Spine Surgery

Analysis of predictive factors for the efficacy of reinforced radiculoplasty in symptomatic sacral Tarlov cysts

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In a single-center retrospective cohort study (n=41) Jin Zhu et al. from the Beijing Jishuitan Hospital, published in Neurosurgical Review to assess clinical predictors of symptom improvement following reinforced radiculoplasty in patients with symptomatic sacral Tarlov cysts (TCs). Reinforced radiculoplasty significantly improves pain and numbness in sacral TC patients. Greater likelihood of pain-free status is associated with older age and lower preoperative VAS scores. No variables significantly predicted numbness relief 1).

Critical Review:

The study targets an underexplored treatment avenue—reinforced radiculoplasty—for symptomatic Tarlov cysts, an entity often managed conservatively due to unclear pathophysiology and outcome data. The authors utilize a small retrospective sample, limiting statistical power and generalizability. While binary logistic regression is appropriately applied, the absence of a control group and the reliance on telephone follow-ups raise concerns regarding recall bias and subjective assessment of outcomes. Furthermore, the study fails to delineate surgical technique variability or operator-dependence, critical factors in neurosurgical outcome studies. The lack of correlation with imaging changes and omission of bowel/bladder symptom stratification are notable limitations.

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AO Spine Knowledge Forum Deformity. Alignment Goals in Adult Spinal Deformity Surgery

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In a narrative review Pizones et al. from La Paz Univ. Hosp, Madrid; additional centers in San Antonio, San Diego, Toronto, Barcelona, Charlottesville, New York published in the Global Spine Journal to critically examine evolving strategies in sagittal alignment targets for adult spinal deformity surgery, shifting focus from generic HRQoL goals to preventing mechanical complications Traditional alignment metrics (PI‑LL, SVA, TK) are limited for personalized planning; compensatory strategies (pelvic retroversion, knee flexion) are essential; individualized, structure-shape–based alignment (e.g., GAP, Roussouly, T4‑L1‑Hip‑Axis) reduces mechanical failure risk, though reoperation rates remain high 1).

Critical Review

The narrative review offers a comprehensive appraisal of alignment paradigms, yet:

* Strengths: Integrates key classification systems; emphasizes pelvic and lower-extremity compensation; aligns recent evidence on shape-based vs. quality-of-life–based targets; timely discussion given recent advances (e.g., T4‑L1‑Hip‑Axis)

* Weaknesses: Lacks systematic methodology or quantitative synthesis; conclusions primarily descriptive; limited critical appraisal of conflicting literature; evidence grade unclear

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Failure to replace removed growth friendly implants results in deteriorating radiographic outcomes

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In a registry-based comparative cohort study (early onset scoliosis patients after implant removal) Matan S Malka et al. from the Morgan Stanley Children’s Hospital (Columbia Univ, New York). Arkansas Children’s Hospital; Shriners Philadelphia; Seattle Children’s Hosp. published in Spine Deformity Journal, to evaluate if re-implanting growth-friendly constructs within 12 months after implant removal (ROI) stabilizes deformity compared to observation-only. Early re-implantation (< 12 mo post-ROI) significantly reduces 2‑year coronal Cobb progression compared to no replacement 1).

Critical Review

– Strengths:

Multicenter registry with well-defined exposure groups.

Radiographic outcomes measured at a meaningful 2‑year follow-up.

Statistically robust with p-values: Cobb 81° vs 53° (p=0.003); progression ≥5°: 64% vs 30% (p=0.04)

– Limitations:

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The Causal Effects Between Circulating Inflammatory Proteins and Osteoarthritis: A Mendelian Randomization and Transcriptomic Analysis

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In a bidirectional two-sample Mendelian randomization and transcriptomic analysis Lin et al. from the Xiangya Hospital, Changsha published in the Journal of Pain Research  to investigate the causal relationship between circulating inflammatory proteins and osteoarthritis (OA) using Mendelian randomization and transcriptomic data. The study suggests causal roles for various inflammatory proteins in osteoarthritis pathogenesis. Certain proteins (e.g., interleukin-8, fractalkine) are associated with higher OA risk, while others (e.g., interleukin-10 receptor subunit alpha) correlate with lower risk. Additionally, OA itself may causally influence inflammatory protein levels, particularly in a joint-specific manner (hip vs knee). Six key OA-related inflammation-related genes (IRGs) were identified as potential biomarkers 2).

Critical Review:

This study leverages the strengths of two-sample Mendelian Randomization (MR) to address directionality in inflammation-OA associations, bolstered by transcriptomic analysis. However, several issues warrant scrutiny:

– Causality overreach: While MR reduces confounding, it still relies on assumptions (e.g., no pleiotropy), which are not exhaustively addressed here. The evidence remains “suggestive” rather than definitive.

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Surgical versus Non-Surgical Treatment of Thoracolumbar Burst Fractures in Neurologically Intact Patients: A Prospective International Multicentre Cohort Study

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In a Prospective multicentre cohort study Dvorak et al. from the University of British Columbia ( – Vancouver), Univ. Medical Center Utrecht, Malteser Waldrankenhaus St. Marien (Erlangen), Univ. of Washington (Seattle), etc. published in the Global Spine Journal to examine whether surgical vs non‑surgical treatment accelerates clinically meaningful improvement (MCID of 12.8 points ODI) in neurologically intact thoracolumbar burst fracture patients within 1 year. Similar median time to reach MCID in both groups (~25 days). Post‑hoc suggests surgery may achieve ‘minimal disability’ (ODI <20) faster (69 vs 82 days; P=0.057). Larger trials needed 2)

Critical Appraisal

  • Strengths: Prospective design, multicentre/international inclusion enhances generalizability; uses accepted ODI threshold.
  • Limitations: Not randomized—treatment selection bias possible; statistical power limited—non-significant trend (P=0.057) may be false negative; outcome centered on ODI improvement, lacking radiographic, complication, or cost analysis within this paper.

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Diagnostic and management concordance between chiropractors and neurosurgeons for patients with low back pain

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In a secondary analysis of RCT comparing diagnostic & management decisions Janny Mathieu et al. from:

  1. Université du Québec à Trois‑Rivières, Trois‑Rivières, QC, Canada
  2. CIUSSS‑MCQ, Trois‑Rivières, QC, Canada
  3. Division of Neurosurgery, Faculty of Medecine, Université de Montréal, Montréal, QC, Canada.
  4. Université de Sherbrooke, Longueuil, QC, Canada
  5. Balgrist University Hospital, Zurich, Switzerland
  6. University of Zurich Spine Centre, Zurich, Switzerland
  7. University of Toronto, Toronto, Canada

published in Scientific Reports to assess agreement in diagnosis and management between chiropractors and neurosurgeons for patients referred for Low back pain consultation. Diagnostic concordance was moderate (74.7%, κ = 0.51), management concordance strong (82%), suggesting chiropractors are competent for triage of non‑surgical low back pain, potentially easing surgical consult load 1)

Critical review:

– Strengths:

  1. Real‑world, clinically relevant sample (mean age ~60, N=101).
  2. Direct comparison with neurosurgeons using standardized categories.
  3. Good statistical rigour with κ, CI, p‑values reported.

– Limitations:

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Paraspinal Intramuscular Hemangioma at L5-S1 With Concurrent Disc Herniation

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In a case report Hamza Mahdi et al. from the Windsor Regional Hospital, Windsor published in the Journal of medical cases to describe a rare case of intramuscular hemangioma in the lumbar paraspinal region with coexisting L5-S1 disc herniation, and to discuss diagnostic complexities and management strategies. This case underscores the diagnostic challenge of distinguishing benign vascular tumors from other soft tissue lesions in the context of coexisting spinal pathologies. The lesion was misidentified preoperatively despite advanced imaging and biopsy, requiring definitive surgical excision for diagnosis. The authors advocate for the inclusion of vascular tumors in the differential diagnosis of persistent lumbar pain, especially when imaging reveals atypical soft tissue masses 1).

Critical Review

This is the seventh documented adult case of lumbar paraspinal intramuscular hemangioma, lending marginal novelty to the case. The radiologic and histologic evaluation is competently detailed, yet the lack of advanced imaging modalities such as contrast-enhanced MRI or MR angiography limits preoperative characterization. Furthermore, the diagnostic sequence—proceeding to surgery after an inconclusive CT-guided biopsy—reflects a pragmatic yet debatable strategy in light of possible biopsy sampling errors.

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Pain Relief, Disability, and Hospital Costs After Intradiscal Ozone Treatment or Microdiscectomy for Lumbar Disc Herniation: A 24-Month Real-World Prospective Study

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In a prospective real-world comparative study Sara Bisshopp et al. from Dr. Negrín University Hospital, Las Palmas published in the Journal of Clinical Medicine to compare clinical outcomes, hospital stay, and direct costs between initial intradiscal ozone treatment and standard microdiscectomy/discectomy in patients with lumbar disc herniation over a 24-month follow-up. Both groups experienced significant improvements in pain and disability scores. The ozone group had similar clinical outcomes to surgery but with significantly fewer surgical interventions (47% vs. 100%), shorter hospital stays, and reduced costs at 12 months 1).

Critical Appraisal

This study taps into a timely and pragmatic clinical question: Can minimally invasive ozone therapy reduce the surgical burden and costs while maintaining efficacy for lumbar disc herniation? While the 24-month prospective design and real-world context strengthen external validity, several methodological shortcomings temper enthusiasm.

First, the non-randomized design introduces considerable selection bias. The criteria for choosing ozone therapy vs. surgery, though labeled as “offered,” are not rigorously controlled. This self-selection can strongly influence outcomes. Second, sample size is modest (n=70), particularly when divided into two groups (32 ozone, 38 surgery), limiting statistical power.

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What drives clinic follow-up after traumatic spinal injury? An observational cohort study from Tanzania

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In a Retrospective Observational Cohort Study Ikwuegbuenyi et al. From Muhimbili Orthopaedic Institute, Dar es Salaam; Weill Cornell Medicine, New York publisher in the journal BMJ Open to identify demographic, injury-related, and healthcare system factors associated with clinic follow-up adherence after traumatic spinal injury (TSI) in Tanzania. Fewer than 13% of patients remained in follow-up at 12 months post-TSI. Key predictors of clinic return included private insurance, injury mechanism, shorter hospital stay, neurological improvement, and female sex. The authors call for targeted strategies to enhance long-term follow-up in LMICs 7).

Content and Scientific Merit

The study attempts to quantify and elucidate predictors of follow-up adherence among patients with traumatic spinal injuries in a low-resource setting. While the topic is relevant, particularly given global disparities in neurosurgical care, the analysis remains superficial. The selection of variables lacks depth—omitting psychological, transportation, or caregiver support factors. The authors rely heavily on retrospective registry data, yet provide minimal discussion of data quality or loss to follow-up bias beyond basic exclusions.

There is also insufficient interrogation of systemic barriers endemic to Tanzanian healthcare—such as infrastructure deficits or cultural mistrust of allopathic medicine—that could more meaningfully contextualize the findings. The regression analysis is underutilized; while odds ratios are presented, there’s no effort to model interaction effects or assess multicollinearity. Additionally, the use of ASIA Impairment Scale categories in logistic regression, without discussion of baseline functional capacity or socioeconomic stratification, undermines interpretability.

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Outcomes of CT-Guided Targeted Epidural Patching for Lateral Dural Tears in Spontaneous Intracranial Hypotension: A Multicenter Retrospective Cohort Study

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In a multicenter retrospective cohort study, Callen et al. — from the University of Colorado Anschutz, Kaiser Permanente Santa Clara, University of Freiburg, Cambridge University Hospitals, Newcastle upon Tyne Hospitals, Guy’s & St Thomas’s / King’s College Hospitals, and King’s College London — published in the American Journal of Neuroradiology, the clinical and radiologic outcomes of CT-guided epidural patching in patients with lateral dural tear causing spontaneous intracranial hypotension (SIH). The study also aimed to determine whether anatomic factors (e.g., herniated arachnoid pouch) or procedural variables (e.g., patch volume, material, approach) predict treatment success.

CT-guided patching led to complete symptom resolution in approximately one-third of patients. The presence of a herniated arachnoid pouch was associated with lower radiologic resolution of CSF collections. Procedural variables — such as patch type, approach, and volume — were not associated with outcomes. Notably, some patients experienced clinical improvement despite persistent CSF collections, highlighting the need for long-term follow-up and cautious reliance on imaging alone.

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🧠 Takeaway Message for Neurosurgeons

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