Degenerative Spine Research Articles

Assessing MRI Scans of Spinal Disc Degeneration Using Machine Learning

Abstract: Chronic back pain caused by degenerative changes in the spinal disc has significantly impacted the quality of life of patients. Magnetic resonance imaging gives a very clear visualization of the intervertebral disc; however, it is still subjective and more mentally demanding when it is a manual assessment. Therefore, the present paper discusses the possibility of integrating image processing techniques with machine learning algorithms in order to arrive at more accurate diagnosis for spinal disc degeneration. Preprocessing the image, segmentation, and feature extraction are incorporated along with various machine learning models like convolutional neural networks (CNN) and support vector machines (SVM) into the review of present methodologies. Our results show that these hybrid approaches improve classification accuracy and aid in early detection for better management of the patient. This project helps in identifying the four stages of spinal disc degeneration.

Relation between Lumbar Spinal Degeneration and Anatomic Pelvic Parameters in Nepalese Population

Relation between Lumbar Spinal Degeneration and Anatomic Pelvic Parameters in Nepalese Population

The use of the psoas-to-lumbar vertebrae index and modified frailty index in predicting postoperative complications in degenerative spine surgery: can sarcopenia or frailty be underestimated?

Degenerative spine disease (DSD) is increasingly prevalent due to aging populations, leading to higher surgical interventions and associated complications. This necessitates a comprehensive preoperative assessment, evaluating frailty through tools such as the modified Frailty Index 5 and modified Frailty Index 11 (mFI-5 and mFI-11). Despite the utility of mFI-5 and mFI-11 in predicting postoperative complications, these indices do not account for sarcopenia, a syndrome related to but distinct from frailty, which is associated with higher complication rates. This paper aims to retrospectively evaluate the influence of sarcopenia and frailty on postoperative adverse events in a cohort of patients who underwent posterior spine fusion for degenerative disease of the lumbar spine. A retrospective review of 286 patients who underwent posterior lumbar spine fusion for DSD was conducted. Frailty was measured using mFI-5 and mFI-11, while sarcopenia was assessed through Psoas to Lumbar Vertebral Index (PLVI) on magnetic resonance images. Primary outcomes included postoperative complications within 30 days. Statistical analysis involved univariate and multivariate models to determine the predictors of complications. Higher frailty scores were significantly associated with increased postoperative complications (p < .05). However, sarcopenia showed no significant correlation with postoperative complications rates, except for pneumological complications (p = .031). Multivariate analysis confirmed frailty as a strong independent predictor of postoperative complications, while sarcopenia had limited impact. Frailty is a robust predictor of postoperative complications in DSD surgeries, while sarcopenia, appears to play a lesser role. The findings suggest that frailty alone provide a more comprehensive assessment of risk than sarcopenia.

Cross-cultural adaptation, validation, and establishment of the minimal clinicallyimportant change score of the European Portuguese Core Outcome Measures Index in patients with cervical degenerative spine disease.

We aimed to validate and cross-culturally adapt the Core Outcome Measures Index (COMI) neck for use in Portuguese patients with cervical spine degenerative disease and define the minimal clinically important change score (MCIC) for this questionnaire and population. The COMI translation and cross-cultural adaptation was done following published guidelines. Patients awaiting surgery in a neurosurgical centre completed the COMI, Neck Disability Index (NDI) and EQ-5D questionnaires, a pain visual analog scale (VAS) twice within a 5-to-15-day period, and a Global Treatment Outcome (GTO) question evaluating whether a clinical status change had occurred during that period. The MCIC was obtained through an anchor method by analysis of changes in pre- to postoperative total COMI scores and GTO dichotomized answers. The COMI first assessment was completed by 101 patients and 72 patients completed both assessments. The questionnaire showed good construct validity (n = 72 patients) as predefined hypotheses were confirmed: scores on each COMI domain correlated with a Spearman ρ > 0.4 with scores for the corresponding domain on other questionnaires and COMI total score displayed good correlation with total NDI score (ρ = 0.67) and EQ-5D total score (ρ = 0.55). Test-retest reliability (n = 72 patients) was confirmed through high intraclass correlation coefficients. The MCIC (n = 76 patients) was calculated as 2 points. The COMI (neck) psychometric qualities were confirmed, such that it can be considered a valid and reliable questionnaire to be applied in the European Portuguese population with surgical cervical spine degenerative disease, with an MCIC of 2 points.

Mixed reality-assisted versus landmark-guided spinal puncture in elderly patients: protocol for a stratified randomized controlled trial.

Performing spinal anesthesia in elderly patients with spine degeneration is challenging for novice practitioners. This stratified randomized controlled trial aims to compare the effectiveness of mixed reality-assisted spinal puncture (MRasp) with that of landmark-guided spinal puncture (LGsp) performed by novice practitioners in elderly patients. This prospective, single-center, stratified, blocked, parallel randomized controlled trial will include 168 patients (aged ≥ 65years) scheduled for elective surgery involving spinal anesthesia. All spinal punctures will be performed by anesthesiology interns and residents trained at Huadong Hospital. Patients will be randomly assigned to the MRasp group (n = 84) or the LGsp group (n = 84). Based on each intern/resident's experience in spinal puncture, participants will be stratified into three clusters: the primary group, intermediate group, and advanced group. The primary outcome will be the comparison of the rate of successful first-attempt needle insertion between the MRasp group and the LGsp group. Secondary outcomes will include the number of needle insertion attempts, the number of redirection attempts, the number of passes, the rate of successful first needle pass, the spinal puncture time, the total procedure time, and the incidence of perioperative complications. A stratified subgroup analysis will also be conducted for interns/residents at different experience levels. The findings from this trial establish the effectiveness of MRasp by novice practitioners in elderly patients. This trial may provide experimental evidence for exploring an effective visualization technology to assist in spinal puncture. Chinese Clinical Trials Registry ChiCTR2300075291. Registered on August 31, 2023. https://www.chictr.org.cn/bin/project/edit?pid=189622 .

A Comparative Review of Spine Surgeries in Two New Neurosurgery Centres in an Urban and Rural Environment in Southeast Nigeria

Background: The Imo State University Teaching Hospital (IMSUTH) located in a rural setting commenced neurosurgical services in January 2016 with a spine procedure as the first case whereas the Imo State Specialist Hospital (IMSSH) located in an urban setting commenced neurosurgical services in April 2021 and spine procedures in August 2021. The presentation of surgically managed spine pathologies in both hospitals were compared. Aims: The study aimed to descriptively compare the number of spine procedures performed in both hospitals including the age and gender distribution of the surgically managed spine patients, the spine pathologies and their distribution. Methods: The surgical records of all spine patients who had surgical procedures at IMSUTH, Orlu, from January 2016 to May 2020 (42 months), and at IMSSH, Owerri, from August 2021 to July 2024 (36 months) were retrospectively reviewed. Results: During the study periods, in IMSUTH, Orlu, there were 27 spine surgeries, giving an average of 1 spine procedure in 2 months whereas in IMSSH, Owerri, there were 157 spine surgeries giving an average of 4 spine surgeries per month. Interestingly the distribution of spine procedures revealed that the highest frequency of spine surgeries was performed in the lumbar spine (n=7, 26% in IMSUTH; n=43, 27.3% in IMSSH) followed by lumbosacral spine (n=6, 22.2% in IMSUTH; n=42, 26.8% in IMSSH) in both hospitals. And quite interesting also is that trauma (n=15, 55.6%) accounted for the highest number of spine surgeries in the rural environment of IMSUTH, Orlu, while degenerative spine diseases (n=113, 71.9%) accounted for the highest number of spine surgeries in the urban environment of IMSSH, Owerri. Conclusion: The study revealed that spine pathologies are not uncommon in resource poor settings especially in the urban environment. There is a male preponderance for spine surgeries. Lumbar/lumbosacral spine pathologies are common in our resource poor settings but trauma related spine pathologies are more common factors for spine surgeries in rural settings. There is need to improve access to spine care in the rural environments.

Risk factors and treatment strategies for adjacent segment disease following spinal fusion (Review).

Adjacent segment disease (ASD) is a significant clinical complication following cervical and lumbar spinal fusion surgery, characterized by the degeneration of spinal segments adjacent to the fused area. The present literature review aimed to elucidate the risk factors contributing to ASD and to evaluate current and emerging treatment strategies. Epidemiological data indicate that patient‑related factors such as age, pre‑existing spinal degeneration and comorbidities, along with surgical factors including the type of fusion, instrumentation and alignment correction, play pivotal roles in ASD development. Biomechanical alterations post‑fusion further exacerbate the risk. The underlying mechanisms of ASD involve changes in spinal kinematics and disc degeneration, driven by inflammatory and degenerative processes. Diagnostic modalities, such as magnetic resonance imaging and computed tomography scans, are essential for early detection and accurate diagnosis. Preventive strategies emphasize meticulous preoperative planning, advanced surgical techniques and postoperative rehabilitation. Treatment approaches range from conservative methods such as physical therapy and pharmacological interventions to surgical solutions, including revision surgeries and the use of motion‑preserving technologies. Emerging therapies, particularly in regenerative medicine, show promise in mitigating ASD. The present review underscored the necessity of a multidisciplinary approach to optimize patient outcomes and highlighted the need for ongoing research to address gaps in the current understanding of ASD in both cervical and lumbar regions.

Mortality in patients older than 65 years undergoing surgery for degenerative lumbar spine disease: a comparison with the general population

BackgroundThe increased life expectancy and prevalence of spondylarthrosis have led to a growing frequency of spinal surgery in older people. This study aims to assess whether there is an excess mortality concerning that expected in the general population associated with surgical procedures performed in patients over 65 years old for a degenerative disease of the lumbar spine.MethodsAll patients aged 65 years or older undergoing surgery at a single center between 2009 and 2019 for lumbar spine degenerative disease were included. Standardized mortality ratios (SMRs) were estimated to compare the mortality risk with the expected in the Spanish population for the same age, gender, and calendar-period. Multivariable Cox analysis was employed to determine risk factors of mortality.ResultsA total of 411 procedures were analyzed. The mean age was 72.6 years old. SMR was 0.67 (CI 95% 0.54–0.84). That benefit was significant in women after gender stratification. Patients operated on between 65–84 years old had a lower mortality rate than that expected for the general population. For patients aged 85 or older, the observed mortality was not different from that expected in the general population. Multivariable Cox analysis observed an association between higher mortality and the variables age, male, and Charlson comorbidity index score.ConclusionsCompared with the general population, patients over 65 years old who underwent spinal surgery for degenerative disease of the lumbar spine experienced a reduction in mortality. This effect was particularly significant in women and patients aged 65–84 years. Age, male gender, and Charlson comorbidity index score were associated with higher mortality risk.Graphical

CASE SERIES: CHALLENGES AND OUTCOMES OF TLIF PROCEDURES IN A PERIPHERAL HOSPITAL IN BHARATPUR, RAJASTHAN

Objective: Chronic back pain, particularly from degenerative spinal conditions, significantly impacts patient quality of life, especially in regions with limited healthcare resources, such as rural Rajasthan. Transforaminal Lumbar Interbody Fusion (TLIF) has been recognized for its efficacy in treating severe spinal degeneration and instability. This case series examines the application of TLIF in a peripheral hospital setting, assessing its challenges and outcomes in such environments. Methods: This study included three patients aged 34 to 75, who underwent TLIF at a peripheral hospital in Bharatpur, Rajasthan, from February to July 2024. Detailed preoperative and postoperative evaluations were conducted, focusing on pain levels and functional mobility. Follow-ups were performed at the first, second, and fourth weeks post-surgery to monitor recovery and assess surgical success. Results: All patients reported significant improvements in pain and mobility by the first-month follow-up. The 34 y old female experienced complete pain relief and returned to full activities by four weeks. The 75 y old female and 65 y old male also showed considerable improvements in pain and function, with no severe complications noted during or after surgery. Conclusion: TLIF can be effectively implemented in peripheral hospital settings with outcomes comparable to those in higher-resource environments. This case series demonstrates the feasibility and significant benefits of advanced spinal surgeries in resource-limited settings, highlighting the potential for expanding such sophisticated interventions to improve healthcare accessibility and patient outcomes in rural areas.

Factors associated with favourable short-term non-operative treatment outcomes among patients with degenerative cervical spine disease at Muhimbili Orthopaedic Institute

Factors associated with favourable short-term non-operative treatment outcomes among patients with degenerative cervical spine disease at Muhimbili Orthopaedic Institute

The Effect of L5 Morphology on Prevention of L5-S1 Degeneration Following Floating Fusion for Degenerative Spine Disorders.

Retrospective Study. The selection of floating fusion or lumbosacral fusion arises when treating patients with instability or stenosis of the lower lumbar spine concomitantly radiographic degeneration of L5-S1. This study aimed to investigate the preoperative anatomical or morphological factors affecting the survivorship of the L5-S1 after floating fusion. This study included 77 patients who had undergone floating fusion surgery through the TLIF approach. Preoperative radiographic parameters were evaluated using anteroposterior and lateral lumbar spine radiographs. The patients were divided into two groups according to the Modified Pfirrmann Grading and total endplate score. Multivariable regression analysis was performed to explore the relationships between the anatomical or morphological characteristics of L5 and the degeneration of L5-S1. The disc degeneration group exhibited a smaller height ratio of the iliac crest (Hi) and a less L5 deep position. Furthermore, the right/left height of L4 (Hr/Hl) and the right/left width of transverse process of L5 (CRt/CLt) were significantly higher in the disc and endplate degeneration groups. Multiple logistic regression analysis revealed that Hi and CRt were independently associated with L5-S1 disc degeneration, whereas Hr was a significant risk factor for L5-S1 endplate degeneration. Anatomical and morphological characteristics of L5, such as smaller Hi, higher CRt and Hr, were associated with an increased risk of L5-S1 degeneration in patients after floating fusion. These findings may indicate the fusion level when addressing lower lumbar degenerative diseases and the concurrent radiographic degeneration of L5-S1.

Machine learning models for predicting dysphonia following anterior cervical discectomy and fusion: a Swedish Registry Study

BACKGROUNDDysphonia is one of the more common complications following anterior cervical discectomy and fusion (ACDF). ACDF is the gold standard for treating degenerative cervical spine disorders, and identifying high-risk patients is therefore crucial. PURPOSEThis study aimed to evaluate different machine learning models to predict persistent dysphonia after ACDF. STUDY DESIGNA retrospective review of the nationwide Swedish spine registry (Swespine). PATIENT SAMPLEAll adults in the Swespine registry who underwent elective ACDF between 2006 and 2020. OUTCOME MEASURESThe primary outcome was self-reported dysphonia lasting at least 1 month after surgery. Predictive performance was assessed using discrimination and calibration metrics. METHODSPatients with missing dysphonia data at the 1-year follow-up were excluded. Data preprocessing involved one-hot encoding categorical variables, scaling continuous variables, and imputing missing values. Four machine learning models (logistic regression, random forest (RF), gradient boosting, K-nearest neighbor) were employed. The models were trained and tested using an 80:20 data split and 5-fold cross-validation, with performance metrics guiding the selection of the best model for predicting persistent dysphonia. RESULTSIn total, 2,708 were included in the study. Twelve key predictors were identified. Four machine learning models were tested, with the RF model achieving the best performance (AUC=0.794). The most significant predictors across models included preoperative NDI, EQ5Dindex, preoperative neurology, number of operated levels, and use of a fusion cage. The RF model, chosen for its superior performance, showed high sensitivity and consistent accuracy, but a low specificity and positive predictive value. CONCLUSIONSIn this study, machine learning models were employed to identify predictors of persistent dysphonia following ACDF. Among the models tested, the RF classifier demonstrated superior performance, with an AUC value of 0.790. The RF model identified NDI, EQ5Dindex, and number of fused vertebrae as key variables. These findings underscore the potential of machine learning models in identifying patients at increased risk for dysphonia persisting for more than 1 month after surgery.

The Association between prior arthroplasty and Paraspinal Muscle Degeneration in patients undergoing elective lumbar surgery.

Spinal and lower extremity degeneration often causes pain and disability. Lower extremity osteoarthritis, eventually leading to total knee- (TKA) and -hip arthroplasty (THA), can alter posture through compensatory mechanisms, potentially causing spinal misalignment and paraspinal muscle (PM) atrophy. This study aims to evaluate the association between prior THA or TKA and PM-degeneration in patients undergoing elective lumbar surgery for degenerative conditions. A retrospective analysis of patients undergoing lumbar surgery for degenerative conditions was conducted. Patients were categorized based on prior THA, TKA, or both. Quantitative analysis of functional cross-sectional area (fCSA) and fat infiltration (FI) of psoas, multifidus (MF), and erector spinae (ES) muscles at L4-level was performed using T2-weighted MRI images. The association between the FI and fCSA of the PM and prior arthroplasty was investigated. Differences were assessed using ANOVA and multivariable linear regression. Overall, 584 patients (60% female, 64 ± 12 years) were included. 66 patients (11%) had prior TKA, 36 patients (6%) THA, and 15 patients (3%) both TKA and THA. Patients with arthroplasty were mostly female (57%) and notably older (p < 0.001). The FI of the MF and the ES was significantly higher in the arthroplasty-group (both p < 0.001). Patients with prior TKA showed significantly higher FI (Est = 4.3%, p = 0.013) and lower fCSA (Est=-0.9 cm2, p = 0.012) in the MF compared to the non-arthroplasty-group. This study demonstrates a significant lower fCSA and higher FI in the MF among individuals with prior TKA. This highlights the complex knee-spine relationship and how these structures interact with each other.

Transcranial MEPs predict clinical outcome during minimally invasive dorsal decompression for cervical spondylotic myelopathy

ObjectivesMotor evoked potential (MEP) monitoring is a reliable method for real-time assessment of corticospinal tract integrity. However, the potential benefits of MEP monitoring during degenerative spine surgery remain controversial. This study aims to determine the role of MEP monitoring during surgery for cervical spondylotic myelopathy (CSM) in prediction of prognosis. MethodsTranscranial electrical stimulation was performed to elicit MEPs during dorsal decompression for the treatment of CSM. MEP-threshold levels were assessed separately at the beginning and end of the surgery in upper extremity muscles corresponding to nerve roots at the level of/distal to the decompression site. Clinical outcome was measured using the modified Japanese Orthopedic Association score (mJOA). ResultsThe study included 47 patients. 31 patients (66 %) showed improvements in neurological function at discharge. A measurable improvement in the majority of tested muscles, or in at least one muscle group, in a given patient highly correlated with mJOA score increase at discharge (p < 0.001) with an odds ratio of 10.3 (CI:2.6–34.4) and 11.4 (CI:2.8–41.3), respectively. Conversely, MEP deterioration was not associated with worse clinical outcome, nor was it predictive of failure to recover. ConclusionMEP improvement during CSM surgery seems to be highly predictive of early postoperative neurological recovery and could indicate subclinically enhanced signal conduction. This highlights the potential of MEP monitoring as an intraoperative, real-time predictive tool for clinical recovery after decompression in patients with CSM.

Risk Factors Analysis and Nomogram Conduction for Major Adverse Events After Lumbar Fusion Surgery in Older Patients: A Prospective Cohort Study

This study aimed to identify risk factors for major adverse events (AEs) after lumbar fusion surgery in patients aged 75 and older and evaluate the role of several common geriatric comprehensive assessment items in predicting postoperative major AEs. This is a prospective cohort study of patients aged ≥75years who underwent open lumbar fusion for degenerative spine disease from August 2019 to August 2022. The primary outcome measure was the incidence of major postoperative AEs within 90days after surgery. Clavien-Dindo III-IV complications and unplanned readmission were defined as major AEs. Patients' characteristics, laboratory tests, assessment results, and surgery-related variables were compared between the major AEs and the nonmajor AEs groups. Multivariable logistic regression analysis was used to identify independent risk factors for major AEs. The logistic regression model was evaluated in another prospective cohort of patients from October 2022 to October2023. A total of 301 patients (mean [SD] age, 79.7 [3.5] years; 60.5% male) were included in the study. Five features, including female (OR 1.99, P=0.040), higher body mass index (OR 1.090, P=0.024), frailty (OR 2.043, P=0.032), hypoalbuminemia (OR 2.489, P=0.040), and higher Charlson comorbidity index (OR 1.397, P=0.024), were independently associated with major AEs and were selected to develop a predictive nomogram of major AEs. The area under the curve values for the development set and validation set were 0.75 and 0.71, respectively. Preoperative frailty, hypoalbuminemia, female sex, greater body mass index, and higher Charlson comorbidity index grade were risk factors for 90-day major AEs after lumbar fusion surgery in older patients. The predictive nomogram that we developed using this data can enhance preoperative risk counseling and optimization for older patients.

Early NRS Leg and Back Thresholds Predict Clinical Recovery after MIS Transforaminal Lumbar Interbody Fusion for Degenerative Spine Disease.

This retrospective study included patients who underwent primary one-level minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spine conditions. To identify early predictors of failing to achieve the Oswestry Disability Index (ODI) minimum clinically important difference (MCID) one-year post-surgery. Early identification of patients at risk of failing to achieve ODI-MCID is crucial for early intervention and improved postoperative counseling. Currently, no specific thresholds guide patient follow-up for optimal recovery. The assessment included demographic information, surgical details, and patient-reported outcome measures (PROMs). PROMs were collected postoperatively at 2-, 6-, and 12-week time points, as well as at 6- and 12-months. The study included 166 patients, with 34% failing to achieve ODI-MCID at one year. Early VAS back and leg scores were found to be significant predictors of ODI-MCID achievement. The optimal thresholds identified were 2.25 for early VAS back and 4.25 for early VAS leg. A rerun regression identified the thresholds as independent predictors of ODI-MCID, with odds ratios of 0.31 for both measures. VAS back and leg score thresholds at 6-12 weeks can predict ODI-MCID achievement one year after MIS TLIF. Patients exceeding the identified thresholds may be at risk of failing ODI-MCID and should be monitored closely. Level 3.

Effect of cannabis use history on postoperative opioid utilization in lumbar fusion patients: an American retrospective study.

A retrospective cohort study. To examine the effect of cannabis use history on postoperative opioid utilization in patients undergoing one- to three-level lumbar fusion for degenerative spine disease. Strategies to minimize dosing and chronic opioid use are needed for spine surgery given their widespread prescription for postsurgical pain management. In this database study, medical coding was used to identify patients who had undergone one- to three-level lumbar fusions between 2012 and 2021. Propensity score matching was used to create two equal cohorts with respect to cannabis use history. Opioid utilization rates (morphine milligram equivalents [MME]/day) and overuse rates at 6 months post-index procedure were assessed. All pvalues <0.05 were considered statistically significant. Following examination of 153,500 patient records, 1,216 patients were matched into cannabis user and non-cannabis user cohorts. Cannabis users had lower rates of opioid utilization compared to non-cannabis users as early as 2 months after fusion (47.7% vs. 41.1%, p <0.05), a relationship which persisted at 6 months (46.2% vs. 37.7%, p <0.01). Additionally, cannabis users had lower rates of high-dose opioid utilization (≥100 MME per day) during the initial 14-30 days following surgery (6.91% vs. 3.79%, p <0.05). Patients with a history of cannabis use were less likely to be using opioids as early as 2 months postoperatively and had lower rates of high-dose opioid utilization in the immediate postoperative period. Physicians operating on these patients should consider their cannabis use patterns to provide appropriate titration of pain medication over time.

Impact of an In-Hospital postoperative imaging after uncomplicated elective posterior lumbar fixation: A case series

Purpose: Following spinal fixation, postoperative imaging is routinely performed. The value of routine postoperative imaging and its impact on the surgical decision remains uncertain, especially in degenerative cases. Moreover, routine postoperative imaging is not free and is an ionizing radiation. This study investigated the value of postoperative imaging after uneventful uncomplicated elective posterior lumbar fixation. Methods: This case series retrospectively reviewed the medical records of patients who underwent elective posterior lumbar fixation surgeries at our institution within two years. A series of 98 cases met our selection criteria. Their mean age was 51.2 years. We reviewed the decisions taken after performing the routine postoperative images. We searched for further diagnostic or imaging studies, revision surgery, or an extended hospital stay. Results: We found no particular decision was made after performing the postoperative imaging after uneventful uncomplicated elective posterior lumbar fixation surgeries. Moreover, there was no change in the hospital stay or the regular postoperative clinical management for all the included patients. No revision surgery was required based on the postoperative routine images. Conclusions: We found that routine postoperative imaging after posterior fixation of a degenerative lumbar spine is of limited value. A randomized, controlled study is helpful to confirm this finding.

Minimally Invasive Spine Surgery for Lumbar Decompression or Disc Herniation

ABSTRACTMany people experience low back pain caused by degenerative disease of the lumbar spine; this includes spinal stenosis, spondylolisthesis, disc degeneration, and disc herniation. Conservative management of degenerative disease, which includes physical therapy, lifestyle modifications, and medications, is the initial approach. If this approach fails, a surgical procedure may be the next step. Previously, open lumbar surgery would have been the planned procedure; today, minimally invasive spine surgery gives patients another choice. Perioperative nurses should understand how minimally invasive spine surgery differs from the open procedure, the steps involved during a minimally invasive procedure, the benefits of this type of procedure, and nursing considerations for patients undergoing minimally invasive spinal procedures.

EVALUATING THE EFFICACY OF MUSCLE STIMULATION IN THE MANAGEMENT OF DEGENERATIVE-DYSTROPHIC CHANGES IN THE CERVICAL SPINE

Degenerative-dystrophic changes in the cervical spine are a common cause of chronic pain and functional impairment, affecting millions of individuals globally. These conditions often result in reduced mobility, muscle atrophy, and declining quality of life. In recent years, muscle stimulation has emerged as a promising adjunctive therapy to improve muscle function and alleviate symptoms. This study evaluates the effectiveness of muscle stimulator application during treating patients with dystrophic-degenerative changes in the cervical spine. A cohort of 10 patients, aged 40-50, diagnosed with cervical degenerative conditions, participated in this randomized controlled trial. Participants were divided into two groups: one receiving conventional physical therapy alone and the other receiving combined therapy using a muscle stimulator targeting the cervical musculature. Over a 12-week intervention period, both groups were assessed using the Visual Analog Scale (VAS) for pain, the Neck Disability Index (NDI), and electromyography (EMG) to measure muscle activity. These findings suggest that muscle stimulator application is a valuable adjunct to conventional therapies, offering a non-invasive and effective means of managing dystrophic-degenerative changes in the cervical spine. Future research should explore the long-term benefits of this intervention and its potential to prevent the progression of cervical spine degeneration.