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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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.
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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.
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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.
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For cases of multilevel lumbar disc herniation (LDH), selecting the surgical approach for Percutaneous Transforaminal Endoscopic Discectomy (PTED) presents significant challenges and heavily relies on the physician's judgment. This study aims to develop a deep learning (DL)-based multimodal model that provides objective and referenceable support by comprehensively analyzing imaging and clinical data to assist physicians. ⋯ The multimodal model demonstrated excellent performance in predicting PTED target segments and approach directions. Its predictive performance surpassed that of the individual DL and ML models.
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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.