To compare the safety and efficacy of unilateral biportal endoscopic lumbar discectomy (UBE) and uniportal non-coaxial spinal endoscopic surgery (UNSES) in patients with far-lateral lumbar disc herniation (FLLDH) involving the foraminal region. This retrospective study enrolled 102 patients with foraminal-region FLLDH who were treated between January 2022 and October 2024. Among them, 43 patients underwent UNSES and 59 underwent UBE. Perioperative variables were recorded. Back and leg pain visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, Japanese Orthopaedic Association (JOA) scores, and modified Macnab outcomes were compared between groups preoperatively and at each postoperative follow-up. Preoperative and postoperative day 1 computed tomography images were analyzed to assess changes in foraminal area. All procedures were completed successfully. Baseline characteristics did not differ significantly between the two groups. Operative time was significantly shorter in the UNSES group than in the UBE group (P < 0.001). In both groups, VAS scores for back and leg pain and ODI scores improved significantly from baseline at all postoperative follow-up time points (all P < 0.05). However, these outcomes did not differ significantly between the groups at any postoperative follow-up time point.On postoperative day 3, the JOA score was significantly higher in the UNSES group than in the UBE group (P = 0.031). JOA scores did not differ significantly between the groups at 3, 6, or 12 months after surgery. Imaging analysis showed that the foraminal area increased postoperatively in both groups. On postoperative day 1, the foraminal area was significantly greater in the UNSES group than in the UBE group (P = 0.017). Surgical-site infection occurred in one patient in the UBE group and two patients in the UNSES group. Neurologic symptoms or signs were observed in four patients in the UBE group and three patients in the UNSES group. These manifestations gradually resolved during follow-up after symptomatic treatment. Recurrence was observed in one patient in the UBE group and two patients in the UNSES group. At the final follow-up, clinical outcomes assessed using the modified Macnab criteria did not differ significantly between the groups. Both UNSES and UBE resulted in significant pain relief and functional improvement in patients with foraminal-region FLLDH. Compared with UBE, UNSES was associated with shorter operative time and greater foraminal enlargement. However, long-term clinical outcomes were comparable between the two techniques.
Artificial intelligence (AI) is increasingly transforming spine care by enabling analysis of imaging, clinical, and textual data to support diagnosis, risk stratification, and treatment planning. Techniques including deep learning–based image analysis, radiomics, and natural language processing (NLP) offer opportunities to standardize interpretation and derive quantitative biomarkers beyond human visual assessment. This narrative review examines recent innovations in spine-focused biomedical informatics and evaluates their clinical relevance and translational challenges. A narrative review was conducted, focusing on AI in spine care across imaging, radiomics, NLP of electronic health records, and clinical decision support. Literature was selected via targeted PubMed searches; studies describing technical development, validation, and clinical implementation were synthesized, addressing explainability, uncertainty, workflow, and regulation. Convolutional neural networks enable vertebral and disc segmentation, detection of degenerative and traumatic pathology, and quantitative assessment of paraspinal musculature. Radiomics approaches extract high-dimensional imaging features that improve the prediction of osteoporosis, fracture risk, tumor characterization, and surgical outcomes. NLP techniques, including emerging large language models, unlock clinically relevant information from unstructured text, enhancing outcome prediction and population-level analyses. Multimodal clinical decision support systems integrating imaging, EHR data, and NLP-derived features demonstrate promise for personalized risk assessment and treatment guidance. Challenges remain regarding data heterogeneity, generalizability, privacy, and prospective validation. AI-driven biomedical informatics holds substantial promise to enhance diagnostic accuracy, prognostication, and personalized decision-making in spine care. Successful clinical translation will require robust validation, explainable, uncertainty-aware models, regulatory alignment, and integration into clinical workflows to ensure safe, trustworthy, and patient-centered adoption.
To assess whether ultrasound-estimated connective tissue proportion in the human lumbar multifidus muscle is changed by restorative neurostimulation, and whether changes are associated with clinical outcomes. Fifty individuals with mechanical chronic low back pain (cLBP) who were scheduled to receive a neurostimulation device to evoke contraction of the multifidus muscle via stimulation of the medial branch of the dorsal ramus at L2 were invited to participate. Connective tissue features of the multifidus and muscle cross-sectional area were extracted from transverse B-mode ultrasound images made bilaterally from L1 to S1. Measurements were made prior to implantation of the neurostimulator and at 6-months post-implantation. Self-reported back pain (numeric rating scale [NRS]), disability (Oswestry disability index [ODI]), and quality of life (EuroQol quality-of-life survey [EQ-5D-5L]) were recorded. Complete data were available for 45 participants. Errors in data collection precluded analysis of the remaining 5 participants. The relative proportion of connective tissue within the multifidus was lower by 6.0(13.5)
Severe spinal deformity correction is associated with substantial perioperative blood loss. Evidence on pre-closure intraoperative fibrinogen administration in this setting remains limited. This study evaluated whether pre-closure intraoperative fibrinogen administration was associated with more favorable early postoperative hemostasis-related parameters. This single-center retrospective study included 50 patients with severe spinal deformity who underwent head-pelvic ring traction followed by corrective surgery. Patients were classified into a fibrinogen group and a non-fibrinogen group according to whether they received pre-closure intraoperative fibrinogen administration. Postoperative coagulation parameters, hemoglobin (Hb) levels, drainage volume, and radiographic correction outcomes were compared between groups. Twenty-five patients were included in each group. Baseline characteristics, operative time, intraoperative blood loss, and radiographic correction outcomes were comparable between groups. Compared with the non-fibrinogen group, the fibrinogen group had lower postoperative prothrombin time and international normalized ratio, and higher prothrombin activity and fibrinogen levels (all P < 0.01). Hb levels on postoperative days 1 and 3 were higher in the fibrinogen group, whereas postoperative drainage volume and postoperative red blood cell transfusion volume were lower (P = 0.002, 0.036, 0.005, and < 0.001, respectively). No significant between-group difference was observed in Hb level on postoperative day 7. Pre-closure intraoperative fibrinogen administration was associated with more favorable early postoperative hemostasis-related parameters in patients undergoing corrective surgery for severe spinal deformity. Given the retrospective design and potential residual confounding, these findings should be interpreted as hypothesis-generating and require validation in prospective studies.
Scoliosis is frequently associated with CM1 and TCS, but its course following neurosurgical treatment remains incompletely understood. The aim of this study was to describe scoliosis development following posterior fossa decompression for CM1 or de-tethering for TCS. A secondary aim was to describe postoperative brace treatment and its association with scoliosis progression. This was a retrospective study including children operated consecutively from the age of one to eighteen years for CM1 or TCS. We included patients with and without preoperative scoliosis who had a last follow-up from five years of age at earliest. Scoliosis patients were categorized based on type of scoliosis and braced patients were analysed based on compliance. We identified 293 patients and 171 (58
