European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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This study aimed to evaluate the applicability and technical feasibility of magnetic resonance imaging (MRI) and ultrasonography (US) fusion-guided transforaminal epidural steroid injection (TFESI) in patients with lumbar disc herniation (LDH) leading to radiculopathy, who are unresponsive to conservative treatment. ⋯ MRI-US fusion-guided TFESI is a feasible and safe technique with a high success rate and low radiation exposure in patients with LDH-induced radiculopathy. Younger age, lower BMI, shorter fluoroscopy duration, and lower radiation dose are significant predictors of procedural success. This technique may enhance spatial orientation during the procedure, potentially improving outcomes particularly in younger patients with lower BMI.
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During full flexion of the spine, the paraspinal muscles are largely inactive. This suggests that passive structures like the posterior osteoligamentous complex (POLC), consisting of interspinous and supraspinous ligaments and the spinous processes, play a key role in spinal stability and protection of the spinal column. The POLC, however, is often resected or damaged during spinal decompression surgeries, whereas the biomechanical implications of this resection or damage are not yet fully understood. ⋯ The experiment indicates that the POLC is the primary passive stabilizer of the fully flexed lumbar spine. Surgical resection of this structure can redistribute loads and increase stresses on remaining spinal tissues, potentially leading to spinal instability, accelerated degeneration, and poor clinical long-term outcomes.
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We utilized the Fast Low Angle Shot (FLASH) sequence to document the sequential changes in cartilaginous (CEP) and bony end plate (BEP) to study the influence on disc degeneration (DD). ⋯ CEP changes identified by FLASH preceded BEP defects and DD. I-TEPS was superior to TEPS in identifying a subgroup of discs that had CEP abnormalities without BEP. An I-TEPS ≥ 7 had a significant correlation to the severity of DD, influenced variations in herniation and also surgical incidence.
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Lateral Lumbar Interbody Fusion (LLIF) has become a minimally invasive procedure for treating degenerative lumbar conditions. While it offers reduced blood loss and faster recovery, patient satisfaction following LLIF surgery shows significant variability. Identifying the factors influencing satisfaction is crucial for optimizing surgical outcomes and improving patient care. This study aims to determine key factors affecting patient satisfaction after LLIF surgery using machine learning (ML) models, including Random Forest, Logistic Regression, Support Vector Machine (SVM), and k-Nearest Neighbors (k-NN). Additionally, the study evaluates the predictive performance of these models to identify the most influential factors contributing to postoperative satisfaction. ⋯ Functional outcomes, particularly improvements in low back pain, walking ability, and mental health, are the primary determinants of patient satisfaction following LLIF surgery. In contrast, surgical factors play a less significant role. Mental health emerged as a critical factor, underscoring the importance of addressing psychological recovery through preoperative counseling and personalized postoperative care. The analysis demonstrated that ML models, especially Random Forest, are effective tools for identifying the factors most predictive of postoperative satisfaction. These findings highlight the potential of ML techniques to enhance personalized treatment planning and improve outcomes by focusing on both physical and mental recovery. Further research, including multi-center studies and the integration of psychological variables, is needed to provide a more comprehensive understanding of patient satisfaction after LLIF surgery.
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Cervical pedicle screw (CPS) instrumentation offers significant biomechanical advantages compared to lateral mass or transarticular fixation. Nonetheless, malpositioning complications constitute a relevant concern. Customized patient-specific 3D-printed templates have been developed to improve CPS placement accuracy and safety. The aim of this study is to present our experience with this surgical technique and its accuracy and safety in a clinical setting. ⋯ Cervical pedicle screw placement using patient-specific guides is safe and accurate, supporting the feasibility of this technique in posterior cervical spine fusion surgery.