L4-L5 anatomy classification system for lateral lumbar interbody fusion.

Lateral lumbar interbody fusion (LLIF), developed by Dr. Luiz Pimenta in 2006, allows access to the spinal column through the psoas major muscle. The technique has many advantages, such as reduced bone and muscular tissue damage, indirect decompression, larger implants, and lordosis correction capabilities. However, this technique also has drawbacks, with the most notorious being the risk of spinal pathologies due to indirect injury of the lumbar plexus, but with low rates of persistent injuries. Therefore, several groups have proposed classifications to help identify patients at a greater risk of presenting with neurological deficits. The present work proposes a classification system that relies on simple observation of easily identifiable key structures to guide lateral L4-L5 LLIF decision-making. Patients aged > 18 years who underwent preoperative magnetic resonance imaging (MRI) between 2022 and 2023 were included until 50 high-quality images were acquired. And excluded as follow Anatomical changes in the vertebral body or major psoas muscles prevent the identification of key structures or poor-quality MRIs. Each anatomy was classified as type I, type II, or type III according to the consensus among the three observers. Fifty anatomical sites were included in this study. 70% of the L4-L5 anatomy were type I, 18% were type II, and 12% were type III. None of the type 3 L4-L5 anatomies were approached using a lateral technique. The proposed classification is an easy and simple method for evaluating the feasibility of a lateral approach to-L4-L5.

Sacroiliac and spine imaging in spondyloarthritis: Does phenotype or sex matter?

BACKGROUND: Spondyloarthritis (SpA) encompasses a spectrum of immune-mediated inflammatory conditions primarily affecting the axial skeleton, including sacroiliitis and spondylitis, each with distinct features. This study aimed to investigate imaging disparities, focusing on sacroiliac magnetic resonance and spine radiography, across phenotypes and between males and females in axial SpA. METHOD: A cross-sectional study was conducted to assess clinical data, laboratory findings, magnetic resonance imaging (MRI) scores of sacroiliac joints using the Spondyloarthritis Research Consortium of Canada (SPARCC) and Sacroiliac Joint Structural Score (SSS), and cervical and lumbar spine radiographs utilizing the Modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The study aimed to compare these parameters between two groups: axial spondyloarthritis (axSpA, radiographic and non-radiographic) and axial psoriatic arthritis (axPsA), as well as between males and females. RESULTS: Ninety-four patients were included, with 62 patients in the axSpA group and 32 patients in the axPsA group. There were no differences in disease activity, mobility, radiographic damage in the spine (Modified Stoke Ankylosing Spondylitis Spine Score- mSASSS), or sacroiliac magnetic resonance imaging (MRI) scores (Spondyloarthritis Research Consortium of Canada Magnetic Resonance Imaging Index - SPARCC and Sacroiliac Joint Structural Score - SSS) between the two phenotypes. Regarding sex, in imaging exams, men had higher mSASSS (p = 0.008), SSS (p = 0.001), and fat metaplasia (MG) score based on SSS (p = 0.001), while women had significantly higher SPARCC scores (p = 0.039). In the male group, the presence of HLA-B27 allele had an impact on more structural lesions on MRI (SSS), p = 0.013. CONCLUSION: In this study, imaging of sacroiliac joints and spine in patients with axial SpA did not show differences in phenotypes but did reveal differences based on sex, which may have an impact on future diagnostic recommendations. Further studies are needed to confirm these findings.

Intraoperative changes of surgical approach and a second surgery after percutaneous endoscopic surgery for lumbar spinal stenosis.

OBJECTIVE: To investigate the reasons for a second surgery after Percutaneous Endoscopic Surgery (PES) for lumbar spinal stenosis and to provide references for the choice of indications and appropriate surgical approach. METHOD: A total of 426 patients received PES for lumbar spinal stenosis. The postoperative, intraoperative, and postoperative data of the subjects were analyzed. The reasons for intraoperative difficulties, poor outcomes after surgery, and a second surgery were analyzed. RESULT: The surgical approach was changed in four out of 426 patients (0.94 %) during surgery, and 6 patients (1.4 %) received a second surgery; 3 out of 4 patients were intraoperatively shifted to PIED using the Delta endoscope, and 1 shifted to ordinary PIED. The reasons for the intraoperative change of surgical approach included severe hyperplasia and obscure anatomic structure in 3 patients and a dural sac tear with neural outflow in 1 patient. The reasons for a second surgery in 19 patients were as follows: nerve entrapment by bone fragments in 1 patient; nerve injury in 3 patients; lumbar instability in 3 patients; untreated or residual Lumbar Intervertebral Disc Herniation (LIDH) in 4 patients; recurrent LIDH in 1 patient; and inadequate decompression in 7 patients. CONCLUSION: Severe hyperplasia, obscure anatomic structure, lumbar instability, and nerve injury are the common reasons for a second surgery after PES for lumbar spinal stenosis. Appropriate indications and surgical approaches can be chosen based on the patient's situations and technical conditions.

Effects of Cannabidiol on Bone Quality in Ovariectomized Rats.

The incidence of osteoporosis and related fractures increases significantly with age, impacting public health and associated costs. Postmenopausal osteoporosis results from increased bone resorption due to decreased estrogen levels. The endocannabinoid system, especially cannabidiol (CBD), has shown therapeutic potential in modulating bone formation. This study investigated the effects of administration of CBD in rats after the onset of with ovariectomy-induced osteopenia (OVX). Forty-eight female Sprague‒Dawley rats were divided into four groups (n = 12): OVX + CBD, SHAM + CBD, OVX + vehicle, and SHAM + vehicle. CBD was administered intraperitoneally for 3 weeks. After euthanasia, the bone quality, mechanical properties, and bone microarchitecture of the femurs and lumbar vertebrae were assessed by microcomputed tomography (micro-CT), bone densitometry, mechanical tests, and histological and immunohistochemical analyses. CBD treatment improved the bone mineral density (BMD) of the lumbar vertebrae and increased the BV/TV% and Tb.N in the femoral neck. There were also improvements in the mechanical properties, such as the maximum force and stiffness of the femurs and vertebrae. CBD significantly increased the bone matrix in osteopenic femurs and vertebrae, Although did not significantly influence the expression of RANKL and OPG, in ovariectomized animals, there was an increase in osteoblasts and a decrease in osteoclasts. Determining the optimal timing for CBD use in relation to postovariectomy bone loss remains a crucial issue. Understanding when and how CBD can be most effective in preventing or treating bone loss is essential to emphasize the importance of early diagnosis and treatment of osteoporosis. However, further studies are needed to explore in more detail the efficacy and safety of CBD in the treatment of postmenopausal osteoporosis.

New ipsilateral full endoscopic interlaminar approach for L5-S1 foraminal and extraforaminal decompression: technique description and initial case series.

BACKGROUND: The L5-S1 interlaminar access described in 2006 by Ruetten et al. represented a paradigm shift and a new perspective on endoscopic spinal approaches. Since then, the spinal community has shown that both the traditional ipsilateral and novel contralateral interlaminar approaches to the L5-S1 foramen are good alternatives to transforaminal access. This study aimed to provide a technical description and brief case series analysis of a new endoscopic foraminal and extraforaminal approach for pathologies at the lumbar L5-S1 level using a new ipsilateral interlaminar approach. METHODS: Thirty patients with degenerative stenotic conditions at the L5-S1 disc level underwent the modified interlaminar approach. The surgical time, blood loss, occurrence of complications, and clinical outcomes were recorded. The data were compiled in Excel and analyzed using R software version 4.2. All continuous variables are presented as the mean, median, minimum, and maximal ranges. For categorical variables, data are described as counts and percentages. RESULTS: Thirty patients were included in the study. The cohort showed significant improvements in all quality-of-life scores (ODI, visual analog scale of back pain, and visual analog scale of leg pain). Five cases of postoperative numbness and three cases of postoperative dysesthesia have been reported. No case of durotomy or leg weakness has been reported. CONCLUSIONS: The fundamental change proposed by this procedure, the new ipsilateral approach, presents potential advantages to surgeons by overcoming anatomical challenges at the L5-S1 level and by providing surgeon-friendly visualization and access. This approach allows for extensive foraminal and extraforaminal decompression, including the removal of hernias and osteophytosis, without causing neural retraction of the L5-S1 roots while maintaining the stability of the operated level.

Evolving Approach to Antibiotic Treatment of Pediatric Spondylodiscitis.

OBJECTIVE: To describe for intervertebral spondylodiscitis (IS) its clinical characteristics, treatment approaches with intravenous (IV) antibiotics, and clinical implications of changes in treatment approach. STUDY DESIGN: This retrospective study included all children aged 0-18 years diagnosed with imaging-confirmed thoracic and lumbar IS from 2000 to 2022 at a tertiary pediatric hospital. Patients with longer IV treatment regimen were compared with those with a shorter clinically directed IV to oral regimen. RESULTS: In all, 124 cases were included with median age 14.9 months (IQR, 12.7-19.4 months) at diagnosis. Irritability and pain while changing diapers were common symptoms (52.4% and 49.2%, respectively). Elevated erythrocyte sedimentation rate (ESR) was the most common laboratory finding (95%; median, 50 mm/h [IQR 34-64 mm/h]). Elevated erythrocyte sedimentation rate was found in higher proportions (95%) compared with elevated C-reactive protein (76%; median, 1.8 mg/dL; P < .001). Since implementing the shorter clinically directed IV treatment duration for patients with thoracic and lumbar IS, hospitalization duration was decreased from a median of 12 to 8 days (P = .008) and IV treatment duration by a median of 14 to 8 days (P < .001). Only 1 patient (1.6%) in the clinically directed treatment group required rehospitalization owing to failure of therapy. Conversely, 9 of 124 children in the cohort suffered from IV treatment-related complications; all had been treated IV for prolonged periods. CONCLUSIONS: Early transition to oral treatment in pediatric spondylodiscitis seems to be appropriate clinically and shortens hospital stay and IV treatment duration without major negative clinical impact.

Topography of the medullary cone of Choloepus didactylus for locoregional anesthesia purposes.

Choloepus didactylus (two-toed sloth) is a Xenarthran mammal whose morphology has so far been little studied. Given the increasing number of sloths requiring clinical and surgical interventions, this lack of clarity regarding anatomical features and landmarks has had a negative impact on veterinary decision-making for this species. We therefore sought to describe the topography of the medullary cone (MC) of Choloepus didactylus in order to provide guidance to qualified professionals on the ideal access for locoregional anesthesia. In evaluating four specimens, radiographs and dissections revealed that Choloepus didactylus has three lumbar vertebrae and five sacral vertebrae. The lumbar intumescence is located between T14 and the cranial half of L2, the medullary cone is located between the caudal half of L2 and L3, with an average length of 2.26 cm, and the cauda equina extends from S1 to S5. Based on these anatomical findings, we propose that the lumbosacral region would be the most suitable target for epidural anesthesia in Choloepus didactylus.

Survey of major complications after prone transpsoas surgery: an analysis of early adopters' practice.

INTRODUCTION: The prone transpsoas technique (PTP) is a modification of the traditional lateral lumbar interbody fusion approach, which was first published in the literature in 2020. The technique provides several advantages, such as lordosis correction and redistribution, single-position surgery framework, and ease of performing posterior techniques when needed. However, the prone position also leads to the movement of some retroperitoneal, vascular, and neurological structures, which could impact the complication profile. Therefore, this study aimed to investigate the occurrence of major complications in the practice of early adopters of the PTP approach. METHODS: A questionnaire containing 8 questions was sent to 50 participants and events involving early adopters of the prone transpsoas technique. Of the 50 surgeons, 32 completed the questionnaire, which totaled 1963 cases of PTP surgeries. RESULTS: Nine of the 32 surgeons experienced a major complication (28%), with persistent neurological deficit being the most frequent (7/9). Of the total number of cases, the occurrence of permanent neurological deficits was approximately 0,6%, and the rate of vascular and visceral injuries were both 0,05% (1/1963 for each case). CONCLUSION: Based on the analysis of the questionnaire responses, it can be concluded that PTP is a safe technique with a very low rate of serious complications. However, future studies with a more heterogeneous group of surgeons and a more rigorous linkage between answers and patient data are needed to support the findings of this study.

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.

Morphological Design and Study of a 3D Printed Integrated Fusion Device Based on CT Measurement Data Assisted Anterior Lumbosacral Spine / Diseño Morfológico y Estudio de un Dispositivo de Fusión Integrado Impreso en 3D Basado en Datos de Medición de TC Asistida de Columna Lumbosacra Anterior

SUMMARY: To measure and study the anatomical morphological data of the lumbar 5 to sacral 1 intervertebral space with the aid of CT and design an anatomical anterior lumbosacral 3D printed integrated interbody fusion for the treatment of degenerative lumbosacral spine diseases. 100 adults (50 of each sex) who underwent CT examination of the lumbar spine in our hospital were selected, and their lumbar 5 to sacral 1 intervertebral space anatomical data were measured, including the anterior lumbar convexity angle, different sagittal and coronal heights, and the sagittal and coronal diameters of the superior and inferior endplates. The measured data were also statistically analyzed, and morphological design and study of the 3D printed integrated fusion device in the anterior lumbosacral spine was performed by applying computer software. When comparing the coronal and sagittal diameters of the superior and inferior endplates from lumbar 5 to sacral 1, the differences were statistically greater in men than in women (P0.001). When comparing the height at different positions in the median sagittal plane, both males and females showed an anterior high and posterior low pattern. In the coronal plane, both males and females showed the highest height in the middle position (P0.001). CT can measure the anatomical data of the lumbosacral spinal hiatus more accurately. The 3D-printed anterior integrated fusion device of the lumbosacral spine designed according to the analysis of the data results is more in line with the anatomical structure of the lumbosacral spine, fits well with the superior and inferior endplates, and effectively restores the height and anterior convexity angle of the lumbosacral space.

El objetivo de este trabajo fue medir y estudiar los datos morfológicos anatómicos del espacio intervertebral lumbar 5 a sacro 1 con la ayuda de TC y diseñar una fusión intersomática integrada anatómica lumbosacra anterior impresa en 3D para el tratamiento de enfermedades degenerativas de la columna lumbosacra. Se seleccionaron en nuestro hospital 100 adultos (50 de cada sexo) que se sometieron a un examen de TC de la columna lumbar y se midieron los datos anatómicos del espacio intervertebral lumbar 5 al sacro 1, incluyendo el ángulo de la convexidad lumbar anterior, diferentes alturas sagital y coronal, y los diámetros sagital y coronal de las placas terminales superior e inferior. Los datos medidos también se analizaron estadísticamente y se realizó el diseño morfológico y el estudio del dispositivo de fusión integrado impreso en 3D en la columna lumbosacra anterior mediante la aplicación de software informático. Al comparar los diámetros coronal y sagital de las placas terminales superior e inferior desde lumbar 5 hasta sacro 1, las diferencias fueron estadísticamente mayores en hombres que en mujeres (P 0,001). Al comparar la altura en diferentes posiciones en el plano mediano, tanto hombres como mujeres mostraron un patrón anterior alto y posterior bajo. En el plano coronal, tanto hombres como mujeres mostraron la altura más alta en la posición media (P0,001). La TC puede medir los datos anatómicos del hiato espinal lumbosacro con mayor precisión. El dispositivo de fusión anterior integrado impreso en 3D de la columna lumbosacra diseñado de acuerdo con el análisis de los resultados de los datos está más en línea con la estructura anatómica de la columna lumbosacra, se adapta bien a las placas terminales superior e inferior y restaura eficazmente la altura y la parte anterior del ángulo de convexidad del espacio lumbosacro.

Endoscopic Treatment of Lumbar Degenerative Disc Disease: A Narrative Review of Full-Endoscopic and Unilateral Biportal Endoscopic Spine Surgery.

BACKGROUND: Degenerative lumbar spine disease is the leading cause of disability and work absenteeism worldwide. Lumbar microdiscectomy became the standard treatment for herniated discs and stenotic disease. With the evolution of different techniques, endoscopic spinal surgery emerged to minimize the surgical footprint while providing at least non-inferior results. Currently, two different types of endoscopic spine procedures are dominating the surgical scenario: "Full-Endoscopic" (FE) and Unilateral Biportal Endoscopic" (UBE) Spine Surgery. The aim of this study is to describe and analyze their indications, their technical characteristicswithitsadvantagesanddisadvantagesofbothtechniquesandtheirfuture trends. METHODS: We performed a narrative review of the most relevant articles published up to August 2023 through a Pub Med search. The search terms " FE Spine Surgery" and " UBE Spine Surgery" were used. The articles selected, were independently reviewed by 3 authors and 55 full text articles were reviewed. RESULTS: The FE and UBE Spine Surgery techniques were described. The FE technique is performed with a monoportal access under constant saline irrigation. The FE comprises the transforaminal and the interlaminar approaches, and the indication depends from the pathology to treat, and still remains controversial. UBE can approach also the spine from a posterior, postero lateral,and para spinal route. It uses two different ports addressed to a target with continuous irrigation. The process of establishing these two portals is called triangulation. CONCLUSIONS: FE and UBE spine surgery have demonstrated outcomes comparable to open surgery, minimizing complications and surgical footprint.

[Utility of topical vancomycin application in the prevention of surgical site infection of the lumbosacral spine]. / Utilidad de la aplicación de vancomicina tópica en la prevención de infección de sitio quirúrgico de la columna lumbosacra.

INTRODUCTION: surgical site infections (SSI) remain a significant cause of morbidity and mortality and one of the most representative causes of nosocomial infections. The use of intrawound vancomycin in lumbar spine surgery is a potential prophylactic measure against SSI; however, evidence regarding its efficacy is contradictory. Our study was designed to research if intrawound vancomycin significantly prevents SSI in lumbar spine surgery. MATERIAL AND METHODS: this is a randomized, double-blinded, controlled clinical trial; 233 patients who underwent lumbar spine surgery, were randomly assigned to a group in which intrawound vancomycin was instilled in the incision before closure (109), or to a control group (114). The main outcome is the presence of SSI; we determined its prevalence and searched for difference between groups for association between SSI and independent variables. RESULTS: global SSI prevalence was 1.8%, in the experimental group was 0.9%, in the control group was 2.6%. There was no significant difference between these values, p = 0.622. The relative risk of SSI in the experimental group was 0.35 (95% CI 0.037-3.30), that of the control group was 2.87 (95% CI 0.30-27.16). The number needed to treat is 58.3. We did not find a significant association between the independent variables studied and the appearance of SSI. CONCLUSIONS: we did not find a significant difference in the prevalence of SSI between groups nor a significant association between SSI and independent variables.

INTRODUCCIÓN: las infecciones postoperatorias del sitio quirúrgico son una importante causa de morbimortalidad y una de las formas más comunes de infecciones nosocomiales. La aplicación de vancomicina al terminar una intervención de columna lumbar es una potencial práctica profiláctica de infecciones del sitio quirúrgico (ISQ). La evidencia que sostiene su uso es controversial. Nuestro estudio investiga si la aplicación de vancomicina disminuye en forma significativa la prevalencia de ISQ. MATERIAL Y MÉTODOS: ensayo clínico aleatorizado, controlado, cegado; 223 pacientes intervenidos de la columna lumbar fueron aleatoriamente asignados a un grupo experimental de 109 pacientes en quienes se colocó vancomicina y a un grupo control de 114 pacientes que no recibió vancomicina. El principal desenlace del estudio es la aparición de ISQ; se estudió la prevalencia de ISQ en ambos grupos y se buscó si existe diferencia significativa. Se analizó la existencia de factores predictores de ISQ. RESULTADOS: la prevalencia global de infección fue 1.8%; en el grupo experimenta 0.09% y en el grupo control 2.6%. No hubo diferencia significativa entre estas cifras, p = 0.622. El riesgo relativo de ISQ en el grupo experimental fue 0.35 (IC95% 0.037-3.30), el del grupo control fue 2.87 (IC95% 0.30-27.16). El número necesario para tratar es 58.3. No encontramos asociación significativa entre las variables independientes estudiadas y la aparición de ISQ. CONCLUSIONES: no encontramos evidencia suficiente de que la aplicación de vancomicina disminuya significativamente la prevalencia de ISQ ni asociación significativa de ISQ con las variables independientes estudiadas.

Lumbar multifidus layers stiffness at L5-S1 level in prone and sitting posture measured by shear wave elastography.

BACKGROUND: Multifidus is an important lumbar muscle with distinct superficial and deep fibers responsible for torque production and stabilization, respectively. Its mechanical properties change when transitioning from lying to sitting positions, necessitating enhanced stability. It holds crucial clinical relevance to assess these layers separately, especially in the sitting posture, which demands increased neuromuscular control compared to the prone position. OBJECTIVE: To compare lumbar multifidus stiffness in lying versus sitting postures, analyzing both superficial and deep layers. METHODS: Supersonic Shear Imaging captured elastographic images from 26 asymptomatic volunteers in prone and seated positions. RESULTS: Left multifidus shear modulus in lying: 5.98 ± 1.80/7.96 ± 1.59 kPa (deep/superficial) and sitting: 12.58 ± 4.22/16.04 ± 6.65 kPa. Right side lying: 6.08 ± 1.97/7.80 ± 1.76 kPa and sitting: 13.25 ± 4.61/17.95 ± 7.12 kPa. No side differences (lying p= 0.99, sitting p= 0.43). However, significant inter-postural differences occurred. CONCLUSION: Lumbar multifidus exhibits increased stiffness in sitting, both layers affected, with superior stiffness in superficial versus deep fibers. Applying these findings could enhance assessing multifidus stiffness changes, for classifying tension-induced low back pain stages.

Biomechanical repercussion of sitting posture on lumbar intervertebral discs: A systematic review.

BACKGROUND: The static sitting position contributes to increased pressure on the lumbar intervertebral disc, which can lead to dehydration and decreased disc height. OBJECTIVE: To systematically investigate the of sitting posture on degeneration of the lumbar intervertebral disc. MATERIALS AND METHODS: One researcher carried out a systematic literature search of articles with no language or time limits. Studies from 2006 to 2018 were found. The searches in all databases were carried out on January 28, 2022, using the following databases: Pubmed, Scopus, Embase, Cochrane, and Physiotherapy Evidence Database (PEDro) databases, and for the grey literature: Google scholar, CAPES Thesis and Dissertation Bank, and Open Grey. The acronym PECOS was used to formulate the question focus of this study: P (population) - male and female subjects; E (exposure) - sitting posture; C (comparison) - other posture or sitting posture in different periods; O (outcomes) - height and degeneration of the lumbar intervertebral disc(s), imaging exam; and S (study) - cross-sectional and case control. RESULTS: The risk of bias was in its moderate totality in its outcome: height and degeneration of the lumbar intervertebral disc(s) - imaging. Of the four selected studies, three found a decrease in the height of the disc(s) in sitting posture. CONCLUSION: The individual data from the manuscripts suggest that the sitting posture causes a reduction in the height of the lumbar intervertebral disc. It was also concluded that there is a need for new primary studies with a more in-depth design and sample size.

Tubular vs. mini-open lumbar discoidectomy: surgical-clinical outcome.

OBJECTIVE: To evaluate the clinical-surgical results of the tubular vs. mini-open approach in lumbar discoidectomy. The tubular approach promises to reduce the number of rest days and an earlier return to daily activities and work. METHOD: A case-control study of patients operated on for disc herniation using tubular surgery (case) and mini-open (control) was carried out. The variables investigated were as follow: radicular and lumbar pain, sex, age, failure in conservative treatment, single-level lumbar hernia, surgical time, bleeding, length of hospital stay, persistence of symptoms, complications, occupational activity, and reintegration into everyday activities. RESULTS: Through 100 surgeries performed, two groups were created, tubular and mini-open, with 50 patients each, with L4-L5 or L5-S1 disc herniation, respectively. The most affected level was L4-L5 (69%). Of the total cases, a significant improvement was found (p < 0.05) at 15 postoperative days in the VAS and ODI scale in the tubular group with respect to mini-open. Complications such as surgical wound infection, durotomy, and persistent pain occurred. CONCLUSIONS: The tubular approach is a safe and effective option for herniated discs of the lumbar segment, and reduces surgical times, bleeding, and the time of reinsertion to daily activities of the patient.

OBJETIVO: Evaluar los resultados clínico-quirúrgicos del abordaje tipo tubular en comparación con el mini-open en la discoidectomía lumbar. El abordaje tubular promete reducir el número de días de reposo y una reincorporación más temprana a las actividades diarias y laborales. MÉTODO: Se realizó un estudio de casos y controles de pacientes operados por hernia discal mediante cirugía tubular (casos) o mini-open (controles). Las variables investigadas fueron: dolor radicular y lumbar, sexo, edad, falla en el tratamiento conservador, hernia lumbar de un solo nivel, tiempo quirúrgico, sangrado, tiempo de estancia hospitalaria, persistencia de síntomas, complicaciones, tipo de actividad ocupacional y reinserción a las actividades cotidianas. RESULTADOS: Se realizaron 100 cirugías y se crearon dos grupos, tubular y mini-open, con 50 pacientes cada uno, con hernia discal de L4-L5 o L5-S1, respectivamente. El nivel más afectado fue L4-L5 (69%). Del total de los casos, se encontró mejoría significativa (p < 0.05) a los 15 días posquirúrgicos en la escala EVA y ODI en el grupo tubular con respecto al mini-open. Ocurrieron complicaciones como infección de herida quirúrgica, durotomía y dolor persistente. CONCLUSIONES: El abordaje tubular es una opción segura y efectiva para hernias discales del segmento lumbar, y reduce los tiempos quirúrgicos, el sangrado y el tiempo de reinserción a las actividades cotidianas del paciente.

Heterogeneity and high prevalence of bone manifestations, and bone mineral density in congenital generalized lipodystrophy subtypes 1 and 2.

Introduction: Congenital Generalized Lipodystrophy (CGL) is a rare autosomal recessive disease caused by mutations in genes responsible for the formation and development of adipocytes. Bone abnormalities are described. However, there is a scarcity of data. Objective: To describe bone characteristics in a large CGL1 and 2 case series. Methods: Cross-sectional study that assessed bone radiological features of CGL patients of a reference hospital in Fortaleza (CE), Brazil. Patients underwent clinical and bone mineral metabolism evaluation, radiographs of the axial and appendicular skeleton and bone mineral density (BMD) assessment by DEXA (dual energy X-ray absorptiometry). Results: Nineteen patients were included, fourteen were CGL1 and 5, CGL2. Median age was 20 years (8-42) and 58% were women. Median BMI and percentage of body fat were, respectively, 21 Kg/m² (16-24), and 10.5% (7.6-15). The median leptin concentration was 1 ng/mL (0.1-3.3). Diabetes mellitus and dyslipidemia were present in 79% and 63% of patients, respectively. Median calcium and phosphate were normal in almost all patients (95%). Median parathyroid hormone and 25-OH-vitamin D were 23 pg/mL (7-75) and 28 ng/mL (18-43). Osteolytic lesions, osteosclerosis and pseudo-osteopoikylosis, were present in 74%, 42% and 32% of patients, respectively. Lytic lesions were found predominantly in the extremities of long bones, bilaterally and symmetrically, spine was spared. Osteosclerosis was present in axial and appendicular skeleton. Pseudo-osteopoikilosis was found symmetrically in epiphyses of femur and humerus, in addition to the pelvis. BMD Z-score greater than +2.5 SD was observed in 13 patients (68.4%). BMD was higher in CGL1 compared to CGL2 in lumbar spine and total body in adults. No associations were found between high BMD and HOMA-IR (p=0.686), DM (p=0.750), osteosclerosis (p=0.127) or pseudo-osteopoikilosis (p=0.342), and, between pain and bone lesions. Fractures were found in 3 patients. Conclusion: Bone manifestations are prevalent, heterogeneous, and silent in CGL1 and CGL2. Osteolytic lesions are the most common, followed by osteosclerosis and pseudo-osteopoikilosis. Bone mass is high in most cases. There was no pain complaint related to bone lesions. Thus, systematic assessment of bone manifestations in CGL is essential. Studies are needed to better understand its pathogenesis and clinical consequences.

Homeopathy for Chronic Non-specific Low Back Pain: Study Protocol for a Randomized, Double-Blind, Crossover, Placebo-Controlled Clinical Trial Investigating the Efficacy of the Biotherapic Lumbar Vertebra (The BIOVERT Trial).

BACKGROUND: Chronic non-specific low back pain (CNSLBP) lacks identifiable anatomical pathology and effective pharmacological treatment. Alternative approaches in homeopathy, specifically clinical homeopathy, utilize ultra-diluted (potentized) biological products. In Brazil, standardized biotherapics from sheep tissues, particularly fifty-millesimal (LM) potencies of sheep Lumbar Vertebra, have shown promise in alleviating CNSLBP. OBJECTIVES: Our objective is to present the study protocol of a clinical trial that will assess the efficacy and safety of the biotherapic Lumbar Vertebra LM2 in the short-term management of CNSLBP and to estimate its therapeutic duration. METHODS: A randomized, double-blind, crossover, placebo-controlled clinical trial spanning 8 weeks per participant was designed. Participants will include 120 individuals (aged 20 to 60 years) with clinically diagnosed CNSLBP by the study's physiotherapist. Exclusion criteria are radicular pain, signs of radiculopathy, specific lumbar spine disorders, pregnancy, or puerperium (up to 60 days after delivery). The medical intervention includes participants being randomly assigned to one of two treatment sequences: homeopathy-placebo or placebo-homeopathy. The treatments will consist of Lumbar Vertebra LM2 oral solution, topical cream, and indistinguishable placebos. Each treatment period will span 2 weeks, with a 4-week washout interval between them. Primary outcome is the assessment of changes in self-reported pain levels using the numeric rating scale (NRS) score, analyzed with a random effects model across both treatment periods. Secondary outcomes are assessment of changes in self-reported disability levels using the Oswestry Disability Index (ODI), analyzed with a random effects model across both treatment periods, and pain and disability variations, evaluated by the NRS score and ODI respectively, after the first and second treatment periods. Adverse events will be assessed at weeks 2 and 8. Pain medications will be used concomitantly. Adherence will be evaluated by the weight of medication returned/standard weight. DISCUSSION: The BIOVERT (Bioactive Vertebra) trial protocol is designed to investigate a homeopathic strategy for short-term CNSLBP treatment. Favorable outcomes for homeopathy could prompt subsequent studies evaluating the long-term effectiveness of LM potencies of Lumbar Vertebra for CNSLBP. TRIAL REGISTRATION: UMIN Clinical Trials Registry - ID: UMIN000051957.

Effects of different surgical treatments on pain, disability, anxiety and quality of life in lumbar disc herniation.

OBJECTIVE: This study aims to compare the effects of microscopic microdiscectomy and microendoscopic discectomy on pain, disability, fear of falling, kinesiophobia, anxiety, quality of life in patients with lumbar disc herniation (LDH). METHODS: A total of 90 patients who underwent microscopic microdiscectomy (n = 40) and microendoscopic discectomy (n = 50) for LDH were included in this study. The patients' pain, disability, fear of falling, kinesiophobia, anxiety, and quality of life were evaluated before the surgery, in the early postoperative period and three months after. RESULTS: In patients who underwent microendoscopic discectomy, the results of pain, disability, fear of falling, kinesiophobia and anxiety were statistically decreased compared with the microscopic microdiscectomy in the early postoperative period and three months later (p < 0.05). Also, a statistically higher increase was observed in the general health perception of patients who underwent microendoscopic discectomy three months after the operation (p < 0.01). CONCLUSION: Microendoscopic microdiscectomy, remains the most effective and widely applied method with advantages on pain, quality of life, and improved physical functions.

OBJETIVO: Este estudio tiene como objetivo comparar los efectos de la microdiscectomía microscópica y la discectomía microendoscópica sobre el dolor, la discapacidad, el miedo a caer, la kinesiofobia, la ansiedad y la calidad de vida en pacientes con hernia de disco lumbar (LDH). MÉTODOS: Se incluyeron en este estudio un total de 90 pacientes sometidos a microdiscectomía microscópica (n = 40) y discectomía microendoscópica (n = 50) por LDH. Se evaluó el dolor, la discapacidad, el miedo a caer, la kinesiofobia, la ansiedad y la calidad de vida de los pacientes antes de la cirugía, en el postoperatorio temprano y tres meses después. RESULTADOS: En los pacientes sometidos a discectomía microendoscópica, los resultados de dolor, discapacidad, miedo a caer, kinesiofobia y ansiedad disminuyeron estadísticamente en comparación con la microdiscectomía microscópica en el postoperatorio temprano y tres meses después (p < 0.05). Además, se observó un aumento estadísticamente mayor en la percepción de salud general de los pacientes sometidos a discectomía microendoscópica tres meses después de la operación (p < 0.01). CONCLUSIÓN: La microdiscectomía microendoscópica sigue siendo el método más eficaz y ampliamente aplicado con ventajas sobre el dolor, la calidad de vida y la mejora de las funciones físicas.

Comparison of perioperative outcomes in obese and non-obese patients subjected to open lumbar spine surgery.

OBJECTIVE: Obesity is a global epidemic affecting developing countries. The relationship between obesity and perioperative outcomes during elective lumbar spine surgery remains controversial, especially in those without morbid disease. MATERIALS AND METHODS: We retrospectively revised the medical records of patients with lumbar spine degeneration subjected to elective surgery. The data retrieved included demographic and clinical characteristics, body mass index (BMI), obesity status (BMI ≥ 30), surgical interventions, estimated blood loss (EBL), operative time, length of stay (LOS), and post-operative complications. Perioperative outcomes were compared between Grade I-II obese and non-obese individuals. RESULTS: We enrolled 53 patients, 18 with Grade I-II obesity. Their median age was 51, with no differences in gender, comorbidities, laboratory parameters, and surgical procedures received between groups. No clinically relevant differences were found between grade I-II obese and non-obese participants in EBL (300 mL vs. 250 mL, p = 0.069), operative time (3.2 h vs. 3.0 h, p = 0.037), and LOS (6 days vs. 5 days, p = 0.3). Furthermore, BMI was not associated with the incidence of significant bleeding and long stay but showed a modest correlation with operative time. CONCLUSION: Grade I-II obesity does not increase surgical complexity nor perioperative complications during open lumbar spine surgery.

OBJETIVO: La obesidad es una epidemia mundial que afecta a países subdesarrollados. Su relación con los resultados de la cirugía de columna lumbar electiva sigue siendo controvertida, especialmente en obesos sin enfermedad mórbida. MÉTODOS: Se revisaron los expedientes de pacientes con degeneración de la columna lumbar sometidos a cirugía. Los datos recuperados incluyeron características demográficas y clínicas, índice de masa corporal (IMC), estado de obesidad (IMC > 30), intervenciones quirúrgicas, sangrado estimado, tiempo operatorio, tiempo de estancia y complicaciones. Los resultados se compararon entre individuos obesos grado I-II y controles. RESULTADOS: Se incluyeron 53 pacientes, 18 con obesidad de grado I-II. La edad media fue de 51 años, sin diferencias en el sexo, las comorbilidades, los parámetros de laboratorio y los procedimientos quirúrgicos recibidos entre grupos. No se encontraron diferencias relevantes entre los participantes obesos y los no obesos en sangrado (300 vs. 250 mL, p = 0.069), tiempo operatorio (3.2 vs. 3.0 horas, p = 0.037) y estancia (6 vs. 5 días, p = 0.3). El IMC no se asoció con hemorragia y larga estancia, pero mostró una correlación modesta con el tiempo operatorio. CONCLUSIONES: La obesidad grado I-II no predispone a complicaciones durante la cirugía de columna lumbar.