Search Results (70)

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: Transcutaneous Randomized Pulsed Radiofrequency (TCPRF-STP) is a non-invasive therapeutic approach increasingly explored for managing spine-related pain, particularly in cases involving disc herniations and degenerative spine conditions. Objectives: To evaluate the use of transcutaneous PRF-STP in the treatment of spine pathologies and its evolution in short-term follow-up. Methods: This case series examines the outcomes of three patients treated with TCPRF-STP for varying spine pathologies, including lumbar and cervical disc herniations, lumbar stenosis, and radiculopathy. All patients had previously undergone conventional conservative therapies without a satisfactory improvement and were unwilling or unable to undergo invasive procedures. The treatment involved the application of electromagnetic fields through adhesive skin patches at targeted sites. Patients underwent three sessions of TCPRF-STP, with follow-up assessments evaluating pain and MRI. Results: Transcutaneous PRF-STP showed notable reductions in pain (VAS 0 in most cases), improvements in movement, and the restoration of normal daily activities. Follow-up MRI scans demonstrated positive structural changes in the treated discs. Although long-term recurrence occurred in one case, the patient remained active without functional limitations. Conclusions: Transcutaneous PRF-STP offers a promising, minimally invasive alternative for patients seeking to avoid surgery, though further studies with larger cohorts and longer follow-up periods are necessary to establish more robust evidence of its efficacy. This technique could become an important adjunct in managing chronic spinal pain conditions, offering patients an option with minimal risk and hospital demands. Full article

Background/Objectives: While anterior lumbar interbody fusion (ALIF) is a well-established treatment for degenerative lumbar spine pathology, the timing and pace of postoperative recovery remain poorly defined. Understanding these temporal trends is clinically important for setting patient expectations and optimizing postoperative care. Methods: This retrospective single-institution study evaluated functional recovery in patients undergoing primary, single-level stand-alone (SA) ALIF, or with percutaneous posterior instrumentation (PI). Patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI), the Visual Analog Scale (VAS) for back and leg pain, and the SF-12 Physical Component Score (PCS), were assessed preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. Achievement of minimum clinically important difference (MCID), global rating change (GRC), and return-to-activity milestones were also analyzed. Results: A total of 143 patients were included (90 SA; 53 PI). PROMs showed significant improvement through 1 year. VAS-back improved by 2 weeks, while ODI and SF12 PCS initially worsened but improved after 6 weeks. By 6 months, over half of the cohort achieved MCID, with continued gains through 1 year. Most patients returned to driving and work, and over 90% discontinued narcotics. Recovery trajectories were comparable between groups, despite early delays in the instrumented cohort. Conclusions: These findings provide time-specific recovery benchmarks that can guide surgical decision-making, patient education, and expectations around functional milestones. Full article

Endoscopic spine surgery (ESS) has traditionally been employed for lumbar disc herniation (LDH). Recent innovations in surgical methods and technologies have expanded its range to address other spinal pathologies, providing minimally invasive solutions with potential clinical benefits. Our review aims to summarize the applications, clinical outcomes, and limitations of ESS beyond LDH, focusing on its role in complex spinal conditions such as stenosis, thoracic disc herniation, spinal tumors, synovial cysts, and failed back surgery syndrome. A thorough review of the literature was conducted to assess and summarize the current evidence regarding ESS applications for spinal conditions beyond LDH surgery. Areas of focus included innovations in technology and technique, as well as comparisons with conventional open surgical methods. ESS shows notable potential across different spinal conditions by providing minimally invasive alternatives to traditional open surgery. Its use could be associated with reduced surgical morbidity, shorter recovery times, and improved patient outcomes. In particular, ESS is versatile in addressing both degenerative and neoplastic conditions of the spine. Despite this, challenges such as technical complexity, steep learning curves, and limited indications for certain pathologies remain as barriers to wider adoption. ESS is evolving in spine surgery, extending its utility beyond LDH surgery. While the current evidence largely supports its clinical efficacy, further studies are needed to address the present limitations and optimize its application. Future developments in surgical training and technology will likely enhance its adoption and broaden its clinical indications. Full article

Background/Objectives: Lumbar spine surgery has undergone significant technological transformation in recent years, driven by the goals of minimizing invasiveness, improving precision, and enhancing clinical outcomes. Emerging tools—including robotics, augmented reality, computer-assisted navigation, and artificial intelligence—have complemented the evolution of minimally invasive surgical (MIS) approaches, such as endoscopic and lateral interbody fusions. Methods: This systematic review evaluates the literature from February 2020 to February 2025 on technological and procedural innovations in LSS. Eligible studies focused on degenerative lumbar pathologies, advanced surgical technologies, and reported clinical or perioperative outcomes. Randomized controlled trials, comparative studies, meta-analyses, and large case series were included. Results: A total of 32 studies met the inclusion criteria. Robotic-assisted surgery demonstrated high accuracy in pedicle screw placement (~92–94%) and reduced intraoperative blood loss and radiation exposure, although long-term clinical outcomes were comparable to conventional techniques. Intraoperative navigation improved instrumentation precision, while AR enhanced ergonomic workflow and reduced surgeon distraction. AI tools showed promise in surgical planning, guidance, and outcome prediction but lacked definitive evidence of clinical superiority. MIS techniques—including endoscopic discectomy and MIS-TLIF—offered reduced blood loss, shorter hospital stays, and faster recovery, with equivalent pain relief, fusion rates, and complication profiles compared to open procedures. Lateral and oblique approaches (XLIF/OLIF) further optimized alignment and indirect decompression, with favorable perioperative metrics. Conclusions: Recent innovations in lumbar spine surgery have enhanced technical precision and perioperative efficiency without compromising patient outcomes. While short-term benefits are clear, long-term clinical advantages and cost-effectiveness require further investigation. Integration of robotics, navigation, AI, and MIS into spine surgery reflects an ongoing shift toward personalized, data-driven, and less invasive care. Full article

Degenerative changes are characterized by the formation of vertebral osteophytes, the hypertrophy of facet joints, and narrowing of the intervertebral space. This study aimed to investigate the concentrations of trace elements (Al, As, Se, Zn, Fe, Mo, Cu) in spinal tissues (intervertebral discs, muscle, and bone) of patients with degenerative lumbar spine disease (DLSD) and their potential associations with the disease. The research involved 13 patients undergoing surgery for symptomatic degenerative spine disease. The trace element concentrations were analyzed using chemical and radiographic assessments, with a statistical analysis performed through a Mann–Whitney U-test, Spearman’s rank correlation test, principal component analysis (PCA), and canonical discriminant analysis (CDA). The results showed significant variations and correlations among the trace elements across different spinal tissues, suggesting their roles in metabolic and oxidative processes and the pathology of spinal degeneration. Full article

Background/Objectives: This study aimed to create a pipeline for standardized data extraction from lumbar-spine MRI radiology reports using a large language model (LLM) and assess the agreement of the extracted data with research-grade semi-quantitative scoring. Methods: We included a subset of data from a multi-site NIH-funded cohort study of chronic low back pain (cLBP) participants. After initial prompt development, a secure application programming interface (API) deployment of OpenAIs GPT-4 was used to extract different classes of pathology from the clinical radiology report. Unsupervised UMAP and agglomerative clustering of the pathology terms’ embeddings provided insight into model comprehension for optimized prompt design. Model extraction was benchmarked against human extraction (gold standard) with F1 scores and false-positive and false-negative rates (FPR/FNR). Then, an expert MSK radiologist provided comprehensive research-grade scores of the images, and agreement with report-extracted data was calculated using Cohen’s kappa. Results: Data from 230 patients with cLBP were included (mean age 53.2 years, 54% women). The overall model performance for extracting data from clinical reports was excellent, with a mean F1 score of 0.96 across pathologies. The mean FPR was marginally higher than the FNR (5.1% vs. 3.0%). Agreement with comprehensive scoring was moderate (kappa 0.424), and the underreporting of lateral recess stenosis (FNR 63.6%) and overreporting of disc pathology (FPR 42.7%) were noted. Conclusions: LLMs can accurately extract highly detailed information on lumbar spine imaging pathologies from radiology reports. Moderate agreement between the LLM and comprehensive scores underscores the need for less subjective, machine-based data extraction from imaging. Full article

The interspinous process device (IPD) has emerged as a viable alternative for managing lumbar degenerative pathologies. Nevertheless, limited research exists regarding mechanical failure modes including device failure and spinous process fracture. This study developed a novel IPD (IPD-NEW) and systematically evaluated its biomechanical characteristics through finite element (FE) analysis and in vitro cadaveric biomechanical testing. Six human L1–L5 lumbar specimens were subjected to mechanical testing under four experimental conditions: (1) Intact spine (control); (2) L3–L4 implanted with IPD-NEW; (3) L3–L4 implanted with Wallis device; (4) L3–L4 implanted with Coflex device. Segmental range of motion (ROM) was quantified across all test conditions. A validated L1–L5 finite element model was subsequently employed to assess biomechanical responses under both static and vertical vibration loading regimes. Comparative analysis revealed that IPD-NEW demonstrated comparable segmental ROM to the Wallis device while exhibiting lower rigidity than the Coflex implant. The novel design effectively preserved physiological spinal mobility while enhancing load distribution capacity. IPD-NEW demonstrated notable reductions in facet joint forces, device stress concentrations, and spinous process loading compared to conventional implants, particularly under vibrational loading conditions. These findings suggest that IPD-NEW may mitigate risks associated with facetogenic pain, device failure, and spinous process fracture through optimized load redistribution. Full article

Minimally invasive spine surgery has advanced significantly over the past decade, integrating technologies such as intraoperative navigation, robotics, and artificial intelligence with innovative techniques such as single-position prone lateral transpsoas lumbar interbody fusion (proLIF). While proLIF offers excellent clinical outcomes for a wide range of lumbar pathologies, the lateral approach to lumbar spine presents technical and ergonomic challenges, including an increased need for soft-tissue dissection and unfavorable ergonomics for surgeons. This review details how the combination of emerging technologies has been applied in minimally invasive lumbar spine surgery. It also describes the novel application of an exoscope during navigation-guided proLIF. The benefits offered by the exoscope included high-resolution, three-dimensional visualization, enhanced maneuverability, and improved surgeon ergonomics. By combining emerging technologies with novel surgical approaches, this review demonstrates the recent advancements in minimally invasive spine surgery and underscores the exoscope’s potential to enhance visualization and optimize ergonomics for surgeons. Full article

Background: Chronic low back pain (LBP) has been associated with intervertebral disc (IVD) degeneration, but its association with abnormal morphology at the discovertebral junction (DVJ) is unclear. The goal of this study was to evaluate the DVJ morphology in asymptomatic (Asx) and symptomatic (Sx) subjects for LBP using ultrashort echo time (UTE) MRI. Methods: We recruited 42 subjects (12 Asx and 32 Sx). Lumbar IVD degeneration was assessed using Pfirrmann grading (1 to 5), while the abnormality of DVJ (0 = normal; 1 = focal; 2 = broad abnormality) was assessed using UTE MRI. The effects of LBP and level on the mean IVD and DVJ grades, the correlation between IVD and DVJ grade, and the effect of LBP and age on the number of abnormal DVJs within a subject were determined. Results: IVD grade was higher in Sx subjects (p = 0.013), varying with disc level (p = 0.033), adjusted for age (p < 0.01). Similarly, DVJ grade was also significantly higher in Sx subjects (p = 0.001), but it did not vary with DVJ level (p = 0.7), adjusted for age (p = 0.5). There was a weak positive (rho = 0.344; p < 0.001) correlation between DVJ and IVD grade. The total number of abnormal DVJs within a subject was higher in Sx subjects (p < 0.001), but not with respect to age (p = 0.6) due to a large spread throughout the age range. Conclusions: These results demonstrate the feasibility of using in vivo UTE MRI of the lumbar spine to evaluate the DVJ and the correlation of DVJ with LBP. This study highlights the need for a better understanding of DVJ pathology and the inclusion of DVJ assessment in routine lumbar MRI. Full article

Bone mineral density (BMD) is an essential indicator of bone strength and plays a crucial role in the clinical management of various spinal pathologies. Hounsfield units (HUs) calculated from computed tomography (CT) scans are a well-established, effective, and non-invasive method to determine bone density in the lumbar spine when juxtaposed to dual-energy X-ray absorptiometry (DEXA) scans, the gold standard for assessing trabecular bone density. Only recently have studies begun to investigate and establish HUs as a reliable and valid alternative for bone quality assessment in the cervical spine as well. In addition, multiple recent studies have identified cervical HUs as an accurate predictor of cage subsidence, an undesired complication of anterior cervical discectomy and fusion (ACDF) of anterior cervical corpectomy and fusion (ACCF) procedures. Subsidence involves migration of the spinal fusion cage into vertebral bodies, causing a loss of disk space, negatively altering spine alignment, and possibly necessitating further unwanted surgical intervention. Using the PRISMA-ScR checklist and the registered scoping review protocol (INPLASY2024100126), this review explores the current research on the use of cervical spine HU measurements as both a determinant of BMD and as a prognosticator of postoperative subsidence following cervical spine procedures (i.e., ACDFs and ACCFs) with the aim of improving clinical and surgical outcomes. Full article

(1) Background: The exploration of various machine learning (ML) algorithms for classifying the state of Lumbar Intervertebral Discs (IVD) in orthopedic patients is the focus of this study. The classification is based on six key biomechanical features of the pelvis and lumbar spine. Although previous research has demonstrated the effectiveness of ML models in diagnosing IVD pathology using imaging modalities, there is a scarcity of studies using biomechanical features. (2) Methods: The study utilizes a dataset that encompasses two classification tasks. The first task classifies patients into Normal and Abnormal based on their IVDs (2C). The second task further classifies patients into three groups: Normal, Disc Hernia, and Spondylolisthesis (3C). The performance of various ML models, including decision trees, support vector machines, and neural networks, is evaluated using metrics such as accuracy, AUC, recall, precision, F1, Kappa, and MCC. These models are trained on two open-source datasets, using the PyCaret library in Python. (3) Results: The findings suggest that an ensemble of Random Forest and Logistic Regression models performs best for the 2C classification, while the Extra Trees classifier performs best for the 3C classification. The models demonstrate an accuracy of up to 90.83% and a precision of up to 91.86%, highlighting the effectiveness of ML models in diagnosing IVD pathology. The analysis of the weight of different biomechanical features in the decision-making processes of the models provides insights into the biomechanical changes involved in the pathogenesis of Lumbar IVD abnormalities. (4) Conclusions: This research contributes to the ongoing efforts to leverage data-driven ML models in improving patient outcomes in orthopedic care. The effectiveness of the models for both diagnosis and furthering understanding of Lumbar IVD herniations and spondylolisthesis is outlined. The limitations of AI use in clinical settings are discussed, and areas for future improvement to create more accurate and informative models are suggested. Full article

Introduction: Painful legs and moving toes (PLMT) syndrome is a rare movement disorder characterized by defuse lower limb neuropathic pain and spontaneous abnormal, involuntary toe movements. Objective: The objective was to present a rare case of PLMT syndrome with a triggering area in an adult patient due to multilevel discogenic pathology, to make a thorough review of this disorder and to provide a practical approach to its management. Case presentation: A 59-years-old male was admitted to the neurology ward with symptoms of defuse pain in the lower-back and the right leg accompanied by involuntary movements for the right toes intensified by tactile stimulation in the right upper thigh. Magnetic resonance imaging (MRI) revealed a multilevel discogenic pathology of the lumbar and cervical spine, with myelopathy at C5-C7 level. A medication with Pregabalin 300 mg/daily significantly improved both the abnormal toe movements and the leg pain. The clinical effect was constant during the 90-day follow-up without any adverse effects. Conclusion: Painful legs and moving toes (PLMT) is a condition that greatly affects the quality of life of patients, but which still remains less known by clinicians. Spontaneous resolution is rare, and oral medications are the first-line treatment. Pregabalin is a safe and effective treatment option for PLMT that should be considered early for the management of this condition. Other medication interventions, such as botulinum toxin injections, spinal blockade, or non-pharmacological treatment options like spinal cord stimulation, and surgical decompressions, are also recommended when the conservative treatment is ineffective in well-selected patients. Full article

Background/Objectives: Transforaminal endoscopic lumbar discectomy (TELD) under local anesthesia is a promising minimally invasive surgical option for intractable lumbar disc herniation (LDH). However, our understanding of access pain prediction during foraminal pathological procedures is limited. To our knowledge, no predictive rules for access pain have been established during TELD for foraminal or extraforaminal LDH. This study, with its potential for predicting access pain during TELD and discussing strategies for pain prevention and management, could significantly benefit the field of endoscopic spine surgery. Methods: This observational study included 73 consecutive patients who underwent TELD for foraminal or extraforaminal LDH between January 2017 and December 2022. Preoperative clinical and radiographic factors affecting significant access pain and the impact of access pain on clinical outcomes were evaluated. Results: The rate of significant access pain was 13.70% (10 of 73 patients). Extraforaminal LDH tended to cause more severe pain than did foraminal LDH during TELD under local anesthesia (p < 0.05). Although the degree of access pain was not related to global clinical outcomes, increased pain was strongly associated with prolonged operative time and length of hospital stay (p < 0.05). Conclusions: TELD could be an effective surgical option for foraminal or extraforaminal LDH under local anesthesia. More access pain might develop during TELD for extraforaminal LDH. The extraforaminal component of LDH could narrow the safe working zone. Significant access pain might prolong the duration of surgery and hospitalization. Thus, a specialized technique is required for the clinical success of TELD. Full article

A 65-year-old woman was admitted to the neurology department with a suspected demyelinating disease due to complaints of progressive pain and weakness in both upper and lower limbs, as well as urinary incontinence. MRI of the spine revealed complex disc osteophyte with compression of the spinal cord in the cervical and lumbar spine at several vertebral levels, and localized enhancement in the cervical spine at the site of maximal spinal canal stenosis. During her hospitalization, the patient underwent extensive evaluation to rule out any systematic inflammatory diseases, infections, and malignancy. Chest CT revealed bilateral mediastinal lymphadenopathy. Transbronchial mediastinal lymph node biopsy showed numerous non-necrotizing granulomas without evidence of malignancy. After a thorough and careful exclusion of a demyelinating, infectious, and paraneoplastic myelopathies, and based on clinical, radiographic, and pathological findings, the patient was diagnosed with both neurosarcoidosis and spondylotic myelopathy. She was then treated for neurosarcoidosis, including glucocorticosteroids, azathioprine, and a biosimilar of the anti-TNF alpha agent infliximab, resulting in both clinical and radiographic improvement. Intramedullary spinal neurosarcoidosis is very rare and may present with clinical features of spondylotic myelopathy, with typical imaging findings occurring only in areas of spinal canal stenosis. Full article