Journal of Spine

Cerebrospinal fluid is a clear, colorless fluid that surrounds the brain and spinal cord, acting as a cushion to protect these vital structures from injury, while also providing nutrients and removing waste products. The flow of CSF is a complex, highly regulated system that involves both production and circulation through the central nervous system, with particular dynamics at various levels of the spinal cord. One of the lesser-understood aspects of CSF physiology is its egress and outflow at the lumbar spine, especially around the nerve roots. Understanding this process is crucial, as disruptions can lead to various neurological conditions, including hydrocephalus, spinal cord injury, and conditions such as idiopathic intracranial hypertension or normal pressure hydrocephalus.

The diagnosis of lumbar spine disorders has evolved considerably over the past few decades, owing largely to the integration of advanced imaging techniques and artificial intelligence. Among the various lumbar spine diseases, intervertebral disc degeneration, herniation, and other degenerative conditions are among the most prevalent, often leading to chronic pain, impaired mobility, and even disability. Traditionally, diagnosing such conditions relied heavily on clinical examination and static imaging, such as X-rays and magnetic resonance imaging. However, these methods alone can sometimes fail to provide sufficient insights, especially when the disc’s condition is subtle or difficult to assess from a single perspective. In this context, the advent of multi-angle intervertebral disc imaging combined with deep learning techniques has opened new avenues for more accurate, automated, and efficient diagnosis of lumbar diseases.

Neuromuscular scoliosis refers to spinal deformities in patients with underlying neurological or muscular conditions that affect posture and mobility, such as cerebral palsy, muscular dystrophy, or spinal cord injury. This condition often leads to progressive spinal deformities, including scoliosis and kyphosis, which, if left untreated, can result in significant health complications, including pain, respiratory issues, and impaired functionality. Non-ambulatory patients, those who are unable to walk, are particularly susceptible to rapid progression of scoliosis due to the lack of active motor control and postural adjustments. For many years, the treatment of severe NMS involved spinal fusion, but this approach has limitations, particularly for growing children.

Spinal arthritis, also known as spondylosis or osteoarthritis of the spine, is a condition that affects the vertebrae and discs in the spine. It occurs when the cartilage that cushions the joints deteriorates over time, leading to pain, stiffness, and reduced mobility. The condition can involve the neck or lower back and often occurs with age, although younger individuals can also be affected due to genetic predisposition or injury. While there is no cure for spinal arthritis, a comprehensive, or holistic, approach to managing the condition can help reduce symptoms, improve quality of life, and prevent further deterioration of the spine. This approach not only targets the physical aspects of the disease but also considers mental and emotional well-being. A combination of lifestyle changes, physical therapies, medications, and alternative treatments can be highly effective in managing spinal arthritis.

Intradural spinal tumors are a diverse group of neoplasms located within the dura mater of the spinal cord, which can be either intramedullary or extramedullary. These tumors, while relatively rare, pose significant challenges to neurosurgeons due to their delicate anatomical location and proximity to critical neural structures. Surgery remains the primary treatment modality for these tumors, but the risk of neurological damage during resection is high because of the intricate relationship between the tumor and surrounding spinal cord tissue, nerve roots, and blood vessels. To mitigate the risk of postoperative neurological deficits, the use of neurophysiological monitoring during spinal tumor surgery has become an increasingly important tool in modern neurosurgery.

Scoliosis, a condition characterized by an abnormal lateral curvature of the spine, affects millions of people worldwide, with varying degrees of severity. In some cases, scoliosis can lead to discomfort, pain, and significant complications in mobility. Treatment options for scoliosis vary depending on the degree of curvature, the age of the patient, and the presence of other underlying health conditions. While conservative treatments such as physical therapy and bracing are often effective in mild cases, more severe cases may require surgical intervention to improve spinal alignment and relieve symptoms. One such surgical option is laminectomy, a procedure traditionally used to treat conditions like spinal stenosis, herniated discs, and nerve compression. However, in certain cases of scoliosis, laminectomy can play a significant role in improving spinal alignment, reducing pain, and preventing further spinal deformity.

Unilateral open-door laminoplasty is a well-established surgical technique used in the treatment of cervical spondylotic myelopathy, a condition caused by compression of the spinal cord due to degenerative changes in the cervical spine. CSM can result in a wide range of neurological symptoms, including arm pain, weakness, numbness, and gait disturbances. In cases where conservative treatments fail, surgical decompression via laminoplasty is considered to relieve spinal cord compression and improve patient outcomes. The "open-door" laminoplasty technique involves creating a hinge on one side of the lamina (the bony plate forming part of the spinal canal) and lifting or "opening" the lamina on the opposite side to create additional space for the spinal cord. The unilateral version of this technique, in which the door (the opening) is created on one side only, has gained popularity because it reduces operative complexity and the associated risks of bilateral decompression.

Spinal cord injuries represent some of the most debilitating conditions, leading to permanent loss of sensory, motor, and autonomic function below the level of injury. With an estimated 250,000 to 500,000 new cases globally each year, the need for effective diagnostic and therapeutic strategies is evergrowing. Recent advances in optical technologies have shown promising potential in improving both the diagnosis and treatment of spinal cord damage. These tools provide non-invasive, high-resolution imaging capabilities, enable detailed functional assessments, and offer novel approaches to treatment. This article explores the latest optical techniques used in the diagnosis and treatment of spinal cord injury, examining their mechanisms, advantages, limitations, and ongoing research aimed at enhancing spinal cord repair and recovery

Laminectomy, a surgical procedure that involves the removal of a portion of the vertebral bone known as the lamina, is a cornerstone in the treatment of various spinal conditions, including degenerative disc disease, spinal stenosis, herniated discs, and certain types of spinal tumors. By providing decompression of the spinal cord or nerve roots, laminectomy aims to relieve pain, improve mobility, and restore function. However, as spinal surgery evolves, so too does the research and understanding surrounding laminectomy, leading to improvements in surgical techniques, patient outcomes, and post-operative care.