Search Results (133)

Background/Objectives: Adult degenerative scoliosis (ADS) is a three-dimensional spinal deformity caused by asymmetric degeneration of intervertebral discs, facet joints, and paraspinal muscles (PSM). Although previous studies have identified bilateral asymmetry in the multifidus (MF), the erector spinae (ES), and psoas (PS), the underlying mechanism remains unclear. This study aims to compare muscle volume (MV), fat infiltration (FI), and degenerative changes on the concave (CC) and convex (CV) sides in symptomatic ADS patients. Methods: This study included patients with ADS who visited Kangbuk Samsung Hospital between 2022 and 2024. MV and FI were measured by CT scans, and facet joint degeneration (FJD), disc degeneration (DD), and foraminal stenosis (FS) were assessed by MRI. The values of CV and CC side were compared. Results: 74 patients were enrolled with a mean age of 71.38 ± 8.6 years. MV of all PSM was significantly lower on the CC side than CV side. FI of ES and MF was significantly higher on the CC side compared to the CV side. Degenerative changes in the intervertebral discs and neural foramen were more severe on the CC side. Conclusions: In patients with ADS, we found that MV was consistently lower on the CC side across all PSM, whereas FI in the MF and ES was higher on the CC side. Degenerative changes in the spine, such as FS and DD, were also more severe on the CC side, although FJD was not. These results suggest that spinal muscle and structural degeneration are not evenly distributed between two sides. Physiotherapy that specifically targets the more affected CC side may offer better outcomes for patients with ADS. Full article

Background: Degenerative lumbar spine disease is a prevalent cause of chronic low back pain that significantly impairs daily function and quality of life. While conservative management is the first line of treatment, many patients ultimately require instrumented lumbar spine surgery. However, postoperative outcomes vary considerably, with emerging evidence suggesting that preoperative psychological factors such as anxiety, depression, and pain catastrophizing may influence recovery. The SAP-LD (Scale for Anxiety and Pain in Lumbar Degeneration) study was designed to assess the prognostic role of these psychological and physical parameters in surgical outcomes. Methods: This prospective observational study enrolled 70 adult patients with degenerative lumbar spine pathology scheduled for instrumented surgical treatment at the University of Brescia and ASST Spedali Civili di Brescia between March and December 2024. Preoperative assessments included demographic, clinical, and radiologic data along with validated scales: the Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), Visual Analogue Scale (VAS), Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scale (HADS). Follow-up evaluations were performed at 45 days and at 6 months, and statistical analyses were conducted using correlation tests, ANOVA, and regression modeling. Results: The demographic analysis of the 70 enrolled patients shows a balanced gender distribution (38 females, 34 males) with a mean age of 61 years (range 23–81). The educational level distribution indicates that the majority of patients (44.29%) have a secondary education level, while 35.71% have a tertiary education level. Regarding employment status, 50% of the patients are retired or not working. Patients with clinically significant anxiety and/or depression showed higher levels of perceived pain, pain catastrophizing, and disability at baseline. These patients reported significantly worse scores on the Visual Analogue Scale (VAS), Pain Catastrophizing Scale (PCS), and Oswestry Disability Index (ODI). The Oswestry Disability Index (ODI) demonstrates a clinically significant improvement (reduction) in disability between the preoperative period (t0) and the 45-day follow-up (t2), with the median decreasing from 39.00 to 13.00. However, there is a partial regression at the 6-month follow-up (t3), with the median increasing to 27.00. For the SF-36 Health Survey, the General Health subscale shows an improvement between t0 and t2 (median increasing from 55.00 to 60.00), followed by a slight decrease at t3 (median 55.00). Similar patterns are observed in most other subscales, with initial improvement followed by partial regression. The Pain Catastrophizing Scale (PCS) shows a substantial reduction in catastrophizing between t0 and t2 (median decreasing from 16.00 to 3.00), followed by an increase at t3 (median 11.00), though still below baseline levels. Pain intensity as measured by the Visual Analogue Scale (VAS) shows a significant reduction at t2 (median decreasing from 5.00 to 3.00), but increases again at t3 (median 6.00), even exceeding the preoperative level. For the Hospital Anxiety and Depression Scale (HADS), no significant differences were observed across time points, with values indicating mild symptoms throughout the study period. Correlation analyses confirmed that higher preoperative anxiety and depression scores were predictive of poorer postoperative outcomes. Specifically, higher HADS scores at baseline are associated with higher ODI scores (increased disability) at all time points (p = 0.002), higher VAS scores (increased pain) at all time points (p = 0.015), and lower scores on SF-36 subscales, particularly Emotional Well-being (p = 0.00023) and Social Functioning (p = 0.002). Higher PCS scores at baseline are associated with higher ODI scores at all time points (p = 0.001), higher VAS scores at all time points (p = 0.008), and lower scores on SF-36 subscales, particularly Pain (p = 0.00023) and Physical Functioning (p = 0.04254). The mixed linear models analysis confirms these findings, showing that the ODI score decreases significantly between t0 and t2 (p = 0.00023) and increases between t2 and t3, though this increase is not statistically significant (p = 0.079). For VAS scores, there is a significant decrease between t0 and t2 (p = 0.00023) and a significant increase between t2 and t3 (p = 0.04254). Patients with elevated preoperative HADS scores tended to have slower recovery trajectories and reported lower satisfaction levels. These findings reinforce the prognostic value of psychological assessments in spine surgery and suggest that targeted psychological interventions could improve patient outcomes. Conclusions: By identifying psychological predictors of postoperative recovery, this study underscores the importance of integrating preoperative psychological screening into routine clinical practice. The results suggest that a multidisciplinary approach, including both surgical and psychological care, could enhance long-term functional outcomes and quality of life for patients undergoing instrumented lumbar spine surgery. Full article

Background/Objectives: Upper lumbar spinal stenosis presents unique challenges because vertically oriented facet joints and narrow laminae increase the risk of iatrogenic instability following decompression. Traditional decompression techniques may damage the facet joints, potentially resulting in further instability and degeneration. This study introduces a novel, facet-preserving bilateral–contralateral decompression strategy using unilateral biportal endoscopy (UBE) for upper lumbar stenosis, aiming to defer unnecessary spinal fusion. Methods: This retrospective series of three cases involved patients with upper lumbar stenosis characterized by vertically oriented facets (>60°) and narrow laminae, including cases of adjacent segment stenosis (ASS) and stenosis with grade 1 spondylolisthesis. Patients were selected using the authors’ facet angle–based criteria (>60°) and laminar morphology to identify anatomically vulnerable segments. All patients exhibited vertical facet orientation and narrow laminae, without significant dynamic instability or severe foraminal compromise. Bilateral–contralateral decompression was performed using biportal endoscopy to preserve facet integrity and defer fusion where feasible. Results: This series demonstrated that bilateral–contralateral decompression provided effective neural decompression and symptom relief while preserving facet structures in the upper lumbar spine characterized by vertical facets and narrow laminae. No progression to instability or requirement for additional fusion was observed during the 6-month follow-up, even among patients with ASS and grade 1 spondylolisthesis. Conclusions: The authors propose that bilateral–contralateral decompression may serve as a facet-preserving and fusion-deferral strategy for upper lumbar stenosis with vertically oriented facets and narrow laminae. This approach is particularly applicable in cases such as ASS and spinal stenosis with grade 1 spondylolisthesis, where preserving structural reserve is critical. These preliminary findings highlight the need for prospective validation through carefully designed observational studies and larger case series. Full article

Background and Objectives: All intervertebral discs (IVDs) degenerate with the progression of age. Currently we are unable to differentiate physiological lumbar intervertebral disc degeneration (LIDD) from pathophysiological using imaging. The first step in differentiating physiological from pathophysiological degeneration is to determine physiological LIDD. Biochemical and histological analysis are not viable tools to look at the IVD in patients or healthy subjects due to their invasive character. For this reason, a non-invasive MRI could be the solution to study the lumbar IVD and LIDD. Therefore, the purpose of this systematic literature review is to identify the physiological aging process of the lumbar IVD based on MRI studies in patients of all ages without a history of spine pathology or surgery. Materials and Methods: After searching four databases (PubMed, Embase, Web of Science, and Cochrane), titles and abstracts of the identified studies were screened using inclusion and exclusion criteria. Eligible articles were subjected to a full-text review. Quality assessment was performed using ROBINS-I for risk of bias and Oxford level of evidence. Results: In total, 38 articles were included in this review. Most studies were non-consecutive studies (n = 36). Two studies were exploratory cohort studies. Twenty-two studies were prospective studies and sixteen were retrospective. Level of evidence ranged from 2b–3b. After analysis, we could construct a timeline of physiological degeneration from the age of 20 until 50. A shift in biochemical composition of the IVD and small structural changes can be detected in this timeline. The loss and breakdown of proteoglycan (PG) appears to have a primary role in this initial stadium of LIDD. After the age of 50, degeneration accelerates, resulting in more ultrastructural changes of the IVD as well as loss of height, volume, and disc convexity. No significant difference in degree of LIDD was found between men and women. Finally, the lower lumbar levels L4/5 and L5/S1 had a significantly higher degree of LIDD than upper lumbar levels (L1/2, L2/3, and L3/4). Conclusions: This systematic literature review conceptualizes the theory of physiological ageing in the lumbar IVD based on MRI. Initially, there is change in biochemical composition of the IVD, which eventually results in ultrastructural changes. Future research should aim to validate this theory, preferably in a prospective cohort study. Full article

Hydrogen-rich water (HRW) has shown neuroprotective effects in acute brain injury, but its role in chronic radiation-induced brain injury (RIBI) remains unclear. This study investigated the long-term efficacy of HRW in mitigating cognitive impairment and neuronal damage caused by chronic RIBI. Fifty male Sprague Dawley rats were randomly divided into five groups: control, irradiation (IR), IR with memantine, IR with HRW, and IR with combined treatment. All but the control group received 20 Gy whole-brain X-ray irradiation, followed by daily interventions for 60 days. Behavioral assessments, histopathological analyses, oxidative stress measurements, ¹⁸F-FDG PET/CT imaging, transcriptomic sequencing, RT-qPCR, Western blot, and serum ELISA were performed. HRW significantly improved anxiety-like behavior, memory, and learning performance compared to the IR group. Histological results revealed that HRW reduced neuronal swelling, degeneration, and loss and enhanced dendritic spine density and neurogenesis. PET/CT imaging showed increased hippocampal glucose uptake in the IR group, which was alleviated by HRW treatment. Transcriptomic and molecular analyses indicated that HRW modulated key genes and proteins, including CD44, CD74, SPP1, and Wnt1, potentially through the MIF, Wnt, and SPP1 signaling pathways. Serum CD44 levels were also lower in treated rats, suggesting its potential as a biomarker for chronic RIBI. These findings demonstrate that HRW can alleviate chronic RIBI by preserving neuronal structure, reducing inflammation, and enhancing neuroplasticity, supporting its potential as a therapeutic strategy for radiation-induced cognitive impairment. Full article

The intervertebral disc, an anatomical compartment interposed between vertebral bodies, plays a key role in spine flexibility and compression loading. It comprises three tissues: the nucleus pulposus, the annulus fibrosus, and the end plates. Degeneration-related changes in the extracellular matrix of the nucleus pulposus upon ageing or pathological conditions prompted the present investigation into the impact of proteoglycan reduction, the main constituent of the healthy nucleus pulposus, on its physicochemical properties and cellular phenotypical changes. To mimic the native extracellular matrix, three-dimensional NP-mimicking constructs were developed using a biomimetic hydrogel composed of collagen type I, collagen type II, and proteoglycans. This system was fabricated using a bottom-up approach, employing highly pure monomeric collagen types I and II, which were induced to form a reconstituted fibrillar structure closely resembling the natural NP microenvironment. A comprehensive physicochemical characterization was conducted at varying proteoglycan percentages using scanning electron microscopy (SEM), FTIR, rheological tests, and water retention property analysis. The effect of microenvironment changes on the phenotype of nucleus pulposus cells was studied by their encapsulation within the various collagen–proteoglycan hydrogels. The morphological and immunochemistry analysis of the cells was performed to study the cell–matrix adhesion pathways and the expression of the cellular regulator hypoxia-inducible factor 1 alpha. These were linked to the analysis of the synthesis of healthy or pathological extracellular matrix components. The findings reveal that the reduction in proteoglycan content in the nucleus pulposus tissue triggers a pathological pathway, impairing the rheological and water retention properties. Consequently, the cell phenotypes are altered, inducing the synthesis of collagen type I rather than securing the natural physiological remodelling process by the synthesis of collagen type II and proteoglycans. Identifying the proteoglycan content threshold that triggers these pathological phenotypical changes could provide new diagnostic markers and early therapeutic strategies for intervertebral disc degeneration. Full article

Intervertebral disc disease is the most common disease of the spine in dogs and is a main cause of pain and neurologic dysfunction. This article reviews fundamental aspects of the pathophysiology, clinical presentation, diagnosis, and treatment of disc extrusions. Chondroid metaplasia of the nucleus pulposus is the central mechanism of disc degeneration. The clinical presentation varies considerably, depending on the breed, the location of the disc extrusion, and the degree of neurological damage. Advanced imaging techniques, such as computed tomography and magnetic resonance imaging, have greatly improved diagnosis, with magnetic resonance considered the gold standard. As for treatment, both medical and surgical management are effective options, depending on the degree of neurological damage and the initial response to conservative treatment. This comprehensive analysis underlines the importance of a multidisciplinary approach to optimize the quality of life of patients affected by intervertebral disc disease. Full article

The traditional bilateral pedicle screw system has been used for the treatment of various lumbar spine conditions including advanced degenerative disc disease. However, there is an ongoing need to develop more effective and less invasive techniques. The purpose of this study was to compare the traditional bilateral pedicle screw system (BPSS) with the novel reverse transdiscal screw system (RTSS) for lumbar disc degenerative disease. A 3D solid lumbar L1–L5 spine model was developed and validated based on a human CT scan. Fusions were simulated at L3–L4. The first scenario comprised a transforaminal lumbar interbody cage in combination with the bilateral pedicle screw-rod system (BPSS-TLIF). In the second scenario, the same TLIF cage was combined with reverse L3–L4 transdiscal screws (RTSS-TLIF). Testing parameters included range of motion (ROM) in three orthogonal axes, hardware (cage and screw) stress, and shear load resistance. The ROM of the surgical model was reduced by approximately 90% compared to the intact model at the fused level. The RTSS model demonstrated less ROM compared to the BPSS model at the fused level for all loading conditions. Overall, the RTSS model exhibited lower stress on both screws and cage compared with the BPSS model in all biomechanical testing conditions. The RTSS model also exhibited higher anterior and posterior shear load resistance than the BPSS model. In conclusion, the RTSS model proved superior to the BPSS model in all respects. These findings indicate that the RTSS could serve as a feasible option for patients undergoing lumbar fusion, especially for adjacent segment disease, potentially enhancing surgical outcomes for disc degeneration. 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

Objectives: To investigate whether preservation of the posterior elements protects the spine from degeneration and improves postoperative symptoms in lumbar spine laminoplasty. Methods: Eighty-five consecutive patients who underwent lumbar spine laminoplasty were retrospectively reviewed. They were non-randomly stratified into two groups, the posterior elements resection (R) group and the preservation (P) group, and they were followed for two years after surgery. We radiographically analyzed the conditions of the spine and intervertebral disc (IVD) two years after surgery. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for symptom assessments. Logistic regression analysis was performed to determine whether the kissing spine was a significant factor for the outcomes in group R. Results: The 2-year D score increment and 2-year IVD height decrement was lower in group P. No difference was found in the flexion–extension angles or incidence of instability between groups. The JOABPEQ revealed higher scores in walking ability, social life function, and mental health in group P one year after surgery. Walking ability was the only score that remained higher two years after surgery. The visual analog scale of pain in the buttocks and lower limbs was lower in group P only one year after surgery. Finally, the kissing spine was not a significant factor in any outcome. Conclusions: The preserved posterior elements were considered to protect the IVD in lumbar spine laminoplasty. In addition, they positively affected postoperative health status from multiple aspects. Full article

The lumbar degenerative cascade is a pathological process that affects most of the aging adult population and has significant negative economic consequences. Lumbar fusion surgery remains a mainstay of treatment for refractory degenerative disease but carries significant long-term consequences. More recently, lumbar arthroplasty and motion-sparing technology has become an increasingly popular alternative surgical option in carefully indicated patients. Arthroplasty technology carries the theoretical benefits of spinal segment motion preservation and decreased degeneration of adjacent segments as compared to traditional fusion procedures. This article will review the lumbar degenerative cascade and its related anatomic considerations, current management strategies and the challenges surrounding lumbar spinal fusion, including adjacent segment disease. This article will also review the theoretical benefits of lumbar arthroplasty and motion preservation. Furthermore, this paper will highlight the current state of lumbar arthroplasty, including current concepts of implant design, limitations, outcomes and ongoing development. It will review the development and current state of artificial disk arthroplasty, total joint arthroplasty and posterior column motion-preserving implants, including flexible rods and facet joint replacement. Full article

Background: Osteoporotic vertebral fractures (OVFs) often lead to poor global sagittal alignment (GSA) and reduced quality of life (QOL). While pseudarthrosis and kyphotic deformities are well-known predictors of conservative treatment failure, the impact of vertebral collapse, paraspinal muscle degeneration, sarcopenia, and nutritional status on GSA remains unclear. This study investigated the relationship between these factors and GSA in patients with conservatively treated OVFs. Methods: This post hoc analysis of a multicenter prospective observational study included 70 patients (single OVF; age ≥ 60 years; 12-month follow-up). Radiographic parameters, paraspinal muscle degeneration, and nutritional status were assessed. GSA was categorized based on the sagittal vertical axis (SVA [mm]): normal (SVA ≤ 40), moderate (40 ≤ SVA ≤ 95), and severe (SVA > 95). Clinical outcomes were assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Oswestry Disability Index (ODI), and visual analog scale (VAS). Results: At 12 months, 22.9% of patients had severe GSA and showed significantly lower JOABPEQ gait dysfunction scores (p = 0.01), higher ODI scores (p < 0.01), and reduced lower lumbar lordosis (p = 0.01). A higher prevalence of lower lumbar OVFs, including prior fractures, was observed in the severe group. No significant correlations were found between GSA and paraspinal muscle degeneration or nutritional status. Conclusions: OVFs in the lower lumbar spine significantly contributed to GSA deterioration. This indicates their critical role in sagittal alignment. Although paraspinal muscle degeneration and malnutrition are common in OVFs, their direct impact on GSA is limited. These findings highlight the need for targeted strategies to manage lumbar OVFs and prevent sagittal malalignment. Full article

Degenerative changes are characterized by the formation of vertebral osteophytes, the hypertrophy of facet joints, and narrowing of the intervertebral space. This study aimed to investigate the concentrations of trace elements (Al, As, Se, Zn, Fe, Mo, Cu) in spinal tissues (intervertebral discs, muscle, and bone) of patients with degenerative lumbar spine disease (DLSD) and their potential associations with the disease. The research involved 13 patients undergoing surgery for symptomatic degenerative spine disease. The trace element concentrations were analyzed using chemical and radiographic assessments, with a statistical analysis performed through a Mann–Whitney U-test, Spearman’s rank correlation test, principal component analysis (PCA), and canonical discriminant analysis (CDA). The results showed significant variations and correlations among the trace elements across different spinal tissues, suggesting their roles in metabolic and oxidative processes and the pathology of spinal degeneration. Full article

This study presents a novel approach for predicting the location and fatigue life of degenerative intervertebral discs (IVDs) under cyclic loading conditions, aiming to improve the understanding of disc degeneration mechanisms. Based on mechanical theories linking IVD degeneration to stress imbalance and water loss, a finite element (FE) model of the L4–L5 lumbar spine was developed, combining probability-weighted anatomical structures, inverse dynamics, and cumulative fatigue mechanics. By quantifying stress variations and calculating cumulative damage across disc regions, stress-concentration areas prone to degeneration were identified, and validation via a case study of a retired weightlifter diagnosed with intervertebral disc disease (IVDD) demonstrated that the predicted degeneration location correlated well with affected areas observed in CT scan images. These findings suggest that prolonged, abnormal stress imbalances within the disc may contribute significantly to degeneration, offering potential clinical applications in preventive assessment and targeted treatment for spine health. Full article

A novel total joint replacement (TJR) that treats lumbar spine degeneration was previously assessed under Mode I and Mode IV conditions. In this study, we relied on these previous wear tests to establish a relationship between finite element model (FEM)-based bearing stresses and in vitro wear penetration maps. Our modeling effort addressed the following question of interest: Under reasonably worst-case misaligned conditions, do the lumbar total joint replacement (L-TJR) polyethylene stresses and strains remain below values associated with Mode IV impingement wear tests? The FEM was first formally verified and validated using the risk-informed credibility assessment framework established by ASME V&V 40 and FDA guidance. Then, based on criteria for unreasonable misuse outlined in the surgical technique guide, a parametric analysis of reasonably worst-case misalignment using the validated L-TJR FEM was performed. Reasonable misalignment was created by altering device positioning from the baseline condition in three scenarios: Axial Plane Convergence (20–40°), Axial Plane A-P Offset (0–4 mm), and Coronal Plane Tilt (±20°). We found that, for the scenarios considered, the contact pressures, von Mises stresses, and effective strains of the L-TJR-bearing surfaces remained consistent with Mode I (clean) conditions. Specifically, the mechanical response values fell below those determined under Mode IV (worst-case) boundary conditions, which provided the upper-bound benchmarks for the study (peak contact pressure 83.3 MPa, peak von Mises stress 32.2 MPa, and peak effective strain 42%). The L-TJR was judged to be insensitive to axial and coronal misalignment under the in vitro boundary conditions imposed by the study. Full article