3 stories this morning, for surgeons and the people who support them.
- AMA CPT Editorial Panel votes a Category I code for posterior vertebral column arthroplasty, covering Premia Spine's TOPS facet replacement, effective January 1, 2028 — Premia Spine announced Oct 1, 2026 that the AMA CPT Editorial Panel voted to establish a Category I CPT code for posterior vertebral column arthroplasty, effective Jan 1, 2028; until then the procedure is reported with Category III code 0202T. TOPS received FDA PMA in June 2023 with a superiority claim over TLIF for grade 1 degenerative spondylolisthesis with stenosis (two-year overall clinical success 77% vs 24%). Second source: https://orthotw.com/2026/10/ama-cpt-editorial-panel-votes-to-establish-a-category-i-cpt-code-for-posterior-vertebral-column-arthroplasty (quotes from CEO Ron Sacher and VP Reimbursement Jeff Withrow). 0202T current coding per Premia's physician coding guide, https://premiaspine.com/wp-content/uploads/2024/07/TOPS-System-Physician-Coding-Quick-Reference.pdf. No prior Morning Brief coverage of Premia/TOPS (grep of all drafts). Source
- J Neurosurg Spine, Washington State Spine COAP registry: intrawound antibiotics not associated with fewer surgical site infections across 24,015 instrumented spine cases — Laynes et al., J Neurosurg Spine, online Oct 2, 2026 (doi 10.3171/2026.4.SPINE251431). Retrospective cohort of prospectively collected Spine COAP data, adult instrumented cervical or lumbar surgery July 2011 to January 2024: 256 of 24,015 (1.1%) developed SSI. Intrawound antibiotic use RR 0.90 (95% CI 0.70-1.16) univariate and not an independent predictor after adjustment. Independent predictors: open approach RR 4.94 (2.26-10.79), lumbar procedures RR 2.33 (1.45-3.75); higher serum albumin protective RR 0.35 (0.24-0.51). Observational; agent and dose not specified in the abstract. Related prior coverage: OTA 2026 local tobramycin RCT on the 2026-09-30 episode. Source
- CORR target trial emulation of 4,564 Japanese periprosthetic hip fractures: no clear 30- or 90-day mortality difference between surgery within two days and surgery on days three to ten — Yoshiyama T, Fukasawa T, Anno T, Masuda S, Matsuda S, Kawakami K (Kyoto University). Does Early Surgery Reduce Mortality Compared With Delayed Surgery Among Patients With Periprosthetic Hip Fracture? A Target Trial Emulation. Clin Orthop Relat Res, online ahead of print Oct 1, 2026. doi 10.1097/CORR.0000000000004146; PMID 42821763; Level III therapeutic. Source verification (2026-10-04): every spoken figure checked against the published abstract retrieved via NCBI E-utilities (https://eutils.ncbi.nlm.nih.gov/entrez/eutils/efetch.fcgi?db=pubmed&id=42821763&rettype=abstract&retmode=text); title, authors, journal and online date confirmed via Crossref (https://api.crossref.org/works/10.1097/CORR.0000000000004146). Full text not accessed; narration limited to what the abstract states. Japanese hospital administrative database 2014-2024; 4,626 potentially eligible, 62 excluded, 4,564 eligible; mean age 84, 80% female. Clone-censor-weight emulation: early = surgery within 2 days of admission, delayed = days 3-10; clones censored for nonadherence, inverse probability weighting for artificial censoring and loss to follow-up; 95% CIs from 500 bootstraps. 30-day mortality 1.72% early vs 0.83% delayed (RD 0.89%, 95% CI -0.32% to 1.72%; RR 2.06, 0.64-3.73), 'no clear evidence of a difference, although the estimates were higher under the early strategy'. 90-day 2.35% vs 2.31% (RD 0.04%, -1.08% to 1.24%; RR 1.01, 0.59-1.68), near the null. Conventional analysis by observed timing gave lower 30-day estimates (1.10% vs 0.48%), attributed to immortal time and selection on eventual surgery. Authors' conclusion: findings do not support assuming the 48-hour native hip fracture standard applies to periprosthetic fractures solely to reduce short-term mortality; surgeons may consider time for medical stabilization and operative planning, but findings do not justify avoidable delay because other outcomes were not evaluated; future studies should incorporate fracture severity, operative complexity and surgical resources and evaluate complications, reoperation and functional recovery. No conflicts declared. Source
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