Search Results (1,231)

Background/Objectives: Altered lumbar sagittal alignment is associated with degenerative and mechanical musculoskeletal disorders. However, conventional angle-based measurements, such as the Cobb angle, may not fully reflect the overall curvature pattern of the lumbar spine. This pilot study investigated whether curvature distribution profiling on sagittal lumbar radiographs is associated with clinically confirmed lumbar musculoskeletal disorders. Methods: This retrospective pilot study included 50 adults who underwent standing sagittal lumbar radiography. Patients were classified as disease-positive or disease-negative according to radiographic findings, short-term clinical follow-up, and chart review. Vertebral body centroids from T12 to S1 were manually identified to construct continuous lumbar curvature profiles. Curvature height was normalized to a standardized baseline for cross-case comparison. Distribution patterns of curvature deviation were analyzed between groups. Total curvature was also calculated as a quantitative descriptor of overall lumbar bending, and group-wise comparisons were performed using the Kruskal–Wallis test. Results: The disease-negative group showed a predominantly unimodal and symmetric curvature distribution, whereas the disease-positive group showed greater dispersion at both hypo-lordotic and hyper-lordotic extremes. The hypo-lordosis subgroup demonstrated a more consistent deviation pattern, whereas the hyper-lordosis subgroup partially overlapped with the disease-negative distribution. These pattern-based findings suggest that deviation from a central curvature profile, rather than lordosis magnitude alone, may be associated with lumbar musculoskeletal disorders. In exploratory quantitative analysis, total curvature showed a distributional shift in the disease-positive group, although the overall between-group difference did not reach statistical significance (p = 0.096). Conclusions: Curvature distribution profiling may provide complementary morphological information in conjunction with conventional angle-based assessment. Both reduced and exaggerated lumbar curvature patterns were observed in association with lumbar musculoskeletal disorders. Larger studies are needed to validate these preliminary findings and to determine the clinical relevance of this approach. Full article

Background and Objectives: Functional neurosurgery encompasses surgical interventions aimed at modulating the function of the central and peripheral nervous systems. Spinal cord stimulation (SCS), as a form of neuromodulation, is an established treatment for chronic pain and is increasingly utilized by both anesthesiologists and neurosurgeons. The aim of this study was to evaluate the effectiveness of SCS in patients with chronic neuropathic spinal pain. Materials and Methods: This prospective study included 42 patients who demonstrated a positive response to trial stimulation. Only patients achieving a clinically meaningful response (≥50% pain reduction) during the trial phase were included in the final analysis. Pain intensity and functional disability were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). All patients underwent a two-stage percutaneous implantation procedure using burst stimulation. A follow-up assessment was performed 3–6 months after implantation. Results: A statistically significant reduction in pain intensity was observed (p < 0.0001), with median VAS scores decreasing from 8 to 3, corresponding to a 62.5% reduction in pain intensity and exceeding the minimal clinically important difference (MCID) for VAS. Functional status improved significantly, with ODI scores decreasing from 74% to 38%, markedly surpassing the established MCID threshold. A clinically meaningful reduction in pain (≥50%) was achieved in the majority of patients. All patients requiring opioid analgesics at baseline discontinued their use following SCS implantation, and a reduction in overall analgesic consumption was observed across the cohort. Conclusions: These findings suggest that burst SCS may be an effective treatment option for carefully selected patients with chronic neuropathic spinal pain who are not candidates for conventional spine surgery. However, the results should be interpreted with caution due to the enriched study design and limited follow-up period. Full article

Background: Gymnasts are reported as a population at high risk of low back pain. The prevention and treatment of low back pain often rely on improving the effectiveness of deep stabilizer muscles through exercises that aim to reach spinal alignment and axial lengthening. However, the scientific evidence regarding the effect of the specific instructions used during exercises on the spinopelvic complex is still lacking. To address this gap of knowledge, the aim of this pilot study was to examine the effect of specific postural and breathing instructions (spine straightening, forced expiration and perineal contraction) on the sagittal alignment of the spine before and after fifteen weeks of a specific muscle strengthening program. Methods: Low-dose biplanar radiographic images were taken in neutral position and in the five specific postures before and after the program and associated skeletal 3D reconstructions were performed allowing calculation of sacral slope, pelvic tilt, lumbar lordosis and thoracic kyphosis. Results: Sixteen gymnasts completed the entire protocol and were included in the analysis. At the end of the program, most of the postures tested led to a decrease in sacral slope, an increase in pelvic tilt, a reduction in lumbar lordosis, and a decrease in thoracic kyphosis, but with varying efficiency; the condition combining spine straightening, perineal contraction and forced expiration appeared to be the most effective in influencing all parameters simultaneously. Conclusions: The results strongly encourage combining an instruction of spine straightening with instructions of both expiration and perineal contraction, which is information of interest for coaches, physiotherapists and medical professionals. Full article

Background: Recent studies suggest that prunes are one of the most effective fruits for preventing and reversing bone loss. Objectives: The purpose of the present systematic review was to summarize the evidence from the randomized controlled studies on the effect of prunes on bone health in humans and to pool the results in a meta-analysis. The hypothesis of the present review was that bone mineral density of the pulled intervention group would be higher than that of the control group. Methods: We conducted a systematic review of randomized controlled studies with a three-level mixed-effects meta-analysis. Results: Of two hundred and eighty-four studies that were initially identified in PubMed, Scopus, and Web of Science using the search words, eleven papers (747 participants) were considered eligible. The effect of prune intervention in postmenopausal women was borderline significant at the lumbar spine, with BMD slightly higher in the intervention group (SMD [95% CI] = 1.30 [−0.03, 2.63]; I² = 98%; p < 0.001). No significant differences were observed at other individual BMD sites. Heterogeneity across studies was high for all measured sites. The difference between the intervention and control groups in the levels of bone formation and resorption markers was not significant. The risk of bias of the included randomized controlled studies, assessed by the RoB v.2 tool, was low. Conclusions: Our meta-analysis provides preliminary evidence of modest skeletal benefits associated with consumption of 50–100 g of prunes, particularly at the lumbar spine, a trabecular-rich site. However, the overall body of research remains limited. Full article

Background/Objectives: The purpose of this study was to examine the sex-specific distribution of traumatic spinal fractures and potential predictive clinical factors for a more well-founded treatment evaluation. Methods: This study is a retrospective cohort study. Data from electronic medical records were analyzed and compiled in a database. Demographic information, trauma-specific characteristics, and radiological measurements, as well as laboratory values and surgical treatments, were collected. Only surgical cases were included in this study. Statistical analyses were performed using the IBM SPSS Statistics program. Chi-square tests, effect sizes, and 95 confidence intervals were used for comparison of categorical variables, and means and standard deviations were calculated, as well as Levene’s test for equality and t-tests for analyzing continuous variables. The statistical significance was set at a two-tailed p < 0.05. Results: A total of 164 patients were included, with a mean age of 58.03 years. Statistically significant differences between sexes were found in age (p = 0.04), GCS (p = 0.03), hemoglobin (p = 0.03), hematocrit (p = 0.007), and the one-year post-surgical intervertebral angle (p = 0.004). AIS score showed statistically significant differences in the cervical and lumbar sections (p < 0.015; p = 0.022) and the overall spine (p = 0.049). No statistically significant difference in the HU values in the vertebra above the fracture was found between men and women. Women showed significantly larger one-year postoperative intervertebral angles than men. Conclusion: Vertebrae with lower HU values tend to collapse despite stable surgical treatment; therefore, additional bone quality assessment should be contemplated. These findings highlight sex-specific considerations for future clinical decision-making. Full article

Background: Osteoporosis has a rising global incidence and social burden. Serum uric acid’s dual roles in oxidative stress and inflammation may influence bone health, but findings are inconsistent and require further research. This study aimed to evaluate the relationship between SUA levels and osteoporosis in a multicenter cohort obtained from different regions of Türkiye. Methods: This multi-center retrospective study included 3280 individuals, postmenopausal women and men aged 45 and older, from 16 centers in Türkiye. Individuals were excluded if they recently consumed alcohol, had severe renal dysfunction, certain hormonal or mineral disorders, specific medications, or certain menopausal statuses. Bone mineral density (BMD) at the hip and lumbar spine was measured using dual-energy X-ray absorptiometry (DXA), and participants were classified as normal or having osteopenia or osteoporosis based on T-score thresholds. Results: Overall, 34.8% were male, and 65.2% were female. For the lumbar spine, 36.8% had osteopenia, and 13.5% had osteoporosis; similarly, for the total hip, 40.8% had osteopenia, and 7.9% had osteoporosis. ROC analysis identified a threshold of 3.9 mg/dL serum uric acid (SUA) (AUC 0.374; p < 0.001), which was positively associated with both lumbar and total hip BMD. Osteoporosis rates were higher in patients with SUA < 3.9 mg/dL compared to those with SUA ≥ 3.9 mg/dL at the lumbar spine (29.1% vs. 14.2%, p < 0.001) and total hip sites (23.6% vs. 15.9%, p = 0.003). After adjustment for potential confounders, SUA was a significant independent predictor of osteoporosis in the lumbar spine (OR 0.70; p < 0.001) and the hip (OR 0.80; p < 0.001). Conclusions: Serum uric acid levels are inversely linked to bone mineral density and osteoporosis risk, indicating a potential role in bone health. However, due to study limitations, causal relationships remain unproven, and further research is needed. Full article

Traditional deadlift guidelines prioritize maintaining a neutral spine to prevent low back injuries. However, recent evidence questions whether moderate spinal flexion under load is inherently harmful, especially among trained individuals. This article proposes a modern, multifactorial framework for deadlift-related injury prevention that moves beyond rigid postural prescriptions. It integrates biomechanical evidence, load management strategies, movement variability principles, and dynamic trunk control. This narrative review synthesizes literature identified through structured searches of PubMed, Scopus, and Google Scholar, prioritizing peer-reviewed studies examining spinal biomechanics, load management, motor control, and injury epidemiology. Evidence suggests that trained lifters often exhibit natural lumbar flexion without clear prospective evidence of increased injury risk. Abrupt increases in training load appear to be consistently associated with elevated injury incidence, although relationships remain probabilistic and context-dependent. While technical factors, including spinal posture, may influence local tissue loading, current evidence suggests that rapid changes in training exposure and cumulative load management appear to be more consistent predictors of injury risk than isolated deviations from an externally defined “neutral” alignment. Movement variability appears protective, and dynamic trunk control is more functionally relevant than static core strength. A paradigm shift is needed in how deadlifts are coached and programmed. Injury prevention should emphasize progressive loading, adaptive movement strategies, and dynamic stability, rather than rigid technique enforcement. Rather than systematically appraising all available evidence, this review offers an interpretative synthesis to guide modern, evidence-informed coaching and rehabilitation practice. Full article

Candida dubliniensis is an opportunistic yeast closely related to Candida albicans and an uncommon cause of central nervous system (CNS) infection. While isolates are often susceptible to azoles, reduced susceptibility or acquired resistance may occur, making species identification and antifungal susceptibility testing clinically relevant. We report a 3-year-old boy with Philadelphia chromosome-positive B-cell precursor acute lymphoblastic leukemia (ALL) in hematologic remission who developed chronic meningitis during maintenance chemotherapy. The initial presentation was non-specific (marked somnolence without fever or meningeal signs) and lumbar puncture performed to exclude CNS relapse revealed neutrophil-predominant pleocytosis and elevated protein; the cerebrospinal fluid (CSF) culture grew C. dubliniensis. Treatment with intravenous liposomal amphotericin B followed by prolonged fluconazole led to clinical improvement and sterile CSF. Six months later, progressive gait disturbance, limb pain, and episodic severe headaches recurred; repeat CSF cultures again yielded C. dubliniensis, with a changed susceptibility profile. Spine MRI demonstrated leptomeningeal enhancement involving the cauda equina nerve roots. Intravenous voriconazole with therapeutic drug monitoring was initiated and combined with intrathecal liposomal amphotericin B (seven doses, dose-escalated up to 3 mg), which was well tolerated and associated with rapid neurologic improvement, CSF sterilization, and radiologic resolution. At 12 months of follow-up, the patient remained infection-free and in leukemia remission. This case highlights that C. dubliniensis chronic meningitis may present subtly yet progress, requiring repeated CSF cultures with susceptibility testing; intrathecal liposomal amphotericin B can be a safe and effective adjunct to systemic therapy in refractory or recurrent disease. Full article

Lumbar spine disorders often require surgical intervention using medical implants to stabilize or replace damaged structures. As the prevalence of these surgeries increases due to an aging population, rigorous preclinical evaluation is critical. This narrative review aims to summarize current testing methods, identify gaps in clinical translatability, and explore the role of emerging computational technologies. Mechanical testing protocols established by the American Society for Testing and Materials (ASTM) and the International Organization for Standardization (ISO) provide essential standardized data on structural integrity but fail to replicate the complex biological interactions of the human spine. Similarly, animal models offer insights into biological responses like osseointegration but are limited by quadrupedal biomechanics and anatomical differences. Recent advancements in Artificial Intelligence (AI) and Finite Element Analysis (FEA) enable rapid, patient-specific modeling and high-throughput screening, significantly reducing the time and cost of physical testing. Future innovations include 3D-printed personalized implants, bio-responsive materials, and genetically modified animal models to bridge existing translatability gaps. In conclusion, improving the clinical success of lumbar spine implants requires an integrated framework that combines mechanical, biological, and computational approaches. This interdisciplinary collaboration is vital for developing safer and more effective treatments for patients. Full article

Background: Epidural procedures benefit from a pre-procedural informed estimation of epidural depth, as anticipating the approximate distance can support safer needle placement and reduce technical difficulties during analgesia or anesthesia procedures. The influence of ethnicity has been established across different populations worldwide; however, there is a lack of Saudi-specific MRI data on epidural depth among the adult population. Aim of this Study: To measure the skin to epidural space distance (SED) at the lumbar interspaces L3–L4 and L4–L5 in the Saudi adult population using magnetic resonance imaging (MRI) and to examine its correlations with age, sex, height, weight, and body mass index (BMI). Methods: In this retrospective cross-sectional study, sagittal T1-weighted lumbar MRI images of the spine of 169 adult Saudi patients were studied. The age group ranged from 20 to 70 years, with an equal distribution of males and females. The skin to epidural space distance (SED) was measured at the L3–L4 and L4–L5 interspaces, and its correlations with age, sex, height, weight, and BMI were analyzed. Results: The average measurement of skin to epidural space distance (SED) was 59.08 mm in L3–L4, and 63.21 in L4–L5. BMI and weight showed strong positive correlations with SED across both levels. Female sex was associated with longer SED values at L4–L5. There was no significant correlation between SED and age or height of the patients. Conclusions: MRI-based assessment of SED revealed strong correlations with weight and BMI, but no correlation with height, age, and sex. These findings support the individualized estimation of epidural depth and needle length selection to enhance procedural safety and reduce complications. Full article

Background/Objectives: Poor bone quality is strongly associated with adverse surgical events. Although dual-energy X-ray absorptiometry (DXA) remains the gold standard for bone mineral density (BMD) assessment, logistical barriers may limit its preoperative application. The Endplate Bone Quality (EBQ) score is an MRI-derived metric quantifying subchondral bone quality at the vertebral endplate with demonstrated predictive value for cage subsidence following lumbar interbody fusion. However, EBQ has been measured exclusively at the operative level in surgical cohorts. This study aimed to assess level-specific EBQ scores across the entire lumbar spine and compare distributions across age, sex and osteoporosis subgroups. Methods: A single-institution retrospective review of T1-weighted lumbar MRI studies from patients evaluated for lower back pain from 2020 to 2025 was performed. EBQ was independently scored by two blinded raters at each disc space from L1–L2 to L5–S1 using 3 mm endplate ROIs normalized to a CSF ROI at L3. Interrater reliability was assessed via ICC, Pearson correlation, and RMSE. Patients were stratified by age (≤60 vs. >60 years), sex, and osteoporosis status, and subgroup comparisons were performed for overall and level-specific EBQ score. Results: A total of 96 patients with an average age of 61.0 ± 9.42 years were included in this study. The majority of patients included were female (87.5%), and 18.8% had been diagnosed with osteoporosis. EBQ scores demonstrated a progressive caudal increase across all subgroups from L2–L3 to L5–S1. Overall interrater reliability was acceptable (ICC = 0.76), with level-specific ICCs ranging from 0.70 to 0.83. No significant differences were observed between age or sex subgroups. Osteoporotic patients demonstrated significantly higher EBQ at L1–L2, L2–L3, and overall (all p < 0.05), with no significant differences at L3–L4 through L5–S1. Conclusions: This study provides normative, level-specific EBQ reference data throughout all levels of the lumbar spine. The increase in EBQ scores seen among caudal levels and reduced osteoporotic discriminatory power support the importance of level-specific context when interpreting EBQ thresholds. These findings may support future studies evaluating threshold development for EBQ. Full article

Background and Objectives: The association between spinal and pelvic alignment significantly impacts sagittal balance in adults. This study, that is retrospective, aims to investigate sagittal alignment anatomy of the pelvis and spine in juvenile idiopathic scoliosis (JIS) and adolescent idiopathic scoliosis (AIS) patients. Materials and Methods: We evaluated nine sagittal parameters from lateral radiographs of 100 JIS and AIS patients, including thoracic kyphosis (TKA), lumbar lordosis (LLA), pelvic tilt (PTA), pelvic incidence (PIA), spinosacral (SSA), sacral slope (SSLA), C7 tilt angles (C7-TA), sagittal vertical axis length (SVAL), and odontoid process hip axis angle (OPHAA) using the ImageJ program. Participants were classified based on their coronal curve group. Analysis of variance compared parameters between curve groups, and Pearson coefficients assessed the relationship between all parameters (p < 0.05). Results: Female participants had an average age of 13.4, and male participants had an average age of 13.0. Female participants had an average scoliosis degree of 19.3, while male participants had 15.2. PIA, PTA, SSLA, and SSA values were significantly higher in women participants than in men participants (p < 0.05). Additionally, PIA, PTA, SSLA, SSA, and OPHAA values were significantly lower in participants with a lower scoliosis degree (p < 0.05). We observed a moderately positive association between LLA and TKA, PIA, SSA, and C7-TA. There was also a moderate positive association between spinopelvic alignment parameters and the degree of scoliosis in participants. Conclusions: Easily measured values such as PIA, PTA, SSLA, SSA, and OPHAA may be related to severity of vertebral column deformities in patients, making them valuable for monitoring scoliosis patients. Full article

Management of unstable upper lumbar fractures with corpectomy and posterior fixation is technically demanding, and conventional workflows may require intraoperative repositioning, increasing operative complexity. Lateral mini-open upper lumbar corpectomy (LMULC) paired with robotic-assisted (RA) posterior percutaneous pedicle screw fixation (PPPSF) can be performed in a single position to facilitate ventral spinal decompression and stabilization in the anatomically constrained upper lumbar spine. In this study, we describe the operative technique and report four illustrative cases of unstable L1 or L2 fractures treated with single-position LMULC, RA-PPPSF, and short-segment fusion. Clinical, radiological, intraoperative variables and postoperative outcomes were evaluated. The mean age was 52.3 ± 17.7 years. The median operation time was 314 min (range 268–361 min); the median estimated blood loss (EBL) was 225 mL (range 100–400 mL). The median preoperative kyphosis was 10.15° (range 8.4–14.6°), the median postoperative kyphosis measured 6.65° (range 1.7–10.8°) and the median correction achieved was 3.5° (range −2.4–12.9°). The median visual analog scale (VAS) pain score reduced from 7 (range 7–9) preoperatively to 4.5 (range 2–6) postoperatively at discharge. At a median follow-up of 12 months (range 6–15 months), all patients had uncomplicated recoveries, demonstrated solid fusion on imaging, and reported favorable MacNab outcomes. Single-position LMULC with RA-PPPSF was technically feasible in this preliminary illustrative series and resulted in favorable clinical and radiographic outcomes. However, further studies in larger cohorts are warranted to help confirm these findings and better define the potential advantages and limitations of this technique. Full article

Low back pain is common in road cyclists and has been associated with prolonged lumbar flexion during cycling. The flexion–relaxation (FR) phenomenon reflects neuromuscular control of the lumbar spine, but its response to prolonged cycling under physiologically individualized conditions remains unclear. Thirty-one pain-free road cyclists completed a laboratory protocol in which exercise intensity was prescribed at 50% of the range between the first and second ventilatory thresholds (VT1 and VT2). Surface electromyography (sEMG) was recorded during trunk flexion extension tasks performed before and after a 60 min cycling trial. FR responses were characterized at both the individual and group levels using the flexion–relaxation ratio (FRR), descriptive classification of altered patterns, and exploratory estimates of mean change, effect size, and 95% confidence intervals. Four cyclists (12.9%; 95% CI: 3.6–29.8%) exhibited altered FR responses: three showed persistent alterations already present before cycling, and one showed an exercise-associated alteration. Group-level changes were minimal (effect sizes: −0.20 to 0.04). These findings suggest that prolonged cycling under controlled physiological load primarily reveals heterogeneous subject-specific neuromuscular patterns rather than a uniform average response. FR assessment using sEMG may therefore be useful as a complementary tool for identifying individual neuromuscular behavior in pain-free cyclists. Full article

Background: Gait analysis offers a comprehensive assessment of locomotion and postural control, which are often altered in individuals with spinal deformities. After validating a stereophotogrammetric protocol for whole-body kinematics, including spinal motion in healthy subjects, its application to clinical populations is needed to assess its clinical relevance. Patients treated with spinal arthrodesis for scoliosis may show reduced trunk mobility and compensatory gait strategies. Methods: The validated spinal protocol was applied to 10 patients with scoliosis who underwent arthrodesis and 5 healthy controls. For each participant, the range of motion (ROM) of the upper thoracic, lower thoracic, and lumbar districts was computed. Group differences were assessed with the Mann–Whitney U test, and time-normalized angular curves were compared using Statistical Parametric Mapping (SPM1d). Results: In the pathological group, the protocol showed moderate-to-excellent intra- and inter-operator reliability (ICC > 0.594). Compared with controls, patients exhibited a significant reduction in ROM in fused or adjacent districts. SPM analysis identified altered upper thoracic flexion–extension patterns, particularly relative to the lower thoracic segment, throughout the gait cycle. Conclusions: The protocol demonstrated preliminary feasibility and sensitivity in identifying segmental and phase-dependent changes in spinal motion after arthrodesis, indicating that it may serve as a useful tool for exploratory postoperative gait evaluation. Full article