Facet Joint Research Articles

Risk factors analysis and predictive model of degree I degenerative lumbar spondylolisthesis

Study designRetrospective Case-Control Study.BackgroundThere have been some previous studies on the risk factors associated with lumbar spondylolisthesis, but there are few studies on the risk factors for disease progression in mild degenerative lumbar spondylolisthesis (DLS). To analyze the risk factors associated with aggravation of spondylolisthesis in patients with grade I degenerative spondylolisthesis and construct a prediction model.MethodsWe conducted a retrospective analysis of 220 patients diagnosed with DLS who were admitted to our hospital between January 2019 and January 2023. Data collected included gender, age, body mass index (BMI), diabetes, hypertension, occupation, and imaging parameters.ResultsA total of 220 patients were included in this study, including 111 males and 109 females; 178 patients with no aggravation of lumbar spondylolisthesis (group A) and 42 patients with aggravation of lumbar spondylolisthesis (group B). Progression of grade I DLS was associated with single factors such as age, BMI, Occupation, vertebral CT value, facet joint angle (FJA), Modic change (MC), Pfirrmann grade of intervertebral disc (PG), Facet joint effusion (FJE), osteophyte formation, and Percentage of the Fat Infiltration (FIA%) of multifidus muscle (MM). BMI, FJA, PG, and FI% of MM had a significant impact on disease progression in lumbar spondylolisthesis.ConclusionBMI, FJA, PG, and FIA% of MM were independent risk factors for the progression of degenerative spondylolisthesis. The risk prediction model was established by including the above four variables and nomograms were drawn. The internal validation proved that the model had good discrimination, calibration, and clinical practicability.

Central lumbar stenosis. Recommendations of the Russian Association for the Study of Pain (RASP)

Narrowing of the central spinal canal in the lumbar spine (central lumbar stenosis, CLS) is one of the most common causes of lumbar pain, disability and spinal surgery in the elderly. The most common is acquired degenerative CLS, in which the main role play lumen-narrowing medial intervertebral disc herniating with ossification phenomena and marginal bone proliferation on the sides of the vertebral bodies – osteophytes, hypertrophy of the facet joints with their medial displacement, hypertrophy of the yellow ligament. The development of CLS can also be a consequence of spondylolisthesis, postoperative changes, rheumatic diseases and other causes. Both the compression of the cauda equine roots due to narrowing of the spinal canal and their ischemia, caused by compression of the radicular vessels and venous congestion play an important role in the pathogenesis of CLS. CLS develops in elderly age and occurs predominantly in men. The main clinical manifestation of CLS is neurogenic (caudogenic) intermittent claudication, which manifests as pain, numbness and weakness in the legs when the patient walks or stands for a long time but subsides when the patient sits or stands and bends forwards (flexion in the lumbar spine). The diagnosis of CLS is confirmed by magnetic resonance imaging (MRI), which shows a narrowing of the spinal canal and makes it possible to rule out specific causes of lumbar pain. It is important to note that, according to MRI, CLS often occurs at an older age, so its detection in the absence of clinical manifestations does not require an immediate discussion of the prospects of surgical treatment. Pain in patients with CLS according to MRI may be musculoskeletal in nature. Therefore, the diagnosis of CLS should include specific clinical manifestations and stenosis on MRI. In patients without clinical manifestations of CLS, osteoporosis and severe concomitant somatic diseases, only conservative therapy is recommended. Modern conservative treatment of CLS includes an educational program, therapeutic exercises (kinesiotherapy), psychological therapy methods for emotional disorders (cognitive-behavioral therapy), manual therapy and pharmacotherapy. Complex conservative treatment of CLS can reduce pain, improve the patient's condition and in some cases increase the patient's walking distance.

Multicenter External Validation of the Accuracy of Computed Tomography Criteria for Detecting Thoracolumbar Posterior Ligamentous Complex Injury.

Recent studies have proposed computed tomography (CT) criteria for posterior ligamentous complex (PLC) injury: disrupted if ≥2 CT findings, indeterminate if single finding, and intact if 0 CT findings. The study aims to validate the CT criteria for PLC injury externally. Three level 1 trauma centers enrolled 614 consecutive patients with acute thoracolumbar fractures (T1-L5) who received CT and MRI. Three reviewers from each center assessed CT for facet joint malalignment, horizontal laminar fracture, spinous process fracture, and interspinous widening and MRI for disrupted PLC, defined as black stripe discontinuity. The primary outcome is the diagnostic accuracy of CT criteria (0, 1, ≥2 findings) in detecting disrupted PLC on MRI using all CT readings. A subgroup analysis was performed for each participating center and reviewer. The inter-reader agreement on PLC status on MRI and CT criteria was assessed using Fleiss Kappa (k). The positive predictive value for PLC injury was 0 findings 3%, single positive CT 43%, and ≥2 CT findings in 94%. The accuracy measures were consistent across various centers and reviewers. The area under the curve for ≥1 CT finding in detecting PLC injury ranged from 90% to 97%, indicating excellent discrimination for all centers. The inter-reader k on PLC status by MRI and overall CT findings was substantial (k > 0.60). This study externally validates the previously proposed CT criteria for PLC injury. A total of ≥2 positive CT findings or 0 CT findings can be used as criteria for a disrupted PLC (B-type injury) or intact PLC (A-type injuries), respectively, without added MRI. A single CT finding implies indeterminate PLC status and the need for further MRI assessment. The CT criteria will potentially guide MRI indications and treatment decisions for neurologically intact thoracolumbar burst fractures.

Comparative evaluation of ultrasound and fluoroscope guided intra-articular sacroiliac joint injection in patients with sacroiliac joint pain

Background: Tissues which transmit pain in the lower back include disc, nerve root, dura, muscles, ligaments, facet joints, and sacroiliac joint (SIJ). The SIJ contributes around 13–30% in patients with chronic low back pain. The SIJ is difficult to enter with a needle because of its complex configuration. Ultrasound and fluoroscopy are the two tools which guide in performing SIJ injections. Aims and Objectives: The SIJ is susceptible to arthritis, trauma, and degeneration which lead to pain and dysfunction. Intra-articular SIJ injections (IASIJIs) have diagnostic and therapeutic value and have been administered for the treatment of SIJ pain. Materials and Methods: Sixty patients (aged 20–60 years) with pain patterns consistent with SIJ pain who did not respond to conservative treatment were included in the study. The patients were randomly divided into two groups of 30 each: Group U (n=30): Ultrasound-guided IASIJI and Group F (n=30): Fluoroscope-guided IASIJI. A total of 3 mL drug solution comprising 1 mL of 0.25% bupivacaine plus 2 mL of methylprednisolone (80 mg) was injected in both groups. Results: There was a statistically significant improvement in pain scores after IASIJI in both groups. The change in pain score was significantly more in Group F as compared to Group U at 3 and 6 months after IASIJI. Two weeks after IASIJI, the mean pain score in both groups remained < 2 at all time intervals throughout the study period. The variation in the Oswestry Disability Index (ODI) at different time intervals when compared to ODI before injection in both the groups was clinically and statistically significant (P<0.001). The change in ODI was more in Group F as compared to Group U at all time intervals. Excellent patient satisfaction was reported by the majority of the patients at different time intervals in both groups. Conclusion: Both techniques were effective and provided good pain relief to the patients with SIJ pain. Fluoroscope-guided SIJ injection is better than ultrasound-guided SIJ injection in terms of improvement in pain score and functional disability.

Impact of sacroiliac interosseous ligament tension and laxity on lumbar spine biomechanics under vertical vibration: a finite element study

Objective To investigate the impact of tension and laxity in the sacroiliac interosseous ligament on lumbar spine displacement and force response in vibration environments. Methods A finite element model of the lumbar-pelvis, previously crafted and rigorously validated, was used to simulate ligament tension and laxity by adjusting the elastic modulus of the SIL under a sinusoidal vertical load of ±40 N at 5 Hz. Comparisons of lumbar spine horizontal and axial displacements as well as annulus fibrous stress, nucleus pulposus pressure, and facet joint force were performed, respectively. Results With the elastic modulus of the SIL varying by +50, −50, and −90%, the maximum vibration amplitude changed by +20.00, −175.00, and −627.27% for lumbar horizontal displacement, +30.00, −157.14, and −627.22% for lumbar axial displacements, +5.88, −19.35, and −245.16% for annulus fibrous stress, +10.00, −25.00, and −157.14% for nucleus pulposus pressure, as well as +6.54, −20.13, and −255.37% for facet joint force, respectively. Conclusion In contrast to static environments, large laxity of the SILs not only diminishes lumbar spine stability in vibrational settings but also significantly amplifies dynamic loads, thereby heightening the risk of lumbar spine vibratory injuries and low back pain disorders.

Restoration of physiologic loading after engineered disc implantation mitigates immobilization-induced facet joint and paraspinal muscle degeneration.

Intervertebral disc degeneration is commonly associated with back and neck pain, and standard surgical treatments do not restore spine function. Replacement of the degenerative disc with a living, tissue-engineered construct has the potential to restore normal structure and function to the spine. Toward this goal, our group developed endplate-modified disc-like angle-ply structures (eDAPS) that recapitulate the native structure and function of the disc. While our initial large animal studies utilized rigid internal fixation of the eDAPS implanted level to ensure retention of the eDAPS, chronic immobilization does not restore full function and is detrimental to the spinal motion segment. The purpose of this study was to utilize a goat cervical disc replacement model coupled with finite element modeling of goat cervical motion segments to investigate the effects of remobilization (removal of fixation) on the eDAPS, the facet joints and the adjacent paraspinal muscle. Our results demonstrated that chronic immobilization caused notable degeneration of the facet joints and paraspinal muscles adjacent to eDAPS implants. Remobilization improved eDAPS composition and integration and mitigated, but did not fully reverse, facet joint osteoarthritis and paraspinal muscle atrophy and fibrosis. Finite element modeling revealed that these changes were likely due to reduced range of motion and reduced facet loading, highlighting the importance of maintaining normal spine biomechanical function with any tissue engineered disc replacement. STATEMENT OF SIGNIFICANCE: : Back and neck pain are ubiquitous in modern society, and the gold standard surgical treatment of spinal fusion limits patient function. This study advances our understanding of the response of the spinal motion segment to tissue engineered disc replacement with provisional fixation in a large animal model, further advancing the clinical translation of this technology.

Multiple Endoscopic Access Lumbar Interbody Fusion (MALIF): A New Technique for Unilateral Biportal Endoscopic Lumbar Interbody Fusion Using Monoportal Endoscopic Spine Surgery Techniques.

This study aims to present a new endoscopic lumbar interbody fusion technique, multiple endoscopic access lumbar interbody fusion (MALIF), which applies the assisted full-endoscopic spine surgery (AFESS) technique to unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF). AFESS represents an advancement over UBE by utilizing a monoportal scope in the camera portal during biportal endoscopic spine surgery, which enables greater stability, controlled irrigation for muscle preservation, and improved protection of neural structures. We performed MALIF on 15 consecutive patients with symptomatic lumbar spondylolisthesis resistant to conservative treatment and showing radiographic evidence of instability. The technique was performed through a unilateral percutaneous pedicle screw (PPS) incision, minimally exposing the lateral facet joint, followed by superior articular process (SAP) resection and interbody cage placement for indirect decompression and fusion. The mean operative time was 97.4 ± 17.5 minutes (range: 70-129 minutes), with minimal blood loss (mean: 24.3 ± 13.8 ml) and short hospital stay (mean: 15.0 ± 3.5 days). All patients showed symptomatic improvement without major complications, except for one case of transient dysesthesia that resolved within two weeks. MALIF offers three key advantages: (1) multi-angle endoscopic access to the surgical site, (2) precise endoscopic discectomy, and (3) enhanced safety through monoportal sleeve protection of the exiting nerve root. These initial results suggest that MALIF is a promising minimally invasive surgical option for lumbar interbody fusion.

Comparing the efficacy of intra-articular injection of Platelet Rich Plasma (PRP) with corticosteroids (CS) in patients with chronic zygapophyseal joint low back pain confirmed by double intra-articular diagnostic blocks: A triple-blinded randomized multicentric controlled trial with a 6-month follow-up

ObjectiveTo compare the safety and effectiveness in improving function and reducing pain of autologous PRP to corticosteroid (CS) zygapophyseal (Z-joint) intra-articular (IA) injections at six months for patients with chronic osteoarthritis Z-joint mediated low back pain (LBP). DesignProspective triple-blinded multicentric randomized controlled trial. MethodsFifty participants with radiological signs of Z-joint OA and chronic Z-joint mediated LBP confirmed by a ≥80 % pain improvement after two IA local anesthetic injections were randomized into PRP and CS groups, using a 1:1 ratio. Participants completed questionnaires at baseline, and at 1-, 3- and 6-month post-treatment, with adverse effect data collected at 1 month. Function (Oswestry disability index (ODI)), pain (Numeric Rating Scale (NRS)), treatment satisfaction (modified MacNab criteria), and quality of life (Short Form survey 36 (SF-36)) were assessed at each follow-up. The primary outcome was the percentage of participants improving their function (ODI score) above the minimal clinically important difference (MCID) of 17 points. The secondary outcomes were the percentage of participants with a >50 % NRS improvement, satisfaction to treatment and mean score improvement. Proportions were compared between groups using a chi-square test. Mean scores were compared using a two-way ANOVA or the nonparametric Brunner & Langer test. ResultsBoth groups were similar at baseline, no major adverse effects occurred, and no participants were lost at follow-up. The proportion of participants improving their ODI scores above the MCID, the proportion of participants with a >50 % NRS improvement, and mean ODI scores were significantly different between groups in favor of PRP at 6 months. Modified MacNab satisfaction scale, NRS and SF36 mean scores were not statistically different between groups, but all followed the same pattern: the CS groups had a greater improvement a one month, both groups were equivalent at three months and the PRP group had a greater improvement at six months. ConclusionThis first triple-blinded multicentric RCT demonstrates the safety of PRP IA Z-joint injections and its superiority in improving pain and function at six months post-treatment compared to CS for patients with chronic OA Z-joint mediated LBP. To perform a blinded control study, two intra-articular treatments were compared. However, knowing that radiofrequency neurotomy (RFN) of the medial branch diagnosed by branch blocks has been standard of care for pain originating from Z-joints, further studies comparing PRP to RFN are still needed. Clinicaltrials gov registry numberNCT05188820.

Evaluation of the paraspinal muscles mophology using magnetic resonance imaging in adult patients with nonspecific chronic low back pain in Port Harcourt Rivers State Nigeria

Background: Nonspecific chronic low back pain (CLBP) is a major public health concern globally and the leading cause of musculoskeletal disability, affecting mainly adults in their productive years with a high economic impact in the society. Objective: This study was designed to evaluate the changes in the paraspinal muscles (lumbar multifidus) morphology using data obtained from MRI of the lumbosacral spine in adult participants with non-specific chronic low back pain. Materials and methods: This was a cross-sectional study, involving 200 adult participants with non-specific chronic low back pain undergoing MRI of the lumbosacral spine at the Department of Radiology, Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Nigeria, during a six months period. Data recorded include lumbar multifidus muscle (LMM) morphology and lumbar spine pathologies Results: The LMM CSA for L1, L2, L3, L4 and L5 were 2.24±0.84, 3.59±1.15, 5.18±1.60, 6.66±1.75 and 7.27±2.62 respectively. The frequency distribution of LMM fatty infiltration in percentage showed Grade 0 was highest at L1 (86.5%, n= 173) and lowest at L5 (6.5%, n=13); Grade 1 was highest at L4 (73%, n=146) and lowest at L1 (13.5%, n=2) and Grade 2 was highest at L5 (22.5%, n=45) and lowest at L1 (0.0%, n=0). The lumbar pathologies noted were 200(100%) disc abnormalities, while 178(89.0%) had neural foraminal narrowing, nerve root compression and spinal canal stenosis each. Facet joint arthrosis and spondylosis were 177(88.5%) and 176(88.0%) respectively. Conclusion: Dysfunctional LMM was observed to increase with advancing age, severe in females and individuals with elevated BMI and cuts across various occupations. Measures aimed at improving and maintaining the quality of the LMM should be encouraged, as this will help in reducing the prevalence of nonspecific CLBP

Traumatic subluxation of the cervical spine in an 1-year-old alpaca mare

A 1-year-old alpaca mare was presented due to lateral deviation of the cervical spine which had been present for a period of 2 weeks. Based on the previous report, a traumatic event was assumed. Feed and water intake were unremarkable, the gait was altered due to slight ataxic movements in all 4 limbs. The animal showed no further neurological deficits on initial presentation. Radiographs revealed a displacement of the cervical vertebrae to the left as part of a subluxation of the articular processes of the cervical vertebrae C4 and C5. During the course of conservative treatment with pain medication, neurologic signs including ataxia and I: mpaired balance developed in spite of unremarkable food intake. Subsequently, the animal died at a time when it was not under observation.Pathologic examination revealed degenerative and inflammatory alterations as well as hemorrhages in the cervical medulla at the level of the axial deviation of the cervical spine. Under consideration of the patient's history, the findings may most likely be seen as the result of blunt trauma and represent the cause of the neurologic signs.This is the first case description of a subluxation of the cervical vertebral column in an alpaca in Germany that has been evaluated in detail.

The Association Between Facet Joint Tropism and Lumbar Disc Herniation

Objective: Facet joint tropism is thought to be associated with lumbar disc herniation (LDH), but this relationship has not been fully established. The aim of this study was to investigate the relationship between facet joint tropism and LDH in patients (25-30 years old and body-mass index 28-30 kg/m²) using computed tomography (CT) and lumbar magnetic resonance imaging (MRI). Method: Facet joint angles were measured on lumbar MRI and CT images of 24 male patients with left-sided LDH; 16 patients with right-sided LDH. Facet joint angle was measured by calculating the angle of the facet joints with the vertebral sagittal line in axial sections parallel to the end plate plane. Patients with trauma, rheumatic and oncologic diseases, additional lumbar or spinal and systemic diseases, patients with far lateral, foraminal and central lumbar disc herniations were excluded. Results: The mean left facet joint angle was 44,56º+/-11,29° and the mean right facet joint angle was 41,2º+/-11,27° in 24 patients with left-sided LDH. In 16 patients with right-sided LDH, the mean right facet joint angle was 45,87º +/-16,41°and the mean left facet joint angle was 42,74º+/-12,54°. Conclusion: In the statistical evaluation, no significant correlation was found between LDH and facet joint angle, but in the numerical analysis, it was observed that the left facet joint angle was larger in patients with left-sided LDH and the right facet joint angle was larger in patients with right-sided LDH.

Radiographic Predictors of Lateral Translation in Patients With Residual Adolescent Idiopathic Scoliosis and Thoracolumbar/Lumbar Curves: A Focus on L3 Lateral Translation

BackgroundPatients with residual adolescent idiopathic scoliosis (AIS) and thoracolumbar/lumbar (TL/L) curves may present with progression after cessation of growth, with lateral translation as a major risk factor. Nonetheless, radiographic predictors and underlying mechanisms remain indefinite. This study aimed to determine these radiographic predictors and structural mechanisms in patients with residual AIS. MethodsRadiographic and clinical data were collected from 45 consecutive patients with preoperative residual AIS and TL/L Cobb angle >40° who subsequently underwent corrective surgery at our institution. Lateral translation was defined as intervertebral slippage ≥6 mm on computed tomography. Statistical analyses included Student’s t-test, Pearson’s correlation coefficients, receiver operating characteristic (ROC) curve analysis, and multivariate logistic regression analysis. ResultsOut of 45 patients, 3 were male, whereas 42 were female, with a mean age of 40.6±17.4 years. L3 slippage was observed in 21 patients, resulting in the categorization into the slippage and non-slippage cohorts. Multivariate logistic regression analysis revealed statistically significant disparities in the bilateral facet angles, facet joint opening, and facet joint vacuum phenomenon between the two cohorts. The ROC analysis determined a 20.5° cut-off value for predicting L3 slippage. In the non-slippage cohort, a strong correlation was particularly observed between L3 slippage and L2–L3 bridging. ConclusionFacet joint instability, L4 tilt ≥20.5°, and L3 cranial vertebral bridging are predictive radiographic factors for L3 lateral translation in patients with residual AIS. Thus, patients exhibiting these characteristics require consistent follow-up or early surgical intervention before lateral translation occurs.

Comparative study between unilateral biportal endoscopic discectomy and percutaneous interlaminar endoscopic discectomy for the treatment of L5/S1 disc herniation

To compare the clinical outcomes of unilateral biportal endoscopic discectomy (UBED) and percutaneous interlaminar endoscopic discectomy (PIED) for treating L5/S1 disc herniation. Patients with L5/S1 disc herniation treated with UBED (n=46) and PIED (n=50) in our hospital during the same period were retrospectively reviewed. Clinical outcome, radiographic parameters and complications of each group were collected and evaluated. The mean follow-up period was 14.11±3.47 months in UBED group, and 14.52±5.37 months in PIED group. There was no significant difference in VAS leg (P=0.836) or lumbar scores (P=0.335) between PIED and UBED group at preoperative, 1-day postoperative, and last follow-up point. Within the same group, there were significant differences in VAS leg (P<0.001) and lumbar scores (P<0.001) compared pairwise at three time points. ODI scores of both groups showed significant improvement at the last follow-up (P<0.001) (P<0.001). And there was no significant difference in patient satisfaction rates (97.8% vs 96%) between two groups based on MacNab criteria. The percentage of facet joint preservation was 96.74±9.10% in UBED group, and 99.22±1.52% in PIED group. The total blood loss and hospitalization cost was more in the UBED Group. One patient in both groups showed postoperative hematoma. A dural tear occurred in UBED group and a never root injury occurred in PIED group. UBED indicates similar short-term efficacy compared with PIED for treating L5/S1 disc herniation. No difference was found in facet joint preservation between two groups. The increased cost of UBED due to surgical consumables is believed to be resolved in the future.

Comparing ultrasound-guided intra-articular injection and medial branch block for lumbar facet joint pain: a clinical study.

This study aims to compare the effectiveness of ultrasound-guided intra-articular (IA) injections with medial branch nerve blocks in treating lumbar facet joint pain. This retrospective study enrolled 94 patients clinically diagnosed with lumbar facet joint pain. Diagnostic blocks confirmed the diagnosis in 82 patients, evidenced by a pain visual analog score (VAS) reduction of at least 50% immediately following the injection. Of these, 42 were treated with ultrasound-guided IA injections (group 1), and 40 received ultrasound-guided medial branch blocks (group 2). Effective pain relief was defined as a VAS reduction of at least 50%. Group 1 showed significantly higher pain relief rates compared with group 2 at both 1-month (54.76% versus 2.5%, P < 0.001) and 3-month (26.19% versus 5%, P = 0.014) follow-ups. Within group 1, patients aged 21-50 years experienced higher relief rates (81.25% at 1-month and 56.25% at 3-month follow-ups) compared with those over 50 (38.46% at 1-month and 7.69% at 3-month follow-ups), which was statistically significant (P = 0.007 at 1-month and P = 0.001 at 3-month follow-ups). Furthermore, in group 1, patients with sedentary jobs reported significantly greater pain relief (90.91% at 1-month and 81.82% at 3-month follow-ups) compared with those with non-sedentary jobs (41.94% at 1-month and 6.45% at 3-month follow-ups) (P = 0.005 at 1-month and P < 0.001 at 3-month follow-ups). Ultrasound-guided IA injection provides better pain relief compared with medial branch nerve blocks. This method serves as a viable alternative for patients, especially younger and middle-aged patients with lumbar facet pain due to sedentary lifestyles. This study compared and analyzed the therapeutic effects of two different ultrasound intervention blockade methods on patients with lumbar facet joint pain, demonstrating that IA injection has a better pain relief effect and can be used as a pain relief method for patients who refuse radiofrequency therapy.

Minimally Invasive Unilateral Pedicle Combined with Contralateral Translaminar Facet Joint Screw Fixation for single-segment Lumbar Degenerative Disease: A 10-year follow-up Study.

This retrospective study compared unilateral pedicle screw combined with contralateral translaminar facet joint screw (UPS+TFS) fixation with bilateral pedicle screw (BPS) fixation in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-segment lumbar degenerative disease. To assess the long-term clinical efficacy of UPS+TFS fixation and BPS fixation in MIS-TLIF. Limited research exists on the long-term clinical outcomes of UPS+TFS fixation in MIS-TLIF. This study addresses this gap by comparing UPS+TFS with the more common BPS fixation technique. A retrospective analysis of 151 patients with single-segment lumbar degenerative disease treated with MIS-TLIF at XXX Hospital (March 2011-December 2012) was conducted. Propensity score matching (1:1) resulted in 32 patients per group (UPS+TFS and BPS). Basic demographic characteristics, preoperative functional scores, perioperative indicators, and postoperative complications were compared between the groups. Lumbar and leg Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores up to 10 years postoperatively were also compared. The surgical outcomes of both groups were evaluated using the MacNab criteria at the final follow-up. The UPS+TFS group had significantly lower lumbar VAS scores at three months postoperatively (P<0.05) with less intraoperative blood loss, shorter surgery time, and reduced hospital stay compared to the BPS group (P<0.05). No significant differences were found in the JOA or ODI scores between the two groups at 3 months and 1, 3, 5, and 10 years post-surgery (P>0.05). UPS+TFS and BPS fixation during MIS-TLIF can achieve favorable clinical outcomes with no difference in long-term clinical efficacy. UPS+TFS demonstrates perioperative advantages such as reduced intraoperative blood loss, shorter operation time, reduced postoperative hospital stay, and less iatrogenic injury. Therefore, MIS-TLIF with UPS+TFS fixation is a reliable treatment for single-segment lumbar degenerative disease.

Duckbill Release Technique for the Outside-in Method in Full-Endoscopic Spine Surgery via Transforaminal Approach: A Technical Note

IntroductionIn full-endoscopic spine surgery via trans-foraminal approach (FESS-TF), the outside-in method facilitates treatment for various cases; however, the technique is difficult to perform. To facilitate this procedure, we developed a duckbill release technique. In this paper, we aimed to introduce the details of this technique and investigate its effectiveness. Materials and MethodsFifty patients who underwent FESS-TF for intervertebral disc herniation were divided into two groups: the conventional technique and the duckbill release technique groups. The time from the initiation of surgery to exposure of the bone outside the superior articular process was measured in both groups. The visual analog scale (VAS) score for leg pain and the Japanese Orthopaedic Association (JOA) score before and after surgery were compared in terms of clinical outcomes. ResultsNo significant differences were observed between the two groups in terms of patient background. The approach time was 252 ± 86 s in the conventional group, while it was 105 ± 26 s in the duckbill release group, which was significantly shorter (p < 0.001). In terms of clinical outcomes, the two groups did not significantly differ in all endpoints of the VAS score for leg pain or the JOA score. ConclusionsThe duckbill release technique for the outside-in method in FESS-TF could be efficient because it is a simple and time-saving approach.

Is There a Relation Between High Pelvic Incidence and Sagittal Angle of Posterior Lumbar Facets?

In recent years, several studies have shown the presence of a linear correlation between the PI and spondylolisthesis . However, no study has attempted to investigate a potential association between facet sagittal angle and spinopelvic parameters, especially PI in the normal population. Abdominopelvic CT scans were collected. Inclusion criteria included age less than 40 and CT done for non-orthopedic diagnostic purposes. All cases with any spinal pathology were excluded. Spinopelvic and lumbar spinal parameters were collected using the KEOPS software, while the facet sagittal angle were evaluated on axial CT images from L1-L2 to L5-S1 using the institution PACS system. 450 patients' imaging were analyzed, with a mean age of 31.3 years (±4.9). Facet sagittal angle was found to be significantly correlated to an increase in PI but only at the L5-S1 level (OR = 2.3). The effect of gender on sagittal angle of facet joints was found to be non-significant compared to high PI. Finally, at the L5-S1 level, facet tropism was associated with a higher PI but was not found to play a direct role in the angle of facet joints. The PI seems to be correlated to the other spondylolisthesis risk factors: facet tropism and female gender. It carries the heaviest load in the progression towards sagittally oriented facet joints, which might lead to segmental instability and eventual spinal pathologies.

Glucocorticoid facet joint injection for chronic back or neck pain.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: The primary objective is to assess the benefits and harms of glucocorticoid facet joint injections in adults with chronic back or neck pain that is presumed to be facet joint-mediated. The secondary objective is to assess whether the effects differ by diagnostic method for facet joint-mediated pain.

Increased stiffness is evidenced in the deep but not superficial lumbar multifidus muscle in professional athletes with chronic low back pain

ObjectivesElevated lumbar multifidus stiffness has been observed in populations with chronic low back pain (LBP). However, the modulation of deep (DLM) and superficial (SLM) lumbar multifidus stiffness, considering their distinct structural characteristics and functions, remains unaddressed, especially in athletes. This study aimed to compare differences in DLM and SLM stiffness in professional athletes from different sports with and without chronic LBP. DesignCross-sectional study. SettingThis study was conducted at a provincial sports training centre. ParticipantsNinety-nine professional athletes (age: 18-27 years) from weightlifting, badminton, and track and field teams were recruited. Thirty-eight had chronic bilateral LBP. InterventionsNot applicable. Main Outcome MeasuresUltrasound shear wave elastography (SWE) measured Young's modulus (stiffness indicator) of DLM and SLM at the L4/5 facet joint level. Two-way analysis of variance examined the effects of chronic LBP and sport type on DLM and SLM stiffness while considering proper confounders. Significance was set at p < 0.05. ResultsAthletes with chronic LBP demonstrated significantly higher DLM stiffness on the dominant (by 17.73%, mean difference (MD) = 2.52kPa, p = 0.001) and non-dominant sides (by 13.54%, MD = 1.83kPa, p = 0.046) compared to pain-free counterparts. SLM stiffness varied significantly among the three athlete groups. Post-hoc analyses revealed greater SLM stiffness on the non-dominant side in weightlifters than in badminton players (by 51.76%, MD = 8.97kPa, p = 0.010) or track and field athletes (by 72.01%, MD = 11.01kPa, p = 0.008). ConclusionsChronic LBP and sport type significantly impact multifidus muscle stiffness, suggesting the need for targeted clinical assessments and reconditioning strategies focusing on DLM for chronic LBP and SLM for athletes in trunk extension-intensive sports.

Intraoperative Facet Joint Block Reduces Pain After Oblique Lumbar Interbody Fusion

Background: Oblique lumbar interbody fusion (OLIF) results in less tissue damage than in other surgeries, but immediate postoperative pain occurs. Notably, facet joint widening occurs in the vertebral body after OLIF. We hypothesized that the application of a facet joint block to the area of widening would relieve facet joint pain. The purpose of this study was to evaluate the analgesic effects of such injections on postoperative pain. Methods: This double-blinded, placebo-controlled study randomized patients into 2 groups. Patients assigned to the active group received an intra-articular injection of a compound mixture of bupivacaine and triamcinolone, whereas patients in the placebo group received an equivalent volume of normal saline solution injection. Back and dominant leg pain were evaluated with use of a visual analog scale (VAS) at 12, 24, 48, and 72 hours postoperatively. Clinical outcomes were evaluated preoperatively and at 6 months postoperatively with use of the Oswestry Disability Index (ODI) and VAS for back and dominant leg pain. Results: Of the 61 patients who were included, 31 were randomized to the placebo group and 30 were randomized to the active group. Postoperative fentanyl consumption from patient-controlled analgesia was higher in the placebo group than in the active group at up to 36 hours postoperatively (p &lt; 0.001) and decreased gradually in both groups. VAS back pain scores were significantly higher in the placebo group than in the active group at up to 48 hours postoperatively. On average, patients in the active group had a higher satisfaction score (p = 0.038) and were discharged 1.3 days earlier than those in the placebo group. Conclusions: The use of an intraoperative facet joint block decreased pain perception during OLIF, thereby reducing opioid consumption and the severity of postoperative pain. This effect was also associated with a reduction in the length of the stay. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.