European Spine Journal最新文献

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.