Search Results (238)

Background/Objectives: Neck pain is highly prevalent among dentists and has been linked to occupational exposure and cervical degeneration. However, the relationship between cervical MRI findings and symptoms remains inconsistent. This study aimed to explore MRI-based cervical structural profiles in active dentists and examine their associations with neck pain, disability, and participant characteristics. Methods: A cross-sectional study was conducted in 57 practicing dentists. Participants reported neck pain and completed the Numeric Pain Rating Scale and the Neck Disability Index (NDI). Cervical MRI scans were assessed by an experienced musculoskeletal radiologist. An exploratory hierarchical cluster analysis (complete linkage, Euclidean distance) was applied using MRI degenerative variables to identify structural profiles, followed by bivariate comparisons with clinical and occupational factors. Results: Degenerative MRI findings were common (disc bulging, 66.7%; disc herniation, 54.4%). Two MRI-based profiles were identified, one characterized by a higher burden of degenerative findings (including disc and facet changes) (70.2%), and another with fewer/milder degenerative features (29.8%). Neck pain and NDI scores ≥ 20 were more frequent in the higher-degeneration profile (p = 0.001 and p = 0.004, respectively). Age showed a non-linear pattern, with younger dentists reporting pain despite milder MRI changes, whereas older dentists showed more degeneration with fewer symptoms. Conclusions: In this exploratory study, individual MRI findings were not independently associated with neck pain, while a higher overall burden of degenerative changes tended to co-occur with greater symptom reporting and disability. These findings should be interpreted as hypothesis-generating and warrant confirmation in larger, longitudinal studies. Full article

Intervertebral disc (IVD) herniation is a complex and multifactorial condition with a challenging diagnosis and limited therapeutic options, highlighting the need for reliable biomarkers to improve clinical decision-making. The aim of this study was to identify circulating prognostic biomarkers of IVD herniation regression. The plasma proteomic profile and the expression of circulating non-coding RNAs were analysed in a rat model of IVD herniation and were correlated with herniation size. Four candidate proteins (TNC, COPS3, JUP, and GNAI2) were significantly correlated with herniation size, with TNC further validated by ELISA. Additionally, miR-143-3p, miR-10b-5p, miR-27a-3p, miR-140-5p, miR-155-5p, miR-146a-5p, and miR-21-5p were positively correlated with herniation size. Moreover, TNC, COPS3, JUP, and GNAI2 were found to be potential targets of miR-155-5p. This study provides the first combined proteomic and miRNA account of preclinical plasma biomarkers of IVD herniation size, where TNC-miR-155-5p emerge as promising elements of a regulatory module with IVD herniation prognostic potential. Full article

Background/Objectives: Transforaminal epidural steroid injection (TFESI) is widely used to treat lumbosacral radicular pain caused by a herniated lumbar disc (HLD). However, therapeutic response varies substantially, and reliable outcome prediction remains challenging because of the multifactorial interplay of clinical and morphological factors. Machine learning (ML) approaches may address this limitation by modeling nonlinear interactions among patient-specific variables. Methods: This retrospective cohort study analyzed 242 patients with HLD-related radiculopathy who underwent single-level lumbar TFESI. Eight variables—age, sex, injection side, injection level, pain duration, pretreatment numeric rating scale (NRS) score, HLD location, and HLD subtype—were used as input features. Therapeutic outcome was defined as a ≥50% reduction in NRS score at 1 month after TFESI. Three predictive models, namely deep neural network (DNN), random forest (RF), and XGBoost, were developed and evaluated using a validation cohort of 49 patients. Results: The DNN model demonstrated the best validation performance, achieving an area under the curve (AUC) of 0.821 (95% confidence interval [CI], 0.690–0.929). The performance of the RF (AUC, 0.711; 95% CI, 0.535–0.865) and XGBoost (AUC, 0.674; 95% CI, 0.498–0.831) models was inferior to that of the DNN. In addition, the DNN produced fewer false-positive predictions and showed more robust discrimination between favorable and poor outcomes than the other ML models. Conclusions: A deep learning–based predictive model demonstrated superior performance in predicting therapeutic outcomes after lumbar TFESI in patients with HLD-related radiculopathy. Integration of routine clinical and magnetic resonance imaging (MRI)-derived features into ML algorithms may enhance individualized prognostication and assist clinicians in optimizing patient selection for interventional procedures. To the best of our knowledge, this is the first study to develop an ML-based model integrating routine clinical variables with MRI findings for the prediction of TFESI outcomes in HLD-related radiculopathy. Nevertheless, the study is limited by its single-center retrospective design, lack of external validation, and reliance on MRI assessments performed by a single rater. Future multicenter studies are warranted to improve generalizability and confirm clinical utility. Full article

Full-endoscopic lumbar discectomy (FELD) has emerged over time as a minimally invasive alternative to conventional microdiscectomy. This narrative review summarizes the available evidence regarding the evolution, indications, techniques, and outcomes of FELD, with a particular focus on how different types of lumbar disc herniations influence the choice of surgical approach. The literature indicates that the transforaminal approach is most suitable for foraminal and upper lumbar disc herniations, whereas the interlaminar approach is preferred for central or migrated L5–S1 herniations due to the larger interlaminar window at this level. Unilateral biportal endoscopy (UBE) provides better flexibility, visualization, and instrument maneuverability, making it particularly useful in certain cases. Reported complication rates remain low overall but vary according to surgical technique and surgeon experience. The learning curve for FELD typically ranges from approximately 20 to over 50 cases, depending on the approach and individual proficiency. Overall, full-endoscopic techniques are redefining the management of lumbar disc herniations by offering less invasive alternatives with favourable clinical outcomes, and their role is expected to expand further as both technology and surgical expertise continue to evolve. Full article

Background/Objectives: The extent to which compression or inflammation contribute to the development of cervical radiculopathy and its associated symptoms remains unclear. This study aimed to evaluate whether herniated disc size correlates with baseline symptom severity and/or clinical outcome in patients with cervical radiculopathy, treated surgically or conservatively. Methods: This multi-centre retrospective cohort study included 206 patients with cervical radiculopathy due to a herniated disc. MRI scans from 108 patients in the NECK trial (surgical treatment, evaluating disc replacement) and 98 from the CASINO trial (surgical versus conservative treatment), were used to classify herniation size. Clinical outcome was assessed using the Visual Analogue Scale for arm and neck pain, the Neck Disability Index and the EuroQol VAS at baseline and one year after treatment. Binary logistic regression models were used to evaluate associations between herniation size and clinical outcome, adjusting for treatment type, gender, Body Mass Index and age. Results: A total of 107 patients presented with a small herniation, and 99 had a large herniation. Baseline mean NDI scores were 39.1 ± 15 (surgical group, n = 165) and 32.9 ± 16 (conservative group, n = 41). No association was observed between herniation size and clinical condition (OR 1.010, p = 0.323). After one year, mean NDI scores were 16.2 ± 15 (surgical group) versus 19.6 ± 22 (conservative group), with no significant associations between herniation size and outcome in either group. Similar findings were found for VAS arm and neck pain and EQ-VAS. Conclusions: Disc herniation size on baseline MRI showed no correlation with symptom severity or one-year clinical outcomes, suggesting that inflammatory mechanisms, rather than mechanical compression alone, play a key role in cervical radiculopathy. Full article

Background: This study aimed to (a) determine how frequently chiropractors use postural assessment when treating patients with back or neck pain, (b) determine the rationale for the use of postural assessment by chiropractors, (c) examine the assessment methods employed, (d) explore which specific aspects of posture are assessed and (e) determine the types of back and neck conditions being treated. Methods: An 11-item online questionnaire was developed. A link to this survey was distributed using SurveyMonkey to the entire membership of the Royal College of Chiropractors. Results: There were 272 respondents to the survey. Of the respondents, 79% ‘almost always’ used postural assessment when treating patients with back or neck pain. Respondents reported using postural assessment to help determine whether a patient was making progress (61.8%), provide an outcome measure (57.1%) and help inform the diagnosis (89.2%) and treatment plan (81.8%); almost all respondents (98.1%) reported carrying out a postural assessment visually, with no aids. Most respondents reported assessing their patients posteriorly, anteriorly and from both left and right sides, observing 44 specific anatomical items. The conditions treated included sacroiliac pain (96.7%), stiff neck (95.6%), non-specific lowback pain (92.6%), lumbar disc herniation (91.5%), cervical arthritis (89.7%), lumbar strain (87.1%), lumbar arthritis (86.4%), thoracic pain (86.4%), neck strain (84.9%) and whiplash (79.8%). Conclusions: The findings suggest that the unaided visual assessment of posture using a large range of anatomical points is used by UK chiropractors for the purposes of aiding diagnosis and treatment of patients with back and neck pathologies. Full article

Background:Streptococcus pneumoniae is a well-known pathogen responsible for respiratory and invasive diseases; however, central nervous system (CNS) involvement in the form of bacterial myelitis is exceedingly rare, particularly in immunocompetent adults. Moreover, the association between pneumococcal infections and reactive arthritis is scarcely documented. We report an unusual case of pneumococcal myelitis complicated by reactive arthritis in an elderly patient with no evident immunosuppression. Case Presentation: A 68-year-old man with a medical history of hypertension, benign prostatic hyperplasia, multiple disc herniations, and a resected pancreatic neuroendocrine tumour presented to the emergency department with acute urinary retention and fever (38.5 °C). The neurological examination revealed lower limb weakness and decreased deep tendon reflexes. Spinal magnetic resonance demonstrated T2 hyperintense lesions suggestive of longitudinally transverse myelitis. Cerebrospinal fluid (CSF) analysis showed pleocytosis with elevated protein levels; the polymerase chain reaction (PCR) test resulted positive result for Streptococcus pneumoniae. The patient received intravenous antimicrobial and corticosteroid therapy with partial neurological improvement. Within days, he developed acute monoarthritis of the right ankle. Joint aspiration revealed sterile inflammatory fluid, negative for crystals and cultures, supporting a diagnosis of reactive arthritis. The articular symptoms resolved with the use of prednisone. An extensive immunological work-up was negative, and no other infectious or autoimmune triggers were identified. The patient underwent a structured rehabilitation program with gradual improvement in motor function over the following weeks. Conclusions: This case illustrates a rare clinical scenario of pneumococcal myelitis associated with reactive arthritis in a patient without overt immunosuppression. It highlights the importance of considering bacterial aetiologies in cases of acute transverse myelitis and the potential for unusual systemic immune responses such as reactive arthritis. Early recognition and the administration of appropriate antimicrobial and supportive therapies are crucial for improving neurological and systemic outcomes. To our knowledge, this is one of the first reported cases describing the co-occurrence of these two conditions in the context of S. pneumoniae infection. Full article

Oxygen–ozone (O₂–O₃) therapy is widely used for treating lumbar disc herniation. However, controversy remains regarding the safest and most effective route of administration. While intradiscal injection is purported to show clinical efficacy, it has also been associated with serious complications. In contrast, the intramuscular route can exhibit a more favourable safety profile and comparable pain outcomes, suggesting its potential as a safer alternative in selected patient populations. This mixed-method study combined computed tomography (CT) imaging, biophysical diffusion modelling, and a meta-analysis of clinical trials to evaluate whether intramuscular O₂–O₃ therapy can achieve disc penetration and therapeutic efficacy comparable to intradiscal nucleolysis, while minimizing procedural risk. Literature searches across PubMed, Scopus, and Cochrane databases identified seven eligible studies (four randomized controlled trials and three cohort studies), encompassing a total of 120 patients. Statistical analyses included Hedges’ g, odds ratios, and number needed to harm (NNH). CT imaging demonstrated gas migration into the intervertebral disc within minutes after intramuscular injection, confirming the plausibility of diffusion through annular micro-fissures. The meta-analysis revealed substantial pain reduction with intramuscular therapy (Hedges’ g = −1.55) and very high efficacy with intradiscal treatment (g = 2.87), though the latter was associated with significantly greater heterogeneity and higher complication rates. The relative risk of severe adverse events was 6.57 times higher for intradiscal procedures (NNH ≈ 1180). O₂–O₃ therapy offers a biologically plausible, safer, and effective alternative to intradiscal injection, supporting its adoption as a first-line, minimally invasive strategy for managing lumbar disc herniation. Full article

Background/Objectives: Spinal MRI segmentation has become increasingly important with the prevalence of disc herniation and vertebral injuries. Artificial intelligence can help orthopedic surgeons and radiologists automate the process of segmentation. Currently, there are few tools for T1-weighted spinal MRI segmentation, with most focusing on T2-weighted imaging. This paper focuses on creating an automatic lumbar spinal MRI segmentation tool for T1-weighted images using deep learning. Methods: An Attention U-Net was employed as the main algorithm because the architecture has shown success in other segmentation applications. Segmentation loss functions were compared, focusing on the difference between BCE and MSE loss. Two board-certified radiologists scored the output of the Attention U-Net versus four other algorithms to assess clinical relevance and segmentation accuracy. Results: The Attention U-Net achieved superior results, with SSIM and DICE coefficients of 0.998 and 0.93, outperforming other architectures. Both radiologists agreed that the Attention U-Net segmented lumbar spinal images with the highest accuracy on the Likert Scale (3.7 ± 0.82). Cohen’s Kappa coefficient was measured at 0.31, indicating a fair level of agreement. MSE loss outperformed BCE with respect to both SSIM and DICE, serving as the loss function of choice. Conclusions: Qualitative observations showed that the Attention U-Net and U-Net++ were the top performing networks. However, the Attention U-Net minimized external noise and focused on internal spinal preservation, demonstrating strong segmentation performance for T1-weighted lumbar spinal MRI. Full article

Accurate labeling of intervertebral discs (IVDs) in MRI scans is crucial for diagnosing spinal-related diseases such as osteoporosis, vertebral fractures, and IVD herniation. However, automatic IVD labeling remains challenging. The main issues include visual similarity to surrounding bone, anatomical variation across individuals, and inconsistencies between MRI scans. Traditional post-detection disc labeling methods often struggle when localization algorithms miss discs or generate false positives. To address these challenges, we propose MSA-Net, a novel multi-scale attention network designed for semantic IVD labeling, emphasizing the use of prior geometric data. MSA-Net efficiently extracts multi-scale features and models intricate spatial dependencies throughout the spinal structure. We also integrate contrastive learning to enforce feature consistency. This helps the network distinguish IVDs from surrounding tissues. Extensive experiments on multi-center spine datasets demonstrate that MSA-Net consistently outperforms previous methods across MRI T1w and T2w modalities. These improvements demonstrate MSA-Net’s ability to handle variability in disc geometry, tissue contrast, and missed detections that challenge prior methods. Full article

Background: Lumbar disc herniation (LDH) has a substantial impact on health-related quality of life (HRQoL), mainly through pain, reduced mobility, and functional limitations. To better reflect these outcomes, we utilized the SF-36 survey, a well-established tool commonly used in both clinical and population research. The purpose was twofold: to evaluate HRQoL and to explore the main factors linked with activity limitation in a community-based group of Romanian patients. Methods: This cross-sectional study included 120 participants with LDH who completed the SF-36 questionnaire. Internal consistency was high (Cronbach’s α = 0.922). Descriptive statistics, Chi-square tests, t-tests, and multivariate regressions were performed using SPSS 18.0. Results: Of the respondents, 53.3% were female and 58.4% were over 60 years old. While 55% reported good or very good health, 26.7% had severe Daily Activity Limitation (DAL) based on the SF-36 physical function score, and 62.5% scored in the poorer range (33–45) of the Physical and Emotional Status (PES) composite derived from the SF-36. Female sex and age over 60 were each associated with nearly a twofold-higher risk of moderate-to-severe DAL (OR = 2.20, 95% CI: 1.04–4.65), while reporting severe or very severe pain increased this risk more than fourfold (OR = 4.64, 95% CI: 1.89–24.21). Conclusions: In patients with LDH, poor self-rated health, older age, female sex, and high pain intensity were significantly associated with reduced functional capacity. The SF-36 proved to be a valuable tool for identifying vulnerable subgroups that require targeted rehabilitation and psychosocial support. From a public health perspective, these findings also support the use of SF-36 in community screening and in guiding resource allocation for multidisciplinary rehabilitation programs. Full article

Background: Haemophilus influenzae rarely causes spinal epidural abscess or septic arthritis of the facet joints. We report a case of lumbar spinal epidural abscess and facet joint septic arthritis caused by H. influenzae in an immunocompetent host. Methods: A 53-year-old female patient with lumbar spine disc herniation presented with lower back pain 5 days before admission. Results: The patient was diagnosed with an epidural abscess at the right posterolateral aspect of the lumbar spine at the L4-5 level, as well as facet joint septic arthritis at the right L4-L5 and L5-S1 levels. The patient had no neurological deficit. On the 2nd day of hospitalization, the patient underwent decompressive laminotomy and posterior instrumentation. H. influenzae was identified in the blood cultures. She was prescribed intravenous ceftriaxone for 11 days until discharge and levofloxacin for 76 days after discharge. The patient recovered without neurological sequelae. Conclusions: This case represents the first report of septic arthritis of the facet joint and indicates that H. influenzae is a rare pathogen of spinal infection but can lead to a spinal epidural abscess, irrespective of the host’s immune status. Full article

Background and Objectives: Preoperative cefazolin is the standard of care for intervertebral disc surgery as it reduces the incidence of iatrogenic spondylodiscitis. The aim of this study was to determine the impact of intervertebral disc degeneration and endplate changes on the penetration of prophylactic cefazolin into the intervertebral disc during spinal surgery. Materials and Methods: Adult patients undergoing single-level microdiscectomy for lumbar disc herniation received prophylaxis with 2 g of cefazolin. Venous blood and intervertebral disc samples were collected and analyzed using high-performance liquid chromatography to determine cefazolin concentrations. The severity of intervertebral disc and endplate changes was assessed on magnetic resonance images using the Pfirrmann and Modic grading systems. Results: Cefazolin concentrations were significantly higher in cases with Modic type II changes compared to type 0/I (14.6 ± 9.2 µg g⁻¹ vs. 10.2 ± 4.5 µg g⁻¹ and 9.2 ± 4.1 µg g⁻¹; p = 0.01). 35.4% of patients with Modic type II changes had concentrations > 16 µg g⁻¹, compared to 10% and 25% for patients with Modic type 0/I (p = 0.008). For Pfirrmann grading, 34.6% of grade V discs reached >16 µg g⁻¹ versus 16.7% and 20.3% for grades III and IV (p = 0.26). Patient age, weight, and timing showed no significant correlations with intradisc concentrations. Conclusions: Ninety-four percent of disc samples exceeded the minimum inhibitory concentration for Staphylococcus aureus (>4 µg/g), but considerable variability in cefazolin levels was observed, with higher concentrations in discs showing Modic type II changes. Full article

Lumbar disk herniation is a common cause of pain in people older than 30, often associated with workload, where the therapeutic approach includes different methods of treatment; therefore, the aim of the study was to inspect the effectiveness of different methods of treating pain caused by lumbar disk herniation in relation to pro-inflammatory and anti-inflammatory parameters before and after two weeks of therapy. There were twenty-eight participants with a diagnosis confirmed by a specialist who also assigned the participant to a clinically appropriate type of treatment. Pain and disability were assessed using the SF-MPQ and ODI (Title: Immune Response During the Conservative and Minimal Invasive Treatment of Pain Caused by Lumbar Disc Herniation, Clinical Trials Number (NCT06545812), Initial Release 23 July 2024, Last Release 27 August 2025). In addition to the above questionnaires, serum samples were collected before and after therapy for analysis of inflammatory biomarkers. Although there was no statistically significant difference, the tendency of decreases in IL-1 beta and IL-8 in the median levels (interquartile range) was observed after conservative treatment. The results indicate role of inflammatory mechanisms in the treatment of disk herniation and support the benefits of a conservative approach through the regulation of pain, disability, and cytokine activity. Full article

Background/Objectives: Calcified thoracic disc herniations are a formidable surgical challenge due to their proximity to the spinal cord and the heightened risk of iatrogenic neurological injury. Traditional anterior and posterolateral approaches, while effective in select scenarios, may not provide adequate exposure for large, centrally located calcified discs. Methods: We performed a narrative review of the literature and retrospective case series of seven patients who underwent transpedicular–transdural thoracic discectomy for central or centrolateral calcified disc herniations at our institution in recent years. All patients were followed clinically for a minimum of three months postoperatively. Surgical technique and intraoperative nuances were also documented. Results: The transdural approach enabled direct access to the ventral thoracic spine, allowing for the effective decompression of calcified herniations in all cases. Six out of seven patients (86%) demonstrated clinical improvement or neurological stability at three-month follow-up, while one out of seven patients (14%) who presented with severe preoperative neurological deficits had persisting neurological deterioration postoperatively. The technical aspects of the microsurgical approach were critical to minimizing risk. Conclusions: The transpedicular–transdural approach is a viable and effective surgical option for select cases of central or centrolateral calcified thoracic disc herniation. When executed with a precise microsurgical technique, it offers safe decompression with favourable short-term outcomes. Full article