Neurospine最新文献

{"title":"Contemporary Management of Coccydynia.","authors":"Victor E Staartjes, Daniel De Wilde, Aron Alakmeh, Omar Alsaleh, Adrian Elmi-Terander, Erik Edström, Gunnar Nilsson","doi":"10.14245/ns.2551726.863","DOIUrl":"10.14245/ns.2551726.863","url":null,"abstract":"<p><p>Coccydynia is a painful condition of the coccyx that is frequently misdiagnosed and managed inconsistently. This review summarizes and grades the current evidence on diagnostic strategies and treatment options. We systematically searched the literature and included 42 studies covering conservative, interventional, and surgical management. Based on these data, we propose a current best framework for diagnostic evaluation and therapeutic management. Initial assessment should include detailed history and focused examination with palpation for localized coccygeal tenderness and symptom provocation. Standard anteroposterior and lateral radiographs are recommended mainly to exclude serious pathology, while dynamic sitting-standing radiographs can be considered when mechanical pain is suspected and symptoms persist. Cross-sectional imaging with magnetic resonance imaging or computed tomography (CT) should be reserved for trauma, red-flag features, suspected neoplasm or infection, or inconclusive basic imaging. First-line treatment should consist of education, ergonomic advice, offloading strategies, nonsteroidal anti-inflammatory drugs or other simple analgesics, and physiotherapy, with extracorporeal shock wave therapy having the strongest support. In patients with persistent pain, image-guided diagnostic and therapeutic injections and radiofrequency procedures can provide substantial relief and help select candidates for more invasive treatment. Coccygectomy should be reserved for patients with chronic, function-limiting pain who have failed conservative and interventional care and show concordant findings on assessment, imaging, and diagnostic blocks, while modified incision strategies and minimally invasive techniques may be considered in selected cases.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"365-379"},"PeriodicalIF":5.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840948","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":"A Commentary on \"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":"Fabrizio Russo, Luca Ambrosio, Gianluca Vadalà, Vincenzo Denaro","doi":"10.14245/ns.26520650.0325","DOIUrl":"10.14245/ns.26520650.0325","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"314-315"},"PeriodicalIF":5.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840875","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":"A Commentary on \"Frailty-Muscle Phenotypes Predict Outcomes After Lumbar Fusion in Adults Aged ≥75 Years: A Retrospective Cohort Study\".","authors":"Julie L Chan, Daniel J Hoh","doi":"10.14245/ns.26520620.0310","DOIUrl":"10.14245/ns.26520620.0310","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"255-256"},"PeriodicalIF":5.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840929","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":"Sagittal Imbalance Deterioration After S2-Alar-Iliac Fixation in Adult Spinal Deformity: What Role Does Dynamic Hip Joint Coverage Play?","authors":"Dongyue Li, Jie Li, Yanjie Xu, Zongshan Hu, Yong Qiu, Zezhang Zhu, Zhen Liu","doi":"10.14245/ns.2551804.902","DOIUrl":"10.14245/ns.2551804.902","url":null,"abstract":"<p><strong>Objective: </strong>To determine the role of dynamic hip joint coverage in maintaining postoperative sagittal balance in adult spinal deformity (ASD) patients following S2-alar-iliac (S2AI) fixation.</p><p><strong>Methods: </strong>A total of 224 ASD patients who underwent S2AI fixation were enrolled. Patients were stratified into 2 groups based on pre-to-post (from preoperative to postoperative) changes in femoral head coverage (ΔFHC): change group (group C) and noncoverage change group (group NC). Group C was further subdivided according to FHC recovery during follow-up into rebound (group C-R) and nonrebound (group C-NR) groups. Clinical outcomes and radiographic parameters of hip and spinopelvic alignment were assessed preoperatively, at the initial postoperative standing, and at the 2-year follow-up.</p><p><strong>Results: </strong>Compared to group C, patients in group NC demonstrated a higher incidence of sagittal imbalance-related mechanical complications at 2-year follow-up, with a greater tendency for sagittal imbalance progression (p=0.013), a larger post-to-follow-up change in sagittal vertical axis (ΔSVA) (p=0.029), and a higher incidence of proximal junctional kyphosis (PJK) (p=0.031). Although there was no significant difference in PJK incidence between group C-NR and group C-R (p=0.845), group C-NR showed a greater tendency for postoperative sagittal imbalance aggravation (p=0.025), with a significantly larger ΔSVA during follow-up (p=0.002). The optimal cutoff values for predicting postoperative sagittal imbalance aggravation were 3.5% for pre-to-post ΔFHC (area under the curve [AUC]=0.694) and 1.8% for post-to-follow-up ΔFHC (AUC=0.713).</p><p><strong>Conclusion: </strong>Dynamic postoperative changes in hip joint coverage, characterized by the FHC, are associated with postoperative sagittal balance maintenance. Patients with limited pre-to-post and post-to-follow-up changes in the FHC demonstrate compromised hip joint compensatory capacity, thereby increasing the risk of postoperative sagittal imbalance-related mechanical complications.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"427-443"},"PeriodicalIF":5.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841043","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":"Agonist-Induced Activation of Transient Receptor Potential Vanilloid 4 Promotes Autophagy and Extracellular Matrix Synthesis in the Rat Intervertebral Disc.","authors":"Kohei Kuroshima, Yoshiki Takeoka, Takashi Yurube, Takeru Tsujimoto, Yutaro Kanda, Kunihiko Miyazaki, Hiroki Ohnishi, Tomoya Matsuo, Masao Ryu, Naotoshi Kumagai, Yoshiaki Hiranaka, Masahiko Furuya, Daisuke Nakagawa, Yu Inoue, Ryosuke Kuroda, Kenichiro Kakutani","doi":"10.14245/ns.2551582.791","DOIUrl":"10.14245/ns.2551582.791","url":null,"abstract":"<p><strong>Objective: </strong>Transient receptor potential vanilloid 4 (TRPV4), a mechanosensitive ion channel, has been implicated in intervertebral disc homeostasis; however, its role in autophagy regulation remains unclear. This study aimed to investigate whether agonist-induced TRPV4 activation promotes autophagy and extracellular matrix (ECM) synthesis in rat intervertebral discs.</p><p><strong>Methods: </strong>In vitro, rat nucleus pulposus (NP) cells were treated with the TRPV4 agonist (GSK1016790) under normal, serum-deprived, or interleukin-1β-stimulated conditions. Cell viability, intracellular Ca2+ influx, adenosine monophosphate-activated protein kinase/mammalian target of rapamycin (mTOR) (AMPK/mTOR) pathway, autophagy, ECM metabolism, apoptosis, and senescence were evaluated. In vivo, TRPV4 agonist was injected into the caudal discs subjected to temporary static compression, and disc changes were assessed by radiography, histomorphology, and immunofluorescence.</p><p><strong>Results: </strong>In vitro, agonist-induced TRPV4 activation rapidly increased intracellular Ca2+ influx and enhanced AMPK phosphorylation. A noncytotoxic concentration of the TRPV4 agonist (10 nM) was selected after dose-response testing. Under the inflammatory stress, TRPV4 agonist enhanced autophagy, promoted ECM synthesis, and suppressed apoptosis and senescence, leading to improved NP cell viability. In vivo, TRPV4 agonist treatment preserved radiographic disc height (p<0.01), reduced histomorphological degeneration (p<0.01), and increased expression of COL2A1, Brachyury, p-AMPK (phosphorylated AMPK), and autophagy markers (p<0.01) compared with controls.</p><p><strong>Conclusion: </strong>These findings demonstrated that TRPV4 activation promotes autophagy and ECM synthesis via the AMPK/mTOR pathway in rat discs and attenuates stress-induced degeneration, suggesting TRPV4 as a potential therapeutic target for disc degeneration.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"347-364"},"PeriodicalIF":5.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840918","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":"Automated Measurement of Occipito-Axial Angle on Cervical Radiographs Using a Deep Learning Object Detection Model: A Proof-of-Concept Study.","authors":"Shun Yamamoto, Yutaro Fuse, Yoshitaka Nagashima, Kensaku Mori, Takashi Abe, Mamoru Matsuo, Tomomi Gonda, Nobuhiro Hata, Yusuke Nishimura, Ryuta Saito","doi":"10.14245/ns.2551878.939","DOIUrl":"10.14245/ns.2551878.939","url":null,"abstract":"<p><strong>Objective: </strong>Maintaining the occipito-axial (O-C2) angle following occipitocervical fusion is crucial to prevent postoperative complications. Although automated O-C2 measurement has been reported, practical methods that provide rapid results for routine practice remain limited. This study aimed to develop a deep learning model using the YOLO (You Only Look Once) object detection algorithm to automatically identify anatomical landmarks and rapidly calculate the O-C2 angle.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using cervical spine radiographs from 2 independent facilities. The internal dataset comprised 574 lateral cervical radiographs from 271 patients for model development, while the external validation dataset included 100 radiographs from 100 patients. Model performance was evaluated against manual measurements by 3 expert raters.</p><p><strong>Results: </strong>The model demonstrated excellent detection performance, achieving perfect metrics for the hard palate (F1 score: 1.00) and high performance for the occipital bone (F1 score: 0.97), anteroinferior corner of C2 (F1 score: 0.99), and posteroinferior corner of C2 (F1 score: 0.99). For O-C2 angle estimation, the mean absolute error was 2.35° and root mean squared error was 2.98°, with an accuracy of 94.7% for determining the presence or absence of the O-C2 angle (i.e., whether all 4 anatomical landmarks were simultaneously detected). Bland-Altman analysis revealed minimal bias (0.57°; 95% confidence interval, -0.06° to 1.12°) with limits of agreement from -5.19° to 6.33°. Inference time was approximately 0.14 s per image.</p><p><strong>Conclusion: </strong>Our deep learning model enables rapid and accurate O-C2 angle measurement on lateral cervical radiographs, demonstrating performance comparable to expert raters and potential clinical utility.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"380-392"},"PeriodicalIF":5.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840850","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":"Data-Driven Clustering for Risk Stratification of Unfavorable Outcomes After Lumbar Fusion Surgery: A Development Study.","authors":"Peng Cui, Hu Tao, Haojie Zhang, Peng Wang, Xiaolong Chen, Shibao Lu","doi":"10.14245/ns.2551770.885","DOIUrl":"10.14245/ns.2551770.885","url":null,"abstract":"<p><strong>Objective: </strong>Lumbar fusion surgery serves as a crucial option for treating lumbar degenerative diseases. However, patient heterogeneity contributes to suboptimal surgical outcomes in a substantial proportion of cases. Therefore, an accurate classification may provide a powerful tool for personalized treatment and enable the identification of individuals at increased risk for unfavorable surgical outcomes (USO). The study aimed to develop a risk stratification model for USO using cluster analysis.</p><p><strong>Methods: </strong>Consecutive patients diagnosed with degenerative lumbar disease who underwent lumbar fusion between April 2019 and January 2023 were enrolled. The outcome of interest was the USO, defined as failure to achieve a minimal clinically important difference in the 36-Item Short Form Health Survey physical component summary score, with the presence of complications. Three machine learning algorithms were employed to identify risk factors associated with USO. Based on these risk factors, we conducted a data-driven clustering analysis to develop a risk stratification model. Furthermore, based on 6 machine learning models, we developed a classification classifier capable of accurately identifying the risk cluster of individual patients.</p><p><strong>Results: </strong>A total of 662 patients were enrolled for risk stratification model, 219 patients were classified as having an USO. Six features were identified as key prognostic predictors, including frailty, depression, PI-LL (pelvic incidence minus lumbar lordosis) match, surgical levels, functional independence measure, and the relative functional cross-sectional area. The K-prototypes clustering algorithm successfully identified 3 distinct clusters. Furthermore, we developed a classification classifier, in which LightGBM (light gradient boosting machine) demonstrated the highest predictive performance (area under the receiver operating characteristic curve, 0.951; 95% confidence interval [CI], 0.814-0.974; area under the precision-recall curve, 0.927; 95% CI, 0.769-0.969).</p><p><strong>Conclusion: </strong>Based on data-driven clustering analysis, we developed a risk stratification model for predicting USO following lumbar fusion surgery, which demonstrated high predictive accuracy. Further studies in larger and more diverse cohorts are warranted to validate the clinical applicability of clustering analysis in USO risk stratification.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 2","pages":"473-486"},"PeriodicalIF":5.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840953","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":"The Gut-Disc Axis: Unraveling the Microbiome's Role in Lumbar Disc Herniation.","authors":"Luca Ambrosio, Jordy Schol, Stone Sima, Clara Ruiz-Fernandez, Victor Chen, Fabrizio Russo, In-Ho Han, Daisuke Sakai, Gianluca Vadalà, Vincenzo Denaro, Ashish D Diwan","doi":"10.14245/ns.2551584.792","DOIUrl":"10.14245/ns.2551584.792","url":null,"abstract":"<p><p>Lumbar disc herniation (LDH) is one of the most common causes of low back and leg pain. While mechanical and degenerative factors have long been considered the main contributors, persistent or recurrent symptoms in many patients suggest additional biological mechanisms. Recent research has highlighted the microbiome as a potential modulator of inflammation, immune response, and pain sensitization, introducing the \"gut-spine axis\" concept. This scoping review summarizes the current evidence on the role of both gut and local disc microbiota in LDH. A systematic search of PubMed/MEDLINE and Scopus was conducted up to June 2025, following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Twenty-six studies were included, encompassing preclinical and clinical investigations. Animal models showed that LDH may alter gut microbial composition and that microbiome-targeted interventions can reduce inflammation, neuroinflammatory signaling, and pain sensitivity. In human studies, low-virulence bacteria, particularly Cutibacterium acnes, were frequently detected in surgically excised intervertebral discs, although results were inconsistent due to methodological heterogeneity and potential contamination. Some studies reported associations between bacterial colonization and Modic changes, disc height loss, or chronic pain. Additionally, genetic and metabolomic data suggest that gut dysbiosis and related microbial metabolites may influence systemic immune and metabolic pathways implicated in disc degeneration and pain perception. Overall, the current evidence suggests the biological plausibility of microbiome involvement in LDH pathophysiology, acting through both systemic and local mechanisms. However, the available data remain preliminary, and no mechanistic study has confirmed the observed correlations to date. Further standardized, contamination-aware studies are required to clarify causality and explore microbiome-targeted therapeutic strategies.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 1","pages":"3-28"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157948","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":"A Commentary on \"International Practice Patterns in the Surgical Management of Primary Lumbar Disc Herniation: An AO Spine Cross-Sectional Study\".","authors":"Jin-Sung Kim","doi":"10.14245/ns.26520108.0054","DOIUrl":"10.14245/ns.26520108.0054","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 1","pages":"40-41"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157723","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":"International Practice Patterns in the Surgical Management of Primary Lumbar Disc Herniation: An AO Spine Cross-Sectional Study.","authors":"Luca Ambrosio, Sathish Muthu, Patrick C Hsieh, S Tim Yoon, Jeffrey C Wang, Gianluca Vadalà, Hans Jörg Meisel, Stipe Ćorluka, Zorica Buser","doi":"10.14245/ns.2551004.502","DOIUrl":"10.14245/ns.2551004.502","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to characterize international practice patterns in the surgical management of primary lumbar disc herniation (LDH) among AO Spine surgeons.</p><p><strong>Methods: </strong>A cross-sectional online survey was distributed in September 2024 to AO Spine members. The questionnaire collected detailed information on demographic characteristics, surgical indications, preferred techniques, and approaches for primary LDH treatment. Data on specialty, practice setting, fellowship training, and surgical case volume were analyzed using univariate and multivariate logistic regression to identify significant associations between surgeon characteristics and treatment preferences.</p><p><strong>Results: </strong>A total of 714 surgeons participated, representing diverse regions: North America (9.0%), Latin America (18.7%), Europe & Southern Africa (34.7%), Middle East & Northern Africa (12.8%), and Asia Pacific (24.8%). Neurological status was the most critical factor influencing early operative treatment in nonurgent cases, while bladder/bowel dysfunction and severe motor deficits were the primary indications in urgent scenarios. The majority of respondents (54.2%) preferred a mini-open technique-using either a surgical microscope or loupes-with partial laminotomy (58.1%) and partial discectomy (63.2%) being the most frequently performed procedures. Regional variations and differences in surgeon training were significantly associated with the choice of surgical approach and overall case volume.</p><p><strong>Conclusion: </strong>The findings reveal substantial variability in the surgical management of primary LDH across regions and specialties. This comprehensive dataset underscores the need for standardized, evidence-based guidelines to harmonize treatment strategies and optimize patient outcomes.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 1","pages":"31-39"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157950","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}