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
-
En-bloc spondylectomy in the lumbar spine is a challenging procedure mainly due to a complex prevertebral anatomy. The aim of our study is to describe the anatomy of the diaphragmatic crura and surrounding vascular and neural structures which may be iatrogenically injured during the surgical resection. ⋯ The L3 level appears to be the riskiest for spondylectomy due to the overlap of both diaphragmatic crura with the thoracic duct and cisterna chyli, respectively. Spondylectomy at the L2 level also brings the risk of lymphatic structures injury while injury to the left sympathetic trunk may be the main issue at the L1 level.
-
A biopsychosocial assessment of a person with low back pain (LBP) should include the detection of psychological risk factors. Pragmatically, clinicians often use their clinical impression rather than questionnaires to screen for psychological risk factors. This scoping review explores how accurately depression, anxiety, and psychological distress can be identified by musculoskeletal (MSK) or spinal clinicians using clinical impression alone. ⋯ Overall, clinician impression alone is insufficient for MSK and spinal clinicians to accurately identify depression, anxiety and psychological distress in adults with LBP. The general tendency of the clinicians was to underestimate their presence. Without formal assessment of the psychological status of patients with LBP, clinicians will have an incomplete understanding of concordant psychological factors, and may fail to notice the requirement to refer on for appropriate psychological management.
-
Prehabilitation before spinal surgery may enhance patients' ability to withstand physical and mental stress during the perioperative period. It has the potential to reduce complications, accelerate recovery, and deliver sustainable, patient-relevant improvements. However, high-quality evidence remains limited, and it is unclear which prehabilitation concepts, training protocols, and outcomes are most effective for different patient groups. ⋯ Based on the current evidence, preparation for spinal surgery is recommended, provided that it is individualized, multimodal, and interdisciplinary, and addresses patients' specific impairments, resources, and expectations. Future research should focus on identifying subgroups defined by biopsychosocial risk factors that may influence short- and long-term perioperative outcomes.
-
Sacropelvic fixation plays a crucial role in complex spinal surgeries, particularly in adult spinal deformity (ASD) and other conditions requiring lumbosacral stabilization. This systematic review and meta-analysis aims to compare the rates of symptomatic screw prominence and screw removal between S2-alar-iliac (S2AI) and iliac screws, as well as those examining each screw type independently, to provide a comprehensive understanding and guide surgical decision-making and improve patient outcomes. ⋯ S2AI screws demonstrate significantly lower rates of symptomatic prominence and screw removal compared to iliac screws, supporting their clinical and economic advantages in sacropelvic fixation for ASD. Technological advancements and innovations in implant design further enhance the efficacy of S2AI screws. These findings advocate for their adoption as an effective fixation technique, reducing hardware complications and improving patient outcomes. Future studies will aim to explore factors influencing prominence risk and optimize surgical strategies in ASD treatment.
-
Intervertebral disc degeneration (IVD) is a leading cause of low back pain, a prevalent musculoskeletal condition. IVD degeneration is characterized by the degradation of nucleus pulposus (NP), annulus fibrosus (AF), and cartilage endplates (EP). Growth Differentiation Factor 6 (GDF6), part of the bone morphogenetic protein family, has demonstrated potential in maintaining disc integrity. However, its precise role in cellular protein synthesis during IVD degeneration remains unclear. ⋯ GDF6 exerts compartment-specific effects on protein synthesis in degenerated IVDs, promoting ECM stability, reducing fibrosis, and potentially preserving hydration. These findings support the potential of GDF6 as a therapeutic agent in treating IVD degeneration, particularly in NP-targeted therapies. Future studies should optimize GDF6 dosing and delivery to maximize its regenerative potential.