Seminars in Spine Surgery最新文献

英文中文

Contributors to authors 作者贡献者

Q4 Medicine

Seminars in Spine Surgery

Pub Date : 2026-02-11 DOI: 10.1053/S1040-7383(26)00005-5

引用次数: 0

Current understanding of in vivo cervical spine biomechanics and its clinical implications 当前对体内颈椎生物力学的认识及其临床意义

Q4 Medicine

Seminars in Spine Surgery

Pub Date : 2025-12-23 DOI: 10.1016/j.semss.2025.101237

Jacob Weinberg , John Bonamer , M. Zino Kuhn , Ryan Kelly , Anuj Vimawala , Kimberly Hua , Clarissa LeVasseur , Rahul Ramanathan , Christopher Gonzalez , Michael Spitnale , Richard Wawrose , Joon Y. Lee , William Anderst

Neck pain and cervical degenerative disease remain major contributors to disability worldwide, and each surgical intervention inherently alters the mechanics of cervical motion. Understanding cervical spine biomechanics is therefore essential for optimizing diagnosis, operative planning, and long-term outcomes. This review integrates contemporary anatomic, kinematic, and clinical evidence to describe how advances in in vivo imaging have redefined the understanding of cervical motion. Techniques such as dynamic magnetic resonance imaging and biplanar radiography now allow direct, three-dimensional quantification of vertebral translation and rotation during physiologic movement. These studies demonstrate that normal motion depends on coordinated coupling among the discs, facets, and ligamentous stabilizers, and that degenerative or postoperative conditions disrupt these interactions, leading to altered instantaneous axes of rotation and changes in load sharing. In vivo findings also challenge traditional explanations of adjacent segment disease, showing that postoperative adaptations reflect altered motion quality rather than excessive hypermobility. These insights provide a biomechanical rationale for motion-preserving constructs such as cervical disc arthroplasty and inform rehabilitation strategies aimed at restoring physiologic coordination. By connecting fundamental biomechanics with surgical application, this review presents an updated framework for interpreting cervical motion in both health and disease and underscores the value of dynamic imaging in guiding the next generation of motion-preserving spine care.

颈部疼痛和颈椎退行性疾病仍然是世界范围内导致残疾的主要原因，每次手术干预都会改变颈椎运动的机制。因此，了解颈椎生物力学对于优化诊断、手术计划和长期预后至关重要。这篇综述整合了当代解剖学、运动学和临床证据，描述了体内成像技术的进步如何重新定义了对颈椎运动的理解。动态磁共振成像和双平面x线摄影等技术现在可以直接、三维地量化生理运动过程中的椎体平移和旋转。这些研究表明，正常运动依赖于椎间盘、关节面和韧带稳定器之间的协调耦合，而退行性或术后的情况会破坏这些相互作用，导致瞬时旋转轴的改变和负荷分担的变化。体内研究结果也挑战了相邻节段疾病的传统解释，表明术后适应反映的是运动质量的改变，而不是过度的活动能力。这些见解为颈椎椎间盘置换术等运动保持结构提供了生物力学基础，并为旨在恢复生理协调的康复策略提供了信息。通过将基础生物力学与外科应用相结合，本综述提出了一个解释健康和疾病中颈椎运动的最新框架，并强调了动态成像在指导下一代保持运动的脊柱护理中的价值。

{"title":"Current understanding of in vivo cervical spine biomechanics and its clinical implications","authors":"Jacob Weinberg , John Bonamer , M. Zino Kuhn , Ryan Kelly , Anuj Vimawala , Kimberly Hua , Clarissa LeVasseur , Rahul Ramanathan , Christopher Gonzalez , Michael Spitnale , Richard Wawrose , Joon Y. Lee , William Anderst","doi":"10.1016/j.semss.2025.101237","DOIUrl":"10.1016/j.semss.2025.101237","url":null,"abstract":"<div><div>Neck pain and cervical degenerative disease remain major contributors to disability worldwide, and each surgical intervention inherently alters the mechanics of cervical motion. Understanding cervical spine biomechanics is therefore essential for optimizing diagnosis, operative planning, and long-term outcomes. This review integrates contemporary anatomic, kinematic, and clinical evidence to describe how advances in <em>in vivo</em> imaging have redefined the understanding of cervical motion. Techniques such as dynamic magnetic resonance imaging and biplanar radiography now allow direct, three-dimensional quantification of vertebral translation and rotation during physiologic movement. These studies demonstrate that normal motion depends on coordinated coupling among the discs, facets, and ligamentous stabilizers, and that degenerative or postoperative conditions disrupt these interactions, leading to altered instantaneous axes of rotation and changes in load sharing. <em>In vivo</em> findings also challenge traditional explanations of adjacent segment disease, showing that postoperative adaptations reflect altered motion quality rather than excessive hypermobility. These insights provide a biomechanical rationale for motion-preserving constructs such as cervical disc arthroplasty and inform rehabilitation strategies aimed at restoring physiologic coordination. By connecting fundamental biomechanics with surgical application, this review presents an updated framework for interpreting cervical motion in both health and disease and underscores the value of dynamic imaging in guiding the next generation of motion-preserving spine care.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"38 1","pages":"Article 101237"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146147341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Biologics in the evolution of spine surgery 脊柱外科发展中的生物制剂

Q4 Medicine

Seminars in Spine Surgery

Pub Date : 2025-12-23 DOI: 10.1016/j.semss.2025.101238

Jacob Weinberg , John Bonamer , Michael Kann , Grant Guzzo , Ryan Kelly , Tyler Kallman , Christopher Gonzalez , Rahul Ramanathan , Michael Spitnale , Richard Wawrose , Joon Y. Lee , Emmett Gannon

Biologics have become central to modern spine surgery, providing tools to enhance fusion and promote biologic healing. Autologous bone graft remains the gold standard for its osteogenic, osteoinductive, and osteoconductive properties, while allografts and demineralized bone matrices expand graft availability and reduce morbidity, albeit with variability in biologic potency. Recombinant bone morphogenetic proteins offer potent osteoinduction and have demonstrated high fusion rates in challenging cases, though dose-related complications and cost have limited use. Advances in materials science have produced synthetic grafts and bioactive ceramics that provide consistent structure and surface-mediated biologic activity. Newer bioengineered constructs, including peptide-enhanced and nanosynthetic formulations, aim to combine osteoconductive scaffolds with molecular or cellular activation. Emerging therapies such as mesenchymal stem cell allografts and gene therapy seek to biologically stimulate bone formation and regeneration at the fusion site. Collectively, these biologics represent a shift from purely structural grafts toward integrated biologic systems that combine mechanical support with targeted molecular activity. Understanding their mechanisms, indications, and limitations is essential to optimize graft selection and advance biologically driven spine surgery.

生物制剂已成为现代脊柱外科的核心，提供了增强融合和促进生物愈合的工具。自体骨移植仍然是其成骨、骨诱导和骨传导特性的金标准，而同种异体骨移植和脱矿骨基质扩大了移植物的可用性并降低了发病率，尽管生物效力存在差异。重组骨形态发生蛋白具有强效的骨诱导作用，在具有挑战性的病例中表现出高融合率，尽管剂量相关并发症和成本限制了使用。材料科学的进步已经产生了合成移植物和生物活性陶瓷，它们提供了一致的结构和表面介导的生物活性。新的生物工程结构，包括肽增强和纳米合成配方，旨在将骨导电性支架与分子或细胞活化结合起来。新兴疗法如间充质干细胞异体移植和基因疗法寻求生物刺激融合部位的骨形成和再生。总的来说，这些生物制剂代表了从纯粹的结构移植物到结合机械支持和靶向分子活性的综合生物系统的转变。了解它们的机制、适应症和局限性对于优化移植物选择和推进生物学驱动的脊柱外科手术至关重要。

{"title":"Biologics in the evolution of spine surgery","authors":"Jacob Weinberg , John Bonamer , Michael Kann , Grant Guzzo , Ryan Kelly , Tyler Kallman , Christopher Gonzalez , Rahul Ramanathan , Michael Spitnale , Richard Wawrose , Joon Y. Lee , Emmett Gannon","doi":"10.1016/j.semss.2025.101238","DOIUrl":"10.1016/j.semss.2025.101238","url":null,"abstract":"<div><div>Biologics have become central to modern spine surgery, providing tools to enhance fusion and promote biologic healing. Autologous bone graft remains the gold standard for its osteogenic, osteoinductive, and osteoconductive properties, while allografts and demineralized bone matrices expand graft availability and reduce morbidity, albeit with variability in biologic potency. Recombinant bone morphogenetic proteins offer potent osteoinduction and have demonstrated high fusion rates in challenging cases, though dose-related complications and cost have limited use. Advances in materials science have produced synthetic grafts and bioactive ceramics that provide consistent structure and surface-mediated biologic activity. Newer bioengineered constructs, including peptide-enhanced and nanosynthetic formulations, aim to combine osteoconductive scaffolds with molecular or cellular activation. Emerging therapies such as mesenchymal stem cell allografts and gene therapy seek to biologically stimulate bone formation and regeneration at the fusion site. Collectively, these biologics represent a shift from purely structural grafts toward integrated biologic systems that combine mechanical support with targeted molecular activity. Understanding their mechanisms, indications, and limitations is essential to optimize graft selection and advance biologically driven spine surgery.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"38 1","pages":"Article 101238"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146147352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Biology of intervertebral disc degeneration 椎间盘退变的生物学

Q4 Medicine

Seminars in Spine Surgery

Pub Date : 2025-12-23 DOI: 10.1016/j.semss.2025.101233

Jacob Weinberg , John Bonamer , Rahul Ramanathan , Christopher Gonzalez , Mario Rotunno , Gwendolyn Sowa , Nam Vo , Michael Spitnale , Joon Y. Lee , Richard Wawrose

Intervertebral disc degeneration (IDD) underlies a substantial portion of chronic low back pain and remains a major cause of disability worldwide. The intervertebral disc, composed of the nucleus pulposus, annulus fibrosus, and cartilaginous endplates, maintains spinal flexibility and distributes mechanical load. Degeneration disrupts this system through cellular dysfunction, loss of hydration, and matrix breakdown. Recent evidence characterizes IDD as a multifactorial biologic cascade rather than a single age-related process. Aging, inflammation, genetic predisposition, abnormal loading, postural malalignment, and lifestyle exposures interact through overlapping pathways that accelerate cellular senescence, oxidative stress, and extracellular matrix degradation. These mechanisms reinforce one another, producing progressive biochemical and structural failure of the disc. Although the sequence of events remains incompletely defined, advances in molecular biology and biomechanics have clarified key drivers of degeneration and identified therapeutic targets. Translational efforts are increasingly directed toward modifying these pathways through biologic and regenerative approaches, including stem cell and extracellular vesicle therapy, gene-based interventions, platelet-rich plasma, growth factors, and tissue-engineered scaffolds. Together, these discoveries support a growing view of IDD as a biologically modifiable disease and highlight the potential for mechanism-based interventions to restore disc function and prevent progression.

椎间盘退变（IDD）是造成慢性腰痛的主要原因，也是世界范围内致残的主要原因。椎间盘由髓核、纤维环和软骨终板组成，维持脊柱柔韧性并分配机械负荷。变性通过细胞功能障碍、水合作用丧失和基质破坏破坏这个系统。最近的证据表明，缺乏症是一个多因素的生物级联，而不是单一的年龄相关过程。衰老、炎症、遗传易感性、异常负荷、体位失调和生活方式暴露通过重叠的途径相互作用，加速细胞衰老、氧化应激和细胞外基质降解。这些机制相互加强，导致椎间盘的生化和结构上的逐渐失效。尽管事件的顺序仍然不完全确定，但分子生物学和生物力学的进展已经阐明了变性的关键驱动因素并确定了治疗靶点。通过生物和再生方法，包括干细胞和细胞外囊泡治疗、基于基因的干预、富血小板血浆、生长因子和组织工程支架，越来越多的转化工作指向改变这些途径。总之，这些发现支持了IDD作为一种生物学上可改变的疾病的观点，并强调了基于机制的干预措施恢复椎间盘功能和预防进展的潜力。

{"title":"Biology of intervertebral disc degeneration","authors":"Jacob Weinberg , John Bonamer , Rahul Ramanathan , Christopher Gonzalez , Mario Rotunno , Gwendolyn Sowa , Nam Vo , Michael Spitnale , Joon Y. Lee , Richard Wawrose","doi":"10.1016/j.semss.2025.101233","DOIUrl":"10.1016/j.semss.2025.101233","url":null,"abstract":"<div><div>Intervertebral disc degeneration (IDD) underlies a substantial portion of chronic low back pain and remains a major cause of disability worldwide. The intervertebral disc, composed of the nucleus pulposus, annulus fibrosus, and cartilaginous endplates, maintains spinal flexibility and distributes mechanical load. Degeneration disrupts this system through cellular dysfunction, loss of hydration, and matrix breakdown. Recent evidence characterizes IDD as a multifactorial biologic cascade rather than a single age-related process. Aging, inflammation, genetic predisposition, abnormal loading, postural malalignment, and lifestyle exposures interact through overlapping pathways that accelerate cellular senescence, oxidative stress, and extracellular matrix degradation. These mechanisms reinforce one another, producing progressive biochemical and structural failure of the disc. Although the sequence of events remains incompletely defined, advances in molecular biology and biomechanics have clarified key drivers of degeneration and identified therapeutic targets. Translational efforts are increasingly directed toward modifying these pathways through biologic and regenerative approaches, including stem cell and extracellular vesicle therapy, gene-based interventions, platelet-rich plasma, growth factors, and tissue-engineered scaffolds. Together, these discoveries support a growing view of IDD as a biologically modifiable disease and highlight the potential for mechanism-based interventions to restore disc function and prevent progression.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"38 1","pages":"Article 101233"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146147336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

“Omics”: the emerging molecular basis of spine research “组学”：脊柱研究的新兴分子基础

Q4 Medicine

Seminars in Spine Surgery

Pub Date : 2025-12-23 DOI: 10.1016/j.semss.2025.101236

John Bonamer , Gwendolyn A. Sowa , Harsha Nagar , Jacob Weinberg , Caroline Lindsey , Rahul Ramanathan , Christopher Gonzalez , Michael Spitnale , Richard Wawrose , Joon Y. Lee , Pedro Baldoni

Omics technologies have transformed spine research by enabling comprehensive molecular characterization of genetic, epigenetic, transcriptomic, proteomic, and microbial factors that contribute to spinal disease. The purpose of this review is to synthesize current applications of omics in elucidating the mechanisms of spinal pathology and to highlight how integrated multi-omics strategies are advancing precision spine medicine. Genomic and epigenomic studies have clarified hereditary and regulatory influences on spine morphology and disease susceptibility, while transcriptomic and proteomic analyses reveal dynamic changes in gene and protein expression that mediate cellular stress, extracellular matrix remodeling, and pain signaling. Microbiomic research has identified potential microbial contributions to disc degeneration and chronic pain. Multi-omics integration now connects these molecular layers to uncover interacting pathways that underlie complex conditions including intervertebral disc degeneration, scoliosis, and ankylosing spondylitis. These advances are accelerating biomarker discovery and the identification of therapeutic targets, fostering mechanism-based, patient-specific interventions. Ongoing challenges include data harmonization, cohort heterogeneity, and the integration of omic datasets with biobanking and electronic health records. As computational modeling and machine learning converge with longitudinal omic datasets, spine research is poised to move from descriptive molecular mapping to actionable, personalized diagnostic and therapeutic strategies.

组学技术通过对导致脊柱疾病的遗传、表观遗传、转录组学、蛋白质组学和微生物因素进行全面的分子表征，改变了脊柱研究。本文综述了目前组学在阐明脊柱病理机制方面的应用，并重点介绍了多组学综合策略如何促进脊柱精准医学的发展。基因组学和表观基因组学研究已经阐明了遗传和调控对脊柱形态和疾病易感性的影响，而转录组学和蛋白质组学分析揭示了介导细胞应激、细胞外基质重塑和疼痛信号的基因和蛋白质表达的动态变化。微生物组学研究已经确定了潜在的微生物对椎间盘退变和慢性疼痛的影响。现在，多组学整合将这些分子层连接起来，揭示了椎间盘退变、脊柱侧凸和强直性脊柱炎等复杂疾病背后的相互作用途径。这些进步正在加速生物标志物的发现和治疗靶点的确定，促进基于机制的、针对患者的干预措施。目前面临的挑战包括数据协调、队列异质性以及基因组数据集与生物银行和电子健康记录的集成。随着计算建模和机器学习与纵向组学数据集的融合，脊柱研究正准备从描述性分子制图转向可操作的、个性化的诊断和治疗策略。

{"title":"“Omics”: the emerging molecular basis of spine research","authors":"John Bonamer , Gwendolyn A. Sowa , Harsha Nagar , Jacob Weinberg , Caroline Lindsey , Rahul Ramanathan , Christopher Gonzalez , Michael Spitnale , Richard Wawrose , Joon Y. Lee , Pedro Baldoni","doi":"10.1016/j.semss.2025.101236","DOIUrl":"10.1016/j.semss.2025.101236","url":null,"abstract":"<div><div>Omics technologies have transformed spine research by enabling comprehensive molecular characterization of genetic, epigenetic, transcriptomic, proteomic, and microbial factors that contribute to spinal disease. The purpose of this review is to synthesize current applications of omics in elucidating the mechanisms of spinal pathology and to highlight how integrated multi-omics strategies are advancing precision spine medicine. Genomic and epigenomic studies have clarified hereditary and regulatory influences on spine morphology and disease susceptibility, while transcriptomic and proteomic analyses reveal dynamic changes in gene and protein expression that mediate cellular stress, extracellular matrix remodeling, and pain signaling. Microbiomic research has identified potential microbial contributions to disc degeneration and chronic pain. Multi-omics integration now connects these molecular layers to uncover interacting pathways that underlie complex conditions including intervertebral disc degeneration, scoliosis, and ankylosing spondylitis. These advances are accelerating biomarker discovery and the identification of therapeutic targets, fostering mechanism-based, patient-specific interventions. Ongoing challenges include data harmonization, cohort heterogeneity, and the integration of omic datasets with biobanking and electronic health records. As computational modeling and machine learning converge with longitudinal omic datasets, spine research is poised to move from descriptive molecular mapping to actionable, personalized diagnostic and therapeutic strategies.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"38 1","pages":"Article 101236"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146147340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Small Animal Models in Translational Spine Surgery Research 翻译脊柱外科研究中的小动物模型

Q4 Medicine

Seminars in Spine Surgery

Pub Date : 2025-12-23 DOI: 10.1016/j.semss.2025.101235

John Bonamer , Robert Bilodeau , Jacob Weinberg , Timothy Edwards , Rahul Ramanathan , Christopher Gonzalez , Michael Spitnale , Joon Y. Lee , Richard Wawrose

Small animal models are foundational to translational spine surgery research, enabling the investigation of disease mechanisms and the preclinical evaluation of therapeutic strategies prior to human application. This narrative review synthesizes current knowledge of mouse, rat, and rabbit models used to study major spinal pathologies, including intervertebral disc degeneration, spinal fusion, spinal cord injury, scoliosis, and osteoporotic vertebral disease. For each application, key experimental methods, principal outcome measures, and the the elements of human pathology most faithfully reproduced by these models are summarized.

While these models have driven significant advances in spine research, several key considerations influence their clinical translation. Quadrupedal biomechanics, persistent notochordal cells, and technical scale limitations may affect degeneration, implant performance, and regenerative capacity compared with humans. Additionally, methodologic variability and inconsistent reporting can limit reproducibility and exaggerate perceived treatment effects.

Emerging approaches including genetic engineering, bioelectronic monitoring, and artificial intelligence–enabled analytics are rapidly improving model fidelity and data quality, thereby positioning small animal research to better support translational decision-making. Continued refinement of biological relevance, standardization of methodological rigor, and ethical stewardship will be essential to maximize the value of these systems in advancing future innovations in spine surgery.

小动物模型是脊柱外科研究的基础，可以研究疾病机制，并在人类应用之前对治疗策略进行临床前评估。本综述综合了目前用于研究主要脊柱病变的小鼠、大鼠和兔模型的知识，包括椎间盘退变、脊柱融合、脊髓损伤、脊柱侧凸和骨质疏松性椎体疾病。对于每个应用，总结了关键的实验方法，主要的结果测量，以及这些模型最忠实地再现的人类病理元素。虽然这些模型在脊柱研究方面取得了重大进展，但有几个关键因素影响着它们的临床转化。与人类相比，四足生物力学、持续性脊索细胞和技术规模限制可能会影响退变、植入物性能和再生能力。此外，方法学的可变性和不一致的报告会限制再现性并夸大治疗效果。包括基因工程、生物电子监测和人工智能分析在内的新兴方法正在迅速提高模型保真度和数据质量，从而使小动物研究更好地支持转化决策。生物学相关性的持续改进、方法严谨性的标准化和伦理管理对于这些系统在推进脊柱外科未来创新方面的价值最大化至关重要。

{"title":"Small Animal Models in Translational Spine Surgery Research","authors":"John Bonamer , Robert Bilodeau , Jacob Weinberg , Timothy Edwards , Rahul Ramanathan , Christopher Gonzalez , Michael Spitnale , Joon Y. Lee , Richard Wawrose","doi":"10.1016/j.semss.2025.101235","DOIUrl":"10.1016/j.semss.2025.101235","url":null,"abstract":"<div><div>Small animal models are foundational to translational spine surgery research, enabling the investigation of disease mechanisms and the preclinical evaluation of therapeutic strategies prior to human application. This narrative review synthesizes current knowledge of mouse, rat, and rabbit models used to study major spinal pathologies, including intervertebral disc degeneration, spinal fusion, spinal cord injury, scoliosis, and osteoporotic vertebral disease. For each application, key experimental methods, principal outcome measures, and the the elements of human pathology most faithfully reproduced by these models are summarized.</div><div>While these models have driven significant advances in spine research, several key considerations influence their clinical translation. Quadrupedal biomechanics, persistent notochordal cells, and technical scale limitations may affect degeneration, implant performance, and regenerative capacity compared with humans. Additionally, methodologic variability and inconsistent reporting can limit reproducibility and exaggerate perceived treatment effects.</div><div>Emerging approaches including genetic engineering, bioelectronic monitoring, and artificial intelligence–enabled analytics are rapidly improving model fidelity and data quality, thereby positioning small animal research to better support translational decision-making. Continued refinement of biological relevance, standardization of methodological rigor, and ethical stewardship will be essential to maximize the value of these systems in advancing future innovations in spine surgery.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"38 1","pages":"Article 101235"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146147338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ligamentum Flavum Hypertrophy: Pathophysiology, Patient Presentation, Management, and Translational Therapeutic Research 黄韧带肥大：病理生理学、患者表现、管理和转化治疗研究

Q4 Medicine

Seminars in Spine Surgery

Pub Date : 2025-12-23 DOI: 10.1016/j.semss.2025.101234

John Bonamer , Jacob Weinberg , Sridula Kallakuri , Rahul Ramanathan , Christopher Gonzalez , Richard Wawrose , Michael Spitnale , Peter Alexander , Joon Y. Lee

Ligamentum flavum hypertrophy (LFH) is a key driver of lumbar spinal stenosis (LSS). This narrative review summarizes the current understanding of LFH pathophysiology, highlighting key structural and cellular features including loss of elastin, accumulation of dense collagen, chronic inflammatory signaling, and fibroblast-to-myofibroblast transition. Classic clinical presentation and diagnostic evaluation of associated stenosis are reviewed and contemporary nonoperative and operative management strategies are outlined. Although LFH and LSS are leading causes of spine associated morbidity, management remains largely binary: nonoperative vs. operative. Nonoperative therapy may provide short-term symptomatic relief, whereas surgical decompression, despite its efficacy, is resource intensive and associated with meaningful complication and reoperation rates. Due to the limited treatment options, there exists a pressing need for the development of preventative, disease modifying, and curative therapeutics targeted at the biological mechanisms driving LFH. Advances in molecular profiling, targeted modulation of microRNAs, and refinement of biologically relevant experimental models are beginning to strengthen translational progress. Early work suggests that regulators such as miR-29a may influence core fibrotic pathways, and preliminary results from a novel rat model offer improved biological fidelity for evaluating therapeutic candidates. Continued integration of mechanistic biology and validated translational frameworks will be essential to develop novel therapies capable of altering and/or preventing the natural history of LFH and associated LSS.

黄韧带肥大（LFH）是腰椎管狭窄（LSS）的关键驱动因素。本文综述了目前对LFH病理生理的理解，强调了关键的结构和细胞特征，包括弹性蛋白的丧失、致密胶原蛋白的积累、慢性炎症信号和成纤维细胞向肌成纤维细胞的转变。回顾了相关狭窄的经典临床表现和诊断评价，并概述了当代非手术和手术治疗策略。虽然LFH和LSS是脊柱相关疾病的主要原因，但治疗方法主要是二元的：非手术与手术。非手术治疗可提供短期的症状缓解，而手术减压，尽管其疗效，是资源密集型的，并与有意义的并发症和再手术率相关。由于治疗选择有限，迫切需要针对驱动LFH的生物学机制开发预防性、疾病修饰性和治疗性治疗方法。分子谱分析、靶向调节microrna和完善生物学相关实验模型的进展正在开始加强翻译进展。早期的研究表明，miR-29a等调节因子可能影响核心纤维化途径，来自一种新型大鼠模型的初步结果为评估候选治疗方案提供了更好的生物保真度。持续整合机制生物学和经过验证的翻译框架对于开发能够改变和/或预防LFH和相关LSS的自然史的新疗法至关重要。

{"title":"Ligamentum Flavum Hypertrophy: Pathophysiology, Patient Presentation, Management, and Translational Therapeutic Research","authors":"John Bonamer , Jacob Weinberg , Sridula Kallakuri , Rahul Ramanathan , Christopher Gonzalez , Richard Wawrose , Michael Spitnale , Peter Alexander , Joon Y. Lee","doi":"10.1016/j.semss.2025.101234","DOIUrl":"10.1016/j.semss.2025.101234","url":null,"abstract":"<div><div>Ligamentum flavum hypertrophy (LFH) is a key driver of lumbar spinal stenosis (LSS). This narrative review summarizes the current understanding of LFH pathophysiology, highlighting key structural and cellular features including loss of elastin, accumulation of dense collagen, chronic inflammatory signaling, and fibroblast-to-myofibroblast transition. Classic clinical presentation and diagnostic evaluation of associated stenosis are reviewed and contemporary nonoperative and operative management strategies are outlined. Although LFH and LSS are leading causes of spine associated morbidity, management remains largely binary: nonoperative vs. operative. Nonoperative therapy may provide short-term symptomatic relief, whereas surgical decompression, despite its efficacy, is resource intensive and associated with meaningful complication and reoperation rates. Due to the limited treatment options, there exists a pressing need for the development of preventative, disease modifying, and curative therapeutics targeted at the biological mechanisms driving LFH. Advances in molecular profiling, targeted modulation of microRNAs, and refinement of biologically relevant experimental models are beginning to strengthen translational progress. Early work suggests that regulators such as miR-29a may influence core fibrotic pathways, and preliminary results from a novel rat model offer improved biological fidelity for evaluating therapeutic candidates. Continued integration of mechanistic biology and validated translational frameworks will be essential to develop novel therapies capable of altering and/or preventing the natural history of LFH and associated LSS.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"38 1","pages":"Article 101234"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146147337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Implications and utility of artificial intelligence in clinical spine surgical practice 人工智能在脊柱外科临床实践中的意义和应用

Q4 Medicine

Seminars in Spine Surgery

Pub Date : 2025-12-23 DOI: 10.1016/j.semss.2025.101239

Jacob Weinberg , John Bonamer , Nicolas Kelhofer , Mohamed Ali Jawad-Makki , Ryan Zuckerbraun , Christopher Gonzalez , Rahul Ramanathan , Joon Y. Lee , Michael Spitnale , Richard Wawrose

Artificial intelligence (AI) is rapidly reshaping modern healthcare, and spine surgery represents one of its most promising frontiers. This narrative review synthesizes current evidence on how AI technologies are being applied throughout the perioperative continuum of spine surgery, from diagnosis and preoperative planning to intraoperative guidance and postoperative care. Machine learning, deep learning, natural language processing, and computer vision have demonstrated strong performance in preoperative applications, such as automating imaging interpretation, identifying surgical candidates, optimizing implant selection, and predicting complications. Intraoperatively, AI supports navigation accuracy, augmented and mixed reality visualization, and adaptive robotic systems that respond to real-time anatomic variation. Postoperatively, predictive models forecast outcomes and complications with greater precision than traditional risk tools, while wearable sensors and telehealth platforms enable continuous monitoring and personalized recovery.

While early results are promising, key challenges remain regarding data privacy, model bias, generalizability, and clinician acceptance. Ongoing efforts to validate, regulate, and ethically implement AI systems will determine their readiness for clinical translation. Ultimately, AI holds the potential to make spine surgery more predictive, precise, and patient-centered, bridging data science with surgical expertise to advance quality and safety in care delivery.

人工智能（AI）正在迅速重塑现代医疗保健，脊柱外科是其最有前途的前沿领域之一。这篇叙述性综述综合了目前关于人工智能技术如何应用于脊柱外科围手术期连续体的证据，从诊断和术前计划到术中指导和术后护理。机器学习、深度学习、自然语言处理和计算机视觉在术前应用中表现出色，如自动成像解释、识别手术候选人、优化植入物选择和预测并发症。术中，人工智能支持导航精度，增强和混合现实可视化，以及响应实时解剖变化的自适应机器人系统。术后，预测模型比传统风险工具更精确地预测结果和并发症，而可穿戴传感器和远程医疗平台可实现持续监测和个性化康复。虽然早期的结果是有希望的，但主要的挑战仍然是关于数据隐私、模型偏差、普遍性和临床医生的接受度。正在进行的验证、规范和道德实施人工智能系统的努力将决定它们是否准备好进行临床翻译。最终，人工智能具有使脊柱手术更具预测性、准确性和以患者为中心的潜力，将数据科学与外科专业知识相结合，以提高护理服务的质量和安全性。

{"title":"Implications and utility of artificial intelligence in clinical spine surgical practice","authors":"Jacob Weinberg , John Bonamer , Nicolas Kelhofer , Mohamed Ali Jawad-Makki , Ryan Zuckerbraun , Christopher Gonzalez , Rahul Ramanathan , Joon Y. Lee , Michael Spitnale , Richard Wawrose","doi":"10.1016/j.semss.2025.101239","DOIUrl":"10.1016/j.semss.2025.101239","url":null,"abstract":"<div><div>Artificial intelligence (AI) is rapidly reshaping modern healthcare, and spine surgery represents one of its most promising frontiers. This narrative review synthesizes current evidence on how AI technologies are being applied throughout the perioperative continuum of spine surgery, from diagnosis and preoperative planning to intraoperative guidance and postoperative care. Machine learning, deep learning, natural language processing, and computer vision have demonstrated strong performance in preoperative applications, such as automating imaging interpretation, identifying surgical candidates, optimizing implant selection, and predicting complications. Intraoperatively, AI supports navigation accuracy, augmented and mixed reality visualization, and adaptive robotic systems that respond to real-time anatomic variation. Postoperatively, predictive models forecast outcomes and complications with greater precision than traditional risk tools, while wearable sensors and telehealth platforms enable continuous monitoring and personalized recovery.</div><div>While early results are promising, key challenges remain regarding data privacy, model bias, generalizability, and clinician acceptance. Ongoing efforts to validate, regulate, and ethically implement AI systems will determine their readiness for clinical translation. Ultimately, AI holds the potential to make spine surgery more predictive, precise, and patient-centered, bridging data science with surgical expertise to advance quality and safety in care delivery.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"38 1","pages":"Article 101239"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146147339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Contributors to authors 作者贡献者

Q4 Medicine

Seminars in Spine Surgery

Pub Date : 2025-11-26 DOI: 10.1053/S1040-7383(25)00069-3

引用次数: 0

Introduction: Advances in Surgical Management of Pediatric Scoliosis 前言：小儿脊柱侧凸的外科治疗进展

Q4 Medicine

Seminars in Spine Surgery

Pub Date : 2025-10-13 DOI: 10.1016/j.semss.2025.101210

Amit Jain, Paul Sponseller

引用次数: 0

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Seminars in Spine Surgery

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀