Search Results (848)

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

Background/Objectives: A caudal epidural steroid injection (CESI) is a widely used technique for managing low back and lower extremity pain due to its relative ease and safety. However, cephalic spread of the injectate may be limited by the long distance from the sacral hiatus and by increased intra-abdominal pressure caused using conventional abdominal pillows during prone positioning. This study aimed to investigate whether an eleven-bar cushion could facilitate higher cephalic spread of contrast medium during CESI compared to a conventional pillow. Methods: This retrospective study was approved by the Institutional Review Board (IRB number: AJOUIRB-DB-2025-103). Data from 76 patients, who underwent CESI between January 2023 and March 2024, were analyzed. Patients were divided into two groups the eleven-bar group (n = 38) using a pelvic eleven-bar cushion and the pillow group (n = 38) using a conventional pillow. Fluoroscopic images were reviewed to identify the highest vertebral level reached by the injectate and the number of nerve roots visualized. Visual analogue scale (VAS) scores before and one month after the procedure were also assessed. Statistical analyses included Mann–Whitney U tests, linear regression, and Poisson regression. Results: Baseline demographic characteristics were similar between groups. The cephalic spread of contrast medium was significantly higher in the eleven-bar group compared with the pillow group (median level L3/4 vs. L4/5, p = 0.0002). No significant differences were observed in the number of nerve roots reached or in the VAS score improvement between groups. Conclusions: The eleven-bar cushion facilitated greater cephalic spread of contrast medium during CESI compared with a conventional pillow. Although this technique did not affect nerve root distribution or pain reduction outcomes, it may represent a useful positioning strategy to enhance drug delivery to higher lumbar levels during caudal epidural injections. Full article

Ultrasound (US) has gained increasing acceptance for evaluating the axial spine, including the lumbar region. While its accuracy for superficial structures such as facet joints and medial branches has been validated, evidence supporting its use for deeper targets, such as the lumbar plexus, remains limited. This cadaveric study aimed to assess the feasibility of US-guided lumbar plexus injection. A fresh-frozen female cadaver with a body mass index of 23 kg/m², prepared using the “Fix-for-Life” technique, was utilized. Using a 2–5 MHz curved linear transducer (HS30; Samsung Medison, Seoul, Republic of Korea), injections were performed with an in-plane approach under continuous needle visualization. A 20-gauge, 7 cm spinal needle was used to deliver 5 mL of green dye targeting the L3 and L4 nerve roots. Dissection confirmed that L3 injection achieved dye spread to the extraforaminal region, whereas L4 injection demonstrated anterior dye distribution adjacent to the intervertebral foramen. The main limitations included the use of a single specimen and acoustic shadowing from articular processes, which impeded visualization of neural structures. This study demonstrates the feasibility of US-guided lumbar plexus injection and supports its potential application in clinical pain management, although further validation with larger sample sizes is warranted. Full article

Background/Objectives: Lumbar degenerative disease drives numerous elective spine surgeries, and anesthetic choice significantly influences airway risk, hemodynamics, analgesia, mobilization, and recovery. Interest in awake lumbar surgery, typically using spinal anesthesia (SA) with light sedation, has grown as comparative studies suggest comparable safety to general anesthesia (GA) with potential reductions in opioid use, nausea, time to ambulation, and efficiency metrics. However, these benefits may be context-dependent under standardized perioperative care. Therefore, the aim of this umbrella review is to synthesize previously published meta-analyses that compare postoperative outcomes between SA and GA in patients undergoing lumbar spine surgery. Methods: A systematic literature search was executed with defined criteria across PubMed, Embase, and Web of Science. Data analysis was performed using the metaumbrella R package to report equivalent Hedges’ g values. Each meta-analysis was evaluated with the AMSTAR2 tool, and the credibility of the evidence was determined with Ioannidis criteria. Results: Seven meta-analyses were included. Pooled data showed that SA was associated with shorter operative time, reduced length of stay, and lower intraoperative blood loss, supported by class III credibility for operative time and length of stay and class IV for blood loss in the setting of high between study heterogeneity. SA was also associated with lower odds of postoperative nausea and vomiting and reduced postoperative analgesic requirements, both graded as class IV with prediction intervals that encompassed the null. Intraoperative hypotension and bradycardia did not differ significantly between SA and GA, and postoperative pain scores and overall complication rates were similarly neutral. Conclusions: This umbrella review identifies potential advantages of SA in lumbar spine surgery, including shorter operative time, reduced length of stay, lower intraoperative blood loss, and lower postoperative nausea and analgesic requirements, while finding no consistent differences in hemodynamic events or overall complications. These findings suggest SA as an alternative pathway to general anesthesia for selected lumbar procedures but highlight substantial heterogeneity and low-to-intermediate credibility for several endpoints, underscoring the need for additional high-quality, protocolized comparative studies to refine effect sizes and define optimal patient and procedural selection. Full article

Background/Objectives: Spinal decompression surgery shows variable outcomes, with reoperation rates up to 37.5%. Surgeons lack objective intraoperative tools to assess decompression adequacy. Mechanomyography (MMG) measures nerve excitability through mechanical muscle responses to electrical stimulation. While compressed nerves require higher stimulation thresholds, optimal quantification approaches remain undefined. We explored associations between intraoperative MMG threshold changes and six-week pain outcomes, comparing metrics anchored to a 2.0 mA reference threshold versus percentage-based measures. Methods: Prospective exploratory pilot study of 42 patients (112 nerves) undergoing lumbar or cervical decompression. MMG thresholds were recorded pre- and post-decompression. Numeric Pain Scale scores were obtained preoperatively and at six weeks. Three metrics were compared: percentage change, Threshold Reduction Ratio (TRR; measuring proportion of threshold elevation above 2.0 mA eliminated by decompression), and Threshold Excess (TE; residual threshold remaining above 2.0 mA), with TRR and TE anchored to 2.0 mA based on published normal ranges. Results: Among 40 patients with baseline pain, threshold-anchored metrics showed substantially stronger correlations with pain improvement than percentage-based measures (TRR: r = 0.656, p < 0.001 vs. percentage: r = 0.397, p = 0.011). Threshold Excess was associated with a linear dose–response: each 1 mA above 2.0 mA corresponded to 6.3% less pain improvement (p = 0.001). Patients achieving ≤2.0 mA had 6.1-fold increased odds of complete pain relief versus those above 2.0 mA (76.5% vs. 34.8%, p = 0.013). Internal leave-one-out cross-validation suggested internal stability (TRR shrinkage ≈ 9.3%; TE’s dose–response slope remained stable). Conclusions: In this exploratory pilot study, threshold-anchored MMG metrics (TRR and TE) showed stronger correlations with early pain outcomes than percentage-based measures. These exploratory findings require external validation in independent cohorts before clinical implementation. If validated prospectively, these metrics could provide objective, real-time feedback for clinical interpretation to inform surgical decision-making during spinal decompression, enabling surgeons to tailor decompression to individual physiology rather than relying on standardized anatomical criteria. Future work should explore patient-specific threshold targets that account for age, chronicity, and comorbidities. Full article

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

Gossypiboma is a retained surgical item, most commonly gauze or sponge, inadvertently left inside a patient’s body after surgery. Although preventable, it can cause severe complications and is often underreported due to medicolegal concerns. We present a case of a 61-year-old woman who experienced left lower abdominal pain for three days. Her history included lumbar disc surgery via the lower left abdomen a decade earlier. Physical examination revealed a non-tender pelvic mass, and abdominal computed tomography (CT) showed a 4.5 × 4.7 × 6.1 cm high-attenuation lesion with internal low-attenuation areas in the left retroperitoneal space. The mass was surgically removed, and gauze material was identified inside, confirming the diagnosis of gossypiboma. The patient recovered uneventfully postoperatively. Gossypiboma can present with subacute or chronic symptoms, making diagnosis challenging. While uncommon, gossypiboma should be considered in differential diagnoses of patients with unexplained abdominal masses and prior surgical history. Prompt surgical management is essential to prevent complications. This case highlights the importance of meticulous surgical counts and awareness of this rare but serious condition. Full article

Background and Objectives: Lumbar interlaminar ventral epidural injection (LIVEI) offers a promising alternative to transforaminal epidural injection (TFEI) by enabling ventral epidural delivery while minimizing complication risks. While previous approaches often required catheter assistance, this pilot study evaluates the safety, technical feasibility, and early outcomes of a simplified LIVEI method at L5–S1 without catheter insertion. Materials and Methods: Twelve patients with lumbosacral radicular pain received unilateral catheter-free LIVEI at L5–S1 between October 2021 and September 2022. This small retrospective pilot cohort did not include a control group. Contrast spread patterns were evaluated fluoroscopically based on AP and lateral views. Spread was classified into three grades depending on anterior epidural distribution, cranio-caudal extent, and foraminal involvement. Visual Analog Scale (VAS) scores were assessed before and two weeks after the procedure. Spread was classified into three grades depending on anterior epidural distribution, cranio-caudal extent, and foraminal involvement. Results: Fluoroscopic images confirmed ventral epidural spread in all patients, with 75% showing foraminal extension and 67% demonstrating cranio-caudal spread over two or more levels. Baseline VAS scores averaged 6.5 ± 1.0, decreasing to 3.42 ± 1.31 two weeks post-procedure (p < 0.0001), with a mean reduction of 3.08 ± 1.00. No adverse events or complications were observed. Conclusions: Catheter-free LIVEI at the L5–S1 level demonstrated consistent anterior and multi-level ventral epidural contrast distribution on fluoroscopy, supporting the technical feasibility of this approach. In addition to this radiographic validation, patients achieved clinically meaningful pain relief with excellent tolerability. Further confirmation through larger-scale controlled studies is warranted to validate long-term clinical effectiveness. Full article

Background: Chronic low back pain (CLBP) patients present with morphological and functional deficits to the lumbar multifidus. Electromyostimulation (EMS) can be used to improve activation and strength in atrophied skeletal muscle, but its effect on multifidus morphology and function in CLBP patients is understudied. The aims of this study were to compare the effect of two EMS protocols on lumbar multifidus morphology, function, and patient-reported outcomes. Methods: Two-arm randomized control trial (RCT). Individuals with CLBP were randomized to receive either the ‘phasic’ or ‘combined’ muscle therapy protocol with the StimaWELL 120MTRS, a medium-frequency EMS device. T-tests and non-parametric equivalents were used to assess change in imaging-based outcomes, and a repeated-measures ANOVA was used for patient-reported outcomes. Results: Apart from a significant within-group decrease in fatty infiltration at left L5-S1 in the combined group (MD = −1.51, 95% CI = −2.79, −0.23, p = 0.024), results revealed no significant within- or between-group changes to multifidus morphology or function. Pairwise comparisons revealed that both groups experienced significant improvements in multiple pain outcome measures, with a significant group*time effect for LBP with sitting (p = 0.019) and pain interference (p = 0.032) in favor of the phasic group. Additionally, there were significant improvements in the phasic group in disability, pain interference, and pain catastrophizing (all p < 0.01). Conclusions: A 10-week EMS intervention produced no between-group differences in multifidus muscle morphology or function. Participants in both groups experienced significant improvements in a variety of patient-reported outcomes. Full article

Background: Extreme lateral interbody fusion (XLIF) is a minimally invasive spine procedure that traditionally relies on fluoroscopy and neuromonitoring for safe disc space access and instrumentation. Augmented reality (AR) navigation offers real-time anatomical visualization and may reduce fluoroscopy use. This is the first description of applying augmented reality to lateral spine surgery. Methods: We conducted a case series of five patients who underwent AR-guided LLIF between May 2024 and July 2025. Surgery was performed in either lateral decubitus or prone transpsoas (PTP) orientation. AR navigation was performed using the Augmedics xvision Spine System, with intraoperative CT–based registration and optical tool tracking. Clinical and operative data, including operative time, estimated blood loss (EBL), length of stay (LOS), radiation exposure, instrumentation accuracy, and postoperative outcomes, were collected and analyzed. Results: Five patients (4 female, 1 male; age > 65; BMI range 20.7–37.2) underwent AR-guided XLIF across 8 levels (L2–L5). The mean operative time was 5 h 1 min (range: 2 h 8 min–6 h 45 min), and mean EBL was 94 mL. Mean LOS was 5.85 days (range: 2–10). Mean radiation exposure was 21.73 mGy, significantly lower than published averages for fluoroscopy-guided XLIF (108.6 mGy). At follow-up, all patients reported pain reduction, with 4/5 achieving complete symptom resolution. Instrumentation accuracy was confirmed radiographically in all cases. Conclusions: This clinical series demonstrates the first clinical application of AR to lateral lumbar interbody fusion. AR navigation was feasible, safe, and effective, providing accurate disc space access and instrumentation with markedly reduced radiation exposure. These findings support AR as a promising adjunct to improve safety, efficiency, and workflow in lateral spine surgery. Full article

Background: Nocardia are a group of bacteria known to cause pulmonary, cutaneous, neurologic, or disseminated diseases, usually in immunocompromised hosts. Within the Nocardia family is Nocardia transvalensis, a rarely encountered and underreported organism in the clinical literature. Case: Here, we report the case of an immunocompetent patient presenting with lumbar pain diagnosed and treated for disseminated Nocardia transvalensis infection. Our patient underwent magnetic resonance imaging (MRI), demonstrating possible abscess and subtle osteomyelitis of the L3-L4 facet joint and transverse process; a subsequent biopsy and culture resulted in Nocardia transvalensis. Further imaging with a computed tomography (CT) scan of the head revealed a 9 mm enhancing supratentorial lesion. The patient was treated with empiric antibiotics, but this was narrowed to levofloxacin, linezolid, and trimethoprim-sulfamethoxazole after antibiotic sensitivities cropped up. Conclusions: Within this case, we extensively discuss the clinical pathogenesis of Nocardia transvalensis in an unusual host, the diagnostic approach to confirming active Nocardia infection, and the susceptibility patterns in a relatively unstudied organism. Full article

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

Background: Intravenous (IV) parecoxib could reduce pain intensity during the acute phase of lumbar spine surgery. However, details pertinent to the specific effect of this medication on promoting early patient mobility are still controversial. We aimed to investigate the effect of intravenous parecoxib on promoting early ambulation. Methods: This retrospective observational study included patients who underwent elective lumbar spinal fusion between January 2017 and December 2021. The electronic medical records were reviewed, and the patients were divided into two groups: those who received intravenous parecoxib and those who received routine opioid therapy. Propensity score matching (PSM) was employed. The incidence of early ambulation within 24 h after surgery. Patients in both groups were compared. Results: A total of 397 patients’ medical records were reviewed. After one-to-one PSM, there were 125 patients in each group. The incidence of early ambulation was higher in the parecoxib group (56% vs. 40%, p = 0.020). The average time point at which patients could ambulate was 10.4 h earlier in the parecoxib group compared to the control group (95% CI −12.84 to −8.06, p < 0.001). Conclusions: The administration of intravenous parecoxib after lumbar spine surgery demonstrated encouraging effects on early ambulation, with patients able to get out of bed and walk within 24 h after surgery. To endorse intravenous parecoxib as a standard postoperative pain protocol for spine surgery, further investigation in randomized controlled trials should be conducted. Full article

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

Background: Pulsed radiofrequency (PRF) applied to the dorsal root ganglion (DRG) has been proposed as an effective neuromodulator treatment for persistent radicular pain. Autologous conditioned serum (ACS) therapy, derived from the patient’s own blood, offers a conservative approach. This study aims to evaluate the efficacy of ACS applied to the DRG as an adjunct in treating lower limb radicular pain (LLRP). Methods: A prospective, randomized, double-blind, placebo-controlled clinical trial was conducted comparing PRF combined with ACS versus PRF with physiological saline (PhS) on the DRG. Seventy patients (35 per group) with radicular pain lasting ≥6 months and refractory to previous treatments were enrolled. The primary outcome measure was the Numeric Pain Rating Scale (NPRS); secondary measures included the Oswestry Disability Index (ODI), Mood Assessment Scale (MOAS), SF-12 quality of life questionnaire, and DN4 neuropathic pain scale. Assessments occurred at baseline, 1 month, 3 months, 6 months, and 12 months post-intervention. Results: A total of 70 patients were included. The ACS group showed a significant reduction in pain compared to controls at 30 days (p < 0.05). Additionally, neuropathic symptoms such as tingling, numbness, stubbing, and burning decreased significantly in the ACS group during this period (p < 0.05). While both groups experienced pain reduction over time, no significant differences persisted at 6 months. No adverse effects were reported. Conclusions: The addition of ACS to PRF provides a short-term, statistically significant reduction in radicular pain at 30 days, suggesting it is a safe and effective adjunct therapy for lower limb radicular pain. Full article