Spinal Stenosis Research Articles

ATTR cardiac amyloidosis after lumbar spinal stenosis- a prospective cohort study

Abstract Background Systemic wild type transthyretin (ATTRwt) amyloidosis is underdiagnosed and generally diagnosed in manifest cardiac disease. Lumbar spinal stenosis (LSS) might be an early sign of ATTRwt and a possible screening target for early diagnosis. Aim To characterize patients with transthyretin amyloid deposits in ligamentum flavum six years after surgery for lumbar spinal stenosis, and assess prevalence of undiagnosed cardiac amyloidosis. Materials and methods In this prospective cohort study, 21 patients who had surgery for LSS in 2016-2018 and grade 3-4 ATTR deposits in ligamentum flavum, without manifest cardiac amyloidosis (CA) were followed up in 2022-2023, including biomarkers and multimodality cardiac imaging. Results Median age at follow-up was 79 years and 62% were male; 16% (3/19) of patients had DPD-scintigraphy and were diagnosed with ATTRwt cardiac amyloidosis. 48% (10/21) had a history of other tenosynovial conditions that associate to ATTRwt amyloidosis. on echocardiography. Conclusion In this prospective cohort study, 16% of patients were diagnosed with ATTRwt cardiomyopathy after a median of six years following surgery for lumbar spinal stenosis. These findings strengthen the hypothesis that LSS is a possible manifestation of ATTRwt amyloidosis and that analysis for amyloid in connective tissue and subsequent cardiac follow-up is of value.

Patient journey from the appearance of red flags to the diagnosis of transthyretin cardiac amyloidosis (ATTR-CM) in Japan: a nationwide retrospective study using a medical claims database

Abstract Introduction Transthyretin amyloid cardiomyopathy (ATTR-CM) is an under-recognized cause of common cardiovascular conditions in the elderly, with relatively high rates among patients diagnosed with heart failure (HF) with preserved ejection fraction. In addition to cardiac symptoms such as HF, extracardiac symptoms such as carpal tunnel syndrome (CTS) and lumbar spinal stenosis (LSS) are also red flags for ATTR-CM. Tafamidis is currently the only disease-modifying therapy approved for the treatment of patients with ATTR-CM and is likely to be more effective in the earlier stage. Patients with ATTR-CM often undergo a long and difficult diagnostic journey because of the nonspecificity of clinical manifestations, resulting in delays in establishing the correct diagnosis. Purpose To identify the timing of appearance of comorbidities in patients with ATTR-CM during diagnosis. Methods In this retrospective, non-interventional, observational study using a claims database (dataset period: April 1, 2014–August 31, 2021), adult patients with a diagnosis of ATTR-CM or prescription for tafamidis 80 mg were included. The index date was defined as the first date of recording ATTR-CM diagnosis or the prescription of tafamidis 80 mg, whichever was earlier. The baseline period was defined as the period between the index date and 6 months before the index date. The onset date was defined as the first date of recording diagnosis of the first red-flags that was suspicious for ATTR-CM. Results Of 11,101,578 patients in the database, 246 patients with ATTR-CM met the inclusion criteria. A total of 239 patients were included, of whom 139 had received tafamidis 80 mg. The median (range) age at the index date was 79.0 (46.0–95.0) years, and 79.9% (191/239) were male. The most frequently reported comorbidity defined as onset of ATTR-CM was conduction disorders (88.7%) followed by atrial fibrillation/atrial flutter (50.6%), hypertensive heart disease (19.7%), aortic stenosis (15.9%), and hypertrophic cardiomyopathy (11.7%), with the median (interquartile range [IQR]) time to the index date being 15.5 (5.0–24.5), 14.0 (5.0–22.0), 9.0 (2.0–18.0), 5.0 (2.0–16.0), and 12.0 (6.5–21.5) months, respectively (Fig. 1). LSS (23.9%), neuropathy (13.0%), and CTS (7.5%) were frequently observed as extracardiac symptoms at baseline, and the median (IQR) time from appearance to the index date was 19 (9.0–28.0), 5.0 (1.0–16.0), and 18.0 (14.0–25.0) months, respectively (Fig. 2). Conclusions This study elucidated the time lag between the appearance of cardiac and extracardiac complications of ATTR-CM and its diagnosis in real-world clinical settings. These novel findings highlight the potential for earlier detection of ATTR-CM.

Minimally Invasive Spine Surgery for Lumbar Decompression or Disc Herniation

ABSTRACTMany people experience low back pain caused by degenerative disease of the lumbar spine; this includes spinal stenosis, spondylolisthesis, disc degeneration, and disc herniation. Conservative management of degenerative disease, which includes physical therapy, lifestyle modifications, and medications, is the initial approach. If this approach fails, a surgical procedure may be the next step. Previously, open lumbar surgery would have been the planned procedure; today, minimally invasive spine surgery gives patients another choice. Perioperative nurses should understand how minimally invasive spine surgery differs from the open procedure, the steps involved during a minimally invasive procedure, the benefits of this type of procedure, and nursing considerations for patients undergoing minimally invasive spinal procedures.

Full Endoscopic Decompression for Single Level Lumbar Stenosis: A Clinical Evaluation

Objective: This study aimed to evaluate the outcomes of full endoscopic decompression for single level lumbar spinal canal stenosis. Methods:This observational study was conducted on a total of 370 patients selected by purposive sampling from January 2022 and December 2023, presenting with symptoms more than 3 months and non-responding to conservative treatment. The procedure was performed by placing the patient on a radiolucent Wilson frame with single-shot epidural analgesia. Outcome was measured in terms of pain reduction using Visual analog scale (VAS) before and after surgery, at 3rd, 6th month, and functional outcome was assessed using the Modified MacNab criteria at 6th month, Results: The mean age of the patients was 56.1 years, with 63% male. The most common stenosis level was L4-L5 (36.5%). The mean operation duration was 53 minutes, and the postoperative complications were minimal. Significant improvement in pain levels was observed, with back pain reduced from a preoperative mean of 3.2 to 1.1 at six months, and leg pain from 7.2 to 1.0 (p < 0.001). According to the Modified MacNab criteria, 91.1% of patients reported excellent outcomes at six months, and 8.4% reported good outcomes. Conclusion: Full endoscopic decompression is a highly effective and safe method for treating lumbar spinal stenosis, providing substantial pain relief and excellent functional outcomes with minimal complications. J Shaheed Suhrawardy Med Coll 2023; 15(1): 3-7

Relationship of anxiety-related symptoms with pain, disability and postoperative period after degenerative lumbar spinal stenosis surgery.

Purpose: This study investigates the anxiety levels of patients who have undergone surgery for degenerative lumbar spinal stenosis (DLSS) and the impact of this condition on their post-operative recovery process. Materials and methods: The study group consisted of 71 patients and the control group consisted of 65 healthy individuals. The study assessed the patients' pain, disability and anxiety levels. The results show that the patients' anxiety levels are higher than those of the general population, and that anxiety levels increase even more in patients with high pain and disability scores. Postoperative State Anxiety (SA) and Trait Anxiety (TA) scores were compared between DLSS patients and healthy individuals. The anxiety scores of the patient group were analyzed in relation to age, gender, pain, physical disability and postoperative period. Results: It was found that the SA scores were statistically significantly higher in the pain group. It was found that the SA scores of patients were statistically significantly different according to their physical disability status. It was also found that both the painful early postoperative group and the painful late postoperative group had higher SA scores than the painless early postoperative group and the painless late postoperative group. Conclusion: These findings highlight the importance of considering pain, physical activity, and anxiety together in supporting the postoperative recovery process. It is suggested that holistic approaches that focus on pain, physical disability and anxiety may have a positive impact on recovery. More extensive and prospective studies are needed to clarify the causal relationship between these concepts

Osteosarcoma with Pathological Fracture: A Rare Case Report

Introduction: Osteosarcoma is a primary malignant bone tumor originating from stem cells and is characterized by the proliferation of tumor cells that directly form immature bone or bone-like tissue. Osteosarcoma represents only 3% to 5% of all spinal malignancies. The aim of study is to discuss the importance of diagnostic investigation for a relatively rare case of spinal osteosarcoma. Case presentation: A 49 years old female came to the Emergency Unit, with a chief complaint of bilateral weakness of lower extremities for 1 year and worsening in 2 weeks. Upon examination, the initial diagnosis was mistaken for a spinal canal stenosis because metastatic bone disease from previous history of malignant melanoma. Subsequently, a decompression with stabilization fusion and biopsy is performed. Primary osteosarcoma was confirmed from histopathology results. Further chemotherapy is planned referring to confirmed primary osteosarcoma on histopathology. Discussion: Spinal osteosarcoma is very rare. Osteosarcoma occurs most frequently in the appendicular skeleton, especially the distal femur and proximal tibial metaphysis, which account for 90% of all cases. Primary osteosarcomas of the vertebral column are uncommon and occur dominantly in the vertebral body. Biopsy remains the gold standard of care for diagnosis. Conclusion: The performance of MRI and pathologic evaluation with immunohistochemistry is particularly important for the differential diagnosis of soft tissue tumors. Histopathologic analysis also plays an important role in differentiating from metastatic bone disease. An aggressive treatment plan and long-term follow-up are mandatory in managing this case. Keywords: osteosarcoma, spinal osteosarcoma, spinal canal stenosis, malignancy, pathological fracture, rare case.

Implementing enhanced recovery after surgery protocol in elderly patients following multi-level posterior lumbar or thoracolumbar instrumented fusion for degenerative diseases.

Enhanced recovery after surgery (ERAS) is an evidence-based multimodal perioperative management strategy. The aim of the present study was to analyze the clinical efficacy of ERAS in elderly patients (> 70 years old) undergoing multi-level posterior lumbar or thoracolumbar instrumented fusion for degenerative diseases. Patients older than 70 years undergoing multi-level lumbar or thoracolumbar instrumented fusion for degenerative disk diseases or spinal stenosis from January 2017 to December 2018 (non-ERAS group) and from January 2020 to December 2021 (ERAS group) were enrolled in present study. Patient-specific and procedure-specific clinical characteristics were collected. Univariate and multivariate regression were performed to determine the risk factors related to length of stay (LOS) and complications. A total of 233 patients were enrolled in this study, 70 in non-ERAS group and 163 in ERAS group. There were comparable baseline characteristics between groups. Further there were no significant differences in 90-day readmission rates and complication rates. However, we observed a significant reduction in LOS (14.89 ± 7.78 days in non-ERAS group versus 11.67 ± 7.26 days in ERAS group, p = 0.002) and overall number of complications (38 in non-ERAS group versus 58 in ERAS group, p = 0.008). Univariate linear regression denoted that operation time (p < 0.001), intraoperative blood loss (p < 0.001), intraoperative blood transfusion (p < 0.001), fusion number ≥ 5 (p < 0.001), spinal surgery including the thoracic spine (p < 0.001), CCI > 2 (p = 0.018), ERAS (p = 0.003) and spinal surgery including lumbar (p = 0.030) were associated with LOS. Furthermore, multivariate linear regression showed that ERAS (p = 0.001), CCI > 2 (p = 0.014), and Fusion number ≥ 5 (p = 0.002) were independent risk factors for LOS. Analogously, univariate logistic regression revealed that longer operation time (p = 0.005), more intraoperative blood loss (p < 0.001), more intraoperative blood transfusion (p = 0.001), fusion number ≥ 5 (p = 0.001), ERAS (p = 0.004) and spinal surgery including thoracic spine (p = 0.002) were related to complications, while implementing ERAS was associated with less complications. Multivariate logistic regression denoted that implementation of ERAS (p = 0.003), Intraoperative blood loss (p = 0.003) and Fusion number ≥ 5 (p = 0.008) were independent risk factors for postoperative complications. In conclusion, the present study reported the first ERAS principles performed in multi-level lumbar or thoracolumbar instrumented fusion for degenerative conditions. Our outcomes shown that the implementation of ERAS in these populations is favorable for reducing LOS and decreasing overall number of complications though the comparable complication rates between two groups. Totally, our ERAS protocols were safe and feasible in these populations.

Observation of the effect of single dose intravenous infusion of tranexamic acid on white blood cell, erythrocyte sedimentation rate and C-reactive protein after double segmental posterior lumbar interbody fusion

To observe the safety and effectiveness of single dose intravenous infusion of tranexamic acid (TXA) in dual level posterior lumbar interbody fusion (PLIF), and to explore the changes and trends in perioperative white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Between October 2020 and September 2022, 46 patients with lumbar degenerative disease were treated with dual level PLIF, including 18 males and 28 females, with an average age of (60.24±10.68) years old, from 34 to 80 years old. They were divided into observation group and control group according to different treatment methods. There were 28 patients in the observation group, including 12 males and 16 females, with an average age of (61.04 ± 9.03) years old. There were 3 cases with lumbar disc herniation (LDH), lumbar spinal stenosis (LSS) 18 cases, lumbar spondylolisthesis (LS) 7 cases. TXA (1 g/100 ml) was administered intravenously 15 min before skin incision after general anesthesia. The control group consisted of 18 patients, including 6 males and 12 females, with an average age of (59.00±13.04) years old. There were 5 cases with LDH, LSS 9 cases, LS 4 cases, and TXA was not used. The operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative deep vein thrombosis (DVT), postoperative hospital stay, postoperative activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), platelet (PLT), red blood cell (RBC), hemoglobin (HB), hematocrit (HCT), the first day, the fourth day, the seventh day and the last tested after operation WBC, ESR and CRP were recorded. The postoperative wounds of the patients healed well and there was no DVT. 46 patients were followed up from 3 to 6 months. The intraoperative blood loss was 400.0 (300.0, 500.0) ml and the postoperative drainage was 260.0 (220.0, 450.0) ml in the observation group, which were lower than the control group[600.0(400.0, 1000.0) ml, 395.0 (300.0, 450.0) ml], P<0.05. There was no significant difference between the two groups in operation time, postoperative hospital stay, postoperative APTT, PT, TT, FIB, PLT, RBC, HB, HCT, and postoperative WBC, ESR and CRP at different times (P>0.05). Single dose intravenous infusion of TXA can reduce the blood loss of bi-segmental PLIF, and has no significant effect on WBC, ESR and CRP after operation.

Risk factors affecting cervical spondylotic myelopathy complicated with traumatic central cord syndrome and the efficacy of different treatment options

ObjectiveTo analyze the influencing factors and treatment options of cervical spondylotic myelopathy (CSM) complicated with traumatic central cord syndrome (TCCS).MethodsA total of 243 patients with CSM admitted to our hospital from January 2021 to September 2022 were retrospectively analyzed, and then divided into the control group (n = 152) and the observation group (n = 91) according to the presence or absence of concurrent TCCS. The clinical data and imaging data of the two groups were compared, and multivariate logistic regression was used to analyze the influencing factors of CSM complicated with TCCS. Patients in the observation group were further divided into the zero notch anterior cervical interbody fusion device (Zero-P) group (n = 45) and the cervical spine locking plate (CSLP) group (n = 46) according to the treatment mode, and the perioperative indexes of the two groups were compared. The treatment effects were evaluated by the American Spinal Injury Association (ASIA) and the Japanese Orthopedic Association (JOA) before surgery, 1 week after surgery and 6 months after surgery. The height of intervertebral space and the cervical lordosis angle were measured.ResultsMultivariate logistic regression analysis showed that the injury mechanism (hyperextension injury), hand muscle weakness, cervical instability, age, degree of cervical spinal stenosis, degree of cervical spinal cord compression, and changes in intramedullary high signal were the risk factors, while the type of compression (soft), ASIA score and JOA score were the protective factor for CSM complicated with TCCS (P < 0.05). Patients in Zero-P group had much shorter operation time and hospitalization time than these in CSLP group (P < 0.05). The cervical lordosis angle and intervertebral space height at 1 week and 6 months after operation in the two groups were both largely higher than these before operation, and the cervical lordosis angle and intervertebral space height in the Zero-P group were significantly higher than these in the CSLP group one week after surgery (P < 0.05). The ASIA score and JOA score were obviously increased in the two groups 1 week and 6 months after surgery, and the ASIA score and JOA score in the Zero-P group were significantly higher than these in the CSLP group at 1 week after surgery (P < 0.05).ConclusionThe mechanism of TCCS in CSM is still controversial, which it is generally believed to be caused by cervical hyperextension injury. The clinical symptoms are diverse, and the treatment methods are also different. This study shows that the mechanism of injury, type of compression, hand muscle weakness, cervical instability, age, cervical stenosis compression, and intramedullary high signal changes are all risk factors for CSM complicated with TCCS. Early identification of risk factors and targeted interventions can effectively reduce the complicated rate of TCCS. Zero-P and CSLP surgical fixation have good efficacy in the treatment of TCCS, and there is little difference in efficacy between the two. However, Zero-P fixation surgery has the advantages of short operation time and fast postoperative recovery.

Sagittal Realignment Following Decompression for Lumbar Spinal Stenosis in Elderly Patients: A Comprehensive EOS Imaging Analysis

Background/Objectives: This study investigated whether decompression surgery for lumbar spinal stenosis can effectively improve sagittal alignment in elderly patients. With the growing focus on sagittal balance in spinal surgery, this study aimed to evaluate post-decompression alignment changes and identify the factors influencing these changes using the EOS imaging system. Methods: A retrospective analysis was conducted on 49 elderly patients who underwent decompression surgery alone for lumbar spinal stenosis. Radiologic parameters, measured using the EOS system, and clinical outcomes were assessed preoperatively, at two weeks postoperatively, and at one year postoperatively. Patients were grouped based on the improvement of the sagittal vertical axis (SVA) by 25 mm or more. A multivariate analysis was performed to identify factors affecting sagittal alignment changes. Results: Significant sagittal alignment improvements were observed postoperatively, including a notable increase in thoracic kyphosis and a decrease in SVA observed at one year. Clinical outcomes, such as the Oswestry disability index (ODI) and EQ-5D, significantly improved at both two weeks and one year postoperatively compared to preoperative values (all p-values &lt; 0.05). Multivariate analysis revealed that greater preoperative SVA and higher ODI were significant predictors of sagittal alignment changes (odds ratio [OR] for SVA = 1.014, OR for ODI = 1.034). Conclusions: Decompression surgery for lumbar spinal stenosis in elderly patients can result in significant improvements in sagittal alignment and clinical outcomes. The study suggests that decompression alone is a viable surgical option for elderly patients, particularly those with a greater preoperative sagittal imbalance and disability, even in the absence of major deformities.

A randomized trial on three different minimally invasive decompression techniques for lumbar spinal stenosis. Five years follow-up from the NORDSTEN-SST.

The short-term clinical outcome for midline-preserving posterior decompression techniques was comparable. The aim of this study was to evaluate long-term clinical results after three different midline-preserving posterior decompression techniques. In the NORDSTEN spinal stenosis trial (NORDSTEN-SST) 437 patients were randomized to three different midline-retaining posterior decompression techniques: Unilateral laminotomy with crossover (UL), bilateral laminotomy (BL) and spinous process osteotomy (SPO). Primary outcome was the mean change in Oswestry disability index (ODI) score at five-years follow-up. Secondary outcomes were the proportion of patients classified as success, mean change in EQ-5D, ZCQ-score, NRS-score for leg and low back pain, a seven-point Global Perceived Effect (GPE) Scale and proportion of subsequential spinal surgery. The number of patients that completed follow-up data after five years was 358 (82%): In the UL, BL and SPO group the numbers were 122, 119 and 117, respectively. Mean age at baseline was 66.7 (SD 8.2) years, mean BMI was 27.8 (SD 4.1), and 172/358 (48%) were female. In the UL group the mean change was -18.2 (95% CI -21.0 -5.4), in the BL group it was -19.0 (95% CI -21.9-16.1) and in the SPO it was -18.6 (95% CI -21.6-15.7) (p = 0.917). No significant differences in the secondary outcomes between the three surgical groups were found, also the subsequent spinal surgery rates were similar. There were no significant differences in patient reported outcomes and subsequent spinal surgery rates after the three different decompression techniques at five-year follow-up.

Anesthetic Management and Considerations During Surgical Dissection of a Schwannoma Causing Severe Cervical Spinal Canal Stenosis and Vertebral Artery Compression

Anesthetic Management and Considerations During Surgical Dissection of a Schwannoma Causing Severe Cervical Spinal Canal Stenosis and Vertebral Artery Compression

Factfinders for patient safety: Epidural steroid injection in patients with lumbar spinal stenosis

This FactFinder presents a brief summary of the evidence suggesting that epidural steroid injections can be safely performed even in the setting of severe, multilevel lumbar spinal stenosis.

Age-Related Association Between Unilateral Single-Channel and Double-Channel Surgery and Postoperative Multifidus Muscle Atrophy and Fat Infiltration.

Unilateral biportal endoscopic laminotomy (UBE) and percutaneous endoscopic laminotomy (PEL) are minimally invasive spinal surgery (MISS) techniques used for unilateral and dual-channel endoscopic laminectomy. However, limited research has been conducted on lumbosacral multifidus muscle injuries in elderly individuals undergoing MISS for lumbar spinal canal stenosis. The objective of this study was to investigate the impact of single-channel and double-channel MISS on the multifidus muscle in elderly patients. A total of 107 patients who underwent MISS were stratified into two cohorts: group A (<65 years) and group B (≥65 years). Preoperative imaging data, including magnetic resonance imaging, were gathered to classify the degree of stenosis based on the nerve root compression. The extent of multifidus muscle atrophy and fat infiltration was assessed by calculating the fat-free cross-sectional area (FCSA)/cross-sectional area (CSA) ratio before and after surgery through measurements of CSA and FCSA. Total cross-sectional area/FCSA were calculated using MRI cross-sectional T2WI. The degree of atrophy and fat infiltration did not change between procedures in group A (P>.05), but changed significantly in group B (P<.05). Unilateral single-channel and double-channel surgery had no significant effect on the degree of multifidus muscle atrophy and fat infiltration in patients younger than 65 years. However, in patients 65 years and older, the degree of multifidus muscle atrophy and fat infiltration significantly increased with the increasing incidence of lateral recess stenosis, which was positively correlated with the duration of surgery. [Orthopedics. 202x;4x(x):xx-xx.].

Effect of facet joint resection on postoperative radiographic and clinical outcomes after microendoscopic laminectomy for single-level lumbar spinal stenosis

Facet joint destruction causes postoperative spinal instability, resulting in poor clinical outcomes after lumbar decompression surgery. However, the effect of facet joint destruction on radiographic and clinical outcomes after microendoscopic laminectomy (MEL) is unknown. Therefore, the current study aimed to examine the effect of facet joint resection on radiographic and clinical outcomes after single-level MEL surgery. This study included 116 patients with lumbar spinal canal stenosis (LSCS) who underwent single-level (L4/5) MEL surgery. Eligible patients were divided into the following groups: group P (facet joint preservation rate = 100%) (n = 70); group PR (50% ≤ the facet joint preservation rate < 100%) (n = 27); and group R (the facet joint preservation rate < 50%) (n = 19). The demographic characteristics of the patients, surgical data, pre- and 1-year postoperative radiographic measurements, and clinical outcomes were compared among the three groups. Moreover, pre- and postoperative radiographic and clinical outcomes were compared after adjusting the demographic characteristics of the patients and surgical data by the inverse probability weighting method with propensity scores. The three unweighted groups did not significantly differ in terms of demographic characteristics, surgical data, and pre- and postoperative radiographic and clinical outcomes. Even after adjusting for the demographic characteristics and surgical data, the pre- and postoperative radiographic and clinical outcomes were comparable among the three weighted groups. The extent of facet joint resection might have a minimal impact on radiographic and clinical outcomes at 1 year after single-level MEL surgery.

Evaluation of the sagittal vertical axis with postural and 3D motion analyses in lumbar spinal stenosis

BackgroundSagittal balance, commonly impaired in lumbar spinal stenosis (LSS) patients, is typically assessed using the sagittal vertical axis (SVA) with EOS imaging. However, to limit X-ray exposure and medical costs, it could be interesting to evaluate the capacity of quantified motion analysis to estimate the 3D modeling of SVA in patients with symptomatic LSS.MethodsAn estimation of the SVA in patients with LSS was performed with 3D motion analysis. SVA and “C7_PSI” (orthogonal horizontal distance between the vertical lines through the markers of the C7 vertebra and the middle of the posterosuperior iliac spine) were measured on 37 LSS patients using EOS radiography and postural and 3D motion analysis, respectively. Multiple stepwise linear regressions were performed with EOS SVA according to age, body mass index, C7_PSI and/or postural variables.ResultsA highly significant relationship was found between SVA and C7_PSI, mediolateral amplitude of CoP displacements and age (adjusted R²=0.69, p < 0.0001). While the postural analysis did not reveal significant relationships, the model using 3D parameters revealed significant relationships between radiographic SVA and C7_PSI and age (adjusted R²=0.65, p < 0.0001). 3D motion parameters with or without postural parameters may explain more than 65% of the variance seen in EOS imaging performed on LSS patients.ConclusionsThese promising results in LSS patients suggest that the estimation of SVA with 3D motion analysis offers an alternative to EOS. In addition, SVA could be assessed at rest and during dynamic tasks.Trial registrationThis study has been published in Clinical Trial registration (reference NCT03194607).

Relationship of the Iliac Crest Height with Subsidence After Oblique Lateral Interbody Fusion at L4-5: A Quantitative and Categorical Analysis.

Background: This study aimed to evaluate the impact of iliac crest height on clinical and radiological outcomes following oblique lateral interbody fusion (OLIF) at the L4-5 level. Methods: Data of patients who underwent single-level OLIF at the L4-5 level for degenerative spinal stenosis were retrospectively analyzed. The patients were categorized into three groups based on their iliac crest height measured relative to the L4 and L5 pedicles. Categorical and quantitative analyses, including univariate and multivariate logistic regressions, were performed to identify subsidence predictors. Clinical outcomes, including visual analog scale scores for back and leg pain, were assessed over a minimum 2-year follow-up. Results: No significant differences in cage obliquity were observed across the iliac crest height groups (axial angles, p = 0.39; coronal angles, p = 0.79). However, subsidence was significantly more common in patients with higher iliac crest heights, particularly at crest level III, where the subsidence rate reached 43% (p = 0.01). Subsidence was predominantly associated with damage to the L5 endplate, which occurred in 83% of subsidence cases at crest level III. A cutoff value of 12 mm for iliac crest height, above which the risk of subsidence significantly increased, was identified (AUC = 0.688, p = 0.042). Conclusions: Iliac crest height is a critical factor for predicting subsidence following OLIF at the L4-5 level. Surgeons should consider alternative strategies and meticulous preoperative planning in patients with an iliac crest height ≥ 12 mm to reduce the risk of adverse outcomes. Further studies are needed to validate these findings and to explore their long-term implications.

Neurosarcoidosis Masquerading as Spinal Stenosis.

A 65-year-old woman was admitted to the neurology department with a suspected demyelinating disease due to complaints of progressive pain and weakness in both upper and lower limbs, as well as urinary incontinence. MRI of the spine revealed complex disc osteophyte with compression of the spinal cord in the cervical and lumbar spine at several vertebral levels, and localized enhancement in the cervical spine at the site of maximal spinal canal stenosis. During her hospitalization, the patient underwent extensive evaluation to rule out any systematic inflammatory diseases, infections, and malignancy. Chest CT revealed bilateral mediastinal lymphadenopathy. Transbronchial mediastinal lymph node biopsy showed numerous non-necrotizing granulomas without evidence of malignancy. After a thorough and careful exclusion of a demyelinating, infectious, and paraneoplastic myelopathies, and based on clinical, radiographic, and pathological findings, the patient was diagnosed with both neurosarcoidosis and spondylotic myelopathy. She was then treated for neurosarcoidosis, including glucocorticosteroids, azathioprine, and a biosimilar of the anti-TNF alpha agent infliximab, resulting in both clinical and radiographic improvement. Intramedullary spinal neurosarcoidosis is very rare and may present with clinical features of spondylotic myelopathy, with typical imaging findings occurring only in areas of spinal canal stenosis.

N6-methyladenosine-modified circCDK14 promotes ossification of the ligamentum flavum via epigenetic modulation by targeting AFF4

BackgroundThe ligamentum flavum (LF) is an important anatomical structure of the spine. Ossification of the LF (OLF) has become the leading cause of thoracic spinal stenosis. Circular RNAs (circRNAs) and N6-methyladenosine (m6A) modification are reported to be associated with several human diseases. However, the role of circRNAs and m6A modification in the pathogenesis of OLF has not been fully investigated. Here, we aimed to explore the vital function of circRNAs and m6A modification in OLF.Materials and methodsWe analysed the circRNA expression of 4 OLF tissues and 4 normal LF tissues using bioinformatic analysis and identified circCDK14 for further analysis. We investigated the effects of circCDK14 on the osteogenic differentiation of LF cells. We observed that circCDK14 regulated its target genes by binding to miRNAs as a miRNA sponge. Moreover, the circRNA pull-down assay indicated that RNA-binding proteins might regulate the expression of circCDK14 via m6A modification.ResultsCircCDK14 was significantly upregulated in OLF tissues compared to normal LF tissues. Overexpression of circCDK14 promoted the osteogenic differentiation of LF cells. Mechanistically, CircCDK14 promoted the expression of ALF transcription elongation Factor 4 (AFF4) by serving as a sponge for miR-93-5p. Moreover, Wilms tumour 1-associated protein (WTAP) increased the stability of circCDK14 via N6-methyladenosine modification.ConclusionThe m6A-modified CircCDK14 binding to miR-93-5p played an important role in the osteogenesis of LF cells by targeting AFF4, providing a promising therapeutic target for OLF.

Prevalence, Radiological, and Pathological Findings of Ossification and Calcification of the Lumbar Spinal Ligamentum Flavum: A Comparative Study with Thoracic Lesions.

This study aimed to determine the prevalence of lumbar ligamentum flavum lesions and identify correlations between radiological and pathological findings. We conducted an observational cross-sectional study of 349 patients (lumbar: n = 296, thoracic: n = 39, lumbar and thoracic: n = 14, mean age: 69 ± 12 years, male: 74%) who underwent posterior surgery for thoracolumbar spinal canal stenosis between January 2008 and April 2023 at our hospital.Computed tomography (CT) revealed that the prevalence of ligamentum flavum lesions defined as a high-density area with a CT value of 200 Hounsfield Unit or higher in the lumbar and thoracic spine was 47% (147/310) and 85% (45/53), respectively. CT showed that most patients had radiologically suspected ossification in the lumbar (90%) and thoracic spine (98%) than radiologically suspected calcification. Lumbar lesions were thinner than the thoracic lesions (2.5 vs 3.7 mm, p < 0.01). Pathological examinations were performed in specimens collected from 34 cases (lumbar: n = 13, thoracic: n = 21), and ossification was found in 62% (8/13) and 95% (20/21) of lumbar and thoracic lesions (p = 0.02), respectively. Lastly, ossification was confirmed pathologically in 72% (8/11) and 95% (19/20) of lumbar and thoracic lesions that showed ossification on imaging (p = 0.13), respectively. The literature review revealed that the prevalence of the lumbar ligamentum flavum lesions varied from 1.5 to 35% and the patient population was mostly asymptomatic.Collectively, we found that the prevalence of lumbar ligamentum flavum lesions in symptomatic patients was greater than previously reported. Histologically confirmed ossification was less common in lumbar lesions than in thoracic lesions.