Treatment Of Spinal Disorders Research Articles

Progress of Clinical Research on the Treatment of Spinal Disorders by the Tongdu Method

Progress of Clinical Research on the Treatment of Spinal Disorders by the Tongdu Method

A Bibliometric Analysis of Artificial Intelligence Applications in Spine Care.

With the rapid development of science and technology, artificial intelligence (AI) has been widely used in the diagnosis and prognosis of various spine diseases. It has been proved that AI has a broad prospect in accurate diagnosis and treatment of spine disorders. On May 7, 2022, the Web of Science (WOS) Core Collection database was used to identify the documents on the application of AI in the field of spine care. HistCite and VOSviewer were used for citation analysis and visualization mapping. A total of 693 documents were included in the final analysis. The most prolific authors were Karhade A.V. and Schwab J.H. United States was the most productive country. The leading journal was Spine. The most frequently used keyword was spinal. The most prolific institution was Northwestern University in Illinois, USA. Network visualization map showed that United States was the largest network of international cooperation. The keyword "machine learning" had the strongest total link strengths (TLS) and largest number of occurrences. The latest trends suggest that AI for the diagnosis of spine diseases may receive widespread attention in the future. AI has a wide range of application in the field of spine care, and an increasing number of scholars are committed to research on the use of AI in the field of spine care. Bibliometric analysis in the field of AI and spine provides an overall perspective, and the appreciation and research of these influential publications are useful for future research.

Retrospective single-surgeon study of prone versus lateral robotic pedicle screw placement: a CT-based assessment of accuracy.

Lateral lumbar interbody fusion including anterior-to-psoas oblique lumbar interbody fusion has conventionally relied on pedicle screw placement (PSP) for construct stabilization. Single-position surgery with lumbar interbody fusion in the lateral decubitus position with concomitant PSP has been associated with increased operative efficiency. What remains unclear is the accuracy of PSP with robotic guidance when compared with the more familiar prone patient positioning. The present study aimed to compare robot-assisted screw placement accuracy between patients with instrumentation placed in the prone and lateral positions. The authors identified all consecutive patients treated with interbody fusion and PSP in the prone or lateral position by a single surgeon between January 2019 and October 2022. All pedicle screws placed were analyzed using CT scans to determine appropriate positioning according to the Gertzbein-Robbins classification grading system (grade C or worse was considered as a radiographically significant breach). Multivariate logistic regression models were constructed to identify risk factors for the occurrence of a radiographically significant breach. Eighty-nine consecutive patients (690 screws) were included, of whom 46 (477 screws) were treated in the prone position and 43 (213 screws) in the lateral decubitus position. There were fewer breaches in the prone (n = 13, 2.7%) than the lateral decubitus (n = 15, 7.0%) group (p = 0.012). Nine (1.9%) radiographically significant breaches occurred in the prone group compared with 10 (4.7%) in the lateral decubitus group (p = 0.019), for a prone versus lateral decubitus PSP accuracy rate of 98.1% versus 95.3%. There were no significant differences in BMI between prone versus lateral decubitus cohorts (30.1 vs 29.6) or patients with screw breach versus those without (31.2 vs 29.5). In multivariate models, the prone position was the only significant protective factor for screw accuracy; no other significant risk factors for screw breach were identified. The present data suggest that pedicle screws placed with robotic assistance have higher placement accuracy in the prone position. Further studies will be needed to validate the accuracy of PSP in the lateral position as single-position surgery becomes more commonplace in the treatment of spinal disorders.

Background, techniques, applications, current trends, and future directions of minimally invasive endoscopic spine surgery: A review of literature.

Across many of the surgical specialties, the use of minimally invasive techniques that utilize indirect visualization has been increasingly replacing traditional techniques which utilize direct visualization. Arthroscopic surgery of the appendicular skeleton has evolved dramatically and become an integral part of musculoskeletal surgery over the last several decades, allowing surgeons to achieve similar or better outcomes, while reducing cost and recovery time. However, to date, the axial skeleton, with its close proximity to critical neural and vascular structures, has not adopted endoscopic techniques at as rapid of a rate. Over the past decade, increased patient demand for less invasive spine surgery combined with surgeon desire to meet these demands has driven significant evolution and innovation in endoscopic spine surgery. In addition, there has been an enormous advancement in technologies that assist in navigation and automation that help surgeons circumvent limitations of direct visualization inherent to less invasive techniques. There are currently a multitude of endoscopic techniques and approaches that can be utilized in the treatment of spine disorders, many of which are evolving rapidly. Here we present a review of the field of endoscopic spine surgery, including the background, techniques, applications, current trends, and future directions, to help providers gain a better understanding of this growing modality in spine surgery.

The value of magnetic resonance imaging and computed tomography in the study of spinal disorders.

Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders.

Commentary: Machine Learning Applications of Surgical Imaging for the Diagnosis and Treatment of Spine Disorders: Current State of the Art.

Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA Correspondence: Khoi D. Than, MD, Department of Neurosurgery, Duke University Medical Center, 200 Trent Drive, Durham, NC27701, USA. Email: [email protected]

Analyzing the Impact of Cannabinoids on the Treatment of Spinal Disorders.

Cannabis is among the most used illicit substances globally, with medical applications, increased legalization, and shifting social attitudes leading to increased use in recent years. Cannabinoids are a group of psychoactive substances found within the cannabis plant, with the most common being Δ9-tetrahydrocannabinol and cannabidiol. Due to the high prevalence of use, it is increasingly important to evaluate the effects of cannabis and cannabinoids on spine patients, in both operative and nonoperative settings. Cannabis and cannabinoids may be effective in treating patients with chronic conditions such as back pain and spinal cord injuries. Longitudinal effects and implications on surgical outcomes and complications are poorly understood. High-quality, outcomes-focused research can inform approaches for clinicians to approach cannabis and cannabinoid use. Studies to elucidate the standardization of cannabis regimens can help develop guidelines for potential therapeutic applications. Cannabis and cannabinoids may be useful alternatives or additions for many spine patients, but future research is needed for recommendations to be determined. Our manuscript reviews the available literature regarding cannabis use and various spinal conditions, organizing our findings into the following narrative themes: (1) the management of chronic lower back pain, (2) perioperative outcomes, (3) cannabis use in general orthopaedic procedures, and (4) spinal cord injuries.

Machine Learning Applications of Surgical Imaging for the Diagnosis and Treatment of Spine Disorders: Current State of the Art.

Recent developments in machine learning (ML) methods demonstrate unparalleled potential for application in the spine. The ability for ML to provide diagnostic faculty, produce novel insights from existing capabilities, and augment or accelerate elements of surgical planning and decision making at levels equivalent or superior to humans will tremendously benefit spine surgeons and patients alike. In this review, we aim to provide a clinically relevant outline of ML-based technology in the contexts of spinal deformity, degeneration, and trauma, as well as an overview of commercial-level and precommercial-level surgical assist systems and decisional support tools. Furthermore, we briefly discuss potential applications of generative networks before highlighting some of the limitations of ML applications. We conclude that ML in spine imaging represents a significant addition to the neurosurgeon's armamentarium-it has the capacity to directly address and manifest clinical needs and improve diagnostic and procedural quality and safety-but is yet subject to challenges that must be addressed before widespread implementation.

Introduction. Biologics in spine surgery.

In this issue, we explore the role of biologics in spinal fusion. The treatment of spinal disorders has been revolutionized over the last 25 years with the introduction of biologics to enhance bone density in preparation for surgery and to promote bony arthrodesis in spinal fusion surgery. The use of these products has become even more important in the era of minimally invasive spinal surgery, where bone graft surface area for fusion is at a premium.Use of osteobiologics for bone fusion is known to promote migration, differentiation, cellular division, or replacement of bone-forming cells, ultimately resulting in

Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain

AbstractTogether, neck pain and back pain are the first cause of disability worldwide, accounting for more than 10% of the total years lived with disability. In this context, chiropractic care provides a safe and effective option for the management of a large proportion of these patients. Chiropractic is a healthcare profession mainly focused on the spine and the treatment of spinal disorders, including spine pain. Basic studies have examined the influence of chiropractic spinal manipulation (SM) on a variety of peripheral, spinal and supraspinal mechanisms involved in spine pain. While spinal cord mechanisms of pain inhibition contribute at least partly to the pain‐relieving effects of chiropractic treatments, the evidence is weaker regarding peripheral and supraspinal mechanisms, which are important components of acute and chronic pain. This narrative review highlights the most relevant mechanisms of pain relief by SM and provides a perspective for future research on SM and spine pain, including the validation of placebo interventions that control for placebo effects and other non‐specific effects that may be induced by SM.SignificanceSpinal manipulation inhibits back and neck pain partly through spinal segmental mechanisms and potentially through peripheral mechanisms regulating inflammatory responses. Other mechanisms remain to be clarified. Controls and placebo interventions need to be improved in order to clarify the contribution of specific and non‐specific effects to pain relief by spinal manipulative therapy.

The Efficacy of Telehealth for the Treatment of Spinal Disorders: Patient-Reported Experiences During the COVID-19 Pandemic.

BackgroundThe use of telehealth saw a rapid surge during the early months of the COVID-19 pandemic. There remains little data on how effectively telehealth replicates traditional office visits in the treatment of spinal disorders and how telehealth is perceived by patients with spinal disorders.Questions/PurposesWe sought to evaluate patient satisfaction with telehealth visits as a platform for delivering care for the treatment of spinal pathology.MethodsPatients undergoing a telehealth visit with providers specializing in the treatment of spinal disorders (one surgeon and two physiatrists) were provided with an anonymous, online survey. Data on patient satisfaction, effectiveness of the telehealth visit (in comparison with in-person visits), and clarity of communication were collected through 5-point Likert scales; visit characteristics and free-text responses were also collected.ResultsEighty-four patients responded to the survey. Their attitudes were largely positive, with an overall mean patient satisfaction score of 4.79. Patients gave high scores for clarity of communication during the visit, and for satisfaction with the formulation of treatment plans and their ability to ask questions, they gave the lowest scores to the effectiveness of telemedicine in replacing an in-person visit and ease of interface navigation.ConclusionsThe high overall patient satisfaction reported by our patients seeking care for a spinal pathology supports the growing body of evidence promoting the use of telehealth for orthopedic care. Further research is needed in a standardized telehealth examination of patients with spinal disorders.Electronic supplementary materialThe online version of this article (10.1007/s11420-020-09808-x) contains supplementary material, which is available to authorized users.

Evaluation of the Results of Rehabilitation of Chronic Low Back Pain Syndrome in Physically Active and Inactive Patients During Leisure Time

Introduction: Movement is one of the main, modifiable factors (behaviour-dependent) that affects the health and quality of life of individuals and the entire population. Physical activity, including evidence-based active rehabilitation, is the subject of many studies on the prevention and treatment of spinal disorders, which are some of the most serious health problems. The largest group of people with spinal disorders are patients suffering from Nonspecific Low Back Pain (ang. Nonspecific Low Back Pain – NLBP), with kinesitherapy having the widest application in the chronic pain phase. A significant part of the research is devoted to the problem of movement in patients with chronic non-specific low back pain (CNLBP). One physiotherapy treatment method used in chronic low back pain syndrome is the DBC method. It is based on a detailed functional diagnosis, answers given to a standardized questionnaire, individualized treatment plans and active exercises with spinal resistance using specialized DBC equipment. Aim: The aim of this study was to evaluate the influence of leisure-time physical activity on the results of the DBC functional restoration program in patients with chronic, non-specific, low back pain after outpatient rehabilitation. The researchers tested the hypothesis that patients with regular physical activity attained better results of functional restoration compared to physically inactive participants. M aterials and Methods: The research group was comprised of one-hundred forty-seven participants. All subjects suffered from low back pain syndrome lasting for a period of at least three months without neurological symptoms. All symptoms were non-specific. The subjects were divided into two groups. Group 1 was comprised of participants who undertake regular physical activity for more than 45-minutes per exercise session, at least twice a week. Participants in Group 2 did not undertake any physical activity other than that resulting from everyday activities. The study commenced with an interview and standardized DBC questionnaire to get participants’ subjective assessment of the following parameters: current level of pain, functional limitations and scale of depression. A clinical trial was conducted prior to the measurement of objective parameters in order to exclude radicular pain (Lasegue test). Next, the objective parameters were measured: bioelectric activity of the lumbar erector spinae muscles (ang. surfasce electromyography – sEMG) on the right and left side in two positions: standing upright and leaning forward with straight legs. Also, DBC devices were used to measure the following range of motion of the lumbo-thoracic spine: flexion, extension, rotation and lateral flexion/bending. Upon completing the tests (Test 1) both groups were subject to active DBC therapeutic treatment. The therapy consisted of 12 meetings carried out within a 6 week period. Each session lasted for 1.5 hours. When the treatments ended testing was repeated for each group (Test 2). Results: Mean values of functional parameters of the lumbar spine were calculated for both groups. Statistical significance was determined between the preliminary (Test 1) and final (Test 2) tests. All the objective parameters in Group 1 showed statistically significant improvement post-therapy. Different results were observed in Group 2 for participants who did not perform regular physical activity. Although all parameters improved, only some achieved statistical significance. Significance between the two groups was also studied at the beginning of the experiment (Test 1) and after its completion (Test 2). There results showed no statistically significant difference in values of some objective parameters prior to the treatment, while some parameters differed. The treatment achieved a statistically significant improvement in the “active” group compared to the “inactive” one in almost every tested parameter excluding the extension. Significant differences between the groups were observed in the subjective parameters such as: functional limitations (ADL) (ang. Activity of Daily Living – ADL) and level of depression both in the first and last tests. Conclusions: Patients with chronic non-specific low back pain syndrome who remain physically active in leisure time and participated in the 6-week DBC rehabilitation program achieved a statistically significant improvement in the functional parameters of the spine. Patients with chronic non-specific low back pain syndrome who remain physically active in leisure time and participated in the 6-week DBC rehabilitation program improved more in the objective and subjective functional parameters of the spine in comparison with the inactive participants. Active leisure time contributes to the efficacy of physiotherapy for people with low back disorders.

History and advances in spinal neurosurgery.

Insight into the historic contributions made to modern-day spine surgery provides context for understanding the monumental accomplishments comprising current techniques, technology, and clinical success. Only during the last century did surgical growth occur in the treatment of spinal disorders. With that growth came a renaissance of innovation, particularly with the evolution of spinal instrumentation and fixation techniques. In this article, the authors capture some of the key milestones that have led to the field of spine surgery today, with an emphasis on the historical advances related to instrumentation, navigation, minimally invasive surgery, robotics, and neurosurgical training.

Repeat Radiography in Monitoring Structural Changes in the Treatment of Spinal Disorders in Chiropractic and Manual Medicine Practice: Evidence and Safety.

There is substantial evidence for normal relationships between spine and postural parameters, as measured from radiographs of standing patients. Sagittal balance, cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic tilt, and the more complex understanding of the interrelations between these essential components of normal stance have evolved to where there are known, established thresholds for normalcy. These spinal parameters are reliably measured from X-ray images and serve as goals of care in the treatment of spine and postural disorders. Initial and follow-up spinal imaging by X-ray is thus crucial for the practice of contemporary and evidence-based structural rehabilitation. Recent studies have demonstrated that improvement in the spine and posture by nonsurgical methods offers superior long-term patient outcomes versus conventional methods that only temporarily treat pain/dysfunction. Low-dose radiation from repeated X-ray imaging in treating subluxated patients is substantially below the known threshold for harm and is within background radiation exposures. Since alternative imaging methods are not clinically practical at this time, plain radiography remains the standard for spinal imaging. It is safe when used in a repeated fashion for quantifying pre–post spine and postural subluxation and deformity patterns in the practice of structural correction methods by chiropractic and other manual medicine practices.

High Intensity Laser Therapy for Treatment of Spinal Disorders

High Intensity Laser Therapy for Treatment of Spinal Disorders

304. Disturbed sleep is associated with worse health outcomes after spine surgery

BACKGROUND CONTEXT Sleep hygiene is an important and essential component of wellbeing; however, little is known regarding the association between sleep disturbance and health-related quality of life (HRQL) in patients undergoing spine surgery. PURPOSE The purpose of this study is determine the association between sleep disturbance and other HRQL measures in patients undergoing spine surgery. We hypothesize that sleep disturbance is significantly correlated with HRQL in patients undergoing surgical treatment of cervical and lumbar spinal disorders, and that patients with preoperative sleep disturbance have significant improvement in sleep postoperatively. STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE A total of 583 spine surgery patients (cervical, lumbar and spinal deformity) with postoperative followup PROMIS scores. OUTCOME MEASURES Improvement in HRQL domains. Including PROMIS pain, fatigue, anxiety, depression, physical function, social satisfaction, Short Form -12 (SF12) and ODI scores. METHODS Spine surgery patients completed the Oswestry Disability Index (ODI), Short Form-12 (SF12) mental (MCS) health and PROMIS sleep, fatigue, physical function, anxiety, depression and social satisfaction domains at preop and 6-week postoperative visit. Pearson correlation was used to assess for correlation between sleep and HRQL measures, significance was set at p RESULTS In 583 patients (mean age 60 years, 55% female) sleep disturbance was prevalent in 177 (30%) and 94 (16%) patients preoperatively and 6 weeks following surgery, respectively. Sleep disturbance was most significantly correlated with MCS and ODI disability scores (r= - 0.485 and 0.405, respectively), p CONCLUSIONS Preoperative sleep disturbance in patients undergoing surgical treatment of spinal disorders is significantly correlated with several established HRQL measurement instruments. Moreover, improvement in sleep disturbance is also a significant predictor of improvement in postop pain, fatigue, depression, anxiety, physical function, social satisfaction and ODI scores. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Biomechanical analysis of spinal implants with different rod diameters under static and fatigue loads: an experimental study

Spinal implants are commonly used in the treatment of spinal disorders or injuries. However, the biomechanical analyses of them are rarely investigated in terms of both biomechanical and clinical perspectives. Therefore, the main purpose of this study is to investigate the effects of rod diameter on the biomechanical behavior of spinal implants and to make a comparison among them. For this purpose, three spinal implants composed of pedicle screws, setscrews and rods, which were manufactured from Ti6Al4V, with diameters of 5.5 mm, 6 mm and 6.35 mm were used and a bilateral vertebrectomy model was applied to spinal systems. Then, the obtained spinal systems were tested under static tension-compression and fatigue (dynamic compression) conditions. Also, failure analyses were performed to investigate the fatigue behavior of spinal implants. After static tension-compression and fatigue tests, it was found that the yield loads, stiffness values, load carrying capacities and fatigue performances of spinal implants enhanced with increasing spinal rod diameter. In comparison to spinal implants with 5.5 mm rods, the fatigue limits of implants showed 13% and 33% improvements in spinal implants having 6 mm and 6.35 mm rods, respectively. The highest static and fatigue test results were obtained from spinal implants having 6.35 mm rods among the tested implants. Also, it was observed that the increasing yield load and stiffness values caused an increase in the fatigue limits of spinal implants.

Optogenetics of the Spinal Cord: Use of Channelrhodopsin Proteins for Interrogation of Spinal Cord Circuits.

Spinal cord circuits play a key role in receiving and transmitting somatosensory information from the body and the brain. They also contribute to the timing and coordination of complex patterns of movement. Under disease conditions, such as spinal cord injury and neuropathic pain, spinal cord circuits receive pain signals from peripheral nerves, and are involved in pain development via neurotransmitters and inflammatory mediators released from neurons and glial cells. Despite the importance of spinal cord circuits in sensory and motor functions, many questions remain regarding the relationship between activation of specific cells and behavioral responses. Optogenetics offers the possibility of understanding the complex cellular activity and mechanisms of spinal cord circuits, as well as having therapeutic potential for addressing spinal cord-related disorders. In this review, we discuss recent findings in optogenetic research employing the channelrhodopsin protein to assess the function of specific neurons and glia in spinal cord circuits ex vivo and in vivo. We also explore the possibilities and challenges of employing optogenetics technology in future therapeutic strategies for the treatment of spinal disorders.

Healthcare burden of osteoporosis

Osteoporosis is responsible for a global medical and economic burden that will grow as the elderly population doubles over the next 20 years. Measuring the cost of the effects of osteoporosis on treatment of spinal disorders is important as we prioritize distribution of resources in the healthcare community. This article examines the monetary cost of osteoporotic disorders associated with spinal care, specifically compression fractures, complications of spinal fusions, and medical treatment of osteoporosis. Examining these costs will allow us to focus further research into the primary cost drivers associated with osteoporosis.

Efficacy of pregabalin in patients with sciatica: a randomized, double-blind, placebo controlled trial

Lumbar spinal disorders such as lumbar disc herniation or lumbar spinal stenosis are a cause of sciatica with or without low back pain (LBP). The natural course, typical age, and efficacy of non-surgical treatments for each disorder are different, and the evidence of pharmacological treatment for spinal disorders remains insufficient. Pregabalin is one of the first-line drugs for pharmacotherapy of neuropathic pain (1).