Steven M. Theiss

Study design: Systematic review. Objective: To synthesise evidence on surgical management, reconstruction strategies, adjuvant therapies, survival outcomes, local recurrence, and prognostic factors in primary spinal osteosarcoma, with emphasis on margin status and multimodal therapy. Methods: A PRISMA 2020-compliant systematic review was performed. PubMed/ MEDLINE, Scopus, Web of Science and Cochrane Library were searched through January 2026. Studies reporting outcomes in histologically confirmed primary spinal osteosarcoma were included. Institutional series and registry-based analyses were eligible. Extracted variables included surgical approach (en-bloc versus intralesional), reconstruction, chemotherapy, radiotherapy, survival, recurrence and prognostic factors. Owing to heterogeneity, qualitative synthesis was undertaken. Results: Eighteen studies comprising 2,239 patients were included. Registry cohorts reported median overall survival of 15–23 months and 5-year survival below 20%. In contrast, selected Institutional surgical series demonstrated median survival exceeding 4–6 years in patients undergoing aggressive resection. En bloc or Enneking-appropriate resection was associated with improved local control and superior unadjusted survival; however, multivariable analyses did not consistently confirm an independent survival benefit. Local recurrence ranged from approximately 10% following en-bloc resection to more than 40% after intralesional resection. Multimodal chemotherapy remained standard. Modern radiotherapy techniques, including intensity-modulated radiation therapy (IMRT), stereotactic body radiotherapy (SBRT), proton-beam therapy and carbon-ion therapy, were increasingly utilised, especially in anatomically unresectable disease. Conclusions: Primary spinal osteosarcoma carries poor population-level survival. Margin-negative resection improves local control, but outcomes are strongly influenced by tumour biology and stage. Multidisciplinary management at specialised centres is essential to optimise survival.

Purpose To evaluate the association between glucagon-like peptide-1 receptor agonist (GLP-1RA) use and perioperative, postoperative and fusion-related outcomes following spine surgery. Methods A systematic search of PubMed/ MEDLINE, Scopus, Web of Science, and the Cochrane Library was conducted from inception through December 2025 in accordance with PRISMA 2020 guidelines. Comparative studies evaluating outcomes of spine surgery in patients exposed to GLP-1RAs versus non-users were included. Random-effects meta-analyses were performed for perioperative outcomes, medical and surgical complications, reoperation and fusion-related outcomes. Subgroup analyses were conducted based on diabetes status, fusion levels and duration of follow-up. Results Twenty comparative studies with 546,668 patients were included in the analysis. GLP-1RA use was not associated with significant differences in perioperative or postoperative outcomes, including transfusion [log odds ratio (OR)=-0.25,95% CI:-0.67,0.17), operative time [mean difference (MD)=-5.3 min,95% CI:-23.9,13.3)], length of stay (MD=-0.19days,95% CI:-1.35,0.96), surgical site infection (logOR = 0.29,95% CI:-0.08,0.66), venous thromboembolism (logOR = 0.19,95% CI:-0.25,0.63), readmission (logOR = 0.31,95% CI:-0.07,0.69), reoperation (logOR = 0.12,95% CI:-0.17,0.42), or implant failure. In contrast, GLP-1RA use was associated with higher fusion success (logOR = 0.42,95% CI:0.33,0.51;p < 0.001), consistent across follow-up intervals. Conclusion In the available observational literature, GLP-1RA use is not associated with increased perioperative complications following spine surgery and may be related to improved fusion outcomes. These findings provide reassurance regarding perioperative safety and suggest a potential long-term benefit in arthrodesis, although prospective studies are needed to confirm causality and define optimal perioperative management strategies. Level of evidence III.

Purpose: Surgical site infections (SSIs) are the third most common complication following spine surgery. The effect of topical vancomycin in addition to perioperative systemic cefazolin remains uncertain. This study sought to investigate the effect of topical vancomycin administration on 90-day postoperative infection risk following adult posterior spinal fusion (PSF). Methods: The TriNetX Global Collaborative database was queried to identify adult patients undergoing PSF. Patients were stratified into two cohorts based on documented administration of topical vancomycin and systemic cefazolin (topical cohort) versus systemic cefazolin alone (control cohort). Patients underwent 1:1 propensity matching based on demographics and relevant comorbidities. The primary outcomes of interest included 90-day rates of infection-related complications. Subgroup analyses were performed to identify the influence of neuromuscular scoliosis, PSF with osteotomies, pelvic fixation, or fusion of greater than six levels on infection rates. Infectious complication rates were also compared between patients receiving topical vancomycin with and without topical gentamicin or tobramycin. Results: After propensity matching, 63,455 patients were included in each cohort. Patients in the topical cohort demonstrated comparable rates of overall infection (3.0% vs. 3.1%, p = 0.794), superficial surgical site infection (SSI) (0.9% vs. 0.8%, p = 0.151), deep SSI (0.6% vs. 0.6%, p = 0.070) and all other infectious complications when compared to the control cohort. Subgroup analysis revealed decreased rate of deep SSI when using topical gentamicin or tobramycin with vancomycin versus topical vancomycin alone (0.7% vs. 1.7%, p = 0.019). No other between-group differences were observed. Conclusion: This study found no significant difference in 90-day postoperative infectious complications following PSF when topical vancomycin was added to standard systemic cefazolin prophylaxis compared to cefazolin prophylaxis alone. Vancomycin with the addition of gentamicin or tobramycin, however, was associated with decreased rates of deep SSI. Level of evidence: Level III, retrospective cohort study.

Background Nonoperative management is an appealing option for purely transosseous thoracolumbar flexion-distraction injuries given the prospects of osseous healing and restoration of the posterior tension band complex. This study seeks to examine differences in outcomes following flexion-distraction injuries after operative and nonoperative management. Methods This study reviews all patients at a single Level 1 trauma center from 2004 to 2022 with AO Spine B1 thoracolumbar injuries treated operatively vs nonoperatively. Inclusion criteria were age greater than 16 years, computed tomography-confirmed transosseous flexion-distraction injuries, and at least 3 months of follow-up with available imaging. The primary outcome assessed was a change in local Cobb angles, with secondary outcomes consisting of complications, time to return to work, and need for subsequent operative fixation. Results Initial Cobb angles in the operative (n = 14) vs nonoperative group (n = 13) were −5° and −13°, respectively (P = 0.225), indicating kyphotic alignment in both cohorts. We noted a significant difference in Cobb angles between cohorts at first follow-up (2.6° and −13.9°, P = 0.015) and within the operative cohort from presentation to first follow-up (P = 0.029). At the second follow-up, there was no significant difference in Cobb angles between cohorts (3.6° and −12.6°, P = 0.07). No significant differences were noted in complication rates (P = 1), time to return to work (P = 0.193), or resolution of subjective back pain (P = 0.193). No crossover was noted. Conclusions Nonoperative management of minimally displaced transosseous flexion-distraction injuries is a safe alternative to surgery. Patient factors, such as compliance with follow-up, and location of the injury should be factored into the surgeon’s management recommendation. Clinical Relevance Overall, no significant differences in outcomes and complications were noted following nonoperative management of AO Spine B1 injuries, indicating the potential for these injuries to be managed conservatively. Level of Evidence 3.

Background/Objectives: Adult scoliosis is traditionally treated with long-segment fusion, which provides strong radiographic correction and significant improvements in health-related quality of life but comes at a high morbidity cost. This systematic review seeks to examine the literature behind limited interventions in adult scoliosis patients and examine the best approaches to treatment. Methods: This is a MEDLINE- and PubMed-based literature search that ultimately included 49 articles with a total of 21,836 subjects. Results: Our search found that long-segment interventions had strong radiographic corrections but also resulted in high perioperative morbidity. Limited interventions were best suited to patients with compensated deformity, with decompression best for neurologic symptoms and fusion needed to treat neurological symptoms secondary to up-down stenosis and to provide stability across unstable segments. Decompression can consist of discectomy, laminotomy, and/or foraminotomy, all of which are shown to provide symptomatic relief of neurologic pain. Short-segment fusion has been shown to provide improvements in patient outcomes, albeit with higher rates of adjacent segment disease and concerns for correctional loss. Interbody devices can provide decompression without posterior element manipulation. Future directions include short-segment fusion in uncompensated deformity and dynamic stabilization constructs. Conclusions: Limited interventions can provide symptomatic relief to adult spine deformity patients, with indications mostly in patients with balanced deformities and neurological pain.

Objectives: The Charlson Comorbidity Index score (CCI) records the presence of comorbidities with various weights for a total score to estimate mortality within 1 year of hospital admission. Our study sought to assess the association of CCI with mortality rates of patients undergoing surgical intervention. Study Design: Retrospective study. Methods: Retrospective study of patients with surgical spinal trauma at a large academic level I trauma tertiary center from 2015 to 2018. Information collected included age, sex, American Society of Anesthesiologists physical status, body mass index, Charlson comorbidities, injury severity score, the presence of spinal cord injury, and mortality. Mortality was measured at 30 days, 90 days, and 1 year. Descriptive and bivariate analyses were completed. The results were significant at P < 0.05. Results: The highest proportion of 1-year mortality was in the patients with cervical (11.3%) and thoracolumbar injuries (7.4%) (P = 0.002). Patients with low CCI had low 1-year mortality (1.7%). Patients with high CCI had high 1-year mortality (13.8%) (P < 0.001). A significant association existed between CCI and mortality at 30 days, 90 days, and 1 year (P < 0.001). Mortality was higher in patients with spinal cord injury (14/108; 13%) than in those without (11/232; 5%) (P = 0.021). No association existed between ISS and mortality (P = 0.26). Discussion: The CCI was associated with a higher proportion of deaths at 30 days, 90 days, and 1 year. This association may help predict this unfortunate complication and guide the surgical team in formulating treatment plans and counseling patients and families regarding mortality associated with these injuries and the risks of surgical intervention.

Hed cohorts from 46 sites in the United States. Patients aged 65 and older with hip fracture surgery between March 15 and December 31, 2020, were included. The main outcomes were 30-day all-cause mortality and all-cause mortality. Results: In this national study that included 3303 adults with hip fracture surgery, the 30-day mortality was 14.6% with COVID-19-positive versus 3.8% in COVID-19-negative, a notable difference. The all-cause mortality for hip fracture surgery was 27.0% in the COVID-19-positive group during the study period. Dicussion: We found higher incidence of all-cause mortality in patients with versus without diagnosis of COVID-19 after undergoing hip fracture surgery. The mortality in hip fracture surgery in this national analysis was lower than other local and regional reports. The medical community can use this information to guide the management of hip fracture patients with a diagnosis of COVID-19....