Search Results (172)

Background and Objectives: Spinopelvic alignment may affect the outcomes of total hip arthroplasty (THA), with pelvic version influencing the risk of mechanical complications occurring after surgery. On the other hand, THA surgery itself may contribute to the modification of pelvis version. The sacro-femoro-pubic (SFP) angle is measured on anteroposterior (AP) radiographs of the pelvis in a supine position, and is used to estimate pelvic tilt (PT), representative of pelvic version, which requires lateral views of the sacrum for its calculation; however, these X rays are not routinely performed in the preoperative setting of hip surgery. This study aims to analyze how THA determines changes in the pelvic version of operated patients; the SFP angle will be used to assess pelvic version on standard AP radiographs. Materials and Methods: This retrospective study included 182 consecutive patients undergoing THA for unilateral primary degenerative hip osteoarthritis (HOA-study group, n = 104) or femoral neck fracture (FNF-control group, n = 78) at the author’s institution. The SFP angle was measured on AP pelvic radiographs of the non-replaced hip preoperatively, postoperatively, and at the last follow-up. PT values were derived from SFP angles. Pre- and postoperative PT and its variations ΔPT were assessed. Study groups were compared in terms of native and postoperative variations of pelvic version. Results: The average absolute value of ΔPT was 2.99° ± 3.07° in the HOA group and 3.57° ± 2.92° in FNF group. There was no significant overall difference in preoperative or postoperative PT values between groups. In both groups, THA surgery led to a certain improvement, still not significant, in pelvic orientation, with FNF patients presenting a greater tendency toward retroversion. No significant differences in complication rates were found comparing patients with different pelvic orientations. Conclusions: THA can lead to a “normalization” of pelvic version in a certain number of patients with preoperative anteversion or retroversion. Although statistically non-significant, this observation may have clinical implications for spinopelvic balance and could support prioritizing THA in patients with concurrent spinal disease. Further research is needed to confirm these findings and to evaluate the long-term impact of THA on spinopelvic alignment. Full article

Objectives: Spinal diseases are commonly encountered health problems with a wide spectrum. In addition to degenerative changes, other common spinal pathologies include metastases and compression fractures. Benign tumors like hemangiomas and infections such as spondylodiscitis are also frequently observed. Although magnetic resonance imaging (MRI) is considered the gold standard in diagnostic imaging, the morphological similarities of lesions can pose significant challenges in differential diagnoses. In recent years, the use of artificial intelligence applications in medical imaging has become increasingly widespread. In this study, we aim to detect and classify vertebral body lesions using the YOLO-v8 (You Only Look Once, version 8) deep learning architecture. Materials and Methods: This study included MRI data from 235 patients with vertebral body lesions. The dataset comprised sagittal T1- and T2-weighted sequences. The diagnostic categories consisted of acute compression fractures, metastases, hemangiomas, atypical hemangiomas, and spondylodiscitis. For automated detection and classification of vertebral lesions, the YOLOv8 deep learning model was employed. Following image standardization and data augmentation, a total of 4179 images were generated. The dataset was randomly split into training (80%) and validation (20%) subsets. Additionally, an independent test set was constructed using MRI images from 54 patients who were not included in the training or validation phases to evaluate the model’s performance. Results: In the test, the YOLOv8 model achieved classification accuracies of 0.84 and 0.85 for T1- and T2-weighted MRI sequences, respectively. Among the diagnostic categories, spondylodiscitis had the highest accuracy in the T1 dataset (0.94), while acute compression fractures were most accurately detected in the T2 dataset (0.93). Hemangiomas exhibited the lowest classification accuracy in both modalities (0.73). The F1 scores were calculated as 0.83 for T1-weighted and 0.82 for T2-weighted sequences at optimal confidence thresholds. The model’s mean average precision (mAP) 0.5 values were 0.82 for T1 and 0.86 for T2 datasets, indicating high precision in lesion detection. Conclusions: The YOLO-v8 deep learning model we used demonstrates effective performance in distinguishing vertebral body metastases from different groups of benign pathologies. Full article

Background/Objectives: Spinal cord injuries (SCIs) are among the most debilitating conditions and are a leading cause of disability in young people. This study aimed to analyze the causes of SCIs, assess injury severity using the AIS scale, and evaluate complications during rehabilitation in a hospital setting. Methods: The study involved 176 individuals with SCI, including 142 with a traumatic SCI (TSCI) and 34 with a non-traumatic SCI (NTSCI), rehabilitated at various times post-injury. The data on injury causes, paresis type, complications, wheelchair use, gender, age, and treatment methods were collected. The injury severity was assessed using the AIS. Results: A significant gender difference was found between the TSCI and NTSCI groups (85.2% male vs. 61.8% male). TSCI individuals were also younger. The causes of TSCI were traffic accidents, falls from height, and diving, while the causes for NTSCI included spinal ischemia, tumors, degenerative disc disease, and inflammation. TSCI individuals had more AIS A lesions (52.8% vs. 26.5%) and more cervical injuries (53.5% vs. 14.7%), whereas NTSCI individuals had more AIS C lesions (38.2% vs. 18.3%) and thoracic damage (58.8% vs. 35.2%). TSCI patients were more often treated surgically (95.7% vs. 61.8%) and used wheelchairs (88% vs. 55.9%). No significant differences were found in terms of complications between the groups, though TSCI individuals underwent more chronic rehabilitation. Conclusions: Our research shows that there are significant differences between TSCI and NTSCI both in terms of the level of damage and the severity of damage to neural structures (AIS scales), and thus significant differences in the patients’ functioning in later life for both groups of individuals. Full article

Brachial plexus root avulsion [BPRA] and concomitant spinal cord injury [SCI] represent devastating injuries that come with limited hope for recovery owing to the adult spinal cord’s loss of intrinsic ability to spontaneously regenerate. BPRA/SCI is an enormous public health issue the world over, and its catastrophic impact goes beyond the patient, the family, businesses, and national health budgets, draining billions of dollars annually. The rising population and economic growth have seen the incidence of SCI surging. Genomic, transcriptomic, and proteomic studies have yielded loads of information on the various molecular events that precede, regulate, and support both regenerative and degenerative pathways post-SCI. Metabolomics, on the other hand, comes in as the search for a cure and the objective monitoring of SCI severity and prognosis remains on the horizon. Despite the large number of review articles on metabolomics and its application fields such as in cancer and diabetes research, there is no comprehensive review on metabolite profiling to study disease mechanisms, biomarkers, or neuroprotection in SCI. First, we present a short review on BPRA/SCI. Second, we discuss potential benefits of metabolomics as applied in BPRA/SCI cases. Next, a look at the analytical techniques that are used in metabolomics. Next, we present an overview of the studies that have used metabolomics to reveal SCI metabolic fingerprints and point out areas of further investigation. Finally, we discuss future research directions. Full article

Background: Lumbar Interbody Fusion (LIF) is a surgical procedure aimed at addressing a range of pathological conditions affecting the structure and function of the spine. Patient-Specific Interbody Cages (PSICs) are an emerging technology that are used in LIF; however, there is a lack of clinical outcome data, making it difficult to assess the potential risks, benefits, and value of PSICs. The purpose of this present study is to contribute data to the field on this new emerging technology. The aims were to investigate Quality of Life (QoL), pain, and the complications of PSICs in LIF. To provide a comparative cohort, we performed a systematic review of patient-reported outcomes of conventional fusion techniques. Methods: This study reports on a multi-surgeon, multi-centre clinical trial of patients with lumbar degenerative disc disease, necessitating discectomy and fusion. All patients underwent LIF procedures with 3D-printed PSICs. Pain Visual Analogue Scale (VAS) and QoL (EQ-5D) scores were collected pre-operatively and at 6m, 12m, and 24m post-operatively. For comparative purposes, we performed a systematic review of the VAS scores from traditional LIF cages and analysed the Australian Spine Registry QoL data. Results: The literature search yielded 4272 publications. The studies were subdivided into four groups based on the interbody device type. All the groups demonstrated improvements in the VAS (for back pain) scores post-operatively. In total, 78 patients (109 instrumented levels) underwent LIF procedures with 3DP PSICs. There were three reoperations (3.8%) and no revisions of any PSIC. The mean VAS scores improved significantly (p < 0.01) from 7.85 (1.50 SD) pre-operatively to 2.03 (2.13 SD) at 24 months post-operatively. The mean QoL index scores improved significantly (p < 0.01) from a pre-operative 0.257 (0.332 SD) to 0.815 (0.208 SD) at 24 months. Conclusions: The systematic review indicated that device fixation to the interbody space was associated with lower VAS scores. The results from the investigational cohort suggest that PSICs may represent a new progression in implant design for spinal fusion, with an associated clinical benefit for LIF. Full article

Background: Structured titanium (ST) cages are designed to enhance osseointegration and fusion in lumbar interbody procedures. However, clinical and radiological outcomes following TLIF using ST cages—particularly with or without adjacent-level dynamic stabilization (DSS)—have not been widely reported. Objective: To evaluate 12-month fusion outcomes and patient-reported outcomes (PROMs) after TLIF with structured titanium cages, comparing cases with and without adjacent-level DSS. Methods: In this retrospective cohort study, 82 patients undergoing TLIF with ST cages were analyzed—41 with hybrid instrumentation (TLIF + DSS) and 41 with TLIF alone. PROMs (ODI, VAS for back and leg pain, EQ-5D-5L) were assessed preoperatively and at 12 months. Fusion was assessed via CT scans at 12 months. Results: PROMs significantly improved over time in both groups (p < 0.001 for ODI, VAS back, VAS leg), but there were no significant differences between the hybrid and non-hybrid groups. Overall, the interbody fusion rate was 84%. Complete fusion was observed in 84% of the hybrid group and 80% of the TLIF-only group (p = 0.716), with very low rates of non-union. Conclusions: Structured titanium cages demonstrated excellent 1-year fusion rates and supported significant clinical improvement after TLIF. The addition of dynamic stabilization had no measurable effect on patient-reported or radiological outcomes at 12 months. Long-term studies are needed to assess any potential effect of DSS on adjacent segment disease. Full article

Background: Spinal cord stimulators can offer an effective treatment in chronic pain refractory to conventional medical management. However, with a failure rate of up to 44% and an annual explantation rate of 6–9%, there is a need to better identify patients at high risk for therapeutic failure. The objective of this retrospective cohort study was to determine predictors of early SCS explantation following device placement. Methods: The Medical Informatics Operating room Vitals and Events Repository database was queried for patients with a spinal cord stimulator and at least two years of follow-up (n = 56). A multivariate logistic regression was fitted. Recursive factor elimination with cross-validation and L1 penalization were used to reduce the number of predictors and minimize the risk of overfitting. The model was used to predict risk factors for explantation, odds ratio (OR), 95% confidence interval (CI), and false discovery rate-adjusted p-value. Results: The final model displayed adequate performance with an average precision of 0.769. Sleep disorders were identified as a statistically significant predictor of SCS explantation (OR: 3.88, CI: 1.36–11.04, FDR p-value: 0.0497). Conclusions: While further prospective studies are needed, our study indicates that sleep disorders are a risk factor for spinal cord stimulator explantation and should be considered during pre-operative evaluation. Full article

Background/Objectives: There exists a need to capture the current landscape of the literature for lumbar decompression on muscle strength, as measured by manual muscle testing (MMT), in cohorts with foot drop secondary to lumbar degenerative disease (LDD). Methods: A literature search of PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from each database’s inception to 21 March 2025. Eligible studies reported patients with LDD-related foot drop treated surgically. This review was registered in PROSPERO (ID: CRD42024550980). Results: A total of 20 studies comprising 918 patients met the eligibility criteria, with most cases attributable to lumbar disc herniation (79% of patients, 95% CI: 0.72–0.85, I² = 96%) or spinal stenosis (22% of patients, 95% CI: 0.15–0.30, I² = 96%). Following surgery, 60% of patients (95% CI: 0.44–0.75, I² = 97%) achieved an MMT score of 4–5, indicating recovery, while 82% (95% CI: 0.76–0.88, I² = 89%) demonstrated an improvement of at least one MMT grade. No improvement was seen in 18% of patients (95% CI: 0.12–0.24, I² = 89%). For pain, the preoperative VAS mean was 5.91 (95% CI: 4.21–7.60, I² = 99%), while the postoperative mean was 1.00 (95% CI: −0.05–2.06, I² = 99%). Overall complications were reported at 1% (95% CI: −0.00–0.02, I² = 0%). Conclusions: Lumbar decompression achieves clinically meaningful recovery of LDD-induced foot drop. However, this meta-analysis highlights the overlooked portion of patients who will not respond, providing a sequential approach for future investigation of these cohorts through foundational evidence of the present literature base. Full article

Background/Objectives: Stand-alone lateral lumbar interbody fusion (LLIF) remains a debated approach in spinal surgery, with limited published evidence supporting its efficacy without supplemental fixation. This prospective study presents the institutional case series on single-level L3-L4 stand-alone LLIF, using next-generation 3D-printed titanium cages, as treatment for degenerative disc disease (DDD). Methods: A cohort of 49 patients with symptomatic DDD, unresponsive to conservative therapy, underwent stand-alone LLIF at L3-L4 (neither posterior pedicle screws nor lateral plating). Clinical outcomes (VAS and ODI) and radiological parameters (disc height, segmental/lumbar lordosis) were collected preoperatively and at 1, 6, and 12 months. Repeated-measures ANOVA with Bonferroni correction was adopted for statistical analysis. Results: Significant improvements were observed in pain and disability scores at all time points, with the mean VAS score decreasing from 6.53 to 0.29, and ODI from 27.6% to 3.84% at one year (p < 0.001). Radiographic analysis confirmed durable increases in disc height and segmental lordosis. Solid fusion was achieved in 97.9% of cases. No patient required posterior revision; transient neurological symptoms were mild and self-limiting. Conclusions: This study demonstrates that stand-alone LLIF at L3-L4 is safe and effective in achieving stable fusion and clinical–radiological improvement. These results challenge the necessity of supplemental fixation and support the broader adoption of a less invasive fusion paradigm. Full article

Transforaminal lumbar interbody fusion (TLIF) is a commonly employed surgical technique for managing lumbar degenerative disease and spinal instability. While it offers advantages over posterior lumbar interbody fusion (PLIF), traditional TLIF often involves prolonged recovery and morbidity due to muscle retraction. To improve outcomes, several alternative techniques have emerged, including minimally invasive TLIF (MIS-TLIF), trans-Kambin percutaneous TLIF (PE-TLIF), and transfacet TLIF (TF-TLIF). Each approach presents distinct anatomical and technical advantages, yet no standardized framework exists to guide their selection based on individual patient anatomy. In this study, we review the evolution of TLIF techniques and propose a novel algorithm that integrates patient-specific imaging, anatomical variability, and segmentation data to guide surgical decision-making. By analyzing the surgical corridors, indications, and limitations of each approach, and presenting representative clinical cases, we demonstrate how this algorithm can be applied in practice. For instance, TF-TLIF may be optimal in patients requiring direct decompression without major deformity, while PE-TLIF may be appropriate for those with Kambin’s triangles measuring ≥ 9 mm, allowing for indirect decompression. This tailored framework aims to optimize outcomes and reduce complications. Further prospective validation and incorporation of AI-driven segmentation tools are needed to support broader clinical implementation. Full article

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. Full article

Background: Cervical degenerative disease is a common condition associated with significant morbidity, often presenting as neck pain, radiculopathy, or myelopathy. Its growing incidence, particularly in the aging population, has led to an increased demand for surgical interventions aimed at relieving neural compression and restoring spinal stability. Objective: This study aims to evaluate surgical outcomes in patients with degenerative cervical conditions, with a particular focus on the role of intraoperative neurophysiological monitoring (IONM) in preventing adverse neurological events both immediately postoperatively and at long-term follow-up. Methods: A retrospective analysis was performed on patients who underwent cervical spine surgery for degenerative conditions between January 2021 and June 2024. Data collected included demographics, comorbidities, surgical details, and intraoperative neurophysiological monitoring. Surgical outcomes were assessed using the modified Rankin Scale (mRS), Odom’s Criteria, and the modified Japanese Association (mJOA) score. Results: Key findings demonstrated that advanced age and the presence of preoperative myelopathy were significantly associated with poorer postoperative outcomes across all evaluated measures. Conversely, factors such as gender, surgical approach, and the number of treated levels did not significantly influence recovery. Although intraoperative neurophysiological monitoring (IONM) did not show an immediate effect on postoperative outcomes, it was linked to prognostic value for long-term neurological status, suggesting a potential protective role in preserving neurological function. Conclusions: This study identifies age, preoperative functional status, and myelopathy as crucial predictors of postoperative recovery in cervical spine surgery for degenerative disease. These findings underscore the importance of early intervention in patients with myelopathy and highlight the complex role of IONM in improving long-term neurological outcomes. IONM changes may help identify patients at higher risk of poor recovery who could benefit from intensive postoperative rehabilitation. Further prospective studies are warranted to elucidate the complex interactions between patient characteristics and surgical factors in optimizing postoperative recovery. Full article

For the past two decades, the consideration of spinopelvic parameters, sagittal balance, and spine shape has gained importance in the diagnosis and optimal surgical management of painful adult spinal deformity. These principles are used with increasing frequency in the surgical planning and treatment of degenerative mechanical lower back pain. Several parameters exist to analyze both global and regional spinal balance. Chronic lower back pain due to degenerative disc disease, degenerative spondylolisthesis, or adult spinal deformity can be surgically managed in a multitude of ways ranging from simple decompression to multilevel arthrodesis with or without corrective osteotomies, depending on the presumed etiology of the pain, surgical planning, and the surgical goal. In surgical candidates, preoperative evaluation of spinopelvic parameters is paramount, as increasing evidence shows that restoration of the shape of the spine while respecting these parameters improves patient-reported outcome measures (PROMs), decreases re-operation rates, and reduces mechanical complications such as proximal junctional kyphosis/failure (PJK/PJF), distal junctional kyphosis/failure (DJK/DJF), adjacent segment disease (ASD), and rod fracture. This review provides a conceptual analysis of spinopelvic alignment, global and regional sagittal balance, and the restoration of the spine’s shape in relation to patient outcomes during surgical treatment of degenerative spine disorders. Full article

Background/Objectives: One of the surgical treatments for lumbar foraminal stenosis, full endoscopic foraminotomy, is known for its numerous advantages and favourable clinical outcomes. While previous studies have analyzed preoperative radiological risk factors associated with recurrence within one year after endoscopic foraminal decompression, no research has investigated postoperative radiological changes. The aim of this study is to analyze the radiological changes occurring in cases of early recurrence within six months after endoscopic foraminal decompression. Methods: A retrospective review was conducted on patients with unilateral lumbar foraminal stenosis who underwent full endoscopic foraminotomy at a single institution. The study included 11 recurrent patients who initially experienced symptomatic improvement and sufficient neural decompression on radiological evaluation, but exhibited recurrent radicular pain and radiological restenosis within six months postoperatively. Additionally, 33 control patients with favourable clinical outcomes and no evidence of restenosis were analyzed. Preoperative and postoperative plain X-ray imaging was used to evaluate sagittal and coronal parameters reflecting spinal anatomical characteristics, including disc height, foraminal height, disc wedging, coronal Cobb’s angle, total lumbar lordosis angle, segmental lumbar lordosis angle, and dynamic segmental lumbar lordosis angle. The study aimed to analyze postoperative changes in these parameters between the recurrent and control groups. Clinical outcomes were assessed using the Visual Analog Scale (VAS). Results: There were no significant differences between the groups in terms of age, sex distribution, presence of adjacent segment disease, or existence of Grade 1 spondylolisthesis. Analysis of preoperative and postoperative radiological changes revealed that, in the recurrent group, disc height and foraminal height showed a significant decrease postoperatively, while disc wedging and the coronal Cobb’s angle demonstrated a significant increase. In contrast, the control group exhibited a significant postoperative increase in the total lumbar lordosis angle and segmental lumbar lordosis angle. Conclusions: Progressive worsening of disc wedging and the coronal Cobb’s angle, and reductions in disc and foraminal height, along with minimal improvement in lumbar lordosis following TELF, suggest the presence of irreversible preoperative degenerative changes. Careful radiologic assessment and close postoperative monitoring are essential to identify patients at risk of early recurrence. Full article

Background and Objective: This observational study aimed to evaluate the clinical efficacy of combined oxygen–ozone (O₂-O₃) therapy under CT guidance with the oral administration of alpha-lipoic acid (ALA), palmitoylethanolamine (PEA), and myrrh in elderly patients suffering from chronic low back pain (LBP). Given the rising prevalence of degenerative spinal diseases in older adults, this study addresses the need for effective, minimally invasive treatment options. Methods: A total of 276 patients aged 65 to 92 years, with chronic unilateral or bilateral LBP, underwent CT-guided paravertebral infiltrations with an O₂-O₃ gas mixture. This treatment was complemented with a 30-day regimen of ALA (800 mg/day), PEA (600 mg/day), and myrrh (200 mg/day). Clinical outcomes were assessed at one month and one year post-treatment using the Visual Analog Scale (VAS) and the modified McNab method. Results: At one month, 32.94% of patients reported an excellent improvement, with the mean VAS score dropping from 8.17 to 2.81. At the one-year follow-up, 68.15% cumulatively experienced positive outcomes, with 17.78% reporting the complete resolution of pain. In this occasion, the mean VAS score was 3.57. Conclusions: The study demonstrates that the combination of oxygen–ozone therapy and oral ALA, PEA, and myrrh is a promising alternative for managing chronic low back pain in the elderly, leading to significant pain reduction and improved quality of life. Findings emphasize the need for further research to validate these results and explore the long-term benefits. Full article