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.

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.

The cross-sectional area of gluteal muscle on multiaxial CT scan as a predictor for diagnosing sarcopenia in patients with degenerative lumbar disease.

PURPOSE: This study examined the predictive value of the gluteal muscle index (GMI) for diagnosing sarcopenia in patients with degenerative lumbar disease (DLD), highlighting the need for effective diagnostic markers in this population. METHODS: This prospective observational study included 202 elderly patients scheduled for lumbar spine surgery. Muscle indices for psoas, paraspinal, and gluteal muscles were measured using multiaxial computed tomography. Sarcopenia was diagnosed per the 2019 Asian Working Group for Sarcopenia (AWGS) criteria. Statistical analysis comprised univariate and multivariate logistic regression to identify predictors of sarcopenia. RESULTS: Of patients, 77% were diagnosed with sarcopenia. The GMI and psoas muscle index (PMI) were identified as significant predictors of sarcopenia in the univariate analysis. Multivariate analysis confirmed their predictive value, with higher indices correlating with a reduced risk of sarcopenia (GMI odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.92-0.97; PMI OR = 0.95, 95% CI = 0.92-0.98, both P < .001). CONCLUSION: The GMI serves as a reliable predictor of sarcopenia in elderly patients undergoing lumbar spine surgery for DLD, suggesting a significant role of gluteal muscles in diagnosing sarcopenia. Incorporating GMI into clinical assessments is critical to better manage and diagnose sarcopenia in this population.

[Reasons and strategies of reoperation after oblique lateral interbody fusion].

OBJECTIVE: To summarize the reasons and management strategies of reoperation after oblique lateral interbody fusion (OLIF), and put forward preventive measures. METHODS: From October 2015 to December 2019, 23 patients who underwent reoperation after OLIF in four spine surgery centers were retrospectively analyzed. There were 9 males and 14 females with an average age of (61.89±8.80) years old ranging from 44 to 81 years old. The index diagnosis was degenerative lumbar intervertebral dics diseases in 3 cases, discogenic low back pain in 1 case, degenerative lumbar spondylolisthesis in 6 cases, lumbar spinal stenosis in 9 cases and degenerative lumbar spinal kyphoscoliosis in 4 cases. Sixteen patients were primarily treated with Stand-alone OLIF procedures and 7 cases were primarily treated with OLIF combined with posterior pedicle screw fixation. There were 17 cases of single fusion segment, 2 of 2 fusion segments, 4 of 3 fusion segments. All the cases underwent reoperation within 3 months after the initial surgery. The strategies of reoperation included supplementary posterior pedicle screw instrumentation in 16 cases;posterior laminectomy, cage adjustment and neurolysis in 2 cases, arthroplasty and neurolysis under endoscope in 1 case, posterior laminectomy and neurolysis in 1 case, pedicle screw adjustment in 1 case, exploration and decompression under percutaneous endoscopic in 1 case, interbody fusion cage and pedicle screw revision in 1 case. Visual analogue scale (VAS) and Oswestry disability index (ODI) index were used to evaluate and compare the recovery of low back pain and lumbar function before reoperation and at the last follow-up. During the follow-up process, the phenomenon of fusion cage settlement or re-displacement, as well as the condition of intervertebral fusion, were observed. The changes in intervertebral space height before the first operation, after the first operation, before the second operation, 3 to 5 days after the second operation, 6 months after the second operation, and at the latest follow-up were measured and compared. RESULTS: There was no skin necrosis and infection. All patients were followed up from 12 to 48 months with an average of (28.1±7.3) months. Nerve root injury symptoms were relieved within 3 to 6 months. No cage transverse shifting and no dislodgement, loosening or breakage of the instrumentation was observed in any patient during the follow-up period. Though the intervertebral disc height was obviously increased at the first postoperative, there was a rapid loss in the early stage, and still partially lost after reoperation. The VAS for back pain recovered from (6.20±1.69) points preoperatively to (1.60±0.71) points postoperatively(P<0.05). The ODI recovered from (40.60±7.01)% preoperatively to (9.14±2.66)% postoperatively(P<0.05). CONCLUSION: There is a risk of reoperation due to failure after OLIF surgery. The reasons for reoperation include preoperative bone loss or osteoporosis the initial surgery was performed by Stand-alone, intraoperative endplate injury, significant subsidence of the fusion cage after surgery, postoperative fusion cage displacement, nerve damage, etc. As long as it is discovered in a timely manner and handled properly, further surgery after OLIF surgery can achieve better clinical results, but prevention still needs to be strengthened.

[One-stage posterior debridement and spinal internal fixation for the treatment of lumbar Brucellar spondylitis].

OBJECTIVE: To explore the clinical efficacy and safety of one-stage posterior lesion removal and internal spinal fixation in patients with lumbar Brucellosis spondylitis. METHODS: The clinical data of 24 patients admitted from October 2017 to October 2022 were retrospectively analyzed, 2 patients were lost to follow-up at 10 months after surgery, at the final 22 cases were included in the study, including 13 males and 9 females with an average age of (52.00±6.89) years old, were treated with one-stage posterior lesion removal and internal spinal fixation. The operation time, intraoperative bleeding, follow-up time, erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) before and after operation were recorded. The pain visual analogue scale(VAS), Oswestry disability index(ODI), the Japanese Orthopaedic Association(JOA) score for neurofunction, American Spinal Injury Association(ASIA) spinal cord injury grade and modified MacNab criteria were ussed to evaluate the efficacy. RESULTS: All patients were followed up from 12 to 30 months with an average of (17.41±4.45) months. The operation time was 70 to 155 min with an average of (116.59±24.32) min;the intraoperative bleeding volume was 120 to 520 ml with an average of (275.00±97.53) ml. CRP and ESR levels decreased more significantly at 1 week and at the final follow-up than preoperative levels(P<0.05). VAS, JOA score and ODI at 1 week and at the latest follow-up were more significantly improved than preoperative results(P<0.05). There was no significant difference between ASIA preoperative and 1 week after operation(P>0.05), and a significant difference between preoperative and last follow-up(P<0.05). In the final follow-up, 21 patients had excellent efficacy, 1 patient had fair, and there was no recurrence during the follow-up. CONCLUSION: One-stage transpedicular lesion removal and internal spinal fixation, with few incisions and short operation time, helps the recovery of neurological function, and the prognosis meets the clinical requirements, which can effectively control Brucella spondylitis.

Global utilization of biportal spinal endoscopy: Case series on management of lumbar pathology in Soddo, Ethiopia.

INTRODUCTION: Biportal spinal endoscopy is a safe and cost-effective methodology for the management of lumbar pathology in rural underserved hospitals that have standard orthopaedic arthroscopic equipment, but lack access to microscopy. METHODS: This is a case series noting 1-year outcomes from 5 patients managed with biportal spinal endoscopy during an 11-day mission trip to Soddo, Ethiopia in November 2022. Surgical complications, postoperative assessments, and patient-reported outcomes (PROs) were retrospectively collected and analyzed. Surgical techniques and equipment utilized were shared with residents and faculty at the hospital. RESULTS: Five Ethiopian patients (4:1, female:male) with no prior spine surgery history elected to undergo biportal surgery for the diagnoses of lumbar stenosis and disc herniation, averaging 31 years of age with Body-Mass-Indices (BMI) <35. Two patients underwent endoscopic discectomy, and three patients underwent endoscopic unilateral laminotomy and bilateral decompression (ULBD). There were no complications. No postoperative functional deficits, infections, readmissions, revisions, or wound dehiscences were noted at 12 months follow-up. VAS-back and VAS-leg scores improved to <2/10 for 80 % of patients. All patients returned to work/activities of daily living. No patients required postoperative pain management beyond the 2-week post-operative follow-up. CONCLUSION: With these five patients, we found that biportal spinal endoscopy can be safely applied in rural hospital settings with limited resources. This supports biportal spinal endoscopy as a viable minimally invasive modality for the management of lumbar pathology. For hospitals with limited resources, but access to arthroscopic equipment, biportal spinal endoscopy is a feasible option. LEVEL OF EVIDENCE: IV.

Preoperative application of CT and MRI registration in lumbar disc herniation endoscopic surgery could improve the postoperative rehabilitation of patients.

BACKGROUND: Percutaneous Endoscopic Lumbar Discectomy (PELD) has emerged as routine treatment for lumbar disc herniation (LDH) due to its minimal invasiveness and quick recovery. However, PELD demands high precision from the surgeon, as the risk of intraoperative complications is substantial, including potential damage to the nerve root and dura, and a higher likelihood of recurrence post-surgery. Thus, preoperative planning utilizing CT and MRI imaging is essential. METHODS: In this study, the clinical data of 140 patients treated with PELD for LDH from January 2021 to December 2023 were retrospectively analyzed. Patients were categorized into two groups based on whether CT and MRI registration (CMR) was employed for surgical planning: a CMR group (n=68) and a control group (n=72). Data collected included surgery time, hospital stay duration, and scores from the Visual Analog Scale (VAS) for low back and leg pain, as well as the Japanese Orthopaedic Association Lumbar Spine Score (JOA). Differences between the two groups were assessed using the Student's t-test. RESULTS: No significant difference was found in hospital stay length between the groups (P=0.277). Surgery time was significantly shorter in the CMR group (P<0.001). Prior to surgery, no significant differences in VAS scores for leg and low back pain were observed between the groups (P=0.341 and P=0.131, respectively); however, at 2 months postoperatively, both scores were significantly lower in the CMR group (P<0.001 and P=0.002, respectively). Similarly, no difference in preoperative JOA scores was noted (P=0.750), but at 2 months postoperative, the CMR group exhibited significantly higher scores (P<0.001). CONCLUSION: Compared with the traditional PELD, the preoperative use of CMR has shown to reduce surgery time, alleviate leg and low back pain, and increase the lumbar JOA score at 2 months after surgery, underscoring its efficacy in enhancing surgical outcomes.

Thoracolumbar fracture and spinal cord injury in blunt trauma: a systematic review, meta-analysis, and meta-regression.

Thoracolumbar (TL) fractures are among the most common vertebral fractures. These patients have high morbidity and mortality due to injury mechanisms and associated injuries. Spinal cord injury (SCI) is a prevalent complication of spinal fractures of the thoracolumbar region. AIM: To determine the pooled rate of thoracolumbar fractures and SCI in blunt trauma patients. METHODS: A systematic review and meta-analysis of observational studies were performed. The search was conducted in the PubMed, Scopus, Web of Science, and Embase databases. The authors screened and selected studies based on predefined inclusion and exclusion criteria. Studies were then evaluated for risk of bias using the JBI checklist. The pooled event rate and 95% confidence intervals (CI) were calculated using random effects models. Subgroup and meta-regression analyses were performed to explore sources of heterogeneity. RESULTS: Twenty-one studies fulfilled the selection criteria. The pooled rate of TL fractures was 8.08% (CI = 6.18-10.50%), with high heterogeneity (I2 = 99.98%, P < 0.001). Thoracic and lumbar fractures accounted for 45.23% and 59.01% of the TL fractures, respectively. Meta-regression revealed that the midpoint of the study period was a significant moderator. The pooled event rate of SCI among TL fracture patients was 15.81% (CI = 11.11 to 22.01%) with high heterogeneity (I2 = 98.31%, P < 0.001). The country of study was identified as a source of heterogeneity through subgroup analysis, and studies from the United States reported higher rates of SCI. Meta-regression revealed that the critical appraisal score was negatively associated with event rate. CONCLUSION: Our study evaluated the rate of TL fractures in multiple countries at different time points. We observed an increase in the rate of TL fractures over time. SCI results also seemed to vary based on the country of the original study.

Accuracy of an artificial intelligence algorithm for detecting moderate-to-severe vertebral compression fractures on abdominal and thoracic computed tomography scans.

Objective: To describe the accuracy of HealthVCF, a software product that uses artificial intelligence, in the detection of incidental moderate-to-severe vertebral compression fractures (VCFs) on chest and abdominal computed tomography scans. Materials and Methods: We included a consecutive sample of 899 chest and abdominal computed tomography scans of patients 51-99 years of age. Scans were retrospectively evaluated by the software and by two specialists in musculoskeletal imaging for the presence of VCFs with vertebral body height loss > 25%. We compared the software analysis with that of a general radiologist, using the evaluation of the two specialists as the reference. Results: The software showed a diagnostic accuracy of 89.6% (95% CI: 87.4-91.5%) for moderate-to-severe VCFs, with a sensitivity of 73.8%, a specificity of 92.7%, and a negative predictive value of 94.8%. Among the 145 positive scans detected by the software, the general radiologist failed to report the fractures in 62 (42.8%), and the algorithm detected additional fractures in 38 of those scans. Conclusion: The software has good accuracy for the detection of moderate-to-severe VCFs, with high specificity, and can increase the opportunistic detection rate of VCFs by radiologists who do not specialize in musculoskeletal imaging.

Objetivo: Descrever a acurácia do software HealthVCF na detecção incidental de fraturas compressivas de corpos vertebrais moderadas a graves em exames de tomografia computadorizada do tórax e abdome. Materiais e Métodos: Foram incluídos 899 exames consecutivos de pacientes com idades entre 51 e 99 anos. As imagens foram retrospectivamente avaliadas pelo software e por dois radiologistas especializados em musculoesquelético que investigaram fraturas compressivas de corpos vertebrais com perda da altura somática > 25%. A análise comparativa foi realizada entre o software e um radiologista geral, usando a avaliação do especialista como referência. Resultados: O software apresentou uma acurácia de 89,6% (IC 95%: 87,4­91,5%) para fraturas compressivas moderadas a graves, com sensibilidade de 73,8%, especificidade de 92,7% e valor preditivo negativo de 94,8%. Entre as 145 tomografias positivas detectadas pelo software, o radiologista geral deixou de relatar as fraturas em 62 (42,8%) e o algoritmo detectou fraturas adicionais em 38 dessas tomografias. Conclusão: O software possui boa acurácia na detecção de fraturas compressivas moderadas a graves, com alta especificidade, podendo aumentar a taxa de detecção oportunística dessas fraturas por radiologistas não especializados em musculoesquelético.

Clinical use of quantitative computed tomography to evaluate the effect of less paraspinal muscle damage on bone mineral density changes after lumbar interbody fusion.

STUDY DESIGN: A retrospective cohort study. PURPOSE: This study aimed to assess the reliability of quantitative computed tomography (QCT) in measuring bone mineral density (BMD) of instrumented vertebrae and investigate the effect of less paraspinal muscle damage on BMD changes after lumbar interbody fusion. OVERVIEW OF LITERATURE: Patients always experience a decrease in vertebral BMD after lumbar interbody fusion. However, to the best of our knowledge, no study has analyzed the effect of paraspinal muscles on BMD changes. METHODS: This retrospective analysis included a total of 155 patients who underwent single-level lumbar fusion, with 81 patients in the traditional group and 74 patients in the Wiltse group (less paraspinal muscle damage). QCT was used to measure the volumetric BMD (vBMD), Hounsfield unit value, and cross-sectional area of the paraspinal muscles at the upper instrumented vertebrae (UIV), vertebrae one segment above the UIV (UIV+1), and the vertebrae one segment above the UIV+1 (UIV+2). Statistical analyses were performed. RESULTS: No significant differences in general data were observed between the two groups (p>0.05). Strong correlations were noted between the preoperative and 1-week postoperative vBMD of each segment (p<0.01), with no significant difference between the two time points in both groups (p>0.05). Vertebral BMD loss was significantly higher in UIV+1 and UIV+2 in the traditional group than in the Wiltse group (-13.6%±19.1% vs. -4.2%±16.5%, -10.8%±20.3% vs. -0.9%±37.0%; p<0.05). However, no statistically significant difference was observed in the percent vBMD changes in the UIV segment between the two groups (37.7%±70.1% vs. 36.1%±78.7%, p>0.05). CONCLUSIONS: QCT can reliably determine BMD in the instrumented spine after lumbar interbody fusion. With QCT, we found that reducing paraspinal muscle destruction through the Wiltse approach during surgery can help preserve the adjacent vertebral BMD; however, it does not help increase the BMD in the instrumented vertebrae.

Hounsfield unit for assessing bone mineral density distribution within lumbar vertebrae and its clinical values.

Study Design: Retrospective radiological analysis. Objective: The aim of this study is to evaluate the distribution of bone mineral density (BMD) in lumbar vertebrae using the Hounsfield unit (HU) measurement method and investigate the clinical implications of HU values for assessing lumbar vertebrae BMD. Method: Two hundred and ninety-six patients were retrospectively reviewed and divided into six groups according to age: Group 1(20-29 years old), Group 2 (30-39 years old), Group 3 (40-49 years old), Group 4 (50-59 years old), Group 5 (60-69 years old), Group 6 (70-79 years old). Six different locations from each vertebra of L1-L5 were selected as regions of interest: the anterior, middle and posterior parts of the upper and lower slices of the vertebrae. HU values were measured for the six regions of interest, followed by statistical analysis. Results: The HU values of vertebrae showed a decreasing trend from young patients to elderly patients in Group 1 to Group 5. There was no significant difference in HU values among different vertebrae in the same age group. In all age groups, the HU values of the anterior and posterior part of the vertebral body were significantly different from L1 to L3, with the anterior part of the vertebral body having lower HU values than the posterior part. The HU values of the anterior and posterior part of the vertebral body of L4 and L5 were statistically significant only in Group 5 and Group 6, and the HU values of the anterior part of the vertebral body were lower than those of the posterior part. The HU values of posterior part of L4 and L5 in Group6 were higher than those in Group5. Conclusion: Bone mineral density in the lumbar vertebrae is not uniformly distributed, potentially attributed to varying stress stimuli. The assessment of local HU values in the lumbar spine is of significant importance for surgical treatment.

Pseudarthrosis risk factors in lumbar fusion: a systematic review and meta-analysis.

This study presents a systematic literature review and meta-analysis of pseudarthrosis risk factors following lumbar fusion procedures. The odds ratio (OR) and 95% confidence interval (95% CI) were used for outcome measurements. The objective of this study was to identify the independent risk factors for pseudarthrosis after lumbar spinal fusion, which is crucial for mitigating morbidity and reoperation. Systematic searches in PubMed, Embase, and Scopus (1990-July 2021) were conducted using specific terms. The inclusion criteria included prospective and retrospective cohorts and case‒control series reporting ORs with 95% CIs from multivariate analysis. The quality assessment utilized the Newcastle-Ottawa scale. Meta-analysis, employing OR and 95% CI, assessed pseudarthrosis risk factors in lumbar fusion surgery, depicted in a forest plot. Of the 568 abstracts identified, 12 met the inclusion criteria (9 retrospective, 2006-2021). The 17 risk factors were categorized into clinical, radiographic, surgical, and bone turnover marker factors. The meta-analysis highlighted two significant clinical risk factors: age (95% CI 1.02-1.11; p = 0.005) and smoking (95% CI 1.68-5.44; p = 0.0002). The sole significant surgical risk factor was the number of fused levels (pooled OR 1.35; 95% CI 1.17-1.55; p < 0.0001). This study identified 17 risk factors for pseudarthrosis after lumbar fusion surgery, emphasizing age, smoking status, and the number of fusion levels. Prospective studies are warranted to explore additional risk factors and assess the impact of surgery and graft type.

Analysis of Risk Factors for Urinary Tract Infection after Lumbar Interbody Fusion.

OBJECTIVE: Urinary tract infection (UTI) is a common postoperative complication, so exploring its risk factors is helpful to provide a basis for clinical prevention. This study aims to analyse the risk factors for UTI after lumbar interbody fusion (LIF). METHODS: A single-centre retrospective study was conducted on the clinical data of 358 patients treated with LIF from April 2020 to April 2023. In accordance with the results of postoperative urine culture, the patients were divided into UTI group (n = 19, those with UTI after LIF) and control group (n = 332, those without UTI after LIF). Binary logistic regression analysis was carried out through collecting the medical records of the two groups to probe into the risk factors for UTI after LIF. RESULTS: After seven patients were excluded, the remaining 351 patients were included in the analysis. In this study, 19 patients (5.41%) developed postoperative UTI, whereas 332 patients (94.59%) had no UTI. Regression analysis results showed drinking (odds ratio (OR) = 16.193, 95% confidence interval (CI): 1.017-257.860) and high preoperative C-reactive protein (CRP) level (OR = 3.237, 95% CI: 1.213-8.636) as risk factors for UTI after LIF. A high professional title of main surgeon (OR = 0.095, 95% CI: 0.010-0.932) and preoperative red blood cell (RBC) count (OR = 0.001, 95% CI: 0.000-0.198) were protective factors for UTI after LIF (p < 0.05). CONCLUSIONS: This study advocated strengthening the prevention and treatment of UTI in patients who had drinking history, high preoperative CRP level and low preoperative RBC count, and received LIF based on the study results. Attention should be paid to the training of physicians with low professional title.

Deep learning reconstruction for lumbar spine MRI acceleration: a prospective study.

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

Investigation of Lumbar Vertebrae and Disc Morphometry with Computed Tomography in Turkish Adults / Investigación de Vértebras Lumbares y Morfometría del Disco con Tomografía Computarizada en Adultos Turcos

SUMMARY: Conducting morphometric studies including many parameters and establishing certain standards for the anatomy of the lumbar spine will facilitate clinical applications. The Turkish example of lumbar vertebrae and disc morphometry has not yet been presented comprehensively. In our study, abdominal computed tomography images of 700 adults were evaluated retrospectively. It was observed that the anterior height of the vertebral bodies increased from L1 to L4 in males, and from L1 to L5 in females. The posterior height of the vertebral bodies was lowest at L5 in both sexes, while it was highest at L3 in males and L4 in females. In all age groups, the values for males were greater (p0.05). In all age groups and both sexes, an increase in anterior disc heights towards disc 5 was observed. The values for males were greater than those for females (p<0.05). The posterior disc height at disc 5 was higher in females, and in other discs, it was higher in males (p<0.05). In conclusion, it was found that the measurement values of the parameters examined varied according to lumbar level and sex, but were independent of age. The morphometric data we obtained are important in terms of providing a reference for the people of our region and contributing to the literature.

La realización de estudios morfométricos que incluyan diversos parámetros anatómicos y el establecimiento de ciertos estándares para la anatomía de la columna lumbar facilitarán los procedimientos clínicos. Como ejemplo, aún no se ha presentado de manera detallada la morfometría de las vértebras lumbares y del disco intervertebral en individuos turcos. En nuestro estudio evaluamos retrospectivamente imágenes de tomografía computarizada abdominal en 700 individuos adultos de ambos sexos. Observamos que la altura anterior de los cuerpos vertebrales aumentaba de L1 a L4 en los hombres y de L1 a L5 en las mujeres. La altura posterior de los cuerpos vertebrales fue más baja en L5 en ambos sexos, mientras que fue más alta en L3 en hombres y L4 en mujeres. En todos los grupos etarios los valores para los hombres fueron mayores (p0,05). En todos los grupos de edad y en ambos sexos se observó un aumento en la altura anterior del disco intervertebral hacia el disco 5. Los valores de los hombres fueron mayores que los de las mujeres (p<0,05). La altura posterior del disco intervertebral en el disco 5 fue mayor en las mujeres y en otros discos fue mayor en los hombres (p<0,05). En conclusión, se encontró que los valores de medición de los parámetros examinados variaron según el nivel lumbar y el sexo, pero fueron independientes de la edad. Los datos morfométricos que obtuvimos son importantes en términos de proporcionar una referencia para la población de nuestra región y contribuir a la literatura.

Pediatric Solid-State 3D Models of Lumbar Vertebrae and Spine.

Introduction While various 3D vertebral models have been utilized in numerous studies, there is a notable gap in the representation of pediatric lumbar vertebrae and spine. This study aimed to describe the changing shapes of lumbar vertebrae and spine with age and to develop precise 3D models. Materials and methods Solid-state 3D models of pediatric lumbar vertebrae and spine were created using SOLIDWORKS® Simulation software for five age groups: newborns, infants (ages 0-1), toddlers (ages 1-3), middle childhood (ages 4-7), and preadolescents (ages 8-12). Models were composed of components with varying biomechanical characteristics. Results Created 3D models replicate variations in the dimensions and configurations of vertebrae, taking into account osteometric analyses conducted on actual vertebral specimens. These models also include elements made of cartilage, representing various phases of vertebral growth during ontogeny. Additionally, through 3D parametric design, we developed comprehensive lumbar spine models, incorporating both the vertebrae and intervertebral disks. Conclusion Created pediatric solid-state vertebral 3D models can be utilized in developing virtual or augmented reality applications and for medical research. Users can interact with models, allowing virtual exploration and manipulation, enhancing learning experiences and facilitating a better understanding of spatial relationships. These solid-state 3D models allow finite element analysis and can be used for further research to calculate internal relative deformations and stress distribution under different conditions.

Quantitative Analysis of Stress-Stretch Curves in Canine Lumbar Vertebrae Using Modified Logistic Functions.

BACKGROUND: The mechanical characteristics of bone are crucial for comprehending its functionality and response to different load conditions, which are essential for advancing medical treatments, implants, and prosthetics. By employing mathematical modeling to analyze the mechanical properties of bone, we can assess stress and deformation under both normal and abnormal conditions. This analysis offers valuable perspectives on potential fracture risks, the effects of diseases, and the effectiveness of various treatments. Therefore, researchers are attempting to find an adequate mathematical description of the mechanical properties of bone. METHODS: Experimental stress-stretch external loading curves were obtained through investigations of canine vertebrae. The obtained experimental curves were fitted using the SciPy Python library with a slightly modified logistic function (logistic function plus additional const). RESULTS: The resulting coefficient of determination R2 (R squared) for most curves was near 0.999, indicating that an appropriate fitting function was selected for the description of the experimental stress-stretch curves. CONCLUSIONS: The stress-stretch behavior of canine vertebrae can be described using a logistic function modified by adding additional parameters for the most accurate fitting results.