Nevin Manimala

J Spine Surg. 2025 Mar 24;11(1):65-73. doi: 10.21037/jss-24-75. Epub 2025 Feb 27.

ABSTRACT

BACKGROUND: Patient-specific spine rods (PSSRs) are custom-designed pre-operatively to align with individual spinopelvic parameters, aiming to optimize post-operative alignment. While effective in correcting adult spinal deformities, their utility in degenerative lumbar fusions remains relatively understudied. This study seeks to assess the outcomes of PSSR utilization in degenerative lumbar fusions by comparing them to a previously published cohort by Leveque et al. in 2018. Through this analysis, we aim to contribute to the understanding of PSSR efficacy and its potential role in improving surgical outcomes in degenerative lumbar conditions.

METHODS: Fifty patients who underwent primary lumbar fusion with PSSRs were included, excluding those with prior lumbar fusion or significant deformities. The study cohort was compared to a historical cohort using conventional rods. Radiographic outcomes were evaluated over a 2-year period, with follow-ups at 6 weeks, 6 months, 1 year, and 2 years postoperatively. Pre-operative and post-operative measurements of pelvic incidence (PI) and lumbar lordosis (LL) were used to assess changes in changes in PI-LL alignment. Statistical analyses included one-way analysis of variance (ANOVA) tests and one/two sample t-tests.

RESULTS: Patients undergoing fusion PSSRs demonstrated a greater degree of change in pre-operative to post-operative PI-LL alignment compared to non-PSSR patients (-4.2° vs. -0.1°, P<0.001). Among the PSSR group, post-operative analysis revealed that 37 patients (74%) were categorized as preserved, indicating maintenance of PI-LL alignment within a predefined range. Additionally, nine patients (18%) were classified as restored, representing an improvement in PI-LL alignment post-operatively. Conversely, two patients (4%) were categorized as not corrected and worsened, indicating no significant change or deterioration in PI-LL alignment post-operatively, respectively. Comparison between the PSSR and non-PSSR groups showed higher restored spinopelvic parameters after surgery in the PSSR group compared to the non-PSSR group (18% vs. 8.7%, P=0.05). Conversely, fewer patients in the PSSR group had not corrected parameters compared to the non-PSSR group (4% vs. 21.3%, P<0.01). These findings suggest that fusion with PSSRs was associated with greater improvement in PI-LL alignment post-operatively and a higher likelihood of achieving restored spinopelvic parameters compared to fusion without PSSRs.

CONCLUSIONS: PSSRs demonstrate significant improvement in spinopelvic parameters, particularly in reducing PI-LL mismatch, in degenerative lumbar fusion surgery. This improvement suggests a potential for enhanced patient outcomes. Follow-up assessments indicate that these improvements are sustained over a 2-year period. However, our findings underscore the need for further research to validate these results on a larger scale and over the long term. Larger-scale studies are necessary to confirm long-term benefits and should aim to explore the specific mechanisms by which PSSRs contribute to improved outcomes and investigate optimal strategies for incorporating PSSRs into clinical practice.

PMID:40242816 | PMC:PMC11998052 | DOI:10.21037/jss-24-75

J Spine Surg. 2025 Mar 24;11(1):65-73. doi: 10.21037/jss-24-75. Epub 2025 Feb 27.

ABSTRACT

BACKGROUND: Patient-specific spine rods (PSSRs) are custom-designed pre-operatively to align with individual spinopelvic parameters, aiming to optimize post-operative alignment. While effective in correcting adult spinal deformities, their utility in degenerative lumbar fusions remains relatively understudied. This study seeks to assess the outcomes of PSSR utilization in degenerative lumbar fusions by comparing them to a previously published cohort by Leveque et al. in 2018. Through this analysis, we aim to contribute to the understanding of PSSR efficacy and its potential role in improving surgical outcomes in degenerative lumbar conditions.

METHODS: Fifty patients who underwent primary lumbar fusion with PSSRs were included, excluding those with prior lumbar fusion or significant deformities. The study cohort was compared to a historical cohort using conventional rods. Radiographic outcomes were evaluated over a 2-year period, with follow-ups at 6 weeks, 6 months, 1 year, and 2 years postoperatively. Pre-operative and post-operative measurements of pelvic incidence (PI) and lumbar lordosis (LL) were used to assess changes in changes in PI-LL alignment. Statistical analyses included one-way analysis of variance (ANOVA) tests and one/two sample t-tests.

RESULTS: Patients undergoing fusion PSSRs demonstrated a greater degree of change in pre-operative to post-operative PI-LL alignment compared to non-PSSR patients (-4.2° vs. -0.1°, P<0.001). Among the PSSR group, post-operative analysis revealed that 37 patients (74%) were categorized as preserved, indicating maintenance of PI-LL alignment within a predefined range. Additionally, nine patients (18%) were classified as restored, representing an improvement in PI-LL alignment post-operatively. Conversely, two patients (4%) were categorized as not corrected and worsened, indicating no significant change or deterioration in PI-LL alignment post-operatively, respectively. Comparison between the PSSR and non-PSSR groups showed higher restored spinopelvic parameters after surgery in the PSSR group compared to the non-PSSR group (18% vs. 8.7%, P=0.05). Conversely, fewer patients in the PSSR group had not corrected parameters compared to the non-PSSR group (4% vs. 21.3%, P<0.01). These findings suggest that fusion with PSSRs was associated with greater improvement in PI-LL alignment post-operatively and a higher likelihood of achieving restored spinopelvic parameters compared to fusion without PSSRs.

CONCLUSIONS: PSSRs demonstrate significant improvement in spinopelvic parameters, particularly in reducing PI-LL mismatch, in degenerative lumbar fusion surgery. This improvement suggests a potential for enhanced patient outcomes. Follow-up assessments indicate that these improvements are sustained over a 2-year period. However, our findings underscore the need for further research to validate these results on a larger scale and over the long term. Larger-scale studies are necessary to confirm long-term benefits and should aim to explore the specific mechanisms by which PSSRs contribute to improved outcomes and investigate optimal strategies for incorporating PSSRs into clinical practice.

PMID:40242816 | PMC:PMC11998052 | DOI:10.21037/jss-24-75

J Spine Surg. 2025 Mar 24;11(1):88-95. doi: 10.21037/jss-24-99. Epub 2025 Mar 7.

ABSTRACT

BACKGROUND: Considering that implant backout is a recognized mode of failure, evaluating the pullout strength is critical for assessing anchoring efficacy. The Sacrix^® fully threaded screw (TS) was designed specifically for Less Exposure Spine Surgery (LESS) to reduce incision size, surgical time, and blood loss, using two implants for sacroiliac joint (SIJ) fixation. This study compares the Sacrix^® design with the SI-Bone iFuse non-threaded triangular titanium implant (TTI) design, which is widely regarded as the industry standard, and represents the first comparative biomechanical pullout strength study of these implant designs currently used in SIJ fusions.

METHODS: We conducted mechanical static axial pullout tests on three 7.0 mm × 45 mm iFuse non-threaded TTIs and six 8.0 mm × 40 mm Sacrix^® fully TS embedded in polyurethane foam blocks. An INSTRON 8874 Bi-Axial Tabletop Servohydraulic Dynamic Testing System was used to perform the tests by applying a 2.5 kN axial load.

RESULTS: The effective surface areas of the iFuse non-threaded TTI and Sacrix^® fully threaded TS were comparable, measuring 294.15 and 289.81 mm², respectively. The TS exhibited a significantly higher mean static axial pullout strength of 814.90 N [standard deviation (SD), ±99.428 N] compared to the TTI 200.14 N (SD, ±14.428 N). Statistical analyses, including Welch’s t-test and Mann-Whitney U test, revealed significant differences in pullout strength between the two implants (P<0.05). Variance analysis confirmed the differences in pullout strength variances between the implants (P=0.040), suggesting that the variability in pullout strength was distinct for each implant.

CONCLUSIONS: The Sacrix^® fully threaded TS demonstrated a threefold increase in pullout strength compared with the SI-Bone iFuse non-threaded TTI, suggesting that future SIJ fusion designs should favor threaded over non-threaded implants for improved anchoring capability.

PMID:40242812 | PMC:PMC11998034 | DOI:10.21037/jss-24-99

J Spine Surg. 2025 Mar 24;11(1):88-95. doi: 10.21037/jss-24-99. Epub 2025 Mar 7.

ABSTRACT

BACKGROUND: Considering that implant backout is a recognized mode of failure, evaluating the pullout strength is critical for assessing anchoring efficacy. The Sacrix^® fully threaded screw (TS) was designed specifically for Less Exposure Spine Surgery (LESS) to reduce incision size, surgical time, and blood loss, using two implants for sacroiliac joint (SIJ) fixation. This study compares the Sacrix^® design with the SI-Bone iFuse non-threaded triangular titanium implant (TTI) design, which is widely regarded as the industry standard, and represents the first comparative biomechanical pullout strength study of these implant designs currently used in SIJ fusions.

METHODS: We conducted mechanical static axial pullout tests on three 7.0 mm × 45 mm iFuse non-threaded TTIs and six 8.0 mm × 40 mm Sacrix^® fully TS embedded in polyurethane foam blocks. An INSTRON 8874 Bi-Axial Tabletop Servohydraulic Dynamic Testing System was used to perform the tests by applying a 2.5 kN axial load.

RESULTS: The effective surface areas of the iFuse non-threaded TTI and Sacrix^® fully threaded TS were comparable, measuring 294.15 and 289.81 mm², respectively. The TS exhibited a significantly higher mean static axial pullout strength of 814.90 N [standard deviation (SD), ±99.428 N] compared to the TTI 200.14 N (SD, ±14.428 N). Statistical analyses, including Welch’s t-test and Mann-Whitney U test, revealed significant differences in pullout strength between the two implants (P<0.05). Variance analysis confirmed the differences in pullout strength variances between the implants (P=0.040), suggesting that the variability in pullout strength was distinct for each implant.

CONCLUSIONS: The Sacrix^® fully threaded TS demonstrated a threefold increase in pullout strength compared with the SI-Bone iFuse non-threaded TTI, suggesting that future SIJ fusion designs should favor threaded over non-threaded implants for improved anchoring capability.

PMID:40242812 | PMC:PMC11998034 | DOI:10.21037/jss-24-99

J Spine Surg. 2025 Mar 24;11(1):24-32. doi: 10.21037/jss-24-116. Epub 2025 Mar 17.

ABSTRACT

BACKGROUND: Endoscopic spine surgery (ESS) has evolved as a new minimally invasive surgical (MIS) approach to the lumbar spine. ESS allows smaller incisions, less paraspinal muscle splitting and surgical trauma compared to conventional open and MIS approaches. We present the first non-inferiority comparison of ESS and open approaches to treat lumbar radiculopathy in an Australian cohort. The aim of this study is to assess if ESS is non-inferior to open approaches for the treatment of lumbar radiculopathy in post operative outcomes of pain and disability scores, in order to address the paucity in data for outcomes of ESS in Australian patients.

METHODS: In this retrospective cohort study, routinely collected prospective data were collated from consecutive patients who had single level endoscopic discectomies for radiculopathy by two surgeons at a single institution between December 2020 and October 2022. Data collected included Visual Analogue Scores for Back (VAS-B) and leg (VAS-L) pain as well as Oswestry Disability Index (ODI) scores, length of stay (LOS) and complication rates. These were compared to data from consecutive patients who underwent open discectomies from August 2020 to September 2022 by the same surgeons at other private hospitals where the endoscope was unavailable, otherwise deemed suitable for either approach, allowing direct comparison of consecutive patients operated on for comparable pathologies differentiated only by equipment availability.

RESULTS: Analysis included 92 endoscopic and 97 open cases. Non-inferiority was established at 6-week with median VAS-L (1.0 vs. 1.8, between group difference -0.5, P<0.001), VAS-B (1.0 vs. 1.0, between group difference -0.3, P=0.002) and ODI (18 vs. 20, between group difference -0.5, P<0.001) and 6-month for ODI (14 vs. 20, between group difference -1.6, P<0.001). Six-month median VAS-L and VAS-B was identical between groups (1.0 and 2.0), however this was not statistically significant. LOS was lower in ESS (LOS <24 h 93% vs. 78%, P=0.005). Reoperation rates were similar (10% vs. 7%, P=0.73). There were fewer complications in the endoscopic cohort than in the open cohort (5% vs. 6%), however this was not statistically significant.

CONCLUSIONS: ESS is non-inferior to open decompression for the management of lumbar radiculopathy up to 6 months. LOS was also found to be lower in ESS. There were fewer complications with ESS however this was not statistically significant.

PMID:40242811 | PMC:PMC11998043 | DOI:10.21037/jss-24-116

J Spine Surg. 2025 Mar 24;11(1):24-32. doi: 10.21037/jss-24-116. Epub 2025 Mar 17.

ABSTRACT

BACKGROUND: Endoscopic spine surgery (ESS) has evolved as a new minimally invasive surgical (MIS) approach to the lumbar spine. ESS allows smaller incisions, less paraspinal muscle splitting and surgical trauma compared to conventional open and MIS approaches. We present the first non-inferiority comparison of ESS and open approaches to treat lumbar radiculopathy in an Australian cohort. The aim of this study is to assess if ESS is non-inferior to open approaches for the treatment of lumbar radiculopathy in post operative outcomes of pain and disability scores, in order to address the paucity in data for outcomes of ESS in Australian patients.

METHODS: In this retrospective cohort study, routinely collected prospective data were collated from consecutive patients who had single level endoscopic discectomies for radiculopathy by two surgeons at a single institution between December 2020 and October 2022. Data collected included Visual Analogue Scores for Back (VAS-B) and leg (VAS-L) pain as well as Oswestry Disability Index (ODI) scores, length of stay (LOS) and complication rates. These were compared to data from consecutive patients who underwent open discectomies from August 2020 to September 2022 by the same surgeons at other private hospitals where the endoscope was unavailable, otherwise deemed suitable for either approach, allowing direct comparison of consecutive patients operated on for comparable pathologies differentiated only by equipment availability.

RESULTS: Analysis included 92 endoscopic and 97 open cases. Non-inferiority was established at 6-week with median VAS-L (1.0 vs. 1.8, between group difference -0.5, P<0.001), VAS-B (1.0 vs. 1.0, between group difference -0.3, P=0.002) and ODI (18 vs. 20, between group difference -0.5, P<0.001) and 6-month for ODI (14 vs. 20, between group difference -1.6, P<0.001). Six-month median VAS-L and VAS-B was identical between groups (1.0 and 2.0), however this was not statistically significant. LOS was lower in ESS (LOS <24 h 93% vs. 78%, P=0.005). Reoperation rates were similar (10% vs. 7%, P=0.73). There were fewer complications in the endoscopic cohort than in the open cohort (5% vs. 6%), however this was not statistically significant.

CONCLUSIONS: ESS is non-inferior to open decompression for the management of lumbar radiculopathy up to 6 months. LOS was also found to be lower in ESS. There were fewer complications with ESS however this was not statistically significant.

PMID:40242811 | PMC:PMC11998043 | DOI:10.21037/jss-24-116

Phys Imaging Radiat Oncol. 2025 Mar 31;34:100759. doi: 10.1016/j.phro.2025.100759. eCollection 2025 Apr.

ABSTRACT

BACKGROUND AND PURPOSE: Locoregional recurrence (LRR) is the primary pattern of failure in head and neck cancer (HNC) following radiation treatment (RT). Predicting an individual patient’s LRR risk is crucial for pre-treatment risk stratification and treatment adaptation during RT. This study aimed to evaluate the feasibility of integrating pre-treatment and mid-treatment diffusion-weighted (DW)-MRI radiomic parameters into multivariable prognostic models for HNC.

MATERIALS AND METHODS: A total of 178 oropharyngeal cancer (OPC) patients undergoing (chemo)radiotherapy (CRT) were analyzed on DW-MRI scans. 105 radiomic features were extracted from ADC maps. Cox regression models incorporating clinical and radiomic parameters were developed for pre-treatment and mid-treatment phases. The models’ discriminative ability was assessed with the Harrel C-index after 5-fold cross-validation.

RESULTS: Gray Level Co-occurrence Matrix (GLCM)-correlation emerged as a significant pre-treatment radiomic predictor of locoregional control (LRC) with a C-index (95 % CI) of 0.66 (0.57-0.75). Significant clinical predictors included HPV status, stage, and alcohol use, yielding a C-index of 0.70 (0.62-0.78). Combining clinical and radiomic data resulted in a C-index of 0.72 (0.65-0.80), with GLCM-correlation, disease stage and alcohol use as significant predictors. The mid-treatment model, which included delta (Δ) mean ADC, stage, and additional chemotherapy, achieved a C-index of 0.74 (0.65-0.82). Internal cross-validation yielded C-indices of 0.60 (0.51-0.69), 0.56 (0.44-0.66), and 0.63 (0.54-0.73) for the clinical, combined, and mid-treatment models, respectively.

CONCLUSION: The addition of Δ ADC improves the clinical model, highlighting the potential complementary value of radiomic features in prognostic modeling.

PMID:40242809 | PMC:PMC12002943 | DOI:10.1016/j.phro.2025.100759

Front Immunol. 2025 Apr 2;16:1572821. doi: 10.3389/fimmu.2025.1572821. eCollection 2025.

ABSTRACT

The intricate interaction between skeletal muscle biomechanics, the tumor microenvironment, and immunotherapy constitutes a pivotal research focus oncology. This work provides a comprehensive review of methodologies for evaluating skeletal muscle biomechanics, including handheld dynamometry, advanced imaging techniques, electrical impedance myography, elastography, and single-fiber experiments to assess muscle quality and performance. Furthermore, it elucidates the mechanisms, applications, and limitations of various immunotherapy modalities, including immune checkpoint inhibitors, adoptive cell therapy, cancer vaccines, and combined chemoimmunotherapy, while examining their effects on skeletal muscle function and systemic immune responses. Key findings indicate that although immunotherapy is effective in augmenting antitumor immunity, it frequently induces muscle-related adverse effects such as weakness, fatigue, or damage, primarily mediated by cytokine release and immune activation. This work underscores the significance of immune niches within the tumor microenvironment in influencing treatment outcomes and proposes strategies to optimize therapy through personalized regimens and combinatorial approaches. This review highlights the need for further research on the formation of immune niches and interactions muscle-tumor. Our work is crucial for advancing the efficacy of immunotherapy, reducing adverse effects, and ultimately improving survival rates and quality of life of patients with cancer.

PMID:40242775 | PMC:PMC12000078 | DOI:10.3389/fimmu.2025.1572821

Front Immunol. 2025 Apr 2;16:1457758. doi: 10.3389/fimmu.2025.1457758. eCollection 2025.

ABSTRACT

PURPOSE: The metabolic pattern in autoimmune encephalitis (AE) has been frequently reported. Through this semi-quantitative analysis, we aim to explore a practical diagnostic model based on positron emission tomography (PET) for timely diagnosis of pediatric AE with high accuracy. Moreover, we aim to identify factors that affect the prognosis of pediatric AE and explore the utility of PET as a prognostic biomarker.

METHOD: Data were collected from 93 AE patients and 67 non-AE patients (age range: 1-18 years old). Semi-quantitative parameters of ¹⁸F-FDG PET imaging were evaluated, including the score of cortical lesion extent and the ratios of lesion-to-basal ganglia and thalamus. The Clinical Assessment Scale in Autoimmune Encephalitis (CASE) was used to rate the disease severity and long-term outcome. Multivariate statistical analysis was used to establish a diagnostic model and analyze predictors.

RESULTS: The diagnostic model includes three PET parameters. The sensitivity, specificity, and accuracy of the model are 91.4%, 85.1%, and 88.8%, respectively. Participants were followed up for a median of 34 months. Logistic regression analysis indicated that male, initial CASE score >4.5,memory dysfunction, and the ratio of the maximum SUV of the lesion to thalamus (SUVRmax_L/T) < 0.577 are independent factors associated with poor prognosis in AE. We established a prognostic model through these predictors.

CONCLUSION: ¹⁸F-FDG PET plays a vital role in the diagnosis and prognosis of AE. The PET-based diagnostic model has higher specificity and accuracy than visual analysis. The prognostic model is a useful predictive tool for the long-term prognosis of children with AE.

PMID:40242763 | PMC:PMC12000777 | DOI:10.3389/fimmu.2025.1457758

Front Psychol. 2025 Apr 2;16:1568284. doi: 10.3389/fpsyg.2025.1568284. eCollection 2025.

ABSTRACT

BACKGROUND: It is known that stress occurring through/against a phenomenon will have physiological and psychological effects on the human organism. Therefore, this research aimed to determine the physiological and psychological effects of weight loss-induced stress before a competition in senior wrestlers.

METHODS: This cross-sectional study used a purposeful sampling method to select participants. Two hundred and forty-three wrestlers participated in the study voluntarily. The perceived stress scale and athlete weight loss methodology and effects scale were used to determine the physiological and psychological effects of weight loss-induced stress. Independent samples t-test, One-way ANOVA, Pearson correlation analysis, and linear regression analysis were used to analyze normally distributed data.

RESULTS: There was no statistical difference in the wrestlers’ body weight loss percentages, stress levels, and weight loss methods and effects sub-dimensions according to their gender and wrestling styles (p > 0.05). Despite this, there was a statistical difference in wrestlers’ stress levels, ergogenic aids sub-dimension from weight loss methods, and psychological effect levels according to body weight loss percentages (p < 0.05). Additionally, there was a positive relationship between the body weight loss percentages of wrestlers with their stress levels (r: 0.461) and psychological effects (r: 0.240). Furthermore, there was a positive relationship between the stress levels of wrestlers with the average physiological (r: 0.298) and psychological (r: 0.508) effects. According to these results, it was determined that as the body weight loss percentages of wrestlers increased, their stress levels and the psychological effects they were exposed to would increase. It was also determined that as the stress level of wrestlers increased, the physiological and psychological effects they were exposed to would increase the weight loss-induced stress levels of wrestlers positively predicted their exposure to physiological and psychological effects at 8.5% (Adj. R ² = 0.085) and 25.8% (Adj. R ² = 0.258), respectively.

CONCLUSION: It was determined that as the percentage of body weight loss increases in wrestlers, the stress level will also increase and the stress level increases, the physiological and psychological effects will also increase. It is thought that weight loss-induced stress has both physiological and psychological effects on wrestlers and may reduce their athletic performance.

PMID:40242746 | PMC:PMC11999944 | DOI:10.3389/fpsyg.2025.1568284