{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:54:14Z","timestamp":1791273254472,"version":"4.1.0"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004826","name":"Natural Science Foundation of Beijing Municipality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>Adjacent segment disease (ASD) is a multifactorial long-term complication of lumbar interbody fusion. In addition to patient-related factors, pre-existing degeneration, sagittal alignment, and fusion-related changes in construct stiffness, iatrogenic disruption of the posterior elements may contribute to altered adjacent-segment biomechanics. The role of the facet joint complex in this process has received comparatively limited attention. This narrative review synthesizes biomechanical, cadaveric, and clinical evidence concerning lumbar facet arthrodesis, posterior-column preservation and reconstruction, and two-column fixation after lumbar interbody fusion. Biomechanical studies suggest that preservation of the posterior ligamentous and facet structures can influence segmental stability, load sharing, and adjacent-level intradiscal or facet stresses. Facet-based fixation provides rotational constraint under experimental conditions and may offer a different stiffness profile from conventional pedicle screw constructs. The potential role of facet arthrodesis appears to depend on the extent of posterior-element disruption, residual instability, and the stability requirements of the overall construct. Current evidence is insufficient to recommend its routine use after TLIF or PLIF or to conclude that it reduces symptomatic ASD, reoperation rates, or improves long-term patient-reported outcomes. Prospective clinical studies with long-term follow-up are required.<\/jats:p>","DOI":"10.3389\/fsurg.2026.1918664","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:33:17Z","timestamp":1791271997000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Facet joint fusion in lumbar surgery: a biomechanical review of posterior column preservation and reconstruction"],"prefix":"10.3389","volume":"13","author":[{"given":"Tong","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyu","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenlei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaocheng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Beijing Mentougou District Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"He","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaobin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhua","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weikang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.1097\/01.brs.0000137069.88904.03","article-title":"Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature","volume":"29","author":"Park","year":"2004","journal-title":"Spine (Phila Pa 1976)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"547","DOI":"10.3928\/01477447-20140728-08","article-title":"Adjacent segment disease","volume":"37","author":"Virk","year":"2014","journal-title":"Orthopedics"},{"key":"B3","doi-asserted-by":"publisher","first-page":"733","DOI":"10.3171\/2023.12.SPINE231251","article-title":"Are there differences in the reoperation rates for operative adjacent-segment disease between ALIF\u2009+\u2009PS, PLIF\u2009+\u2009PS, TLIF\u2009+\u2009PS, and LLIF\u2009+\u2009PS? An analysis of a cohort of 5,291 patients","volume":"40","author":"Bains","year":"2024","journal-title":"J Neurosurg Spine"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e443","DOI":"10.1016\/j.wneu.2024.07.155","article-title":"Pelvic incidence\u2013lumbar lordosis mismatch is not associated with early reoperation for adjacent segment disease after lumbar fusion","volume":"190","author":"Younis","year":"2024","journal-title":"World Neurosurg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"E831","DOI":"10.1097\/BRS.0000000000000917","article-title":"Adjacent segment disease after posterior lumbar interbody fusion: based on cases with a minimum of 10 years of follow-up","volume":"40","author":"Nakashima","year":"2015","journal-title":"Spine (Phila Pa 1976)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/j.spinee.2023.10.003","article-title":"Primary anterior lumbar interbody fusion, with and without posterior instrumentation: a 1,377-patient cohort from a multicenter spine registry","volume":"24","author":"Laiwalla","year":"2024","journal-title":"Spine J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"E45","DOI":"10.1097\/BSD.0000000000001351","article-title":"Comparison of adjacent segment degeneration after minimally invasive or open transforaminal lumbar interbody fusion: a minimum 5-year follow-up","volume":"36","author":"Jia","year":"2023","journal-title":"Clin Spine Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e0171546","DOI":"10.1371\/journal.pone.0171546","article-title":"Minimally invasive procedure reduces adjacent segment degeneration and disease: new benefit-based global meta-analysis","volume":"12","author":"Li","year":"2017","journal-title":"PLoS One"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e435","DOI":"10.1016\/j.wneu.2021.06.134","article-title":"Can indirect decompression reduce adjacent segment degeneration and the associated reoperation rate after lumbar interbody fusion? A systemic review and meta-analysis","volume":"153","author":"Chang","year":"2021","journal-title":"World Neurosurg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"6570","DOI":"10.3390\/jcm14186570","article-title":"Radiographic analysis of early changes in upper adjacent segments after fusion surgery: oLIF vs. PLIF","volume":"14","author":"Lee","year":"2025","journal-title":"J Clin Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.22603\/ssrr.2019-0017","article-title":"Biomechanics of the lumbar facet joint","volume":"4","author":"Inoue","year":"2019","journal-title":"Spine Surg Relat Res"},{"key":"B12","doi-asserted-by":"publisher","first-page":"105011","DOI":"10.1016\/j.clinbiomech.2020.105011","article-title":"Lumbar stability following graded unilateral and bilateral facetectomy: a finite element model study","volume":"75","author":"Ahuja","year":"2020","journal-title":"Clin Biomech (Bristol)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1841","DOI":"10.1016\/j.spinee.2015.03.038","article-title":"The influence of facet joint orientation and tropism on the stress at the adjacent segment after lumbar fusion surgery: a biomechanical analysis","volume":"15","author":"Kim","year":"2015","journal-title":"Spine J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e85542","DOI":"10.1371\/journal.pone.0085542","article-title":"Angiopoietin-like protein 2 induced by mechanical stress accelerates degeneration and hypertrophy of the ligamentum flavum in lumbar spinal canal stenosis","volume":"9","author":"Nakamura","year":"2014","journal-title":"PLoS One"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e70030","DOI":"10.1002\/jsp2.70030","article-title":"Posterior ligamentum complex preservation alleviate ASD-related biomechanical deterioration in lumbar interbody fusion models: a finite element analysis","volume":"8","author":"He","year":"2025","journal-title":"JOR Spine"},{"key":"B16","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1186\/s13018-023-03838-x","article-title":"Fixation-induced surgical segment\u2019s high stiffness and the damage of posterior structures together trigger a higher risk of adjacent segment disease in patients with lumbar interbody fusion operations","volume":"18","author":"Cai","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1111\/os.70003","article-title":"Biomechanical comparison of a novel facet joint fusion fixation device with conventional pedicle screw fixation device: a finite element analysis","volume":"17","author":"Sun","year":"2025","journal-title":"Orthop Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.3171\/foc.2007.22.1.1","article-title":"Biomechanics of the posterior lumbar articulating elements","volume":"22","author":"Serhan","year":"2007","journal-title":"Neurosurg Focus"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2584","DOI":"10.3390\/jcm15072584","article-title":"A review of finite element analysis in spine surgery decision-making","volume":"15","author":"Beaulieu","year":"2026","journal-title":"J Clin Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"110430","DOI":"10.1016\/j.jbiomech.2021.110430","article-title":"A comprehensive approach for the validation of lumbar spine finite element models investigating post-fusion adjacent segment effects","volume":"121","author":"Azadi","year":"2021","journal-title":"J Biomech"},{"key":"B21","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1007\/s13244-018-0638-x","article-title":"Facet joint syndrome: from diagnosis to interventional management","volume":"9","author":"Perolat","year":"2018","journal-title":"Insights Imaging"},{"key":"B22","doi-asserted-by":"publisher","first-page":"071010","DOI":"10.1115\/1.4004493","article-title":"Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions","volume":"133","author":"Jaumard","year":"2011","journal-title":"J Biomech Eng"},{"key":"B23","doi-asserted-by":"publisher","first-page":"E689","DOI":"10.1097\/BRS.0b013e3181ab4456","article-title":"Range of motion and orientation of the lumbar facet joints in vivo","volume":"34","author":"Kozanek","year":"2009","journal-title":"Spine (Phila Pa 1976)"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1097\/00007632-199308000-00009","article-title":"Articular facets of the human spine. Quantitative three-dimensional anatomy","volume":"18","author":"Panjabi","year":"1993","journal-title":"Spine (Phila Pa 1976)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"693971","DOI":"10.1155\/2013\/693971","article-title":"Lumbar facet joint arthritis is associated with more coronal orientation of the facet joints at the upper lumbar spine","volume":"2013","author":"Jentzsch","year":"2013","journal-title":"Radiol Res Pract"},{"key":"B26","doi-asserted-by":"publisher","first-page":"E579","DOI":"10.1097\/BRS.0b013e3181aa2acb","article-title":"Facet orientation and tropism: associations with facet joint osteoarthritis and degenerative","volume":"34","author":"Kalichman","year":"2009","journal-title":"Spine (Phila Pa 1976)"},{"key":"B27","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1097\/00007632-198409000-00005","article-title":"Mechanism of facet load transmission as a hypothesis for low-back pain","volume":"9","author":"Yang","year":"1984","journal-title":"Spine (Phila Pa 1976)"},{"key":"B28","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1302\/0301-620X.62B3.6447702","article-title":"The effect of posture on the role of the apophysial joints in resisting intervertebral compressive forces","volume":"62","author":"Adams","year":"1980","journal-title":"J Bone Joint Surg Br"},{"key":"B29","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1097\/00007632-199105000-00009","article-title":"Finite-element evaluation of contact loads on facets of an L2\u2013L3 lumbar segment in complex loads","volume":"16","author":"Shirazi-Adl","year":"1991","journal-title":"Spine (Phila Pa 1976)"},{"key":"B30","first-page":"127","article-title":"Supraspinous and interspinous ligaments of the human lumbar spine","volume":"125","author":"Heylings","year":"1978","journal-title":"J Anat"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e1332","DOI":"10.5435\/JAAOS-D-22-00908","article-title":"The posterior ligamentous complex: anatomic and biomechanical considerations in injury classification and management","volume":"33","author":"Mo","year":"2025","journal-title":"J Am Acad Orthop Surg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"5157","DOI":"10.1007\/s00586-025-08690-7","article-title":"The importance of the posterior osteoligamentous complex of the lumbar spine: dogma changing biomechanical insights","volume":"34","author":"Jokeit","year":"2025","journal-title":"Eur Spine J"},{"key":"B33","doi-asserted-by":"publisher","first-page":"168","DOI":"10.21037\/jss.2017.05.03","article-title":"Subsidence following anterior lumbar interbody fusion (ALIF): a prospective study","volume":"3","author":"Rao","year":"2017","journal-title":"J Spine Surg"},{"key":"B34","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1111\/os.12625","article-title":"Development and application of oblique lumbar interbody fusion","volume":"12","author":"Li","year":"2020","journal-title":"Orthop Surg"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e819","DOI":"10.1016\/j.wneu.2019.02.164","article-title":"Biomechanical evaluation of transforaminal lumbar interbody fusion and oblique lumbar interbody fusion on the adjacent segment: a finite element analysis","volume":"126","author":"Wang","year":"2019","journal-title":"World Neurosurg"},{"key":"B36","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s13018-022-03480-z","article-title":"Computational comparison of anterior lumbar interbody fusion and oblique lumbar interbody fusion with various supplementary fixation systems: a finite element analysis","volume":"18","author":"Ouyang","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"B37","doi-asserted-by":"publisher","first-page":"55","DOI":"10.6040\/j.issn.1671-7554.0.2021.0609","article-title":"A finite element analysis of three different fusion methods of lumbar internal fixation","volume":"60","author":"Li","year":"2022","journal-title":"J Shandong Univ Health Sci"},{"key":"B38","doi-asserted-by":"publisher","first-page":"88","DOI":"10.13543\/j.bhxbzr.2024.03.009","article-title":"Biomechanical finite element analysis of lumbar posterior interbody fusion for different fixation schemes","volume":"51","author":"Cheng","year":"2024","journal-title":"J Beijing Univ Chem Technol Nat Sci Ed"},{"key":"B39","doi-asserted-by":"publisher","first-page":"935","DOI":"10.14444\/8355","article-title":"Comparison of the biomechanical effect of the FFX device compared with other lumbar fusion devices: a finite element study","volume":"16","author":"Simon","year":"2022","journal-title":"Int J Spine Surg"},{"key":"B40","doi-asserted-by":"publisher","first-page":"996","DOI":"10.14444\/7149","article-title":"Facet arthrodesis with the FFX device: one-year results from a prospective multicenter study","volume":"14","author":"Srour","year":"2021","journal-title":"Int J Spine Surg"},{"key":"B41","doi-asserted-by":"publisher","first-page":"104122","DOI":"10.1016\/j.compbiomed.2020.104122","article-title":"Does oblique lumbar interbody fusion promote adjacent degeneration in degenerative disc disease: a finite element analysis","volume":"128","author":"Du","year":"2021","journal-title":"Comput Biol Med"},{"key":"B42","doi-asserted-by":"publisher","first-page":"65","DOI":"10.4103\/0974-8237.77669","article-title":"Facet distraction spacers for treatment of degenerative disease of the spine: rationale and an alternative hypothesis of spinal degeneration","volume":"1","author":"Goel","year":"2010","journal-title":"J Craniovertebr Junction Spine"},{"key":"B43","doi-asserted-by":"publisher","first-page":"672","DOI":"10.3171\/2011.8.SPINE11249","article-title":"Distraction of facets with intraarticular spacers as treatment for lumbar canal stenosis: report on a preliminary experience with 21 cases","volume":"19","author":"Goel","year":"2013","journal-title":"J Neurosurg Spine"},{"key":"B44","doi-asserted-by":"publisher","first-page":"157","DOI":"10.4103\/0974-8237.147079","article-title":"Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the goel intraarticular facetal spacer distraction technique","volume":"5","author":"Satoskar","year":"2014","journal-title":"J Craniovertebr Junction Spine"},{"key":"B45","doi-asserted-by":"publisher","first-page":"E902","DOI":"10.1097\/BRS.0000000000001480","article-title":"Biomechanical evaluation of the CD HORIZON spire Z spinal system with pedicle and facet fixation","volume":"41","author":"Godzik","year":"2016","journal-title":"Spine (Phila Pa 1976)"},{"key":"B46","doi-asserted-by":"publisher","first-page":"328","DOI":"10.21037\/jss-24-10","article-title":"A comparative cadaveric biomechanical study of bilateral FacetFuse\u00ae transfacet pedicle screws versus bilateral or unilateral pedicle screw\u2013rod construct","volume":"10","author":"Chin","year":"2024","journal-title":"J Spine Surg"},{"key":"B47","doi-asserted-by":"publisher","first-page":"e22931","DOI":"10.7759\/cureus.22931","article-title":"Comparison of operative time and blood loss with the FFX\u00ae device versus pedicle screw fixation during surgery for lumbar spinal stenosis: a retrospective cohort study","volume":"14","author":"Srour","year":"2022","journal-title":"Cureus"},{"key":"B48","doi-asserted-by":"publisher","first-page":"E269","DOI":"10.1097\/BSD.0000000000001704","article-title":"Evaluation of the efficacy and safety of FFX facet cages compared with pedicle screw fixation in patients with lumbar spinal stenosis: a long-term study","volume":"38","author":"Houari","year":"2025","journal-title":"Clin Spine Surg"},{"key":"B49","doi-asserted-by":"publisher","first-page":"1757","DOI":"10.1016\/j.jbiomech.2014.04.002","article-title":"Comparison of eight published static finite element models of the intact lumbar spine: predictive power of models improves when combined together","volume":"47","author":"Dreischarf","year":"2014","journal-title":"J Biomech"},{"key":"B50","doi-asserted-by":"publisher","first-page":"17892","DOI":"10.1038\/s41598-021-97288-2","article-title":"Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine","volume":"11","author":"Ebrahimkhani","year":"2021","journal-title":"Sci Rep"},{"key":"B51","doi-asserted-by":"publisher","first-page":"2342","DOI":"10.1016\/j.jbiomech.2013.07.014","article-title":"What have we learned from finite element model studies of lumbar intervertebral discs in the past four decades?","volume":"46","author":"Schmidt","year":"2013","journal-title":"J Biomech"},{"key":"B52","doi-asserted-by":"publisher","first-page":"e15805","DOI":"10.7717\/peerj.15805","article-title":"Development and validation of lumbar spine finite element model","volume":"11","author":"Wiczenbach","year":"2023","journal-title":"PeerJ"},{"key":"B53","doi-asserted-by":"publisher","first-page":"135","DOI":"10.3171\/2022.7.SPINE22536","article-title":"Prospective, randomized controlled multicenter study of posterior lumbar facet arthroplasty for the treatment of spondylolisthesis","volume":"38","author":"Coric","year":"2023","journal-title":"J Neurosurg Spine"},{"key":"B54","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.2106\/JBJS.23.00719","article-title":"Lumbar facet arthroplasty versus fusion for grade-I degenerative spondylolisthesis with stenosis: a prospective randomized controlled trial","volume":"106","author":"Nassr","year":"2024","journal-title":"J Bone Joint Surg Am"},{"key":"B55","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2024.1.SPINE23841","article-title":"Impact of bilateral facet joint violation on radiographic degeneration of superior adjacent segments and clinical outcomes","volume":"41","author":"Ding","year":"2024","journal-title":"J Neurosurg Spine"},{"key":"B56","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1016\/j.spinee.2012.12.009","article-title":"Update on the evidence for adjacent segment degeneration and disease","volume":"13","author":"Helgeson","year":"2013","journal-title":"Spine J"},{"key":"B57","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1186\/s13018-025-05561-1","article-title":"Impact of iatrogenic alterations on adjacent segment degeneration after lumbar fusion surgery: a systematic review","volume":"20","author":"Jokeit","year":"2025","journal-title":"J Orthop Surg Res"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1918664\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:33:21Z","timestamp":1791272001000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1918664\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":57,"alternative-id":["10.3389\/fsurg.2026.1918664"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1918664","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"article-number":"1918664"}}