Olga N. Leonova

Posterior microsurgical decompression for cervical spondylotic myelopathy: study protocol | Baykov | Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika) Задняя микрохирургическая декомпрессия при вертеброгенной шейной миелопатии: протокол исследования* | Байков | Хирургия позвоночника

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Background Clinical studies have identified threshold HU values above which the risk of lumbar implant instability increases significantly; however, these threshold values have a very wide range. Furthermore, there is a lack of rationale for HU value thresholds based on biomechanical models to predict fusion failure. The purpose of the study is to provide biomechanical evidence for using an HU threshold to predict lumbar fusion failure. Methods A fused model of the L4–L5 lumbar segment with screws and an interbody cage was developed. The model was then numerically investigated under standard static loading conditions (flexion, extension, lateral bending and axial rotation). The von Mises stresses were investigated in different elements of the fused segment, including the vertebral trabecular bone, with HU values varied from 256 to 90. Results The highest stresses in the trabecular bone of the vertebral bodies were observed in the areas of contact with the screws during extension, lateral bending, and axial rotation in the lumbar segment. High stress concentrations were also found in the contact zones between the cage and the vertebral body during compression and extension. At HU values of 165 and above, the maximum stress in the vertebral trabecular bone was far below its ultimate strength. At HU = 140, the stress exceeds the ultimate strength during flexion. At HU = 125, the stress exceeds the ultimate strength under four loading conditions: flexion, extension, left bending, and clockwise axial rotation. The highest stresses in the cortical bone (100 MPa) and in the screws (180 MPa) did not reach critical values for cortical bone damage even at the lowest HU value of 90. Conclusion This study suggests that, within the assumptions of this single-level finite element model, an HU value of approximately 125 represents a transition point at which trabecular bone stresses approach or exceed predicted strength under multiple loading modes in lumbar fusion with screw fixation. Cortical bone remained intact even at the lowest trabecular bone HU value of 90.

Transforaminal interbody fusion: possibilities of segmental lordosis correction | Leonova | Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika) Трансфораминальный межтеловой спондилодез: возможности коррекции сегментарного угла | Леонова | Хирургия позвоночника

Study Design.: An open-label, randomized, non-inferiority clinical trial Objective.: To determine the effectiveness of the MIS-TLIF over the O-TLIF in patients with symptomatic lumbar stenosis combined with low-grade spondylolisthesis by comparing the clinical efficacy and safety. Summary of Background Data.: In patients with combined lumbar spinal stenosis and spondylolisthesis, it remains uncertain whether minimally invasive fusion surgery is non-inferior to the open approach. Methods.: We conducted an open-label, non-inferiority trial involving patients with symptomatic lumbar stenosis combined with low-grade spondylolisthesis. Patients were randomly assigned in a 1:1 ratio to undergo either MIS-TLIF or open TLIF surgery. The primary endpoint was the reduction in the Oswestry Disability Index (ODI) score from baseline to 3 months post-surgery, with a non-inferiority margin of 12 points. Secondary outcomes included 3-month changes from baseline in back and leg pain, neuropathic pain, satisfaction with treatment, intraoperative data, and cost-effectiveness. Results.: In the modified intention-to-treat population, the mean difference was 0.4, with the corresponding 90% confidence interval of (−5.7 to 6..5) having a lower bound below the non-inferiority margin of 12. Similar results were obtained by analysis of the per-protocol population. 82.8% of patients achieved the MCID for the ODI. Results for secondary outcomes (clinical scales, complications) showed no significant differences between the treatment groups (all P >0.05). Although the open TLIF group had a hospital stay that was 1.5 day days longer ( P =0.005) and required additional analgesia more frequently ( P =0.026), direct costs were 10.5% higher in the MIS-TLIF group ( P <0.001). Conclusions.: This is the first high-quality study comparing open TLIF and MIS-TLIF with a validated primary endpoint. Among patients with combined lumbar degenerative stenosis and degenerative spondylolisthesis, MIS-TLIF resulted in clinical outcomes at 3 months that were non-inferior to those with open TLIF.

Динамика сагиттального профиля позвоночника после изолированной декомпрессии интраканальных сосудисто-нервных образований при дегенеративном поясничном стенозе: протокол проспективного мультицентрового исследования*

BACKGROUND: Currently, there are several platforms for remote physician–patient interaction aimed at developing telemedicine services in the Russian Federation. Given the high prevalence of degenerative spine diseases in the population, the frequent need for medical care, including surgical interventions, and the growing workload on healthcare providers, there is a clear need to automate monitoring and data collection specifically for this patient cohort. AIM: The work aimed to develop automated interaction scenarios between a healthcare facility, physicians, and patients during the perioperative period using the example of a spine surgery department and to evaluate the effectiveness of their implementation. METHODS: Eight patient data collection scenarios were developed on the Medsenger platform. These scenarios were adapted to the specific characteristics of the clinical entities of patients with degenerative spine disorders, the type of planned surgical intervention, the scope of preoperative examination, and the collection of clinical data. RESULTS: During the first quarter of 2025, 89% of patients (317/356) activated their accounts, indicating a high level of engagement in the treatment process. Test results of more than 92% of patients (224/242) were successfully reviewed by a physician in advance. Moreover, preliminary review of examination results reduced the duration of the physician’s assessment in the admission ward from 40 to 20 minutes (a twofold reduction). Preliminary evaluation of diagnostic data by the admitting physician also reduced the number of hospitalization cancellations by sevenfold compared with the previous year. Remote completion of the required clinical questionnaires substantially reduced the workload of nursing staff: previously, questionnaires had been completed on paper or in electronic form under their supervision. CONCLUSION: The development of Medsenger platform scenarios is challenging and requires substantial effort and time; however, with appropriate adaptation, routine use of the platform considerably facilitates the routine work of the ward’s staff. Comprehensive data collection from hospitalized patients, as well as dynamic monitoring of clinical data, constitutes the basis for conducting scientific research and creating disease registries.

Purpose While recent advances in deep learning have enabled automated Pfirrmann grading systems for intervertebral disc degeneration (IDD), many models remain inaccessible due to proprietary restrictions. This study aimed to develop and validate a convolutional neural network (CNN) for automated Pfirrmann grading using a diverse clinical dataset, to compare our model’s performance with previously published results, and to create an open-source web application with a graphical user interface capable of grading both DICOM studies and individual MRI slices provided as image files. Methods We trained a CNN-based model using the YOLOv8x architecture on two datasets: a well-curated Russian disc degeneration study (RuDDS) cohort and an open-access dataset, totaling 484 lumbar MRI scans. Ground truth grading was provided by expert radiologists. The model was designed to simultaneously detect intervertebral discs and classify degeneration grades from single MRI slices. Performance was evaluated using standard metrics, including precision, recall, and mean average precision (mAP) across Pfirrmann grades I to V. Results Our model achieved predictive accuracy between 0.78 and 0.82 depending on lumbar level. The highest performance was observed for Grade IV discs (mAP50 = 0.872), while performance for Grade V was lower (mAP50-95 = 0.525), likely due to poor contrast and indistinct boundaries in highly degenerated discs. Overall, the model demonstrated a precision of 0.75 and a recall of 0.808. Comparison with previous studies revealed that our results are consistent with expert-level performance. The developed model formed the basis of a specialized web application, SpineScan, implemented using the Streamlit framework. Conclusions The developed model shows strong potential for automated grading of lumbar disc degeneration and performs comparably to expert radiologists in most cases. Our findings support the potential applicability of SpineScan for AI-assisted Pfirrmann grading.

Сегментарный лордоз при стабилизации на поясничном уровне у пациентов с дегенеративной патологией: несистематический обзор литературы

Study Design: Prospective disease-oriented study. Objective: To describe the MRI findings in patients with failed conservative treatment for degenerative lumbar diseases and to identify predictors of back pain intensity in these patients. Methods: We analyzed demographic (sex, age) and clinical scale data as well as the lumbar MRI findings (Pfirrmann disc degeneration, Modic types, endplate defects, disc height and osteophytes) in RuDDS patients. We examined the prevalence of degenerative changes in different age groups and searched for predictors of back pain intensity after the procedure in patients with specific leading syndromes. Results: Patients with failed conservative treatment demonstrate more severe degeneration of the discs and endplates, more Modic changes, and higher Jarosz scores than reported in population-based studies. Individuals with degenerative stenosis have the most severe lumbar spine degeneration compared to patients with other leading syndromes (facet joint pain, lumbar disc herniation, degenerative deformity) ( P < 0.004). Lumbar MRI findings had a weak (β < 0.1) though statistically significant effect on back pain intensity before the procedure and clinically significant back pain attenuation after it. Smoking had a greater impact on back pain and its attenuation after the procedure, especially in patients with degenerative stenosis (β = 0.307 and OR = 2.03, respectively). Conclusion: This is the first characterization of MRI findings in patients with failed conservative treatment. Smokers show more prominent back pain attenuation after the procedure than non-smokers; however it is not clear whether this treatment effect is sufficient. The trial registry number is NCT04600544 on clinicaltrials.gov .