European Spine Journal最新文献

Purpose: Clinical practices vary between healthcare providers when it comes to asking for a Magnetic Resonance Imaging (MRI) during follow-up for chronic low-back pain (LBP). The association between progressive changes on the MRI and the clinical relevance of these findings is not clearly defined. The objective of our study is to investigate to what extent do MRI findings change during a period less than or equal to two years in patients with chronic LBP. We question the efficacy of its routinary use as a tool for follow-up and we also study the correlation between new changes on MRI and modifications in therapeutic attitude.

Methods: Data was collected from 468 lumbar spine MRIs from 209 patients undergoing two or more MRIs between January 2015 and December 2019 with a mean of 2.24 MRIs per patient. The evaluated data included diagnosis, reason for request, MRI findings and treatment offered post-MRI. MRIs were assessed according to a standardized scoring system from 0 to 14 points according to the severity in findings (modified Babinska Score). Radiological changes were defined as increased severity of findings in the most affected segment.

Results: 51.06% of MRI requests had no documented reason to be asked for. The average score of the findings on the first MRI was 5,733 (SD 2,462) and 6,131 (SD 2,376) on the second, not reaching a statistically significant difference (p = 0.062). There was no difference on the findings between the first and the second MRI in 40, 15% (n = 104) and up to 89, 96% with only mild changes (-1/ + 2 points over 14 possibles). After repeating the MRI, no modification to the treatment plan was made in 44, 79% of patients (n = 116) and only in 11.58% (n = 30) was surgical treatment indicated.

Conclusion: The rate of lumbar MRI has risen to an alarming pace without evidence of consequent improvements in patient outcomes. A significant number of repeated MRIs did not show radiological changes, nor did they give rise to further surgical treatment after obtaining these images. This study should help to review the real applications of clinical guides on the appropriate use for image tests.

Background: Although chronic low back pain (LBP) is a complex condition often associated with altered motor control and compensatory postural adjustments, existing literature provides inconsistent reports on the underlying control mechanisms for maintaining balance.

Purpose: This study aimed to compare differences in sway distances between the center of pressure (COP) and the center of gravity (COG), while considering limb dominance, in adults with and without LBP.

Methods: There were 26 subjects with LBP and 39 control subjects who performed three repeated unilateral standing tasks on a force platform. Outcome measures included the sway distances between COP and COG in the anteroposterior (AP) and mediolateral (ML) directions, as well as the results of the fall efficacy scale (FES).

Results: A significant group interaction was demonstrated on limb dominance and direction for the sway distance (F = 5.46, p = 0.02). Specifically, the third trial in the ML direction while standing on the dominant limb indicated a significant difference in COP-COG sway distance (t = -2.30, p = 0.01). When FES scores were used as a covariate, a significant three-way interaction (dominance x direction x trial) was found (F = 4.06, p = 0.04).

Conclusion: Although no significant group interaction was observed for dominance, direction, and trial, the LBP group demonstrated an ability to leverage fall efficacy following repeated trials to reduce ML balance deficits. Clinicians should consider neuromuscular control and limb dominance when developing fall efficacy strategies for postural adaptations in adults with LBP.

Purpose: This study aimed to investigate the application of quantitative magnetic resonance imaging of paraspinal muscles in assessing the young CNLBP with unilateral symptom.

Methods: This prospective study enrolled 107 young individuals with unilateral symptomatic CNLBP (56 cases) and a normal cohort (51 cases). All subjects underwent conventional lumbar sequences, T2 mapping, and IDEAL-IQ scans at 3T. T2 values and fat fraction (FF) of bilateral multifidus (mid-levels of L2-L5 vertebrae) and erector spinae (mid-levels of L1-L4 vertebrae) were measured. CNLBP severity, Japanese Orthopedic Association (JOA) score, and Visual Analogue Scale (VAS) score were recorded. Wilcoxon signed-rank tests were used to compare parameter differences between painful and non-painful sides in the case group. Mann-Whitney U tests were employed to evaluate differences between the case and normal group. Logistic regression analysis was conducted to identify predictive factors and to establish a combined model.

Results: In the case group, erector spinae FF values (L4 level), erector spinae T2 values (L1, L2, and L4 levels), and multifidus T2 values (L4 and L5 levels) were higher on the painful side (P<0.05). Multifidus T2 values (L5 level) and FF values (L2-L5 levels) were higher in the case group compared to the normal group (P<0.05). The optimal performance in differentiating young CNLBP was the combination of L5 level multifidus T2 value with FF (AUC = 91.81%). Negative correlation existed between T2 values and FF of multifidus at L5 level and JOA scores (r=-0.41, P < 0.05), and positive correlation with VAS scores (r = 0.46, P < 0.05).

Conclusion: The combination of T2 value and FF may provide deeper insights into the pathological alterations of paraspinal muscles in young CNLBP, providing an important imaging basis for clinical judgment and preventive treatment of non-painful side in unilateral symptomatic patients.

Objective: The purpose was to analyze how rod characteristics, screw density and cages influence the incidence of mechanical complications compared to patient-related factors and alignment in adult spinal deformity instrumented T9-T11 to pelvis.

Methods: Register data of 302 patients was analyzed. Relative lumbar lordosis (RLL) and relative sagittal alignment (RSA) was measured. Surgical data included rod characteristics, pedicle screw density and interbody cages. Univariate and multivariate logistic regression models were used.

Results: Pseudarthrosis occurred in 24.1%. On univariate analysis Odds Ratio (OR) was 0.74 for ≥ 3 cages (p = 0.452), 0.48 for 4 rods (p = 0.008), 4.30 for high screw density (p = 0.001). Patient-related factors were non-significant. Multivariate OR was 0.59 for 4 rods (p = 0.084) and 4.67 for high screw density (p = 0.005). PJK/PJF occurred in 19.2%. Age > 60 had an OR 2.83 (p = 0.023), postoperative RSA malaligned OR 2.84 (p = 0.030), severely malaligned OR 6.54 (p < 0.001). Implant characteristics were non-significant. Multivariate OR was 1.26 for age > 60 (p = 0.657), 2.32 for malaligned RSA (p = 0.097), 5.69 for severely malaligned RSA (p = 0.001). Screw loosening occurred in 8.9%. Univariate OR was 0.95 for ≥ 3 cages (p = 0.920), 1.64 for 4 rods (p = 0.235), 0.25 for high screw density 1.5-2 (p = 0.011). Patient-related factors were non-significant. Multivariate OR for high screw density was 0.23 (p = 0.022).

Conclusion: Four rods decrease the pseudarthrosis risk. Cages have a secondary role. High screw density doesn't prevent from pseudarthrosis. Postoperative malalignment is the main PJK/PJF risk factor. Age plays a secondary role. Implant characteristics have a minor influence. High screw density constructs have a lower risk for screw loosening.

Level of evidence: 3-Retrospective register study.

Purpose: Owing to the unknow types of infiltrating macrophages and the corresponded factors, we aimed to investigate the specific types of infiltrating macrophages involved in HLF and the expression of macrophage-related factors.

Methods: The ligamentum flavum was obtained from patients with lumbar spinal stenosis (HLF group; n = 15) and lumbar disc herniation (non-hypertrophic ligamentum flavum [NLF] group; n = 15). Ligamentum flavum specimens were paraffin embedded, followed by histological and immunohistochemical staining to identify the macrophage type and expression of macrophage-related factors.

Results: The HLF group demonstrated CD206 marker expression, while the NLF group did not (P < 0.0001; n = 11). CD68 marker was expressed in both groups (P > 0.05; n = 11). CCR7 was not expressed in either group. The expression levels of the extracellular matrix proteins aggrecan (Agg), type I collagen (Coll1), and type II collagen (Coll2) were higher in the HLF group than in the NLF group (P < 0.0001; n = 11). The aging markers p21, p16, and p53 were expressed in the HLF group, but not in the NLF group (P < 0.0001; n = 11). The expression levels of the inflammatory factors TNF-α and IL-1β were higher in the HLF group than in the NLF group (P < 0.0001; n = 11). Similarly, the expression level of the fibrosis factor TGF-β1 was higher in the HLF group than in the NLF group (P < 0.0001; n = 11).

Conclusions: The infiltration of M2 macrophages may be involved in HLF, while involvement of M1 macrophages may only occur early in inflammation. The expression of extracellular matrix proteins and macrophage-related factors was increased. Aging may also be associated with HLF.

Objective: The aim of this study was to explore the correlation between PI and standing-to-sitting changes of the sagittal alignment in patients with lumbar degenerative diseases, and investigate the differences in posture changes among Roussouly types.

Methods: A total of 209 patients with lumbar degenerative disease were retrospectively included in this study. All the patients received lateral full body imaging in both standing and sitting positions. Sagittal parameters including SVA, OD-HA, PT, PI, PT/PI, SS, LL, TK, Upper LL (L1-L4) and Lower LL (L4-S1) were measured in both standing and sitting position, and the parameters were compared between two positions. The correlations between PI and lumbo-pelvic changes were analyzed. The postural changes were compared among different Roussouly types.

Results: From standing to sitting, all the parameters except PI significantly changed, including SVA, OD-HA, PT, PT/PI, SS, LL, TK, Upper LL and Lower LL. The contribution of lower LL was greater to global LL than upper LL. PI had a significant correlation with ΔPT, ΔSS, ΔLL, ΔUpper LL and ΔLower LL. From standing to sitting, type 4 patients had the most pronounced ΔPT, ΔSS and ΔLL, and ΔLower LL of types 3 and 4 were greater than that of types 1 and 2.

Conclusions: In patients with degenerative disease, PI plays an important role in determining the extent of lumbo-pelvic changes from standing to sitting. Among different Roussouly types, type 4 patients have the most pronounced changes of PT, SS and LL, suggesting the relatively greater flexibility of pelvis and lumbar spine.

Purpose: To report a rare case of isolated lumbar vertebral body infarction following lumbar artery embolization for suspected retroperitoneal haemorrhage.

Methods: We present the case of a 75-year-old male who underwent lumbar artery embolization due to a suspected retroperitoneal haemorrhage post-surgery. Magnetic resonance imaging (MRI) was performed to monitor post-embolization severe lumbar pain.

Results: Initial MRI two days post-embolization showed no osseous signal changes or epidural abscess. A subsequent MRI 26 days post-embolization was performed because of increasing lumbar back pain and it revealed a new bone infarction at the L3 vertebral body. CT showed embolization deposits within the vertebral body, not present before the procedure.

Conclusion: This unique case underscores the importance of considering vertebral body infarction as a potential complication following lumbar artery embolization. MRI was critical in early detection of the bone infarction, while CT confirmed the presence of embolization material. Awareness of this rare complication is crucial for prompt diagnosis and management.

Purpose: The Core Outcome Measures Index (COMI) is a short, multidimensional instrument translated into several languages that covers five domains recommended in the assessment of outcome in patients with low-back and neck pain. The purpose of this study was to cross-culturally adapt the COMI from English to Czech language and to test the face and construct validity and reproducibility of its results in patients with low-back and neck pain.

Methods: Participants (n = 125) were included from primary and secondary care. The participants reported moderate pain and disability levels. All participants filled in the COMI forms before and after surgery. Descriptive statistics, Wilcoxon paired test, Crombach's alpha, principal component analysis and information entropy calculation were used.

Results: The instrument was successfully forward and back-translated. It can be seen that the questionnaire applied as part of our intervention study produces answers with a sufficient degree of variability and with a satisfactory degree of representation of extreme values. It can be also seen that the questionnaire can diagnose an objectively occurring change associated with the surgeon within the intervention procedure. Our other findings support the idea of ​​a possible reduction in the number of questions that measure the same latent variable. Our investigations also showed that it is possible to reduce the range of the point scale of the perception of pain to 5 degrees of intensity and thus unify the range with the other questions.

Conclusion: The Czech COMI shows acceptable properties and is thus suitable to use as a short instrument for measuring important domains in patients with low-back and neck pain.

Background: Since scoliosis is a three-dimensional deformity, it causes some movement limitations in the spine and related joints. However, functional limitations associated with scoliosis-related hip joint involvement are the subject of research.

Aims: This study aims to investigate the physical characteristics and functional limitations associated with idiopathic scoliosis (IS), focusing on hip joint.

Methods: Demographic characteristics, scoliosis-specific assessments and hip joint active range of motion (RoM), lumbar mobility (Modified Schober test), lumbopelvic stability (Single leg squat test-SLS), hip joint position sense, lower extremity balance (Y-balance test) and lower extremity functionality (Lower extremity functional scale-LEFS) were evaluated.

Results: The study included 120 individuals, with 86 in the scoliosis group (mean age: 15.7 ± 3.4 years) and 34 in the control group (mean age: 16.1 ± 4.8 years). The scoliosis group exhibited limited RoM of the hip joint in flexion, extension, right abduction, adduction, internal rotation, and left external rotation compared to controls (p < 0.001). Lumbar mobility was decreased (p < 0.001). In the joint position sense test, the mean difference for right flexion was and for left flexion. Bilateral decreased SLS test performances (p < 0.001) and Y-balance test performance (p < 0.05) in individuals with IS. LEFS scores were statistically different but not clinically different between groups (p < 0.05).

Conclusion: Individuals with IS show decreased hip mobility, lumbopelvic stability, hip joint position sense, and balance compared to healthy peers; however, these limitations do not have a clinical impact on daily living activities.

Purpose: There is a paucity of data regarding the sagittal spine-pelvis-leg alignment and the compensatory mechanisms in patients with lumbar spinal stenosis (LSS) and hip osteoarthritis (HOA). In this study, we aim to evaluate the association of HOA with sagittal spine-pelvis alignment parameters in a population of patients with lumbar spinal stenosis and sagittal malalignment.

Methods: We retrospectively analyzed a cohort of prospectively enrolled patients with degenerative LSS and sagittal malalignment between January 2019 and December 2023. Radiographic parameters evaluated were pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), PI-LL, sagittal vertical axis (SVA), T1-pelvic angle (T1PA), sacrofemoral angle (SFA), pelvic obliquity (PO), and femoral inclination (FI). HOA was graded by Kellgren-Lawrence (K/L) grades and divided into low-grade HOA (LOA; grade 0-2) and severe HOA (SOA; grade 3 or 4) groups. LOA group patients were propensity-score matched (PSM) 1:1 to SOA group patients based on age and PI. Univariate, multivariate, and subgroup analyses were used to analyze the association between HOA and sagittal malalignment.

Results: Out of 379 patients, 116 with LOA and 116 with SOA were analyzed after propensity score matching for age and PI. SOA patients exhibited significantly lower FPA (184.01 ± 9.97 vs 186.78 ± 10.11, p = 0.036), higher SS (33.05 ± 9.38 vs. 30.51 ± 9.47, p = 0.042), and lower PT (16.28 ± 8.67 vs. 18.53 ± 7.84, p = 0.040) compared to the LOA group. Subgroup analysis revealed that SOA patients with a SVA > 4 cm had significantly higher PI (51.49 ± 11.64 vs. 47.83 ± 10.73, p = 0.025) and PT (18.71 ± 8.76 vs. 14.67 ± 8.56, p < 0.001), which were not observed in the LOA group. Multivariable linear regression analysis revealed that a greater Kellgren-Lawrence (K/L) Grade was significantly associated with a higher SVA after adjusting for age, BMI, and PI.

Conclusion: In this PSM study, patients with SOA exhibit reduced pelvic tilt and hip extension in standing positions compared to those with LOA. Additionally, the SOA patients had worse global sagittal alignment than their LOA counterparts.