Search Results (222)

Background: The efficacy of postoperative exercise rehabilitation after spine surgery is controversial, and a protocol for exercise treatment and detailed outcomes based on functional activity have not yet been established. This study aimed to determine the efficacy of exercise rehabilitation after lumbar spine surgery. Methods: A prospective, randomized controlled trial was conducted in 40 patients who underwent lumbar spine surgery (20 patients each in the exercise and control groups) for 12 weeks. Clinical outcomes were assessed using the visual analog scale (VAS) for pain and EuroQol-5 Dimensions 5-Level version (EQ-5D-5L). Body proportions, including body mass index, total muscle mass, and body fat percentage were analyzed. Functional activity was evaluated based on the range of motion of the lumbar spine, strength and endurance of lumbar flexion/extension, flexibility, 6 min walking test, single-leg stance, coordination, and gait pattern analysis. Results: The exercise group showed significantly greater improvement in VAS for pain (66.67% versus 20.00%, p < 0.001) and EQ-5D-5L (45.56% versus 20.00, p = 0.039) compared to the control group. Serial assessment revealed significant improvement in strength of lumbar flexion/extension, 6 min walking test, single-leg stance, coordination, and gait patterns in the exercise group compared to the control group. In particular, the single-leg stance time for the affected leg improved more markedly in the exercise group (280.9% versus 48.7%, p < 0.001). Conclusion: Tailored postoperative exercise after lumbar spine surgery is effective in reducing pain and enhancing functional recovery, including strength and balance. Full article

Monitoring posture and movement accurately and efficiently is essential for both physical therapy and athletic training evaluation and interventions. Motion Tape (MT), a self-adhesive wearable skin-strain sensor made of piezoresistive graphene nanosheets (GNS), has demonstrated promise in capturing low back posture and movements. However, to address some of its limitations, this work explores alternative materials by replacing GNS with multi-walled carbon nanotubes (MWCNT). This study aimed to characterize the electromechanical properties of MWCNT-based MT. Cyclic load tests for different peak tensile strains ranging from 1% to 10% were performed on MWCNT-MT made with an aqueous ink of 2% MWCNT. Additional tests to examine load rate sensitivity and fatigue were also conducted. After characterizing the properties of MWCNT-MT, a human subject study with 10 participants was designed to test its ability to capture different postures and movements. Sets of six sensors were made from each material (GNS and MWCNT) and applied in pairs at three levels along each side of the lumbar spine. To record movement of the lower back, all participants performed forward flexion, left and right bending, and left and right rotation movements. The results showed that MWCNT-MT exceeded GNS-MT with respect to consistency of signal stability even when strain limits were surpassed. In addition, both types of MT could assess lower back movements. Full article

Background: Although percutaneous laser disc decompression (PLDD) has been proposed as an alternative to conventional surgery for lumbar disc herniation (LDH), we specifically propose it for patients with contained herniations where standard surgical intervention is not the first option. This study evaluates PLDD compared to conservative therapy as an early treatment alternative. Methods: This retrospective observational study compared PLDD to conservative treatment in adult patients with contained LDH. All patients underwent 3 months of standard conservative therapy. Those who remained dissatisfied according to the Visual Analog Scale (VAS) and/or Macnab criteria were then treated with PLDD. We analyzed outcomes from both treatment phases using the Wilcoxon signed-rank test and the Mann–Whitney U test. Results: 121 patients underwent outpatient evaluation for LDH and received an average of 90 days of conservative therapy. Of these 103 patients, dissatisfied with the outcomes of conservative treatment, subsequently underwent PLDD. Following conservative treatment, the average VAS score reduction was 4.1%. Six months after PLDD, the VAS scores demonstrated a significant reduction, with an average decrease of 30% (p < 0.0001). In terms of functional outcomes assessed by the Macnab criteria, 39.8% of patients treated with PLDD achieved ‘Excellent’ or ‘Good’ outcomes, compared to only 11.4% after conservative treatment. Conclusions: PLDD appears to be a viable alternative to conservative therapy for this subgroup of patients with contained LDH. It may be beneficial to propose PLDD early in the therapeutic regimen to accelerate short term clinical improvement. Further studies are required to evaluate the long term efficacy of this treatment approach. Full article

Background/Objectives: Stand-alone lateral lumbar interbody fusion (LLIF) remains a debated approach in spinal surgery, with limited published evidence supporting its efficacy without supplemental fixation. This prospective study presents the institutional case series on single-level L3-L4 stand-alone LLIF, using next-generation 3D-printed titanium cages, as treatment for degenerative disc disease (DDD). Methods: A cohort of 49 patients with symptomatic DDD, unresponsive to conservative therapy, underwent stand-alone LLIF at L3-L4 (neither posterior pedicle screws nor lateral plating). Clinical outcomes (VAS and ODI) and radiological parameters (disc height, segmental/lumbar lordosis) were collected preoperatively and at 1, 6, and 12 months. Repeated-measures ANOVA with Bonferroni correction was adopted for statistical analysis. Results: Significant improvements were observed in pain and disability scores at all time points, with the mean VAS score decreasing from 6.53 to 0.29, and ODI from 27.6% to 3.84% at one year (p < 0.001). Radiographic analysis confirmed durable increases in disc height and segmental lordosis. Solid fusion was achieved in 97.9% of cases. No patient required posterior revision; transient neurological symptoms were mild and self-limiting. Conclusions: This study demonstrates that stand-alone LLIF at L3-L4 is safe and effective in achieving stable fusion and clinical–radiological improvement. These results challenge the necessity of supplemental fixation and support the broader adoption of a less invasive fusion paradigm. Full article

Obesity and low back pain (LBP) are major contributors to global disability and healthcare burden in both adults and children. Although a growing body of research supports a bidirectional relationship between these conditions, the underlying mechanisms remain poorly integrated in the current literature. While mechanical overload has traditionally been viewed as the principal link, emerging evidence points to additional roles for metabolic dysregulation, chronic low-grade inflammation, and adipokine activity in the development and persistence of LBP. This review addresses the need for a comprehensive synthesis of how obesity affects spinal structures, including the intervertebral discs, paraspinal muscles, facet joints, and epidural fat, through both biomechanical and systemic biological pathways. We specifically highlight key mechanisms such as oxidative stress, adipokine signalling, and neuroinflammation that may accelerate spinal degeneration and promote chronic pain. In doing so, we aim to bridge gaps between anatomical, biochemical, and clinical perspectives. Additionally, we assess current clinical evidence on weight loss as a potential strategy for alleviating LBP symptoms. By consolidating diverse lines of evidence, this review provides a clearer framework for understanding obesity-related spinal pathology and outlines priorities for future research and targeted interventions. Full article

Individualized exercise therapy is crucial for effective postoperative rehabilitation. However, a widely accepted, standardized framework for measuring individual exercise capabilities after lumbar spine surgery (LSS) is lacking. This study aimed to develop a novel Exercise Rehabilitation Functional Group (ERFG) classification system to enable systematic, individualized rehabilitation after LSS. Eight exercise parameters and two clinical factors were assessed in 428 volunteers within 12 weeks of single-segment LSS to establish reference data for the ERFG. The study cohort included 411 participants (mean age 67.10 ± 11.60; 128 males and 283 females) with an average postoperative interval of 42.96 ± 20.25 days. Key metrics included lumbar spine ROM (mean 74.24 ± 25.30°), trunk muscle strength (mean 15.71 ± 5.14 kg), trunk muscle endurance (mean 95.80 ± 35.66 s), whole-body flexibility (mean 3.30 ± 10.65 cm), cardiopulmonary capability (mean 433.91 ± 118.75 m), gait with affected single leg (mean 36.26 ± 5.98%), single-leg balance (median 13.60 s), coordination capability (mean 8.21 ± 3.23 s), EuroQol 5-Dimension 5-Level score (mean 9.39 ± 4.17), and visual analog scale for low back pain (mean 3.78 ± 2.55). Data were categorized into five grades using Cajori’s five-grade mathematical method. Significant correlations were observed between the eight exercise parameters and two clinical factors. This study established a foundational framework for standardizing baseline exercise capabilities after LSS. This ERFG system may provide a basis for individualized rehabilitation strategies to enhance patient outcomes. Full article

Background/Objectives: This paper analyzes the movement and relationships within the lumbopelvic–hip complex during forward trunk bending in young women with chronic low back pain. Methods: This study involved 24 women aged 20–24 with chronic low back pain. They were randomly divided into two equal-sized groups: Group 1 participated in a 12-week functional training program, and Group 2 was a control without any intervention. The level of perceived pain was assessed using the Visual Analog Scale (VAS). Qualitative motion analysis was performed using the BTS SMART-D system. Custom indicators were developed to evaluate the angular relationships and ranges of motion in the lumbar spine and the lumbopelvic–hip complex. The functional training program consisted of three sections: motor control and stabilization, muscle strengthening, and stretching exercises. Statistical analysis was performed using Statistica 13.3. Results: The therapy resulted in a reduction in perceived pain levels reported by the participants. There was a significant improvement in the quality of the forward trunk bending pattern in women who underwent functional training. Conclusions: Significant modifications in the quality, technique, and angular relationships within the lumbopelvic–hip complex were observed during the forward trunk bending pattern in women undergoing functional training. It has proven to be an effective form of therapy for chronic low back pain. 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

Background/Objectives: Chronic low back pain (LBP) remains a leading cause of disability and healthcare utilization globally, with complex, multifactorial pathophysiology. Despite advances in imaging, diagnosis often remains challenging due to poor correlation between structural findings and clinical symptoms. Recent evidence suggests inflammatory mechanisms may underlie persistent pain. This study investigated whether systemic inflammatory cytokines are altered in military personnel with chronic LBP and examined their relationships with clinical manifestations, psychological factors, and radiological findings. Methods: In this cross-sectional study, we enrolled 50 patients with chronic non-specific LBP (duration ≥ 3 months) and 50 age-, sex-, and BMI-matched healthy controls. All patients underwent a comprehensive clinical assessment, which included evaluation of pain intensity (VAS), neuropathic pain screening (DN4), psychological assessment (HADS), fibromyalgia screening (FIRST), and assessment of functional disability (Oswestry Disability Index and Roland-Morris Disability Questionnaire, EIFEL). Serum levels of IL-6, IL-8, IL-1β, TNF-α, and IL-10 were measured using chemiluminescence and enzyme-linked immunosorbent assay (ELISA) techniques. Radiological findings were documented through MRI and CT imaging of the lumbar spine. Results: Serum IL-8 levels were significantly elevated in patients with chronic LBP compared to healthy controls (8.52 ± 6.7 vs. 4.8 ± 0.56 pg/mL, p < 0.001). Weak positive correlations were observed between IL-8 levels and anxiety scores (r = 0.3, p = 0.02) and functional disability, as measured by the EIFEL questionnaire (r = 0.3, p = 0.04); however, these associations did not remain significant after Bonferroni correction for multiple testing. Similarly, IL-6 showed a weak positive correlation with BMI (r = 0.21, p = 0.03) and a weak negative correlation with lumbar mobility, as assessed by Schober’s test (r = −0.38, p = 0.03), which also did not survive correction for multiple comparisons. Conclusions: This study identified serum IL-8 as a potential biomarker for chronic LBP. While we observed associations between specific inflammatory markers and psychological distress and functional disability, these correlations were weak and did not remain significant after correction for multiple testing. These preliminary findings suggest possible connections between inflammation and the psychophysiological aspects of chronic LBP that warrant further investigation in larger cohorts. Full article

Background/Objectives: Chronic low back pain (CLBP) is a prevalent condition that significantly impacts the aging population. Among non-invasive assessment tools, infrared thermography (IRT) has been highlighted as a radiation-free method to evaluate thermal variations in the lumbar region. However, its applicability in clinical practice and correlation with functional and pain-related parameters remain unclear. This study aimed to analyze the thermal profile of the lumbar region in elderly individuals with CLBP and explore potential correlations between lumbar temperature patterns and clinical factors such as pain intensity and functional capacity. Methods: A cross-sectional observational study was performed in an outpatient setting. The population included thirty-one elderly individuals diagnosed with CLBP. IRT was used to assess the lumbar temperature distribution, including participants who reported pain radiating to the lower limbs. Pain intensity was measured using a numerical rating scale (0–10). The functional assessments included spine mobility tests and validated questionnaires evaluating clinical characteristics. Results: No significant differences in lumbar temperature patterns were observed among the participants. Additionally, no correlation was found between pain intensity and functional capacity based on a thermographic analysis. Nonetheless, individuals reporting lower fatigue levels and those with a higher body mass index (BMI) were generally associated with cooler thermal readings on the lumbar region’s thermographic maps. Conclusions: These findings suggest that IRT may require methodological refinements, including optimized technical specifications and image acquisition protocols, to enhance its applicability in assessing CLBP. Indeed, IRT might not be the most effective tool for evaluating pain-related thermal changes in elderly populations. Further research is needed to clarify its role in clinical assessments. Full article

Long-term manual material handling (MMH) work leads to the trend of the younger onset of work-related musculoskeletal disorders (WMSDs), with low back pain (LBP) being the most common, which causes great trouble for both society and patients. To effectively prevent LBP and provide support for workers engaged in MMH work, wearable lumbar assistive exoskeletons have played a key role in industrial scenarios. This paper divides wearable lumbar assistive exoskeletons into powered, unpowered, and quasi-passive types, systematically reviews the research status of each type of exoskeleton, and compares and discusses the key factors such as driving mode, mechanical structure, control strategy, performance evaluation, and human–machine interaction. It is found that many studies focus on the assistive performance, human–machine coupling coordination, and adaptability of wearable lumbar assistive exoskeletons. At the same time, the analysis results show that there are many types of performance evaluation indicators, but a unified and standardized evaluation method and system are still lacking. This paper analyzes current research findings, identifies existing issues, and provides recommendations for future research. This study provides a theoretical basis and design ideas for the development of wearable lumbar assistive exoskeleton systems. Full article

Background: Acupotomy is a modern acupuncture technique using a knife-shaped needle for pain treatment, combining traditional and anatomical knowledge. This study evaluates the diversity and safety of acupotomy procedures for lumbar spine disorders to aid in developing safety and reporting guidelines for clinical studies. Methods: A literature search was conducted on 30 October 2023 in PubMed, five Korean databases, and relevant journals with keywords like ‘low back pain’ and ‘acupotomy’. The search included clinical trial articles in English or Korean on lumbar spinal disorders treated by acupotomy. We reviewed 22 clinical studies involving 731 Korean patients published from 2008 to 2023. Data extracted included disease types, diagnosis methods, treatment specifics, needling factors, anesthesia, clinical outcomes, and safety reports. Results: Most studies focused on lumbar herniated discs and stenosis, with acupotomy performed on damaged tissue sites. Treatment frequency varied, and outcomes included pain scales and imaging assessments. Reporting gaps were found in needle size, insertion depth, and anesthesia status. Safety measures were poorly documented, with only six studies addressing safety and two reporting adverse events. Conclusions: There is a critical need for standardized clinical and reporting guidelines for acupotomy, akin to acupuncture’s existing guidelines, to enhance research consistency and quality. Future studies should develop guidelines covering target tissues, needle details, techniques, anesthesia, and adverse effects to improve acupotomy safety and effectiveness. Full article

Prolonged periods of standing are linked to low back pain (LBP). Evaluating lumbar spine biomechanics in real-world contexts can provide novel insights into these links. This study aimed to determine if standing behaviour can be quantified, in individuals with LBP, in real-world environments. A three-stage design was used, (i) Verification of a bespoke algorithm characterising lumbar standing behaviour, (ii) Day-long assessment of standing behaviours of individuals with posture-related low back discomfort, and (iii) Case study application to individuals with clinical LBP. Analysis of standing posture across time included variability, fidgeting, and amplitude probability distribution function analysis. The study demonstrated that accelerometers are a valid method for extracting standing posture from everyday activity data. There was a wide variety of postures throughout the day in people with posture-related low back discomfort and people with clinical LBP. Frequency profiles ranged from slightly flexed to slightly extended postures, with skewed bell-shaped distributions common. Postural variability ranged from 3.4° to 7.7°, and fidgeting from 1.0° to 3.0°. This work presents a validated accelerometer-based method to capture, identify, and quantify real-world lumbar standing postures. The distinct characteristics of people with low back discomfort or pain highlight the importance of individualised approaches. Full article

Background: S1 nerve roots are difficult to approach during percutaneous procedures for the diagnostic and treatment procedures of low back pain with radicular symptoms. This is harder in older patients with obscure anatomies, due to the low bone density with overimposing degenerative changes in the facets and deformations. The otherwise straightforward procedure for the lumbar nerve roots, placing the needle in the proximity of the S1 under fluoroscopic guidance, becomes quite a challenge. Case presentation: In the proposed technique, the initial target for the needle is the lower part of the S1 facet in the convergent trajectory of the needle. After achieving contact with the bone the tip of the needle is moved caudally as, in proximity, it reaches the dorsal foramina of the S1/S2 segment—this is named “wandering to the hole”. The convergent trajectory of the needle ensures the success of the procedure with a minimal risk of intravenous drug administration, which is characteristic for the suprapedicular technique. Conclusions: The proposed technique is straightforward and reproducible due to the combination of the understanding of the surgical and radiological anatomy of this region, in spite of degenerative changes in the spine. Full article

Background/Objectives: Functional spinal instability from multifidus dysfunction has been proposed as a mechanism for chronic postsurgical pain. Prior studies reported structural impairments in the lumbar multifidus in patients with chronic low back pain, including a reduced cross-sectional area, muscle thickness, and increased fat infiltration. This preliminary report examined the prevalence of multifidus fat infiltration after Spinal Cord Stimulation (SCS), an established pain management technique. It also assessed inter-rater reliability in evaluating fat infiltration using MRI. Methods: The medical imaging data from four patients with Persistent Spinal Pain Syndrome Type II (PSPS II) treated with SCS were collected. Two independent operators performed the manual segmentation of the multifidus muscle on axial MRI images of the lumbar spine. The fat-to-muscle ratio was quantified and rated using a four-point classification system, categorizing multifidus fat infiltration as normal, mild, moderate, or severe. To assess the reliability of the manual segmentations, inter-rater reliability was determined. Results: The median fat-to-muscle ratio at the levels L2–L3 was 46.12 (Q1–Q3: 44.88–47.35). At the levels L3–L4, L4–L5, and L5–S1, the median values were 50.45 (Q1–Q3: 45.57–52.98), 52.11 (Q1–Q3: 48.81–52.80), and 52.84 (Q1–Q3: 49.09–56.39), respectively. An ICC value of one (95% CI from 0.999 to 1, p < 0.001) was found for inter-rater agreement on the muscle volume of the multifidus muscle. Conclusions: All the patients had moderate-to-severe fat infiltration of the multifidus muscle at each lumbar spinal level. Although time-consuming, the manual segmentation of the multifidus muscle in patients treated with SCS was feasible and yielded excellent inter-rater reliability when determining muscle volume. Future endeavors should focus on the automation of segmentation and classification. Full article