From the Editor-in-Chief: Featured Articles in the June 2025 Issue

Inbo Han

doi:10.14245/ns.2550894.447

In this editorial, we highlight the most notable research articles featured in the June 2025 issue of Neurospine. This issue includes 2 exceptional papers from the PSPS (Pacific Spine & Pain Society)/KNPS (Korean Neuro-Pain Society) special feature and 3 distinguished articles from regular submissions.

Article 1: “Transcranial Optogenetic Stimulation Promotes Corticospinal Tract Axon Regeneration to Repair Spinal Cord Injury by Activating the JAK2/STAT3 Pathway”

This groundbreaking study [1] demonstrates that modified transcranial optogenetic stimulation promotes corticospinal tract (CST) axon regeneration following complete spinal cord injury (SCI) in ChR2-YFP transgenic mice. Using a novel light emitting diode (LED) device for bilateral motor cortex activation, the researchers achieved significant enhancement of CST axon regrowth and improved hindlimb motor function. In vitro LED stimulation of motor cortex slices demonstrated increased neurite outgrowth, while proteomic analysis identified activation of the JAK2/STAT3 pathway as the key underlying mechanism. Pharmacological inhibition of this pathway suppressed neurite extension, confirming its critical role. These findings present optogenetically induced JAK2/STAT3 signaling as a promising therapeutic avenue for CST regeneration after SCI, offering new hope for translational applications in spinal cord injury treatment.

Article 2: “Establishing a Standardized Fellowship Curriculum for Advanced Minimally Invasive Spine Interventions: A Multidisciplinary Approach to Training and Competency”

This comprehensive editorial [2] addresses the urgent need for standardized training in minimally invasive spine interventions (MISI) for physicians from nonsurgical specialties. In response to the growing demand for alternatives to lumbar fusion and concerns about overutilization, the authors propose a structured 1-year fellowship program emphasizing multidisciplinary training. The curriculum encompasses spinal anatomy, biomechanics, and advanced procedures including sacroiliac joint fusion, percutaneous lumbar decompression, and spinal cord stimulation. Core components feature hands-on rotations in both spine surgery and interventional pain practices. A comprehensive competency framework incorporating written examinations, objective structured clinical examinations, and detailed procedural logs is outlined. The editorial calls for collaborative efforts among stakeholders to standardize MISI training and expand access to safe, effective spine care alternatives.

Article 3: “The Role of K-Line and Canal-Occupying Ratio in Surgical Outcomes for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Multicenter Study”

This extensive study [3] evaluated the prognostic significance of the K-line and canal-occupying ratio (COR) in 575 patients with multilevel cervical ossification of the posterior longitudinal ligament (OPLL) undergoing decompression surgery. Japanese Orthopaedic Association recovery was significantly superior in patients with K-line positive status and COR less than 50%. In cases with high COR (≥50%), K-line negative status predicted substantially poorer outcomes. Anterior decompression with fusion demonstrated the best overall results across all patient groups. Notably, laminoplasty proved optimal for K-line positive patients with high COR, while laminectomy with fusion was preferable for K-line negative patients with high COR. The study revealed that K-line status was influenced by cervical alignment parameters (C2 slope, T1 slope) in high COR cases, but predominantly determined by COR percentage in low COR cases.

Article 4: “Proximal Thoracic Alignment Change Influences Cervical Sagittal Alignment After Correction Surgery in Patients With Lenke Type 2 Adolescent Idiopathic Scoliosis”

This important study [4] analyzed factors affecting cervical sagittal alignment (CSA) following posterior spinal fusion (PSF) in 102 patients with Lenke type 2 adolescent idiopathic scoliosis (AIS). Preoperatively, 55.9% of patients exhibited cervical malalignment (CM), characterized by greater cervical kyphosis, reduced proximal thoracic kyphosis (PTK), and diminished T1 slope compared to the non-CM group. At 2-year follow-up, CSA demonstrated significant improvement in the CM group, with increased PTK and T1 slope values. Main thoracic kyphosis (MTK) remained unchanged throughout the follow-up period. The findings suggest that PSF-induced enhancement of PTK, rather than MTK, elevates the T1 slope and contributes to CSA correction in Lenke type 2 AIS patients.

Article 5: “Evidence-Based Clinical Practice Guidelines for Patients With Lumbar Disc Herniation With Radiculopathy in South Korea”

This comprehensive study [5] developed evidence-based clinical practice guidelines specifically tailored for managing lumbar disc herniation with radiculopathy in South Korean clinical practice. Employing rigorous evidence-based medicine principles, the authors conducted systematic literature reviews across major databases, with data quality assessed using Cochrane risk of bias tools and GRADE methodology. The guidelines provide structured recommendations categorized by surgical, interventional, and physical therapy approaches, addressing 4 core clinical questions relevant to contemporary practice. Recommendation strength grades (A–I) reflect evidence reliability and clinical applicability. These guidelines integrate international evidence with expert consensus to improve treatment outcomes and reduce healthcare costs, with emphasis on continuous updates to accommodate evolving clinical data and domestic healthcare system needs.