European Spine Journal最新文献

{"title":"Lumbar disc herniation modelling: a review of ex-vivo mechanical models and a comparison with clinical data.","authors":"Thomas David Slater, Hans-Joachim Wilke, Gnanaprakash Gurusamy, Shanmuganathan Rajasekaran, Nicolas Newell","doi":"10.1007/s00586-025-09054-x","DOIUrl":"https://doi.org/10.1007/s00586-025-09054-x","url":null,"abstract":"<p><strong>Purpose: </strong>Ex-vivo herniation models are essential for studying lumbar disc herniation mechanisms, but their morphological accuracy remains unclear due to limited validation against patient-derived clinical data. This review collates clinical lumbar disc herniation characteristics and evaluates whether existing models replicate real-world pathology. By identifying the most morphologically relevant models, this study provides a stronger foundation for improving mechanistic herniation models.</p><p><strong>Methods: </strong>A systematic review following PRISMA guidelines identified clinical studies detailing herniation characteristics and experimental models of ex-vivo lumbar disc failure. Models were categorised by loading conditions (complex ultimate compression; cyclic; and intradiscal pressurisation), then compared to clinical data to assess their validity.</p><p><strong>Results: </strong>In patients, extrusions (50%) and protrusions (34%) are the most common lumbar disc herniation types, with paracentral herniations (61%) predominantly occurring at L4-L5 (49%) and L5-S1 (42%). Structural failure patterns varied, with annulus fibrosus failure reported in 35-81% of cases and endplate junction failure in 19-68%. Among 25 analysed models, all loading types induced herniations, but often with different damage patterns. Complex ultimate compression caused abrupt failures and fractures, while cyclic led to progressive annular damage. Intradiscal pressurisation highlighted nucleus pulposus migration pathways. Within a single herniation model, the damage mechanisms seen were similar between discs.</p><p><strong>Conclusions: </strong>Clinical herniation patterns show significant variability, while ex-vivo models yield more repeatable outcomes. Cyclic, complex ultimate compression, and intradiscal pressurisation models provide valuable mechanistic insights but differ in physiological relevance. Researchers must consider the physiological relevance of the applied load and the differences between animal and human discs when selecting a model. Future research should focus on understanding herniation progression and identifying initiating factors to improve prevention strategies.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483749","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":"Percutaneous endoscopic treatment for lumbar disorders as day surgery: A-2-Year Follow-Up retrospective cohort study.","authors":"Shuo Wang, Mingzheng Chang, Dinglin An, Luoran Wang, Yuze Wang, Yanguo Wang, Lianlei Wang, Xinyu Liu","doi":"10.1007/s00586-025-09084-5","DOIUrl":"https://doi.org/10.1007/s00586-025-09084-5","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483752","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":"A comparison of key performance metrics of major robotic platforms in spine surgery: a network meta-analysis of 14,462 screws.","authors":"Robert Koucheki, John-Peter Bonello, Aazad Abbas, Johnathan Lex, Anne L Versteeg, Mohammad Zarrabian, Perry Dhaliwal, Joel Finkelstein, Stephen Lewis, Jay Toor","doi":"10.1007/s00586-025-08990-y","DOIUrl":"https://doi.org/10.1007/s00586-025-08990-y","url":null,"abstract":"<p><strong>Purpose: </strong>This meta-analysis compares prominent robotic platforms for spinal surgery, using conventional (freehand or fluoroscopy) and non-robotic navigation as common controls.</p><p><strong>Methods: </strong>Literature searches were conducted using MEDLINE and EMBASE databases. Studies comparing screw placement of robot-assisted surgery with freehand/fluoroscopic or non-robotic navigation were included. Standard pairwise and network meta-analysis techniques with a random effects model (REM) were used with significance set at P < 0.05. Primary objective was to compare screw placement accuracy and breach incidence across robot platforms. Secondary objective was to compare neurologic complication (NC) rate and blood loss (BL) among platforms.</p><p><strong>Results: </strong>A total of 27 studies totaling 3404 patients were included. The robotic group demonstrated significantly fewer breaches compared to the conventional group (OR 0.54, P = 0.0004). The TiRobot (TINAVI) and Renaissance (Mazor) demonstrated the best overall accuracy. The robotic group demonstrated significantly lower NC (OR 0.3, P = 0.02) and lower BL (MD: - 112.74 mL, P = 0.002) compared to the conventional approach (freehand or fluoroscopy). Potential conflicts of interest and source bias were found in 60% of TiRobot and 30% of SpineAssist studies. Robotic surgery had significantly lower major breach rates compared to non-robotic navigation (OR 0.39, P = 0.04). The Mazor X model was superior between all robotic platforms, with an OR of 0.15 (95% CrI 0.01 to 0.69, P < 0.00001, I² = 0%) for major breaches compared to non-robotic navigation.</p><p><strong>Conclusion: </strong>Robot-assisted navigation platforms show significant reduction in breach rates compared to conventional and non-robotic navigation approaches in adult spinal instrumentation surgery. MazorX (Mazor), TiRobot (TINAVI) and Renaissance (Mazor) emerge as leaders in robotic spine surgery, each contributing to the increase efficacy. To obtain a more reliable evidence base guiding clinical practice and decision-making on the safety, efficacy, and superiority of specific robot-assisted navigation platforms in spinal surgery, further unbiased RCTs with international collaborations are needed.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483748","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":"Stretch neuropraxia after L5-S1 anterior lumbar interbody fusion: effect of cage height and lordosis.","authors":"Manjot Singh, Phillip Schmitt, Naya Melvani, Joseph Nassar, Michael Farias, Bassel Diebo, Alan Daniels","doi":"10.1007/s00586-025-09091-6","DOIUrl":"https://doi.org/10.1007/s00586-025-09091-6","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483753","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":"The role of generative artificial intelligence in deciding fusion treatment of lumbar degeneration: a comparative analysis and narrative review.","authors":"Taha M Taka, Christopher E Collins, Andrew Miner, Isaac Overfield, David Shin, Lauren Seo, Olumide Danisa","doi":"10.1007/s00586-025-09052-z","DOIUrl":"https://doi.org/10.1007/s00586-025-09052-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study analyzed responses and readability of generative artificial intelligence (AI) models to questions and recommendations from the 2014 Journal of Neurosurgery: Spine (JNS) guidelines for fusion procedures in the treatment of degenerative lumbar spine disease.</p><p><strong>Methods: </strong>Twenty-four questions were generated from JNS guidelines and asked to ChatGPT 4o, Perplexity, Microsoft Copilot, and Gemini. Answers were \"concordant\" if the response highlighted all points from the JNS guidelines; otherwise, answers were considered \"non-concordant\" and further sub-categorized as either \"insufficient\" or \"overconclusive.\" Responses were evaluated for readability via the Flesch-Kincaid Grade Level, Gunning Fog Index, Simple Measure of Gobbledygook (SMOG) Index, and Flesch Reading Ease test.</p><p><strong>Results: </strong>ChatGPT 4o had the highest concordance rate at 66.67%, with non-concordant responses distributed at 16.67% for both insufficient and over-conclusive classifications. Perplexity displayed a 58.33% concordance rate, with 25% insufficient and 16.67% over-conclusive responses. Copilot showed 50% concordance, with 37.5% over-conclusive and 16.67% insufficient responses. Gemini demonstrated 54.17% concordance, with 20.83% insufficient and 25% over-conclusive responses. The Flesch-Kincaid Grade Level scores ranged from 14.03 (Copilot) to 15.66 (Perplexity). The Gunning Fog Index scores varied between 15.15 (Copilot) and 18.13 (Perplexity). The SMOG Index scores ranged from 14.69 (Copilot) to 16.49 (Perplexity). The Flesch Reading Ease scores were low across all models, with Copilot showing the highest score of 20.71.</p><p><strong>Conclusions: </strong>ChatGPT 4.0 emerged as the best-performing model in terms of concordance, while Perplexity displayed the highest complexity in text readability. AI can be a valuable adjunct in clinical decision-making but cannot replace clinician judgment.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495449","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":"Investigation of the validity and reliability of the Turkish version of Back-Health-Related postural habits in daily activities questionnaire.","authors":"Merve İlhan, Saniye Aydoğan Arslan, Meral Sertel","doi":"10.1007/s00586-025-09088-1","DOIUrl":"https://doi.org/10.1007/s00586-025-09088-1","url":null,"abstract":"<p><p>Aim of the study to determine the validity and reliability of the Turkish version of the Back-Health-Related Postural Habits In Daily Activities Questionnaire (BEHALVES-T). 162 adolescents were included in the study. Test-retest method and internal consistency analysis were used for reliability. The validity was determined using the Back Pain and Body Posture Evaluation İnstrument (BackPEI). When Test-retest values for BEHALVES-T was examined, it was seen that using a bag, carrying weight, reaching and the total score of the scale were consistent (ICC > 0.70). Standing and sitting posture sub-dimensions were found to be borderline consistent (p < 0.01). Examining the scale's internal consistency showed that the sub-dimensions' consistency levels were low, but the total value scale's internal consistency was medium. The relationship between BEHALVES-T, BACKPEI (r = -0.238) was found to be weak. The content validity index was found to be 0.98. According to the results of this study, the Turkish version of the BEHALVES is a valid and reliable questionnaire for adolescents.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474368","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":"Positioning and clinical application of the inflection point of the uncinate process in anterior cervical discectomy and fusion (ACDF): a retrospective study.","authors":"Jianfeng Jiang, Jun Ma, Lintao Su, Yaozheng Han, Changyu Lei, Chenguang Ge, Xiang Jiang, Hui Kang","doi":"10.1007/s00586-025-09071-w","DOIUrl":"https://doi.org/10.1007/s00586-025-09071-w","url":null,"abstract":"<p><strong>Objective: </strong>We propose a novel intraoperative landmark for decompression during anterior cervical discectomy and fusion (ACDF), referred to as the inflection point of the uncinate process (IPUP). Its safety and efficacy were systematically assessed through comprehensive radiographic analyses and clinical investigations during ACDF.</p><p><strong>Methods: </strong>Computed tomography (CT) scan data from 135 patients were analyzed retrospectively. Eight imaging parameters were evaluated: inflection point of uncinate process (IPUP) distance, medial wall of the transverse foramen (MTF)-IPUP distance, anterior wall of the transverse foramen (ATF)-IPUP distance, posterior wall of the transverse foramen (PTF)-IPUP distance, the intervertebral foraminal decompression line(IFDL)-MTF distance, the intervertebral foraminal decompression (IFD) distance, the intervertebral foraminal decompression (IFD) angle, and the maximum decompression angle. A retrospective analysis was conducted on the radiographic data of 87 patients with cervical spondylosis who underwent ACDF between January 2020 and January 2023. Patients were divided into two groups: the IPUP group and the non-IPUP group. Three postoperative radiographic parameters were evaluated: the decompression width, the effective rate of intervertebral foraminal decompression, and the transverse diameter of the spinal cord at the surgical level.</p><p><strong>Results: </strong>The IPUP distance gradually increased from C3 to C6. The minimal MTF-IPUP distance and PTF-IPUP distance were observed at C5, while the minimal ATF-IPUP distance occurred at C4. The shortest MTF-IFDL distance was observed at C5, while it exceeded 2 mm across all cervical levels. The IFD distance and IFD angle both decreased from C3 to C6, whereas the maximum decompression angle increased. Postoperatively, the decompression width in the IPUP group exceeded the transverse diameter of the spinal cord in all patients and was significantly greater than that in the non-IPUP group at all levels except C3.</p><p><strong>Conclusion: </strong>Using the IPUP as an intraoperative decompression landmark during ACDF can safely achieve broader spinal cord and nerve root decompression. Vertical decompression confined within the medial borders of the bilateral IPUPs is generally sufficient in most cases. In patients with foraminal stenosis, additional safe neural decompression can be accomplished either by oblique decompression at an 11° lateral deviation from the IPUP or by extending 3 mm laterally at the base of the intervertebral foramen.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474369","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":"New options and techniques in reconstructing the sacrum.","authors":"Radek Kaiser, Alessandro Gasbarrini, Stefano Pasini, Anhelina Khadanovich, Gerard Mawhinney, Henk Giele, Jan Stulik, Jeremy Reynolds","doi":"10.1007/s00586-025-09058-7","DOIUrl":"10.1007/s00586-025-09058-7","url":null,"abstract":"<p><strong>Purpose: </strong>Sacral tumours, both benign and malignant, often necessitate surgical removal (sacrectomy) to achieve optimal outcomes. However, this procedure disrupts the pelvic ring's stability, potentially leading to pain and limited mobility.</p><p><strong>Methods: </strong>This article explores innovative approaches to reconstruct the sacrum and restore function in primary and secondary sacral tumours.</p><p><strong>Results: </strong>Beyond traditional bone graft-based spino-pelvic fixation, the paper delves into minimally invasive alternatives like robotic-assisted surgery which may be used especially as a palliative procedure in destructive lumbosacral junction metastases. This technique offers enhanced precision for implant placement and often a reduced surgical exposure, potentially improving patient recovery. Additionally, the article discusses the application of 3D-printed custom implants, precisely matched the patient's anatomy to provide immediate structural support. It also explores the use of vascularised long bone flaps for pelvic reconstruction to achieve both stability and ambulation after sacrectomy. Additionally, it is necessary to mention the crucial role of soft tissue reconstruction using local flaps or free flaps from other body regions.</p><p><strong>Conclusion: </strong>By presenting these advancements in sacral reconstruction techniques, this article empowers surgeons to select an individualised approach for their patient. This personalised approach can optimise post-operative outcomes, allowing patients to regain function and improve their quality of life.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483751","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":"Three-dimensional gait analysis reveals differences in spinal balance and muscle activity during prolonged walking in patients with dropped head syndrome based on global spinal alignment.","authors":"Kotaro Sakashita, Kousei Miura, Hideki Kadone, Tomoyuki Asada, Takahiro Sunami, Takane Nakagawa, Yosuke Ogata, Shun Okuwaki, Hisanori Gamada, Hiroshi Noguchi, Hiroshi Takahashi, Toru Funayama, Masao Koda, Masashi Yamazaki","doi":"10.1007/s00586-025-09040-3","DOIUrl":"https://doi.org/10.1007/s00586-025-09040-3","url":null,"abstract":"<p><strong>Purpose: </strong>No studies have elucidated the dynamic spinal balance in patients with dropped head syndrome (DHS) categorized by global spinal alignment. We investigated the differences in dynamic spinal balance and corresponding muscle activity during prolonged walking in patients with DHS based on their global spinal alignment.</p><p><strong>Methods: </strong>Three-dimensional gait analysis combined with electromyography was conducted to evaluate kinematic spinal parameters during walking, including the sagittal vertical axis (SVA) in the cervical (C-SVA), thoracic (T-SVA), and lumbar (L-SVA) regions, along with the muscle activity. Patients were divided into two groups based on C7 SVA from standing whole spine radiographs: SVA + and SVA-. Parameter changes were compared between the first and final laps of prolonged walking in each group.</p><p><strong>Results: </strong>Twenty-eight patients were included (11 in the SVA + group and 17 in the SVA- group). In the SVA + group, prolonged walking caused a significant increase in T-SVA and L-SVA (P = 0.002, 0.014), with no compensatory increase in paraspinal muscle activity. In the SVA- group, C-SVA and T-SVA increased significantly (P = 0.002), with a decrease in cervical paraspinal muscle activity (P = 0.009).</p><p><strong>Conclusion: </strong>Three-dimensional gait analysis with electromyography highlighted the distinct pathophysiological mechanisms in patients with DHS, as determined by their global spinal alignment. In the SVA + group, gait-induced thoracolumbar imbalance increased without compensatory activation of the lumbar paraspinal muscle. Conversely, in the SVA- group, gait-induced cervicothoracic imbalance increased without compensatory activation in cervical paraspinal muscle activity. These findings suggest that although DHS presents with similar symptoms, it may involve different underlying pathophysiologies depending on the global spinal alignment.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474370","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":"Application of extracorporeal collagenase chemonucleolysis and combined intradiscal and extracorporeal collagenase chemonucleolysis via FLEX electrode in patients with lumbar disc herniation: a retrospective study.","authors":"Chao Ma, Peng Song, Qiqi Chen, Yan Xu, Shengdeng Fan, Yongjun Zhang, Yan Yuan","doi":"10.1007/s00586-025-09067-6","DOIUrl":"10.1007/s00586-025-09067-6","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate and compare the short-term and long-term clinical outcomes of extracorporeal collagenase chemonucleolysis(ECCNL) and intradiscal-extracorporeal collagenase chemonucleolysis(IECCNL) via FLEX electrode in patients with lumbar disc herniation (LDH).</p><p><strong>Method: </strong>A retrospective analysis was performed on 65 patients diagnosed with LDH who met the inclusion criteria between April 2021 and April 2022. Patients were divided into two groups: 30 received ECCNL via FLEX electrodes (Group A) and 35 received IECCNL via FLEX electrode (Group B). Clinical outcomes were evaluated using the modified MacNab criteria, Numerical Rating Scale (NRS), and Japanese Orthopaedic Association (JOA) scores to assess the excellent/good rate, excellent rate, pain severity, and neurological function at specified intervals (3, 6, 12, and 24 months for clinical outcomes; 3 days, 1, 3, 6, 12, and 24 months for pain/neurological status). Perioperative complications, recurrence rates, and reoperation rates were systematically documented.</p><p><strong>Results: </strong>A total of 58 patients were included. At 1 month postoperatively, Group A showed significantly lower NRS scores compared to Group B (P < 0.05) and a higher pain relief rate (P < 0.05). Although Group A had higher JOA scores than Group B at 3 days postoperatively (P < 0.05), Group B showed higher JOA scores than Group A at 24 months postoperatively (P < 0.05). The excellent-good rate between the two groups at any postoperative time point, Group B demonstrated a significantly higher excellent rate than Group A at both 3 months and 24 months postoperatively (P < 0.05). In Group A, there was 1 case of recurrence and 2 reoperations, with a recurrence rate of 3.45% [95% CI: 0.09%, 17.7%] and reoperation rate of 6.90% [95% CI: 0.84%, 22.8%]. Group B showed no recurrences or reoperations [95% CI: 0%, 9.7%] for both outcomes. No statistically significant differences were observed between the two groups. During the 24-month follow-up period, no severe complications were observed in Group A. However, one case of nerve root injury occurred in Group B.</p><p><strong>Conclusion: </strong>FLEX electrode application in conjunction with two collagenase injection strategies enhances therapeutic outcomes. Short-term results favor ECCNL alone, whereas long-term benefits are more pronounced with the intradiscal-extracorporeal therapy.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368743","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}