Degenerative Spinal Disorders Research Articles

Interventional Pain Management in Degenerative Spine Disorders: A Case Report

Low back pain (LBP) is a common health issue affecting a significant portion of the population, particularly adults aged 35-55 years. Nearly 70-80% of individuals in developed countries experience LBP at some point in their lives. We reported a 54-year-old female presenting with LBP persisting for one year. Her pain predominantly occurs during walking, is limited to 100 meters, and is characterized by gripping sensations in the thigh and calf, exacerbated by positional changes but relieved with rest. Imaging revealed anterior listhesis of the L4 vertebral body relative to L5 (<25%) and multiple bulging discs at various lumbar levels, most notably severe at L4-5 with moderate central and severe bilateral neural foraminal stenosis. The patient underwent Selective Nerve Root Block (SNRB) and facet joint blocks with local anesthetic and steroid medication, resulting in a reduction of pain complaints and decreased leg numbness post-intervention. Understanding and addressing specific spinal pathologies in this case was expected to guide effective treatment strategies to alleviate symptoms and improve patient function.

The Effect of L5 Morphology on Prevention of L5-S1 Degeneration Following Floating Fusion for Degenerative Spine Disorders.

Retrospective Study. The selection of floating fusion or lumbosacral fusion arises when treating patients with instability or stenosis of the lower lumbar spine concomitantly radiographic degeneration of L5-S1. This study aimed to investigate the preoperative anatomical or morphological factors affecting the survivorship of the L5-S1 after floating fusion. This study included 77 patients who had undergone floating fusion surgery through the TLIF approach. Preoperative radiographic parameters were evaluated using anteroposterior and lateral lumbar spine radiographs. The patients were divided into two groups according to the Modified Pfirrmann Grading and total endplate score. Multivariable regression analysis was performed to explore the relationships between the anatomical or morphological characteristics of L5 and the degeneration of L5-S1. The disc degeneration group exhibited a smaller height ratio of the iliac crest (Hi) and a less L5 deep position. Furthermore, the right/left height of L4 (Hr/Hl) and the right/left width of transverse process of L5 (CRt/CLt) were significantly higher in the disc and endplate degeneration groups. Multiple logistic regression analysis revealed that Hi and CRt were independently associated with L5-S1 disc degeneration, whereas Hr was a significant risk factor for L5-S1 endplate degeneration. Anatomical and morphological characteristics of L5, such as smaller Hi, higher CRt and Hr, were associated with an increased risk of L5-S1 degeneration in patients after floating fusion. These findings may indicate the fusion level when addressing lower lumbar degenerative diseases and the concurrent radiographic degeneration of L5-S1.

Machine Learning Models for Predicting Dysphonia Following Anterior Cervical Discectomy and Fusion – A Swedish Registry Study

BACKGROUNDDysphonia is one of the more common complications following anterior cervical discectomy and fusion (ACDF). ACDF is the gold standard for treating degenerative cervical spine disorders, and identifying high-risk patients is therefore crucial. PURPOSEThis study aimed to evaluate different machine learning models to predict persistent dysphonia after ACDF. STUDY DESIGNA retrospective review of the nationwide Swedish spine registry (Swespine) PATIENT SAMPLEAll adults in the Swespine registry who underwent elective ACDF between 2006 and 2020. OUTCOME MEASURESThe primary outcome was self-reported dysphonia lasting at least one month after surgery. Predictive performance was assessed using discrimination and calibration metrics. METHODS: Patients with missing dysphonia data at the one-year follow-up were excluded. Data preprocessing involved one-hot encoding categorical variables, scaling continuous variables, and imputing missing values. Four machine learning models (logistic regression, random forest (RF), gradient boosting, K-nearest neighbor) were employed. The models were trained and tested using an 80:20 data split and 5-fold cross-validation, with performance metrics guiding the selection of the best model for predicting persistent dysphonia. RESULTSIn total, 2,708 were included in the study. Twelve key predictors were identified. Four machine learning models were tested, with the RF model achieving the best performance (AUC = 0.794). The most significant predictors across models included preoperative NDI, EQ5Dindex, preoperative neurology, number of operated levels, and use of a fusion cage. The RF model, chosen for its superior performance, showed high sensitivity and consistent accuracy, but a low specificity and positive predictive value. CONCLUSIONSIn this study, machine learning models were employed to identify predictors of persistent dysphonia following ACDF. Among the models tested, the RF classifier demonstrated superior performance, with an AUC value of 0.790. The RF model identified NDI, EQ5Dindex, and number of fused vertebrae as key variables. These findings underscore the potential of machine learning models in identifying patients at increased risk for dysphonia persisting for more than one month after surgery.

Prognostic Factors for Outcome of Fusion Surgery in Patients With Chronic Low Back Pain - A Systematic Review.

Systematic review. This systematic review aims to identify prognostic factors, encompassing biomedical and psychosocial variables, linked to outcome of fusion surgery for chronic low back pain (CLBP) in single or two-level lumbar degenerative spinal disorders. Identifying these factors is crucial for decision making and therefore long-term treatment outcome. A systematic search (PROSPERO ID: CRD4202018927) from January 2010 to October 2022 was conducted, utilizing Medline, Embase, and the Cochrane Database of Systematic Reviews (CDSR, CENTRAL). Prognostic factors associated with various outcomes, including functional status, back and leg pain, health-related quality of life, complications, return to work, and analgesic use, were assessed. Risk of bias was determined using QUIPS, and the quality of evidence was evaluated using GRADE approach. Of the 9852 initially screened studies, eleven studies (n = 16,482) were included in the analysis. In total, 161 associations were identified, with 67 prognostic factors showing statistical significance (P < 0.05). Thirty associations were supported by two or more studies, and only eight associations were eligible for meta-analyses: female gender remained statistically significant associated with decreased postoperative back pain, but negatively associated with complication rates and functional status, and smoking with increased postoperative back pain. Only female gender and smoking were consistently associated with outcome of fusion for CLBP. Most of the included studies exhibited low to moderate methodological quality, which may explain the relatively weak associations identified for the assessed prognostic factors.

Prone Single Position Approach to Lateral Lumbar Interbody Fusion: Systematic Review and Meta-Analysis.

Lateral lumbar interbody fusion (LLIF) with posterior screw fusion is a safe and effective treatment for patients suffering from degenerative spine disorders. While LLIF has been shown to restore disc height, decompress neural components, correct sagittal imbalances, and improve pain scores, the approach requires repositioning patients for posterior pedicle fixation, which requires 2 separate surgeries. The evolution of surgical techniques, navigation, and robotics has allowed for a single position approach to LLIF with the patient in the prone position. The purpose of this study was to perform a systematic review and meta-analysis comparing the prone single position (PSP) LLIF approach to the dual position LLIF approach. We hypothesized that PSP LLIF will have a reduced operative time, complication rate, and blood loss compared with the dual position LLIF procedure. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed and Embase databases were searched with key terms: (lateral AND [interbody OR "inter body"] AND lumbar AND fusion) AND (prone OR single). Results were extracted and reviewed by 2 authors (MR and RB) per selection criteria. Patient demographics were extracted from the selected studies, along with surgical, patient-reported, and radiographic outcomes. A meta-analysis was performed using an unstandardized mean difference or log odds ratio with a confidence level of 95%. Fifteen studies were included in the systematic review and 5 studies compared PSP LLIF to dual position LLIF for meta-analysis. PSP LLIF had a reduced operative time and length of stay compared with the dual position approach, although there was no significant reduction in estimated blood loss. Additionally, PSP LLIF improved lumbar lordosis more effectively than dual position LLIF. There was no difference in segmental lordosis or pelvic tilt. There was no difference in intraoperative complications, postoperative complications, or reoperations. PSP LLIF reduces operative time and length of stay, with no relative increase in complications or reoperations compared with the dual position approach. Additionally, PSP LLIF improves lumbar lordosis relative to dual position LLIF, which may improve functional outcomes and reduce the risk of developing adjacent segment disease. The associated operative and postoperative benefits of PSP LLIF may improve long-term outcomes of patients undergoing spinal fusion.

Perioperative Complications of Oblique Lumbar Interbody Fusion (OLIF): 5 Years of Experience with OLIF

Abstract Objective The objective of this study was to share our early experience with oblique lumbar interbody fusion (OLIF), with emphasis on the perioperative complications and determine clinical outcomes following OLIF. Materials and Methods It was a retrospective prospective study performed at a single institute from March 2019 to August 2023. A total of 56 consecutive patients who had undergone OLIF for degenerative spine disorders were enrolled in the study. Pre-, intra-, and postoperative data on these patients were collected. All the patients were followed up at regular intervals with an evaluation of Visual Analog Scale (VAS), Oswestry Disability Index (ODI), neurological parameters, and X-rays to look for fusion, screw loosening, pseudoarthrosis, and cage slippage. Statistical analysis was done with the odds ratio, chi-square test, and Student's t-test. A p-value of &lt; 0.05 was considered significant. Results The overall incidence of complications was 25%, with no mortality. Intraoperative complications were noted in 10.7% of cases. This included endplate fractures (n = 3), peritoneal lacerations (n = 2), and ureteric injury (n = 1). The most common early postoperative complications were postoperative ileus (n = 6), followed by anterior thigh or groin numbness (n = 3), ipsilateral psoas weakness (n = 2), and superficial surgical site infection (n = 2). Of the late postoperative complications, cage subsidence was the most common, which occurred in 4 patients, followed by adjacent segment degeneration (n = 2) and loss of indirect decompression (n = 1). The mean ODI and VAS scores showed significant improvement (p &lt; 0.05) at the final follow-up. Conclusion OLIF is a promising surgical technique with the potential to treat a variety of degenerative conditions of the lumbar spine with a good clinical outcome. Despite its various benefits, OLIF can lead to complications in rare instances, which every spine surgeon should be aware of.

Determining critical monitoring periods for accurate wearable step counts in patients with degenerative spine disorders

Longitudinal physical activity monitoring is a novel and promising objective outcome measure for patients with degenerative spine disorder (DSD) that currently lacks established standards for data collection and interpretation. Here, we monitored 100 patients with DSD with the Apple Watch to establish the optimal duration and pattern of step count monitoring needed to estimate their weekly physical activity before their elective surgery. Participants were predominantly female (65.3%), had an average age of 61.5 years, and showed consistent step counts between preoperative days, as well as across weekends and weekdays. Intraclass correlations (ICC) analysis showed that a step count average over 2 days achieved an ICC of 0.92 when compared to a 7-day average before surgery, while 4 days were required for a similar agreement of 0.93 with a 14-day average. Sequential linear regression demonstrated that incorporating additional preoperative days improved the model’s ability to predict 7- and 14-days step count averages. We conclude that, while daily preoperative step counts remain relatively stable, longer activity monitoring is necessary to account for the variance in step count over an increasing time frame, and the full extent of data fluctuation may only become apparent with long-term trend analysis.

Benchmarking Large Language Models for Cervical Spondylosis.

Cervical spondylosis is the most common degenerative spinal disorder in modern societies. Patients require a great deal of medical knowledge, and large language models (LLMs) offer patients a novel and convenient tool for accessing medical advice. In this study, we collected the most frequently asked questions by patients with cervical spondylosis in clinical work and internet consultations. The accuracy of the answers provided by LLMs was evaluated and graded by 3 experienced spinal surgeons. Comparative analysis of responses showed that all LLMs could provide satisfactory results, and that among them, GPT-4 had the highest accuracy rate. Variation across each section in all LLMs revealed their ability boundaries and the development direction of artificial intelligence.

Full-Endoscopic Spinal Surgery for Older Patients With Degenerative Spinal Pathology: A Narrative Review

The aging population worldwide is experiencing an increasing incidence of degenerative spinal disorders, leading to significant morbidity and diminished quality of life. Traditional open surgical approaches for treating these conditions in older patients often entail substantial risks and prolonged recovery times. However, recent advancements in endoscopic surgical techniques have provided promising alternatives with potentially reduced morbidity and quicker recovery. This paper reviews the current literature regarding full-endoscopic spinal surgery (FESS) for degenerative spinal pathology in older patients. We discuss the evolution of endoscopic techniques, patient selection criteria, surgical indications, outcomes, and complications associated with FESS in older adults. Several studies have reported favorable outcomes of FESS in older patients, including reduced postoperative pain, shorter hospital stays, faster recovery, and comparable or even improved clinical outcomes compared with traditional open surgery. Moreover, FESS offers the advantages of minimal tissue disruption, preservation of spinal stability, and decreased blood loss, which are particularly advantageous in older patients with multiple comorbidities. However, challenges such as a steep learning curve for surgeons, limited visualization, and technical constraints in managing complex pathologies remain significant concerns. Additionally, the long-term durability and effectiveness of FESS in older patients require further investigation. In conclusion, FESS presents a promising minimally invasive option for treating degenerative spinal pathology in older adults. Further research and technological advancements are needed to optimize patient selection, refine surgical techniques, and improve long-term outcomes in this growing demographic category of patients.

Osteoporosis, spinal degenerative disorders, and their association with low back pain, activities of daily living, and physical performance in a general population

Osteoporosis, vertebral fractures, and spinal degenerative diseases are common conditions that often coexist in older adults. This study aimed to determine the factors influencing low back pain and its impact on activities of daily living (ADL) and physical performance in older individuals with multiple comorbidities. This cross-sectional study was part of a large-scale population-based cohort study in Japan, involving 1009 participants who underwent spinal magnetic resonance imaging (MRI) to assess cervical cord compression, radiographic lumbar spinal stenosis, and lumbar disc degeneration. Vertebral fractures in the thoracolumbar spine were evaluated using sagittal MRI with a semi-quantitative method. Bone mineral density was measured using dual-energy X-ray absorptiometry. Low back pain, Oswestry Disability Index (ODI), and physical performance tests, such as one-leg standing time, five times chair-stand time, maximum walking speed, and maximum step length, were assessed. Using clinical conditions as objective variables and image evaluation parameters as explanatory variables, multiple regression analysis showed that vertebral fractures were significantly associated with low back pain and ODI. Vertebral fractures and osteoporosis significantly impacted physical performance, whereas osteoporosis alone did not affect low back pain or ODI. Our findings contribute to new insights into low back pain and its impact on ADL and physical performance.

Is Type 2 Diabetes Mellitus Associated with Spinal Degenerative Disorders?: Evidence from Observational and 2-Sample Mendelian Randomization Analyses.

Type 2 diabetes mellitus (T2DM) and spinal degenerative disorders (SDD) are common diseases that frequently coexist. However, both traditional observational studies and recent Mendelian randomization (MR) studies have demonstrated conflicting evidence on the association between T2DM and SDD. This comparative study explored and compared the association between T2DM and SDD using observational and MR analyses. For observational analyses, cross-sectional studies (44,972 participants with T2DM and 403,095 participants without T2DM), case-control studies (38,234 participants with SDD and 409,833 participants without SDD), and prospective studies (35,550 participants with T2DM and 392,046 participants without T2DM with follow-up information until 2022) were performed to test the relationship between T2DM and SDD using individual-level data from the U.K. Biobank from 2006 to 2022. For MR analyses, the associations between single-nucleotide polymorphisms with SDD susceptibility obtained using participant data from the U.K. Biobank, which had 407,938 participants from 2006 to 2022, and the FinnGen Consortium, which had 227,388 participants from 2017 to 2022, and genetic predisposition to T2DM obtained using summary statistics from a pooled genome-wide association study involving 1,407,282 individuals were examined. The onset and severity of T2DM are not available in the databases being used. Participants with T2DM were more likely to have SDD than their counterparts. Logistic regression analysis identified T2DM as an independent risk factor for SDD, which was confirmed by the Cox proportional hazard model results. However, using single-nucleotide polymorphisms as instruments, the MR analyses demonstrated no causal relationship between T2DM and SDD. The lack of such an association was robust in the sensitivity analysis, and no pleiotropy was seen. Our results suggest that the association between T2DM and SDD may be method-dependent. Researchers and clinicians should be cautious in interpreting the association, especially the causal association, between T2DM and SDD. Our findings provide fresh insights into the association between T2DM and SDD by various analysis methods and guide future research and clinical efforts in the effective prevention and management of T2DM and SDD. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Large Databases Can Answer Difficult Questions: Commentary on an article by Ming-Xiang Zou, MD, PhD, et al.: "Is Type 2 Diabetes Mellitus Associated with Spinal Degenerative Disorders? Evidence from Observational and 2-Sample Mendelian Randomization Analyses".

Large Databases Can Answer Difficult Questions: Commentary on an article by Ming-Xiang Zou, MD, PhD, et al.: "Is Type 2 Diabetes Mellitus Associated with Spinal Degenerative Disorders? Evidence from Observational and 2-Sample Mendelian Randomization Analyses".

Radiographic Assessment and Clinical Outcomes of Conservative Management in Atlanto-Axial Osteoarthritis: A Study of 108 Patients

Abstract Background: Atlanto-axial osteoarthritis (AAOA) is a degenerative cervical spine disorder predominantly affecting the elderly. The patients typically present with cervico-occipital pain and restricted and painful neck rotations. The condition is primarily diagnosed with an open-mouth view radiograph, and conservative management is the mainstay of treatment. This study aimed to evaluate the effectiveness of conservative management and a novel technique of greater occipital nerve (GON) block in AAOA and assess the radiographic changes in facet angles and autofusion of the facet joints following conservative management. Materials and Methods: This study was conducted in patients with AAOA. Pre- and post-treatment visual analog scale (VAS) and neck disability index (NDI) scores were compared to evaluate clinical improvement following conservative treatment. Additionally, the radiographs were also assessed for changes in the facet angles observed in AAOA. Data analysis was performed using SPSS version 25.0 (IBM, Chicago, IL, USA). Statistical tests including paired t tests and correlation coefficients were used. Results: The atlanto-axial facet angle was significantly reduced on the affected side (P &lt; 0.001) compared to the unaffected side. GON block significantly improved VAS and NDI scores (P &lt; 0.001). Auto-fusion of the arthritic facet joint was observed in 15.47% of patients following conservative treatment. Conclusion: Conservative management is the mainstay of AAOA treatment, effectively alleviating pain and improving the quality of life in the affected individuals.

Enhancing contrast distribution with the far lateral approach in lumbar transforaminal epidural steroid injections: A retrospective analysis.

Herniated intervertebral disc (HIVD) with radiculopathy is a common degenerative spine disorder. Transforaminal epidural steroid injection (TFESI) is one of the pain relief treatments for lumbar radiculopathy recommended by evidence-based guidelines. Adequate contrast distribution is correlated with better pain control, but the best approach has not been confirmed yet. To confirm the distribution of contrast medium injected with a new approach of TFESI, that is, far lateral lateral recess approach (FLLR-TFESI). Patients receiving TFESI due to HIVD with radiculopathy between 2010 January and 2020 August were retrospectively enrolled. While the FLLR-TFESI was taken as the experimental group, the conventional approach was viewed as the control group. The baseline characteristics, the pattern of contrast enhancement under fluoroscopic guidance, and the complications of these patients were collected and analyzed. A total of 380 patients were analyzed (143 in control group and 237 in experimental group). The two groups were balanced in most baseline characteristics, except disc extrusion (p = 0.01) and scoliosis (p = 0.04). The FLLR-TFESI have a better contrast distribution (p < 0.01), even after adjustment (p < 0.001). No intrathecal injection was noted, but higher rate of intra-disc injection was noted in FLLR-TFESI group (10% vs. 3%, p = 0.008). The FLLR-TFESI has a superior contrast enhancement and distribution in comparison to conventional approach. Prospective study to confirm the study result as well as the clinical benefits is suggested in the future.

The use of the Core Yellow Flags Index for the assessment of psychosocial distress in patients undergoing surgery of the cervical spine.

Psychosocial distress (the presence of yellow flags) has been linked to poor outcomes in spine surgery. The Core Yellow Flags Index (CYFI), a short instrument assessing the 4 main yellow flags, was developed for use in patients undergoing lumbar spine surgery. This study evaluated its ability to predict outcome in patients undergoing cervical spine surgery. Patients with degenerative spinal disorders (excluding myelopathy) operated in one centre, from 2015 to 2019, were asked to complete the CYFI at baseline and the Core Outcome Measures Index (COMI) at baseline and 3 and 12months after surgery. The relationship between CYFI and COMI scores at baseline as well as the predictive ability of the CYFI on the COMI follow-up scores were tested using structural equation modelling. From 731 eligible patients, 547 (61.0 ± 12.5years; 57.2% female) completed forms at all three timepoints. On a cross-sectional basis, preoperative CYFI and COMI scores were highly correlated (β = 0.54, in men and 0.51 in women; each p < 0.001). CYFI added significantly and independently to the prediction of COMI at 3months' FU in men (β = 0.36) and 12months' FU in men and women (both β = 0.20) (all p < 0.001). The CYFI had a low to moderate but significant and independent association with cervical spine surgery outcomes. Implementing the CYFI in the preoperative workup of these patients could help refine outcome predictions and better manage patient expectations.

Do TLIF and PLIF Techniques Differ in Perioperative Complications? - Comparison of Complications Rates of Two High Volume Centers.

Retrospective bicentric Cohort Study. Posterior (PLIF) and transforaminal lumbar interbody fusion (TLIF) have been clinically proven for the surgical treatment of degenerative spinal disorders. Despite many retrospective studies, the superiority of either technique has not been proven to date. In the literature, the complication rate of the conventional PLIF technique is reported to be significantly higher, but with inconsistent complication recording. In this retrospective bicentric study, a less invasive PLIF technique was compared with the conventional TLIF technique and complications were recorded using the validated SAVES V2 classification system. 1142 patients underwent PLIF (702) or TLIF (n = 440) up to 3 levels in two specialized centers. Epidemiological data, intra- and postoperative complications during hospitalization and after discharge were analyzed according to SAVES V2. The overall complication rate was 13.74%. TLIF-patients had slightly significant more complications than PLIF-patients (TLIF = 16.6%/PLIF = 11.9%, P = .0338). Accordingly, complications during revision surgeries were more frequent in the first cohort (TLIF = 20.9%/PLIF = 12.6%; P = .03252). In primary interventions, the surgical technique did not correlate with the complication rate (TLIF = 12.4%/PLIF = 11.7%). There were no significant differences regarding severity of complications. An important component of this work is the complication recording according to a uniform classification system (SAVES V2). In contrast to previous literature, we could demonstrate that there is not a significant difference between the two surgical techniques.

Usability and outcomes of self-monitored surgical wound healing using a smartphone-based application by patients following neurosurgery

The Radboudumc developed a smartphone application (WondGezond) to collect surgical wound-healing information provided by the patient. To evaluate usability and outcomes to assess its potential for early surgical site infection (SSI) detection. Patients surgically treated for degenerative spinal disorders or carpal tunnel syndrome between August 2020 and February 2023 were enrolled one day post surgery and asked to download the app via a quick-response (QR) code. Participants uploaded a photoand answered four questions about their wound daily, for 14 days. Afterwards, participants indicated whether they received treatment for a suspected SSI (participant-reported outcome). Two neurosurgeons independently assessed photos and questionnaire answers for suspected SSIs (physician-assessed outcome). The association between both outcomes was determined by calculating sensitivity, specificity, and positive and negative predictive value (PPV/NPV). After 2009 surgeries, 1695 QR-codes were distributed and 412 (21%) were activated. In all, 232 (56%) participants completed the 14-day period of whom 22 (10%) reported SSI treatment. Physician assessment identified 15 (7%) SSIs. Concordance was reached in 88% of cases. Among 27 discordant cases were 17 false-positives and 10 false-negatives, resulting in low sensitivity (33%) and PPV (23%), but high NPV (95%). WondGezond provides clinicians with information regarding wound healing and SSIs to follow-up on patients at risk, while possibly also reducing antibiotic (over)treatment and unnecessary visits for patients without issues in wound healing. However, the low participation and false-positive results render the app in its current form unsuitable for surveillance purposes. Further validation of WondGezond is required.

Spine Surgery in a Geriatric Population. Is it Really Different?

Spinal degenerative disorders are a major cause of morbidity in the elderly resulting in high dependency. Most of them have a trend to be managed conservatively considering age, comorbidities, and apprehensions of surgical complications. Surgical intervention at early stage with appropriate indications can have better outcomes rather than conservative management in fit patients. The objective of the study is to evaluate the functional outcome in geriatric patients > 60 years who have undergone various spinal procedures for degenerative spine. The study is retrospective, which includes all cases of spinal degenerative disease operated between 2014 and 2016. They were divided into geriatric (>60 years) and non-geriatric cohorts. These include all patients undergoing spinal decompression and/or instrumentation for degenerative disorders of the spine. Patients were interviewed for their functional outcomes in the follow-up period. A total of 184 spine cases were operated upon by a single surgeon, out of which a total of 139 cases were operated for the spinal degenerative condition. Forty-eight patients underwent lumbar spinal fusion procedures, 67 underwent non-instrumented lumbar decompression, and 24 patients underwent cervical procedures. These were further divided into 65 geriatric cases and 74 non-geriatric cases. The outcome was assessed with improvement and functional outcomes for spinal disability. Statistical analysis was performed using SPSS 20. It is concluded that surgical intervention for spinal problems in geriatric patients is not different from the general population. The outcome is also satisfactory provided, the choice of surgical procedure as per its indication is appropriate. The usual preoperative evaluation for the geriatric age group is very important. The performance status before surgery and the comorbidities have a direct bearing on the outcome in these patients.

Selenium-SelK-GPX4 axis protects nucleus pulposus cells against mechanical overloading-induced ferroptosis and attenuates senescence of intervertebral disc

Intervertebral disc degeneration (IVDD) is one of the most prevalent spinal degenerative disorders and imposes places heavy medical and economic burdens on individuals and society. Mechanical overloading applied to the intervertebral disc (IVD) has been widely recognized as an important cause of IVDD. Mechanical overloading-induced chondrocyte ferroptosis was reported, but the potential association between ferroptosis and mechanical overloading remains to be illustrated in nucleus pulposus (NP) cells. In this study, we discovered that excessive mechanical loading induced ferroptosis and endoplasmic reticulum (ER) stress, which were detected by mitochondria and associated markers, by increasing the intracellular free Ca2+ level through the Piezo1 ion channel localized on the plasma membrane and ER membrane in NP cells. Besides, we proposed that intracellular free Ca2+ level elevation and the activation of ER stress are positive feedback processes that promote each other, consistent with the results that the level of ER stress in coccygeal discs of aged Piezo1-CKO mice were significantly lower than that of aged WT mice. Then, we confirmed that selenium supplementation decreased intracellular free Ca2+ level by mitigating ER stress through upregulating Selenoprotein K (SelK) expression. Besides, ferroptosis caused by the impaired production and function of Glutathione peroxidase 4 (GPX4) due to mechanical overloading-induced calcium overload could be improved by selenium supplementation through Se-GPX4 axis and Se-SelK axis in vivo and in vitro, eventually presenting the stabilization of the extracellular matrix (ECM). Our findings reveal the important role of ferroptosis in mechanical overloading-induced IVDD, and selenium supplementation promotes significance to attenuate ferroptosis and thus alleviates IVDD, which might provide insights into potential therapeutic interventions for IVDD.

Impact of restricted physical activity on pain intensity and functional impairment in patients with degenerative spinal disorders

Impact of restricted physical activity on pain intensity and functional impairment in patients with degenerative spinal disorders