Comparison of Clinical Outcomes of Posterior-Only Transforaminal Debridement and Interbody Fusion With Preservation of Posterior Ligamentous Complex Versus Conventional Posterior-Only Debridement and Interbody Fusion for Thoracic Spine Tuberculosis: A Prospective, Randomized, Controlled, Clinical Trial - A Pilot Study.

OBJECTIVE: The main objective of this study was to analyze the efficacy and feasibility of surgical management for patients with thoracic spinal tuberculous spondylitis (STB) by using posterior-only transforaminal debridement and interbody fusion (PTDIF) with preservation of posterior ligamentous complex (PLC) and noninferior of PTDIF compared with conventional posterior-only debridement and interbody fusion (CPDIF). METHODS: From January 2019 to January 2022, a prospective, randomized, controlled trial was conducted in which patients with thoracic STB were enrolled and assigned to undergo either the PTDIF group (group A) or CPDIF group (group B) in a 1:1 ratio. The clinical efficacy was evaluated on average operation time, blood loss, hospitalization durations, visual analogue scale, Oswestry Disability Index scores, erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), and neurological function recovery using the American Spinal Injury Association's impairment scale and operative complications. Radiological measurements included kyphosis correction, loss of correction. The outcomes were compared between the groups at preoperation, postoperaion, and final follow-up. RESULTS: All 65 patients were completely cured during the follow-up. The intraoperative blood loss and operation time in group B were more than that in group A. All patients were pain-free at the final follow-up visit. ESR, CRP returned to normal limits in all patients 3 months after surgery. All patients had improved neurological signs. No significant difference was found in kyphosis angle correction, loss of correction between the 2 groups. CONCLUSION: PTDIF, with preservation of PLC, achieved debridement, decompression, and reconstruction of the spine's stability, similar to CPDIF in the surgical treatment of thoracic STB. PTDIF has less surgical trauma with less intraoperative blood loss and operation time.

Comprehensive Radiological Imaging for the Characterization of Spinal Dysraphism and Associated Anomalies in a Pediatric Case.

Spinal dysraphism is a spectrum of congenital anomalies caused by incomplete neural tube closure during early development, leading to spine and spinal cord defects. These can be broadly categorized into anomalies of gastrulation (including disorders of notochord formation and integration), anomalies of primary neurulation (such as premature disjunction and nondisjunction), combined anomalies of gastrulation and primary neurulation, and anomalies of secondary neurulation. This case report focuses on a 15-year-old male patient who exhibits a range of congenital spinal anomalies of spinal dysraphism spectrum, each contributing to a complex clinical picture. The primary aim of this report is to highlight the critical role of multimodal imaging in the evaluation of such conditions. Detailed imaging studies, particularly magnetic resonance imaging (MRI), are indispensable in accurately diagnosing, guiding surgical planning, and managing the diverse anomalies associated with spinal dysraphism. In this case, imaging findings were pivotal in identifying multiple congenital abnormalities, including scoliosis, butterfly vertebrae, block vertebrae, spina bifida occulta, and diastematomyelia. These conditions pose significant diagnostic and management challenges due to their varied presentations and complications.

Clinical application of a modified wiltse approach in middle and lower thoracic vertebrae: a case-control study of thoracic fracture patients.

BACKGROUND: The Wiltse approach has been extensively employed in thoracolumbar surgeries due to its minimal muscle damage. However, in the middle and lower thoracic spine, the conventional Wiltse approach necessitates the severance of the latissimus dorsi and trapezius muscles, potentially leading to muscular injury. Consequently, we propose a modified Wiltse approach for the middle and lower thoracic vertebrae, which may further mitigate muscular damage. METHODS: From May 2018 to April 2022, 60 patients with spinal fractures in the middle and lower thoracic vertebrae (T5-12) were enrolled in this study. Thirty patients underwent surgery using the modified Wiltse approach (Group A), while the remaining 30 patients received traditional posterior surgery (Group B). The observation indices included operation time, intraoperative blood loss, incision length, number of C-arm exposures, postoperative drainage, postoperative ambulation time, discharge time, as well as preoperative and postoperative Cobb's angle, percentage of anterior vertebral body height (PAVBH), visual analog scale (VAS) Score, and Oswestry disability index (ODI). RESULTS: Compared to the traditional posterior approach, the modified Wiltse approach demonstrated significant advantages in operation time, intraoperative blood loss, length of incision, postoperative ambulation time, postoperative drainage, and discharge time, as well as postoperative VAS and ODI scores. No significant differences were observed between the two groups in terms of number of C-arm exposures, postoperative Cobb's angle, or postoperative PAVBH. CONCLUSION: We propose a modification of the Wiltse approach for the middle and lower thoracic vertebral regions, which may further minimize muscular damage and facilitate the recovery of patients who have undergone surgery in the middle and lower thoracic vertebrae.

Precaudal Vertebrae in the Postcranial Region of Moray Eels Form Ventral Processes.

Fish vertebrae are primarily morphologically classified into precaudal vertebrae jointed to the ribs and caudal vertebrae with hemal spines, through which the caudal artery and veins pass. Moray eels (family Muraenidae) capture prey by directly biting, combining oral and pharyngeal jaw. During feeding motions, they exhibit various head manipulations, such as neurocranial elevation, ventral flexion, and horizontal shaking, with their postcranial region acting like the neck of amniotes. However, the bone morphology supporting these movements remains unclear. In this study, the vertebral morphologies of the Kidako moray (Gymnothorax kidako), starry moray (Echidna nebulosa), pink-lipped moray (Echidna rhodochilus), tidepool snake moray (Uropterygius micropterus), and Seychelles moray (Anarchias seychellensis) were investigated using X-ray computed tomography. These five species exhibited longitudinal ventral processes in the second to approximately 12th precaudal vertebrae with canals for blood vessels, structurally similar to hemal spines. In addition, the morphology of the precaudal vertebrae in three Anguilliformes species closely related to moray eels and two Gasterosteiformes species, including a seahorse that flexes its head ventrally as a feeding motion, was compared with that of moray eels. However, no remarkable ventral processes were observed in their precaudal vertebrae in the postcranial region, suggesting that these structural features in the postcranial vertebrae were preserved in Muraenidae but not necessarily required for the fish to bend its head ventrally. Although the functional significance of the ventral process has yet to be determined, our findings highlight a novel aspect of fish vertebral morphology.

Impact of posture and axial loading on lumbar intervertebral disc dimensions investigated by transabdominal ultrasound.

PURPOSE: To use transabdominal ultrasound (US) to investigate the impact of posture and axial loading on the lumbar intervertebral disc (IVD) dimensions in healthy adults. METHOD: For this single-center, prospective cross-sectional study 54 healthy volunteers (mean age 23.76 ± 3, 26 men) underwent transabdominal US. Lumbar IVD dimensions (height, length, width) at the levels L3/4 and L4/5 were assessed in three test conditions: supine, standing, and standing position with additional axial load of 50 % body weight (standing+50%). Success rates for the longitudinal and transverse US acquisitions and IVD dimension measurements were determined. IVD dimensions were compared across test conditions using two-way repeated measures analysis of variance and post-hoc pairwise t-tests with Bonferroni correction. RESULTS: The success rate for longitudinal and transverse US acquisition was 100 %. The overall success rate for IVD dimension measurement was 96.4 %, it was highest for IVD height (99.2 %) and lowest for IVD length (93.3 %). IVD height at L4/5 decreased significantly from the supine to standing position (p < 0.05) and from the supine to standing+50% position (p < 0.01). IVD width at L3/4 increased significantly from the supine to standing+50% position (p < 0.05). No significant differences were found for IVD length. CONCLUSIONS: Transabdominal US is a feasible tool to investigate IVD dimensions at L3/4 and L4/5 in different postures and with axial loading. Posture and axial loading significantly influence IVD height and width, but not length.

Effects of Auricular Acupressure on Pain and Stress in Nursing College Students With Cervical Pain: A Single-Blind Placebo-Controlled Trial.

PURPOSE: This study aimed to examine the effects of auricular acupressure (AA) on neck pain and stress in nursing students with neck pain. METHODS: This single-blind, randomized, and placebo-controlled comparative pretest-posttest study involved administering AA for four weeks. The subjects included nursing students experiencing neck pain. The experimental group comprised 17 subjects, and the control group comprised 14 subjects. In the experimental group, AA was applied to the Shenmen, cervical vertebrae, shoulder, and liver areas to improve neck pain and reduce stress. In the control group, AA was applied to the anus, rectum, urethra, and external genitalia areas, which are not associated with neck pain and stress. To assess the intervention effects, NRS (Numeric Rating Scale), NDI (Neck Disability Index), and PSS (Perceived Stress Scale) scores were measured. RESULTS: The NRS scores in the experimental group with AA significantly decreased over time (F = 7.463, p < .001). The between group and group-by-time interaction results were F = 8.564, p = .007 and F = 3.252, p = .025, respectively. The NDI scores in the experimental group showed a statistically significant difference between the groups (F = 13.762, p = .001); however, there were no significant differences over time or in the group-by-time interaction (F = 1.086, p = .347) (F = .301, p = .757). The PSS scores in the experimental group decreased significantly over time (F = 5.557, p = .013), but there were no significant differences between the groups (F = .636, p = .432) or in the group-by-time interaction (F = .063, p = .891). CONCLUSION: AA applied for four weeks was found to be safe, noninvasive, and effective in reducing neck pain in nursing students with cervical pain.

Unilateral biportal endoscopic discectomy via translaminar approach for highly upward-migrated lumbar disc herniation: a technical note and preliminary treatment outcomes.

STUDY DESIGN: A technical note and retrospective case series. OBJECTIVE: Highly upward-migrated lumbar disc herniation (LDH) is challenging due to its problematic access and incomplete removal. The most used interlaminar approach may cause extensive bony destruction. We developed a novel translaminar approach using the unilateral portal endoscopic (UBE) technique, emphasizing effective neural decompression, and preserving the facet joint's integrity. METHODS: This retrospective study included six patients receiving UBE translaminar discectomy for highly upward-migrated LDHs from May 2019 to June 2021. The migrated disc was removed through a small keyhole on the lamina of the cranial vertebra. The treatment results were evaluated by operation time, hospital stays, complications, visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, and modified MacNab criteria. RESULTS: The mean pre-operative VAS for back pain (5.0 ± 4.9), VAS for leg pain (9.2 ± 1.0), JOA score (10.7 ± 6.6), and ODI (75.7 ± 25.3) were significantly improved to 0.3 ± 0.5, 1.2 ± 1.5, 27.3 ± 1.8, 5.0 ± 11.3 respectively at the final follow-up. Five patients had excellent, and one patient had good outcomes according to the Modified MacNab criteria. The hospital stay was 2.7 ± 0.5 days. No complication was recorded. The MRI follow-up showed complete disc removal, except for one patient with an asymptomatic residual disc. CONCLUSIONS: UBE translaminar discectomy is a safe and effective minimally invasive procedure for highly upward-migrated LDH with satisfactory treatment outcomes and nearly 100% facet joint preservation.

Integrating Ultrasound-Guided Multifidus Injections with Repeated Peripheral Magnetic Stimulation for Low Back Pain: A Feasibility Study.

Background: Low back pain is a globally prevalent musculoskeletal issue. Repetitive peripheral magnetic stimulation (rPMS) is emerging as a promising modality for managing musculoskeletal pain, while ultrasound-guided lumbar facet/multifidus injections are a potential therapeutic option for low back pain. This study explores the feasibility of combining these two treatments for managing low back pain. Materials and Methods: Ultrasound-guided injections were administered using 5 mL of 50% dextrose and 5 mL of 1% lidocaine. Bilateral injections targeted the L4/L5 and L5/S1 facet joints with 1 mL at each site, and the remaining 8 mL was distributed over the multifidus muscles using peppering techniques. Following injections, rPMS therapy was conducted with the TESLA Stym® device, targeting the bilateral lumbosacral region over 12 sessions. Pain intensity was measured using the visual analog scale (VAS), and disability was assessed with the Oswestry disability index (ODI) at baseline, after six sessions, and after 12 sessions of rPMS. Results: Three participants were enrolled. Baseline VAS and ODI scores were 8.33 ± 0.29 cm and 49.63 ± 1.28%, respectively. After six rPMS sessions, VAS and ODI scores changed to 4.33 ± 3.75 cm and 21.48 ± 19.42%, respectively. After 12 sessions, VAS decreased to 0.83 ± 1.44 cm and ODI to 5.19 ± 8.98%. Significant differences were observed between baseline and final assessments. Conclusion: Combining ultrasound-guided lumbar facet/multifidus injections with rPMS shows promise for treating low back pain. However, long-term efficacy and comparison with conventional treatments require further investigation through prospective randomized controlled trials.

Insufficient endplate-bone graft contact is a risk factor for high-grade cage subsidence occurring after lateral lumbar interbody fusion supplemented with lateral plate: An analysis of 121 cases.

BACKGROUND: Lateral lumbar interbody fusion (LLIF) is a minimally invasive fusion technique that can be performed with lateral plate. Insufficient contact between the endplate and bone graft may result in cage subsidence. This study aimed to investigate the potential risk factor for high-grade cage subsidence (HCS) occurring after LLIF supplemented with lateral plate. METHODS: Between June 2017 and February 2023, 121 patients (48 males, 73 females; mean age 63.0 years; minimum follow-up period 12 months) undergoing LLIF supplemented with lateral plate were retrospectively reviewed. The incidence of HCS was assessed, and patients were categorized into HCS group or non-HCS group based on the occurrence of HCS. A revision surgery of posterior pedicle screw fixation was performed in patients with cage subsidence and complained with intolerable back pain or radicular symptoms. Comparative analyses were performed on demographic characteristics, surgical variables, and parameters related to endplate-bone graft contact between the two groups. Multivariable logistic regression analysis was employed to identify the potential risk factors associated with HCS. The receiver operating characteristic (ROC) analysis was used to calculate the cutoff values for the risk factors. Clinical outcomes were evaluated using Oswestry Disability Index (ODI), and radiographic fusion at the final follow-up was assessed based on the Bridwell grading system. RESULTS: The HCS group comprised 12 patients, while the non-HCS group included 109 patients. The incidence of HCS occurring after LLIF supplemented with lateral plate was 9.9 %. Compared to non-HCS group, patients in HCS group had lower sagittal and coronal endplate-bone graft contact rates and larger cage-endplate angles. Low sagittal (OR, 1.099; 95 % CI, 1.033-1.169; P=0.003) and low coronal (OR, 1.149, 95 % CI, 1.061-1.243, P=0.001) endplate-bone graft contact rates were determined to be correlated with HCS. The cutoff value of the sagittal and coronal endplate-bone graft contact rate was 63.5 % and 60.9 %. Eleven (91.7 %) patients in HCS group underwent revision posterior pedicle screw fixation. Both HCS and non-HCS groups experienced significant improvements in ODI at the final follow-up, while there were no differences between groups. Ninety-five (87.2 %) patients in non-HCS group, and nine (81.8 %) of the 11 patients who underwent revision surgery in HCS group achieved radiographic fusion at the final follow-up. CONCLUSIONS: The incidence of HCS occurring after LLIF supplemented with lateral plate was 9.9%. Insufficient endplate-bone graft contact is an important risk factor of HCS, and sagittal and coronal endplate-bone graft contact rates can be used as effective predictors for HCS.

Comparison of the short-term efficacy of MIS-TLIF and Endo-LIF for the treatment of two-segment lumbar degenerative disease.

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.