Search Results (305)

Spinal pathologies, including degenerative disc disease, spinal cord injury, and conditions requiring spinal fusion, pose a substantial global health burden. While contemporary interventions provide symptomatic relief, achieving durable tissue repair in biologically compromised environments remains a critical challenge. This narrative review synthesizes the current literature on three major nanotechnology applications in spine care: nanostructured implant surfaces, nanoparticle-enhanced bone grafts, and nano-drug delivery systems (NDDSs). Preclinical evidence indicates that nanoscale surface modifications and nanoparticle-augmented synthetic grafts significantly enhance osseointegration and bone fusion by mimicking the native extracellular matrix. Furthermore, in animal models of intervertebral disc degeneration, NDDSs utilizing polymeric nanoparticles and exosomes facilitate sustained, stimuli-responsive therapeutic delivery into the avascular disc space. Although early clinical data on nanostructured cages demonstrate reduced subsidence and stable long-term fusion, the direct translation of these robust preclinical outcomes to widespread clinical efficacy faces substantial hurdles. Significant translational barriers include stringent Class III regulatory classifications, sparse long-term safety data regarding nanoparticle biodistribution, and scale-up manufacturing challenges such as batch variability. Future progress relies on artificial intelligence-guided design, three-dimensional (3D) bioprinting, and multifunctional “smart” nanomaterials. Ultimately, close collaboration among materials scientists, clinicians, and regulatory bodies is essential to safely bridge the gap between preclinical innovation and predictable clinical therapeutic success. Full article

Background/Objectives: Extracellular matrix remodeling, cellular stress responses, and blood–brain/blood–tumor barrier-related alterations are important processes involved in brain tumor biology. This exploratory cross-sectional pilot study evaluated circulating circulating protein disulfide isomerase A4 (PDIA4), matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), and claudin-2 (CLDN2) concentrations in vitamin D-deficient patients with different brain tumor entities and aimed to provide preliminary effect-size estimates for future studies. Methods: A total of 62 vitamin D-deficient participants were included, comprising patients with glioblastoma (GBM; n = 15), brain metastases (n = 20), and meningioma (n = 8) and surgical controls with degenerative spine disease (n = 19). Serum biomarker concentrations were measured using enzyme-linked immunosorbent assays. Global between-group effect sizes were estimated using η², while exploratory pairwise comparisons and associations with tumor size were assessed using non-parametric methods. Effect-size estimates were prioritized, with p-values reported to provide complementary inferential context. Results: The largest global between-group effect-sizes were observed for CLDN2 (η² = 0.35) and MMP-2 (η² = 0.22), whereas the estimated effects were small for MMP-9 (η² = 0.05) and negligible for PDIA4 (η² = 0.00). Exploratory pairwise comparisons indicated lower serum MMP-2 concentrations in patients with GBM than in surgical controls and lower CLDN2 concentrations in patients with GBM and brain metastases than in controls. Positive exploratory associations were observed between tumor size and PDIA4 concentration in the GBM group (Spearman’s rho = 0.56; 95% CI: 0.02–0.90) and between tumor size and MMP-2 concentration in patients with brain metastases (rho = 0.46; 95% CI: 0.01–0.90). Conclusions: These preliminary effect-size estimates, together with the exploratory correlations with tumor size, may inform biomarker selection and sample-size planning in future prospective studies. The findings should not be interpreted as robust diagnostic or prognostic evidence and require validation in larger, independent, and well-controlled cohorts. Full article

Background/Objectives: Sciatica and hip osteoarthritis (OA) are common causes of lower extremity pain and functional impairment. Because both conditions may produce overlapping symptoms, distinguishing them can be challenging. Misdiagnosis may lead to inappropriate treatment, delayed intervention and unnecessary procedures. In addition, the frequent coexistence of hip and lumbar degenerative pathology, commonly referred to as hip–spine syndrome, further complicates diagnostic evaluation. This review aims to examine current diagnostic strategies used to differentiate lumbar radiculopathy from hip OA and to introduce the Athena Sign, which is presented as a preliminary, hypothesis-generating clinical observation requiring prospective validation. Methods: A narrative review of the literature was performed focusing on the pathophysiology, clinical presentation, differential diagnosis, physical examination and imaging evaluation of sciatica and hip OA. Particular emphasis was placed on clinical examination techniques and diagnostic injections used to identify the primary pain generator. Results: Both conditions share overlapping symptom patterns and inflammatory mechanisms, which may obscure the source of pain. Careful assessment of gait, hip range of motion, neurological findings and provocative maneuvers remains essential for accurate diagnosis. Imaging findings should be interpreted in conjunction with clinical examination due to the high prevalence of asymptomatic degenerative changes. The Athena Sign, observed with internal and external rotation of the hips in a prone position with the knee flexed, is associated with anterior intra-articular hip pathology and may provide an additional diagnostic indicator in patients with ambiguous hip–spine presentations. Conclusions: A systematic diagnostic approach integrating clinical examination, imaging and targeted diagnostic injections is essential for distinguishing between lumbar radiculopathy and hip OA. Recognition of dynamic clinical findings such as the Athena Sign may further improve diagnostic accuracy and guide appropriate management in patients presenting with overlapping hip and lumbar symptoms. Full article

Background/Objectives: Sagittal spinal alignment is a key determinant of function and quality of life in degenerative spinal disorders. While age is an established determinant of sagittal balance, the independent contribution of BMI remains insufficiently characterized, particularly in degenerative scoliosis cases. This study aimed to investigate the association between BMI and sagittal alignment, quantify its effect relative to age, and explore potential sex-specific differences. Methods: This retrospective single-center study included 293 adults with degenerative scoliosis who underwent standing full-spine EOS imaging. Multivariable linear regression models assessed the association between BMI and sagittal vertical axis (SVA), adjusting for age, sex, diabetes mellitus, and osteoporosis. Secondary analyses examined associations with coronal deformity (Cobb angle) and lumbar degeneration (Wilke score). Sex-stratified analyses and Receiver Operating Characteristic (ROC) analyses for sagittal decompensation were also performed. Results: The cohort had a median BMI of 26.2 kg/m² (56% female; median age 71 years). Median SVA measured 56.4 mm (interquartile range 30.6–87.1), and 58% of patients exhibited sagittal decompensation. In sex-stratified analyses, higher BMI was independently associated with greater SVA in women (p = 0.015), whereas no significant association was observed in men (p = 0.061). ROC analysis demonstrated limited overall discrimination; however, a BMI ≥ 35 kg/m² showed high specificity and positive predictive values exceeding 80% for sagittal decompensation. Conclusions: BMI is independently associated with sagittal alignment in degenerative scoliosis and contributes to sagittal decompensation to a degree comparable to age. These findings suggest that body weight represents a clinically relevant biomechanical factor that should be considered alongside age and spinopelvic parameters when interpreting sagittal alignment, although BMI’s limited discriminatory performance for sagittal decompensation precludes its use as a standalone screening tool. Full article

Objectives: Retrospective comparative cohort study. This study aimed to compare the clinical and radiological outcomes of rigid, dynamic, and hybrid stabilization systems in the surgical management of degenerative lumbar spine disease, with a focus on adjacent segment disease (ASD), fusion-related complications, and postoperative recovery. Rigid fusion techniques provide immediate stability but may increase mechanical stress at adjacent segments, leading to ASD. Dynamic and hybrid constructs aim to preserve more physiological motion, potentially reducing fusion-related complications. Methods: A retrospective analysis was conducted on 86 patients who underwent posterior lumbar stabilization between January 2017 and December 2021. Patients were categorized into four groups based on the surgical technique: Rigid (titanium rod), Dynamic (PEEK rod), Rigid + TLIF (Transforaminal Lumbar Interbody Fusion), and Hybrid (Dynamic + TLIF). Clinical evaluation included the Visual Analog Scale (VAS) for back and leg pain. Radiological assessments comprised segmental and total range of motion (ROM), disc and foraminal height, fusion success, pseudoarthrosis, and the presence of ASD. Results: All surgical approaches resulted in significant postoperative improvement in back and leg pain (p < 0.001). The incidence of ASD was highest in the Rigid + TLIF group (45.5%, p < 0.001) and lowest in the Dynamic (4.8%) and Hybrid (4.2%) groups. Pseudoarthrosis was most frequently observed in the Rigid group (26.3%). The Hybrid group demonstrated favorable outcomes, with a high anterior fusion rate (91.7%) and low rates of ASD and pseudoarthrosis. Conclusions: All stabilization techniques were associated with significant postoperative clinical improvement. In this retrospective cohort, dynamic and hybrid constructs showed lower observed rates of early symptomatic ASD than the Rigid + TLIF construct, while TLIF-treated groups showed higher anterior fusion rates. Because treatment allocation was nonrandomized and adjustment for all potential confounders was not possible, these findings demonstrate associations rather than causal treatment effects. Larger prospective studies with longer follow-up are required to determine whether the stabilization strategy independently influences ASD, fusion, or pseudoarthrosis. Full article

Background/Objectives: Spinopelvic alignment represents the sagittal relationship between the lumbar spine and pelvis and is closely related to compensatory posture and disability in degenerative lumbar diseases. Previous studies have mainly focused on magnetic resonance imaging (MRI)-derived paraspinal muscle morphology, whereas evidence linking objective dynamic trunk strength to spinopelvic alignment remains limited. The present study aims to investigate the associations between spinopelvic alignment and muscle degeneration as assessed by MRI-based morphology and trunk isokinetic dynamometry. Methods: In this prospective cross-sectional study, patients undergoing lumbar fusion surgery for degenerative lumbar diseases at a tertiary center were consecutively enrolled. Peak trunk isokinetic torques were measured using the BioniX Sim3 Pro system. Preoperative paraspinal muscle degeneration and spinopelvic alignment were measured. Results: A total of 119 patients were analyzed (52.1% female). In the total sample, paraspinal muscle degeneration, isokinetic torques, and spinopelvic alignment showed statistically significant but generally weak associations. After adjustment for age, sex, and body mass index (BMI), rotation and flexion torques were associated with pelvic tilt, and multifidus functional cross-sectional area (MF-fCSA) was associated with lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence-lumbar lordosis (PI-LL), and PI-LL mismatch. In the hypothesis-generating sex-stratified analyses, trunk isokinetic torques were associated with spinopelvic alignment in males but not females, whereas MF-fCSA was associated with spinopelvic alignment in both sexes. Conclusions: Paraspinal muscle morphology and trunk isokinetic strength were significantly associated with spinopelvic alignment, although the magnitudes of these associations were weak. These findings suggest that imaging-based muscle morphology and dynamic trunk muscle performance are associated with spinopelvic alignment but their implications should be interpreted with caution. Paraspinal muscle imaging and dynamic isokinetic strengths may provide complementary information in the assessment of patients with degenerative lumbar disease. Longitudinal studies are needed to determine their prognostic and clinical value. Full article

Background: Delta large-channel endoscopic decompression is an emerging, minimally invasive approach for lumbar degenerative disease, but its comparative effectiveness and perioperative performance have not been comprehensively synthesized. We performed a systematic review and meta-analysis to evaluate clinical, functional, and safety outcomes of Delta large-channel endoscopy relative to established decompression techniques. Methods: PubMed, Embase, and Scopus were searched from database inception through July 2025 (PROSPERO #CRD420251107750). Peer-reviewed English-language studies reporting extractable outcomes after Delta large-channel endoscopic surgery in adults were included. Random-effects meta-analyses were used for pooled comparisons. Results: Nine studies met the inclusion criteria, comprising 737 patients overall, including 379 treated with Delta large-channel endoscopy and 358 treated with comparator procedures. Reported outcome assessment generally ranged from 1 week to 12 months postoperatively, or variable latest follow-up timepoints, and mean follow-up was inconsistently reported. All studies originated in China and included five retrospective cohorts, two randomized controlled trials, one prospective cohort, and one case series. The pooled mean operative time for Delta procedures was 88.28 min (95% CI, 79.24–97.31), pooled mean intraoperative blood loss was 24.58 mL (95% CI, 11.14–38.02), and pooled mean hospital stay was 4.59 days (95% CI, 2.87–6.31). Compared with microscopic, endoscopic, and open techniques, Delta large-channel endoscopy showed no statistically significant differences in operative time (MD = 6.95 min, 95% CI: −11.51–25.40 min; p = 0.4037), intraoperative blood loss (MD, −40.62 mL; 95% CI, −83.68–2.44; p = 0.0598), 3-month ODI change from baseline (MD, 1.26; 95% CI, −2.17–4.69; p = 0.3661), or complication rates (OR, 0.67; 95% CI, 0.40–1.12; p = 0.1094). Delta procedures were associated with shorter hospital stay (MD, −1.69 days; 95% CI, −2.83 to −0.56; p = 0.0122) and marginally greater improvement in six-month VAS low back pain change from baseline (MD, 0.28; 95% CI, 0.26–0.29; p = 0.0002), though clinically insignificant. The pooled complication rate for Delta procedures was 6.0% (95% CI, 4–10%) and reported rates of excellent or good MacNab outcomes ranged from 80 to 93% across Delta cohorts. Conclusions: Delta large-channel endoscopy may provide clinical and functional outcomes comparable to established decompression techniques, with similar safety and potential perioperative benefits, including shorter hospitalization. However, these findings are based on limited, low-certainty evidence with high heterogeneity and should be interpreted as exploratory rather than definitive. Additional multicenter studies with longer follow-up, broader geographic representation, and higher methodological quality are necessary before definitive conclusions regarding comparative effectiveness can be established. Full article

Background: Successful spinal stabilization depends not only on early mechanical fixation but also on durable biological integration at the bone–implant interface. This study aimed to compare a two-stage allograft-augmented fixation strategy, intended to promote biological fixation, with conventional posterior segmental stabilization (PSS) in the treatment of screw loosening following multilevel spinal surgery for degenerative spine pathology. Methods: This retrospective comparative study included 40 patients who underwent multilevel spinal stabilization between January 2022 and February 2025, with follow-up completed by November 2025. Patients were divided into a conventional PSS group (n = 28) and a two-stage allograft-augmented fixation group (OI-focused strategy, n = 12). Demographic characteristics, comorbidity burden, length of hospital stay, complications, Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), and sagittal radiographic parameters—including lumbar lordosis (LL), sagittal vertical axis (SVA), sacral slope (SS), and pelvic incidence (PI)—were evaluated preoperatively and at 1, 6, and 9 months postoperatively. Results: The groups were similar in terms of age, sex, body mass index, smoking status, and number of operated levels. Despite the significantly higher Charlson Comorbidity Index and Elixhauser Comorbidity Index scores in the OI-focused group, hospital stay was significantly shorter. VAS and ODI scores were comparable preoperatively and at 1 month; however, significantly better pain and functional outcomes were observed in the OI-focused group at 6 and 9 months. Radiologically, SVA was significantly lower in the OI-focused group at 6 and 9 months. Late differences were also observed in LL and SS, while PI remained similar between groups. Fusion-related findings were interpreted cautiously because fusion was assessed using plain radiographs and osseointegration was not directly measured. Conclusions: The two-stage allograft-augmented fixation strategy was associated with better mid-term pain control, improved functional recovery, and better preservation of selected sagittal alignment parameters compared with conventional PSS. However, these findings should be interpreted cautiously due to the retrospective design, limited sample size, imbalanced groups, absence of direct osseointegration measurement, and lack of CT-based fusion analysis. Full article

Background: Postoperative pulmonary complications (PPCs) remain common in older adults undergoing degenerative spine surgery and are associated with adverse outcomes. We aimed to develop and externally validate an explainable machine-learning model using routinely available perioperative variables to estimate individual PPC risk. Methods: We conducted a two-center retrospective cohort study including consecutive patients aged ≥65 years undergoing degenerative cervical or lumbar spine surgery under general anesthesia. The development cohort included 1200 patients (Affiliated Nanhua Hospital, University of South China; 2024–2025), and the external validation cohort included 600 patients (First Affiliated Hospital, University of South China; 2025). PPCs within 7 postoperative days were defined using EPCO criteria. Twenty-five prespecified predictors were considered. Missing data were handled using multiple imputation, and continuous variables were standardized. Feature selection was performed using LASSO with 10-fold cross-validation and the 1-standard-error rule. We trained six machine-learning models (DT, RF, SVM, XGBoost, LightGBM, ANN) and logistic regression as a benchmark, with hyperparameters tuned by 5-fold cross-validation in the development cohort. Performance was assessed by AUROC, calibration (plots and Brier score), decision-curve analysis, and threshold-based metrics; SHAP was used for interpretability. A web-based calculator was implemented for clinical use. Results: PPCs occurred in 222/1200 (18.5%) patients in the development cohort and 123/600 (20.5%) in the external validation cohort. LASSO selected 11 predictors. In external validation, the random forest model achieved AUROC 0.786 (95% CI 0.740–0.829) and Brier score 0.137 (95% CI 0.119–0.154), with favorable decision-curve performance, and achieved an accuracy of 73.83%, sensitivity of 68.29%, specificity of 75.26%, PPV of 41.58%, NPV of 90.20%, and an F1 score of 51.69% at the prespecified threshold. Conclusions: We developed and externally validated multiple prediction models for PPCs in older adults undergoing degenerative spine surgery. The random forest model provided balanced performance and SHAP-based interpretability and was retained as an implementation-focused model for perioperative or immediate postoperative risk estimation. Further prospective validation, comparison with established clinical risk scores, and model updating in more diverse clinical settings are needed before routine clinical implementation. Full article

Background and Objectives: In degenerative spine disease, compensatory mechanisms are activated to maintain upright posture, extending beyond the spine to involve the pelvis, lower limbs, and feet. These adaptations may be accompanied by differences in foot alignment, which could be associated with sagittal balance. The aim of this study is to investigate the relationship between foot alignment and spinal posture in patients with degenerative spine disease and evaluate whether foot deformities are associated with sagittal imbalance in degenerative spine disease. Materials and Methods: We retrospectively reviewed 98 patients with degenerative spine disease who underwent preoperative standing EOS imaging between 2017 and 2025 at a single academic spine centre. Meary’s angle, talocalcaneal angle, and calcaneal pitch were measured on lateral EOS images to classify feet as flat, normal, or cavus. Spinopelvic parameters were extracted from EOS and conventional radiographs. Differences in spinal parameters across foot groups were compared using ANOVA, and linear regression evaluated associations between sagittal vertical axis (SVA) and foot angles. Results: Among spinopelvic parameters, only SVA significantly differed between foot groups, with flatfoot patients showing greater forward imbalance (p = 0.035). Regression analysis demonstrated an inverse relationship between SVA and both talocalcaneal angle (p = 0.003) and calcaneal pitch (p = 0.034), suggesting that greater forward trunk inclination was associated with flatter feet. Degenerative scoliosis patients demonstrated a bimodal pattern with more flat and cavus feet (p = 0.006), while herniated disc patients more often exhibited flatfoot (p = 0.031). Conclusions: Foot posture abnormalities, particularly flatfoot, are associated with sagittal spinal imbalance, suggesting foot posture may be associated with global alignment and could reflect distal postural adaptations. Full article

Background/Objectives: degenerative cervical myelopathy (DCM) is the leading cause of spinal cord impairment in adults, often resulting in disability and reduced quality of life (QoL). Surgery is recommended for moderate and severe cases, while its role in mild DCM remains debated. Emerging evidence suggests that early surgery may improve outcomes, particularly QoL. Methods: We conducted a retrospective, single-center observational study of a cohort of patients undergoing cervical spine surgery for DCM between January 2020 and August 2023 at a single institution (Policlinico di Monza, Italy). Demographic, clinical, radiological and surgical data, as well as complications and outcomes, were analyzed. Neurological status was assessed using the modified Japanese Orthopedic Association (mJOA) score and QoL was evaluated using the Short Form-36 (SF-36) questionnaire preoperatively, at discharge, and at follow-up. Results: 51 patients were included (mean age 58.1 years; 41% female), with anterior surgery performed in 67%. Mild preoperative mJOA score was observed in 74% of patients. At follow-up, 65% achieved complete recovery, 29% improved, and 6% remained stable. No neurological deterioration was recorded. Univariate analysis identified age, anterior cervical discectomy and fusion (ACDF), and mild preoperative mJOA score as significant predictors of recovery. Multivariate logistic regression analysis identified mild preoperative mJOA score as a strong independent predictor of complete clinical recovery (OR = 240.64, 95% CI: 6.82–8496.22, p = 0.002). SF-36 showed significant improvements in emotional well-being, social functioning, pain, and general health, particularly in mild cases. Complications were low (5.8%) and limited to transient dysphagia. Conclusions: early surgical treatment in selected patients with mild DCM may be associated with favorable neurological and quality-of-life outcomes, although larger prospective studies are needed. Full article

Background: Endoscopic spine surgery (ESS) is an established minimally invasive approach for degenerative spinal conditions. Advances in instrumentation and visualization have expanded its application to spinal tumor resection. This review synthesizes reported clinical outcomes and technical considerations of ESS for primary spinal tumors. Methods: PubMed was queried from 2000 to 2025 for studies reporting endoscopic resection of primary spinal tumors. Studies involving metastatic disease or non-resective interventions were excluded. Data were descriptively analyzed given heterogeneity and limited sample size. Results: Eleven patients across seven studies were included (mean age = 50.3 years). Pathologies comprised schwannoma (n = 5), meningioma (n = 3), osteoid osteoma (n = 2), and Ewing sarcoma (n = 1). Seven tumors were intradural extramedullary (63.6%) and four were extradural (36.4%); no intramedullary lesions were included. Of the seven intradural cases, one was performed via uniportal full-endoscopic technique, one via biportal endoscopy, and five via tubular retractor-assisted endoscopy. Across all eleven patients, gross total resection was achieved in 90.9% of cases. Gross total resection was achieved in 100% of cases in which it was the operative intent (10/10); the remaining case was a planned biopsy of recurrent Ewing sarcoma. One transient postoperative lower extremity weakness was reported; no cerebrospinal fluid leaks, reoperations, or perioperative deaths occurred. No recurrences were observed across a mean follow-up of 21.9 months (range 4–48 months), though this duration may be insufficient to assess long-term recurrence for slow-growing tumors such as meningioma and schwannoma. Conclusions: ESS of primary spinal tumors appears feasible and safe in carefully selected cases, particularly for small, well-circumscribed lesions in favorable anatomical locations. Intradural resection introduced distinct technical challenges, including irrigation management and dural closure, which influence platform selection. These findings are limited by small sample size, short follow-up, and likely publication bias. ESS should be considered an emerging minimally invasive option rather than a replacement for established microsurgical approaches. Prospective comparative studies are needed to better define its role in spinal oncology. Full article

Minimally invasive spine surgery (MISS) has progressively transformed the management of spinal disorders by reducing soft-tissue disruption, perioperative morbidity, and recovery time while maintaining clinical outcomes comparable to conventional open techniques. Beyond its technical evolution, MISS has increasingly assumed a central role in the treatment of bone-related spinal conditions, including vertebral fractures, degenerative instability, metastatic disease, and osteoporosis-associated pathology. This narrative review provides a comprehensive overview of the evolution of MISS with a specific focus on its interaction with vertebral bone biology, implant stability, and fusion processes. A structured literature search of the PubMed/MEDLINE database was conducted, including English-language studies published between 1980 and June 2025 addressing MISS techniques, enabling technologies, and bone-related clinical outcomes. Current evidence suggests that MISS may preserve paraspinal vascularization and soft tissue integrity, potentially supporting bone healing and fusion, although high-quality comparative data remain limited. The effectiveness of MISS in osteoporotic and metastatic vertebral disease is closely linked to bone quality, implant anchorage, and biomechanical considerations, particularly in the context of pedicle screw fixation and interbody support. Emerging technologies—including navigation, robotics, and artificial intelligence—may enhance accuracy in implant placement and reduce bone-related complications, but robust evidence of long-term benefit is still lacking. Despite its advantages, MISS presents important limitations, including a steep learning curve, increased costs, and uncertain superiority in terms of fusion rates and long-term biomechanical stability. Future research should prioritize high-quality comparative studies focusing on bone healing, implant integration, and patient-specific factors such as bone density. MISS should therefore be interpreted not only as a surgical paradigm shift but as an evolving strategy for optimizing outcomes in bone-related spinal disorders. Full article

Background/Objectives: i-Factor™ Bone Graft is a composite bone substitute containing P-15 synthetic collagen fragment that has demonstrated noninferiority to local autograft in single-level anterior cervical discectomy and fusion (ACDF); however, direct head-to-head comparisons with demineralized bone matrix (DBM) using contemporary 3D-printed titanium cages are lacking. The aim of this retrospective study was to compare radiographic fusion rates, segmental stability, and clinical outcomes between i-Factor™ and DBM in single-level ACDF, with a particular focus on the early time course of fusion. Methods: A retrospective propensity score-matched cohort study was conducted in patients with single-level cervical degenerative disc disease (cervical disc herniation, cervical spondylotic radiculopathy, or cervical spondylotic myelopathy) operated between December 2021 and January 2024 at a single tertiary care hospital. Seventy-six consecutive patients undergoing single-level ACDF with 3D-printed titanium cages were matched 1:1 (i-Factor™ vs. DBM) on age, sex, and operative level. Fusion status was assessed by serial dynamic radiographs at 1, 3, 6, and 12 months and by 3D-CT at 12 months in all patients (with additional CT at earlier timepoints when plain films were equivocal), by two independent spine surgeons blinded to graft type; inter-rater agreement (Cohen’s κ) was computed. Results: Mean follow-up was 18.1 months. Fusion rates for i-Factor™ at 3, 6, and 12 months were 94.7%, 100%, and 100%, respectively, compared to 71.1%, 84.2%, and 94.7% for DBM. The differences were statistically significant at 3 months (p = 0.047) and 6 months (p = 0.012), but not at 12 months (p = 0.493). Inter-rater agreement was almost perfect (κ = 0.86–1.00). No adverse reactions or device-related complications were observed. Conclusions: In this matched cohort, i-Factor™ was associated with significantly faster fusion than DBM in single-level ACDF, with similar 12-month fusion rates. No adverse reactions were observed, although the sample size is insufficient to exclude rare complications. Full article

Artificial intelligence (AI) is increasingly reshaping musculoskeletal (MSK) imaging across the entire imaging pathway. This narrative review summarizes current AI applications in MSK radiology across four domains: acquisition and reconstruction, detection and triage, characterization and quantification, and prognosis and decision support. AI-based reconstruction has enabled faster MRI acquisitions, improved denoising and artifact reduction, and supported low-dose CT imaging while preserving diagnostic quality. Fracture detection and triage currently represent the most mature clinical applications, particularly in emergency settings. AI is also promoting a shift from qualitative interpretation to quantitative imaging phenotyping through automated assessment of body composition, cartilage, bone density, degenerative spine disease, skeletal maturity, and lesion heterogeneity. Emerging applications in prognostic modeling, implant evaluation, and multimodal risk stratification remain promising but less mature. Broader clinical implementation is still limited by restricted interpretability, dataset bias, insufficient prospective validation, regulatory complexity, and unresolved medico-legal issues. Overall, AI should be viewed as a tool to augment, not replace, radiological expertise. Full article