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Objective: In lumbar spondylolisthesis, conventional standing flexion-extension radiography can yield varying results depending on the patient's effort and cooperation. Previous research suggested that assisted flexion radiography provides larger flexion with a significantly greater change in lumbar lordosis (ΔLL) and increased sagittal translation (ST), posterior opening (PO), segmental angulation (SA), and instability detection rates. In this study, the authors aimed to identify a safe, simple, and valid position for obtaining functional radiographs to evaluate abnormal instability in lumbar spondylolisthesis., Methods: Consecutive patients diagnosed with L4-5 degenerative lumbar spondylolisthesis were included. The patients underwent upright and extension radiography and three different flexion radiography positions: conventional flexion (CF), hand-knee (HK), and hand-ankle (HA). Measurements included ΔLL, ST, PO, and SA, with instability rates compared between the three flexion techniques., Results: This study included 117 patients (81 women, mean age of the study sample 76.8 years). The median ΔLL values were 10.8° (interquartile range [IQR] 5.2°-18.2°) in the CF position, 30.0° (IQR 21.0°-41.1°) in the HK position, and 32.1° (IQR 23.0°-42.4°) in the HA position, with significant differences noted (p < 0.05). For PO and SA, significant differences were observed between the techniques (p < 0.05). ST medians were CF 5.5% (IQR 3.6%-8.1%), HK 9.5% (IQR 7.7%-11.1%), and HA 9.7% (IQR 7.4%-11.4%), with HK and HA positions differing significantly from the CF position (p < 0.001), but not the HK from the HA position (p = 0.15). Instability detection rates were 29.1% in the CF position, 76.1% in the HK position, and 76.9% in the HA position, with significant differences between the HK, HA, and CF positions (p < 0.001), but not between the HK and HA positions (p > 0.99)., Conclusions: The study showed that HK and HA flexion radiographs provided greater ΔLL, ST, PO, SA, and better instability detection than the CF position. Given its safety and simplicity, the HK position is suitable for detecting abnormal lumbar mobility in degenerative lumbar spondylolisthesis.

Objective: This study aimed to elucidate postoperative outcomes in patients with spinal metastases of prostate cancer, with a focus on patient-oriented assessments., Methods: This was a prospective multicenter registry study involving 35 centers. A total of 413 patients enrolled in the Japanese Association for Spine Surgery and Oncology Multicenter Prospective Study of Surgery for Metastatic Spinal Tumors were evaluated for inclusion. The eligible patients were followed for at least 1 year after surgery. The Frankel Classification, Eastern Cooperative Oncology Group Performance Status, visual analog scale for pain, face scale, Barthel Index, vitality index, indications for oral pain medication, and the EQ-5D-5L questionnaire were used for evaluating functional status, activities of daily living, and patient motivation., Results: Of the 413 eligible patients, 41 with primary prostate cancer were included in the study. The patient-oriented assessments indicated that the patients experienced postoperative improvements in quality of life and motivation in most items, with the improvements extending for up to 6 months. More than half of the patients with Frankel classifications B or C showed improved neurological function at 1 month after surgery, and most patients presented maintained or improved their classification at 6 months., Conclusion: Surgical intervention for spinal metastases of prostate cancer significantly improved neurological function, quality of life, and motivation of the patients. Consequently, our results support the validity of surgical intervention for improving the neurological function and overall well-being of patients with spinal metastases of prostate cancer., Competing Interests: Declaration of competing interest The Authors declare that there is no conflict of interest., (Copyright © 2024 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

A 70-year-old woman developed severe buttock pain that progressed to a walking disturbance. Radiographs and computed tomography scans revealed an osteolytic lesion with osteosclerosis extending from the body to the arch of the fifth lumbar vertebra. Magnetic resonance imaging showed multinodular masses in the fifth lumbar vertebral body extending into the spinous processes and right transverse process. The masses were hypointense to isointense on T1-weighted images and hypointense to hyperintense on T2-weighted images. Histologic examination of biopsy specimens showed destruction of the trabecula of the vertebral bone by a fascicular and solid proliferation of spindle tumor cells and scattered rhabdomyoblasts, in a fibrotic background. The tumor cells were immunoreactive for keratins, vimentin, desmin, MyoD1, myogenin, and anaplastic lymphoma kinase. Fluorescence in situ hybridization detected split signals for FUS and TFCP2 in 80% and 64% of the tumor cells, respectively, suggesting FUS-TFCP2 fusion. Reverse transcription-polymerase chain reaction revealed a FUS-TFCP2 fusion. The final diagnosis was spindle cell rhabdomyosarcoma of a lumbar vertebra with a FUS-TFCP2 fusion. A spindle cell rhabdomyosarcoma with a FUS-TFCP2 fusion in a vertebral bone is rare and should be differentiated from metastatic carcinoma, particularly in the elderly., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

Objective:: Prior studies advocate the subjective visual differences between meningioma and schwannoma on T 2 weighted images, however objective measurement of signal intensity differences may be useful in certain cases. The aim of this study was to investigate whether an objective evaluation of SIs on T 2 weighted images would be useful to differentiate spinal schwannomas from meningiomas., Methods:: The patients with spinal MRIs demonstrating path proven and subsequently treated intradural extramedullary spinal tumors were selected between April 2008 and May 2017. Regions of interest (ROIs) were measured in the tumor and subcutaneous fat on the same image, and we calculated the SI ratio between tumor and fat ROIs., Results:: Twenty patients each with meningioma and schwannoma were enrolled. The SI ratios of schwannomas were significantly higher than those of meningiomas (both researcher 1 and 2: p = 0.002). The areas under the curve by researchers 1 and 2 were 0.780. The cutoff value of SI ratio by both of researchers 1 and 2 to differentiate between schwannomas from meningiomas was 0.420 (sensitivity: 80.0%, specificity: 70.0-75.0%)., Conclusion:: The SI ratio, calculated from the SIs of the tumor and fat on T 2 weighted images, is useful for differentiating spinal schwannomas from meningiomas to obtain an accurate diagnosis., Advances in Knowledge:: Signal intensity ratio of the spinal tumor and fat on T 2 weighted images is useful for differentiating schwannomas from meningiomas to obtain an accurate diagnosis.

Introduction: There have been several reports on surgical techniques involving microendoscopy or percutaneous endoscopy for treating lumbar foraminal stenosis (LFS). However, no studies have assessed the mid-term clinical results of endoscopic techniques in spite of their relatively long history. In this study, we report 20 consecutive cases of LFS treated by our microendoscopic technique focusing on clinical results with a follow-up of at least two years., Methods: Twenty consecutive cases of LFS treated with microendoscopic decompression were followed up at 1, 2, 6, and 12 months postoperatively and annually thereafter. The patients were 14 males and 6 females, and the mean age at the time of surgery was 64.7 years. The Japanese Orthopaedic Association (JOA) score was used as the clinical outcome index., Results: Of the 20 patients, 16 were monitored successfully for more than 2 years. The follow-up rate was 80.0%, and the mean follow-up period was 66.3 months. The JOA score improved from 13.8 points before surgery to 24.6 points at final follow-up. Revision fusion surgeries were performed in two cases for LFS recurrence., Conclusions: The microendoscopic technique effectively treats LFS., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Study Design:  A retrospective comparative study., Objective:  To compare retrospectively the clinical results and surgical invasiveness of two different types of minimally invasive surgery for lumbar spinal canal stenosis: microendoscopic muscle-preserving interlaminar decompression (ME-MILD) and spinal process splitting laminectomy (SPSL)., Summary of Background Data:  ME-MILD and SPSL are minimally invasive procedures. However, the two procedures have not been compared in the literature., Materials and Methods:  We retrospectively enrolled patients who underwent ME-MILD or SPSL from 2011 to 2015. The surgical invasiveness of each technique was determined by evaluating the time required for the surgical procedure, amount of blood loss, serum creatine kinase (CK) levels on postoperative day (POD) 1, C-reactive protein (CRP) levels on POD 3 and 7, and the hospitalization. The clinical results were evaluated using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire score, the Short Form (36) Health Survey patient-reported outcome score, the visual analog scale for pain, a patient satisfaction score, and the incidence of surgical complications., Results:  A total of 97 patients were evaluated: 58 patients underwent ME-MILD, and 39 patients underwent SPSL. No significant differences were observed in the clinical results between the two groups. Regarding surgical invasiveness, no significant difference was found in the amount of blood loss, levels of CK, hospitalization, or time required for the procedure. However, CRP levels were significantly lower in the ME-MILD group., Conclusions:  ME-MILD and SPSL are both minimally invasive procedures. In a comparison of these two procedures, CRP was significantly lower in the ME-MILD group., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)

Background  Clinical results and recurrence rate after microendoscopic diskectomy (MED) with long-term follow-up is still unclear, in spite of its relatively long history. Materials and Methods  A total of 112 who underwent MED participated in this study. Operative time, blood loss, serum C-reactive protein (CRP), creatine kinase (CK), and visual analog scale (VAS) were evaluated as indexes of surgical invasiveness. The 36-Item Short Form Survey Instrument (SF-36), Japanese Orthopaedic Association (JOA) score, patient satisfaction, and recurrence were also evaluated with a follow-up of at least 5 years. Results  The mean operative time was 86.7 minutes, and the mean blood loss was 35.7 mL. The mean CRP on postoperative day 3 and CK on the first postoperative day was 0.72 mg/dL and 224.6 IU/L, respectively, and VAS to assess surgical site pain on the first postoperative day was 24.9 mm on average. The improvement rate in the JOA score was 68.7%. The physical component summary of SF-36 in norm-based scoring was improved from 23.4 to 48.6. Overall, 90.8% of patients evaluated their response to the surgery as extremely satisfied or satisfied. The recurrence rate was 10.5%, and reoperation was performed in 7.9% of patients. Conclusions  MED is a technique that offers both reduced invasiveness and good long-term clinical results., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)