkar, Meghana Bhimreddy, Arjun D. Menta, Daniel Davidar, Andrew Hersh, Carly Weber-Levine, Kelly Jiang, Patrick Kramer, Ritvik Jillala, Maria Jennings, Jawad M. Khalifeh, Tej D. Az
    Operative Neurosurgery.2025;[Epub]     CrossRef
  • From the Editor-in-Chief: Featured Articles in the March 2024 Issue
    Inbo Han
    Neurospine.2024; 21(1): 1.     CrossRef
  • Commentary on “A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Methods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques”
    Jacob Yoong-Leong Oh
    Neurospine.2024; 21(1): 95.     CrossRef
  • 8,916 View
  • 170 Download
  • 5 Web of Science
  • 6 Crossref

Bone Biology and Osteoporosis Special Issue

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The Combined Effects of RhBMP-2 and Systemic RANKL Inhibitor in Patients With Bone Density Loss Undergoing Posterior Lumbar Interbody Fusion: A Retrospective Observational Analysis With Propensity Score Matching
Neurospine. 2023;20(4):1186-1192.   Published online December 31, 2023
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The Combined Effects of RhBMP-2 and Systemic RANKL Inhibitor in Patients With Bone Density Loss Undergoing Posterior Lumbar Interbody Fusion: A Retrospective Observational Analysis With Propensity Score Matching
Neurospine. 2023;20(4):1186-1192.   Published online December 31, 2023
Close
Objective
The risks of nonunion and subsidence are high in patients with bone density loss undergoing spinal fusion surgery. The internal application of recombinant human bone morphogenic protein 2 (rhBMP-2) in an interbody cage improves spinal fusion; however, related complications have been reported. Denosumab, a human monoclonal antibody targeting the receptor activator of nuclear factor kappa B ligand (RANKL), hinders osteoblast differentiation and function. Therefore, this study aimed to observe the combined effect of the local application of rhBMP-2 in a lumbar cage and systemic RANKL inhibition on postoperative spinal fusion in patients with bone density loss undergoing posterior lumbar interbody fusion (PLIF).
Methods
This retrospective observational study included 251 consecutive patients with spinal stenosis who underwent PLIF at a single center between 2017 and 2021. Clinical outcomes were assessed, and radiographic evaluations included lumbar flexion, extension, range of motion, and subsidence. Statistical analyses were conducted to identify the combined effect of the treatment and the subsidence and spinal fusion status.
Results
One hundred patients were included in the final analysis. Denosumab treatment significantly reduced the rate of osteolysis (p = 0.013). When denosumab was administered in combination with rhBMP-2, the fusion status remained similar; however, the incidences of postoperative osteolysis and postoperative oozing day decreased.
Conclusion
The combined use of rhBMP-2 and RANKL inhibition in patients with bone density loss can enhance bone formation after PLIF with fewer complications than rhBMP-2 alone.

Citations

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  • Postoperative bone loss after posterior lumbar interbody fusion is a risk factor of cage subsidence independently of preoperative CT-derived attenuation: a retrospective study based on hounsfield unit
    Yunsheng Wang, Ruiling Wang, Tong Tong, Dechao Miao, Feng Wang, Linfeng Wang
    BMC Musculoskeletal Disorders.2026;[Epub]     CrossRef
  • Histomorphologic Assessment of Osteoregeneration in a Rabbit Femur Model With Xenograft, Bone Morphogenetic Protein-2, Platelet-Rich Plasma, and Denosumab
    Berik Tuleubayev, Yevgeniy Kamyshanskiy, Yerkin-Dauir Kurmangaliyev, Amina Koshanova, Ivan Avromidi, Yekaterina Kossilova, Daryn Darybayev
    Plastic and Reconstructive Surgery - Global Open.2026; 14(4): e7593.     CrossRef
  • Comparison of Hounsfield Unit, Vertebral Bone Quality, and Dual-Energy X-Ray Absorptiometry T-Score for Predicting Cage Subsidence After Posterior Lumbar Interbody Fusion
    Yunsheng Wang, Jiali Zhang, Tong Tong, Dechao Miao, Feng Wang, Linfeng Wang
    Global Spine Journal.2025; 15(4): 2226.     CrossRef
  • Antiosteoporosis medication in patients with posterior spine fusion: a systematic review and meta-analysis
    HyungSub Jin, HyungJu Jin, Kyung-Soo Suk, Byung Ho Lee, Si Young Park, Hak-Sun Kim, Seong-Hwan Moon, Sub-Ri Park, Namhoo Kim, Jae Won Shin, Ji-Won Kwon
    The Spine Journal.2025; 25(9): 1877.     CrossRef
  • Impact of Frailty and Other Factors as Estimated by HU to Predict Response to Anabolic Bone Medications
    Abdelrahman M. Hamouda, Zach Pennington, Rahul Kumar, Michael L. Martini, Derrick Obiri-Yeboah, Maria Astudillo Potes, Nicholas Kendall, Anthony L. Mikula, Michelle J. Clarke, William E. Krauss, Ahmad N. Nassr, Brett A. Freedman, Arjun S. Sebastian, Melvi
    Journal of Clinical Medicine.2025; 14(9): 3247.     CrossRef
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    V.S. Kuznetsova, V.A. Sinelnikova, A.V. Vasilyev
    Stomatology.2025; 104(3): 101.     CrossRef
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    Jun Ho Lee, Ji Hyun Youn, Hyun Jung Park, Seung-Jae Hyun
    Journal of Korean Neurosurgical Society.2025; 68(6): 632.     CrossRef
  • Promotion of Bone Formation in a Rat Osteoporotic Vertebral Body Defect Model via Suppression of Osteoclastogenesis by Ectopic Embryonic Calvaria Derived Mesenchymal Stem Cells
    Yerin Yu, Somin Lee, Minsung Bock, Seong Bae An, Hae Eun Shin, Jong Seop Rim, Jun-oh Kwon, Kwang-Sook Park, Inbo Han
    International Journal of Molecular Sciences.2024; 25(15): 8174.     CrossRef
  • The Canal Bone Ratio
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    Spine.2024; 49(22): 1570.     CrossRef
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Three-Dimensional Quantitative Assessment of Pedicle Screw Accuracy in Clinical Utilization of a New Robotic System in Spine Surgery: A Multicenter Study
Neurospine. 2023;20(3):1028-1039.   Published online September 30, 2023
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Three-Dimensional Quantitative Assessment of Pedicle Screw Accuracy in Clinical Utilization of a New Robotic System in Spine Surgery: A Multicenter Study
Neurospine. 2023;20(3):1028-1039.   Published online September 30, 2023
Close
Objective
The objective of this study was to evaluate the accuracy of pedicle screw placement in patients undergoing percutaneous pedicle screw fixation with robotic guidance, using a newly developed 3-dimensional quantitative measurement system. The study also aimed to assess the clinical feasibility of the robotic system in the field of spinal surgery.
Methods
A total of 113 patients underwent pedicle screw insertion using the CUVIS-spine pedicle screw guide system (CUREXO Inc.). Intraoperative O-arm images were obtained, and screw insertion pathways were planned accordingly. Image registration was performed using paired-point registration and iterative closest point methods. The accuracy of the robotic-guided pedicle screw insertion was assessed using 3-dimensional offset calculation and the Gertzbein-Robbins system (GRS).
Results
A total of 448 screws were inserted in the 113 patients. The image registration success rate was 95.16%. The average error of entry offset was 2.86 mm, target offset was 2.48 mm, depth offset was 1.99 mm, and angular offset was 3.07°. According to the GRS grading system, 88.39% of the screws were classified as grade A, 9.60% as grade B, 1.56% as grade C, 0.22% as grade D, and 0.22% as grade E. Clinically acceptable screws (GRS grade A or B) accounted for 97.54% of the total, with no reported neurologic complications.
Conclusion
Our study demonstrated that pedicle screw insertion using the novel robot-assisted navigation method is both accurate and safe. Further prospective studies are necessary to explore the potential benefits of this robot-assisted technique in comparison to conventional approaches.

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  • Evaluation of pedicle screw accuracy and deviation from preoperative planning in intraoperative Cone-Beam Computed Tomography-Navigated lumbar spinal fusion: a prospective study
    Gianluca Vadalà, Giuseppe Francesco Papalia, Niccolò Nardi, Fabrizio Russo, Luca Ambrosio, Girolamo Maltese, Rocco Papalia, Vincenzo Denaro
    Brain and Spine.2026; 6: 105988.     CrossRef
  • Combining Engineering Precision with Clinical Relevance: A Novel Dual Framework for Assessing Pedicle Screw Accuracy in Spine Surgery
    Arnaud Delafontaine, Olivier Cartiaux, Bernard G. Francq, Virginie Cordemans
    Journal of Clinical Medicine.2026; 15(6): 2328.     CrossRef
  • Robotic Spine Surgery: Systematic Review of Common Error Types and Best Practices
    Diwas Gautam, Sheela Vivekanandan, Marcus D. Mazur
    Operative Neurosurgery.2025; 28(3): 295.     CrossRef
  • Advancements in robotic-assisted spine surgery: A literature review and technology comparison
    Jonathan Hammond, Stefano Priola
    Interdisciplinary Neurosurgery.2025; 40: 102056.     CrossRef
  • Robotic-Guided Spine Surgery: Implementation of a System in Routine Clinical Practice—An Update
    Mirza Pojskić, Miriam Bopp, Omar Alwakaa, Christopher Nimsky, Benjamin Saß
    Journal of Clinical Medicine.2025; 14(13): 4463.     CrossRef
  • Evaluating accuracy in robotic-assisted thoracolumbar pedicle screw placement: Insights from a single-center study of 410 patients
    Abhishek Soni, Vidyadhara Srinivasa, Akhil Xavier Joseph, Balamurugan Thirugnanam, Alia Vidyadhara
    Journal of Craniovertebral Junction and Spine.2025; 16(4): 408.     CrossRef
  • Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
    Jun Seok Lee, Dong Wuk Son, Su Hun Lee, Jong Hyeok Lee, Young Ha Kim, Sang Weon Lee, Bu Kwang Oh, Soon Ki Sung, Geun Sung Song, Seong Yi
    Neurospine.2024; 21(1): 116.     CrossRef
  • Artificial Intelligence (AI)-Robotics Started When Human Capability Reached Limit, Human Creativity Begin Again When the Capability of AI-Robotics Reaches a Plateau
    Seong Yi
    Neurospine.2024; 21(1): 3.     CrossRef
  • Navigation-Guided/Robot-Assisted Spinal Surgery: A Review Article
    Young-Seok Lee, Dae-Chul Cho, Kyoung-Tae Kim
    Neurospine.2024; 21(1): 8.     CrossRef
  • Fully automated determination of robotic pedicle screw accuracy and precision utilizing computer vision algorithms
    Benjamin N. Groisser, Ankush Thakur, Howard J. Hillstrom, Akshitha Adhiyaman, Colson Zucker, Jerry Du, Matthew Cunningham, M. Timothy Hresko, Ram Haddas, John Blanco, Hollis G. Potter, Douglas N. Mintz, Ryan E. Breighner, Jessica H. Heyer, Roger F. Widman
    Journal of Robotic Surgery.2024;[Epub]     CrossRef
  • 9,664 View
  • 228 Download
  • 12 Web of Science
  • 10 Crossref

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Commentary on “Cervical Inclination Angle: Normative Values in an Adult Multiethnic Asymptomatic Population”
Neurospine. 2023;20(1):410-411.   Published online March 31, 2023
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Commentary on “Cervical Inclination Angle: Normative Values in an Adult Multiethnic Asymptomatic Population”
Neurospine. 2023;20(1):410-411.   Published online March 31, 2023
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  • 4,163 View
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Predicting Mechanical Complications After Adult Spinal Deformity Operation Using a Machine Learning Based on Modified Global Alignment and Proportion Scoring With Body Mass Index and Bone Mineral Density
Neurospine. 2023;20(1):265-274.   Published online March 31, 2023
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Predicting Mechanical Complications After Adult Spinal Deformity Operation Using a Machine Learning Based on Modified Global Alignment and Proportion Scoring With Body Mass Index and Bone Mineral Density
Neurospine. 2023;20(1):265-274.   Published online March 31, 2023
Close
Objective
This study aimed to create an ideal machine learning model to predict mechanical complications in adult spinal deformity (ASD) surgery based on GAPB (modified global alignment and proportion scoring with body mass index and bone mineral density) factors.
Methods
Between January 2009 and December 2018, 238 consecutive patients with ASD, who received at least 4-level fusions and were followed-up for ≥ 2 years, were included in the study. The data were stratified into training (n = 167, 70%) and test (n = 71, 30%) sets and input to machine learning algorithms, including logistic regression, random forest gradient boosting system, and deep neural network.
Results
Body mass index, bone mineral density, the relative pelvic version score, the relative lumbar lordosis score, and the relative sagittal alignment score of the global alignment and proportion score were significantly different in the training and test sets (p < 0.05) between the complication and no complication groups. In the training set, the area under receiver operating characteristics (AUROCs) for logistic regression, gradient boosting, random forest, and deep neural network were 0.871 (0.817–0.925), 0.942 (0.911–0.974), 1.000 (1.000–1.000), and 0.947 (0.915–0.980), respectively, and the accuracies were 0.784 (0.722–0.847), 0.868 (0.817–0.920), 1.000 (1.000–1.000), and 0.856 (0.803–0.909), respectively. In the test set, the AUROCs were 0.785 (0.678–0.893), 0.808 (0.702–0.914), 0.810 (0.710–0.910), and 0.730 (0.610–0.850), respectively, and the accuracies were 0.732 (0.629–0.835), 0.718 (0.614–0.823), 0.732 (0.629–0.835), and 0.620 (0.507–0.733), respectively. The random forest achieved the best predictive performance on the training and test dataset.
Conclusion
This study created a comprehensive model to predict mechanical complications after ASD surgery. The best prediction accuracy was 73.2% for predicting mechanical complications after ASD surgery.

Citations

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  • Determining the risk factors for postoperative mechanical complication in degenerative scoliosis: a machine learning approach based on musculoskeletal metrics
    Jie Li, Zhen Tian, Yinyu Fang, Zhong He, Yanjie Xu, Hui Xu, Zezhang Zhu, Yong Qiu, Zhen Liu
    European Spine Journal.2026; 35(1): 156.     CrossRef
  • Development and validation of a deep learning–powered system for multi-version global alignment and proportion score to predict mechanical complications after adult degenerative scoliosis surgery
    Qifeng Lan, Shanshan Liu, Cheng Zhang, Chenyi Guo, Yiming Shi, Jian He, Xingyu Zhou, Jiaheng Shang, Qiang Qi, Zhaoqing Guo, Zhuoran Sun, Siyu Zhou, Ji Wu, Nanfang Xu, Weishi Li
    European Spine Journal.2026; 35(2): 375.     CrossRef
  • Predicting postoperative mechanical complications with the ethnicity-adjusted global alignment and proportion score in degenerative scoliosis: does paraspinal muscle degeneration matter?
    Peiyu Li, Jie Li, Abdukahar Kiram, Zhen Tian, Xing Sun, Xiaodong Qin, Benlong Shi, Yong Qiu, Zhen Liu, Zezhang Zhu
    The Spine Journal.2025; 25(2): 347.     CrossRef
  • Uso de inteligencia artificial para predecir complicaciones en cirugías de columna toracolumbar degenerativa: revisión sistemática
    G. Ricciardi, J.I. Cirillo Totera, R. Pons Belmonte, L. Romero Valverde, F. López Muñoz, A. Manríquez Díaz
    Revista Española de Cirugía Ortopédica y Traumatología.2025; 69(5): 446.     CrossRef
  • Risk Factors of 90-Day Unplanned Readmission After Lumbar Spine Surgery for Degenerative Lumbar Disk Disease: A Systematic Review and Meta-Analysis
    Jeong In Seol, Jeong Hoon Yoo, Hyeon Gyu Sung, Hyun Ho Park, Sung Hyeon Noh
    Neurosurgery.2025; 97(4): 908.     CrossRef
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    Mohsin Khan, Kaustubh Ahuja, Athanasios I Tsirikos
    Bone & Joint Open.2025; 6(5): 569.     CrossRef
  • Novel risk factors and personalized risk calculator for predicting proximal junctional kyphosis after adult spinal deformity surgery
    Qijun Wang, Zheng Wang, Dongfan Wang, Xuan Zhao, Xiaolong Chen, Shibao Lu
    The Bone & Joint Journal.2025; 107-B(8): 829.     CrossRef
  • [Translated article] Use of artificial intelligence to predict complications in degenerative thoracolumbar spine surgery: A systematic review
    G. Ricciardi, J.I. Cirillo Totera, R. Pons Belmonte, L. Romero Valverde, F. López Muñoz, A. Manríquez Díaz
    Revista Española de Cirugía Ortopédica y Traumatología.2025; 69(5): T446.     CrossRef
  • Applications of Artificial Intelligence in the Diagnosis and Treatment of Pediatric Congenital malformations: Recent Advances
    鑫 王
    Advances in Clinical Medicine.2025; 15(09): 91.     CrossRef
  • The predictive value of the global alignment and proportion (GAP) score for mechanical complications following adult spinal deformity surgery: A systematic review and meta-analysis
    Vinicius Ricieri Ferraz, Guilherme Santos Piedade, Carlos R. Goulart, Maria Fernanda Ricieri Ferraz Franco de Souza, Marcelo Ochoa Coelho de Souza Furlan, Philippe A. Mercier, Tobias A. Mattei
    North American Spine Society Journal (NASSJ).2025; 24: 100816.     CrossRef
  • Predicting proximal junctional failure in adult spinal deformity patients using machine learning models based on spinal alignment parameters
    Akihiko Hiyama, Daisuke Sakai, Hiroyuki Katoh, Masato Sato, Masahiko Watanabe
    Scientific Reports.2025;[Epub]     CrossRef
  • Evaluating Computer Vision, Large Language, and Genome-Wide Association Models in a Limited Sized Patient Cohort for Pre-Operative Risk Stratification in Adult Spinal Deformity Surgery
    Ethan Schonfeld, Aaradhya Pant, Aaryan Shah, Sina Sadeghzadeh, Dhiraj Pangal, Adrian Rodrigues, Kelly Yoo, Neelan Marianayagam, Ghani Haider, Anand Veeravagu
    Journal of Clinical Medicine.2024; 13(3): 656.     CrossRef
  • Lower Hounsfield Units at the Planned Lowest Instrumented Vertebra Is an Independent Risk Factor for Complications Following Adult Cervical Deformity Surgery
    Tyler K. Williamson, Ezekial J. Koslosky, Jordan Lebovic, Stephane Owusu-Sarpong, Peter Tretiakov, Jamshaid Mir, Pooja Dave, Andrew J. Schoenfeld, Bassel G. Diebo, Heiko Koller, Renaud Lafage, Virginie Lafage, Peter G. Passias
    Clinical Spine Surgery.2024; 37(10): E503.     CrossRef
  • Commentary on “Performance of a Large Language Model in the Generation of Clinical Guidelines for Antibiotic Prophylaxis in Spine Surgery”
    Sun-Ho Lee
    Neurospine.2024; 21(1): 147.     CrossRef
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    Sung Hyun Noh, Gaeun Lee, Hyun-Jin Bae, Ju Yeon Han, Su Jeong Son, Deok Kim, Jeong Yeon Park, Seung Kyeong Choi, Pyung Goo Cho, Sang Hyun Kim, Woon Tak Yuh, Su Hun Lee, Bumsoo Park, Kwang-Ryeol Kim, Kyoung-Tae Kim, Yoon Ha
    Bioengineering.2024; 11(5): 481.     CrossRef
  • Research of Global Tilt and Functional Independence: Insights into Spinal Health of Older Women
    Yu-Chieh Chiu, Ping-Chiao Tsai, Ssu-Hsien Lee, Wen-Tien Wu, Tzai-Chiu Yu, Ru-Ping Lee, Ing-Ho Chen, Jen-Hung Wang, Kuang-Ting Yeh
    Bioengineering.2024; 11(5): 493.     CrossRef
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    Woon Tak Yuh, Jinhee Kim, Mi-Sook Kim, Jun-Hoe Kim, Young Rak Kim, Sum Kim, Chun Kee Chung, Chang-Hyun Lee, Sung Bae Park, Kyoung-Tae Kim, John M. Rhee, Young San Ko, Chi Heon Kim, Kentaro Yamada
    PLOS ONE.2024; 19(6): e0305128.     CrossRef
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    Nader Toossi, Ozhan Jerry
    Artificial Intelligence Surgery.2024; 4(3): 258.     CrossRef
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    Wenbin Jiang, Huagang Shi, Tao Gu, Zonglin Cai, Qinglong Li
    SLAS Technology.2024; 29(6): 100222.     CrossRef
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    Rongpeng Dong, Xueliang Cheng, Mingyang Kang, Yang Qu
    BMC Medical Informatics and Decision Making.2024;[Epub]     CrossRef
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    Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee
    Neurospine.2024; 21(4): 1080.     CrossRef
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    Emily S. Mills, Kevin Mertz, Ethan Faye, Jennifer A. Bell, Andy T. Ton, Jeffrey C. Wang, Ram K. Alluri, Raymond J. Hah
    Neurospine.2023; 20(2): 662.     CrossRef
  • Proximal Junctional Failure in Adult Spinal Deformity Surgery: An In-depth Review
    Mitsuru Yagi, Kento Yamanouchi, Naruhito Fujita, Haruki Funao, Shigeto Ebata
    Neurospine.2023; 20(3): 876.     CrossRef
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    Byung-Jou Lee, Sung Soo Bae, Ho Young Choi, Jin Hoon Park, Seung-Jae Hyun, Dae Jean Jo, Yongjae Cho
    Neurospine.2023; 20(3): 863.     CrossRef
  • Development and Validation of an Online Calculator to Predict Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery Using Machine Learning
    Chang-Hyun Lee, Dae-Jean Jo, Jae Keun Oh, Seung-Jae Hyun, Jin Hoon Park, Kyung Hyun Kim, Jun Seok Bae, Bong Ju Moon, Chang-Kyu Lee, Myoung Hoon Shin, Hyun Jun Jang, Moon-Soo Han, Chi Heon Kim, Chun Kee Chung, Seung-Myung Moon
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  • Commentary on “Development and Validation of an Online Calculator to Predict Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery Using Machine Learning”
    In Ho Han
    Neurospine.2023; 20(4): 1281.     CrossRef
  • 7,816 View
  • 251 Download
  • 25 Web of Science
  • 26 Crossref

Review Article

CSRS Special Issue

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Surgical Strategies and Perioperative Considerations for Cervical Deformity With Cerebral Palsy: A Comprehensive Review of the Literature
Neurospine. 2022;19(4):868-875.   Published online December 31, 2022
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Surgical Strategies and Perioperative Considerations for Cervical Deformity With Cerebral Palsy: A Comprehensive Review of the Literature
Neurospine. 2022;19(4):868-875.   Published online December 31, 2022
Close
The complex nature of the cervical spine makes surgical intervention challenging when treating cervical deformity in patients with cerebral palsy (CDCP). However, few studies have investigated the unique characteristics of cerebral palsy that create the need for surgery, the most effective surgical strategies, and the possible perioperative complications. The intended benefit and the potential risk of postoperative complications must be considered when deciding to operate for CDCP. Because the approach and correction strategy depend on the type of cervical deformity, as well as the patient’s comorbidities and functional status, a customized strategy is needed. Perioperatively, botulinum toxin injections and muscle division techniques can help control excessive involuntary movements and improve the spinal fusion success rate. Surgical intervention for CDCP requires a multidisciplinary approach, and the information presented in this article is intended to help in the perioperative management and surgical treatment of CDCP.

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  • Predictive Factors for Postoperative Outcomes of Cervical Spondylotic Myelopathy in Individuals With Cerebral Palsy
    Su Ji Lee, Jihye Hwang, Min Gyu Kang, Minjae Cho, Yoon Ha, Sung-Rae Cho
    Global Spine Journal.2026; 16(1): 75.     CrossRef
  • Management and treatment of musculoskeletal problems in adults with cerebral palsy: Experience gained from two lifespan clinics
    Mark Katsma, Haiqing Liu, Xiaoyu Pan, Kyle J. Ryan, David P. Roye, Henry G. Chambers, Rachel Byrne, Heakyung Kim, Raffi Najarian, Justin Ramsey, Sruthi Thomas
    Journal of Pediatric Rehabilitation Medicine.2024; 17(1): 19.     CrossRef
  • 6,610 View
  • 191 Download
  • 2 Web of Science
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Original Article

Regular Issue

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Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study
Neurospine. 2022;19(4):1013-1025.   Published online October 23, 2022
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Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study
Neurospine. 2022;19(4):1013-1025.   Published online October 23, 2022
Close
Objective
This multicenter study compared radiological parameters and clinical outcomes between surgical and nonsurgical management and investigated treatment characteristics associated with the successful management of unstable atlas fractures.
Methods
We retrospectively evaluated 53 consecutive patients with unstable atlas fracture who underwent halo-vest immobilization (HVI) or surgical fixation. Clinical outcomes were assessed using neck visual analogue scale and disability index. The radiological assessment included total lateral mass displacement (LMD) and the anterior atlantodental interval (AADI).
Results
Thirty-two patients underwent surgical fixation and 21 received HVI (mean follow-up, 24.9 months). In the surgical fixation, but not in the HVI, LMD, and AADI showed statistically significant improvements at the last follow-up. The osseous healing rate and time-to-healing were 100% and 14.3 weeks with surgical fixation, compared with 71.43% and 20.0 weeks with HVI, respectively. Patients treated with HVI showed poorer neck pain and neck disability outcomes than those who received surgical treatment. LMD showed an association with osseous healing outcomes in nonoperative management. Clinical outcomes and osseous healing showed no significant differences according to Dickman’s classification of transverse atlantal ligament injuries.
Conclusion
Surgical internal fixation had a higher fusion rate, shorter fracture healing time, more favorable clinical outcomes, and a more significant reduction in LMD and AADI compared to nonoperative management. The pitfalls of external immobilization are inadequate maintenance and a lower probability of reducing fractured lateral masses. Stabilization by surgical reduction with interconnected fixation proved to be a more practical management strategy than nonoperative treatment for unstable atlas fractures.

Citations

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  • Motion preserving C1 ring lateral mass screw fixation with transverse rod for isolated unstable Jefferson fracture of atlas vertebra: a multicentric study
    Nathan Beucler, Anis Choucha, Kaissar Farah, Mikael Meyer, Arnaud Dagain, Stéphane Fuentes
    European Spine Journal.2026; 35(2): 936.     CrossRef
  • Anatomical basis for a new method of atlas osteosynthesis in unstable C1 vertebra fractures
    V.N. Rashidov, I.Yu. Lisitskii, A.V. Lychagin, R.L. Kambiev, K.M. Kulakov, A.Yu. Zarov, A.L. Korkunov, V.G. Cherepanov, I.A. Vyazankin, E.Yu. Tselischeva
    Burdenko's Journal of Neurosurgery.2026; 90(2): 37.     CrossRef
  • Original surgical technique of unstable atlas fracture osteosynthesis: case series analysis
    I. Yu. Lisitsky, V. N. Rashidov, A. V. Lychagin, A. Yu. Zarov, A. L. Korkunov, V. G. Cherepanov, I. A. Vyazankin, E. Yu. Tselishcheva
    Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika).2025; 22(1): 53.     CrossRef
  • Perioperative outcomes and technical and patient-reported success of rigid occipitocervical fusions in adults: a systematic review and meta-analysis
    Alexander O. Aguirre, Mohamed A.R. Soliman, Isabelle G. Stockman, Gaitree R. Boojraj, Esteban Quiceno, Asham Khan, Kyungduk Rho, John Pollina, Jeffrey P. Mullin
    European Spine Journal.2025; 34(8): 3408.     CrossRef
  • More postoperative complications and revision surgery after occipitocervical fusion than after atlantoaxial fusion: a retrospective multicenter cohort study
    Koji Uotani, Angel Oscar Paz Flores, Masato Tanaka, Shashank J Ekade, Shinya Arataki, Tadashi Komatsubara, Yoshiaki Oda, Kensuke Shinohara, Toshifumi Ozaki
    Asian Spine Journal.2025; 19(3): 444.     CrossRef
  • Craniocervical traumatic ligamentous injuries – AO spine type B injuries – Anatomy, biomechanics and clinical perspectives
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Editorial

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Scientific Achievements of Our Era: “Making the Lame Walk”
Neurospine. 2022;19(1):246-248.   Published online March 31, 2022
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Scientific Achievements of Our Era: “Making the Lame Walk”
Neurospine. 2022;19(1):246-248.   Published online March 31, 2022
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  • Advancements in neuroregenerative and neuroprotective therapies for traumatic spinal cord injury
    Gregor Fischer, Linda Bättig, Martin N. Stienen, Armin Curt, Michael G. Fehlings, Nader Hejrati
    Frontiers in Neuroscience.2024;[Epub]     CrossRef
  • 5,052 View
  • 175 Download
  • 1 Web of Science
  • 1 Crossref

Original Articles

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Clinical, Radiographic, and Genetic Analyses in a Population-Based Cohort of Adult Spinal Deformity in the Older Population
Neurospine. 2021;18(3):608-617.   Published online September 30, 2021
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Clinical, Radiographic, and Genetic Analyses in a Population-Based Cohort of Adult Spinal Deformity in the Older Population
Neurospine. 2021;18(3):608-617.   Published online September 30, 2021
Close
Objective
This study aimed to identify the sagittal parameters associated with health-related quality of life and genetic variations that increase the risk of adult spinal deformity (ASD) onset in the older population.
Methods
We recruited 120 participants who had a sagittal vertical axis > 50 mm in a sagittal imbalance study. Sagittal radiographic parameters, cross-sectional area, and intramuscular fatty infiltration using the Goutallier classification in the paraspinal lumbar muscles were evaluated. Functional scales included the self-reported Oswestry Disability Index (ODI), 36-item Short Form Health Survey (SF-36), and visual analogue scales (VAS) for back and leg pain. We performed whole-exome sequencing and an exome-wide association study using the 100 control subjects and 63 individuals with severe phenotypes of sagittal imbalance.
Results
Pelvic incidence minus lumbar lordosis (PI–LL) mismatch was negatively associated with the SF-36 and positively correlated with ODI and VAS for back and leg pain. PI–LL was related to the quality and size of the paraspinal muscles, especially the multifidus muscle. We identified common individual variants that reached exome-wide significance using single-variant analysis. The most significant single-nucleotide polymorphism was rs78773460, situated in an exon of the SVIL gene (odds ratio, 9.61; p = 1.15 × 10-9).
Conclusion
Older age, higher body mass index, and a more significant PI–LL mismatch were associated with unfavorable results on functional scales. We found a genetic variation in the SVIL gene, which has been associated with the integrity of the cytoskeleton and the development of skeletal muscles, in severe ASD phenotypes. Our results help to elucidate the pathogenesis of ASD.

Citations

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    Global Spine Journal.2026; 16(2): 1165.     CrossRef
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Modified Global Alignment and Proportion Scoring With Body Mass Index and Bone Mineral Density Analysis in Global Alignment and Proportion Score of Each 3 Categories for Predicting Mechanical Complications After Adult Spinal Deformity Surgery
Neurospine. 2021;18(3):484-491.   Published online September 30, 2021
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Modified Global Alignment and Proportion Scoring With Body Mass Index and Bone Mineral Density Analysis in Global Alignment and Proportion Score of Each 3 Categories for Predicting Mechanical Complications After Adult Spinal Deformity Surgery
Neurospine. 2021;18(3):484-491.   Published online September 30, 2021
Close
Objective
This study aimed to analyze the prediction rate of the modified Global Alignment and Proportion (GAP) scoring system with body mass index and bone mineral density (GAPB) in each GAP of the 3 categories.
Methods
Between January 2009 and December 2016, 203 consecutive patients with adult spinal deformity (ASD) underwent corrective fusion of more than 4 levels and were followedup for more than 2 years. As a validation of the GAPB, the GAPB was divided into tertiles (Q1, Q2, Q3) for each section of the GAP score. Each patient’s GAP score and GAPB system complication rate were examined.
Results
Of the 203 patients, 89 patients (44%) developed mechanical complications after ASD surgery. A GAP score analysis of the patients found that 42 patients were proportioned, 85 patients were moderately disproportioned, and 76 patients were severely disproportioned. Mechanical complications occurred with increasing GAPB in the proportioned group, but were not statistically significant (p = 0.0534). However, mechanical complications occurred in a statistically significant manner in the moderately disproportioned and severely disproportioned groups as GAPB increased (p < 0.001).
Conclusion
The GAPB system showed improved predictability for mechanical complications after surgery for ASD in each category of the GAP score.

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