Use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is increasing among patients presenting for spine surgery, but their perioperative safety and impact on surgical outcomes, particularly pseudoarthrosis, remain uncertain. We conducted a PRISMA-compliant systematic review and meta-analysis (PROSPERO CRD420251111692) of comparative studies enrolling adults undergoing any spine surgery, comparing perioperative GLP-1 RA use with no GLP-1 RA. PubMed, Embase, Web of Science, and EBSCO were searched through August 1, 2025. Two reviewers independently screened, extracted data, and assessed risk of bias with ROBINS-I. Random-effects models were used for dichotomous outcomes, reported as odds ratios (OR) with 95% confidence intervals (CI). Meta-analyses were performed when at least 3 studies reported a given outcome, and outlier studies were excluded from sensitivity analyses. Thirteen retrospective cohort studies were included. Across cohorts, baseline characteristics were broadly similar between GLP-1 users (n = 13,754) and controls (n = 17,591): weighted mean age approximately 61 years, weighted mean BMI in the low-to-mid 30 s, and high prevalence of type 2 diabetes and hypertension. Seven studies evaluating pseudarthrosis showed much heterogeneity, but there was a lower risk with GLP-1 RA use (OR 0.74; 95% CI: 0.55–1.00; p = .049; I² = 91.7%). This finding was heterogeneous but represented sensitivity analysis (OR 0.64; 95% CI: 0.57–0.73; p < .001; I² = 45.3%). Pooled analyses found no significant differences for other surgical and nonsurgical outcome measures. There was a nonsignificant trend toward higher nerve injury with GLP-1 exposure (OR 1.57; 95% CI: 0.99–2.48; p = .056; I² = 42.4%). Heterogeneity varied by outcome and was highest for reoperation and utilization endpoints. In adults undergoing spine surgery, perioperative GLP-1 RA use appears safe and is associated with a nonrobust, lower risk of pseudarthrosis, with no consistent differences in infection, wound, neurologic, thromboembolic, pulmonary, or utilization outcomes. Given confounders and retrospective designs, prospective, agent-specific studies are needed to validate fusion benefits and refine perioperative management.

Background/Objectives: Degenerative lumbar spine disease (DLSD) is increasingly managed with minimally invasive surgery (MIS) and evolving anesthesia methods. While general anesthesia (GA) remains standard, spinal anesthesia (SA) may offer faster recovery and fewer side effects. This study compares the clinical and economic outcomes of GA versus SA in transforaminal lumbar interbody fusion (TLIF). Methods: A retrospective review of 18 TLIF patients (2018–2022) was performed, with 9 patients in each cohort. Patients were matched by demographics and procedure type. Data collected included operative time, blood loss, complications, postoperative opioid utilization, and 30-day readmissions. Costs were analyzed in categories: anesthesia, implants, inpatient care, operating room (OR) supplies, OR time, and PACU fees, using Wilcoxon Rank T-tests and Pearson Chi-Squared tests. Results: Clinical outcomes such as blood loss, and operative time were similar between groups. However, SA patients had significantly shorter LOS compared to GA (SA: 12 h vs. GA: 84 h, % difference: −150%, p = 0.04). Additionally, SA patients had lower total direct costs ($27,881.85 vs. $35,669.01; p = 0.027). Significant cost reductions with SA were noted in OR supplies/medications ($7367.93 vs. $10,879.46; p = 0.039) and inpatient costs ($621.65 vs. $3092.66; p = 0.027). Within these categories, reductions were observed for intravenous solutions, sedatives/anesthetics, pressure management, labs, imaging, evaluations, hospital care, and medications. Although costs for implants, anesthesia care, OR time, and PACU fees were lower with SA, these differences did not reach statistical significance. Conclusions: In TLIF for DLSD, SA provides significant economic advantages over GA while yielding comparable clinical outcomes. These results support SA as a cost-effective alternative, warranting further prospective studies to confirm these findings.

Human glioblastoma (GBM) is a remarkable example of a highly aggressive and untreatable tumor. A formidable challenge in treating GBM is its extensive intratumor heterogeneity, which traditional bulk tissue analysis fails to capture. Fluorescence-guided multiple sampling, utilizing 5-aminolevulinic acid for tumor visualization, offers objective tumor tissue identification and enhanced spatial resolution. In this study, we present a perspective on a novel “spatial-in-spatial” approach that enables comprehensive analysis of tumor areas and their microenvironment—at macroscopic and microscopic levels—by combining fluorescence-guided multiple sampling with spatial-omics technologies. This perspective discusses how this integrated methodology has the potential to advance our understanding of GBM biology through the high-resolution, multidimensional characterization of tumor heterogeneity and identification of novel, area-specific therapeutic targets.

INTRODUCTION: In Zimbabwe, pediatric neurosurgery encounters distinctive hurdles, primarily due to restricted access to specialized care and essential resources. Yet, within this challenging landscape, a culture of innovation perseveres, fueled by an unwavering dedication to providing exemplary patient care. This commitment underscores a relentless pursuit of improving patient outcomes and overall healthcare efficacy. METHODS: This study employed a mixed-methods approach to comprehensively assess the landscape of pediatric neurosurgical care in Zimbabwe. Qualitative methods included structured interviews with pediatric neurosurgeons, nurses, and administrators from major healthcare institutions, aiming to gather insights into daily challenges, innovative solutions, and perspectives on the current state and future prospects of pediatric neurosurgery. Additionally, focus group discussions with caregivers of pediatric neurosurgery patients provided valuable perspectives on their experiences accessing care and the quality of healthcare services received. Quantitative methods involved distributing surveys among pediatric neurosurgeons across various hospitals in Zimbabwe to quantify the prevalence of specific challenges, resource limitations, and utilization rates of innovative techniques or technologies. Data from these surveys were analyzed using descriptive statistics to identify common themes, trends, and disparities in pediatric neurosurgical care provision. RESULTS: Our findings revealed significant challenges within the pediatric neurosurgical care landscape in Zimbabwe, including limited access to specialized care due to regional disparities, shortages of essential medical supplies and personnel, and infrastructure deficiencies that contribute to treatment delays and poorer patient outcomes. Despite these challenges, the study also highlighted the resilience and innovative practices adopted by healthcare providers. Local adaptations and improvisations in surgical techniques and resource management demonstrated creative solutions to overcome limitations. CONCLUSIONS: Despite constrained access to specialized care and essential resources, a culture of innovation prevails, driven by an unwavering commitment to delivering exceptional patient care. Through our comprehensive assessment, we have identified key challenges and explored innovative practices that underscore the dedication of healthcare professionals in Zimbabwe. By extracting actionable insights from our findings, we aim to pave the way for future advancements in pediatric neurosurgery within the Zimbabwean healthcare system. As we continue to unravel challenges, innovate solutions, and enhance care, our collective efforts hold the promise of improving patient outcomes and healthcare efficacy for the pediatric neurosurgery landscape in Zimbabwe and beyond.