Neurospine最新文献

{"title":"Frailty-Muscle Phenotypes Predict Outcomes After Lumbar Fusion in Adults Aged ≥75 Years: A Retrospective Cohort Study.","authors":"Ma Chao Guo, Xiangyu Li, Shuaikang Wang, Xiaolong Chen, Chao Kong, Yuxi Liu, Shibao Lu","doi":"10.14245/ns.2551838.919","DOIUrl":"10.14245/ns.2551838.919","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether combining clinical frailty with magnetic resonance imaging (MRI)-derived posterior paraspinal muscle degeneration identifies perioperative risk phenotypes in adults aged ≥75 years undergoing lumbar fusion.</p><p><strong>Methods: </strong>We retrospectively studied patients aged ≥75 years undergoing lumbar fusion with preoperative lumbar MRI. Frailty was assessed using the Fried phenotype (frail: score ≥3). Posterior paraspinal muscle degeneration across L1-S1 was quantified using automated segmentation and a composite posterior frailty index (PFI); severe degeneration was defined as the upper quartile of PFI. Patients were classified into 4 frailty×muscle phenotypes. Primary outcomes were any in-hospital complication and prolonged length of stay (LOS ≥16 days).</p><p><strong>Results: </strong>Among 248 patients, phenotypes A-D (A, nonfrail/nonsevere; B, frail/nonsevere; C, nonfrail/severe; D, frail/severe) comprised 132, 54, 20, and 42 patients, respectively. Any in-hospital complication occurred in 18.2% of phenotype A compared with 50.0%-57.1% in phenotypes B-D (p<0.001). Prolonged LOS (≥16 days; cohort 75th percentile) occurred in 0.8% of phenotype A versus 38.9% (B), 35.0% (C), and 78.6% (D) (p<0.001), corresponding to absolute risk increases of +34.2 to +77.8 percentage points. After adjustment, higher-risk phenotypes remained independently associated with increased odds of any complication and prolonged LOS; however, the prolonged-LOS odds estimates were imprecise due to sparse events in the reference group. Phenotype was not independently associated with 90-day readmission. Pain improvement (ΔVAS [visual analogue scale]) was attenuated in phenotypes B and D, while differences in ΔODI (Oswestry Disability Index) were not statistically significant.</p><p><strong>Conclusion: </strong>Integrating frailty and MRI-based posterior paraspinal degeneration provides actionable stratification of complication and prolonged LOS risk after lumbar fusion in older adults.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"242-254"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Value of Metagenomic Next-Generation Sequencing for Suspected Native Spinal Brucella Infection: A Multicenter Study.","authors":"Zhaohui Li, Qiang Zhang, Huafeng Wang, Zehua Zhang, Jiaming Liu, Litao Li, Yuhan Lin, Yuelei Wang, Chuqiang Yin, Wenqiao Wang, Feng Shen, Zengshuai Han, Shenshen Hao, Peishan Cong, Tingting Tian, Qing Liu, XiaoTong Chen, HongQi Zhan, Tao Peng, Xiang Yu, XinKai Pu, Xiaofeng Lian, Ting Wang","doi":"10.14245/ns.2551698.849","DOIUrl":"10.14245/ns.2551698.849","url":null,"abstract":"<p><strong>Objective: </strong>The aim is to study the diagnostic positive rates of metagenomic next-generation sequencing (mNGS), microbial culture, and serologic testing in suspected native spinal brucellosis, and to evaluate the clinical value of their combined application.</p><p><strong>Methods: </strong>In this multicenter, retrospective observational study, 128 patients with suspected native spinal brucellosis from 6 medical centers (February 2020 to February 2025) were enrolled. Specimens from infection sites were subjected to microbial culture, mNGS, and serological testing (agglutination test).</p><p><strong>Results: </strong>Of the 128 patients with suspected native spinal Brucella infections, 118 patients were diagnosed with Brucella spondylitis. Among the 118 confirmed Brucella spondylitis cases, mNGS demonstrated a positivity rate of 92.37% (109 of 118), significantly higher than that of culture (26.27%, 31 of 118) and agglutination test (83.05%, 98 of 118). In the 87 culture-negative samples, mNGS detected Brucella in 91.95% (80 of 87), compared to 82.76% (72 of 87) by agglutination test. mNGS confirmed Brucella infection in all 16 cases that were agglutination test negative. mNGS combined with agglutination tests can effectively complement each other, improving the sensitivity of diagnosis and thereby minimizing missed diagnoses to the greatest extent. Among the 10 nonbrucellar spinal pathologies, agglutination test showed a high false-positive rate of 90% (9 of 10), whereas mNGS had a 10% (1 of 10) false-positive rate. Therefore, the agglutination test has a relatively high rate of false positives.</p><p><strong>Conclusion: </strong>mNGS detection represents an effective adjunct to microbial culture and the agglutination test. The concurrent use of all 3 methods enhances diagnostic accuracy and reduces the likelihood of missed and incorrect diagnoses, significantly improving patient prognosis and guiding personalized clinical treatment.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"487-499"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Effectiveness Versus Efficacy in a Study Environment: How Smartphones Help Capture Meaningful Patient Recovery Trajectories - A Commentary on \"Physical Performance Continues to Improve After Surgery for Sciatica, Exceeding Recovery Periods of Physical Capacity and Patient-Reported Outcomes: Multicenter Prospective Observational Study\".","authors":"Victor E Staartjes","doi":"10.14245/ns.26520534.0267","DOIUrl":"10.14245/ns.26520534.0267","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"239-241"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Pixels to Precision: Generative Artificial Intelligence as a Paradigm Shift in Spine Imaging-Technical Foundations, Clinical Applications, and the Path to Safe Clinical Deployment.","authors":"Daniyal Ashraf, Vivek Sanker, Linda Liverani, Chelsea Park, Ravi Teja Medikonda, Maria Jose Cavagnaro, Ikchan Jeon, John Ratliff, Atman Desai","doi":"10.14245/ns.2551862.931","DOIUrl":"10.14245/ns.2551862.931","url":null,"abstract":"<p><p>Spine imaging represents a complex diagnostic frontier characterized by anatomical variability, motion artifacts, metallic instrumentation interference, and significant inter-reader diagnostic variability (κ=0.20 across institutions). While conventional discriminative artificial intelligence (AI) models achieve >95% accuracy in detecting degenerative changes, they remain limited by data scarcity, heterogeneous protocols, and poor generalizability. In the spine, these limitations are particularly relevant because clinical decisions can often depend on subtle distinctions (such as differentiating levels of canal or foraminal stenosis, characterizing Modic endplate changes, or assessing pedicle and vertebral morphology), where small inconsistencies can meaningfully alter management or surgical planning. Generative AI (GenAI) systems-including generative adversarial networks (GANs), diffusion models, and vision-language models (VLMs)-offer a paradigm shift by learning underlying data structures to generate high-quality synthetic outputs rather than merely classifying existing data. This narrative review, conducted using SANRA (scale for the assessment of narrative review articles) methodology across PubMed, Scopus, Embase, and Cochrane Library, examined GenAI applications in spine imaging. Eligible studies included observational designs through randomized controlled trials exploring image reconstruction, synthetic computed tomography (CT) generation, segmentation, and surgical planning applications. GAN-generated synthetic magnetic resonance imaging sequences reduce scan times by ~40% while maintaining diagnostic confidence; diffusion models enable radiation-free synthetic CT for preoperative planning; and VLMs generate structured radiology reports with hallucination rates <1.12%. However, critical barriers impede clinical translation: external validation gaps reveal AI performance collapse in real-world cohorts (sensitivity drops to 54.9% in cervical fracture detection); hallucinations and anatomical inaccuracies risk misguiding implant sizing; bias amplification magnifies demographic underrepresentation; and fragmented, small datasets lack standardized benchmarks. Technical fragility, computational demands, clinician trust deficits, and unresolved regulatory frameworks for iteratively-updating systems remain unaddressed. Successful integration requires coordinated development across 5 priorities: (1) multi-institutional datasets with cross-vendor harmonization, (2) federated learning frameworks preserving privacy, (3) uncertainty quantification and explainability tools, (4) outcome-linked clinical validation replacing technical metrics, and (5) workflow-integrated systems with DICOM-native interfaces and provenance tracking.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"293-313"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapt, Mitigate, and Target: The Role of Oxidative Stress in Intervertebral Disc Homeostasis and Disc Degeneration.","authors":"Shota Tamagawa, Jordy Schol, Luca Ambrosio, Hidetoshi Nojiri, Muneaki Ishijima, Daisuke Sakai","doi":"10.14245/ns.26420332.0166","DOIUrl":"10.14245/ns.26420332.0166","url":null,"abstract":"<p><p>The intervertebral disc (IVD) is defined by a uniquely avascular niche characterized by constitutive hypoxia, limited nutrient diffusion, acidic pH, hyperosmolarity, and repetitive mechanical loading. These stressors interact with each other rather than acting in isolation. Reduced endplate transport exacerbates hypoxia and glucose deprivation, driving glycolytic lactate accumulation and acidification. In parallel, acid-osmotic stress perturbs ion homeostasis and mitochondrial membrane potential, while mechanical loading promotes microdamage and inflammatory mediator release. Together they converge on common reactive oxygen species (ROS)-generating nodes, including mitochondrial electron transport disruption, membrane oxidase activation, and endoplasmic reticulum stress, while redox-sensitive signaling by nuclear factor erythroid 2-related factor 2, hypoxia-inducible factor 1/2, nuclear factor kappa B, and mitogen-activated protein kinases integrates metabolic rewiring with catabolic and inflammatory programs. In a healthy state, controlled ROS levels participate in healthy cell signaling and are counterbalanced by antioxidant systems; however, when compensatory capacity is exceeded, oxidative stress becomes self-reinforcing through inflammation-ROS feedback, mitochondrial dysfunction, and impaired proteostasis. This shift drives apoptosis and senescence of disc cells, extracellular breakdown, and endplate, thereby promoting IVD degeneration and creating a microenvironment for vascular and nerve ingrowth associated with discogenic low back pain. We propose an \"Adapt-Mitigate-Target\" framework that maps (1) physiological adaptation, (2) transition to redox breakdown, and (3) therapeutic opportunities to reduce the oxidative stress burden. We also highlight translational constraints imposed by disc transport barriers and discuss stage-appropriate systemic, local/intradiscal, and mitochondria-directed strategies, alongside a roadmap for biomarkers, precision phenotyping, and combination therapies.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"316-334"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply Letter: A Commentary on \"Biomechanical Impact of Cement Augmentation on Pedicle Screw Fixation and Adjacent Segment Disease in Multilevel Lumbar Fusion: A Finite Element Analysis\".","authors":"Hyung-Youl Park","doi":"10.14245/ns.2551864.932","DOIUrl":"10.14245/ns.2551864.932","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"502-503"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Implant Fixation as a Clinically Important Endpoint - A Commentary on \"Romosozumab Enhances Implant Stability in Glucocorticoid-Induced Osteoporotic Bone: A Rabbit Model Study\".","authors":"Ji-Won Kwon, Byung Ho Lee","doi":"10.14245/ns.26520182.0091","DOIUrl":"10.14245/ns.26520182.0091","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"510-512"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Resilience in Chronic Low Back Pain: Dissociating Magnetic Resonance Imaging Abnormalities From Real-World Disability in the Wakayama Spine Study.","authors":"Masatoshi Teraguchi, Marinko Rade, Hiroshi Hashizume, Jeremy Fairbank, Yuyu Ishimoto, Keiji Nagata, Ryohei Kagotani, Shizumasa Murata, Hiroyuki Oka, Toshiko Iidaka, Sakae Tanaka, Noriko Yoshimura, Munehito Yoshida, Hiroshi Yamada","doi":"10.14245/ns.26520312.0156","DOIUrl":"10.14245/ns.26520312.0156","url":null,"abstract":"<p><strong>Objective: </strong>Low back pain (LBP) is common, yet many individuals maintain normal activities of daily living despite chronic symptoms and structural changes evident on imaging. We hypothesized that functional resilience, defined as preserved functional capacity despite pain and age‑typical degenerative changes, represents a meaningful clinical phenotype, and that function‑centered outcome measures would better discriminate disability status than structural imaging features.</p><p><strong>Methods: </strong>This study analyzed 347 participants reporting LBP from the Wakayama Spine Study (N=866). Maintained function was defined a priori as Oswestry Disability Index (ODI) ≤20%. We compared those with maintained function (n=220, 63.4%) to those with impairment (n=127) across demographics, lifestyle, metabolic components, physical performance (grip strength, gait speed), and lumbar magnetic resonance imaging (MRI) findings. Multivariable logistic regression among participants with LBP, including age, sex, obesity, metabolic factors, pain intensity, physical performance, and MRI phenotypes, was used to identify independent predictors of functional resilience.</p><p><strong>Results: </strong>Functional resilience was common: 63.0% of LBP participants had ODI ≤20%. Resilient individuals were younger (65.0±11.9 years vs. 74.6±10.9 years, p<0.001) with superior physical performance. In multivariable models, male sex predicted maintained function (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.03-3.00; p<0.05), while obesity (body mass index ≥25 kg/m2) was associated with reduced odds of resilience (OR, 0.50; 95% CI, 0.30-0.84; p<0.01). Standard MRI features, including disc degeneration, Modic changes, and Schmorl nodes, were not independently associated with functional status after adjustment, despite disc degeneration being highly prevalent even among resilient participants (95.4%).</p><p><strong>Conclusion: </strong>These data confirm that functional resilience is common in LBP and is not negated by the presence of structural MRI abnormalities. Among LBP patients, male sex and absence of obesity are independent predictors of maintained function, whereas standard MRI features do not independently predict functional status after age adjustment. Function-centered metrics (ODI, gait speed, grip strength) better discriminate functional status than structural imaging findings.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"276-289"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Accuracy Assessment of Thoraco-Lumbo-Sacral Orthosis Fabrication: Conventional Contact Casting Versus Noncontact 3-Dimensional Digital Scanning.","authors":"Naotoshi Kumagai, Takashi Yurube, Masao Ryu, Yoshiki Takeoka, Yutaro Kanda, Kohei Kuroshima, Yoshiaki Hiranaka, Masahiko Furuya, Daisuke Nakagawa, Yu Inoue, Ryosuke Kuroda, Kenichiro Kakutani","doi":"10.14245/ns.2551610.805","DOIUrl":"10.14245/ns.2551610.805","url":null,"abstract":"<p><strong>Objective: </strong>Contact casting with plaster bandages is a standard technique for thoraco-lumbo-sacral orthosis (TLSO) fabrication. However, this hands-on process depends on the operator's skill as well as requires a close physical contact, involving potential risks of coronavirus and influenza virus infection and the patient's personal space violation. Recently, noncontact, highly accurate molding technology using 3-dimensional (3D) digital scanning has been developed. Although 3D scanning is widely applied for limb orthosis, its spinal application mainly focuses on pediatric scoliosis. Comparative studies across diverse body types remain limited. Therefore, this study aimed to clarify the adaptability, accuracy, and fabrication time of TLSO produced using noncontact 3D digital scanning, comparing with conventional contact plaster-bandage casting.</p><p><strong>Methods: </strong>TLSO was fabricated using both contact and noncontact techniques for mannequins with 4 different body types. High-precision scanner and computed tomography (CT) were used to assess the shape reproducibility by quantifying the gap area between the orthosis and mannequin. In addition, total fabrication time was compared between the 2 techniques.</p><p><strong>Results: </strong>High-precision scanner identified that 3D scanning showed a higher shape reproducibility than conventional casting, particularly in curvilinear areas (all p<0.001). In CT measurement, 3D scanning demonstrated a smaller gap area in all the body types (all p<0.001). Fabrication time was also shorter during 3D scanning (54.9±0.9 minutes) than during conventional casting (100.0±5.5 minutes) (p<0.001).</p><p><strong>Conclusion: </strong>Noncontact 3D digital scanning facilitates a rapid, accurate, and reproducible TLSO fabrication across diverse body types, providing a safer and more efficient alternative to conventional contact plaster-bandage casting.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"335-346"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Predictive Accuracy in Finite Element Analysis of Cement Augmentation: Methodological Considerations - A Commentary on \"Biomechanical Impact of Cement Augmentation on Pedicle Screw Fixation and Adjacent Segment Disease in Multilevel Lumbar Fusion: A Finite Element Analysis\".","authors":"Fan Mo, Shaoqi He","doi":"10.14245/ns.2551682.841","DOIUrl":"10.14245/ns.2551682.841","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"500-501"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}