European Spine Journal最新文献

Purpose: To describe patient outcomes and associated factors after surgical treatment for lumbar disc herniation (LDH) with motor deficit.

Methods: A prospective observational study was conducted of all patients with LDH and motor deficit treated in one of nine centers in France between August 2023 and April 2024. The inclusion criteria were age ≥ 18 years, a Medical Research Council (MRC) muscle strength score ≤ 3 out of 5 in at least one muscle group, absence of spondylolisthesis and absence of scoliosis. Clinical evaluations were performed preoperatively, on day 1 after surgery and at 1-3 and 10-12 months' follow-up. The main outcome variable was complete motor recovery (MRC score = 5).

Results: Eighty-three of the 144 included patients (58%) had complete motor recovery. Complete motor recovery was independently associated with earlier treatment (odds ratio (OR) [95% confidence interval], 0.73 [0.57 to 0.91] per 10 day increase) less severe preoperative weakness (OR, 6.0 [1.8 to 21.8] for MRC score ≥ 2 vs. < 2), day 1 postoperative resolution of radicular pain (OR, 2.5 [1.1 to 6.1] for pain score = 0 vs. > 0) and day 1 gains in muscle strength (OR, 6.9 [2.7 to 19.4] for increase in MRC score vs. no increase). Complete motor recovery was significantly associated with sensory recovery.

Conclusion: The strongest predictor of complete motor recovery after surgery for LDH was day 1 postoperative improvement in muscle strength. This prognosis was also associated with lower postoperative radicular pain, shorter time to treatment, higher preoperative muscle strength. These results can help inform clinicians and patients on likely outcomes after LDH surgery.

Purpose: Anterior cervical discectomy and fusion (ACDF) is commonly performed to treat cervical myelopathy. However, its effectiveness in decompressing posterior structures like hypertrophied ligamentum flavum, remains unclear. This study aimed to identify disc-level factors that predict radiographic improvement of posterior cord compression caused by ligamentum flavum (CCLF) after ACDF.

Methods: We retrospectively analyzed 75 cervical disc levels from 43 patients who underwent ACDF for degenerative cervical disease with preoperative CCLF on MRI. Postoperative CCLF changes were evaluated, and discs were divided into improved and unimproved groups. Preoperative disc angle, segmental lordosis, disc height, preoperative disc range of motion, cage-to-disc ratio, Hounsfield units (HU) values, and facet joint degeneration were compared. Multivariate logistic regression was used to identify independent predictors of failure to improve CCLF.

Results: Postoperative improvement in the CCLF was observed in 59 of 75 disc levels (79%). The unimproved group showed significantly larger preoperative disc angles (5.1° vs. 2.3°, p = 0.003) and higher HU values (368 vs. 326, p = 0.04). In addition, advanced facet osteoarthritis was significantly more frequent in the unimproved group (P = 0.027). Multivariate analysis demonstrated that greater preoperative disc angle (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.01-1.45, p = 0.041), higher HU values (OR: 1.007, 95% CI: 1-1.015, p = 0.048) and advanced facet degeneration (OR = 8.92, 95% CI: 1.01-78.6, p = 0.049) were independently associated with failure to improve CCLF.

Conclusion: Indirect decompression via ACDF may be less effective in segments with greater disc angles, higher bone densities, or advanced facet degeneration. These findings highlight the importance of preoperative disc-level assessment in surgical planning.

Purpose: This study aimed to investigate the prospective association between cumulative average weight-adjusted waist index (WWI), a novel indicator of central obesity, and the incidence of low back pain (LBP) among middle-aged and older Chinese adults, and to assess its consistency across subpopulations.

Methods: Data were from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015), including 7,123 participants aged ≥ 45 years without baseline LBP. Cumulative average WWI was calculated as waist circumference divided by the square root of body weight and categorized into quartiles. Multivariable logistic regression assessed the association with incident LBP. Restricted cubic spline analyses evaluated nonlinear relationships, and subgroup and sensitivity analyses tested robustness.

Results: Over a 4-year follow-up, 1,561 participants (21.9%) developed LBP. Compared with the lowest quartile of cumulative average WWI (Q1), participants in the highest quartile (Q4) had a significantly higher risk of LBP (OR = 1.27, 95% CI: 1.05-1.54; p for trend = 0.027). Each 1-SD increase in WWI was associated with a 10.2% higher risk of LBP (OR = 1.10, 95% CI: 1.03-1.18). Restricted cubic spline analyses demonstrated a J-shaped association (p for nonlinearity = 0.016). Stronger associations were observed among women and individuals with dyslipidemia (p for interaction < 0.05). Sensitivity analyses confirmed the robustness of these findings.

Conclusion: Elevated WWI is nonlinearly associated with higher LBP risk, particularly in women and individuals with dyslipidemia, indicating cumulative central obesity is an independent risk factor for low back pain in middle-aged and older adults.