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Objective • The study aimed to evaluate the impact of OLIF on spinal-pelvic sagittal parameters and its correlation with clinical outcomes in patients with degenerative lumbar spondylolisthesis. Methods • A retrospective analysis of 43 patients (23 males, 20 females) with lumbar 4/5 degenerative spondylolisthesis who underwent OLIF from January 2018 to January 2023 was conducted. Key parameters studied included SP, DH, FH, AS, LL, SS, PT, PI, and LASD. Results • All surgeries were successfully completed according to the original plan, and the minimum followup time was greater than 6 months, with a mean operation time of 198.21±51.32 min; the mean intraoperative bleeding volume was 121.00±56.88 ml. The VAS score of lumbar pain and ODI index decreased from the preoperative VAS score, and the ODI index of lower lumbar pain from the preoperative VAS score of 6.50±1.36 and 74.36±6.27 to the postoperative Lumbar pain of 3.20±1.28 and 32.41±8.21, respectively, and the differences were statistically significant (P < .05). 6.27 to 3.20±1.28 and 32.41±8.21 at the final follow-up visit. The differences were statistically significant (P < .05). The results of Pearson correlation analysis showed positive correlation between postoperative LL and FH, SP and AS, VAS (P < .05), and service correlation between SP and SS, LASD (P < .05), and correlation between pre- and postsurgery difference of LL, FH, SP and the improvement rate of ODI and VAS scores (P < .05), with the difference of pre- and post-surgery difference of LL, FH and the ODI, VAS score improvement rate were the strongest correlation. Postoperatively, significant improvements were observed in LL and FH. Pearson correlation analysis indicated a positive correlation between changes in sagittal parameters and clinical outcomes, measured by VAS and ODI scores. Conclusion • The postoperative spine-pelvis sagittal parameters were significantly improved compared with the preoperative ones, and the changes of the spine-pelvis sagittal parameters before and after the operation were correlated with the clinical outcomes, among which the differences of LL and FH had the strongest correlation with the improvement rates of ODI and VAS scores. OLIF effectively improved spinal-pelvic sagittal parameters and clinical outcomes in degenerative lumbar spondylolisthesis, with changes in LL and FH showing the strongest correlation with patient-reported outcome improvements. An oblique lateral interbody fusion can effectively reconstruct spine-pelvis sagittal parameters in patients with degenerative lumbar spondylolisthesis. [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]

Objectives: To compare the diagnostic performance and image quality of dual-energy computed tomography (DECT) with electron density (ED) image reconstruction with those of DECT with standard CT (SC) and virtual non-calcium (VNCa) image reconstructions, for diagnosing lumbar disc herniation (L-HIVD). Methods: A total of 59 patients (354 intervertebral discs from T12/L1 to L5/S1; mean age, 60 years; 30 women and 29 men) who underwent DECT with spectral reconstruction and 3-T MRI within 2 weeks were enrolled between March 2021 and February 2022. Four radiologists independently assessed three image sets of randomized ED, SC, and VNCa images to detect L-HIVD at 8-week intervals. The coefficient of variance (CV) and the Weber contrast of the ROIs in the normal and diseased disc to cerebrospinal fluid space (NCR-normal/-diseased, respectively) were calculated to compare the image qualities of the noiseless ED and other series. Results: Overall, 129 L-HIVDs were noted on MRI. In the detection of L-HIVD, ED showed a higher AUC and sensitivity than SC and VNCa; 0.871 vs 0.807 vs 833 (p = 0.002) and 81% vs 70% vs 74% (p = 0.006 for SC), respectively. CV was much lower in all measurements of ED than those for SC and VNCa (p < 0.001). Furthermore, NCR-normal and NCR-diseased were the highest in ED (ED vs SC in NCR-normal and NCR-diseased, p = 0.001 and p = 0.004, respectively; ED vs VNCa in NCR-diseased, p = 0.044). Conclusion: Compared to SC and VNCa images, DECT with ED reconstruction can enhance the AUC and sensitivity of L-HIVD detection with a lower CV and higher NCR. Clinical relevance statement: To our knowledge, this is the first study to quantify the image quality of noiseless ED images. ED imaging may be helpful for detecting L-HIVD in patients who cannot undergo MRI. Key Points: ED images have diagnostic potential, but relevant quantitative analyses of image quality are limited. ED images detect disc herniation, with a better coefficient of variance and normalized contrast ratio values. ED images could detect L-HIVD when MRI is not an option. [ABSTRACT FROM AUTHOR]

Study Design: A modified Delphi study. Purpose: This study sought to establish expert consensus on the use of cortical bone trajectory (CBT) for lumbar pedicle screws. Overview of Literature: The CBT technique is widely used in the treatment of various degenerative lumbar diseases because it reduces surgical time, soft tissue exposure, and blood loss; improves biomechanical stability; and allows for faster patient recovery. However, as an emerging surgical technique, CBT remains controversial in terms of preoperative evaluation methods, key surgical techniques, complication prevention and treatment, postoperative follow-up, and other aspects, resulting in unclear indications and contraindications for some doctors and posing great challenges to the steady promotion of this technique. Methods: From May 2021 to August 2021, panelists were chosen to collect expert feedback using the modified Delphi method, and 74 spine surgeons from across China agreed to participate. Four rounds were conducted: one in-person meeting and three subsequent survey rounds. Each question received at least 70.0% agreement, indicating a consensus. The grade A, B, and C recommendation were defined as having ≥90.0%, 80.0%–89.9%, and 70.0%–79.9% agreement on each question, respectively. Results: The panelist group consisted of 74 experts, and 72, 70, and 69 questionnaires were collected in three rounds, respectively. In total, 24 questions with 59 options reached consensus after the Delphi rounds, including indications (adjacent vertebral diseases after lumbar internal fixation) and contraindications (previous surgery or bone destructive diseases lead to the destruction or absence of bone in the lamina or isthmus); advantages (intraoperative traction of paravertebral soft tissue is small) and disadvantages (not three-column fixation.); preoperative evaluation; complications; and postoperative follow-up evaluation, of CBT. Conclusions: The modified Delphi method achieved expert consensus on the clinical use of CBT for lumbar pedicle screws. This consensus document establishes clear guidelines for indications, contraindications, surgical techniques, and postoperative management, thereby enhancing clinical decision-making and promoting the safe and effective use of CBT. While the initial study focused on Chinese surgeons, future research will seek to validate and expand these findings from a broader international perspective. [ABSTRACT FROM AUTHOR]

Study Design. Observational cohort study (secondary analysis of two randomized trials). Objective. The aim of this study was to investigate whether function, disability, pain, and quality of life before surgery and patient-reported outcome as well as complication and reoperation rates up to 2 years after surgery differ between lumbar spinal stenosis patients with and without spondylolisthesis. Summary of Background Data. Lumbar spinal stenosis is a degenerative condition of the spine, which appears with or without degenerative spondylolisthesis often presenting similar signs and symptoms. Materials and Methods. This study is a secondary analysis of two randomized trials on patients with lumbar spinal stenosis with and without spondylolisthesis conducted at 16 public Norwegian hospitals. Disability, function, back pain, leg pain, quality of life, complication, and reoperation rates up to 2 years after surgery were compared between the two cohorts patients with spondylolisthesis [median age: 67.0 yr (IQR: 61.0-72.0 yr); 68.7% female] and 437 patients without spondylolisthesis [median age: 68.0 yr (IQR: 62.0-73.0 yr); 52.9% female]. In the linear mixed-model analysis there were no significant differences in disability, function, back pain, leg pain, and quality of life scores between the two cohorts of patient with and without spondylolisthesis before surgery or at 2 years of follow-up. The complication rate was 22.9% in patients with spondylolisthesis and 12.1% in patients without spondylolisthesis (P < 0.001). There were no significant differences in reoperation rates. Conclusions. In patients with lumbar spinal stenosis the symptom burden before surgery and the clinical outcome up to 2 years after surgery were similar independently of a concomitant spondylolisthesis. [ABSTRACT FROM AUTHOR]

To compare the value of adipose tissues in abdomen and lumbar vertebra for predicting Crohn's disease (CD) activity based on chemical shift encoded magnetic resonance imaging (CSE-MRI). 84 CD patients were divided into remission, mild, and moderate-severely groups based on CD activity index (CDAI). Differences in different adipose parameters [subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), mesenteric fat index (MFI), and bone marrow fat fraction (BMFF)] and blood inflammatory indicators among three groups, as well as the correlation of above parameters and CDAI were analyzed. The areas under the receiver-operating characteristic curves (AUCs) for the parameters selected by multivariate logistic regression analysis for predicting active CD were calculated. There were no significant differences in VAT and MFI among three groups (both P > 0.05). The cross-sectional areas of SAT in moderate-severe group were significantly lower than those in remission group (P = 0.014). BMFF values of remission group were significantly higher than those in the mild and moderate-severe groups (both P < 0.001). BMFF was negatively correlated with CDAI (r = −0.595, P < 0.001). SAT exhibited no significant correlation with CDAI. Erythrocyte sedimentation rate (ESR) and BMFF were the independent predictors of CDAI. Both combined had a higher diagnostic efficacy for active CD with an AUC of 0.895. BMFF is the best marker for predicting CD activity in fat parameters of abdomen and lumbar vertebra based on CSE-MRI. The model based on BMFF and ESR has a high efficiency in predicting active CD. No. 22 K164 (Registered 18-07-2022). [ABSTRACT FROM AUTHOR]

Introduction: Despite the long-term use of intramuscular and intraosseous lidocaine trigger point injections (LTPI) in the treatment of patients with low back pain, there have been no studies examining their efficiency in treatment of residual pain after degenerative lumbar spinal stenosis (DLSS) decompression surgery. The purpose of our research is to examine the LTPI efficiency in the treatment of residual lumbar pain after DLSS decompression surgery and to compare the analgesic and recovery effects of intramuscular and intraosseous LTPI administered in the L4–S1 region and in the posterior superior iliac spine (PSIS) after treatment and during four months of follow-up. Materials and Methods: We observed 99 patients (F:50, M:49) aged 42 to 59 years with residual neurological disorders after DLSS decompression surgery. In all patients, the pain syndrome exceeded 6 points on the VAS and averaged 7.2 ± 0.11 points. The control group (n = 21) underwent only pharmacotherapy. In addition to pharmacotherapy, the LTPI group underwent intramuscular LTPI in L4–S1 (n = 20), intramuscular LTPI in the PSIS (n = 19), intraosseous LTPI in L5, S1 (n = 20), and intraosseous LTPI in the PSIS (n = 19). A neurological examination was carried out before treatment, 7 days after completion of treatment, and at the end of the second and fourth months of the follow-up period. Results: In the control group, intramuscular LTPI in L4–S1 subgroup, intramuscular LTPI in PSIS subgroup, intraosseous LTPI in L5, S1 subgroup, and intraosseous LTPI in PSIS subgroup, the severity of pain decreased after treatment by 27.1% (p ≤ 0.05), 41.7% (p ≤ 0.01), 50.7% (p ≤ 0.01), 69% (p ≤ 0.01), and 84.7% (p ≤ 0.01), respectively, and at the end of the second month of follow-up, by 14.3% (p > 1), 29.2% (p ≤ 0.05), 38% (p ≤ 0.01), 53.5% (p ≤ 0.01), and 72.2% (p ≤ 0.01), respectively. Reduction of neurogenic claudication, regression of sensory deficit, increase of daily step activity, and improvement of quality of life after treatment were noted in intramuscular LTPI subgroups by 19.6% (p ≤ 0.05), 36.4 (p ≤ 0.05), 40.3% (p ≤ 0.01), and 21.0% (p ≤ 0.05), respectively, and in interosseous LTPI subgroups by 48.6% (p ≤ 0.01), 67.4% (p ≤ 0.01), 68.3% (p ≤ 0.01), and 46% (p ≤ 0.01), respectively. Conclusions: LTPI is highly effective in the treatment of patients with residual pain after DLSS decompression surgery. High analgesic effect, significant regression of sensory deficits and gait disorders, and remarkable improvement of daily step activity and quality of life are noted not only after the end of LTPI treatment but also continue for at least 2 months after treatment. Intraosseous LTPI is more effective than intramuscular LTPI by 92%, and LTPI in PSIS is more effective than LTPI in L4–S1 by 28.6%. [ABSTRACT FROM AUTHOR]

Background: This study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches. Methods: From January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion. Results: There were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS(back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups. Conclusion: There was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient's financial situation, their ability to tolerate surgery, and the surgeon's expertise. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study is a retrospective analysis aimed at understanding the incidence and risk factors of proximal junctional kyphosis (PJK) following long-instrumented spinal fusion from L1 to the sacrum in patients with mild to moderate sagittal imbalance. Materials and Methods: It recruited consecutive patients undergoing instrumented fusion from L1 to the sacrum for degenerative lumbar disease between June 2006 and November 2019 in a single institution. The patients' preoperative clinical data, muscle status at T12-L1 on magnetic resonance images, and sagittal spinopelvic parameters were analyzed. Univariate analysis was used to compare clinical and radiographic data between PJK and non-PJK patients. Logistic regression analysis was used to investigate the independent risk factors for PJK. Results: A total of 56 patients were included in this study. The mean age at surgery was 67.3 years and mean follow-up period was 37.3 months. In total, 10 were male and 46 were female. PJK developed in 23 (41.1%) out of 56; of these patients, 20 (87.0%) developed PJK within 1 year postoperatively. In the univariate analysis between PJK and non-PJK patients, the PJK group showed more frequent osteoporosis, lower body mass index, smaller cross-sectional area (CSA) and more fat infiltration (FI) in erector spinae muscle at T12-L1 and larger preoperative TLK and PT with statistical significance (p < 0.05). In the logistic regression analysis, severe (>50%) FI in erector spinae muscle (OR = 43.60, CI 4.10–463.06, R2N = 0.730, p = 0.002) and osteoporosis (OR = 20.49, CI 1.58–264.99, R2N = 0.730, p = 0.021) were statistically significant. Conclusions: Preexisting severe (>50%) fat infiltration in the erector spinae muscle and osteoporosis were independent risk factors associated with PJK following instrumented fusion from L1 to the sacrum, but age was not a risk factor. [ABSTRACT FROM AUTHOR]

Background/Objectives: We sought to improve accuracy while minimizing radiation hazards, improving surgical outcomes, and preventing potential complications. Despite the increasing popularity of these systems, a limited number of papers have been published addressing the historical evolution, detailing the areas of use, and discussing the advantages and disadvantages, of this increasingly popular system in lumbar spine surgery. Our objective was to offer readers a concise overview of navigation system history in lumbar spine surgeries, the techniques involved, the advantages and disadvantages, and suggestions for future enhancements to the system. Methods: A comprehensive review of the literature was conducted, focusing on the development and implementation of navigation systems in lumbar spine surgeries. Our sources include PubMed-indexed peer-reviewed journals, clinical trial data, and case studies involving technologies such as computer-assisted surgery (CAS), image-guided surgery (IGS), and robotic-assisted systems. Results: To develop more practical, effective, and accurate navigation techniques for spine surgery, consistent advancements have been made over the past four decades. This technological progress began in the late 20th century and has since encompassed image-guided surgery, intraoperative imaging, advanced navigation combined with robotic assistance, and artificial intelligence. These technological advancements have significantly improved the accuracy of implant placement, reducing the risk of misplacement and related complications. Navigation has also been found to be particularly useful in tumor resection and minimally invasive surgery (MIS), where conventional anatomic landmarks are lacking or, in the case of MIS, not visible. Additionally, these innovations have led to shorter operative times, decreased radiation exposure for patients and surgical teams, and lower rates of reoperation. As navigation technology continues to evolve, future innovations are anticipated to further enhance the capabilities and accessibility of these systems, ultimately leading to improved patient outcomes in lumbar spine surgery. Conclusions: The initial limited utilization of navigation system in spine surgery has further expanded to encompass almost all fields of lumbar spine surgeries. As the cost-effectiveness and number of trained surgeons improve, a wider use of the system will be ensured so that the navigation system will be an indispensable tool in lumbar spine surgery. However, continued research and development, along with training programs for surgeons, are essential to fully realize the potential of these technologies in clinical practice. [ABSTRACT FROM AUTHOR]

This study analyzed and explored the relationship between isthmic spondylolisthesis and disc degeneration by comparing the degree of disc degeneration in patients with isthmic spondylolisthesis, lumbar disc herniation, and asymptomatic healthy individuals. This study included a total of 138 cases, consisting of L5-S1 single segment lesion patients and a normal lumbar spine population. The cases were divided into 3 groups based on the type of disease: fifty eight cases in the isthmic spondylolisthesis (IS) group, 50 cases in the lumbar disc herniation (LDH) group, and 30 cases in the normal lumbar vertebrae (NLV) group. The research findings indicate that the proportion of intervertebral disc degeneration in the LDH group is significantly higher than that in the IS group and NLV group (65.3% vs. 33.3% vs. 25.8%, P < 0.05). The Pfirrmann grades of lumbar intervertebral discs (L1-L4) in the LDH group are significantly higher than those in the IS group and NLV group (P < 0.05), and the intervertebral height index (IHI) (L1-L4) of lumbar vertebrae in the LDH group is significantly lower than that in the IS group and NLV group (P < 0.05). The results showed that the degree of intervertebral disc degeneration in patients with isthmic spondylolisthesis was lighter than that in patients with LDH, and even similar to that in healthy individuals. The occurrence of IS may have slowed down the degeneration of nonaffected segment intervertebral discs through certain factors. [ABSTRACT FROM AUTHOR]

Lumbar degenerative disc disease (LDDD) significantly contributes to low back pain, with a complicated etiology involving genetic and environmental facts. The aim of study was to investigate the association between the Taq I (rs731236) polymorphism of the vitamin D receptor (VDR) gene with LDDD. In total, 248 patients with symptomatic LDDD and 146 control subjects were examined. The evaluation of clinical features of patients with LDDD comprised radiodiagnostic magnetic resonance imaging, neurologic examinations, pain scores including the visual analog scale (VAS), and disability investigation with Oswestry Disability Index (ODI). Genotyping of the VDR gene polymorphism was conducted using polymerase chain reaction–based methods. Individuals of the LDDD group who were VDR TaqI AA genotype carriers were significantly greater than the other group (P = 0.014), whereas those with GG genotype were significantly lower (P = 0.028) in the patient group. In addition, VAS and ODI scores were significantly lower in the GG genotype carrier group, whereas AA genotype carriers had the greatest scores (P = 0.004). Carrying the G allele decreased the risk of LDDD 1.7 times (P = 0.014) and carrying the A allele enhanced the risk 1.8 times (P = 0.028). Moreover, G-allele carriers had significantly lower VAS (P = 0.002) and ODI scores (P < 0.0001). VDR Taq I (rs731236) GG genotype and G allele have protective potential, whereas the AA genotype and A allele are risk factors for LDDD. The findings reveal a statistically significant association of the Taq I (rs731236) polymorphism of VDR gene polymorphism with LDDD. This result highlights the potential role of genetic factors in developing LDDD and suggests avenues for future research in genetic screening and personalized treatment strategies. [ABSTRACT FROM AUTHOR]

To report the first case of hyperacute onset of adjacent segmental disease (ASD) with dorsally migrated herniated nucleus pulposus (HNP) causing cauda equina syndrome. A 55-year-old female complained of lower back pain with radiating pain in both lower extremities that had not responded to conservative treatment over the previous six months. Plain radiographs and magnetic resonance imaging (MRI) findings revealed degenerative spondylolisthesis with spinal stenosis at L3–4, L4–5, and a slight bulging disc at L2–3. The patient underwent decompressive total laminectomy and posterior fusion at L3–4 and L4–5. The stenotic symptoms improved significantly after surgery, and she was then discharged on postoperative day 7. However, the patient visited the emergency department four days after discharge (postoperative day 11) complaining of sudden onset of bilateral lower extremity weakness and voiding and defecation difficulties. The follow-up MRI showed dorsally migrated huge HNP and a detached posterior longitudinal ligament (PLL) at L2–3, which was diagnosed as hyperacute onset of ASD causing cauda equina syndrome. The patient underwent an emergency second operation consisting of partial laminectomy at L2–3 with removal of the dorsally migrated huge HNP. After the second operation, the symptoms of cauda equina syndrome improved. One year after the second operation, the patient is doing well without recurrence of symptoms. Our case showed that hyperacute onset of ASD with dorsally migrated huge HNP can cause cauda equina syndrome, even within 2 weeks after lumbar fusion surgery. Therefore, a high index of suspicion, timely diagnosis, and surgical treatment are needed to avoid the catastrophic neurologic complications in similar extremely rare cases. [ABSTRACT FROM AUTHOR]

• Patients with endplate defects had more severe symptoms of low back pain. • Up-regulated COX-2/PGE-2/EP-4 axis expression was found in cartilage endplates in patients with defected endplates. • COX-2/PGE-2/EP-4 axis may contribute to the progression of chronic low back pain in patients with endplate defects. Vertebral endplate defects are often implicated in degenerative disc disorders, yet their connection to patient-reported symptoms remains unclear. COX-2 and PGE-2 are known for their roles in inflammation and pain, with EP-4 receptor involvement in pain signaling. Examining their expression in vertebral endplate tissues may provide insights into pathomechanism of low back pain. To investigate the association between endplate defects and patient-reported symptoms and to further clarify the role of the COX-2/PGE-2/EP-4 axis in the pathogenesis of chronic low back pain. Retrospective study. A total of 71 patients who had undergone single-level L4/5 or L5/S1 modified laminectomy decompression preserving proximal upper laminae and transforaminal lumbar interbody fusion surgery were included in this study, including 18 patients diagnosed with lumbar disc herniation, 19 with lumbar disc herniation accompanied by degenerative lumbar spinal stenosis, and 34 with degenerative spondylolisthesis. Demographic data, Pfirrmann grade, Modic changes, endplate defect score, visual analog scale (VAS) for back and leg pain, and Oswestry Disability Index (ODI) before surgery, 3-month and 6-month follow-up, and the percentage of immune-positive cells (COX-2, PGE-2, and EP-4) in endplate tissue sections. Patients were divided into defect and nondefect groups according to endplate morphology on lumbar MR. All intraoperative endplate specimens were immediately fixed in 10% formaldehyde, and then embedded in paraffin 3 days later for tissue sections. The outcome measures were compared between the defect group and nondefect group. Data were analyzed using independent t -tests and χ² tests. Pearson's rank correlation test was used to assess correlations between patient-reported symptoms and the percentage of immune-positive cells in the groups. Multivariable logistic regression models using the forward stepwise likelihood ratio method were used to identify the factors that were independently associated with endplate defects. The age of Defect group was significantly higher than that of nondefect group (52.5±7.7 vs 57.2±9.1. p=.024). There were no significant differences in gender, diagnosis, BMI, comorbidities, or surgical level between the two groups. Modic changes (Type Ⅱ/Type Ⅲ) were more common in patients of Defect group than nondefect group (38.5% vs 11.1%, p<.001), and so was disc degeneration (Pfirrmann grade Ⅳ/Ⅴ) (69.2% vs 33.3%, p<.001). Defect group had significantly higher VAS-Back (6.5±2.0 vs 4.9±1.6, p<.001) and ODI scores (62.9±10.7 vs 45.2±14.8, p<.001) than nondefect group, while there was no significant differences between the two groups during the 3 and 6-month follow-up after surgery. Histologically, Defect group was characterized by upregulation of COX-2, PGE-2, and EP-4 in endplate tissue sections. Both in defect and nondefect groups, VAS-Back showed moderate positive correlations with the expressions of COX-2 (r=0.643; r=0.558, p both<.001), PGE-2 (r=0.611; r=0.640, p both<.001), and EP-4 (r=0.643; r=0.563, p both<.001). Multivariate regression analyses reveled that percentage of COX-2-positive cells was associated with endplate defects (OR=1.509, 95%CI [1.048–2.171], p=.027), as well as percentage of PGE-2-positive (OR=1.291, 95%CI [1.106–1.508], p=.001) and EP-4-positive cells (OR=1.284, 95%CI [1.048∼2.171], p=.003). Patients with endplate defects had worse quality of life, more severe disc degeneration and Modic changes, and up-regulated COX-2/PGE-2/EP-4 axis expression in cartilage endplates in patients with defected endplates. Inflammatory factors may significantly contribute to the onset and progression of chronic low back pain in patients with endplate defects, consequently impacting patient-reported symptoms. [ABSTRACT FROM AUTHOR]

Purpose: Selective nerve root blocks (SNRB) are used both as a therapeutic and diagnostic tool for lumbar radicular pain. Most studies evaluate the effect of SNRB simply by its relation to pain reduction. It is well known that pain is associated with other factors such as depression, anxiety, inactivity and sleeping disorders, but these patient-related outcomes are seldom evaluated. This study evaluated the influence of SNRB on pain-related outcomes including depression, anxiety, fatigue, pain interference, activity and sleep. Methods: One hundred three patients with lumbar radicular pain were treated with a SNRB. Patient-reported outcome measures (PROMs) were assessed with the PROMIS-29 for 12 weeks (84 days) following the SNRB. Patients were stratified based on their pain reduction at the 14-day follow up as responders (≥ 30% pain reduction) and non-responders (< 30% pain reduction). Post-treatment duration was estimated with the Kaplan–Meier analysis with return to baseline as an event. A paired t-test was used to compare pre- and post-treatment responses at specific time intervals. Results: Forty-four percent (n = 45) of the patients were responders and showed significant improvement in all parameters throughout the 84-days follow-up, the exception was sleep that lost significance at day 70. The mean post-treatment duration among responders was 59 (52–67) days. Non-responders showed significant improvements in pain interference and pain intensity until day 35 and in ability for social participation until 21-day. Conclusion: SNRB can improve pain intensity, pain interference, physical function, fatigue, anxiety, depression, sleep disturbance and the ability to participate in social roles. [ABSTRACT FROM AUTHOR]

One of the most common complications of lumbar fusions is cage subsidence, which leads to collapse of disc height and reappearance of the presenting symptomology. However, definitions of cage subsidence are inconsistent, leading to a variety of subsidence calculation methodologies and thresholds. To review previously published literature on cage subsidence in order to present the most common methods for calculating and defining subsidence in the anterior lumbar interbody fusion (ALIF), oblique lateral interbody fusion (OLIF), and lateral lumbar interbody fusion (LLIF) approaches. A search was completed in PubMed and Embase with inclusion criteria focused on identifying any study that provided descriptions of the method, imaging modality, or subsidence threshold used to calculate the presence of cage subsidence. A total of 69 articles were included in the final analysis, of which 18 (26.1%) reported on the ALIF approach, 22 (31.9%) on the OLIF approach, and 31 (44.9%) on the LLIF approach, 2 of which reported on more than one approach. ALIF articles most commonly calculated the loss of disc height over time with a subsidence threshold of > 2 mm. Most OLIF articles calculated the total amount of cage migration into the vertebral bodies, with a threshold of > 2 mm. LLIF was the only approach in which most articles applied the same method for calculation, namely, a grading scale for classifying the loss of disc height over time. We recommend future articles adhere to the most common methodologies presented here to ensure accuracy and generalizability in reporting cage subsidence. [ABSTRACT FROM AUTHOR]

Purpose: Greater trochanter pain syndrome (GTPS) is highly discussed during spine surgeons, accompanies lumbar pain and complicates differential diagnosis. The aim is to raise awareness among physicians and demonstrate the lumbar spine degenerative diseases (LSDD) association with GTPS. Methods: A retro-prospective analysis enrolled 172 patients with LSDD with GTPS signs. Group I – retrospective (n = 112), group II – prospective (n = 60). Patients of group II with the confirmed diagnosis clinically and by the ultrasound recieved a GCS injection (Betamethasone 2 mg\ml + 5 mg\ml — 1.0). Also the VAS, X-ray and SPSS Statistics package were used. Results: 112 patients in group I, 89 (79.5%) had increased pain in the hip early postOp to 7.8 points by VAS. All patients required trigger point injections of GCS and 68 (77%) received a repeat injection. 76 from 112 patients were tracked for long-term results, and recurrence of GTPS was detected in five people who treated conservatively for three months without dynamics. They were identified GTPS by ultrasound. During the injection, 39 from 43 (90%) patients noted pain reduction to 2.1 by VAS, but symptoms of radiculopathy or spinal stenosis persisted. Two patients (5%) did not note any changes. Two patients (5%) noted complete pain regression and refused the surgery. Conclusion: Timely detection of GTPS among spinal surgeons influences tactics and, in some cases, allows one to avoid unnecessary surgical interventions. In turn, ignoring the symptoms of GTPS in the preoperative period can lead to pain intensification in the greater trochanter after surgery for degenerative diseases of the spine. [ABSTRACT FROM AUTHOR]

Purpose: To investigate variation in treatment decisions among spine surgeons in South Africa and the association between surgeon characteristics and the treatment they select. Methods: We surveyed 79 South African spine surgeons. We presented four vignettes (cervical spine distractive flexion injury, lumbar disc herniation, degenerative spondylolisthesis with stenosis, and insufficiency fracture) for them to assess and select treatments. We calculated the index of qualitative variation (IQV) to determine the degree of variability within each vignette. We used Fisher's exact, and Kruskal–Wallis tests to assess the relationships between surgeons' characteristics and their responses per vignette. We compared their responses to the recommendations of a panel of spine specialists. Results: IQVs showed moderate to high variability for cervical spine distractive flexion injury and insufficiency fracture and slightly lower levels of variability for lumbar disc herniation and degenerative spondylolisthesis with stenosis. This confirms the heterogeneity in South African spine surgeons' management of spinal pathologies. The surgeon characteristics associated with their treatment selection that were important were caseload, experience and training, and external funding. Also, 19% of the surgeons selected a treatment option that the Panel did not support. Conclusion: The findings make a case for evaluating patient outcomes and costs to identify value-based care. Such research would help countries that are seeking to contract with providers on value. Greater uniformity in treatment and easily accessible outcomes reporting would provide guidance for patients. Further investment in training and participation in fellowship programs may be necessary, along with greater dissemination of information from the literature. [ABSTRACT FROM AUTHOR]

Purpose: Baastrup's disease is characterized by abnormal contact between adjacent spinous processes. Our study is the first to systematically incorporate the STIR sequence, recognized for its heightened sensitivity to fluid and edema, into the MRI protocol for diagnosing Baastrup's disease in symptomatic individuals. The objective is to determine its prevalence and association with lumbar spinal degenerative changes. Materials and methods: Lumbar spinal MRI examinations of 375 patients performed between January 2021 and 2022 were retrospectively reviewed by two radiologists. Baastrup's disease was diagnosed based on meeting any of the following criteria: lumbar interspinous bursitis, hyperintense signal changes in adjacent spinous processes, and ligaments on the STIR sequence. The study also investigated the presence of degenerative changes and interreader agreement among radiologists. Results: Baastrup's disease was found in 141 of 375 individuals (37.8%). It correlated significantly with degenerative lumbar changes such as bulging (P = 0.0012), herniation (P = 0.0033), disc degeneration (P = 0.0013), Modic changes (P = 0.034), facet osteoarthritis (P = 0.0041), spinal stenosis (P = 0.005), and anterolisthesis (P = 0.0049). No significant associations were observed with gender (P = 0.468) or retrolisthesis (P = 0.167). Its occurrence increased gradually, peaking at 87.5% in individuals aged 80 and above. Radiologists showed complete agreement with Baastrup's diagnoses. Conclusion: Baastrup's disease is more commonly observed than being considered rare, displaying an incremental occurrence with increasing age in symptomatic individuals notably discernible on the STIR sequence. Using the STIR sequence seems to promote a consensus among radiologists, irrespective of their experience levels. [ABSTRACT FROM AUTHOR]

Background: Despite improvements in drug therapy and treatment of lumbar spinal disorders, dependence on opioid medication for postoperative pain control remains a concern nationwide. This study assessed the ability to diminish the reliance on opioid medication postoperatively with the Food and Drug Administration-approved local anesthetic liposomal bupivacaine in open posterior lumbar decompression and fusion procedures. In addition, the possible effects of this modality on other parameters were studied regarding patients and their recovery. Materials and Methods: A retrospective chart review of 198 patients who underwent an open posterior lumbar laminectomy and fusion surgery with instrumentation treated by a single surgeon in a single institution was conducted. Ninety-nine patients who received liposomal bupivacaine administered intraoperatively were then matched by age, sex, and procedure with the same number of patients treated prior to the availability of liposomal bupivacaine. We evaluated how the use of liposomal bupivacaine affected the requirement for postoperative opioid medication, as well as related changes in length of stay, the use of antiemetics, and urinary retention postoperatively. Results: The patients who received liposomal bupivacaine required less than half of the morphine milligram equivalents of narcotic medications during their hospital stay compared with patients who did not receive liposomal bupivacaine (approximately 57% reduction). Conclusion: The findings of this study suggest that the addition of liposomal bupivacaine to traditional pain management modalities can augment pain management for patients undergoing posterior lumbar surgery, as evidenced by the significant decrease in postoperative morphine milligram equivalents required. [Orthopedics. 2024;47(4):244–248.] [ABSTRACT FROM AUTHOR]

Background: We compared magnetic resonance imaging (MRI) turbo spin-echo images reconstructed using a deep learning technique (TSE-DL) with standard turbo spin-echo (TSE-SD) images of the lumbar spine regarding image quality and detection performance of common degenerative pathologies. Methods: This prospective, single-center study included 31 patients (15 males and 16 females; aged 51 ± 16 years (mean ± standard deviation)) who underwent lumbar spine exams with both TSE-SD and TSE-DL acquisitions for degenerative spine diseases. Images were analyzed by two radiologists and assessed for qualitative image quality using a 4-point Likert scale, quantitative signal-to-noise ratio (SNR) of anatomic landmarks, and detection of common pathologies. Paired-sample t, Wilcoxon, and McNemar tests, unweighted/linearly weighted Cohen κ statistics, and intraclass correlation coefficients were used. Results: Scan time for TSE-DL and TSE-SD protocols was 2:55 and 5:17 min:s, respectively. The overall image quality was either significantly higher for TSE-DL or not significantly different between TSE-SD and TSE-DL. TSE-DL demonstrated higher SNR and subject noise scores than TSE-SD. For pathology detection, the interreader agreement was substantial to almost perfect for TSE-DL, with κ values ranging from 0.61 to 1.00; the interprotocol agreement was almost perfect for both readers, with κ values ranging from 0.84 to 1.00. There was no significant difference in the diagnostic confidence or detection rate of common pathologies between the two sequences (p ≥ 0.081). Conclusions: TSE-DL allowed for a 45% reduction in scan time over TSE-SD in lumbar spine MRI without compromising the overall image quality and showed comparable detection performance of common pathologies in the evaluation of degenerative lumbar spine changes. Relevance statement: Deep learning-reconstructed lumbar spine MRI protocol enabled a 45% reduction in scan time compared with conventional reconstruction, with comparable image quality and detection performance of common degenerative pathologies. Key points: • Lumbar spine MRI with deep learning reconstruction has broad application prospects. • Deep learning reconstruction of lumbar spine MRI saved 45% scan time without compromising overall image quality. • When compared with standard sequences, deep learning reconstruction showed similar detection performance of common degenerative lumbar spine pathologies. [ABSTRACT FROM AUTHOR]

Objective: Given the distinct physiological and societal traits between women and men, we propose that there are distinct risk factors for lumbar degenerative disc disease surgeries, including lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS), in middle‐aged and older populations. However, few studies have focused on middle‐aged and older women. This study aims to identify these risk factors specifically in this population. Methods: In this case–control study, the study group comprised 1202 women aged ≥ 45 years who underwent operative treatment of lumbar degenerative disc disease (LDH, n = 825; LSS, n = 377), and the control group comprised 1168 women without lumbar disease who visited a health examination clinic during the same period. The study factors included demographics (age, body mass index [BMI], smoking, labor intensity, and genetic history), female‐specific factors (menopausal status, number of deliveries, cesarean section, and simple hysterectomy), surgical history (number of abdominal surgeries, hip joint surgery, knee joint surgery, and thyroidectomy), and systemic diseases (hypercholesterolemia, hypertriglyceridemia, hyper‐low‐density lipoprotein cholesterolemia, hypertension, diabetes, cardiovascular disease, and cerebrovascular disease). Multivariate binary logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) of associated factors. Results: The risk factors for surgical treatment of LDH in middle‐aged and older women included BMI (OR = 1.603), labor intensity (OR = 1.189), genetic history (OR = 2.212), number of deliveries (OR = 1.736), simple hysterectomy (OR = 2.511), hypertriglyceridemia (OR = 1.932), and hyper‐low‐density lipoprotein cholesterolemia (OR = 2.662). For surgical treatment of LSS, the risk factors were age (OR = 1.889), BMI (OR = 1.671), genetic history (OR = 2.134), number of deliveries (OR = 2.962), simple hysterectomy (OR = 1.968), knee joint surgery (OR = 2.527), hypertriglyceridemia (OR = 1.476), hyper‐low‐density lipoprotein cholesterolemia (OR = 2.413), and diabetes (OR = 1.643). Cerebrovascular disease was a protective factor against surgery for LDH (OR = 0.267). Conclusions: BMI, genetic history, number of deliveries, simple hysterectomy, hypertriglyceridemia, and hyper‐low‐density lipoprotein cholesterolemia were independent risk factors for surgical treatment of both LDH and LSS in middle‐aged and older women. Two disparities were found: labor intensity was a risk factor for LDH patients, and knee joint surgery and diabetes were risk factors for LSS patients. [ABSTRACT FROM AUTHOR]

Lumbosacral transitional vertebrae (LSTV) are congenital anomalies of the L5-S1 segments characterized by either sacralization of the most caudal lumbar vertebra or lumbarization of the most cephalad sacral vertebra. This variation in anatomy exposes patients to additional surgical risks. In order to shed light on surgical considerations reported for lumbar spine cases involving LSTV as described in the extant literature, we performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We also present a case example in which wrong level surgery was avoided due to anatomical understanding of LSTV. A 48-year-old female presented with severe back pain after sustaining a fall from ten feet. The patient exhibited full motor function in all extremities but had begun to experience urinary retention. On initial imaging read, the patient was suspected to have an L1 burst fracture. A review of the imaging demonstrated a transitional vertebra. Therefore, based on the last rib corresponding to T12, the fractured level was L2. This case illustrates the risk LSTV carries for wrong site surgery; appropriate levels were then decompressed and instrumented. On systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a three database literature search identified 39 studies describing 885 patients with LSTV and relevant surgical considerations. The primary indications for surgery were for disc herniation (37%), Bertolotti's syndrome (35%), and spinal stenosis (25%). This cohort displayed a mean follow-up time of 23 months. Reherniation occurred in 12 patients (5.5%). Medical management through steroid injection was 24, 72% (n = 80) for the sample. Wrong level surgery occurred in 1.4% (n = 12) of patients. LSTV represents a constellation of changes in anatomy beyond just a sacralized or lumbarized vertebra. These anatomical differences expose the patient to additional surgical risks. This case and review of the literature highlight avoidable complications and in particular wrong level surgery. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic value of axial T1-weighted imaging for patients suffering from lower back pain. Materials and methods: In this retrospective study, 100 consecutive lumbar spine MRIs obtained in patients with chronic low back pain were reviewed in two sessions: First, readers viewed core sequences (sagittal T1-weighted, STIR and T2-weighted, and axial T2-weighted) with axial T1-weighted sequences, and second, readers viewed cores sequences alone. Readers recorded the presence of disc degeneration, nerve root compromise, facet joint arthritis, and stenosis at each lumbar spine level as well as the presence of lipoma of filum terminale (LFT), spondylolisthesis, transitional vertebrae, and fractures. The McNemar, Wilcoxon signed-rank, and student T tests were utilized. Results: For 100 studies, 5 spine levels were evaluated (L1–L2 through L5–S1). There were cases of disc disease (444/500 bulges, 56/500 herniations), nerve root compromise (1/500 nerve enlargement, 36/500 contact only, 20/500 displacement or compression), facet arthritis (438/500), stenosis (58/500 central canal, 64/500 lateral recess, 137/500 neuroforaminal), 6/100 LFTs, and other abnormalities (58/500 spondylolisthesis, 10/100 transitional vertebrae, 10/500 fracture/spondylolysis). There was no difference in diagnostic performance between the interpretation sessions (with and without axial T1-weighted imaging) at any level (p > 0.05), although four small additional LFTs were identified with axial T1-weighted imaging availability. Conclusion: There was no clinically significant difference in the interpretation of lumbar spine MRI viewed with and without axial T1-weighted imaging, suggesting that the axial T1-weighted sequence does not add diagnostic value to routine lumbar spine MRI. [ABSTRACT FROM AUTHOR]

Lumbar back pain is one of the main causes of disability around the world. Most patients will complain of back pain at least once in their lifetime. The degenerative spine is considered the main cause and is extremely common in the elderly population. Consequently, treatment-related costs are a major burden to the healthcare system in developed and undeveloped countries. After the failure of conservative treatments or to avoid daily chronic drug intake, invasive treatments should be suggested. In a world where many patients reject surgery and prefer minimally invasive procedures, interventional radiology is pivotal in pain management and could represent a bridge between medical therapy and surgical treatment. We herein report the different image-guided procedures that can be used to manage degenerative spine-related low back pain. Particularly, we will focus on indications, different techniques, and treatment outcomes reported in the literature. This literature review focuses on the different minimally invasive percutaneous treatments currently available, underlining the central role of radiologists having the capability to use high-end imaging technology for diagnosis and subsequent treatment, allowing a global approach, reducing unnecessary surgeries and prolonged pain-reliever drug intake with their consequent related complications, improving patients' quality of life, and reducing the economic burden. [ABSTRACT FROM AUTHOR]

Cage subsidence after lumbar fusion can lead to many adverse outcomes. Low bone mineral density (BMD) is a widely recognized risk factor for cage subsidence. Conventional methods can predict and evaluate BMD, but there are many shortcomings. Recently, MRI-based assessment of bone quality in specific parts of the vertebral body has been proposed, including scores for vertebral bone quality (VBQ) and endplate bone quality (EBQ). However, the predictive accuracy of the two scoring systems for cage subsidence after transforaminal lumbar interbody fusion (TLIF) remains unknown. Therefore, we investigated MRI-based VBQ and EBQ scores for assessing bone quality and compared their predictive value for cage subsidence after TLIF. To compare the predictive value between MRI-based VBQ and EBQ scores for cage subsidence after TLIF. A retrospective case-control study. Patients with degenerative lumbar diseases underwent single-level TLIF at our medical center between 2014 and 2020, all of whom had preoperative MRIs available. Cage subsidence, disc height, VBQ score, EBQ score, upper and lower vertebral body bone quality (UL-VBQ) score. Data were retrospectively examined for a consecutive sample of 346 patients who underwent TLIF at our medical center between 2014 and 2020. Patients who subsequently experienced cage subsidence or not were matched to each other based on propensity scoring, and the two matched groups (52 patients each) were compared using conditional logistic regression to investigate the association between the potential radiographic factors and cage subsidence. Scores for VBQ and EBQ were assessed for their ability to predict cage subsidence in the matched patients based on the area under the receiver operative characteristic curve (AUC). Among matched patients, those who suffered cage subsidence had significantly higher VBQ score (3.7 vs 3.1, p<.001) and EBQ score (5.0 vs 4.3, p<.001), and regression linked greater risk of subsidence to higher VBQ score (OR 4.557, 95% CI 1.076–19.291, p=.039) and higher EBQ score (OR 5.396, 95% CI 1.158–25.146, p=.032). A cut-off VBQ score of 3.4 predicted the cage subsidence among matched patients with an AUC of 0.799, sensitivity of 84.6%, and specificity of 69.2%. A cut-off EBQ score of 4.7 predicted subsidence with an AUC of 0.829, sensitivity of 76.9%, and specificity of 82.7%. Higher VBQ and EBQ scores are associated with a greater risk of cage subsidence following TLIF, and EBQ may perform better because of greater specificity. [ABSTRACT FROM AUTHOR]

Introduction: Interventional treatment options for the lumbar degenerative spine have undergone a significant amount of innovation over the last decade. As new technologies emerge, along with the surgical specialty expansion, there is no manuscript that utilizes a review of surgical treatments with evidence rankings from multiple specialties, namely, the interventional pain and spine communities. Through the Pacific Spine and Pain Society (PSPS), the purpose of this manuscript is to provide a balanced evidence review of available surgical treatments. Methods: The PSPS Research Committee created a working group that performed a comprehensive literature search on available surgical technologies for the treatment of the degenerative spine, utilizing the ranking assessment based on USPSTF (United States Preventative Services Taskforce) and NASS (North American Spine Society) criteria. Results: The surgical treatments were separated based on disease process, including treatments for degenerative disc disease, spondylolisthesis, and spinal stenosis. Conclusions: There is emerging and significant evidence to support multiple approaches to treat the symptomatic lumbar degenerative spine. As new technologies become available, training, education, credentialing, and peer review are essential for optimizing patient safety and successful outcomes. [ABSTRACT FROM AUTHOR]

Background: Adjacent segment disease (ASD) is a known sequela of thoracolumbar instrumented fusions. Various surgical options are available to address ASD in patients with intractable symptoms who have failed conservative measures. However, the optimal treatment strategy for symptomatic ASD has not been established. We examined several clinical outcomes utilizing different surgical interventions for symptomatic ASD. Methods: A retrospective review was performed for a consecutive series of patients undergoing revision surgery for thoracolumbar ASD between October 2011 and February 2022. Patients were treated with endoscopic decompression (n = 17), microdiscectomy (n = 9), lateral lumbar interbody fusion (LLIF; N = 26), or open laminectomy and fusion (LF; N = 55). The primary outcomes compared between groups were re-operation rates and numeric pain scores for leg and back at 2 weeks, 10 weeks, 6 months, and 12 months postoperation. Secondary outcomes included time to re-operation, estimated blood loss, and length of stay. Results: Of the 257 patients who underwent revision surgery for symptomatic ASD, 107 patients met inclusion criteria with a minimum of 1-year follow-up. The mean age of all patients was 67.90 ± 10.51 years. There was no statistically significant difference between groups in age, gender, preoperative American Society of Anesthesiologists scoring, number of previously fused levels, or preoperative numeric leg and back pain scores. The re-operation rates were significantly lower in LF (12.7%) and LLIF cohorts (19.2%) compared with microdiscectomy (33%) and endoscopic decompression (52.9%; P = 0.005). Only LF and LLIF cohorts experienced significantly decreased pain scores at all 4 follow-up visits (2 weeks, 10 weeks, 6 months, and 12 months; P < 0.001 and P < 0.05, respectively) relative to preoperative scores. Conclusion: Symptomatic ASD often requires treatment with revision surgery. Fusion surgeries (either stand-alone lateral interbody or posterolateral with instrumentation) were most effective and durable with respect to alleviating pain and avoiding additional revisions within the first 12 months following revision surgery. Clinical Relevance: This study emphasizes the importance of risk-stratifying patients to identify the least invasive approach that treats their symptoms and reduces the risk of future surgeries. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: Progenitor cells derived from intervertebral disc tissue demonstrated immunomodulatory and regenerative properties in preclinical studies. We report the safety and efficacy results of a Us Food and Drug Administration-approved clinical trial of these cells for the treatment of symptomatic degenerative disc disease. Methods: sixty patients with symptomatic single-level lumbar degenerative disc disease (mean age 37.9 years, 60% men) were enrolled in a randomized, double-blinded, placebo-controlled Phase I/Phase II study at 13 clinical sites. They were randomized to receive single intradiscal injections of either low-dose cells (N = 20), high-dose cells (N = 20), vehicle alone (N = 10), or placebo (N = 10). The primary endpoint was mean visual analog scale (VAs) pain improvement >30% at 52 weeks. Disc volume was radiologically assessed. Adverse events (AEs), regardless of whether they were related to treatment, were reported. Patients were assessed at baseline and at 4, 12, 26, 52, 78, and 104 weeks posttreatment. Results: At week 52, the high-dose group had a mean VAs percentage decrease from baseline (-62.8%, P = 0.0005), achieving the endpoint of back pain improvement >30%; the mean change was also significantly greater than the minimal clinically important difference of a 20-point decrease (-42.8, P = 0.001). This clinical improvement was maintained at week 104. The vehicle group had a smaller significant decrease in VAs (-52.8%, P = 0.044), while the low-dose and placebo groups showed nonsignificant improvements. Only the high-dose group had a significant change in disc volume, with mean increases of 249.0 mm3 (P = 0.028) at 52 weeks and 402.1 mm3 (P = 0.028) at 104 weeks. A minority of patients (18.3%) reported AEs that were severe. Overall, 6.7% of patients experienced serious AEs, all in the vehicle (n = 1) or placebo (n = 3) groups, none treatment related. Conclusions: High-dose allogeneic disc progenitor cells produced statistically significant, clinically meaningful improvements in back pain and disc volume at 1 year following a single intradiscal injection and were safe and well tolerated. These improvements were maintained at 2 years post-injection. Level of Evidence: 1. Clinical Trial Registration: NCT03347708--study to Evaluate the safety and Preliminary Efficacy of Injectable Disc Cell Therapy, a Treatment for symptomatic Lumbar Intervertebral Disc Degeneration. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this study is to present our experience in the surgical treatment of calcified thoracic herniated disc disease via a transthoracic approach in the lateral position with the use of intraoperative computed tomography (iCT) and augmented reality (AR). Materials and Methods: All patients who underwent surgery for calcified thoracic herniated disc via a transthoracic transpleural approach at our Department using iCT and microscope-based AR were included in the study. Results: Six consecutive patients (five female, median age 53.2 ± 6.4 years) with calcified herniated thoracic discs (two patients Th 10–11 level, two patients Th 7–8, one patient Th 9–10, one patient Th 11–12) were included in this case series. Indication for surgery included evidence of a calcified thoracic disc on magnet resonance imaging (MRI) and CT with spinal canal stenosis of >50% of diameter, intractable pain, and neurological deficits, as well as MRI-signs of myelopathy. Five patients had paraparesis and ataxia, and one patient had no deficit. All surgeries were performed in the lateral position via a transthoracic transpleural approach (Five from left side). CT for automatic registration was performed following the placement of the reference array, with a high registration accuracy. Microscope-based AR was used, with segmented structures of interest such as vertebral bodies, disc space, herniated disc, and dural sac. Mean operative time was 277.5 ± 156 min. The use of AR improved orientation in the operative field for identification, and tailored the resection of the herniated disc and the identification of the course of dural sac. A control-iCT scan confirmed the complete resection in five patients and incomplete resection of the herniated disc in one patient. In one patient, complications occurred, such as postoperative hematoma, and wound healing deficit occurred. Mean follow-up was 22.9 ± 16.5 months. Five patients improved following surgery, and one patient who had no deficits remained unchanged. Conclusions: Optimal surgical therapy in patients with calcified thoracic disc disease with compression of dural sac and myelopathy was resectioned via a transthoracic transpleural approach. The use of iCT-based registration and microscope-based AR significantly improved orientation in the operative field and facilitated safe resection of these lesions. [ABSTRACT FROM AUTHOR]

This document is an editorial published in the journal Frontiers in Neurology. It discusses the advances and controversies in the pathophysiology, diagnosis, and treatment of myelopathies and spinal cord injuries. The editorial highlights the high burden of spinal cord injuries on population health and the lack of universally effective treatment. It also explores various topics related to spinal cord injuries, including transverse myelitis, neuroprotective agents, regenerative neurology, degenerative cervical myelopathy, and central cord syndrome. The articles in this research topic provide a wide perspective on spinal cord injuries and contribute to our understanding of their pathophysiology and clinical management. [Extracted from the article]

Introduction: In Indonesia, spine procedure including surgery was increasing in the current years. However, there was a lack of data about it in Indonesia as a developing country. We collected and described all of spine procedure that had been done in a single center in Klaten regency as a representative of the facilities at rural area in developing settings. Method: This is a retrospective study including all patients who were undergoing spine procedure in the Department of Neurosurgery Dr Soeradji Tirtonegoro Central Public hospital of Klaten during the period of study from January 2019 to December 2022. The number of spine procedures was recorded and plotted in a pie chart and bar diagram. The data consisting pathology of the spine, spinal level affected, and type of procedure were obtained from medical records. Result: In the last four years, out of 210 cases in total, there was an increasing pattern of spine procedure with degenerative condition being the most common pathology of our cases. Lumbar region is the highly affected level of spine and our procedures mainly consisted of spine instrumentation. Conclusion: Even a rural area in developing country has a huge potency to develop advanced spine procedures. [ABSTRACT FROM AUTHOR]

The occurrence of surgical site infection (SSI) after lumbar spinal fusion is a serious complication. Therefore, an increasing number of clinicians are applying vancomycin powder topically in the surgical field to reduce the incidence of SSI. However, there is concern that topical vancomycin powder application may affect intervertebral fusion. The purpose of this study was to analyse the effect of clinically relevant topical vancomycin doses on the rate of intervertebral fusion after lumbar fusion and to further investigate the effect of vancomycin powder on the prevention of SSI. The clinical data of 192 patients with degenerative lumbar spine disease admitted from January 2019 to June 2022, all of whom underwent posterior lumbar fusion, were retrospectively analysed. According to the infection prevention protocol, they were divided into a vancomycin group and a control group (no vancomycin), and the vancomycin group was sub-divided into 0.5 g, 1.0 g, and 1.5 g vancomycin groups. General information and surgical evaluation indexes were compared between the control and vancomycin groups and intervertebral fusion was compared between the vancomycin groups at 6 months and 12 months, postoperatively. The rate of SSI in the vancomycin group was 0.0%, which was significantly lower than that in the control group (5.3%, P < 0.05), and intervertebral fusion was good in all 3 vancomycin groups at 6 months and 12 months postoperatively, with no statistically-significant differences (P > 0.05). Topical application of 0.5 g, 1.0 g, or 1.5 g vancomycin powder did not affect the rates of intervertebral fusion after lumbar fusion. In addition, topical application of vancomycin powder significantly reduced the rates of SSI. [ABSTRACT FROM AUTHOR]

To investigate the factors associated with the occurrence of Baastrup's disease (BA) in patients with lumbar degenerative diseases (LDDs). A retrospective analysis was conducted on 168 patients with LDDs (including lumbar disc herniation, lumbar spinal stenosis, and lumbar spondylolisthesis) who were treated at our hospital from January 2020 to January 2023, comprising 95 males and 73 females, aged 48–84 years.Patients were divided into two groups based on the presence of Baastrup's disease: those with BA (Group A) and those without BA (Group B).Relevant patient factors were extracted, including age, gender, occupation, smoking history, alcohol consumption history, body mass index, bone density, presence of internal diseases (diabetes, hypertension), lumbar lordosis angle, endplate Modic changes, degree of intervertebral disc degeneration, and facet joint degeneration (Weishaupt grading).Statistical analysis was performed using, Statistical Package for the Social Sciences 26.0 software to compare the differences in these factors between the two groups, and statistically significant results were included in a multivariate logistic regression analysis. Univariate analysis indicated that there were no statistically significant differences between the two groups in terms of gender, smoking history, alcohol consumption history, bone density, presence of internal diseases (diabetes, hypertension), lumbar lordosis angle, and endplate Modic changes (P>0.05),whereas age, occupation, body mass index, degree of intervertebral disc degeneration, and degree of facet joint degeneration showed statistically significant differences (P < 0.05).Multivariate logistic regression analysis revealed that age, degree of intervertebral disc degeneration, and degree of facet joint degeneration were independent risk factors for the occurrence of BA in patients with LDDs (P < 0.05). BA is relatively common in patients with LDDs, and advanced age, severe intervertebral disc degeneration, and facet joint degeneration are its independent risk factors. [ABSTRACT FROM AUTHOR]

This study evaluates ChatGPT's performance in diagnosing and managing spinal pathologies. Patients underwent evaluation by two spine surgeons (and the case was discussed and a consensus was reached) and ChatGPT. Patient data, including demographics, symptoms, and available imaging reports, were collected using a standardized form. This information was then processed by ChatGPT for diagnosis and management recommendations. The study assessed ChatGPT's diagnostic and management accuracy through descriptive statistics, comparing its performance to that of experienced spine specialists. A total of 97 patients with various spinal pathologies participated in the study, with a gender distribution of 40 males and 57 females. ChatGPT achieved a 70% diagnostic accuracy rate and provided suitable management recommendations for 95% of patients. However, it struggled with certain pathologies, misdiagnosing 100% of vertebral trauma and facet joint syndrome, 40% of spondylolisthesis, stenosis, and scoliosis, and 22% of disc-related pathologies. Furthermore, ChatGPT's management recommendations were poor in 53% of cases, often failing to suggest the most appropriate treatment options and occasionally providing incomplete advice. While helpful in the medical field, ChatGPT falls short in providing reliable management recommendations, with a 30% misdiagnosis rate and 53% mismanagement rate in our study. Its limitations, including reliance on outdated data and the inability to interactively gather patient information, must be acknowledged. Surgeons should use ChatGPT cautiously as a supplementary tool rather than a substitute for their clinical expertise, as the complexities of healthcare demand human judgment and interaction. [ABSTRACT FROM AUTHOR]

In this case report, we describe an uncommon case of neuroendocrine cancer of unknown origin began with cauda equina syndrome in a patient affected by Paget disease of bone (PDB). A 76-year-old man with diagnosis of PDB, without history of pain or bone deformity, developed sudden severe low back pain. Bone alkaline phosphatase was increased and MRI and whole-body scintigraphy confirmed the localization of the disease at the third vertebra of the lumbar spine. Treatment with Neridronic Acid was started, but after only 2 weeks of therapy anuria and bowel occlusion occurred together with lower limb weakness and walking impairment. Cauda equina syndrome consequent to spinal stenosis at the level of L2–L3 was diagnosed after admission to Emergency Department and the patient underwent neurosurgery for spinal medulla decompression. The histologic results showed a complete subversion of bone structure in neoplastic tissue, consistent with metastatic neuroendocrine carcinoma of unknown origin. In conclusion, low back pain in the elderly may require deep investigation to individuate rare diseases. In asymptomatic patients with apparently stable PDB, the sudden appearance of pain or neurologic symptoms may alert the clinician for the possibility of other superimposing diseases, like bone metastases. [ABSTRACT FROM AUTHOR]

Lumbar radicular pain is a common symptom of lumbar disc herniation and spinal canal stenosis, and L4 nerve root impingement is difficult to diagnose. This study aimed to elucidate the extension rate of L4 nerve roots in Thiel-embalmed specimens using both classic and new femoral nerve stretch test (FNST), as well as straight leg raising test (SLRT). Additionally, the extension rate of the L2 and L3 nerve roots and L5 and S1 roots were determined using FNST (both classic and new) and SLRT, respectively. Four Thiel-embalmed specimens were used. The extension rate data of the nerve root were obtained using a displacement sensor under the following conditions: knee joint flexed to 0°/45°/90°/135° with either the hip extension/flexion of 0° (classic FNST) or extension of 15° (new FNST); and hip joint flexed to 0°/30°/60°/90° with the knee flexion of 0° (SLRT). Case A had almost no L4 nerve root lengthening at 45° and 90° knee joint flexion; however, at 135° of knee flexion, the nerve root was lengthened. In Case B, the L4 nerve root was hardly extended by the classic FNST, but it was extended at 135° of knee flexion and 15° of hip extension. In Case C, the L4 nerve root showed little change by classic FNST and it was shortened by new FNST, whereas, it was extended by SLRT. Case D showed a shortened L4 nerve root at 135° of knee flexion in classic FNST and at 0°/45°/90°/135° of knee flexion and 15° of hip extension. Further, no root shortening was observed for L2 and L3 nerve roots according to both classic and new FNST. In contrast, the extension of L2 and L3 nerve root with the new FNST was high. In all cases, nerve roots were lengthened by the SLRT. Further, as the hip flexion angle increased, the rate of nerve elongation also increased. It was shown that in patients in whom L4 nerve root was extended by FNST, it was shortened by SLRT. The opposite pattern was also observed. Further, it is believed that FNST and SLRT are reliable tests for L2 and L3 radiculopathy and L5 and S1 radiculopathy, respectively, and that more tension on the femoral and sciatic nerves is better. Furthermore, we recommend that FNST should be performed with 15° hip extension and 135° knee flexion to improve the diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Preoperative identification of osteoporosis during spine surgery is of critical importance. Additionally, the Hounsfield units (HU) measured using computed tomography (CT) have gained considerable attention. This study aimed to propose a more accurate and convenient screening method for predicting vertebral fractures after spinal fusion in elderly patients by analyzing the HU value of different range of interests of thoracolumbar spine. Our sample pool for analysis consisted of 137 elderly female patients aged >70 years who underwent one- or two-level spinal fusion surgery with a diagnosis of adult degenerative lumbar disease. The HU values of the anterior 1/3 of the vertebral bodies based on sagittal plane and those of vertebral bodies based on axial plane at T11-L5 were measured using the perioperative CT. The incidence of postoperative vertebral fractures with respect to the HU value was investigated. Vertebral fractures were identified in 16 patients during the mean follow-up period of 3.8 years. While no significant association was found between HU value of L1 vertebral body or minimum HU value from axial plane and the incidence of the postoperative vertebral fracture, the minimum vertebral HU value of the anterior 1/3 of vertebral body from sagittal plane was associated with the incidence of the postoperative vertebral fracture. Patients with a minimum anterior 1/3 vertebral HU value of <80 had a higher incidence of postoperative vertebral fractures. The adjacent vertebral fractures occurred at the level of the vertebra with the lowest HU value, with a high probability. The existence of the vertebra with a minimum HU value of <80 within two levels of upper instrumented vertebrae was a risk factor for adjacent vertebral fracture. HU measurement of the anterior 1/3 of vertebral body predicts the risk of vertebral fracture after short spinal fusion surgery. [ABSTRACT FROM AUTHOR]

Purpose: Periostin, an extracellular matrix protein closely related to mechanical stress, inflammation, and ageing, has been implicated in intervertebral disc degeneration (IVDD) in basic research. However, it has not been examined in clinical cases. This study aimed to evaluate the association between IVDD severity and serum periostin concentration as well as to analyse potential associations between IVDD and clinical and demographic factors. Methods: This retrospective cohort study included 198 patients who underwent lumbar disc herniation and lumbar canal stenosis between January 2020 and December 2022. The severity of IVDD was evaluated using the Pfirrmann grading, whereas serum periostin levels were measured using ELISA kits. Clinical demographics, including age, sex, body mass index, comorbidities, psoas muscle index, and spinal disease, were also recorded. Results: This study demonstrated a significant correlation between high serum periostin levels and IVDD severity, as indicated by a high cumulative Pfirrmann score. Serum periostin levels were identified as an independent risk factor for IVDD in a multivariate regression model. Correlation analysis showed a correlation between periostin levels and Pfirrmann grade at each lumbar level (ρ = 0.458–0.550, p < 0.001) and a strong correlation with cumulative Pfirrmann score (ρ = 0.690, p < 0.001). Conclusion: The higher the serum periostin level, the higher the cumulative Pfirrmann score. Multivariate analysis showed that serum periostin was an independent risk factor for IVDD. Periostin levels may be a clinically suitable and useful biomarker for diagnosing IVDD, estimating disease progression and activity, providing prognostic information, and evaluating treatment options. [ABSTRACT FROM AUTHOR]

Purpose: To explore degeneration and fatty infiltration (FI) of lumbar paraspinal muscles in patients with dynamic sagittal imbalance (DSI) and the relationship between lumbar paraspinal muscles degeneration, fatty infiltration and severity of the disease. Methods: We recruited 41 DSI patients and selected 22 lumbar spinal stenosis (LSS) patients without osphyalgia as controls. All patients received magnetic resonance imaging (MRI) scan and DSI patients also received pre-walk and post-walk X-rays. DSI patients were divided into 2 subgroups according to their symptom improvement after conservative treatment. We calculated rmCSA and FI of the lumbar paraspinal muscles. The rmCSA and FI between DSI and control and between DSI subgroups were compared by t test. The regression analysis was used to explore the risk factors influencing disease severity. Receiver operating characteristic (ROC) curves and area under curves (AUCs) were used to evaluate the severity of the disease. Results: In comparison of rmCSA and FI between DSI and control, there are significant differences of most muscles. In comparison of rmCSA between two subgroups, there are significant differences of most muscles, while in comparison of FI, only muscles in L4 segment have significant different. In logistic regression analysis, total rmCSA and total FI are risk factors influencing disease severity. ROC curves shows that total rmCSA and total FI both achieve an AUC greater than 0.7. Conclusion: Compared with control, DSI patients have degeneration and fatty infiltration of the lumbar paraspinal muscles. The degeneration and fatty infiltration are risk factors influencing disease severity. The total rmCSA and total FI can be used as an indicator to determine whether a patient has severe DSI. [ABSTRACT FROM AUTHOR]

Background: Multifidus muscle (MF) in the back of the vertebral column plays an important role in spinal stability. MF morphology and fatty infiltration can be influenced by factors affecting low back pain (LBP) and evaluated using MRI, CT and US, however MRI provides a higher resolution and allows for better detection of soft tissues. We proposed a new method to assess the degree of MF degeneration in this study. Methods: The multifidus score was calculated by summation of degree of MF degeneration, with minimum score of 0 and maximum of 6. In cases of disproportion affection of MF on each side, we chose the higher degree of MF affection. A score of 6 means that MF degeneration is graded 2 in either side. We mentioned the influence of other vertebral degenerative pathologies including facet arthropathies, neural canal stenosis and Modic end plate changes. We defined disc pathology as disc bulge, herniation. The main factors affecting MF degeneration are age, body mass index (BMI), duration of compliant in years, presence of sciatica and VAS visual analogue scale (VAS) score. Results: VAS scores were statistically significantly correlated with degree of MF degeneration, with p value < 0.001. The degree of MF degeneration was significantly correlated with a number of disc pathologies. Conclusions: Our study concluded a significant relation between MF degeneration and each of VAS and duration of pain, although this relation was not related to the measurement of proportionate changes between each side and different degrees of MF degeneration. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is an inherited disorder of red blood cells caused by mutation in the hemoglobin beta chain and is the most common inherited genetic disorder in the United States. Postoperative outcomes following single-level posterior lumbar interbody fusion (PLIF) in patients with SCD are not well characterized. To examine 90-day postoperative outcomes among a matched cohort of patients with and without SCD who underwent single level PLIF utilizing a national administrative database. Retrospective database study. Adult patients without and with SCD who underwent single level PLIF from 2010 to 2021 Q1 were identified and matched 10:1 based on age, sex and ECI. Exclusion criteria included: age <18 years old, recent history of infection, neoplasm, or trauma, as well as not being active in the database for 90 days following their procedure. Ninety-day postoperative adverse events and emergency department (ED) visits. The matched cohorts were defined, and 90-day adverse event and ED visit rates were compared with univariable analyses and multivariable logistic regression, controlling for age, sex, and Elixhauser comorbidity index (ECI). Overall, 191,765 PLIF patients were identified, of which SCD was noted for 76 (0.04%). On multivariable analysis of the matched populations, patients with SCD were at increased odds ratio (OR) of the following (in decreasing OR order): transfusion (OR 17.69), pneumonia (OR 6.30), sepsis (OR 4.86), aggregated minor adverse events (OR 4.65), aggregated all adverse events (OR 3.87), ED visits (OR 3.53), and aggregated severe adverse events (OR 2.80) (p<.05 for all). The current study examined a relatively small, but largest to date, cohort of SCD patients undergoing PLIF. Patients with this condition were at greater odds of several perioperative adverse events, and these findings may be helpful for patient counselling and surgical planning. [ABSTRACT FROM AUTHOR]

Objective: Investigating the early biomechanical effects of the one-hole split endoscope (OSE) technique on lumbar spine after decompression surgery. Methods: A retrospective analysis was conducted on 66 patients with lumbar spinal stenosis (LSS) who underwent OSE technique surgery at the affiliated hospital of Binzhou Medical University from September 2021 to September 2022. The patients had complete postoperative follow-up records. The mean age was (51.73 ± 12.42) years, including 33 males and 33 females. The preoperative and postoperative imaging data were analyzed, including disc height (DH), foraminal height (FH), lumbar lordosis angle (LLA), changes in disc angle, anterior-posterior translation distance, and lumbar intervertebral disc Pfirrmann grading. The visual analogue scale (VAS) was applied to evaluate the severity of preoperative, postoperative day 1, postoperative 3 months, and final follow-up for back and leg pain. The Oswestry Disability Index (ODI) was applied to assess the functionality at all the listed time points. The modified MacNab criteria were applied to evaluate the clinical efficacy at the final follow-up. Results: In 66 patients, there were statistically significant differences (p < 0.05) in DH and FH at the affected segments compared to preoperative values, whereas no significant differences (p > 0.05) were found in DH and FH at the adjacent upper segments compared to preoperative values. There was no statistically significant difference in the LLA compared to preoperative values (p > 0.05). Both the affected segments and adjacent upper segments showed statistically significant differences in Pfirrmann grading compared to preoperative values (p < 0.05). There were no statistically significant differences in the changes in disc angle or anterior-posterior translation distance in the affected or adjacent segments compared to preoperative values (p > 0.05). The VAS scores for back and leg pain, as well as the ODI, significantly improved at all postoperative time points compared to preoperative values. Among the comparisons at different time points, the differences were statistically significant (p < 0.05). The clinical efficacy was evaluated at the final follow-up using the modified MacNab criteria, with 51 cases rated as excellent, 8 cases as good, and 7 cases as fair, resulting in an excellent-good rate of 89.39%. Conclusions: The OSE technique, as a surgical option for decompression in the treatment of LSS, has no significant impact on lumbar spine stability in the early postoperative period. However, it does have some effects on the lumbar intervertebral discs, which may lead to a certain degree of degeneration. [ABSTRACT FROM AUTHOR]

Introduction: Understanding the complex nature of low back pain (LBP) is crucial for effective management. The PainDETECT questionnaire is a tool that distinguishes between neuropathic (NeP), nociceptive (NoP), and ambiguous pain. This study aimed to investigate the relationship between pain classification and lumbar intervertebral degenerative parameters obtained from imaging. Methods: A cohort study was conducted involving 279 patients, aged 18 years and above, who completed PainDETECT questionnaires and underwent lumbar MRI and/or X-ray scans. Results: The study included 102 patients with NoP, 78 with ambiguous pain, and 99 with NeP. The NeP group had lower mean age (58.21 vs. 53.63, p < 0.05) and higher mean numerical rating scale score (7.9 vs. 5.9, p < 0.001) compared to the NoP group. A negative correlation was found between PainDETECT scores and pelvic incidence (τ = − 0.177, p = 0.043). The NeP group exhibited significantly higher severity of foraminal stenosis (U = 18.962, p = 0.002), spinal stenosis (U = 14.481, p = 0.005), and Pfirrmann grade (U = 14.221, p = 0.028) compared to the NoP group. A higher proportion of NeP patients had intervertebral disk bulge (96% vs. 78% vs. 78%, p = 0.002) and high-intensity zones (51% vs. 41% vs. 19%, p < 0.001) compared to those with NoP and ambiguous pain. Conclusion: NeP, as determined by the PainDETECT questionnaire, is associated with more severe neural compression, increased presence of discogenic disease and inflammatory disk severity, and decreased pelvic incidence. This pioneering study establishes a connection between pathological findings and pain categorization, providing clinicians with valuable guidance for formulating tailored management plans and reducing the need for unnecessary pharmacotherapy, imaging, and non-targeted surgical interventions. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have suggested that genetic factors are important in the development of degenerative disk disease (DDD). However, the concordance rates for the phenotypes requiring surgery are unknown. The purpose of this study was to determine the concordance rates for DDD requiring surgery by studying monozygotic (MZ) and dizygotic (DZ) twin pairs. Methods: Patients, aged between 18 and 85 years, operated for DDD between 1996 and 2022 were identified in the national Swedish spine register (Swespine) and matched with the Swedish twin registry (STR) to identify MZ and DZ twins. Pairwise and probandwise concordance rates were calculated. Results: We identified 11,207 patients, 53% women, operated for DDD. By matching the Swespine patients with the STR, we identified 121 twin pairs (37 MZ and 84 DZ) where one or both twins were surgically treated for DDD. The total twin incidence for operated DDD was 1.1%. For DDD requiring surgery, we found no concordant MZ pair and no concordant DZ pair where both twins were operated for DDD. When we evaluated pairs where at least one twin was operated for DDD, we found two concordant MZ pairs (the co-twins were operated for spinal stenosis) and two concordant DZ pairs (one co-twin operated for spinal stenosis and one (co-twin operated for disk herniation). Conclusions: Our findings suggest that genetic factors are probably not a major etiologic component in most cases of DDD requiring surgery. The findings of this study can be used for counseling patients about the risk for requiring DDD surgery. [ABSTRACT FROM AUTHOR]

Objectives: The five-repetition sit-to-stand (5R-STS) test was designed to capture objective functional impairment (OFI), and thus provides an adjunctive dimension in patient assessment. It is conceivable that there are different subsets of patients with OFI and degenerative lumbar disease. We aim to identify clusters of objectively functionally impaired individuals based on 5R-STS and unsupervised machine learning (ML). Methods: Data from two prospective cohort studies on patients with surgery for degenerative lumbar disease and 5R-STS times of ≥ 10.5 s—indicating presence of OFI. K-means clustering—an unsupervised ML algorithm—was applied to identify clusters of OFI. Cluster hallmarks were then identified using descriptive and inferential statistical analyses. Results: We included 173 patients (mean age [standard deviation]: 46.7 [12.7] years, 45% male) and identified three types of OFI. OFI Type 1 (57 pts., 32.9%), Type 2 (81 pts., 46.8%), and Type 3 (35 pts., 20.2%) exhibited mean 5R-STS test times of 14.0 (3.2), 14.5 (3.3), and 27.1 (4.4) seconds, respectively. The grades of OFI according to the validated baseline severity stratification of the 5R-STS increased significantly with each OFI type, as did extreme anxiety and depression symptoms, issues with mobility and daily activities. Types 1 and 2 are characterized by mild to moderate OFI—with female gender, lower body mass index, and less smokers as Type I hallmarks. Conclusions: Unsupervised learning techniques identified three distinct clusters of patients with OFI that may represent a more holistic clinical classification of patients with OFI than test-time stratifications alone, by accounting for individual patient characteristics. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) of the cervical spine is one of the routine MRI scans of the cervical region in investigating spinal disc pathologies, spinal stenosis, and the detection of spinal lesions, which are the major parameters to be evaluated in this examination. Purpose: The authors of this study are focused on a different aspect of cervical MRI, revealing the incidences and reporting rates of extraspinal incidental findings. Methods: A total of 1000 patients (324 males, 676 females, mean age 47 ± 14) who had undergone an MRI of the cervical spine were enrolled in this study. The magnetic resonance (MR) images of these patients were re-interpreted with respect to the incidental extraspinal imaging findings. The incidence and reporting rate of each incidental finding encountered during the evaluation were presented in percentages. Results: 726 patients in this study had at least one incidental lesion. The results of this study revealed that the most common incidental lesions encountered during the reinterpretation of cervical MRI were nasopharyngeal mucosal thickening (n = 442) and thyroid hypertrophy (n = 231). The total reporting rate of incidental findings was 5.29%. Conclusion: There are many data to be reported and evaluated by MR imaging of the cervical spine, not only the main parameters of MRI scanning in the routine daily practice of radiologists. All our colleagues should be aware and careful of these incidental findings, which may be the initial medical data of the patients' diagnoses, or to avoid undesirable medicolegal problems. [ABSTRACT FROM AUTHOR]

Study design: Retrospective Cohort Study Objectives: To compare early postoperative radiological and clinical outcomes between 2-level minimally invasive (MIS) trans-psoas lateral lumbar interbody fusion (LLIF) and MIS transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spinal stenosis. Methods: Fifty three consecutive patients undergoing 2-level lumbar interbody fusion from L3-L5 for degenerative lumbar spinal stenosis were enrolled. Twenty four patients underwent LLIF and 29 underwent TLIF. Results: Operative time and length of stay were similar between LLIF and TLIF (272.8 ± 82.4 vs 256.1 ± 59.4 minutes; 5.5 ± 2.8 vs 4.7 ± 3.3 days, P >.05), whereas blood loss was lower for LLIF (229.0 ± 125.6 vs 302.4 ± 97.1mls, P =.026). Neurological deficits were more common in LLIF (9 vs 3, P =.025), whereas persistent deficits were rare for both (1 vs 1, P = 1). For both groups, all patient reported outcomes visual analogue scale (VAS back pain, VAS leg pain, ODI, SF-36 physical) improved from preoperative to 2-years postoperative (P <.05), with both groups showing no significant differences in extent of improvement for any outcome. Lateral lumbar interbody fusion demonstrated superior restoration of disc height (L3-L4: 4.1 ± 2.4 vs 1.2 ± 1.9 mm, P <.001; L4-L5: 4.6 ± 2.4 vs.8 ± 2.8 mm, P <.001), foraminal height (FH) (L3-L4: 3.5 ± 3.6 vs 1.0 ± 3.6 mm, P =.014; L4-L5: 3.0 ± 3.5 vs -.1 ± 4.4 mm, P =.0080), segmental lordosis (4.1 ± 6.4 vs -2.1 ± 8.1°, P =.005), lumbar lordosis (LL) (4.1 ± 7.0 vs -2.3 ± 12.6°, P =.026) and pelvic incidence-lumbar lordosis (PI-LL) mismatch (−4.1 ± 7.0 vs 2.3 ± 12.6°, P =.019) at 2-years follow-up. Conclusion: The superior radiological outcomes demonstrated by 2-level trans-psoas LLIF did not translate into difference in clinical outcomes compared to 2-level TLIF at the 2-years follow-up, suggesting both approaches are reasonable for 2-level lumbar interbody fusion in degenerative lumbar spinal stenosis. [ABSTRACT FROM AUTHOR]

Introduction: Low back pain is a common problem affecting millions worldwide. Even after surgical treatment some patients do not improve; others suffer from persistent radiculopathy. We define Complex Chronic Low Back Pain (CCLBP) as any low back pain that has lasted for at least three months and has at least two triggering pain mechanisms. Objective: To describe our experience with plateletrich plasma (PRP) therapy in managing CCLBP with a neuropathic component Methods: Quantitative, retrospective analysis from 57 medical records of patients treated with PRP for CCLBP. We used IBMSPSS 21 to obtain descriptive statistics, Chi-square, Student T and Odds-Ratio. Results: The mean age of our sample was 59.8 (±14.4) years, with 6.51 (±8.7) years of pain and a follow-up of 9 (±12.2) months. 33.3% had lumbar surgery, 29.8% had lumbar trauma, 31.6% used a walking aid, 56.7% had MODIC changes on MRI, and 42% of them received intraosseous-PRP technic. 84.2% reported severe pain (VAS 8-10). The results showed that 96.5% of patients experienced some improvement after PRP treatment. Additionally, 10.5% experienced pain suppression. No significant differences in age, lumbar trauma, lumbar surgery, diseases, or the use of walking aids between patients who benefited from PRP treatment and those who did not. VAS after treatment shows significance (p<0.01) with 5.36±2.6 points. Subjects with less than five years of radicular pain had an improvement greater than 3 points on VAS (OR 7.38, IC95% 1.72-31.7). Conclusion: Autologous platelet-rich plasma injections for chronic low back pain with a neuropathic component are an effective alternative to address CCLBP's current challenge. New studies with greater statistical power are necessary to make a statement of efficacy, but with the data obtained, it seems a promising option. [ABSTRACT FROM AUTHOR]

Lumbar spinal stenosis is a clinical syndrome that affects more than 200,000 people in the United States annually. It is a common cause of chronic insidious low back pain, especially in older patient populations (mean age = 64 years). Lumbar spinal stenosis is a degenerative condition of the spine leading to narrowing in the spaces around the neurovascular bundles and the classic symptom of low back pain that radiates to the buttocks and lower extremities bilaterally. It is typically a progressive waxing and waning process that may deteriorate over years. The pain is typically burning or cramping, which worsens with standing and walking and improves with bending forward or sitting. Magnetic resonance imaging is the recommended diagnostic test because it allows cross-sectional measurement of the spinal canal. Options for nonsurgical management include physical therapy, exercise programs, spinal injections with and without corticosteroids, chiropractic treatment, osteopathic manipulation, acupuncture, and lifestyle modifications; however, few of these treatments have high-quality randomized trials demonstrating effectiveness. Surgery may be considered if nonsurgical management is ineffective. (Am Fam Physician. 2024; 109(4): 350–359. Copyright © 2024 American Academy of Family Physicians.) [ABSTRACT FROM AUTHOR]