European Spine Journal最新文献

{"title":"Falls efficacy and directional postural sway responses during the sensory organization test in adults with nonspecific chronic low back pain.","authors":"Paul Sung, Dongchul Lee","doi":"10.1007/s00586-025-09423-6","DOIUrl":"https://doi.org/10.1007/s00586-025-09423-6","url":null,"abstract":"<p><strong>Background: </strong>Nonspecific chronic low back pain (CLBP) is frequently associated with impaired postural regulation and increased reliance on visual input for balance. However, little is known about how individuals with CLBP adapt to progressively challenging conditions.</p><p><strong>Purpose: </strong>This study examined the effects of visual input and task repetition on postural stability during bipedal stance in older adults with and without CLBP.</p><p><strong>Methods: </strong>Seventy-two participants (CLBP group: 68.48 ± 8.15 years old: n = 31; control group 66.63 ± 7.65 years old: n = 41) completed three trials of the Sensory Organization Test, which manipulated visual and somatosensory cues. Postural stability was assessed via center of pressure excursions in both anteroposterior (AP) and mediolateral (ML) directions while considering the modified Falls Efficacy Scale (FES).</p><p><strong>Results: </strong>Significant effects of sensory condition were observed across trials (Trial 2: F = 18.51, p = 0.001; Trial 3: F = 13.25, p = 0.001), with the most significant instability occurring under vestibular-reliant and multisensory conflict conditions. Condition × FES interactions indicated that adults with lower falls efficacy scores demonstrated larger sway excursions, particularly in Trials 2 and 3 (p = 0.001). Within the CLBP group, ML sway was significantly greater than AP sway (p < 0.01).</p><p><strong>Conclusion: </strong>Although sway excursion decreased slightly across repeated trials, postural deficits in the CLBP group were exacerbated under multisensory conflicts, particularly in the ML direction. These findings highlight the need for balance strategies that address both sensory integration and psychological factors, such as fear of falling, to improve postural stability.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Answer to the Letter to the Editor of A. Bilge, et al. concerning \"Serotonin-norepinephrine reuptake inhibitor and gabapentinoid use independently predict greater postoperative opioid consumption in lumbar fusion patients\" by Narayanan R, Dalton J, A McCurdy M, et al. (Eur Spine J [2025] doi:10.1007/s00586-025-08764-6).","authors":"Rajkishen Narayanan, Jonathan Dalton, Gregorio Baek, Michael A McCurdy, Tariq Z Issa, Robert J Oris, Alexa Tomlak, Yunsoo Lee, Kenneth McCall, Dodger Norceide, John J Mangan, Mark F Kurd, Ian David Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1007/s00586-025-09378-8","DOIUrl":"https://doi.org/10.1007/s00586-025-09378-8","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Answer to the Letter to the Editor of S.T. Hassan, et al. concerning \"Anxiety and depression 1-year after spinal tumor surgery: a retrospective analysis of psychological and clinical predictors\" by R.Z. Ahmed, et al. (Eur Spine J [2025]; doi: 10.1007/s00586-025-09325-7).","authors":"Refah Z Ahmed","doi":"10.1007/s00586-025-09438-z","DOIUrl":"https://doi.org/10.1007/s00586-025-09438-z","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Successful minimally invasive sacroiliac joint fusion in patients presenting with concomitant sacroiliac joint dysfunction and joint auto fusion\".","authors":"Matthew Hentschel, Kevin T Kim, Nathan B Han, Charles Sansur","doi":"10.1007/s00586-025-09413-8","DOIUrl":"https://doi.org/10.1007/s00586-025-09413-8","url":null,"abstract":"<p><strong>Background: </strong>Sacroiliac joint dysfunction is a common cause of lower back pain, especially in patients undergoing lumbar fusion surgery. While spontaneous bony fusion, i.e. auto-fusion, of the sacroiliac joint may provide mechanical stability, the underlying pathophysiology of this disease remains incompletely understood. Here, we present two patients with pre-operative auto-fused joints presenting with sacroiliac joint dysfunction who underwent successful minimally invasive sacroiliac joint fusion.</p><p><strong>Case presentations: </strong>Two patients presented with pre-existing radiologic auto-fusion of their sacroiliac joints with intra-articular injection-proven sacroiliac joint dysfunction refractory to conservative management. Both patients underwent minimally invasive sacroiliac joint fusion and reported complete and sustained pain relief persisting at one year post-operatively. Radiologic findings confirmed the appropriate placement of fixation hardware without complications.</p><p><strong>Discussion: </strong>These cases challenge the conventional understanding that bony fusion resolves sacroiliac joint dysfunction by highlighting the potential role of non-mechanical factors, including neural contributions, in driving persistent pain. Neural innervation of the sacroiliac joint, including lateral branches of the L5-S3 dorsal rami, may be implicated, as supported by recent evidence of effective neural-based interventions.</p><p><strong>Conclusions: </strong>This report highlights that sacroiliac joint dysfunction may be present in patients with pre-existing auto-fusion. The presence of bony fusion of the sacroiliac joint(s) may not preclude a diagnosis of sacroiliac joint dysfunction, and patients may benefit from minimally invasive fusion surgery. The underlying mechanism of sacroiliac joint dysfunction is complex and incompletely understood.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of clinical efficacy of unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy in the treatment of lumbar disc herniation at different segments.","authors":"Qipeng Gao, Yongxin Ren, Xiangjun Lu, Zhijin Chai, Dexuan Zhao, Jie Li, You Lv, Rujie Qin","doi":"10.1007/s00586-025-09414-7","DOIUrl":"https://doi.org/10.1007/s00586-025-09414-7","url":null,"abstract":"<p><strong>Objective: </strong>To compare outcomes of unilateral biportal endoscopic discectomy (UBED) and percutaneous endoscopic interlaminar discectomy (PEID) for lumbar disc herniation (LDH) at L3-S1 levels, aiming to identify the optimal segment-specific approach given anatomical variations between laminae.</p><p><strong>Methods: </strong>A retrospective analysis of 210 LDH patients was conducted (UBED: n = 102 [L3/4 = 22, L4/5 = 42, L5/S1 = 38]; PEID: n = 108 [L3/4 = 16, L4/5 = 47, L5/S1 = 45]). Both groups had a follow-up period of more than six months. Assessed parameters included: intraoperative blood loss, postoperative hemoglobin loss, surgical duration, incision length, drainage volume, hospital stay, costs, VAS (back/leg pain at 3d/1m/6m), ODI, and modified MacNab criteria.</p><p><strong>Results: </strong>Both groups showed significant postoperative improvement in VAS and ODI scores. Overall, UBED had larger incisions, greater drainage volume, higher costs, and longer hospital stays than PEID. For L4/5 and L5/S1 LDH, UBED resulted in more intraoperative blood loss, greater hemoglobin loss, and longer surgical duration. Conversely, for L3/4 LDH, UBED had significantly shorter surgical time. No significant differences existed in 6-months postoperative complications or MacNab scores.</p><p><strong>Conclusions: </strong>UBED and PEID both achieve good clinical outcomes. PEID demonstrates significant advantages for L4/5 and L5/S1 LDH, offering less bleeding and shorter surgical time. UBED is advantageous for L3/4 LDH due to shorter surgical duration. PEID also allows omission of drainage tubes due to minimal postoperative drainage.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wasting phenotype for differentiating spinal tuberculosis from spinal pyogenic infection.","authors":"Zijun Wu, Fangxu Jia, Yiyan Chen, Yunran Wang, Haoling He, Ruixin Feng, Ziyang Zhu, Qile Gao, Xiaoping Yi, Bihong T Chen","doi":"10.1007/s00586-025-09434-3","DOIUrl":"https://doi.org/10.1007/s00586-025-09434-3","url":null,"abstract":"<p><strong>Background: </strong>Spinal tuberculosis (STB) and pyogenic spinal infection (PSI) often present with overlapping clinical manifestations and imaging features, leading to delayed diagnosis and suboptimal outcomes. Identifying reliable laboratory-based markers may improve early differential diagnosis.</p><p><strong>Purposes: </strong>To investigate wasting phenotype-related clinical and laboratory indicators for differentiating STB from PSI and to establish a clinically applicable diagnostic model.</p><p><strong>Methods: </strong>In this prospective study, 253 patients with confirmed spinal infections were enrolled, including 159 with STB (62.85%) and 94 with PSI (37.15%). Demographic, clinical, and routine laboratory data were collected. Eight candidate metabolic and inflammatory variables were assessed using univariate analyses and multivariable logistic regression. Model performance was evaluated by receiver operating characteristic (ROC) analysis, calibration testing, and Youden-derived optimal thresholds.</p><p><strong>Results: </strong>Three key variables-body temperature, high-density lipoprotein (HDL), and blood glucose-were independently associated with STB. In the adjusted model, each 1 °C increase in temperature reduced the odds of STB by approximately 69% (OR = 0.318; 95% CI: 0.138-0.731; P = 0.009), each 1 mmol/L increase in HDL increased the odds by 3.7-fold (OR = 3.692; 95% CI: 1.311-10.394; P = 0.011), and each 1 mmol/L increase in blood glucose reduced the odds by 24% (OR = 0.764; 95% CI: 0.622-0.938; P = 0.014). The model demonstrated moderate discrimination (AUC = 0.673, 95% CI: 0.604-0.740) but good calibration (P = 0.609). ROC-derived optimal thresholds were T ≤ 36.7 °C, HDL ≥ 0.89 mmol/L, and blood glucose ≤ 5.85 mmol/L, providing practical reference points for clinical application.</p><p><strong>Conclusion: </strong>A composite wasting phenotype defined by lower body temperature, lower blood glucose, and elevated HDL significantly improves early differentiation of STB from PSI. While individual thresholds show limited standalone diagnostic value, the combined model provides a biologically plausible, interpretable, and clinically useful tool to aid decision-making in managing spinal infections.</p><p><strong>Levels of evidence: </strong>Level 3 (According to the Oxford CEBM 2016 criteria for diagnostic studies).</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor concerning \"Anxiety and depression 1-year after spinal tumor surgery: a retrospective analysis of psychological and clinical predictors\" by R.Z. Ahmed, et al. (Eur spine J [2025]; doi: 10.1007/s00586-025-09325-7).","authors":"Syed Tawassul Hassan, Faizan Haider, Asjad Rizvi","doi":"10.1007/s00586-025-09437-0","DOIUrl":"https://doi.org/10.1007/s00586-025-09437-0","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-class cervical spine fracture classification using deep ensemble model based on CT images.","authors":"K Goutham Raju, Ravikumar S","doi":"10.1007/s00586-025-09415-6","DOIUrl":"https://doi.org/10.1007/s00586-025-09415-6","url":null,"abstract":"<p><p>Cervical spine fractures present considerable challenges in both diagnosis and treatment. With the increasing incidence of such injuries and the limitations of conventional diagnostic tools, there is a pressing demand for more precise and effective detection methods. This study proposes a robust Multi-class Classification model for Cervical Spine Fractures (MC-CSF) using Computed Tomography (CT) images to enable the precise identification of fracture types. The process of MC-CSF starts with preprocessing input images using an Enhanced Wiener Filtering (EWF) technique to minimize noise while retaining critical structural features. Following this, a Modified Residual Block-assisted ResUNet (MRB-RUNet) model is utilized for segmentation to precisely isolate the cervical spine area. Once segmented, feature extraction combines both deep learning approaches and texture-based analysis, in which deep features are extracted from established models like VGG16 and Residual Network (ResNet), while Local Gabor Transitional Pattern (LGTrP) captures subtle local texture variations. These features are then processed by an ensemble of sophisticated classifiers, including Enhanced LeNet (E-LNet), ShuffleNet, and a deep convolutional neural network (DCNN), each tasked with distinguishing between different fracture types. To enhance overall classification accuracy, a soft voting approach is applied, where the probabilistic outputs of multiple classifiers are aggregated. This strategy leverages the complementary strengths of individual models, resulting in a more robust and reliable prediction of cervical spine fracture categories. The Ensemble model consistently outperforms the traditional approaches with peak accuracy of 0.954, precision of 0.813 and NPV of 0.974, respectively.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical study of PEID in the treatment of LDH based on the position relationship between nucleus pulposus of lumbar disc herniation and compressed nerve root.","authors":"Huaize Dong, Qiming Mao, Lu Zhu, Yan Zhao, Qiuqiu Xia, Fujun Wu, Jiyue Xia, Zijing Weng, Shuai Feng, Yuanming Lu, Youhong Jiang, Mingqiang Ding, Wei Zhang, Zhijun Xin","doi":"10.1007/s00586-025-09406-7","DOIUrl":"https://doi.org/10.1007/s00586-025-09406-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study addresses the suboptimal outcomes occasionally observed following posterior interlaminar endoscopic lumbar discectomy (PEID). By refining the surgical targeting technique based on the anatomical relationship between herniated nucleus pulposus and the compressed nerve root, this study proposes and evaluates an optimized localization protocol. We compare postoperative recovery outcomes between this optimized method and the conventional PEID approach to support improved clinical implementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this randomized controlled trial, 199 patients undergoing elective single-level PEID (L4/5 or L5/S1) at our institution from January 2023 to January 2024 were enrolled. Patients were randomly assigned to either an experimental group, in which preoperative planning was guided by imaging-based classification of the nucleus pulposus-nerve root relationship, or a control group, in which conventional positioning was used without this classification reference. The final analysis included 104 patients in the experimental group and 95 in the control group. Clinical outcomes included the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) for both low back and leg pain, assessed preoperatively, at 3 days postoperatively, and at 1, 3, 6, and 12 months postoperatively. Surgical efficacy was further evaluated using the modified MacNab criteria at final follow-up. Radiographic parameters were assessed to compare spinal stability between groups. Subgroup analysis by disc level and herniation classification was also conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Baseline characteristics were comparable between groups, including sex distribution (62 males and 42 females in the experimental group; 50 males and 45 females in the control group) and age (46.49 ± 13.72 vs. 45.89 ± 13.54 years, respectively). No significant differences were observed in baseline clinical or radiologic parameters (P &gt; 0.05). The experimental group exhibited shorter operative times and fewer localization attempts at both L4/5 and L5/S1 levels (P &lt; 0.05). No significant differences were found in pre- and postoperative intervertebral space height indices between groups (P &gt; 0.05). Clinical outcome highlights include: (1) Postoperative VAS scores at day 1 were significantly lower in the experimental group across both disc levels (P &lt; 0.05);(2) Both groups showed significant improvements in VAS and ODI scores postoperatively (P &lt; 0.05), with the experimental group reporting superior VAS scores on day 3 (P &lt; 0.05);(3) At 3 months, the ODI scores for the shoulder and axillary types of L4/5 herniation were significantly better in the experimental group (P &lt; 0.05), though differences diminished at later timepoints (P &gt; 0.05);(4) MacNab criteria showed a significantly higher rate of excellent/good outcomes in the experimental group at final follow-up (P &lt; 0.05);(5) At L5/S1, the ODI scores for all herniation types were lower ","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ShPCFHNet: shepherd parallel convolutional forward harmonic net for spinal cord injury detection using CT images.","authors":"Bhagyashri Thakare, Bhushan Chaudhari, Madhuri Patil, Sachin Kamble","doi":"10.1007/s00586-025-09365-z","DOIUrl":"https://doi.org/10.1007/s00586-025-09365-z","url":null,"abstract":"<p><p>Computed Tomography (CT)has gained recognition as the leading imaging method, extensively used in the diagnosis of spinal cord injuries. The reliance on CT imaging for acute care in patients with Spinal Cord Injury (SCI) has expanded rapidly. However, the diagnosis of initial clinical injury is crucial to accurately predict functional prediction, which is a difficult task for both clinicians and radiologists. To conquer this issue, an efficient model based on SCI detection is proposed, named as Shepard Parallel Convolutional Forward Harmonic Net (ShPCFHNet). The first step involves improving the CT image by applying logarithmic transformations in the enhancement phase. Spinal cord segmentation is then performed with the aid of the proposed Dual-branch UNet, whose loss function is adapted using Sensitivity-Specificity Loss (SSL). Following this, disc localization is carried out using an active contour model, and feature extraction is subsequently performed. The final step involves detecting SCI using ShPCFHNet, which combines the Shepard Convolutional Neural Network (ShCNN) and Parallel Convolutional Neural Network (PCNN) with Harmonic analysis. The proposed model achieved performance metrics of 91.397% accuracy, 92.684% True Positive Rate (TPR), and 90.366% True Negative Rate (TNR).</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}