Search Results (342)

Background and Objectives: Older patients with lumbar spinal stenosis often have comorbidities and limited physiological reserve that complicate conventional decompression under general anesthesia. This study aimed to evaluate the surgical technique and preliminary 1-year clinical outcomes of full-endoscopic unilateral laminotomy for bilateral decompression (FE-ULBD) performed under surgeon-directed local anesthesia. Materials and Methods: This retrospective cohort study included 24 consecutive patients aged ≥75 years who underwent FE-ULBD under surgeon-directed local anesthesia for symptomatic central lumbar spinal stenosis between March 2024 and April 2025. Clinical outcomes were evaluated using the visual analog scale (VAS) for leg pain, Oswestry Disability Index (ODI), and modified MacNab criteria. Additionally, perioperative outcomes and complications were analyzed. Results: The mean age of patients was 80.5 ± 3.8 years. The mean VAS scores improved from 8.46 ± 0.72 preoperatively to 2.08 ± 0.83 at 12 months, while ODI scores improved from 68.83% ± 8.07% to 18.34% ± 13.74% (both p < 0.001). Of the 24 patients, 21 (87.5%) achieved excellent or good outcomes. Procedure-related complications included an incidental dural tear in one patient (4.2%) and transient postoperative dysesthesia in 4 patients (16.7%). No major anesthesia-related complications or revision surgeries were observed. Conclusions: FE-ULBD under surgeon-directed local anesthesia was feasible and associated with improvements in pain and function at 12 months in carefully selected older patients. These preliminary findings warrant confirmation in larger prospective studies with a comparator cohort of older patients receiving general anesthesia. Full article

Degenerative lumbar disorders are commonly treated with lumbar interbody fusion, but comparative evidence among ALIF, OLIF, and XLIF remains limited. This prospective multicenter observational cohort study compared perioperative outcomes, complications, and patient-reported outcomes (PROMs) after single- or multi-level ALIF, OLIF, or XLIF in 242 consecutive adults (108, 75, and 59, respectively) treated at Spanish centers. Age and surgical indications differed significantly across groups (p < 0.05), reflecting indication-based approach selection. Primary outcomes were intra- and postoperative complications through 6 months; secondary outcomes included operative time, blood loss, visual analog scale (VAS) pain scores, and the Oswestry Disability Index (ODI). XLIF had the shortest operative time (median, 63 min) and lowest blood loss. Overall intra- and postoperative complication rates were 3.3% and 7.8%, with no significant overall differences among techniques, although patterns differed: vascular injuries were associated with ALIF, cage subsidence was more frequent after XLIF, neurological deficits occurred with similar frequency in the XLIF and OLIF groups, and OLIF had the lowest intraoperative rate. All groups showed significant VAS and ODI improvements, with greater 6-month gains after ALIF and OLIF than after XLIF. These approaches are effective but have distinct risk–benefit profiles, supporting individualized selection. Full article

Background: Herniated intervertebral disc (HIVD) with radiculopathy and foot drop can lead to substantial functional impairment. Although both pharmacopuncture and motion-style acupuncture treatment (MSAT) have demonstrated therapeutic potential individually, evidence on their combined use remains limited. In this single-case report, we described the clinical course of a patient with HIVD with radiculopathy and foot drop who underwent a novel approach combining ultrasound (US)-guided Shinbaro 2 pharmacopuncture targeting multiple nerve roots with tibialis anterior muscle motion-style acupuncture treatment (TA MSAT). Case Presentation: A 40-year-old man with lower back pain (LBP), radiculopathy, and foot drop attributed to acute HIVD was treated with high-dose US-guided Shinbaro 2 pharmacopuncture and TA MSAT. Outcomes were measured using the Numeric Rating Scale (NRS) for LBP, L5, and S1 radiculopathy; Manual Muscle Testing (MMT) for dorsiflexion and great toe extension; the Oswestry Disability Index (ODI) for lumbar function; the EuroQol Five-Dimension (EQ-5D) Index for quality of life; and the Patient Global Impression of Change (PGIC) for satisfaction. After 14 weeks of treatment, NRS scores for LBP, L5, and S1 radiculopathy decreased from 5 to 1, 8 to 1, and 8 to 1, respectively. MMT grades for dorsiflexion and great toe extension improved from 3 to 5 and 2 to 5, respectively, indicating full functional recovery. ODI and EQ-5D scores improved from 62.22 to 6.67 and 0.344 to 1.0, respectively. The PGIC score was 1, indicating clinical improvement. Conclusions: Our integrative approach involving US-guided pharmacopuncture and TA MSAT demonstrates therapeutic potential for the management of acute HIVD. Full article

Background/Objectives: Non-specific chronic low back pain is a prevalent musculoskeletal disorder that impairs flexibility, sleep quality, functional capacity, and quality of life. Conservative treatments such as Kinesio taping and foam roller exercises are widely used, yet comparative evidence remains limited. This study aimed to compare their effects on pain, disability, flexibility, sleep quality, and kinesiophobia in individuals with non-specific chronic low back pain. Methods: Sixty patients were randomly assigned to Kinesio taping or foam roller groups. The Kinesio taping group received lumbar taping twice weekly, while the foam roller group performed foam roller exercises for 5 min per session over a 6-week intervention period. Outcomes included the Visual Analogue Scale, Oswestry Disability Index, Pressure Pain Threshold, Pittsburgh Sleep Quality Index, Schober Test, Tampa Scale for Kinesiophobia, and Fingertip-to-Floor Distance. Results: Both groups showed significant improvements in pain intensity, disability, pressure pain threshold, and flexibility (p < 0.001). Sleep quality (p = 0.012) and kinesiophobia (p = 0.003) improved significantly only in the Kinesio taping group. Between-group comparisons showed lower post-treatment pain intensity in the foam roller group (p = 0.015) and lower kinesiophobia in the Kinesio taping group (p = 0.009). The between-group mean difference in pain change was −0.86 cm (95% CI: −1.57 to −0.15). No significant between-group differences were observed for the other outcomes. Conclusions: Both interventions improved pain and physical outcomes, with different response patterns. Foam roller showed more favorable findings for pain intensity, whereas Kinesio taping showed more favorable findings for kinesiophobia, with no between-group difference in sleep quality. Full article

Background/Objectives: Low-back pain (LBP) is a common musculoskeletal disorder, with a lifetime prevalence reported to be as high as 84%. Chuna manipulative therapy (CMT), a Korean style of manual therapy for correcting joint misalignment, has rarely been evaluated in randomized controlled trials (RCTs). This study primarily aimed to evaluate the feasibility of a future large-scale, multicenter RCT comparing thrust and non-thrust CMT; preliminary clinical and safety data were collected as secondary, exploratory objectives. Methods: This multicenter, assessor-blinded pilot RCT randomized 30 participants with non-acute LBP and pelvic deviation into thrust (n = 15) or non-thrust (n = 15) CMT groups for a 4-week treatment. Feasibility outcomes (eligibility, recruitment, adherence, retention, data completeness, and treatment fidelity) were the primary endpoints. Preliminary clinical effects (Numeric Rating Scale (NRS), Oswestry Disability Index (ODI)) and adverse events were assessed over 24 weeks as exploratory outcomes. Results: Of the 35 screened, 30 (85.7%) were randomized, and the planned 15 per center was achieved at both sites. Twenty-nine (96.7%) received at least the minimum number of sessions and were retained to week 24, with complete outcome data and no protocol deviations in intervention delivery. In exploratory analyses, both groups improved from baseline and between-group differences favored thrust CMT, but as the trial was not powered to compare effectiveness, these findings are preliminary only. Nine mild adverse events resolved spontaneously. Conclusions: A large-scale, multicenter RCT comparing thrust and non-thrust CMT in pelvic deviation is feasible. The observed feasibility outcomes can inform its progression criteria, whereas the exploratory clinical findings require confirmation in an adequately powered definitive trial. Full article

Background/Objectives: Andersson lesions are uncommon discovertebral complications of ankylosing spondylitis and may be overlooked when a new mechanical pain pattern is attributed to chronic inflammatory disease. This report describes the diagnostic reasoning, operative decision-making, and short-term outcome of a severe lumbar lesion with three-column instability. Methods: A 38-year-old woman with a 15-year history of ankylosing spondylitis presented with progressive low-back pain, left L5 radiculopathy, and marked functional decline without major trauma. Radiographs, computed tomography, and magnetic resonance imaging were used to characterize the lesion and assess spinal instability and neural compression. A Cawley type E Andersson lesion at L4/5 with severe three-column instability was diagnosed. The patient underwent single-stage posterior–anterior circumferential reconstruction consisting of L4/5 decompression, long-segment L2-S2 fixation, anterior debridement, and tricortical iliac crest grafting. Results: A postoperative gastrocnemius intramuscular venous thrombosis was detected and treated with anticoagulation. At 3 months, the activity-related visual analog scale score improved from 8 to 1, the Oswestry Disability Index improved from 68% to 18%, independent ambulation was restored, and imaging showed stable instrumentation with progressive osseous bridging. At the latest 9-month telephone follow-up, the patient reported maintained pain relief, mobility, and daily function; no new imaging was available. Conclusions: A change from inflammatory to mechanical pain or the development of neurologic findings in ankylosing spondylitis should prompt targeted imaging for an Andersson lesion. In carefully selected patients with severe three-column instability and substantial anterior column deficiency, circumferential reconstruction may provide effective short-term stabilization and functional recovery. Because radiographic follow-up was limited to 3 months, definitive fusion and long-term construct durability cannot be established. Full article

Background and Objectives: Unilateral biportal endoscopic (UBE) decompression has become an increasingly popular minimally invasive technique for the treatment of lumbar spinal stenosis. Although irrigation management is a critical component of this procedure that may influence operative efficiency and irrigation-related complications, comparative evidence regarding irrigation systems remains limited. Therefore, this study aimed to compare gravity-based and pump-assisted irrigation systems in patients undergoing UBE decompression for lumbar spinal stenosis with respect to clinical and functional outcomes, operative efficiency, and complication rates. Materials and Methods: This retrospective study included 107 patients who underwent single-level UBE decompression for lumbar spinal stenosis between 1 June 2023 and 1 January 2026. Patients were allocated to either the gravity-based (n = 51) or pump-assisted (n = 56) irrigation group according to the availability of the pump-assisted irrigation device at the time of surgery. Pain and functional outcomes were evaluated using the Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI). Operative time, bleeding control time, and perioperative complications were compared between the groups. A mixed-design ANCOVA was used to analyze the changes in clinical outcomes over time. Multivariable linear and logistic regression analyses were performed to identify the independent factors associated with operative time and complications. Results: Significant improvements in the NRS and ODI scores were observed in both groups during follow-up (time effect, p < 0.001 for both), with no significant differences between the irrigation methods (group effect, p > 0.05). Operative and bleeding control times were significantly shorter in the pump-assisted irrigation group (both p < 0.001). Multivariable linear regression analysis demonstrated that pump-assisted irrigation independently reduced operative time by approximately 8 min (p < 0.001), whereas bilateral decompression independently increased operative time by approximately 24.5 min (p < 0.001). Although the overall complication rate was lower in the pump-assisted irrigation group (12.5% vs. 27.5%), the difference was not statistically significant (p = 0.052). Multivariable logistic regression analysis also demonstrated a trend toward a lower risk of complications with pump-assisted irrigation (OR = 0.408, p = 0.096). Conclusions: Pump-assisted irrigation improved operative efficiency by reducing operative and bleeding control times while providing clinical and functional outcomes comparable to those of gravity-based irrigations. Although the reduction in complication rates did not reach statistical significance, pump-assisted irrigation may represent an effective irrigation strategy that improves operative efficiency and may contribute to surgical safety in UBE decompression surgery. Full article

Background/Objectives: Biportal endoscopic (BE) surgery is increasingly used for transforaminal lumbar interbody fusion (TLIF), but its hemodynamic profile and early recovery in two-level fusion remain undefined relative to tubular minimally invasive surgery (MIS) and open approaches. We compared the hemodynamic burden and early functional recovery among BE-, MIS-, and open two-level TLIF. Methods: In this retrospective single-center study of three sequential, non-contemporaneous cohorts, 96 patients undergoing two-level (L2–S1) TLIF (BE, n = 22; MIS, n = 39; open, n = 35) were analyzed. The single primary endpoint was transfusion-corrected total blood loss (corrected TBL), derived from hematocrit changes. Secondary endpoints were intraoperative estimated blood loss (EBL), drainage, allogeneic transfusion, hidden blood loss (HBL), complications, and the Numeric Rating Scale(NRS), Oswestry Disability Index (ODI), and Functional Rating Index (FRI) at 3 months. Effect sizes with 95% confidence intervals (CIs) are reported alongside p-values. Results: Corrected TBL was highest in open TLIF (2.07 ± 0.86 L) versus BE-TLIF (1.36 ± 0.54 L; mean difference −0.71 L, 95% CI −1.09 to −0.34) and MIS-TLIF (1.53 ± 0.50 L; −0.55 L, −0.88 to −0.21), whereas BE- and MIS-TLIF were comparable (−0.17 L, −0.45 to 0.12). Transfusion was required in 13.6%, 20.5%, and 60.0%, respectively (p < 0.001), with no difference between the minimally invasive groups. Intraoperative EBL was lower in BE-TLIF than in MIS-TLIF (−226.8 mL, −395.3 to −58.2). HBL was lowest in open TLIF (p = 0.030), reflecting its far larger drainage volume. At 3 months, BE-TLIF showed greater FRI improvement than MIS-TLIF (−3.97, −7.04 to −0.90); for ODI, BE-TLIF exceeded open TLIF but not MIS-TLIF. Wound problems (11.4%) and delirium (22.9%) occurred only or most often after open TLIF. Conclusions: In two-level fusion, BE-TLIF was associated with a lower overall hemodynamic burden and transfusion requirement than open TLIF, while corrected TBL was comparable between BE- and MIS-TLIF. Given the non-contemporaneous cohorts, baseline imbalances, limited sample size, and potential residual confounding, these findings should be considered hypothesis-generating and require confirmation in prospective or contemporaneously controlled studies. Full article

Introduction: Degenerative lumbar kyphosis (DLK) is a common cause of sagittal imbalance, pain, and functional disability. While three-column osteotomies provide powerful correction, they are associated with substantial morbidity. We evaluated the radiographic and clinical outcomes of a novel posterior-based correction strategy combining Posterior Interpedicular Osteotomy (PIO), bilateral discectomy, and hyperlordotic transforaminal lumbar interbody fusion (TLIF) in patients with DLK. Materials and Methods: A retrospective single-center case series was conducted including 215 consecutive patients with symptomatic DLK and pelvic incidence–lumbar lordosis (PI–LL) mismatch >10° treated between 2019 and 2023. All patients underwent PIO combined with bilateral discectomy and insertion of a 20° hyperlordotic TLIF cage. Radiographic parameters, including lumbar lordosis (LL), pelvic tilt (PT), and sacral slope (SS), were assessed preoperatively and up to 24 months postoperatively. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36). Complications were systematically recorded. Results: Mean lumbar lordosis improved from 15.7° ± 8.3° preoperatively to 45.4° ± 11.6° at 24 months, corresponding to a mean correction of 29.7° ± 10.1° and 12.4° ± 2.9° per treated level (p < 0.001). Significant improvements were observed in PT, SS, VAS, ODI, and SF-36 scores (all p < 0.001), with maintenance of correction throughout follow-up. Mean operative time was 218.4 ± 47.3 min and mean blood loss was 483.2 ± 195.7 mL. The overall complication rate was 16.3%, with incidental durotomy being the most common event (14.9%). No cases of cage migration, deep infection, neurological deterioration, or radiographic pseudarthrosis were identified among patients who underwent CT evaluation. Conclusions: PIO combined with bilateral discectomy and hyperlordotic TLIF achieved substantial and durable sagittal correction with significant clinical improvement and an acceptable safety profile. By combining extensive posterior release with preservation of the anterior tension band, this technique may represent an effective intermediate alternative between conventional posterior column osteotomies and more invasive three-column deformity correction procedures. Full article

Background/Objectives: Chronic low back pain (CLBP) is the leading global cause of years lived with disability, but long-term real-world evidence for non-surgical management remains scarce, particularly in low- and middle-income countries. This study aimed to describe 5-year trajectories of pain, disability, healthcare utilization, patient satisfaction, and surgical conversion among patients with non-specific CLBP initially managed non-surgically at a tertiary spine center in Northwest China. We also compared long-term outcomes between unimodal therapy and multidisciplinary biopsychosocial care and examined baseline demographic, clinical, and psychosocial predictors of treatment success and conversion to surgery. Methods: We conducted a 5-year retrospective cohort study of consecutive patients with non-specific CLBP at a tertiary spine center in Northwest China. Of 485 consecutive patients screened for eligibility, 420 were enrolled and were compared on the basis of unimodal therapy with multidisciplinary biopsychosocial care. Primary outcomes were pain (Numerical Pain Rating Scale, NPRS) and disability (Oswestry Disability Index, ODI), analyzed using linear mixed-effects models; predictors of surgical conversion were identified via multivariable Cox regression. Results: Of the 420 patients, 352 (83.8% retention) completed the 5-year follow-up. Both pain and disability improved substantially during the first 12 months. Thereafter, pain intensity increased slightly (NPRS from 4.8 to 5.4), whereas functional disability continued to improve (ODI from 31.7 to 26.5). Early multidisciplinary care was associated with sustained superior outcomes (adjusted functional disability (ODI) difference: −8.2 points at 5 years) and a 42% lower observed risk of surgery (HR = 0.58). The cumulative 5-year surgical rate was 14.2%, with high pain catastrophizing as the strongest independent predictor (HR = 3.10). Conclusions: In patients with non-specific CLBP, non-surgical management yields substantial 12-month gains; function continues to improve through 5 years, while pain shows partial recurrence. Early multidisciplinary biopsychosocial care was associated with more durable outcomes and lower surgical conversion; because treatment was not randomized, these associations warrant confirmation in pragmatic trials and support routine psychosocial screening and stratified care. Full article

Background/Objectives: Low back pain (LBP) is a leading cause of disability worldwide, and exercise-based rehabilitation is recognized as an effective management strategy. However, adherence to exercise remains challenging. Fully immersive virtual reality (VR) exercise interventions may enhance engagement and clinical outcomes. This study aimed to examine the effect of a fully immersive VR exercise game on pain, fear-avoidance beliefs, and disability in individuals with chronic non-specific LBP. Methods: A single-blinded randomized controlled trial was conducted, involving 28 participants aged 18–60 years with chronic non-specific LBP. Participants were randomly allocated to either a VR exercise group with standard education (n = 14) or a conventional home exercise group with standard education (n = 14). Both groups performed their assigned intervention once per day for two weeks. Outcomes included the Fear-Avoidance Beliefs Questionnaire (FABQ), Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Back Beliefs Questionnaire (BBQ), and functional performance tests (six-minute walk test, repeated sit-to-stand, and trunk flexion). Measures were assessed at baseline and after a 2-week intervention period. Exercise adherence was recorded using a self-reported log. Results: No significant within- or between-group differences were observed for FABQ scores. However, a significant between-group difference was reported for pain reduction in the VR group (p = 0.044). No significant differences were reported for disability or belief-related outcomes, or for physical performance outcomes, including the 6 min walk test, repeated sit-to-stand test, and trunk flexion test. Conclusions: A fully immersive VR exercise intervention resulted in greater short-term pain reduction compared to conventional exercise in individuals with chronic non-specific LBP. However, it had little impact on fear-avoidance beliefs or disability, highlighting the need for multimodal approaches that address broader biopsychosocial factors. Full article

Background/Objectives: Total en bloc spondylectomy (TES) remains one of the most invasive and selectively used procedures in spine oncology. Its role has become more selective in the modern era of stereotactic body radiotherapy, separation surgery, targeted systemic therapy, immunotherapy, and multidisciplinary cancer care. This study evaluated long-term survival, imaging-defined systemic disease burden, operative morbidity, patient-reported outcomes, and frailty-related variables after TES in a rare single-center cohort, with the goal of identifying selection-relevant survival and treatment-burden signals rather than developing a validated decision algorithm. Methods: We performed a retrospective single-center cohort study of consecutive adults who underwent TES for spinal tumors between 2011 and 2022. Of the 36 screened patients, 30 had sufficient clinical and survival data for analysis; patients without reliable survival or last-contact data were not included. Contrast-enhanced CT and PET-CT were reviewed for extraspinal metastases, lymphadenopathy, pleural effusion, and soft-tissue extension. Survival was analyzed using Kaplan–Meier methods, log-rank testing, and exploratory univariate Cox regression. Patient-reported outcomes included the Oswestry Disability Index (ODI) and SF-36 when available; frailty was summarized with the modified frailty index-5 (mFI-5) when component data were present. Results: The cohort included 13 men and 17 women with a mean age of 54.8 ± 15.2 years. At final follow-up, 18 patients had died, and 12 were alive. Five-year overall survival was approximately 76% in the full cohort. Extraspinal metastases were present in 72.2% of deceased patients compared with 8.3% of survivors and showed the clearest exploratory association with increased mortality (HR 3.46, 95% CI 1.23–9.78; p = 0.019). Metastatic disease demonstrated inferior survival compared with primary bone or soft-tissue tumors. Perioperative blood loss and transfusion burden were substantial but were not associated with survival in univariate analysis. ODI and SF-36 data were available only in small subsets and were therefore interpreted as descriptive signals of treatment burden. Conclusions: TES remains relevant in modern spine oncology, but only as an increasingly selective intervention. In this rare cohort, systemic disease burden, particularly extraspinal metastases, was the clearest selection-relevant survival signal, while blood loss, transfusion requirements, complications, and limited patient-reported outcomes illustrated substantial treatment burden. These findings do not establish a validated selection algorithm but support a contemporary decision threshold that integrates tumor biology, systemic disease status, anticipated margins, physiologic reserve, operative morbidity, and patient goals. Full article

Background and Objectives: Fragility fractures of the sacrum are increasingly recognized in elderly osteoporotic patients and can cause persistent pain, immobility, and progressive pelvic ring instability. We previously described a modified S1 corridor targeting the higher-density cranial–ventral S1 vertebral body for safe percutaneous implant placement. This study reports the clinical outcomes of osteoporotic and pathologic sacral fractures treated through this corridor and presents an exploratory comparison of two 3D-printed titanium sacroiliac fusion implants: the triangular iFuse™ Implant System and the threaded iFuse TORQ™ (SI-BONE, Inc., Santa Clara, CA, USA). Materials and Methods: This retrospective single-center study analyzed 58 patients with fragility or pathologic sacral fractures (FFP IIIb–V; OF 2–5) treated via the modified S1 corridor between January 2021 and March 2026. Of these, 27 patients received triangular iFuse™ implants, and 31 patients received threaded iFuse TORQ™ implants. The primary outcome was procedural safety (implant revision, neurological injury, cortical breach). Secondary outcomes included the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) for pain, operative time, and need for additional fixation. Group comparisons used non-parametric tests; multivariable linear regression adjusted for age, fracture severity (OF classification), and additional fixation. Results: At a mean follow-up of 17.8 ± 9.1 months (iFuse) and 4.1 ± 2.1 months (TORQ), no implant revisions, clinically significant cortical breaches, or neurological injuries were observed in either group. Patient-reported outcome data were available for 48 of 58 patients (20 iFuse, 28 TORQ). Patients in the iFuse™ group were older (80.9 ± 8.5 vs. 76.0 ± 9.8 years; p = 0.050), and OF classification differed between groups, with a higher proportion of OF 4 fractures in the TORQ™ group (p = 0.003). After adjustment for age, OF classification, and additional fixation, TORQ™ implantation was associated with a 15.6-point lower postoperative ODI (p < 0.001), a 13.5-point greater ODI improvement (p < 0.001), a 0.94-point lower postoperative VAS (p = 0.006), and a 1.36-point greater VAS reduction (p < 0.001). Findings remained significant in a sensitivity analysis restricted to patients without additional fixation. Conclusions: Sacroiliac fusion via a modified density-oriented S1 corridor was safe for both large implant types, with no revisions in the analyzed cohort. In this retrospective, non-randomized cohort, threaded iFuse TORQ™ implants were associated with better patient-reported outcomes after adjustment for baseline imbalances. Because the groups were not randomized and follow-up duration differed substantially, these comparative findings are hypothesis-generating and require confirmation in prospective, controlled studies. Full article

Background: Chronic low back pain (CLBP) is a leading cause of global disability, linked to elevated IL-6 and vitamin D deficiency or insufficiency. While interferential current (IFC) therapy and exercise therapy are established treatments, their combined effect with vitamin D supplementation on inflammatory biomarkers, pain, and functional disability remains underexplored. Objective: The aim of this study was to evaluate the combined effects of physiotherapy and vitamin D supplementation on pain, disability, IL-6 expression, and vitamin D levels in CLBP patients. Methods: This two-arm, parallel-group, randomized controlled trial enrolled 60 CLBP patients, randomized into Group A (physiotherapy alone: IFC therapy and exercise therapy; n = 30) or Group B (physiotherapy plus vitamin D supplementation; n = 30). Outcomes included pain intensity (11-point Numeric Pain Rating Scale (NPRS)), disability (Arabic Oswestry Disability Index (ODI), 0–100%), and serum IL-6 and 25-hydroxyvitamin D (both by ELISA; pg/mL and ng/mL, respectively), which were assessed at baseline and 6 weeks. All 60 participants enrolled had laboratory-confirmed vitamin D deficiency or insufficiency (serum 25(OH)D < 20 ng/mL) at screening. Independent samples t-tests compared continuous baseline characteristics and between-group differences in 6-week change scores; paired t-tests assessed within-group change from baseline to 6 weeks; the chi-square test compared the categorical variable of gender (α = 0.05). Results: Both groups showed significant improvements in NPRS and ODI at six weeks (p < 0.001). Group B demonstrated significant reductions in NPRS (−3.01 vs. −1.71) and ODI (21.83% vs. 16.33%). IL-6 decreased significantly only in Group B (18.24 pg/mL, p < 0.001), with no significant change in Group A (25.96 pg/mL, p = 0.626). Vitamin D levels increased significantly in Group B (31.68 ng/mL, p < 0.001) compared with Group A (19.68 ng/mL, p = 0.115), a between-group difference that was also statistically significant. Conclusions: Combining physiotherapy with vitamin D supplementation improves outcomes in the management of CLBP. This approach effectively reduces pain, functional disability, inflammation, and vitamin D deficiency or insufficiency, offering a comprehensive, evidence-based treatment strategy. Full article

Background/Objectives: SPINEHealthie is a smartphone-based application enabling remote patient monitoring, care delivery and standardized collection of patient-reported outcome measures (PROMs). This registry-based analysis evaluates patient satisfaction with the platform across a large, heterogeneous spine surgery cohort. Methods: A total of 1729 thoracolumbar spine surgery cases were eligible for analysis. Among these, 881 (50.9%) completed the in-app feedback survey and constituted the primary feedback cohort. The global app experience was categorized as “Very Good” or “Poor”. Clinical outcomes, i.e., the Visual Analogue Scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) were assessed at baseline and in the postoperative period; Δ denotes the change from baseline to two weeks postoperation. Results: Among feedback responders, 800 patients (90.8%) rated their app experience as “Very Good”, while 80.8% of 639 patients with surgical outcome data reported that the surgery met their expectations. However, app experience and surgical outcome expectations were assessed using different items at different postoperative time points. Among patients whose surgery did not meet expectations, 84.6% rated their app experience as “Very Good”. Patients with a “Very Good” app-experience rating demonstrated significantly greater improvement in back pain (ΔVAS Back pain 2.94 vs. 2.13, p = 0.027), leg pain (ΔVAS Leg pain 3.16 vs. 2.14, p = 0.019) and disability (ΔODI 11.00 vs. 2.41, p < 0.001). In the primary model, older age, shorter follow-up duration and smaller ODI improvement were associated with an unfavorable app experience; only the association with age remained consistent across sensitivity analyses. Conclusions: Among feedback responders, SPINEHealthie was associated with a high proportion of favorable global app-experience ratings. Favorable app-experience ratings remained high, even among patients with unmet surgical expectations or failure to achieve the exploratory two-week ODI-improvement threshold, suggesting that perceived platform value is not solely explained by surgical outcome. Older patients and those with limited functional recovery were identified as subgroups that may benefit from targeted onboarding and engagement strategies. Full article