Search Results (291)

Background/Objectives: Pedicle screw placement is crucial for restoring stability. Emerging robot-assisted technologies may offer enhanced precision and reduced radiation exposure. This study aimed to compare the accuracy and clinical outcomes of robot-assisted versus conventional fluoroscopy-guided pedicle screw placements. Methods: This retrospective cohort study included 218 patients undergoing pedicle screw placement at a single spine center between 2019 and 2023. Of these, 105 patients underwent robot-assisted surgery using the Mazor X™ Stealth Edition (Medtronic, Minneapolis, MN, USA), and 113 underwent conventional fluoroscopy-guided surgery. The primary outcome was screw placement accuracy (Grade 0 = optimal, Grades 1–3 = suboptimal, according to the Gertzbein–Robbins classification). Secondary outcomes included estimated blood loss (EBL), radiation exposure, length of hospital stay (LOS), clinical outcome according to the Macnab classification, postoperative pain, and adverse events. Results: Robot-assisted surgery demonstrated significantly higher accuracy in screw placement, with 93.33% achieving Grade 0 accuracy versus 78.76% in the conventional group (p = 0.002). This corresponded to an odds ratio (OR) of 3.78 (95% CI: 1.55–9.19, p = 0.003). The number needed to treat (NNT) to achieve one additional optimal screw placement was 6.9. Robot-assisted surgery demonstrated significantly higher accuracy in screw placement. Moreover, robot-assisted procedures were associated with reduced estimated blood loss (EBL), shorter length of stay (LOS), and lower radiation exposure times; patient-reported outcomes (VAS and Macnab) were also improved (OR = 3.34, 95% CI: 1.89–5.91). Duration of surgery, adverse events, and revision rates were comparable between the two groups. Conclusions: This study supports the clinical benefits of robot-assisted pedicle screw placement, particularly in achieving higher accuracy and reducing EBL and LOS. Future research should explore long-term outcomes, cost-effectiveness, and the generalizability of these results to a broader patient population. Full article

Background/Objectives: Chronic low back pain (CLBP) is a leading cause of disability worldwide, with lumbar medial branch radiofrequency ablation (LRFA) widely used to manage facet-mediated pain; however, emerging evidence raises concerns regarding its potential to denervate the multifidus muscle—an essential stabilizer of the lumbar spine—thereby exacerbating dysfunction. This narrative review synthesizes current evidence on multifidus atrophy and dysfunction following LRFA, emphasizes its clinical significance, and highlights gaps that warrant further research and therapeutic development. Methods: A comprehensive literature search was conducted using SANRA criteria across the Cochrane Library, Web of Science Core Collection, Scopus, PubMed, and MEDLINE. Studies assessing multifidus morphology or function after LRFA were identified and analyzed. Data were extracted from studies meeting predefined inclusion criteria. The narrative synthesis included a thematic analysis and interpretive integration focusing on clinical practice. Results: Six eligible studies were identified, five cohort studies and one case series. Of these, two confirmed decreased multifidus function post-LRFA. Four studies analyzed post-LRFA structural changes, two of which reported reduced cross-sectional area/fatty infiltration, one no measurable difference, and another an apparent enlargement. The findings are constrained by substantial differences in study design, patient populations, and outcome measures, which limit the ability to establish consistent conclusions. Conclusions: Current evidence suggests that LRFA may lead to structural and functional changes in the multifidus muscle, although findings remain inconsistent due to significant study heterogeneity. Further high-quality, prospective research with standardized imaging and functional assessments is needed to clarify the long-term clinical impact. Full article

This paper develops a dynamic information-theoretic network framework to quantify systemic risk in China’s maritime–commodity nexus with a focus on the Yangtze River Basin using eight monthly indicators, CCFI, CBCFI, BDI, YRCFI, GAUP, MPCT, CPUS, and ASMC. We resample, impute, standardize, and difference series to achieve stationary time series. Nonlinear interdependencies are estimated via KSG mutual information (MI) within sliding windows; networks are filtered using the Planar Maximally Filtered Graph (PMFG) with bootstrap edge validation (95th percentile) and benchmarked against the MST. Average MI indicates moderate yet heterogeneous dependence (about 0.13–0.17), revealing a container/port core (CCFI–YRCFI–MPCT), a bulk/energy spine (BDI–CPUS), and commodity bridges via GAUP. Dynamic PMFG metrics show a generally resilient but episodically vulnerable structure: density and compactness decline in turbulence. Stress tests demonstrate high redundancy to diffuse link failures (connectivity largely intact until ∼70–80% edge removal) but pronounced sensitivity of diffusion capacity to targeted multi-node outages. Early-warning indicators based on entropy rate and percolation threshold Z-scores flag recurring windows of elevated fragility; change point detection evaluation of both metrics isolates clustered regime shifts (2015–2016, 2018–2019, 2021–2022, and late 2023–2024). A Systemic Importance Index (SII) combining average centrality and removal impact ranks MPCT and CCFI as most critical, followed by BDI, with GAUP/CPUS mid-peripheral and ASMC peripheral. The findings imply that safeguarding port throughput and stabilizing container freight conditions deliver the greatest resilience gains, while monitoring bulk/energy linkages is essential when macro shocks synchronize across markets. Full article

Background/Objectives: The efficacy of zoledronic acid (ZOL) compared to denosumab (DMAB) after teriparatide (TPTD) is largely unknown. We compared the effect of ZOL or DMAB treatment after TPTD on BMD changes and fracture (FX) occurrence. Methods: We retrospectively revised data from 77 patients treated at Fondazione IRCCS Ca’Granda Milan, Italy, with TPTD (≥18 months), given at withdrawal (T0), single ZOL 5 mg (Group A, N = 56) or DMAB 60 mg/6 months (Group B, N = 21). BMD changes and incident FX were assessed after 24 months (T1) in all patients and after 48 months (T2) in 46 patients (Group A1, N = 15, treated with a single ZOL at T0; Group A2, N = 17, treated with ZOL at T0 and T1; Group B, N = 14, treated with DMAB since T0 to T2). Results: During the T0–T1 period, in all groups, both spine (LS) and total hip (TH) T-scores improved (mean ± SD, T0 vs. T1): Group A (LS −2.5 ± 1.2 vs. −2.3 ± 1.3, p = 0.006; TH −2.2 ± 1.0 vs. −2.0 ± 1.1, p = 0.002) and Group B (LS −2.4 ± 1.4 vs. −1.8 ± 1.4, p < 0.001; TH −2.4 ± 1.0 vs. −2.2 ± 1.0, p = 0.003). At T2 vs. T0, all groups showed an increase in TH-BMD (A1 −1.8 ± 0.9 vs. −1.4 ± 1.0, p = 0.008; A2: −1.8 ± 0.8 vs. −1.6 ± 0.9, p = 0.032; B: −2.6 ± 0.7 vs. −2.2 ± 0.7, p < 0.001), while LS-BMD increased only in Group B (−2.7 ± 1.4 vs. −2.0 ± 1.2, p = 0.002), with stability in A1 and A2. No significant differences in incident FX between groups were observed. Conclusions: At 24 months after TPTD withdrawal, both ZOL and DMAB improved BMD at all sites; after 48 months, both ZOL (1 or 2 infusions) and DMAB led to BMD improvement at TH, whereas only DMAB led to an increase in LS-BMD. Full article

Background/Objectives: Traumatic dislocation of the lumbosacral facet joints without associated fractures is exceedingly rare in the pediatric population. Due to the unique anatomical and biomechanical features of the pediatric spine, such injuries present diagnostic and therapeutic challenges. This study aims to describe a rare case of bilateral L5–S1 jumped facets without fracture in a 13-year-old boy and to review the existing literature on pediatric traumatic facet dislocations. Methods: We performed a systematic review according to PRISMA guidelines, searching PubMed, Embase, Scopus, and the Cochrane Library up to 16 January 2025. Keywords included “pediatric traumatic spondylolisthesis” and “pediatric traumatic facet joint”. Eligible studies reported traumatic lumbosacral or thoracolumbar facet dislocations in patients aged <18 years. In addition, we report the clinical course, surgical management, and outcome of a representative case from our institution. Results: The systematic review identified 14 pediatric cases across 11 studies. Most patients were male (71.4%), with high-energy trauma as the primary mechanism. The L5–S1 level was most frequently involved (57.1%). Neurological impairment was present in 57.1% of cases. All patients underwent surgical treatment, with posterior fixation being the most common approach. Our case involved bilateral L5–S1 jumped facets without fracture, successfully treated with open reduction and posterior fusion. Postoperative recovery was favorable, with neurological improvement. Conclusions: Traumatic bilateral facet dislocation without fracture is an extremely rare but serious condition in pediatric patients. Early recognition and surgical stabilization are essential to prevent permanent neurological damage. This study reinforces the importance of advanced imaging and prompt multidisciplinary management in optimizing outcomes. Full article

Background: Fatigue can be a useful tool to understand the effects of physical activity (PA) and sedentary behavior on musculoskeletal health in university students. Methods: The aim of this cross-sectional study was to examine gender differences in the relationships between fatigue and specific types and levels of PA, posture, sleep quality (SQ), and non-specific low back pain (NS-LBP) in young adult university students aged 18–25 years. A total of 180 students completed all required tests. Results: Female students had higher total fatigue as they generally engaged in more PA in contrast to male students, who had higher total fatigue when they engaged in less moderate and less vigorous PA. With increasing sedentary behavior, overall fatigue was pronounced in both sexes, although female students spent significantly more time sitting. Poorer SQ correlated with NS-LBP and higher levels of sleep-related fatigue in female students. Males with pronounced hypekyphosis and females with pronounced lordosis were more fatigued. In addition, fatigue was more pronounced in female students with a higher extensor/flexor ratio, suggesting that trunk extensors are more fatigued due to the need to maintain lumbar spine stability. Conclusions: Our findings suggest that the choice of PA should be gender-specific to prevent chronic musculoskeletal disorders and fatigue in young adult university students. Full article

Background: Patients with ankylotic spines suffering from vertebral column fractures are frequently operated on to maintain spinal stability and prevent secondary displacement and nerve damage. The aim of this study was to identify a subset of patients that may be treated non-operatively, thus avoiding operative complications in this group of patients. Methods: Extension-type injuries in patients with DISH (diffuse idiopathic skeletal hyperostosis) not involving the posterior elements of the spine comprised the study group. Results: Twenty two extension fractures occurred in 21 patients with DISH in SZMC (Shaare Zedek Medical Cente) between 2014–2025. All patients were treated non-operatively. Patients were allowed free mobilization, and no orthosis was used. The only limitation was keeping the bed inclined to 20–30 degrees to prevent extension at the fracture site. All fractures healed uneventfully, and no patient required late surgical intervention, and no neurological complications were noted. Conclusions: Patients with DISH who sustain extension-type injuries of the thoracolumbar spine, with no involvement of the posterior elements, may be treated non-operatively, with good results. Full article

Background: Multisegmental lumbar degenerative disease (ms-LDD) is a common condition in older adults, often requiring surgical intervention. While rigid stabilization remains the gold standard, it is associated with complications such as adjacent segment disease (ASD), higher blood loss, and longer recovery times. The Dynesys dynamic stabilization system offers an alternative by preserving motion while stabilizing the spine. However, data comparing Dynesys with fusion in multisegmental cases are limited. Objective: This study evaluates the clinical and radiographic outcomes of Dynesys dynamic stabilization versus rigid stabilization in the treatment of ms-LDD. Methods: A retrospective analysis was conducted on 53 patients (mean age: 62.25 ± 15.37 years) who underwent either Dynesys dynamic stabilization (n = 27) or PLIF (n = 26) for ms-LDD involving at least seven motion segments. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), while radiological parameters such as lumbar lordosis (LL), sagittal vertical axis (SVA), and spinopelvic parameters (pelvic incidence, pelvic tilt and, sacral slope) were analyzed. A two-stage surgical approach was employed in the Dynesys group to enhance osseointegration, particularly in elderly osteoporotic patients. Results: Both groups showed significant improvements in VAS and ODI scores postoperatively (p < 0.001), with no significant differences between them. However, the Dynesys group demonstrated superior sagittal alignment correction, with a significant increase in LL (p < 0.002) and a significant decrease in SVA (p < 0.0015), whereas changes in the rigid stabilization group were not statistically significant. Additionally, the Dynesys group had fewer complications, including a lower incidence of ASD (0 vs. 6 cases). The two-stage technique facilitated improved screw osseointegration and reduced surgical risks in osteoporotic patients. Conclusions: Dynesys dynamic stabilization is an effective alternative to rigid stabilization in ms-LDD, offering comparable pain relief and functional improvement while preserving motion and reducing ASD risk. The two-stage approach enhances long-term stability, making it particularly suitable for elderly or osteoporotic patients. Further long-term studies are needed to confirm these findings. Full article

Background/Objectives: Metastatic spine disease (MSD) affects a significant proportion of patients with advanced malignancies and often necessitates surgical intervention to preserve neurological function, alleviate pain, and maintain spinal stability. While oncologic spine surgery is ideally performed in a planned, semi-elective setting, a substantial number of patients require unplanned (urgent or emergent) surgery due to acute deterioration. The impact of surgical planning status on postoperative outcomes following metastatic spine tumor surgery remains underexplored. This study aimed to compare the patient characteristics and short-term outcomes of those undergoing planned versus unplanned surgery for spinal metastases. Methods: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2018 to 2023. Patients with disseminated cancer undergoing tumor surgery were identified. Case types were grouped into planned (elective) and unplanned (urgent or emergent). The primary endpoint was failure to rescue (FTR); secondary endpoints included 30-day major complications, 30-day mortality, and length of hospital stay. Univariable and multivariable regression analyses were performed. Results: A total of 2147 patients met our inclusion criteria, out of whom 60% (n = 1284) underwent planned and 40% (n = 863) underwent unplanned surgery. Patients in the unplanned surgery group had a significantly higher prevalence of severe hypoalbuminemia, severe anemia, and ASA class IV status (p ≤ 0.001 for all). For our primary endpoint, a multivariable analysis showed a significant association between unplanned surgery and FTR (OR 2.11 [95% CI 1.24 to 3.56]; p = 0.005). Significant associations were also found with 30-day mortality (OR 1.84 [95% CI 1.25 to 2.72]; p = 0.002) and length of hospital stay (β 2.7 [95% CI 1.97 to 3.43]; p < 0.001). However, unplanned surgery could not independently predict 30-day major complications (OR 1.21 [95% CI 0.97 to 1.51]; p = 0.08). Conclusions: Our study found that unplanned surgery for spinal metastases was associated with significantly higher rates of FTR, 30-day mortality, and extended hospital stay, independent of other covariates. These findings highlight the importance of the timely identification of patients requiring surgery and the potential benefits of semi-elective care. Full article

Pedicle screw fixation is a critical technique for stabilizing lumbar fractures in canines, yet the biomechanical implications of insertion angles remain underexplored. This study aims to identify optimal screw trajectories by analyzing stress distribution and deformation patterns in beagle lumbar segments (L6-L7) using finite element analysis (FEA). A 3D finite element model was reconstructed from CT scans of a healthy beagle, incorporating cortical/cancellous bone, intervertebral disks, and cartilage. Pedicle screws (2.4 mm diameter, 22 mm length) were virtually implanted at angles ranging from 45° to 65°. A 10 N vertical load simulated standing conditions. Equivalent stress and total deformation were evaluated under static loading. The equivalent stress occurred at screw–rod junctions, with maxima at 50° (11.73 MPa) and minima at 58° (3.25 MPa). Total deformation ranged from 0.0033 to 0.0064 mm, with the highest at 55° and the lowest at 54°. The 58° insertion angle demonstrated optimal biomechanical stability with minimal stress concentration, with 56–60° as a biomechanically favorable range for pedicle screw fixation in canine lumbar fractures, balancing stress distribution and deformation control. Future studies should validate these findings in multi-level models and clinical settings. Full article

Background: Traumatic fractures of the cervical spine pose significant challenges in management, particularly in young patients, where preserving mobility is crucial. Patient Characteristics: A 30-year-old woman presented with a C3 lateral mass and pedicle fracture following a motor vehicle collision. Initial conservative management with a rigid cervical collar for three months failed to reduce the diastasis, and the debilitating neck pain worsened. Preoperative imaging confirmed fracture instability without spinal cord compression. Intervention and Outcome: Preoperative screw trajectory planning was conducted with the My Spine MC system (Medacta), and fine-tuning was achieved on a 3D-printed model of the vertebra. A posterior midline approach was employed to expose the C3 vertebra, and a Herbert screw was inserted under fluoroscopic guidance. Imaging at three months demonstrated significant fracture reduction and early bone fusion. The patient achieved substantial improvement in functional mobility without complications. Conclusion: Herbert screw fixation holds potential as a less-invasive alternative to conventional posterior stabilization for selected cervical fractures. This technical note provides the reader with the required information to support surgical planning and execution. Full article

Introduction: Synovitis and damage to natural stabilizers of many axial and peripheral joints make patients with rheumatoid arthritis particularly susceptible to sagittal balance disorders of the axial skeleton. This may determine the high individual variability of cervical spine deformities as well as differences in the rate of development of disease symptoms in these patients, such as radiculopathy and myelopathy. Methods: In the scientific literature, in addition to systemic factors, more and more attention is paid to work on biomechanical factors in the development of cervical spine instability. One of the methods for assessing the influence of biomechanical factors, which can also be used in everyday practice, is the analysis of radiological parameters of sagittal balance. Results: Among the selected sagittal balance parameters studied, a statistical relationship between C4 and C5 distance and the OI parameter has been found, indicating a relationship to a parameter that remains constant throughout an individual’s life in the group of patients with disease duration over 20 years. Conclusions: The development of instability and deformity in the subaxial segment of the cervical spine in patients with rheumatoid arthritis may be the result of insufficiently understood components of biomechanical factors; hence, further research in this field is necessary. Full article

Spinal injuries have a major impact on patients’ quality of life due to the implacable consequences they bring, such as reduced mobility and loss of flexibility, in most cases requiring surgery to restore spinal stability and functionality. In this respect, spinal fixation devices represent an important strategy to stabilize the spine after severe injuries or degenerative conditions, providing structural support and preserving spinal function. However, at the moment, the materials used to manufacture spinal implants present numerous disadvantages (e.g., Young’s modulus larger than cortical bone, which can produce bone resorption and implant enlargement) that can lead to implant failure. In this context, nanotechnology can offer promising solutions, bringing improved properties (e.g., biocompatibility, osseointegration, and increased mechanical performance) that increase the potential for obtaining devices customized to patients’ needs. Thus, the present work aims to present an overview of the types of nanocoating surface modification, the impact of rough and porous implant surfaces, and the integration of bioactive nanoparticles that reduce the risk of infection and implant rejection. In addition, incorporating 3D printing technology and the use of biodegradable materials into the discussion provides a valuable perspective for future studies in this field. Although the emerging results are encouraging, further studies to assess the long-term safety of implant coatings are needed. Full article

Background: The objective was to evaluate and compare the efficacy of direct fragment impaction, indirect reduction through ligamentotaxis, and the combination of both techniques in burst fractures of the thoracolumbar (TL) spine. Methods: The fractures were categorized using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and assessed via standard computed tomography (CT) scans for spinal canal area (SCA) and mid-sagittal diameter (MSD). The Frankel classification was used to assess neurological deficits. Only single vertebrae AO types A3 and A4 thoracic or lumbar fractures were included. All patients received bisegmental posterior stabilization, one of the reduction techniques, and, if neurological deficits were present, a spinal decompression. Mean preoperative (µSCApre/µMSDpre), postoperative (µSCApost/µMSDpost) and difference (∆SCA/∆MSD) in radiographic values were obtained and analyzed using the Mumford formula. The significance of the reduction from preoperative stenosis was assessed using a t-test, while the effectiveness of the reduction techniques was compared using the Kruskal–Wallis test and Dunn’s post hoc test. The manuscript was focused primarily on radiographic outcomes; therefore, aside from the neurostatus, no other clinical parameters were statistically analyzed. Results: Thirteen patients (38.2%) received stand-alone indirect reduction, 13 patients (38.2%) underwent direct reduction, and a combined reduction was used in eight patients (23.6%). All methods resulted in a statistically significant reduction in spinal canal stenosis (p < 0.05), with a minimal mean ∆SCA of 19%. Patients in the direct reduction group had significantly higher µSCApre values compared to those in the indirect reduction group (p = 0.02). Conclusions: All of the tested reduction techniques provided a significant reduction in spinal canal stenosis. Patients who underwent mere direct reduction had significantly higher preoperative spinal canal stenosis compared to the indirect reduction group. Full article

The integration of biomimetic pectoral fins into robotic fish presents a promising approach to enhancing maneuverability, stability, and braking efficiency in underwater robotics. This study investigates a 1-DOF (degree of freedom) pectoral fin mechanism integrated into the SpineWave robotic fish. Through force measurements and particle image velocimetry (PIV), we optimized control parameters to improve braking and turning performances. The results show a 50% reduction in stopping distance, significantly enhancing agility and control. The fin-assisted braking and turning modes enable precise movements, making this approach valuable for autonomous underwater vehicles. This research lays the groundwork for adaptive fin designs and real-time control strategies, with applications in underwater exploration, environmental monitoring, and search-and-rescue operations. Full article