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Purpose Extreme lateral interbody fusion provides minimally invasive treatment of spinal deformity, but complications including nerve and psoas muscle injury have been noted. To avoid nerve injury, mini-open anterior retroperitoneal lumbar interbody fusion methods using an approach between the aorta and psoas, such as oblique lumbar interbody fusion (OLIF) have been applied. OLIF with percutaneous pedicle screws without posterior decompression can indirectly decompress the spinal canal in lumbar degenerated spondylolisthesis. In the current study, we examined the radiographic and clinical efficacy of OLIF for lumbar degenerated spondylolisthesis. Methods We assessed 20 patients with lumbar degenerated spondylolisthesis who underwent OLIF and percutaneous pedicle screw fixation without posterior laminectomy. MR and CT images and clinical symptoms were evaluated before and 6 months after surgery. Cross sections of the spinal canal were evaluated with MRI, and disk height, cross-sectional areas of intervertebral foramina, and degree of upper vertebral slip were evaluated with CT. Clinical symptoms including low back pain, leg pain, and lower extremity numbness were evaluated using a visual analog scale and the Oswestry Disability Index before and 6 months after surgery. Results After surgery, significant increases in axial and sagittal spinal canal diameter (12 and 32 %), spinal canal area (19 %), disk height (61 %), and intervertebral foramen areas (21 % on the right side, 39 % on the left), and significant decrease of upper vertebral slip (−9 %) were found ( P  < 0.05). Low back pain, leg pain, and lower extremity numbness were significantly reduced compared with before surgery ( P  < 0.05). Conclusions Significant improvements in disk height and spinal canal area were found after surgery. Bulging of disks was reduced through correction, and stretching the yellow ligament may have decompressed the spinal canal. Lumbar anterolateral fusion without laminectomy may be useful for lumbar spondylolisthesis with back and leg symptoms.

Introduction Aging spine is characterized by facet joints arthritis, degenerative disc disease, bone remodeling and atrophy of extensor muscles resulting in a progressive kyphosis of the lumbar spine. Objective The aim of this paper is to describe the different compensatory mechanisms for patients with severe degenerative lumbar spine. Material and methods According to the severity of the imbalance, three stages are observed: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permit to limit the consequences of loss of lumbar lordosis on global sagittal alignment and therefore contribute to keep the sagittal balance of the spine. Results The basic concept is to extend adjacent segments of the kyphotic spine allowing for compensation of the sagittal unbalance but potentially inducing adverse effects. Conclusion Finally, we propose a three-step algorithm to analyze the global balance status and take into consideration the presence of the compensatory mechanisms in the spinal, pelvic and lower limb areas.

PurposeTo evaluate the use of the modified and simplified vertebral bone quality (VBQ) method based on T1-weighted MRI images of S1 vertebrae in assessing bone mineral density (BMD) for patients with lumbar degenerative diseases.MethodsWe reviewed the preoperative data of patients with lumbar degenerative diseases undergoing lumbar spine surgery between January 2019 and June 2022 with available non-contrast T1-weighted magnetic resonance imaging (MRI), computed tomography (CT) images and dual-energy X-ray absorptiometry (DEXA). S1 vertebral bone quality scores (S1 VBQ) and S1 CT Hounsfield units were measured with picture archiving and communication system (PACS). One-way ANOVA was applied to present the discrepancy between the S1 VBQ of patients with normal bone density (T-score ≥ − 1.0), osteopenia (− 2.5 < T-score < − 1.0) and osteoporosis (T-score ≤ − 2.5). The receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic performance of S1 VBQ in distinguishing low BMD. Statistical significance was set at p < 0.05.ResultsA total of 207 patients were included. The S1 VBQ were significantly different between groups (p < 0.001). Interclass correlation coefficient for inter-rater reliability was 0.86 (95% CI 0.78–0.94) and 0.94(95% CI 0.89–0.98) for intra-rater reliability. According to the linear regression analysis, the S1 VBQ has moderate-to-strong correlations with DEXA T-score (r = − 0.48, p < 0.001). The area under the ROC curve indicated a predictive accuracy of 82%. A sensitivity of 77.25% with a specificity of 70% could be achieved for distinguishing low BMD by setting the S1 VBQ cutoff as 2.93.ConclusionsThe S1 VBQ was a promising tool in distinguishing poor bone quality in patients with lumbar degenerative diseases, especially in cases where the previously reported VBQ method based on L1–L4 was not available. S1 VBQ score could be useful as opportunistic assessment for screening and complementary evaluation to DEXA T-score before surgery.

In this randomized, controlled trial comparing decompression surgery alone with decompression surgery plus fusion surgery for patients with lumbar spinal stenosis, there was no significant between-group difference in clinical outcomes at 2 and 5 years. Lumbar spinal stenosis is caused by a gradual narrowing of the spinal canal. Patients with lumbar spinal stenosis typically present with low back pain and leg pain, which occur especially when they are walking. This degenerative condition severely restricts function, walking ability, and quality of life. Lumbar spinal stenosis has become the most common indication for spinal surgery, 1 – 4 and studies have shown that surgical treatment in selected patients is more successful than conservative alternatives. 5 – 7 As the use of surgery to treat lumbar spinal stenosis has increased during the past decades, so has the complexity of the surgical procedures. . . .

Objective The posterior ligamentous complex (PLC) plays a crucial role in maintaining lumbar spine stability. PLC injuries have become a key factor in lumbar instability, with the increase in degenerative spinal conditions and surgical interventions. This study aimed to systematically quantify the impact of single and multi-ligament injuries on spinal stability and analyze their effects on lumbar biomechanical indices and intervertebral disc stress distribution. Methods Finite element analysis (FEA) and experimental measurements were employed to examine the effects of 12 ligament resection combinations on lumbar range of motion (RoM) and intervertebral disc stress distribution. Detailed statistical analysis, including the Kruskal-Wallis Test, was used to evaluate the significance of observed differences. Functional contributions of individual ligaments and their combinations were analyzed to assess their roles in restricting spinal motion. Results The results indicated that ligament resection combinations significantly impacted lumbar biomechanical indices ( P  = 0.016), with an effect size (η²) of 0.058, reflecting a moderate impact on segmental stability. The interspinous ligament (ISL) demonstrated the most significant role in restricting excessive spinal motion, followed by the ligamentum flavum (LF), while the supraspinous ligament (SSL) and facet joint capsules (FJC) had limited effects. Combined multi-ligament injuries, particularly ISL and LF resection, markedly increased spinal instability and altered intervertebral disc stress distribution. Despite significant stability loss from multi-ligament injuries, intact ligaments provided functional compensation, mitigating instability. Conclusion This study revealed the nonlinear cumulative effects of PLC damage on spinal stability, emphasizing the dominant roles of ISL and LF in maintaining biomechanical integrity. The findings provide critical quantitative insights for clinical decision-making, surgical planning, and postoperative rehabilitation strategies, highlighting the importance of preserving intact ligaments to leverage their compensatory capacity in mitigating instability.

Background Gardnerella vaginalis , which is mainly distributed in the female genitourinary tract, is the main agent causing bacterial vaginosis, as well as a relatively uncommon cause of extragenital infection, and a rare source of joint or spinal infections. Case presentation We report a 51-year-old female patient with no underlying disease who presented with intermittent low back pain, evident after both being sedentary and prolonged activity. The patient was diagnosed with a pyogenic spinal infection at another hospital and treated with analgesic and cephalosporin anti-infective therapies. The patient then attended our hospital and was initially considered to have a gram-positive bacterial infection; tuberculosis infection could not be excluded. After 3 weeks of empiric anti-infective therapy with vancomycin and linezolid, the patient complained of no improvement in pain and the inflammatory markers had not declined significantly. A clear lumbar spine infection lesion was detected, with evident bone destruction; therefore, we performed surgery for lumbar lesion removal and internal fixation. Lesion specimens were subjected to pathological examination and high-throughput sequencing, which revealed G. vaginalis infection, and the patient received postoperative antibiotic therapy with lincomycin and metronidazole. After 12 weeks of consecutive anti-infective treatment, the pain symptoms of the patient improved. No signs of recurrence were detected at 16 months postoperative follow-up. Conclusions We reported a rare case of isolated G. vaginalis lumbar spine infection. Additionally, we reviewed 13 published cases of joint or spinal infections caused by Gardnerella . G. vaginalis should be considered in cases of joint or spinal infections. Clinical presentation and imaging are insufficient to diagnose spinal infections caused by G. vaginalis , and invasive procedures, such as biopsy, microbial culture, and high-throughput sequencing, are required. Lincosamide or nitroimidazole antibiotic treatment for ≥ 6 weeks is effective in treating bone and joint infections caused by G. vaginalis .

Measurements of skeletal muscle cross-sectional area, index, and radiation attenuation utilizing clinical computed tomography (CT) scans are used in assessments of sarcopenia, the loss of skeletal muscle mass and function associated with aging. To classify individuals as sarcopenic, sex-specific cutoffs for ‘low’ values are used. Conventionally, cutoffs for skeletal muscle measurements at the level of the third lumbar (L3) vertebra are used, however L3 is not included in several clinical CT protocols. Non-contrast-enhanced CT scans from healthy kidney donor candidates (age 18–40) at Michigan Medicine were utilized. Skeletal muscle area (SMA), index (SMI), and mean attenuation (SMRA) were measured at each vertebral level between the tenth thoracic (T10) and the fifth lumbar (L5) vertebra. Sex-specific means, standard deviations (s.d.), and sarcopenia cutoffs (mean-2 s.d.) at each vertebral level were computed. Associations between vertebral levels were assessed using Pearson correlations and Tukey’s difference test. Classification agreement between different vertebral level cutoffs was assessed using overall accuracy, specificity, and sensitivity. SMA, SMI, and SMRA L3 cutoffs for sarcopenia were 92.2 cm 2 , 34.4 cm 2 /m 2 , and 34.3 HU in females, and 144.3 cm 2 , 45.4 cm 2 /m 2 , and 38.5 HU in males, consistent with previously reported cutoffs. Correlations between all level pairs were statistically significant and high, ranging from 0.65 to 0.95 (SMA), 0.64 to 0.95 (SMI), and 0.63 to 0.95 (SMRA). SMA peaks at L3, supporting its use as the primary site for CT sarcopenia measurements. However, when L3 is not available alternative levels (in order of preference) are L2, L4, L5, L1, T12, T11, and T10. Healthy reference values reported here enable sarcopenia assessment and sex-specific standardization of SMA, SMI, and SMRA in clinical populations, including those whose CT protocols do not include L3.

Purpose This study investigated the association of measurements from a clinical X-ray dark-field prototype system and CT-based finite element analysis (FEA) in lumbar spine specimens. Materials and Methods In this prospective study, human cadaveric spine specimens (L2 to L4) were examined using a clinical prototype for dark-field radiography, yielding both attenuation and dark-field images. Specimens were scanned in vertical and horizontal positions. Volumetric bone mineral density (BMD) values were derived from quantitative CT measurements. Bone segmentation masks derived from CT-images were used for FEA-estimated fracture load (FL) calculations. FEA-estimated FL, dark-field, and attenuation signals were compared between osteoporotic/osteopenic (BMD < 120 mg/cm 3 ) and non-osteoporotic/osteopenic specimens using the paired t-test and the Wilcoxon Mann–Whitney U test. Associations were tested using Spearman correlation. Results Fifty-nine vertebrae from 20 lumbar spine specimens (mean age, 73 years ± 13; 11 women) were studied. FEA-estimated FL correlated with BMD (r = 0.75, p  < .001) and was significantly lower in osteoporotic/osteopenic vertebrae (1222 ± 566 vs. 2880 ± 1182, p  < .001). Dark-field and attenuation signals were positively correlated with FEA-estimated FL, in both vertical (r darkfield  = 0.64, p  < .001, r attenuation  = 0.82, p   < .001) and horizontal position (r darkfield  = 0.55, p  < .001, r attenuation  = 0.81, p  < .001). Conclusion Dark-field and attenuation signals assessed using a clinical X-ray dark-field system significantly correlated with FEA-estimated FL in human spine specimens with and without osteoporosis/osteopenia. Dark-Field imaging may complement existing assessment methods for bone strength as a dose-efficient, accessible tool.

Patient-reported outcome measures (PROMs) are commonly used to estimate disability of patients with spinal degenerative disease. Emerging technological advances present an opportunity to provide objective measurements of activity. In a prospective, observational study we utilized a low-cost consumer grade wearable accelerometer (LCA) to determine patient activity (steps per day) preoperatively (baseline) and up to one year (Y1) after cervical and lumbar spine surgery. We studied 30 patients (46.7% male; mean age 57 years; 70% Caucasian) with a baseline activity level of 5624 steps per day. The activity level decreased by 71% in the 1 st postoperative week (p < 0.001) and remained 37% lower in the 2 nd (p < 0.001) and 23% lower in the 4 th week (p = 0.015). At no time point until Y1 did patients increase their activity level, compared to baseline. Activity was greater in patients with cervical, as compared to patients with lumbar spine disease. Age, sex, ethnic group, anesthesia risk score and fusion were variables associated with activity. There was no correlation between activity and PROMs, but a strong correlation with depression. Determining activity using LCAs provides real-time and longitudinal information about patient mobility and return of function. Recovery took place over the first eight postoperative weeks, with subtle improvement afterwards.

Objective The aim of this study is to investigate the biomechanical changes in the sandwich vertebrae (SV), fractured vertebrae, and adjacent vertebrae at the thoracolumbar vertebrae in patients with osteoporotic vertebral compression fracture (OVCF) who underwent several percutaneous vertebroplasties (PVP) with varied cement volumes. Methods The finite element (FE) model of the T10-L2 thoracolumbar vertebral body is established. The augmented vertebrae (AV) of T11 and L1 is simulated and cylindrical bone cement is placed vertically in its center. The models are categorized into four types according to the volume of bone cement, 2mL bone cement group (model A), 4-mL bone cement group (model B), 6-mL bone cement group (model C), and 8-mL bone cement group (model D). By applying 500 N axial load on the upper surface of T10 and fixing the lower surface of L2, the maximum von Mises stress of the vertebrae and the maximum displacement of the sandwich vertebrae are analyzed and compared. Results The maximum von Mises stresses of the T11 and L1 augmented vertebrae of Model C are lower than those of the fractured vertebrae of Models A and B in all directions of activity. The von Mises stresses of the augmented vertebrae of Model C and Model D are similar. The von Mises stresses of the fractured adjacent vertebrae T10 and L2, and the sandwich vertebrae T12 do not change significantly with the change in cement volume. In addition, the von Mises stress of T12 is lower than that of T10 in all four groups. The minimum value of T12 displacement in Model C is 3.0 mm. Conclusion Under the condition of no leakage, the stress distribution of the AV can be optimized by expanding the supporting area of bone cement to about 6 ml, which not only reduces the risk of recurrent fractures of adjacent vertebrae and AV, but also prolongs the service life of the implants by reducing the stress of bone cement, which provides the basis for the appropriate amount of bone cement required for clinical multi-level PVP.