Search Results (68)

Chronic pain is increasingly understood as a neuroimmune disorder rather than a purely neuronal condition, in which immune mediators and immune-like signaling within the nervous system regulate nociceptive gain across peripheral tissues, dorsal root ganglia (DRG), spinal cord, and supraspinal networks. Seminal and recent syntheses show that microglia, macrophages, cytokines/chemokines, and innate immune sensors can initiate and maintain maladaptive plasticity and central sensitization, helping explain the frequent clinical dissociation between structural pathology, systemic inflammatory markers, and pain severity. However, immune biology is bidirectional: alongside pronociceptive pathways, a growing literature describes active “pain-resolving” programs that terminate sensitization and restore homeostasis, including regulatory T cell (Treg)–IL-10 signaling and specialized pro-resolving mediators (SPMs). A structured search of PubMed/MEDLINE, supplemented by Europe PMC and PubMed Central, was performed, and citation chasing through broad scholarly indices was used to identify high-impact reviews, meta-analyses, and translational mechanistic studies. Systematic biomarker syntheses in low back pain, neck pain, and fibromyalgia indicate modest and heterogeneous systemic inflammatory signals, underscoring the need for mechanistic endotyping and stage-specific interventions. Based on this evidence, a clinically oriented framework is presented that distinguishes immune-driven pain amplification from impaired resolution and outlines practical implications for assessment, biomarker interpretation, and precision-oriented trial design. Full article

Background/Objectives: This study aimed to clinically investigate how variations in foot morphology influence spinal and lower limb alignment, based on the concept of an ascending kinetic chain. Methods: We analyzed the medical records of 100 patients who met the inclusion criteria. The X-ray image data used in the analysis included weight-bearing lateral views of both feet, whole-spine anteroposterior (AP) and lateral views, and full-length standing AP scanograms of the lower legs. In the obtained X-ray images, Calcaneal Inclination Angle (CIA), Tibiotalar Tilt Angle (TTA), Tibiotalar Angle (TA), Quadriceps Angle (Q-angle), Pelvic Incidence (PI), Pelvic Tilt (PT), Sacral Slope (SS), and L1–S1 Lordosis (LL) were measured. Participants were categorized into subgroups based on their CIA values: Pes Planus, Normal, and Pes Cavus. These subgroups were analyzed by foot orientation (right and left) using one-way analysis of variance (ANOVA) and Pearson correlation coefficient analysis. Results: The one-way ANOVA identified significant differences in mean right foot PT values among subgroups. Correlation analysis shows moderate associations between foot CIA and Q-angle of the knee, as well as pelvic parameters including PI, PT, SS, and LL. Conclusions: Analysis of the correlation between foot parameters and body alignment, in the context of diagnostic and evaluative aspects of Chuna manual medicine (CMM), revealed moderate correlations among the foot, ankle, knee, pelvis, and lumbosacral regions. These findings suggest that foot morphology may play a clinically relevant role in posture-related disorders and could contribute to preventive and corrective strategies for musculoskeletal alignment. Full article

Total hip arthroplasty (THA) reliably restores function, yet instability remains a clinically relevant complication. Increasing evidence indicates that postoperative stability is strongly influenced by the dynamic spine–pelvis–hip interaction, which modulates functional acetabular orientation across postures. This narrative review summarizes current evidence on postoperative spinopelvic alignment changes after THA with emphasis on temporal patterns, underlying mechanisms, and predictive factors. Early after THA, restoration of hip motion can partially normalize hip-driven compensatory patterns, however substantial interindividual variability persists. Mid- to long-term follow-up shows that pelvic orientation continues to evolve, particularly progressive posterior pelvic tilt in standing, largely driven by aging and spinal degeneration, with acceleration in older patients and those with spinal pathology. Prediction of postoperative pelvic behavior requires integrated assessment of pelvic orientation, spinal alignment and mobility, contralateral hip status, and whether imbalance is hip-driven versus spine-driven. Although classification- and model-based approaches can estimate postoperative pelvic tilt, clinically meaningful prediction uncertainty remains, supporting a strategy focused on risk stratification and adaptive preoperative planning. Full article

Background: Congenital scoliosis (CS) associated with multiple vertebral anomalies (MVAs) represents a biologically dynamic deformity in which cumulative segmental asymmetry, residual growth potential, and mechanobiological modulation interact to drive progression. Unlike isolated congenital lesions, MVAs exhibit growth-dependent and configuration-specific behavior, complicating risk stratification and timing of intervention. Despite extensive literature on congenital deformities, an integrated growth-oriented decision framework for this subgroup remains lacking. Methods: This narrative review synthesizes embryological, biomechanical, and clinical evidence related to vertebral growth potential, anomaly configuration, progression patterns, and age-dependent treatment strategies in CS with MVAs. A structured literature search of major databases was performed, and findings were analyzed thematically to propose a biologically grounded growth-based decision framework. Results: Across the literature, three interdependent determinants of progression consistently emerge: anomaly configuration, residual segmental growth capacity, and mechanobiological amplification during growth. High-risk configurations—particularly mixed formation–segmentation defects and fully segmented hemivertebrae with contralateral growth arrest—demonstrate rapid and often non-linear progression. Thoracic involvement further modifies clinical urgency due to its impact on pulmonary development. Integration of developmental biology and mechanobiological principles supports a structured, growth-informed approach to surveillance and intervention timing. Conclusions: MVAs should be conceptualized as dynamic growth systems rather than static structural defects. A shift from angle-driven to growth-informed decision-making may enhance early identification of high-risk patterns while minimizing unnecessary premature fusion in lower-risk cases. Adoption of a structured growth-based framework provides a biologically coherent foundation for individualized management and long-term optimization of spinal and thoracic development. Full article

Muscle degeneration is the hallmark of muscular dystrophies—genetically heterogeneous disorders traditionally approached through the lens of molecular pathogenesis or symptomatic management in isolation. Here, we present a deliberately interdisciplinary synthesis that bridges molecular genetics, clinical phenotyping, and evidence-based orthopedic decision-making to address a significant critical gap: the lack of genotype-informed, function-oriented frameworks for musculoskeletal complications. We re-evaluate disease entities—not only by their molecular etiology (e.g., DMD, LMNA, DUX4 dysregulation), but through the prism of orthopedic manifestations as diagnostic gateways and therapeutic milestones. For instance, early rigid spine in LMNA-related dystrophy is not merely a sign of contracture, but a red flag demanding cardiac risk stratification before surgical planning, in alignment with current consensus. Similarly, scoliosis management in Duchenne muscular dystrophy is discussed through quantitative decision thresholds (Cobb angle ≥ 20–30°, FVC ≥ 30–35%) derived from long-term outcome studies, rather than general clinical recommendations. Critically, we confront challenges posed by disease-modifying therapies: patients now survive into their 30s and 40s, yet develop novel, therapy-exacerbated orthopedic phenotypes (e.g., steroid-induced osteoporosis, atypical spinal rigidity). Therefore, we argue that precision orthopedics—tailored surveillance, genotype-stratified intervention timing (e.g., D4Z4 repeat-guided monitoring in FSHD, and realistic functional goal-setting (e.g., scapular arthrodesis for overhead function)—should become the gold standard of care. For example, desminopathies may show marked phenotypic variability even within the same mutation. Our review thus serves not only as a molecular overview, but as a practical roadmap for neurologists, geneticists, orthopedic surgeons, and rehabilitation specialists seeking to translate genomic insights into durable functional outcomes. Full article

Wheelchair-mounted robotic arms (WMRAs) are assistive manipulators designed to increase the functional independence of individuals with limitations in the upper and lower extremities. While previous research has identified several visual, cognitive, and physical abilities that facilitate optimal operation of such a device, these have yet to be accounted for when designing the human–robot interface. This study investigates whether interface-level compensations can improve usability and support more personalized control across users with different abilities. Five interface compensations were implemented and evaluated: object highlighting, move suggestions, slowing near objects, a one-click approach, and a level indicator. A user study was conducted among individuals with spinal cord injury as well as able-bodied younger and older adults serving as comparison groups. Evaluations of task performance metrics, perceived WMRA usability, and user experience were conducted. The results indicate that younger adults achieved the highest task efficiency, followed closely by participants with spinal cord injury, with both groups reporting good-to-excellent usability, whereas older adults showed lower efficiency and rated the system as having fair usability. The one-click automated object approach feature was identified as the most useful compensation among all participant groups. Overall, participant feedback indicated that spatial visualization and spatial orientation were the most important individual differences affecting the operation of the arm. Full article

This study introduces a novel framework for defining screw trajectory that utilizes PointNet—a deep neural network trained on lumbar vertebrae point clouds—to improve the manual surgical planning procedures. The conventional architecture of PointNet was modified to accommodate various vertebral orientations and predict six values, which were reconstructed into two control points that define a linear trajectory. A custom loss function was designed to align the predicted trajectory with the ground-truth trajectory. The neural networks were trained on 4284 point clouds of vertebrae, and 28 unseen point clouds were used to evaluate the model’s performance based on translational error, angular error, and clinical accuracy. For the left pedicle, the mean translational errors were 1.5 ± 0.8 mm at the entry point and 2.3 ± 1.2 mm at the target point. For the right pedicle, the mean translational errors were 1.5 ± 0.7 mm at the entry point and 2.3 ± 1.0 mm at the target point. The mean angular error was 3.5 ± 2.3° for the left pedicle and 3.9 ± 1.7° for the right pedicle. Clinically, the network generated 52 out of 56 trajectories without medial-cortical violations of the spinal canal. The trained neural network demonstrated promising technical and clinical accuracy, generating feasible screw trajectories across various vertebral orientations. Integrating a spinal segmentation network with the proposed framework could enable fully automated surgical planning in the future. Full article

Background and Clinical Significance: Fourth-ventricular epidermoid cysts are rare intracranial lesions. They account for fewer than 1% of all primary brain tumors. Fourth-ventricular epidermoid cysts grow slowly because they are closely related to brainstem, cerebellum, and major blood vessels, so their treatment requires special caution. Because the cyst capsule attaches to functionally sensitive locations, complete removal is usually not possible without compromising some aspect of brain or spinal cord function. Surgical decision-making always involves weighing the need to remove the entire cyst against the potential loss of function of the affected area. The following case study describes how a patient was treated with a focus on the relationship between the cyst and surrounding anatomy, allowing for successful decompression with minimal risk to the patient’s neurologic status. Case Presentation: A young adult female patient was hospitalized with progressive truncal ataxia, disequilibrium and occipital headache accompanied by papilledema. Her physical examination disclosed significant dysfunction of the midline cerebellar region (SARA score = 18/40, ICARS score = 42/100), gaze-evoked nystagmus and bilaterally elevated grade II papilledema. MRI and MRA demonstrated a large, lobulated, nonenhancing, avascular mass located within the fourth ventricle, encroaching upon the dorsal medulla and obstructing both the foramen of Magendie and foramina of Luschka—findings typical of an epidermoid cyst. Microsurgical resection was accomplished via a median suboccipital craniectomy using a telovelar approach along the embryonic cerebellomedullary fissure to protect the integrity of the vermis and brainstem. The cyst contained layers of keratin embedded in a thin, translucent capsule. The capsule was carefully dissected away from the floor of the fourth ventricle. A very narrow band of capsule attached to the rhomboid fossa was intentionally spared to avoid damaging the cranial nerves. The patient had normal cerebrospinal fluid circulation restored and normal ventricular pulsation observed during surgery. Histopathology confirmed a benign epidermoid cyst consisting of keratinizing stratified squamous epithelium containing cholesterol clefts and laminated keratin debris. After surgery, the patient exhibited continuous neurological improvement including restoration of balance, disappearance of her headaches, and normalization of ocular pursuit. Sequential imaging studies were conducted post-operatively at one week, one month, three months, five months, and seven months to document stable decompression of the fourth ventricle, re-expansion of the fourth ventricle, and no evidence of cyst recurrence. Post-operative course was uncomplicated and the patient has remained free of symptoms and fully independent functionally at most recent follow-up. Conclusions: This case illustrates that when anatomically oriented, “maximal safe resection” can result in long-lasting decompression and clinically meaningful improvement in neurological function in patients with fourth-ventricular epidermoid cysts. Restoration of the patient’s natural cerebrospinal fluid pathway and preservation of neural interface relationships is more beneficial than pursuing aggressive removal of the cyst capsule. Although the risk of late recurrence is present even after nearly total removal, continuous radiologic monitoring is necessary to identify any recurrence. These experiences illustrate that with the principles of surgical restraint and anatomical guidance, there can be a balance between long-term stability and low operative risk. Full article

Virtual reality (VR) offers built-in wearable sensor-based tracking capabilities. Current research focusses on position and orientation error, with limited results on more clinically relevant metrics, such as joint angles. This leads us to our first objective, to characterize the accuracy of upper extremity VR motion capture. Since the intent is for clinical translation, our second objective is to compare the errors across people identified as healthy controls and people who had experienced a spinal cord injury (SCI). Spatially and temporally synced VR and infrared motion capture data were collected during a variety of custom VR Beat Saber levels. Error values were found with infrared motion capture as the ground truth. The median RMSE was found to be below 7° for shoulder horizontal adduction and elbow flexion and 5° for shoulder elevation and wrist joint metrics. The percentage median error for the range of motion was found to be below 30%, 15%, and 5% for the frontal wrist, sagittal wrist, and all other joints, respectively. Larger standard deviations suggest that repetitions are needed to obtain reliable measurements. No statistical difference in any error metric was found between the control cohort and SCI cohort, providing evidence for clinical translation for post-SCI treatment. Full article

This feasibility study evaluated a wearable sensor-based haptic feedback system designed to promote ergonomic awareness and influence posture and muscle activation patterns during a standard dental procedure. Inertial measurement units (IMUs) monitored posture by tracking back and neck angles, while four surface electromyography sensors recorded muscle activation in the lower erector spinae (LES) and upper trapezius (UT) muscles. Two IMUs with vibrotactile motors delivered real-time haptic feedback when participants maintained mechanically disadvantageous postures for extended periods during a cast metal crown preparation procedure on a manikin typodont. Data from four dental students participating in a total of 24 trials, half with and half without feedback, were analyzed via a two-way ANOVA to determine the effects of feedback and activity (e.g., inspections or drilling) on posture and muscle activation. Feedback slightly increased neck angles, but back angles remained nominally unchanged. Reduced UT activation and increased right LES activation suggests altered muscle recruitment strategies. Heatmap and RULA analyses indicated a shift toward more varied and potentially safer postural distributions during feedback trials. Postural and muscle activation data were also analyzed across four activity labels, which revealed that Drilling was consistently associated with higher ergonomic risk. Real-time haptic feedback influenced posture and muscle activation in dental students, particularly by reducing UT strain despite increased neck flexion. These findings support the integration of wearable feedback systems into preclinical training to enhance ergonomic awareness and potentially reduce the risk of developing musculoskeletal disorders, to which dentists are particularly prone. Full article

Background/Objectives: Upper lumbar spinal stenosis presents unique challenges because vertically oriented facet joints and narrow laminae increase the risk of iatrogenic instability following decompression. Traditional decompression techniques may damage the facet joints, potentially resulting in further instability and degeneration. This study introduces a novel, facet-preserving bilateral–contralateral decompression strategy using unilateral biportal endoscopy (UBE) for upper lumbar stenosis, aiming to defer unnecessary spinal fusion. Methods: This retrospective series of three cases involved patients with upper lumbar stenosis characterized by vertically oriented facets (>60°) and narrow laminae, including cases of adjacent segment stenosis (ASS) and stenosis with grade 1 spondylolisthesis. Patients were selected using the authors’ facet angle–based criteria (>60°) and laminar morphology to identify anatomically vulnerable segments. All patients exhibited vertical facet orientation and narrow laminae, without significant dynamic instability or severe foraminal compromise. Bilateral–contralateral decompression was performed using biportal endoscopy to preserve facet integrity and defer fusion where feasible. Results: This series demonstrated that bilateral–contralateral decompression provided effective neural decompression and symptom relief while preserving facet structures in the upper lumbar spine characterized by vertical facets and narrow laminae. No progression to instability or requirement for additional fusion was observed during the 6-month follow-up, even among patients with ASS and grade 1 spondylolisthesis. Conclusions: The authors propose that bilateral–contralateral decompression may serve as a facet-preserving and fusion-deferral strategy for upper lumbar stenosis with vertically oriented facets and narrow laminae. This approach is particularly applicable in cases such as ASS and spinal stenosis with grade 1 spondylolisthesis, where preserving structural reserve is critical. These preliminary findings highlight the need for prospective validation through carefully designed observational studies and larger case series. Full article

Objectives: The primary objective was to investigate and compare the effects of three paired-pulse repetitive trans-spinal magnetic stimulation (PP-rTSMS) protocols on balance control and corticospinal network function. Methods: PP-rTSMS (800 pulses, frequency 100 Hz, intensity 70% of the resting motor threshold) was applied over the eighth thoracic vertebra (Th8) in twenty-seven young healthy individuals. Each proband received three verum sessions (using a verum coil with handle oriented (i) cranially, (ii) caudally, and (iii) laterally) and (iv) one sham session (using a sham coil) in a randomised order. Balance ability (Y Balance Test) and corticospinal network functions (motor evoked potentials (MEPs), cortical silent periods (SCPs)) were tested immediately (i) prior to and (ii) after each interventional session. Results: Each verum session induced a significant improvement in balance ability (cranially (F_1,26 = 8.009; p = 0.009; η² = 0.236), caudally (F_1,26 = 4.846; p = 0.037; η² = 0.157), and laterally (F_1,26 = 23,804; p ≤ 0.001; η² = 0.478) oriented grip) as compared to the sham session. In addition, the laterally oriented coil grip was associated with significantly greater balance benefits than both the cranial (F_1,26 = 10.173; p = 0.004; η² = 0.281) and caudal (F_1,26 = 14.058; p ≤ 0.001; η² = 0.351) grip orientations. No significant intervention-induced effects were detected on corticospinal network functions. Conclusions: Our data show that PP-rTSMS effectively supports balance control and that coil orientation significantly influences these effects. Further studies should test variations of this promising approach on healthy and disabled cohorts. Full article

Study Design: Prospective observational study. Background: Lumbar spinal stenosis (LSS) impairs balance and gait function, increasing fall risk and limiting quality of life. Although postoperative recovery of balance is clinically important, longitudinal data using multidimensional balance assessments are limited. Methods: A prospective cohort study was conducted in 101 patients (mean age 74.9 ± 6.9 years) undergoing surgery for LSS. The Brief Balance Evaluation Systems Test (Brief BESTest), Oswestry Disability Index (ODI), Modified Falls Efficacy Scale (MFES), Zurich Claudication Questionnaire (ZCQ), and Visual Analog Scales (VAS) for pain/numbness were evaluated preoperatively and at 6 and 12 months postoperatively. Changes over time and correlations between Brief BESTest and PROMs were analyzed. Results: The total Brief BESTest score significantly improved from 13.3 ± 5.3 preoperatively to 16.1 ± 5.1 at 6 months and 16.0 ± 5.1 at 12 months (p < 0.01). Subdomains including Anticipatory Adjustments, Postural Responses, Sensory Orientation, and Stability in Gait improved significantly, while Stability Limits did not. At 12 months postoperatively, ODI decreased by 19.1%, ZCQ symptom and function scores improved by 0.8 and 0.9 points, respectively, and VAS scores improved by 17.1 mm for low back pain, 26.5 mm for lower limb pain, and 19.5 mm for numbness, all showing marked improvements from baseline. MFES also increased significantly postoperatively. The Brief BESTest score correlated significantly with MFES and ZCQ-PFS at baseline, and with ODI, ZCQ, and VAS scores at 12 months. Conclusions: Balance ability in LSS patients improved after surgery, as measured by the Brief BESTest, with clinically meaningful changes maintained for 12 months. Improvements in balance were significantly associated with reductions in pain, disability, and fear of falling, suggesting the Brief BESTest is a comprehensive indicator of postoperative recovery. Full article

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

Background/Objectives: Correction surgery for adult spinal deformity (ASD) reduces disability but may lead to spinal stiffness. Cultural diversity may also influence how this stiffness affects daily life. We aimed to evaluate the impact of correction surgery on Japanese patients with ASD using a newly developed questionnaire and to clarify how these patients adapt to their living environment postoperatively in response to spinal stiffness. Methods: This retrospective study included 74 Japanese patients with operative ASD (mean age: 68.2 ± 7.5 years; fusion involving >5 levels) with a minimum follow-up of 1 year. Difficulties in performing various activities of daily living (ADLs) were assessed using a novel 20-item questionnaire tailored to the Oriental lifestyle. The questionnaire also evaluated lifestyle and environmental changes after surgery. Sagittal and coronal spinal parameters were measured using whole-spine radiographs, and clinical outcomes were assessed using the ODI and SRS-22 scores. Results: Coronal and sagittal alignment significantly improved postoperatively. Although the total ADL score remained unchanged, four trunk-bending activities showed significant deterioration. The lower instrumented vertebrae level and pelvic fusion were associated with lower scores in 11 items closely related to trunk bending or the Oriental lifestyle. After surgery, 61% of patients switched from a Japanese-style mattress to a bed, and 72% swapped their low dining table for one with chairs. Both the ODI and SRS-22 scores showed significant postoperative improvements. Conclusions: Trunk-bending activities worsened postoperatively in Japanese patients with ASD, especially those who underwent pelvic fusion. Additionally, patients often modified their living environment after surgery to accommodate spinal stiffness. Full article