Neurospine 2025 December Issue eTOC

Inbo Han
(Korea)
Editor-in-Chief

In this editorial, we highlight the most noteworthy articles featured in the December 2025 issue of Neurospine.

Byung Ho Lee
(Korea)

Article 1: "Romosozumab Enhances Implant Stability in Glucocorticoid-Induced Osteoporotic Bone: A Rabbit Model Study"

This experimental study¹ demonstrates a clear anabolic effect of romosozumab on implant stability in glucocorticoid-induced osteoporotic bone. Using a rabbit model, the authors compared romosozumab with conventional antiosteoporotic agents, including parathyroid hormone (PTH) and PTH combined with denosumab. Compared with untreated osteoporotic controls, romosozumab treatment resulted in significantly higher bone-to-implant contact, a greater bone area fraction, and nearly twice the pull-out strength. Histological analysis revealed dense collagenous tissue and active new bone formation around the implant.
These results highlight the potential of romosozumab to enhance osseointegration and mechanical fixation in severe osteoporotic conditions and suggest a promising adjunctive role in improving fixation strength in spinal instrumentation in patients receiving long-term glucocorticoid therapy.

Richard G. Fessler
(USA)

Article 2: "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"

This radiographic study² provides an insightful comparative analysis of endplate coverage by 3 types of interbody fusion implants: static TLIF, 3-dimensional (3D)-expandable TLIF, and anterior lumbar interbody fusion (ALIF). Using postoperative computed tomography images from a multicenter retrospective cohort, the authors quantified the endplate coverage ratio to assess the degree of implant-endplate contact.
The results demonstrate a significant mechanical advantage of the 3D-expandable TLIF design. It achieved nearly twice the endplate coverage of static TLIF implants and approached the larger contact area typical of ALIF implants at the lumbar segments L3–4 and L4–5. Although ALIF maintained superior coverage at the L5–S1 segment, the increased contact area of the 3D-expandable TLIF implants suggests improved load distribution and the potential for higher fusion rates without an anterior approach.
These results underscore how technological advancements in implant design can optimize biomechanical contact and inform future surgical decisions in minimally invasive spinal fusion strategies.

Victor E. Staartjes
(Sweden)

Article 3: "Epidemiology and Screening of Traumatic Vertebral Artery Injuries at a Large Scandinavian Level 1 Trauma Center"

This study³ offers valuable insights into the epidemiology and diagnostic efficiency of screening strategies for traumatic vertebral artery injury (tVAI) in a high-volume, level 1 Scandinavian trauma center. Reviewing data from over 2,800 trauma patients over 7 years, the authors compared selective versus universal computed tomography angiography (CTA) screening protocols to determine their relative diagnostic yield and clinical efficiency.
The analysis revealed a tVAI incidence of 2.2% and a posterior circulation stroke rate of 0.9%. Switching to universal screening nearly doubled the number of imaging studies required to detect tVAI, but the overall detection rate did not improve significantly. These findings call into question the widespread use of universal CTA screening and suggest that a selective, risk-based approach could offer a more efficient ratio of diagnostic sensitivity to resource utilization.
By quantifying diagnostic performance in everyday clinical practice, this study provides important insights for the ongoing debate on rational imaging strategies in trauma treatment and underlines the need to reconcile clinical vigilance with responsible imaging practice.

Jun Hu
(China)

Article 4: "Magnetic Resonance Spectroscopy Lipids Peak May Serve as a Potential Biomarker for Back Pain in Intervertebral Disc Degeneration: An Integrative Metabolomics and Proteomics Study Investigating the Role of the Lipid Droplets-Interleukin-17 Inflammatory Axis"

This integrative study⁴ identifies a predominant lipid peak on magnetic resonance spectroscopy (MRS) as a promising imaging biomarker that correlates with the severity of symptoms in intervertebral disc degeneration. Patients were stratified into groups with and without a predominant lipids peak, and nucleus pulposus tissue underwent lipidomic, proteomic, and functional analyses. Patients with a dominant lipid peak had significantly higher preoperative visual analogue scale back and Oswestry Disability Index scores, indicating greater pain and disability. Multiomics analysis revealed that the dominant lipid peak phenotype is characterized by the accumulation of lipid droplets in nucleus pulposus cells and activation of the interleukin 17 (IL-17)-mediated inflammatory pathway. Symptom scores correlated positively with IL-17 expression and relative lipid content. Multivariate analysis identified the proportion of IL-17-positive cells and triglyceride levels as independent factors for back pain intensity.
Taken together, these results support the hypothesis that the inflammatory axis between lipid droplets and IL-17 is an important factor in discogenic pain and position the MRS lipid peak as a noninvasive biomarker for the diagnosis and monitoring of back pain in patients with disc degeneration.

Sun Joon Yoo
(Korea)

Inbo Han, MD, PhD
Editor-in-Chief

Wen-Cheng Huang, MD, PhD
Deputy Editor

Masahito Hara, MD, PhD
Deputy Editor

Jin Sung Kim, MD, PhD
Deputy Editor