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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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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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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This study aimed to evaluate the clinical and radiological outcomes of two patient groups with congenital kyphosis and kyphoscoliosis who underwent posterior surgical correction using Schwab grade 3-4 and Schwab grade 5-6 osteotomies. ⋯ Posterior surgical correction using Schwab grade 3-4 and Schwab grade 5-6 osteotomies yields satisfactory radiological and clinical outcomes in patients with congenital kyphosis and kyphoscoliosis. However, higher osteotomy grades, necessitated by greater deformity severity, are associated with increased complication rates.
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During full flexion of the spine, the paraspinal muscles are largely inactive. This suggests that passive structures like the posterior osteoligamentous complex (POLC), consisting of interspinous and supraspinous ligaments and the spinous processes, play a key role in spinal stability and protection of the spinal column. The POLC, however, is often resected or damaged during spinal decompression surgeries, whereas the biomechanical implications of this resection or damage are not yet fully understood. ⋯ The experiment indicates that the POLC is the primary passive stabilizer of the fully flexed lumbar spine. Surgical resection of this structure can redistribute loads and increase stresses on remaining spinal tissues, potentially leading to spinal instability, accelerated degeneration, and poor clinical long-term outcomes.
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This study aimed to evaluate the applicability and technical feasibility of magnetic resonance imaging (MRI) and ultrasonography (US) fusion-guided transforaminal epidural steroid injection (TFESI) in patients with lumbar disc herniation (LDH) leading to radiculopathy, who are unresponsive to conservative treatment. ⋯ MRI-US fusion-guided TFESI is a feasible and safe technique with a high success rate and low radiation exposure in patients with LDH-induced radiculopathy. Younger age, lower BMI, shorter fluoroscopy duration, and lower radiation dose are significant predictors of procedural success. This technique may enhance spatial orientation during the procedure, potentially improving outcomes particularly in younger patients with lower BMI.