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Background: Over the past decades, spine research has grown substantially, and as the body of literature grows, it is valuable to understand the research landscape. This study aims to examine the geographic origins, author demographics, including the number and gender of authors, and publication output of three prominent spine journals and to assess their scholarly impact.

Methods: A retrospective, bibliometric, cross-sectional analysis was conducted on articles published between 2000 and 2004 (period 1, P1), 2010 and 2014 (period 2, P2), and 2020 and 2024 (period 3, P3) in three spine journals: European Spine Journal (ESJ), Spine, and The Spine Journal (TSJ). Bibliometric data were retrieved using PubMed's Application Programming Interface (API).

Results: Some 14,653 articles underwent analysis. Spine had the highest output in P2 (2946 articles), while TSJ peaked in P3. A marked increase in Asian contributions was observed, with a notable surge in Chinese publications within ESJ; these rose from 4 in P1 to 454 in P3. In the TSJ, the number of articles written by Asian authors increased from 23 to 306. Female first authorship in the ESJ increased from 10.0% to 17.1% and in TSJ, from 5.5% to 14.1%. A notable increase in the average number of authors per publication was observed across all journals. In ESJ, this rose from 4.3 to 7.6; in Spine, from 4.6 to 9.0; and in TSJ, from 4.0 to 8.3.

Conclusions: This study reveals a rise in the number of scientific publications in spine surgery, characterized by an increasing proportion of publications originating from Asia, a higher number of authors per publication, and a growing proportion of female authors. While the progress observed in contributing countries and the increase in gender diversity are promising, disparities persist.

Objective verification of pedicle screw placement on postoperative imaging is essential for patient safety and for evaluating the biomechanical integrity of spinal constructs. Inaccurate screw positioning may compromise stability and increase the risk of neurological injury. Deep learning provides opportunities to automate segmentation of implants and surrounding anatomy, enabling objective and reproducible assessment of implant–anatomy relationships. This study evaluated the feasibility of training readily available convolutional neural networks (CNNs) to segment vertebrae, the spinal canal, and pedicle screws in postoperative thoracolumbar CT images using a limited dataset and 2D slice-based segmentation. One hundred manually annotated axial postoperative CT slices from 20 patients who had undergone posterior fixation were included and divided into training, validation, and test sets across two data splits. Four CNN architectures: YOLOv8, DeepLabv3+, U-net, and Attention U-net, were trained for multi-class segmentation. Model performance was assessed using class-wise Dice Similarity Coefficients (DSC). Across both splits, segmentation accuracy varied by model and anatomical class, mean DSC 0.62–0.90, reflecting variations across classes and models. DeepLabv3+ achieved the highest overall performance, mean DSC 0.83 and 0.78. YOLOv8 demonstrated stable results across splits, particularly for screw segmentation. U-net and Attention U-net performed comparably for spinal canal and screw-head segmentation in the first split but showed reduced performance in the second split. Qualitative assessment confirmed that all models were able to identify key anatomical structures and implants, although metal artifacts affected performance. As a feasibility demonstration, the study showed that DeepLabv3+ and YOLOv8 provided the most consistent results, indicating that robust automated screw–canal assessment is achievable even with limited clinical data.

Background: Renal Cell Carcinoma (RCC) represents about 2% of all cancers in Sweden. While RCC is known for its potential to metastasize to the skeleton, few studies have examined the risk factors for pathological fractures and their impact on survival. The Fuhrman grade and AJCC staging systems are commonly used to assess disease aggressiveness, but their relationship to fracture risk and post-fracture outcomes remains unclear.

Methods: This study cross-linked data from the Swedish Fracture Register (SFR) and the Swedish Renal Cancer Register (SNR) to identify RCC patients with pathological fractures. Fracture characteristics, cancer staging (Fuhrman, TNM, AJCC), and histological subtypes were analysed. Survival was estimated using the Kaplan-Meier method.

Results: One hundred four RCC patients (72 men, 32 women) with pathological fractures were included, with clear cell carcinoma being most common (n = 93). Fuhrman grade 3 (n = 34) and fractures in the femur (n = 44) and humerus (n = 37) predominated. Median time from cancer diagnosis to fracture was 11 months. Higher Fuhrman grade, TNM, and AJCC stages were significantly associated with shorter time to fracture (p < 0.001). The median overall survival was 31 months and was related to Fuhrman grade (p = 0.013) and AJCC stage (p < 0.001). The median survival post-fracture was 8 months, with no significant association with cancer grade or stage.

Conclusion: Advanced Fuhrman grade and AJCC stage predict faster progression to pathological fractures in RCC. Given the poor prognosis after pathological fractures, early risk stratification and individualized treatment approaches are essential to improve outcomes.

Purpose. To quantify the risk of clinically overt venous thromboembolism (VTE) and major bleeding (MB) during the first year following surgery for lumbar spinal stenosis (LSS) relative to a matched population cohort.

Methods: This nationwide, retrospective cohort study utilized data from the Swedish National Spine Register (Swespine), including 77,145 patients who underwent surgical treatment for LSS between 2003 and 2023. These patients were matched 1:5 to 385,388 referents from the general population. Outcomes (VTE and MB) were identified through cross-linkage with the National Patient Register (NPR) and the Swedish Stroke Register (Riksstroke). Adjusted Cox piecewise regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for VTE and MB across prespecified postoperative intervals.

Results: Within the first 30 days after inclusion, patients exhibited substantially higher incidence rates of venous thromboembolism (VTE) and major bleeding (MB) compared with referents. The incidence rate of VTE was 30.39 per 1,000 person-years among patients versus 8.14 among referents, while the corresponding rates for MB were 88.78 and 31.87 per 1,000 person-years, respectively. Compared with referents, patients had a HR of 3.68 (95% CI, 3.05-4.44) for VTE and a HR of 2.52 (95% CI 2.27-2.80) for MB within the first 30 days after inclusion. The risk for VTE remained elevated through the 31–60-day interval (HR 2.09; 95% CI, 1.63-2.69), whereas the risk for MB declined sharply after the first month (HR 1.02; 95% CI 0.87-1.21).

Conclusion: Patients undergoing surgery for LSS face a significantly higher risk for VTE and MB compared to a matched population. This hazard was most acute during the first 30 postoperative days. While these risks decline sharply thereafter, the risk of VTE remains significantly elevated during the first 2 months following LSS surgery.

INTRODUCTION: Pain, comprising sensory and emotional elements, is influenced by pain catastrophizing, which magnifies pain and promotes helplessness and rumination. This study explores the relationship between pain catastrophizing and outcomes following selective nerve root blockade (SNRB) in patients with lumbar radicular pain (LRP).

METHODS: A prospective cohort study of 103 LRP patients, confirmed by MRI, was conducted. All participants underwent SNRB at Umeå University Hospital. Outcomes were measured using PROMIS-29 and the Pain Catastrophizing Scale (PCS) at baseline and several intervals up to 84 days post-intervention. Patients were categorized into responder (≥30% pain reduction) and non-responder groups and stratified into three groups based on baseline PCS scores. Changes in outcomes from baseline to 14 days post-SNRB were analyzed in relation to PCS groups. PCS changes over time were evaluated between responders and non-responders. Statistical analyses assessed PCS and outcome changes.

RESULTS: Baseline pain catastrophizing was not a significant predictor of pain response to SNRB. However, responders demonstrated significant reductions in pain catastrophizing following the intervention, suggesting that SNRB may influence cognitive coping mechanisms related to pain.

CONCLUSION: SNRB reduces pain catastrophizing in LRP patients, although baseline catastrophizing does not predict pain outcomes. Addressing catastrophizing remains important but may serve better as an outcome measure rather than a predictor of treatment response.

Coffin-Lowry syndrome (CLS) is a rare X-linked disorder marked by intellectual disability, craniofacial and skeletal anomalies, and progressive spinal deformities like scoliosis and hyperlordosis. Corrective posterior spinal fusion (PSF) surgery is often required. Mesocardia, a congenital anomaly where the heart is positioned centrally in the thorax, may affect perioperative hemodynamics, particularly in the prone surgical position. This report presents a case illustrating the perioperative challenges of PSF in a patient with both CLS and mesocardia.

A 17-year-old male with CLS, mesocardia, and severe scoliosis underwent PSF (T2-S2). During prone positioning, the patient experienced a gradual hemodynamic collapse, characterized by a decrease in oxygen saturation and a marked drop in both pulse rate and blood pressure. Repositioning to the supine position led to immediate recovery. Imaging ruled out pulmonary or vascular obstruction, pneumothorax, and embolism. The event was attributed to mechanical cardiac compression related to syndromic soft tissue laxity, thoracic deformity, mesocardia, and posterior soft-tissue release. Surgery was completed using a modified lateral oblique prone position, maintaining hemodynamic stability.

This case illustrates the importance of anticipating cardiopulmonary compromise due to anatomical and positional factors and that personalized surgical planning and modified positioning can be crucial in complex spinal deformity surgery in syndromic patients with thoracic abnormalities.

Study design: A prospective cohort study.

Objective: The aim was to investigate changes in lumbar lordosis (LL) and its association to changes in patient reported outcome measures (PROMs) after decompressive surgery for lumbar spinal stenosis (LSS).

Summary of background: Few studies have addressed change in LL after decompression surgery for LSS in relation to outcomes.

Method: Pre- and postoperative data from 310 patients having standing x-ray both before and 2 years after surgery were included. The patients were grouped based on the change in LL preoperatively to 2 years after surgery; group 1: <5 degrees (n=196), group 2: ≥5 <10 degrees (n=55) or group 3: ≥10 degrees (n=59) of change in LL. The changes in function, disability and pain were assessed by the Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), and the Zurich claudication questionnaire (ZCQ). The three groups were compared regarding baseline variables using the ANOVA test for continuous variables and the chi-square test for categorical variables. The groups were further compared with a likelihood ratio test in relation to changes in PROMs 2 year after surgery and outcomes were adjusted for respective baseline PROMs, age, sex, smoking, BMI, Schizas and Pfirrmann scores.

Results: LL was significantly changed at group level 2 years after surgery with a mean difference of 2.2 (SD 9.4) degrees (P=0.001). The three LL change groups did not show any significant differences in patient characteristics, function, disability, and pain at baseline. The two groups with a change of more than 5 degrees in LL 2 year after surgery (group 2 and 3) had significantly greater improvements in ODI (P=0.022) and ZCQ function (P=0.016) in the adjusted analyses, but was not significant for back and leg pain

Conclusion: Changed LL after decompressive surgery for LSS was associated with improved ODI and physical function.