Neurospine最新文献

{"title":"Bracing and Activity Restriction After Lumbar Discectomy Surgery: An International Survey of AO Spine Members.","authors":"Waeel O Hamouda, Stipe Ćorluka, Sathish Muthu, Luca Ambrosio, Carla Cunha, Stjepan Ivandic, Mohamed A R Soliman, Fabrizio Russo, Sibylle Grad, In Ho Han, Gianluca Vadala, Hans-Jorg Meisel, Sam K Cho, Tim S Yoon, Jeffrey C Wang, Amit Jain, Zorica Buser","doi":"10.14245/ns.2551622.811","DOIUrl":"10.14245/ns.2551622.811","url":null,"abstract":"<p><strong>Objective: </strong>Bracing after lumbar discectomy surgery (LDS) is a controversial topic with paucity of related scientific literature. Previous surveys on spine surgeons' preferences were limited both in geographical coverage and number of respondents. The aim of this study is to fill this gap in the literature.</p><p><strong>Methods: </strong>An international online survey among AO Spine members regarding the postoperative recommendations for bracing (PoBr), activity restriction (AR), and associated factors, was performed.</p><p><strong>Results: </strong>A total of 703 spine surgeons participated in the survey of which 34% recommended PoBr, with half of them reported usage for 4 weeks. Main influencing variables were being from Europe/South Africa region, greater extent of bony decompression, and larger amount of excised disc material. Seventy-nine percent of the respondents recommended postoperative AR. Prolonged standing, prolonged sitting, and driving were usually restricted for 2 weeks. Bending, twisting, lifting, and low-intensity physical activities for 3 months, while high-intensity physical activities and direct contact sports for 6 months were restricted.</p><p><strong>Conclusion: </strong>Despite recent literature insights showing limited evidence of efficacy, 34% and 80% of a large cohort of international surgeons practice bracing and recommend AR after LDS for variable durations. Extensive bony decompression and radical discectomy significantly influenced the decision to brace, similarly endoscopic approaches and radical discectomy influenced the decision to restrict activity. These findings emphasize the persistent evidence-practice gap and the wide variability on the global level. More randomized controlled trials are warranted on this topic to reach an evidence-based recommendation.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 1","pages":"109-116"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157904","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":"Evolving Paradigms in Lumbar Disc Herniation: From Prediction to Precision Surgery.","authors":"Gianluca Vadalà","doi":"10.14245/ns.2551624.812","DOIUrl":"10.14245/ns.2551624.812","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 1","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158000","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":"Disuse Bone Loss in Fusion Constructs After Multilevel Lumbar Fusion: A Computed Tomography Hounsfield Unit Analysis.","authors":"Hyun-Jun Jang, Dongkyu Kim, Bong-Ju Moon, Kyung-Hyun Kim, Jeong-Yoon Park, Sung-Uk Kuh, Keun-Su Kim, Dong-Kyu Chin","doi":"10.14245/ns.2551272.636","DOIUrl":"10.14245/ns.2551272.636","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate long-term bone quality changes within the fusion construct (FC) after 2- to 3-level lumbar fusion using computed tomography (CT)-derived Hounsfield units (HUs).</p><p><strong>Methods: </strong>Among 520 screened patients, 222 who underwent 2- to 3-level posterior lumbar interbody fusion met the inclusion criteria. HU values were measured on CT scans preoperatively, at 1-year postoperative, and at final follow-up. The percentage change in HU (HU [final-pre]%) was calculated for each vertebral level.</p><p><strong>Results: </strong>At the final follow-up, the FC demonstrated a significant decline in HU compared to preoperative values (median [10th-90th percentile], 132.0 [86.5-220.4]; 95% confidence interval [CI], 116.0-142.5 vs. 124.5 [71.0- 210.0]; 109.8-135.1; HU (final-pre)%: -11.0 [-62.0 to 48.5]; -19.9 to -6.1; p<0.001). In contrast, HU increased significantly at the uppermost instrumented vertebra (HU (final-pre)%: median [10th-90th percentile], 28.3 [-19.9 to 102.9]; 95% CI, 21.1-36.4; p<0.001), likely reflecting increased mechanical demands. Subgroup analysis revealed a more pronounced decline in HU in patients with longer follow-up durations, particularly in the FC group (p=0.003).</p><p><strong>Conclusion: </strong>CT-derived HU revealed progressive trabecular bone loss within FC over time after lumbar fusion. In patients with longer postoperative intervals, clinicians should remain aware of the potential weakening of the FC, which has important implications when considering implant removal or planning revision surgery.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 1","pages":"176-186"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157953","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":"Lumbar Disc Herniation Resorption: When and How Does It Occur?","authors":"Carla Cunha, Hanzhi Yang, Zorica Buser, Carola Rojas, Marisa Cunha, Paulo Pereira, In Ho Han, Li Jin, Xudong Li","doi":"10.14245/ns.2551538.769","DOIUrl":"10.14245/ns.2551538.769","url":null,"abstract":"<p><p>Low back pain is a leading cause of disability worldwide, with intervertebral disc herniation contributing substantially to its burden. Most patients improve with conservative care, often associated with disc resorption. Although increasingly recognized as a major determinant of recovery, the mechanisms underlying resorption remain poorly understood. Herniated disc tissue induces immune cell infiltration and release of cytokines and proteolytic enzymes, yet standard anti-inflammatory treatments may paradoxically impede this process. Outcomes are also influenced by physical therapy, lifestyle, herniation characteristics, and immunological background, but predictive biomarkers are lacking. This review summarizes the current knowledge gap and explores strategies to harness intrinsic healing for personalized management.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 1","pages":"82-93"},"PeriodicalIF":5.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157956","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 \"Beyond the Microscope: Is Endoscopic Discectomy the Next Gold Standard for Lumbar Disc Herniation?\"","authors":"Patrick C Hsieh","doi":"10.14245/ns.26520110.0055","DOIUrl":"10.14245/ns.26520110.0055","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 1","pages":"80-81"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157715","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":"Socioeconomic Implications of Recurrent Lumbar Disc Herniation: A Narrative Review.","authors":"Rachel Bratescu, Anthony Robayo, Evan Wang, Chibuikem A Ikwuegbuenyi, Lawrance K Chung, Noah Willett, Andreas K Demetriades, Sun-Ho Lee, Roger Härtl","doi":"10.14245/ns.2551644.822","DOIUrl":"10.14245/ns.2551644.822","url":null,"abstract":"<p><p>Recurrent lumbar disc herniation (RLDH) is a common complication after discectomy, occurring in 2%-25% of patients and contributing to higher reoperation rates, reduced satisfaction, and substantial direct and indirect costs. This review evaluates the economic consequences of RLDH and the relative cost-effectiveness of available management strategies. A systematic search of OVID, MEDLINE, and the Cochrane Library was performed through August 2025. Peer-reviewed, English-language studies were included if they examined adults (≥18 years) with RLDH and reported economic data. Exclusion criteria were studies limited to primary, cervical, or thoracic herniations; animal or cadaveric models; and abstracts. Extracted variables included study design, sample size, follow-up duration, and cost components. Of 283 records identified, 220 were screened and 35 underwent full-text review. Six studies met inclusion criteria, with 2 added through citation searching. Reported costs varied considerably: repeat discectomy added $6,907 in one analysis, while fusion increased expenses by more than 350%. Across studies, repeat discectomy remained the most cost-efficient option, providing comparable outcomes with reduced perioperative expenditures. Conservative management had the lowest immediate direct costs (≈$2,300) but likely underestimates the overall burden due to unmeasured productivity losses. Annular closure devices demonstrated potential cost savings of $2,000-5,000 over 2-5 years. RLDH imposes a substantial economic burden. Heterogeneity in costing methods remains a major limitation which hinders evidence-based determinations. Greater transparency, methodological standardization, and incorporation of societal perspectives are essential to accurately assess the socioeconomic impact of RLDH.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"23 1","pages":"94-108"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157944","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":"Incidence of Hoarseness After General Spine Surgery: Interim Report of Prospective Observational Study.","authors":"Sum Kim, Yunhee Choi, Hangeul Park, Young-Rak Kim, Jun-Hoe Kim, Woo-Young Jo, Kyung Won Shin, Hyongmin Oh, Hyung-Chul Lee, Hee-Pyoung Park, Chang-Hyun Lee, Chi Heon Kim, Chun Kee Chung","doi":"10.14245/ns.2550636.318","DOIUrl":"10.14245/ns.2550636.318","url":null,"abstract":"<p><strong>Objective: </strong>Hoarseness can occur after spinal surgery under general anesthesia, which has been assessed through self-report measures based on questionnaires. Given the inherent biases associated with self-report instruments, there is a need for more objective measures to assess hoarseness.</p><p><strong>Methods: </strong>Single institute, a prospective observational study was planned to include 427 patients after spine surgery. This interim analysis was planned to include 215 patients who met the inclusion criteria. All subjects included in this study submitted a questionnaire of Korean Voice Handicap Index (KVHI)-10. Voice analysis including low or high pitch (Herz), frequency variation rate (jitter), amplitude variation rate (Shimmer), and noise-to-harmonic ratio (NHR) was performed with a software of Pratt.</p><p><strong>Results: </strong>This interim report enrolled a total of 215 patients who met the inclusion criteria, and among them, 162 patients (75.5%) were subjected to interim analysis after excluding those with data loss (8 patients), operation cancellation (3 patients), and loss to follow-up (42 patients). The incidence of hoarseness was 35.0% on postoperative day (POD)0 and 5.5% on POD30. In the acoustic parameters analyzed, hertz and jitter were significantly positively correlated with the KVHI-10 scores on POD0, while only the jitter value significantly correlated with POD30. The optimal cutoff values of the acoustic parameter on POD30 from the receiver operating characteristic curve were 0.65% in jitter, 4.67% in shimmer, and 16.96 dB in NHR.</p><p><strong>Conclusion: </strong>This study revealed a correlation between objective acoustic parameters obtained from voice analysis and subjective questionnaire scores for hoarseness.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 4","pages":"1041-1051"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934511","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":"Mesenchymal Stromal Cells for the Treatment of Discogenic Low Back Pain: A Systematic Review of Clinical Studies.","authors":"Gianluca Vadalà, Fabrizio Russo, Giuseppe Francesco Papalia, Luca Ambrosio, Maria Tucci, Giorgia Petrucci, Inbo Han, Rocco Papalia, Vincenzo Denaro","doi":"10.14245/ns.2551046.523","DOIUrl":"10.14245/ns.2551046.523","url":null,"abstract":"<p><p>This study aimed to elucidate the efficacy and safety of mesenchymal stromal cell (MSC) therapy for chronic discogenic low back pain (LBP). A systematic literature search was conducted on PubMed/Medline, Scopus, Cochrane, and ClinicalTrials.gov following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Eligible studies included published and ongoing clinical trials assessing intradiscal MSC injections in patients with chronic discogenic LBP unresponsive to conservative treatment. Risk-of-bias (RoB) assessment was performed through MINORS (Methodological Index for Non-randomized Studies) and RoB 2 tools. Within- and between-group differences were expressed as means and 95% confidence intervals. Effect sizes were calculated through Cohen d and g. Data from 10 published clinical studies (n=736; 470 in treatment and 266 in control groups) revealed a mean age of 41.5 years and an average follow-up of 21.6 (range, 6-72) months. Various MSC sources were employed, including autologous and allogeneic bone marrow-derived MSCs and adipose-derived MSCs, with doses ranging from 6×10⁶ to over 50×10⁶ cells/disc. Visual analogue scale, Oswestry Disability Index, and quality-of-life questionnaires indicated modest improvements in pain, disability, and functional status. Additionally, magnetic resonance imaging assessments occasionally demonstrated increased disc hydration and stabilization or improvement of Pfirrmann grade. Data from 8 ongoing trials (n=498 participants; 276 treatment, 222 control) with follow-up periods ranging 6-24 months further corroborate the feasibility and safety of MSC-based interventions. MSC therapy is a biologically-driven approach for managing chronic discogenic LBP. While preliminary data support its potential to alleviate pain and improve disc integrity, further high-quality, standardized trials are necessary to optimize treatment protocols and confirm long-term clinical benefits.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 4","pages":"998-1011"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933460","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 \"Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion\".","authors":"John H Chi","doi":"10.14245/ns.2551840.920","DOIUrl":"10.14245/ns.2551840.920","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 4","pages":"951-952"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934466","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":"Epidemiology and Screening of Traumatic Vertebral Artery Injuries at a Large Scandinavian Level 1 Trauma Center.","authors":"Paulina Cewe, Victor E Staartjes, Victor Gabriel El-Hajj, Ihab Ahmad Al-Rikabi, Basel Musmar, Joana M Roy, Dennis Troung, Mats Beckman, Marcus Ohlsson, Pascal Jabbour, Adrian Elmi-Terander, Erik Edström","doi":"10.14245/ns.2551070.535","DOIUrl":"10.14245/ns.2551070.535","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic vertebral artery injuries (tVAIs) are uncommon but potentially devastating if missed. While computed tomography angiography (CTA) is routinely used for diagnosis, data on the number needed to image (NNI) remain limited. We hence analyzed tVAI epidemiology and imaging practices at a major Scandinavian level 1 trauma center.</p><p><strong>Methods: </strong>A retrospective study (2013-2020) was performed based on a single-center trauma registry. Patients were grouped based on CTA imaging protocol used; selective screening (2013-2017) and universal screening (2018-2020). Imaging protocols, treatment strategies, and outcomes were analyzed.</p><p><strong>Results: </strong>Among 2,843 patients admitted with level 1 trauma and receiving CTA imaging, 62 had a tVAI (2.2%) yielding a NNI of 46 patients to diagnose 1 tVAI. Twenty-five of these patients (40.3%) were found to have a posterior circulation stroke, resulting in an incidence of 0.9%, and a NNI of 114 to diagnose 1 stroke on CTA. NNIs for both tVAI and stroke detection increased with adoption of universal screening (tVAI: 35→65; stroke: 90→149). However, the detection rate of tVAI during the universal screening period was not significantly higher than during the selective screening period (p=0.261).</p><p><strong>Conclusion: </strong>In our level 1 trauma cohort, the incidence of tVAI was 2.2% and stroke rate 0.9%. The NNI rose with universal screening, yet detection rates did not improve. These findings suggest that selective screening based on risk factors may be more efficient than a universal approach. Further research is needed to balance diagnostic accuracy with resource use in trauma care.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 4","pages":"905-915"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934494","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}