Objective To evaluate early postoperative mobility after lumbar decompression using real-time location system (RTLS)-derived objective metrics and to explore differences in mobility patterns between biportal endoscopic decompression and open decompression.
Methods This retrospective cohort study included 323 patients who underwent lumbar decompression for degenerative lumbar spinal stenosis between March 2020 and May 2024. RTLS sensors embedded in wristbands continuously recorded patient mobility during postoperative days (PODs) 1–4. Primary RTLS-derived outcomes included total walking distance, mean walking speed, and active movement ratios (top 20% and top 50%). Between-group comparisons were performed using nonparametric tests. Propensity score matching and multivariable median quantile regression adjusting for age, American Society of Anesthesiologists physical status, and preoperative mobility were conducted.
Results RTLS identified differences in early postoperative activity patterns between surgical approaches. In adjusted analyses, activity-intensity–based metrics, particularly the top 20% activity ratio, remained significantly higher in the biportal endoscopic decompression group across multiple PODs. Subgroup analyses demonstrated minimal differences after single-level decompression, whereas activity-based differences were more frequently observed in multilevel procedures.
Conclusion RTLS-based continuous monitoring detected differences in early postoperative activity patterns following lumbar decompression. These findings support the role of RTLS as an objective tool for assessing early functional recovery in spine surgery.
Spine imaging represents a complex diagnostic frontier characterized by anatomical variability, motion artifacts, metallic instrumentation interference, and significant inter-reader diagnostic variability (κ=0.20 across institutions). While conventional discriminative artificial intelligence (AI) models achieve >95% accuracy in detecting degenerative changes, they remain limited by data scarcity, heterogeneous protocols, and poor generalizability. In the spine, these limitations are particularly relevant because clinical decisions can often depend on subtle distinctions (such as differentiating levels of canal or foraminal stenosis, characterizing Modic endplate changes, or assessing pedicle and vertebral morphology), where small inconsistencies can meaningfully alter management or surgical planning. Generative AI (GenAI) systems—including generative adversarial networks (GANs), diffusion models, and vision-language models (VLMs)—offer a paradigm shift by learning underlying data structures to generate high-quality synthetic outputs rather than merely classifying existing data. This narrative review, conducted using SANRA (scale for the assessment of narrative review articles) methodology across PubMed, Scopus, Embase, and Cochrane Library, examined GenAI applications in spine imaging. Eligible studies included observational designs through randomized controlled trials exploring image reconstruction, synthetic computed tomography (CT) generation, segmentation, and surgical planning applications. GAN-generated synthetic magnetic resonance imaging sequences reduce scan times by ~40% while maintaining diagnostic confidence; diffusion models enable radiation-free synthetic CT for preoperative planning; and VLMs generate structured radiology reports with hallucination rates <1.12%. However, critical barriers impede clinical translation: external validation gaps reveal AI performance collapse in real-world cohorts (sensitivity drops to 54.9% in cervical fracture detection); hallucinations and anatomical inaccuracies risk misguiding implant sizing; bias amplification magnifies demographic underrepresentation; and fragmented, small datasets lack standardized benchmarks. Technical fragility, computational demands, clinician trust deficits, and unresolved regulatory frameworks for iteratively-updating systems remain unaddressed. Successful integration requires coordinated development across 5 priorities: (1) multi-institutional datasets with cross-vendor harmonization, (2) federated learning frameworks preserving privacy, (3) uncertainty quantification and explainability tools, (4) outcome-linked clinical validation replacing technical metrics, and (5) workflow-integrated systems with DICOM-native interfaces and provenance tracking.
Citations
Citations to this article as recorded by
A Commentary on “From Pixels to Precision: Generative Artificial Intelligence as a Paradigm Shift in Spine Imaging—Technical Foundations, Clinical Applications, and the Path to Safe Clinical Deployment” Fabrizio Russo, Luca Ambrosio, Gianluca Vadalà, Vincenzo Denaro Neurospine.2026; 23(2): 314. CrossRef
From the Editor-in-Chief: Featured Articles in the April 2026 Issue Inbo Han Neurospine.2026; 23(2): 227. CrossRef
Objective To longitudinally analyze smartphone-based real-life activity data and compare it with established clinical outcome measures in patients undergoing lumbar spine surgery for sciatica, focusing on identifying divergence in recovery trajectories.
Methods Fifty patients were assessed preoperatively and at 6 weeks (6W), 3 months (3M), and 6 months (6M). Outcomes included smartphone-derived daily Step Count, objective capacity (6-minute walking test [6WT]), and subjective disability (visual analogue scale [VAS] leg/back, Core Outcome Measures Index [COMI] back, and Oswestry Disability Index [ODI]). All metrics were standardized into z-scores relative to baseline. Piecewise linear mixed-effects (LME) models compared recovery slopes across 2 segments: phase I (early: 0–6 weeks) and phase II (late: 6 weeks–6 months).
Results The cohort (mean age, 50.7 years; 24 females) included 33 patients with lumbar disc herniation and 17 with lateral recess stenosis. All measures improved significantly during phase I (all p<0.05). However, LME modeling revealed a significant interaction between time segment and measurement type in phase II. Daily Step Count was the only metric maintaining a significant, linear upward recovery slope during the late phase (β=0.31 Z/mo). Conversely, slopes for 6WT, ODI, and COMI were significantly flatter (p<0.001 vs. Step Count), indicating a statistical plateau or “ceiling effect.” Spearman correlations between Step Count and traditional metrics weakened from strong at baseline to weak at 6 months.
Conclusion Smartphone-derived real-life activity data detect continuous functional improvement up 6 months postoperatively, whereas conventional objective and subjective measures plateau by 6 weeks. Real-world activity monitoring provides a more sensitive assessment of long-term surgical success.
Citations
Citations to this article as recorded by
From the Editor-in-Chief: Featured Articles in the April 2026 Issue Inbo Han Neurospine.2026; 23(2): 227. CrossRef
Real-World Effectiveness Versus Efficacy in a Study Environment: How Smartphones Help Capture Meaningful Patient Recovery Trajectories – A Commentary on “Physical Performance Continues to Improve After Surgery for Sciatica, Exceeding Recovery Periods of P Victor E. Staartjes Neurospine.2026; 23(2): 239. CrossRef
Objective Lumbar fusion surgery serves as a crucial option for treating lumbar degenerative diseases. However, patient heterogeneity contributes to suboptimal surgical outcomes in a substantial proportion of cases. Therefore, an accurate classification may provide a powerful tool for personalized treatment and enable the identification of individuals at increased risk for unfavorable surgical outcomes (USO). The study aimed to develop a risk stratification model for USO using cluster analysis.
Methods Consecutive patients diagnosed with degenerative lumbar disease who underwent lumbar fusion between April 2019 and January 2023 were enrolled. The outcome of interest was the USO, defined as failure to achieve a minimal clinically important difference in the 36-Item Short Form Health Survey physical component summary score, with the presence of complications. Three machine learning algorithms were employed to identify risk factors associated with USO. Based on these risk factors, we conducted a data-driven clustering analysis to develop a risk stratification model. Furthermore, based on 6 machine learning models, we developed a classification classifier capable of accurately identifying the risk cluster of individual patients.
Results A total of 662 patients were enrolled for risk stratification model, 219 patients were classified as having an USO. Six features were identified as key prognostic predictors, including frailty, depression, PI–LL (pelvic incidence minus lumbar lordosis) match, surgical levels, functional independence measure, and the relative functional cross-sectional area. The K-prototypes clustering algorithm successfully identified 3 distinct clusters. Furthermore, we developed a classification classifier, in which LightGBM (light gradient boosting machine) demonstrated the highest predictive performance (area under the receiver operating characteristic curve, 0.951; 95% confidence interval [CI], 0.814–0.974; area under the precision-recall curve, 0.927; 95% CI, 0.769–0.969).
Conclusion Based on data-driven clustering analysis, we developed a risk stratification model for predicting USO following lumbar fusion surgery, which demonstrated high predictive accuracy. Further studies in larger and more diverse cohorts are warranted to validate the clinical applicability of clustering analysis in USO risk stratification.
Spinal arthroplasty aims to preserve or reconstruct the normal biomechanical functions of the spine with motion-preserving implants. Although fusion is a proven technique to stabilize the spine, it is nonphysiologic with known limitations such as loss of mobility and risk of adjacent segment disease. This paper focuses on the main areas of spinal arthroplasty including cervical disc replacement, lumbar disc replacement, and lumbar facet arthroplasty. We review the biomechanics, history, outcomes, and future directions for each of these over the last 30 years. Although today spinal arthroplasty is only used in very specific degenerative settings, as innovation in spinal arthroplasty progresses, this will lead to wider adoption and a future where spine surgery is truly reconstructive and motion-preserving.
Citations
Citations to this article as recorded by
A Commentary on “A Comprehensive Review of Spinal Arthroplasty” Sonja Häckel, Fabienne Pohle Neurospine.2026; 23(2): 273. CrossRef
From the Editor-in-Chief: Featured Articles in the April 2026 Issue Inbo Han Neurospine.2026; 23(2): 227. CrossRef
Objective To develop and externally validate a dual-mechanism deep learning (DL) model that integrates vertebral segmentation and lesion detection for automated evaluation of lumbar degeneration and structured report generation on plain radiographs.
Methods In this retrospective study, 5,964 patients who underwent standing anteroposterior and lateral lumbar radiographs at a single institution and 600 patients from a public dataset (BUU-Spine) were included. Vertebral corners from T11–L5 (and S1 on lateral views) and 7 degenerative findings (scoliosis, straightened/preserved lordosis, spondylolisthesis, disc space narrowing, osteophytes, vertebral compression, and abdominal aortic calcification) were annotated by 3 spine surgeons. Two independently trained, parallel networks were developed, including a ResNet-based segmentation network and a YOLOv8-based detection network. A rule-based integration strategy reconciled both outputs and generated structured diagnostic reports. Segmentation accuracy, quantitative measurement agreement, diagnostic performance, and clinical acceptability of reports were evaluated.
Results Intra- and interobserver landmark distances within 3 mm reached 96% and >95%, respectively. On the internal test set, the percentage of correct keypoints within 3 mm was 95.7%–98.6%, with intraclass correlation coefficients of 0.84–0.89 and Pearson correlation coefficient (r) of 0.90–0.94 for key radiographic parameters. The segmentation- and detection-based models achieved precision of 92.2%–96.9% and 91.7%–95.5%, and recall of 91.6%–94.8% and 93.3%–95.2%, respectively. Under the dual-positive condition, the integrated model yielded the highest precision (93.8%–97.3%), whereas the any-positive condition achieved the highest recall (94.1%–97.6%). Of 596 automatically generated structured reports, 557 (93.4%) were deemed clinically acceptable.
Conclusion The proposed dual-mechanism DL framework enables accurate, multilesion assessment of lumbar degeneration and generation of clinically acceptable structured reports from plain radiographs, supporting workflow optimization in lumbar spine imaging.
Objective Transient receptor potential vanilloid 4 (TRPV4), a mechanosensitive ion channel, has been implicated in intervertebral disc homeostasis; however, its role in autophagy regulation remains unclear. This study aimed to investigate whether agonist-induced TRPV4 activation promotes autophagy and extracellular matrix (ECM) synthesis in rat intervertebral discs.
Methods In vitro, rat nucleus pulposus (NP) cells were treated with the TRPV4 agonist (GSK1016790) under normal, serum-deprived, or interleukin-1β-stimulated conditions. Cell viability, intracellular Ca2+ influx, adenosine monophosphate-activated protein kinase/mammalian target of rapamycin (mTOR) (AMPK/mTOR) pathway, autophagy, ECM metabolism, apoptosis, and senescence were evaluated. In vivo, TRPV4 agonist was injected into the caudal discs subjected to temporary static compression, and disc changes were assessed by radiography, histomorphology, and immunofluorescence.
Results In vitro, agonist-induced TRPV4 activation rapidly increased intracellular Ca2+ influx and enhanced AMPK phosphorylation. A noncytotoxic concentration of the TRPV4 agonist (10 nM) was selected after dose-response testing. Under the inflammatory stress, TRPV4 agonist enhanced autophagy, promoted ECM synthesis, and suppressed apoptosis and senescence, leading to improved NP cell viability. In vivo, TRPV4 agonist treatment preserved radiographic disc height (p<0.01), reduced histomorphological degeneration (p<0.01), and increased expression of COL2A1, Brachyury, p-AMPK (phosphorylated AMPK), and autophagy markers (p<0.01) compared with controls.
Conclusion These findings demonstrated that TRPV4 activation promotes autophagy and ECM synthesis via the AMPK/mTOR pathway in rat discs and attenuates stress-induced degeneration, suggesting TRPV4 as a potential therapeutic target for disc degeneration.
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.
Citations
Citations to this article as recorded by
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
Objective To biomechanically compare the stress distribution of established posterior cervical fixation techniques—conventional pedicle screw (PS), Abumi technique, unicortical lateral mass screw (LMS), and bicortical LMS—with a novel PS method, the Lee point technique, using finite element modeling (FEM).
Methods A patient-specific FEM of C5–6 was developed using high-resolution computed tomography scan data of a degenerative cervical spine. Five fixation models were constructed: Lee point, Abumi, conventional PS, unicortical LMS, and bicortical LMS. Screw dimensions were ø3.5×28 mm for PS and ø3.5×14/18 mm for LMS. A pure moment of 1.0 N·m was applied in flexion, extension, axial rotation, and lateral bending, and the peak von Mises stress (PVMS) of both the vertebrae and implants was recorded for each loading condition.
Results Abumi technique showed the highest PVMS at C5–6 (23.09–43.22 MPa and 24.96–39.91 MPa), with stress concentrated at the pedicle entry and medial wall. Lee point and conventional PS demonstrated more evenly distributed stress across the pedicle and near cortex of the lateral mass. Unicortical and bicortical LMS showed stress mainly at the entry point, with overall lower and more uniform magnitudes. Implant stress was greatest in Abumi construct (up to 295 MPa), moderate in Lee and conventional PS, and lowest in LMS models.
Conclusion Abumi technique showed higher localized stress concentrations that may warrant careful patient selection, particularly in those with compromised bone quality. Lee point technique achieved a balanced stress profile comparable to conventional PS, suggesting a favorable biomechanical profile for posterior cervical fixation.
Citations
Citations to this article as recorded by
Optimizing Postoperative Sagittal Alignment: The Effect of Pedicle Screw Fixation in 540° Combined Surgery for Degenerative Cervical Disease Sang-Ho Kim, Byung-Ho Lee, Hak-Sun Kim, Seong-Hwan Moon, Kyung-Soo Suk, Joong-Won Ha, Yung Park, Si-Young Park, Hyoung-Bok Kim, Ji-Won Kwon, Jae-Won Shin Global Spine Journal.2026;[Epub] CrossRef
Luca Ambrosio, Sathish Muthu, Patrick C. Hsieh, S. Tim Yoon, Jeffrey C. Wang, Gianluca Vadalà, Hans Jörg Meisel, Stipe Ćorluka, Zorica Buser, AO Spine Knowledge Forum Degenerative
Neurospine 2026;23(1):31-39. Published online January 31, 2026
Objective This study aimed to characterize international practice patterns in the surgical management of primary lumbar disc herniation (LDH) among AO Spine surgeons.
Methods A cross-sectional online survey was distributed in September 2024 to AO Spine members. The questionnaire collected detailed information on demographic characteristics, surgical indications, preferred techniques, and approaches for primary LDH treatment. Data on specialty, practice setting, fellowship training, and surgical case volume were analyzed using univariate and multivariate logistic regression to identify significant associations between surgeon characteristics and treatment preferences.
Results A total of 714 surgeons participated, representing diverse regions: North America (9.0%), Latin America (18.7%), Europe & Southern Africa (34.7%), Middle East & Northern Africa (12.8%), and Asia Pacific (24.8%). Neurological status was the most critical factor influencing early operative treatment in nonurgent cases, while bladder/bowel dysfunction and severe motor deficits were the primary indications in urgent scenarios. The majority of respondents (54.2%) preferred a mini-open technique—using either a surgical microscope or loupes—with partial laminotomy (58.1%) and partial discectomy (63.2%) being the most frequently performed procedures. Regional variations and differences in surgeon training were significantly associated with the choice of surgical approach and overall case volume.
Conclusion The findings reveal substantial variability in the surgical management of primary LDH across regions and specialties. This comprehensive dataset underscores the need for standardized, evidence-based guidelines to harmonize treatment strategies and optimize patient outcomes.
Objective Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common complications following long-segment spinal fusion, particularly in adult spinal deformity (ASD) correction surgery. Various surgical techniques have been proposed to prevent these complications, but high-quality evidence remains limited. This study aimed to evaluate the effectiveness of surgical strategies for preventing PJK and PJF after ASD correction or long-segment spinal fusion in adults.
Methods A systematic search was conducted in PubMed, Embase, and the Cochrane Library through March 2025. Eligible studies included adults who underwent ASD surgery or long-segment (≥4 levels) posterior spinal fusion, comparing PJK or PJF incidence across surgical techniques such as tethering, hook fixation, prophylactic vertebral augmentation, rod characteristics, and upper instrumented vertebra (UIV) level. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Results Thirty-eight retrospective studies were included in the systematic review and 33 in the meta-analysis. Spinous process tethering reduced PJK incidence (OR, 0.35; 95% CI, 0.22–0.56). Hook fixation (OR, 0.34; 95% CI, 0.21–0.55) and prophylactic vertebral augmentation (OR, 0.58; 95% CI, 0.35–0.95) reduced PJF incidence. Lower PJK rates were observed with UIV at T10 or above (OR, 0.15; 95% CI, 0.03–0.64) and lower PJF rates with UIV at L1 or above (OR, 0.29; 95% CI, 0.14–0.61).
Conclusion Surgical strategies such as tethering, hook fixation, and prophylactic vertebral augmentation may reduce the risk of PJK/PJF. Additionally, placing the UIV at or slightly above T10 may enhance junctional stability. Further prospective studies are needed to validate these findings and guide preventive strategies.
Objective Transforaminal lumbar interbody fusion (TLIF) has become a mainstay technique for interbody fusion, allowing for large contact area between implant and endplate, and providing increased stability and greater area for fusion. The development of 3-dimensional (3D)-expandable implants that provide multidimensional (3D) expansion has shown to provide better height restoration and clinical outcomes when compared to static implants. Comparison of the endplate coverage between 3D-expandable and static TLIF implants has yet to be studied. This study compares endplate coverage achieved with static TLIF, 3D-expandable TLIF, and anterior lumbar interbody fusion (ALIF) implants.
Methods A retrospective review of patients undergoing interbody fusion with either static TLIF, 3D-expandable TLIF, or ALIF between the years 2014 and 2022 was conducted. Postoperative computed tomography (CT) imaging was used to measure endplate and implant dimensions. 3D-expandable TLIF interbody device areas were calculated using diameter measurements on postoperative CT. The coverage ratio was defined as the ratio of twice the area of the implant and the sum of the superior and inferior endplate areas at the operative level.
Results A total of 53 patients per cohort were included. The average endplate coverage ratios for static TLIF, 3D-expandable TLIF, and ALIF implants were 0.19±0.04, 0.35±0.06, and 0.46±0.13, respectively. Subgroup analysis showed comparable coverage of 3D-expandable TLIF to ALIF implants at L3–4 and L4–5, while ALIF remained superior at L5–S1.
Conclusion 3D-expandable TLIF interbody devices provide greater endplate coverage when compared to static TLIF devices and approach comparable coverage to ALIF implants.
Citations
Citations to this article as recorded by
A Commentary on “Radiographic Analysis of Endplate Coverage of a 3-Dimensional-Expandable Transforaminal Lumbar Interbody Fusion (TLIF) Implant Compared to Static TLIF and Anterior Lumbar Interbody Fusion Implants” Kun Wang, Xiaofeng Lian Neurospine.2025; 22(4): 902. CrossRef
From the Editor-in-Chief: Featured Articles in the December 2025 Issue Inbo Han Neurospine.2025; 22(4): 877. CrossRef
Paulina Cewe, Victor E. Staartjes, Victor Gabriel El-Hajj, Ihab Ahmad Al-Rikabi, Basel Musmar, Joana M Roy, Dennis Troung, Mats Beckman, Marcus Ohlsson, Pascal Jabbour, Adrian Elmi-Terander, Erik Edström
Neurospine 2025;22(4):905-915. Published online December 31, 2025
Objective Traumatic vertebral artery injuries (tVAIs) are uncommon but potentially devastating if missed. While computed tomography angiography (CTA) is routinely used for diagnosis, data on the number needed to image (NNI) remain limited. We hence analyzed tVAI epidemiology and imaging practices at a major Scandinavian level 1 trauma center.
Methods A retrospective study (2013–2020) was performed based on a single-center trauma registry. Patients were grouped based on CTA imaging protocol used; selective screening (2013–2017) and universal screening (2018–2020). Imaging protocols, treatment strategies, and outcomes were analyzed.
Results Among 2,843 patients admitted with level 1 trauma and receiving CTA imaging, 62 had a tVAI (2.2%) yielding a NNI of 46 patients to diagnose 1 tVAI. Twenty-five of these patients (40.3%) were found to have a posterior circulation stroke, resulting in an incidence of 0.9%, and a NNI of 114 to diagnose 1 stroke on CTA. NNIs for both tVAI and stroke detection increased with adoption of universal screening (tVAI: 35→65; stroke: 90→149). However, the detection rate of tVAI during the universal screening period was not significantly higher than during the selective screening period (p=0.261).
Conclusion In our level 1 trauma cohort, the incidence of tVAI was 2.2% and stroke rate 0.9%. The NNI rose with universal screening, yet detection rates did not improve. These findings suggest that selective screening based on risk factors may be more efficient than a universal approach. Further research is needed to balance diagnostic accuracy with resource use in trauma care.
Citations
Citations to this article as recorded by
Optimizing Diagnostic Yield: Evidence Against Universal Computed Tomography Angiography for Traumatic Vertebral Artery Injury Screening – A Commentary on “Epidemiology and Screening of Traumatic Vertebral Artery Injuries at a Large Scandinavian Level 1 Tr Jae Taek Hong Neurospine.2025; 22(4): 916. CrossRef
From the Editor-in-Chief: Featured Articles in the December 2025 Issue Inbo Han Neurospine.2025; 22(4): 877. CrossRef
Sum Kim, Yunhee Choi, Hangeul Park, Young-Rak Kim, Jun-Hoe Kim, Woo-Young Jo, Kyung Won Shin, Hyongmin Oh, Hyung-Chul Lee, Hee-Pyoung Park, Chang-Hyun Lee, Chi Heon Kim, Chun Kee Chung
Neurospine 2025;22(4):1041-1051. Published online December 31, 2025
Objective Hoarseness can occur after spinal surgery under general anesthesia, which has been assessed through self-report measures based on questionnaires. Given the inherent biases associated with self-report instruments, there is a need for more objective measures to assess hoarseness.
Methods Single institute, a prospective observational study was planned to include 427 patients after spine surgery. This interim analysis was planned to include 215 patients who met the inclusion criteria. All subjects included in this study submitted a questionnaire of Korean Voice Handicap Index (KVHI)-10. Voice analysis including low or high pitch (Herz), frequency variation rate (jitter), amplitude variation rate (Shimmer), and noise-to-harmonic ratio (NHR) was performed with a software of Pratt.
Results This interim report enrolled a total of 215 patients who met the inclusion criteria, and among them, 162 patients (75.5%) were subjected to interim analysis after excluding those with data loss (8 patients), operation cancellation (3 patients), and loss to follow-up (42 patients). The incidence of hoarseness was 35.0% on postoperative day (POD)0 and 5.5% on POD30. In the acoustic parameters analyzed, hertz and jitter were significantly positively correlated with the KVHI-10 scores on POD0, while only the jitter value significantly correlated with POD30. The optimal cutoff values of the acoustic parameter on POD30 from the receiver operating characteristic curve were 0.65% in jitter, 4.67% in shimmer, and 16.96 dB in NHR.
Conclusion This study revealed a correlation between objective acoustic parameters obtained from voice analysis and subjective questionnaire scores for hoarseness.
Objective Unilateral biportal endoscopic (UBE) spine surgery is a minimally invasive technique that uses continuous irrigation to improve visualization and control bleeding. Effective water pressure management is crucial for patient safety, particularly at the cervical and thoracic levels where spinal cord injury risk is higher. However, real-time pressure monitoring remains underexplored. This study evaluates the impact of real-time water pressure monitoring on safety during UBE surgery.
Methods A prospective study was conducted involving 20 patients undergoing UBE lumbar spine surgery. Patients were divided into 2 groups based on the irrigation system: gravity-based or infusion pump. Real-time water pressure was monitored using a digital sensor throughout surgery. Each procedure was categorized into 3 phases: phase I, working space preparation; phase II, laminectomy; phase III, flavectomy, dura exposure, and discectomy. Data was analyzed according to the type of irrigation system and surgical phase.
Results The mean water pressure in the surgical field during UBE spine surgery was 17.98± 8.07 mmHg, with no significant differences between surgical phases. However, the infusion pump system maintained significantly lower mean pressure (12.10±3.51 mmHg) compared to the gravity-based system (23.86±6.97 mmHg, p=0.001). The infusion pump system consistently maintained a significantly lower mean water pressure compared to the gravity-based system.
Conclusion Real-time water pressure monitoring during UBE surgery enhances safety by enabling improved control of pressure within the surgical field. Both the gravity-based and infusion pump systems safely maintained working space pressure, with the pump system showing significantly lower pressure levels.
Citations
Citations to this article as recorded by
Case Report: Spinal epidural lipomatosis with incomplete cauda equina syndrome treated with unilateral biportal endoscopic technique Zaiyin Deng, Yujin Wang, Mohammed Saud Shaik, Duanyang Li, Rongjing Di, Zhourui Wu, Bin Ma Frontiers in Surgery.2026;[Epub] CrossRef
Epidemiology of spinal cord hypertension syndrome in water-mediated uniportal full endoscopic thoracolumbar surgery: a single-center experience Haiyang Wu, Luyang Wang, Yiping Zheng, Xizhong Zhu, Wanqi Ren, Ziheng Li, Shoule Ma, Mingwang Zhao, Xingchen Li, Yusheng Xu European Spine Journal.2026;[Epub] CrossRef
Controlled versus gravity-based irrigation in endoscopic spine surgery: pressure stability, thresholds, and safety implications Rajendra Singh, Thomas Cha, Alexander Vaccaro, Alan Hilibrand, Gregory Schroeder, Gregory Kepler, Afshin Razi, Mitchell Ng European Spine Journal.2026;[Epub] CrossRef
First
Prev
