Ravij Mehta, Sarthak Mohanty, Andrew Parker Hallmark, Veeraj Shah, Tom Ross, Eric A. Bogner, Tejbir S. Pannu, Mathieu Bannwarth, Sohrab Virk, Sravisht Iyer, James C. Farmer, Russel C. Huang, Darren R. Lebl, Bernard A. Rawlins, Harvinder S. Sandhu, Han Jo Kim, Matthew E. Cunningham, Sheeraz Qureshi, Todd J. Albert, Chitra L. Dahia
Background
Aging is a major risk factor for IVD degeneration and chronic lower back pain. Comparing degenerative patterns in human and mice, a commonly used pre-clinical model, is crucial for validating it in preclinical mechanistic research. The goal of the study was to compare the effect of age and spine level on degeneration in human and mouse lumbar IVDs.
Methods
T2-weighted MRI images of human lumbar spine were graded using the Pfirrmann system. H&E-stained mid-coronal sections of mouse lumbar IVDs were scored using the Melgoza and Chenna system. Age, gender, IVD level, and lumbar IVD degeneration scores, respectively, were used for statistical analysis in each species. Linear regression and one-way ANOVA with post hoc Tukey analysis were used to compare regression slopes and intercepts. Age conversion from mouse to human was performed according to the Jackson Laboratory's outline of mouse age and its human equivalents. Generalized estimating equations (GEE) were used to model continuous degeneration scores, accounting for intra-subject correlation due to multiple IVD levels per subject. Main effects included sex, IVD level (L1–S1), and age, with an interaction term assessing the impact of age across levels. An autoregressive correlation structure was specified.
Results
Age significantly correlated with IVD degeneration in humans (p < 0.0001) and mice (p < 0.0002). And the IVD level predicted degeneration in both species (L5–S1 in human, and L6–S1 in mice). Normalizing age and pathology revealed an earlier onset of degeneration in humans than in mice.
Conclusions
Age and spinal IVD level influence lumbar IVD degeneration in both human and mice with a higher rate of degeneration at the lumbosacral junction in both species. These findings suggest that mice are a suitable model for studying the cellular and molecular basis of IVD degeneration and associated neurological symptoms, with the L6–S1 level being the most relevant.
{"title":"Age and Spinal Level as Predictors of Lumbar Disc Degeneration in Humans and Mice: A Comparative Analysis","authors":"Ravij Mehta, Sarthak Mohanty, Andrew Parker Hallmark, Veeraj Shah, Tom Ross, Eric A. Bogner, Tejbir S. Pannu, Mathieu Bannwarth, Sohrab Virk, Sravisht Iyer, James C. Farmer, Russel C. Huang, Darren R. Lebl, Bernard A. Rawlins, Harvinder S. Sandhu, Han Jo Kim, Matthew E. Cunningham, Sheeraz Qureshi, Todd J. Albert, Chitra L. Dahia","doi":"10.1002/jsp2.70122","DOIUrl":"10.1002/jsp2.70122","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Aging is a major risk factor for IVD degeneration and chronic lower back pain. Comparing degenerative patterns in human and mice, a commonly used pre-clinical model, is crucial for validating it in preclinical mechanistic research. The goal of the study was to compare the effect of age and spine level on degeneration in human and mouse lumbar IVDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>T2-weighted MRI images of human lumbar spine were graded using the Pfirrmann system. H&E-stained mid-coronal sections of mouse lumbar IVDs were scored using the Melgoza and Chenna system. Age, gender, IVD level, and lumbar IVD degeneration scores, respectively, were used for statistical analysis in each species. Linear regression and one-way ANOVA with post hoc Tukey analysis were used to compare regression slopes and intercepts. Age conversion from mouse to human was performed according to the Jackson Laboratory's outline of mouse age and its human equivalents. Generalized estimating equations (GEE) were used to model continuous degeneration scores, accounting for intra-subject correlation due to multiple IVD levels per subject. Main effects included sex, IVD level (L1–S1), and age, with an interaction term assessing the impact of age across levels. An autoregressive correlation structure was specified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Age significantly correlated with IVD degeneration in humans (<i>p</i> < 0.0001) and mice (<i>p</i> < 0.0002). And the IVD level predicted degeneration in both species (L5–S1 in human, and L6–S1 in mice). Normalizing age and pathology revealed an earlier onset of degeneration in humans than in mice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Age and spinal IVD level influence lumbar IVD degeneration in both human and mice with a higher rate of degeneration at the lumbosacral junction in both species. These findings suggest that mice are a suitable model for studying the cellular and molecular basis of IVD degeneration and associated neurological symptoms, with the L6–S1 level being the most relevant.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14876,"journal":{"name":"JOR Spine","volume":"8 4","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin M. Bell, Rachel E. Roos, Zakiy Alfikri, William Anderst, Anna Bailes, William W. Clark, Harold A. Cook, Jessa Darwin, Marit Johnson, Gina P. McKernan, Sebastian Murati, Bambang Parmanto, Nam V. Vo, Leming Zhou, Gwendolyn A. Sowa
<div> <section> <h3> Background</h3> <p>The University of Pittsburgh Mechanistic Research Center, entitled, “Low Back Pain: Biological, Biomechanical, Behavioral Phenotypes (LB<sup>3</sup>P),” is part of the National Institutes of Health's Helping to End Addiction Long-term Initiative. LB<sup>3</sup>P conducted a prospective, observational cohort study to identify phenotypes from over 1000 participants with chronic low back pain (cLBP). This article reports findings from multi-level inertial measurement unit (IMU) kinematic data collected during performance-based tests obtained at the in-person LB<sup>3</sup>P enrollment visit.</p> </section> <section> <h3> Methods</h3> <p>Participants with cLBP were recruited and performed self-paced and fast-paced movements while wearing inertial measurement units (IMUs) placed over T1/T2, T12/L1, L5/S1, and along the right femur. For self-paced tests: axial rotation (AR), lateral bending (LB), and flexion and extension (F/E), participants performed to their maximum range of motion (ROM), and for fast-paced tests: combined rotation/flexion (CRF), AR, LB, flexion, five times sit to stand (5STS), and postural lifting strategy (PLS), participants performed at their maximum speed. ROM, velocity, acceleration, and lumbopelvic rhythm (LPR) were calculated for tests using IMU data. LPR was calculated as the ratio of absolute lumbar to hip movement and was extracted for each motion quartile (0%–25%, 25%–50%, 50%–75%, and 75%–100%) during neutral-to-flexion and neutral-to-extension.</p> </section> <section> <h3> Results</h3> <p>Analysis of sensor data of 954 participants (58.6 ± 16.4 years old; 40% male and 60% female) revealed variable kinematic patterns across spinal and hip regions during isolated and functional movements. Noticeable variations were observed based on movement type, with the trunk region demonstrating predominant mobility during self-paced movements like AR and LB, while the hip region played a critical role in functional tasks (CRF, 5STS, PLS). LPR evaluation indicated that individuals with cLBP typically adopt a hip-dominant movement pattern, with slightly greater lumbar contributions during the initial phase of flexion. Sex and age analyses unveiled females generally exhibit greater ROM and higher velocities compared to males. Younger participants (< 60 years old) show more dynamic movement patterns, except in the hip region during F/E, where older (≥ 60) participants exhibited greater excursion.</p> </section> <section> <h3> Conclusions</h3> <p>This study characterized spinal and hip movement in
{"title":"Lumbopelvic Kinematics During Functional Tasks in a Chronic Low Back Pain Observational Cohort","authors":"Kevin M. Bell, Rachel E. Roos, Zakiy Alfikri, William Anderst, Anna Bailes, William W. Clark, Harold A. Cook, Jessa Darwin, Marit Johnson, Gina P. McKernan, Sebastian Murati, Bambang Parmanto, Nam V. Vo, Leming Zhou, Gwendolyn A. Sowa","doi":"10.1002/jsp2.70117","DOIUrl":"https://doi.org/10.1002/jsp2.70117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The University of Pittsburgh Mechanistic Research Center, entitled, “Low Back Pain: Biological, Biomechanical, Behavioral Phenotypes (LB<sup>3</sup>P),” is part of the National Institutes of Health's Helping to End Addiction Long-term Initiative. LB<sup>3</sup>P conducted a prospective, observational cohort study to identify phenotypes from over 1000 participants with chronic low back pain (cLBP). This article reports findings from multi-level inertial measurement unit (IMU) kinematic data collected during performance-based tests obtained at the in-person LB<sup>3</sup>P enrollment visit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants with cLBP were recruited and performed self-paced and fast-paced movements while wearing inertial measurement units (IMUs) placed over T1/T2, T12/L1, L5/S1, and along the right femur. For self-paced tests: axial rotation (AR), lateral bending (LB), and flexion and extension (F/E), participants performed to their maximum range of motion (ROM), and for fast-paced tests: combined rotation/flexion (CRF), AR, LB, flexion, five times sit to stand (5STS), and postural lifting strategy (PLS), participants performed at their maximum speed. ROM, velocity, acceleration, and lumbopelvic rhythm (LPR) were calculated for tests using IMU data. LPR was calculated as the ratio of absolute lumbar to hip movement and was extracted for each motion quartile (0%–25%, 25%–50%, 50%–75%, and 75%–100%) during neutral-to-flexion and neutral-to-extension.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analysis of sensor data of 954 participants (58.6 ± 16.4 years old; 40% male and 60% female) revealed variable kinematic patterns across spinal and hip regions during isolated and functional movements. Noticeable variations were observed based on movement type, with the trunk region demonstrating predominant mobility during self-paced movements like AR and LB, while the hip region played a critical role in functional tasks (CRF, 5STS, PLS). LPR evaluation indicated that individuals with cLBP typically adopt a hip-dominant movement pattern, with slightly greater lumbar contributions during the initial phase of flexion. Sex and age analyses unveiled females generally exhibit greater ROM and higher velocities compared to males. Younger participants (< 60 years old) show more dynamic movement patterns, except in the hip region during F/E, where older (≥ 60) participants exhibited greater excursion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study characterized spinal and hip movement in ","PeriodicalId":14876,"journal":{"name":"JOR Spine","volume":"8 4","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jsp2.70117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145196320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Richard D. Bell, Evie C. Reddick, David J. Lillyman, Fei San Lee, Rebecca A. Wachs
Background
Preclinical models of disc degeneration are important tools to discover disease pathology. Histopathology is often used to understand these changes, but analyses remain reliant on pathologists or graders using time-consuming scoring systems. The integration of computational pathology can improve this process by leveraging machine learning (ML) algorithms. Thus, this work aimed to develop a segmentation model to identify seven distinct disc tissues and utilize the segmented tissue areas generated from the model, along with other derived measures, to estimate pathological changes that align with traditional histological scoring.
Methods
Hematoxylin and eosin-stained motion segment sections were collected from four independent studies. Each study included a disc injury puncture in Sprague Dawley rats. An active learning technique and a trained deep convolutional neural network were used to infer tissue segmentation. The model was then applied to untrained images to infer tissue segmentation, extract geometric and cell count features, and correlate these measurements with histologic scores from a standard scoring system.
Results
The segmentation model was highly performant with an Intersection over Union (mIOU) and frequency weighted Intersection over Union (fwIOU) of 0.83 ± 0.04 and 0.94 ± 0.02 in the Test set, respectively. The ML-derived measures correlated well with histologic scores, with absolute ranges from rho = 0.65 to 0.87. Further, these ML-derived measures were altered with disc degeneration with significant differences in NP cell number, NP area ratio, NP/AF border, NP roundness, and AF perimeter. Lastly, our model could measure additional tissue changes not captured through a standard histological scoring system.
Conclusions
Herein, we developed the first computational pathology model to phenotype disc degeneration tissue. Our model significantly correlates with traditional histopathology scoring methods, detects subtle differences between groups by directly measuring pathologic features in the images, and increases efficiency by automating the majority of the process.
背景椎间盘退变的临床前模型是发现疾病病理的重要工具。组织病理学通常用于了解这些变化，但分析仍然依赖于病理学家或使用耗时评分系统的评分员。计算病理学的整合可以通过利用机器学习（ML）算法来改善这一过程。因此，本研究旨在建立一个分割模型，以识别七种不同的椎间盘组织，并利用该模型产生的分割组织区域，以及其他衍生测量，来估计与传统组织学评分一致的病理变化。方法收集4个独立研究的苏木精和伊红染色的运动切片。每项研究都包括在Sprague Dawley大鼠中穿刺椎间盘损伤。采用主动学习技术和训练好的深度卷积神经网络进行组织分割。然后将该模型应用于未经训练的图像，以推断组织分割，提取几何和细胞计数特征，并将这些测量结果与标准评分系统中的组织学评分相关联。结果该分割模型具有良好的分割性能，在测试集中，mIOU （Intersection over Union）和fwIOU （frequency weighted Intersection over Union）分别为0.83±0.04和0.94±0.02。ml衍生的测量结果与组织学评分有很好的相关性，其绝对范围为rho = 0.65至0.87。此外，这些ml衍生的测量随椎间盘退变而改变，在NP细胞数量、NP面积比、NP/AF边界、NP圆度和AF周长方面存在显著差异。最后，我们的模型可以测量通过标准组织学评分系统无法捕获的额外组织变化。在此，我们建立了第一个计算病理模型来表型椎间盘退变组织。我们的模型与传统的组织病理学评分方法显著相关，通过直接测量图像中的病理特征来检测组间的细微差异，并通过自动化大部分过程来提高效率。
{"title":"Automated Computational Pathology to Assess Degenerative Disc Histology","authors":"Richard D. Bell, Evie C. Reddick, David J. Lillyman, Fei San Lee, Rebecca A. Wachs","doi":"10.1002/jsp2.70119","DOIUrl":"https://doi.org/10.1002/jsp2.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preclinical models of disc degeneration are important tools to discover disease pathology. Histopathology is often used to understand these changes, but analyses remain reliant on pathologists or graders using time-consuming scoring systems. The integration of computational pathology can improve this process by leveraging machine learning (ML) algorithms. Thus, this work aimed to develop a segmentation model to identify seven distinct disc tissues and utilize the segmented tissue areas generated from the model, along with other derived measures, to estimate pathological changes that align with traditional histological scoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Hematoxylin and eosin-stained motion segment sections were collected from four independent studies. Each study included a disc injury puncture in Sprague Dawley rats. An active learning technique and a trained deep convolutional neural network were used to infer tissue segmentation. The model was then applied to untrained images to infer tissue segmentation, extract geometric and cell count features, and correlate these measurements with histologic scores from a standard scoring system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The segmentation model was highly performant with an Intersection over Union (mIOU) and frequency weighted Intersection over Union (fwIOU) of 0.83 ± 0.04 and 0.94 ± 0.02 in the Test set, respectively. The ML-derived measures correlated well with histologic scores, with absolute ranges from rho = 0.65 to 0.87. Further, these ML-derived measures were altered with disc degeneration with significant differences in NP cell number, NP area ratio, NP/AF border, NP roundness, and AF perimeter. Lastly, our model could measure additional tissue changes not captured through a standard histological scoring system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Herein, we developed the first computational pathology model to phenotype disc degeneration tissue. Our model significantly correlates with traditional histopathology scoring methods, detects subtle differences between groups by directly measuring pathologic features in the images, and increases efficiency by automating the majority of the process.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14876,"journal":{"name":"JOR Spine","volume":"8 4","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jsp2.70119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145196259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Screw loosening is a frequently reported complication following pedicle screw fixation, resulting in various adverse outcomes. The primary trigger for screw loosening is biomechanical deterioration. Iatrogenic injury to the pedicle is a commonly observed scenario. This alteration can lead to an increased risk of pedicle screw loosening. Bilateral pedicle screws distribute load during the patient's daily activities and can be regarded as an integrated structure from a biomechanical perspective. Consequently, biomechanical interactions are prevalent between the two sides of the pedicle screws. This study aimed to determine whether unilateral pedicle injury influences contralateral screw loosening by deteriorating the local biomechanical environment.
Methods
The numerical model of the L5 vertebral body, developed in our previous studies, was employed in this investigation. Bilateral pedicle screws were inserted following the standard trajectory. Simulations of both half and complete ventral and dorsal side pedicle injuries were performed on the right-side pedicle. Stress and strain values of the screw trajectory, along with screw displacement values on the contralateral side, were recorded to assess the potential risk of screw loosening.
Results
Compared to the model without pedicle injury, models with pedicle injuries exhibited higher interfacial stress and strain, as well as greater screw displacement. This effect was particularly pronounced when the pedicle on the side of torque restriction (e.g., caudal side pedicle injury under the flexion loading condition) was considered. Furthermore, unilateral iatrogenic injury to the pedicle can trigger multi-degree-of-freedom coupled motion under a single-direction torque.
Conclusions
Single-side iatrogenic pedicle injury can lead to multi-degree-of-freedom coupled motion of the screw-fixed vertebral body, and biomechanical deterioration of the contralateral screw trajectory, thereby increasing the risk of contralateral pedicle screw loosening.
{"title":"Single-Side Iatrogenic Pedicle Injury May Trigger an Increased Risk of Contralateral Screw Loosening: An In Silico Study","authors":"Jiexiang Yang, Junjie Chen, Guoyou Wang, Lijunpeng Jia, Yingguang Zhou, Jingchi Li","doi":"10.1002/jsp2.70124","DOIUrl":"https://doi.org/10.1002/jsp2.70124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Screw loosening is a frequently reported complication following pedicle screw fixation, resulting in various adverse outcomes. The primary trigger for screw loosening is biomechanical deterioration. Iatrogenic injury to the pedicle is a commonly observed scenario. This alteration can lead to an increased risk of pedicle screw loosening. Bilateral pedicle screws distribute load during the patient's daily activities and can be regarded as an integrated structure from a biomechanical perspective. Consequently, biomechanical interactions are prevalent between the two sides of the pedicle screws. This study aimed to determine whether unilateral pedicle injury influences contralateral screw loosening by deteriorating the local biomechanical environment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The numerical model of the L5 vertebral body, developed in our previous studies, was employed in this investigation. Bilateral pedicle screws were inserted following the standard trajectory. Simulations of both half and complete ventral and dorsal side pedicle injuries were performed on the right-side pedicle. Stress and strain values of the screw trajectory, along with screw displacement values on the contralateral side, were recorded to assess the potential risk of screw loosening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to the model without pedicle injury, models with pedicle injuries exhibited higher interfacial stress and strain, as well as greater screw displacement. This effect was particularly pronounced when the pedicle on the side of torque restriction (e.g., caudal side pedicle injury under the flexion loading condition) was considered. Furthermore, unilateral iatrogenic injury to the pedicle can trigger multi-degree-of-freedom coupled motion under a single-direction torque.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Single-side iatrogenic pedicle injury can lead to multi-degree-of-freedom coupled motion of the screw-fixed vertebral body, and biomechanical deterioration of the contralateral screw trajectory, thereby increasing the risk of contralateral pedicle screw loosening.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14876,"journal":{"name":"JOR Spine","volume":"8 4","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jsp2.70124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145196322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zakiy F. Alfikri, Marit E. Johnson, Brad E. Dicianno, Carol M. Greco, Bambang Parmanto, Sara R. Piva, Rachel E. Roos, Andi Saptono, Gwendolyn A. Sowa, Leming Zhou, Kevin M. Bell
Background
Chronic low back pain (cLBP) requires precise phenotyping for tailored treatments. This study introduces a mobile health (mHealth) system for cLBP assessment, aiming to collect extensive biomechanical and behavioral data from in-clinic and seven-day at-home assessments from 1000 individuals with cLBP to accommodate accurate phenotyping.
Methods
Using a user-centered design approach, an integrated mHealth system was developed, comprising two mobile applications: a clinician-facing in-clinic app and a participant-facing at-home app. The in-clinic app aids physical therapists in conducting in-clinic assessments, while the at-home app allows cLBP patients to manage and submit responses to ecological momentary assessments (EMA). Usability evaluations were conducted using the mHealth App Usability Questionnaire (MAUQ) and qualitative open-ended questions asking about ease of use, learnability, overall impression and satisfaction, and reflective questions. Scores from MAUQ were summarized using median and interquartile range (IQR). The usability results were used to iteratively refine the system's design and functionality.
Results
Three physical therapists and 337 out of 522 cLBP patients participated in the usability evaluations. The evaluations demonstrated positive feedback for both apps. For the in-clinic app, the first iteration median MAUQ score was 6 (IQR 1) and the second iteration median MAUQ score was also 6 (IQR 2). For the at-home app, the median MAUQ scores were consistently high across five iterations (median score of 7 (IQR 1) for all iterations). These scores indicated good usability, meaning they were easy to use, efficient, and satisfying. Iterative modifications based on the feedback focused on enhancing navigation consistency, responsiveness, and user interface, resulting in overall improved usability.
Conclusion
The in-clinic app was successfully used by physical therapists for the assessments of 1000 cLBP patients, receiving positive feedback. Similarly, 989 cLBP patients used the at-home app to complete and submit their EMA, finding it easier to comply with the assessment.
{"title":"Mobile Health (mHealth) for Chronic Low Back Pain Assessment: Design, Development, and Usability Evaluation","authors":"Zakiy F. Alfikri, Marit E. Johnson, Brad E. Dicianno, Carol M. Greco, Bambang Parmanto, Sara R. Piva, Rachel E. Roos, Andi Saptono, Gwendolyn A. Sowa, Leming Zhou, Kevin M. Bell","doi":"10.1002/jsp2.70118","DOIUrl":"https://doi.org/10.1002/jsp2.70118","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic low back pain (cLBP) requires precise phenotyping for tailored treatments. This study introduces a mobile health (mHealth) system for cLBP assessment, aiming to collect extensive biomechanical and behavioral data from in-clinic and seven-day at-home assessments from 1000 individuals with cLBP to accommodate accurate phenotyping.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a user-centered design approach, an integrated mHealth system was developed, comprising two mobile applications: a clinician-facing in-clinic app and a participant-facing at-home app. The in-clinic app aids physical therapists in conducting in-clinic assessments, while the at-home app allows cLBP patients to manage and submit responses to ecological momentary assessments (EMA). Usability evaluations were conducted using the mHealth App Usability Questionnaire (MAUQ) and qualitative open-ended questions asking about ease of use, learnability, overall impression and satisfaction, and reflective questions. Scores from MAUQ were summarized using median and interquartile range (IQR). The usability results were used to iteratively refine the system's design and functionality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three physical therapists and 337 out of 522 cLBP patients participated in the usability evaluations. The evaluations demonstrated positive feedback for both apps. For the in-clinic app, the first iteration median MAUQ score was 6 (IQR 1) and the second iteration median MAUQ score was also 6 (IQR 2). For the at-home app, the median MAUQ scores were consistently high across five iterations (median score of 7 (IQR 1) for all iterations). These scores indicated good usability, meaning they were easy to use, efficient, and satisfying. Iterative modifications based on the feedback focused on enhancing navigation consistency, responsiveness, and user interface, resulting in overall improved usability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The in-clinic app was successfully used by physical therapists for the assessments of 1000 cLBP patients, receiving positive feedback. Similarly, 989 cLBP patients used the at-home app to complete and submit their EMA, finding it easier to comply with the assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14876,"journal":{"name":"JOR Spine","volume":"8 4","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jsp2.70118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145196316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew A. Halanski, Cameron Jeffers, Yousuf Abubakr, Minhao Zhou, Brittney Kokinos, Max Twedt, David Bennett, Susan Hamman, Thomas Crenshaw, Grace D. O'Connell, Hani Haider
<div> <section> <h3> Background</h3> <p>Vertebral body tethering (VBT) is a fusionless surgical technique for correcting spinal deformities through asymmetric growth inhibition. Standard VBT often relies on intraoperative overcorrection with an anterior center of rotation, which may decrease disc height and inhibit vertebral growth. Strategies that promote, rather than inhibit, growth could expand the vertebral growth modulation toolkit.</p> </section> <section> <h3> Purpose</h3> <p>Determine how the center of rotation location during overcorrection influences vertebral growth, and to evaluate the feasibility of growth-promoting techniques, including anterior vertebral periosteal transection and a novel uniplanar, unidirectional, length-stable posterior implant.</p> </section> <section> <h3> Methods</h3> <p>Validated finite element model (FEM) simulated anterior versus posterior centers of rotation, assessing effects on disc height, physeal stress, and sagittal vertebral growth. Six swine underwent anterior periosteal transection, with growth rates measured against adjacent vertebrae. In a kyphotic swine model, a posterior fixed-length implant was applied across the most kyphotic disc space, shifting the center of rotation posteriorly; growth modulation was compared to non-operative controls.</p> </section> <section> <h3> Study Design</h3> <p>Computational analysis and large animal study.</p> </section> <section> <h3> Results</h3> <p>FEM predicted that a posterior (convex) center of rotation increased disc height, redistributed physeal stress to promote growth, and improved deformity correction, whereas an anterior center of rotation decreased disc height and inhibited growth. Periosteal transection did not accelerate vertebral growth (170 ± 19 μm/day control vs. 155 ± 25 μm/day treated; <i>p</i> = 0.054). In contrast, the posterior implant achieved overcorrection and induced corrective % appositional metaphyseal growth modulation (+24% ± 10% vs. −11% ± 13% in controls; <i>p</i> = 0.001).</p> </section> <section> <h3> Conclusion</h3> <p>Periosteal resection/transection did not reliably enhance vertebral growth. Shifting the corrective center of rotation posteriorly using a fixed-length, uniplanar device preserved disc height and promoted corrective growth.</p> </section> <section>
椎体系扎术（VBT）是一种通过不对称生长抑制矫正脊柱畸形的无融合手术技术。标准的VBT通常依赖于术中过度矫正和前旋转中心，这可能会降低椎间盘高度并抑制椎体生长。促进而不是抑制生长的策略可以扩展椎体生长调节工具。目的确定过度矫正过程中旋转中心的位置如何影响椎体生长，并评估生长促进技术的可行性，包括椎体前段骨膜横断和一种新型的单平面、单向、长度稳定的后路种植体。方法验证有限元模型（FEM）模拟前后旋转中心，评估对椎间盘高度、物理应力和矢状椎体生长的影响。6头猪接受了前骨膜横断术，测量了相邻椎骨的生长速率。在猪后凸模型中，将后路固定长度的植入物应用于最后凸的椎间盘间隙，将旋转中心向后移动；生长调节与非手术对照组比较。研究设计计算分析和大型动物研究。结果FEM预测后（凸）旋转中心增加椎间盘高度，重新分配物理应力以促进生长，并改善畸形矫正，而前旋转中心降低椎间盘高度并抑制生长。骨膜横断不加速椎体生长（对照组为170±19 μm/天，对照组为155±25 μm/天；p = 0.054）。相比之下，后路种植体实现了过度矫正和诱导矫正%相对干骺端生长调节（对照组为+24%±10% vs - 11%±13%；p = 0.001）。结论骨膜切除/横断不能可靠地促进椎体生长。使用固定长度的单平面装置向后移动矫正中心旋转，保持椎间盘高度并促进矫正生长。临床意义后路，长度稳定的植入物可以作为标准VBT的可行替代方案，特别是当传统技术无法将旋转中心从畸形的凹面移开时。
{"title":"Vertebral Growth Modulation Through Periosteal Resection and Fixed Length Deformity Overcorrection: Computational and In Vivo Pilot Study","authors":"Matthew A. Halanski, Cameron Jeffers, Yousuf Abubakr, Minhao Zhou, Brittney Kokinos, Max Twedt, David Bennett, Susan Hamman, Thomas Crenshaw, Grace D. O'Connell, Hani Haider","doi":"10.1002/jsp2.70121","DOIUrl":"https://doi.org/10.1002/jsp2.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Vertebral body tethering (VBT) is a fusionless surgical technique for correcting spinal deformities through asymmetric growth inhibition. Standard VBT often relies on intraoperative overcorrection with an anterior center of rotation, which may decrease disc height and inhibit vertebral growth. Strategies that promote, rather than inhibit, growth could expand the vertebral growth modulation toolkit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Determine how the center of rotation location during overcorrection influences vertebral growth, and to evaluate the feasibility of growth-promoting techniques, including anterior vertebral periosteal transection and a novel uniplanar, unidirectional, length-stable posterior implant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Validated finite element model (FEM) simulated anterior versus posterior centers of rotation, assessing effects on disc height, physeal stress, and sagittal vertebral growth. Six swine underwent anterior periosteal transection, with growth rates measured against adjacent vertebrae. In a kyphotic swine model, a posterior fixed-length implant was applied across the most kyphotic disc space, shifting the center of rotation posteriorly; growth modulation was compared to non-operative controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Computational analysis and large animal study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>FEM predicted that a posterior (convex) center of rotation increased disc height, redistributed physeal stress to promote growth, and improved deformity correction, whereas an anterior center of rotation decreased disc height and inhibited growth. Periosteal transection did not accelerate vertebral growth (170 ± 19 μm/day control vs. 155 ± 25 μm/day treated; <i>p</i> = 0.054). In contrast, the posterior implant achieved overcorrection and induced corrective % appositional metaphyseal growth modulation (+24% ± 10% vs. −11% ± 13% in controls; <i>p</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Periosteal resection/transection did not reliably enhance vertebral growth. Shifting the corrective center of rotation posteriorly using a fixed-length, uniplanar device preserved disc height and promoted corrective growth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 ","PeriodicalId":14876,"journal":{"name":"JOR Spine","volume":"8 4","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jsp2.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145196321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thomas D. Slater, Beatrice Gagliostri, Matthew J. Kibble, Nazli S. Tümer, Peter A. Cripton, Nicolas Newell
<div> <section> <h3> Study Design</h3> <p>Microstructural investigation of mechanical load induced acute disc herniation on five animal models.</p> </section> <section> <h3> Objective</h3> <p>To compare how spinal discs in different animal models herniate under a standardized complex compressive load.</p> </section> <section> <h3> Summary of Background Data</h3> <p>Animal models in disc herniation research offer reduced degeneration-associated variability, lower cost, and greater availability compared to human specimens. However, there is limited consensus regarding which species is best suited for modeling human herniation, making a comprehensive comparison of species-specific herniation mechanisms necessary.</p> </section> <section> <h3> Materials and Methods</h3> <p>A standardized shear and compressive load, designed to herniate intervertebral discs, was applied to isolated discs of five cadaveric animal models (<i>n</i> = 30, 6 specimens per group): bovine tail, bovine lumbar, ovine lumbar, porcine lumbar, and porcine cervical. The segments were flexed (7°), and a shear-compressive load was applied at a crosshead displacement rate of 40 mm min<sup>−1</sup>, until a force drop, or a displacement limit was reached (~80% of disc height). Microstructural analysis was undertaken to identify failure modes.</p> </section> <section> <h3> Results</h3> <p>Clinically relevant herniation features were observed in all models—including endplate and annulus fibrosus (AF) tearing, AF delamination, vertebral body (VB) fracture, nucleus pulposus (NP) extrusion into VB, and radial NP movement. Bovine lumbar, porcine cervical, and porcine lumbar segments exhibited high rates of radial NP movement (84%, 100%, and 67%, respectively), with ovine lumbar discs displaying VB fracture (84%) and NP extrusions into the VB (67%). Bovine tail discs showed minimal damage but were characterized by sequential lamellar AF tears (67%).</p> </section> <section> <h3> Conclusions</h3> <p>Porcine cervical, bovine lumbar, and porcine lumbar discs are suitable for annulus-failure herniation research, although porcine cervical discs may be the most appropriate due to exhibiting the highest rate of relevant damages. Ovine lumbar discs are relevant for studying endplate junction failure herniations, and bovine tail discs are appropriate for implant-related studies.</p> </se
5种动物模型机械负荷致急性椎间盘突出的显微结构研究。目的比较不同动物模型的椎间盘在标准复杂压缩负荷下的突出情况。与人类标本相比，椎间盘突出研究的动物模型提供了更少的与退变相关的变异性、更低的成本和更大的可用性。然而，对于哪种物种最适合模拟人类疝气，目前还没有达成有限的共识，因此有必要对物种特异性疝气机制进行全面比较。材料与方法采用标准化的剪切压缩载荷，对牛尾、牛腰、羊腰、猪腰和猪颈5种尸体动物模型（n = 30，每组6个标本）的离体椎间盘施加突出椎间盘。将关节段弯曲（7°），并以40 mm min - 1的十字位移速率施加剪切压缩载荷，直到力下降或达到位移极限（~80%的圆盘高度）。进行微观结构分析以确定失效模式。结果所有模型均观察到临床相关的突出特征，包括终板和纤维环（AF）撕裂、AF剥离、椎体（VB）骨折、髓核（NP）向VB挤压、NP径向运动。牛腰椎节段、猪颈椎节段和猪腰椎节段表现出高的径向NP运动率（分别为84%、100%和67%），绵羊腰椎间盘表现为VB骨折（84%）和NP向VB内挤压（67%）。牛尾盘损伤最小，但以连续板层AF撕裂为特征（67%）。结论猪颈椎间盘、牛腰椎间盘和猪腰椎间盘适合于环失败型疝的研究，但由于相关损伤率最高，猪颈椎间盘可能是最合适的。绵羊腰椎间盘适用于研究终板连接失败的突出症，而牛尾椎间盘适用于与植入物相关的研究。
{"title":"A Comparison of Five Animal Models for Acute Intervertebral Disc Herniation Research","authors":"Thomas D. Slater, Beatrice Gagliostri, Matthew J. Kibble, Nazli S. Tümer, Peter A. Cripton, Nicolas Newell","doi":"10.1002/jsp2.70116","DOIUrl":"https://doi.org/10.1002/jsp2.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Microstructural investigation of mechanical load induced acute disc herniation on five animal models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare how spinal discs in different animal models herniate under a standardized complex compressive load.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary of Background Data</h3>\u0000 \u0000 <p>Animal models in disc herniation research offer reduced degeneration-associated variability, lower cost, and greater availability compared to human specimens. However, there is limited consensus regarding which species is best suited for modeling human herniation, making a comprehensive comparison of species-specific herniation mechanisms necessary.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A standardized shear and compressive load, designed to herniate intervertebral discs, was applied to isolated discs of five cadaveric animal models (<i>n</i> = 30, 6 specimens per group): bovine tail, bovine lumbar, ovine lumbar, porcine lumbar, and porcine cervical. The segments were flexed (7°), and a shear-compressive load was applied at a crosshead displacement rate of 40 mm min<sup>−1</sup>, until a force drop, or a displacement limit was reached (~80% of disc height). Microstructural analysis was undertaken to identify failure modes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Clinically relevant herniation features were observed in all models—including endplate and annulus fibrosus (AF) tearing, AF delamination, vertebral body (VB) fracture, nucleus pulposus (NP) extrusion into VB, and radial NP movement. Bovine lumbar, porcine cervical, and porcine lumbar segments exhibited high rates of radial NP movement (84%, 100%, and 67%, respectively), with ovine lumbar discs displaying VB fracture (84%) and NP extrusions into the VB (67%). Bovine tail discs showed minimal damage but were characterized by sequential lamellar AF tears (67%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Porcine cervical, bovine lumbar, and porcine lumbar discs are suitable for annulus-failure herniation research, although porcine cervical discs may be the most appropriate due to exhibiting the highest rate of relevant damages. Ovine lumbar discs are relevant for studying endplate junction failure herniations, and bovine tail discs are appropriate for implant-related studies.</p>\u0000 </se","PeriodicalId":14876,"journal":{"name":"JOR Spine","volume":"8 3","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jsp2.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paolo Giaccone, Elisabetta de Rinaldis, Federico D'Antoni, Fabrizio Russo, Luca Ambrosio, Giorgia Petrucci, Mario Merone, Leandro Pecchia, Sergio Iavicoli, Gianluca Vadalà, Rocco Papalia, Vincenzo Denaro
<div> <section> <h3> Study Design</h3> <p>Cross-sectional retrospective cohort study.</p> </section> <section> <h3> Objectives</h3> <p>Chronic low back pain (cLBP) is a major cause of disability worldwide, significantly affecting return to work (RTW). This study aimed to assess the biopsychosocial factors influencing occupational functioning in workers with cLBP using artificial intelligence (AI) data-driven patient phenotyping.</p> </section> <section> <h3> Methods</h3> <p>Data of workers affected by cLBP were collected through a comprehensive assessment of demographic, clinical, and occupational factors. Hierarchical clustering was employed to identify distinct phenotypes based on patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Work Ability Index (WAI), Nordic score, and Patient Health Questionnaire-2 (PHQ-2). Independent <i>t</i> tests and Mann–Whitney <i>U</i> tests were used for phenotype profiling, distinguishing between continuous and categorical responses, respectively, to assess the most discriminative queries and highlight the most significantly different features (<i>p</i> < 0.05).</p> </section> <section> <h3> Results</h3> <p>A total of 304 patients were included in the analysis. The AI-driven phenotyping approach identified two distinct clusters, representing 51% (Cluster 1) and 49% (Cluster 2) of the dataset. Compared to Cluster 1, Cluster 2 exhibited significantly higher absenteeism (17.00 vs. 5.22 days, <i>p <</i> 0.05), lower WAI (33.34 <i>±</i> 6.84 vs. 38.96 <i>±</i> 4.31, <i>p <</i> 0.05), worse pain-related outcomes in terms of higher VAS (5.98 <i>±</i> 2.06 vs. 4.48 <i>±</i> 2.48, <i>p <</i> 0.05) and ODI (33.52 <i>±</i> 16.56 vs. 20.08 <i>±</i> 13.59, <i>p <</i> 0.05), more frequent occupational exposure to manual handling of loads (84% vs. 16%) and higher psychological distress assessed through PHQ-2 (70% vs. 30%).</p> </section> <section> <h3> Conclusion</h3> <p>Our study identified the most relevant PROMs differentiating between cLBP clusters of patients, emphasizing different levels of absenteeism and pain-related outcomes.</p> <p>These findings contributed to unravel the data-driven AI potential in suggesting personalized interventions targeting specific biopsychosocial profiles, which may improve clinical outcomes and occupational functioning in workers with cLBP, ultimately enhancing their overall well-bei
研究设计：横断面回顾性队列研究。目的：慢性腰痛（cLBP）是世界范围内致残的主要原因，严重影响重返工作岗位（RTW）。本研究旨在利用人工智能（AI）数据驱动的患者表型分析，评估影响cLBP工人职业功能的生物心理社会因素。方法：通过人口统计学、临床和职业因素的综合评估，收集受cLBP影响的工人的资料。基于患者报告的结果测量（PROMs），包括Oswestry残疾指数（ODI）、视觉模拟量表（VAS）、工作能力指数（WAI）、北欧评分和患者健康问卷-2 (PHQ-2)，采用分层聚类来识别不同的表型。独立t检验和Mann-Whitney U检验用于表型分析，分别区分连续反应和分类反应，以评估最具判别性的查询并突出最显著的不同特征(p)结果：共有304名患者被纳入分析。人工智能驱动的表型方法确定了两个不同的集群，分别占数据集的51%（集群1）和49%（集群2）。与集群1相比，集群2的旷工率显著高于集群1 (17.00 vs. 5.22天，p 0.05)， WAI(33.34±6.84 vs. 38.96±4.31,p 0.05)，疼痛相关结果(VAS（5.98±2.06 vs. 4.48±2.48,p 0.05）和ODI（33.52±16.56 vs. 20.08±13.59,p 0.05）更差，更频繁的职业暴露于手工处理负荷（84% vs. 16%），通过PHQ-2评估的心理困扰（70% vs. 30%）更高。结论：我们的研究确定了与cLBP患者群最相关的PROMs，强调了不同程度的缺勤和疼痛相关的结果。这些发现有助于揭示数据驱动的人工智能潜力，提出针对特定生物心理社会特征的个性化干预措施，这可能会改善cLBP患者的临床结果和职业功能，最终提高他们的整体幸福感。
{"title":"Exploring the Biopsychosocial Impact of Chronic Low Back Pain in Workers Through Artificial Intelligence-Driven Phenotyping","authors":"Paolo Giaccone, Elisabetta de Rinaldis, Federico D'Antoni, Fabrizio Russo, Luca Ambrosio, Giorgia Petrucci, Mario Merone, Leandro Pecchia, Sergio Iavicoli, Gianluca Vadalà, Rocco Papalia, Vincenzo Denaro","doi":"10.1002/jsp2.70110","DOIUrl":"10.1002/jsp2.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Cross-sectional retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Chronic low back pain (cLBP) is a major cause of disability worldwide, significantly affecting return to work (RTW). This study aimed to assess the biopsychosocial factors influencing occupational functioning in workers with cLBP using artificial intelligence (AI) data-driven patient phenotyping.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data of workers affected by cLBP were collected through a comprehensive assessment of demographic, clinical, and occupational factors. Hierarchical clustering was employed to identify distinct phenotypes based on patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Work Ability Index (WAI), Nordic score, and Patient Health Questionnaire-2 (PHQ-2). Independent <i>t</i> tests and Mann–Whitney <i>U</i> tests were used for phenotype profiling, distinguishing between continuous and categorical responses, respectively, to assess the most discriminative queries and highlight the most significantly different features (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 304 patients were included in the analysis. The AI-driven phenotyping approach identified two distinct clusters, representing 51% (Cluster 1) and 49% (Cluster 2) of the dataset. Compared to Cluster 1, Cluster 2 exhibited significantly higher absenteeism (17.00 vs. 5.22 days, <i>p <</i> 0.05), lower WAI (33.34 <i>±</i> 6.84 vs. 38.96 <i>±</i> 4.31, <i>p <</i> 0.05), worse pain-related outcomes in terms of higher VAS (5.98 <i>±</i> 2.06 vs. 4.48 <i>±</i> 2.48, <i>p <</i> 0.05) and ODI (33.52 <i>±</i> 16.56 vs. 20.08 <i>±</i> 13.59, <i>p <</i> 0.05), more frequent occupational exposure to manual handling of loads (84% vs. 16%) and higher psychological distress assessed through PHQ-2 (70% vs. 30%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study identified the most relevant PROMs differentiating between cLBP clusters of patients, emphasizing different levels of absenteeism and pain-related outcomes.</p>\u0000 \u0000 <p>These findings contributed to unravel the data-driven AI potential in suggesting personalized interventions targeting specific biopsychosocial profiles, which may improve clinical outcomes and occupational functioning in workers with cLBP, ultimately enhancing their overall well-bei","PeriodicalId":14876,"journal":{"name":"JOR Spine","volume":"8 3","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valerio Tonelli Enrico, William Anderst, Kevin M. Bell, J. Paulo Coelho, Jessa Darwin, Anthony Delitto, Carol M. Greco, Joon Y. Lee, Gina P. McKernan, Charity G. Patterson, Sara R. Piva, Michael J. Schneider, Lauren Wilcox, Nam V. Vo, Gwendolyn A. Sowa
<div> <section> <h3> Background</h3> <p>Chronic low back pain (cLBP) is a multifactorial condition that can have various contributing factors, including biological, biomechanical, and behavioral. Recent evidence suggests that systemic inflammation may contribute to cLBP, impacting pain sensitivity and individuals' functional status. Circulatory pro- and anti-inflammatory cytokines are widely used to determine individuals' systemic inflammatory status. The University of Pittsburgh Mechanistic Research Center, part of the National Institutes of Health's (NIH) Helping to End Addiction Long-term Initiative, conducted a prospective, observational study to identify phenotypes in a large cohort of individuals with cLBP. The present work reports the quantification of key circulatory cytokines in this cLBP cohort.</p> </section> <section> <h3> Methods</h3> <p>A total of 1007 individuals with cLBP were enrolled. Plasma samples were available from 936 participants, and concentrations of pro-inflammatory (IL-6, IFN-γ, TNF, IL-15, Leptin) and anti-inflammatory (IL-1ra, IL-10) cytokines were measured via immunoassays. Pain and functional status were assessed using validated self-reported numeric pain ratings scale and the Oswestry Disability Index. Descriptive statistics of analyzed cytokines were reported across the overall population, stratified by age (< 60 and ≥ 60 years old) and sex, and by pain levels as mild (0–5), moderate (6, 7), and severe (8–10), and ODI, categorized as minimal disability (0%–20%), moderate (21%–40%), and severe disability (> 40%).</p> </section> <section> <h3> Results</h3> <p>The values of circulating cytokines assessed in this study aligned with those reported in the literature for other painful inflammatory conditions and, in most cases, exceeded those documented for healthy populations. IL-6, IL-1ra, and Leptin demonstrated higher concentrations with higher pain and disability severity. TNF showed higher concentration in participants with higher disability severity. Concentration levels of IFN-γ, IL-15, and IL-10 exhibited no differences across pain or ODI categories. Notably, TNF levels were higher in older adults (≥ 60 years), whereas Leptin levels were higher in females than in males.</p> </section> <section> <h3> Conclusion</h3> <p>This study provides a snapshot of key circulating cytokines in a large cLBP cohort, revealing differences in pro- and anti-inflammatory cytokines across pain and disability for the overall population and in sex and age subgroups. Additional longitudinal and mechanistic studies are required to
{"title":"Plasma Pro- and Anti-Inflammatory Cytokines in an Observational Chronic Low Back Pain Cohort","authors":"Valerio Tonelli Enrico, William Anderst, Kevin M. Bell, J. Paulo Coelho, Jessa Darwin, Anthony Delitto, Carol M. Greco, Joon Y. Lee, Gina P. McKernan, Charity G. Patterson, Sara R. Piva, Michael J. Schneider, Lauren Wilcox, Nam V. Vo, Gwendolyn A. Sowa","doi":"10.1002/jsp2.70095","DOIUrl":"10.1002/jsp2.70095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic low back pain (cLBP) is a multifactorial condition that can have various contributing factors, including biological, biomechanical, and behavioral. Recent evidence suggests that systemic inflammation may contribute to cLBP, impacting pain sensitivity and individuals' functional status. Circulatory pro- and anti-inflammatory cytokines are widely used to determine individuals' systemic inflammatory status. The University of Pittsburgh Mechanistic Research Center, part of the National Institutes of Health's (NIH) Helping to End Addiction Long-term Initiative, conducted a prospective, observational study to identify phenotypes in a large cohort of individuals with cLBP. The present work reports the quantification of key circulatory cytokines in this cLBP cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 1007 individuals with cLBP were enrolled. Plasma samples were available from 936 participants, and concentrations of pro-inflammatory (IL-6, IFN-γ, TNF, IL-15, Leptin) and anti-inflammatory (IL-1ra, IL-10) cytokines were measured via immunoassays. Pain and functional status were assessed using validated self-reported numeric pain ratings scale and the Oswestry Disability Index. Descriptive statistics of analyzed cytokines were reported across the overall population, stratified by age (< 60 and ≥ 60 years old) and sex, and by pain levels as mild (0–5), moderate (6, 7), and severe (8–10), and ODI, categorized as minimal disability (0%–20%), moderate (21%–40%), and severe disability (> 40%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The values of circulating cytokines assessed in this study aligned with those reported in the literature for other painful inflammatory conditions and, in most cases, exceeded those documented for healthy populations. IL-6, IL-1ra, and Leptin demonstrated higher concentrations with higher pain and disability severity. TNF showed higher concentration in participants with higher disability severity. Concentration levels of IFN-γ, IL-15, and IL-10 exhibited no differences across pain or ODI categories. Notably, TNF levels were higher in older adults (≥ 60 years), whereas Leptin levels were higher in females than in males.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study provides a snapshot of key circulating cytokines in a large cLBP cohort, revealing differences in pro- and anti-inflammatory cytokines across pain and disability for the overall population and in sex and age subgroups. Additional longitudinal and mechanistic studies are required to ","PeriodicalId":14876,"journal":{"name":"JOR Spine","volume":"8 3","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dean Esposito, Benjamin Brown, Mark Jonathan Hancock, Samuel Stuart Graham King, Isaac Gerard Tom Searant, Hazel Jenkins
Background Context
An array of different MRI (magnetic resonance imaging) based grading systems is used to measure disc degeneration (DD) in the lumbar spine. It is currently unclear which grading systems are most commonly used to assess lumbar DD and how these grading systems are applied and reported.
Purpose
The aim of this scoping review was to describe different MRI-based grading systems for DD in the lumbar spine and report which grading systems have been assessed for measurement properties such as reliability, validity, and sensitivity to change.
Study Design/Setting
Scoping review.
Methods
A search was conducted in EMBASE, Medline, and CINAHL for studies related to MRI-based grading systems for DD in the lumbar spine, conducted in living humans. Data were extracted from each study, including the description of the grading system, which levels of the lumbar spine were graded, who graded the degeneration, how the degeneration was scored for analysis, and whether measurement properties such as reliability, validity, and sensitivity to change were assessed.
Results
The search identified 569 studies that graded DD. Ninety-three different grading systems were identified, including 63 subjective systems, 25 quantitative systems, and 5 that were unspecified. The Pfirrmann method was used in over 50% of all reports. A range of grading components was used to measure DD, with disc signal intensity (DSI), disc height (DH), and the assessment of the distinctiveness between the annulus and nucleus being most common. Sensitivity to change was rarely assessed.
Conclusion
A large number of DD grading systems were identified in this review, many of which were infrequently used. Variability in methods of assessing DD on MRI and how the MRI data is synthesized may influence reported associations between DD and low back pain (LBP).
{"title":"MRI-Based Grading Systems for Assessing Lumbar Disc Degeneration: A Scoping Review","authors":"Dean Esposito, Benjamin Brown, Mark Jonathan Hancock, Samuel Stuart Graham King, Isaac Gerard Tom Searant, Hazel Jenkins","doi":"10.1002/jsp2.70113","DOIUrl":"https://doi.org/10.1002/jsp2.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background Context</h3>\u0000 \u0000 <p>An array of different MRI (magnetic resonance imaging) based grading systems is used to measure disc degeneration (DD) in the lumbar spine. It is currently unclear which grading systems are most commonly used to assess lumbar DD and how these grading systems are applied and reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this scoping review was to describe different MRI-based grading systems for DD in the lumbar spine and report which grading systems have been assessed for measurement properties such as reliability, validity, and sensitivity to change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design/Setting</h3>\u0000 \u0000 <p>Scoping review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A search was conducted in EMBASE, Medline, and CINAHL for studies related to MRI-based grading systems for DD in the lumbar spine, conducted in living humans. Data were extracted from each study, including the description of the grading system, which levels of the lumbar spine were graded, who graded the degeneration, how the degeneration was scored for analysis, and whether measurement properties such as reliability, validity, and sensitivity to change were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The search identified 569 studies that graded DD. Ninety-three different grading systems were identified, including 63 subjective systems, 25 quantitative systems, and 5 that were unspecified. The Pfirrmann method was used in over 50% of all reports. A range of grading components was used to measure DD, with disc signal intensity (DSI), disc height (DH), and the assessment of the distinctiveness between the annulus and nucleus being most common. Sensitivity to change was rarely assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A large number of DD grading systems were identified in this review, many of which were infrequently used. Variability in methods of assessing DD on MRI and how the MRI data is synthesized may influence reported associations between DD and low back pain (LBP).</p>\u0000 </section>\u0000 </div>","PeriodicalId":14876,"journal":{"name":"JOR Spine","volume":"8 3","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jsp2.70113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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