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Xinjian Kang,1,2 Man Qian,3 Mingli Liu,2 Haiwei Xu,4 Baoshan Xu4 1Department of Orthopedics, Traditional Chinese Medicine Hospital of Qinhuangdao, Qinhuangdao, Hebei, People’s Republic of China; 2Tianjin Medical University, Graduate School, Tianjin, People’s Republic of China; 3Department of Refractive Surgery, Qinhuangdao Aier Ophthalmic Hospital, Qinhuangdao, Hebei, People’s Republic of China; 4Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, People’s Republic of ChinaCorrespondence: Baoshan Xu, Department of Minimally Invasive Spine Surgery, Tianjin Hospital, No. 406 Jiefangnan Road, Hexi District, Tianjin, People’s Republic of China, Tel +86 13502028198, Fax +86- 22 -28241184, Email baoshanxu99@tmu.edu.cnPurpose: To explore the predictive factors of neck pain (NP) in patients with cervical degenerative disease by retrospectively analyzing their occupational and demographic characteristics and to provide a valuable reference for preventing and treating chronic NP.Patients and Methods: We retrospectively reviewed the occupational and demographic data of patients with cervical degenerative disease who had undergone anterior cervical surgery between June 2021 and December 2022 at our center. The patients were divided into NP and no-NP groups based on whether they had chronic NP before surgery. Relevant occupational and demographic data from all patients were statistically analyzed, and all variables were made categorical. Forward stepwise logistic regression models were constructed for preoperative chronic neck pain to explore the possible risk factors associated with chronic neck pain.Results: The differences in smoking, being an office worker, BMI, and disease types between NP and no-NP groups were statistically significant. In contrast, there were no statistically significant in age, sex, academic level, duration, and degeneration grade between the two groups. Moreover, further logistic regression analysis indicated that smoking, being an office worker, having an abnormal BMI, and cervical spondylotic radiculopathy (CSR) were related to chronic neck pain.Conclusion: The present study indicated that smoking, being an office worker, having an abnormal BMI, and CSR were predisposing risk factors for NP associated with cervical degenerative disease. Although intervertebral disc degeneration is the pathology basis of NP, the degeneration grade was not related to the occurrence of NP in our current study. Therefore, quitting smoking, avoiding sedentariness, and maintaining a normal BMI may prevent NP to some extent.Keywords: discogenic pain, radiating pain, musculoskeletal disorder, intervertebral disc degeneration

Jia Chen,1,2 Hai-Jian Ni,1,2 Fei Xue,3 Yun-Shan Fan,1,2 Xi-Fan Li,4 Xian-Zhen Chen,3 Shi-Sheng He1,2 1Department of Orthopaedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 2Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 3Department of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 4Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of ChinaCorrespondence: Shi-Sheng HeSpinal Pain Research Institute, Tongji University School of Medicine, 301 Yanchang Middle Road, Jing’an District, Shanghai, 200072, People’s Republic of ChinaEmail tjhss7418@tongji.edu.cnXian-Zhen ChenDepartment of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Jing’an District, Shanghai, 200072, People’s Republic of ChinaEmail chenxianzheny@126.comBackground: Intradural disc herniation (IDH) is a rare type of disc degeneration that infrequently affects the upper lumbar spine. Pre- and intraoperative diagnosis and surgical management of IDH are challenging. The present case study provides insight into these aspects of upper lumbar IDH and discusses possible mechanisms.Case Description: A 63-year-old female with a history of chronic lower back and leg pain presented with an acute lumbar sprain that had occurred 1 month prior. The pain progressed and spread to the front of the left thigh, which affected her ability to lift her leg when ascending/descending stairs. Sagittal gadolinium-enhanced magnetic resonance imaging (MRI) revealed a disc protruding into the ventral dural sac showing a hawk-beak sign, and the posterior edge of the disc annulus and local posterior longitudinal ligament was broken. Total L2 laminectomy was performed, and the dorsal side of the dural sac was exposed and incised to enable exploration of the ventral side of the dura. We found two free fragments protruding into the inner wall of the dura through the left ventral dura mater defect. After carefully and completely removing the mass, we repaired the defect and performed internal fixation. Postoperative pathologic analysis confirmed that the mass was nucleus pulposus tissue from the degenerated disc. The patient’s pain significantly improved after surgery, and she was able to walk normally at the 1-month follow-up.Conclusion: Upper lumbar IDH is an extremely rare type of disc degeneration. An enhanced MRI scan can provide diagnostic evidence, but the final diagnosis requires surgical exploration of the path of herniation and pathologic examination of the mass lesion.Keywords: lower back pain, radiating pain, upper lumbar, intradural disc herniation, case report