Journal of Personalized Medicine

Personalized treatment specifically tailored to the patient’s needs is nowadays a successful and necessary therapeutic approach [...]

Background/Objectives: Spinal decompression surgery shows variable outcomes, with reoperation rates up to 37.5%. Surgeons lack objective intraoperative tools to assess decompression adequacy. Mechanomyography (MMG) measures nerve excitability through mechanical muscle responses to electrical stimulation. While compressed nerves require higher stimulation thresholds, optimal quantification approaches remain undefined. We explored associations between intraoperative MMG threshold changes and six-week pain outcomes, comparing metrics anchored to a 2.0 mA reference threshold versus percentage-based measures. Methods: Prospective exploratory pilot study of 42 patients (112 nerves) undergoing lumbar or cervical decompression. MMG thresholds were recorded pre- and post-decompression. Numeric Pain Scale scores were obtained preoperatively and at six weeks. Three metrics were compared: percentage change, Threshold Reduction Ratio (TRR; measuring proportion of threshold elevation above 2.0 mA eliminated by decompression), and Threshold Excess (TE; residual threshold remaining above 2.0 mA), with TRR and TE anchored to 2.0 mA based on published normal ranges. Results: Among 40 patients with baseline pain, threshold-anchored metrics showed substantially stronger correlations with pain improvement than percentage-based measures (TRR: r = 0.656, p < 0.001 vs. percentage: r = 0.397, p = 0.011). Threshold Excess was associated with a linear dose–response: each 1 mA above 2.0 mA corresponded to 6.3% less pain improvement (p = 0.001). Patients achieving ≤2.0 mA had 6.1-fold increased odds of complete pain relief versus those above 2.0 mA (76.5% vs. 34.8%, p = 0.013). Internal leave-one-out cross-validation suggested internal stability (TRR shrinkage ≈ 9.3%; TE’s dose–response slope remained stable). Conclusions: In this exploratory pilot study, threshold-anchored MMG metrics (TRR and TE) showed stronger correlations with early pain outcomes than percentage-based measures. These exploratory findings require external validation in independent cohorts before clinical implementation. If validated prospectively, these metrics could provide objective, real-time feedback for clinical interpretation to inform surgical decision-making during spinal decompression, enabling surgeons to tailor decompression to individual physiology rather than relying on standardized anatomical criteria. Future work should explore patient-specific threshold targets that account for age, chronicity, and comorbidities.

Background: Osteoporosis is a prevalent metabolic disorder frequently managed with bisphosphonates, which reduce fracture risk but, with prolonged use, may predispose to atypical femoral fractures (AFFs). These rare but serious complications highlight the need for individualized treatment strategies within the framework of precision medicine. Methods: We retrospectively analyzed six female patients (mean age around 70 years) with AFFs surgically treated at the University of Catania between September 2022 and March 2023. All patients had received bisphosphonate therapy for more than seven years. Demographic, clinical, and radiographic data were collected according to ASBMR criteria. Outcomes included fracture healing, hip and knee range of motion, quality of life (SF-36), and residual pain (VAS) at 12 months. Results: Fractures were subtrochanteric in two cases and mid-diaphyseal in four. All patients underwent intramedullary nailing. Mean radiographic union occurred at 5 ± 1.5 months, and functional recovery occurred at 4.5 ± 1.2 months. Quality of life declined from a pre-fracture SF-36 score of 77 to 57 at one year. Residual pain was minimal (VAS 2). Conclusions: Prolonged bisphosphonate therapy was strongly associated with AFFs, longer healing times, and reduced quality of life. These findings emphasize the importance of personalized management of osteoporosis, including risk-based treatment duration, tailored monitoring protocols, and early therapeutic adjustments to balance efficacy and safety in long-term care.