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Introduction: Unlike the most common training approaches for bodybuilding, powerlifting programs are generally based on maximum and submaximal loads, putting enormous stresses on the lumbar spine. The flexion relaxation phenomenon evaluation is a clinical tool used for low back pain (LBP) assessment. This study aimed to evaluate the role of the flexion relaxation phenomenon in the analysis of LBP in the powerlifters. Methods: Healthy professional powerlifters participated in the study. In fact, we divided the participants into a LBP-low-risk group and a LBP-high-risk group, based on a prior history of LBP. Outcome measures included flexion relaxation ratio (FRR) and trough surface electromyography collected during trunk maximum voluntary flexion; furthermore, during a bench press lifting, we measured the height of the arched back (ARCH), using a camera and the Kinovea video editing software, to consider a potential correlation with the risk of LBP. Results: We included a group of 18 male (aged 24–39 y) powerlifters of 93 kg category. We measured a nonsignificant mean difference of ARCH between low-risk LBP group and high-risk LBP subjects. Curiously, maximum voluntary flexions were both above the threshold of 3.2 μV; therefore, with an absence of appropriate myoelectric silence, on the contrary, the FRR ratios were higher than 9.5, considering the presence of the phenomenon, exclusively for the low-risk group. The lumbar arched back measurement data did not report any association with the LBP risk, regarding the maximum voluntary flexion value, and even more than the FRR there is a relationship with the presence or the absence of LBP risk. Conclusions: FRR could be considered as a useful parameter for studying the risk of LBP in powerlifting. The FRR index not only refers to the possible myoelectric silence of the lumbar muscles in trunk maximum forward flexion but also takes into account the energy value delivered by the lumbar muscles during the flexion. Furthermore, we can indicate that the size of the powerlifter ARCH may not be a determining factor in the occurrence of LBP. [ABSTRACT FROM AUTHOR]

Postural assessments of the lumbar spine lack valuable information about its properties. The purpose of this study was to assess neutral zone (NZ) characteristics via in vivo lumbar spine passive stiffness and relate NZ characteristics to standing lumbar lordosis. A comparison was made between those that develop low back pain during prolonged standing (pain developers) and those that do not (nonpain developers). Twenty-two participants with known pain status stood on level ground, and median lumbar lordosis angle was calculated. Participants were then placed in a near-frictionless jig to characterize their passive stiffness curve and location of their NZ. Overall, both pain developers and nonpain developers stood with a lumbar lordosis angle that was more extended than their NZ boundary. Pain developers stood slightly more extended (in comparison to nonpain developers) and had a lower moment corresponding to the location of their extension NZ boundary. Overall, in comparison to nonpain developers, pain developers displayed a lower moment corresponding to the location of their extension NZ boundary which could correspond to greater laxity in the lumbar spine. This may indicate why pain developers have a tendency to stand further beyond their NZ with greater muscle co-contraction. [ABSTRACT FROM AUTHOR]

Resistance exercise training (RET) can be applied effectively to increase muscle mass and function in older adults (65–75 years). However, it has been speculated that older adults above 85 years are less responsive to the benefits of RET. This study compares the impact of RET on muscle mass and function in healthy older adults 65–75 years versus older adults above 85 years. We subjected 17 healthy older adults 65–75 years (OLDER 65–75, n = 13/4 [female/male]; 68 ± 2 years; 26.9 ± 2.3 kg/m2) and 12 healthy older adults above 85 years (OLDER 85+, n = 7/5 [female/male]; 87 ± 3 years; 26.0 ± 3.6 kg/m2) to 12 weeks of whole-body RET (three times per week). Prior to, and after 6 and 12 weeks of training, quadriceps and lumbar spine vertebra 3 muscle cross-sectional area (computed tomography scan), whole-body lean mass (dual-energy X-ray absorptiometry scan), strength (one-repetition maximum test), and physical performance (timed up and go and short physical performance battery) were assessed. Twelve weeks of RET resulted in a 10% ± 4% and 11% ± 5% increase in quadriceps cross-sectional area (from 46.5 ± 10.7 to 51.1 ± 12.1 cm2, and from 38.9 ± 6.1 to 43.1 ± 8.0 cm2, respectively; p <.001; η2 =.67); a 2% ± 3% and 2% ± 3% increase in whole-body lean mass (p =.001; η2 =.22); and a 38% ± 20% and 46% ± 14% increase in one-repetition maximum leg extension strength (p <.001; η2 =.77) in the OLDER 65–75 and OLDER 85+ groups, respectively. No differences in the responses to RET were observed between groups (Time × Group, all p >.60; all η2 ≤.012). Physical performance on the short physical performance battery and timed up and go improved (both p <.01; η2 ≥.22), with no differences between groups (Time × Group, p >.015; η2 ≤.07). Prolonged RET increases muscle mass, strength, and physical performance in the aging population, with no differences between 65–75 years and 85+ years older adults. [ABSTRACT FROM AUTHOR]

Study Design: A technical note and retrospective case series. Objective: Highly upward-migrated lumbar disc herniation (LDH) is challenging due to its problematic access and incomplete removal. The most used interlaminar approach may cause extensive bony destruction. We developed a novel translaminar approach using the unilateral portal endoscopic (UBE) technique, emphasizing effective neural decompression, and preserving the facet joint's integrity. Methods: This retrospective study included six patients receiving UBE translaminar discectomy for highly upward-migrated LDHs from May 2019 to June 2021. The migrated disc was removed through a small keyhole on the lamina of the cranial vertebra. The treatment results were evaluated by operation time, hospital stays, complications, visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, and modified MacNab criteria. Results: The mean pre-operative VAS for back pain (5.0 ± 4.9), VAS for leg pain (9.2 ± 1.0), JOA score (10.7 ± 6.6), and ODI (75.7 ± 25.3) were significantly improved to 0.3 ± 0.5, 1.2 ± 1.5, 27.3 ± 1.8, 5.0 ± 11.3 respectively at the final follow-up. Five patients had excellent, and one patient had good outcomes according to the Modified MacNab criteria. The hospital stay was 2.7 ± 0.5 days. No complication was recorded. The MRI follow-up showed complete disc removal, except for one patient with an asymptomatic residual disc. Conclusions: UBE translaminar discectomy is a safe and effective minimally invasive procedure for highly upward-migrated LDH with satisfactory treatment outcomes and nearly 100% facet joint preservation. [ABSTRACT FROM AUTHOR]

Background: To analyze the characteristics of an unnamed interlaminar ligaments(ILL) through magnetic resonance image (MRI), endoscopy and pathological examination. Method: A retrospective study was conducted to analyze the clinical data of patients who underwent posterior endoscopic surgery for lumbar disc herniation or lumbar spinal stenosis from January 2021 to February 2022 at our medical center. The height, width and cross-sectional thickness of the ligament was analyzed using T2 weighted MRI. Meanwhile, the morphological and pathological characteristics were also compared with those of the ligamentum flavum to highlight the differences between above mentioned ligaments. Result: Forty-three patients were included in this study, including 27 males and 16 females, with an average age of 46.6 ± 12.1y. There were 20 cases of lumbar disc herniation and 23 cases of lumbar spinal stenosis. The width, length, thickness of the ILL, the thickness of LF and surgical time in the lumbar disc group were 17.7 ± 3.5 mm, 4.3 ± 1.3 mm, 18.3 ± 3.5 mm, 5.3 ± 1.9 mm, 53.2 ± 14.5 min, respectively. In the lumbar spinal stenosis group, the corresponding parameters were 16.0 ± 3.1 mm, 4.1 ± 1.6 mm, 17.6 ± 4.8 mm, 6.3 ± 0.8 mm, 61.8 ± 12.4 min, respectively. The intergroup difference in thickness of the ligamentum flavum was statistically significant (P = 0.02). The difference in surgical time was also established(P = 0.04). Endoscopic differences were identified as to the location of the anchor points and appearances among the two ligaments. Significant differences in the density and direction of fibrous structures were also observed under biopsy. Under endoscopy, significant difference as to the grade of ILL thickness was established when compared regarding disease spectrum (P = 0.09.) Conclusion: The interlaminar ligament is a structure that has not yet been officially named, which has significant structural differences from those of the ligamentum flavum. For posterior endoscopic procedure, its clinical significance lies in its ability to serve as the endpoint of soft tissue channel establishment. The thickness of the ligamentum flavum in MRI and the thickness of ILL under endoscopy vary according to the disease spectrum. [ABSTRACT FROM AUTHOR]

Object: Evaluation of the impact of patients' participation on postoperative recovery and satisfaction who underwent the Percutaneous Endoscopic Interlaminar Discectomy(PEID). Methods: We collected data from sixty-nine patients who underwent PEID surgery at Chuzhou Chinese and Western Medicine Hospital between January 2020 and December 2022. All patients had L5/S1 lumbar disc herniation and met the inclusion and exclusion criteria. The patients were divided into two groups: non-communication group (n = 33) and communication group (n = 36). The division was made based on whether the patients had preoperative surgical video viewing and intraoperative communication. We compared the baseline data, surgical time, VAS score, lumbar JOA score, surgical complications, and patient satisfaction between the two groups. Result: The communication group showed better pain control and functional recovery in the early postoperative period. The communication group had better VAS scores on the first day and month after surgery, as well as JOA scores on the first week and month after surgery, with statistically significant differences (P < 0.05). There was no significant difference in hospital stay, VAS score, JOA score, and postoperative complications between the two groups of patients at 3 and 6 months after surgery. The communication group had higher patient satisfaction (P < 0.05). Conclusion: Preoperative surgical video viewing and intraoperative communication by PEID patients can alleviate pain, accelerate functional recovery, improve symptoms, and increase patients' satisfaction. We need to do more work to develop this new model. [ABSTRACT FROM AUTHOR]

Background: Health-related physical fitness (HRPF) attributes are considered important markers beneficial to various health outcomes. However, the literature is divergent regarding HRPF and bone health in adulthood, especially due to the end of the second and beginning of the third decades of life when the peak bone mass period occurs. Objective: To analyze which HRPF variables are areal bone mineral density (aBMD) predictors in adult males and females. Methods: This study evaluated 137 healthy young adults aged 18–25 years (50% males). Dual-energy X-ray absorptiometry (DXA) was used to estimate fat mass and lean mass and aBMD, hand grip strength test, sit-ups test, flexibility test, lower limb muscle strength and 20-meter run were used to evaluate physical fitness. Multiple linear regression using the backward method was used to analyze bone mineral density predictors by sex. Results: HRPF indicators showed correlations from R = 0.28 in the right femoral neck aBMD to R = 0.61 in the upper limbs aBMD in males; in females, correlations from R = 0.27 in total body aBMD to R = 0.68 in the lower limbs aBMD were found. In males, body mass and HRPF indicators were aBMD predictors with HRPF indicators explaining variance from R²=0.214 in the lumbar spine to R²=0.497 in the upper limbs, and in females, with the exception of the lumbar spine, variance from R²=0.237 in the right femoral neck aBMD to R²=0.442 in the lower limbs aBMD was found. Conclusion: Health-related physical fitness components were able to predict aBMD in different anatomical regions in young adults, especially muscle strength and cardiorespiratory fitness indicators for males, while only lean mass and fat mass for females. [ABSTRACT FROM AUTHOR]

Background: This study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches. Methods: From January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion. Results: There were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS(back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups. Conclusion: There was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient's financial situation, their ability to tolerate surgery, and the surgeon's expertise. [ABSTRACT FROM AUTHOR]

Objective: To investigate in vivo 6-degree-of-freedom (DOF) vertebral motion in patients with isthmic spondylolisthesis (IS) during various functional weight-bearing activities. Methods: Fifteen asymptomatic volunteers (mean age 54.8 years) and fourteen patients with IS at L4-5 (mean age 53.4 years) were recruited. The positions of the vertebrae (L4-L5) in the supine, standing, flexion–extension, left–right twisting and left–right bending positions were determined using previously described CT-based models and dual fluoroscopic imaging techniques. Local coordinate systems were established at the center of the anterior vertebra of L4 isthmic spondylolisthesis (AIS), the posterior lamina of L4 isthmic spondylolisthesis (PIS) and the center of the L5 vertebra to obtain the 6DOF range of motion (ROM) at L4-L5 and the range of motion (ROM) between the AIS and the PIS. Results: The translation along the anteroposterior axis at L4-L5 during flexion–extension, left–right bending and left–right twisting was significantly greater than that of the healthy participants. However, the translation along the mediolateral axis at L4-L5 presented paradoxical motion under different positions: the ROM increased in the supine-standing and flexion–extension positions but decreased in the left–right bending and left–right twisting positions. The separation along the anteroposterior axis during flexion was significantly greater than that during standing, on average, reaching more than 1 mm. The separation along the mediolateral axis during standing, flexion and extension was significantly greater than that in the supine position. Conclusions: This study revealed the occurrence of displacement between the AIS and PIS, primarily in the form of separation during flexion. Symptomatic patients with isthmic spondylolisthesis exhibit intervertebral instability, which might be underestimated by flexion–extension radiographs. [ABSTRACT FROM AUTHOR]

Injury mechanisms of the lumbar spine under dynamic loading are dependent on spine curvature and anatomical variation. Impact simulation with finite element (FE) models can assist the reconstruction and prediction of injuries. The objective of this study was to determine which level of individualization of a baseline FE lumbar spine model is necessary to replicate experimental responses and fracture locations in a dynamic experiment. Experimental X-rays from 26 dynamic drop tower tests were used to create three configurations of a lumbar spine model (T12 to L5): baseline, with aligned vertebrae (positioned), and with aligned and morphed vertebrae (morphed). Each model was simulated with the corresponding loading and boundary conditions from dynamic lumbar spine experiments. Force, moment, and kinematic responses were compared to the experimental data. Cosine similarity was computed to assess how well simulation responses match the experimental data. The pressure distribution within the vertebrae was used to compare fracture risk and fracture location between the different models. The positioned models replicated the injured spinal level and the fracture patterns quite well, though the morphed models provided slightly more accuracy. However, for impact reconstruction or injury prediction, the authors recommend pure positioning for whole-body models, as the gain in accuracy was relatively small, while the morphing modifications of the model require considerably higher efforts. These results improve the understanding of the application of human body models to investigate lumbar injury mechanisms with FE models. [ABSTRACT FROM AUTHOR]

Objectives: Our aim was to predict the prevalence of osteopenia and osteoporosis and their associated risk factors among postmenopausal women from Jordan. Methodology: In this cross‐sectional study, a total of 368 postmenopausal women were recruited from King Abdullah University Hospital (KAUH) in the North of Jordan between September 2022 and April 2023. Bone mineral density (BMD) was measured using a dual‐energy X‐ray absorptiometry scan. T‐score was used for osteoporosis diagnosis in accordance with the International Society for Clinical Densitometry (ISCD) guidelines. Data about sociodemographic and lifestyle variables were collected using face‐to‐face interviews. Medical records were used to retrieve participants' BMD information. Predictors of osteoporosis were identified using logistic regression. Results: Prevalence of osteoporosis was 40.5%, while 44.6% of participants were diagnosed with osteopenia. The lumbar spine had the highest frequency of osteoporosis (30.4%), while the left femoral neck had the highest prevalence of osteopenia (46.3%). Postmenopausal women's age (p‐value =.024), and history of chronic diseases (p‐value =.038) were significant factors associated with increased osteoporosis risk. Conclusions: Postmenopausal women from Jordan had high prevalence of osteoporosis and osteopenia. It is therefore necessary to target risk factors leading to osteoporosis and to improve patients' lifestyles through patient education. Healthcare systems should consider early screening approaches for osteoporosis at the age of menopause and thereafter. Supplements of calcium and vitamin D may be routinely considered for this age group depending on their serum levels. [ABSTRACT FROM AUTHOR]

In multiple myeloma (MM) bone marrow infiltration by monoclonal plasma cells can occur in both focal and diffuse manner, making staging and prognosis rather difficult. The aim of our study was to test whether texture analysis of 18 F-2-deoxy-d-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) images can predict survival in MM patients. Forty-six patients underwent 18 F-FDG-PET/CT before treatment. We used an automated contouring program for segmenting the hottest focal lesion (FL) and a lumbar vertebra for assessing diffuse bone marrow involvement (DI). Maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean) and texture features such as Coefficient of variation (CoV), were obtained from 46 FL and 46 DI. After a mean follow-up of 51 months, 24 patients died of myeloma and were compared to the 22 survivors. At univariate analysis, FL SUVmax (p = 0.0453), FL SUVmean (p = 0.0463), FL CoV (p = 0.0211) and DI SUVmax (p = 0.0538) predicted overall survival (OS). At multivariate analysis only FL CoV and DI SUVmax were retained in the model (p = 0.0154). By Kaplan-Meier method and log-rank testing, patients with FL CoV below the cut-off had significantly better OS than those with FL CoV above the cut-off (p = 0.0003), as well as patients with DI SUVmax below the threshold versus those with DI SUVmax above the threshold (p = 0.0006). Combining FL CoV and DI SUVmax by using their respective cut-off values, a statistically significant difference was found between the resulting four survival curves (p = 0.0001). Indeed, patients with both FL CoV and DI SUVmax below their respective cut-off values showed the best prognosis. Conventional and texture parameters derived from 18F-FDG PET/CT analysis can predict survival in MM patients by assessing the heterogeneity and aggressiveness of both focal and diffuse infiltration. [ABSTRACT FROM AUTHOR]

Females who engage in high levels of sports have a high prevalence of menstrual cycle disorders and bone stress injuries (BSI). In this study, we determined the prevalence of menstrual disorders and fractures in female athletes and their association with bone mineral density (BMD) parameters. Cross-Sectional Study. Forty-one female athletes from a public High-Performance Regional Centre; 24 high-endurance athletes (HEA) and 17 other athletes, were included. To form the control group, we invited medical students from a public University. Twenty-nine non-athletes (NA) were included. A health surveys and a dual-energy X-ray absorptiometry (DXA) were conducted for all participants. Among the participants (median age, 24 years; body mass index, 21 kg/m2), the percentage of long-term amenorrhoea was 42 % in HEA vs. 0 % in NHEA (OR 25.35; 95 % CI 1.37–470.50, p = 0.008) or 10 % in NA (OR 6.20; 95 % CI 1.46–26.24, p = 0.022), and the percentage of BSI was 29 % in HEA vs. 0 % in NHEA or NA. Both groups of female athletes (HEA and NHEA) showed higher Z-scores than those of NA in the femur; however, only NHEA had a significant increase in the BMD on lumbar spine than that of NA. The prevalence of long-term amenorrhoea and/or BSI was significantly higher in the HEA than in the NHEA or NA females. In contrast, HEA, like NHEA, had higher BMD values in the femur than those of controls. It is unlikely that DXA parameters can be used to estimate cortical BSI risk in this population. [Display omitted] [ABSTRACT FROM AUTHOR]

The association between low back pain and lumbar spine local dynamic stability (LDS) appears to be modulated by if and how someone catastrophizes about pain, suggesting that the cognitive perceptions of pain may influence an individual's ability to control lumbar spine motion. Previous work also demonstrates that directing cognitive resources and attentional focus can influence movement performance. Therefore, we aimed to examine whether distracting attentional focus would influence lumbar spine LDS during repetitive flexion-extension movements. Sixteen participants performed repetitive spine flexion-extension movements under two baseline conditions (pre- and post-), and while attentional focus was distracted by either an external sensory stimulus or a cognitive-motor dual-task, both targeted at the hands. Lumbar spine LDS was examined over 30 continuous movement repetitions using maximum Lyapunov exponents. In comparison to both Baseline and Post-Baseline trials, the perceived mental workload was significantly elevated during the cognitive-motor dual-task trial but not the external sensory stimulus trial. The only statistically significant effect on LDS occurred in the Post-Baseline trial, where LDS was higher than in the cognitive-motor dual-task. In combination with previous work, these findings suggest that distracting attentional focus during repetitive lumbar spine flexion-extension movements does not have a negative influence on lumbar spine LDS. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic ankle instability (CAI) presents neuromuscular control and functional performance difficulties. Although ankle-focused rehabilitation is widely practised, the relative effects of exercises targeting thoracic mobility and lumbopelvic stabilization in addressing CAI have not been thoroughly investigated. OBJECTIVE: The study aims to compare the effects of thoracic mobility and lumbopelvic stabilization exercises in patients with CAI. METHODS: The study was designed as a prospective randomized controlled clinical trial. A total of 30 participants (mean age = 31.93 ± 7.31; 21F/9M) who scored 27 points or on the Cumberland ankle instability tool voluntarily were enrolled in the study. The participants were randomly divided into two groups. In addition to the rehabilitation protocols, each participant was given a home exercise program, including ankle-strengthening exercises (3 times a week). The first group trained with thoracic mobility (TM), while the second group did lumbopelvic stabilization (LS) exercises under supervision twice a week for eight weeks. Participants' pre and post-treatment assessments spanned an 8-week rehabilitation period, during which ankle and hip joint range of motion measurements were obtained using an electronic goniometer. Additionally, dynamic balance was assessed through the Y balance test, while ankle proprioception was evaluated using joint position sense measurements. The flexibility was assessed with an active straight leg raise test. RESULTS: Y balance, CAIT, and active straight leg raise test scores were improved in the eighth week in the thoracic mobility group (p < 0.05), while only active straight leg raise test and CAIT scores were significantly different in the lumbopelvic stabilization group (p < 0.05) according to intra group variables. In comparing the post-treatment scores between the groups, the thoracic mobility group had superior results in the joint position sense test for the right side of the hip and plantarflexion. (hip; TM: 70.71 ± 6.80, LS: 68.76 ± 5.50, plantarflexion; TM: 44.24 ± 7.28, LS: 38.30 ± 5.08). CONCLUSION: The findings suggest that while both interventions are effective in addressing various aspects of ankle instability, the thoracic mobility exercises may offer additional benefits, particularly in enhancing joint position sense, thereby providing valuable insights for the optimization of rehabilitation protocols for individuals with chronic ankle instability. [ABSTRACT FROM AUTHOR]

Objectives: To determine the characteristics of lumbar foraminal stenosis (LFS) on magnetic resonance (MR) images and their association with back pain and radiating leg pain in a population-based sample of Chinese subjects. Methods: This study was an extension of the Hangzhou Lumbar Spine Study, a cross-sectional study focusing on back pain and lumbar spine MR imaging findings. Questionnaire data, including demographics, lifestyle, occupational exposures, back pain and radiating leg pain were included. On lumbar spine MR images, disc degeneration was assessed using Pfirrmann grade and Modic changes were evaluated. Using Lee's scale, the L3-S1 intervertebral foramina were evaluated, with grade 2–3 representing substantial LFS and grade 0–1 no LFS. Characteristics of LFS were noted, and associations of LFS with back pain and radiating leg pain were examined. Results: Among the 644 study subjects, 141 (21.9%) had at least one LFS, and its occurrence was associated with greater age (OR = 1.93 for each 10 years, p < 0.001). Substantial LFS was associated with the presence of back pain (OR = 1.92, p = 0.001) and the intensity of the worst back pain (Coef = 8.30, p < 0.001) over the past 12 months, and disabling back pain during their lifetime (OR = 2.25, p < 0.001). Substantial LFS was also associated with leg pain (OR = 14.27, p < 0.001), with a sensitivity of 75.7% for the presence of radiating leg pain and a specificity of 81.4%. Conclusion: Substantial LFS on MR images was a common age-related degenerative phenotype in adults, and appears to be an independent risk factor for back pain and leg pain. [ABSTRACT FROM AUTHOR]

Summary: This multicentre, prospective cohort study measured the effect of romosozumab for 12 months on bone mineral density, taking into account prior therapies. Prior antiresorptive therapy blunted the BMD response to romosozumab, and the duration was correlated with BMD changes at both the lumbar spine and total hip. Introduction: In Switzerland, romosozumab is administered to high-risk osteoporosis patients. Our study aimed to assess the effect of romosozumab on bone mineral density (BMD), taking into account prior therapies. Methods: This multicentre, prospective cohort study measured the effect of romosozumab for 12 months in patients in a nationwide Swiss osteoporosis registry. BMD and bone turnover marker (P1NP and CTX) changes were measured and compared between pre-treated and treatment naïve patients. Results: Ninety-nine patients (92 women and 7 men, median age 71 years [65, 76]) were enrolled from January 2021 to December 2023. Among them, 22 had no prior treatment before romosozumab, while 77 had previous therapy (including 23 with a history of prior teriparatide therapy), with a median duration of 6 years [4, 11] of cumulative antiresorptive treatment. Over 12 months, romosozumab led to BMD changes of 10.3% [7.5, 15.5] at the lumbar spine, 3.1% [1.1, 5.8] at the total hip and 3.1% [0.5, 5.3] at the femoral neck, indicating notable variability. Significantly lower BMD responses were observed in pre-treated patients, with the duration of prior antiresorptive therapy inversely associated with BMD increases at the lumbar spine and hip. Other predictors of BMD changes at the total hip included baseline T-scores at the hip, body mass index and baseline CTX level, while the BMD response at the lumbar spine was associated with the lumbar spine T-score at baseline, age and baseline CTX level. Conclusion: Prior antiresorptive therapy blunted the BMD response to romosozumab, and the duration was correlated with BMD changes at both the lumbar spine and total hip. [ABSTRACT FROM AUTHOR]

Summary: In severe osteoporosis, the optimal approach for sequential treatment between denosumab and romosozumab is unclear. We utilised a novel overlapping strategy in three patients with very-high fracture risk despite long-term denosumab which led to greater bone density improvements than previously reported with standard approaches. Larger confirmatory prospective studies are needed. Purpose/introduction: In patients with severe osteoporosis, the optimal approach for sequential treatment between denosumab and romosozumab has not been established. The ideal strategy would maximise gains in bone mineral density (BMD) with romosozumab and effectively mitigate the risk of rebound increased bone turnover when sequencing from denosumab. Limited studies exploring the sequence from denosumab to romosozumab report only modest-to-no improvement in BMD and inadequate suppression of rebound bone turnover. Methods: We describe three patients with severe osteoporosis and multiple fragility fractures despite long-term denosumab. A novel overlapping sequential treatment approach was utilised to maximise therapeutic benefit given these patients had a very high fracture risk. Romosozumab was commenced 3 months after the last denosumab dose. Instead of waiting until completion of romosozumab, denosumab was recommenced 6 months after commencing romosozumab in response to rising bone turnover markers. Results: Patients experienced a ~ 5–22% increase in lumbar spine BMD, and one patient had an 8% increase in total hip BMD after 12 months romosozumab. Serum bone turnover markers demonstrated an anabolic effect of romosozumab occurred despite overlapping treatment with denosumab. Recommencement of denosumab suppressed an increase in bone resorption in all cases. No new vertebral fractures occurred during this treatment. Conclusions: A novel overlapping sequential treatment approach between denosumab and romosozumab produced greater improvements in lumbar spine and hip BMD than previously reported with standard approaches. Larger prospective controlled studies are needed to confirm these findings and establish the optimal use of romosozumab in patients pre-treated with denosumab to maximise BMD gains and minimise fracture risk. [ABSTRACT FROM AUTHOR]

Summary: Our study showed that B vitamins did not have significant effect on fracture incidence, bone mineral density, and bone turnover markers. However, the research data of B vitamins on bone mineral density and bone turnover markers are limited, and more clinical trials are needed to draw sufficient conclusions. Purpose: The objective of this study was to identify the efficacy of B vitamin (VB) (folate, B6, and B12) supplements on fracture incidence, bone mineral density (BMD), and bone turnover markers (BTMs). Methods: A comprehensive search was performed in PubMed, MEDLINE, EMBASE, Cochrane databases, and ClinicalTrials.gov up to September 4, 2023. The risk of bias was assessed according to Cochrane Handbook and the quality of evidence was assessed according to the GRADE system. We used trial sequential analysis (TSA) to assess risk of random errors and Stata 14 to conduct sensitivity and publication bias analyses. Results: Data from 14 RCTs with 34,700 patients were extracted and analyzed. The results showed that VBs did not significantly reduce the fracture incidence (RR, 1.06; 95% CI, 0.95 − 1.18; p = 0.33; I2 = 40%) and did not affect BMD in lumbar spine and femur neck. VBs had no significant effect on bone specific alkaline phase (a biomarker for bone formation), but could increase the serum carboxy-terminal peptide (a biomarker for bone resorption) (p = 0.009; I2 = 0%). The TSA showed the results of VBs on BMD and BTMs may not be enough to draw sufficient conclusions due to the small number of sample data included and needed to be demonstrated in more clinical trials. The inability of VBs to reduce fracture incidence has been verified by TSA as sufficient. Sensitivity analysis and publication bias assessment proved that our meta-analysis results were stable and reliable, with no significant publication bias. Conclusions: Available evidence from RCTs does not support VBs can effectively influence osteoporotic fracture risk, BMD, and BTMs. Trial registration: PROSPERO registration number: CRD42023427508. [ABSTRACT FROM AUTHOR]

Due to ethical issues and simplification of traditional biomechanical models, experimental methods and traditional computer methods were difficult to quantify the effects of foot excitation and shin posture on vibration behavior of the entire spine inside a seated human body under vertical whole-body vibration. This study developed and verified different three-dimensional (3D) finite element (FE) models of seated human body with detailed anatomical structure under the biomechanical characteristics to predict vibration behavior of the entire spine inside a seated human body with different foot excitation (with and without vibration) and shin posture (vertical and tilt posture). Random response analysis was performed to study the transmissibility of the entire spine to seat under vertical white noise excitation between 0 and 20 Hz at 0.5 m/s2 r.m.s. The results showed that although the foot excitation could reduce the fore-aft transmissibility in the cervical spine (23% reduction), it could significantly increase that in the lumbar spine (52% increase), which resulted in complex alternating stresses at lumbar spine and made the lumbar spine more vulnerable to injury in long-term vibration environment. Moreover, the shin tilt posture made the maximum fore-aft transmissibility in the lumbar spine move to the upper lumbar spine. The study provided new insights into the influence of foot excitation and shin posture on the vibration behavior of the entire spine inside a seated human body. Foot excitation exposed the lumbar spine to complex alternating stresses and made it more vulnerable to injury in long-term whole body vibration. [ABSTRACT FROM AUTHOR]

Purpose: Measuring trunk extensor muscle endurance is important for identifying non-specific low back pain (LBP) risk factors and prognostic indicators, planning treatment goals, and measuring patient progress. This randomized cross-over study evaluated the reliability and validity of a newly instrumented device for measuring lumbar spine extensor muscle endurance. Methods: Thirty healthy men participated in this study. The Biering-Sørensen test (for the endurance time) and the newly invented device (for the number of repetitions) were applied to measure lumbar spine extensor muscle endurance in two separate weeks at a similar time of a day and with the same rater. Test–retest reliability and validity of the devices were examined via an intra-class correlation coefficient [ICC (2,1)], 95% confidence intervals (95% CI), standard errors of the measurement (SEM), minimal detectable change (MDC), and Pearson's correlation coefficient, respectively. Results: Test–retest reliability of the newly instrumented device demonstrated an excellent level of reliability [ICC (2,1): 0.969; 95% CI: 0.934–0.985; SEM: 2.65 repetition; MDC: 3.75 repetition]; while a moderate to good degree of test–retest reliability was found between the Biering-Sørensen test measurements [ICC (2,1): 0.884; 95% CI: 0.758–0.944; SEM: 13.31 s; MDC: 18.82 s]. Compared to the Biering-Sørensen test, the newly instrumented device had a moderately positive correlation (r = 0.283). Conclusion: The newly instrumented device demonstrated adequate reliability and validity compared with the Biering-Sørensen test. Future studies should assess its clinometric properties in patients with musculoskeletal pain also including female participants. [ABSTRACT FROM AUTHOR]

Background: To compare the clinical and radiological outcomes of modified mini-open transforaminal lumbar interbody fusion (mMO-TLIF) via posterior midline incision for "targeted limited dissection" versus minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) via Wiltse approach in lumbar degenerative diseases. Methods: A total of 60 consecutive patients in our center from January 2019 to March 2020 were enrolled, including 30 patients who were treated with mMO-TLIF via posterior midline incision and 30 treated with MIS-TLIF through the Wiltse approach. Perioperative parameters were recorded. The questionnaires of Oswestry Disability Index (ODI) and Visual Analogue Score (VAS) were conducted before the operation and after the operation (3 days, 1 week, and 2 years). CT and MRI radiological outcomes were evaluated before the operation and at a 2-year follow-up. Results: There were no significant differences in the general data, gender, age, and BMI between the two groups. All patients were successfully operated without intraoperative complications. There were significant differences between the two groups in the operation time (p < 0.001) and intraoperative bleeding (p < 0.05). There was no difference in ODI and VAS scores between groups pre- and post-operatively, but they were both significantly improved compared to those before the operation (p < 0.01). At a 2-year follow-up, the paraspinal muscle atrophy and fat infiltration were increased comparing to pre-operation, but the difference was also not statistically significant (p > 0.05). In addition, both the two groups' fusion rates were more than 90% at a 2-year follow-up, however, no difference was detected between the two groups. Conclusion: mMO-TLIF via midline incision for "targeted limited dissection" could achieve similar clinical and radiological outcomes as MIS-TLIF for lumbar degenerative disease. [ABSTRACT FROM AUTHOR]

PURPOSE: We tested the ability of [18F] fluorthanatrace (FTT), a radiolabeled analog of poly(ADP-ribose) polymerase (PARP)-1 inhibitors, to demonstrate target engagement on positron emission tomography (PET) scans from patients with newly diagnosed primary breast cancer receiving the PARP inhibitor (PARPi) talazoparib. METHODS: Seven patients with germline BRCA1/2 pathogenic variants underwent [18F]FTT PET-computed tomography scanning at baseline, and five underwent repeat scanning 14 days after talazoparib initiation. Maximum uptake on PET was quantified in the primary tumor, involved nodes, contralateral pectoralis muscle, and lumbar vertebra body level 3, and compared between the two time points. RESULTS: Blocking of [18F]FTT was observed on the second scan. Potentially strong but nonsignificant correlations were found between changes in tumor volume (on ultrasound at 1 month v baseline) and percentage changes in tumor-to-muscle uptake ratio at 14 days from baseline (Spearman rank correlation coefficient r = 1; P =.083); and between the highest-grade hematologic toxicity and baseline bone marrow-to-muscle (B/M) uptake ratio (r = 0.72; P =.068) and percentage change in B/M ratio at 14 days from baseline (r = 0.87; P =.058). CONCLUSION: We conclude that [18F]FTT can image target engagement by PARPi, but larger studies are needed to determine whether [18F]FTT uptake can predict response to PARPi and whether uptake of [18F]FTT in bone marrow may be an early predictor of hematologic toxicity. [18F]FTT PET may predict response to PARP inhibitors and early hematologic toxicity from therapy. [ABSTRACT FROM AUTHOR]

Peripheral neuropathy is a prevalent complication in plasma cell disorders, posing significant diagnostic and therapeutic challenges. This study presents three cases initially diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP). Despite initial symptom regression post-immunomodulatory treatment, the patients exhibited progressive neurological deficits. Advanced laboratory evaluation confirmed monoclonal protein presence, yet traditional diagnostic methods, including bone marrow biopsy and flow cytometry, yielded normal results. Utilizing 18F-FDG PET/CT, we identified multiple hypermetabolic vertebral lesions, which upon biopsy, confirmed the diagnosis of plasmacytoma. Our findings underscore the utility of PET/CT as a reliable diagnostic tool for monoclonal gammopathy associated neuropathy, advocating for its consideration in cases with equivocal diagnosis. When the diagnosis is in doubt, biopsy of a lesion may facilitate early and accurate diagnosis, potentially influencing treatment strategies and patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is increasingly being recognized in children, mostly secondary to systemic underlying conditions or medication. However, no imaging modality currently provides a full evaluation of bone health in children. We compared DXA, a radiographic bone health index (BHI (BoneXpert) and cone-beam CT for the assessment of low bone mass in children with juvenile idiopathic arthritis (JIA). Methods: Data used in the present study was drawn from a large multicentre study including 228 children aged 4–16 years, examined between 2015 and 2020. All had a radiograph of the left hand, a DXA scan and a cone-beam CT of the temporomandibular joints within four weeks of each other. For the present study, we included 120 subjects, selected based on DXA BMD and BoneXpert BHI to secure values across the whole range to be tested. Results: One hundred and twenty children (60.0% females) were included, mean age 11.6 years (SD 3.1 years). There was a strong correlation between the absolute values of BHI and BMD for both total body less head (TBLH) (r = 0.75, p < 0.001) and lumbar spine (L1-L4) (r = 0.77, p < 0.001). The correlation between BHI standard deviation score (SDS) and BMD TBLH Z-scores was weak (r = 0.34) but significant (0 = 0.001), varying from weak (r = 0.31) to moderate (r = 0.42) between the three study sites. Categorizing BHI SDS and DXA BMD Z-scores on a 0–5 scale yielded a weak agreement between the two for both TBLH and LS, with w-kappa of 0.2, increasing to 0.3 when using quadratic weights. The agreement was notably higher for one of the three study sites as compared to the two others, particularly for spine assessment, yielding a moderate kappa value of 0.4 – 0.5. For cone-beam CT, based on a 1–3 scale, 59 out of 94 left TMJ's were scored as 1 and 31 as score 2 by the first observer vs. 87 and 7 by the second observer yielding a poor agreement (kappa 0.1). Conclusions: Categorizing DXA LS and automated radiographic Z-scores on a 0–5 scale gave a weak to moderate agreement between the two methods, indicating that a hand radiograph might provide an adjuvant tool to DXA when assessing bone health children with JIA, given thorough calibration is performed. [ABSTRACT FROM AUTHOR]

Objective: There is a dearth of comprehensive research on the stability of the spinal biomechanical structure when combining Oblique Lumbar Interbody Fusion (OLIF) with internal fixation methods. Hence, we have devised this experiment to meticulously examine and analyze the biomechanical changes that arise from combining OLIF surgery with different internal fixation techniques in patients diagnosed with degenerative lumbar spondylolisthesis. Methods: Seven validated finite element models were reconstructed based on computed tomography scan images of the L3-L5 segment. These models included the intact model, a stand-alone (S-A) OLIF model, a lateral screw rod (LSR) OLIF model, a bilateral pedicle screw (BPS) OLIF model, an unilateral pedicle screw (UPS) OLIF model, a bilateral CBT (BCBT) OLIF model, and an unilateral CBT(UCBT) OLIF model. The range of motion (ROM), as well as stress levels in the cage, L4 lower endplate, L5 upper endplate, and fixation constructs were assessed across these different model configurations. Results: S-A model had the highest average ROM of six motion modes, followed by LSR, UPS, UCBT, BPS and BCBT. The BCBT model had a relatively lower cage stress than the others. The maximum peak von Mises stress of the fixation constructs was found in the LSR model. The maximum peak von Mises stress of L4 lower endplate was found in the S-A model. The peak von Mises stress on the L4 lower endplate of the rest surgical models showed no significant difference. The maximum peak von Mises stress of the L5 upper endplate was found in the S-A model. The minimum peak von Mises stress of the L5 upper endplate was found in the BCBT model. No significant difference was found for the peak von Mises stress of the L5 upper endplate among LSR, BPS, UPS and UCBT models. Conclusion: Among the six different fixation techniques, BCBT exhibited superior biomechanical stability and minimal stress on the cage-endplate interface. It was followed by BPS, UCBT, UPS, and LSR in terms of effectiveness. Conversely, S-A OLIF demonstrated the least stability and resulted in increased stress on both the cage and endplates. Combining OLIF with BCBT fixation technique enhanced biomechanical stability compared to BPS and presented as a less invasive alternative treatment for patients with degenerative lumbar spondylolisthesis. [ABSTRACT FROM AUTHOR]

Objective: This systematic review and meta-analysis aimed to investigate the association between circulating irisin levels and osteoporosis in women, exploring irisin's potential role in the pathophysiology and management of osteoporosis. Method: We searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang, and VIP databases up to January 2023. The inclusion criteria were observational studies reporting on circulating irisin levels in women. The standardized mean difference (SMD) and correlation coefficients with a 95% confidence interval (CI) were used as the main effect measures under a random-effects model. Heterogeneity was evaluated using the Cochrane Q statistic and the I2 statistics. Subgroup analysis and univariate meta-regression analysis were performed to identify the sources of heterogeneity. The quality of the included study was assessed by the Newcastle-Ottawa Score. The quality of evidence was evaluated using the GRADE system. Publication bias was assessed using Begg's and Egger's test, and the trim-and-fill method. Sensitivity analysis was performed to assess the stability of the results. Results: Fifteen studies with a total of 2856 participants met the criteria. The analysis showed significantly lower irisin levels in postmenopausal osteoporotic women compared to non-osteoporotic controls (SMD = -1.66, 95% CI: -2.43 to -0.89, P < 0.0001; I² = 98%, P < 0.00001) and in postmenopausal individuals with osteoporotic fractures than in non-fractures controls (SMD = -1.25, 95% CI: -2.15 to -0.34, P = 0.007; I² = 97%, P < 0.00001). Correlation analysis revealed that irisin levels positively correlated with lumbar spine BMD (r = 0.37, 95% CI: 0.18 to 0.54), femoral BMD (r = 0.30, 95% CI: 0.18 to 0.42), and femoral neck BMD (r = 0.31, 95% CI: 0.14 to 0.47) in women. Despite significant heterogeneity, the robustness of the results was supported by using the random effects model and sensitivity analysis. Conclusion: The current evidence suggests that lower irisin levels are significantly associated with osteoporosis and fracture in postmenopausal women, suggesting its utility as a potential biomarker for early detection of osteoporosis and therapeutic target. However, further high-quality prospective research controlling for confounding factors is needed to clarify the relationship between irisin levels and osteoporotic outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Lumbar spine fixation and fusion is currently performed with intraoperative tools such as intraoperative CT scan integrated to navigation system to provide accurate and safe positioning of the screws. The use of microscopic visualization systems enhances visualization and accuracy during decompression of the spinal canal as well. Methods: We introduce a novel setting in microsurgical decompression and fusion of lumbar spine using an exoscope with robotized arm (RoboticScope) interfaced with navigation and head mounted displays. Conclusion: Spinal canal decompression and fusion can effectively be performed with RoboticScope, with significant advantages especially regarding ergonomics. [ABSTRACT FROM AUTHOR]

Background: In recent years, deep learning (DL) technology has been increasingly used for the diagnosis and treatment of lumbar intervertebral disc (IVD) degeneration. This study aims to evaluate the performance of DL technology for IVD segmentation in magnetic resonance (MR) images and explore improvement strategies. Methods: We developed a PRISMA systematic review protocol and systematically reviewed studies that used DL algorithm frameworks to perform IVD segmentation based on MR images published up to April 10, 2024. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess methodological quality, and the pooled dice similarity coefficient (DSC) score and Intersection over Union (IoU) were calculated to evaluate segmentation performance. Results: 45 studies were included in this systematic review, of which 16 provided complete segmentation performance data and were included in the quantitative meta-analysis. The results indicated that DL models showed satisfactory IVD segmentation performance, with a pooled DSC of 0.900 (95% confidence interval [CI]: 0.887–0.914) and IoU of 0.863 (95% CI: 0.730–0.995). However, the subgroup analysis did not show significant effects of factors on IVD segmentation performance, including network dimensionality, algorithm type, publication year, number of patients, scanning direction, data augmentation, and cross-validation. Conclusions: This study highlights the potential of DL technology in IVD segmentation and its further applications. However, due to the heterogeneity in algorithm frameworks and result reporting of the included studies, the conclusions should be interpreted with caution. Future research should focus on training generalized models on large-scale datasets to enhance their clinical application. [ABSTRACT FROM AUTHOR]

Background: Offspring consistently exhibit similar imaging features as their parents in cases of degenerative lumbar scoliosis (DLS). Nevertheless, the role of genetic factors in the pathogenesis of DLS remains uncertain. Methods: A prospective analysis was conducted on 35 patients with DLS and their 36 offspring. Genomic DNA was extracted from 71 blood samples for gene mutation analysis using whole exome sequencin. Various demographic and imaging parameters were compared. Results: In 11 pedigrees of the 35 family members with DLS, 13 suspected pathogenic genes were identified. Among the 35 DLS patients, 11/35(31.5%) exhibited susceptibility gene mutations (mutant group), while 24/35(68.5%) had no pathogenic gene mutations (non-mutant group). AVR was more severe in mutant group than that in no-mutant group (p < 0.05). Among the 36 offspring, 11/36(30.6%) cohorts presented susceptibility genes (mutant group), 25/36(69.4%) cohorts presented no pathogenic genes (no-mutant group). More cohorts in the mutant group presented vertebral rotation (72.8%) and scoliosis (45.5%) than those (24%), (12%) in the no-mutant group, respectively (p < 0.05). Among the 36 offspring, 8/36(22.2%) presented scoliosis (study group), they all presented the same scoliosis orientation and apex vertebrae/disc location to their parents, the other 28/36(77.8%) cohorts without scoliosis were enrolled as control group, the mutation rate (62.5%) was higher in study group than that (21.4%) in control group. Conclusions: Genetic influences are significant in the onset of DLS, with affected families showing similar scoliosis patterns and identical apex vertebrae. Moreover, individuals with genetic mutations tend to have more pronounced vertebral rotation and at a higher risk of developing scoliosis. [ABSTRACT FROM AUTHOR]

Objective: As there are no substantial selection criteria for determining the lowest instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) Lenke 5C/6C, thus, many surgeons base their selection on experience. The study aims to compare the selection of the lowest instrumented vertebrae (LIV) lumbar vertebra three (L3) with the use of direct vertebrae rotation (DVR) to the lowest instrumented vertebrae (LIV) lumbar vertebra four (L4) with the use of non-DVR for the correction of adolescent idiopathic scoliosis (AIS) Lenke 5C/6C when the lower end vertebrae (LEV) is at lumbar vertebrae four (L4). Methods: This prospective study involved 101 patients who were divided into two groups based on different techniques. The patients were prospectively followed up for at least four years. All patients included in the study had a lower end vertebra (LEV) at L4, while patients older than 18 years and patients with prior surgical procedures were excluded. The DVR group consisted of 49 patients, and the non-DVR group included 51 patients. Results: The preoperative mean LIV disc angle was 3.1 ± 3 and 3.1 ± 1, P = 0.097, which corrected to 1.2 ± 0 and 1.1 ± 0 in both groups at 4-year follow-up without statistical significance. The LIVDA and LIVT were statistically insignificant at the preoperative, and there were no significant differences at the follow-up visitation. The DVR group achieved a satisfactory coronal and Cobb's angle correction compared to the NDVR group; however, there were no statistical differences at the follow-up visitations. Both groups achieve a satisfactory correction rate without substantial significance in clinical and radiological outcomes. Furthermore, no post-surgical complications were recorded in either group. Conclusions: DVR is suitable for selecting L3 as the LIV in AIS Lenke 5C/6C compared to L4 in non-DVR. DVR preserved more segments without substantial complications during the follow-up visitations. Nevertheless, both groups will continue to be followed up to prevent adding-on post-surgical complications. [ABSTRACT FROM AUTHOR]

Background: There is a corresponding increase in the prevalence of osteoporosis and related fractures with the aging population on the rise. Furthermore, osteoporotic vertebral compression fractures (OVCF) may contribute to higher patient mortality rates. It is essential to conduct research on risk factors for OVCF and provide a theoretical basis for preventing such fractures. Methods: We retrospectively recruited patients who had spine CT for OVCF or back pain. Demographic and CT data were collected. Quantitative computed tomography (QCT) software analyzed the CT data, using subcutaneous fat and paraspinal muscles as reference standards for BMD processing. BMD of cortical and cancellous bones in each patient's vertebral body was determined. Results: In this study, 144 patients were divided into non-OVCF (96) and OVCF (48) groups. Non-OVCF patients had higher cortical BMD of 382.5 ± 52.4 to 444.6 ± 70.1 mg/cm3, with T12 having the lowest BMD (p < 0.001, T12 vs. L2). Cancellous BMD ranged from 128.5 ± 58.4 to 140.9 ± 58.9 mg/cm3, with L3 having the lowest BMD. OVCF patients had lower cortical BMD of 365.0 ± 78.9 to 429.3 ± 156.7 mg/cm3, with a further decrease in T12 BMD. Cancellous BMD ranged from 71.68 ± 52.07 to 123.9 ± 126.2 mg/cm3, with L3 still having the lowest BMD. Fractured vertebrae in OVCF patients (T12, L1, and L2) had lower cortical bone density compared to their corresponding vertebrae without fractures (p < 0.05). Conclusions: T12 had the lowest cortical BMD and L3 had the lowest cancellous BMD in OVCF patients, with T12 also having the highest incidence of osteoporotic fractures. These findings suggest that reduction in cortical BMD has a greater impact on OVCF than reduction in cancellous BMD, along with biomechanical factors. [ABSTRACT FROM AUTHOR]

Background: As implant treatment cases increase, many cases of failure/side effects also occur. Generally, dental clinics determine the density of the jawbone using cone beam CT (CBCT). Considering the known potential role of this tool for bone assessment in primary osteoporosis, this study evaluated patients with secondary endocrine causes of low bone mass. Methods: The study included 83 patients with endocrine causes of osteoporosis who were evaluated by dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and mental foramen (MF) region CBCT. The following CBCT indices were measured: anterior (A)—thickness of inferior mandibular cortex 10 mm anterior from MF; molar (M)—thickness of inferior mandibular cortex 10 mm posterior from MF; posterior (P)—thickness of inferior mandibular cortex 25 mm posterior from MF; symphysis (S)—thickness of inferior mandibular cortex equidistant from the centers of right and left MF. Results: The highest correlation coefficient in the secondary causes group was between the A index and the lumbar BMD (r = 0.375, p = 0.001) and the P index and the femoral neck BMD (r = 0.38, p = 0.001). Hypercortisolism seems to be the most predictable cause of secondary osteoporosis using the A, M, and P indices. The A, M, and P indices showed predictive values of the bone micro-architecture that was evaluated using TBS score, and were statistically significant. The symphysis index does not significantly predict osteoporosis or impaired bone micro-architecture. Conclusions: These findings support the potential usefulness of A, M, and P CBCT-derived radiomorphometric mandibular indices in secondary osteoporosis, underlining the well-known effects of these pathologies on bone micro-architecture rather than bone quantity. [ABSTRACT FROM AUTHOR]

Background/Objectives: We sought to improve accuracy while minimizing radiation hazards, improving surgical outcomes, and preventing potential complications. Despite the increasing popularity of these systems, a limited number of papers have been published addressing the historical evolution, detailing the areas of use, and discussing the advantages and disadvantages, of this increasingly popular system in lumbar spine surgery. Our objective was to offer readers a concise overview of navigation system history in lumbar spine surgeries, the techniques involved, the advantages and disadvantages, and suggestions for future enhancements to the system. Methods: A comprehensive review of the literature was conducted, focusing on the development and implementation of navigation systems in lumbar spine surgeries. Our sources include PubMed-indexed peer-reviewed journals, clinical trial data, and case studies involving technologies such as computer-assisted surgery (CAS), image-guided surgery (IGS), and robotic-assisted systems. Results: To develop more practical, effective, and accurate navigation techniques for spine surgery, consistent advancements have been made over the past four decades. This technological progress began in the late 20th century and has since encompassed image-guided surgery, intraoperative imaging, advanced navigation combined with robotic assistance, and artificial intelligence. These technological advancements have significantly improved the accuracy of implant placement, reducing the risk of misplacement and related complications. Navigation has also been found to be particularly useful in tumor resection and minimally invasive surgery (MIS), where conventional anatomic landmarks are lacking or, in the case of MIS, not visible. Additionally, these innovations have led to shorter operative times, decreased radiation exposure for patients and surgical teams, and lower rates of reoperation. As navigation technology continues to evolve, future innovations are anticipated to further enhance the capabilities and accessibility of these systems, ultimately leading to improved patient outcomes in lumbar spine surgery. Conclusions: The initial limited utilization of navigation system in spine surgery has further expanded to encompass almost all fields of lumbar spine surgeries. As the cost-effectiveness and number of trained surgeons improve, a wider use of the system will be ensured so that the navigation system will be an indispensable tool in lumbar spine surgery. However, continued research and development, along with training programs for surgeons, are essential to fully realize the potential of these technologies in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Biomechanical analysis of the sagittal alignment of the lumbar spine and pelvis on radiographs is common in clinical practices including chiropractic, physical therapy, scoliosis-related thoraco-lumbo-sacral orthosis (TLSO) management, orthopedics, and neurosurgery. Of specific interest is the assessment of pelvic morphology and the relationship between angle of pelvic incidence, sacral slope, and lumbar lordosis to pain, disability, and clinical treatment of spine conditions. The current state of the literature on the reliability of common methods quantifying these parameters on radiographs is limited. Methods: The objective of this systematic review is to identify and review the available studies on the reliability of different methods of biomechanical analysis of sagittal lumbo-pelvic parameters used in clinical practice. Our review followed the recommendations of the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The design of this systematic review was registered with PROSPERO (CRD42023379873). Results: The search strategy yielded a total of 2387 articles. A total of 1539 articles were screened after deduplication and exclusion by automation tools, leaving 473 full-text articles that were retrieved. After exclusion, 64 articles met the inclusion criteria. The preponderance of the evidence showed good to excellent reliability for biomechanical assessment of sagittal lumbo-pelvic spine alignment. Conclusions: The results of this systematic review of the literature show that sagittal radiographic analysis of spinal biomechanics and alignment of the human lumbo-pelvic spine is a reliable tool for aiding diagnosis and management in clinical settings. [ABSTRACT FROM AUTHOR]

Problems, such as broken screws, broken rods, and cage subsidence after clinical spinal fusion surgery affect the success rate of fusion surgery and the fixation effect of fusion segments, and these problems still affect the treatment and postoperative recovery of patients. In this study, we used the biomechanical finite element analysis method to analyze and study the fixation effect of three kinds of spinal internal fixation systems on L4–L5 lumbar spine segments in percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF). The three different fixation systems compared in this study include bilateral pedicle screw fixation (M1); bilateral pedicle screw with cross-link fixation (M2); bilateral pedicle screws with double bent rods fixation (M3). The internal fixation systems with different structures were analyzed with the help of Hypermesh, and Abaqus. It was found that the internal fixation system with double bent rods reduced screw stresses by 23.8 and 22.2% in right and left axial rotation than the traditional bilateral pedicle screw system, while titanium rod stresses were reduced by 9.6, 3.7, 9.6, and 2.9% in flexion, left and right lateral bending, and right axial rotation, respectively, and L5 upper endplate stresses were reduced by 35.5, 18.9, 38.4, 10.2, and 48.3% in flexion, left and right lateral bending, and left and right axial rotation, respectively. The spinal range of motion (ROM) of the M3 internal fixation system was less than that of the M1 and M2 internal fixation systems in left lateral bending, left lateral rotation, and right axial rotation, and the intact vertebral ROM was reduced by 93.7, 94.9, and 90.9%, respectively. The double bent rod structure of the spinal internal fixation system has better biomechanical properties, which can effectively reduce the risk of screw breakage, loosening, cage subsidence, and endplate collapse after fusion surgery. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the impact of contrast media application on CT attenuation of the bone using a novel calcium-only imaging technique (VCa) from dual-layer spectral detector CT (DLCT), which enables CT-based bone mineral density measurement unimpeded by soft tissue components. For this, true non-contrast (TNC) and venous phase images (VP) of n = 97 patients were acquired. CT attenuation of the first lumbar vertebra (L1) was measured in TNC-VCa, VP-VCa, and in virtual non-contrast images (VNC). CT attenuation was significantly higher in VP-VCa than in TNC-VCa (p < 0.001), although regression analyses revealed a strong linear association between these measures (R2 = 0.84). A statistical model for the prediction of TNC-VCa CT attenuation was established (TNC-VCa[HU] = − 6.81 + 0.87 × VP-VCa[HU]-0.55 × body weight[kg]) and yielded good agreement between observed and predicted values. Furthermore, a L1 CT attenuation threshold of 293 HU in VP-VCa showed a sensitivity of 90% and a specificity of 96% for detecting osteoporosis. The application of contrast media leads to an overestimation of L1 CT attenuation in VCa. However, CT attenuation values from VP-VCa can be used within CT-based opportunistic osteoporosis screening eighter by applying a separate threshold of 293 HU or by converting measured data to TNC-VCa CT attenuation with the given regression equation. [ABSTRACT FROM AUTHOR]

Low back pain is the most common musculoskeletal complaint accounting for over 30 million visits to primary care physicians annually. Serious pathology is found in less than 1% of these visits. Therefore it is often a challenge to distinguish worrisome findings requiring further workup and treatment from common complaints of pain. Gout is an inflammatory arthritis that most commonly affects the appendicular skeleton. It is characterized by the saturation of uric acid and deposition of monosodium urate crystals in joints and tissues. Spinal involvement is rare and is not typically considered on the differential diagnosis for a patient presenting with acute low back pain. We present such a case of a 35-year-old male who presented with intractable back pain, highlighting the need to recognize signs and symptoms that raise suspicion for spinal gout. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated potential use of computed tomography (CT)-based parameters in the lumbar spine as a surrogate for magnetic resonance imaging (MRI)-based findings. Methods: In this retrospective study, all individuals, who had a lumbar spine CT scan and MRI between 2006 and 2012 were reviewed (n = 198). Disc height (DH) and endplate degeneration (ED) were evaluated between Th12/L1-L5/S1. Statistics consisted of Spearman correlation and univariate/multivariable regression (adjusting for age and gender). Results: The mean CT-DH increased kranio-caudally (8.04 millimeters (mm) at T12/L1, 9.17 mm at L1/2, 10.59 mm at L2/3, 11.34 mm at L3/4, 11.42 mm at L4/5 and 10.47 mm at L5/S1). MRI-ED was observed in 58 (29%) individuals. CT-DH and MRI-DH had strong to very strong correlations (rho 0.781-0.904, p <.001). MRI-DH showed higher absolute values than CT-DH (mean of 1.76 mm). There was a significant association between CT-DH and MRI-ED at L2/3 (p =.006), L3/4 (p =.002), L4/5 (p <.001) and L5/S1 (p <.001). A calculated cut-off point was set at 11 mm. Conclusions: In the lumbar spine, there is a correlation between disc height on CT and MRI. This can be useful in trauma and emergency cases, where CT is readily available in the lack of an MRI. In addition, in the middle and lower part of the lumbar spine, loss of disc height on CT scans is associated with more pronounced endplate degeneration on MRIs. If the disc height on CT scans is lower than 11 mm, endplate degeneration on MRIs is likely more pronounced. Level and design: Level III, a retrospective study. [ABSTRACT FROM AUTHOR]

Purpose: Superficial surgical site infection (SSSI) is a prominent problem in spine surgery. Intracutaneous sutures and staple-assisted closure are two widely used surgical techniques for skin closure. Yet, their comparative impact on wound healing and infection rates is underexplored. Our goal was to address this gap and compare wound healing between these two techniques. Methods: This study was a multicenter international prospective randomized trial. Patient data were prospectively collected at three large academic centers, patients who underwent non-instrumented lumbar primary spine surgery were included. Patients were intraoperatively randomized to either intracutaneous suture or staple-assisted closure cohorts. The primary endpoint was SSSI within 30 days after surgery according to the wound infection Centers for Disease Control and Prevention (CDC) classification system. Results: Of 207 patients, 110 were randomized to intracutaneous sutures and 97 to staple-assisted closure. Both groups were homogenous with respect to epidemiological as well as surgical parameters. Two patients (one of each group) suffered from an A1 wound infection at the 30-day follow up. Median skin closure time was faster in the staple-assisted closure group (198 s vs. 13 s, p < 0,001). Conclusion: This study showed an overall low superficial surgical site infection rate in both patient cohorts in primary non instrumented spine surgery. [ABSTRACT FROM AUTHOR]

Background: Managing medication use in older orthopedic patients is imperative to extend their healthy life expectancy in an aging society. However, the actual situation regarding polypharmacy, the intake of potentially inappropriate medications (PIMs), and fall risk-increasing drugs (FRIDs) among older orthopedic patients is not well characterized. This study aimed to investigate the medication-based profiles of older orthopedic patients to highlight the critical points of concern. Methods: We retrospectively reviewed the clinical data of consecutive patients aged ≥ 65 years who underwent orthopedic surgery at two acute care hospitals between April 2020 and March 2021. The cutoff number of prescribed drugs for polypharmacy was set at 6. According to the specified guidelines, 19 categories of drugs were identified as PIMs, and 10 categories were classified as FRIDs. Results: A total of 995 older patients with orthopedic surgery were assessed, of which 57.4% were diagnosed with polypharmacy, 66.0% were receiving PIMs, and 41.7% were receiving FRIDs. The prevalence of FRID intake did not significantly differ among patients with degenerative spinal disease (n = 316), degenerative disease of extremities (n = 331), and fractures (n = 272). Compared with patients with degenerative disease of the extremities, the multivariable-adjusted prevalence ratios (PRs) of polypharmacy and PIM intake were significantly higher in patients with degenerative spinal disease (1.26 [confidence intervals (CI): 1.11–1.44] and 1.12 [CI: 1.00–1.25]), respectively. Use of antiemetic drugs (adjusted PR, 13.36; 95% CI: 3.14–56.81) and nonsteroidal anti-inflammatory drugs (adjusted PR, 1.37; 95% CI: 1.05–1.78) was significantly higher in patients with degenerative spinal disease. Among patients with degenerative spinal disease, the prevalence of antiemetic drug intake was 8.7% in lumbar spinal patients and 0% in cervical spinal patients. Conclusions: More than half of the orthopedic patients in this study were affected by polypharmacy, and approximately two-thirds were prescribed some form of PIMs. Patients with degenerative spinal disease showed a significantly higher prevalence of polypharmacy and PIM use compared with other orthopedic diseases. Particular attention should be paid to the high frequency of antiemetic drugs and nonsteroidal anti-inflammatory drugs intake among patients with degenerative lumbar spine conditions. [ABSTRACT FROM AUTHOR]

Background: Spondylodiscitis is an infection of the vertebral body extending to the intervertebral disc, and possibly the surrounding paraspinal structures. Objectives: To evaluate the clinical results of posterior long segment transpedicular screws fixation and decompression of the infected area for management of idiopathic pyogenic spondylodiscitis of the thoracic and lumbar spine. Methods: This retrospective study included 14 patients with idiopathic active pyogenic spondylodiscitis of the lumber and thoracic spine between January 2017 and December 2021, with follow-up continuing until December 2022. All patients had posterior long-segment rigid fixation with infection decompression. Results: All patients after 6-month follow-up had achieved complete fusion. There was no evidence of postoperative wound infection, and no patient had a recurrence of infection at the lesion site during follow-up. Prior to surgery, the mean VAS score for back pain was 7.6 (range 6–9), however, after surgery, it fell to 1.3 (0–3), a statistically significant improvement (P < 0.001) during the last follow-up. According to the Kirkaldy-Willis criteria, the functional prognosis was excellent in 11 individuals, good in two, and fair in one. Conclusions: Posterior long-segment fixation in conjunction with decompression of the affected area effectively resolved bacterial spinal infection and restored neurological impairment. [ABSTRACT FROM AUTHOR]

The purpose of the study was to determine whether running is associated with greater bone mineral density (BMD) by comparing the BMD of regularly active male runners (AR) with inactive nonrunner male controls (INC). This cross-sectional study recruited 327 male AR and 212 male INC (aged 18–65) via a stratified recruitment strategy. BMD of the whole body (WB) and partial segments (spine, lumbar spine (LS), leg, hip, femoral neck (FN), and arm for each side) were measured by dual-energy x-ray absorptiometry (DXA) and lower leg dominance (dominant-D/nondominant-ND) was established by functional testing. An ANCOVA was used to compare AR and INC. The AR had greater BMD for all segments of the lower limb (p<0.05), but similar BMD for all segments of the upper limb (p>0.05) compared with INC. Based on the pairwise comparison of age groups, AR had greater BMD of the ND leg in every age group compared with INC (p<0.05). AR had grater BMD of the D leg in every age group except for (26–35 and 56–65) compare with INC (p<0.05). In the youngest age group (18–25), AR had greater BMD in every measured part of lower extremities (legs, hips, femoral necks) compared with INC (p<0.05). In the 46–55 age group AR had greater BMD than INC (p < 0.05) only in the WB, D Leg, D neck, and ND leg. In the 56–65 age group AR had greater BMD than INC (p<0.05) only in the ND leg. Overall, AR had greater BMD compared with INC in all examined sites except for the upper limbs, supporting the notion that running may positively affect bone parameters. However, the benefits differ in the skeletal sites specifically, as the legs had the highest BMD difference between AR and INC. Moreover, the increase in BMD from running decreased with age. [ABSTRACT FROM AUTHOR]

Objective: To elucidate the effectiveness and safety of different traditional Chinese medicines (TCMs) for treating primary osteoporosis (POP) using network meta-analysis. Materials and Methods: We conducted a systematic review and network meta-analysis to assess the efficacy and safety of Chinese patent medicine (CPM) combined with conventional Western medicine for POP treatment. From March 5, 2004, to March 5, 2024, electronic databases such as the Cochrane Library, VIP, PubMed, Embase, CBM, Wanfang, CNKI, and Web of Science were comprehensively searched. Only randomized controlled trials (RCTs) were included in this systematic review. After screening and data extraction, the Cochrane risk of bias evaluation tool was utilized to assess the methodological quality of the included studies. Stata 15.1 was utilized to synthesize the data. Results: In total, 44 studies involving 4859 patients were included. There were 2577 patients in the treatment group and 2282 in the control group, with 12 types of CPMs. Qing’e Pill, in combination with conventional treatment, significantly improved the total effective rate [relative risk (RR)=2.57, 95% confidence interval (CI) (1.32, 5.00)]. In combination with conventional treatment, Liuwei Dihuang Pill significantly increased the bone mass density (BMD) of the lumbar spine [WMD =0.17, 95% CI (0.05, 0.28)] and femoral neck [WMD =0.23, 95% CI (0.11, 0.35)]. Furthermore, Hugu capsules effectively decreased the VAS score [WMD =−2.48, 95% CI (−3.85, −1.11)]. The presence of the genus Gusongbao markedly decreased the serum ALP concentration [WMD =−15.67, 95% CI (−32.73, 1.39)]. In all studies, no serious adverse reactions were noted, with most studies suggesting only mild gastrointestinal reactions. Conclusions: CPM and conventional treatment combo enhances POP therapy; each CPM offers unique benefits. More high-quality RCTs needed for conclusions. Meds tailored to patient traits in clinics. [ABSTRACT FROM AUTHOR]

Spinal fusion surgery is one of the most common major surgical procedures in youth. Adolescent idiopathic scoliosis (AIS) is the most frequent reason for corrective spinal fusion. AIS (∼25%–47% of cases) and spinal fusion surgeries are associated with pain, including the development of new onset chronic pain for up to 15% of youth. This research used photovoice approaches to explore the journeys of youth from before, during, and after spinal fusion surgery, to demonstrate their experiences both of and beyond pain. Twenty participants were recruited from a previous study conducted by the senior author's lab. Participants captured photos/videos in their daily life (Phase 1); collected previously taken photos/videos from before/during/after their surgery (Phase 2); and participated in individual interviews to reflexively discuss the meaning behind photos/videos (Phase 3). Before interviews, a questionnaire was administered to assess pain characteristics. Nineteen girls/women with scoliosis and one boy/man with kyphosis (12–19 years old, M age = 16 years) participated; they identified as white (80%), other (15%), and Southeast Asian (5%). The researchers used a reflexive thematic analysis approach, which generated five themes: (1) body aesthetic versus machine; (2) expectations and anticipation of surgery/outcomes; (3) desire of normalcy and freedom; (4) navigating a hoped-for positive surgery experience; and (5) the journey sculpts identity formation and sense of self. Findings support youth advocacy, underscoring the need to validate youth concerns and inform healthcare professionals of the importance of individualized care. Youth perspectives highlighted opportunities for optimizing surgery/healthcare experiences and the psychosocial impacts of scoliosis on body image and appearance. [ABSTRACT FROM AUTHOR]

For Caucasian women, the QCT (quantitative CT) lumbar spine (LS) bone mineral density (BMD) cutpoint value for classifying osteoporosis is 80 mg/ml. At the age of approximate 78 years, US Caucasian women QCT LS BMD population mean is 80 mg/ml, while that of Chinese women and Japanese women is around 50 mg/ml. Correlation analyses show, for Chinese women and Japanese women, QCT LS BMD of 45 mg/ml corresponds to the dual-energy X-ray absorptiometry cutpoint value for classifying osteoporosis. For Chinese and Japanese women, if QCT LS BMD 80 mg/ml is used as the threshold to classify osteoporosis, then the specificity of classifying subjects with vertebral fragility fracture into the osteoporotic group is low, whereas threshold of 45 mg/ml approximately achieve a similar separation for women with and without vertebral fragility fracture as the reports for Caucasian women. Moreover, by using 80mg/ml as the cutpoint value, LS QCT leads to excessively high prevalence of osteoporosis for Chinese women, with the discordance between hip dual-energy X-ray absorptiometry and LS QCT measures far exceeding expectation. Considering the different bone properties and the much lower prevalence of fragility fractures in the East Asian women compared with Caucasians, we argue that the QCT cutpoint value for classifying osteoporosis among older East Asian women will be close to and no more than 50 mg/ml LS BMD. We suggest that it is also imperative the QCT osteoporosis classification criterion for East Asian male LS, and male and female hips be re-examined. [ABSTRACT FROM AUTHOR]

Purpose: Subtle spinal compression fractures can easily be missed. AI may help in interpreting these images. We propose to test the performance of an FDA-approved algorithm for fracture detection in radiographs on a per vertebra basis, assessing performance based on grade of compression, presence of foreign material, severity of degenerative changes, and acuity of the fracture. Methods: Thoracic and lumbar spine radiographs with inquiries for fracture were retrospectively collected and analyzed by the AI. The presence or absence of fracture was defined by the written report or cross-sectional imaging where available. Fractures were classified semi-quantitatively by the Genant classification, by acuity, by the presence of foreign material, and overall degree of degenerative change of the spine. The results of the AI were compared to the gold standard. Results: A total of 512 exams were included, depicting 4114 vertebra with 495 fractures. Overall sensitivity was 63.2% for the lumbar spine, significantly higher than the thoracic spine with 50.6%. Specificity was 96.7 and 98.3% respectively. Sensitivity increased with fracture grade, without a significant difference between grade 2 and 3 compression fractures (lumbar spine: grade 1, 52.5%; grade 2, 72.3%; grade 3, 75.8%; thoracic spine: grade 1, 42.4%; grade 2, 60.0%; grade 3, 60.0%). The presence of foreign material and a high degree of degenerative changes reduced sensitivity. Conclusion: Overall performance of the AI on a per vertebra basis was degraded in clinically relevant scenarios such as for low-grade compression fractures. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility of using large language models (LLMs), specifically ChatGPT-4, to generate concise and accurate layperson summaries of musculoskeletal radiology reports. Methods: Sixty radiology reports, comprising 20 MR shoulder, 20 MR knee, and 20 MR lumbar spine reports, were obtained via PACS. The reports were deidentified and then submitted to ChatGPT-4, with the prompt "Produce an organized and concise layperson summary of the findings of the following radiology report. Target a reading level of 8-9th grade and word count <300 words." Three (two primary and one later added for validation) independent readers evaluated the summaries for completeness and accuracy compared to the original reports. Summaries were rated on a scale of 1 to 3: 1) summaries that were incorrect or incomplete, potentially providing harmful or confusing information; 2) summaries that were mostly correct and complete, unlikely to cause confusion or harm; and 3) summaries that were entirely correct and complete. Results: All 60 responses met the criteria for word count and readability. Mean ratings for accuracy were 2.58 for reader 1, 2.71 for reader 2, and 2.77 for reader 3. Mean ratings for completeness were 2.87 for reader 1 and 2.73 for reader 2 and 2.87 for reader 3. For accuracy, reader 1 identified three summaries as a 1, reader 2 identified one, and reader 3 identified none. For the two primary readers, inter-reader agreement was low for accuracy (kappa 0.33) and completeness (kappa 0.29). There were no statistically significant changes in inter-reader agreement when the third reader's ratings were included in analysis. Conclusion: Overall ratings for accuracy and completeness of the AI-generated layperson report summaries were high with only a small minority likely to be confusing or inaccurate. This study illustrates the potential for leveraging generative AI, such as ChatGPT-4, to automate the production of patient-friendly summaries for musculoskeletal MR imaging. [ABSTRACT FROM AUTHOR]

Pannexin 3 (Panx3) is a glycoprotein that forms mechanosensitive channels expressed in chondrocytes and annulus fibrosus cells of the intervertebral disc (IVD). Evidence suggests Panx3 plays contrasting roles in traumatic versus aging osteoarthritis (OA) and intervertebral disc degeneration (IDD). However, whether its deletion influences the response of joint tissue to forced use is unknown. The purpose of this study was to determine if Panx3 deletion in mice causes increased knee joint OA and IDD after forced treadmill running. Male and female wildtype (WT) and Panx3 knockout (KO) mice were randomized to either a no‐exercise group (sedentary; SED) or daily forced treadmill running (forced exercise; FEX) from 24 to 30 weeks of age. Knee cartilage and IVD histopathology were evaluated by histology, while tibial secondary ossification centers were analyzed using microcomputed tomography (µCT). Both male and female Panx3 KO mice developed larger superficial defects of the tibial cartilage after forced treadmill running compared with SED WT mice. Additionally, Panx3 KO mice developed reduced bone volume, and female PANX3 KO mice had lengthening of the lateral tubercle at the intercondylar eminence. In the lower lumbar spine, both male and female Panx3 KO mice developed histopathological features of IDD after running compared to SED WT mice. These findings suggest that the combination of deleting Panx3 and forced treadmill running induces OA and causes histopathological changes associated with the degeneration of the IVDs in mice. [ABSTRACT FROM AUTHOR]

Purpose: Ossification of the mamillo-accessory ligament (MAL) results in the formation of a mamillo-accessory foramen (MAF), which is associated with aging. The MAL tethers the medial branches of the lumbar dorsal rami to the lumbar vertebrae. A MAL ossified at the lumbar vertebrae can cause low back pain by compressing the medial branch of a dorsal ramus. Age ranges related to ossification of the MAL have not been reported in previous studies. The objective of the present study was to determine the prevalence of ossification of the MAL in the lumbar column and its relationship to aging, and to measure the newly formed MAF at each level of the lumbar vertebrae. Methods: This study examined 935 dried lumbar vertebrae from 187 donors at Khon Kaen University, Thailand, consisting of 93 females and 94 males. The research focused on ossification patterns of the MAL, categorizing them into three patterns. Results: We found that over 50% of ossified MAL occurred in the 30–45-year-old range and the frequency increased with age. The prevalence of ossified lumbar MAL was 72.73%, especially in L5 on the left side in females (76.92%). The width of the MAF did not differ significantly between the sexes, but it was greater on the left side (2.46 ± 1.08; n = 76) than the right (2.05 ± 0.95; n = 72) (p = 0.016). Conclusion: Ossification of the MAL into the MAF progresses with age, leading to low back pain from nerve compression. Physicians should be aware of the MAF during anesthesia block to treat low back pain. [ABSTRACT FROM AUTHOR]