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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]

Introduction: There is limited and inconsistent data on the relationship between vitamin D deficiency and Modic changes (MCs). Also, which type of MCs is associated with vitamin D is not clear. Vitamin D has anti-inflammatory effects, while type 1 MCs has inflammatory nature. Accordingly, patients with type 1 may have lower vitamin D levels than those with type 2 MCs. This study aimed to compare type 1 and type 2 MCs for serum vitamin D concentrations. Materials and Methods: Between May 2019 and July 2020, a total of 53 patients with type 1 or type 2 MCs were included in this study. Patients' demographics were recorded, and back pain severity was assessed by using visual analog scale. Serum levels of vitamin D were measured as total 25-hydroxy vitamin D. Accordingly, serum levels of vitamin D (µg/L) are graded as deficient (<20), insufficient (20 -30), and sufficient (30-80). Results: Type 1 MCs (n=26) and type 2 MCs (n=27) groups were similar in age (p=0.199), gender, BMI, work status, pain duration, vitamin D concentration, degree of vitamin D deficiency (p=0.773), and spinal levels. Type 1 MCs patients had more painful low back than type 2 MCs patients. Conclusion: Type 1 MCs are similar to type 2 MCs for serum vitamin D concentration. The more painful low back of type 1 MCs may be related to its inflammatory nature, but may not be associated with vitamin D insufficiency. [ABSTRACT FROM AUTHOR]

Aim: To examine the impact of lumbosacral transitional vertebra (LSTV) on lumbar spine degeneration, disc protrusion, and spondylolisthesis among patients with low back pain. Methods: The records of the patients who had undergone anterioposterior lumbar radiographs and lumbar magnetic resonance imaging (MRI) for low back pain between November 2014 and September 2021 were extracted retrospectively and assessed for eligibility. Of the remaining patients, those with LSTV were assigned as "case group." Age‐ and sex‐matched patients without LSTV were assigned as "control group." On digitalized lumbar MRIs, Modic degeneration (type I–III) and Pfirrman's disc degeneration (grade I–V) immediately cephalad to the transitional level were evaluated; intervertebral disc height (mm), disc protrusion (mm), and percentage of vertebral slippage (%) were measured. Results: Of the 501 patients with low back pain, 128 ineligible patients were excluded; 113 patients with LSTV and 117 age‐ and sex‐matched controls were included in the study. LSTV group revealed decreased intervertebral disc height, increased vertebral endplate degeneration, and slippage, as well as increased disc degeneration and protrusion when compared with controls (p < 0.001). Patients with type III LSTV had greater disc protrusion and higher percentage of slippage compared to those with type I LSTV (p = 0.008 and p = 0.009, respectively). Vertebral endplate degeneration, disc height, and disc degeneration did not differ across categories of LSTV type. Conclusion: Lumbosacral transitional vertebra malformation is related to decreased intervertebral disc height, increased disc degeneration, vertebral endplate degeneration, disc protrusion, and slippage above the level of transition. Patients with type III LSTV revealed the highest percentage of slippage and disc protrusion. [ABSTRACT FROM AUTHOR]

This study was designed to systematically review and meta-analyze the functional and radiological outcomes between lateral and posterior approaches in adult degenerative scoliosis (ADS). Both lateral (lumbar, extreme, and oblique) and posterior interbody fusion (posterior lumbar and transforaminal) are used for deformity correction in patients with ADS with unclear comparison in this cohort of patients in the existing literature. A literature search using three electronic databases was performed to identify studies that reported outcomes of lateral (group L) and posterior interbody fusion (group P) in patients with ADS with curves of 10°–40°. Group P was further subdivided into minimally invasive surgery (MIS-P) and open posterior (Op-P) subgroups. Data on functional, radiological, and operative outcomes, length of hospital stay (LOHS), fusion rates, and complications were extracted and meta-analyzed using the random-effects model. A total of 18 studies (732 patients) met the inclusion criteria. No significant difference was found in functional and radiological outcomes between the two groups on data pooling. Total operative time in the MIS-P subgroup was less than that of group L (233.86 minutes vs. 401 minutes, p

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.

This study was designed to systematically review and meta-analyze the functional and radiological outcomes between lateral and posterior approaches in adult degenerative scoliosis (ADS). Both lateral (lumbar, extreme, and oblique) and posterior interbody fusion (posterior lumbar and transforaminal) are used for deformity correction in patients with ADS with unclear comparison in this cohort of patients in the existing literature. A literature search using three electronic databases was performed to identify studies that reported outcomes of lateral (group L) and posterior interbody fusion (group P) in patients with ADS with curves of 10°-40°. Group P was further subdivided into minimally invasive surgery (MIS-P) and open posterior (Op-P) subgroups. Data on functional, radiological, and operative outcomes, length of hospital stay (LOHS), fusion rates, and complications were extracted and meta-analyzed using the random-effects model. A total of 18 studies (732 patients) met the inclusion criteria. No significant difference was found in functional and radiological outcomes between the two groups on data pooling. Total operative time in the MIS-P subgroup was less than that of group L (233.86 minutes vs. 401 minutes, p <0.05). The total blood loss in group L was less than that in the Op-P subgroup(477 mL vs. 1,325.6 mL, p <0.05). Group L had significantly less LOHS than the Op-P subgroup (4.15 days vs. 13.5 days, p <0.05). No significant difference was seen in fusion rates, but complications were seen except for transient sensorimotor weakness (group L: 24.3%, group P: 5.6%; p <0.05). Complications, such as postoperative thigh pain (7.7%), visceral injuries (2%), and retrograde ejaculation (3.7%), were seen only in group L while adjacent segment degeneration was seen only in group P (8.6%). Lateral approach has an advantage in blood loss and LOHS over the Op-P subgroup. The MIS-P subgroup has less operative time than group L, but with comparable blood loss and LOHS. No significant difference was found in functional, radiological, fusion rates, pseudoarthrosis, and complications, except for transient sensorimotor deficits. Few complications were approach-specific in each group. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare bone mineral density (BMD) values in patients with lumbar osteoarthritis (OA) with and without osteoporosis (OP). This study evaluated the effect of lumbar osteoarthritis in patients with osteoporosis on Dexa scores using the Lane and Wilke scale., Methods: A total of 51 individuals with OA, 20 with OP, and 31 without OP were included in the study. Lumbar osteoarthritis was assessed and recorded using the Lane and Wilke scale. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at the waist and hip (femoral neck, lumbar vertebrae). Frax assessed the risk of osteoporosis and fracture risk., Results: The mean age of patients with OP was 68.1±8.2 years, and the mean age of patients without OP was 68.6±9.4 years. There was a significant decrease between the lumbar vertebrae and femoral neck BMD values of the two groups in favor of the osteoporosis group. The t-scores of the OP group were significantly lower (p = 0.045). All variables showed a statistically significant difference between the group with OP and those without OP (p<0.05). The median values of L1-L2, L2-L3, L3-L4, and total L1-L4 were higher in absolute value in the group with OP. In frax hip and frax primary osteoporosis, the median values were higher in the group with OP than in the group without OP (p = 0.023/p = 0.020). All L1-L2, L2-L3, and L3-L4 dexa parameters with and without OP were not significantly different between the groups according to the Lane and Wilke classification (p > 0.05)., Conclusion: There was no statistically significant difference between DEXA parameters in osteoporosis and non-osteoporosis patients with low back osteoarthritis (according to the Lane and Wilke classification)., Competing Interests: Declaration of conflicting interest The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2024 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)

Objective: Describe the association between biomarkers and lumbar spine degeneration (vertebral osteophytes [OST], facet joint osteoarthritis [FOA], and disc space narrowing [DSN]), for persons with and without low back pain (LBP) and determine whether clusters based on biomarkers differentiate lumbar spine structure with and without LBP. Methods: Using data from the Johnston County Osteoarthritis Project (2006–2010), we measured serum N-cadherin, Keratin-19, Lumican, CXCL6, RANTES, HA, IL-6, BDNF, OPG, and NPY, and urinary CTX-II. Biomarkers were used to group participants using k-means cluster analysis. Logistic regression models were used to compare biomarker clusters. Results: The sample consisted of 731 participants with biospecimens and lumbar spine radiographic data. Three biomarker subgroups were identified: one characterized by structural degenerative changes; another characterized by structural degenerative changes and inflammation, with pain; and a referent cluster with lower levels of biomarkers, pain, and structural degenerative changes. Compared to the referent subgroup, the structural change subgroup was associated with DSN (OR ​= ​1.94, 95% CI 1.30–2.90) and FOA (OR ​= ​1.72, 95% CI 1.12–2.62), and the subgroup with structural degenerative change, inflammation, and pain was associated with OST with LBP (OR ​= ​1.60, 95% CI 1.04–2.46), FOA with LBP (OR ​= ​1.59, 95% CI 1.04–2.45), and LBP (OR ​= ​1.63, 95% CI 1.11–2.41). The subgroup with structural degenerative changes was more likely to have OST (OR ​= ​1.82, 95% CI 1.06–3.13) and less likely to have FOA with LBP (OR ​= ​0.62, 95% CI 0.40–0.96) compared to the group with inflammation and pain. Conclusion: Clustering by biomarkers may assist in differentiating patients for specific clinical interventions aimed at decreasing LBP.

Study DesignRetrospective study.PurposeIn this study, we compared the postoperative outcomes of extreme lateral interbody fusion (XLIF) indirect decompression with that of mini-open transforaminal lumbar interbody fusion (TLIF) in patients with lumbar degenerative spondylolisthesis.Overview of LiteratureThere are very few reports examining postoperative results of XLIF and minimally invasive TLIF for degenerative lumbar spondylolisthesis, and no reports comparing XLIF and mini-open TLIF.MethodsForty patients who underwent 1-level spinal fusion, either by XLIF indirect decompression (X group, 20 patients) or by mini-open TLIF (T group, 20 patients), for treatment of lumbar degenerative spondylolisthesis were included in this study. Invasiveness of surgery was evaluated on the basis of surgery time, blood loss, hospitalization period, and perioperative complications. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), disc angle (DA), disc height (DH), and slipping length (SL) were evaluated before surgery, immediately after surgery, and at 12 months after surgery. Cross-sectional spinal canal area (CSA) was also measured before surgery and at 1 month after surgery.ResultsThere was no significant difference between the groups in terms of surgery time or hospitalization period; however, X group showed a significant decrease in blood loss (p

Objective To study the clinical effect of Yaotongning capsule combined with etoricoxib for the pain and inflammation of lumbar vertebrae in elderly patients with lumbar osteoarthritis. Methods 120 elderly patients with lumbar osteoarthritis admitted to our hospital from January 2016 to June 2018 were randomly divided into the control group and the observation group, with 60 patients in each group. Patients in the control group were treated with etoricoxib, while patients in the observation group were treated with etoricoxib plus Yaotongning capsule orally. Both groups received medications for 2 weeks. Spinal pain and quality of life score changes were recorded. The inflammatory cytokines in serum TNF-α, GM-CSF, COX-2 and BMP-2 levels were monitored. The clinical efficacy was compared and drug safety profile was evaluated for two groups. Results The effective rates of the control group and the observation group were 78.33% and 91.67% respectively. The effective rate in the observation group weas significantly higher (P<0.05). After treatment, the VAS score for the patients in the observation group was significantly lower than that in the control group (P<0.05). The SF-36 score in the observation group was significantly increased (P<0.05), and the levels of TNF-α,GM-CSF and COX-2 in the serum were significantly lower than those in the control group (P<0.05), and the levels of BMP-2 were significantly increased (P<0.05). Conclusion Yaotongning capsule combined with etoricoxib in the treatment of senile lumbar osteoarthritis has definite curative effect. It significantly reduced lumbar pain, improved quality of life, inhibited inflammatory reaction, and had a better drug safety profile. The further clinical investigation for the combination therapy is warranted. [ABSTRACT FROM AUTHOR]

Study DesignA retrospective study.PurposeTo assess postoperative bone regrowth at surgical sites after lumbar decompression with >5 years of follow-up. Postoperative preservation of facet joints and segmental spinal instability following surgery were also evaluated.Overview of LiteraturePrevious reports have documented bone regrowth after conventional laminectomy or laminotomy and several factors associated with new bone formation.MethodsForty-nine patients who underwent microscopic bilateral decompression via a unilateral approach at L4–5 were reviewed. Primary outcomes included correlations among postoperative bone regrowth, preservation of facet joints, radiographic parameters, and clinical outcomes. Secondary outcomes included comparative analyses of radiographic parameters and clinical outcomes among preoperative diagnoses (lumbar spinal stenosis, degenerative spondylolisthesis, and degenerative lumbar scoliosis).ResultsThe average value of bone regrowth at the latest follow-up was significantly higher on the dorsal side of the facet joint (3.4 mm) than on the ventral side (1.3 mm). Percent facet joint preservation was significantly smaller on the approach side (79.2%) than on the contralateral side (95.2%). Bone regrowth showed a significant inverse correlation with age, but no significant correlation was observed with facet joint preservation, gender, postoperative segmental spinal motion, or clinical outcomes. Subanalysis of these data revealed that bone regrowth at the latest follow-up was significantly greater in patients with degenerative lumbar scoliosis than in those with lumbar spinal stenosis. Postoperative segmental spinal motion at L4–L5 did not progress significantly in patients with degenerative spondylolisthesis or degenerative lumbar scoliosis compared with those with lumbar spinal stenosis.ConclusionsMicroscopic bilateral decompression via a unilateral approach prevents postoperative spinal instability because of satisfactory preservation of facet joints, which may be the primary reason for inadequate bone regrowth. Postoperative bone regrowth was not related to clinical outcomes and postoperative segmental spinal instability.

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

Study DesignCross sectional study.PurposeTo evaluate characteristics of back muscle strength in patients scheduled for lumbar fusion surgery.Overview of LiteratureLittle is known regarding muscle strength in patients with symptomatic lumbar degenerative diseases who require fusion surgery.MethodsConsecutive 354 patients scheduled for posterior lumbar interbody fusion due to symptomatic degenerative diseases were approached for participation. 316 patients were enrolled. Before surgery, muscle strength was assessed by measuring maximal isometric extension strength at seven angular positions (0°, 12°, 24°, 36°, 48°, 60°, and 72°) and mean isometric strength was calculated. The Oswestry Disability Index (0-100) and visual analogue scale (0-100) for back pain were recorded. Muscle strength was compared according to gender, age (0.05). Isometric strengths showed significant, but weak, inverse correlations with age and Oswestry Disability Index (r

Study Design. A population-based study. Objective. To study the prevalence and features of symptomatic degenerative lumbar osteoarthritis in adults. Summary of Background Data. Lumbar osteoarthritis adversely affects individuals and is a heavy burden. There are limited data on the prevalence of lumbar osteoarthritis. Methods. A representative, multistage sample of adults was collected. Symptomatic degenerative lumbar osteoarthritis was diagnosed by clinical symptoms, physical examinations, and imaging examinations. Personal information was obtained by faceto- face interview. Information included the place of residence, age, sex, income, type of medical insurance, education level, body mass index, habits of smoking and drinking, type of work, working posture, duration of the same working posture during the day, mode of transportation, exposure to vibration, and daily amount of sleep. Crude and adjusted prevalence was calculated. The features of populations were analyzed by multivariable logistic regression in total and subgroup populations. Results. The study included 3859 adults. The crude and adjusted prevalence of lumbar osteoarthritis was 9.02% and 8.90%, respectively. There was no significant difference in the prevalence of lumbar osteoarthritis between urban, suburban, and rural populations (7.66%, 9.97%, and 9.44%) (P = 0.100). The prevalence of lumbar osteoarthritis was higher in females (10.05%) than in males (9.1%, P = 0.021). The prevalence of lumbar osteoarthritis increased with increasing age. Obese people (body mass index >28 kg/m²), those engaged in physical work, those who maintained the same work posture for 1 to 1.9 hours per day, those who were exposed to vibration during daily work, and those who got less than 7 hours of sleep per day had a higher prevalence. These features differed by subgroup. Conclusion. This study established epidemiological baseline data for degenerative lumbar osteoarthritis in adults, especially for people younger than 45 years. Lumbar osteoarthritis is epidemic in Beijing and will become a more severe problem in aging society. Different populations have different features that require targeted interventions. [ABSTRACT FROM AUTHOR]

Objective: Describe the association between biomarkers and lumbar spine degeneration (vertebral osteophytes [OST], facet joint osteoarthritis [FOA], and disc space narrowing [DSN]), for persons with and without low back pain (LBP) and determine whether clusters based on biomarkers differentiate lumbar spine structure with and without LBP., Methods: Using data from the Johnston County Osteoarthritis Project (2006-2010), we measured serum N-cadherin, Keratin-19, Lumican, CXCL6, RANTES, HA, IL-6, BDNF, OPG, and NPY, and urinary CTX-II. Biomarkers were used to group participants using k-means cluster analysis. Logistic regression models were used to compare biomarker clusters., Results: The sample consisted of 731 participants with biospecimens and lumbar spine radiographic data. Three biomarker subgroups were identified: one characterized by structural degenerative changes; another characterized by structural degenerative changes and inflammation, with pain; and a referent cluster with lower levels of biomarkers, pain, and structural degenerative changes. Compared to the referent subgroup, the structural change subgroup was associated with DSN (OR = 1.94, 95% CI 1.30-2.90) and FOA (OR = 1.72, 95% CI 1.12-2.62), and the subgroup with structural degenerative change, inflammation, and pain was associated with OST with LBP (OR = 1.60, 95% CI 1.04-2.46), FOA with LBP (OR = 1.59, 95% CI 1.04-2.45), and LBP (OR = 1.63, 95% CI 1.11-2.41). The subgroup with structural degenerative changes was more likely to have OST (OR = 1.82, 95% CI 1.06-3.13) and less likely to have FOA with LBP (OR = 0.62, 95% CI 0.40-0.96) compared to the group with inflammation and pain., Conclusion: Clustering by biomarkers may assist in differentiating patients for specific clinical interventions aimed at decreasing LBP., Competing Interests: Declaration of competing interest All authors disclose they have no financial or personal relationships with other people or organizations that could potentially and inappropriately bias their work and conclusions.

Abstract: Lumbar osteoarthritis is defined by three elementary lesions: disk space narrowing, osteophytes, endplates osteocondensation. There are valid methods for measuring lumbar osteoarthritis. The prevalence of lumbar osteoarthritis is very high and increases with age. The main factor promoting discarthrosis is genetic. A much smaller role is attributed to physical exertion, overweight and smoking. There is an association between the existence of a current or back pain in the past and the presence of osteophytes. A similar association between low back pain (LBP) and discarthrosis is found. No association was demonstrated between LBP and posterior apophyseal osteoarthritis. [Copyright &y& Elsevier]

Introduction Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is increasingly used to treat lumbar degenerative pathology. Its effect on sagittal parameters remains controversial. Static and expandable lordotic interbody devices (cages) were developed to improve segmental and overall lumbar lordosis. This study aimed to compare the radiographic and patient-reported outcomes (PROs) between static lordotic and non-lordotic titanium cages in patients undergoing 1-2 level MI-TLIF for degenerative conditions.  Methods We reviewed consecutive eligible patients who underwent 1-2 level MI-TLIF (7/2017-11/2019) at a single institution by multiple surgeons. Standing X-rays and PROs were collected at preoperative, 1-month, and 6-month postoperative intervals. Using univariate analyses, we compared the two cohorts regarding confounders, radiographic parameters, and proportions of patients reaching minimal clinically important difference (MCID) for PROs. Results One-hundred-twenty-five patients were reviewed. Forty-seven had lordotic and seventy-eight non-lordotic cages. The lordotic cohort was significantly younger than the non-lordotic (55.9 years vs. 60.7 years, p= 0.042). The baseline radiographic parameters were not significantly different between cohorts. At the preoperative-6-month interval, the lordotic cohort had significant improvement in lumbar lordosis versus non-lordotic cohort (2.95° ± 7.2° vs. -0.3° ± 7.1°, p=0.024). Both cohorts showed improvement in segmental lordosis, anterior and posterior interspace height, and low subsidence grade with no significant difference between cohorts at all intervals. Overall, 69.1-83.8% of patients achieved MCID in all PROs with no significant difference between cohorts. Conclusions The use of a static lordotic titanium cage in 1-2 level MI-TLIF did not result in significantly different radiographic improvements or PROs compared with a non-lordotic cage., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Lawless et al.)

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

Study Design: Retrospective study., Purpose: In this study, we compared the postoperative outcomes of extreme lateral interbody fusion (XLIF) indirect decompression with that of mini-open transforaminal lumbar interbody fusion (TLIF) in patients with lumbar degenerative spondylolisthesis., Overview of Literature: There are very few reports examining postoperative results of XLIF and minimally invasive TLIF for degenerative lumbar spondylolisthesis, and no reports comparing XLIF and mini-open TLIF., Methods: Forty patients who underwent 1-level spinal fusion, either by XLIF indirect decompression (X group, 20 patients) or by mini-open TLIF (T group, 20 patients), for treatment of lumbar degenerative spondylolisthesis were included in this study. Invasiveness of surgery was evaluated on the basis of surgery time, blood loss, hospitalization period, and perioperative complications. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), disc angle (DA), disc height (DH), and slipping length (SL) were evaluated before surgery, immediately after surgery, and at 12 months after surgery. Cross-sectional spinal canal area (CSA) was also measured before surgery and at 1 month after surgery., Results: There was no significant difference between the groups in terms of surgery time or hospitalization period; however, X group showed a significant decrease in blood loss ( p <0.001). Serious complications were not observed in either group. In clinical assessment, no significant differences were observed between the groups with regard to the JOABPEQ results. The change in DH at 12 months after surgery increased significantly in the X group ( p <0.05), and the changes in DA and SL were not significantly different between the two groups. The change in CSA was significantly greater in the T group ( p <0.001)., Conclusions: Postoperative clinical results were equally favorable for both procedures; however, in comparison with mini-open TLIF, less blood loss and greater correction of DH were observed in XLIF., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Study Design: A retrospective study., Purpose: To assess postoperative bone regrowth at surgical sites after lumbar decompression with >5 years of follow-up. Postoperative preservation of facet joints and segmental spinal instability following surgery were also evaluated., Overview of Literature: Previous reports have documented bone regrowth after conventional laminectomy or laminotomy and several factors associated with new bone formation., Methods: Forty-nine patients who underwent microscopic bilateral decompression via a unilateral approach at L4-5 were reviewed. Primary outcomes included correlations among postoperative bone regrowth, preservation of facet joints, radiographic parameters, and clinical outcomes. Secondary outcomes included comparative analyses of radiographic parameters and clinical outcomes among preoperative diagnoses (lumbar spinal stenosis, degenerative spondylolisthesis, and degenerative lumbar scoliosis)., Results: The average value of bone regrowth at the latest follow-up was significantly higher on the dorsal side of the facet joint (3.4 mm) than on the ventral side (1.3 mm). Percent facet joint preservation was significantly smaller on the approach side (79.2%) than on the contralateral side (95.2%). Bone regrowth showed a significant inverse correlation with age, but no significant correlation was observed with facet joint preservation, gender, postoperative segmental spinal motion, or clinical outcomes. Subanalysis of these data revealed that bone regrowth at the latest follow-up was significantly greater in patients with degenerative lumbar scoliosis than in those with lumbar spinal stenosis. Postoperative segmental spinal motion at L4-L5 did not progress significantly in patients with degenerative spondylolisthesis or degenerative lumbar scoliosis compared with those with lumbar spinal stenosis., Conclusions: Microscopic bilateral decompression via a unilateral approach prevents postoperative spinal instability because of satisfactory preservation of facet joints, which may be the primary reason for inadequate bone regrowth. Postoperative bone regrowth was not related to clinical outcomes and postoperative segmental spinal instability., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Study Design: Cross sectional study., Purpose: To evaluate characteristics of back muscle strength in patients scheduled for lumbar fusion surgery., Overview of Literature: Little is known regarding muscle strength in patients with symptomatic lumbar degenerative diseases who require fusion surgery., Methods: Consecutive 354 patients scheduled for posterior lumbar interbody fusion due to symptomatic degenerative diseases were approached for participation. 316 patients were enrolled. Before surgery, muscle strength was assessed by measuring maximal isometric extension strength at seven angular positions (0°, 12°, 24°, 36°, 48°, 60°, and 72°) and mean isometric strength was calculated. The Oswestry Disability Index (0-100) and visual analogue scale (0-100) for back pain were recorded. Muscle strength was compared according to gender, age (<60, 60-70, and ≥70 years) and scheduled fusion level (short, <3; long, ≥3)., Results: Isometric strength was significantly decreased compared with previously reported results of healthy individuals, particularly at extension positions (0°-48°, p<0.05). Mean isometric strength was significantly lower in females (p<0.001) and older patients (p<0.05). Differences of isometric strength between short and long level fusion were not significantly different (p>0.05). Isometric strengths showed significant, but weak, inverse correlations with age and Oswestry Disability Index (r<0.4, p<0.05)., Conclusions: In patients with symptomatic lumbar degenerative diseases, back muscle strength significantly decreased, particularly at lumbar extension positions, and in females and older patients.

Background: To assess the radiographic results in patients who underwent transforaminal lumbar interbody fusion (TLIF), particularly the changes in segmental lordosis in the fusion segment, whole lumbar lordosis and disc height., Methods: Twenty six cases of single-level TLIF in degenerative lumbar diseases were analyzed. The changes in segmental lordosis, whole lumbar lordosis, and disc height were evaluated before surgery, after surgery and at the final follow-up., Results: The segmental lordosis increased significantly after surgery but decreased at the final follow-up. Compared to the preoperative values, the segmental lordosis did not change significantly at the final follow-up. Whole lumbar lordosis at the final follow-up was significantly higher than the preoperative values. The disc height was significantly higher in after surgery than before surgery (p = 0.000) and the disc height alter surgery and at the final follow-up was similar., Conclusions: When performing TLIF, careful surgical techniques and attention are needed to restore and maintain the segmental lordosis at the fusion level.