Objective Lumbar disc herniation is among the most common and disabling spinal disorders, driven by the interplay of mechanical overload, structural failure, and cellular dysfunction. Despite advances in surgical interventions, achieving true biological repair of herniated discs remains a major clinical challenge. This review aims to critically examine the biomechanical landscape of disc herniation, focusing on how altered load transmission, tissue stiffness, and structural disruption influence cellular behavior and tissue regeneration. It further explores mechanobiological mechanisms governing repair and highlights emerging biomimetic models and technologies that integrate mechanical and biological insights to promote functional disc restoration.
Methods A comprehensive literature review was conducted using the Web of Science Core Collection, PubMed (National Library of Medicine), and ScienceDirect databases. The search was limited to peer-reviewed journal articles published in English and focused on studies related to lumbar disc herniation.
Results While decades of research have elucidated the biomechanical factors contributing to disc herniation, recent advances in mechanobiology have uncovered how mechanical cues influence cellular behavior, tissue repair, and degeneration. Evidence suggests that true disc regeneration cannot be achieved through biological replacement or mechanical stabilization alone; rather, it requires restoring functional biomechanics, specifically, the disc’s ability to sense, adapt to, and sustain physiological loading.
Conclusion Viewing disc herniation through a mechanobiological lens offers new opportunities to develop targeted therapies aimed at restoring both tissue integrity and load-bearing functionality, paving the way for more effective regenerative interventions.
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Integrating Structures and Biology: Cellular and Molecular Interactions with Functionally Graded Spinal Cage Designs Yuen Ho Cheng, Amy Libing Fu, Jessica Gaff, Gianluca Vadala, Amit Jain, Javad Tavakoli International Journal of Molecular Sciences.2026; 27(10): 4531. CrossRef
Waeel O. Hamouda, Stipe Ćorluka, Sathish Muthu, Luca Ambrosio, Carla Cunha, Stjepan Ivandic, Mohamed A.R. Soliman, Fabrizio Russo, Sibylle Grad, In Ho Han, Gianluca Vadala, Hans-Jorg Meisel, Sam K. Cho, Tim S. Yoon, Jeffrey C. Wang, Amit Jain, Zorica Buser, AO Spine Knowledge Forum Degenerative
Neurospine 2026;23(1):109-116. Published online January 31, 2026
Objective Bracing after lumbar discectomy surgery (LDS) is a controversial topic with paucity of related scientific literature. Previous surveys on spine surgeons’ preferences were limited both in geographical coverage and number of respondents. The aim of this study is to fill this gap in the literature.
Methods An international online survey among AO Spine members regarding the postoperative recommendations for bracing (PoBr), activity restriction (AR), and associated factors, was performed.
Results A total of 703 spine surgeons participated in the survey of which 34% recommended PoBr, with half of them reported usage for 4 weeks. Main influencing variables were being from Europe/South Africa region, greater extent of bony decompression, and larger amount of excised disc material. Seventy-nine percent of the respondents recommended postoperative AR. Prolonged standing, prolonged sitting, and driving were usually restricted for 2 weeks. Bending, twisting, lifting, and low-intensity physical activities for 3 months, while high-intensity physical activities and direct contact sports for 6 months were restricted.
Conclusion Despite recent literature insights showing limited evidence of efficacy, 34% and 80% of a large cohort of international surgeons practice bracing and recommend AR after LDS for variable durations. Extensive bony decompression and radical discectomy significantly influenced the decision to brace, similarly endoscopic approaches and radical discectomy influenced the decision to restrict activity. These findings emphasize the persistent evidence-practice gap and the wide variability on the global level. More randomized controlled trials are warranted on this topic to reach an evidence-based recommendation.
Objective The aim of this study was to compare all-cause reoperation rates and costs in nonelderly patients treated with anterior cervical discectomy and fusion (ACDF) with structural allograft versus synthetic cages for degenerative pathology.
Methods We queried a private claims database to identify adult patients ( ≤ 65 years) who underwent single-level ACDF in a hospital setting using either structural allograft or a synthetic cage (polyetheretherketone, metal, or hybrid device), from 2010 to 2016. The rate of all-cause reoperations at 2 years were compared between the 2 groups. Index hospitalization costs and 90-day complication rates were also compared. Significance was set at p < 0.05.
Results A total of 26,754 patients were included in the study. 11,514 patients (43%) underwent ACDF with structural allograft and 15,240 (57%) underwent ACDF with a synthetic cage. The patients in the allograft group were younger and more likely to be male. There was no significant difference between the 2 groups with respect to 90-day complications including: wound dehiscence, dysphagia, dysphonia, and hematoma/seroma. In the 2-year postoperative period, the synthetic cage group had a significantly higher rate of allcause reoperation compared to the allograft group (9.1% vs. 8.0%, p = 0.002). Index hospitalization costs were significantly higher in the synthetic cage group compared to those in the allograft group ($23,475 vs. $20,836, p < 0.001).
Conclusion Structural allograft is associated with lower all-cause reoperation rates and lower index costs in nonelderly patients undergoing ACDF surgery for degenerative pathology. It is important to understand this data as we transition toward value-based care.
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Revision Surgery after Single Level Anterior Cervical Discectomy and Fusion With Plate vs Stand-Alone Cage over 2 to 5 Year Follow-Up Wesley M. Durand, Rajan Khanna, Gabriel I. Nazario-Ferrer, Sang H. Lee, Richard L. Skolasky, Amit Jain Global Spine Journal.2025; 15(4): 2014. CrossRef
Considering the Effects of Age and Patient Factors on Subsidence and Implant Selection in Anterior Cervical Discectomy and Fusion Jeffrey B. Weinreb, Jake Carbone, Hershil Patel, Amit Ratanpal, Rohan I. Suresh, Tyler J. Pease, Ryan A. Smith, Joseph Blommer, Anthony K. Chiu, Idris Amin, Louis J. Bivona, Julio J. Jauregui, Daniel L. Cavanaugh, Eugene Y. Koh, Charles A. Sansur, Steven Clinical Spine Surgery.2025;[Epub] CrossRef
Reoperation Rate Following Single-Level Anterior Cervical Discectomy and Fusion With Standalone Cage Versus Anterior Plating in a Large Matched Cohort Adeesya Gausper, Andrew M. Miller, Vivien Chan, Suhas K. Etigunta, Andy M. Liu, David Skaggs, Tiffany Perry, Corey Walker, Alexander Tuchman Clinical Spine Surgery.2025;[Epub] CrossRef
Anterior Cervical Discectomy and Fusion With Structural Allograft is Associated With Lower Postoperative Health Care Utilization and Reoperations Compared With Cage Implants Andrew Y. Powers, Darren Z. Nin, Ya-Wen Chen, Ruijia Niu, David H. Kim, David C. Chang, Raymond W. Hwang Operative Neurosurgery.2024; 26(1): 16. CrossRef
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Structural Allograft versus Polyetheretherketone Cage in Anterior Cervical Discectomy and Fusion: A Meta-Analysis Tu Thai Bao Nguyen, Nguyen Anh Duy Tran, Huu Dat Nguyen, Khai Duy Lam, Thanh Tan Nguyen, Yi-Jie Kuo, Yu-Pin Chen World Neurosurgery.2024; 191: e730. CrossRef
A Five-Year Cost-Utility Analysis Comparing Synthetic Cage Versus Allograft Use in Anterior Cervical Discectomy and Fusion Surgery for Cervical Spondylotic Myelopathy Micheal Raad, Amy L. Xu, Carlos Ortiz-Babilonia, Majd Marrache, Wesley M. Durand, Marc Greenberg, Amit Jain Spine.2023; 48(5): 330. CrossRef
Clinical Outcomes and Cost Profiles for Cage and Allograft Anterior Cervical Discectomy and Fusion Procedures in the Adult Population: A Propensity Score-Matched Study Adrian John Rodrigues, Kunal Varshneya, Martin Nikolaus Stienen, Ethan Schonfeld, Khoi Duc Than, Anand Veeravagu Asian Spine Journal.2023; 17(4): 620. CrossRef
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Prospective, Randomized, Blinded Clinical Trial Comparing PEEK and Allograft Spacers in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgeries Alan T. Villavicencio, E. Lee Nelson, Sharad Rajpal, Kara Beasley, Sigita Burneikiene Spine.2022; 47(15): 1043. CrossRef
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Objective Lumbar discectomy is commonly performed for symptomatic lumbar disc herniation. We aimed to examine prescribing patterns and risk factors for chronic opioid use following lumbar discectomy.
Methods Using a private insurance claims database, patients were identified who underwent primary lumbar discectomy from 2010–2015 and had 1-year of continuous enrollment postoperatively. Patients were excluded with spinal fusion. The strength of opioid prescriptions was quantified using morphine milligram equivalents daily (MMED). Univariate and multivariate logistic regression models were built to examine risk factors associated with chronic postoperative opioid use.
Results A total of 5,315 patients were included in the study (mean age, 59 years; 50% female). 1,198 of patients (23%) used chronic opioids postoperatively. Chronic opioid use declined significantly from 27% in 2010 to 17% in 2015, p < 0.001. In addition, there were significantly fewer patients receiving high and very high-dose opioid prescriptions from 2010–2015, p < 0.001. The median duration that patients used opioids postoperatively was 211 days in 2010 (interquartile range [IQR], 29–356 days), and decreased significantly to 44 days (IQR, 10–294 days) in 2015. The strongest factors associated with chronic opioid use were preoperative opioid use (odds ratio [OR], 4.0), drug abuse (OR, 2.6), depression (OR, 1.6), surgery in the west (OR, 1.6) or south (OR, 1.6), anxiety (OR, 1.5), or 30-day readmission (OR, 1.4).
Conclusion Chronic opioid use following primary lumbar discectomy has declined from 2010–2015. A variety of factors are associated with chronic opioid use. Preoperative recognition of some of these risk factors may aid in perioperative management and counseling.
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Cervical alignment as a concept has come to the forefront for spine deformity research in the last decade. Studies on cervical sagittal alignment started from normative data, and expanded into correlation with global sagittal balance, prognosis of various conditions, outcomes of surgery, definition and classification of cervical deformity, and prediction of targets for ideal cervical reconstruction. Despite the recent robust research efforts, the definition of normal cervical sagittal alignment and cervical spine deformity continues to elude us. Further, many studies continue to view cervical alignment as a continuation of thoracolumbar deformity and do not take into account biomechanical features unique to the cervical spine that may influence cervical alignment, such as the importance of musculature connecting cranium-cervical-thoracic spine and upper extremities. In this article, we aim to summarize the relevant literature on cervical sagittal alignment, discuss key results, and list potential future direction for research using the ‘5W1H’ framework; “WHO” are related?, “WHY” important?, “WHAT” to evaluate and “WHAT” is normal?, “HOW” to evaluate?, “WHEN” to apply sagittal balance?, and “WHERE” to go in the future?
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Objective The aim of the study was to compare trends and differences in preoperative and prolonged postoperative opioid use following spinal cord stimulator (SCS) implantation and to determine factors associated with prolonged postoperative opioid use.
Methods A database of private-payer insurance records was queried to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-C3655) from 2008–2015. Our resulting cohort was stratified into those with prolonged postoperative opioid use, opioid use between 3- and 6-month postoperation, and those without. Multivariate logistic regression was used to determine the effect preoperative opioid use and other factors of interest had on prolonged postoperative opioid use. Subgroup analysis was performed on preoperative opioid users to further quantify the effect of differing magnitudes of preoperative opioid use.
Results A total of 2,374 patients who underwent SCS placement were identified. Of all patients, 1,890 patients (79.6%) were identified as having prolonged narcotic use. Annual rates of preoperative (p = 0.023) and prolonged postoperative narcotic use (p < 0.001) decreased over the study period. Significant independent predictors of prolonged postoperative opioid use were age < 65 years (odds ratio [OR], 1.52; p = 0.004), male sex (OR, 1.33; p = 0.037), preoperative anxiolytic (OR, 1.55; p = 0.004) and muscle relaxant (OR, 1.42; p = 0.033), and narcotic use (OR, 15.04; p < 0.001). Increased number of preoperative narcotic prescriptions correlated with increased odds of prolonged postoperative use.
Conclusion Patients with greater number of preoperative opioid prescriptions may not attain the same benefit from SCSs as patients with less opioid use. The most significant predictor of prolonged narcotic use was preoperative opioid use.
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Objective Although spinal cord stimulators (SCS) continue to gain acceptance as a viable nonpharmacologic option for the treatment of chronic back pain, recent trends are not well established. The aim of this study was to evaluate recent overall demographic and regional trends in paddle lead SCS placement and to determine if differences in trends exist between private-payer and Medicare beneficiaries.
Methods A retrospective review of Medicare and private-payer insurance records from 2007–2014 was performed to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-63655). Each study cohort was queried to determine the annual rate of SCS placements and demographic characteristics. Yearly SCS implantation rates within the study cohorts were adjusted per 100,000 beneficiaries. A chi-square analysis was used to compare changes in annual rates.
Results A total of 31,352 Medicare and 2,935 private-payer patients were identified from 2007 to 2014. Paddle lead SCS placements ranged from 5.9 to 17.5 (p<0.001), 1.9 to 5.9 (p<0.001), and 5.2 to 14.5 (p<0.001) placements per 100,000 Medicare, private-payer, and overall beneficiaries respectively from 2007 to 2014. SCS placements peaked in 2013 with 19.6, 7.1, and 16.8 placements per 100,000 Medicare, private-payer, and overall patients.
Conclusion There was an overall increase in the annual rate of SCS placements from 2007 to 2014. Paddle lead SCS placements peaked in 2013 for Medicare, private-payer, and overall beneficiaries. The highest incidence of implantation was in the Southern region of the United States and among females. Yearly adjusted rates of SCSs were higher among Medicare patients at all time points.
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