Journal of spine research and surgery最新文献

Lumbar spinal stenosis (LSS) is a common condition caused by the narrowing of the spinal canal, resulting in compression of neural and vascular structures. This compression leads to symptoms such as claudication, paresthesia, and lower extremity weakness. LSS is the leading cause of low back pain and functional limitations, affecting over 103 million people worldwide. Degenerative changes, including ligamentum flavum hypertrophy, facet joint osteoarthritis, and intervertebral disc degeneration, are the primary contributors to LSS. Additional factors, such as genetic predisposition, congenital abnormalities, and autoimmune conditions, are also emerging as contributors. A major challenge in managing LSS lies in differentiating it from other causes of neurogenic symptoms and low back pain while devising an appropriate treatment plan from the wide array of conservative and surgical options available. Minimally invasive surgical techniques, such as lumbar spinous process-splitting laminoplasty and partial facetectomy, are often compared to the gold standard laminectomy with or without fusion. Surgical interventions offer significant improvements in pain relief, disability, and quality of life within 3-6 months; however, these benefits often diminish after 2-4 years. Contrasting evidence demonstrates that long-term outcomes of non-surgical treatments, such as physical therapy, pharmacological management, and lifestyle modifications, are often comparable to surgical modalities. Emerging therapies, including interspinous devices and stem cell therapy, show promise but require further research. Managing LSS requires a multidisciplinary approach tailored to patient-specific factors, including age, comorbidities, and functional goals. Future research should aim to improve diagnostic accuracy, refine surgical techniques, and explore innovative therapies to enhance outcomes for patients with LSS.

Lower back pain associated with degenerative disc disease is a common occurrence, with many surgical treatments targeting the degenerated disc to relieve symptoms. Current surgical options for degenerative disc disease primarily consist of a discectomy followed by either spinal fusion or artificial disc replacement, with the former being increasingly more common in the lumbar region despite the risk of adjacent segment disease. Though artificial disc replacement aims to provide an increase in range of motion and decreases risk of adjacent segment disease, surgeons are increasingly opting for spinal fusion in the lumbar region. This review investigates underlying factors that may be contributing to this trend by assessing lumbar artificial disc replacement selection criteria, clinical outcomes, surgical technique, complications, revision burden, and overall cost. While these factors had some role in the physician's decision, ultimately the narrow selection criteria and lack of cost reimbursement by insurance has primarily led to the decline in lumbar artificial disc replacement.

Individuals with chronic spinal cord injury (SCI) face elevated risks of cardiometabolic diseases, including cardiovascular disease and type 2 diabetes, due to factors like physical inactivity, neurogenic obesity, and disrupted glucose and insulin regulation. We conducted a prospective intervention cohort study involving 20 individuals with SCI (aged 28-60) with neurologic injuries at levels C4-T10 and ASIA scale grades A-D, lasting over a year. Our study assessed the impact of a therapeutic lifestyle intervention (TLI) based on the Diabetes Prevention Program (DPP) and its maintenance phase. The TLI comprised circuit resistance training, a Mediterranean-style calorie-restricted diet, and tailored behavioral support. Key outcomes measured included cardiometabolic risks (plasma analytes and disease biomarkers), anthropometrics (body mass, BMI, tissue composition), global metabolism, fitness (aerobic capacity, peak strength), and health-related quality of life (SF36). Results demonstrated a significant reduction in body mass and BMI by 7.5%, a 7% decrease in total fat mass, and substantial improvements in glucose regulation and insulin sensitivity. Lipid profiles improved, with reduced total cholesterol, triglycerides, and LDL-C, and increased HDL-C. Resting energy expenditure and fat oxidation increased by 27.4% and 58.5%, respectively. Aerobic capacity and dynamic strength also improved significantly. The Physical and Mental Composite Scores of the SF36 improved by 22.8% and 30.5%, respectively. Following the maintenance phase, several positive outcomes persisted, indicating a reduction in risk for cardiovascular disease and comorbid disorders. Our findings support the effectiveness of TLI in reducing cardiometabolic risks, enhancing fitness, and improving health-related quality of life in individuals with chronic SCI.

Trial registration: ClinicalTrials.gov, ID: NCT02853149 Registered August 2, 2016.

Peripheral nerve injury has detrimental effects on the quality of life for patients and is a worldwide issue with high rates of morbidity. Research on the molecular mechanisms of nerve injury, microsurgical techniques, and advances in stem cell research have led to substantial progress in the field of translational neurophysiology. Current research on peripheral nerve regeneration aims to accelerate peripheral nerve development through pluripotent stem cells and potential use of smart exosomes, pharmacological agents, and bioengineering of nerve conduits. In this article critically reviewed and summarized various methods used for peripheral nerve regeneration and highlight the opportunities and challenges that come along with these strategies.

Intervertebral disk degeneration (IDD) is an intricate pathological process contributing to one of the major causes of low back pain. The degradation of the extracellular matrix (ECM), inflammation, and apoptosis have all been investigated as critical factors involved in the pathology of degenerative disk disease. Additionally, the presence of aberrant microRNAs (miRNAs), conserved molecules that regulate the amount protein post-transcriptionally, may play a crucial role in the pathogenesis of IDD. Research regarding the dysfunction of miRNAs in IDD has been well researched over the past five years. Here, we provide a critical overview of the current knowledge of miRNAs, emphasizing the processes involved in the degenerative disk pathology.