Background: Ac Lumbo-sacral transitional vertebra (LSTV) represents a common congenital anomaly at the lumbo-sacral junction, often associated with altered biomechanics, early degeneration and chronic low back pain (CLBP). Despite its clinical significance, regional data from South Kashmir remain limited. Objective: To determine the prevalence and types of LSTV among chronic low back pain patients in South Kashmir, using radiological evaluation (X-ray and MRI), and to assess associated degenerative changes and radiculopathy. Methods: This hospital-based cross-sectional study included patients aged 16–80 years presenting with chronic low back pain at MMABM Hospital, GMC Anantnag in South Kashmir, from June 2024 to May 2025. All subjects underwent lumbo-sacral spine imaging—either X-ray, MRI, or both. LSTV was identified and classified according to Castellvi’s classification1. Degenerative changes, adjacent segment disc pathology, and nerve root involvement were assessed. Data were analyzed for prevalence, laterality, and radiological correlations. Results: Of 208 patients evaluated, 35% (n=73) demonstrated LSTV on radiology. The most frequent subtype was Castellvi Type II (40%), followed by Type I (30%). Unilateral LSTV cases exhibited more severe degenerative changes and earlier disc space narrowing than bilateral types. Adjacent segment disc degeneration was observed in a majority of LSTV patients (70%), particularly at the L4–L5 level. Radiculopathy was present in a substantial proportion of cases with LSTV, frequently corresponding to foraminal stenosis or nerve root compression above the transitional level. Conclusion: LSTV is a frequent finding among chronic low back pain patients in South Kashmir, with a prevalence of approximately 35%. Unilateral variants are associated with more pronounced degeneration and radicular symptoms. Recognition of this variant on X-ray and MRI is vital for accurate diagnosis, classification, and management of low back pain

Introduction:Lumbar foraminal stenosis (LFS) is a recognized source of radiculopathy and chronic low back pain, yet the relationship between radiological severity and clinical presentation remains uncertain. Although magnetic resonance imaging (MRI) is routinely used to evaluate foraminal narrowing, imaging findings frequently do not parallel symptom burden. This systematic review examined the diagnostic value of imaging modalities and the strength of radiological-clinical correlation in LFS.Materials and Methods:A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Science Direct and Cochrane Library databases were searched up to May 2025. Randomized controlled trials, cohort studies, and observational studies involving adult patients with lumbar or foraminal stenosis assessed using MRI or computed tomography were included if correlations between imaging findings and clinical outcomes were reported. Study selection and data extraction were performed independently by two reviewers. Risk of bias (RoB) was assessed using RoB 2 and RoB in non-randomized studies – of interventions tools, and overall certainty of evidence was graded using the grading of recommendations assessment, development and evaluation framework.Results:Twelve studies involving 1,133 patients were included in the study. A moderate correlation (r = 0.3–0.6) was observed between imaging severity and pain intensity. Severe stenosis grades demonstrated sensitivity ranging from 60% to 85% and specificity from 70% to 90% for symptomatic cases. However, several studies reported poor correlation between MRI grading and disability scores or walking capacity. Foraminal cross-sectional area below 40–50 mm2 was associated with increased symptom likelihood. The sedimentation sign showed high diagnostic specificity. Interobserver reliability was strong for disk morphology but only moderate for nerve root compression. Study heterogeneity limited pooled interpretation.Conclusion:Imaging findings demonstrate only moderate alignment with clinical severity in LFS. MRI should be interpreted alongside functional assessment and clinical evaluation rather than in isolation. A multidimensional diagnostic approach is necessary to guide appropriate management.

» C5 palsy is an infrequent but clinically meaningful complication after cervical decompression, classically presenting as new deltoid—and often biceps—weakness (with or without shoulder pain) that is typically delayed in onset (most often postoperative days 2-7) and occurs without global neurologic decline. » Incidence varies by procedure and technique—pooled estimates are roughly 4% to 7% overall, with the highest rates after multilevel posterior laminectomy and fusion (∼9%-12%), lower rates after laminoplasty (∼4%-5%; technique-dependent), and generally lower but nonzero rates after anterior procedures (with corpectomy higher risk than anterior cervical discectomy and fusion). » Risk appears multifactorial, but the most reproducible predictors center on C4-5 anatomy and postoperative cord/foraminal mechanics (notably preexisting C4-5 foraminal stenosis, greater posterior cord drift/shift, and factors such as ossified posterior longitudinal ligament), with additional associations including male sex, older age, multilevel surgery, posterior longitudinal ligament resection, corpectomy (especially ≥3 levels), and asymmetric/wide decompression. » Prevention is best approached as risk-adapted surgical planning rather than a single maneuver: incorporate approach selection when equipoise exists, scrutinize preoperative imaging for C4-5 foraminal and cord morphology, avoid excessive/asymmetric decompression or alignment changes that may exacerbate cord drift, and consider selective prophylactic C4-5 foraminotomy in high-risk patients (recognizing most supporting evidence is observational). » Most patients improve substantially with conservative management, but prognosis depends on initial severity; management should prioritize early imaging to exclude surgically correctable causes, structured rehab/close strength monitoring, and early referral for peripheral nerve evaluation when severe palsy (manual muscle testing ≤2/5) shows little improvement by ∼3 months, given the time-sensitive window for successful nerve transfer reconstruction (often performed within the first ∼6-9 months when indicated).

Background: Oblique lateral interbody fusion (OLIF) is a minimally invasive technique with various complications. Here, a 55-year-old female karate instructor with previous L4/5 laminectomy underwent L4/5 OLIF that resulted in an inguinal hernia. Case Description: A 55-year-old female karate instructor with previous L4/5 laminectomy underwent L4/5 OLIF for symptomatic foraminal stenosis. Postoperatively, she experienced immediate symptom relief, but developed a left lower abdominal bulge on postoperative day 13. Despite negative computed tomography findings, laparoscopic exploration at 6 months confirmed the presence of an indirect inguinal hernia, which was successfully repaired. Three surgical factors likely led to this hernia (1) retroperitoneal dissection requiring incision of the transverse fascia, causing mechanical stress, collagen reduction/inflammatory changes that weakened the posterior wall of the inguinal canal; (2) the lumbar corset increased the intra-abdominal pressure (2–4 mmHg average, peaks up to 10 mmHg) redirecting pressure caudally toward Hesselbach’s triangle; and (3) occupational activities required repetitive Valsalva maneuvers, thus imposing recurrent pressure loading on weakened fascial structures. Conclusion: This report documents that a 55-year-old female karate instructor with previous L4/5 laminectomy following a L4/5 OLIF developed a delayed inguinal hernia. Spine surgeons should include inguinal hernia in differential diagnosis of postoperative lower abdominal bulging, and emphasize the need for meticulous fascial reconstruction.

How to summarise or combine lumbar MRI-findings for studying associations with low back pain: A modified Delphi study.

Acquired and Degenerative Conditions of the Cervical Vertebral Column in Horses.

A parametric analysis of interbody fusion cages placement: A finite elements approach comparing lumbar lordosis of bullet and steerable banana cages.

The effects of foraminotomy and distraction-stabilization on the dimensions of the lumbosacral neuroforamen throughout range of motion.

Objective: Cervical foraminotomy is a critical surgical intervention for addressing foraminal stenosis. Traditional magnetic resonance imaging may be insufficient for diagnosing transcanal stenosis. This lacuna is efficiently solved by using 2-dimensional sagittal-oblique multiplanar reconstruction computed tomography (CT) scans (2D-SOMPR). Standard medial facetectomy is insufficient if pathology extends to the outer foramen. This study investigates a combined approach, utilizing unilateral biportal endoscopy with CT scan-aided imaging, to achieve decompression in complex foraminal stenosis.Methods: A cohort of 23 patients with severe transcanal foraminal stenosis underwent the combined foraminotomy technique. Thirteen patients received single-level decompression, while 4 underwent multilevel procedures. Three patients with bilateral root involvement underwent hemilaminectomy for cervical myelopathy.Results: All patients reported complete neurological symptom relief at a mean follow-up of 12 months. Visual analogue scale and Neck Disability Index scores showed significant improvements, with 22 patients achieving excellent outcomes. Minor transient irritation of the exiting nerve root was observed in 8 patients, resolving within 8 weeks. One patient with preoperative C5–6–7 root palsy experienced partial recovery. No permanent neurological deficits, infections, or surgical complications were noted.Conclusion: The combined standard and inclinatory foraminotomy approach is a safe and effective solution for complex cervical foraminal stenosis. This technique ensures complete neural decompression while preserving facet joint function.

We report 2 cases of cervical myelopathy treated using a posterior cervical muscle-preserving interspinous process approach with decompression. This technique allows effective central decompression while preserving the extensor musculature and the anchoring function of the spinous processes. The first case involved a 64-year-old woman with multilevel cervical stenosis and myelopathy who underwent decompression at C5–7. The second case involved a 70-year-old woman with C4–5 ossification of the yellow ligament and progressive left arm weakness who underwent single-level decompression. Notably, neither case exhibited significant foraminal stenosis. In both procedures, a small midline incision was made to expose the interspinous space, followed by retraction of the interspinalis cervicis using a blunt mini-Gelpi retractor and undercutting decompression performed with a Kerrison punch and a high-speed drill. No intraoperative complications were observed. Postoperatively, both patients demonstrated neurological and functional improvement, including increased modified Japanese Orthopaedic Association and 36-Item Short Form Health Survey scores, decreased visual analogue scale pain scores, and preserved cervical alignment without evidence of dynamic instability on flexion–extension radiographs. The accompanying surgical videos illustrate the operative steps in detail and highlight the advantages of this minimally invasive technique for both single-level and multilevel decompression.

Objective: Partial resection of the superior articular process (SAP) is commonly performed during transforaminal endoscopic lumbar foraminotomy (TELF) for the treatment of lumbar foraminal stenosis (LFS). The present study evaluated the efficacy and feasibility of total SAP resection using the selective superior articular process resection (SSAPR) technique, in comparison with conventional TELF.Methods: This retrospective cohort study included 79 patients with symptomatic LFS who were treated using TELF (52 segments) or SSAPR (34 segments) between March 2018 and September 2022. Clinical outcomes were evaluated using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and MacNab criteria. Vertebral slippage was measured to assess segmental stability, and postoperative complications were systematically analyzed.Results: The study cohort consisted of 79 patients (39 men and 40 women; mean age, 61.9±14.2 years) who were followed for a mean duration of 14.5±2.2 months. At the final follow-up, no significant differences were identified between the TELF and SSAPR groups in VAS or ODI scores (p=0.603 and p=0.776, respectively). Vertebral slippage increased significantly in the TELF group, from 5.49±3.64 mm to 8.75±6.78 mm (p=0.019), whereas only minimal changes were observed in the SSAPR group, from 3.67±3.57 mm to 3.86±3.17 mm (p=0.858). Grade 2 dysesthesia occurred in 12.8% of TELF cases but was not observed in the SSAPR group (p=0.07).Conclusion: The SSAPR technique provides effective foraminal decompression with improved surgical efficiency and a lower risk of postoperative nerve irritation, while maintaining segmental stability. These findings support the clinical utility of total SAP resection as a safe and viable alternative to conventional partial SAP resection for the treatment of LFS.

Objective: To evaluate the clinical efficacy of unilateral biportal endoscopy contralateral inclinatory approach (UBE-CIA) in the treatment of lumbar foraminal stenosis. Methods: A retrospective case series study was conducted on 32 patients with lumbar foraminal stenosis who underwent UBE-CIA at Department of Orthopaedics, the Second Affiliated Hospital of Anhui Medical University between March 2021 and December 2024. There were 14 males and 18 females, with an age of (54.7±12.3) years (range:27 to 77 years). In terms of clinical indicators, the visual analogue scale (VAS) for pain and the Oswestry disability index (ODI) were recorded preoperatively,postoperatively, and at final follow-up. The modified MacNab criteria were used to evaluate clinical efficacy. Regarding radiological indicators, the changes in the foraminal area and facet joint area were measured preoperatively and postoperatively. Repeated measures analysis of variance was used for comparing repeated measurement data, and the Student-Newman-Keuls test was used for pairwise comparisons. Paired sample t-test was used for comparing radiological data. Results: All 32 patients underwent operations successfully with an operative time of (91.9±33.4) min (range:43 to 172 min) and postoperative hospital stay of (5.8±1.7)d (range:2 to 10 d). All patients were followed up for (17.1±4.6) months (range:7 to 30 months). The VAS score for lower extremity pain in patients before surgery was 7.2±1.0, which decreased to 2.0±0.8 one week after surgery and further to 0.8±0.5 at the last follow-up (F=406.822, P<0.01); the VAS score for low back pain before surgery was 4.5±1.2, which dropped to 1.8±0.9 one week after surgery and further to 0.7±0.5 at the last follow-up (F=175.579, P<0.01); the ODI before surgery was (69.0±8.7)%, which decreased to (25.9±6.0)% one week after surgery and further to (10.3±2.5)% at the last follow-up (F=662.586, P<0.01). All differences were statistically significant. The excellent and good rate according to the modified MacNab criteria was 93.8% (30/32). The foraminal area increased from (61.4±14.6) mm² to (108.4±16.9) mm², with a statistically significant difference (t=-18.190, P<0.01). The facet joint preservation rate was (85.8±3.9)%. Conclusions: UBE-CIA provides excellent clinical efficacy for lumbar foraminal stenosis. It effectively relieves lower limb and back pain, significantly improves functional disability, and achieves effective decompression of the exiting nerve root, providing an effective treatment option for complex foraminal stenosis diseases.

Segmental zoster paresis (SZP) of the upper limb is a complication of herpes zoster (HZ), but the risk factors for onset and prognosis of SZP are still unknown. The aims of this study were to analyze the correlations between neural foraminal stenosis (NFS) and the incidence and prognosis of upper-limb SZP. In this retrospective case-control study, 87 HZ inpatients with C5-T1 spinal nerves affected were reviewed and divided into a case group (n = 21) and a control group (n = 66) based on whether they had SZP. Logistic regression analysis was used to assess correlation between NFS and the incidence of upper-limb SZP. Within the case group, Cox regression analyses were used to evaluate the correlation between NFS and complete muscle strength recovery at 24 months. Univariate and multifactor logistic analysis revealed that the grade of NFS was an independent risk factor for the incidence of upper extremity SZP [mild NFS (aOR = 18, p < 0.05); moderate NFS (aOR = 30, p < 0.05); severe NFS (aOR = 90, p < 0.05)]. Univariate and multifactorial Cox regression analyses confirmed the grade of NFS (HR = 0.186, p < 0.05) and baseline muscle strength (HR = 23.015, p < 0.05) as independent prognostic factors affecting complete muscle strength recovery of upper-limb SZP. The grade of NFS is an independent risk factor for the occurrence and poor prognosis of SZP in patients with upper extremity HZ. The evaluation of NFS should be incorporated into the prognosis assessment and individualized treatment strategy development for patients with upper limb SZP. Prospective cohort studies with larger sample sizes are needed.

Retrospective cohort study from a single academic institution. To identify clinical and radiographic predictors for sacral extension (SE) during revision lumbar fusion. Lumbar fusion is common, with revision rates up to 25.9% within two years. When planning a revision of lumbar fusion, surgeons may extend constructs from L5 to the sacrum to improve stability, decompression, or alignment, but sacral extension alters biomechanics and increases risks such as pseudoarthrosis, adjacent segment disease, and proximal junctional kyphosis. Predictors for sacral extension during revision remain poorly defined. Adult patients undergoing anterior or transforaminal lumbar interbody fusion (ALIF or TLIF) between 2017-2022 at a single academic institution, and those referred for revision with sacral extension, were reviewed. Eligible patients had an index fusion spanning L1-L4 to L5 or above. Sacral extension was defined as instrumentation to S1 or the pelvis within two years. Demographics, frailty indices, radiographic parameters, and complications were collected. Operative notes were reviewed to identify indications. Analyses included t-tests, chi-square, and multivariable logistic regression. Of 181 patients, 50 (27.6%) underwent SE and 131 (72.4%) remained fused between L1-L5. SE patients had higher frailty scores (MFI-5, P=0.018) and lower L4-L5 lordosis (P=0.020). Independent predictors included increased frailty (OR 7.015, P=0.032), greater fusion length (OR 1.796, P=0.012), and reduced L4-S1 lordosis (OR 1.137, P=0.007). Closer alignment of L1PA to ideal was protective (OR 0.81 per degree, P=0.009). Common indications were distal junctional degeneration (58%), foraminal stenosis (40%), and pseudoarthrosis (38%). Frailty, longer constructs, and inadequate caudal lordosis independently predicted sacral extension during revision, while optimal L1PA alignment was protective. The most common indications were distal junctional degeneration, pseudoarthrosis, foraminal stenosis, and spondylolisthesis. These findings may aid preoperative risk stratification and surgical planning.

We aimed to evaluate the association between the radiological grade of lumbar foraminal spinal stenosis (LFSS) and the outcomes of dorsal root ganglion (DRG) pulsed radiofrequency (PRF) treatment. This is an observational, single-center study. Patients with LFSS who had undergone lumbar DRG-PRF treatment were evaluated according to the radiological grade of stenosis: Grades 1, 2, and 3. Severity of pain, presence of neuropathic pain, and functional status were assessed using a numerical rating scale (NRS), the Douleur Neuropathique en 4 (DN4) Questionnaire, and the Oswestry Disability Index (ODI) at baseline, first, and third months. The groups by grade consisted of 18, 22, and 23 patients, respectively, for Grades 1, 2, and 3. NRS scores are similar at baseline and first month, but higher in Group 3 than in Groups 1 and 2 at the third month (p = 0.010, p = 0.04). Similarly, DN4 scores are similar at baseline and first month, but higher in Group 3 than in Group 1 (p = 0.017). ODI scores and weekly analgesic intake at baseline, first, and third months are similar. There are significant decreases in the NRS, DN4, ODI, and weekly analgesic consumption in all groups during follow-up (p < 0.05). The ratios of meaningful pain relief were 72.2%, 68.2%, and 69.6% at the first month, and 50.0%, 63.6%, and 43.5% at the third month for Grades 1, 2, and 3 groups, respectively, without significant differences at the first and third months (p > 0.05). The DRG-PRF treatment is effective for pain and functional disability in LFSS in all grades, although pain scores remained higher in Grade 3 stenosis at the third month. Studies with larger sample sizes for each stenosis grade may provide more accurate and detailed information.

Dynamic compensation in spinopelvic alignment and its relation to symptom severity in patients with lumbar spinal stenosis.

Clinical Study on Percutaneous Spinal Endoscopic Treatment for New-Onset Lumbosacral Pain Following Vertebral Augmentation Procedures.

Abstract Background: Lumbar spinal stenosis (LSS) is a dynamic condition whose severity can be underestimated on conventional supine magnetic resonance imaging (cMRI), especially in patients with a clinico-radiological mismatch between symptoms and imaging findings. Axial loaded MRI (al-MRI) has been proposed to simulate the spine conditions under physiological load, potentially improving the diagnostic accuracy. Materials and Methods: In this retrospective observational study, patients with clinically suspected LSS, whose cMRI findings did not fully explain their symptoms, underwent additional al-MRI between L3 and S1. Disk levels were assessed for changes in the grade of central canal stenosis, lateral recess stenosis, foraminal stenosis, and dural sac cross-sectional area (DSA). Results: Out of 237 patients (711-disk levels), significant changes were observed on al-MRI compared to cMRI. Central canal stenosis grade increased from A/B to C/D in 87-disk levels in 73 patients (30.8%). Lateral recess stenosis changed in 33 patients (13.9%) with clear nerve root compression on al-MRI. DSA decreased from &gt;75 mm² to &lt;75 mm² in 93-disk levels (18.1%) in 80 patients (33.8%). Foraminal stenosis grade changed in 178 of 1422 foramina examined, with definite nerve root compression identified in 13 foramina across 11 patients (4.6%). Additionally, occult facet synovial cysts were detected in three patients on al-MRI but not on cMRI. Conclusion: Axial-loaded MRI provides valuable additional diagnostic information in patients with suspected LSS and a clinico-radiological mismatch on conventional MRI. Its routine use in carefully selected cases may enhance diagnostic accuracy and guide appropriate management.

Previous studies comparing the anterior versus posterior approach for the treatment of degenerative cervical myelopathy (DCM) report similar neurological outcomes. Although multilevel DCM is frequently combined with foraminal stenosis, previous studies have analyzed the outcomes of myelopathy without specifically addressing the outcomes of combined radicular symptoms. To compare the outcomes following anterior and posterior decompressive procedures for DCM combined with multilevel foraminal stenosis. A retrospective study. A cohort of patients with DCM with multilevel foraminal stenosis (>3 levels) who underwent decompression was analyzed. In the anterior group (group A), multilevel anterior cervical decompression and fusion were performed, and the posterior group (group P) consisted of laminoplasty with foraminotomies. Nurick grade, visual analogue scale (VAS) of neck and arm pain, neck disability index (NDI), short-form 36 (SF-36), complications, clinical adjacent segment pathologies (CASP), and additional operations performed were analyzed. C2-7 angle and range of motion, and Kellgren grade of radiographic adjacent segment pathology (RASP) were evaluated. A total of 96 patients were enrolled (M:F=53:43, mean age 60.8y, A: P=54:42, mean 36.6mo follow-up). All clinical parameters showed significant improvement from preoperative neurological status without significant difference between the 2 groups at the final follow-up. Both RASP grade and incidence of CASP were higher in the anterior group (A: 42.6% vs. P: 19.2%, P=0.014). The incidence of additional procedures was similar (A: 9.3% vs. P: 16.7%, P=0.276); however, the etiology was mainly CASP in the anterior group (4-5 cases) and persistent radicular symptoms in the posterior group (6-7 cases). Anterior and posterior decompressive surgeries are reliable for the surgical treatment of DCM with multilevel foraminal stenosis and showed similar outcomes for both myelopathy and upper extremity radicular symptoms. The major etiology compromising the clinical outcome was a higher incidence of CASP in the anterior group and persistent or recurrent upper extremity radicular symptoms in the posterior group.

Background: Lumbar disc herniation (LDH) is a common cause of low back pain (LBP) and disability in adults, often requiring advanced imaging for diagnosis. Although magnetic resonance imaging (MRI) is the gold standard for assessing intervertebral disc pathology, few epidemiological studies have described its prevalence in Mexican populations. Objective: To determine the prevalence and radiological characteristics of lumbar disc herniations in adult patients with LBP undergoing MRI at General Hospital 450, Durango, Mexico, during 2024. Methods: We conducted a retrospective, observational, cross-sectional study including electronic medical records and MRI reports of adult patients with LBP. Sociodemographic variables and imaging findings were analyzed. Descriptive statistics were applied to estimate prevalence and disc involvement patterns. Results: A total of 320 patients were included (63.4% women, mean age 51.2 years). Disc herniation was identified in 32.5% of cases, most frequently as protrusions (27.5%) and less commonly as extrusions (5.0%). Single-level involvement predominated (82.7%), with L4–L5 being the most affected segment (37.7%), followed by L5–S1 (27.0%). Disc bulging was present in 57.7% of cases, and advanced degeneration (Pfirrmann grade IV) was the most frequent degenerative change (61.5%). Foraminal stenosis was reported in 38.9%, and nerve root compression in 36.5%. Overweight and obesity were documented in 72.5% of patients. Conclusion: LDH prevalence among Mexican adults with LBP was 32.5%, with disc protrusion at L4–L5 being the most common presentation. The high frequency of overweight and obesity suggests potential modifiable risk factors. These findings provide epidemiological evidence to optimize diagnostic strategies and preventive measures in similar populations. Keywords: lumbar disc herniation, low back pain, magnetic resonance imaging, prevalence, degenerative disc disease.