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Key Takeaways *  Nomenclature Shift:  BMLs are not "edema" (fluid); they are active lesions of fibrosis, microfracture, and necrosis.  *  Predictive Power:  Progressive BMLs carry a  threefold higher risk  of rapid radiographic OA onset (Moradi et al., 2024).  *  The Spine Connection:  In the vertebral column, these lesions are clinically recognized as  Modic Changes , sharing the same inflammatory pathology as knee BMLs.  *  Therapeutic Target:  Long-term data suggest subcho

Preoperative spine planning is now exacting: Pelvic incidence is measured to a degree. Instrumentation is templated to the millimeter. Yet one variable that directly impacts fusion success is still often left to intraoperative judgment: 𝗕𝗼𝗻𝗲 𝗴𝗿𝗮𝗳𝘁 𝘃𝗼𝗹𝘂𝗺𝗲. A recent study in the European Spine Journal makes a compelling case that deserves more attention. 𝗗𝗲𝗳𝗼𝗿𝗺𝗶𝘁𝘆 𝗦𝘂𝗿𝗴𝗲𝗿𝘆 𝗮𝘀 𝗮 “𝗦𝘁𝗿𝗲𝘀𝘀 𝗧𝗲𝘀𝘁” 𝗳𝗼𝗿 𝗙𝘂𝘀𝗶𝗼𝗻 𝗕𝗶𝗼𝗹𝗼𝗴𝘆 Kazarian

Every surgeon has seen it: the first 1–2 mL of aspirate is thick and cellular... and everything after that becomes progressively thinner until it looks like pure venous blood. If the marrow cavity is “full of marrow,” why does peripheral blood replace it so quickly? The answer lies in marrow structure, pressure physiology, and fluid dynamics. 𝗠𝗮𝗿𝗿𝗼𝘄 𝗦𝘁𝗿𝗼𝗺𝗮 𝗜𝘀 𝗮 𝗦𝘁𝗿𝘂𝗰𝘁𝘂𝗿𝗲, 𝗡𝗼𝘁 𝗮 𝗟𝗶𝗾𝘂𝗶𝗱 The marrow cavity is not a fluid-filled space—it’s a semi-