Neurospine最新文献

{"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":5.0,"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":"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":5.0,"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":"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":5.0,"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":"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":5.0,"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":"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":5.0,"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":"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":5.0,"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":5.0,"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}

{"title":"Real-Time Location System Assessment of Early Postoperative Recovery After Lumbar Decompression According to Surgical Approach.","authors":"Sub-Ri Park, Jaenam Lee, Sujin Kwon, Namhoo Kim, Dong Won Kim, Dukyong Yoon, Kyoung Min Kim, Byung Ho Lee","doi":"10.14245/ns.26520018.0009","DOIUrl":"10.14245/ns.26520018.0009","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate early postoperative mobility after lumbar decompression using real-time location system (RTLS)-derived objective metrics and to explore differences in mobility patterns between biportal endoscopic decompression and open decompression.</p><p><strong>Methods: </strong>This retrospective cohort study included 323 patients who underwent lumbar decompression for degenerative lumbar spinal stenosis between March 2020 and May 2024. RTLS sensors embedded in wristbands continuously recorded patient mobility during postoperative days (PODs) 1-4. Primary RTLS-derived outcomes included total walking distance, mean walking speed, and active movement ratios (top 20% and top 50%). Between-group comparisons were performed using nonparametric tests. Propensity score matching and multivariable median quantile regression adjusting for age, American Society of Anesthesiologists physical status, and preoperative mobility were conducted.</p><p><strong>Results: </strong>RTLS identified differences in early postoperative activity patterns between surgical approaches. In adjusted analyses, activity-intensity-based metrics, particularly the top 20% activity ratio, remained significantly higher in the biportal endoscopic decompression group across multiple PODs. Subgroup analyses demonstrated minimal differences after single-level decompression, whereas activity-based differences were more frequently observed in multilevel procedures.</p><p><strong>Conclusion: </strong>RTLS-based continuous monitoring detected differences in early postoperative activity patterns following lumbar decompression. These findings support the role of RTLS as an objective tool for assessing early functional recovery in spine surgery.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"459-472"},"PeriodicalIF":5.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841027","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":"Deep Learning-Assisted Lumbar Degeneration Evaluation Using Plain Radiographs: Development and Validation of a Novel Dual-Mechanism Architecture.","authors":"Ziqian Ma, Aobo Wang, Xingyu Liu, Ruiyuan Chen, Tianyi Wang, Yu Xi, Minghui Liang, Ning Fan, Shuo Yuan, Peng Du, Dong Liu, Yiling Zhang, Lei Zang","doi":"10.14245/ns.2551672.836","DOIUrl":"10.14245/ns.2551672.836","url":null,"abstract":"<p><strong>Objective: </strong>To develop and externally validate a dual-mechanism deep learning (DL) model that integrates vertebral segmentation and lesion detection for automated evaluation of lumbar degeneration and structured report generation on plain radiographs.</p><p><strong>Methods: </strong>In this retrospective study, 5,964 patients who underwent standing anteroposterior and lateral lumbar radiographs at a single institution and 600 patients from a public dataset (BUU-Spine) were included. Vertebral corners from T11-L5 (and S1 on lateral views) and 7 degenerative findings (scoliosis, straightened/preserved lordosis, spondylolisthesis, disc space narrowing, osteophytes, vertebral compression, and abdominal aortic calcification) were annotated by 3 spine surgeons. Two independently trained, parallel networks were developed, including a ResNet-based segmentation network and a YOLOv8-based detection network. A rule-based integration strategy reconciled both outputs and generated structured diagnostic reports. Segmentation accuracy, quantitative measurement agreement, diagnostic performance, and clinical acceptability of reports were evaluated.</p><p><strong>Results: </strong>Intra- and interobserver landmark distances within 3 mm reached 96% and >95%, respectively. On the internal test set, the percentage of correct keypoints within 3 mm was 95.7%-98.6%, with intraclass correlation coefficients of 0.84-0.89 and Pearson correlation coefficient (r) of 0.90-0.94 for key radiographic parameters. The segmentation- and detection-based models achieved precision of 92.2%-96.9% and 91.7%-95.5%, and recall of 91.6%-94.8% and 93.3%-95.2%, respectively. Under the dual-positive condition, the integrated model yielded the highest precision (93.8%-97.3%), whereas the any-positive condition achieved the highest recall (94.1%-97.6%). Of 596 automatically generated structured reports, 557 (93.4%) were deemed clinically acceptable.</p><p><strong>Conclusion: </strong>The proposed dual-mechanism DL framework enables accurate, multilesion assessment of lumbar degeneration and generation of clinically acceptable structured reports from plain radiographs, supporting workflow optimization in lumbar spine imaging.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"393-403"},"PeriodicalIF":5.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840960","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":"Occipital Bone Erosion Following C1-2 Posterior Fixation: A Comparative Per-Screw Analysis of Tan versus Harms-Goel Techniques.","authors":"Shigeo Ueda, Nobuaki Naito, Hokuto Yamashita, Jiro Ohara, Atsuhiko Toyoshima, Miyuki Fukuda, Nobuhiro Sasaki, Masayuki Kuroda, Minoru Hoshimaru","doi":"10.14245/ns.2551796.898","DOIUrl":"10.14245/ns.2551796.898","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relationship between C1 screw trajectory and occipital bone erosion in C1-2 posterior fixation.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 27 patients (54 screws) who underwent C1-2 posterior fixation between March 2018 and March 2023 at a single institution by multiple surgeons. Screws were classified by trajectory: Tan technique (n=39) or Harms-Goel (HG) technique (n=15). Primary outcome was occipital bone erosion; the secondary outcome was breach of inner cortical layer. Per-screw analysis was performed using generalized estimating equations to account for bilateral screw clustering.</p><p><strong>Results: </strong>Mean follow-up was 48.3 (range, 24-84) months. Occipital bone erosion occurred in 51.3% (20 of 39) of Tan screws versus 6.7% (1 of 15) of HG screws (p<0.001). Breach of inner cortical layer occurred exclusively with the Tan technique (10.3% vs. 0%, p=0.302). In mixed Tan+HG cases (n=3), erosion occurred only on the Tan side (2 of 3 screws) with no erosion on HG side (0 of 3 screws). C1 upper line transgression was a critical risk factor; no erosion occurred in screws that did not exceed this anatomical landmark (adjusted relative risk [RR], 6.82; 95% confidence interval [CI], 2.41-19.31). Additional risk factors included height O-C1 ≤4.5 mm (RR, 3.81; 95% CI, 1.51-6.28) and height O-C1 extension ≤1 mm (RR, 4.86; 95% CI, 2.05-11.53). No patients required reoperation for erosion-related symptoms during follow-up.</p><p><strong>Conclusion: </strong>Screw trajectory is the primary determinant of occipital bone erosion following C1-2 fixation. The HG technique demonstrated significantly lower erosion rates (6.7% vs. 51.3%). When anatomically feasible, HG technique may be considered to reduce erosion risk.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"404-410"},"PeriodicalIF":5.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841012","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}