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Background While a laminectomy is often mandated for spinal canal stenosis, foraminal stenosis may account for pain and functional limitations instead of central canal issues. Targeted treatment directed at this specific region may enhance patient outcomes. Methods Retrospective observational study of a total of 30 patients with previous decompression laminectomies for lumbar spinal canal stenosis were operated upon for foraminotomies from November 2012 to November 2018. The surgeries were clinically done, and EMG-confirmed nerve root compressions were treated with exact decompression techniques according to the anatomy and pathology in each case. Additionally, a systematic review followed PRISMA guidelines was conducted, utilizing Scopus and PubMed databases to identify studies on reoperation rates after decompression with or without fusion in lumbar spinal stenosis. Results The results were fearsome post-operatively, trying significant improvement in pain, functional status, and walking distance. Pain reduction was achieved in 80% of patients by an increase in the Carnovsky rating scale with evidence of improved pain reduction and walking endurance; this points to minimal resulting complications of one complete case of foot drop and three infective cases managed conservatively. It was shown in the systematic review that fusion surgeries lowered the rates of reoperations at the index level but increased those for adjacent segment reoperations, while decompression alone had higher index-level reoperation rates due to recurrent stenosis. Conclusion Most of the emphasis on foraminal stenosis, rather than traditional laminectomies, significantly reduces postoperative pain and improves functional outcomes. This strategy brings a promising alternative to the management of recurrent symptoms in patients with lumbar spinal canal stenosis.

Objective: A clinical audit was carried out on the opinions of doctors working in the Emergency Department (ED) of a large urban hospital regarding the diagnosis and management of cervical spine radiculopathy (CSR). Using international guidelines and current research, it aimed to determine if patients attending this ED were diagnosed and managed in line with best practice, and to identify any discrepancies or areas for improvement in relation to this. Method: Doctors working in this ED were sent an online questionnaire and descriptive analysis was performed on the results to ascertain how they diagnose and manage patients who present with symptoms of CSR. It covered; presentation and definitions of CSR, identification of red flags, clinical tests used, diagnostic test criteria, appropriate management, education and advice given, and the criteria for further management. Additionally, it looked at their opinion on the services' needs. Results: Most agreed that CSR will improve within 4 weeks with non‐operative management; however, there was a lack of consensus regarding the most affected nerve root, differential diagnosis and appropriate diagnostic tests. Opinions aligned regarding the identification of red flags and early management, especially with widespread neurological deficits. However, the management of ongoing pain or new neurological signs, differed between clinicians. Most participants strongly agreed that access to MRIs affected referrals within an ED episode. Conclusion: Overall, the opinions matched recommended guidelines; however, some gaps in knowledge and differing management approaches were identified, indicating the need for ongoing education and standardisation of management. [ABSTRACT FROM AUTHOR]

Electrodiagnostic evaluations are commonly requested for patients with suspected radiculopathy. Understanding lower extremity musculoskeletal conditions is essential for electrodiagnostic medicine specialists, as musculoskeletal disorders often mimic or coexist with radiculopathy. This review delineates radicular pain from other types originating from the lumbosacral spine and describes musculoskeletal conditions frequently mimicking radiculopathy, such as those that cause radiating pain and sensorimotor dysfunction. In clinical evaluation, a history of pain radiating along a specific dermatomal territory with associated sensory disturbance suggests radiculopathy. Physical examination findings consistent with radiculopathy include myotomal weakness, depressed or absent muscle stretch reflexes, focal atrophy along a discrete nerve root territory, and potentially positive dural tension maneuvers like the straight leg raise. However, electrodiagnostic medicine specialists must be knowledgeable of musculoskeletal mimics, which may manifest as incomplete radiation within or beyond a dermatomal territory, non‐radiating pain, tenderness, and give‐way weakness, in the context of a normal neurological examination. A systematic approach to musculoskeletal examination is vital, and this review focuses on high‐yield physical examination maneuvers and diagnostic investigations to differentiate between musculoskeletal conditions and radiculopathy. This approach ensures accurate diagnoses, promotes resource stewardship, enhances patient satisfaction, and optimizes care delivery. Musculoskeletal conditions resembling L1 to S4 radiculopathy are reviewed, emphasizing their distinctive features in history, physical examination, and diagnostic investigation. Among the more than 30 musculoskeletal disorders reviewed are hip and knee osteoarthritis, lumbar facet syndrome, myofascial pain syndrome, greater trochanteric pain syndrome, and plantar fasciitis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Epidural steroid injections are common procedures used to treat lumbosacral radicular pain due to lumbar disc herniation (LDH). It is crucial for the clinician to anticipate which patients can benefit from interventional treatment options. OBJECTIVE: This study aimed to examine the effect of radiological and clinical parameters on lumbar transforaminal epidural steroid injections (TFESI)/local anesthetic injection outcomes in patients with LDH. METHODS: This study included 286 patients with LDH (146 males and 140 females). All patients received a fluoroscopically guided TFESI (triamcinolone acetonide 40 mg, lidocaine 2%, and 2.5 ml of physiological saline). Patients were evaluated according to radicular pain, the Oswestry Disability Index (ODI) and the Hospital Anxiety and Depression Scale at baseline and 3 months after the injections. Demographic, clinical and magnetic resonance imaging (MRI) findings were recorded to assess the predictive factors for TFESI outcomes. Pfirrmann Grades 1 and 2 were classified as low-grade nerve root compression and Grade 3 was classified as highgrade nerve root compression. RESULTS: Compared to baseline measurements there were significant improvements in radicular pain, ODI score, Laseque angle, and Schober test scores 3 months after injection. Improvements of at least 50% in radicular pain relief and the ODI functionality index were (n = 214) 82%, (n = 182) 70% respectively at 3 months. Correlation analyses revealed that a shorter duration of symptoms, lowgrade nerve root compression and foraminal/extraforaminal location on MRI findings were associated with a favorable response. CONCLUSIONS: Lowgrade nerve root compression was a predictor of a favorable response to TFESI. [ABSTRACT FROM AUTHOR]

Background: The most prevalent disorder affecting the spinal cord is lumbar radiculopathy. The incidence of this condition is estimated between 3% and 5% of the population and it impacts both male and female equally. The goal of this present study is to compare the effectiveness of dry needling to interferential therapy [IFT] in terms of reducing pain and increasing the lumbar range of motion in patients with lumbar radiculopathy. Purpose: To determine the effect of dry needling on patients with lumbar radiculopathy in reducing pain and increasing lumbar ROM compared to interferential therapy. Materials and Methods: 30 subjects participated and pre assessment and post assessment was taken using Numerical Pain Rating Scale [NPRS] and the Modified-Modified Schober Test [MMST]. For both groups, the intervention period lasted for 2 weeks and the entire study procedure was carried out from November 2022 to April 2023. Result: This study showed an extremely satisfied statistical significance difference between post-test values of both groups (p<0.0001). However, the experimental group showed substantially greater statistical significance than the control group in terms of the decrease in pain levels and the increase in lumber ROM. Conclusion: The study concluded that intervention provided to the experimental group was more effective than intervention provided to the control group. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the muscle activation of patients with lumbar disc herniation (LDH) during walking by surface electromyography (SEMG) and establish a diagnostic model based on SEMG parameters using random forest (RF) algorithm for localization diagnosis of compressed nerve root in LDH patients. Methods: Fifty-eight patients with LDH and thirty healthy subjects were recruited. The SEMG of tibialis anterior (TA) and lateral gastrocnemius (LG) were collected bilaterally during walking. The peak root mean square (RMS-peak), RMSpeak time, mean power frequency (MPF), and median frequency (MF) were analyzed. A diagnostic model based on SEMG parameters using RF algorithm was established to locate compressed nerve root, and repeated reservation experiments were conducted for verification. The study evaluated the diagnostic efficiency of the model using accuracy, precision, recall rate, F1-score, Kappa value, and area under the receiver operating characteristic (ROC) curve. Results: The results showed that delayed activation of TA and decreased activation of LG were observed in the L5 group, while decreased activation of LG and earlier activation of LG were observed in the S1 group. The RF model based on eight SEMG parameters showed an average accuracy of 84%, with an area under the ROC curve of 0.93. The RMS peak time of TA was identified as the most important SEMG parameter. Conclusion: These findings suggest that the RF model can assist in the localization diagnosis of compressed nerve roots in LDH patients, and the SEMG parameters can provide further references for optimizing the diagnosis model in the future. [ABSTRACT FROM AUTHOR]

AIM: The main aim of this study was to evaluate functional disability in patients with cervical radiculopathy. Our second aim was to compare neck disability between males and females. METHODS: The study included 35 participants of both sexes, in which 21 were female and 14 male. We have used three scales for the evaluation of neck disability: (1) Cervical radiculopathy Impact Scale (CRIS), (2) Neck Pain and Disability (NPAD) Scale, and (3) Copenhagen Neck Functional Disability (CNFD) Scale. RESULTS: The mean scores of CRIS were 14.35 ± 15.59 in males and 33.22 ± 17.58 in females. The NPAD Scale scores were 14.35 ± 15.59 in males and 33.22 ± 17.58 in females. The mean scores of the CNFD Scale were 7.92 ± 5.56 in males and 13.50 ± 5.61 in females. All three scales showed a significant difference between the scores of the two genders, indicating more disability in female patients as compared with the male patients. CONCLUSION: Our results showed 26.22% and 25.88% disability as per CRIS and Neck Pain and Disability Scale, respectively. We found mild-to-moderate disability in our subjects according to the CNFD Scale. The study concluded that females have more disability in cervical radiculopathy as compared to males.

Objective This study aimed to investigate the reliability and diagnostic accuracy of typical dermatomes and myotomes for determining the pathologic level in surgically verified patients with cervical radiculopathy. Methods Patients who underwent single-level surgery due to cervical radiculopathy with at least a 60% reduction in preoperative symptoms or recovery of muscle power after surgery were included. The observed clinical symptoms (pain, paresthesia, motor weakness) were compared to those of typical cervical dermatomes and myotomes. Results Among the 227 patients reviewed, 142 (62.6%) had a standard dermatomal pattern, and 74 of 110 (67.3%) had a standard myotomal pattern. The myotome of C5/6 radiculopathy showed much more variance than those of other cervical segments. Among the patients with severe motor weakness (muscle strength ≤ grade 3 or obvious muscle atrophy), all those with involvement of root C5, C7, and C8 showed a typical pattern (C4/5: 13 of 13 patients, C6/7: 5 of 5 patients, C7/T1: 3 of 3 patients), while only 2 of the 6 patients (33.3%) with severe motor weakness caused by C5/6 radiculopathy fit the typical pattern. Conclusion Among various symptoms, cervical myotome is of great value in determining the pathological level. However, it should be noted that there is high variability in human dermatomes and myotomes, especially for motor weakness due to C6 root compression, which is more variable than others.

The primary objective of the present study was to determine if imaging findings of unilateral lumbar nerve root compression (ULNRC) impact performance on a coordinated motor performance task and to determine if there were correlations between motor performance and self-reported clinical measures. People with back pain (N = 45) were stratified into 3 groups based on combinations of: lumbar imaging; and clinical presentation for ULNRC. Group 1 included people with imaging of lumbar nerve root compression, who presented with neurological deficit. Group 2 people demonstrated imaging evidence of nerve compression, without motor, sensory or reflex change. Group 3 participants possessed only degenerative changes on lumbar imaging films, and were neurologically intact. Performance measures included behavioral and kinematic variables from an established lower limb Fitts' Task requiring movements to targets of different difficulties. Self-reported measures of disability, function and pain were collected. Analysis of variance for between and within group variables were conducted, and Pearson correlation compared performance with self-reported measures. All groups yielded main effects for movement time with increasing task difficulty as predicted by Fitts' Law. A main effect revealed Group 1 participants performed less accurately than Group 3 participants. Positive correlations were predominantly found between self-report measures and motor performance for Group 2 and Group 3. Imaging, and self-reported measures alone did not predict function, however, Fitts' task performance accuracy effectively differentiated groups. [ABSTRACT FROM AUTHOR]

AIM: The main aim of this study was to evaluate functional disability in patients with cervical radiculopathy. Our second aim was to compare neck disability between males and females. METHODS: The study included 35 participants of both sexes, in which 21 were female and 14 male. We have used three scales for the evaluation of neck disability: (1) Cervical radiculopathy Impact Scale (CRIS), (2) Neck Pain and Disability (NPAD) Scale, and (3) Copenhagen Neck Functional Disability (CNFD) Scale. RESULTS: The mean scores of CRIS were 14.35 ± 15.59 in males and 33.22 ± 17.58 in females. The NPAD Scale scores were 14.35 ± 15.59 in males and 33.22 ± 17.58 in females. The mean scores of the CNFD Scale were 7.92 ± 5.56 in males and 13.50 ± 5.61 in females. All three scales showed a significant difference between the scores of the two genders, indicating more disability in female patients as compared with the male patients. CONCLUSION: Our results showed 26.22% and 25.88% disability as per CRIS and Neck Pain and Disability Scale, respectively. We found mild-to-moderate disability in our subjects according to the CNFD Scale. The study concluded that females have more disability in cervical radiculopathy as compared to males. [ABSTRACT FROM AUTHOR]

Ao-lin Yuan,1 Xin Shen,2 Bin Chen1 1Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, Hebei Province, People’s Republic of China; 2Breast and Thyroid Surgical Oncology, Hebei Medical University Second Affiliated Hospital, Shijiazhuang, Hebei Province, People’s Republic of ChinaCorrespondence: Bin Chen, Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, Hebei Province, People’s Republic of China, Email drchenbin@vip.sina.comPurpose: This study aimed to investigate the use of the percutaneous intervertebral foramen lens technology for secondary molding of the intervertebral foramen in the treatment of calcified lumbar discs.Methods: The study included 104 patients who were divided into two groups. Group A comprised 50 patients with calcified lumbar disc herniation and group B comprised 54 patients with non-calcified lumbar disc herniation diagnosed by computed tomography and magnetic resonance imaging. Patients underwent a percutaneous endoscopic lumbar discectomy at our hospital from January 1, 2017, to December 31, 2019. Demographic characteristics before the surgery and perioperative outcomes were retrospectively reviewed. The treatment outcome was analyzed using the numerical rating scale (NRS) score, Oswestry Disability Index (ODI) score, and modified Macnab criteria.Results: Patients in groups A and B showed significant improvement in both the NRS and ODI scores after the surgery and maintained relatively low ODI and NRS scores during subsequent follow-ups. According to the evaluation under the modified MacNab standard, the good–excellent rate of clinical efficacy was 94% in group A and 92.6% in group B at the 3 month follow-up. In group A, one patient developed neck pain during the surgery, which was diagnosed as spinal hypertension syndrome, and the surgery was suspended until the patient’s condition improved. No similar complications occurred in group B. In both the groups, no patient reported any dural leak, infection, or other related complications.Conclusion: The use of transforaminal remolding technology can significantly improve the symptoms and dysfunction of patients with calcified and non calcified lumbar disc herniation. There are few intraoperative and postoperative complications and have little impact on vertebral stability. It can provide a reference for the treatment of special types of lumbar disc herniation.Keywords: lumbar disc herniation, calcification, percutaneous transforaminal endoscopic surgery, nerve root compression, visual analog scale, Oswestry, disability index, Macnab criteria

Asymmetry in the degenerative lumbar spine may eventually evolve to debilitating scoliosis. The point where it starts to accelerate in some individuals is obscure. Discreet preclinical asymmetry may be a prognostic feature of the condition. The aim of this study was to assess the asymmetry of the intervertebral foramina of lower lumbar motion segments of the spine based on morphometric measurements using novel techniques of three-dimensional imaging. Computed tomography scans of 19 subjects with axial low back pain aged 50 to 78 of both sexes were digitally processed, and 3D reconstruction of L4/L5 and L5/S1 motion segments were obtained. The planes of intervertebral foramina were defined in reference to the axis of the pedicles bordering the intervertebral canal and the measurements were performed yielding absolute values in millimeters. The circumference ranged from 33.4 mm to 63.86 mm on the left side and from 33.01 mm to 73.54 mm on the right side. The horizontal dimension ranged from 6.86 mm to 17.84 mm on the left side and from 5.41 mm to 17.63 mm on the right side. The vertical dimension ranged from 10.17 mm to 23.65 mm on the left side and from 9.04 mm to 29.69 mm on the right side. All the measurements were combined to assess the asymmetry. Only in three cases (15%), symmetry in both segments was confirmed. No defined lateralization of asymmetry was found, as well as no significant link between the sex and age could be confirmed. This is the first study confirming the asymmetry among the intervertebral foramina. It seems that it is the dominant phenotype for intervertebral foramina. As the observed asymmetry lacks the dominant lateralization, it may be linked with the same trait of degenerative scoliosis. Though no direct link between the age and sex was confirmed in this study, it suggests other factors should be considered in prediction of the progress and magnitude of the deformity. [ABSTRACT FROM AUTHOR]

Cervical spondylotic radiculopathy (CSR) is one of the most common degenerative diseases of the spine that is commonly treated with surgery. The primary goal of surgery is to relieve symptoms through decompression or relieving pressure on compressed cervical nerves. Nevertheless, cutaneous pain distribution is not always predictable, making accurate diagnosis challenging and increasing the likelihood of inadequate surgical outcomes. With the widespread application of minimally invasive surgical techniques, the requirement for precise preoperative localization of the affected segments has become critical, especially when treating patients with multi-segmental CSR. Recently, the preoperative use of a selective nerve root block (SNRB) to localize the specific nerve roots involved in CSR has increased. However, few reviews discuss the currently used block approaches, risk factors, and other aspects of concern voiced by surgeons carrying out SNRB. This review summarized the main cervical SNRB approaches currently used clinically and the relevant technical details. Methods that can be used to decrease risk during cervical SNRB procedures, including choice of steroids, vessel avoidance, guidance with radiographs or ultra-sound, contrast agent usage, and other concerns, also are discussed. We concluded that a comprehensive understanding of the current techniques used for cervical SNRB would allow surgeons to perform cervical SNRB more safely. [ABSTRACT FROM AUTHOR]

An English Springer Spaniel presented with an acute onset, progressive, left pelvic limb lameness. Magnetic resonance imaging, computed tomography and intraoperative findings revealed an enlarged L5 left nerve root without additional abnormalities and, therefore, no underlying cause for the nerve root enlargement could be identified. The dog made a quick recovery following hemilaminectomy and was clinically normal 45 months after surgery. Morphometric analysis was obtained by measuring sagittal intervertebral foramen (IVF) surface areas. IVF areas in the clinical case were similar to unpublished data in normal English Springer Spaniels. Although a diagnosis of primary IVF stenosis could not be confirmed morphometrically, the lack of additional anatomical abnormalities in combination with an excellent clinical outcome was supportive of this condition. Nerve root enlargement can be caused by benign or malignant conditions. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective analysis of prospectively collected registry data using multivariable analyses of imputed data.Objective: We sought to demonstrate that age would not be associated with complications in patients undergoing anterior cervical discectomy and fusion (ACDF).Summary Of Background Data: Elderly patients (≥70 yrs) undergoing ACDF are considered a higher risk for complications. However, conclusive evidence is lacking. The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a quality improvement collaborative with 30 hospitals across Michigan.Methods: The study included all patients who had 1 to 4 level ACDF (September 2015-August 2019) for 90-day complications. Major and minor complications were defined using a validated classification. Multiple imputations were used to generate complete covariate datasets. Generalized estimating equation model was used to identify associations with complications using the whole cohort and elderly subgroup analyses. Bonferroni correction was used.Results: Nine thousand one hundred thirty five patients (11.1% ≥ 70 yrs and 88.9% <70 yrs) with 2266 complications were analyzed. Comparing elderly versus non-elderly, the elderly had a significantly higher rate of any complications (31.5% vs. 24.0%, P < 0.001) and major complications (14.1% vs. 7.0%, P < 0.001). On multivariable analysis, age was not independently associated with any complication. POD#0 ambulation and preop independent ambulation were independently associated with significantly decreased odds of any complication. In the elderly, independent preoperative ambulation was protective for any complication (odds ratio [OR] 0.53, 0.39-0.73 95% confidence interval [CI]), especially major complications (OR 0.41, 0.27-0.61 95% CI).Conclusion: Age was not an independent risk factor for complications in patients that underwent ACDF. In the elderly, independent preoperative ambulation was especially protective for major complications.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Asymmetry in the degenerative lumbar spine may eventually evolve to debilitating scoliosis. The point where it starts to accelerate in some individuals is obscure. Discreet preclinical asymmetry may be a prognostic feature of the condition. The aim of this study was to assess the asymmetry of the intervertebral foramina of lower lumbar motion segments of the spine based on morphometric measurements using novel techniques of three-dimensional imaging. Computed tomography scans of 19 subjects with axial low back pain aged 50 to 78 of both sexes were digitally processed, and 3D reconstruction of L4/L5 and L5/S1 motion segments were obtained. The planes of intervertebral foramina were defined in reference to the axis of the pedicles bordering the intervertebral canal and the measurements were performed yielding absolute values in millimeters. The circumference ranged from 33.4 mm to 63.86 mm on the left side and from 33.01 mm to 73.54 mm on the right side. The horizontal dimension ranged from 6.86 mm to 17.84 mm on the left side and from 5.41 mm to 17.63 mm on the right side. The vertical dimension ranged from 10.17 mm to 23.65 mm on the left side and from 9.04 mm to 29.69 mm on the right side. All the measurements were combined to assess the asymmetry. Only in three cases (15%), symmetry in both segments was confirmed. No defined lateralization of asymmetry was found, as well as no significant link between the sex and age could be confirmed. This is the first study confirming the asymmetry among the intervertebral foramina. It seems that it is the dominant phenotype for intervertebral foramina. As the observed asymmetry lacks the dominant lateralization, it may be linked with the same trait of degenerative scoliosis. Though no direct link between the age and sex was confirmed in this study, it suggests other factors should be considered in prediction of the progress and magnitude of the deformity.

OBJECTIVE: To determine the accuracy of limited protocol Magnetic resonance imaging of lumbar spine in determination of lumbar disc herniation, nerve root compression and annular tear taking findings of routine MRI as a reference standard. METHODOLOGY: A descriptive cross-sectional study was conducted from August 2016 to February 2017 at Dow Institute of Radiology (DIR), Dow University of Health Sciences (DUHS). All patients of either gender aged 20 years or more presenting for MRI with low back pain were included. Routine complete protocol included T1W spin echo (SE) images on the sagittal plane, fat suppression sequence on the sagittal plane and T2W fast spin echo (FSE) images on the sagittal and axial planes, while limited protocol included T2W fast spin echo images on the sagittal and axial planes. Statistical analysis for social sciences (SPSS version 24), Inc, USA was used for the purpose of statistical analysis. RESULTS: The sensitivity and specificity of limited protocol of disc herniation, nerve root compression, and AT were found to be 100% taking full protocol for disc herniation, nerve root compression, and AT as a gold standard. A significant difference of disc herniation was observed with age (p-value: <0.001), gender (p-value: 0.011), NRC (p-value: <0.001), and AT (p-value: <0.001). CONCLUSION: Limited protocol MRI of lumbar spine can lead to a definite diagnosis of LDH, NRC and AT without causing any loss of information. [ABSTRACT FROM AUTHOR]

Objective: Magnetic resonance imaging (MRI) is usually the modality of choice to assess sciatica and intervertebral disc herniation. Despite remarkable progression in diagnostic imaging and surgical techniques, definite diagnosis based on imaging interpretation is still a great challenge. The aim of this study was to determine interobserver and intraobserver variability in reporting lumbar MRI between two neuroradiologists based on the new 2014 version of disc nomenclature. Patients and methods: The study population was composed of 134 irresponsive to conservative therapy patients with clinical presentations of disc herniation and lumbar radiculopathy. MRI was taken from all the participants using a 1.5 T MRI system. Two neuroradiologists evaluated the images, separately and one of them did it twice and interpreted the scans in sagittal and axial planes. Disc bulge, disc herniation and nerve root compression were evaluated at each level. Interobserver and interaobserver agreements between two neuroradiologists, and one neuroradiologist in two times of reporting were calculated for the evaluation of bulging and herniated discs and nerve root compression by applying the Kappa statistics. Results: Bulging disc, herniated disc, the type of disc, location of the discs, and nerve root compression diagnosis were significantly in excellent agreement (kappa>0.7, p-value

Charcot spine arthropathy (CSA), a result of reduced afferent innervation, is an occurrence of Charcot joint, a progressive, degenerative disorder in vertebral joints, related mostly to spinal cord injury. The repeated microtrauma is a result of a lack of muscle protection and destroys cartilage, ligaments, and disc spaces, leading to vertebrae destruction, joint instability, subluxation, and dislocation. Joint destruction compresses nerve roots, resulting in pain, paresthesia, sensory loss, dysautonomia, and spasticity. CSA presents with back pain, spinal deformity and instability, and audible spine noises during movement. Autonomic dysfunction includes bowel and bladder dysfunction. It is slowly progressive and usually diagnosed at a late stage, usually, on average, 20 years after the first initial insult. Diagnosis is rarely clinical related to the nature of nonspecific symptoms and requires imaging with computed tomography (CT) and magnetic resonance imaging (MRI). Conservative management focuses on the prevention of fractures and the progression of deformities. This includes bed rest, orthoses, and braces. These could be useful in elderly or frail patients who are not candidates for surgical treatment, or in minimally symptomatic patients, such as patients with spontaneous fusion leading to a stable spine. Symptomatic treatment is offered for autonomic dysfunction, such as anticholinergics for bladder control. Most patients require surgical treatment. Spinal fusion is achieved with open, minimally-open (MOA) or minimallyinvasive (MIS) approaches. The gold standard is open circumferential fusion; data is lacking to determine the superiority of open or MIS approaches. Patients usually improve after surgery; however, the rarity of the condition makes it difficult to estimate outcomes. This is a review of the latest and seminal literature about the treatment and chronic management of Charcot spine. The review includes the background of the syndrome, clinical presentation, and diagnosis, and compares the different treatment options that are currently available. [ABSTRACT FROM AUTHOR]

Study Design: Multicenter retrospective cohort study.Objective: The aim of this study was to compare reoperation rates at 5-year follow-up of unilateral laminotomy for bilateral decompression (ULBD) versus posterior decompression with instrumented fusion (Fusion) for patients with low-grade degenerative spondylolisthesis (DS) with lumbar spinal stenosis (LSS) in a multicenter database.Summary Of Background Data: Controversy exists regarding whether fusion should be used to augment decompression surgery in patients with LSS with DS. For years, the standard has been fusion with standard laminectomy to prevent postoperative instability. However, this strategy is not supported by Level 1 evidence. Instability and reoperations may be reduced or prevented using less invasive decompression techniques.Methods: We identified 164 patients with DS and LSS who underwent ULBD between January 2007 and December 2011 in a multicenter database. These patients were propensity score-matched on age, sex, race, and smoking status with patients who underwent Fusion (n = 437). Each patient required a minimum of 5-year follow-up. The primary outcome was 5-year reoperation. Secondary outcome measures included postoperative complication rates, blood loss during surgery, and length of stay. Logistic regression models were used to estimate the odds ratio of the 5-year reoperation rate between the two surgical groups.Results: The reoperation rate at 5-year follow-up was 10.4% in the ULBD group and 17.2% in the Fusion group. ULBD reoperations were more frequent at the index surgical level; Fusion reoperations were more common at an adjacent level. The two types of operations had similar postoperative complication rates, and both groups tended to have fusion reoperations.Conclusion: For patients with stable DS and LSS, ULBD is a viable, durable option compared to fusion with decreased blood loss and length stay, as well as a lower reoperation rate at 5-year follow-up. Further prospective studies are required to determine the optimal clinical scenario for ULBD in the setting of DS.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Introduction: Lumbar spine Magnetic Resonance Imaging (MRI) is the most frequently performed MRI procedure. Radiologist’s reporting on qualification of lumbar neural foramen stenosis varies considerably, as there is no widely accepted grading system. We formulated a new MRI grading system comprising three grades of stenosis and normal foramen. Aim: To evaluate the reliability of new grading system for lumbar neural foramina stenosis. Materials and Methods: This descriptive study was conducted in the Department of Radiology at Tertiary Care Hospital in mid Kerala, South India between the period of April 2016 to June 2016. The four grades of the new grading system are based on sagittal MRI, relying T1WI. Grade 0 refers to normal neural foramen; Grade 1 refers to mild foraminal stenosis without perineural fat obliteration; Grade 2 refers to moderate foraminal stenosis showing partial perineural fat obliteration and Grade 3 refers to severe foraminal stenosis showing effacement of perineural fat or nerve root compression. We evaluated 762 neural foramina of 127 consecutive patients aged above 50 years with diagnosis of degenerative disc disease after MRI of the lumbar spine. Two general Radiologists independently graded L3/4, L4/5 and L5/S1 neural foramina in MRI studies, using the new grading system. One radiologist regarded neural foramina after one month, blinded to all previous grading. Interobserver agreement between the two radiologists and intraobserver agreement of one radiologist for new grading system was calculated using kappa statistics. Results: Overall inter-rater and intra-rater agreements (κ) for new grading system are 0.836 (range: 0.771 to 0.906) and 0.947 (range: 0.907-0.969) respectively. Conclusion: New grading system is optimal for routine radiologic reporting, as it is simple and reproducible.

Background Endoscopic surgery has been successfully applied in treatment of degenerative spinal disease, but few studies have assessed its use in treating sacral metastasis. We report a successful full endoscopic interlaminar approach for sacral nerve root decompression of a sacral metastatic tumor. Case Description An 80-year-old man with a history of hepatocellular carcinoma presented with buttock pain with radiation to the right lower leg for 1 week. There was also decreased muscle power of the right lower extremity. Lumbosacral magnetic resonance imaging revealed metastasis of the sacral spine and right iliac bone with S1 exiting nerve root compression. S1 nerve root decompression via a full endoscopic interlaminar approach under local anesthesia was performed. Under fluorescence guidance, a working sleeve with a beveled opening was placed in the interlaminar space of L5-S1. We entered the sacral canal and identified the S1 exiting nerve root. A laminotomy was performed from the internal edge of the right sacral laminae toward the lateral recess. During decompression of the nerve root, buttock and leg pain improved gradually. There was almost complete resolution of leg pain after surgery, and the patient recovered the ability to walk. Visual analog scale score for pain decreased from 8 to 2 after 3 months of follow-up. Conclusions For patients with sacral metastasis without spinal instability or difficulty lying in prone position under local anesthesia, the full endoscopic interlaminar approach for nerve root decompression of sacral metastasis may be a suitable method. [ABSTRACT FROM AUTHOR]

Introduction: MRI is a primary imaging modality in assessing chronic low backache. Many of the findings identified on MRI may not be symptomatic. Nerve root compressions, compression of cauda equina, posterior annular tear, facetal arthropathy are more likely to be symptomatic. Management of each of these pathologies vary. It is essential to identify the pathologies that can cause pain and symptoms in lumbar spondylosis. Aim: To identify the specific finding/pathology on MRI that corresponds to the clinical presentation of the patient with lumbar spondylosis. Materials and Methods: The study was done between May and December 2016 and included 100 patients who were referred for MRI of lumbosacral spine with history of debilitating backache for more than 2 weeks. After ruling out other causes, clinical evaluation of patients was done to localize leve; and type of pain. T1, T2 weighted and STIR imaging of lumbo-sacral spine was done. The images were studied to localize the pathology which most likely caused the pattern of pain the patient experienced. Results: The study included 55 ladies and 45 men. 42 people had radiculopathy. In 86% of cases, MRI helped in localizing the exact pathology responsible for the pattern of pain the patients experienced. Nerve compressions were seen in 86% of patients with radiculopathy. Among the people without radiculopathy, the cause for pain could be localized in 86%. The most common cause of pain identified was horizontal posterior annular fissure (40%). Conclusion: In a significant number of patients with chronic low backache, we can identify the specific pathology that corroborates with the clinical symptomatology of the patient. This aids in guiding specific management to provide symptomatic relief.

Objectives: To evaluate the diagnostic accuracy of multidetector CT (MDCT) for detection of lumbar disc herniation with MRI as standard of reference.Methods: Patients with low back pain underwent indicated MDCT (128-row MDCT, helical pitch), 60 patients with iterative reconstruction (IR) and 67 patients with filtered back projection (FBP). Lumbar spine MRI (1.5 T) was performed within 1 month. Signal-to-noise ratios (SNR) of cerebrospinal fluid (CSF), annulus fibrosus (AF) and the spinal cord (SC) were determined for all modalities. Two readers independently rated image quality (IQ), diagnostic confidence and accuracy in the diagnosis of lumbar disc herniation using MRI as standard of reference. Inter-reader correlation was assessed with weighted κ.Results: Sensitivity, specificity, precision and accuracy of MDCT for disc protrusion were 98.8%, 96.5%, 97.1%, 97.8% (disc level), 97.7%, 92.9%, 98.6%, 96.9% (patient level). SNR of IR was significantly higher than FBP. IQ was significantly better in IR owing to visually reduced noise and improved delineation of the discs. κ (>0.90) was excellent for both algorithms.Conclusion: MDCT of the lumbar spine yields high diagnostic accuracy for detection of lumbar disc herniation. IR improves image quality so that the provided diagnostic accuracy is principally equivalent to MRI.Key Points: • MDCT is an accurate alternative to MRI in disc herniation diagnosis. • By IR enhanced image quality improves MDCT diagnostic confidence similar to MRI. • Advances in CT technology contribute to improved diagnostic performance in lumbar spine imaging. [ABSTRACT FROM AUTHOR]

Direct lateral lumbar interbody fusion (DLIF) has been introduced as an effective new thoracolumbar fusion technique for patients with degenerative lumbar diseases. DLIF associated with easy-to-learn, high fusion rate, improved restoration of spinal alignment, and early patient mobilization due to minimally invasive nature. However, ipsilateral L2-L5 nerve root irritation and injury are well-known complications. However, damage to the contralateral nerve root has been rarely reported and, to the best of our knowledge, there have not been any reports about contralateral nerve root injury after DLIF in Korea. Thus, we report a case of contralateral nerve root compression due to osteophyte from the lower endplate of the vertebral body and position of intervertebral cage after DLIF. [ABSTRACT FROM AUTHOR]

We report a case of an osteochondroma in a 47-year-old woman presenting with a 2-month history of thoracic back pain that radiated down her left arm. Based on imaging features, the osteochondroma was initially thought to represent a calcified meningioma. The unusual features of the case include the location of the tumor, patient age, the erosion of the vertebra, and the confusing neuroradiological features. We review reported cases in which a solitary costal osteochondroma impinges on the neural foramina or central spinal canal and we discuss reasons for the misdiagnosis in our case. [ABSTRACT FROM AUTHOR]

Background & objectives: Magnetic resonance imaging (MRI) is frequently done for the evaluation of chronic low backache (CLBA), however, its significance in Indian patients has not been evaluated. We report here the MRI findings in patients with CLBA and their sensitivity and specificity with clinical evidence of radiculopathy and localized CLBA as well as correlate these with pain severity and disability. Methods: Seventy two patients with CLBA aged 20-70 yr without trauma, infection, tumour, metastasis and vascular malformation were included in the study. Their demographic characteristics, lifestyle, education and employment were noted. Lumbosacral MRI was carried out and 19 MRI parameters at six levels (D12-L1-L5-S1) were noted. The severity of pain was assessed by Numeric Rating Scale (NRS, 0-10) and disability by Oswestry Disability Index (ODI). Results: MRI was abnormal in all patients, the most common being disc desiccation (90.3%) followed by facet joint arthropathy (FJA; 75%) and nerve root compression (NRC; 72.2%). Endplate changes and high-intensity zone were noted in 58 and 50 per cent of patients, respectively. One-third patients with FJA, however, were below 30 yr of age. NRC on MRI had 61.3 per cent sensitivity and 10 per cent specificity with clinical radiculopathy. FJA had 60.7 per cent sensitivity and 15.9 per cent specificity with localized CLBA. None of the MRI parameters and MRI sum score correlated with NRS and ODI. On multivariate analysis, NRS was independent predictor of ODI (odds ratio 0.58, 95% confidence interval 0.35-0.98, P=0.04). Interpretation & conclusions: In patients with CLBA, NRC on MRI showed poor specificity with corresponding clinical radiculopathy and FJA with localized backache. None of the MRI abnormality correlated with the severity of pain or disability. [ABSTRACT FROM AUTHOR]

Study Design: Systematic review OBJECTIVE.: The aim of the study was to investigate whether magnetic resonance imaging (MRI) findings change over a relatively short period of time (<1 yr) in people with low back pain (LBP) or sciatica. We also investigated whether there was an association between any change in MRI findings and change in clinical outcomes.Summary Of Background Data: MRI offers the potential to identify possible pathoanatomic sources of LBP and/or sciatica; however, the clinical importance of MRI findings remains unclear. Little is known about whether lumbar MRI findings change over the short term and if so whether these changes are associated with changes in clinical outcomes.Methods: Medline, EMBASE, and CINAHL databases were searched. Included were cohort studies that performed repeat MRI scans within 12 months in patients with LBP and/or sciatica. Data on study characteristics and change in MRI findings were extracted from included studies. Any data describing associations between change in MRI findings and change in clinical outcomes were also extracted.Results: A total of 12 studies met the inclusion criteria and were included in the review. Pooling was not possible due to heterogeneity of studies and findings. Seven studies reported on changes in disc herniation and reported 15% to 93% of herniations reduced or disappeared in size. Two studies reported on changes in nerve root compression and reported 17% to 91% reduced or disappeared. Only one study reported on the association between change in MRI findings and change in clinical outcomes within 1 year, and found no association.Conclusion: This review found moderate evidence that the natural course of herniations and nerve root compression is favorable over a 1-year period in people with sciatica or LBP. There is a lack of evidence on whether other MRI findings change, and whether changes in MRI findings are associated with changes in clinical outcomes.Level Of Evidence: 1. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the muscle activation of patients with lumbar disc herniation (LDH) during walking by surface electromyography (SEMG) and establish a diagnostic model based on SEMG parameters using random forest (RF) algorithm for localization diagnosis of compressed nerve root in LDH patients., Methods: Fifty-eight patients with LDH and thirty healthy subjects were recruited. The SEMG of tibialis anterior (TA) and lateral gastrocnemius (LG) were collected bilaterally during walking. The peak root mean square (RMS-peak), RMS-peak time, mean power frequency (MPF), and median frequency (MF) were analyzed. A diagnostic model based on SEMG parameters using RF algorithm was established to locate compressed nerve root, and repeated reservation experiments were conducted for verification. The study evaluated the diagnostic efficiency of the model using accuracy, precision, recall rate, F1-score, Kappa value, and area under the receiver operating characteristic (ROC) curve., Results: The results showed that delayed activation of TA and decreased activation of LG were observed in the L5 group, while decreased activation of LG and earlier activation of LG were observed in the S1 group. The RF model based on eight SEMG parameters showed an average accuracy of 84%, with an area under the ROC curve of 0.93. The RMS peak time of TA was identified as the most important SEMG parameter., Conclusion: These findings suggest that the RF model can assist in the localization diagnosis of compressed nerve roots in LDH patients, and the SEMG parameters can provide further references for optimizing the diagnosis model in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wang, Wang, Li, Wang and Qie.)

La cola de caballo representa la continuación caudal de la médula espinal. Esta porción del sistema nervioso es asiento de numerosas patologías. Se presenta un caso clínico que debutó de forma aguda con un síndrome de la cola de caballo, secundario a una hernia discal lumbar traumática. Se trata de un paciente masculino de 45 años de edad, que acude al servicio de urgencias, porque refiere síntomas que inician siete días antes de forma aguda y progresiva, luego de haber caído de una altura de tres metros. Al interrogarlo existía debilidad muscular del miembro inferior izquierdo y dificultad para caminar. El examen físico corroboró la disminución de la fuerza muscular y arreflexia Aquileo-plantar. Se realizó estudio de resonancia magnética, que demostró una hernia discal extruída en el interespacio L5-S1. El paciente se llevó al salón de urgencia y se realizó exeresis de la hernia. Egresó al séptimo día con discreta mejoría clínica. Se ha seguido en consulta externa durante un periodo de 8 meses, con muy poca recuperación del control esfinteriano, de la actividad motora y sensitiva.Horse-tail represents the caudal continuation of the spinal cord. This portion of the nervous system is the seat of numerous pathologies. We present a case report of acute debuted with a syndrome of the cauda equina, secondary to traumatic lumbar disc herniation. This is a male patient aged 45, who was admitted to the emergency room because he referred acute and progressive symptoms starting seven days before, after falling from three meters high. By questioning, we found muscle weakness in his left leg and difficulty at walking. The physical examination confirmed the decrease in muscle strength and Achilles-plantar areflexia. We performed MRI, which showed extruded disc herniation in L5-S1 interspace. The patient was taken to the emergency room and we performed the hernia excision. He was discharged at the seventh day with mild clinical improvement. We have continued the follow up as outpatient for a period of eight months. There is very little recovery of sphincter control, motor and sensory activity.