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Objectives Materials and Methods Results Conclusions This single‐arm, open‐label, single‐center observational pilot study assessed the safety and efficacy of ultrahigh‐frequency dorsal root ganglia (UHF‐DRG) stimulation in patients with chronic leg pain with or without low back pain. Such high‐frequency electrostimulation had not been conducted in the human central nervous system previously.The primary objective was to evaluate the safety of UHF‐DRG stimulation (2 Hz pulses with 50 msec pulse‐width and 500 kHz intrapulse sine waves, 5‐min duration per stimulation) by identifying incident adverse events (AE) and severe adverse events (SAE) during the trial. The secondary objectives included assessment of pain reduction using a numerical rating score (NRS), presence of paraesthesia, and changes in four pain medications (weak opioids, anticonvulsants, antidepressants, and non‐steroid‐anti‐inflammatory drugs). One DRG lead was implanted for one day then removed, and the patients received maximal three times of UHF stimulation in total.The study focused on ten cases. Two of them did not complete the study due to difficulty of lead implantation. There was no SAE in this trial. Among the ten cases, AEs occurred in eight, three experienced injection‐related local pain and one of them had a post‐dural‐puncture headache, others had symptoms un‐related to implantation procedure or UHF stimulation. The average NRS was reduced from 6.4 ± 1.1 at baseline to 2.9 ± 1.1 on the second‐day post‐implantation, and it was striking that the NRS was maintained at 3.6 ± 2.8 until 2 days after lead removal. The results showed a trend of lower frequency in medication use for all types of analgesics.In this first‐in‐human pilot study, we discovered that intermittent pulsed UHF‐DRG stimulations ameliorated chronic lower limb pain for an extended period in humans. Our finding opens up a new neuromodulatory concept and may initiate a novel paradigm for treating intractable pain. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective clinical study. Objective: The purpose of this study was to establish a novel classification of migrated lumbar disk herniation (LDH) based on magnetic resonance imaging and provide appropriate treatment strategies for each type through algorithms. Summary of Background Data: Full‐endoscopic lumbar discectomy is a surgical technique that has been developed rapidly in recent years. For migrated LDH, few surgeons currently classify it with multiplanar positioning, and there is no consensus on the choice of treatment strategy. Therefore, we established a new multiplanar classification criteria that can localize the lesions more accurately than previous studies. Methods: A total of 263 eligible patients from March 2017 to March 2022 were included. Protrusions for each patient were located based on our classification and the surgical approach was selected according to our algorithms. The clinical symptoms of all patients before surgery, and at 1 day, 1 month, 3 months, 6 months, and 12 months after surgery were collected. Evaluations were performed using visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria. We used the chi‐squared test, one‐way analysis of variance (ANOVA), and t‐test to compare perioperative results and postoperative 3‐month, 6‐month, and 12‐month follow‐up results. Results: VAS (low back pain) scores were reduced from 5.33 ± 2.67 to 0.73 ± 0.77 (p < 0.001), and VAS (leg pain) scores were reduced from 7.44 ± 2.21 to 0.37 ± 0.51 (p < 0.001). ODI scores improved from 58.46 ± 8.04 to 12.57 ± 2.51 (p < 0.001). According to the modified MacNab criteria, the excellent and good rate reached 92.78% at the 12‐month follow‐up. Twenty‐six patients developed complications, all of which improved after treatment. Recurrence occurred in 13 patients, and four of them underwent secondary surgery. Conclusions: This is an innovative classification method using multi‐plane positioning, and the algorithm used with it can help surgeons make appropriate choices when using endoscopic technology to treat migrated LDH. Statistical analysis of follow‐up data confirmed that this is a safe and effective strategy. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion There are two approaches to treating pelvic congestion syndrome (PCS): (i) the keep‐it‐simple (KIS) approach, which involves embolising only the refluxing vein(s), typically the left ovarian vein (LOV) unless the right ovarian vein (ROV) or left/right internal iliac vein (IIV) tributaries are also refluxing; and (ii) the extensive (EXT) approach, which empirically embolises almost all of the LOV, ROV, and left and right IIV tributaries. The aim of this study is to determine whether the KIS approach can effectively treat PCS while minimising the number of treated veins and coils used, without the need for injecting sclerosing agents into pelvic veins or the use of occlusion balloons.This is a single‐institution retrospective cohort study. Our records identified 154 women who underwent venograms for possible PCS, with the intent to proceed with embolisation. Refluxing veins were treated using the KIS approach, deploying minimal number of coils, ‘sandwiching’ sclerosing foam. Short‐term follow‐up was conducted at 6 weeks; long‐term follow‐ups (between 12 and 60 months) were conducted via an electronic survey consisting of 19 questions assessing pelvic pain/pressure, leg and back pain, fatigue, and bladder and menstrual symptoms.Fifteen women had negative venogram; 139 women had one or more refluxing veins on venogram. Most women (73%) required unilateral ovarian vein (OV) embolisation, 14% required bilateral OV embolisation, and 12% underwent pelvic vein embolisation. Most cases required only four pushable coils. Clinical success was 89% at 6 weeks and 84% at 1–5 years. A visual analogue scale reduction of 5.2 points (from 7.8 to 2.7) was achieved. There were no instances of coil dislodgement or other complications.The keep‐it‐simple approach, embolising only the refluxing ovarian and/or iliac veins, can achieve a successful clinical outcome for pelvic congestion syndrome. The extensive approach of empirically embolising all ovarian veins and internal iliac veins may not be necessary. This carries implications for potential savings in procedure time, cost and radiation dose. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Conclusion Percutaneous pedicle screw fixation (PPSF) technique requires a very precise entry point of the Jamshidi needle, which leads to repeated adjustments, damaging the pedicle and increasing radiation exposure. This study was designed to propose an improved percutaneous pedicle screw fixation technique‐trajectory dynamic adjustment (TDA) technique, and evaluate its feasibility and assess the clinical outcomes.A total of 445 patients with lumbar spondylolisthesis or lumbar spinal stenosis associated with instability from June 2017 to May 2022 were included in the retrospective study. They were randomly separated into two groups. Two hundred thirty‐one patients underwent TDA technique (TDA group). Two hundred fourteen patients underwent traditional PPSF technique (PPSF group). All patients underwent postoperative CT to assess the accuracy of screw placement, superior facet joint violation (FJV). The evaluated clinical outcomes were needle insertion time, radiation exposure, blood loss, hospital stay, the Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) scores for lower back pain (LBP), and leg pain, lumbar interbody fusion rate, and postoperative complications. The independent‐sample t test and paired t‐test were used for continuous data. The contingency table and Mann–Whitney U test were used for categorical data.The time of the insertion in TDA group was significantly lower than that in PPSF group (p < 0.05). Similarly, the fluoroscopy frequency in TDA group was significantly lower than that in PPSF group (p < 0.05). There was no difference in intraoperative blood loss and hospital stay between the two groups (p > 0.05). Overall, there was no significant difference in the proportion of clinically acceptable screws between the two groups (p > 0.05). In addition, the lateral screw misplacement in TDA group was higher. Moreover, FJV rate was significantly lower than that in PPSF group (p < 0.05). In both TDA group and PPSF group, postoperative back and leg pain and the JOA score were significantly improved (p < 0.05). However, there were no significant differences in the pre‐ and postoperative VAS score for back and leg pain and the JOA score, JOA recovery rate, intervertebral fusion rate, and complications rate between the two groups (p > 0.05).Compared to traditional PPSF technique, TDA technique is a safer and more effective procedure which has shorter surgical time, lower radiation exposure, and lower facet joint violation rate. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this systematic review was to ascertain guideline‐recommended pharmaceutical approaches to lumbosacral radicular symptoms, assess the quality of the clinical practice guidelines (CPGs) with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool, and qualitatively synthesize the guideline recommendations. Literature Survey: Literature searches were performed in PubMed, Cochrane Database of Systematic Reviews, Index to Chiropractic Literature, Allied and Complementary Medicine Database (AMED), Cumulative Index for Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence Database (PEDro). We included guidelines published between January 1, 2017, and January 9, 2022, written in the English language, related to radiculopathy, sciatica, and/or low back pain with leg pain, and that provided recommendations on oral medication. Methodology: The review was performed in accordance with Preferred Reporting Items for Systemic Reviews and Meta‐Analyses (PRISMA) and the protocol was pre‐registered with the International Prospective Register of Systematic Reviews (PROSPERO). Eligibility screening, full‐text review, extraction of information pertaining to pharmacological management, and synthesis of results were performed independently by two authors and a third investigator was recruited to arbitrate any disagreements. The AGREE II tool was administered by four authors to appraise CPG quality. Synthesis: After screening 413 citations and assessing 37 full‐text articles, 11 CPGs met the inclusion criteria. They represented seven countries (Belgium, Canada, England, France, Japan, Korea, and United States) and three continents (Asia, Europe, and North America), as well as the Global Spine Care Initiative aimed at a worldwide presence. The mean overall AGREE II score was 87.1% (standard deviation [SD] 12.6%), generally reflecting high‐quality CPGs. The highest domain mean score was for Clarity of Presentation (96.7%, SD 4.4%), and the lowest was Applicability (75.6%, SD 22.8%). Five classes of medications were recommended by at least one CPG: anticonvulsants, antidepressants, oral corticosteroids, nonsteroidal anti‐inflammatory drugs (NSAIDs), and opioids. Conclusions: The most common medication class recommended by the CPGs for lumbar radiculopathy was antidepressants. No CPGs recommended prescribing acetaminophen, benzodiazepines, muscle relaxants, or antibiotics. There was very little agreement between the CPGs, and all the medication classes had at least one CPG recommended against its use. Three guidelines reviewed did not recommend any medications due to lack of supporting literature, and instead recommended nonpharmacologic therapy. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Energy‐reducing spinal cord stimulation (SCS) approaches have the potential to impact patient experience with rechargeable and non‐rechargeable SCS devices through reducing device recharge time or enhancing device longevity. This prospective, multi‐center study evaluated the safety, effectiveness, and actual energy usage of differential target multiplexed (DTM) endurance therapy, a reduced energy DTM SCS derivative.Subjects who reported an overall pain visual analog score (VAS) of ≥6/10 cm and an Oswestry Disability Index score of 21–80 out of 100 at baseline with moderate to severe chronic, intractable back and/or leg pain were eligible. Evaluation visits occurred at 1, 3, 6, and 12 months post‐device activation. The primary objective was to characterize change in overall pain intensity, as measured by VAS, from baseline to 3‐month visit.Fifty‐seven subjects enrolled at 12 US sites from November 2020 through June 2021, 35 were implanted with a rechargeable SCS device, and 27 completed the 12‐month visit. Subjects experienced a 50.4% mean reduction in overall pain from baseline at the 3‐month follow‐up that was sustained through 12 months. Additional outcomes including changes in overall, back, and leg pain intensity, quality of life, disability, therapy satisfaction, safety, and current battery usage are shown through 12‐month follow‐up.The use of DTM endurance SCS therapy in this study resulted in reductions in pain relief through 12 months, demonstrating that energy‐reducing stimulation patterns can provide clinical benefit. Clinically effective, reduced energy SCS derivatives have the potential to impact patient experience through either reduced recharge requirements or increased device longevity. [ABSTRACT FROM AUTHOR]

This document summarizes a Cochrane Review titled "Exercise therapy for treatment of acute non-specific low back pain." The review examined the benefits and harms of exercise therapy for adults with acute nonspecific low back pain compared to sham/placebo treatment or no treatment. The review included 23 studies with a total of 2674 participants. The findings suggest that exercise therapy may not have a significant effect on pain or functional status compared to sham/placebo treatment, no treatment, or other conservative treatments. However, the certainty of evidence was generally low or moderate. The review did not report on perceived recovery, health-related quality of life, or adverse events. The authors concluded that exercise therapy does not provide any benefit for acute nonspecific lower back pain. They suggest that exercise therapy may still have a role in the treatment of chronic low back pain, but personalized approaches, patient education, shared decision-making, and alternative evidence-based interventions should be considered by rheumatologists when treating acute low back pain. Regular monitoring and reassessment of treatment plans are also important. [Extracted from the article]

Key Clinical Message: Diagnosis of Erdheim–Chester disease (ECD) requires the clinician to be familiar with its various manifestations, classic radiologic and histologic features. This case highlights the significance of considering ECD in any patient presenting with bone pain and symmetric osteosclerosis of long bones of extremities to allow for early diagnosis and treatment. Erdheim–Chester disease (ECD) is a rare non‐Langerhans histiocytic disorder with diverse clinical manifestations, ranging from indolent, localized presentation to life‐threatening, multi‐systemic disease. Delayed or erroneous diagnosis is common. The presence of classic radiographic finding along with foamy histiocytes that is positive for CD68 but negative for CD1a on histologic examination establishes the diagnosis. We report a second case of ECD from Ethiopia. A 50‐year‐old Ethiopian man presented with a 13‐year history of bilateral lower leg bone pain, cold intolerance, somnolence, constipation, impotence, decreased libido, and secondary infertility. The diagnosis was suspected when skeletal X‐ray revealed bilateral symmetric sclerosis of metadiaphysis of femur, tibia, and humerus. The demonstration of foamy histiocytes that were positive for CD68 but negative for CD1a on histologic examination with immunohistochemical staining confirmed the diagnosis. Evaluation for the extent of the disease revealed coated aorta sign, hairy kidney sign, and cystic lesion with ground glass opacity of lung, primary hypothyroidism, and hypergonadotropic hypogonadism. ECD is rare histiocytic neoplasm with wide range of clinical features which often delay the diagnosis. Clinician should be mindful of the various presentations and the classic radiographic and histologic features of ECD. This case highlights the significance of entertaining ECD in any patient presenting with lower leg bone pain and symmetric osteosclerosis of long bones of lower extremities to allow for early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Gestational trophoblastic neoplasia (GTN) with spinal metastasis is rare with few documented cases worldwide. Few studies have explored chemotherapy combined with radiotherapy in the treatment of such cases. However, because of its rarity, there is still no standardized treatment regimen. A 34‐year‐old Gravida 1 Para 0 (0010) was diagnosed with GTN with metastasis to the lumbosacral spine, resulting in conus medullaris syndrome with lumbar radiculopathy. She presented with a 14‐month history of amenorrhea, left lower extremity pain, and urinary and bowel retention. On examination, there was a 10.0 × 7.0 cm lumbosacral mass and atrophy of the left lower extremity. Transvaginal ultrasound showed a cul de sac mass, and diluted β‐human chorionic gonadotropin (β‐hCG) titer was markedly elevated at more than 1000 000 mIU/mL. Magnetic resonance imaging (MRI) of the lumbosacral spine showed an ill‐defined sacral mass measuring 13.3 × 11.5 × 6.3 cm with spinal canal, bone, muscle, and nerve root involvement. She was treated with 10 cycles of EMACO and palliative radiotherapy with 10 sessions of 30 Gy of external beam radiation therapy directed toward the lumbosacral mass. Repeat MRI showed a decrease in size of the mass to 6.6 × 8.2 × 4.1 cm with concurrent decrease in β‐hCG to 1.30 mIU/ml, and resolution of leg pain and urinary and bowel symptoms. She was declared to be in remission 3 months after the last cycle of EMACO. [ABSTRACT FROM AUTHOR]

This article is a systematic review of the use of therapeutic plasma exchange (TPE) for acute complications of sickle cell disease (SCD). The review found that TPE may provide benefits by removing inflammatory cytokines and plasma-based acute phase proteins. The review analyzed studies on TPE for multi-organ failure, thrombotic microangiopathy, intrahepatic cholestasis, and other indications. More evidence is needed to fully understand the impact of TPE on patient outcomes. The text provides a series of case studies on patients with sickle cell disease who underwent TPE as a treatment. TPE was found to improve hemodynamic and respiratory status, resolve organ dysfunction, and lead to good outcomes in some cases. However, there were also instances where patients died or remained dependent on hemodialysis. The text also compares the outcomes of patients who received TPE with those who received red blood cell exchange (RBCX) alone and found similar mortality rates and hospital length of stay. This document provides information on TPE procedures and outcomes for patients with multi-organ failure (MOF) and thrombotic microangiopathy (TMA) related to sickle cell disease. For MOF, TPE was performed after RBCX, with an average plasma volume exchanged of 3.0 liters. The most common TPE outcomes were clinical improvement, hospital length of stay, and in-hospital mortality. For TMA, TPE was used in combination with other treatments, [Extracted from the article]

Elderly patients often have more than one disease that affects walking behavior. An objective tool to identify which disease is the main cause of functional limitations may aid clinical decision making. Therefore, we investigated whether gait patterns could be used to identify degenerative diseases using machine learning. Data were extracted from a clinical database that included sagittal joint angles and spatiotemporal parameters measured using seven inertial sensors, and anthropometric data of patients with unilateral knee or hip osteoarthritis, lumbar or cervical spinal stenosis, and healthy controls. Various classification models were explored using the MATLAB Classification Learner app, and the optimizable Support Vector Machine was chosen as the best performing model. The accuracy of discrimination between healthy and pathologic gait was 82.3%, indicating that it is possible to distinguish pathological from healthy gait. The accuracy of discrimination between the different degenerative diseases was 51.4%, indicating the similarities in gait patterns between diseases need to be further explored. Overall, the differences between pathologic and healthy gait are distinct enough to classify using a classical machine learning model; however, routinely recorded gait characteristics and anthropometric data are not sufficient for successful discrimination of the degenerative diseases. [ABSTRACT FROM AUTHOR]

Purpose: To identify patient characteristics associated with forearm chronic exertional compartment syndrome (CECS) and to demonstrate the distribution of intramuscular pressure (IMP) values at 1 min postexercise in a cohort of patients with exercise‐induced forearm pain. Methods: A consecutive series of 99 patients seeking orthopaedic consultation for chronic exertional forearm pain underwent IMP measurements between 2010 and 2023. The diagnosis of CECS was confirmed (n = 34) or ruled out (n = 65) based on the patient's history, clinical examination and IMP measurements. Results: There were significantly more male patients in the CECS group than in the group of patients where the diagnosis was ruled out. Furthermore, a significantly higher proportion of the CECS patients had been previously treated for CECS of the lower legs. The most common occupation was office worker (21%), followed by craftsperson (18%). The most common main physical activities were strength training (21%) and cycling (15%). The median (range) 1‐min postexercise IMP values for patients with CECS were 34 (23–68) mmHg for the flexor compartment and 32 (25–67) mmHg for the extensor compartment. Conclusion: This study demonstrates a more general population of CECS patients compared to previous studies. Notably, more than a fifth of the CECS patients had previously been treated for CECS in the lower legs. Importantly, considering the 95% confidence interval for IMP values in patients without CECS, the most used IMP cutoff value for diagnosing CECS appears to be too high for the forearm compartments. Level of Evidence: Level II. [ABSTRACT FROM AUTHOR]

Objective: Lumbar degenerative diseases (LDDs) with huge herniation in the left lateral recess or central canal present challenges for oblique lateral lumbar interbody fusion (OLIF) or endoscope‐assisted OLIF procedures. Currently, minimally invasive transforaminal lumbar interbody fusion (MIS‐TLIF) is the primary approach for this issue. This study aims to provide a standardized technical description of the anterior lumbar discectomy and fusion (ALDF) and evaluate the medium‐term clinical effectiveness of both ALDF and MIS‐TLIF techniques. Methods: A retrospective review was performed on LDDs who underwent ALDF and MIS‐TLIF surgery from January 2018 to January 2020. The evaluation encompassed various clinical outcomes, such as the visual analogue scale (VAS) scores for back pain and leg pain (VAS‐back, VAS‐leg), the Oswestry disability index (ODI), the 36‐item short‐form health survey mental component summary (SF‐36 MCS), and the physical component summary (SF‐36 PCS). Additionally, radiological parameters, including disc height (DH), segmental disk angle (SDA), lumbar lordosis (LL), and cross‐sectional area (CSA), were assessed. Data including radiculopathy, estimated blood loss, operation time, time of getting out of bed, fusion rate, and complications were recorded. Student's independent samples t test and Pearson's chi‐square test were used to compare the differences between groups. Results: In total, 47 patients were treated by ALDF and 48 patients were treated by MIS‐TLIF. The ALDF group exhibited statistically significant lower estimated blood loss and earlier time of getting out of bed compared to the MIS‐TLIF group (p < 0.05). The ALDF group demonstrated lower VAS‐back scores and a higher remission rate of low back pain 3 years after the surgery (p < 0.05). During the entire follow‐up period, the ALDF group exhibited higher increases in DH and SDA compared to the MIS‐TLIF group (p < 0.05). At 6 months, the fusion rate in the ALDF group was significantly higher than in the MIS‐TLIF group (p < 0.05). The comparison revealed no statistically significant differences in complication rates between the two groups (p > 0.05). Conclusion: The ALDF could be considered as a viable surgical alternative for the treatment of LDDs that necessitate ventral neural direct decompression. ALDF exhibited favorable medium‐term outcomes in patients with LDDs, displaying advantages in facilitating expedited recovery, enhancing radiographic outcomes, and elevating the remission rate of low back pain. Although ALDF presents slightly higher complication rates compared to MIS‐TLIF, it does not adversely affect clinical outcomes. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Spinal subdural hematoma is uncommon but may become more prevalent with increasing anticoagulant use. Early diagnosis from symptoms like lower back pain and leg paralysis is crucial for timely intervention. [ABSTRACT FROM AUTHOR]

Objective: The connection between alterations in the disc structure following percutaneous endoscopic lumbar discectomy (PELD) and symptoms in patients postsurgery has not been reported yet. The purpose of the present study was to discuss the potential correlation between the changes in the morphological characteristics of various reference surfaces of the intervertebral disc after percutaneous endoscopic lumbar discectomy (PELD) and clinical outcomes, to identify the morphological parameters that affect efficacy and provide an evidence‐based foundation for assessing postoperative efficacy. Methods: From October 2019 to October 2021, after percutaneous endoscopic lumbar discectomy (PELD), 98 individuals were enrolled. MRI DICOM data of the lumbar spine were obtained before and after surgery, specifically around 3 months. The morphological parameters of the operated and adjacent segments of the discs were measured using T2‐weighted images from three reference planes. Outcomes were assessed using the Oswestry disability index (ODI), visual analogue pain scores for the back and leg (VAS‐back/VAS‐leg), Japanese Orthopaedic Association (JOA) scores, and recovery rates. Postoperative changes in disc parameters and outcomes were compared between patients with different severity and types of LDH based on the MSU staging. Patients completed the questionnaire during outpatient follow‐up appointments 3, 6, and 12 months after the surgery. The follow‐up period was 14.69 ± 4.21 months, ranging from 12 to 24 months. Results: Parameters such as area and circumference of intervertebral discs in the cross‐section were not associated with the change in the efficacy index. Postoperatively, a negative correlation between the variation of the disc height, disc height index, and protrusion distance and the difference in VAS scores for low back pain at 3 and 6 months was observed among the two sagittal change parameters. Differences between changes in disc imaging parameters and postoperative efficacy were not statistically significant between various types of lumbar disc herniation. Conclusion: For the patients after percutaneous endoscopic lumbar discectomy, the changes in parameters such as disc area and circumference in the cross‐sectional plane are not associated with efficacy, and the changes in disc height and herniation distance in the sagittal plane provide a morphologic basis for the assessment of short‐term postoperative efficacy. In addition, the changes in disc morphologic parameters and postoperative efficacy do not differ between various types of lumbar disc herniation. [ABSTRACT FROM AUTHOR]

Blood flow occlusion (BFO) has been previously used to investigate physiological responses to muscle ischemia, showing increased perceptual effort (RPE) and pain along with impaired neuromuscular performance. However, at present, it is unclear how BFO alters corticomuscular activities when either applied to the exercising or nonexercising musculature. The present study therefore set out to assess the corticomuscular response to these distinct BFO paradigms during an isometric contraction precision task. In a repeated measures design, fifteen participants (age = 27.00 ± 5.77) completed 15 isometric contractions across three experimental conditions; no occlusion (CNTRL), occlusion of the contralateral (i.e., nonexercising) limb (CON‐OCC), and occlusion of the ipsilateral (i.e., exercising) limb (IPS‐OCC). Measures of force, electroencephalographic (EEG), and electromyographic (EMG) were recorded during contractions. We observed that IPS‐OCC broadly impaired force steadiness, elevated EMG of the vastus lateralis, and heightened RPE and pain. IPSI‐OCC also significantly decreased corticomuscular coherence during the early phase of contraction and decreased EEG alpha activity across the sensorimotor and temporoparietal regions during the middle and late phases of contraction compared with CNTRL. By contrast, CON‐OCC increased perceived levels of pain (but not RPE) and decreased EEG alpha activity across the prefrontal cortex during the middle and late phases of contraction, with no changes observed for EMG and force steadiness. Together, these findings highlight distinctive psychophysiological responses to experimental pain via BFO showing altered cortical activities (CON‐OCC) and altered cortical, corticomuscular, and neuromuscular activities (IPS‐OCC) when applied to the lower limbs during an isometric force precision task. Blood flow occlusion is a common experimental model to induce pain and fatigue during exercise. However, the corticomuscular mechanisms underlying this model remain poorly understood. In this study, we show that blood flow occlusion of non‐exercising musculature elicits a suppression of electromyographic (EEG) alpha activity across the prefrontal cortex. By contrast, occlusion of exercising musculature elicits a suppression of EEG alpha activity across central and posterior cortical regions and impairs both brain‐muscle communication and neuromuscular activation. [ABSTRACT FROM AUTHOR]

Background: An experimental study was performed to improve the anterior approach model of intervertebral disc degeneration (IVDD). Objective: The aims of this study were to investigate the anterior approach model of IVDD for the cause of death, phenotypes, and underlying mechanisms of low back pain in mice. Method: In this study, we conducted an anterior puncture procedure on a cohort of 300 C57BL/6J mice that were 8 weeks old. Our investigation focused on exploring the causes of death in the study population (n = 300) and assessing the time‐course changes in various parameters, including radiographical, histological, immunofluorescence, and immunohistochemistry analyses (n = 10). Additionally, we conducted behavioral assessments on a subset of the animals (n = 30). Results: Transverse vertebral artery rupture is a major factor in surgical death. Radiographical analyses showed that the hydration of the nucleus pulposus began to decrease at 2 weeks after puncture and obviously disappeared over 4 weeks. 3D‐CT showed that disc height was significantly decreased at 4 weeks. Osteophyte at the anterior vertebral rims was observed at 2 weeks after the puncture. As the time course increased, histological analyses showed progressive disruption of the destruction of the extracellular matrix and increased secretion of inflammatory cytokines and apoptosis. Behavioral signs of low back pain were increased between the puncture and sham groups at 4 weeks. Conclusion: The improvement of anterior intervertebral disc approach model in mice will be useful to investigate underlying mechanisms and potential therapeutic strategies for behavior and phenotypes. Furthermore, the application of vibrational pre‐treatment can be used to increase the sensitivity of axial back pain in the model, thereby providing researchers with a reliable method for measuring this critical phenotype. [ABSTRACT FROM AUTHOR]

Background: This systematic review and meta‐analysis aimed to summarize evidence regarding the effectiveness and safety of oral antibiotic intervention for chronic low back pain (CLBP) patients with/without type‐1 Modic changes (MC1). Methods: AMED, CINAHL, Cochrane Library, Embase, and Medline were searched from inception to March 3, 2023. Randomized controlled trials (RCTs) or non‐RCTs that investigated the effectiveness or safety of oral antibiotics in treating CLBP patients were eligible for inclusion. Two independent reviewers screened abstracts, full‐text articles, and extracted data. The methodological quality of each included article were evaluated by RoB2 and NIH quality assessment tools. The quality of evidence was appraised by GRADE. Meta‐analyses were performed, where applicable. A subgroup analysis was conducted to evaluate the RCTs and case series separately, and to evaluate the effect of removing a low‐quality RCT. Results: Three RCTs and four case series were included. All Amoxicillin‐clavulanate/Amoxicillin treatments lasted for approximately 3 months. Moderate‐ and low‐quality evidence suggested that antibiotic was significantly better than placebo in improving disability and quality of life in CLBP patients with MC1 at 12‐month follow‐up, respectively. Low‐quality evidence from meta‐analyses of RCTs showed that oral antibiotic was significantly better than placebo in improving pain and disability in CLBP patients with MC1 immediately post‐treatment. Very low‐quality evidence from the case series suggested that oral Amoxicillin‐clavulanate significantly improved LBP/leg pain, and LBP‐related disability. Conversely, low‐quality evidence found that oral Amoxicillin alone was not significantly better than placebo in improving global perceived health in patients with CLBP at the 12‐month follow‐up. Additionally, oral antibiotic users had significantly more adverse effects than placebo users. Conclusions: Although oral antibiotics were statistically superior to placebo in reducing LBP‐related disability in patients with CLBP and concomitant MC1, its clinical significance remains uncertain. Future large‐scale high‐quality RCTs are warranted to validate the effectiveness of antibiotics in individuals with CLBP. [ABSTRACT FROM AUTHOR]

This article discusses the case of a 12-year-old boy who presented with symptoms of petechiae, arthralgias, and muscle weakness. The boy was diagnosed with scurvy, which is caused by a deficiency in vitamin C. The patient had a poor diet consisting mainly of unhealthy foods and had oral aversions to fruits and vegetables. Treatment with vitamin C and other supplements led to improvement in symptoms. The article also provides information on the clinical presentation, risk factors, and diagnosis of scurvy. [Extracted from the article]

Objective: Uniportal full‐endoscopic unilateral laminotomy for bilateral decompression (UFE‐ULBD) has been used to treat lumbar spinal stenosis (LSS) with satisfactory outcomes. However, a limited number of studies have investigated the relationship between decompression range and clinical outcomes. This study aimed to investigate the efficacy of UFE‐ULBD for single‐segment LSS and to explore the relationship between the decompression range and functional outcomes. Methods: Single‐segment LSS patients who had undergone UFE‐ULBD using an interlaminar approach between November 2021 and February 2023 were retrospectively analyzed. Patient demographics, visual analogue scale (VAS) scores for leg and back pain, Oswestry disability index (ODI) scores, modified MacNab grades, and radiological outcomes, including the decompression ratio of the disc‐flava ligament space and osseous lateral recess, the enlargement ratio of superior articular process interval, lamina interval dural sac cross‐sectional area (DSCA), were collected. The independent sample t‐tests, paired sample t‐tests, chi‐square tests, Fisher's exact tests, and Pearson's and Spearman's correlation analyses were used. Results: Forty patients (23 males, and 17 females) were retrospectively enrolled in this study. The mean follow‐up period was 12 months. At the last follow‐up, VAS scores for leg pain and back pain decreased from 6.0 ± 0.8 to 1.0 ± 1.9 (p < 0.001), and from 6.0 ± 0.8 to 1.2 ± 1.8 (p < 0.001) respectively; ODI score decreased from 71.7 ± 6.2 to 24.3 ± 21.3 (p < 0.001). According to the modified MacNab criteria, the results were excellent in 28 (70%), good in 5 (12.5%), fair in 6 (15%), and poor in 1 (2.5%), with an excellent‐good rate of 82.5%. The postoperative DSCA enlarged from 57.69 ± 21.86 to 150.75 ± 39.33 mm2 (p < 0.001), with an enlargement ratio of 189.43 ± 107.83%. No difference in clinical or radiological parameters was detected between patients with excellent, good, fair, or poor outcomes based on the modified MacNab criteria. Conclusion: UFE‐ULBD can provide satisfactory clinical and radiological outcomes in single‐segment LSS patients. With sufficient exposure to the dural sac boundary, the functional outcome was not related to the radiological decompression range in LSS patients who had undergone UFE‐ULBD. [ABSTRACT FROM AUTHOR]

Background: Pheochromocytoma is an adrenal medullary neuroendocrine tumor that rarely metastasizes to the spine. Currently, its specific treatment methods still present challenges. Case Description: A 41‐year‐old male patient who underwent left total adrenalectomy due to pheochromocytoma 3 years ago presented with lower back pain, accompanied by numbness and decreased muscle strength in both legs, as well as decreased sensation. Abnormal transmittance of the L3 vertebral body could be seen on anterior–posterior and lateral lumbar X‐rays, irregular bone destruction of the L3 vertebral body was found on CT, and an MRI scan showed that the tumor was located within the L3 vertebral body, protruding into the spinal canal and compressing the epidural sac. No recurrence was found in the abdomen. Preoperatively, perform local embolization of the blood vessels supplying the tumor. First, the L2‐3 intervertebral disc, L3‐4 intervertebral disc and L3 vertebral body were removed using an anterior approach, the whole tumor was removed, and some of the vertebrae were taken for pathological examination and replaced with a 3D‐printed prosthesis. Then, four pedicle screws were placed in the bilateral pedicles of L2 and L4 using the posterior approach, pre‐bent connecting rods were installed to replace the bone cortex of the lamina and articular process followed by bone graft fusion of the interlaminar and facet joints. The postoperative results were satisfactory, and there were no perioperative complications. Conclusion: Lumbar pheochromocytoma metastasis is rare, difficult to treat, and should be considered in spinal metastases' differential diagnoses so early diagnosis can be made based on medical history and imaging. Preoperative local vascular imaging and embolization of the blood supply vessels were performed. After total en‐bloc spondylectomy of the tumor during surgery, a prosthesis was implanted and combined with pedicle screw fixation to reconstruct spinal biomechanical stability, achieving satisfactory results. Therefore, 3D printed artificial vertebral bodies are a good choice for treating adrenal pheochromocytoma lumbar metastasis. The key to successful treatment is close interdisciplinary collaboration in formulating rigorous comprehensive perioperative plans. [ABSTRACT FROM AUTHOR]

Background: Numerous conditions are grouped under the generic term exercise-induced leg pain (EILP), yet clear diagnostic guidelines are lacking. This scoping review was conducted to clarify the definition and diagnostic criteria of nine commonly occurring EILP conditions. Methods: Three online databases were searched from inception to April 2022 for any English language original manuscripts identifying, describing, or assessing the clinical presentation and diagnostic criteria of the nine most common conditions that cause EILP. We included manuscripts considering all adults with any reported diagnostic criteria for EILP in any setting. Methodological quality was assessed using the Mixed Method Appraisal tool. Condition definitions were identified and categorised during data charting. Twenty-five potential elements of the history, 24 symptoms, 41 physical signs, 21 investigative tools, and 26 overarching diagnostic criteria, were identified and coded as counts of recommendation per condition, alongside qualitative analysis of the clinical reasoning. Condition definitions were constructed with 11 standardised elements based on recent consensus exercises for other conditions. Results: One hundred nineteen retained manuscripts, of which 18 studied multiple conditions, had a median quality of 2/5. A combination of the history, pain location, symptoms, physical findings, and investigative modalities were fundamental to identify each sub-diagnosis alongside excluding differentials. The details differed markedly for each sub-diagnosis. Fifty-nine manuscripts included data on chronic exertional compartment syndrome (CECS) revealing exertional pain (83% history), dull aching pain (76% symptoms), absence of physical signs (78% physical findings) and elevated intercompartment pressure (93% investigative modality). Twenty-one manuscripts included data on medial tibial stress syndrome (MTSS), revealing persistent pain upon discontinuation of activity (81% history), diffuse medial tibial pain (100% pain location), dull ache (86% symptoms), diffuse tenderness (95% physical findings) and MRI for exclusion of differentials (62% investigative modality). Similar analyses were performed for stress fractures (SF, n = 31), popliteal artery entrapment syndrome (PAES, n = 22), superficial peroneal nerve entrapment syndrome (SPNES, n = 15), lumbar radiculopathy (n = 7), accessory/low-lying soleus muscle syndrome (ALLSMS, n = 5), myofascial tears (n = 3), and McArdle's syndrome (n = 2). Conclusion: Initial diagnostic frameworks and definitions have been developed for each condition of the nine most common conditions that cause EILP, suitable for clinical consideration and consensus confirmation. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Lumbar spinal stenosis (LSS) is a prevalent cause of leg and back pain. In the youth, LSS is not common and mainly results from hereditary musculoskeletal disorders. Moreover, spinal fusion is a surgical approach to the treatment of LSS. Entrapment of surgical tools due to breakage is a rare yet important phenomenon in such operations. Therefore, neurological sequelae of these events need to be explored. The case was a 24‐year‐old male complaining of local back pain. Initially, he was diagnosed with LSS at L4 and L5. After the fusion of the vertebrae by the posterior spinal fusion (PSF) method, the patient's pain was resolved. However, the subject complained of worsening local back pain limiting his ability to do routine tasks. A few years later, radiographical evaluations indicated the possible presence of a surgical tool that could not be removed via surgery. During a third operation, the object was removed, and the patient's symptoms recovered. Immediate removal of entrapped surgical objects is necessary due to risks associated with migration and central nervous system damage. Comparing our results to other similar reports, we conclude that in cases of foreign object entrapment, neurological sequelae may be nonexistent or progressively worsen. Also, sequelae emerge either soon after the operation or emerge later. This complicates the diagnosis of such events and the decision of whether to subject the patient to additional neurosurgical operations to remove the tool. These variations may be observed due to the moving of the entrapped tool. Follow‐up of neurological sequelae in spinal surgery patients is recommended. [ABSTRACT FROM AUTHOR]

Background: Exercise‐related lower leg pain (ERLLP) is one of the most common injuries among adolescent runners; however, there is limited information available on lower extremity musculotendinous characteristics in relationship to injury. Ultrasound imaging has previously been used to evaluate musculotendinous structures among adults with chronic lower limb injuries. Similar measurement approaches may be adopted to assess young runners with ERLLP. Objective: To compare ultrasound‐derived lower extremity musculotendinous thickness, echogenicity, and muscle fiber pennation angles between adolescent runners with and without ERLLP. Design: Cross‐sectional design. Setting: Hospital‐affiliated sports injury prevention center. Participants: Twenty‐eight adolescent runners with (N = 14) and without ERLLP (N = 14). Interventions: Runners' patellar and Achilles tendons, and tibialis anterior, medial gastrocnemius, abductor hallicus, and flexor digitorum brevis muscles were assessed with ultrasound imaging using standardized procedures. Main Outcome Measures: Separate repeated measures multivariate analyses of covariance (covariate: gender) were used to compare groups and limbs for mass‐normalized musculotendinous thickness, musculotendinous echogenicity, and extrinsic ankle muscle fiber pennation angles. Results: The adolescent ERLLP group had reduced average muscle size for all structures except the tibialis anterior compared to the uninjured group (mean difference [MD] range: −0.12–0.49 mm/kg; p range:.002–.05), and reduced average medial gastrocnemius pennation angles on their case limb compared to their contralateral limb and the uninjured group (MD range: −3.7–6.4°; p <.001). The ERLLP group additionally had reduced average patellar and Achilles tendon size (MD range: −0.14–−0.15 mm/kg; p range:.02–.03), and lower Achilles tendon echogenicity compared to uninjured counterparts (MD: −18; p =.02). Conclusions: Adolescent runners with ERLLP exhibited morphological musculotendinous changes that may occur either as a result of or as a contributing factor to pain and persistent dysfunction. The findings highlight key targets for rehabilitation for young, injured runners, particularly intrinsic foot muscle strengthening. [ABSTRACT FROM AUTHOR]

Introduction: Pain during pregnancy affects women's well‐being, causes worry and is a risk factor for the child and the mother during labor. The aim was to investigate the relative importance of an extensive set of pregnancy‐related physiological symptoms and psychosocial factors assessed in the first trimester compared with the occurrence of pregnancy‐related pain symptoms later in the pregnancy. Material and methods: Included were all women who booked an appointment for a first prenatal visit in one of 125 randomly selected general practitioner practices in Eastern Denmark from April 2015 to August 2016. These women answered an electronic questionnaire containing questions on the occurrence of five pregnancy‐related pain symptoms: back pain, leg cramps, pelvic cavity pain, pelvic girdle pain and uterine contractions. The questionnaire also included sociodemographic questions and questions on chronic diseases, physical symptoms, mental health symptoms, lifestyle and reproductive background. The questionnaire was repeated in each trimester. The relative importance of this set of factors from the first trimester on the five pregnancy‐related pain symptoms compared with the second and third trimesters was assessed in a dominance analysis. Results: A total of 1491 women were included. The most important factor for pregnancy‐related pain in the second trimester and third trimester is the presence of the corresponding pain in the first trimester. Parity was associated with pelvic cavity pain and uterine contractions in the following pregnancies. For back pain and pelvic cavity pain, the odds increased as the women's estimated low self‐assessed fitness decreased and had low WHO‐5 wellbeing scores. Conclusions: When including physical risk factors, sociodemographic factors, psychological factors and clinical risk factors, women's experiences of pregnancy‐related pain in the first trimester are the most important predictors for pain later in pregnancy. Beyond the expected positive effects of pregnancy‐related pain, notably self‐assessed fitness, age and parity were predictive for pain later in pregnancy. [ABSTRACT FROM AUTHOR]

Visceral factors are negative emotions and drive and feeling states that grab people's attention and motivate them to engage in certain behaviors. They can contribute to discrepancies between an individual's long‐term self‐interest and their actual behavior. One such discrepancy concerns risk‐taking in health contexts as well as in a variety of other domains such as financial or career‐related decisions. This study examines the relationship between somatic symptoms of pain and domain‐specific risk attitudes in participants of a large population‐based cohort study. Somatic symptoms refer to back pain; pain in arms, legs, or joints; and headache. We show that the association between pain and risk attitudes is especially robust for the financial and leisure/sports domain across different model specifications. Pain is negatively associated with willingness to take risks in both domains. When controlling for fatigue (another visceral factor), the relationship between pain and risk attitudes persists only in the financial context. However, associations between fatigue and risk attitudes emerge in the general, health, leisure/sports, and career domains. We discuss potential implications of our findings especially in light of financial decision‐making. [ABSTRACT FROM AUTHOR]

This document is a summary of a Cochrane Review titled "Systemic corticosteroids for radicular and non-radicular low back pain." The review examines the effectiveness and safety of systemic corticosteroids for treating low back pain. The authors found that systemic corticosteroids may slightly decrease pain and improve function in patients with radicular low back pain in the short term. However, the evidence for non-radicular low back pain and spinal stenosis is limited or unclear. The use of systemic corticosteroids for low back pain does not seem to be associated with serious harms. Further research is needed in these areas, and other treatment options should be considered. [Extracted from the article]

This article discusses two cases of patients with aortoiliac occlusive disease, a large vessel obstructive vasculopathy. The patients presented with painful ulcers on their right lower limbs, which is a unique manifestation of the disease. The article highlights the importance of considering non-dermatological factors in diagnosing and managing such cases. The authors suggest that chronic smoking and cocaine abuse may contribute to the development of the disease. It is crucial for dermatologists to be aware of this presentation to avoid unnecessary investigations and delays in diagnosis. [Extracted from the article]

Objective: There are difficulties on removing migrated disc herniation (MDH) using a microscope. The purpose of this study was to introduce a unilateral biportal endoscopic (UBE) translaminar approach to treat up‐migrated lumbar disc herniation (LDH). Patients and Methods: A total of 12 patients from March 2021 to February 2022 with up‐migrated LDH were treated with a UBE translaminar approach. Clinical outcomes such as a visual analog scale (VAS) (back and leg pain) and MacNab criteria were assessed preoperative, postoperative, and 1 month after surgery. Results: Seven patients were diagnosed with high‐grade up‐migrated LDH, while five patients presented very‐high grade up‐migrated LDH. In all cases, the migrated LDH were removed completely and were confirmed by postoperative magnetic resonance imaging. The VAS for back pain were improved from 4.5 (SD = 3.1) to 2.0 (SD = 1.0) and 1.0 (SD = 1.0) for immediately postoperative and in 1‐month follow‐up, respectively, showing a statistically significant difference (p < 0.001). VAS for leg pain was 6.5 (SD = 2.5) preoperatively to 2.3 (SD = 1.1) and 0.8 (SD = 0.4) immediately postoperative and 1‐month follow‐up, respectively, also showing a significant difference (p < 0.001). According to the MacNab criteria, we observed excellent outcomes in 66.6% and good outcomes in 33.3%. Conclusion: The UBE translaminar approach showed a high success rate with high patient satisfaction for the management of up‐migrated LDH. It could be considered a feasible alternative surgical option to treat up‐migrated LDH. [ABSTRACT FROM AUTHOR]

We present a unique case of 6th nerve palsy following accidental durotomy in endoscopic lumbar spine surgery, which has not been reported in the literature before. A 72‐ year‐old female patient was admitted to our outpatient clinic complaining of right leg pain for 6 months. A 4/5 motor paresis was observed on her right toe with a positive Lasegue test at 45°. On her magnetic resonance imaging (MRI), a L5‐S1 disc herniation was detected. The patient was planned for percutaneous endoscopic interlaminar disc surgery. The extruded disc was adherent to the dura. During removal, a dural tear was observed. She was relieved of her right leg pain immediately after surgery, but after 30 min postoperatively, she complained of double vision with left abducens nerve paralysis. On cranial MRI, no abnormality could be observed. Intravenous fluids were administered and the paralysis resolved on the postoperative 24th hour. The patient was discharged from the hospital and did not show any complaints on her follow‐ups. A 6th nerve palsy can be caused due to alterations of intracranial pressure or mechanic injury. We believe that the durotomy following removing of the disc fragment caused a rapid drainage of CSF, leading to intracranial hypotension and injury of the abducens nerve. Intracranial pressure should be monitored perioperatively and brisk deteriorations has to result in immediate finishing of the surgery to avoid further secondary damage. [ABSTRACT FROM AUTHOR]

Purpose: Treatment of adjacent segment disease (ASD) is still controversial. The aim of this study was to evaluate the short‐term efficacy and safety and to analyze the technical advantages, surgical approach, and indications of percutaneous full endoscopic lumbar discectomy (PELD) in the treatment of ASD after lumbar fusion in elderly patients. Methods: A retrospective of 32 patients with symptomatic ASD were accepted for PELD from October 2017 to January 2020. All patients used the transforaminal approach and recorded the operation time and intraoperative conditions. Preoperative, 3, 12, 24 months of postoperative and at the last follow‐up, the pain of back and leg of visual analog scale (VAS), Oswestry dysfunction index (ODI), and Japanese Orthopaedic Association Assessment Treatment Score (JOA) were performed, and the paired student's t test was used to the compare the continuous variables preoperatively and postoperatively. The clinical efficacy was evaluated according to MacNab standards. The lumbar MRI was performed to evaluate the decompression of the nerve roots, and the lumbar lateral and dynamic X‐rays were performed to evaluate the stability of the surgical segment. Results: A total of 32 patients were included in the study, including 17 males and 15 females. The follow‐up time ranged from 24 to 50 months, with an average of (33.2 ± 8.1) months and an average operation time of (62.7 ± 28.1) minutes. Compared to preoperatively, the VAS score of the back and leg pain (p < 0.05), ODI (p < 0.05), and JOA (p < 0.05) postoperatively were significantly improved. At the last follow‐up, according to the modified MacNab standard assessment, 24 cases were excellent, five cases were good, and three cases were fair, the excellent and good rate was 90.65%. As for complications, one case had a small rupture of the dural sac during the operation, which was found but not repaired during the operation, and one case recurred after the operation. At the last follow‐up, there were three cases of intervertebral instability. Conclusion: PELD showed satisfactory short‐term efficacy and safety in the management of ASD after lumbar fusion in elderly patients. Therefore, PELD might be an alternative choice for elderly patients with symptomatic ASD after lumbar fusion, but surgical indications must be strictly controlled. [ABSTRACT FROM AUTHOR]

A novel 3D‐printed biodegradable cage composed of polycaprolactone (PCL) and beta‐tricalcium phosphate (β‐TCP) in a mass ratio of 50:50, with stable resorption patterns and mechanical strength has been developed for lumbar interbody fusion. This is a prospective cohort study to evaluate the short‐ and mid‐term safety and efficacy of this biodegradable cage in posterior lumbar interbody fusion (PLIF) surgery. This was a prospective single‐arm pilot clinical trial in 22 patients with a follow‐up time of 1, 3, 6, and 12 months, postoperatively. Clinical outcomes were assessed using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Visual analogue scale (VAS) for leg pain and low back pain. Radiological examination included X‐ray, CT scan, and three‐dimensional reconstruction to evaluate surgical indications, intervertebral space height (ISH), intervertebral bone fusion and cage degradation. A total of 22 patients was included, with an average age of 53.5 years. Among 22 patients, one patient lost to follow‐up and one patient withdrew from the clinical trial because of cage retropulsion. The remaining 20 patients showed significant improvement in clinical and imaging outcomes compared to the preoperative period. The overall mean VAS for back decreased from 5.85 ± 0.99 preoperatively to 1.15 ± 0.86 at the 12‐month follow‐up (p <.001); the VAS for leg decreased from 5.75 ± 1.11 to 1.05 ± 0.76 (p <.001); the JOA score improved from 13.8 ± 2.64 to 26.45 ± 2.46 (p <.001). The mean intervertebral space height (ISH) increased from 11.01 ± 1.75 mm preoperatively to 12.67 ± 1.89 mm at the 12‐month follow‐up and the bone fusion reached 95.2% (20/21 disc segments). Partial resorption (inferior to 50% compared with the initial cage size) were found in all cages (21/21). The clinical and radiological assessments showed that the application of 3D‐printed biodegradable PCL/β‐TCP cages in PLIF yielded satisfactory results at the 12‐month follow‐up. In the future, long‐term clinical observations and controlled clinical trials are required to further validate the safety and efficacy of this novel cage. [ABSTRACT FROM AUTHOR]

Background: Increased torsional deformity of femur is one of the most important factors in recurrent patellofemoral instability. And distal femoral derotational osteotomy is an effective treatment option in patients with increased femoral torsional deformity. However, groin pain is a rare complication after femoral derotational osteotomy. Case presentation: The patient was a 23‐year‐old female suffering from anterior knee pain and patellar instability in her left leg. Continuous CT scans of the hip, knee, and ankle were performed and the femoral anteversion was 44.99°. Considering the significant enlargement of the femoral internal torsion which may contribute most for dislocation of patella, we did a derotational osteotomy of distal femur. The anterior knee pain and patellar instability were resolved after surgery. The femoral internal torsion angle was corrected to 21.47°. But she developed left hip pain in the groin area which she had never encountered before 1 year after the surgery. We believed that the hip pain was closely related to the surgery. And the imaging and follow‐up partly confirmed this. Conclusions: The situation of the hip joint should be carefully evaluated before doing derotational osteotomy in recurrent patellofemoral instability and patient should be informed that derotational osteotomy may cause hip pain. Clinical studies are needed to further clarify the impact of derotational osteotomy on the hip. [ABSTRACT FROM AUTHOR]

Objectives: To compare the clinical and radiographic outcomes of oblique lateral lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion in patients with grade‐1 L4/5 degenerative spondylolisthesis. Methods: Based on the inclusion and exclusion criteria, the comparative analysis included consecutive patients with grade‐1 degenerative spondylolisthesis who underwent oblique LIF (OLIF, n = 36) or minimally invasive transforaminal LIF (MI‐TLIF, n = 45) at the Department of Spine Surgery, Beijing Jishuitan Hospital from January 2016 to August 2017. Patient satisfaction Japanese Orthopaedic Association score, visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI), radiographic outcomes including anterior/posterior disc heights (ADH/PDH), foraminal height (FH), foraminal width (FW), cage subsidence, cage retropulsion, and fusion rate were assessed during a 2‐year follow‐up. Continuous data are presented as mean ± standard deviation and were compared between groups using the independent sample t‐test. Categorical data are presented as n (%) and were compared between groups using the Pearson chi‐squared test or Fisher's exact test. Repetitive measurement and analysis of variance was employed in the analysis of ODI, back pain VAS score, and leg pain VAS score. Statistical significance was defined as p < 0.05. Results: The OLIF and MI‐TLIF groups comprised 36 patients (age, 52.1 ± 7.2 years; 27 women) and 45 patients (age, 48.4 ± 14.4 years; 24 women), respectively. Satisfaction rates at 2 years post procedure exceeded 90% in both groups. The OLIF group had less intraoperative blood loss (140 ± 36 vs 233 ± 62 mL), lower back pain VAS score (2.42 ± 0.81 vs 3.38 ± 0.47), and ODI score (20.47 ± 2.53 vs 27.31 ± 3.71) at 3 months follow‐up (with trends toward lower values at 2 years follow‐up), but higher leg pain VAS scores at all postoperative time points than the MI‐TLIF group (all p < 0.001). ADH, PDH, FD, and FW improved in both groups post‐surgery. At the 2 year follow‐up, the OLIF group had a higher rate of Bridwell grade‐I fusion (100% vs 88.9%, p = 0.046) and lower incidences of cage subsidence (8.33% vs 46.67%, p < 0.001) and retropulsion (0% vs 6.67%, p = 0.046) than the MI‐TLIF group. Conclusions: In patients with grade‐I spondylolisthesis, OLIF was associated with lower blood loss and greater improvements in VAS for back pain and ODI and radiologic outcomes than MI‐TLIF. The OLIF is more suitable for these patients with low back pain as the main symptoms are accompanied by mild or no leg symptoms before operation. [ABSTRACT FROM AUTHOR]

A new clinical care standard provides evidence-based guidance to help clinicians deliver best care for people with low back pain In September 2022, the Australian Commission on Safety and Quality in Health Care released its Low Back Pain Clinical Care Standard.[1] The Standard covers the early clinical management of people who present with a new acute episode of low back pain. The Low Back Pain Clinical Care Standard provides an excellent guide for how each of the professions can contribute to better care of low back pain. Conclusion The Low Back Pain Clinical Care Standard meets an urgent need to provide a resource to ensure curricula relevant to low back pain are up to date, and a clear roadmap for existing clinicians to deliver best care for people with low back pain. [Extracted from the article]

Macrophage infiltration and polarization during lumbar intervertebral disc herniation (LDH) have attracted increased attention but their role remains unclear. To explore macrophage polarization in herniated nucleus pulposus (NP) tissue of patients with LDH and investigate the association between cell frequency and different clinical characteristics or symptoms, we conducted a retrospective study by analyzing NP tissue samples from 79 patients. Clinical features and symptoms, using the visual analog scale (VAS) and Oswestry disability index (ODI), were collected. The macrophage markers CD68, CCR7, CD163, and CD206; pro‐inflammatory cytokine TNF‐α; and anti‐inflammatory factor IL‐4 were analyzed by immunohistochemistry. The frequency of polarized macrophages and positivity rate of pro‐ and anti‐inflammatory cytokines showed significant differences in some of clinical characteristics. Specifically, higher CCR7+ and TNF‐α + proportions were identified in the high‐intensity zone (HIZ) and the type of extrusion and sequestration NP tissue than in non‐HIZ and protrude NP tissue. Higher CD206+ and IL‐4+ proportion were detected in Modic changes. However, no differences in gender, age, smoking status, Pfirrmann grade, analgesic use, leg pain duration, and segments were found between groups. CD68+, CCR7+, and CD206+ cell proportions, and TNF‐α and IL‐4 showed positive associations with VAS scores preoperation. Associations between ODI and the macrophages markers were weak/insignificant. Our results indicated that macrophage polarization or macrophage‐like cells contribute to LDH pathological features. Macrophage populations displaying significant associations with VAS score reflected continuous M1/M2 transition contributing to pain during LDH. These findings may contribute to enhanced/personalized pharmacological interventions for patients with LDH considering pain heterogeneity. [ABSTRACT FROM AUTHOR]

Background: Low back pain or sciatic pain because of lumbar intervertebral disc herniation (LDH) is caused by mechanical compression and/or an inflammatory component on the nerve root. However, it is difficult to define to what extent each component contributes to the pain. This study attempted to explore the effects of macrophage polarization on clinical symptoms in patients experiencing LDH after surgery, and investigated the association between macrophage cell percentages and clinical efficacy. Methods: This study retrospectively harvested nucleus pulposus (NP) tissue samples from 117 patients. Clinical symptoms and efficacy using the visual analog scale (VAS) and Oswestry Disability Index (ODI) were evaluated at different time points preoperatively and postoperatively. CD68, CCR7, CD163, and CD206 were selected as macrophage phenotypic markers. Results: Seventy‐six samples showed positive expression of macrophage markers in NP samples of patients with LDH, whereas 41 patients displayed negative results. No significant differences were detected between the two groups, involvement of several demographic data, and preoperative clinical findings. With respect to the macrophage‐positive group, no significant correlation was detected between the positive rate of the four markers and the VAS score or ODI after surgery. However, patients with NP samples positive for CD68 and CCR7 expression showed significantly lower VAS scores 1 week after surgery compared with those in the negative group. Moreover, the improvement in VAS score showed a strong positive correlation with CD68‐ and CCR7‐positive cell percentages. Conclusions: Our results indicated that pro‐inflammatory M1 macrophages may be associated with the reduction of chronic pain after surgery. Therefore, these findings contribute to better personalized pharmacological interventions for patients with LDH, considering the heterogeneity of pain. [ABSTRACT FROM AUTHOR]

Aim: To describe chronic pain in Duchenne muscular dystrophy (DMD) from children's/adolescents' perspectives, explore patient variables associated with self‐reported pain, and examine the relationship between chronic pain, psychological functioning, and health‐related quality of life (HRQoL). Method: This observational study included a paediatric cohort (aged 8–18 years; median age 9 years 4 months) with DMD under multidisciplinary care (n = 45). Clinical data of the latest visit were extracted from the electronic health record and assessment of pain, psychological distress, and HRQoL were performed during the same visit. Results: Thirty‐two patients reported pain during the previous 4 weeks, and 18 reported persistent or recurrent chronic pain. Average pain intensity of chronic pain was mild, with regions of the legs (n = 12), lower back (n = 6), hips (n = 6), and shoulder (n = 6) most frequently affected. Older age, higher body mass index, being non‐ambulatory, wheelchair dependency, and spinal deformities were contextual variables related to the presence of chronic pain. Furthermore, chronic pain was significantly associated with psychological distress and reduced HRQoL in paediatric patients with DMD. Interpretation: Chronic pain in paediatric DMD is frequent and widespread, highlighting the need for pain to be addressed in the routine care of affected young people. Chronic pain may make a significant contribution to psychological distress and impaired HRQoL in paediatric patients with DMD. What this paper adds: Chronic pain differs in aetiology, scope, and nature compared with acute pain in paediatric Duchenne muscular dystrophy (DMD).Older age, higher body mass index, being non‐ambulatory, wheelchair dependency, and spinal deformities are important patient variables.Chronic pain is significantly associated with psychological distress and reduced health‐related quality of life in paediatric DMD. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to demonstrate a new sequence and determine the repeatability of simultaneous dynamic measurements of blood flow, venous oxygen saturation (SvO2), and relative perfusion (change from resting perfusion) in calf muscle during recovery from plantar flexion exercise. The feasibility of near simultaneous measurement of bio‐energetic parameters was also demonstrated. A sequence was developed to simultaneously measure arterial blood flow using flow‐encoded projection, SvO2 using susceptibility‐based oximetry, and relative perfusion using arterial spin labeling in combination with dynamic plantar flexion exercise. The parameters were determined at rest and during recovery from single leg plantar flexion exercise. Test–retest repeatability was analyzed using Bland–Altman analysis and intraclass correlation coefficients (ICC). The mitochondrial capacity of skeletal muscle was also measured immediately afterwards with dynamic phosphorus magnetic resonance spectroscopy. Eight healthy subjects participated in the study for test–retest repeatability. Popliteal artery blood flow at rest was 1.79 ± 0.58 ml/s and increased to 11.18 ± 3.02 ml/s immediately after exercise. Popliteal vein SvO2 decreased to 45.93% ± 6.5% from a resting value of 70.46% ± 4.76% following exercise. Relative perfusion (change from rest value) was 51.83 ± 15.00 ml/100 g/min at the cessation of exercise. The recovery of blood flow and SvO2 was modeled as a single exponential with time constants of 38.03 ± 6.91 and 71.19 ± 14.53 s, respectively. All the measured parameters exhibited good repeatability with ICC ranging from 0.8 to 0.95. Bioenergetics measurements were within normal range, demonstrating the feasibility of near simultaneous measurement of hemodynamic and energetic parameters. Clinical feasibility was assessed with Barth syndrome patients, demonstrating reduced oxygen extraction from the blood and reduced mitochondrial oxidative capacity compared with healthy controls. The proposed protocol allows rapid imaging of multiple parameters in skeletal muscle that might be affected in disease. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In dealing with bowed limbs along with increased alkaline phosphatase (ALP), even if the typical changes to the face are not very noticeable at first glance, Paget's disease of the bone (PDB) should be suspected, and the necessary investigations should be carried out to confirm the diagnosis. Paget's disease of the bone (PDB) is the second most prevalent metabolic bone disorder worldwide with disorganized bone remodeling. Here, a patient is presented with pain and bending of the right leg, whose skull and forehead changes are not noticeable at first glance, but with clinical suspicion and additional diagnostic evaluations, PDB diagnosis is confirmed for the patient. [ABSTRACT FROM AUTHOR]

Low back pain is a common and significant health issue worldwide, affecting about 80% of the population at some point in their lives. It is caused by a variety of factors, both spinal and extra-spinal. The use of imaging techniques, such as MRI, has revolutionized the diagnosis and understanding of low back pain. In recent years, there has been increased attention on the assessment of paraspinal muscles, which play a crucial role in spinal stability. A new study in the Journal of Magnetic Resonance Imaging explores the use of magnetic resonance elastography, a technique that measures the stiffness of muscles, in assessing lumbosacral musculature. This research provides important insights into the reproducibility of this technique and its potential role in diagnosing and understanding low back disorders. [Extracted from the article]

Purpose: In the past decades, haemophilia treatment has greatly improved the health of persons with haemophilia (PWH). This study compares PWH to the general population on social conditions and health. Methods: In December 2021, all Danes with moderate or severe haemophilia A or B, or von Willebrands disease type 3 were invited to participate in an online self‐report survey concerning sociodemographic factors, self‐rated health, teeth status, chronic health conditions, symptoms and loneliness. This study compares responses from the 124 adult male PWH with responses from a male general population sample (N = 4849). Analyses used logistic regression, controlling for age and highest completed education. Results: Fewer PWH were in the oldest age group (65‐84 years). Controlling for age, no significant differences were found regarding cohabitation status or education. Fewer PWH were employed (OR =.48, [.33‐.71])—particularly in the 45–64 age group. PWH were less likely to report good health (OR =.49, [.31‐.77]). The odds of joint disease was much higher (OR = 13.00, [8.37‐20.28]). Also, hypertension (OR = 2.25, [1.13‐5.65]) and previous stroke (OR = 2.51, [1.44‐3.50]) were more frequent. PWH were more likely to report pain in the arms/hands/legs/hips (OR = 2.94, [1.92‐4.52]), but less likely to report pain in the head/neck/shoulder (OR =.66, [.45‐.96]). Conclusion: The disease burden of haemophilia has improved so PWH resembles the general population in areas such as marriage and education. However, even for young PWH, the disease still imposes a significant burden from hemophilia arthropathy and pain in extremities and joints. Middle‐aged PWH also have poorer levels of employment than same‐aged peers. [ABSTRACT FROM AUTHOR]

Background: Ischemic pain with no‐obstructive coronary artery (INOCA) is clinically significant and defined by nonobstructive coronary stenosis <50%. Coronary microvascular dysfunction (CMD) is a relevant cause associated with adverse outcomes. Objectives: Investigated the effect of no‐stenosis (0% stenosis) and non‐obstructive (0% < stenosis < 50%) on the prognostic impact of CMD in INOCA. Method: A retrospective study assessed the coronary microvascular function in 151 INOCA patients who underwent invasive angiography by the coronary angiography‐derived index of microcirculation‐resistance (caIMR). CZT‐SPECT was performed to evaluate myocardial perfusion imaging (MPI) abnormalities. Chi‐square test/Fisher exact test, Student t‐test, Kaplan–Meier curve, and Uni‐multivariable Cox proportional models were used for analysis. Clinical outcomes were major adverse cardiovascular events (MACE) during a median follow‐up of 35 months. Result: No‐stenosis was present in 71 (47%) INOCA patients, and 80 (53%) were with nonobstructive. CMD (caIMR ≥ 25) was more prevalent in patients with no‐stenosis than nonobstructive (76.1% vs. 48.8%, p =.001), along with abnormal MPI (39.4% vs. 22.5%, p =.024). The MACE rates were not different between no‐stenosis and nonobstructive stenosis. CMD showed an increased risk of MACE for all INOCA. No‐stenosis with CMD had the worst prognosis. Cox regression analysis identified CMD and abnormal MPI as predictors of MACE in all INOCA and patients with no‐stenosis. However, no‐stenosis and nonobstructive stenosis were not predictors of MACE in INOCA. Conclusion: CMD was more frequently present in INOCA with no‐stenosis. However, there was no difference in long‐term clinical outcomes between no‐stenosis and nonobstructive stenosis. CMD could independently predict poor outcomes in INOCA, particularly in patients with no‐stenosis. [ABSTRACT FROM AUTHOR]

Objectives: The operative microscope (OM) has revolutionized the field of modern spine surgery, however, it remains limited by several drawbacks. Recently, the exoscope (EX) system has been designed to assistant spine surgery. It provides a three‐dimensional (3D) high‐definition (HD) operative experience and becomes an alternative to the OM. The aim of the study was to evaluate the clinical outcomes, advantages and limitations of EX‐assisted minimally invasive transforaminal lumbar interbody fusion (EMIS‐TLIF) and OM‐assisted MIS‐TLIF (OMIS‐TLIF). Methods: The clinical outcomes were assessed in 47 patients with lumbar degenerative diseases (LDD) who underwent MIS‐TLIF assisted with the OM or EX between January 2019 and September 2020. A total of 22 were treated with EMIS‐TLIF, and 25 received OMIS‐TLIF. Perioperative parameters (including sex, age, number of fusion levels and body mass index), perioperative parameters (operation time, intraoperative blood loss, postoperative drainage, postoperative hospitalization stay, and duration of follow‐up), visual analogue scale (VAS) of back pain, VAS of leg pain, Oswestry disability index (ODI) scores and clinical outcomes were assessed and compared. Image quality, handling of equipment, ergonomics, 3D glasses and educational usefulness were scored according to a questionnaire. Results: Operation time in the OMIS‐TLIF group (121.92 ± 16.92 min) was significantly increased compared with that in the EMIS‐TLIF group (111.00 ± 19.87 min) (P < 0.05). The VAS of the back pain and ODI scores in the EMIS‐TLIF group were significantly lower compared with the OMIS‐TLIF group at 1 week postoperatively (P < 0.05). The good‐excellent outcomes rate was 90.91% in the EMIS‐TLIF group and 88.00% in the OMIS‐TLIF group, and there was no significant difference. A total of 44 visits completed the questionnaire. The results of the questionnaire showed that the EX has exhibited advantages regarding handing of equipment, ergonomics and educational usefulness, and comparable image quality as compared with the OM, however, operating surgeons complained uncomfortable sensation when wearing 3D glasses. Conclusions: The EMIS‐TLIF was a safe and effective procedure in the management of LDD as compared with the OMIS‐LIF. Meanwhile, EMIS‐TLIF might resulted in a short operation time. [ABSTRACT FROM AUTHOR]

Introduction: The aim was to investigate whether common pregnancy‐related symptoms—nausea, vomiting, back pain, pelvic girdle pain, pelvic cavity pain, vaginal bleeding, itching of vulva, pregnancy itching, leg cramps, uterine contractions and varicose veins—in the first trimester of pregnancy add to the identification of women at high risk of future pregnancy and birth complications. Material and methods: Survey data linked to national register data. All women booking an appointment for a first prenatal visit in one of 192 randomly selected General Practices in East Denmark in the period April 2015–August 2016. The General Practices included 1491 women to this prospective study. Two outcomes, pregnancy complications and birth complications, were collected from the Danish Medical Birth Register. Results: Among the 1413 included women, 199 (14%) experienced complications in later pregnancy. The most serious complication, miscarriage, was experienced by 65 women (4.6%). Other common pregnancy complications were gestational diabetes mellitus (n = 11, 0.8%), gestational hypertension without proteinuria (n = 34, 2.4%), mild to moderate preeclampsia (n = 34, 2.4%) and gestational itching with effect on liver (n = 17, 1.2%). Women who experienced pelvic girdle pain, pelvic cavity pain or vaginal bleeding in the first trimester of pregnancy had a higher risk of pregnancy complications later on in later pregnancy. None of the other examined symptoms showed associations to pregnancy complications. No associations were found between pregnancy‐related physical symptoms in first trimester and birth complications. Conclusions: Symptoms in early pregnancy do not add much information about the risk of pregnancy or birth complications, although pain and bleeding may give reason for some concern. This is an important message to women experiencing these common symptoms and to their caregivers. [ABSTRACT FROM AUTHOR]

Post‐exertional symptom exacerbation (PESE) is a characteristic symptom of post‐COVID syndrome (PCS). This prospective study investigated the effect of a 6‐week structured World Health Organization (WHO) Borg CR‐10 5‐phase pacing protocol on PESE episodes and quality of life in a cohort of individuals with long‐standing PCS (average duration of symptoms was 17 months). Participants received weekly telephone calls with a clinician to complete the Leeds PESE questionnaire (LPQ) and identify the appropriate phase of the pacing protocol. EQ‐5D 5L was completed at the intervention's beginning and end to measure overall health. Thirty‐one participants completed the 6‐week protocol, with a statistically and clinically significant reduction in the average number of PESE episodes (from 3.4 episodes in Week 1 to 1.1 in Week 6), with an average decrease of 16% (95% CI: 9%−24%; p < 0.001) each week, and reduction across all three exertional triggers (physical, cognitive, and emotional). Physical activity levels showed moderate improvements during the intervention period. Mean EQ‐5D 5L scores improved from 51.4 to 60.6 points (paired difference of 9.2 points, 95% CI: 3.2−15.2 points; p = 0.004). A structured pacing protocol significantly reduces PESE episodes and improves overall health in PCS. [ABSTRACT FROM AUTHOR]

2019; 59 (1): 3. 4 Fernandes S, Santos S, Freitas I, Salgado M, Afonso A, Cardoso J. Linear lupus erythematosus profundus as an initial manifestation of systemic lupus erythematosus in a child. Keywords: nodules; pediatric EN nodules pediatric 730 732 3 07/17/23 20230701 NES 230701 CASE PRESENTATION A 9-year-old girl presented with a 6-month history of painful erythematous nodules on her left thigh. Diagnosis: Lupus panniculitis/lupus profundus Histopathology showed a perivascular and periadnexal lymphocytic infiltrate in the dermis extending to the dermo-hypodermic interface. [Extracted from the article]

Intervertebral disc degeneration (IDD) is a high incidence disease of musculoskeletal system that often leads to stenosis, instability, pain and even deformity of the spinal segments. IDD is an important cause of discogenic lower back pain and often leads to large economic burden to families and society. Currently, the treatment of IDD is aimed at alleviating symptoms rather than blocking or reversing pathological progression of the damaged intervertebral disc. Resveratrol (RSV) is a polyphenol phytoalexin first extracted from the Veratrum grandiflflorum O. Loes and can be found in various plants and red wine. Owing to the in‐depth study of pharmacological mechanisms, the therapeutic potential of RSV in various diseases such as osteoarthritis, neurodegenerative diseases, cardiovascular diseases and diabetes have attracted the attention of many researchers. RSV has anti‐apoptotic, anti‐senescent, anti‐inflammatory, anti‐oxidative, and anabolic activities, which can prevent further degeneration of intervertebral disc cells and enhance their regeneration. With high safety and various biological functions, RSV might be a promising candidate for the treatment of IDD. This review summarizes the biological functions of RSV in the treatment of IDD and to facilitate further research. [ABSTRACT FROM AUTHOR]

Objective: Adequacy of decompression for oblique lateral interbody fusion (OLIF) is a real concern in patients with severe lumbar spinal stenosis (LSS). With this in mind, we combined OLIF with spinal endoscopic technique to achieve a solid fusion and an adequate decompression after one operation. Methods: This is a technical note. The theoretical basis and operation process of this technique were introduced, and consecutive cases were retrospectively collected. Consecutive patients diagnosed with monosegmental severe LSS (L4/5) and underwent oblique lateral endoscopic decompression and interbody fusion (OLEDIF) from January 2018 to February 2020 were retrospectively collected. Clinical outcomes were assessed by claudication distance, Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores. Secondary indicators included operation time, operative blood loss, and postoperative complications. Results: Ten patients were selected for the OLEDIF procedure. They were five women and five men ranging in age from 49 to 75 years (mean age of 63.9 years) and in BMI from 25.4 to 30.2 kg/m2 (mean BMI of 27.5 kg/m2). The preoperative claudication distance was 160.00 ± 68.96 m (range 70–250 m), which was significantly extended on the 3‐month and 1‐year follow‐up (1020.00 ± 407.70 m and 1040.00 ± 416.87 m, respectively). The preoperative VAS score of back pain and radiating leg pain was 5.50 ± 0.97 (range 4–7) and 6.40 ± 0.97 (range 5–8). The score on postoperative month 3 was 1.60 ± 0.52 (range 1–2) and 1.20 ± 0.79 (range 0–2), and the 1‐year follow‐up score was 1.90 ± 0.74 (range 1–3) and 1.60 ± 0.70 (range 1–3), respectively. The preoperative ODI was 72.23 ± 6.30 (range 64.4–82.2), the 3‐month follow‐up ODI was 31.12 ± 4.20 (range 24.4–35.6), and the 1‐year follow‐up ODI was 29.33 ± 5.92 (range 20.0–37.8). Compared with the transforaminal lumbar interbody fusion (TLIF) in the literature, the operation time was not prolonged (189.3 ± 32.5 min vs. 214.9 ± 60.0 min) but the amount of blood loss decreased significantly (113.3 ± 26.7 ml vs. 366.8 ± 298.2 ml). No complications were found except one case presented with dysesthesia of the left leg. Imaging results showed good fusion without cage subsidence during 1‐year follow‐up. Conclusion: OLEDIF can achieve complete ventral decompression of the spinal canal and solid fusion of the lumbar spine at one time. It is an effective minimally invasive technique for the treatment of monosegmental severe LSS, which is promising and worthy of further clinical practice. [ABSTRACT FROM AUTHOR]