Paradigm Shift in Spinal Diseases: From Diagnosis to Therapy

Topic Information

Dear Colleagues,

Recently, new spinal imaging technology and innovative spinal surgery have emerged as promising techniques. Regarding imaging technology, dynamic contrast-enhanced (DSC) MR perfusion imaging can differentiate hypervascular spinal tumors from hypovascular spinal tumors. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are MRI techniques based on measuring the microscopic diffusion of water in living tissues, which is possible for spinal intramedullary tumors. Furthermore, 3D-MRI/CT fusion imaging can detect lumbar nerve root compromise. These imaging technologies, in addition to spinal navigation, and robot-assisted surgery, provide spine surgeons with innovative options for spinal surgery. The advantages of applying robotic technology in spine surgery include the possibility of improving screw accuracy and reducing complications. Spinal navigation surgery has been under development for twenty years. Because of the increase in the aging population around the world, minimally invasive surgery (MIS), including the endoscopic technique, has been in a rapid phase of development since the turn of the 21st century. With these technological developments, this Special Issue welcomes original research and review articles in this field.

Specific topics of interest include investigations of the human spine that demonstrate the following:

• Advances in image acquisition, including dual-energy X-ray absorptiometry (DXA); multi-detector computed tomography (MDCT); and the new magnetic resonance imaging (MRI) technique, 3D-MRI/CT fusion imaging.
• Novel spinal surgery, which includes new technology or imaging techniques, as well as navigation, robot-assisted surgery and endoscopic surgery.

Dr. Masato Tanaka
Dr. Chenkun Liaw
Topic Editors

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Diagnostics diagnostics	3.0	4.7	2011	20.3 Days	CHF 2600
Journal of Clinical Medicine jcm	3.0	5.7	2012	16 Days	CHF 2600
Medicina medicina	2.4	3.3	1920	17.1 Days	CHF 2200
BioMed biomed	-	-	2021	21.9 Days	CHF 1000
Surgeries surgeries	-	0.8	2020	21.8 Days	CHF 1200

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Published Papers (6 papers)

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10 pages, 2018 KiB  

Open AccessArticle

Pain, Function and Trunk/Hip Flexibility Changes Immediately after Clinical Pilates Exercises in Young Adults with Mild Chronic Low Back Pain

by Li Yi Tan, Ryan Han Rong Teh and Boon Chong Kwok

BioMed 2024, 4(3), 203-212; https://doi.org/10.3390/biomed4030016 - 26 Jun 2024

Cited by 2 | Viewed by 2276

Abstract

Background: Pilates is among the best conservative management strategies for chronic low back pain. However, several variations of Pilates exist. This study aimed to investigate physical measures that would detect immediate changes after a brief session of Clinical Pilates exercises. Changes in self-reported [...] Read more.

Background: Pilates is among the best conservative management strategies for chronic low back pain. However, several variations of Pilates exist. This study aimed to investigate physical measures that would detect immediate changes after a brief session of Clinical Pilates exercises. Changes in self-reported clinical outcomes, pain and function were also evaluated. Methods: A prospective cohort study was conducted. Eighteen young adults with chronic low back pain participated in this study. Participants were assessed for pain and function subjectively, and hip/knee strength and trunk/hip flexibility objectively, followed by a session of Clinical Pilates assessment and exercises. After the exercises, the participants were immediately reassessed for pain, function, strength, and flexibility. Results: Trunk/hip flexibility showed statistically significant changes after exercise, which were measured with the sit-and-reach test (−3.44 cm, 95% CI [−5.10, −1.79], p < 0.001) and the finger-to-floor test (−6.29 cm [−9.51, −3.06], p = 0.001). Statistical significance was not found in detecting strength changes in hip extension, hip abduction, and knee extension. Changes in pain (1.56 points [0.83, 2.28], p < 0.001) and patient-specific functional scale (−1.52 points [−1.93, −1.10], p < 0.001) were also found after exercise. Conclusions: Trunk/hip flexibility measures detected physical changes after Clinical Pilates exercise, as well as self-reported pain and function outcomes, without reducing strength performance. Full article

(This article belongs to the Topic Paradigm Shift in Spinal Diseases: From Diagnosis to Therapy)

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12 pages, 7649 KiB  

Open AccessTechnical Note

A Novel Technique for Basilar Invagination Treatment in a Patient with Klippel–Feil Syndrome: A Clinical Example and Brief Literature Review

by Masato Tanaka, Abd El Kader Al Askar, Chetan Kumawat, Shinya Arataki, Tadashi Komatsubara, Takuya Taoka, Koji Uotani and Yoshiaki Oda

Medicina 2024, 60(4), 616; https://doi.org/10.3390/medicina60040616 - 10 Apr 2024

Cited by 1 | Viewed by 3268

Abstract

Objectives and Background: To present a novel technique of treatment for a patient with basilar invagination. Basilar invagination (BI) is a congenital condition that can compress the cervicomedullary junction, leading to neurological deficits. Severe cases require surgical intervention, but there is debate [...] Read more.

Objectives and Background: To present a novel technique of treatment for a patient with basilar invagination. Basilar invagination (BI) is a congenital condition that can compress the cervicomedullary junction, leading to neurological deficits. Severe cases require surgical intervention, but there is debate over the choice of approach. The anterior approach allows direct decompression but carries high complication rates, while the posterior approach provides indirect decompression and offers good stability with fewer complications. Materials and Methods: A 15-year-old boy with severe myelopathy presented to our hospital with neck pain, bilateral upper limb muscle weakness, and hand numbness persisting for 4 years. Additionally, he experienced increased numbness and gait disturbance three months before his visit. On examination, he exhibited hyperreflexia in both upper and lower limbs, muscle weakness in the bilateral upper limbs (MMT 4), bilateral hypoesthesia below the elbow and in both legs, mild urinary and bowel incontinence, and a spastic gait. Radiographs revealed severe basilar invagination (BI). Preoperative images showed severe BI and that the spinal cord was severely compressed with odontoid process. Results: The patient underwent posterior surgery with the C-arm free technique. All screws including occipital screws were inserted into the adequate position under navigation guidance. Reduction was achieved with skull rotation and distraction. A follow-up at one year showed the following results: Manual muscle testing results and sensory function tests showed almost full recovery, with bilateral arm recovery (MMT 5) and smooth walking. The cervical Japanese Orthopedic Association score of the patient improved from 9/17 to 16/17. Postoperative images showed excellent spinal cord decompression, and no major or severe complications had occurred. Conclusions: Basilar invagination alongside Klippel–Feil syndrome represents a relatively uncommon condition. Utilizing a posterior approach for treating reducible BI with a C-arm-free technique proved to be a safe method in addressing severe myelopathy. This novel navigation technique yields excellent outcomes for patients with BI. Full article

(This article belongs to the Topic Paradigm Shift in Spinal Diseases: From Diagnosis to Therapy)

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14 pages, 5352 KiB  

Open AccessArticle

Percutaneous Computed Tomography-Guided Oxygen-Ozone (O₂O₃) Injection Therapy in Patients with Lower Back Pain—An Interventional Two-Year Follow-Up Study of 321 Patients

by Kristina Davidovic, Sebastian Cotofana, Stephan Heisinger, Slavica Savic, Michael Alfertshofer, Tatjana Antonić, Sanja Jovanović, Marko Ercegovac, Mario Muto, Danilo Jeremić, Aleksandar Janićijević, Lukas Rasulić, Vesna Janošević, Lidija Šarić, Deborah Chua, Dragan Masulovic and Ružica Maksimović

Diagnostics 2023, 13(21), 3370; https://doi.org/10.3390/diagnostics13213370 - 2 Nov 2023

Viewed by 2908

Abstract

Objectives: To assess the effect of oxygen-ozone therapy guided by percutaneous Computed Tomography (CT) compared to corticosteroids in individuals experiencing lower back pain (LBP) not attributed to underlying bone-related issues. Methods: A total of 321 patients (192 males and 129 females, mean age: [...] Read more.

Objectives: To assess the effect of oxygen-ozone therapy guided by percutaneous Computed Tomography (CT) compared to corticosteroids in individuals experiencing lower back pain (LBP) not attributed to underlying bone-related issues. Methods: A total of 321 patients (192 males and 129 females, mean age: 51.5 ± 15.1 years) with LBP were assigned to three treatment groups: group A) oxygen-ozone only, group B) corticosteroids only, group C) oxygen-ozone and corticosteroids. Treatment was administered via CT-guided injections to the intervertebral disc (i.e., intradiscal location). Clinical improvement of pain and functionality was assessed via self-reported pain scales and magnetic resonance (MR) and CT imaging. Results: At all follow-up times, the mean score of the numeric rating scale and the total global pain scale (GPS) of study groups receiving oxygen-ozone (groups A and C) were statistically significantly lower than the study group receiving corticosteroids only (group B), with p < 0.001. There was a statistically significant difference between groups A and C at 30 days for the numeric rating scale. Conclusions: The percutaneous application of oxygen-ozone in patients with LBP due to degeneration of the lumbosacral spine showed long-lasting significant pain reduction of up to two years post-treatment when compared to corticosteroids alone. Combination therapy of oxygen-ozone and corticosteroids can be useful as corticosteroids showed statistically significant improvement in LBP earlier than the oxygen-ozone-only treatment. Full article

(This article belongs to the Topic Paradigm Shift in Spinal Diseases: From Diagnosis to Therapy)

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10 pages, 1410 KiB  

Open AccessArticle

Evaluation of Paraspinal Muscle Degeneration on Pain Relief after Percutaneous Epidural Adhesiolysis in Patients with Degenerative Lumbar Spinal Disease

by Misun Kang, Shin Hyung Kim, Minju Jo, Hyun Eom Jung, Jungbin Bae and Hee Jung Kim

Medicina 2023, 59(6), 1118; https://doi.org/10.3390/medicina59061118 - 9 Jun 2023

Cited by 1 | Viewed by 2180

Abstract

Background and Objectives: The analgesic effectiveness of epidural adhesiolysis may be influenced by morphological changes in the paraspinal muscles, particularly in elderly patients. The objective of this study was to assess whether the cross-sectional area or fatty infiltration of the paraspinal muscles [...] Read more.

Background and Objectives: The analgesic effectiveness of epidural adhesiolysis may be influenced by morphological changes in the paraspinal muscles, particularly in elderly patients. The objective of this study was to assess whether the cross-sectional area or fatty infiltration of the paraspinal muscles impacts the treatment outcomes of epidural adhesiolysis. Materials and Methods: The analysis included a total of 183 patients with degenerative lumbar disease who underwent epidural adhesiolysis. Good analgesia was defined as a reduction in pain score of ≥30% at the 6-month follow up. We measured the cross-sectional area and fatty infiltration rate of the paraspinal muscles and divided the study population into age groups (≥65 years and <65 years). Variables were compared between the good and poor analgesia groups. Results: The results revealed that elderly patients experienced poorer analgesic outcomes as the rate of fatty infiltration in the paraspinal muscles increased (p = 0.029), predominantly in female patients. However, there was no correlation between the cross-sectional area and the analgesic outcome in patients younger than or older than 65 years (p = 0.397 and p = 0.349, respectively). Multivariable logistic regression analysis indicated that baseline pain scores < 7 (Odds Ratio (OR) = 4.039, 95% Confidence Interval (CI) = 1.594–10.233, p = 0.003), spondylolisthesis (OR = 4.074, 95% CI = 1.144–14.511, p = 0.030), and ≥ 50% fatty infiltration of the paraspinal muscles (OR = 6.576, 95% CI = 1.300–33.268, p = 0.023) were significantly associated with poor outcomes after adhesiolysis in elderly patients. Conclusions: Fatty degeneration of paraspinal muscles is correlated with inferior analgesic outcomes following epidural adhesiolysis in elderly patients, but not in young and middle-aged patients. The cross-sectional area of the paraspinal muscles is not associated with pain relief after the procedure. Full article

(This article belongs to the Topic Paradigm Shift in Spinal Diseases: From Diagnosis to Therapy)

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12 pages, 1086 KiB  

Open AccessSystematic Review

Intra-Articular Facet Joint Injection of Normal Saline for Chronic Low Back Pain: A Systematic Review and Meta-Analysis

by Areerat Suputtitada, Tanawin Nopsopon, Thanitsara Rittiphairoj and Krit Pongpirul

Medicina 2023, 59(6), 1038; https://doi.org/10.3390/medicina59061038 - 28 May 2023

Cited by 3 | Viewed by 4900

Abstract

Objective: This systematic review and meta-analysis compared the patient-reported outcomes of intra-articular facet joint injections of normal saline and selected active substances to identify a more effective agent for treating subacute and chronic low back pain (LBP). Methods: The PubMed, Embase, [...] Read more.

Objective: This systematic review and meta-analysis compared the patient-reported outcomes of intra-articular facet joint injections of normal saline and selected active substances to identify a more effective agent for treating subacute and chronic low back pain (LBP). Methods: The PubMed, Embase, Scopus, Web of Science, and CENTRAL databases were searched for randomized controlled trials and observational studies published in English. A research quality assessment was performed using ROB2 and ROBINS-I. A meta-analysis was conducted using a random-effects model, and the mean differences (MD) with 95% confidence intervals (CI) in efficacy outcomes, including pain, numbness, disability, and quality of life, were assessed. Results: Of the 2467 potential studies, 3 were included (247 patients). The active substances and normal saline had similar therapeutic effects on pain within 1 h, after 1–1.5 months, and after 3–6 months, with MD and 95% CI of 2.43 and −11.61 to 16.50, −0.63 and −7.97 to 6.72, and 1.90 and −16.03 to 19.83, respectively, as well as on the quality of life after 1 and 6 months. Conclusions: The short- and long-term clinical effects of intra-articular facet joint injections of normal saline are comparable to those of other active substances in patients with LBP. Full article

(This article belongs to the Topic Paradigm Shift in Spinal Diseases: From Diagnosis to Therapy)

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12 pages, 1430 KiB  

Open AccessArticle

Comparison of C-Arm-Free Oblique Lumbar Interbody Fusion L5-S1 (OLIF51) with Transforaminal Lumbar Interbody Fusion L5-S1 (TLIF51) for Adult Spinal Deformity

by Masato Tanaka, Sumeet Sonawane, Umesh Meena, Zhichao Lu, Yoshihiro Fujiwara, Takuya Taoka, Koji Uotani, Yoshiaki Oda, Tomoyoshi Sakaguchi and Shinya Arataki

Medicina 2023, 59(5), 838; https://doi.org/10.3390/medicina59050838 - 26 Apr 2023

Cited by 4 | Viewed by 2254

Abstract

Background and Objectives: Adult spinal deformity (ASD) surgery, L5-S1 lordosis is very important factor. The main objective of the research is to retrospectively compare symptomatic presentation and radiological presentation in the sequelae of oblique lumbar inter-body spinal fusion at L5-S1 (OLIF51) and [...] Read more.

Background and Objectives: Adult spinal deformity (ASD) surgery, L5-S1 lordosis is very important factor. The main objective of the research is to retrospectively compare symptomatic presentation and radiological presentation in the sequelae of oblique lumbar inter-body spinal fusion at L5-S1 (OLIF51) and transforaminal lumbar interbody fusion (TLIF) for ASD. Materials and Methods: We retrospectively evaluated 54 patients who underwent corrective spinal fusion for ASD between October 2019 and January 2021. Thirteen patients underwent OLIF51 (average 74.6 years old, group O) and 41 patients underwent TLIF51 (average 70.5 years old, group T). Mean follow-up period was 23.9 months for group O and 28.9 months for group T, ranging from 12 to 43 months. Clinical and radiographic outcomes are assessed using values including visual analogue scale (VAS) for back pain and Oswestry disability index (ODI). Radiographic evaluation was also collected preoperatively and at 6, 12, and 24 months postoperatively. Results: Surgical time in group O was less than that in group T (356 min vs. 492 min, p = 0.003). However, intraoperative blood loss of both groups were not significantly different (1016 mL vs. 1252 mL, p = 0.274). Changes in VAS and ODI were similar in both groups. L5-S1 angle gain and L5-S1 height gain in group O were significantly better than those of group T (9.4° vs. 1.6°, p = 0.0001, 4.2 mm vs. 0.8 mm, p = 0.0002). Conclusions: Clinical outcomes were not significantly different in both groups, but surgical time in OLIF51 was significantly less than that in TLIF51. The radiographic outcomes showed that OLIF51 created more L5-S1 lordosis and L5-S1 disc height compared with TLIF 51. Full article

(This article belongs to the Topic Paradigm Shift in Spinal Diseases: From Diagnosis to Therapy)

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