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Background: Previous evidence showed altered lumbar multifidus (LM) activa-tion in populations with chronic nonspecific low back pain (LBP). We aimed toinvestigate the test–retest and inter-examiner reliability of ultrasound imaging(US) for assessing LM thickness at rest and activation during the active straightleg raise test (ASLR) and the association between thickness changes with clinicaloutcomes.Methods: Fifty- two patients with LBP and two examiners (one experienced andone novice) participated in this study. A total of 18 B- mode images at L4–L5 orL5–S1 level (both sides, 3 at rest and 6 during ASLR) were collected. For assess-ing test–retest reliability, the experienced examiner repeated the procedure after7 days. Intraclass correlation coefficients (ICC), standard error of measurements(SEM) and minimal detectable changes (MDC) were calculated.Results: Inter-examiner agreement was good to excellent (ICC3,2 = 0.71–0.92)and test–retest reliability was excellent (ICC3,1 = 0.91–0.98). Mean average ofmultiple measurements improved the agreement. Greater LM thickness at rest(p < .05) and greater thickness change after 3 s (p < .01) and 10 s (homolateralside, p < .01; contralateral side, p < .05) were associated with less pain intensity.Conclusions: US is a reliable method to assess the LM thickness at rest andcontracted during the ASLR in patients with LBP. The measurement at 3 s aftermaintaining ASLR, as well as the use of the mean of three measurements, hasbeen shown to be the most reliable method for measuring LM muscle thicknessduring ASLR.K E Y W O R D Slow back pain, lumbar multifidus, lumbar spine, reliability, stabilization, ultrasound imaging, Sección Deptal. de Radiología, Rehabilitación y Fisioterapia (Enfermería), Fac. de Enfermería, Fisioterapia y Podología, TRUE, pub

BACKGROUND: Low protein intake (LPI) has been suggested as a treatment for chronic kidney disease (CKD). However, protein intake is essential for bone health. METHODS: We studied the database of the National Health and Nutrition Examination Survey, 2005-2010. Basic variables, metabolic diseases, and bone density of different femoral areas were stratified into four subgroups according to different protein intake (DPI) (that is, <0.8, 0.8-1.0, 1.0-1.2, and >1.2 g/kg/day). RESULTS: Significant differences were found among all lumbar area bone mineral density (BMD) and T-scores (p < 0.0001). There was an apparent trend between a decreasing BMD in the CKD groups with increasing DPI in all single lumbar spines (L1, L2, L3, and L4) and all L spines (L1-L4). Compared with DPI (0.8-1.0 g/day/kg), higher risks of osteoporosis were noticed in the subgroup of >1.2 g/day/kg over L2 (relative risk (RR)=1.326, 95% confidence interval (CI)=1.062-1.656), subgroup >1.2 g/day/kg over L3 (RR = 1.31, 95%CI = 1.057-1.622), subgroup <0.8 g/day/kg over L4 (RR = 1.276, 95%CI = 1.015-1.605), subgroup <0.8 g/day/kg over all L spines (RR = 11.275, 95%CI = 1.051-1.548), and subgroup >1.2 g/day/kg over all L spines (RR = 0.333, 95%CI = 1.098-1.618). However, a higher risk of osteoporosis was observed only in the non-CKD group. There was an apparent trend of higher DPI coexisting with lower BMD and T scores in patients with CKD. For osteoporosis (reference:0.8-1.0 g/day/kg), lower (<0.8 g/day/kg) or higher DPI (>1.2 g/day/kg) was associated with higher risks in the non-CKD group, but not in the CKD group. CONCLUSIONS: In the CKD group, LPI for renal protection was safe without threatening L spine bone density and without causing a higher risk of osteoporosis.

Lumbar interbody fusion (LIF) is an established surgical treatment for lower back pain caused by degenerative disc diseases. It involves the replacement of a deteriorated disc with a spinal cage and bone grafting to fuse adjacent vertebrae. Despite the wide acceptance of this surgery, adverse events such as non-union at fusion site, and post-operative complications such as cage subsidence and migration can ultimately require revision surgery. Customised spinal cages generated from personalised computational lumbar models have been shown to result in reduced complication rates; however, the extensive time and cost associated with pre-operative planning remain a challenge for implementation. This dissertation aimed to facilitate and accelerate the spinal cage customisation which addresses the lumbar endplate- and cage-related risk factors for LIF. The risk factors were collected from observational/clinical studies in literature and the results of a cadaveric experiment. A pipeline was developed to automatically generate personalised lumbar finite element (FE) model and customised spinal cage using the findings of risk factors for LIF. The results based on observational studies showed that the primary risk factors for LIF are associated with the bone quality and cage-endplate interactions. Consequently, a cadaveric experiment was conducted to evaluate the influences between bone mineral density, endplate- and cage-related parameters and cage-endplate contact variables, which illustrated that the bone mineral density, cage orientation and lateral position on the endplate were the key factors that affect cage-endplate contact stress and area. Finally, an automated pipeline was developed to morph template lumbar FE model to new shapes and generate customised spinal cages as well as the lumbar FE model with cage, which allowed varied controls of cage parameters to accommodate different vertebral conditions. These outputs were achieved within a relatively short period of ti

PurposeHigh quality scan prescription that optimally covers the area of interest with scan planes aligned to relevant anatomical structures is crucial for error-free radiologic interpretation. The goal of this project was to develop a machine learning pipeline for oblique scan prescription that could be trained on localizer images and metadata from previously acquired MR exams.MethodsA novel Multislice Rotational Region-based Convolutional Neural Network (MS-R2CNN) architecture was developed. Based on this architecture, models for automated prescription sagittal lumbar spine acquisitions from axial, sagittal, and coronal localizer slices were trained. The automated prescription pipeline was integrated with the scanner console software and evaluated in experiments with healthy volunteers (N = 3) and patients with lower-back pain (N = 20).ResultsExperiments in healthy volunteers demonstrated high accuracy of automated prescription in all subjects. There was good agreement between alignment and coverage of manual and automated prescriptions, as well as consistent views of the lumbar spine at different positions of the subjects within the scanner bore. In patients with lower-back pain, the generated prescription was applied in 18 cases (90% of the total number). None of the cases required major adjustment, while in 11 cases (55%) there were minor manual adjustments to the generated prescription.ConclusionsThis study demonstrates the ability of oriented object detection-based models to be trained to prescribe oblique lumbar spine MRI acquisitions without the need of manual annotation or feature engineering and the feasibility of using machine learning-based pipelines on the scanner for automated prescription of MRI acquisitions.

Objective Lordosis Distribution Index (LDI) is a new radiographic parameter associated with postoperative residual symptoms in patients undergoing Transforaminal Lumbar Interbody Fusion (TLIF). Recently, it has been applied on patients undergoing instrumented spine surgery, however not correlated to Patient Related Outcome Measures (PROMs). This study investigates whether the obtained the postoperative LDI after TLIF surgery correlates with the clinical outcome measured with PROMs. Methods This study was based on prospectively obtained data in patients undergoing TLIF throughout 2017 at a Danish university hospital. Medical records and the DaneSpine Database were accessed to obtain preoperative, operative and follow-up data. Primary outcome was Oswestry Disability Index (ODI) 12 months postoperatively. Secondary outcomes included revision rate and additional PROMs. Results 126 patients were included. 70 patients were classified with normolordosis (56 %), 42 hypolordosis (33 %) and 14 hyperlordosis (11 %). All groups experienced significant radiological changes undergoing surgery. Average reduction in ODI at 12 months postoperatively was −15.3 (±20.0). Minimally clinical important difference was achieved in 68 patients (54.0 %). No significant difference in PROMs between LDI-groups was observed in unadjusted or adjusted analyses. Revision surgery was performed in 8 patients with normolordosis (11.4 %), 7 hypolordosis (16.7 %) and 4 hyperlordosis (28.6 %). Conclusions We found no significant correlation between postoperative LDI subgroups of normolordotic, hypo- or hyperlordotic patients and the clinical outcome of posterolateral fusion and TLIF surgery. A trend towards lower rate of revision surgery in the normolordotic group compared to the hypo- and hyperlordotic group was observed., Objective: Lordosis Distribution Index (LDI) is a new radiographic parameter associated with postoperative residual symptoms in patients undergoing Transforaminal Lumbar Interbody Fusion (TLIF). Recently, it has been applied on patients undergoing instrumented spine surgery, however not correlated to Patient Related Outcome Measures (PROMs). This study investigates whether the obtained the postoperative LDI after TLIF surgery correlates with the clinical outcome measured with PROMs. Methods: This study was based on prospectively obtained data in patients undergoing TLIF throughout 2017 at a Danish university hospital. Medical records and the DaneSpine Database were accessed to obtain preoperative, operative and follow-up data. Primary outcome was Oswestry Disability Index (ODI) 12 months postoperatively. Secondary outcomes included revision rate and additional PROMs. Results: 126 patients were included. 70 patients were classified with normolordosis (56 %), 42 hypolordosis (33 %) and 14 hyperlordosis (11 %). All groups experienced significant radiological changes undergoing surgery. Average reduction in ODI at 12 months postoperatively was −15.3 (±20.0). Minimally clinical important difference was achieved in 68 patients (54.0 %). No significant difference in PROMs between LDI-groups was observed in unadjusted or adjusted analyses. Revision surgery was performed in 8 patients with normolordosis (11.4 %), 7 hypolordosis (16.7 %) and 4 hyperlordosis (28.6 %). Conclusions: We found no significant correlation between postoperative LDI subgroups of normolordotic, hypo- or hyperlordotic patients and the clinical outcome of posterolateral fusion and TLIF surgery. A trend towards lower rate of revision surgery in the normolordotic group compared to the hypo- and hyperlordotic group was observed.

Objective Lordosis Distribution Index (LDI) is a new radiographic parameter associated with postoperative residual symptoms in patients undergoing Transforaminal Lumbar Interbody Fusion (TLIF). Recently, it has been applied on patients undergoing instrumented spine surgery, however not correlated to Patient Related Outcome Measures (PROMs). This study investigates whether the obtained the postoperative LDI after TLIF surgery correlates with the clinical outcome measured with PROMs. Methods This study was based on prospectively obtained data in patients undergoing TLIF throughout 2017 at a Danish university hospital. Medical records and the DaneSpine Database were accessed to obtain preoperative, operative and follow-up data. Primary outcome was Oswestry Disability Index (ODI) 12 months postoperatively. Secondary outcomes included revision rate and additional PROMs. Results 126 patients were included. 70 patients were classified with normolordosis (56 %), 42 hypolordosis (33 %) and 14 hyperlordosis (11 %). All groups experienced significant radiological changes undergoing surgery. Average reduction in ODI at 12 months postoperatively was −15.3 (±20.0). Minimally clinical important difference was achieved in 68 patients (54.0 %). No significant difference in PROMs between LDI-groups was observed in unadjusted or adjusted analyses. Revision surgery was performed in 8 patients with normolordosis (11.4 %), 7 hypolordosis (16.7 %) and 4 hyperlordosis (28.6 %). Conclusions We found no significant correlation between postoperative LDI subgroups of normolordotic, hypo- or hyperlordotic patients and the clinical outcome of posterolateral fusion and TLIF surgery. A trend towards lower rate of revision surgery in the normolordotic group compared to the hypo- and hyperlordotic group was observed., Objective: Lordosis Distribution Index (LDI) is a new radiographic parameter associated with postoperative residual symptoms in patients undergoing Transforaminal Lumbar Interbody Fusion (TLIF). Recently, it has been applied on patients undergoing instrumented spine surgery, however not correlated to Patient Related Outcome Measures (PROMs). This study investigates whether the obtained the postoperative LDI after TLIF surgery correlates with the clinical outcome measured with PROMs. Methods: This study was based on prospectively obtained data in patients undergoing TLIF throughout 2017 at a Danish university hospital. Medical records and the DaneSpine Database were accessed to obtain preoperative, operative and follow-up data. Primary outcome was Oswestry Disability Index (ODI) 12 months postoperatively. Secondary outcomes included revision rate and additional PROMs. Results: 126 patients were included. 70 patients were classified with normolordosis (56 %), 42 hypolordosis (33 %) and 14 hyperlordosis (11 %). All groups experienced significant radiological changes undergoing surgery. Average reduction in ODI at 12 months postoperatively was −15.3 (±20.0). Minimally clinical important difference was achieved in 68 patients (54.0 %). No significant difference in PROMs between LDI-groups was observed in unadjusted or adjusted analyses. Revision surgery was performed in 8 patients with normolordosis (11.4 %), 7 hypolordosis (16.7 %) and 4 hyperlordosis (28.6 %). Conclusions: We found no significant correlation between postoperative LDI subgroups of normolordotic, hypo- or hyperlordotic patients and the clinical outcome of posterolateral fusion and TLIF surgery. A trend towards lower rate of revision surgery in the normolordotic group compared to the hypo- and hyperlordotic group was observed.

PurposeUsing ultrashort echo time (UTE) MRI, we determined prevalence of abnormal cartilaginous endplate (CEP), and the relationship between CEP and disc degeneration in human lumbar spines.Materials and methodsLumbar spines from 71 cadavers (age 14-74 years) were imaged at 3 T using sagittal UTE and spin echo T2 map sequences. On UTE images, CEP morphology was defined as "normal" with linear high signal intensity or "abnormal" with focal signal loss and/or irregularity. On spin echo images, disc grade and T2 values of the nucleus pulposus (NP) and annulus fibrosus (AF) were determined. 547 CEPs and 284 discs were analysed. Effects of age, sex, and level on CEP morphology, disc grade, and T2 values were determined. Effects of CEP abnormality on disc grade, T2 of NP, and T2 of AF were also determined.ResultsOverall prevalence of CEP abnormality was 33% and it tended to increase with older ages (p = 0.08) and at lower spinal levels of L5 than L2 or L3 (p = 0.001). Disc grades were higher and T2 values of the NP were lower in older spines (p < 0.001) and at lower disc level of L4-5 (p < 0.05). We found significant association between CEP and disc degeneration; discs adjacent to abnormal CEPs had high grades (p < 0.01) and lower T2 values of the NP (p < 0.05).ConclusionThese results suggest that abnormal CEPs are frequently found, and it associates significantly with disc degeneration, suggesting an insight into pathoetiology of disc degeneration.

Numerous studies are based on the use of animal models; however, in bipedal andtetrapedal organisms there are significant differences in the biomechanics of the spinalcolumn, which can significantly impair the quality and applicability of the resultsobtained. The aim of this study is to obtain basic data on the morphometric parametersof guinea pig lumbar vertebrae, the analysis of which will indicate the location of thebiggest mechanical load. The lumbar vertebra morphometry test was performed bymeans of X-ray imageing obtained from 12 guinea pigs, with equal numbers of malesand females. The results of investigations show that guinea pig lumbar vertebrae havean irregular trapezoid geometry and that the measured body lengths of L4 and L5 arethe largest. The height parameters determined in the medial level showed that L4 hadthe most concave body. Moreover, L4 had the greatest depth of the spinal canal at thesame measurement level. Consequently, in guinea pigs, the greatest load is in the L4region, unlike in humans, where, due to the axial load of the spinal column, the highestpressure is exerted on the last lumbar vertebrae.

PURPOSE: The purpose of this study was to understand potential baseline transcriptional expression differences in paraspinal skeletal muscle from patients with different underlying lumbar pathologies by comparing multifidus gene expression profiles across individuals with either disc herniation, facet arthropathy, or degenerative spondylolisthesis. METHODS: Multifidus biopsies were obtained from patients (n = 44) undergoing lumbar surgery for either disc herniation, facet arthropathy, or degenerative spondylolisthesis. Diagnostic categories were based on magnetic resonance images, radiology reports, and intraoperative reports. Gene expression for 42 genes was analysed using qPCR. A one-way analysis of variance was performed for each gene to determine differences in expression across diagnostic groups. Corrections for multiple comparisons across genes (Benjamini-Hochberg) and for between-group post hoc comparisons (Sidak) were applied. RESULTS: Adipogenic gene (ADIPOQ) expression was higher in the disc herniation group when compared to the facet arthropathy group (p = 0.032). Adipogenic gene (PPARD) expression was higher in the degenerative spondylolisthesis group when compared to the disc herniation group (p = 0.013), although absolute gene expression levels for all groups was low. Fibrogenic gene (COL3A1) had significantly higher expression in the disc herniation group and facet arthropathy group when compared to the degenerative spondylolisthesis group (p < 0.001 and p = 0.038, respectively). When adjusted for multiple comparisons, only COL3A1 remained significant (p = 0.012). CONCLUSION: Individuals with disc herniation and facet arthropathy demonstrate higher COL3A1 gene expression compared to those with degenerative spondylolisthesis. Future research is required to further understand the biological relevance of these transcriptional differences.

STUDY DESIGN: In vivo retrospective study of fully automatic quantitative imaging feature extraction from clinically acquired lumbar spine magnetic resonance imaging (MRI). OBJECTIVE: To demonstrate the feasibility of substituting automatic for human-demarcated segmentation of major anatomic structures in clinical lumbar spine MRI to generate quantitative image-based features and biomechanical models. SETTING: Previous studies have demonstrated the viability of automatic segmentation applied to medical images; however, the feasibility of these networks to segment clinically acquired images has not yet been demonstrated, as they largely rely on specialized sequences or strict quality of imaging data to achieve good performance. METHODS: Convolutional neural networks were trained to demarcate vertebral bodies, intervertebral disc, and paraspinous muscles from sagittal and axial T1-weighted MRIs. Intervertebral disc height, muscle cross-sectional area, and subject-specific musculoskeletal models of tissue loading in the lumbar spine were then computed from these segmentations and compared against those computed from human-demarcated masks. RESULTS: Segmentation masks, as well as the morphological metrics and biomechanical models computed from those masks, were highly similar between human- and computer-generated methods. Segmentations were similar, with Dice similarity coefficients of 0.77 or greater across networks, and morphological metrics and biomechanical models were similar, with Pearson R correlation coefficients of 0.69 or greater when significant. CONCLUSIONS: This study demonstrates the feasibility of substituting computer-generated for human-generated segmentations of major anatomic structures in lumbar spine MRI to compute quantitative image-based morphological metrics and subject-specific musculoskeletal models of tissue loading quickly, efficiently, and at scale without interrupting routine clinical care.

Low back pain is a health care problem that involves high consequences to health system and who are suffering any episode of the entity, because, sometimes it becomes into a disability. It´s important to know the different types of low back pain and recognize the risk factors and red flags in order to give the best therapeutic approach. There must be establish criteria for using medical imaging and the benefit that can give in the therapeutic context of each patient. There must be consider that optimal bed rest shouldn’t be longer than 48 hours because it may aggravate the low back pain, and the ordinary activity that shouldn’t involve physical overexertion must be included as a fundamental point in the treatment; additionally, paracetamol is the first line treatment due to minimal adverse effects compared to nonsteroidal anti-inflammatory drugs, there´s a synergistic therapeutic effect on efficacy and relief of pain when the first line treatment is combined with vitamin B complex. Low intensity opioids can be helpful in refractory cases due to nonsteroidal anti-inflammatory drugs. The steroidal drugs can be used in case of low back pain with inflammatory components., La lumbalgia es un problema de salud pública que implica grandes consecuencias para el sistema de salud y para quienes sufren algún episodio de esta patología, ya que en ocasiones se torna incapacitante para quien lo sufre. Es importante conocer la clínica de las diversas presentaciones de la lumbalgia y reconocer los factores de riesgo o banderas rojas, para brindarle el mejor abordaje terapéutico. De este modo, se deben establecer estudios de imágenes para determinar con mayor claridad la sintomatología y buscar el mejor escenario para el paciente. Se debe tomar en cuenta que el reposo absoluto por más de 48 horas puede ser perjudicial en la lumbalgia, y que se debe incluir como parte fundamental en su tratamiento las actividades diarias que no requieran esfuerzo físico; asimismo, la primera línea de tratamiento es el paracetamol, debido a los mínimos efectos adversos que ocasiona, comparado con los antiinflamatorios no esteroideos. La combinación de analgésicos con complejos de vitamina B aumenta la eficacia del tratamiento y brindan un mayor alivio de la sintomatología. Los opioides de baja intensidad pueden ser de utilidad en los casos refractarios a AINES, y los esteroides son de beneficio en las lumbalgias con componentes inflamatorios.

Isthmic spondylolysis results in fracture of pars interarticularis of the lumbar spine, found in as many as half of adolescent athletes with persistent low back pain. While computed tomography (CT) is the gold standard for the diagnosis of spondylolysis, the use of ionizing radiation near reproductive organs in young subjects is undesirable. While magnetic resonance imaging (MRI) is preferable, it has lowered sensitivity for detecting the condition. Recently, it has been shown that ultrashort echo time (UTE) MRI can provide markedly improved bone contrast compared to conventional MRI. To take UTE MRI further, we developed supervised deep learning tools to generate (1) CT-like images and (2) saliency maps of fracture probability from UTE MRI, using ex vivo preparation of cadaveric spines. We further compared quantitative metrics of the contrast-to-noise ratio (CNR), mean squared error (MSE), peak signal-to-noise ratio (PSNR), and structural similarity index (SSIM) between UTE MRI (inverted to make the appearance similar to CT) and CT and between CT-like images and CT. Qualitative results demonstrated the feasibility of successfully generating CT-like images from UTE MRI to provide easier interpretability for bone fractures thanks to improved image contrast and CNR. Quantitatively, the mean CNR of bone against defect-filled tissue was 35, 97, and 146 for UTE MRI, CT-like, and CT images, respectively, being significantly higher for CT-like than UTE MRI images. For the image similarity metrics using the CT image as the reference, CT-like images provided a significantly lower mean MSE (0.038 vs. 0.0528), higher mean PSNR (28.6 vs. 16.5), and higher SSIM (0.73 vs. 0.68) compared to UTE MRI images. Additionally, the saliency maps enabled quick detection of the location with probable pars fracture by providing visual cues to the reader. This proof-of-concept study is limited to the data from ex vivo samples, and additional work in human subjects with spondylolysis would be

This paper addresses the challenge of grading visual features in lumbar spine MRI using Deep Learning. Such a method is essential for the automatic quantification of structural changes in the spine, which is valuable for understanding low back pain. Multiple recent studies investigated different architecture designs, and the most recent success has been attributed to the use of transformer architectures. In this work, we argue that with a well-tuned three-stage pipeline comprising semantic segmentation, localization, and classification, convolutional networks outperform the state-of-the-art approaches. We conducted an ablation study of the existing methods in a population cohort, and report performance generalization across various subgroups. Our code is publicly available to advance research on disc degeneration and low back pain.

Numerous studies are based on the use of animal models; however, in bipedal andtetrapedal organisms there are significant differences in the biomechanics of the spinalcolumn, which can significantly impair the quality and applicability of the resultsobtained. The aim of this study is to obtain basic data on the morphometric parametersof guinea pig lumbar vertebrae, the analysis of which will indicate the location of thebiggest mechanical load. The lumbar vertebra morphometry test was performed bymeans of X-ray imageing obtained from 12 guinea pigs, with equal numbers of malesand females. The results of investigations show that guinea pig lumbar vertebrae havean irregular trapezoid geometry and that the measured body lengths of L4 and L5 arethe largest. The height parameters determined in the medial level showed that L4 hadthe most concave body. Moreover, L4 had the greatest depth of the spinal canal at thesame measurement level. Consequently, in guinea pigs, the greatest load is in the L4region, unlike in humans, where, due to the axial load of the spinal column, the highestpressure is exerted on the last lumbar vertebrae.

The aim of this thesis was to describe three aspects of lumbar spine (lower back) and slippage of the lumbar vertebrae due to degeneration or surgery, called spondylolisthesis. The first part is about the normal motion of the lumbar spine, of which a firm definition has not yet been discovered. Inter- and intra-individual differences should be taken into account to determine a method for defining normality in motion of the lumbar spine. In the second part, the risk of developing spondylolisthesis after decompression surgery has been discussed in which part of the vertebral arc has to be resected to decompress the nerves. Female sex, spondylolisthesis before decompression surgery and level of surgery are associated with symptomatic spondylolisthesis after decompression surgery. High BMI and larger facet angles (the two joints in the lumbar spine at the back) have a lower probability to develop spondylolisthesis. In the third part, different aspects regarding the treatment of spondylolisthesis were reviewed. The most common surgical techniques - TLIF versus PLIF – were compared. No differences in effect, blood loss, duration of surgery or hospitalization, and complications were demonstrated. The cost-effectiveness review illustrates the knowledge gap of cost-effectiveness in spine surgery, with high heterogeneity among studies. Finally, image-guided techniques used during screw insertion during fusion surgeries were compared. Fluoroscopy led to the highest radiation exposure for surgeon and patients, but still has advantages of short learning curve and wide availability. Furthermore, it resulted in novel postoperative neurological complaints in only 3.25% of the study population.

The ability of musculoskeletal models to acquire metrics and simulate human motion enables researchers to perform biomechanical analysis of daily activities. The improved analysis of human motion could for instance help recognize physical decline early. The sit-to-stand movement, which is performed 60 times daily on average, is one greatly affected by physical decline. Predictive simulation could enhance comprehension of the influence of physical decline, but most musculoskeletal models are not suitable for predictive simulation as they lack computational speed. In this project, a simplified musculoskeletal model called the H1126 with 11 joints and 26 muscular actuators suitable for sit-to-walk simulations is developed. Muscle moment arms at vertebral levels T12 through S1 are based on literature and optimized in OpenSimCreator using via points. Muscle-tendon minus tendon slack length, normalized fiber length, and maximum joint moments of the H1126 are compared to three state-of-the-art OpenSim models containing torso musculature. Results show that the H1126 performs well in terms of muscle geometry and force output. The H1126 muscle moment arms are within a 2 SD margin compared to the literature. The H1126 muscle-tendon length minus tendon slack length and normalized fiber length are within a 10\% margin compared to the state-of-the-art comparison models. Maximum joint moments of the H1126 are also within a 2 SD margin compared to the state-of-the-art torso models and literature. The H1126 is more suitable for predictive simulation than the comparison models as it is computationally faster due to the minimized number of muscle fascicles and the use of purely via points while performing similarly in terms of force output., Biomedical Engineering

PurposeThe paraspinal muscles (PSM) are a key feature potentially related to low back pain (LBP), and their structure and composition can be quantified using MRI. Most commonly, quantifying PSM measures across individual muscles and individual spinal levels renders numerous separate metrics that are analyzed in isolation. However, comprehensive multivariate approaches would be more appropriate for analyzing the PSM within an individual. To establish and test these methods, we hypothesized that multivariate summaries of PSM MRI measures would associate with the presence of LBP symptoms (i.e., pain intensity).MethodsWe applied hierarchical multiple factor analysis (hMFA), an unsupervised integrative method, to clinical PSM MRI data from unique cohort datasets including a longitudinal cohort of astronauts with pre- and post-spaceflight data and a cohort of chronic LBP subjects and asymptomatic controls. Three specific use cases were investigated: (1) predicting longitudinal changes in pain using combinations of baseline PSM measures; (2) integrating baseline and post-spaceflight MRI to assess longitudinal change in PSM and how it relates to pain; and (3) integrating PSM quality and adjacent spinal pathology between LBP patients and controls.ResultsOverall, we found distinct complex relationships with pain intensity between particular muscles and spinal levels. Subjects with high asymmetry between left and right lean muscle composition and differences between spinal segments PSM quality and structure are more likely to increase in pain reported outcome after prolonged time in microgravity. Moreover, changes in PSM quality and structure between pre and post-spaceflight relate to increase in pain after prolonged microgravity. Finally, we show how unsupervised hMFA recapitulates previous research on the association of CEP damage and LBP diagnostic.ConclusionOur analysis considers the spine as a multi-segmental unit as opposed to a series of discrete and isolated spine segm

Cement discoplasty has been developed to treat patients with advanced intervertebral disc degeneration. In discoplasty, poly(methylmethacrylate) (PMMA) bone cement is injected into the disc, leading to reduced pain and certain spinal alignment correction. Standard PMMA-cements have much higher elastic modulus than the surrounding vertebral bone, which may lead to a propensity for adjacent fractures. A PMMA-cement with lower modulus might be biomechanically beneficial. In this study, PMMA-cements with lower modulus were obtained using previously established methods. A commercial PMMA-cement (V-steady(R), G21 srl) was used as control, and as base cement. The low-modulus PMMA-cements were modified by 12 vol% (LA12), 16 vol% (LA16) and 20 vol% (LA20) linoleic acid (LA). After storage in 37 degrees C PBS from 24 h up to 8 weeks, specimens were tested in compression to obtain the material properties. A lower E-modulus was obtained with increasing amount of LA. However, with storage time, the E-modulus increased. Standard and low-modulus PMMA discoplasty were compared in a previously developed and validated computational lumbar spine model. All discoplasty models showed the same trend, namely a substantial reduction in range of motion (ROM), compared to the healthy model. The V-steady model had the largest ROM-reduction (77%), and the LA20 model had the smallest (45%). The average stress at the endplate was higher for all discoplasty models than for the healthy model, but the stresses were reduced for cements with higher amounts of LA. The study indicates that low-modulus PMMA is promising for discoplasty from a mechanical viewpoint. However, validation experiments are needed, and the clinical setting needs to be further considered.

Cement discoplasty has been developed to treat patients with advanced intervertebral disc degeneration. In discoplasty, poly(methylmethacrylate) (PMMA) bone cement is injected into the disc, leading to reduced pain and certain spinal alignment correction. Standard PMMA-cements have much higher elastic modulus than the surrounding vertebral bone, which may lead to a propensity for adjacent fractures. A PMMA-cement with lower modulus might be biomechanically beneficial. In this study, PMMA-cements with lower modulus were obtained using previously established methods. A commercial PMMA-cement (V-steady(R), G21 srl) was used as control, and as base cement. The low-modulus PMMA-cements were modified by 12 vol% (LA12), 16 vol% (LA16) and 20 vol% (LA20) linoleic acid (LA). After storage in 37 degrees C PBS from 24 h up to 8 weeks, specimens were tested in compression to obtain the material properties. A lower E-modulus was obtained with increasing amount of LA. However, with storage time, the E-modulus increased. Standard and low-modulus PMMA discoplasty were compared in a previously developed and validated computational lumbar spine model. All discoplasty models showed the same trend, namely a substantial reduction in range of motion (ROM), compared to the healthy model. The V-steady model had the largest ROM-reduction (77%), and the LA20 model had the smallest (45%). The average stress at the endplate was higher for all discoplasty models than for the healthy model, but the stresses were reduced for cements with higher amounts of LA. The study indicates that low-modulus PMMA is promising for discoplasty from a mechanical viewpoint. However, validation experiments are needed, and the clinical setting needs to be further considered.

Cement discoplasty has been developed to treat patients with advanced intervertebral disc degeneration. In discoplasty, poly(methylmethacrylate) (PMMA) bone cement is injected into the disc, leading to reduced pain and certain spinal alignment correction. Standard PMMA-cements have much higher elastic modulus than the surrounding vertebral bone, which may lead to a propensity for adjacent fractures. A PMMA-cement with lower modulus might be biomechanically beneficial. In this study, PMMA-cements with lower modulus were obtained using previously established methods. A commercial PMMA-cement (V-steady(R), G21 srl) was used as control, and as base cement. The low-modulus PMMA-cements were modified by 12 vol% (LA12), 16 vol% (LA16) and 20 vol% (LA20) linoleic acid (LA). After storage in 37 degrees C PBS from 24 h up to 8 weeks, specimens were tested in compression to obtain the material properties. A lower E-modulus was obtained with increasing amount of LA. However, with storage time, the E-modulus increased. Standard and low-modulus PMMA discoplasty were compared in a previously developed and validated computational lumbar spine model. All discoplasty models showed the same trend, namely a substantial reduction in range of motion (ROM), compared to the healthy model. The V-steady model had the largest ROM-reduction (77%), and the LA20 model had the smallest (45%). The average stress at the endplate was higher for all discoplasty models than for the healthy model, but the stresses were reduced for cements with higher amounts of LA. The study indicates that low-modulus PMMA is promising for discoplasty from a mechanical viewpoint. However, validation experiments are needed, and the clinical setting needs to be further considered.

PurposeThe paraspinal muscles (PSM) are a key feature potentially related to low back pain (LBP), and their structure and composition can be quantified using MRI. Most commonly, quantifying PSM measures across individual muscles and individual spinal levels renders numerous separate metrics that are analyzed in isolation. However, comprehensive multivariate approaches would be more appropriate for analyzing the PSM within an individual. To establish and test these methods, we hypothesized that multivariate summaries of PSM MRI measures would associate with the presence of LBP symptoms (i.e., pain intensity).MethodsWe applied hierarchical multiple factor analysis (hMFA), an unsupervised integrative method, to clinical PSM MRI data from unique cohort datasets including a longitudinal cohort of astronauts with pre- and post-spaceflight data and a cohort of chronic LBP subjects and asymptomatic controls. Three specific use cases were investigated: (1) predicting longitudinal changes in pain using combinations of baseline PSM measures; (2) integrating baseline and post-spaceflight MRI to assess longitudinal change in PSM and how it relates to pain; and (3) integrating PSM quality and adjacent spinal pathology between LBP patients and controls.ResultsOverall, we found distinct complex relationships with pain intensity between particular muscles and spinal levels. Subjects with high asymmetry between left and right lean muscle composition and differences between spinal segments PSM quality and structure are more likely to increase in pain reported outcome after prolonged time in microgravity. Moreover, changes in PSM quality and structure between pre and post-spaceflight relate to increase in pain after prolonged microgravity. Finally, we show how unsupervised hMFA recapitulates previous research on the association of CEP damage and LBP diagnostic.ConclusionOur analysis considers the spine as a multi-segmental unit as opposed to a series of discrete and isolated spine segm

Introduction : Hemangioblastoma in the spine mainly occurs at the cervical and thoracic levels and is often associated with von Hippel-Lindau (VHL) syndrome. Here, we reported a quite rare case of spinal sporadic hemangioblastoma arising from the cauda equina. Case presentation : A 66-year-old woman presented with a 5-year history of low back and leg pain. Imaging revealed a hypervascular intradural extramedullary tumor in the lumbar region. Preoperative angiography helped to identify the feeding arteries and draining vein, and so facilitated subsequent tumor resection. The pain was dramatically improved but weakness of the left tibialis anterior and left extensor hallucis longus muscles persisted. Discussion : We reported a rare case of spinal hemangioblastoma arising from the cauda equina. Preoperative angiography may be useful for diagnosis and understanding of the anatomy of feeding veins.

Low vertebral bone mass is a major risk factor for vertebral compression fractures. Although sarcopenia has been shown to be associated with low bone mineral density (BMD), it is not known whether trunk musculature is directly associated with lumbar BMD, and whether exercise modifies this association. Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we sought to determine the association of muscle density and fat fraction of the psoas, paraspinal, and oblique muscle groups with L3 lumbar volumetric BMD, and whether these associations were modified by exercise. We obtained L3 vBMD measurements, and fat and muscle measurements (in Hounsfield units [HU]) from abdominal computed tomography (CT) scans spanning the L2 -L4 intervertebral disc spaces. Muscle density was defined as the mean HU value for a muscle group area. Fat fraction was calculated as the mean HU value for the muscle group fat area/total muscle group area (cm2 ). Exercise data were self-reported (MET-minute/week). We utilized multivariable linear regression to evaluate these associations, stratified by gender, and adjusting for demographics, body mass index (BMI), smoking status, impaired fasting glucose, and corticosteroid and anti-resorptive medication use. Among 1923 MESA participants, mean ± standard deviation (SD) age was 62 ± 10 years, 49% were female, 40% white, 21% black, 26% Hispanic/Latino, and 13% Chinese. In fully adjusted analysis, for every 1-SD higher psoas fat fraction, there was a 3.19-SD lower L3 vBMD in men and 4.3-SD lower L3 vBMD in women (p < 0.001). For every 1-SD higher psoas density, there was a 0.2-SD higher L3 vBMD (p < 0.001) in men and 0.19-SD higher L3 vBMD (p < 0.001) in women. Findings were similar for paraspinal and oblique muscles. Intentional exercise did not modify these associations. In men and women, trunk muscle density was positively associated with higher lumbar BMD, suggesting a local association. Future studies are warranted to determine

Cement discoplasty has been developed to treat patients with advanced intervertebral disc degeneration. In discoplasty, poly(methylmethacrylate) (PMMA) bone cement is injected into the disc, leading to reduced pain and certain spinal alignment correction. Standard PMMA-cements have much higher elastic modulus than the surrounding vertebral bone, which may lead to a propensity for adjacent fractures. A PMMA-cement with lower modulus might be biomechanically beneficial. In this study, PMMA-cements with lower modulus were obtained using previously established methods. A commercial PMMA-cement (V-steady(R), G21 srl) was used as control, and as base cement. The low-modulus PMMA-cements were modified by 12 vol% (LA12), 16 vol% (LA16) and 20 vol% (LA20) linoleic acid (LA). After storage in 37 degrees C PBS from 24 h up to 8 weeks, specimens were tested in compression to obtain the material properties. A lower E-modulus was obtained with increasing amount of LA. However, with storage time, the E-modulus increased. Standard and low-modulus PMMA discoplasty were compared in a previously developed and validated computational lumbar spine model. All discoplasty models showed the same trend, namely a substantial reduction in range of motion (ROM), compared to the healthy model. The V-steady model had the largest ROM-reduction (77%), and the LA20 model had the smallest (45%). The average stress at the endplate was higher for all discoplasty models than for the healthy model, but the stresses were reduced for cements with higher amounts of LA. The study indicates that low-modulus PMMA is promising for discoplasty from a mechanical viewpoint. However, validation experiments are needed, and the clinical setting needs to be further considered.

BACKGROUND: While evaluation of blood perfusion in lumbar paraspinal muscles is of interest in low back pain, it has not been performed using noncontrast magnetic resonance (MR) techniques. PURPOSE: To introduce a novel application of a time-resolved, noncontrast MR perfusion technique for paraspinal muscles and demonstrate effect of exercise on perfusion parameters. STUDY TYPE: Longitudinal. SUBJECTS: Six healthy subjects (27-48 years old, two females) and two subjects with acute low back pain (46 and 65 years old females, one with diabetes/obesity). FIELD STRENGTH/SEQUENCE: 3-T, MR perfusion sequence. ASSESSMENT: Lumbar spines of healthy subjects were imaged axially at L3 level with a tag-on and tag-off alternating inversion recovery arterial spin labeling technique that suppresses background signal and acquires signal increase ratio (SIR) from the in-flow blood at varying inversion times (TI) from 0.12 seconds to 3.5 seconds. SIR vs. TI data were fit to determine the perfusion metrics of peak height (PH), time to peak (TTP), mean transit time, apparent muscle blood volume (MBV), and apparent muscle blood flow (MBF) in iliocostal, longissimus, and multifidus. Imaging was repeated immediately after healthy subjects performed a 20-minute walk, to determine the effect of exercise. STATISTICAL TESTS: Repeated measures analysis of variance. RESULTS: SIR vs. TI data showed well-defined leading and trailing edges, with sharply increasing SIR to TI of approximately 500 msec subsiding quickly to near zero around TI of 1500 msec. After exercise, the mean SIR at every TI increased markedly, resulting in significantly higher PH, MBV, and MBF (each P < 0.001 and F > 28.9), and a lower TTP (P < 0.05, F = 4.5), regardless of the muscle. MBF increased 2- to 2.5-fold after exercise, similar to the expected increase in cardiac output, given the intensity of the exercise. DATA CONCLUSIONS: Feasibility of an MR perfusion technique for muscle perfusion imaging

Introduction : Hemangioblastoma in the spine mainly occurs at the cervical and thoracic levels and is often associated with von Hippel-Lindau (VHL) syndrome. Here, we reported a quite rare case of spinal sporadic hemangioblastoma arising from the cauda equina. Case presentation : A 66-year-old woman presented with a 5-year history of low back and leg pain. Imaging revealed a hypervascular intradural extramedullary tumor in the lumbar region. Preoperative angiography helped to identify the feeding arteries and draining vein, and so facilitated subsequent tumor resection. The pain was dramatically improved but weakness of the left tibialis anterior and left extensor hallucis longus muscles persisted. Discussion : We reported a rare case of spinal hemangioblastoma arising from the cauda equina. Preoperative angiography may be useful for diagnosis and understanding of the anatomy of feeding veins.

Background Posterior pedicle screw (PS) fixation, a common treatment method for widespread low-back pain problems, has many uncertain aspects including stress concentration levels, effects on adjacent segments, and relationships with physiological motions. A better understanding of how posterior PS fixation affects the biomechanics of the lumbar spine is needed. For this purpose, a finite element (FE) model of a lumbar spine with posterior PS fixation at the L4-L5 segment level was developed by partially removing facet joints (FJs) to imitate an actual surgical procedure. This FE study aimed to investigate the influence of the posterior PS fixation system on the biomechanics of the lumbar spine before and after fusion by determining which physiological motions have the most increase in posterior instrumentation (PI) stresses and FJ loading. Results It was determined that posterior PS fixation increased FJ loading by approximately 35% and 23% at the L3-L4 adjacent level with extension and lateral bending motion, respectively. This increase in FJ loading at the adjacent level could point to the possibility that adjacent segment disease has developed or progressed after posterior lumbar interbody fusion. Furthermore, analyses of peak von Mises stresses on PI showed that the maximum PI stresses of 272.1 MPa and 263.7 MPa occurred in lateral bending and flexion motion before fusion, respectively. Conclusions The effects of a posterior PS fixation system on the biomechanics of the lumbar spine before and after fusion were investigated for all physiological motions. This model could be used as a fundamental tool for further studies, providing a better understanding of the effects of posterior PS fixation by clearing up uncertain aspects.

Posterior pedicle screw instrumentation (PPSI) is a well-known method in lumbar spine surgery. Understanding how PPSI affects the biomechanics of the lumbar spine is an important issue. In particular, during PPSI operations, surgeons bend rods according to the patients' spinal curvatures based on their own experiences. As a result, residual stresses develop on the rods due to this bending. Although many finite element-based biomechanical studies have been performed for PPSI, studies comparing the effects of residual stresses arising from rod contouring on the construct stresses are lacking. Thus, this study aimed to investigate the effects of residual stress in PPSI using rods contoured with a French bender and an in-situ bender, as well as comparing the differences in stress increment with straight and contoured rods for different physiological motions. Accordingly, a finite element (FE) model of the L4-L5 lumbar spine segment was developed for PPSI and the effects of residual stresses on rods were investigated by using different bending methods. In the simulations, it was found that rods contoured with a French bender with residual stress resulted in significantly more increased stress in PPSI compared to those contoured with an in-situ bender. The results of this study emphasize that increased stress in PPSI due to the residual stresses for different physiological motions may increase the risk of PPSI failures. Additionally, the finite element modeling approach employed here could be used as a fundamental tool for further investigations of topics such as PPSI fatigue life and failure studies.

Background Posterior pedicle screw (PS) fixation, a common treatment method for widespread low-back pain problems, has many uncertain aspects including stress concentration levels, effects on adjacent segments, and relationships with physiological motions. A better understanding of how posterior PS fixation affects the biomechanics of the lumbar spine is needed. For this purpose, a finite element (FE) model of a lumbar spine with posterior PS fixation at the L4-L5 segment level was developed by partially removing facet joints (FJs) to imitate an actual surgical procedure. This FE study aimed to investigate the influence of the posterior PS fixation system on the biomechanics of the lumbar spine before and after fusion by determining which physiological motions have the most increase in posterior instrumentation (PI) stresses and FJ loading. Results It was determined that posterior PS fixation increased FJ loading by approximately 35% and 23% at the L3-L4 adjacent level with extension and lateral bending motion, respectively. This increase in FJ loading at the adjacent level could point to the possibility that adjacent segment disease has developed or progressed after posterior lumbar interbody fusion. Furthermore, analyses of peak von Mises stresses on PI showed that the maximum PI stresses of 272.1 MPa and 263.7 MPa occurred in lateral bending and flexion motion before fusion, respectively. Conclusions The effects of a posterior PS fixation system on the biomechanics of the lumbar spine before and after fusion were investigated for all physiological motions. This model could be used as a fundamental tool for further studies, providing a better understanding of the effects of posterior PS fixation by clearing up uncertain aspects.

Posterior pedicle screw instrumentation (PPSI) is a well-known method in lumbar spine surgery. Understanding how PPSI affects the biomechanics of the lumbar spine is an important issue. In particular, during PPSI operations, surgeons bend rods according to the patients' spinal curvatures based on their own experiences. As a result, residual stresses develop on the rods due to this bending. Although many finite element-based biomechanical studies have been performed for PPSI, studies comparing the effects of residual stresses arising from rod contouring on the construct stresses are lacking. Thus, this study aimed to investigate the effects of residual stress in PPSI using rods contoured with a French bender and an in-situ bender, as well as comparing the differences in stress increment with straight and contoured rods for different physiological motions. Accordingly, a finite element (FE) model of the L4-L5 lumbar spine segment was developed for PPSI and the effects of residual stresses on rods were investigated by using different bending methods. In the simulations, it was found that rods contoured with a French bender with residual stress resulted in significantly more increased stress in PPSI compared to those contoured with an in-situ bender. The results of this study emphasize that increased stress in PPSI due to the residual stresses for different physiological motions may increase the risk of PPSI failures. Additionally, the finite element modeling approach employed here could be used as a fundamental tool for further investigations of topics such as PPSI fatigue life and failure studies.

AIMS: Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse. METHODS: We retrieved data from the Swedish spine register about 3,291 patients who underwent primary surgery for a lumbar disc prolapse between January 2007 and December 2008. These patients were followed until December 2020 to record all additional lumbar spine operations and the reason for them. RESULTS: In total, 681 of the 3,291 patients (21%) needed one or more additional operations. More than three additional operations was uncommon (2%; 15/906). Overall, 906 additional operations were identified during the time period, with a mean time to the first of these of 3.7 years (SD 3.6). The most common reason for an additional operation was recurrent disc prolapse (47%; 426/906), followed by spinal stenosis or degenerative spondylolisthesis (19%; 176/906), and segmental pain (16%; 145/906). The most common surgical procedures were revision discectomy (43%; 385/906) and instrumented fusion (22%; 200/906). Degenerative spinal conditions other than disc prolapse became a more common reason for additional surgery with increasing length of follow-up. Most patients achieved the minimally important change (MIC) for the patient-reported outcomes after the index surgery. After the third additional spinal operation, only 20% (5/25) achieved the MIC in terms of leg pain, and 29% (7/24) in terms of the EuroQol five-dimension index questionnaire visual analogue scale. CONCLUSION: More than one in five patients operated on for a lumbar disc prolapse underwent further surgery during the 13-year follow-up period. Recurrent disc prolapse was the most common reason for additional surgery, followed by spinal stenosis and segmental pain. This study shows that additional operations after pri

Cement discoplasty has been developed to treat patients with advanced intervertebral disc degeneration. In discoplasty, poly(methylmethacrylate) (PMMA) bone cement is injected into the disc, leading to reduced pain and certain spinal alignment correction. Standard PMMA-cements have much higher elastic modulus than the surrounding vertebral bone, which may lead to a propensity for adjacent fractures. A PMMA-cement with lower modulus might be biomechanically beneficial. In this study, PMMA-cements with lower modulus were obtained using previously established methods. A commercial PMMA-cement (V-steady(R), G21 srl) was used as control, and as base cement. The low-modulus PMMA-cements were modified by 12 vol% (LA12), 16 vol% (LA16) and 20 vol% (LA20) linoleic acid (LA). After storage in 37 degrees C PBS from 24 h up to 8 weeks, specimens were tested in compression to obtain the material properties. A lower E-modulus was obtained with increasing amount of LA. However, with storage time, the E-modulus increased. Standard and low-modulus PMMA discoplasty were compared in a previously developed and validated computational lumbar spine model. All discoplasty models showed the same trend, namely a substantial reduction in range of motion (ROM), compared to the healthy model. The V-steady model had the largest ROM-reduction (77%), and the LA20 model had the smallest (45%). The average stress at the endplate was higher for all discoplasty models than for the healthy model, but the stresses were reduced for cements with higher amounts of LA. The study indicates that low-modulus PMMA is promising for discoplasty from a mechanical viewpoint. However, validation experiments are needed, and the clinical setting needs to be further considered.

OBJECTIVE: High-impact exercise may improve bone health, but the feasibility and efficacy of home-based exercise in postmenopausal women with low bone mineral density (BMD) is unclear. We aimed to determine feasibility and safety, and changes in BMD, bone microarchitecture, physical function, and bone turnover markers, following a pilot 16-week home-based, high-impact exercise intervention in postmenopausal women with low BMD. METHOD(S): 50 community-dwelling postmenopausal women with BMD T-scores < -1.0 participated in 16-weeks of home-based high-impact exercise progressively increasing to 50 multi-directional unilateral hops on each leg for 7 days a week. Bone density and structure was assessed by lumbar spine and total hip dual-energy X-ray absorptiometry (DXA), 3D modelling algorithms (3D-SHAPER) of hip DXA scans, and distal tibial high-resolution peripheral quantitative computed tomography scans (HR-pQCT). Physical performance was assessed by repeated chair stand time and stair climb time. RESULT(S): 44 women (mean+/-SD age 64.5+/-7.5 years) completed the intervention, with adherence to exercise sessions of 84.7+/-18.0%. Six (12%) women did not complete the study due to related soreness (n=2), unrelated injury (n=1) and loss of interest (n=3). Femoral neck areal BMD significantly increased by 1.13+/-3.76% (p=0.048). Trabecular volumetric BMD of the total hip and femoral neck estimated by 3D-SHAPER significantly increased (2.27+/-7.03%; p=0.038 and 3.20+/-5.39%; p<0.001, respectively). Additionally, femoral neck integral (trabecular plus cortical) volumetric BMD increased by 1.81+/-4.33% (p=0.010). At the distal tibia, total volumetric BMD significantly increased by 0.32+/-0.88% (p=0.032) and cortical cross-sectional area significantly increased by 0.55+/-1.54% (p=0.034). Chair stand and stair climb time significantly improved by 2.3+/-1.88s (p<0.001) and 0.27+/-0.49s (p<0.001), respectively. CONCLUSION(S): A pilot 16-week home-based, high-impact exercise interv

Objective: We sought to compare the image quality of iterative model reconstruction (IMR) with statistical iterative reconstruction (SIR) in lumbar spine (L-spine) images reconstructed from computed tomography (CT) image data from examinations of the abdomen and pelvis compared with routine L-spine CT images reconstructed with SIR. Method(s): We conducted a retrospective study to compare image noise in L-spine reconstructions using SIR and IMR techniques in consecutive CT abdomen and pelvis (CTAP) examinations, with L-spine CT images reconstructed using SIR. Hounsfield units and their standard deviations in areas of image noise were measured in bone, cerebrospinal fluid (CSF), and lumbar discs. The results of SIR and IMR were compared using paired t tests. The results of CTAP and CT L-spine were compared using the Mann-Whitney U test. A p value <0.05 was considered significant. Qualitative assessment of the bone/CSF, disc/CSF, and disc/bone interface was performed by two readers. Result(s): IMR generated less image noise than SIR with CTAP and L-spine CT with SIR, particularly on bone windows. There was also significant improvement in the clarity of interfaces between vertebral bodies, discs, epidural fat, and CSF with IMR. The mean radiation dose was much higher for L-spine CT compared with CTAP. Conclusion(s): IMR is superior to SIR for the image quality of reconstructed lumbar spine images from CTAP. The IMR lumbar spine image from CTAP image data acquired with a lower radiation dose was also shown to be clearer when compared with routine SIR L-spine CT images. Copyright © 2021 Hong Kong College of Radiologists.

Objective There are concerns that lumbar spine imaging represents low value care. Our aim was to examine the use of lumbar spine imaging [radiography, computed tomography (CT), magnetic resonance imaging (MRI)] over 20 years, and costs and person-level characteristics of imaging in a large cohort of Australian women. Methods The Australian Longitudinal Study on Women's Health (ALSWH) is a longitudinal population-based survey of women randomly selected from national health insurance scheme (Medicare) database. This study examined 13458 women born in 1973-1978 who consented to link their ALSWH and Medical Benefits Scheme records. Self-reported data on demographics, body mass index, depression, physical and mental health, and back pain were collected in each survey performed in 1996, 2000, 2003, 2006, 2009, 2012, and 2015. Data on lumbar spine imaging from 1996 to 2015 were obtained from the Medical Benefits Scheme database. Results 38.9% of women underwent some form of lumbar spine imaging over 20 years. While radiography increased from 1996 to 2011 and decreased thereafter, CT and MRI continued to increase from 1996 to 2015. In women with self-reported back pain, depression and poorer physical health were associated with imaging, with no significant differences in types of imaging. Based on imaging rates in ALSWH, the estimated costs for Australian women aged 30-39 years were AU$51,735,649 over 2011-2015. Conclusions Lumbar spine imaging was common in population-based Australian women, with rates increasing over 20 years. Depression and poor physical health were associated with lumbar spine imaging. Raising awareness of this in clinicians is likely to result in significant cost savings if clinical guidelines are followed, with the potential of freeing resources for high value care and health outcomes.Copyright © 2020 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, dist

Objective: We sought to compare the image quality of iterative model reconstruction (IMR) with statistical iterative reconstruction (SIR) in lumbar spine (L-spine) images reconstructed from computed tomography (CT) image data from examinations of the abdomen and pelvis compared with routine L-spine CT images reconstructed with SIR. Method(s): We conducted a retrospective study to compare image noise in L-spine reconstructions using SIR and IMR techniques in consecutive CT abdomen and pelvis (CTAP) examinations, with L-spine CT images reconstructed using SIR. Hounsfield units and their standard deviations in areas of image noise were measured in bone, cerebrospinal fluid (CSF), and lumbar discs. The results of SIR and IMR were compared using paired t tests. The results of CTAP and CT L-spine were compared using the Mann-Whitney U test. A p value <0.05 was considered significant. Qualitative assessment of the bone/CSF, disc/CSF, and disc/bone interface was performed by two readers. Result(s): IMR generated less image noise than SIR with CTAP and L-spine CT with SIR, particularly on bone windows. There was also significant improvement in the clarity of interfaces between vertebral bodies, discs, epidural fat, and CSF with IMR. The mean radiation dose was much higher for L-spine CT compared with CTAP. Conclusion(s): IMR is superior to SIR for the image quality of reconstructed lumbar spine images from CTAP. The IMR lumbar spine image from CTAP image data acquired with a lower radiation dose was also shown to be clearer when compared with routine SIR L-spine CT images. Copyright © 2021 Hong Kong College of Radiologists.

OBJECTIVE: High-impact exercise may improve bone health, but the feasibility and efficacy of home-based exercise in postmenopausal women with low bone mineral density (BMD) is unclear. We aimed to determine feasibility and safety, and changes in BMD, bone microarchitecture, physical function, and bone turnover markers, following a pilot 16-week home-based, high-impact exercise intervention in postmenopausal women with low BMD. METHOD(S): 50 community-dwelling postmenopausal women with BMD T-scores < -1.0 participated in 16-weeks of home-based high-impact exercise progressively increasing to 50 multi-directional unilateral hops on each leg for 7 days a week. Bone density and structure was assessed by lumbar spine and total hip dual-energy X-ray absorptiometry (DXA), 3D modelling algorithms (3D-SHAPER) of hip DXA scans, and distal tibial high-resolution peripheral quantitative computed tomography scans (HR-pQCT). Physical performance was assessed by repeated chair stand time and stair climb time. RESULT(S): 44 women (mean+/-SD age 64.5+/-7.5 years) completed the intervention, with adherence to exercise sessions of 84.7+/-18.0%. Six (12%) women did not complete the study due to related soreness (n=2), unrelated injury (n=1) and loss of interest (n=3). Femoral neck areal BMD significantly increased by 1.13+/-3.76% (p=0.048). Trabecular volumetric BMD of the total hip and femoral neck estimated by 3D-SHAPER significantly increased (2.27+/-7.03%; p=0.038 and 3.20+/-5.39%; p<0.001, respectively). Additionally, femoral neck integral (trabecular plus cortical) volumetric BMD increased by 1.81+/-4.33% (p=0.010). At the distal tibia, total volumetric BMD significantly increased by 0.32+/-0.88% (p=0.032) and cortical cross-sectional area significantly increased by 0.55+/-1.54% (p=0.034). Chair stand and stair climb time significantly improved by 2.3+/-1.88s (p<0.001) and 0.27+/-0.49s (p<0.001), respectively. CONCLUSION(S): A pilot 16-week home-based, high-impact exercise interv

Chronic low back pain (CLBP) is a complex multifactorial condition. There are multiple factors associated with CLBP-related disability, including neuromuscular, behavioural and psychological factors. Traditional assessments of neuromuscular impairments (e.g., lumbar extension strength, lumbar range of motion, the ability to contract lumbar multifidus (LM) and transversus abdominus in isolation) have been shown to be weakly associated with CLBP-related disability. Despite this, exercise interventions, such as strengthening exercises, are efficacious and recommended by clinical practice guidelines for reducing disability in people with CLBP; however, there is presently no indication as to which form of exercise is optimal. A recent study identified a relationship between CLBP-related disability and reduced neuromuscular control of the lumbar extensors. These findings suggest that exercises based on retraining neuromuscular control of these muscles may be efficacious for CLBP patients; however, this has not been subject to experimental investigation. Considering the already determined positive effect of strengthening exercises on disability in this population, a combination of strengthening and novel neuromuscular exercises may yield meaningful clinical changes in CLBP-related disability. Thus, the main aims of this thesis are to i) determine whether the addition of neuromuscular retraining of lumbar extension to a program of general muscle strengthening reduces CLBP-related disability compared to a muscle strengthening program in isolation, and ii) investigate the neuromuscular, biomechanical and psychosocial mechanisms in which neuromuscular control retraining and muscle strengthening may influence CLBP-related disability. Muscles in the lumbar spine work synergistically during movement and functional tasks (e.g., lifting). Specifically, iliocostalis lumborum (IL) plays an important role in movements and stabilisation of the lumbar spine. However, structural changes

Purpose : To analyze extraosseous signal changes (ESCs) on magnetic resonance imaging (MRI) in pediatric patients with stress fractures occurring in the lamina. Methods : This study was a retrospective review of 69 consecutive pediatric patients with stress fractures occurring in the lamina. We analyzed MRI scans obtained at the first presentation. Results : We used mainly axial short tau inversion recovery images acquired through the pedicle of these 84 fracture sites to identify the ESCs. These were then divided into three groups: “invisible” when no ESC was detected, “periosteal” for ESC seen on only the dorsal side of the lamina, and “perimuscular” for ESC distinctly spread around / in the paravertebral muscles. In total, 78 (92.9%) fracture sites showed ESCs on the dorsal side of the lamina among which 72 ESCs were located on only the “dorsal” side, while 6 ESCs were on the ventral side against the transverse process. Conclusion : ESCs on MRI were detected in more than 90% of patients before stress fracture became apparent in the lamina, which was considered similar to findings of periosteal thickening / edema detected at the onset of stress fracture in long bone.

Ultra-short echo time (UTE) MRI with post-processing is a promising technique in bone imaging that produces a similar contrast to computed tomography (CT). Here, we propose a 3D slab-selective ultrashort echo time (UTE) sequence together with image post-processing to image bone structures in the lumbar spine. We also explore the intermodality agreement between the UTE and CT images. The lumbar spines of two healthy volunteers were imaged with 3D UTE using five different resolutions to determine the best imaging protocol. Then, four patients with low back pain were imaged with both the 3D UTE sequence and CT to investigate agreement between the imaging methods. Two other patients with low back pain were then imaged with the 3D UTE sequence and clinical conventional T1-weighted and T2-weighted fast spin-echo (FSE) MRI sequences for qualitative comparison. The 3D UTE sequence together with post-processing showed high contrast images of bone and high intermodality agreement with CT images. In conclusion, post-processed slab-selective UTE imaging is a feasible approach for highlighting bone structures in the lumbar spine and demonstrates significant anatomical correlation with CT images.

Study Design: Population-based birth cohort study. Objective: The aim of this study was to evaluate the relationship between vertebral dimensions and lumbar MC. Summary of Background Data: Low back pain (LBP) has become the leading cause of disability worldwide. Modic changes (MC) of the lumbar spine are one potential LBP-associated etiological factor. Mechanical stress is considered to play a key role in the development of MC through damage to endplates. There is speculation that vertebral dimensions play a role in some degenerative changes in the spine. Previous studies have also shown a positive association between moderate-to-vigorous physical activity (MVPA) and both vertebral dimensions and MC. In this study, we aimed to evaluate the relationship between vertebral dimensions and MC. Methods: The study population consisted of 1221 participants from the Northern Finland Birth Cohort 1966 who underwent lumbar magnetic resonance imaging (MRI) and physical activity measurements at the age of 46–48. The presence of Type 1 (MC1) and Type 2 (MC2) MC and the height, axial cross-sectional area (CSA), and volume of the L4 vertebra were determined from MRI scans. MVPA (≥3.5 metabolic equivalents) was measured by a wrist-worn accelerometer. We analyzed the association between lumbar MC and vertebral height, CSA, and volume using logistic regression models before and after adjustment for sex, height, weight, smoking, education level, and MVPA. Results: Vertebral height was positively associated with the presence of MC2 (odds ratio [OR] 3.51; 95% confidence interval [CI] 1.43–8.65), whereas vertebral CSA was not associated with the presence of lumbar MC. Vertebral volume was positively associated with the presence of any MC (OR 1.04; 95% CI 1.00–1.07), but the association did not persist when analyzing MC1 and MC2 separately. Conclusions: Vertebral height was associated with the presence of MC2. Further studies are needed to clarify the role of vertebral dimensions

Low back pain is a very common symptom and the leading cause of disability throughout the world. Several degenerative imaging findings seen on magnetic resonance imaging are associated with low back pain but none of them is specific for the presence of low back pain as abnormal findings are prevalent among asymptomatic subjects as well. The purpose of this population-based study was to investigate if more specific magnetic resonance imaging predictors of low back pain could be found via texture analysis and machine learning. We used this methodology to classify T₂-weighted magnetic resonance images from the Northern Finland Birth Cohort 1966 data to symptomatic and asymptomatic groups. Lumbar spine magnetic resonance imaging was performed using a fast spin-echo sequence at 1.5 T. Texture analysis pipeline consisting of textural feature extraction, principal component analysis, and logistic regression classifier was applied to the data to classify them into symptomatic (clinically relevant pain with frequency ≥30 days and intensity ≥6/10) and asymptomatic (frequency ≤7 days, intensity ≤3/10, and no previous pain episodes in the follow-up period) groups. Best classification results were observed applying texture analysis to the two lowest intervertebral discs (L4-L5 and L5-S1), with accuracy of 83%, specificity of 83%, sensitivity of 82%, negative predictive value of 94%, precision of 56%, and receiver operating characteristic area-under-curve of 0.91. To conclude, textural features from T₂-weighted magnetic resonance images can be applied in low back pain classification.

Physical activity (PA) influences bone tissue throughout the lifespan and is believed to have a positive effect on vertebral size also during adulthood, thus potentially improving vertebral strength and reducing fracture risk. Modic changes (MC), divided in three subgroups (MC1, MC2, MC3), are vertebral bone marrow changes visible in magnetic resonance imaging (MRI) that are associated with non-specific low back pain (LBP). This thesis includes three population-based cohort studies (I, II, III) which aim was to investigate the association between device-measured moderate to vigorous intensity PA (MVPA, ≥ 3.5 METs), vertebral cross-sectional area (CSA) (I), and lumbar MC (II), and to determine the relationship between vertebral dimensions and lumbar MC (III), using a subsample (n = 1202–1374) of the Northern Finland Birth Cohort 1966. Participants aged 46 to 48 underwent lumbar MRI from which vertebral dimensions and lumbar MC were assessed, and their daily MVPA was determined by a wrist-worn activity monitor. The results showed that MVPA was positively associated with vertebral CSA among both sexes. Among men, a higher amount of MVPA was associated with increased odds of any lumbar MC, particularly MC2, whereas among women no such association was found. Exploration of the relationship between vertebral dimensions and lumbar MC revealed that vertebral height was positively associated with the presence of lumbar MC2, whereas vertebral CSA and volume were not associated with MC. The results of this thesis propose that MVPA has a positive impact on vertebral size among both sexes at midlife, thus lifelong MVPA might be a preventive action for reducing future vertebral fractures. Lumbar MC seem to be associated with higher vertebrae. MVPA seems to be associated with an increased likelihood of lumbar MC, but only among men and especially with MC2, strengthening the hypothesis that changed mechanical conditions due to hyperloading are connected to MC2. Further stu, Tiivistelmä Alaselkäkipu on yleisin työikäisten toimintakykyä heikentävä sairaus, ja nikamamurtumat ovat merkittävä ikääntyvän väestön liikuntakykyä ja elämänlaatua heikentävä tekijä maailmanlaajuisesti. Fyysinen aktiivisuus vaikuttaa luustoon läpi elämän, ja sillä on mahdollisesti positiivinen vaikutus nikaman kokoon vielä aikuisiässäkin vahvistaen nikamaa ja ennaltaehkäisten murtumia. Modic-muutokset (MC:t, alaryhmät MC1, MC2, MC3) ovat magneettikuvauksessa nähtäviä selkänikamien luuydinmuutoksia, jotka ovat yhteydessä pitkittyneeseen alaselkäkipuun. Väitöstutkimuksen (osatyöt I, II, III) tavoitteena oli selvittää kiihtyvyysanturiin perustuvalla ranteessa pidettävällä aktiivisuusmittarilla mitatun vähintään kohtuullisesti kuormittavan fyysisen aktiivisuuden (≥ 3.5 METs) yhteyttä nikaman poikkipinta-alaan (I) ja lannerangan MC:n riskiin (II). Lisäksi selvitettiin nikaman koon ja MC:n välistä yhteyttä (III). Tutkimusaineistona oli väestöpohjainen Pohjois-Suomen syntymäkohortti 1966. Tutkittavien (n = 1202–1374) ollessa 46–48-vuotiaita, he osallistuivat fyysisen aktiivisuuden mittauksiin ja lannerangan magneettikuvaukseen. Tulokset osoittivat, että vähintään kohtuullisesti kuormittava fyysinen aktiivisuus oli positiivisesti yhteydessä nikaman poikkipinta-alaan molemmilla sukupuolilla. Miehillä suurempi määrä päivittäistä vähintään kohtuukuormitteista fyysistä aktiivisuutta oli positiivisesti yhteydessä lannerangan MC:n, erityisesti MC2:n, naisilla yhteyttä ei havaittu. Nikaman korkeus oli positiivisesti yhteydessä lannerangan MC2:n, nikaman poikkipinta-ala ja tilavuus eivät sen sijaan olleet yhteydessä MC:n. Tutkimustulosten perusteella voidaan todeta, että vähintään kohtuukuormitteisella fyysisellä aktiivisuudella on positiivinen vaikutus nikaman kokoon keski-iässä molemmilla sukupuolilla ja sitä voidaan pitää yhtenä varteenotettavana nikamamurtumien ennaltaehkäisykeinona. Lannerangan MC:t saattavat olla yhteydessä korkeampaan nikamaan, ja miehillä vähintään kohtuuk

Low back pain (LBP) is a common symptom among people of all ages and its economic costs are comparable to the costs of cardiovascular diseases, cancer and mental health. Modic changes (MC) are vertebral endplate (EP) and bone marrow changes associated with intervertebral disc degeneration, which are visualized on magnetic resonance imaging (MRI). MC are associated with LBP, type 1 MC (M1) more strongly than other MC types. Effective treatments for LBP related to MC are lacking. Bisphosphonates such as intravenously administered zoledronic acid (ZA), may be a potential treatment option because of its beneficial effect on bone marrow lesions and on pain symptoms in osteoarthritis. This randomized controlled study evaluated the efficacy of a single intravenous infusion of 5 mg of ZA (n=20) in comparison to a saline infusion (n=20) for LBP associated with MC. The effect was evaluated on the basis of LBP intensity and disability, the type and size of MC lesions and serum biomarkers, especially inflammatory and bone turnover markers. ZA reduced LBP intensity in the short term at one month and reduced the use of NSAIDs at one year. ZA tended to speed up the conversion of M1-dominant to type 2-dominant MC and decreased the size of M1-dominant MC, although statistical significance was not reached. Different trends were observed in the serum biomarkers of the ZA and placebo groups. At one year, the concentration of the chemokine IP-10 was elevated in the ZA group and reduced in the placebo group, whereas two bone metabolism biomarkers (AFOS and iPINP) had decreased in the ZA group. In conclusion, ZA is a promising treatment for MC-associated LBP. However, future studies with larger sample size are required., Tiivistelmä Alaselkäkipu on yleinen oire kaiken ikäisillä ihmisillä ja sen taloudelliset vaikutukset ovat verrattavissa sydän- ja verisuonisairauksien, syövän ja mielenterveysongelmien aiheuttamiin kuluihin. Modic-muutokset ovat välilevyrappeumaan liittyviä nikaman päätelevyjen ja rustonalaisen luun muutoksia, jotka voidaan havaita magneettikuvantamisella. Modic-muutokset, etenkin Modic tyyppi 1-muutokset, ovat yhteydessä alaselkäkipuun. Modic-muutoksiin liittyvään alaselkäkipuun ei ole tehokkaita hoitomenetelmiä tarjolla. Bisfosfonaatit, kuten laskimonsisäisesti annosteltava bisfosfonaatti tsoledronihappo, voivat olla potentiaalinen lääke Modic-muutoksiin liittyvään alaselkäkipuun, koska niiden on todettu pienentävän luuytimen muutosten kokoa ja lievittävän oireita polven nivelrikkopotilailla. Tässä satunnaistetussa kaksoissokkotutkimuksessa verrattiin yksittäistä 5 mg tsoledronihappoinfuusiota (n=20) keittosuolainfuusioon (n=20) Modic-muutoksiin liittyvässä alaselkäkivussa. Hoitojen vaikutusta arvioitiin alaselkäkipuun ja alaselkäkivusta aiheutuvaan haittaan, Modic-muutoksen tyyppiin ja kokoon sekä seerumin biomarkkereihin, etenkin inflammaation ja luun aineenvaihdunnan markkereihin. Tsoledronihappo vähensi alaselkäkipua kuukauden kohdalla infuusion jälkeen ja vähensi tulehduskipulääkkeiden käyttöä vuoden seurannassa. Tsoledronihapolla oli taipumus nopeuttaa tyyppi 1-dominanttien muutosten muuntumista tyyppi 2-dominanteiksi ja pienentää tyyppi 1- muutosten kokoa, vaikka tämä ei saavuttanutkaan tilastollista merkittävyyttä. Vuoden kohdalla kemokiini IP-10:n pitoisuus oli noussut merkittävästi tsoledronihapporyhmässä ja pienentynyt lumeryhmässä kun taas kahden luun aineenvaihdunnan markkerin (AFOS ja iPINP) pitoisuudet olivat laskeneet tsoledronihapporyhmässä. Tsoledronihappo on lupaava lääkehoito Modic-muutoksiin liittyvässä selkäkivussa. Tarvitaan kuitenkin lisää tutkimuksia suuremmilla aineistoilla.

Algorithms based on the unscented Kalman filter (UKF) have been proposed as an alternative for registration of point clouds obtained from vertebral ultrasound (US) and computerised tomography (CT) scans, effectively handling the US limited depth and low signal-to-noise ratio. Previously proposed methods are accurate, but their convergence rate is considerably reduced with initial misalignments of the datasets greater than 30. or 30 mm. We propose a novel method which increases robustness by adding a coarse alignment of the datasets' principal components and batch-based point inclusions for the UKF. Experiments with simulated scans with full coverage of a single vertebra show the method's capability and accuracy to correct misalignments as large as 180. and 90 mm. Furthermore, the method registers datasets with varying degrees of missing data and datasets with outlier points coming from adjacent vertebrae.

Introduction/Aims Intrathecal nusinersen administration can be challenging in certain adult spinal muscular atrophy (SMA) patients with difficult spinal anatomy who require imaging techniques (fluoroscopy or computed tomography scans) or invasive approaches (catheter placement, laminotomy) to identify the intrathecal space. We used ultrasound (US) assistance to access the lumbar intrathecal space in patients with SMA who experienced previous difficulties or failures with intrathecal dosing. Methods Eighteen adult patients with difficult spines were enrolled. We used US assistance, and we recorded the successful administrations, number of attempts, procedure times, and "patient satisfaction." Results There were 57 consecutive successful nusinersen spinal administrations in all patients enrolled. In 50% of patients, two or fewer attempts were needed to obtain a successful administration, with four or fewer attempts in 83.3%; only three patients reported more than four attempts because of both severe scoliosis and severe spine rotation (two patients) and obesity (one patient). The mean procedure time was 11.8 min (range, 1.7-28.9). Patient satisfaction was 4.97/5 (range, 4-5; median, 5) on Likert scale at 5 min and at 72 h. No major adverse events were reported, and two post dural puncture headaches were managed with medical therapy and with complete resolution within 72 h. Discussion US assistance seems to be a valid option among treatment choices for intrathecal nusinersen administration in patients with difficult spine. The absence of radiation exposure and the lack of need for intravenous sedation or general anesthesia are additional potential advantages to US assisted administration.

Background: Degenerative processes in the lumbar spine can lead to a decrease of the disc height and an alteration of the foramen with potential compression of the nerve root. Several osteopathic manipulative techniques are designed to improve the intervertebral joints and the foraminal area. Objective: This study was intended to explore the effect of so-called osteopathic manipulative locking technique (OMLT) on the lumbar foramen. Methods: Ten asymptomatic volunteers underwent CT scan examination in neutral position and during OMLT targeting the L4-L5 level on the left side. Two subjects were excluded from the sample due to lumbosacral transitional anomaly. Anatomical modeling was obtained by segmenting imaging CT data. 3D kinematics and intervertebral foramen dimensions (height, width and area) were computed for both positioning. Results: The findings indicate that OLMT applied on the L4-L5 level consisted in small combined angular motions including extension, contralateral Lateral Bending and contralateral Axial Rotation. These motion components result in a significant alteration of the foramen height on the targeted side. In contrast, other foramen variables remained unchanged on both sides. Conclusion: Better understanding of how osteopathic manipulative technique may affect the intervertebral motion and the foraminal area could improve the knowledge in osteopathic approaches. Further investigations are needed to confirm these primary outcomes and to determine the potential clinical effects of such an application., SCOPUS: ar.j, info:eu-repo/semantics/published

Objective: The demand for spinal fusion is increasing, with concurrent reports of iatrogenic adult spinal deformity (flatback deformity) possibly due to inappropriate lordosis distribu-tion. This distribution is assessed using the lordosis distribution index (LDI) which describes the upper and lower arc lordosis ratio. Maldistributed LDI has been associated to adjacent segment disease following interbody fusion, although correlation to later-stage deformity is yet to be assessed. We therefore aimed to investigate if hypolordotic lordosis maldistribu-tion was associated to radiographic deformity-surrogates or revision surgery following instrumented lumbar fusion. Methods: All patients undergoing fusion surgery (≤ 4 vertebra) for degenerative lumbar diseases were retrospectively included at a single center. Patients were categorized according to their postoperative LDI as: “normal” (LDI 50–80), “hypolordotic” (LDI < 50), or “hyper-lordotic” (LDI > 80). Results: We included 149 patients who were followed for 21 ± 14 months. Most attained a normally distributed lordosis (62%). The hypolordotic group had increased postoperative pelvic tilt (PT) (p < 0.001), pelvic incidence minus lumbar lordosis (PI–LL) mismatch (p < 0.001) and decreased global lordosis (p = 0.007) compared to the normal group. Survival analyses revealed a significant difference in revision surgery (p = 0.03), and subse-quent multivariable logistic regression showed increased odds of 1-year revision in the hy-polordotic group (p = 0.04). There was also a negative, linear correlation between preoperative pelvic incidence (PI) and postoperative LDI (p < 0.001). Conclusion: In patients undergoing instrumented lumbar fusion surgery, hypolordotic lor-dosis maldistribution (LDI < 50) was associated to increased risk of revision surgery, increased postoperative PT and PI–LL mismatch. Lordosis distribution should be considered prior to spinal fusion, especially in high PI patients.

Objective: The demand for spinal fusion is increasing, with concurrent reports of iatrogenic adult spinal deformity (flatback deformity) possibly due to inappropriate lordosis distribu-tion. This distribution is assessed using the lordosis distribution index (LDI) which describes the upper and lower arc lordosis ratio. Maldistributed LDI has been associated to adjacent segment disease following interbody fusion, although correlation to later-stage deformity is yet to be assessed. We therefore aimed to investigate if hypolordotic lordosis maldistribu-tion was associated to radiographic deformity-surrogates or revision surgery following instrumented lumbar fusion. Methods: All patients undergoing fusion surgery (≤ 4 vertebra) for degenerative lumbar diseases were retrospectively included at a single center. Patients were categorized according to their postoperative LDI as: “normal” (LDI 50–80), “hypolordotic” (LDI < 50), or “hyper-lordotic” (LDI > 80). Results: We included 149 patients who were followed for 21 ± 14 months. Most attained a normally distributed lordosis (62%). The hypolordotic group had increased postoperative pelvic tilt (PT) (p < 0.001), pelvic incidence minus lumbar lordosis (PI–LL) mismatch (p < 0.001) and decreased global lordosis (p = 0.007) compared to the normal group. Survival analyses revealed a significant difference in revision surgery (p = 0.03), and subse-quent multivariable logistic regression showed increased odds of 1-year revision in the hy-polordotic group (p = 0.04). There was also a negative, linear correlation between preoperative pelvic incidence (PI) and postoperative LDI (p < 0.001). Conclusion: In patients undergoing instrumented lumbar fusion surgery, hypolordotic lor-dosis maldistribution (LDI < 50) was associated to increased risk of revision surgery, increased postoperative PT and PI–LL mismatch. Lordosis distribution should be considered prior to spinal fusion, especially in high PI patients.