Sang-Il Kim

Park S, et al. J Korean Med Sci. 2027 Feb;42:e30. https://doi.org/10.3346/jkms.2027.42.e30

Background/Objectives: Ureteral complications following oblique lumbar interbody fusion (OLIF) are uncommon and are typically attributed to direct mechanical injury. Functional ureteral obstruction without overt ureteral damage remains poorly characterized. We report two cases that provide clinical and intraoperative evidence of a previously underrecognized mechanism of ureteral obstruction associated with anterior cage positioning during OLIF. Case Presentation: Among 180 OLIF procedures performed by a single surgeon, two cases (1.1%) of postoperative or intraoperative ureteral compromise without direct structural injury were identified. In the first case, postoperative imaging revealed hydronephrosis and focal angulation of the left proximal ureter at the level of the interbody cage, without contrast extravasation. The obstruction was managed with double-J ureteral stenting, and serial renal function monitoring confirmed preserved renal function throughout the clinical course. In the second case, retroperitoneal tissue including the ureter was directly observed intraoperatively to be interposed between the anterior longitudinal ligament and the interbody cage during anterior cage placement. Release of the interposed tissue resulted in immediate ureteral decompression without structural damage. Correlation of the postoperative findings in the first case with the intraoperative observations of the second case supports a unified mechanistic explanation: anterior cage advancement may draw retroperitoneal tissue into the cage–anterior longitudinal ligament interface, subjecting the ureter to focal compression or angulation. Conclusions: Functional ureteral obstruction during OLIF may occur secondary to retroperitoneal tissue interposition rather than direct ureteral trauma. Awareness of this mechanism and meticulous protection of the anterior retroperitoneal layer during cage advancement may help prevent avoidable ureteral complications.

Background/Objectives: Osteoporotic vertebral fractures (OVFs) are frequently associated with progressive kyphotic deformity and vertebral height loss, adversely affecting spinal alignment and function. Although romosozumab and teriparatide are established anabolic therapies, comparative data on their longitudinal radiologic effects after OVFs remain limited. This study compared radiologic and clinical outcomes between these agents in patients with OVFs. Methods: Sixty-two patients with single-level OVFs were included: 34 patients in the romosozumab group and 28 patients in the teriparatide group, analyzed in a retrospective, observational comparative study. All patients received anabolic therapy for 6 months followed by sequential denosumab. Radiologic parameters (Cobb angle, vertebral wedge angle, and anterior and middle vertebral body heights) were evaluated at baseline and at 1, 3, 6, and 12 months. Bone mineral density (BMD) and clinical outcomes were assessed at baseline and 12 months. Results: Baseline characteristics were comparable between groups. No statistically significant between-group differences were observed in radiologic parameters over 12 months. However, the romosozumab group showed numerically smaller increases in kyphotic angles and less vertebral height loss, particularly beyond 6 months. Lumbar spine BMD increased in both groups, with a greater absolute gain in the romosozumab group. Back pain improved substantially in both groups, while disability improvement was greater in the teriparatide group. Conclusions: Romosozumab and teriparatide demonstrated comparable radiologic and clinical outcomes in OVFs. Although differences were not statistically significant, romosozumab showed a numerical trend toward better preservation of spinal alignment and vertebral height.

Background/Objectives: Surgical site infection (SSI) remains a significant complication following spine surgery, yet the optimal duration of prophylactic antibiotic administration remains debated. We investigated the association between prophylactic antibiotic duration and SSI rates following spine surgery using a nationwide claims database. Methods: This retrospective cohort study analyzed data from the Health Insurance Review and Assessment Service quality assessment database across four assessment waves (2014–2020, sixth to ninth). Adult patients (aged ≥19 years) undergoing elective spine surgery (decompression, instrumented fusion, vertebroplasty, or kyphoplasty) were categorized into two groups based on prophylactic antibiotic duration: p < 0.05). After adjustment for confounders, prolonged antibiotic prophylaxis (≥24 h) was associated with increased odds of SSI (adjusted odds ratio [aOR] = 10.73, 95% CI = 7.30–15.79), non-surgical-site infections (aOR = 16.06, 95% CI = 13.11–19.67), and total postoperative infections (aOR = 17.82, 95% CI = 14.83–21.42). Conclusions: In this nationwide cohort, early discontinuation of prophylactic antibiotics within 24 h was not associated with increased SSI risk. Prolonged antibiotic prophylaxis beyond 24 h was associated with higher SSI rates, although confounding by indication likely contributed to this finding. These results are consistent with current guideline recommendations for limiting prophylactic antibiotic duration to 24 h or less in routine spine surgery, while recognizing that individualized approaches may be warranted in some high-risk patients.

Background/Objectives: Atlantoaxial posterior fusion has unique characteristics, and it is anticipated that adjacent segment degenerative changes following fusion surgery may present distinctive findings. This study aims to analyze the risk factors for degenerative changes in subaxial levels following the increasingly common atlantoaxial posterior fusion procedure. Methods: A total of 58 patients (19 males, 39 females) who had neutral, flexion, and extension plain lateral radiographs taken and a follow-up record of approximately two years post-surgery were included in the final study cohort. The study analyzed surgical methods, patient demographics, hospitalization-related factors, visual analog scale (VAS) for neck pain, and radiologic parameters. Patients were classified into the radiologic subaxial pathology (RSP) group (n = 34) and the non-RSP group (n = 24) using several radiologic indicators of spinal instability or arthritic changes, and the risk factors for RSP were analyzed. Results: The RSP group showed a significantly higher proportion of females and prevalence of rheumatoid arthritis (RA). At 3 months postoperatively, the C1-7 sagittal vertical axis (SVA) was significantly lower in the RSP group. Multivariate regression analysis using significant variables (p < 0.05) such as sex, RA and 3-month C1-7 SVA showed that RA and 3-month C1-7 SVA were significantly associated with RSP. Among radiologic parameters related to surgery, multivariate analysis identified 3-month C1-7 SVA as the sole risk factor for RSP. To explore its correlation with other radiologic parameters at 3 months postoperatively, linear logistic regression analysis was conducted. Significant positive correlations were observed with the C1-2 Cobb angle. Conclusions: This study identified RA and C1-7 SVA as the most significant risk factors for RSP in atlantoaixal posterior fusion.

Jang Y, et al. J Korean Med Sci. 2026 May;41:e149. https://doi.org/10.3346/jkms.2026.41.e149

Purpose To identify how symptom duration of aggravated symptoms prior to surgery impacts patient satisfaction for LSS fusion surgery and to determine the threshold point for unsatisfactory results. Methods A retrospective review of 132 patients who underwent lumbar fusion surgery for degenerative LSS between January 2021 and December 2023 was conducted. Patient satisfaction was evaluated using a 4-point Likert scale at minimum one-year follow-up. PROMs such as VAS, ODI, and PainDetect scores, were also collected. The patients were divided into satisfactory and unsatisfactory groups. Multiple variables, including demographics, and radiological findings, were analyzed for their correlation with patient satisfaction. Results Among 132 patients, 70.4% reported satisfaction with surgical outcomes (51.5% were very satisfied, 18.9% were satisfied). The satisfied group showed significantly shorter duration of aggravated symptoms compared to the unsatisfied group (10.30 ± 9.47 vs. 19.7 ± 14.60 months, p < 0.001). The satisfied group was younger and had lower PainDETECT scores. The satisfaction rates declined markedly after 12 months of symptom duration. Multivariate analysis confirmed prolonged symptom duration, older age and higher PainDetect scores were risk factors for unsatisfactory results. Conclusion In our study, 70.4% of patients who underwent short level lumbar fusion surgery for degenerative LSS were satisfied with the treatment. Additionally, we identified that longer duration of aggravated symptoms (particularly beyond 12 months), advanced age, and severity of neuropathic pain were risk factors for lower satisfaction rates. It can be suggested that timely surgical intervention, before the progression of neuropathic pain and development of age-related comorbidities, can provide better patient satisfaction outcomes.

Background/Objectives: Vertebroplasty (VP) and kyphoplasty (KP) are widely performed minimally invasive procedures for osteoporotic vertebral compression fractures and vertebral metastases. Although generally safe, postoperative surgical site infections (SSIs) can lead to severe complications. The true incidence of SSIs and optimal prophylactic antibiotic strategies remains unclear. This study evaluated SSI incidence and the impact of antibiotic timing and type using a nationwide quality assessment (QA) database in South Korea. Methods: We analyzed data from the 7th to 9th QA waves of the Health Insurance Review and Assessment (HIRA) Service, including 23,868 patients who underwent VP or KP. SSI incidence was compared across antibiotic timing groups (preoperative-only, postoperative-only, and combined) and antibiotic types. Multivariate logistic regression identified independent risk factors for SSIs. Results: SSI occurred in 47 patients (0.20% of 23,868 procedures). No infections were observed in the preoperative-only group, compared with 0.36% in the postoperative-only group and 0.19% in the pre- and postoperative group. The lowest incidence (0.16%) was seen with first- or second-generation cephalosporins. Multivariate analysis found no significant difference between the preoperative-only and the combined regimens, nor between first-/second-generation cephalosporins and broad-spectrum antibiotics. However, surgery at a tertiary hospital (aOR: 3.566) and malnutrition (aOR: 2.915) were independently associated with increased SSI risk. Conclusions: This nationwide study, the largest to date on VP and KP, demonstrated that SSIs are rare (0.2%). A single preoperative dose of first- or second-generation cephalosporins was as effective as combined or broader-spectrum regimens. Targeted preventive measures may be warranted for high-risk groups such as patients with malnutrition or those treated in tertiary hospitals.

Bone fusion is one of the mainstay managements for degenerative spinal diseases and critical-sized bone defects resulting from trauma, tumors, infection, and nonunion. Bone graft materials are required for promoting bone healing, with autografts historically considered the gold standard due to their osteogenic, osteoinductive, and osteoconductive properties. However, donor site morbidities have led to the development of alternative bone graft substitutes. Currently available alternative options for bone fusion include allografts, ceramics, demineralized bone matrix (DBM), and bone morphogenetic proteins (BMPs). Each material has its advantages and disadvantages. Allografts avoid donor site morbidities but lack osteogenic properties and pose disease transmission risks. DBMs are acid-extracted allografts that have osteoconductive and osteoinductive properties but require combination with autografts because of the lack of evidence for their stand-alone use. BMP-2 has potent osteoinductive properties and is considered an ideal fusion material, but faces unresolved challenges related to optimal dosage and carrier. Synthetic peptides, mimicking the cell-binding domain of type I collagen, facilitate the attachment of osteogenic cells (such as osteoblasts) to the graft material and the production of extracellular matrix, leading to improved bone growth at the fusion site. The development of materials with ideal properties is a research hotspot. Recent advancements in biomaterials, such as hydrogels, nanomaterials, and three-dimensional-printed biomaterials, offer promising future options for bone fusion. This review provides an overview of available bone fusion materials, their advantages and disadvantages, and introduces emerging candidate options for bone fusion.