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

BACKGROUND: Epidermoid cysts (ECs) are rare, benign lesions which comprise less than 1 % of all spinal tumors. Calcification of spinal ECs is rare, and EC ossification within the lumbar spine has never been documented. We report the only known congenital lumbar epidermoid tumor with ossification and a literature review of intradural lumbar ECs. METHODS: Studies meeting the following criteria were included: 1) EC as the primary tumor type, 2) intradural location, 3) involvement of the lumbar spinal level, and 4) primary presentation. Studies lacking individual patient data or published in a non-English language were excluded. RESULTS: A total of 172 studies were reviewed and 43 were included in analysis. Of the 83 total patients, 37 (45.1 %) were male and 45 (54.9 %) female, at an average age of 26 years. The L3 and L4 spinal levels were most frequently involved. Acquired etiology was reported in 49 (59.0 %) patients, and 24 (28.9 %) cases were congenital. Multivariate analyses demonstrated trends between decreased age and improved outcome, decreased delay in diagnosis and improved outcome, and increased extent of resection with reduced recurrence. Nine calcified spinal ECs were identified, with no previous report of EC ossification in the lumbar spine. CONCLUSION: We present a case report of the only known ossified epidermoid tumor of the lumbar spine and a comprehensive literature review of 83 patients with intradural lumbar ECs. This review demonstrated trends between reduced age and improved outcome, reduced delay in diagnosis and improved outcome, and increased extent of resection with reduced recurrence.

INTRODUCTION: The disco-vertebral junction (DVJ) of the lumbar spine contains thin structures with short T2 values, including the cartilaginous endplate (CEP) sandwiched between the bony vertebral endplate (VEP) and the nucleus pulposus (NP). We previously demonstrated that ultrashort-echo-time (UTE) MRI, compared to conventional MRI, is able to depict the tissues at the DVJ with improved contrast. In this study, we sought to further optimize UTE MRI by characterizing the contrast-to-noise ratio (CNR) of these tissues when either single echo or echo subtraction images are used and with varying echo times (TEs). METHODS: In four cadaveric lumbar spines, we acquired 3D Cones (a UTE sequence) images at varying TEs from 0.032 ms to 16 ms. Additionally, spin echo T1- and T2-weighted images were acquired. The CNRs of CEP-NP and CEP-VEP were measured in all source images and 3D Cones echo subtraction images. RESULTS: In the spin echo images, it was challenging to distinguish the CEP from the VEP, as both had low signal intensity. However, the 3D Cones source images at the shortest TE of 0.032 ms provided an excellent contrast between the CEP and the VEP. As the TE increased, the contrast decreased in the source images. In contrast, the 3D Cones echo subtraction images showed increasing CNR values as the second TE increased, reaching statistical significance when the second TE was above 10 ms (p < 0.05). CONCLUSIONS: Our study highlights the feasibility of incorporating UTE MRI for the evaluation of the DVJ and its advantages over conventional spin echo sequences for improving the contrast between the CEP and adjacent tissues. Additionally, modulation of the contrast for the target tissues can be achieved using either source images or subtraction images, as well as by varying the echo times.

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

BACKGROUND: The study of the lumbar spine and pelvis in patients with Lenke type 5 lordosis is limited to the coronal and sagittal planes, and the threedimensional relationship between the scoliosis and the pelvis has not yet been clarified. OBJECTIVE: To analyze the effect of lumbar scoliosis on the pelvis in patients with Lenke type 5 lordosis and to study the correlation between the lumbar spine and the three-dimensional spatial position of the pelvis. METHODS: Imaging data of 60 patients with Lenke type 5 lordosis scoliosis admitted to the 3D Printing Reception Center of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from January 2019 to September 2023 were retrospectively analyzed, including Cobb angle, coronal pelvic tilt, lumbar lordosis, left and right pelvic hip width ratio (sacroiliac-anterior superior iliac spine), spinal rotation angle, pelvic tilt, sacral slope, pelvic incidence, coronal deformity angular ratio, sagittal deformity angular ratio, C7 plumb line-center sacral vertical line, apical vertebral translation, and coronal sacral inclination. The information was summarized as a database. SPSS 22.0 software was used to analyze the data related to the lumbar spine and pelvis of the patients with Lenke type 5 primary lumbar curvature adolescent idiopathic scoliosis using Spearman’s correlation analysis and linear regression. RESULTS AND CONCLUSION: (1) Cobb angle was highly positively correlated with coronal deformity angular ratio, apical vertebral translation, and spinal rotation angle (r=0.91, r=0.841, r=0.736). (2) Coronal deformity angular ratio was highly positively correlated with apical vertebral translation (r=0.737), moderately positively correlated with C7 plumb line-center sacral vertical line (r=0.514), and moderately negatively correlated with sagittal deformity angular ratio (r=-0.595). (3) There was a high positive correlation between lumbar lordosis and sagittal deformity angular ratio (r=0.942) and a moderate negative correlation with coronal deformity angular ratio (r=-0.554). (4) There was a moderate positive correlation between Cobb angle with coronal pelvic tilt and coronal sacral inclination (r=0.522, r=0.534) and a moderate positive correlation between C7 plumb line-center sacral vertical line and coronal pelvic tilt (r=0.507). Apical vertebral translation with coronal pelvic tilt and coronal sacral inclination showed a moderate positive correlation (r=0.507, r=0.506). Lumbar lordosis with sacral slope and pelvic incidence showed a moderate positive correlation (r=0.512, r=0.538). Sagittal deformity angular ratio was moderately positively correlated with sacral slope and pelvic incidence (r=0.614, r=0.621). (5) Studies have found that the relative position of the lumbar spine and the pelvis is closely related in the horizontal, sagittal and coronal planes. When the lumbar spine affects scoliosis and is rotated, the relative position of the pelvis will also change to compensate, which indicates that while correcting scoliosis, the correction of the pelvis cannot be ignored. [ABSTRACT FROM AUTHOR]

Vertebral compression fracture is a common disease in the current orthopedic field. However, the occurrence of re-fracture in neighboring vertebrae after surgery is a problem that cannot be ignored, which has a serious impact on the normal life of patients. OBJECTIVE: The aim of this study is to establish four postoperative models with different recovery heights using computed tomography images. By using finite element analysis, we derived the stresses on the neighboring vertebrae at different recovery heights and further explored the importance of postoperative recovery of the height of the injured vertebrae. METHODS: A finite element model of the thoracolumbar spine (T11-L3) was established and validated, on the basis of which four postoperative finite element models of L1 with different recovery heights of 100%, 80%, 60%, and 40% were constructed, in which the cement capacity varied with the recovery height. The specific models are as follows: Model 1 was the postoperative model with normal recovery height, and the cement capacity was 8.3 mL. Model 2 was the postoperative model in which 20% of the anterior height of the L1 was removed and the posterior convexity angle became 10.41°, and the cement capacity was 6.9 mL. Model 3 was the postoperative model in which 40% of the anterior height of the L1 was removed and the posterior convexity angle became 20.17°, and the cement capacity was 4.7 mL. Model 4 was a postoperative model with 60% of the L1 anterior height removed and the posterior convexity angle changed to 28.85°, with a cement capacity of 3.6 mL. For evaluation of the postoperative model, we applied a moment of 7 Nm and an axial force of 500 N. The followings were recorded and analyzed: peak stresses in the L2 upper endplate and T12 lower endplate; peak stresses in the L2 and T12 cancellous bone. RESULTS AND CONCLUSION: (1) The highest peak stresses for each condition of the L2 upper endplate, T12 lower endplate, L2 cancellous bone, and T12 cancellous bone occurred in Model 1 and Model 4. In particular, the T12 lower endplate, except for the posterior extension condition, the anterior flexion, left and right lateral bending, and left and right rotation conditions all reached their highest peak stresses in Model 4, with stresses of 50.3, 33.1, 44.9, 34.3, and 31.9 MPa. (2) Based on the peak stresses in the adjacent vertebral endplates and cancellous bone, after excluding Model 1 and Model 4, the minimum peak stresses for most of the conditions appeared in the Model 2, and the minimum peak stresses appeared in the Model 2 in 66.6% of the cases, especially in the upper endplates of the L2 and cancellous bone except for the posterior extension condition, the minimum peak stresses all appeared on the Model 2. (3) Therefore, controlling the recovery height at about 100% and 40% of the original height was a dangerous recovery height, which had a greater impact on the neighboring vertebrae. Controlling the recovery height at about 80% of the original height may be a more ideal choice. With a recovery height of about 80% of the original height, the adjacent vertebrae are subjected to less stress, thus reducing the risk of re-fracture of the adjacent vertebrae in the patient. [ABSTRACT FROM AUTHOR]

Accurate representation of spinal geometry is necessary in biomechanical modelling to properly understand the function of the spine. The objective of this study was to create a large database of image-derived digital spine surface models for geometric studies and computational biomechanics investigation. Computed tomography scan data was acquired from 60 asymptomatic subjects (30 males and 30 females). Subjects ranged in age from 20 to 68 with equal numbers selected in each 10-year age bracket. Three-dimensional geometric surface models were generated for each subject's spine. A series of distance measures were also computed for each vertebral body to assess variation in the population. Geometric measures were able to show the significant variation in vertebrae size and shape within the subject population and as a function of vertebral level, gender, and age. This database enables the biomechanical evaluation of the variation in spinal loads that occurs within the population due to geometry. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionTo investigate the impact of tension and laxity in the sacroiliac interosseous ligament on lumbar spine displacement and force response in vibration environments.A finite element model of the lumbar-pelvis, previously crafted and rigorously validated, was used to simulate ligament tension and laxity by adjusting the elastic modulus of the SIL under a sinusoidal vertical load of ±40 N at 5 Hz. Comparisons of lumbar spine horizontal and axial displacements as well as annulus fibrous stress, nucleus pulposus pressure, and facet joint force were performed, respectively.With the elastic modulus of the SIL varying by +50, −50, and −90%, the maximum vibration amplitude changed by +20.00, −175.00, and −627.27% for lumbar horizontal displacement, +30.00, −157.14, and −627.22% for lumbar axial displacements, +5.88, −19.35, and −245.16% for annulus fibrous stress, +10.00, −25.00, and −157.14% for nucleus pulposus pressure, as well as +6.54, −20.13, and −255.37% for facet joint force, respectively.In contrast to static environments, large laxity of the SILs not only diminishes lumbar spine stability in vibrational settings but also significantly amplifies dynamic loads, thereby heightening the risk of lumbar spine vibratory injuries and low back pain disorders. [ABSTRACT FROM AUTHOR]

Background: Thoracolumbar and lumbar spine injuries account for 30–60% of spinal fractures, especially at the thoracolumbar junction. Conservative treatment is recommended for stable fractures without neurological symptoms, but studies suggest surgical intervention may offer better outcomes. However, there is no consensus on the best stabilization method. Methods: This non-randomized, prospective study was conducted on 114 patients divided into groups based on the surgical technique selected: pedicle stabilization using Schanz screw constructs (Group One, n = 37) stabilization above and below the fractured vertebra using pedicle screws (Group Two, n = 32), and intermediate fixation with a pedicle screw additionally inserted into the fractured vertebra (Group Three, n = 45). Outcomes were assessed using the Cobb angle, anterior and posterior vertebral wall height, and patient quality of life via the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). X-ray imaging was performed before, during, and after surgery in the control group. Results: This statistical study showed that the location and type of injury significantly influenced the choice of short-segment stabilization method. In the case of measuring the Cobb angle and the high anterior wall, the statistical analysis showed that the best result was observed in the Schanz Group. Patients from this study group had the lowest pain and the highest efficiency. Conclusions: Schanz screw stabilization may offer superior outcomes for thoracolumbar spine injuries, providing better clinical and quality of life results compared to other methods. [ABSTRACT FROM AUTHOR]

Background/Objectives: Cage implantation decompresses neural elements, stabilizes segments, and promotes fusion, with sagittal balance influenced by cage size, geometry, and position. This retrospective study compared the effects of lumbar interbody cages with 10° and 15° lordotic angles on global and segmental lordosis in patients undergoing transforaminal lumbar interbody fusion (TLIF). Methods: Data from 215 patients who underwent 259 TLIF procedures between 2018 and 2022 were analyzed. All the surgeries were performed by a single senior orthopedic spine surgeon, and cages were selected by the surgeon based on patients' clinical and anatomical factors. Radiographic assessments included measurements of global and segmental lordosis. Results: Patients who received 15° cages demonstrated significantly greater segmental lordosis compared to those who received 10° cages in both bisegmental and monosegmental procedures (p < 0.001). While the global lordosis in the 10°-cage group remained unchanged postoperatively (p = 0.687), bisegmental procedures showed a small but statistically significant increase (p = 0.035). Moreover, global lordosis did not significantly differ between the 10°- and 15°-cage groups. Conclusions: Cage geometry significantly influenced segmental lordosis, with 15° cages achieving overall more superior radiographic results compared to 10° cages. However, global lordosis was unaffected by cage angle, thereby highlighting the multifaceted nature of factors that influence overall spinal alignment. These findings provide valuable insights into lumbar spine surgery, thus emphasizing the need for comprehensive preoperative planning and consideration of individual patient characteristics. [ABSTRACT FROM AUTHOR]

Adult spinal deformity is a common problem in today's aging adult population, particularly in the thoracolumbar spine. This can lead to severe pain and disability, leading to a poorer quality of life. Traditionally, open deformity correction has been the mainstay of treatment for these patients as it provides an excellent operative corridor; however, this comes with severe risk and high complication rates. There has been a trend toward more minimally invasive approaches to correct the deformity while preserving the muscle and soft tissue surrounding the bony spine across the fusion. We describe a minimally invasive surgical technique through a Wiltse approach without invading the paraspinal musculature to gain access to the bony spine to perform lumbar interbody fusions and osteotomies. A total of 3 patients were identified for this technical note who underwent the transfascial oblique posterior interbody correction procedure for adult spinal deformity. The patients had severe coronal and rotational imbalances. We were able to achieve adequate correction through an approach without disturbing the spinal musculature and soft tissues. This technique provides benefits of spinal rotational and coronal plane correction and restores lordosis with current advancements of today's technologies without the downsides of an open surgical approach. [ABSTRACT FROM AUTHOR]

Lumbar spinal fusion is an increasingly common operation to treat symptoms related to degenerative disorders of the spine including radiculopathy and pain. As the volume of spine surgeries grows, it is becoming increasingly common for procedures to take place in nontertiary care centers, including orthopaedic specialty hospitals (OSH). While previous research demonstrates that surgical outcomes at an OSH are noninferior to those at a tertiary referral center (TRC), the implications of this difference on patient-reported outcome measures (PROMs) have not been sufficiently assessed. The objectives of this study were (1) to determine if changes in patient reported outcome measures (PROMs) after elective lumbar spinal fusion surgery differ between patients who undergo surgery at an orthopedic specialty hospital (OSH) and those who undergo surgery at a tertiary referral center (TRC) and (2) to characterize differences in short-term outcomes between hospitals. Retrospective cohort study. Adult patients (≥18 years old) who underwent primary, elective single-level posterior lumbar decompression and fusion between January 2014 and December 2021 at a tertiary referral center or an orthopaedic specialty hospital. PROMs: Oswestry Disability Index (ODI), Short-form 12 (SF12) Mental Component Summary (MCS); SF12 Physical Component Summary (PCS); Visual Analogue Back and Leg (VAS Back/Leg). PROMs were collected preoperatively, 6 months after surgery, and 1 year after surgery. Six-month and 1-year delta PROM values were calculated by subtracting the preoperative PROM score from the 6-month or 1-year score, respectively. Multivariable linear regression analyses were conducted to assess the independent effect of hospital location on postoperative PROM scores. A total of 288 patients were identified as part of the study cohort including 205 patients who underwent surgery at the tertiary hospital and 83 patients who underwent surgery at the OSH. OSH patients had shorter length of stay (1.57±0.72 vs 3.28±1.32, p<.001), however there was no difference in discharge disposition or 90-day readmission rates between hospitals (p>.05). At 6 months, having surgery at the specialty hospital was associated with higher PCS (estimate=2.96, confidence interval: 0.21–5.71, p=.035). At 1-year postoperatively, the location of surgery no longer demonstrated significant associations with PROM scores. Preoperative PROM scores demonstrated significant associations with 6-month and 1-year scores for each PROM (p<.05) except VAS leg at 6 months postoperatively. To our knowledge, this is one of the largest studies investigating PROMs at OSH versus TRCs for single-level lumbar fusions. We demonstrated that at 1-year follow-up, there is not a significant difference in PROM improvement between patients who undergo surgery at a TRC and patients who do so at an OSH. [ABSTRACT FROM AUTHOR]

Study Design. This is an in vitro biomechanical study. Objective. This study evaluated the influence of localized trabecular bone strength deficits and loading rate as determinants of Schmorl's node and fracture lesion incidence. The failure load (ultimate compression tolerance [UCT]), loading stiffness, and failure morphology were assessed after acute compression loading and failure. Summary of Background Data. The cartilaginous endplate is vulnerable to injuries such as Schmorl's nodes and fracture lesions. While both injuries are associated with acute compression traumas, the factors that distinguish their incidence are poorly understood. Methods. Forty-eight porcine spinal units (domestic hog, 5-10 mo, ~110 kg) were assigned to one of eight experimental groups that differed by initial condition (control, sham, experimentally produced chemical fragility, and structural void) and loading rate (3 kN/s, 9kN/s). A servo-hydraulic materials testing system was used to perform acute compression testing until observed failure in the specimen. Post-loading dissection was performed to classify injury morphologies. Between group differences in UCT and loading stiffness were evaluated using a general linear model and injury distributions were evaluated using chi-squared statistics. Results. Schmorl's nodes occurred exclusively in chemical fragility (63%) and structural void groups (37%) and were more prevalent with a 9 kN/s (75%) loading rate compared with 3 kN/s (25%). In contrast, fracture lesions occurred in all FSUs assigned to the control groups (100%) and the majority of those assigned to the sham groups (92%). No between-group differences were observed for UCT and loading stiffness. Conclusion. Pre-existing strength deficits of the subchondral trabecular bone can alter endplate injury morphology, particularly when coupled with high loading rates, but the localized strength deficits that were associated with Schmorl's nodes did not appreciably influence measured joint properties. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective cohort study. Objective. The purpose of this study is to determine which demographic, surgical, and radiographic preoperative characteristics are most associated with the need for subsequent fusion after decompression lumbar spinal surgery. Summary of Background Data. There is a relatively high rate of the need for repeat decompression or fusion after an index decompression procedure for degenerative spine disease. Nevertheless, there is a dearth of literature identifying risk factors for lumbar fusion following decompression surgery Methods. Patients 18 years or older receiving a primary lumbar decompression surgery within the levels of L3-S1 between 2011 and 2020 were identified. All patients had preoperative radiographs and 2 years of follow-up data. Chart review was performed for surgical characteristics and demographics. The sagittal parameters included lumbar lordosis (LL), segmental lordosis (SL), anterior disk height (aDH), posterior disk height (pDH), sacral slope (SS), and pelvic tilt (PT). Pelvic incidence (PI = PT+SS) and pelvic incidence minus lumbar lordosis (PI-LL) were calculated. In addition, the Roussouly classification was determined for each patient. Bivariant and multivariant analyses were performed. Results. Of the 363 patients identified in this study, 96 patients had a fusion after their index decompression surgery. Multivariable analysis identified involvement of L4-L5 level in the decompression [odds ratio (OR) = 1.83 (1.09-3.14), P = 0.026], increased L5-S1 segmental lordosis [OR = 1.08 (1.03-1.13), P = 0.001], decreased SS [OR = 0.96 (0.93-0.99), P = 0.023], and decreased endplate obliquity [OR = 0.88 (0.77-0.99), P = 0.040] as significant independent predictors of fusion after decompression surgery. Conclusions. This is one of the first studies to assess preoperative sagittal parameters in conjunction with demographic variables to determine predictors of the need for fusion after index decompression. We demonstrated that decompression at L4-L5, greater L5-S1 segmental lordosis, decreased sacral slope, and decreased endplate obliquity were associated with higher rates of fusion after decompression surgery. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective review. Objective. The purpose of this study was to evaluate disparities in patient-reported outcome measures (PROM) completion rates and baseline function scores among newly presenting spine patients. Summary of Background Data. Prior studies have demonstrated that minority patients and those of low socioeconomic status may present with worse physical and mental health on PROMs. As PROMs are increasingly used in clinical care, research, and health policy, accurate assessment of health status among populations relies on the successful completion of PROM instruments. Methods. A retrospective review of 10, 803 consecutive new patients presenting to a single multidisciplinary spine clinic from June 2020 to September 2022 was performed. Univariate statistics were performed to compare demographics between patients who did and did not complete PROMs. Multivariable analysis was used to compare PROM instrument completion rates by race, ethnicity, and Social Vulnerability Index (SVI) and baseline scores among responders. Results. A total of 68.4% of patients completed PROMs at the first clinic visit. After adjusting for age, sex, body mass index, and diagnosis type, patients of non-White race (OR = 0.661, 95% CI = 0.599-0.729, P < 0.001), Hispanic ethnicity (OR = 0.569, 95% CI = 0.448-0.721, P < 0.001), and increased social vulnerability (OR = 0.608, 95% CI = 0.511-0.723, P < 0.001) were less likely to complete PROMs. In the multivariable models, patients of non-White race reported lower levels of physical function (β = -6.5, 95% CI = -12.4 to -0.6, P = 0.032) and higher levels of pain intensity (β = 0.6, 95% CI = 0.2-1.0, P = 0.005). Hispanic ethnicity (β = 1.5, 95% CI = 0.5-2.5, P = 0.004) and increased social vulnerability (β = 1.1, 95% CI = 0.4-1.8, P = 0.002) were each associated with increased pain intensity. Conclusions. Among newly presenting spine patients, those of non-White race, Hispanic ethnicity, and with increased social vulnerability were less likely to complete PROMs. As these subpopulations also reported worse physical function or pain intensity, additional strategies are needed to better capture patient- reported health status to avoid bias in clinical care, outcomes research, and health policy. Level of Evidence. 4. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to determine the short- and long-term effects of foam rolling (FR) on the pressure pain threshold and the range of motion of the lumbar spine in healthy subjects. Methods: 43 healthy subjects without back problems were randomly assigned to an experimental group (EG) or a control group (CG). The subjects in the EG underwent a 4-week FR program (12 sessions). The subjects in the CG received no intervention. Range of motion was measured using the modified-modified Schober test for flexion and fingertip-to-floor distance for lateral flexion. The pressure pain threshold was measured with a hand-held pressure algometer. The measurements were taken before and after the first FR, after the 4-week program and at the 1-, 3- and 6-month follow-up. The significance level was set at p ≤ 0.05 and the desired power of the test was 92%. Results: We found an improvement in flexion (p = 0.03) and lateral flexion (p < 0.001) in the EG after the first FR and recorded a significant improvement in all measured variables (flexion, lateral flexion and algometry: p < 0.001) at the end of the entire 4-week program. The effects were noticeable up to 6 months after the end of the program (p ≤ 0.03) and were statistically significantly better than in the CG (p ≤ 0.04). The calculated Cohen's d value was 1.15 for flexion, 1.06 for lateral flexion and 0.98 for algometry, which represents a large effect size. Discussion: FR improves the pressure pain threshold and mobility of the lumbar spine in healthy subjects. The effects are noticeable at least 6 months after the end of an FR program. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Lumbar facet fracture‐dislocation is rare, often due to hyperflexion with rotational force. Abnormal scoliosis on radiography is a key sign, prompting further imaging. Facetectomy and laminectomy ensure safe reduction, while instrumented fusion is an effective surgical treatment. Traumatic lumbar facet dislocation is an uncommon condition, particularly when unilateral lumbar facet dislocation is accompanied by a contralateral facet fracture. The patient had a locked facet joint at the left L4–L5, a fracture of the right superior articular process of L5 and a comminuted fracture at the peritrochanteric region of the right femur following a fall. Emergent operation was conducted, starting with open reduction and fixation for the right proximal femur, followed by posterior open reduction and posterolateral fusion with instrumentation, without interbody fusion, for the lumbar spine injury. The patient exhibited positive outcomes throughout the follow‐up. This article highlights the trauma mechanism of lumbar facet dislocation, emphasizing hyperflexion with rotational force. Abnormal local scoliosis is a distinctive imaging sign of facet joint dislocation. Facetectomy and laminectomy are recommended for safe reduction and instrumented fusion is considered a safe and effective surgical treatment for facet joint dislocation injuries. [ABSTRACT FROM AUTHOR]

Objective: The development of adjacent segment disease or the progression of spondylosis following the surgical treatment of spinal stenosis and spondylolisthesis is well documented and can lead to subsequent functional decline after a successful index surgery. The early detection of negative inflection points during patients' functional recovery can improve timely intervention. In this study, we developed machine learning (ML) models to predict the occurrence of post-operative decline in patient mobility. Methods: Patients receiving spine surgery for degenerative spinal stenosis or spondylolisthesis were retroactively consented and enrolled. Activity data (steps-per-day) previously recorded across a 4-year peri-operative were collected alongside relevant clinical and demographic variables. Logistic regression (LR), random forest (RF), and extreme gradient boosting (XGBoost) ML models were constructed and trained on 80% of the dataset and validated using the remaining 20%. The study's primary endpoint was the models' ability to predict post-operative decline in patient mobility. Results: A total of 75 patients were included. Following training, RF and XGBoost models achieved accuracy values of 86.7% (sensitivity 80%, specificity 90%) and 80% (sensitivity 60%, specificity 90%), respectively, in predicting post-operative functional decline. The LR model was the least effective with an accuracy of 73.3% (sensitivity 50%, specificity 88.8%). Receiver operating characteristic curves showed an area under the curve of 0.80 for RF, 0.70 for XGBoost, and 0.69 for LR. Conclusions: ML models trained on activity data collected from smartphones successfully forecast functional decline in post-operative activity following spine surgery. These results lay the groundwork for the future integration of ML into the surgeon's toolbox for prognostication and surgical planning. [ABSTRACT FROM AUTHOR]

Objective: The cortical bone trajectory (CBT) technology is an effective substitute for traditional pedicle screw (PS) technology. However, there is still controversy about the CBT screw technology placement strategy. The objective of this study was to simulate cortical screw placement with the help of three‐dimensional (3D) software, to discuss the differences in screws between genders and vertebral segments, and to explore a safer and more efficient strategy for cortical screw placement. Methods: Mimics Medical software was used to construct a 3D model of the lumbar spine, and the placement of CBT screws was simulated. The volume of each vertebral body from L1 to L5, the pedicle isthmus height (IH), the pedicle isthmus width (IW), and the sagittal vertebral distance (SAVD) were measured. The transverse distance (TD) and the longitudinal distance (LD) between the ideal starting point (SP) and the clinical SP (the intersection Q of the midline of the superior articular process and the horizontal line 1 mm below the transverse process) were measured. The cephalad angle (CA), lateral angle (LA), maximum screw diameter (MSD), maximum screw length (MSL) of each trajectory of the L1 to L5 vertebral bodies, and the percentage of the screw insertion depth (PSID) into the vertebral body were measured. Data were statistically analyzed using Student's t‐test, one‐way analysis of variance (ANOVA), and Tukey's test. Results: Vertebral anatomical parameters and CBT screw parameters differed between males and females. Female patients had lower IH, IW, SAVD, CA, LA, MSD, and MSL than males. IH was greatest in L1 (male, 17.81 mm; female, 16.12 mm) and the smallest in L5 (male, 14.11 mm; female, 13.05 mm). IW was smallest in L1 (male, 8.89 mm; female, 7.37 mm) and greatest in L5 (male, 16.59 mm; female, 15.43 mm). The MSD of males was smallest in L1 (6.05 mm) and greatest in L3 (7.06 mm); the MSD of females was smallest in L1 (5.13 mm) and greatest in L4 (6.64 mm). MSL was greatest at L3 (male, 33.63 mm; female, 32.28 mm) and smallest at L5 (male, 31.25 mm; female, 29.97 mm). CA was smallest in L1 (male, 22.80°; female, 21.92°) and greatest in L3 (male, 25.29°; female, 24.33°). LA was smallest in L1 (male 12.37°, female 11.27°) and greatest in L5 (male 13.56°, female 12.96°). Among the males, TD was smallest at L1 (−0.51 mm) and greatest at L5 (1.37 mm), while LD was greatest at L2 (3.46 mm) and smallest at L5 (2.40 mm). In females, TD was greatest at L1 (0.12 mm) and smallest at L3 (−0.51 mm), while LD was greatest at L1 (3.69 mm) and smallest at L5 (2.08 mm). In the overall sample, the incidence of SAVD and PSID gradually increased from L1 to L5. Conclusion: The optimal screw placement strategy for CBT screws varies significantly according to sex and vertebral body segments, particularly noting the specificity of screw placement at L5. The optimal screw placement strategy should be selected based on the patient's sex and segment characteristics before surgery to maximize the safety and accuracy of CBT screw placement. [ABSTRACT FROM AUTHOR]

Purpose: To provide lumbar spine anatomical parameters relevant to the UBE technique and explore their intraoperative application. Methods: CT imaging data processed by Mimics for parametric measurements, including laminar abduction angle (LAA), laminar slope angle (LSA), minimum laminar height (MLH), distance between the inferior margin of the lamina and attachment of the ligamentum flavum onto the cephalad lamina (DLL), distance between the initial point and the middle of the articular process (DIA), and distance from the inferior margin of the lamina to the inferior border of the vertebral body (DLV), and were manually measured. Results: LAA and DIA gradually increase from L1 to L5. At L1, the DIA is approximately the length of 2 drill bits with a diameter of 3 mm (male: 7.77 ± 1.39 mm, female: 7.22 ± 1.09 mm), while at L5, it can reach the length of 4–5 drill bits (male: 14.96 ± 2.24 mm, female: 13.67 ± 2.33 mm). MLH, DLL, and DLV reach their maximum values at the L3 and decrease toward the cranial and caudal ends. The DLL is smallest at L5 (male: 9.58 ± 1.90 mm, female: 9.38 ± 2.14 mm), equivalent to the length of 3 drill bits, while the DLL at L3 is the length of 4–5 drill bits (male: 14.17 ± 2.13 mm, female: 14.01 ± 2.07 mm). Conclusion: Referring to the drill diameter during surgery can mark the extent of laminotomy. The characteristics of vertebral plate angles at different lumbar levels can provide references for preoperative incision design. [ABSTRACT FROM AUTHOR]

Purpose: To test equivalency of deep-learning 3D lumbar spine MRI with "CT-like" contrast to CT for virtual pedicle screw planning and geometric measurements in robotic-navigated spinal surgery. Methods: Between December 2021 and June 2022, 16 patients referred for spinal fusion and decompression surgery with pre-operative CT and 3D MRI were retrospectively assessed. Pedicle screws were virtually placed on lumbar (L1-L5) and sacral (S1) vertebrae by three spine surgeons, and metrics (lateral deviation, axial/sagittal angles) were collected. Vertebral body length/width (VL/VW) and pedicle height/width (PH/PW) were measured at L1-L5 by three radiologists. Analysis included equivalency testing using the 95% confidence interval (CI), a margin of ± 1 mm (± 2.08° for angles), and intra-class correlation coefficients (ICCs). Results: Across all vertebral levels, both combined and separately, equivalency between CT and MRI was proven for all pedicle screw metrics and geometric measurements, except for VL at L1 (mean difference: − 0.64 mm; [95%CI − 1.05, − 0.24]), L2 (− 0.65 mm; [95%CI − 1.11, − 0.20]), and L4 (− 0.78 mm; [95%CI − 1.11, − 0.46]). Inter- and intra-rater ICC for screw metrics across all vertebral levels combined ranged from 0.68 to 0.91 and 0.89–0.98 for CT, and from 0.62 to 0.92 and 0.81–0.97 for MRI, respectively. Inter- and intra-rater ICC for geometric measurements ranged from 0.60 to 0.95 and 0.84–0.97 for CT, and 0.61–0.95 and 0.93–0.98 for MRI, respectively. Conclusion: Deep-learning 3D MRI facilitates equivalent virtual pedicle screw placements and geometric assessments for most lumbar vertebrae, with the exception of vertebral body length at L1, L2, and L4, compared to CT for pre-operative planning in patients considered for robotic-navigated spine surgery. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical effects of oblique lumbar interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) in the treatment of degenerative disc disease of the lumbar spine. Method: This was a retrospective study. The clinical data of 80 patients with lumbar disc degenerative disease who underwent surgery in Affiliated Hospital of Beihua University from May 2018 to May 2023 were selected. The patients were divided into LLIF group and OLIF group according to surgical methods. Compare the 36-Item Short- Form Health Survey(SF-36), Visual Analog Scale(VAS) scores, Oswesterly Disability Index(ODI), Japanese Orthopedic Association(JOA) scores, Cobb angle, and intervertebral height changes between two groups of patients pre- and posttreatment, and evaluate the differences in clinical efficacy and surgical complications. Result: Postsurgery, the SF-36 score, VAS score, ODI index, and JOA score of two groups were significantly better than presurgery(p<0.05); After three months of treatment, the improvement in OLIF group was better than LLIF group(p<0.05), while there was no statistically significant difference between the two groups at six months postsurgery(p>0.05). Six months postsurgery, the intervertebral space height and Cobb angle of the two groups were significantly improved compared to presurgery (p<0.05), but there was no significant difference between the groups(p>0.05). There was no difference in clinical efficacy and incidence between the two groups(p>0.05). Conclusion: LLIF and OLIF may be both safe and effective minimally invasive surgical methods for the treatment of degenerative disc disease of the lumbar spine. [ABSTRACT FROM AUTHOR]

To evaluate the feasibility of an ultrasound-guided technique targeting the medial branches of the dorsal ramus of the spinal nerves (DRSN) by injecting a dye solution at the caudal aspect of the base of lumbar mammillary processes [i.e. the retromammillary (RM) space]. Feasibility, descriptive, anatomical study. Eleven canine cadavers. Using anatomical dissections, the relationship between the mammillary processes and the branches of the DRSN of the thoracolumbar and lumbar spine was studied in two cadavers. Subsequently, ultrasound-guided RM injections were administered in nine cadavers, randomly assigned to low volume (LV; 0.01 mL kg–1) of a dye solution at multiple points from L3 to L6 on one side, and high volume (HV; 0.4 mL kg–1) at a single L4 point on the contralateral side. Gross anatomical dissections were immediately performed after the injections. The RM injections were feasible if ultrasonographic landmarks were identifiable in at least 80% of cases, and 80% of LV injections showed medial branch staining. A one-sample binomial test was used for testing feasibility. The medial branches emerged shortly after the DRSN exited the intervertebral foramen and traveled towards the caudal aspect of the base of the mammillary process, which served as the target injection point. With LV, 36 out of 36 (100%) injected medial branches were stained, meeting the criteria of feasibility (p < 0.001). The median (range) number of stained medial branches per cadaver were 4 (4–4) and 2 (1–3), with LV and HV, respectively. Although no lateral branches were stained with LV, 1 (0–2) was stained with HV. Neither ventral branch staining nor epidural spread was noted in any cadaver. Ultrasound-guided RM injections are feasible and allow for selective staining of the medial branch of the DRSN in canine cadavers at the lumbar spine. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Nusinersen intrathecal administration can be challenging in spinal muscular atrophy (SMA) adults. We aimed to determine if the ultrasound (US)‐assistance reduces the number of needle attempts and needle redirections needed for intrathecal drug administration and its impact on the procedure time, the incidence of adverse events (AEs), and patient satisfaction in these patients. Methods: Fifty‐eight patients aged 18 years and older scheduled for intrathecal nusinersen injection were enrolled and randomized (1:1 ratio) into Group 1 (nusinersen infusion with US‐assisted technique) or Group 2 (nusinersen infusion with landmark‐based technique). The number of attempts, number of redirections, periprocedural time, AEs and patient satisfaction were reported. Continuous variables were compared with the Student t‐test or Wilcoxon rank sum test. Categorical variables were evaluated with the Chi‐square test or Fisher's exact test in case of expected frequencies <5. The p‐values <.05 were considered statistically significant. Results: There were no statistical differences in the number of attempts, AEs, or patient satisfaction between the two groups. The number of needle redirections was significantly lower in the ultrasound group versus landmark‐based group (p <.05) in both the overall group of patients and in the subgroup with difficult spines. The periprocedural time was about 40 seconds longer in US‐group versus landmark‐based group (p <.05). Discussion: In SMA adults, US assistance reduces the number of needle redirections needed for intrathecal drug administration. These results suggest that the US assistance may be advantageous for nusinersen therapy to reduce the therapeutic burden of intrathecal infusion. [ABSTRACT FROM AUTHOR]

Copyright of Zentralblatt fuer Arbeitsmedizin, Arbeitsschutz und Ergonomie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Edema in the subcutaneous soft tissue of the lumbar spine is a frequent incidental finding in spinal magnetic resonance imaging, however, its exact explanation is yet to be determined. The aim of this paper is to provide a systematic literature review on posterior lumbar subcutaneous edema (LSE). The present systematic literature search was carried out in October 2023 using electronic databases: PubMed, Cochrane library, and Scopus. The current evidence suggests that lumbar edema is correlated with clinical data such as weight and age, and potentially female sex. Moreover, LSE is related to several specific conditions, including both systemic and spinal disorders, such as heart or kidney disorders, as well as low back pain and degenerative and/or inflammatory diseases. It is important to be aware that there is an association between LSE and a variety systemic and spinal disorders. [ABSTRACT FROM AUTHOR]

Copyright of CT Theory & Applications is the property of Editorial Department of CT Theory & Applications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Study Design: Multicenter prospective study. Objective: Patients with central sensitization (CS) are reported to be at high risk of poor outcomes after spinal surgery. However, the influence of CS on surgical outcomes for lumbar disc herniation (LDH) remains unknown. This study aimed to examine the association between preoperative CS and surgical outcomes in LDH patients. Methods: A total of 100 consecutive patients with LDH (mean age 51.2) who underwent lumbar surgery were included in this study. The extent of CS was evaluated using the central sensitization inventory (CSI), a screening tool for CS-related symptoms. The patients completed the following CSI and clinical outcome assessments (COAs) preoperatively and 12 months postoperatively: the Japanese Orthopaedic Association (JOA) score for back pain, JOA back pain evaluation questionnaire (JOABPEQ), and Oswestry Disability Index (ODI). The association between preoperative CSI scores, and preoperative and postoperative COAs was analyzed, and the postoperative changes were statistically evaluated. Results: The preoperative CSI score significantly decreased 12 months postoperatively. Preoperative CSI scores showed a significant correlation with most COAs; however, a significant correlation was only identified in the social function and mental health domains of JOABPEC postoperatively. Higher preoperative CSI showed worse preoperative COAs; however, all COAs significantly improved regardless of CSI severity. There were no significant differences in any COAs among the CSI severity groups 12 months postoperatively. Conclusions: The results of this study showed that lumbar surgeries significantly improved the COAs regardless of preoperative severity of CS in patients with LDH. [ABSTRACT FROM AUTHOR]

Contemporary injury tolerance of the lumbar spine for under-body blast references axial compression and bending moments in a limited range. Since injuries often occur in a wider range of flexion and extension with increased moment contribution, this study expands a previously proposed combined loading injury criterion for the lumbar spine. Fifteen cadaveric lumbar spine failure tests with greater magnitudes of eccentric loading were incorporated into an existing injury criterion to augment its applicability and a combined loading injury risk model was proposed by means of survival analysis. A loglogistic distribution was the most representative of injury risk, resulting in optimized critical values of Fr,crit = 6011 N, and My,crit = 904 Nm for the proposed combined loading metric. The 50% probability of injury resulted in a combined loading metric value of 1, with 0.59 and 1.7 corresponding to 5 and 95% injury risk, respectively. The inclusion of eccentric loaded specimens resulted in an increased contribution of the bending moment relative to the previously investigated flexion/extension range (previous My,crit = 1155 Nm), with the contribution of the resultant sagittal force reduced by nearly 200 N (previous Fr,crit = 5824 N). The new critical values reflect an expanded flexion/extension range of applicability of the previously proposed combined loading injury criterion for the human lumbar spine during dynamic compression. [ABSTRACT FROM AUTHOR]

BACKGROUND: Finite element analysis is a commonly used mathematical modeling method to analyze the biomechanics of the lumbar spine. By constructing finite element models of the complex tissues such as muscles, blood vessels, and nerves in the lumbar region, mechanical analysis is performed to elucidate the pathogenesis of lumbar spine disorders and the mechanical mechanisms of treatment approaches. OBJECTIVE: To review the progress of finite element analysis in understanding the pathogenesis and treatment modalities of lumbar spine disorders, and to propose a new clinical workflow for the implementation of finite element analysis, aiming to provide a reference for future studies and promote the widespread utilization of finite element analysis in clinical diagnosis and treatment. METHODS: The PubMed database was searched using English keywords “finite element analysis, lumbar vertebra”, while the WanFang and China National Knowledge Infrastructure (CNKI) databases were searched using Chinese keywords “finite element analysis, lumbar vertebra”. A total of 73 articles were included for review. RESULTS AND CONCLUSION: (1) Lumbar spine degeneration in non-slipped patients typically originates from the posterior annulus fibrosus, while in patients with lumbar spine spondylolisthesis, degeneration starts from the lumbar facet joints due to abnormal mechanical mechanisms. (2) Restoring vertebral body height can prevent adjacent-level degeneration, and finite element analysis-measured vertebral compression strength can serve as an effective predictor of fracture risk, replacing bone density measurements. (3) In lumbar spine fusion surgery, selecting fusion devices of appropriate height and placing them transversely can prevent device subsidence. Increased intervertebral strain, circumferential stress, and intervertebral pressure in adjacent segments after fusion surgery may contribute to the occurrence of degenerative changes in neighboring segments. (4) Finite element analysis results suggest that preoperative planning for transforaminal endoscopic surgery should include considerations for osteotomy size to avoid excessive destruction of the articular process, and intraoperatively, preferential selection of a technique that traverses the superior articular process for foraminal dilatation. (5) In percutaneous kyphoplasty, bilateral pedicle screw augmentation should be performed, distributing bone cement on both sides of the pedicle. More advanced non-aluminum glass polyalkenoate cement materials should be selected. (6) Traction therapy should be personalized based on individual patient characteristics, including customized traction angles and forces, to achieve optimal therapeutic effects. (7) Manual therapy can induce relative displacement between the herniated intervertebral disc and the nerve root, thereby reducing compression. (8) The workflow involving CT/MR-AI Plus FEA-AI Plus Surgical robots can enable more precise diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Patients with symptomatic lumbar spinal stenosis (sLSS) are often limited in their walking range because of worsening symptoms, which is thought to induce changes in the gait pattern. The aim of this study was to determine whether changes in gait pattern and muscle activity in these patients are elicited by a walking stress and differ from asymptomatic controls. Twenty patients with sLSS and 19 asymptomatic controls performed a 30-minute walking stress. Gait was assessed using seven inertial sensors and sagittal joint range of motion (ROM) was calculated during different phases of gait. Muscle activation of the gluteus medius, erector spinae and multifidus muscles was measured by surface electromyography (EMG) and integrated EMGs (normalized to the maximum during gait) were calculated. Differences between groups and time points (beginning and end) were assessed using mixed factorial analysis of variance. Patients had less knee extension ROM in terminal stance, less knee flexion ROM in swing and less overall hip flexion/extension ROM than controls (p ≤ 0.03). There were no functionally relevant changes in these parameters during the walking stress. The integrated EMG was greater in all muscles in patients than in controls and increased in both groups during the walking stress in the paraspinal but not in the gluteus medius muscle. There was no interaction between group and time for any of the parameters. Differences in gait pattern and muscle activity between patients with sLSS and controls are generally present, but are not amplified by a walking stress. • Patients with lumbar spinal stenosis had less knee and hip range of motion. • Gluteus medius and paraspinal muscle activity was greater in patients. • Muscle activity increased in patients and controls during the walking stress. • Differences in gait pattern were not amplified by a walking stress. • In symptomatic spinal stenosis, a prolonged walking stress may not be necessary. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the impact of iliac crest height on clinical and radiological outcomes following oblique lateral interbody fusion (OLIF) at the L4–5 level. Methods: Data of patients who underwent single-level OLIF at the L4–5 level for degenerative spinal stenosis were retrospectively analyzed. The patients were categorized into three groups based on their iliac crest height measured relative to the L4 and L5 pedicles. Categorical and quantitative analyses, including univariate and multivariate logistic regressions, were performed to identify subsidence predictors. Clinical outcomes, including visual analog scale scores for back and leg pain, were assessed over a minimum 2-year follow-up. Results: No significant differences in cage obliquity were observed across the iliac crest height groups (axial angles, p = 0.39; coronal angles, p = 0.79). However, subsidence was significantly more common in patients with higher iliac crest heights, particularly at crest level III, where the subsidence rate reached 43% (p = 0.01). Subsidence was predominantly associated with damage to the L5 endplate, which occurred in 83% of subsidence cases at crest level III. A cutoff value of 12 mm for iliac crest height, above which the risk of subsidence significantly increased, was identified (AUC = 0.688, p = 0.042). Conclusions: Iliac crest height is a critical factor for predicting subsidence following OLIF at the L4–5 level. Surgeons should consider alternative strategies and meticulous preoperative planning in patients with an iliac crest height ≥ 12 mm to reduce the risk of adverse outcomes. Further studies are needed to validate these findings and to explore their long-term implications. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective cohort study. Objective. To investigate the impact of age on the incidence of vascular complications in patients undergoing anterior lumbar approach surgery. Background. Anterior approach lumbar spinal surgery may facilitate the use of intervertebral devices with larger endplate coverage and increased lordosis. Despite the advantages of this approach, risks related to vascular injury in older patients have been described in the literature. Patients and Methods. In total, 751 consecutive patients with degenerative spinal pathology who underwent stand-alone anterior lumbar interbody fusion (ALIF), ALIF combined with posterior fusion and/or instrumentation (360), total disc replacement, or hybrid procedures (ALIF and total disc replacement) were included. Data collected included general patient descriptive data, surgery details, intraoperative vascular injury, and postoperative vascular complications (deep vein thrombosis and/or pulmonary embolism). Rates of vascular complications were compared across age groups. In addition, the mean age of patients was compared between those with versus without vascular complications. Results. Overall mean age was 50.4 years (range: 20--83 yr). The mean estimated blood loss was 91.3 mL (range: 10--2800 mL). A total of 15 patients, 2.0%, had vascular complications. There were 10 cases (1.3%) of intraoperative injury to iliac arteries or iliolumbar veins (mean blood loss was 721 mL, and all were repaired intraoperatively). Postoperatively, 6 patients (0.8%) developed deep vein thrombosis and/or pulmonary embolism (one patient had both). With respect to age, there were no significant differences in rates of intraoperative, postoperative, or combined vascular complication rates across the age group (P > 0.38). In addition, there were no statistically significant differences in the mean ages of patients with versus those without vascular complications (P > 0.17). Conclusion. Overall incidence of vascular complications was 2.0%. No relationship between vascular complications and age was demonstrated. These data suggest that increased age may not necessarily be an absolute contraindication for anterior lumbar approach surgery. [ABSTRACT FROM AUTHOR]

Background/Objectives: Various surgical approaches have been proposed for treating adjacent segment disease (ASD) after lumbar fusion. However, studies using oblique lumbar interbody fusion (OLIF) to treat ASD are lacking. The current study assessed the postoperative outcomes of single-level OLIF for ASD, comparing the results with those for patients undergoing transforaminal lumbar interbody fusion (TLIF). Methods: Patients who underwent single-level OLIF or TLIF for lumbar ASD were retrospectively included. Clinical outcomes, that is, the results of assessments using the Euroqol 5-Dimension quality of life scale (EQ-5D), the Oswestry Disability Index, and the visual analog scale, were evaluated. Radiologic parameters, including disc height (DH), segmental lordosis (SL), segmental coronal angle (SCA), lumbar lordosis, and pelvic incidence–lumbar lordosis mismatch, were also assessed. Results: A total of 65 patients were enrolled: 32 in the OLIF group and 33 in the TLIF group. The median follow-up time was 24.0 months in both groups. The clinical outcomes and radiologic parameters significantly improved in both groups postoperatively. According to intergroup comparisons, the OLIF group had significantly less blood loss and superior improvement in radiologic parameters (DH, SL, and SCA) whereas the TLIF group had significantly shorter operation times. For the OLIF patients who did not undergo posterior decompression, the operation time was similar to that of the TLIF group, but the surgical blood loss and length of hospital stay were significantly reduced compared with the TLIF group. Conclusions: Compared with TLIF, OLIF provides similar clinical outcomes, leads to less surgical blood loss, and has superior radiologic parameters; however, the operation time is significantly longer. OLIF without posterior decompression may be a superior option to TLIF for certain patients. [ABSTRACT FROM AUTHOR]

Objective: Spine fixation surgery affects the biomechanical environment in the sacroiliac joint (SIJ), which may lead to the SIJ pain or degeneration after surgery. The purpose of this study is to determine the impact of the number and position of fixed segments on the SIJs and provide references for surgeons to plan fixation levels and enhance surgical outcomes. Methods: The intact lumbar‐pelvis finite element (FE) models and 11 fixation FE models with different number and position of fixed segments were developed based on CT images. A 400N follower load and 10° range of motion (ROM) of the spine were applied to the superior endplate of L1 to simulate the flexion, extension, bending and torsion motion after surgery. The peak stress on the SIJs, lumbar intervertebral discs, screws and rods were calculated to evaluate the biomechanical effects of fixation procedures. Results: With the lowermost instrumented vertebra (LIV) of L5 or S1, the peak stress on SIJs increased with the number of fixed segments increasing. The flexion motion led to the greater von Mises stress on SIJ compared with other load conditions. Compared with the intact model, peak stress on all fixed intervertebral discs was reduced in the models with less than three fixed segments, and it increased in the models with more than three fixed segments. The stress on the SIJ was extremely high in the models with all segments from L1 to L5 fixed, including L1‐L5, L1‐S1 and L1‐S2 fixation models. The stress on the segment adjacent to the fixed segments was significant higher compared to that in the intact model. The peak stress on rods and screws also increased with the number of fixed segments increasing in the flexion, extension and bending motion, and the bending and flexion motions led to the greater von Mises stress on SIJs. Conclusion: Short‐term fixation (≤2 segments) did not increase the stress on the SIJs significantly, while long‐term segment fixation (≥4 segments) led to greater stress on the SIJs especially when all the L1‐L5 segments were fixed. Unfixed lumbar segments compensated the ROM loss of the fixed segments, and the preservation of lumbar spine mobility would reduce the risks of SIJ degeneration. [ABSTRACT FROM AUTHOR]

The golf swing has been associated with mechanical injury risk factors at many joints. One swing, the Minimalist Golf Swing, was hypothesised to reduce lumbar spine, lead hip, and lead knee ranges of motion and peak net joint moments, while affecting swing performance, compared to golfers' existing swings. Existing and MGS swings of 15 golfers with handicaps ranging from +2 to −20 were compared. During MGS downswing, golfers had 18.3% less lumbar spine transverse plane ROM, 40.7 and 41.8% less lead hip sagittal and frontal plane ROM, and 39.2% less lead knee sagittal plane ROM. MGS reduced lead hip extensor, abductor, and internal rotator moments by 17.8, 19.7 and 43%, while lead knee extensor, abductor, adductor and external rotator moments were reduced by 24.1, 26.6, 37 and 68.8% respectively. With MGS, club approach was 2° shallower, path 4° more in-to-out and speed 2 m/s slower. MGS reduced certain joint ROM and moments that are linked to injury risk factors, while influencing club impact factors with varying effect. Most golf injuries are from overuse, so reduced loads per cycle with MGS may extend the healthy life of joints, and permit golfers to play injury-free for more years. [ABSTRACT FROM AUTHOR]

As few anaesthetists provide lumbar erector spinae block for disc surgery, there is a need to provide training to enable a randomised controlled trial investigating analgesia after painful spinal surgery (NIHR153170). The primary objective of the study was to develop and measure the construct validity of a checklist for assessment of skills in performing lumbar and thoracic erector spinae fascial plane injection using soft-embalmed Thiel cadavers. Twenty-four UK consultant regional anaesthetists completed two iterations of a Delphi questionnaire. The final checklist consisted of 11 steps conducive to best practice. Thereafter, we validated the checklist by comparing the performance of 12 experts with 12 novices, each performing lumbar and thoracic erector spinae plane injections or fascia iliaca, serrato-pectoral (PEC II) and serratus injections, randomly allocated to the left and right sides of six soft-embalmed Thiel cadavers. Six expert, trained raters blinded to operator and site of block examined 120 videos each. The mean (95% confidence interval) internal consistency of the 11-item checklist for erector spinae plane injection was 0.72 (0.63–0.79) and interclass correlation was 0.88 (0.82–0.93). The checklist showed construct validity for lumbar and thoracic erector spinae injection, experts vs novices {median (interquartile range [range]) 8.0 (7.0–10.0 [1–11]) vs 7.0 (5.0–9.0 [4–11]), difference 1.5 (1.0–2.5), P <0.001}. Global rating scales showed construct validity for lumbar and thoracic erector spinae injection, 28.0 (24.0–31.0 [7–35]) vs 21.0 (17.0–24.0 [7–35]), difference 7.5 (6.0–8.5), P <0.001. The most difficult items to perform were identifying the needle tip before advancing and always visualising the needle tip. Instrument handling and flow of procedure were the areas of greatest difficulty on the global rating scale (GRS). Checklists and GRS scores correlated. There was homogeneity of regression slopes controlling for status, type of injection, and rater. Generalisability analysis showed a high reliability using the checklist and GRS for all fascial plane blocks (Rho [ρ2] 0.93–0.96: Phi [ϕ] 0.84–0.87). An 11-point checklist developed through a modified Delphi process to provide best practice guidance for fascial plane injection showed construct validity in performing lumbar and thoracic erector spinae fascial plane injection in soft-embalmed Thiel cadavers. [ABSTRACT FROM AUTHOR]

Osteoporosis is under-diagnosed while detectable by measuring bone mineral density (BMD) using quantitative computer tomography (QCT). Opportunistic screening for low BMD has previously been suggested using lumbar QCT. However, thoracic QCT also possesses this potential to develop upper and lower cut-off values for low thoracic BMD, corresponding to the current cut-offs for lumbar BMD. In participants referred with chest pain, lumbar and thoracic BMD were measured using non-contrast lumbar- and cardiac CT scans. Lumbar BMD cut-off values for very low (< 80 mg/cm3), low (80–120 mg/cm3), and normal BMD (> 120 mg/cm3) were used to assess the corresponding thoracic values. A linear regression enabled identification of new diagnostic thoracic BMD cut-off values. The 177 participants (mean age 61 [range 31–74] years, 51% women) had a lumbar BMD of 121.6 mg/cm3 (95% CI 115.9–127.3) and a thoracic BMD of 137.0 mg/cm3 (95% CI: 131.5–142.5), p < 0.001. Categorization of lumbar BMD revealed 14%, 35%, and 45% in each BMD category. When applied for the thoracic BMD measurements, 25% of participants were reclassified into a lower group. Linear regression predicted a relationship of Thoracic BMD = 0.85 * Lumbar BMD + 33.5, yielding adjusted thoracic cut-off values of < 102 and > 136 mg/cm3. Significant differences in BMD between lumbar and thoracic regions were found, but a linear relationship enabled the development of thoracic upper and lower cut-off values for low BMD in the thoracic spine. As Thoracic CT scans are frequent, these findings will strengthen the utilization of CT images for opportunistic detection of osteoporosis. [ABSTRACT FROM AUTHOR]

Background: Oblique lumbar interbody fusion (OLIF) through a prepsoas approach was identified as an alternative to alleviate complications associated with direct lateral interbody fusion. Cage placement is known to influence cage subsidence and fusion rates due to suboptimal biomechanics. There are limited studies exploring cage obliquity as a potential factor influencing fusion outcomes. Hence, our objective was to assess the effects of cage obliquity and position on fusion rates, subsidence, and sagittal alignment in patients who underwent OLIF. Methods: Patients who underwent OLIF for levels L1 to L5 in our center, performed by a single surgeon and with a minimum of 12 months of follow-up, were included in the study. Cage obliquity and sagittal placement were measured, and their correlation with fusion, subsidence, and sagittal alignment correction was assessed. Fusion and subsidence were evaluated using the Bridwell Criteria and Marchi Criteria, respectively. Results: Among the included patients (age, 67.5 ± 7.93 years; 16 men and 37 women), 97 fusion levels were studied. The mean cage obliquity was 4.2° ± 2.8°. Ninety-six levels (99.0%) were considered to have achieved fusion with a Bridwell score of 1 or 2. Eighty-one (83.5%), 14 (14.4%), and 2 (2.06%) operated levels had a Marchi score of 0, 1, and 2, respectively. A Marchi grade of 1 or higher was considered indicative of significant subsidence. There was good improvement in both the segmental lordosis angle (4.2° ± 5.7°; P < 0.0001) and disc height (4.5 ± 3.8 mm; P < 0.0001). Cage placement did not have any statistical correlation with fusion rates, subsidence, or sagittal alignment. Conclusions: Our results indicate that OLIF facilitates appropriate cage placement with only a minor degree of cage obliquity, typically less than 20°. This minor obliquity does not lead to lower fusion rates, increased subsidence, or sagittal malalignment. Despite subsidence being common, the majority of these cases resulted in complete fusion. [ABSTRACT FROM AUTHOR]

Objectives: The general concern about low back pain (LBP) necessitates thoroughly examining its various causes and feasible therapies. The current study investigated the causes and surgical treatments of back pain by tailoring treatments to the patient’s specific needs. Methods: Two hundred individuals with LBP have been enrolled in this cross-sectional research. The radiological, magnetic resonance imaging (MRI) images and clinical evaluations were completed by neurosurgeons and used to categorize the selected patients from those attending neurosurgical outpatient clinics. Multiple causes of LBP, including disk prolapse, spinal stenosis, and muscular spasms, were investigated. Detailed descriptions of surgical approaches for various stages of disk prolapse and stenosis were given to help decide the optimal surgical tactics. The data were compiled into an Excel sheet, and the percentages and numbers were sorted and computed appropriately. Results: The data present an extensive overview of the distribution pattern of back pain causes, disk prolapse, and spinal stenosis in the study community, along with the surgical procedures employed. Muscle spasms, disk prolapse, and spinal stenosis are the main causes of back pain (20%, 40%, and 13%, respectively). L5 and S1 are the most commonly involved in single-level disk prolapse (10%). Different spinal levels may have varying percentages of multiple-level disk prolapse (20%). There are multiple lumbar levels where spinal stenosis can occur, but the most common are L4 and L5 (20%). Distinct surgical approaches are employed for disk prolapse and stenosis at various levels of the spine, and the most frequent intervention was laminectomy in about 39% of total participants. Discussion: The study’s results demonstrate the complexity of the etiologies of back pain and the need for advanced surgical techniques. Particular emphasis is concentrated on spinal stenosis, including single- and multiple-level disk prolapse, and the relationship between surgical methods and causes. The study’s thorough comprehension is essential for tailored interventions based on patient traits, ultimately enhancing therapy and patient care.

Introduction: Intervertebral disc degeneration (IDD) is a primary cause of chronic back pain and disability, highlighting the need for precise detection and grading for effective treatment. This study focuses on developing and validating a convolutional neural network (CNN) with a You Only Look Once (YOLO) architecture model using the Pfirrmann grading system to classify and grade lumbar intervertebral disc degeneration based on magnetic resonance imaging (MRI) scans. Methods: We developed a deep learning model trained on a dataset of anonymized MRI studies of patients with symptomatic back pain. MRI images were segmented and annotated by radiologists according to the Pfirrmann grading for the datasets. The segmentation MRI-disc image dataset was prepared for three groups: a training set (1,000), a testing set (500), and an external validation set (500) to assess model generalizability without overlapping images. The model's performance was evaluated using accuracy, sensitivity, specificity, F1 score, prediction error, and ROC-AUC. Results: The AI model showed high performance across all metrics. For Grade I IDD, the model achieved an accuracy of 97%, 95%, and 92% in the training, testing, and external validation sets, respectively. For Grade II, the sensitivity was 100% in both training and testing sets and 98% in the validation set. For Grade III, the specificity was 95.4% in the training set and 94% in both testing and validation sets. For Grade IV, the F1 score was 97.77% in the training set and 95% in both testing and validation sets. For Grade V, the prediction error was 2.3%, 2%, and 2.5% in the training, testing, and validation sets, respectively. The overall ROC-AUC was 97%, 92%, and 95% in the training, testing, and validation sets, respectively. Conclusions: The AI-based classification model exhibits high accuracy, sensitivity, and specificity in detecting and grading lumbar IDD using the Pfirrmann grading. AI has significantly enhanced diagnostic precision and reliability, providing a powerful tool for clinicians in managing IDD. The potential impact is substantial, although further clinical validation is necessary before integrating this model into routine practice.

Objective The cortical bone trajectory (CBT) technology is an effective substitute for traditional pedicle screw (PS) technology. However, there is still controversy about the CBT screw technology placement strategy. The objective of this study was to simulate cortical screw placement with the help of three‐dimensional (3D) software, to discuss the differences in screws between genders and vertebral segments, and to explore a safer and more efficient strategy for cortical screw placement. Methods Mimics Medical software was used to construct a 3D model of the lumbar spine, and the placement of CBT screws was simulated. The volume of each vertebral body from L1 to L5, the pedicle isthmus height (IH), the pedicle isthmus width (IW), and the sagittal vertebral distance (SAVD) were measured. The transverse distance (TD) and the longitudinal distance (LD) between the ideal starting point (SP) and the clinical SP (the intersection Q of the midline of the superior articular process and the horizontal line 1 mm below the transverse process) were measured. The cephalad angle (CA), lateral angle (LA), maximum screw diameter (MSD), maximum screw length (MSL) of each trajectory of the L1 to L5 vertebral bodies, and the percentage of the screw insertion depth (PSID) into the vertebral body were measured. Data were statistically analyzed using Student's t‐test, one‐way analysis of variance (ANOVA), and Tukey's test. Results Vertebral anatomical parameters and CBT screw parameters differed between males and females. Female patients had lower IH, IW, SAVD, CA, LA, MSD, and MSL than males. IH was greatest in L1 (male, 17.81 mm; female, 16.12 mm) and the smallest in L5 (male, 14.11 mm; female, 13.05 mm). IW was smallest in L1 (male, 8.89 mm; female, 7.37 mm) and greatest in L5 (male, 16.59 mm; female, 15.43 mm). The MSD of males was smallest in L1 (6.05 mm) and greatest in L3 (7.06 mm); the MSD of females was smallest in L1 (5.13 mm) and greatest in L4 (6.64 mm). MSL was greatest at L3 (male, 33.63 mm; female, 32.28 mm) and smallest at L5 (male, 31.25 mm; female, 29.97 mm). CA was smallest in L1 (male, 22.80°; female, 21.92°) and greatest in L3 (male, 25.29°; female, 24.33°). LA was smallest in L1 (male 12.37°, female 11.27°) and greatest in L5 (male 13.56°, female 12.96°). Among the males, TD was smallest at L1 (−0.51 mm) and greatest at L5 (1.37 mm), while LD was greatest at L2 (3.46 mm) and smallest at L5 (2.40 mm). In females, TD was greatest at L1 (0.12 mm) and smallest at L3 (−0.51 mm), while LD was greatest at L1 (3.69 mm) and smallest at L5 (2.08 mm). In the overall sample, the incidence of SAVD and PSID gradually increased from L1 to L5. Conclusion The optimal screw placement strategy for CBT screws varies significantly according to sex and vertebral body segments, particularly noting the specificity of screw placement at L5. The optimal screw placement strategy should be selected based on the patient's sex and segment characteristics before surgery to maximize the safety and accuracy of CBT screw placement.

Objective: In this study, we aimed to compare the accuracies and efficiencies of dual-layer spectral computed tomography (CT), quantitative CT (QCT), and dual-energy X-ray absorptiometry (DXA) in diagnosing osteoporosis. Methods: From January to October, 2023, 30 outpatients, including 15 males (age (56.6±8.31) years old) and 15 females (age (65.13±7.16) years old), at the spine surgery department of Beijing Jishuitan Hospital were retrospectively analyzed. All patients underwent bilayer spectral CT, QCT, and DXA of the lumbar spine. Additionally, bone mineral density (BMD) values for the L1~L3 vertebral bodies and areal BMD values were measured using DXA. Based on the diagnostic criteria for osteoporosis using lumbar spine QCT and DXA, the study participants were divided into three groups: normal bone mass, abnormal/low bone mass, and osteoporosis groups. Accuracies of dual-energy spectral CT, QCT, and DXA for BMD measurements to diagnose osteoporosis were compared using Fisher’s exact test. Moreover, sensitivity and specificity of dual-energy spectral CT to measure volumetric BMD values for osteoporosis diagnosis were calculated using receiver operating characteristic curves. Results: A strong correlation was observed among the average BMD values for L1~L3 measured using all three methods (0.751~0.971). Accuracies of osteoporosis diagnosis using dual-energy spectral CT, QCT, and DXA were 66.7% (10/15), 53.3% (8/15), and 40% (6/15), respectively, in males and 93.3% (14/15), 86.7% (13/15), and 60% (9/15), respectively, in females, with statistically significant differences. Dual-energy spectral CT showed area under the curve values of 0.995 (sensitivity: 88.9%; specificity: 90.5%) and 0.784 (sensitivity: 60%; specificity: 93.3%) with QCT and DXA as reference standards, respectively, for osteoporosis diagnosis. Conclusion: Volumetric BMD values measured using dual-energy spectral CT were comparable to those measured using QCT for osteoporosis diagnosis, and both outperformed DXA in terms of diagnostic efficiency.

Abstract Background To establish a three-dimensional finite element model of the lumbar spine and investigate the impact of different fixation techniques on the biomechanical characteristics of oblique lumbar interbody fusion (OLIF). Methods The study aimed to establish and validate a comprehensive three-dimensional model of the lower lumbar spine (L3-S1) using the finite element method. L4-L5 was selected as the surgical segment, and four distinct OLIF surgical models were constructed: Stand-alone (SA), unilateral cortical bone trajectory screw (UCBT), bilateral cortical bone trajectory screw (BCBT), and bilateral pedicle screw (BPS). The models were underwent a pure moment of 10N·m to simulate lumbar extension, flexion, left bending, right bending, left and right rotation movements. Subsequently, the range of motion (ROM), cage stress, and fixation stress were calculated. Results In the L3-L5 segment, the BCBT group showed the most limited range of motion (ROM) under exercise load, indicating superior stability within this group. The ROM and cage stress values were found to be highest in the SA group. In contrast, the cage and internal fixation stress in the BPS group were observed to be lowest (9.91 ~ 53.83MPa, 44.93 ~ 84.85 MPa). With the exception of right bending and right rotation, the UCBT group demonstrated higher levels of internal fixation stress (102.20 ~ 164.62 MPa). Conclusions The study found that OLIF-assisted internal fixation improved segmental stability and reduced cage stress. The BPS group had advantages over the CBT group in preventing endplate damage and reducing the risk of cage subsidence. However, BCBT group has distinct merits in maintaining surgical segment stability, distributing stress load on the spinal motor unit, and reducing the likelihood of adjacent segment degeneration (ASD).

Objective Spine fixation surgery affects the biomechanical environment in the sacroiliac joint (SIJ), which may lead to the SIJ pain or degeneration after surgery. The purpose of this study is to determine the impact of the number and position of fixed segments on the SIJs and provide references for surgeons to plan fixation levels and enhance surgical outcomes. Methods The intact lumbar‐pelvis finite element (FE) models and 11 fixation FE models with different number and position of fixed segments were developed based on CT images. A 400N follower load and 10° range of motion (ROM) of the spine were applied to the superior endplate of L1 to simulate the flexion, extension, bending and torsion motion after surgery. The peak stress on the SIJs, lumbar intervertebral discs, screws and rods were calculated to evaluate the biomechanical effects of fixation procedures. Results With the lowermost instrumented vertebra (LIV) of L5 or S1, the peak stress on SIJs increased with the number of fixed segments increasing. The flexion motion led to the greater von Mises stress on SIJ compared with other load conditions. Compared with the intact model, peak stress on all fixed intervertebral discs was reduced in the models with less than three fixed segments, and it increased in the models with more than three fixed segments. The stress on the SIJ was extremely high in the models with all segments from L1 to L5 fixed, including L1‐L5, L1‐S1 and L1‐S2 fixation models. The stress on the segment adjacent to the fixed segments was significant higher compared to that in the intact model. The peak stress on rods and screws also increased with the number of fixed segments increasing in the flexion, extension and bending motion, and the bending and flexion motions led to the greater von Mises stress on SIJs. Conclusion Short‐term fixation (≤2 segments) did not increase the stress on the SIJs significantly, while long‐term segment fixation (≥4 segments) led to greater stress on the SIJs especially when all the L1‐L5 segments were fixed. Unfixed lumbar segments compensated the ROM loss of the fixed segments, and the preservation of lumbar spine mobility would reduce the risks of SIJ degeneration.

BACKGROUND: Lumbosacral transitional vertebrae (LSTVs) are congenital anomalies that occur in the spinal segments of L5-S1. These vertebrae result from sacralization of the lowermost lumbar segment or lumbarization of the uppermost sacral segment. When the lowest lumbar vertebra fuses or forms a false joint with the sacrum (pseudoarticulation), it can cause pain and manifest clinically as Bertolotti syndrome. OBSERVATIONS: A 36-year-old female presented with severe right-sided low-back pain. Computed tomography was unremarkable except for a right-sided Castellvi type IIA LSTV. The pain proved refractory to physical therapy and lumbar epidural spinal injections, but targeted steroid and bupivacaine injection of the pseudoarticulation led to 2 weeks of complete pain relief. She subsequently underwent minimally invasive resection of the pseudoarticulation, with immediate improvement in her low-back pain. The patient continued to be pain free at the 3-year follow-up. LESSONS: LSTVs alter the biomechanics of the lumbosacral spine, which can lead to medically refractory mechanical pain requiring surgical intervention. Select patients with Bertolotti syndrome can benefit from operative management, including resection, fusion, or decompression of the pathologic joint.

Laparoscopic anterior lumbar interbody fusion (L-ALIF), which employs laparoscopic cameras to facilitate a less invasive approach, originally gained traction during the 1990s but has subsequently fallen out of favor. As the envelope for endoscopic approaches continues to be pushed, a recurrence of interest in laparoscopic and/or endoscopic anterior approaches seems possible. Therefore, evaluating the current evidence base in regard to this approach is of much clinical relevance. To this end, a systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following keywords: (laparoscopic OR endoscopic) AND (anterior AND lumbar). Out of the 441 articles retrieved, 22 were selected for quantitative analysis. The primary outcome of interest was the radiographic fusion rate. The secondary outcome was the incidence of perioperative complications. Meta-analysis was performed using RStudios metafor package. Of the 1,079 included patients (mean age, 41.8±2.9 years), 481 were males (44.6%). The most common indication for L-ALIF surgery was degenerative disk disease (reported by 18 studies, 81.8%). The mean follow-up duration was 18.8±11.2 months (range, 6-43 months). The pooled fusion rate was 78.9% (95% confidence interval [CI], 68.9-90.4). Complications occurred in 19.2% (95% CI, 13.4-27.4) of L-ALIF cases. Additionally, 7.2% (95% CI, 4.6-11.4) of patients required conversion from L-ALIF to open surgery. Although L-ALIF does not appear to be supported by studies available in the literature, it is important to consider the context from which these results have been obtained. Even if these results are taken at face value, the failure of endoscopy to have a role in the ALIF approach does not mean that it should not be incorporated in posterior approaches.

Introduction: Pedicle screw loosening is a major problem in spine surgery. Computed tomography (CT) is the gold standard to diagnose screw loosening. Disadvantages of CT include low sensitivity and specificity for the detection of loosened screws as well as the need for radiation exposure. The aim of this study was to provide a proof of concept of a novel, non-invasive, inductive sensing device for transcutaneous detection of screw loosening using a pulse induction metal detector. Materials/Methods: Two fresh frozen human cadavers were initially instrumented in the lumbar spinal region (L1 to L5). After assessment of the sensing device behavior using a wooden beam and 3D printed place holders of predefined distances, the ability of implant detection and screw stability determination were assessed during two experiments. Pedicle screw loosening was induced using 3D printed drill/loosening guides during the instrumentation of the lumbar spine. Screw stability was determined by applying weight to the spinous processes of interest and measuring the relative movement of the pedicle screw using the inductive sensor coil. Results: The sensitivity of our detection coil for an implant movement measurement showed to be high at close distances (60mV voltage change per mm movement), with signal amplitude vanishing at sensing distances of 50mm or greater. Signal amplitude significantly (p < .05) differed with the number of instrumented levels. When differentiating between instrumentation with and without loosened screws, significant (p < .05) mean differences were found in half of all comparative cases. All these differences were smaller than the predefined signal voltage threshold of (60 mV/mm). Discussion/Conclusion: In this study, the feasibility of a new, inductive and non-invasive sensor concept was tested. While the basic principle of the approach is promising, our implementation was not successful in demonstrating sufficient sensitivity for the required detectability. It appears conceivable that the concept can be successfully implemented with more sensitive sensors and more complex evaluation methods.

BACKGROUND: It has been proved clinically that adhesion of fibrous scar with the dura mater or nerve root after lumbar operation is an important factor for postoperative symptoms, such as postoperative pain and numbness. OBJECTIVE: To verify the inhibitory effect of autologous ligamentum flavum on the formation of epidural fibrous scar after lumbar surgery and explore the possible molecular biological mechanism. METHODS: Forty-eight Japanese white rabbits (6-8 months old) were randomly divided into three groups: a ligamentum flavum preservation group, a ligamentum flavum non-preservation group, and an autologous fat reposition group. A lumbar laminectomy model was established in all the three groups of rabbits, and rabbit epidural tissues were collected at 3 and 6 weeks after modeling. Hematoxylin-eosin staining was used to observe histological changes and the number and density of fibroblasts, VG staining was used to observe the percentage of collagen fiber area, and immunohistochemistry was used to observe the expression of transforming growth factor β1 and Smad3 proteins. RESULTS AND CONCLUSION: Hematoxylin-eosin staining results revealed that fibroblasts in the ligamentum flavum preservation group were few and loosely arranged, while the cells in the ligamentum flavum non-preservation and autologous fat reposition groups were more numerous and closely arranged. The number density of fibroblasts in the ligamentum flavum preservation group was lower than that in the ligamentum flavum non-preservation and autologous fat reposition groups at 3 and 6 weeks after surgery (P < 0.05); however, there was no significant difference between the latter two groups. VG staining results showed that the collagen fibers in the ligamentum flavum preservation group were sparse and distributed unevenly, while a lot of red collagen fibers were gathered in the ligamentum flavum non-preservation and autologous fat reposition groups. The area percentage of collagen fibers in the ligamentum flavum preservation group was lower than that in the ligamentum flavum non-preservation and autologous fat reposition groups at 3 and 6 weeks after surgery (P < 0.05), but there was no significant difference between the latter two groups. The results of immunohistochemistry showed that the degree of positive staining of retained histone the ligamentum flavum preservation group was significantly lower than that of the other two groups. The absorbance value of transforming growth factor β1 and Smad3 in the ligamentum flavum preservation group was significantly lower than that in the other two groups at 3 and 6 weeks after surgery (P < 0.05), but there was no significant difference between the latter two groups. To conclude, there are different degrees of epidural fibrous scar formation after lumbar surgery. If the ligamentum flavum is preserved, it can help to reduce the number of epidural fibroblasts as well as the formation of collagen fibers, thus reducing the adhesion of the fibrous scar tissue to the dural sac and nerve root. The mechanism is not only a purely mechanical blockade, but also to reduce the formation of epidural fibrous scar by interfering with the transforming growth factor β1/Smad3 signaling pathway. [ABSTRACT FROM AUTHOR]