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Objective: To evaluate the effects of cervical artificial disc replacement (ADR) and anterior discectomy and fusion (ACDF) on adjacent spinal alignments.Methods: The cohort consisted of 33 patients who undergone single-level cervical ADR (15 patients) and ACDF (18 patients) for radiculopathy, who had not had any previous spine surgery, and who had a minimum follow-up of 2 years. Whole-spine lateral radiographs were taken at the pre-operative and follow-up consultations. Cervical lordosis, thoracic kyphosis, lumbar lordosis, and sagittal balance were measured each time. The patients filled out pre-operative and follow-up functional evaluation forms including visual analogue scale (VAS) of neck and arm. The mean follow-up durations of patients who had cervical ADR and ACDF were 28 ± 5.0 and 30 ± 5.8 months, respectively. The patients having ACDF had the higher mean age (53 ± 9.0 years) than that of patients with cervical ADR (45 ± 11.7 years).Results: The cervical lordosis and thoracic kyphosis in cervical ADR group increased significantly more than those of the ACDF group in follow-up assessment (P = 0.011 and 0.012). There was no significant change of lumbar lordosis in intra- and inter-group analyses. The follow-up sagittal balances for the cervical ADR and ACDF groups moved towards a neutral value. Although the follow-up neck and arm VAS of the both groups improved than those of the pre-operative status, the groups did not differ significantly except for a difference in neck VAS, which improved more after ADR.Conclusions: The remodeling of cervical and thoracic curves after cervical ADR and ACDF was coupled and complementary. Cervical ADR contributed the restorations of angulations of cervical and thoracic spines. The neck VAS improved more after cervical ADR than after ACDF. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Case series. OBJECTIVE: The object of this study is to present surgical outcomes for treatment of large ventral intradural extramedullary (IDEM) spinal cord tumors with conventional laminectomy. SUMMARY OF BACKGROUND DATA: Most IDEM spinal cord tumors are meningiomas and schwannomas, which are separated from the spinal cord by a discrete anatomical barrier (the arachnoid or pia membrane). As a result of this anatomical barrier, a tumor can be removed using the posterior approach with conventional laminectomy. Although many reports have demonstrated the feasibility of the posterior approach for ventral tumors, there have been no studies detailing large ventral IDEM tumors. METHODS: From 2001 to 2008, we operated on 18 consecutive patients with a large ventral IDEM tumor using the posterior approach (8 cervical and 10 thoracic). Preoperatively, eight patients were classified as having Nurick grade 1 myelopathy, six patients had grade 2, and four had grade 3. Tumors were removed through a slit-like space between the dura and spinal cord without retraction of the spinal cord. Complete removal of the tumor was possible in 17 cases. The follow-up period was 39 ± 28 months (range = 10-97 months). RESULTS: There were 7 cases of meningiomas and 11 of schwannomas. One schwannoma was mixed with the cervical rootlets and the mass in the foramen was left behind. Clinical symptoms improved in 16 patients and stabilized in 2. The one residual mass was stable for 62 months. There were no cases of recurrence. Neither kyphotic change nor instability developed in any of the patients during the follow-up period. CONCLUSION: Large ventral IDEM spinal cord tumors can be completely removed using a posterior approach and conventional laminectomy. An understanding of the anatomical and growth characteristics of these tumors is extremely important for successful removal. However, this approach should be applied prudently and with a thorough understanding of its limitations. [ABSTRACT FROM AUTHOR]

Background and Objective: Recent advancements in brain-computer interface (BCI) technology have seen a significant shift towards incorporating complex decoding models such as deep neural networks (DNNs) to enhance performance. These models are particularly crucial for sophisticated tasks such as regression for decoding arbitrary movements. However, these BCI models trained and tested on individual data often face challenges with limited performance and generalizability across different subjects. This limitation is primarily due to a tremendous number of parameters of DNN models. Training complex models demands extensive datasets. Nevertheless, group data from many subjects may not produce sufficient decoding performance because of inherent variability in neural signals both across individuals and over time METHODS: To address these challenges, this study proposed a transfer learning approach that could effectively adapt to subject-specific variability in cortical regions. Our method involved training two separate movement decoding models: one on individual data and another on pooled group data. We then created a salience map for each cortical region from the individual model, which helped us identify the input's contribution variance across subjects. Based on the contribution variance, we combined individual and group models using a modified knowledge distillation framework. This approach allowed the group model to be universally applicable by assigning greater weights to input data, while the individual model was fine-tuned to focus on areas with significant individual variance RESULTS: Our combined model effectively encapsulated individual variability. We validated this approach with nine subjects performing arm-reaching tasks, with our method outperforming (mean correlation coefficient, r = 0.75) both individual (r = 0.70) and group models (r = 0.40) in decoding performance. In particular, there were notable improvements in cases where individual models showed low performances (e.g., r = 0.50 in the individual decoder to r = 0.61 in the proposed decoder) CONCLUSIONS: These results not only demonstrate the potential of our method for robust BCI, but also underscore its ability to generalize individual data for broader applicability., Competing Interests: Declaration of competing interest The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This study investigates the complex relationship between upper limb movement direction and macroscopic neural signals in the brain, which is critical for understanding brain-computer interfaces (BCI). Conventional BCI research has primarily focused on a local area, such as the contralateral primary motor cortex (M1), relying on the population-based decoding method with microelectrode arrays. In contrast, macroscopic approaches such as electroencephalography (EEG) and magnetoencephalography (MEG) utilize numerous electrodes to cover broader brain regions. This study probes the potential differences in the mechanisms of microscopic and macroscopic methods. It is important to determine which neural activities effectively predict movements. To investigate this, we analyzed MEG data from nine right-handed participants while performing arm-reaching tasks. We employed dynamic statistical parametric mapping (dSPM) to estimate source activity and built a decoding model composed of long short-term memory (LSTM) and a multilayer perceptron to predict movement trajectories. This model achieved a high correlation coefficient of 0.79 between actual and predicted trajectories. Subsequently, we identified brain regions sensitive to predicting movement direction using the integrated gradients (IG) method, which assesses the predictive contribution of each source activity. The resulting salience map demonstrated a distribution without significant differences across motor-related regions, including M1. Predictions based solely on M1 activity yielded a correlation coefficient of 0.42, nearly half as effective as predictions incorporating all source activities. This suggests that upper limb movements are influenced by various factors such as movement coordination, planning, body and target position recognition, and control, beyond simple muscle activity. All of the activities are needed in the decoding model using macroscopic signals. Our findings also revealed that contralateral and ipsilateral hemispheres contribute equally to movement prediction, implying that BCIs could potentially benefit patients with brain damage in the contralateral hemisphere by utilizing brain signals from the ipsilateral hemisphere. In conclusion, this study demonstrates that macroscopic activity from large brain regions significantly contributes to predicting upper limb movement. Non-invasive BCI systems would require a comprehensive collection of neural signals from multiple brain regions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors whose names are listed in “Macroscopic brain dynamics beyond contralateral primary motor cortex for movement prediction” certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Focal cortical dysplasia type I (FCD I) is the most common cause of pharmaco-resistant epilepsy with the poorest prognosis. To understand the epileptogenic mechanisms of FCD I, we obtained tissue resected from patients with FCD I epilepsy, and from tumor patients as control. Using whole-cell patch clamp in acute human brain slices, we investigated the cellular properties of fast-spiking interneurons (FSINs) and pyramidal neurons (PNs) within the ictal onset zone. In FCD I epilepsy, FSINs exhibited lower firing rates from slower repolarization and action potential broadening, while PNs had increased firing. Importantly, excitatory synaptic drive of FSINs increased progressively with the scale of cortical activation as a general property across species, but this relationship was inverted towards net inhibition in FCD I epilepsy. Further comparison with intracranial electroencephalography (iEEG) from the same patients revealed that the spatial extent of pathological high-frequency oscillations (pHFO) was associated with synaptic events at FSINs., (© 2024. The Author(s).)

Intracranial implants for diagnosis and treatment of brain diseases have been developed over the past few decades. However, the platform of conventional implantable devices still relies on invasive probes and bulky sensors in conjunction with large-area craniotomy and provides only limited biometric information. Here, an implantable multi-modal sensor array that can be injected through a small hole in the skull and inherently spread out for conformal contact with the cortical surface is reported. The injectable sensor array, composed of graphene multi-channel electrodes for neural recording and electrical stimulation and MoS 2 -based sensors for monitoring intracranial temperature and pressure, is designed based on a mesh structure whose elastic restoring force enables the contracted device to spread out. It is demonstrated that the sensor array injected into a rabbit's head can detect epileptic discharges on the surface of the cortex and mitigate it by electrical stimulation while monitoring both intracranial temperature and pressure. This method provides good potential for implanting a variety of functional devices via minimally invasive surgery., (© 2024 The Authors. Advanced Materials published by Wiley‐VCH GmbH.)

Dual-position oblique lumbar interbody fusion with fluoroscopy (D-OLIF) requires repositioning the patient to a prone position for pedicle screw insertion. Recently, single-position surgery with navigation has been introduced. However, there are concerns regarding pedicle screw accuracy and achieving appropriate sagittal balance in single-position OLIF with navigation (S-OLIF). The purpose of this study is to evaluate the clinical and radiological outcomes of S-OLIF compared to D-OLIF. A retrospective analysis was conducted on 102 patients who underwent single-level OLIF at a single institution. The patients were divided into two groups: 55 in the S-OLIF group and 47 in the D-OLIF group. The numeric rating scale for back and leg, Oswestry disability index, and walking distance improvements showed no significant difference. However, the EuroQol 5-dimension 5-level index showed higher improvement in the S-OLIF (P = 0.029). The segmental lordosis, lumbar lordosis, and C7 sagittal vertical axis showed no significant difference. S-OLIF had significantly fewer cases of pedicle screw malposition (P = 0.045). Additionally, the surgery time was shorter in the S-OLIF (P = 0.002). In conclusion, S-OLIF exhibited clinical and radiological outcomes comparable to D-OLIF, with the added advantages of reduced surgery time and enhanced accuracy in pedicle screw placement., (© 2024. The Author(s).)

For commercial processes, through-hole AAO membranes are fabricated from high-purity aluminum by chemical etching. However, this method has the disadvantages of using heavy-metal solutions, creating large amounts of material waste, and leading to an irregular pore structure. Through-hole porous alumina membrane fabrication has been widely investigated due to applications in filters, nanomaterial synthesis, and surface-enhanced Raman scattering. There are several means to obtain freestanding through-hole AAO membranes, but a fast, low-cost, and repetitive process to create complete, high-quality membranes has not yet been established. Here, we propose a rapid and efficient method for the multi-detachment of an AAO membrane at room temperature by integrating the one-time potentiostatic (OTP) method and two-step electrochemical polishing. Economical commercial AA1050 was used instead of traditional high-cost high-purity aluminum for AAO membrane fabrication at 25 °C. The OTP method, which is a single-step process, was applied to achieve a high-quality membrane with unimodal pore distribution and diameters between 35 and 40 nm, maintaining a high consistency over five repetitions. To repeatedly detach the AAO membrane, two-step electrochemical polishing was developed to minimize damage on the AA1050 substrate caused by membrane separation. The mechanism for creating AAO membranes using the OTP method can be divided into three major components, including the Joule heating effect, the dissolution of the barrier layer, and stress effects. The stress is attributed to two factors: bubble formation and the difference in the coefficient of thermal expansion between the AAO membrane and the Al substrate. This highly efficient AAO membrane detachment method will facilitate the rapid production and applications of AAO films.

Although one can recognize the environment by soundscape substituting vision to auditory signal, whether subjects could perceive the soundscape as visual or visual-like sensation has been questioned. In this study, we investigated hierarchical process to elucidate the recruitment mechanism of visual areas by soundscape stimuli in blindfolded subjects. Twenty-two healthy subjects were repeatedly trained to recognize soundscape stimuli converted by visual shape information of letters. An effective connectivity method called dynamic causal modeling (DCM) was employed to reveal how the brain was hierarchically organized to recognize soundscape stimuli. The visual mental imagery model generated cortical source signals of five regions of interest better than auditory bottom-up, cross-modal perception, and mixed models. Spectral couplings between brain areas in the visual mental imagery model were analyzed. While within-frequency coupling is apparent in bottom-up processing where sensory information is transmitted, cross-frequency coupling is prominent in top-down processing, corresponding to the expectation and interpretation of information. Sensory substitution in the brain of blindfolded subjects derived visual mental imagery by combining bottom-up and top-down processing., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background and Objectives: In cases where dumbbell-shaped cervical schwannoma encases the vertebral artery (VA), there is a risk of VA injury during surgery. The objective of this study is to propose a strategy for preserving the VA during the surgical excision of tumors adjacent to the VA through the utilization of anatomic layers., Methods: A retrospective analysis was conducted on 37 patients who underwent surgery for dumbbell-shaped cervical schwannoma with contacting VA from January 2004 to July 2023. The VA encasement group consisted of 12 patients, and the VA nonencasement group included 25 patients., Results: The perineurium acted as a protective barrier from direct VA exposure or injury during surgery. However, in the VA encasement group, 1 patient was unable to preserve the perineurium while removing a tumor adjacent to the VA, resulting in VA injury. The patient had the intact dominant VA on the opposite side, and there were no new neurological deficits or infarctions after the surgery. Gross total resection was achieved in 25 patients (67.6%), while residual tumor was confirmed in 12 patients (32.4%). Four patients (33.3% of 12 patients) underwent reoperation because of the regrowth of the residual tumor within the neural foramen. In the case of the 8 patients (66.7% of 12 patients) whose residual tumor was located outside the neural foramen, no regrowth was observed, and there was no recurrence of the tumor within the remaining perineurium after total resection., Conclusion: In conclusion, when resecting a dumbbell-shaped cervical schwannoma contacting VA, subperineurium dissection prevents VA injury because the perineurium acts as a protective barrier., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Encoding artificial perceptions through brain stimulation, especially that of higher cognitive functions such as speech perception, is one of the most formidable challenges in brain-computer interfaces (BCI). Brain stimulation has been used for functional mapping in clinical practices for the last 70 years to treat various disorders affecting the nervous system, including epilepsy, Parkinson's disease, essential tremors, and dystonia. Recently, direct electrical stimulation has been used to evoke various forms of perception in humans, ranging from sensorimotor, auditory, and visual to speech cognition. Successfully evoking and fine-tuning artificial perceptions could revolutionize communication for individuals with speech disorders and significantly enhance the capabilities of brain-computer interface technologies. However, despite the extensive literature on encoding various perceptions and the rising popularity of speech BCIs, inducing artificial speech perception is still largely unexplored, and its potential has yet to be determined. In this paper, we examine the various stimulation techniques used to evoke complex percepts and the target brain areas for the input of speech-like information. Finally, we discuss strategies to address the challenges of speech encoding and discuss the prospects of these approaches., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hong, Ryun and Chung.)

During the first year of the COVID-19 pandemic, the Republic of Korea (ROK) experienced three epidemic waves in February, August, and November 2020. These waves, combined with the overarching pandemic, significantly influenced trends in spinal surgery. This study aimed to investigate the trends in degenerative lumbar spinal surgery in ROK during the early COVID-19 pandemic, especially in relation to specific epidemic waves. Using the National Health Information Database in ROK, we identified all patients who underwent surgery for degenerative lumbar spinal diseases between January 1, 2019 and December 31, 2020. A joinpoint regression was used to assess temporal trends in spinal surgeries over the first year of the COVID-19 pandemic. The number of surgeries decreased following the first and second epidemic waves (p<0.01 and p = 0.34, respectively), but these were offset by compensatory increases later on (p<0.01 and p = 0.05, respectively). However, the third epidemic wave did not lead to a decrease in surgical volume, and the total number of surgeries remained comparable to the period before the pandemic. When compared to the pre-COVID-19 period, average LOH was reduced by 1 day during the COVID-19 period (p<0.01), while mean hospital costs increased significantly from 3,511 to 4,061 USD (p<0.01). Additionally, the transfer rate and the 30-day readmission rate significantly decreased (both p<0.01), while the reoperation rate remained stable (p = 0.36). Despite the impact of epidemic waves on monthly surgery numbers, a subsequent compensatory increase was observed, indicating that surgical care has adapted to the challenges of the pandemic. This adaptability, along with the stable total number of operations, highlights the potential for healthcare systems to continue elective spine surgery during public health crises with strategic resource allocation and patient triage. Policies should ensure that surgeries for degenerative spinal diseases, particularly those not requiring urgent care but crucial for patient quality of life, are not unnecessarily halted., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yuh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Lumbar spinal stenosis (LSS) and spondylolisthesis (SPL) are characterized as degenerative spinal pathologies and share considerable similarities. However, opinions vary on whether to recommend exercise or restrict it for these diseases. Few studies have objectively compared the effects of daily physical activity on LSS and SPL because it is impossible to restrict activities ethnically and practically. We investigated the effect of restricting physical activity due to social distancing (SoD) on LSS and SPL, focusing on the aspect of healthcare burden changes during the pandemic period., Methods: We included first-visit patients diagnosed exclusively with LSS and SPL in 2017 and followed them up for two years before and after the implementation of the SoD policy. As controls, patients who first visited in 2015 and were followed for four years without SoD were analyzed. The common data model was employed to analyze each patient's diagnostic codes and treatments. Hospital visits and medical costs were analyzed by regression discontinuity in time to control for temporal effects on dependent variables., Results: Among 33,484 patients, 2,615 with LSS and 446 with SPL were included. A significant decrease in hospital visits was observed in the LSS (difference, -3.94 times/month·100 patients; p = 0.023) and SPL (difference, -3.44 times/month·100 patients; p = 0.026) groups after SoD. This decrease was not observed in the data from the control group. Concerning medical costs, the LSS group showed a statistically significant reduction in median copayment (difference, -$45/month·patient; p < 0.001) after SoD, whereas a significant change was not observed in the SPL group (difference, -$19/month·patient; p = 0.160)., Conclusion: Restricted physical activity during the SoD period decreased the healthcare burden for patients with LSS or, conversely, it did not significantly affect patients with SPL. Under circumstances of physical inactivity, patients with LSS may underrate their symptoms, while maintaining an appropriate activity level may be beneficial for patients with SPL., (© 2024. The Author(s).)

Anodic aluminum oxide (AAO) has been widely applied for the surface protection of electronic component packaging through a pore-sealing process, with the enhanced hardness value reaching around 400 Vickers hardness (HV). However, the traditional AAO fabrication at 0~10 °C for surface protection takes at least 3-6 h for the reaction or other complicated methods used for the pore-sealing process, including boiling-water sealing, oil sealing, or salt-compound sealing. With the increasing development of nanostructured AAO, there is a growing interest in improving hardness without pore sealing, in order to leverage the characteristics of porous AAO and surface protection properties simultaneously. Here, we investigate the effect of voltage on hardness under the same AAO thickness conditions in oxalic acid at room temperature from a normal level of 40 V to a high level of 100 V and found a positive correlation between surface hardness and voltage. The surface hardness values of AAO formed at 100 V reach about 423 HV without pore sealing in 30 min. By employing a hybrid pulse anodization (HPA) method, we are able to prevent the high-voltage burning effect and complete the anodization process at room temperature. The mechanism behind this can be explained by the porosity and photoluminescence (PL) intensity of AAO. For the same thickness of AAO from 40~100 V, increasing the anodizing voltage decreases both the porosity and PL intensity, indicating a reduction in pores, as well as anion and oxygen vacancy defects, due to rapid AAO growth. This reduction in defects in the AAO film leads to an increase in hardness, allowing us to significantly enhance AAO hardness without a pore-sealing process. This offers an effective hardness enhancement in AAO under economically feasible conditions for the application of hard coatings and protective films.

From sensory input to motor action, encoded sensory features flow sequentially along cortical networks for decision-making. Despite numerous studies probing the decision-making process, the subprocess that compares encoded sensory features before making a decision has not been fully elucidated in humans. In this study, we investigated sensory feature comparison by presenting two different tasks (a discrimination task, in which participants made decisions by comparing two sequential tactile stimuli; and a detection task, in which participants responded to the second tactile stimulus in two sequential stimuli) to epilepsy patients while recording electrocorticography (ECoG). By comparing tactile-specific gamma band (30-200 Hz) power between the two tasks, the decision-making process was divided into three subprocesses-categorization, comparison, and decision-consistent with a previous study (Heekeren et al., 2004). These subprocesses occurred sequentially in the dorsolateral prefrontal cortex, premotor cortex, secondary somatosensory cortex, and parietal lobe. Gamma power showed two different patterns of correlation with response time. In the inferior parietal lobule (IPL), there was a negative correlation. This means that as gamma power increased, response time decreased. In the secondary somatosensory cortex (S2), there was a positive correlation. Here, as gamma power increased, response time also increased. These results indicate that the IPL and S2 encode tactile feature comparison differently. Our connectivity analysis showed that the S2 transmitted tactile information to the IPL. Our findings suggest that multiple areas in the parietal lobe encode sensory feature comparison differently before making a decision., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: This study aims to investigate the potential of direct cortical stimulation (DCS) to modulate tactile categorization and decision-making, as well as to identify the specific locations where these cognitive functions occur., Methods: We analyzed behavioral changes in three epilepsy patients with implanted electrodes using electrocorticography (ECoG) and a vibrotactile discrimination task. DCS was applied to investigate its impact on tactile categorization and decision-making processes. We determined the precise location of the electrodes where each cognitive function was modulated., Results: This functional discrimination was related with gamma band activity from ECoG. DCS selectively affected either tactile categorization or decision-making processes. Tactile categorization was modulated by stimulating the rostral part of the supramarginal gyrus, while decision-making was modulated by stimulating the caudal part., Conclusions: DCS can enhance cognitive processes and map brain regions responsible for tactile categorization and decision-making within the supramarginal gyrus. This study also demonstrates that DCS and the gamma activity of ECoG can concordantly identify the detailed brain mapping in a tactile process compared to other functional neuroimaging., Significance: The combination of DCS and ECoG gamma activity provides a more nuanced and detailed understanding of brain function than traditional neuroimaging techniques alone., (Copyright © 2023 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

This study aimed to compare the long-term effects of flexion- and extension-based lumbar exercises on chronic axial low back pain (LBP). This was a 1-year follow-up of a prospective, assessor-blind, randomized controlled trial. Patients with axial LBP (intensity ≥ 5/10) for > 6 months allocated to the flexion or extension exercise group. Patients underwent four sessions of a supervised treatment program and were required to perform their assigned exercises daily at home. Clinical outcomes were obtained at baseline, 1, 3, 6 months, and 1-year. A total of 56 patients (age, 54.3 years) were included, with 27 and 29 in the flexion and extension groups, respectively. Baseline pain and functional scales were similar between both groups. The mean (± standard deviation) baseline average back pain was 6.00 ± 1.00 and 5.83 ± 1.20 in the flexion and extension groups, respectively. At 1-year, the average pain was 3.78 ± 1.40 and 2.26 ± 2.62 (mean between-group difference, 1.52; 95% confidence interval 0.56-2.47; p = 0.002), favoring extension exercise. The extension group tended to have more improvements in current pain, least pain, and pain interference than the flexion group at 1-year. However, there was no group difference in worst pain and functional scales. In this controlled trial involving patients with chronic axial LBP, extension-based lumbar exercise was more effective in reducing pain than flexion-based exercises at 1-year, advocating lumbar extension movement pattern as a component for therapeutic exercise for chronic LBP.Clinical Trial Registration No.: NCT02938689 (Registered on www.clinicaltrial.gov ; first registration date was 19/10/2016)., (© 2024. The Author(s).)

Although the role of plain radiographs in diagnosing lumbar spinal stenosis (LSS) has declined in importance since the advent of magnetic resonance imaging (MRI), diagnostic ability of plain radiographs has improved dramatically when combined with deep learning. Previously, we developed a convolutional neural network (CNN) model using a radiograph for diagnosing LSS. In this study, we aimed to improve and generalize the performance of CNN models and overcome the limitation of the single-pose-based CNN (SP-CNN) model using multi-pose radiographs. Individuals with severe or no LSS, confirmed using MRI, were enrolled. Lateral radiographs of patients in three postures were collected. We developed a multi-pose-based CNN (MP-CNN) model using the encoders of the three SP-CNN model (extension, flexion, and neutral postures). We compared the validation results of the MP-CNN model using four algorithms pretrained with ImageNet. The MP-CNN model underwent additional internal and external validations to measure generalization performance. The ResNet50-based MP-CNN model achieved the largest area under the receiver operating characteristic curve (AUROC) of 91.4% (95% confidence interval [CI] 90.9-91.8%) for internal validation. The AUROC of the MP-CNN model were 91.3% (95% CI 90.7-91.9%) and 79.5% (95% CI 78.2-80.8%) for the extra-internal and external validation, respectively. The MP-CNN based heatmap offered a logical decision-making direction through optimized visualization. This model holds potential as a screening tool for LSS diagnosis, offering an explainable rationale for its prediction., (© 2024. The Author(s).)

Background: Hospital acquired pressure injury (HAPI) is associated with poor clinical outcomes and high medical costs. Patients undergoing surgery in the prone position are particularly vulnerable to perioperative HAPI. This prospective observational study investigated the factors associated with HAPI in patients undergoing elective spine surgery in the prone position., Methods: Two hundred eighty-seven patients undergoing elective spine surgery participated in this study. Demographics, perioperative vital signs, laboratory findings, surgical data, and intraoperative data were prospectively recorded. The sites and stages of HAPI were investigated on postoperative day 2. The stages of HAPI were evaluated using the pressure injury staging system of the National Pressure Ulcer Advisory Panel., Results: Perioperative HAPI was observed in 71 (24.7%) patients (stage 1, 40; stage 2, 31). The most frequent site (number) of HAPI was the upper extremities (33), followed by the chest (32), lower extremities (20), face (18), pelvis (10), and abdomen (9). In multivariate analysis, the duration of prone positioning per hour (odds ratio [95% confidence interval], 1.48 [1.25-1.74]; P <0.001) and intraoperative pH ≤7.35 (1.98 [1.05-3.76]; P =0.036) were associated with perioperative HAPI., Conclusions: The incidence of perioperative HAPI was 24.7% in patients undergoing elective spine surgery in the prone position. Long duration of prone positioning and intraoperative acidosis were associated with increased development of perioperative HAPI., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Most studies on the enhanced recovery after surgery (ERAS) protocol in spine surgery have focused on patients with degenerative spinal diseases (DSDs), resulting in a lack of evidence for a comprehensive ERAS protocol applicable to patients with primary spine tumors (PSTs) and other spinal diseases. The authors had developed and gradually adopted components of the comprehensive ERAS protocol for all spine surgical procedures from 2003 to 2011, and then the current ERAS protocol was fully implemented in 2012. This study aimed to evaluate the impact and the applicability of the comprehensive ERAS protocol across all spine surgical procedures and to compare outcomes between the PST and DSD groups., Methods: Adult spine surgical procedures were conducted from 2003 to 2021 at the Seoul National University Hospital Spine Center and data were retrospectively reviewed. The author divided the study periods into the developing ERAS (2003-2011) and post-current ERAS (2012-2021) periods, and outcomes were compared between the two periods. Surgical procedures for metastatic cancer, infection, and trauma were excluded. Interrupted time series analysis (ITSA) was used to assess the impact of the ERAS protocol on medical costs and clinical outcomes, including length of stay (LOS) and rates of 30-day readmission, reoperation, and surgical site infection (SSI). Subgroup analyses were conducted on the PST and DSD groups in terms of LOS and medical costs., Results: The study included 7143 surgical procedures, comprising 1494 for PSTs, 5340 for DSDs, and 309 for other spinal diseases. After ERAS protocol implementation, spine surgical procedures showed significant reductions in LOS and medical costs by 22% (p = 0.008) and 22% (p < 0.001), respectively. The DSD group demonstrated a 16% (p < 0.001) reduction in LOS, whereas the PST group achieved a 28% (p < 0.001) reduction, noting a more pronounced LOS reduction in PST surgical procedures (p = 0.003). Medical costs decreased by 23% (p < 0.001) in the DSD group and 12% (p = 0.054) in the PST group, with a larger cost reduction for DSD surgical procedures (p = 0.021). No statistically significant differences were found in the rates of 30-day readmission, reoperation, and SSI between the developing and post-current ERAS implementation periods (p = 0.65, p = 0.59, and p = 0.52, respectively)., Conclusions: Comprehensive ERAS protocol implementation significantly reduced LOS and medical costs in all spine surgical procedures, while maintaining comparable 30-day readmission, reoperation, and SSI rates. These findings suggest that the ERAS protocol is equally applicable to all spine surgical procedures, with a more pronounced effect on reducing LOS in the PST group and on reducing medical costs in the DSD group.

Objective: Although adult spinal deformity (ASD) surgery aims to restore and maintain alignment, proximal junctional kyphosis (PJK) may occur. While existing scoring systems predict PJK, they predominantly offer a generalized 3-tier risk classification, limiting their utility for nuanced treatment decisions. This study seeks to establish a personalized risk calculator for PJK, aiming to enhance treatment planning precision., Methods: Patient data for ASD were sourced from the Korean spinal deformity database. PJK was defined a proximal junctional angle (PJA) of ≥ 20° at the final follow-up, or an increase in PJA of ≥ 10° compared to the preoperative values. Multivariable analysis was performed to identify independent variables. Subsequently, 5 machine learning models were created to predict individualized PJK risk post-ASD surgery. The most efficacious model was deployed as an online and interactive calculator., Results: From a pool of 201 patients, 49 (24.4%) exhibited PJK during the follow-up period. Through multivariable analysis, postoperative PJA, body mass index, and deformity type emerged as independent predictors for PJK. When testing machine learning models using study results and previously reported variables as hyperparameters, the random forest model exhibited the highest accuracy, reaching 83%, with an area under the receiver operating characteristics curve of 0.76. This model has been launched as a freely accessible tool at: (https://snuspine.shinyapps.io/PJKafterASD/)., Conclusion: An online calculator, founded on the random forest model, has been developed to gauge the risk of PJK following ASD surgery. This may be a useful clinical tool for surgeons, allowing them to better predict PJK probabilities and refine subsequent therapeutic strategies.

Background Context: C3 laminectomy in cervical laminoplasty is a modified laminoplasty technique that can preserve the semispinalis cervicis muscle attached to the C2 spinous process. Several previous studies have shown that this technique can lead to better outcomes of postoperative axial neck pain and C2-C3 range of motion (ROM) than conventional cervical laminoplasty. However, there is still a lack of understanding of total and proportional postoperative cervical sagittal alignment outcomes., Purpose: To assess the effects of C3 laminectomy in cervical laminoplasty on postoperative cervical alignment and clinical outcomes., Design: A single-center, patient-blinded, randomized controlled trial., Patient Sample: We included consecutive 126 patients diagnosed with cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) who were scheduled for cervical laminoplasty from March 2017 to January 2020., Outcome Measures: The primary outcome measures were C2-C7 Cobb angle (CA) and neck disability index (NDI). Secondary outcomes measures included other clinical outcomes and radiographic parameters including segmental Cobb angle and presence of C2-C3 interlaminar fusion., Methods: Patients were randomly allocated to either the C3 laminectomy with C4-C6 laminoplasty group (LN group) or the C3-C6 laminoplasty group (LP group) at a 1:1 ratio. Laminoplasty was performed using a unilateral open-door technique and stabilized with titanium mini plates. A linear mixed model analysis was employed to examine the longitudinal data from postoperative 1-year through 3-year. Additional analysis between three types of cervical sagittal alignment morphology was done., Results: Among 122 patients who were randomly allocated to one of two groups (LN group, n=61; LP group, n=61), modified intent-to-treat analysis was done for 109 patients (LN group, n=51, LP group, n=58) who had available at least a year of postoperative data. Postoperative C2-C7 CA was not significantly different between the two groups. However, NDI was significantly different between the two groups (12.8±1.0 in the LN group vs 8.6±1.0 in LP group, p=.005), which exceeded the minimum clinically important difference (MCID). The postoperative C2-C3 CA was significantly greater in the LN group (7.1±0.5° in LN group vs 3.2±0.5° in LP group, p<.001) while C4-C7 CA was significantly smaller in the LN group (3.9±0.8° in LN group vs 7.7±0.7° in LP group, p<.001) with greater cSVA in the LN group (31.6±1.4 mm in LN group vs 25.5±1.3 mm in LP group at postoperative 3-year, p=.002). Postoperative Euro-Quality of Life-5 Dimension (EQ-5D), numerical rating scores for neck pain (NRS-N) were significantly better in the LP group than in the LN group (all p<.05) and only EQ-5D surpassed the MCID. The C2-C3 fusion rate was significantly different between the LN group (9.8%) and the LP group (44.8%) (p<.001). The LN group showed a higher prevalence of a specific cervical alignment morphology characterized by a sigmoid shape with proximal lordosis and distal kyphosis (S curve). This S curve demonstrated significantly unfavorable outcomes across multiple outcome variables., Conclusion: The impact of C3 laminectomy in cervical laminoplasty on postoperative kyphosis among patients with CSM or OPLL did not significantly differ from that of C3-C6 laminoplasty. However, C3 laminectomy in cervical laminoplasty might result in an unfavorable clinical outcome with an unbalanced cervical sagittal alignment characterized by a sigmoid shape with proximal lordosis and distal kyphosis., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Nanoporous anodic aluminum oxide (AAO) is an important template for 1D nanomaterial synthesis. It is used as an etching template for nanopattern transfer in a variety of contexts, including nanostructured material synthesis, electrical sensors, optical sensors, photonic and electronic devices, photocatalysis, and hardness and anticorrosion improvement. In this review, we focus on various fabrication methods, pore geometry modification, and recent advances of AAO, as well as sensor applications linked to our environment, daily life, and safety. Pore geometry is concerned with the material composition, applied voltage mold, electrolyte type, temperature, and anodizing time during the fabrication of AAOs and for adjusting their pore size and profile. The applied voltage can be divided into four types: direct current anodization (DCA), reverse pulse anodization, pulse anodization (PA), and hybrid pulse anodization (HPA). Conventional AAOs are fabricated using DCA and mild anodization (MA) at a relatively low temperature (-5~15 °C) to reduce the Joule heating effect. Moreover, the issues of costly high-purity aluminum and a long processing time can be improved using HPA to diminish the Joule heating effect at relatively high temperatures of 20-30 °C with cheap low-purity (≤99%) aluminum. The AAO-based sensors discussed here are primarily divided into electrical sensors and optical sensors; the performance of both sensors is affected by the sensing material and pore geometry. The electrical sensor is usually used for humidity or gas measurement applications and has a thin metal film on the surface as an electrode. On the contrary, the AAO optical sensor is a well-known sensor for detecting various substances with four kinds of mechanisms: interference, photoluminescence, surface plasma resonance, and surface-enhanced Raman scattering (SERS). Especially for SERS mechanisms, AAO can be used either as a solid support for coating metal nanoparticles or a template for depositing the metal content through the nanopores to form the nanodots or nanowires for detecting substances. High-performance sensors will play a crucial role in our living environments and promote our quality of life in the future., Competing Interests: The authors declare no conflict of interest.

Triboelectric nanogenerators (TENGs) are a kind of mechanical energy harvester with a larger force sensing range and good energy conversion, which is often applied to human kinetic energy collection and motion sensing devices. Polymer materials are the most commonly used materials in TENGs' triboelectric layers due to their high plasticity and good performance. Regarding the application of TENGs in insoles, research has often used brittle Teflon for high output performance together with hard materials, such as springs, for the mechanism to maintain its stability. However, these combined materials increase the weight and hardness of the insoles. Here, we propose a polyethylene terephthalate (PET)-based TENG with a micro-needle polydimethylsiloxane (PDMS) elastomer, referred to as MN-PDMS-TENG, to enhance performance and maintain comfort flexibility, and structural stability. Compared with a flat PDMS, the TENG with a microstructure enhances the output open-circuit voltage (Voc) from 54.6 V to 129.2 V, short-circuit current (Isc) from 26.16 μA to 64.00 μA, power from 684 µW to 4.1 mW, and ability to light up from 70 to 120 LEDs. A special three-layer TENG insole mechanism fabricated with the MN-PDMS-TENG and elastic materials gives the TENG insole high stability and the ability to maintain sufficient flexibility to fit in a shoe. The three-layer TENG insole transforms human stepping force into electric energy of 87.2 V, which is used as a self-powered force sensor. Moreover, with the calibration curve between voltage and force, it has a sensitivity of 0.07734 V/N with a coefficient of determination of R 2 = 0.91 and the function between force and output voltage is derived as F = 12.93 V - 92.10 under human stepping force (300~550 N). Combined with a micro-control unit (MCU), the three-layer TENG insole distinguishes the user's motion force at different parts of the foot and triggers a corresponding device, which can potentially be applied in sports and on rehabilitation fields to record information or prevent injury.

Although resection is the gold standard treatment for spinal ependymoma, permanent neurological deterioration has been reported postoperatively in 20%-27% of patients. Despite thorough dissection of the tumor from its surroundings, conventional longitudinally directed midline myelotomy can lead to injury to the dorsal column, possibly due to deformation of the posterior median septum as the tumor grows. To address this issue, the authors have been performing precise midline myelotomy through the anatomical posterior median septum by directly dissecting the dorsal column. This video presents the principles and application of this technique., Competing Interests: Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication.The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication., (© 2023, The Authors.)

Objective: Surgery for spinal giant cell tumors (GCTs) is challenging because these tumors often exhibit a poor clinical course owing to their locally aggressive features. This study aimed to investigate the prognostic factors of GCT recurrence in the spine by focusing on surgical factors., Methods: We retrospectively reviewed patients who underwent surgery for spinal GCTs between January 2005 and December 2016. Using the Kaplan-Meier method, surgical variables were evaluated for disease-free survival (DFS). Since tumor violation may occur at the pedicle during en bloc resection of the spine, it was further analyzed as a separate variable. Multivariate Cox proportional hazard regression analysis was performed for other clinical and radiographic variables. A total of 28 patients (male:female = 8:20) were included. The mean follow-up period was 90.5 months (range, 15-184 months)., Results: Among the 28 patients, gross total resection (GTR) was the most important factor for DFS (P = 0.001). Any form of tumor violation was also correlated with DFS (P = 0.049); however, use of en bloc resection technique did not show a significant DFS gain compared to piecemeal resection (P = 0.218). In the patient group that achieved GTR, the mode of resection was not a significant factor for DFS (P = 0.959). In the multivariate analysis, the extent of resection was the only significant variable that affected DFS (P = 0.016)., Conclusions: Conflicting results on tumor violation from univariate and multivariate analyses suggest that GTR without tumor violation should be the treatment goal for spinal GCTs. However, when tumor violation is unavoidable, it would be important to prioritize GTR over adhering to en bloc resection., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: Spinal schwannomas often require laminectomy for gross total resection. However, laminectomy may not be necessary due to the unique anatomy of epidural schwannomas at the C1-2 level, even with the intradural part. This study aimed to determine the need for laminectomy by comparing factors between patients who underwent laminectomy and those who did not and to identify the benefits of not performing laminectomy., Methods: Fifty patients with spinal epidural schwannoma confined to C1-C2 level were retrospectively collected and divided into groups based on whether laminectomy was intended and performed. In all cases where laminectomy was conducted, patients underwent laminoplasty using microplate-and-screws, which deviates from the conventional laminectomy approach. Tumor characteristics were compared, and a cut-off value for laminectomy was determined. Outcomes were compared between groups, and factors influencing laminectomy were identified. Postoperative changes in cervical curves were measured., Results: The diameter of the intradural part of the tumor was significantly longer in the laminectomy performed group, with a 14.86 mm cut-off diameter requiring laminectomy. Recurrence rates did not differ significantly between groups. Surgery time was substantially longer for the laminectomy performed group. No significant changes were observed in Cobb's angles of Oc-C2, C1-C2, and Oc-C1 before and after surgery., Conclusion: The study showed that the diameter of the intradural part of the tumor influenced the decision to perform laminectomy for removing epidural schwannomas at C1-C2. The cut-off value of the diameter of the intradural part of the tumor for the laminectomy was 14.86 mm. Not performing laminectomy can be a viable option with no significant differences in removal and complication rates., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Background and Objectives: Oblique lumbar interbody fusion (OLIF) procedures involve anterior insertion of interbody cage in lateral position. Following OLIF, insertion of pedicle screws and rod system is performed in a prone position (OLIF-con). The location of the cage is important for restoration of lumbar lordosis and indirect decompression. However, inserting the cage at the desired location is difficult without reduction of spondylolisthesis, and reduction after insertion of interbody cage may limit the amount of reduction. Recent introduction of spinal navigation enabled both surgical procedures in one lateral position (OLIF-one). Therefore, reduction of spondylolisthesis can be performed prior to insertion of interbody cage. The objective of this study was to compare the reduction of spondylolisthesis and the placement of cage between OLIF-one and OLIF-con., Methods: We retrospectively reviewed 72 consecutive patients with spondylolisthesis for this study; 30 patients underwent OLIF-one and 42 underwent OLIF-con. Spinal navigation system was used for OLIF-one. In OLIF-one, the interbody cage was inserted after reducing spondylolisthesis, whereas in OLIF-con, the cage was inserted before reduction. The following parameters were measured on X-rays: pre- and postoperative spondylolisthesis slippage, reduction degree, and the location of the cage in the disc space., Results: Both groups showed significant improvement in back and leg pains (p < .05). Transient motor or sensory changes occurred in three patients after OLIF-con and in two patients after OLIF-one. Pre- and postoperative slips were 26.3±7.7% and 6.6±6.2% in OLIF-one, and 23.1±7.0% and 7.4±5.8% in OLIF-con. The reduction of slippage was 74.4±6.3% after OLIF-one and 65.4±5.7% after OLIF-con, with a significant difference between the two groups (p = .04). The cage was located at 34.2±8.9% after OLIF-one and at 42.8±10.3% after OLIF-con, with a significant difference between the two groups (p = .004)., Conclusion: Switching the sequence of surgical procedures with OLIF-one facilitated both the reduction of spondylolisthesis and the placement of the cage at the desired location., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)