Asian Spine JournalPub Date : 2025-06-01Epub Date: 2025-03-04DOI: 10.31616/asj.2024.0505
Jin-Sung Park, Hyun-Jun Kim, Se-Jun Park, Dong-Ho Kang, Chong-Suh Lee
{"title":"A comprehensive review of risk factors and prevention strategies: how to minimize mechanical complications in corrective surgery for adult spinal deformity.","authors":"Jin-Sung Park, Hyun-Jun Kim, Se-Jun Park, Dong-Ho Kang, Chong-Suh Lee","doi":"10.31616/asj.2024.0505","DOIUrl":"10.31616/asj.2024.0505","url":null,"abstract":"<p><p>Adult spinal deformity (ASD) surgery aims to correct abnormal spinal alignment in both the sagittal and coronal planes to alleviate pain and improve functional activities of daily living. Despite the advancements in surgical techniques that have led to better clinical outcomes, postoperative mechanical complications remain. These complications include instrumentation failure, with proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and rod fractures (RFs) being the most common. Such complications deteriorate clinical outcomes and often require revision surgery, which can be more burdensome for surgeons and patients, than index surgery. Thus, the risk factors for mechanical complications must be identified, and effective preventive strategies established. Therefore, this study aimed to review the risk factors for mechanical complications, focusing on PJK, PJF, and RF, and explore prevention strategies for these complications in ASD surgery, drawing upon recent literature.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"463-475"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"More postoperative complications and revision surgery after occipitocervical fusion than after atlantoaxial fusion: a retrospective multicenter cohort study.","authors":"Koji Uotani, Angel Oscar Paz Flores, Masato Tanaka, Shashank J Ekade, Shinya Arataki, Tadashi Komatsubara, Yoshiaki Oda, Kensuke Shinohara, Toshifumi Ozaki","doi":"10.31616/asj.2024.0374","DOIUrl":"10.31616/asj.2024.0374","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective multicenter cohort study.</p><p><strong>Purpose: </strong>We sought to determine whether occipitocervical (OC) fusion is followed by more postoperative complications and revision surgery than is atlantoaxial (AA) fusion. We aim to compare postoperative complications and revision surgery associated with OC fusion and AA fusion.</p><p><strong>Overview of literature: </strong>OC and AA fusion are established techniques for restoring upper cervical stability. However, the outcomes of the two methods have not been compared.</p><p><strong>Methods: </strong>This study included 90 patients who underwent upper spinal fusion surgery for mechanical instability, performed by three surgeons in two hospitals from 2011 to 2023; OC fusion was indicated for irreducible AA subluxation, os odontoideum, and severe upper C1 fracture. Of the patients, 38 (mean age, 58.7 years) underwent OC fusion, and 52 (mean age, 62.8 years) underwent AA fusion. To evaluate surgical outcomes, we documented surgical time, intraoperative blood loss, postoperative complications, and the rate of revision surgery. Radiographs were obtained to identify screw malposition, rod breakage, and nonunion. To compare the outcomes of the two techniques, we used the Mann-Whitney U test for continuous variables and the chi-square or Fisher's exact test for dichotomous variables.</p><p><strong>Results: </strong>OC fusion took significantly longer (175.4 minutes) than AA fusion (150.7 minutes, p=0.020) and had a higher complication rate (39.5% vs. 11.5%, p <0.0001). The reoperation rate was 23.7% (9/38) after OC fusion and 3.8% (2/52) after AA fusion; the difference was statistically significant (p=0.0073). Average amounts of blood loss were 224 mL during OC fusion and 224 mL during AA fusion; the difference was not significant (p=0.947).</p><p><strong>Conclusions: </strong>Although OC fusion is indispensable for certain conditions, particularly basilar invagination, it entails more risk than dose AA fusion; the choice of technique thus warrants careful consideration.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"444-451"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asian Spine JournalPub Date : 2025-06-01Epub Date: 2025-03-04DOI: 10.31616/asj.2024.0279
Abhinav Sharma, Paramveer Birring, Nischal Acharya, Manaav Mehta, Nicole Liu Goldenhersh, Michael Steinhaus, Hao-Hua Wu, Sohaib Hashmi, Don Young Park, Yu-Po Lee, Nitin Bhatia
{"title":"Decompression and fusion for lumbar degenerative spondylolisthesis is associated with higher early morbidity rates and risk of perioperative complications compared with decompression alone: a retrospective study in the United States.","authors":"Abhinav Sharma, Paramveer Birring, Nischal Acharya, Manaav Mehta, Nicole Liu Goldenhersh, Michael Steinhaus, Hao-Hua Wu, Sohaib Hashmi, Don Young Park, Yu-Po Lee, Nitin Bhatia","doi":"10.31616/asj.2024.0279","DOIUrl":"10.31616/asj.2024.0279","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Purpose: </strong>To assess differences in 30-day morbidity and mortality and postoperative complications between two surgical treatment options.</p><p><strong>Overview of literature: </strong>The choice of decompression with fusion or decompression alone for the management of degenerative spondylolisthesis (DS) is controversial.</p><p><strong>Methods: </strong>The American College of Surgeons National Quality Improvement Program database was queried for laminectomy or laminotomy with and without fusion from 2015 to 2020. The estimated 30-day mortality and morbidity, 30-day complications, and American Society of Anesthesiologist (ASA) classification were evaluated through chi-square and analysis of variance tests, with the results further stratified according to the ASA classification.</p><p><strong>Results: </strong>Of the 4,120 patients, 2,384 (58%) underwent a laminectomy or laminotomy without fusion and 1,736 (42%) underwent a laminectomy or laminotomy with fusion. Patients undergoing decompression with fusion had higher mean mortality (estimated probability 0.0034 vs. 0.0027, p<0.001), mean morbidity (estimated probability 0.053 vs. 0.048, p<0.001), mean length of stay (3.62±3.4 days vs. 3.15±4.3 days, p<0.001), and bleeding risk necessitating transfusion (9.5% vs. 7.6%, p =0.038). There was a higher rate of overall 30-day postoperative complications associated with an increasing ASA score for both cohorts.</p><p><strong>Conclusions: </strong>Decompression with fusion was associated with higher estimated mortality, morbidity, and 30-day complications. Decompression alone is an appealing treatment option for lumbar DS, particularly for patients with higher ASA scores and those at higher risk.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"346-354"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asian Spine JournalPub Date : 2025-06-01Epub Date: 2025-03-04DOI: 10.31616/asj.2024.0405
Vishwajeet Singh, Marcelo Oppermann, Nathan Evaniew, Alexandra Soroceanu, Fred Nicholls, Bradley Jacobs, Kenneth Thomas, Ganesh Swamy
{"title":"Estimation of proximal junctional failure and associated risk factors in adult spine deformity surgery: an observational study from a single institution.","authors":"Vishwajeet Singh, Marcelo Oppermann, Nathan Evaniew, Alexandra Soroceanu, Fred Nicholls, Bradley Jacobs, Kenneth Thomas, Ganesh Swamy","doi":"10.31616/asj.2024.0405","DOIUrl":"10.31616/asj.2024.0405","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective observational cohort study.</p><p><strong>Purpose: </strong>To estimate the proximal junctional failure (PJF) rate and identify associated factors.</p><p><strong>Overview of literature: </strong>Proximal junctional pathologies are challenging and common complications of adult spine deformity (ASD) surgery. However, the PJF rate was not accurately defined within the ASD cohort. A correct estimate of PJF incidence and associated factors will inform clinicians on reoperation risk and prevention strategies.</p><p><strong>Methods: </strong>This retrospective observational study included patients with degenerative or adult idiopathic thoracolumbar deformity, extended instrumentation, sacropelvic fixation, and more than 2 years of follow-up. Patients with post-traumatic or iatrogenic sagittal malalignment were excluded. Demographic and operative data were obtained from the electronic medical records. Preoperative and followup scoliosis radiographs were reviewed to calculate the spinal alignment parameters. Patients were categorized into the PJF and non- PJF groups using the modified Hart-ISSG criteria, and their demographic, surgical, and radiographic parameters were compared using descriptive statistics. Multivariable logistic regression models were fitted to estimate the association measures of PJF occurrence, and their odds ratios (ORs) were reported with corresponding 95% confidence intervals (CI).</p><p><strong>Results: </strong>Of the eligible 157 patients who underwent surgery between 2011 and 2018, 130 were included. The mean age was 64.6±8 years, and 73% of the patients were female. Moreover, 42 (32%) and 88 patients (68%) were allocated to the PJF and non-PJF groups, respectively. The mean change in the proximal junctional angle (△PJA) in the PJF group was 26°±8.2°, and 33 patients (79%) had a final PJA >20°, 4 (10%) had an additional upper instrumented vertebra (UIV)/UIV+1 fracture, and 5 (12%) had an additional screw dislodgement or fixation failure. Postoperative changes in PJA (OR, 1.23; 95% CI, 1.12-1.37; p <0.001), thoracic kyphosis (TK; OR, 1.06; 95% CI, 1.02-1.11; p =0.004), and the use of a proximal tether (OR, 0.22; 95% CI, 0.04-0.82; p =0.03) were associated with PJF.</p><p><strong>Conclusions: </strong>In this study, the PJF rate was 32%, of which 67% of the patients underwent reoperation. Postoperative PJA and TK changes and the use of proximal tethers were significantly associated with PJF.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"452-462"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asian Spine JournalPub Date : 2025-06-01Epub Date: 2025-03-04DOI: 10.31616/asj.2024.0494
Masatoshi Yamamoto, Koji Ohta, Daisuke Hirano, Maki Noguchi, Shuhei Ayukawa, Keigo Shirasaki, Kenya Ishizu, Tetsuya Watanabe, Keiichiro Iida
{"title":"Evaluating the effect of early balloon kyphoplasty on adjacent vertebral fracture risk in osteoporotic vertebral fracture management: a retrospective study.","authors":"Masatoshi Yamamoto, Koji Ohta, Daisuke Hirano, Maki Noguchi, Shuhei Ayukawa, Keigo Shirasaki, Kenya Ishizu, Tetsuya Watanabe, Keiichiro Iida","doi":"10.31616/asj.2024.0494","DOIUrl":"10.31616/asj.2024.0494","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>To evaluate whether the timing of balloon kyphoplasty (BKP) affects the risk of adjacent vertebral fractures (AVFs) in the management of osteoporotic vertebral fractures.</p><p><strong>Overview of literature: </strong>Osteoporotic vertebral fractures are usually managed conservatively; however, complications such as nonunion, neurologic deficits, and high-grade kyphosis can arise. BKP, a minimally invasive procedure for pain relief, has been associated with AVF risk. Although meta-analyses suggest no significant difference in AVF rates between BKP and conservative treatment, retrospective studies report higher AVF rates after BKP. Many of these cases involve patients resistant to conservative treatment, which implies that differences in the incidence of AVF may be influenced by the delay before performing BKP.</p><p><strong>Methods: </strong>We retrospectively analyzed 189 patients who underwent BKP between 2012 and 2023, excluding those with pathological fractures. The incidence of AVF was assessed at 3 months after BKP. Risk factors, including age, sex, fracture site, prior vertebral fractures, bone mineral density, kyphosis angle, endplate damage, signal changes in the fractured vertebral body on magnetic resonance imaging, vertebral instability, and timing of BKP, were evaluated.</p><p><strong>Results: </strong>The overall incidence of AVFs was 29%. The AVF rate was 21% in patients treated with BKP within 30 days, as compared with 32% in those treated later; however, this difference was not statistically significant (p =0.15). Multivariate analysis identified vertebral instability as the only significant risk factor for AVF (odds ratio, 2.73; p =0.01), whereas the timing of BKP showed no significant association with AVF risk.</p><p><strong>Conclusions: </strong>Early BKP does not significantly reduce the risk of AVF. The findings suggest that the management of osteoporotic vertebral fractures should focus on vertebral stability rather than intervention timing.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"408-414"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asian Spine JournalPub Date : 2025-06-01Epub Date: 2025-03-04DOI: 10.31616/asj.2024.0344
Megan Havard, Ronan McKeogh, Abi Goodier, Gemma Johns, Sashin Ahuja
{"title":"To Zoom or not to Zoom? A retrospective comparative study to assess the validity of video versus face-to-face consultations and examinations for diagnosing lower back pain in Wales.","authors":"Megan Havard, Ronan McKeogh, Abi Goodier, Gemma Johns, Sashin Ahuja","doi":"10.31616/asj.2024.0344","DOIUrl":"10.31616/asj.2024.0344","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective comparative study.</p><p><strong>Purpose: </strong>To evaluate the accuracy of examination findings and diagnoses established after initial spinal consultations for low back pain conducted virtually in comparison with face-to-face (F2F) consultations.</p><p><strong>Overview of literature: </strong>The COVID-19 (coronavirus disease 2019) pandemic required a shift from F2F to virtual consultations in healthcare, with documented benefits such as reduced costs, CO2 emissions, and time. However, the diagnostic accuracy of telemedicine for conditions requiring physical examinations, such as low back pain, remains underexplored. Although studies have highlighted the feasibility and high satisfaction of virtual spinal assessments, they have not thoroughly investigated their diagnostic accuracy.</p><p><strong>Methods: </strong>This study included 154 new patients with degenerative lumbar spine problems who were assessed via virtual consultations (VCs) (n=77) or F2F (n=77) by a single orthopedic spinal surgeon between May 2020 and January 2021. Patients were matched by age and sex, and examinations followed the \"telemedicine musculoskeletal examination\" protocol by the Mayo Clinic. Diagnostic changes from initial to definitive diagnoses were recorded and compared between the two groups.</p><p><strong>Results: </strong>The diagnostic accuracy of VCs was comparable with that of F2F examinations, with no significant difference in the rate of diagnostic changes between the groups (p=0.814 for any change; p=0.405 for more significant changes). Motor deficits were the only examination component with significant false-positive rates in the VC group (p=0.023).</p><p><strong>Conclusions: </strong>The study findings indicate that the initial spinal VCs and examinations are effective, safe, and beneficial in the evaluation of low back pain, providing the same diagnostic accuracy as initial F2F consultations. All erroneous motor deficit findings were false positive, which means that no serious pathology was missed during the initial VC evaluation. Future research should focus on refining virtual examination techniques, particularly for assessing motor deficits.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"415-421"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asian Spine JournalPub Date : 2025-06-01Epub Date: 2025-06-26DOI: 10.31616/asj.2025.0225.r1
Pravallika Ambati, Bishlesh
{"title":"Letter to editor: Evaluating the effect of early balloon kyphoplasty on adjacent vertebral fracture risk in osteoporotic vertebral fracture management: a retrospective study.","authors":"Pravallika Ambati, Bishlesh","doi":"10.31616/asj.2025.0225.r1","DOIUrl":"10.31616/asj.2025.0225.r1","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"19 3","pages":"505-506"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asian Spine JournalPub Date : 2025-06-01Epub Date: 2025-02-04DOI: 10.31616/asj.2024.0520
Young-Hoon Kim, Ki-Won Kim, Kee-Won Rhyu, Jong-Beom Park, Jae-Hyuk Shin, Young-Yul Kim, Jun-Seok Lee, Joong-Hyun Ahn, Ji-Hyun Ryu, Hyung-Youl Park, Sang-Il Kim
{"title":"Bone fusion materials: past, present, and future.","authors":"Young-Hoon Kim, Ki-Won Kim, Kee-Won Rhyu, Jong-Beom Park, Jae-Hyuk Shin, Young-Yul Kim, Jun-Seok Lee, Joong-Hyun Ahn, Ji-Hyun Ryu, Hyung-Youl Park, Sang-Il Kim","doi":"10.31616/asj.2024.0520","DOIUrl":"10.31616/asj.2024.0520","url":null,"abstract":"<p><p>Bone fusion is one of the mainstay managements for degenerative spinal diseases and critical-sized bone defects resulting from trauma, tumors, infection, and nonunion. Bone graft materials are required for promoting bone healing, with autografts historically considered the gold standard due to their osteogenic, osteoinductive, and osteoconductive properties. However, donor site morbidities have led to the development of alternative bone graft substitutes. Currently available alternative options for bone fusion include allografts, ceramics, demineralized bone matrix (DBM), and bone morphogenetic proteins (BMPs). Each material has its advantages and disadvantages. Allografts avoid donor site morbidities but lack osteogenic properties and pose disease transmission risks. DBMs are acid-extracted allografts that have osteoconductive and osteoinductive properties but require combination with autografts because of the lack of evidence for their stand-alone use. BMP-2 has potent osteoinductive properties and is considered an ideal fusion material, but faces unresolved challenges related to optimal dosage and carrier. Synthetic peptides, mimicking the cell-binding domain of type I collagen, facilitate the attachment of osteogenic cells (such as osteoblasts) to the graft material and the production of extracellular matrix, leading to improved bone growth at the fusion site. The development of materials with ideal properties is a research hotspot. Recent advancements in biomaterials, such as hydrogels, nanomaterials, and three-dimensional-printed biomaterials, offer promising future options for bone fusion. This review provides an overview of available bone fusion materials, their advantages and disadvantages, and introduces emerging candidate options for bone fusion.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"490-500"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asian Spine JournalPub Date : 2025-06-01Epub Date: 2025-04-11DOI: 10.31616/asj.2024.0364
Kevin Jonathan Sjukur, Willy Adhimarta, Andi Asadul Islam, Bambang Priyanto, Andriany Qanitha
{"title":"Inhibitory effect of MLC901 on axonal demyelination in experimental animals undergoing circumferential lumbal stenosis by increasing transforming growth factor-β1 levels.","authors":"Kevin Jonathan Sjukur, Willy Adhimarta, Andi Asadul Islam, Bambang Priyanto, Andriany Qanitha","doi":"10.31616/asj.2024.0364","DOIUrl":"10.31616/asj.2024.0364","url":null,"abstract":"<p><strong>Study design: </strong>Experimental study using circumferential lumbar stenosis (CLS) rat model.</p><p><strong>Purpose: </strong>To investigate the effect of MLC901 administration on transforming growth factor (TGF)-β1 level and the degree of axonal demyelination in the CLS rat model.</p><p><strong>Overview of literature: </strong>CLS is common in older adults, causing neuropathic pain that impairs daily functioning. TGF-β1 plays an essential role in nerve regeneration and reducing axonal demyelination in CLS. MLC901, a traditional therapeutic formula, has shown promise in preclinical studies, including modulating proinflammatory cytokines. While MLC901's effect on serum TGF-β1 levels in the CLS rat model has been explored, its impact on tissue TGF-β1 expression remains understudied.</p><p><strong>Methods: </strong>Rats were randomly allocated into one of six groups: no CLS (baseline), CLS only (pretreatment), short treatment (1 day) with MLC901, short treatment with placebo, longer treatment (7 days) with MLC901, and longer treatment with placebo. The CLS model was induced by laminectomy at the lumbar 5th vertebra, followed by teflon insertion around the dura mater. Serum TGF-β1 levels were measured using enzyme-linked immunosorbent assay. Tissue TGF-β1 expression and the degree of axonal demyelination were assessed by immunohistochemistry and histopathology, respectively.</p><p><strong>Results: </strong>Long treatment MLC901 group had significantly higher serum TGF-β1 levels than the pretreatment group (p<0.001). Long treatment MLC901 group also exhibited the highest TGF-β1 tissue expression among all treatment groups, including the baseline group (p=0.013). Axonal demyelination was lowest in the long treatment MLC901 group, indicated by the highest number of Schwann cells (p<0.001), the fewest inflammatory cells (except versus baseline) (p=0.001), and the fewest vacuoles (except versus baseline) (p=0.015).</p><p><strong>Conclusions: </strong>MLC901 can inhibit axonal demyelination in experimental animals undergoing CLS surgery by upregulating TGF-β1 levels. MLC901 has the potential to be used as an adjuvant therapy in CLS surgery.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"333-345"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}