Search Results (952)

Background: Radiculopathy originating from a previously fused lumbar segment is a clinically relevant but often underrecognized problem. Progressive foraminal stenosis may develop due to postoperative structural changes, leading to mechanical irritation of the exiting nerve root. Transforaminal endoscopic lumbar foraminotomy (TELF) is a minimally invasive option, but its role in this setting is not well defined. Methods: In this retrospective cohort study, we included 36 consecutive patients who underwent TELF for symptomatic foraminal stenosis at a previously fused segment between 2020 and 2023. Clinical outcomes were assessed using the visual analog scale (VAS) for leg pain, Oswestry Disability Index (ODI), and modified MacNab criteria, with follow-up of up to 2 years. Radiographic and intraoperative findings were reviewed to explore the underlying mechanisms. Results: The mean VAS score improved significantly from 8.36 preoperatively to 2.00 at 2 years, and the mean ODI decreased from 70.9% to 16.8%. According to the modified MacNab criteria, 86.1% of the patients achieved excellent or good outcomes. Intraoperative findings revealed fibrotic or hypertrophic foraminal stenosis in 86.1% patients (n = 31), whereas 13.9% of patients (n = 5) showed pedicle screw-related nerve root irritation. Five patients experienced transient postoperative dysesthesia, and no postoperative instability was observed. Conclusions: Radiculopathy at the fused segment is primarily caused by progressive mechanical foraminal compromise after fusion. TELF provides effective symptom relief through direct decompression and may serve as a less invasive alternative to revision fusion in selected patients. Full article

Background/Objectives: To determine whether ESS provides superior clinical, radiologic, or perioperative outcomes compared with non-ESS surgical strategies in lumbar spondylolisthesis. Methods: We conducted a PRISMA-guided systematic review and meta-analysis comparing ESS with non-ESS strategies specifically for lumbar spondylolisthesis. PubMed, Web of Science, Scopus, and CENTRAL were searched from inception to December 2025, plus reference-list screening. Primary outcomes were mean change in VAS back pain, VAS leg pain, and Oswestry Disability Index (ODI); secondary outcomes included radiologic measures (disc height, lumbar lordosis angle, fusion rate) and perioperative outcomes (blood loss, operative time, length of stay, complications). Results: Eighteen studies (16 retrospective cohorts, 1 RCT, 1 case–control) involving 1200 patients with lumbar spondylolisthesis (2019–2025) were included. ESS showed no significant differences versus non-ESS in mean change in VAS back pain (13 studies; MD −0.07), VAS leg pain (14 studies; MD 0.08), or ODI (12 studies; MD 0.51). No statistically significant differences were detected in radiological outcomes (disc height, lumbar lordosis angle, and fusion rate). ESS was associated with reduced blood loss (MD −132.98) and shorter hospital stay (MD −2.86 days), with no difference in operative time (MD 3.96) or postoperative complications (RR 0.86). Subgroup analyses compared endoscopic fusion with MIS fusion, open fusion, and non-endoscopic decompression. Endoscopic versus MIS fusion showed lower blood loss (MD: −50.9 mL) and shorter hospital stay (MD: −1.4 days) but longer operative time (MD: +17.2 min), with no differences in clinical outcomes. Comparisons involving decompression and open fusion were limited by the small number of studies and should be considered exploratory. Conclusions: For lumbar spondylolisthesis, no statistically significant differences were detected between ESS and non-endoscopic approaches in pain, disability, radiologic outcomes, or complication rates, with potential perioperative advantages in blood loss and length of stay. However, these findings should be interpreted cautiously because the available evidence is predominantly retrospective, procedurally heterogeneous, and affected by substantial variation in follow-up duration. Full article

Background/Objectives: Type II endoleaks (T2ELs) remain one of the most frequent causes of aneurysm sac enlargement following endovascular abdominal aortic aneurysm repair (EVAR). While embolization may be effective in typical T2ELs with a clearly identifiable feeding vessel, management becomes more challenging when no visible communication with a side branch can be demonstrated. Emerging evidence suggests that hypertrophic vasa vasorum may contribute to aneurysm sac expansion in these atypical cases. We present a case of refractory atypical T2EL treated by open conversion and discuss the potential role of the vasa vasorum network in its pathophysiology. Case Presentation: A 77-year-old man presented with lumbar pain ten years after EVAR for a symptomatic abdominal aortic aneurysm. Computed tomography angiography demonstrated progressive aneurysm sac enlargement to 8.5 cm despite three previous translumbar embolization procedures. Multiple areas of contrast pooling were identified within the aneurysm sac, but no clear communication with a feeding side branch was observed. Owing to persistent sac expansion and symptoms, open conversion was performed with partial endograft explantation and reconstruction using a bifurcated PTFE graft. Results: After opening the aneurysm sac and evacuating the thrombus, diffuse bleeding was observed from numerous small vascular orifices distributed throughout the inner sac surface. These findings were considered consistent with a prominent vasa vasorum network. Hemostasis was achieved using a combination of figure-of-eight sutures and electrocautery. The postoperative course was uneventful, and the patient was discharged on postoperative day five. Follow-up imaging demonstrated normal graft patency without complications. Conclusions: This case supports the hypothesis that an extensive vasa vasorum network may contribute to aneurysm sac expansion in atypical T2ELs and possibly endotension after EVAR. In patients with refractory sac enlargement, open conversion remains a definitive treatment option. Further research is needed to clarify the underlying mechanisms and to explore targeted therapeutic strategies aimed at modulating angiogenesis and vascular remodeling. Full article

Background/Objectives: To investigate the prevalence and associated factors of postoperative radiculitis in patients treated with Anterior Lumbar Interbody Fusion (ALIF) in L4–L5 or L5–S1 utilizing lumbopelvic sagittal parameters and ideal alignment values calculated with GAP score components. Methods: A retrospective review using Natural Language Processing (NLP) for automated data extraction from clinical notes was conducted. 61 adult patients were included in the analysis. Postoperative radiculitis was defined as the new onset of unilateral or bilateral pain in the L4–S1 radicular territory with preserved motor function. Clinical parameters (Oswestry Disability Index), radiographic parameters (lumbopelvic sagittal alignment using GAP score components), and surgical factors (cage size and disc height modification) were evaluated and subsequently entered into a multivariable logistic regression analysis. Results: Postoperative radiculitis occurred in 29.5% of patients, with symptoms primarily manifesting within the first six weeks following surgery and lasting up to six months. Patients in the Pain group showed notable differences in pre- and postoperative GAP score parameters, specifically higher values for relative lumbar lordosis (RLL) and relative pelvic version (RPV). Furthermore, multivariable logistic regression identified postoperative RLL and the anterior disc height (ADH) ratio to be independently associated with the development of radiculitis. Conclusions: Excessive disc space enlargement during ALIF is associated with a higher likelihood of postoperative radiculitis, particularly in patients with pre-existing near-ideal lumbar alignment. To mitigate this iatrogenic complication in this group, the degree of correction must be individualized. This tailored approach should incorporate parameters from the GAP score and a careful assessment of the relationship between the anterior disc height and the vertebral body. Full article

Introduction: Low back pain is one of the commonly overlooked late complications of an intestinal stoma. Its severity may be associated with impaired quality of life across multiple dimensions of patient functioning. Objective: This cross-sectional study evaluated the impact of low back pain on self-reported health-related quality of life in colostomy patients. Material and Methods: The study was conducted using a cross-sectional questionnaire-based design across 12 regional branches of the Pol-ILKO Association in Poland between December 2023 and September 2024. The study sample consisted of 95 patients. The standardized Oswestry Disability Index (ODI) questionnaire, which assesses the level of disability in patients with back pain, and the WHOQOL-BREF questionnaire, which assesses health-related quality of life, were used in the survey. In addition, detailed data on medical history, past surgical interventions, and stoma self-care skills were collected using an author-developed tool. Results: Greater disability due to back pain is associated with lower self-rated quality of life. The higher the degree of disability as assessed by the Oswestry questionnaire and the higher the number of postoperative complications, the worse the subjective rating of health-related quality of life (HRQoL) (p < 0.05). Factors associated with a significantly (p < 0.05) increased risk of lower back pain include postoperative complications, irrespective of the time since stoma creation, as well as avoidance or restriction of full trunk movements. Preoperative agreement on the stoma site was associated with greater independence in stoma hygiene. Conclusions: The results underscore the importance of early and targeted interventions to improve physical and psychosocial well-being in the subject population, especially at the preoperative stage. More attention should be paid to the needs of colostomy patients, both in hospitals and in outpatient specialty care centers, to improve their overall quality of life and self-assessment of their condition. Full article

Introduction: Chronic non-specific low back pain (CNLBP) is associated with altered lumbopelvic mechanics and impaired hip mobility. This study examined whether changes in pain-provoking hip flexion are associated with changes in low back pain and assessed agreement between inertial measurement units (IMUs) and a markerless motion capture system. Methods: Thirty-six patients with CNLBP completed a longitudinal repeated-measures rehabilitation protocol consisting of approximately 13 physiotherapy sessions over a period of up to 6 weeks. Active hip flexion was assessed in the symptomatic limb (the limb provoking lumbar pain). Hip flexion was recorded during the same movement trial using IMUs and a markerless system. Pain and disability were assessed using the Visual Analogue Scale and Oswestry Disability Index. Results: Improvements in hip flexion were moderately associated with pain reduction (markerless: r = −0.52; IMU: r = −0.57), with negligible associations with disability. Markerless and IMU measurements showed a strong correlation (r = 0.87), while Bland–Altman analysis showed consistent underestimation by the markerless system (bias = −3.67°). Conclusions: Symptom-specific hip mobility is associated with pain reduction in CNLBP, highlighting the role of lumbopelvic biomechanics. IMUs demonstrated higher consistency, while markerless systems offered a more accessible alternative for clinically meaningful movement assessment. Full article

Hydronephrosis caused by malignant ureteral obstruction or radiotherapy-induced ureteral stenosis is a frequent complication in patients with cervical cancer. Effective management requires continuous urinary drainage, which can be achieved either internally through ureteral stent placement or externally via percutaneous nephrostomy. Among available devices, the Allium^TM fully covered nitinol mesh ureteral stent is designed to treat ureteral or urethral strictures while allowing safe and easy removal. However, serious complications have been reported, including uretero-enteric, uretero-arterial, and uretero-vaginal fistulas, pseudoaneurysm, ureteral perforation and sepsis. We report the case of a 44-year-old woman diagnosed in 2020 with stage IIIC1 cervical cancer (FIGO classification) who underwent surgery followed by adjuvant radiotherapy. In 2021, a right metallic ureteral stent was placed to treat ureteral obstruction. Two years later, she presented with right lumbar pain, and abdominal ultrasonography revealed grade III right hydronephrosis. CT scan demonstrated migration of the metallic ureteral stent into the rectal wall. Endoscopic extraction of the migrated stent was successfully performed via colonoscopy. Retrograde pyelography and CT imaging confirmed the presence of a recto-ureteral fistula. A 6 Ch/26 cm double-J ureteral stent was subsequently placed with good positioning and drainage. At the six-month follow-up, replacement of the double-J stent was performed. Imaging studies showed only minor residual hydronephrosis. Although metallic ureteral stents are effective for managing malignant ureteral obstruction, particularly in complex oncologic cases, they are not free of severe complications. The risk appears increased in patients who have undergone radiotherapy, emphasizing the need for careful monitoring and long term follow-up. Full article

Background: Giant retroperitoneal schwannomas with vertebral body erosion are exceedingly rare, and the decision regarding spinal instrumentation following tumor resection remains controversial in the absence of established guidelines. A 25% vertebral body involvement threshold has been proposed as an indication for fixation, yet this criterion does not account for bone quality or the potential biological adaptation of bone to chronic mechanical loading. Case Presentation: A 56-year-old man presented with bilateral gluteal pain and urinary urgency secondary to a giant retroperitoneal lumbar schwannoma (97 × 67 mm) with 36.6% erosion of the L5 vertebral body, confirmed by CT-guided biopsy (S100+, SOX10+, Ki-67 < 5%). Despite erosion exceeding the proposed instrumentation threshold, complete tumor resection was performed via an anterior laparotomic approach without spinal fixation, based on the absence of clinical or radiological signs of instability and the integrity of the intervertebral disc and posterior ligamentous complex. Intraoperative neurophysiological monitoring guided sacrifice of the tumor-origin root. The postoperative course was uneventful, with complete resolution of symptoms and no new complaints or neurological deficits at one-year follow-up. Conclusions: Post-hoc Hounsfield Unit measurements on pre-operative CT demonstrated markedly elevated bone density at the eroded L5 vertebral body (480 HU) compared with the adjacent L4 vertebra (317 HU), consistent with compensatory sclerosis induced by chronic mechanical compression. Pre-operative HU assessment may represent a valuable, readily available adjunct to anatomical erosion criteria in the surgical decision-making process for giant schwannomas with vertebral body involvement. Full article

Lower back pain (LBP) is a leading cause of disability globally, characterized by multifactorial origins that complicate accurate diagnosis and effective treatment planning. Artificial intelligence (AI), including machine learning (ML), deep learning (DL), and radiomics, has shown promise for improving the reproducibility and quantitative assessment of spine neuroimaging. This narrative review synthesizes current evidence on AI-derived imaging biomarkers in magnetic resonance imaging (MRI) and computed tomography (CT), with emphasis on disc degeneration, spinal stenosis, endplate signal abnormalities, paraspinal muscle composition, vertebral fractures, and spinal alignment. AI-based reconstruction, segmentation, and classification methods may reduce reader variability and enable standardized quantification of imaging features. However, the current evidence base remains dominated by technical and retrospective validation studies, and high diagnostic performance should not be interpreted as proof of improved patient-centered outcomes. The present review distinguishes technical feasibility, diagnostic assistance, prognostic association, and clinical utility, and highlights the persistent efficacy-effectiveness gap in AI-based spine imaging. Although multimodal models integrating imaging, clinical, biomechanical, and patient-reported data may improve future risk stratification, clinical translation remains constrained by heterogeneous datasets, limited external validation, incomplete interpretability, and evolving regulatory frameworks. Prospective multicenter validation and outcome-linked evaluation are required before AI-derived imaging biomarkers can be considered established tools for routine LBP management. Full article

Fibromyalgia (FM) is associated with altered pain modulation and heterogeneous responses to exercise. Exercise-induced hypoalgesia (EIH), typically observed in healthy individuals, appears inconsistent in FM. Immersive virtual reality-based exercise (VRBE) may influence pain through cognitive and attentional mechanisms, but its relationship with EIH remains unclear. This study aimed to identify exploratory response patterns based on changes in pressure pain thresholds (ΔPPT) following a single VRBE session and to explore associations with clinical and cognitive variables. A secondary pre–post analysis was conducted in 35 women with FM who completed a standardized VRBE protocol. PPTs were assessed at the trapezius, lumbar region, and knee before and after the intervention. K-means clustering was applied to ΔPPT values, and repeated measures ANOVA evaluated time × cluster interactions. No significant group-level changes in PPT were observed (p ≥ 0.432). Three response patterns were identified: positive responders (17%), negative responders (23%), and non-responders (60%), with significant time × cluster interactions across all sites (p < 0.001). Cognitive function and educational level were associated with ΔPPT but did not predict cluster membership. These findings indicate interindividual variability in EIH responses following VRBE in FM, highlighting the potential relevance of individualized monitoring during VR-based exercise interventions and the need for further investigation of underlying mechanisms. Full article

Background/Objectives: We describe a case series of two patients with non-specific chronic low back pain (CLBP) and measurable decreased quality of life, who showed improvements after a specific multi-modal conservative spine and postural therapy regimen. CLBP is the leading cause of years lived with disability and disability-adjusted life years. This case series adds observational data to the medical literature on conservative treatment of CLBP and potentially improves diagnostic and treatment understanding of how conservative therapies can benefit patients suffering with CLBP. Methods: Two patients (Patient A: 58-year-old female; Patient B: 43-year-old male) presented with severe CLBP who did not find relief with prior traditional chiropractic manipulation. The patients sought treatment at a spine rehabilitation facility closest to their remote locations in Wyoming, USA. The conservative rehabilitation treatment program consisted of multi-modal therapies to strengthen postural muscles, postural spinal manipulation, and specific Mirror Image^® traction. After 36 treatments over 12 weeks in office and home rehabilitation exercises, baseline tests and outcome measures were repeated. Results: Patient-reported objective outcomes, disability indices, and radiographic analysis demonstrated changes at the conclusion of treatment that were maintained at long-term follow-up re-examination. Lumbar lordosis initially changed from −21.8° L1–L5 lordosis to post-treatment −33.6° for patient A and from −22.6° to −42.4° for patient B. Long-term follow-up demonstrated continued resolution of initial symptoms and maintained spine alignment. Conclusions: In these two patients, the described multimodal conservative program was associated with sustained improvements in symptoms, function, and radiographic parameters. This case series adds to prior biomedical literature regarding potential conservative interventions for treating CLBP and abnormal posture. Larger randomized controlled studies are required to evaluate generalizability and relative effectiveness. Full article

Background: Lumbar facet joints are a significant source of chronic low back pain (CLBP), and medial branch blocks (MBBs) are the widely accepted reference diagnostic approach for diagnosis. However, clinical response varies. This study aims to investigate whether sagittal spinopelvic alignment parameters can predict the clinical efficacy of MBB in patients with facet-mediated CLBP. Methods: In this prospective observational study, 110 patients (aged 40–80) with facet-related CLBP underwent diagnostic MBBs using a double-block protocol. Spinopelvic parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL), were measured on standing lateral radiographs. Clinical response was defined as a ≥80% reduction in Visual Analog Scale (VAS) scores. Data were analyzed using multivariate logistic regression and Receiver Operating Characteristic (ROC) curves. Results: Responders (n = 68) were significantly younger and had a lower BMI than non-responders (n = 42) (p < 0.05). Non-responders exhibited significantly higher PI–LL mismatch (18.6° ± 7.4 vs. 3.9° ± 4.2, p < 0.001), higher PT (23.6° ± 5.1 vs. 17.4° ± 4.5, p < 0.001), and lower LL (35.8° ± 7.2 vs. 45.2° ± 6.4, p < 0.001). ROC analysis identified a PI–LL mismatch threshold of >12.5° as the strongly associated with negative short-term diagnostic response (AUC = 0.892). Multivariate analysis confirmed that PI–LL mismatch > 12.5° was a potential associated factor within the investigated model of poor response (OR: 4.25, 95% CI: 2.10–8.60, p < 0.001), while age and BMI were not significant in the adjusted model. Conclusions: Sagittal spinopelvic malalignment, specifically an increased PI–LL mismatch, is strongly associated with reduced diagnostic utility of MBB. Integrating biomechanical assessment into clinical decision-making may improve patient selection and treatment outcomes for facet-mediated pain. Full article

Background: Walking a dog on-leash is a common activity for a large portion of our society. Many dogs consistently pull on the leash, which transmits potentially dangerous forces to the human body. The purpose of this in silico study was to determine the effects of dog-leash tension and human posture on lumbar compression, and how comparable the effects of dog walking on lumbar compression are to lifting, an activity known to contribute to low back pain. Methods: Dog-leash simulations were performed with 50–300 N directed along the arm segment of a static three-dimensional musculoskeletal model across a range of trunk segment and shoulder joint angles. Lifting simulations were performed across a range of test postures with the model holding a 50–300 N weight close to the ground. Lumbar compression was computed for each simulation using McGill’s polynomial equation and compared with the 3400 N cutoff used to develop occupational safety guidelines. Results: Lumbar compression increased as trunk segment flexion increased for all simulation conditions. With 200 N of leash tension, lumbar compression exceeded 3400 N for all postures with 25° or more of trunk segment flexion. When lifting 150 N, lumbar compression exceeded 3400 N for all postures with shank segment angle of 80° or greater and knee flexion angle of 100° or less. Conclusions: Our in silico results suggest that dog owners should seek intervention if their dog routinely pulls on the leash with a force of 200 N or greater and should attempt to lean backward when resisting leash pulling to reduce lumbar compression and injury risk. Full article

Introduction: The concomitant occurrence of myeloproliferative neoplasms (MPNs) and plasma cell dyscrasias is rare and presents significant diagnostic challenges. Accurate distinction between overlapping features is essential, particularly when bone marrow fibrosis (BMF) is present. Case Description: We report a 57-year-old female, with a 10-year history of thrombocytosis managed with antiplatelet therapy, who presented with anemia and severe lumbar pain. Bone marrow biopsy revealed marked fibrosis, and imaging revealed multiple vertebral lesions. Diagnostic workup identified features consistent with myelofibrosis (MF) and coexisting IgG-Kappa multiple myeloma (MM). Although the patient initially fulfilled WHO criteria for MF, the rapid resolution of fibrosis following first-line plasma-cell-directed therapy suggested a secondary, cytokine-mediated process rather than a true concomitant MPN. Conclusions: This case highlights the importance of an integrated diagnostic approach in patients with overlapping features of hematologic malignancies. Differentiating between MM-associated fibrosis and true concurrent MPN and MM is critical, as misclassification may alter both prognosis and therapeutic strategy. In triple-negative cases, the histologic response to plasma-cell-directed therapy can serve as a key discriminating criterion. Awareness of the potential association between MM with fibrosis and extramedullary disease is also essential for clinical management. This case underscores the importance of an integrated diagnostic approach in patients with overlapping hematologic features. Full article

Background/Objectives: Spinal pain is common among schoolchildren and is associated with poor postural habits and sedentary behavior. Schools represent an optimal setting for prevention; however, they are also key environments for prevention strategies in children who already experience spinal pain. This study focused on children aged 9–11 years and aimed to evaluate the effectiveness of a physiotherapist-led, classroom-based workshop as a prevention intervention to improve spinal pain outcomes. Methods: A quasi-experimental single-group pre–post intervention study was conducted in public primary schools. The intervention consisted of two 45 min theoretical–practical sessions. A 21-item questionnaire assessed spinal pain, postural habits, backpack-related behaviors, physical activity, screen use and spinal literacy at baseline and three months post-intervention. McNemar and Wilcoxon tests were applied (p < 0.05). Results: A total of 287 schoolchildren participated. Cervical and thoracic pain decreased significantly (p = 0.036; p = 0.040), while lumbar pain showed no change. Postural habits improved: sitting with back support increased (+12.7%; p < 0.001), sitting on the chair edge decreased (−10.5%; p < 0.001), and side-lying sleeping increased (p = 0.006). Knowledge of proper backpack load distribution also improved (+17.9%; p < 0.001). No significant changes were observed in physical activity, screen use, rising-from-bed technique, or backpack type. Conclusions: The workshop improved upper-spine pain, spinal literacy and modifiable habits, while automated motor behaviors and family-dependent routines showed limited change. Full article