Search Results (147)

Background/Objectives: Lateral lumbar interbody fusion (LLIF) has gained popularity as an effective technique for indirect decompression through ligamentotaxis. Despite the perceived importance of using appropriately sized cages for achieving optimal decompression, comprehensive reports on cage size and its impact on indirect decompression are limited. This study aimed to assess the ligamentotaxis effect by measuring the “backward bulging” length in pre- and postoperative MRIs and examining its correlation with cage size and subsidence. Methods: T2 images of 270 patients with lumbar herniated disc and/or lumbar spondylolisthesis (June 2022 to March 2025) were analyzed for 530 intervertebral spaces. Data on gender, age, length of hospital stay, preoperative and postoperative lumbar JOA scores, and the level of the disease were collected. Measurements included backward bulging length, intervertebral height, and cage subsidence. Statistical analysis was performed using StatMate. Surgical procedures involved oblique lateral interbody fusion (OLIF) to minimize impact on the iliopsoas and lumbar plexus. Trial cages starting from 8 mm were sequentially inserted, with confirmation through lateral fluoroscopy. Posterior fixation was performed using percutaneous pedicle screws. Results: Analysis of 530 intervertebral spaces revealed that 70% could accommodate a cage 3 mm or larger than the preoperative intervertebral height. Significant backward bulging shortening (3 mm or more) occurred in 339 spaces, predominantly with larger cages. Only 8.8% of cases (14/159) with a large backward bulging shortening had an intervertebral height extension of 3 mm or less. On the other hand, a large reduction in backward bulging was observed in 91.3% of cases (339/371) with an intervertebral height extension of 3 mm or more. Postoperative cage subsidence was observed in 9.2% (49/530) of all intervertebral spaces and 8.6% (32/371) in spaces where a cage larger than 3 mm was used. There was no statistically significant difference between these two groups. Conclusions: To achieve a sufficient ligamentotaxis effect, it is necessary to select a cage size that allows for an intervertebral height increase of at least 3 mm compared to the preoperative measurement. Full article

Background/Objectives: Lumbar disc herniation (LDH) is the most common condition associated with low back pain, and it adversely impacts individuals’ health. The interplay between energy metabolism and apoptosis is critical, as the loss of viable cells in the intervertebral disc (IVD) can lead to a cascade of degenerative changes. Efferocytosis is a key biological process that maintains homeostasis by removing apoptotic cells, resolving inflammation, and promoting tissue repair. Therefore, enhancing mitochondrial energy metabolism and efferocytosis function in IVD cells holds great promise as a potential therapeutic approach for LDH. Methods: In this study, energy metabolism and efferocytosis-related differentially expressed genes (EMERDEGs) were identified from the transcriptomic datasets of LDH. Machine learning approaches were used to identify key genes. Functional enrichment analyses were performed to elucidate the biological roles of these genes. The functions of the hub genes were validated by RT-qPCR. The CIBERSORT algorithm was used to compare immune infiltration between LDH and Control groups. Additionally, we used single-cell RNA sequencing dataset to analyze cell-specific expression of the hub genes. Results: By using bioinformatics methods, we identified six EMERDEGs hub genes (IL6R, TNF, MAPK13, ELANE, PLAUR, ABCA1) and verified them using RT-qPCR. Functional enrichment analysis revealed that these genes were primarily associated with inflammatory response, chemokine production, and cellular energy metabolism. Further, we identified candidate drugs as potential treatments for LDH. Additionally, in immune infiltration analysis, the abundance of activated dendritic cells, neutrophils, and gamma delta T cells varied significantly between the LDH group and Control group. The scRNA-seq analysis showed that these hub genes were mainly expressed in chondrocyte-like cells. Conclusions: The identified EMERDEG hub genes and pathways offer novel insights into the molecular mechanisms underlying LDH and suggest potential therapeutic targets. Full article

Lumbar spine Magnetic Resonance Imaging (MRI) is commonly used for intervertebral disc (IVD) and vertebral body (VB) evaluation during low back pain. Segmentation of these tissues can provide useful quantitative information such as shape and volume. The objective of the study was to determine the performances of Segment Anything Model (SAM) and medical SAM (MedSAM), two “zero-shot” deep learning models, in segmenting lumbar IVD and VB from MRI images and compare against the nnU-Net model. This cadaveric study used 82 donor spines. Manual segmentation was performed to serve as ground truth. Two readers processed the spine MRI using SAM and MedSAM by placing points or drawing bounding boxes around regions of interest (ROI). The outputs were compared against ground truths to determine Dice score, sensitivity, and specificity. Qualitatively, results varied but overall, MedSAM produced more consistent results than SAM, but neither matched the performance of nnU-Net. Mean Dice scores for MedSAM were 0.79 for IVDs and 0.88 for VBs, and significantly higher (each p < 0.001) than those for SAM (0.64 for IVDs, 0.83 for VBs). Both were lower compared to nnU-Net (0.99 for IVD and VB). Sensitivity values also favored MedSAM. These results demonstrated the feasibility of “zero-shot” DL models to segment lumbar spine MRI. While performance falls short of recent models, these zero-shot models offer key advantages in not needing training data and faster adaptation to other anatomies and tasks. Validation of a generalizable segmentation model for lumbar spine MRI can lead to more precise diagnostics, follow-up, and enhanced back pain research, with potential cost savings from automated analyses while supporting the broader use of AI and machine learning in healthcare. Full article

Objectives: To investigate whether preservation of the posterior elements protects the spine from degeneration and improves postoperative symptoms in lumbar spine laminoplasty. Methods: Eighty-five consecutive patients who underwent lumbar spine laminoplasty were retrospectively reviewed. They were non-randomly stratified into two groups, the posterior elements resection (R) group and the preservation (P) group, and they were followed for two years after surgery. We radiographically analyzed the conditions of the spine and intervertebral disc (IVD) two years after surgery. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for symptom assessments. Logistic regression analysis was performed to determine whether the kissing spine was a significant factor for the outcomes in group R. Results: The 2-year D score increment and 2-year IVD height decrement was lower in group P. No difference was found in the flexion–extension angles or incidence of instability between groups. The JOABPEQ revealed higher scores in walking ability, social life function, and mental health in group P one year after surgery. Walking ability was the only score that remained higher two years after surgery. The visual analog scale of pain in the buttocks and lower limbs was lower in group P only one year after surgery. Finally, the kissing spine was not a significant factor in any outcome. Conclusions: The preserved posterior elements were considered to protect the IVD in lumbar spine laminoplasty. In addition, they positively affected postoperative health status from multiple aspects. Full article

This study evaluated attenuation values of lumbar epaxial musculature in dogs with acute spinal pathology using computed tomography (CT) and compared them with values in dogs without spinal disease. Sixty client-owned dogs were included: thirty dogs with thoracolumbar spinal lesions (intervertebral disc herniation) and thirty control dogs without spinal abnormalities. Mean Hounsfield unit (HU) values of epaxial muscles (multifidus–longissimus–iliocostalis group) were measured bilaterally at three lumbar levels for each dog—one level cranial to the lesion, the lesion level, and one level caudal to the lesion; for controls, the corresponding segments were T13, L1, L2, and L3. Dogs with spinal pathology showed a significant local decrease in muscle HU at the lesion site (average ~48 HU) compared to the segment cranial to the lesion (~50–51 HU, p < 0.01). In contrast, control dogs had relatively uniform muscle HU (~52–54 HU) across T13–L3 with no significant differences between these levels. Side to side differences were minimal in both groups. A logistic regression using the HU drop between segments correctly classified ~70% of cases, indicating moderate diagnostic value. Age and breed influenced overall muscle HU; older dogs had lower values (r = –0.39, p = 0.03 in controls), and French Bulldogs showed lower HU than other breeds. In conclusion, dogs with acute thoracolumbar disc herniation exhibit a focal reduction in paraspinal muscle HU at the lesion level. This acute change is subtle but detectable with CT and may serve as an additional indicator of lesion presence or chronicity, although its clinical utility requires further investigation in larger studies. Full article

Background: This study aimed to evaluate the long-term clinical usefulness and radiologic changes around the Coflex device following decompression with Coflex insertion for degenerative lumbar spinal stenosis (DLSS), with an average follow-up of 14 years. Methods: This retrospective study included 147 patients who underwent decompression and Coflex insertion for single-level DLSS at a single institution between January 2007 and December 2010. Patients with spinal stenosis unresponsive to 3 months of conservative treatment were treated surgically. The mean follow-up duration was 173.9 ± 23.7 (range, 119–214) months. Results: The mean visual analog scale score decreased from 8.22 ± 1.06 preoperatively to 2.08 ± 1.58 postoperatively. Intervertebral disc height and foramen height at the Coflex insertion site decreased by 5.3% and 2.0%, respectively, after surgery. The reoperation rate at the operated site was 25% (n = 37). A significantly higher reoperation rate was observed in patients with translational instability (odds ratio [OR], 7.77; 95% confidence interval [CI], 2.453–24.658; p < 0.01) and angular instability (OR, 1.59; 95% CI, 0.492–5.133; p < 0.001). Eight patients underwent reoperation due to rapid progression of instability within 2 years of Coflex insertion; thereafter, a similar cumulative incidence rate was consistently observed. The adjacent-segment reoperation rate was 10.8% (n = 16). Conclusions: The Coflex interspinous device helps preserve disc and foramen height but is associated with a high reoperation rate, particularly in patients with spinal instability. Therefore, careful patient selection is crucial when considering its use. Full article

Degenerative changes are characterized by the formation of vertebral osteophytes, the hypertrophy of facet joints, and narrowing of the intervertebral space. This study aimed to investigate the concentrations of trace elements (Al, As, Se, Zn, Fe, Mo, Cu) in spinal tissues (intervertebral discs, muscle, and bone) of patients with degenerative lumbar spine disease (DLSD) and their potential associations with the disease. The research involved 13 patients undergoing surgery for symptomatic degenerative spine disease. The trace element concentrations were analyzed using chemical and radiographic assessments, with a statistical analysis performed through a Mann–Whitney U-test, Spearman’s rank correlation test, principal component analysis (PCA), and canonical discriminant analysis (CDA). The results showed significant variations and correlations among the trace elements across different spinal tissues, suggesting their roles in metabolic and oxidative processes and the pathology of spinal degeneration. Full article

This study presents a novel approach for predicting the location and fatigue life of degenerative intervertebral discs (IVDs) under cyclic loading conditions, aiming to improve the understanding of disc degeneration mechanisms. Based on mechanical theories linking IVD degeneration to stress imbalance and water loss, a finite element (FE) model of the L4–L5 lumbar spine was developed, combining probability-weighted anatomical structures, inverse dynamics, and cumulative fatigue mechanics. By quantifying stress variations and calculating cumulative damage across disc regions, stress-concentration areas prone to degeneration were identified, and validation via a case study of a retired weightlifter diagnosed with intervertebral disc disease (IVDD) demonstrated that the predicted degeneration location correlated well with affected areas observed in CT scan images. These findings suggest that prolonged, abnormal stress imbalances within the disc may contribute significantly to degeneration, offering potential clinical applications in preventive assessment and targeted treatment for spine health. Full article

Although the existence of highly prevalent pain, disability, and work time lost associated with discogenic low back pain is well known, the recognition of the culpability of universally present disc degradation and mechanical insufficiency in the first three decades of life is often overlooked. There is a corresponding “treatment gap” and no current interventions with demonstrated capabilities to address the pain and resist the usual progression of increasing structural failure of spinal tissues with increasing levels of pain and disability. This narrative review summarizes more than forty years of the literature describing the pathomechanics of progressive degradation of lumbar discs, with a focus on studies that implicate an increasing mechanical insufficiency in the etiology of early-stage chronic and recurrent discogenic low back pain. Topics highlighted in this review include the deleterious biological changes that begin soon after birth, stress intensification due to the loss of fluid phase load support, fatigue weakening and damage accumulation in non-regenerative tissue, disc tears, segmental instability, and the timeline for first incidence of chronic low back pain. The review concludes with preferred treatment characteristics and a brief summary of emerging treatment approaches. Full article

Lumbar disc degeneration (LDD) is a common musculoskeletal disorder that leads to chronic pain and functional impairment. Recent studies have suggested that the vitamin D receptor (VDR) plays a key part in regulating matrix metabolism, inflammation, and apoptosis in intervertebral discs (IVDs). The objective of this study was to examine cytokine expression and DNA methylation status of the VDR gene in blood leukocytes and lumbar disc tissues from patients with varying degrees of LDD severity. We aimed to explore correlations between VDR expression, methylation status, and clinical parameters such as pain intensity and functional disability. We conducted a prospective case-control study including 50 participants 35 LDD patients and 15 lumbar disc herniation (LDH) controls. Blood and lumbar disc tissue samples were collected for RNA and DNA extraction, followed by quantitative real-time PCR for gene expression and methylation-specific polymerase chain reaction for VDR promoter methylation analysis. Serum and nucleus pulposus (NP) VDR protein levels were measured using enzyme-linked immunosorbent assay. Clinical parameters, including pain intensity (NRS) and functional disability (ODI), were assessed. LDD patients exhibited significantly lower VDR mRNA expression in both blood leukocytes and NP tissue compared to controls (p < 0.05). LDD patients had significantly greater serum TNF-α levels than controls (p < 0.001); however, serum IL-1β levels were not different between two groups. Serum VDR protein levels were elevated in LDD patients (p = 0.016), whereas NP VDR protein was significantly reduced in the LDD group (p = 0.013). VDR promoter methylation was significantly higher in both the blood and NP tissue of LDD patients compared to controls (p < 0.001). Additionally, higher VDR promoter methylation in blood was correlated with advanced disc degeneration (p < 0.05), while NP methylation was associated with all grades of degeneration (p < 0.001). Serum VDR protein levels were inversely correlated with pain intensity (r = −0.39, p = 0.02), while NP VDR levels positively correlated with NRS scores (r = 0.43, p = 0.01). Aberrant VDR expression and increased promoter methylation are associated with LDD severity. Dysregulated VDR signaling, potentially mediated by DNA methylation, may play a critical role in the pathophysiology of LDD. These findings suggest that VDR could be a novel biomarker reflecting disease severity and a potential therapeutic target for managing LDD. Full article

Lumbar and lumbosacral pain in dogs often involves multiple concurrent spinal pathologies, complicating the identification of primary pain generators. This study assessed the associations between MRI-diagnosed spinal pathologies and pain to provide clinically relevant insights for their diagnosis and management. MRI scans and clinical records of 518 client-owned dogs were retrospectively reviewed, documenting demographic data, pain status, and MRI findings. Multivariable logistic regression models evaluated the associations between spinal pathologies and pain, adjusting for age and weight. The intervertebral disc (IVD) extrusion was the primary pathology associated with lumbar pain, while radiculopathy had the strongest association with lumbosacral pain. Additional lumbosacral pathologies, including foraminal stenosis, IVD bulging, and IVD protrusion, were also significantly associated with pain. However, some dogs with MRI-diagnosed abnormalities showed no pain, whereas others with pain had no detectable MRI pathology, underscoring the need to interpret imaging within the clinical context. Pain responses observed during physical examination often overlapped between spinal and hip conditions, complicating diagnostic accuracy. These findings emphasise the importance of integrating imaging, clinical assessment, and targeted diagnostic techniques to improve pain localisation and treatment decisions, providing veterinarians with valuable data to refine the management of lumbar and lumbosacral pain in dogs. Full article

Background/Objectives: The aim of the study is to investigate the role of microRNA-17 (miRNA-17), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) in the pathogenesis of lumbar degenerative disc disease (LDDD). The goal is to explore how miRNA-17 regulates inflammation and apoptosis within the intervertebral discs, with a particular focus on its involvement in inflammatory pathways via NF-κB signaling. This research seeks to uncover the molecular mechanisms that contribute to LDDD and its associated chronic lower back pain and disability. Methods: A case–control study was conducted, involving 110 patients diagnosed with LDDD and 17 healthy control individuals. Serum levels of miRNA-17, TNF-α, and IL-6 were measured using quantitative real-time PCR and enzyme-linked immunosorbent assays (ELISAs). The patients were further categorized based on the severity of their condition using the Oswestry Disability Index (ODI), which classified them into five subgroups. The correlation between miRNA-17 expression, pro-inflammatory cytokines, and disease severity was analyzed statistically. Results: The results demonstrated a significant downregulation of microRNA-17 in patients with LDDD compared to healthy controls. Inflammatory markers TNF-α and IL-6 were found to be significantly elevated in the patient group. A peak in inflammation and miRNA-17 expression was observed in patients with moderate to severe disability (ODI Grade 3), while inflammation levels decreased in more advanced stages of the disease (ODI Grades 4 and 5), suggesting a possible shift in disease dynamics. Conclusions: This study demonstrates that miRNA-17 plays a regulatory role in inflammation during the progression of LDDD, particularly through the modulation of TNF-α and IL-6 levels. The findings indicate that inflammation is most pronounced in the mid-stages of LDDD, while the later stages are characterized by structural damage rather than ongoing inflammation. These insights could help guide future therapeutic strategies aimed at targeting the molecular mechanisms underlying LDDD, potentially improving patient outcomes. Full article

Conservative treatment is primarily performed for the treatment of patients with lumbar disc herniation (LDH), but if it does not respond, surgical treatment can be performed. Surgical intervention has a positive effect on the rapid improvement of LDH symptoms. However, the effectiveness of surgical versus conservative treatment for LDH is controversial, especially regarding long-term effects. Recently, a treatment using platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), low-intensity pulsed ultrasound (LIPUS), etc., has been actively conducted as a treatment to avoid side effects of surgery and promote tissue regeneration. In this paper, the literature evaluating the effectiveness of non-surgical treatment options is reviewed with an emphasis on the effectiveness of clinical application. Several clinical studies have shown that PRP, biomaterials, BMAC, and LIPUS treatment promote tissue regeneration and alleviate symptoms. Although PRP-applied studies have suggested disc height changes, cell therapy and LIPUS treatment have many shortcomings in clinical aspects of tissue regeneration. Therefore, it is necessary to establish a unified, safe protocol and standardize the method of presenting results to confirm the clinical effect of the treatment for impaired intervertebral regeneration in patients with intervertebral disc degeneration (IDD), including LDH. Full article

Background: Chronic low back pain (LBP) has been associated with intervertebral disc (IVD) degeneration, but its association with abnormal morphology at the discovertebral junction (DVJ) is unclear. The goal of this study was to evaluate the DVJ morphology in asymptomatic (Asx) and symptomatic (Sx) subjects for LBP using ultrashort echo time (UTE) MRI. Methods: We recruited 42 subjects (12 Asx and 32 Sx). Lumbar IVD degeneration was assessed using Pfirrmann grading (1 to 5), while the abnormality of DVJ (0 = normal; 1 = focal; 2 = broad abnormality) was assessed using UTE MRI. The effects of LBP and level on the mean IVD and DVJ grades, the correlation between IVD and DVJ grade, and the effect of LBP and age on the number of abnormal DVJs within a subject were determined. Results: IVD grade was higher in Sx subjects (p = 0.013), varying with disc level (p = 0.033), adjusted for age (p < 0.01). Similarly, DVJ grade was also significantly higher in Sx subjects (p = 0.001), but it did not vary with DVJ level (p = 0.7), adjusted for age (p = 0.5). There was a weak positive (rho = 0.344; p < 0.001) correlation between DVJ and IVD grade. The total number of abnormal DVJs within a subject was higher in Sx subjects (p < 0.001), but not with respect to age (p = 0.6) due to a large spread throughout the age range. Conclusions: These results demonstrate the feasibility of using in vivo UTE MRI of the lumbar spine to evaluate the DVJ and the correlation of DVJ with LBP. This study highlights the need for a better understanding of DVJ pathology and the inclusion of DVJ assessment in routine lumbar MRI. Full article

(1) Background: The exploration of various machine learning (ML) algorithms for classifying the state of Lumbar Intervertebral Discs (IVD) in orthopedic patients is the focus of this study. The classification is based on six key biomechanical features of the pelvis and lumbar spine. Although previous research has demonstrated the effectiveness of ML models in diagnosing IVD pathology using imaging modalities, there is a scarcity of studies using biomechanical features. (2) Methods: The study utilizes a dataset that encompasses two classification tasks. The first task classifies patients into Normal and Abnormal based on their IVDs (2C). The second task further classifies patients into three groups: Normal, Disc Hernia, and Spondylolisthesis (3C). The performance of various ML models, including decision trees, support vector machines, and neural networks, is evaluated using metrics such as accuracy, AUC, recall, precision, F1, Kappa, and MCC. These models are trained on two open-source datasets, using the PyCaret library in Python. (3) Results: The findings suggest that an ensemble of Random Forest and Logistic Regression models performs best for the 2C classification, while the Extra Trees classifier performs best for the 3C classification. The models demonstrate an accuracy of up to 90.83% and a precision of up to 91.86%, highlighting the effectiveness of ML models in diagnosing IVD pathology. The analysis of the weight of different biomechanical features in the decision-making processes of the models provides insights into the biomechanical changes involved in the pathogenesis of Lumbar IVD abnormalities. (4) Conclusions: This research contributes to the ongoing efforts to leverage data-driven ML models in improving patient outcomes in orthopedic care. The effectiveness of the models for both diagnosis and furthering understanding of Lumbar IVD herniations and spondylolisthesis is outlined. The limitations of AI use in clinical settings are discussed, and areas for future improvement to create more accurate and informative models are suggested. Full article