Spine

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-

A new study from the Rizzoli Orthopedic Institute (Life Sciences, 2025) takes a closer look at 𝘃𝗲𝗿𝘁𝗲𝗯𝗿𝗮𝗹 𝗯𝗼𝗻𝗲 𝗺𝗮𝗿𝗿𝗼𝘄 𝗮𝘀𝗽𝗶𝗿𝗮𝘁𝗲 (𝘃𝗕𝗠𝗔) 𝗰𝗹𝗼𝘁𝘀 harvested during pedicle screw prep. While this is not a comparative trial, the findings raise several interesting possibilities for spine surgeons to consider. 𝟭. 𝗩𝗲𝗿𝘁𝗲𝗯𝗿𝗮𝗹 𝗺𝗮𝗿𝗿𝗼𝘄 𝗮𝘀 𝗮𝗻 𝘂𝗻𝗱𝗲𝗿𝘂𝘀𝗲𝗱 𝗯𝗶𝗼𝗹𝗼𝗴𝗶𝗰 𝘀𝗼𝘂𝗿𝗰𝗲 The authors harvested marrow directly from the ve

If you’ve been around orthobiologics, you’ve heard of 𝗜𝗥𝗔𝗣 — 𝗜𝗻𝘁𝗲𝗿𝗹𝗲𝘂𝗸𝗶𝗻-𝟭 𝗥𝗲𝗰𝗲𝗽𝘁𝗼𝗿 𝗔𝗻𝘁𝗮𝗴𝗼𝗻𝗶𝘀𝘁 𝗣𝗿𝗼𝘁𝗲𝗶𝗻. Its job: block 𝗜𝗟-𝟭, the cytokine that drives joint inflammation and cartilage loss. When IL-1 is blocked by 𝗜𝗟-𝟭𝗥𝗮, inflammation cools — often dramatically. 𝗪𝗵𝗲𝗿𝗲 𝗜𝘁 𝗦𝘁𝗮𝗿𝘁𝗲𝗱 In the early 2000s, 𝗗𝗿. 𝗣𝗲𝘁𝗲𝗿 𝗪𝗲𝗵𝗹𝗶𝗻𝗴 (Germany) discovered that incubating blood with treated glass beads triggered white ce

A recent Spine Journal study comparing expandable vs. static TLIF cages caught my attention ( https://pubmed.ncbi.nlm.nih.gov/39349256/...

In the dynamic world of spinal fusion surgery,  Bone Marrow Aspirate (BMA)  stands as a foundational therapy. For years, the prevailing...