Neurospine最新文献

Objective: Transforaminal lumbar interbody fusion (TLIF) has become a mainstay technique for interbody fusion, allowing for large contact area between implant and endplate, and providing increased stability and greater area for fusion. The development of 3-dimensional (3D)-expandable implants that provide multidimensional (3D) expansion has shown to provide better height restoration and clinical outcomes when compared to static implants. Comparison of the endplate coverage between 3D-expandable and static TLIF implants has yet to be studied. This study compares endplate coverage achieved with static TLIF, 3D-expandable TLIF, and anterior lumbar interbody fusion (ALIF) implants.

Methods: A retrospective review of patients undergoing interbody fusion with either static TLIF, 3D-expandable TLIF, or ALIF between the years 2014 and 2022 was conducted. Postoperative computed tomography (CT) imaging was used to measure endplate and implant dimensions. 3D-expandable TLIF interbody device areas were calculated using diameter measurements on postoperative CT. The coverage ratio was defined as the ratio of twice the area of the implant and the sum of the superior and inferior endplate areas at the operative level.

Results: A total of 53 patients per cohort were included. The average endplate coverage ratios for static TLIF, 3D-expandable TLIF, and ALIF implants were 0.19±0.04, 0.35±0.06, and 0.46±0.13, respectively. Subgroup analysis showed comparable coverage of 3D-expandable TLIF to ALIF implants at L3-4 and L4-5, while ALIF remained superior at L5-S1.

Conclusion: 3D-expandable TLIF interbody devices provide greater endplate coverage when compared to static TLIF devices and approach comparable coverage to ALIF implants.

Objective: To evaluate the clinical significance of a negative K-line in the neck flexion position (FK-line [-]), which indicates that cervical ossification of the posterior longitudinal ligament (OPLL) crosses the K-line during flexion, and to compare surgical outcomes between laminoplasty (LP) and laminectomy with fusion (LF) for multilevel FK-line (-) cervical OPLL.

Methods: A total of 349 patients with multiple cervical OPLL who underwent posterior decompression surgery (LP or LF) with a minimum of 2 years of follow-up were stratified by FK-line status. Clinical and radiological parameters were compared between the FK-line (+) and FK-line (-) groups. Subgroup analysis of FK-line (-) patients evaluated the efficacy of LP versus LF. Multivariate regression identified predictors of neurological recovery.

Results: Patients with FK-line (-) OPLL exhibited a smaller FK-line distance, more kyphotic alignment, greater cervical flexion, and lower recovery ratios compared to those with FK-line (+). In the FK-line (-) subgroup, LF achieved a significantly greater increase in FK-line distance, better correction of the flexion angle, and more neurological recovery than LP. Multivariate analyses identified postoperative FK-line distance, C2-7 flexion angle, and preoperative dynamic extension reserve as independent predictors of neurological outcomes.

Conclusion: FK-line status reflects the sagittal cord position and predicts surgical outcomes in cervical OPLL. In FK-line (-) patients, LF provides better neurological recovery and more effective posterior cord shift and kyphotic alignment correction than LP. Incorporating FK-line assessment to guide surgical planning could improve individualized treatment outcomes for multilevel OPLL.

Objective: To explore and validate clinical magnetic resonance spectroscopy (MRS) biomarkers associated with patient-reported symptoms in intervertebral disc degeneration, and to further elucidate the pathogenic mechanisms linking these symptoms to MRS biomarkers via an integrative multiomics approach.

Methods: Patients categorized into the predominant lipids peak (pLP) group and the non-pLP group based on MRS spectrum lipids peak. Nucleus pulposus cells underwent lipidomics, proteomics and functional experiments. Outcome measures compared, and Pearson correlation coefficient evaluated relationships between symptoms, interleukin (IL)-17 immune-positive cells, and lipid contents. Multivariate linear analysis was employed to analyze the contributions of various variables to patient-reported symptoms.

Results: The pLP group exhibited significantly higher preoperative visual analogue scale (VAS)-back scores (6.5 vs. 4.7, p<0.01) and Oswestry Disability Index (ODI) scores (63.3% vs. 51.2%, p<0.01) compared to the non-pLP group. The multiomics analysis revealed the pLP group was characterized by lipid droplets accumulation in nucleus pulposus cells, and the activation of interleukin-17 (IL-17) inflammatory pathway. Preoperative VAS-back and ODI scores showed positive correlations with the expressions of IL-17 (r=0.555, p<0.001; r=0.566, p<0.001) and the relative lipid contents (r=0.567, p<0.001; r=0.561, p<0.001). Multivariate linear analysis revealed that percentage of IL-17 positive cells and the relative triglyceride contents were associated with preoperative VAS-back pain (p=0.021, p=0.046).

Conclusion: Patients with the MRS pLP spectrum showed reduced quality of life and upregulation of the lipid droplets-IL-17 inflammatory pathway in nucleus pulposus cells. Inflammatory factors contribute significantly to chronic low back pain development and progression, affecting patient-reported symptoms. The MRS lipids peak may serve as a potential biomarker for diagnosing and monitoring low back pain.

Objective: Intervertebral disc degeneration (IDD), a prevalent musculoskeletal disorder, imposes significant socioeconomic and health care burdens worldwide. Despite its clinical impact, the molecular mechanisms driving IDD pathogenesis remain poorly characterized, and effective pharmacological interventions are urgently needed. This study elucidated the molecular mechanisms underlying IDD progression through multiomics integration.

Methods: We performed systematic transcriptomic, proteomic, metabolomic, and lipidomic profiling of human degenerated nucleus pulposus (NP) tissues to identify disease-associated molecular signatures and therapeutic targets. Functional validation experiments were conducted using in vitro and ex vivo models of IDD.

Results: Multiomics analyses revealed that lysosomal membrane lipid remodeling plays a critical role in IDD progression. Dysregulation of lysosomal phosphatidylcholine (PC) metabolism caused by reduced lysophosphatidylcholine acyltransferase 1 (LPCAT1) expression led to lysosomal membrane permeabilization (LMP) and subsequent ferroptosis in NP cells. Mechanistically, the LPCAT1-PC axis was identified as a key regulatory pathway: LPCAT1 downregulation in IDD correlated with decreased lysosomal PC content, impaired membrane stability and increased LMP-driven ferroptosis. Conversely, LPCAT1 overexpression increased the number of endoplasmic reticulum-lysosome contact sites, facilitating phospholipid transfer and lysosomal membrane repair. This restoration of lysosomal integrity effectively suppressed ferroptotic cell death.

Conclusion: Our findings establish the LPCAT1-PC axis as a potential protective mechanism against IDD by maintaining lysosomal homeostasis through interorganellar lipid trafficking. This study provides the first evidence linking lysosomal lipid composition, membrane stability, and ferroptosis in NP cells, offering new therapeutic strategies targeting lipid metabolism and organelle crosstalk for IDD management.

Objective: To evaluate the biomechanical characteristics of 2 anterior fixation techniques (clival plate fixation [CPF], transoral atlantoaxial reduction plate [TARP]) versus posterior occipitocervical fixation (POCF) for basilar invagination with atlantoaxial dislocation (BI-AAD), under varying atlantoaxial lateral mass cage heights (4-10 mm).

Methods: Seven fresh cadaveric specimens (occiput to C3, Oc-C3) were tested in the following conditions: (1) intact state; (2) BI-AAD state; (3) BI-AAD+CPF; (4) BI-AAD+TARP fixation; (5) BI-AAD+POCF. A pure 1.5 N·m moment loads to specimens in flexion/extension, lateral bending and axial rotation. Range of motion (ROM) and neutral zone (NZ) values at Oc-C2 were calculated and compared.

Results: ROM of the C1-2 segment under the intact and BI-AAD states were as follows: 9.3°±4.6° versus 21.3°±8.3° in flexion, 4.6°±1.9° versus 9.3°±3.8° in extension, 3.6°±2.2° versus 12.0°±6.5° in lateral bending, and 68.9°±14.4° versus 76.6°±6.6° in axial rotation, respectively. Compared with BI-AAD states, all internal fixation techniques significantly reduced the ROM of the Oc-C2 segment. TARP fixation exhibited larger ROM in flexion-extension. While in lateral bending and axial rotation, the ROM values for the anterior plate constructs were smaller than that of POCF, with a statistically significant difference observed between CPF and POCF. Cage height variations showed no significant impact on overall biomechanical stability.

Conclusion: Anterior plate fixation techniques demonstrated superior resistance to lateral bending and rotational forces compared to posterior approaches, with clival plate fixation exhibiting optimal biomechanical stability for BI-AAD. Variations in cage height exhibited negligible impact on stability when internal fixation achieved adequate rigidity.

Objective: Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common complications following long-segment spinal fusion, particularly in adult spinal deformity (ASD) correction surgery. Various surgical techniques have been proposed to prevent these complications, but high-quality evidence remains limited. This study aimed to evaluate the effectiveness of surgical strategies for preventing PJK and PJF after ASD correction or long-segment spinal fusion in adults.

Methods: A systematic search was conducted in PubMed, Embase, and the Cochrane Library through March 2025. Eligible studies included adults who underwent ASD surgery or long-segment (≥4 levels) posterior spinal fusion, comparing PJK or PJF incidence across surgical techniques such as tethering, hook fixation, prophylactic vertebral augmentation, rod characteristics, and upper instrumented vertebra (UIV) level. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

Results: Thirty-eight retrospective studies were included in the systematic review and 33 in the meta-analysis. Spinous process tethering reduced PJK incidence (OR, 0.35; 95% CI, 0.22-0.56). Hook fixation (OR, 0.34; 95% CI, 0.21-0.55) and prophylactic vertebral augmentation (OR, 0.58; 95% CI, 0.35-0.95) reduced PJF incidence. Lower PJK rates were observed with UIV at T10 or above (OR, 0.15; 95% CI, 0.03-0.64) and lower PJF rates with UIV at L1 or above (OR, 0.29; 95% CI, 0.14-0.61).

Conclusion: Surgical strategies such as tethering, hook fixation, and prophylactic vertebral augmentation may reduce the risk of PJK/PJF. Additionally, placing the UIV at or slightly above T10 may enhance junctional stability. Further prospective studies are needed to validate these findings and guide preventive strategies.

Objective: To determine the optimal targets of the L1 pelvic angle (L1PA) that minimize the risk of both proximal junctional kyphosis (PJK) and pelvic nonresponse (PNR) following adult spinal deformity (ASD) surgery.

Methods: A retrospective study was conducted on 323 patients who underwent fusion surgery from the low thoracic spine (T9-12) to the pelvis and were followed up for 2 years. Risk factors for PJK and PNR were evaluated separately using multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve analyses were performed to identify L1PA cutoff values predictive of PJK and PNR across 3 pelvic incidence (PI) categories: <45°, 45°-60°, and ≥60°. L1PA thresholds were defined to delineate "ideal" alignment.

Results: Risk factor analyses revealed that low L1PA was an independent risk factor for PJK (odds ratio [OR], 0.927; p=0.019), while high PI-LL (OR, 1.101; p<0.001) and high L1PA (OR, 1.249; p<0.001) were significant risk factors for PNR. On ROC curve analyses, optimal L1PA ranges were 2.5°-4.5° for PI<45°, 8.7°-12.6° for PI 45°-60°, and 15.1°-17.3° for PI≥60°. Patients within these ideal L1PA ranges had significantly lower rates of both PJK and PNR compared to those exceeding ideal L1PA ranges.

Conclusion: This study demonstrated that optimal correction based on these L1PA targets reduced the risk of both PJK and PNR. Therefore, these L1PA targets can serve as reliable alignment goals to optimize surgical outcomes in ASD surgery.

Objective: Spinal fusion surgery is effective for treating various adult spinal deformities. However, spinal fusion surgery is associated with the risk of adjacent segment disease (ASD; 5%-30%), particularly proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Proximal junctional tethering (PJT) has become a popular technique owing to increasing evidence that it can decrease the rate of PJK or PJF.

Methods: A literature search was conducted using PubMed, Embase, and Cochrane Library. Twelve eligible studies were identified. These studies were predominantly retrospective in nature and compared the incidence of PJK or PJF in adults undergoing spinal fusion surgery with or without PJT. Risk of bias was assessed using the Newcastle-Ottawa scale. All outcomes were analyzed using R software (ver. 4.4.1).

Results: We included 8 retrospective cohort studies and 3 propensity-score-matched analyses; these studies comprised 1,424 patients. PJT was associated with a significant decrease in the odds of development of PJK (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.27-0.71) and PJF (OR, 0.36; 95% CI, 0.19-0.69) compared with control. Subgroup analysis results revealed no significant difference in ASD rates between geographical locations, between tethering with and without crosslinks, and between specific tethering techniques.

Conclusion: PJT significantly reduces the odds of both PJK and PJF in adults undergoing spinal fusion surgery.

Objective: Motor-evoked potential (MEP) loss during intramedullary (IM) spinal cord tumor surgery impairs the ability to monitor further neural injury. Direct wave (D-wave) monitoring may allow continued assessment of corticospinal tract integrity after MEP loss. This study evaluates the role of D-wave-guided surgery in preserving function and enabling safe resection after MEP loss.

Methods: A retrospective study was conducted in adult patients with ependymoma (EPN), cavernous angioma (CA) or subependymoma who experienced MEP loss during IM tumor resection between January 2012 and May 2025. Patients who underwent continued resection under D-wave guidance after MEP loss were compared with those who did not.

Results: Among 37 eligible patients, 9 underwent D-wave-guided surgery and 28 did not. Functional improvement at the last follow-up was more frequent in the D-wave-guided surgery group (66.7% vs. 17.9%, p=0.011). This trend remained significant in EPN patients (74.4% vs. 9.1%, p=0.003), but not in CA patients. Immediate postoperative motor grade ≤3 was more common in the D-wave-guided surgery group (66.7% vs. 39.3%), although this difference was not statistically significant (p=0.251). By last follow-up, the proportions of patients self-ambulatory without external aids (88.9% vs. 89.3%, p=1.000) were similar between groups. Extent of resection, complications, and recurrence rates showed no significant differences.

Conclusion: D-wave-guided surgery may enable safe continuation of tumor resection after MEP loss without increasing morbidity. It offers a viable intraoperative strategy to preserve long-term motor function by extending monitoring beyond MEP limitations.