Endoscopic spine surgery relies on continuous irrigation to maintain visualization and hemostasis. Gravity-based and improvised high-flow systems may generate unstable or excessive pressures, potentially increasing the risk of neurologic complications. Pump-controlled irrigation offers regulated pressure delivery, but its comparative safety and pressure behavior remain incompletely defined.

To systematically review the literature comparing controlled pump versus gravity-based or high-flow irrigation systems in endoscopic spine surgery, with a focus on pressure dynamics and pressure-related complications.

This systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, Web of Science, and Google Scholar were searched from database inception through January 2026 using predefined search terms related to endoscopic spine surgery, irrigation, and pressure dynamics. Eligible studies included experimental, animal, and clinical investigations reporting irrigation-related pressure measurements (epidural, intradural, intracranial) or pressure-associated complications. Two reviewers independently screened studies, extracted data using a standardized framework, and assessed risk of bias using the Newcastle–Ottawa Scale and MINORS criteria. Due to heterogeneity in study design and outcomes, a qualitative synthesis was performed.

Eleven studies (a retrospective series, cadaveric, and living animal models) met inclusion criteria. Baseline epidural, intradural, and intracranial pressures were low and remained near physiologic ranges during routine operative conditions (approximately 12–18 mmHg). One study found pump-controlled irrigation produced significantly lower working-space pressures compared with gravity-based systems (12.10 ± 3.51 vs 23.86 ± 6.97 mmHg, p = 0.001). Outflow obstruction and dural disruption were consistently identified as primary drivers of pressure escalation. Intracranial pressure remained below 20 mmHg with patent drainage but increased to 86–90 mmHg when outflow occlusion and dural compromise coexisted. One study found symptom onset was associated with pressures exceeding 37 mmHg, with mean symptomatic pressures of 52.9 ± 9.2 mmHg. Neurologic complications, including seizures, were reported in 0.52% of cases and were most frequently associated with impaired drainage and dural violation.

Findings are limited by heterogeneity in study design, pressure measurement techniques, and reliance on observational and experimental data. Direct comparative clinical studies are limited, and publication bias cannot be excluded.

Irrigation during endoscopic spine surgery generally maintains pressures within physiologic ranges under conditions of intact dura and adequate outflow. However, impaired drainage and dural disruption can result in rapid and clinically significant pressure elevations. Pump-controlled irrigation appears to provide more stable pressure profiles than gravity-based systems, though safety is ultimately dependent on maintaining effective outflow. These findings highlight the importance of intraoperative vigilance regarding drainage patency and dural integrity to mitigate neurologic risk.

Total sacrectomy is now a standard curative procedure for primary malignant sacral tumours. Reconstruction, however, remains demanding because of the complex regional anatomy and unique biomechanical environment. Several spinopelvic reconstruction techniques have been reported, all yielding satisfactory functional outcomes. This study aims to evaluate both the clinical outcomes and the biomechanical behavior of a modified spinopelvic fixation construct, which incorporates a novel three-dimensional-printed component following total sacrectomy.

We conducted a retrospective cohort study of 12 consecutive patients (4 men, 8 women; mean age 38 years, range 17–61 years) treated between 2021 and 2024. Eleven patients with primary malignant sacral tumours underwent total en-bloc sacrectomy, and one patient with a giant-cell tumour (GCT) underwent piecemeal resection. All patients received modified spinopelvic reconstruction. Tumour extent was L5–S5 in two patients with recurrent malignant peripheral nerve sheath tumour (MPNST), S1–S5 in eight patients with primary malignancies, S1–S5 in the patient with GCT, and S1–S5 with extension into pelvic zones I/IV in one patient with osteosarcoma. Operative time, oncological outcomes, functional outcomes, complications, and implant status were all reviewed. A finite-element analysis was performed to evaluate the biomechanical behaviour of the novel construct and to compare it with previously described reconstruction models.

All 12 patients had a confirmed histological diagnosis before surgery. Three osteosarcoma and four malignant peripheral nerve sheath tumour (MPNST) patients received neoadjuvant and postoperative chemotherapy; one giant-cell tumour (GCT) patient was treated with denosumab. Mean operative time was 11.5 h (range 7.5–15 h) and mean intra-operative blood loss was 2,616 ml (range 1,200–4,000 ml). During follow-up, local recurrence was detected in two chordoma cases. Functionally, S1–S5 root transection caused sphincter disturbance in 11 patients; two of these also sacrificed a unilateral L5 root, yet none required colostomy or chronic catheterisation. Nine patients lost dorsiflexion strength. At the latest follow-up, 10 patients could walk independently, and 2 required assistive devices. No major perioperative complications were observed; three patients experienced wound healing complications, which were successfully managed with simple debridement, suturing, and negative pressure wound therapy. Only one overweight patient experienced unilateral iliac screw failure without further revision; the remaining 11 patients had no mechanical complications. Finite-element analysis suggested that the current reconstruction may have favorable load-bearing capacity and stability characteristics compared with previously described models.

The modified spinopelvic fixation with the fifth rod and 3D-printing element represents a potential option for anterior column reconstruction after total sacrectomy, with preliminary evidence of satisfactory clinical outcomes in non-overweight patients. Finite-element analysis suggests that the construct may possess adequate stiffness and stability characteristics that could contribute to preventing pelvic–spinal collapse, though these biomechanical findings require further clinical validation. Stress values from the finite-element model indicate a theoretically low risk of implant fracture under static loading or fatigue conditions, but long-term follow-up is necessary to confirm implant durability and exclude late complications such as loosening or breakage.

Lateral lumbar interbody fusion (LLIF) is a minimally invasive technique for degenerative lumbar disease, but selecting appropriate candidates for indirect decompression remains challenging. This study developed and internally validated the iLLIF score to estimate the likelihood of successful indirect decompression without additional intervention.

A retrospective cohort study was conducted on 200 patients who underwent LLIF between 2014 and 2024. Patients were categorized based on clinical outcomes: successful (no intervention or reoperation at the index level within 12 months) versus unsuccessful. Independent preoperative predictors of success were identified using multivariate logistic regression. A five-point scoring system (iLLIF Score) was derived from significant predictors and validated using the area under the receiver operating characteristic curve (AUC).

Among the 200 patients, 168 (84%) achieved successful outcomes. Multivariate analysis identified five independent preoperative predictors of success: (1) rest symptoms less than 50%, (2) reducible disc height greater than 13%, (3) radiographic instability, (4) absence of severe lateral recess stenosis, and (5) no history of previous surgery at an adjacent level. Each factor was assigned one point, yielding a score ranging from 0 to 5. A cutoff of ≥ 3 provided the best balance between sensitivity and specificity. The scoring model demonstrated high predictive performance (AUC 0.973; 95% CI 0.946–1.000).

The iLLIF Score is a simple, internally validated preoperative tool that may help estimate the likelihood of successful indirect decompression following LLIF. It may assist in patient selection and surgical planning, although external validation is required before routine clinical implementation.

Patients undergoing surgery for spinal metastases often have limited physiologic reserve. Although hypoalbuminemia is a recognized risk marker, its graded association with short-term postoperative outcomes and discharge disposition has not been well defined in large national cohorts. We evaluated the relationship between preoperative serum albumin and early postoperative outcomes following surgery for spinal metastases.

Adults undergoing surgery for metastatic extradural spinal tumors (laminectomy or tumor excision with or without fusion) were identified in ACS-NSQIP (2010–2022). Hypoalbuminemia was defined as albumin < 3.5 g/dL and stratified as mild (3.0–3.49), moderate (2.5–2.99), or severe (< 2.5). Primary outcomes were any 30-day complication, 30-day mortality, and non-home discharge. Multivariable logistic regression adjusted for demographic, clinical, and operative factors. Exploratory machine-learning models assessed discrimination and variable importance.

Among 4,126 patients, 1,534 (37.2%) were hypoalbuminemic. Hypoalbuminemia was associated with higher rates of complications, mortality, non-home discharge, and longer hospitalization (all p < 0.001), with outcomes worsening stepwise across albumin strata. After adjustment, hypoalbuminemia independently predicted complications (OR 1.52), mortality (OR 2.73), and non-home discharge (OR 1.89) (all p < 0.001). Albumin ranked among the most influential predictors in machine-learning models.

Preoperative hypoalbuminemia shows a dose-dependent, independent association with early morbidity, mortality, and post-acute care needs after surgery for spinal metastases, supporting its use in perioperative risk stratification and care planning.

Readmission after surgery for spinal deformities is linked to the recurrence of hospital stays and considerable healthcare expenditures. Yet, there is significant ambiguity surrounding the incidence and risks associated with hospital readmissions. The objective of this study was to provide a quantitative and thorough synthesis of the readmission rates and associated risk factors after spinal deformity surgery, thereby guiding the development of preventative measures.

We systematically searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and the Cochrane Library from inception to September 1, 2025, for studies published in English or Chinese studies evaluating postoperative readmission rates and risk factors in spinal deformity. Eleven studies involving 222,307 patients were included. Study quality was assessed using the Newcastle–Ottawa Scale (NOS). A systematic review and meta-analysis were performed to estimate pooled readmission rates and quantify risk factors.

The meta-analysis showed that the pooled 30-day readmission rate after surgical treatment in patients with spinal deformity was 10.2% (95% CI: 6.3–14.2%), while the pooled 90 - day readmission rate was 17.2% (95% CI: 11.6–22.7%). The pooled 30-day reoperation rate after surgical treatment in patients with spinal deformity was 5.8% (95% CI: 0.9–10.8%), and the pooled 90 - day reoperation rate was 6.2% (95% CI: 3.0–9.5%). Obesity was identified as a risk factor for readmission after surgical treatment in patients with spinal deformity (OR = 1.30, 95% CI: 1.14–1.49).

The pooled 30-day readmission rate after surgical treatment in patients with spinal deformity was 10.2%, and the pooled 90-day readmission rate was 17.2%. The pooled 30-day reoperation rate was 5.8%, and the pooled 90-day reoperation rate was 6.2%. Given the heterogeneity among the included studies, we believe that interpreting the readmission and reoperation rates in conjunction with their confidence intervals provides greater clinical relevance. In addition, this study identified obesity as a risk factor for postoperative readmission in patients with spinal deformity.

Psychological outcomes after cervical spine surgery remain underexplored, particularly the development of new-onset depression. This study aimed to compare the long-term incidence of new-onset depression following anterior cervical discectomy and fusion (ACDF) versus cervical artificial disc replacement (ADR), hypothesizing that motion preservation with ADR may be associated with a lower risk of postoperative depression.

We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including patients who underwent ACDF or ADR between 2005 and 2020. Patients with pre-existing mood disorders or prior antidepressant use were excluded. A 1:1 propensity score matching was performed based on demographics and baseline comorbidities. New-onset depression was identified using ICD-10 diagnoses and/or antidepressant prescriptions. Time-to-event analyses were conducted using Kaplan–Meier curves, and hazard ratios (HRs), absolute risk differences, and numbers needed to treat (NNTs) were calculated.

At 5-year follow-up, ADR was associated with a significantly lower incidence of new-onset depression compared with ACDF (HR, 0.79; 95% CI, 0.72–0.87). The absolute risk difference was − 5.2%, corresponding to an NNT of 19. Consistent results were observed across alternative depression definitions.

In this large real-world cohort, ADR was associated with a modest but clinically meaningful reduction in the risk of new-onset depression compared with ACDF. These findings are hypothesis-generating and should be interpreted with caution given the observational design and the potential for residual confounding. Further prospective studies incorporating patient-reported outcomes are warranted.

Adolescent idiopathic scoliosis (AIS) affects 2–3% of adolescents, causing spinal curvature and functional limitations. Traditional assessment using the Cobb angle may only partially capture patient concerns about aesthetics. The Schroth scoliosis-specific exercises (SSE), focusing on posture correction, have shown promise for reducing the Cobb angle and preventing progression, though research on its cosmetic impact is limited. Surface topography (ST) offers a radiation-free alternative to assess AIS, but determining what is a meaningful change for patients remains underexplored. The objective of this study is to determine the Minimal Clinically Important Changes (MCIC) in ST parameters in AIS after undergoing 6 months of Schroth SSE exercises.

This is a secondary analysis from a randomized controlled trial. Participants (n = 124) were recruited from a Scoliosis Clinic and randomized into standard care (observation or bracing) and Schroth intervention added to standard care groups (one-hour weekly supervised session, 30–40 min daily home exercises). A global Rating of Change (GRC) was self-reported after six months, and asymmetry parameters of root mean square (RMS) and maximum deviation (MaxDev) over the asymmetry patch corresponding to the spinal curve were obtained through surface torso scans captured at baseline and six months. Pearson correlation and receiver-operating characteristic (ROC) curve analysis were performed to determine the MCICs. Subgroup analyses were also conducted to ascertain MCICs for thoracic and lumbar curve types.

GRC ratings correlated with changes in RMS (r=-0.510, p < 0.001) and MaxDev (r=-0.409, p < 0.001). Participants who reported improved (GRC ≥ 2) posture saw a 1.76 ± 2.9 mm and 3.29 ± 6.5 mm decrease in RMS and MaxDev, respectively. In contrast, RMS and MaxDev increased by 1.03 ± 3.0 mm and 1.26 ± 5.6 mm, respectively, among individuals who stated that their posture had deteriorated or not changed (GRC < 2). Using ROC analysis, MCICs for RMS and MaxDev were determined to be -0.27 mm (area under the curve (AUC) 0.746, sensitivity 67%, specificity 74%) and − 0.49 mm (AUC 0.717, sensitivity 64%, specificity 68%), respectively, for overall improvement perception. Having met both thresholds reduced sensitivity to 62% and achieved 74% specificity. MCICs for thoracic curve types were − 0.58 mm (AUC 0.618, sensitivity 60%, specificity 53%) for RMS and − 1.32 mm (AUC 0.632, sensitivity 73%, specificity 92%) for MaxDev. MCICs for lumbar curve types were − 0.26 mm for RMS (AUC 0.881, sensitivity 73%, specificity 92%) and − 0.61 mm for MaxDev (AUC 0.811, sensitivity 68%, specificity 83%).

Changes in RMS and MaxDev were aligned to GRC score reflecting perceived improvements in back condition. Stronger associations were observed between ST parameters and perceived improvement in lumbar than thoracic or combining all curves.

We aimed to evaluate 15-year trends in the prevalence and healthcare expenditure of spinal diseases in South Korea, encompassing the COVID-19 pandemic and the transition to a super-aged society.

Claims records registered in the Health Insurance Review and Assessment Service between 2010 and 2024 served as the analytical source for this population-level investigation. All patients diagnosed with spinal diseases (ICD-10: M40–M54) were identified. We calculated age-standardized rates (ASRs) per 100,000 population using the WHO 2000 World Standard Population. Joinpoint regression analysis was performed to identify significant trend changes by sex and disease subgroup.

A total of 9.50 million patients in 2010 increased to 13.26 million in 2024 (+ 39.6%). Male ASR rose at an average annual percent change (AAPC) of 1.73% (95% CI: 1.47–1.99; p < 0.001), while female ASR remained stable (AAPC: 0.05%; 95% CI: −0.24 to 0.35; p = 0.706). The female-to-male ASR ratio declined from 1.42 to 1.13. Back pain (M54) showed significant increases in both sexes. Total healthcare expenditure grew from 1.42 to 3.26 billion USD (+ 130%).

Males, not females, accounted for most of the 39.6% growth. The sex ratio compressed (1.42 to 1.13). A 130% cost surge against 39.6% patient growth signals escalating treatment intensity per episode; sex-tailored prevention and expenditure governance may warrant consideration.

Aggressive vertebral hemangiomas (VHs) are rare benign tumors but can cause neurological deficits. Currently, the optimal treatment strategy for aggressive VHs remains controversial. The purpose of study is to evaluate the safety and efficacy of decompression surgery with intraoperative vertebroplasty for the treatment of aggressive VHs.

A total of 85 aggressive VH patients with neurological deficits who underwent decompression surgery with intraoperative vertebroplasty between January 2010 and May 2024 were included in this study. Clinical data such as patient demographics, symptoms, neurological function, pain levels, radiologic features, surgical information, pathology, and perioperative complications, were recorded and analyzed. Enneking staging was determined based on radiological findings. Neurological function and pain levels were assessed using the Frankel grade and the Visual Analogue Scale (VAS), respectively. The minimum follow-up duration was 12 months.

The average age of 85 patients (49 male and 36 female) was 51.1 ± 14.3 (21–77) years. Lesions were located in the cervical spine in 1 case, the thoracic spine in 67 cases, and the lumbar spine in 17 cases. All surgery procedures were completed successfully with an average surgery duration of 168.2 ± 83.3 (90–500) minutes and an average blood loss of 670.1 ± 674.8 (50–2500) ml. Preoperative embolization significantly reduced intraoperative blood loss (P < 0.01). Postoperatively, the pain levels of patients were significantly alleviated (P < 0.01). The average follow-up duration was 76.1 ± 55.1 (12–182) months and all patients remained alive at the final follow-up. Recurrence was observed in eight patients, one of whom underwent surgery combined with radiotherapy, while the remaining seven received radiotherapy alone, and at the last follow-up, these patients were symptom-free. Adequate and satisfactory intraoperative filling of bone cement could reduce the risk of recurrence (P < 0.01).

Decompression surgery with intraoperative vertebroplasty can effectively reduce blood loss, alleviate neurological symptoms and reduce the risk of recurrence, and is a safe and effective approach in the management of aggressive VHs.

The management of primary tumors of the spine has long been a challenge in oncological surgery. En bloc resection with wide or marginal margins is considered the gold standard for achieving local control and reducing recurrence rates, particularly for aggressive benign and malignant tumors. In cases not eligible for en bloc resection, the recent advancements in adjuvant radiotherapy, particularly charged-particle therapies (proton therapy and carbon ion radiotherapy), could improve the outcomes of intralesional surgery.

The study is a retrospective analysis of data prospectively collected. It includes patients affected by primary tumors of the mobile spine who were treated by intralesional surgery at a tertiary center specialized for spinal diseases between March 2015 and February 2024. After the intralesional surgery, all patients underwent charged- particle radiotherapy, Carbon ion radiation therapy (CIRT) or Proton Beam Therapy (PBT), at specialized external centers. Patients were followed up longitudinally through clinical visits and imaging studies. Local recurrences (LR) after surgery were recorded.

A total of 36 patients were included in the study: 24 males and 12 females, with a mean age of 57.5 years at the time of surgery. The most frequent tumor type was chordoma (26 cases, 72.2%), and the most frequent localization was lumbar (44.4%). Most patients (27/36, 75%) had already undergone prior surgeries for the same lesion. Patients underwent intralesional intracapsular excision in 11 cases (30.6%) or intralesional extracapsular excision (gross total resection) in 25 cases (69.4%) with CFR-PEEK posterior instrumentation for most patients (27, 75%). All patients underwent charged-particle therapy after the intralesional surgery: 27 patients (75%) were treated by PBT and 9 patients (25%) were treated by CIRT. The survival probability at 3 years of follow-up was 88.3% (95% CI: 78.2–99.8), decreasing to 61.4% (95% CI: 45.4–82.9) at 5 years. The occurrence of LR at any point during follow-up emerged as a significant predictor for mortality (HR = 3.70 [95% CI 1.48, 9.27]). Eighteen patients (50%) had one or more post-operative local recurrences after the index surgery. Fifteen out of 18 patients (83.3%) with post-operative LR had also local recurrence before the index surgery. The pre-operative LR or the type of intralesional surgery had no significant impact on the occurrence of LR during the follow up period.

The results of this study suggest that for primary tumors not eligible for en bloc resection the intralesional excision followed by charged-particle radiotherapy provides acceptable results in terms of local control and survival rates, even in cases of recurrent tumors.

Clinical manifestations of aging spine, such as lumbar spinal stenosis, intervertebral disc degeneration, osteoporosis and sciatica, frequently co-occur, yet their shared genetic basis remains unclear.

We assembled large-scale GWAS summary statistics for telomere length, osteoporosis, intervertebral disc degeneration, lumbar spinal stenosis and sciatica, and applied Genomic structural equation modelling to model their SNP-based heritability and genetic covariance structure. A latent aging spine factor was fitted to capture common genetic liability, followed by mvGWAS of the factor, fine-mapping, MAGMA, SCCA-TWAS with FOCUS, pathway, cell-type and functional enrichment analysis.

All five traits showed non zero SNP based heritability and a coherent pattern of genetic covariance, and were well summarized by a single latent aging spine factor that loaded most strongly on lumbar spinal stenosis, sciatica and intervertebral disc degeneration. GWAS of this factor identified 273 independent lead variants, and fine mapping highlighted a focused set of putatively causal SNPs, such as rs61981103, rs111736973 and rs963278. Integrative TWAS and MAGMA analysis converged on susceptibility genes such as LRRC34, MYNN, SAMHD1 and EEF1A2. Enrichment analysis consistently implicated telomere biology, chromosome maintenance and genomic stability pathways.

These findings support the aging spine as a biologically meaningful construct with a shared genetic basis, and provide an initial map of its polygenic architecture that extends previous single-trait studies.

Complex craniocervical malformations pose significant challenges to surgical fixation. The biomechanical advantage of occipital plate fixation versus short-lever modified C1 lateral mass screw fixation remains controversial, and finite element analysis (FEA) is a reliable tool for implant performance evaluation.

To compare biomechanical characteristics of occipital plate fixation and modified C1 lateral mass screw fixation in AOZ-BI and AOZ-AAD models via FEA, and guide surgical decision-making.

A validated healthy occipito-atlantoaxial (C0-C2) FEA model was established using CT data. Two pathological models were constructed: AOZ-BI (Group A, atlantoaxial distance [ADI] < 5 mm) and AOZ-AAD (Group B, ADI ≥ 5 mm with transverse ligament dysfunction), each divided into occipital plate and modified C1 lateral mass screw subgroups. Static loads (40 N preload + 1.5 N·m torque) simulated flexion (Fe), extension (Ex), lateral bending (LB), and axial rotation (AR). C1-C2 range of motion (ROM) and screw-rod peak Von Mises stress (PVMS) were measured.

Modified C1 lateral mass screw fixation reduced C1-C2 ROM by 19.67% (flexion-extension) to 48.51% (lateral bending) compared with occipital plate fixation. In flexion/extension/axial rotation, C1 lateral mass screw fixation increased screw-rod peak Von Mises stress (PVMS) by 51.17%–131.37% in the AOZ-BI group and 36.51%–56.02% in the AOZ-AAD group; in lateral bending, PVMS decreased by 19.46% in the AOZ-BI group but increased by 5.24% in the AOZ-AAD group. occipital plate fixation consistently had higher ROM (Group B highest) but lower PVMS.

Modified C1 lateral mass screw fixation provides superior C1-C2 stability for AOZ-associated BI-AAD but increases implant stress in Fe/Ex/AR. Occipital plate fixation is less stable but reduces stress. Clinically, C1 lateral mass screw is preferred for AOZ-BI; AOZ-AAD requires balancing stability and stress risk. Occipital plate suits patients with severe C1 lateral mass hypoplasia. FEA effectively evaluates craniocervical fixation biomechanics.

Hardware failure (HF) after instrumented fixation for spinal metastases affects 2–22% of patients. Despite growing adoption of cement-augmented pedicle screw fixation (CAPS), no meta-analysis has quantified its effect on HF rates. We aimed to provide pooled HF estimates for CAPS versus conventional fixation and explore the Spinal Instability Neoplastic Score (SINS) as a potential effect modifier.

A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines, searching five databases through April 2026. Pooled HF rates were computed using Freeman-Tukey double arcsine transformation with DerSimonian-Laird random-effects models. Sensitivity analysis was performed restricting to SINS-reporting studies. Certainty of evidence was assessed using GRADE.

Thirteen studies (n = 886) met eligibility criteria. The pooled HF rate was 4.3% (95% CI 1.8–7.9%; I² = 46.8%) in CAPS arms (k = 10, n = 349) versus 12.5% (95% CI 2.9–27.5%; I² = 93.3%) in non-augmented controls (k = 5, n = 537). The sole comparative study demonstrated OR 0.13 (95% CI 0.02–0.81; p = 0.029). Sensitivity analysis restricted to SINS-reporting studies confirmed stability (4.5%, I² = 23.4%). All outcomes were rated low to very low certainty.

CAPS was associated with a numerically lower pooled HF rate compared to conventional fixation in metastatic spine surgery (4.3% vs. 12.5%; indirect comparison). While certainty of evidence was low to very low, these findings may inform implant strategy decisions and highlight the need for standardised HF definitions. INPLASY registration: INPLASY202640045.

The precise contribution of visceral obesity to the pathogenesis of low back pain (LBP) is still uncertain. The aim of this study was to understand the relationship between central obesity determined using the waist-to-weight index (WWI) and LBP prevalence and how biological ageing acceleration (BAA) exerts an indirect effect in such an association.

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999–2004 and 2009–2010 databases, with 11,737 participants aged ≥ 18 years. The WWI was calculated as the ratio of waist circumference to the square root of weight, and BAA was assessed using the Klemera–Doubal method (KDM)-BAA, phenotypic age (PhenoAge) acceleration, and the allostatic load index (ALI).

A greater WWI was significantly positively associated with greater odds of LBP (OR per 1-SD increase: 1.132; 95% CI: 1.082–1.185; p < 0.001). Mediation analysis revealed significant influences of BAA, where KDM-BAA, PhenoAge acceleration, and the ALI mediated 9.238%, 8.573%, and 8.046% of the associations, respectively (p < 0.001 for all). The indirect effects of BA on the association between the WWI and the odds of LBP were also nonnegligible in females, accounting for 8.762%, 19.171%, and 17.321% of the intermediary association mediated by KDM-BAA, PhenoAge acceleration, and the ALI, respectively.

This study provides evidence of the significant associations between the WWI and LBP prevalence and highlights the indirect effects of BAA in these associations.

The study of spinopelvic alignment in asymptomatic individuals is essential for understanding physiological sagittal balance and establishing reference values for spinal deformity assessment. However, the availability of large datasets of healthy subjects is limited by ethical, logistical, and radiation-related constraints. Artificial intelligence (AI)-based synthetic data generation may represent a promising strategy to overcome these limitations.

Full-spine standing radiographs from 123 asymptomatic subjects were retrospectively analyzed. Demographic characteristics and multiple spinopelvic parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and cervical alignment measures, were recorded. An AI-driven probabilistic Gaussian resampling approach with anatomical constraints was used to generate a synthetic dataset of 10,000 biologically plausible cases. Correlations identified within the synthetic dataset were subsequently validated against the original cohort using Pearson correlation analysis and bootstrap resampling (1,000 iterations).

The synthetic dataset preserved the statistical distribution of the original population while substantially increasing analytical power. Significant correlations were identified between PI and PT (PT = 0.34 × PI − 7.2), PI and SS (SS = 0.66 × PI + 7.2), and PI and LL (|LL| = 0.55 × PI + 32.0). These relationships were consistent with previously published anatomical models and remained robust when tested in the original cohort and through bootstrap validation. No significant correlation was observed between PI and TK. A significant association was also identified between T1 slope and cervical lordosis.

AI-driven dataset amplification represents a feasible and reproducible approach for investigating spinopelvic relationships in limited clinical cohorts. The combination of synthetic data generation, validation on real-world observations, and bootstrap resampling enables the identification of biologically plausible correlations while minimizing the need for additional imaging studies. This methodology may serve as a valuable exploratory tool in spine research and other fields characterized by limited datasets.

Although complications are known to affect mortality in patients with spinal cord compression (MSCC), the impact of specific complication subtypes on survival and their risk factors remain poorly defined. The aim was to identify risk factors for perioperative and postoperative local and systemic complications in patients who underwent surgery for MSCC and to evaluate their association with postoperative survival.

We retrospectively analyzed 256 patients who underwent surgical treatment for MSCC between 2003 and 2022. Complications occurring within 30 days postoperatively were classified as perioperative, postoperative local, or postoperative systemic complications. Associations between complications and patient-related variables (age, comorbidities, smoking status, performance status, preoperative ambulatory status, and prior radiotherapy) and surgery-related variables (approach, intraoperative blood loss, and duration of surgery) were examined.

At least one complication occurred in 86 patients (33,6%): 14 perioperative, 39 systemic, and 33 local complications. Postoperative systemic complications (HR 1.8, 95% CI 1.2–2.5; p = 0.003) and lower performance status (HR 1.9, 95% CI 1.4–2.6; p < 0.001), were independently associated with reduced postoperative survival. Impaired preoperative ambulatory function was associated with postoperative complications (HR 2.1, 95% CI 1.0–4.3; p = 0.04).

Postoperative systemic complications were associated with reduced survival following surgery for MSCC. Impaired preoperative ambulatory function increases the risk of complications and should be emphasized in preoperative risk assessment and surgical decision-making.

To investigate the safety, efficacy, and radiological outcomes of posterior unilateral approach with unilateral pedicle screw + contralateral laminar screw + lateral mass reconstruction (UPS + CLS+LM) for cervical dumbbell tumors in a consecutive case series.

A single-center retrospective study was performed on 10 consecutive patients with cervical dumbbell tumors treated with UPS + CLS+LM reconstruction between April 2018 and April 2025. Perioperative parameters (operative time, estimated blood loss [EBL]), clinical outcomes (Japanese Orthopaedic Association [JOA] score, neurological improvement rate), and radiographic outcomes (gross total resection [GTR] rate, bony fusion rate, implant-related complications) were collected and analyzed. Paired t-test was applied to compare preoperative and postoperative JOA scores.

All 10 patients achieved 100% GTR and 100% solid bony fusion, with a mean follow-up of 31.70 ± 26.80 months. The mean 17-point JOA score improved significantly from 13.60 ± 1.35 preoperatively to 16.70 ± 0.67 at final follow-up (t = − 9.86, P < 0.0001), with a mean neurological improvement rate of 88.9%. No implant failure, cervical segmental instability, or tumor recurrence was detected in this case series.

The UPS + CLS+LM technique appears safe and effective for unilateral cervical dumbbell tumors in this case series. It achieves complete tumor resection and reliable cervical stability, preserves the contralateral musculoligamentous complex, minimizes iatrogenic injury, and shows favorable clinical value for unilateral cervical dumbbell tumors in this case series.

Benign notochordal cell tumours (BNCTs) are non-aggressive intraosseous lesions arising from notochordal remnants within the axial skeleton. This study aimed to evaluate their computed tomography (CT) and magnetic resonance imaging (MRI) features and to define how serial imaging follow-up can be used to monitor these lesions.

A retrospective review with institutional ethical approval included all patients diagnosed with spinal BNCTs at a tertiary orthopaedic oncology centre between June 2008 and October 2025. Imaging studies were reviewed by consensus of three fellowship-trained musculoskeletal radiologists. Lesions were assessed using CT and MRI for location, size, margins, presence of concerning features, and interval change on follow-up imaging.

Nineteen patients were included (11 females, 8 males; mean age 44.6 years, range 16–66 years). All BNCTs were incidentally discovered, solitary, well-defined, intraosseous lesions located in the midline of the vertebral bodies, without cortical destruction or extraosseous components. Most were sacral (14/19, 73.7%). Mean maximal lesion size was 1.7 cm. On MRI, 18/19 lesions demonstrated homogeneous low-to-intermediate T1-weighted and high T2-weighted/STIR signal intensity. Internal microscopic fat was present in 9/12 cases. On CT, lesions typically presented with faint sclerosis (10/12). Four lesions with atypical imaging features underwent biopsy and were confirmed as BNCTs. Mean imaging follow-up was 34.2 months (range 1 month to 11 years). All lesions remained stable throughout follow-up.

Incidental spinal BNCTs demonstrate characteristic non-aggressive CT and MRI features and stability on longitudinal imaging follow-up. Lesions without concerning imaging features can be appropriately managed with interval imaging surveillance.