L5-S1 Segment Research Articles

Does metabolic syndrome exacerbate spinal degeneration in patients with lumbar disc herniation: a two-year retrospective cohort study.

Does metabolic syndrome exacerbate spinal degeneration in patients with lumbar disc herniation: a two-year retrospective cohort study.

Adaptation of the Lumbar Spine From Orthostasis to Supine.

Observational-ecologic study. Spine and pelvis undergo modifications in alignment so that the individual can maintain an orthostatic position, but to date there is no evidence as to the contribution of each lumbar segment and the change that occurs in them when moving from orthostasis to supine position. To identify the difference in the contribution of the lumbar segments and pelvis to the formation of lumbar lordosis in both positions (orthostasis and supine) and how each one alters in this change. lumbar lordosis adapts to the individual's body position and can be physiological or pathologic. Retrospective cohort study that included 174 patients: the segments total lumbar lordosis (LL), L1-L4, L4-S1, L4-L5, L5-S1, and sacral slope were measured on x-rays (orthostasis) and MRI (supine). We obtained the mean values, correlations and models proposed for the relationship between the values found. The SS, LL, L1-L4, L4-S1, and L4-L5 had their angular value reduced, and L5-S1 had its contribution to lordosis significantly increased when lying down. Moderate and strong correlations were obtained between SS × LL, L1-L4 and L4-S1, and between LL versus L1-L4 and L4-S1 in both positions. When using linear regression, proposed models were obtained with a high coefficient of determination between LL versus SS, L1-L4 and L4-S1 in orthostasis, for the same measurements and SS versus L4-S1 in supine, as well as for lordosis when comparing the 2 positions. The L5-S1 segment has no change in angular value when lying in supine and is thus the largest contributor to lordosis in supine. L1-L4 increases its angular value when standing in orthostasis, the position in which it is the greatest contributor to lordosis.

Biomechanical Comparison of a Novel Facet Joint Fusion Fixation Device With Conventional Pedicle Screw Fixation Device: A Finite Element Analysis.

The biomechanics of a novel facet joint fusion device is unknown. The objective of this study is to analyze and compare the biomechanical properties of a novel facet joint fusion device integrated with oblique lateral interbody fusion (OLIF) to those of a conventional pedicle screw fixation device, employing finite element analysis. A comprehensive three-dimensional finite element model of the L3-S1 lumbar spine was developed and validated. Based on this model, three surgical groups were created: OLIF combined with the bilateral facet joint fusion fixation (BFJFF + OLIF), unilateral pedicle screw fixation (UPSF + OLIF), and bilateral pedicle screw fixation (BPSF + OLIF), focusing on the L4-L5 level. A torque of 7.5 Nm was applied to simulate vertebral activities under six conditions: flexion, extension, lateral bending (left and right), and axial rotation (left and right). The maximum displacement at the L4-L5 segment was then calculated. The maximum stress values were recorded at the L4-L5 interbody fusion cage and the L3-L4 and L5-S1 segments. When compared to the other two models, the BFJFF + OLIF model exhibited the smallest maximum displacement value at the L4-L5 segment across all six working conditions. The BFJFF + OLIF model also demonstrated the lowest maximum stress value at the L4-L5 segment interbody fusion cage under flexion, as well as left and right lateral bending and axial rotation conditions when compared with the other models. However, under the extension condition at the L4-L5 interbody fusion cage, the BPSF + OLIF model showed the lowest maximum stress value. At the adjacent L3-L4 segments, the BFJFF + OLIF model registered the lowest maximum stress value during flexion and left lateral bending conditions. At L3-L4, under extension and right lateral bending conditions, the UPSF + OLIF model exhibited the lowest maximum stress value. Under left axial rotation at the L3-L4 segment, both the BFJFF + OLIF and UPSF+OLIF models demonstrated the smallest maximum stress values. Under right axial rotation at the L3-L4 segment, the BPSF + OLIF model recorded the smallest maximum stress value. Concurrently, at the L5-S1 segment, the BFJFF + OLIF model presented the lowest maximum stress value under conditions of flexion, as well as left and right lateral bending and axial rotation. In the L5-S1 segment during the extension condition, the UPSF+OLIF model exhibited the lowest maximum stress value. This study demonstrates that the novel device, when combined with OLIF, achieves 360° lumbar fusion by fusing the lumbar facet joints, thereby enhancing spinal stability post-fusion. Concurrently, stress on adjacent segments was diminished. The findings suggest that this device may serve as a novel internal fixation method. It may provide a new option for the surgical treatment of patients with low back pain in the future.

Bilateral Lumbar Micro-Foraminotomy and Micro-Discectomy with 18 Months Postoperative Follow-Up: A Series of 27 Cases

Background: Bilateral lumbar micro foraminotomy and bilateral micro-discectomy is considered as a gold standard surgical technique for the treatment of patients with lumbar disc hernia (LDH) with lateral recess stenosis (LRS) although various types of treatment are being developed. Objective: This study aimed to investigate the safety and efficacy of bilateral lumbar micro-foraminotomy and bilateral micro-discectomy for the treatment of patients with lumbar disc hernia (LDH). Methodology: This was a retrospective cohort study conducted in the Department of Neurosurgery & Neuro-ICU at Enam Medical College & Hospital, Savar, Dhaka during the period of January 2019 to December 2020. All data were collected from patient files. Data were collected pre-designed data collection sheet. Results: This study shows shows maximum (48.1%) were 41 to 50 years followed by 37.0% were 31 to 40 years and 14.8% were 20 to 30 years. The average age was 39.66±9.25 years. Majority (77.8%) were male and 22.2% cases were female. The most common levels affected by soft disc prolapse recess stenosis are L4-5 and L5-S1 segments. This study shows the mean Oswestry Disability Index (ODI) were 76.11±12.81 in preoperative and 5.00±7.72 postoperative. The decrease in values has been found to be significant in preoperative and postoperative (P<0.001). Study found only 3.7% was complications. Conclusion: Bilateral lumbar micro foraminotomy and bilateral micro-discectomy is an effective and safe method in the treatment of soft disc prolapse with lateral recess stenosis as it has low complication rates. Journal of National Institute of Neurosciences Bangladesh, January 2024;10(1):17-20

Difference in stiffness-related functional disability between decompression alone and decompression with short segments fusion (1 or 2 levels) in the lower lumbar region: a propensity scores matching study.

Difference in stiffness-related functional disability between decompression alone and decompression with short segments fusion (1 or 2 levels) in the lower lumbar region: a propensity scores matching study.

Lumbar total disk replacement versus microsurgical lumbar discectomy in treatment of radicular and back pain in railway workers: a prospective randomized controlled trial.

Currently, there remains a high percentage of complications after lumbar discectomy, while there is no uniform tactic to prevent their development. Purpose of the study was to compare the clinical efficacy and return to work rate (RWR) after total disk replacement (TDR) and microsurgical lumbar discectomy (MLD) in railway workers with lumbar disk herniation (LDH). We randomly assigned 75 patients out of a total of 81 patients, between 25 and 35 years of age who had one level LDH to undergo single-level TDR surgery (group I, n=37) or MLD surgery (group II, n=38) in the L4-L5 or L5-S1 segments. The functional state was assessed using the Oswestry Disability Index (ODI), pain severity was analyzed using the Visual Analogue Scale (VAS) for back pain and leg pain, quality of life was assessed according to SF-36 preoperatively, at discharge, and at 3, 6, and 12 months postoperatively. The X-ray assessment was used to assess the efficacy of the respective surgical methods pre-operatively and last follow-up of 1-year. Workload intensity criterions were used to analyze return to work 1 year after surgery. Clinical and radiographic observers were blinded for the assigned treatment during the 12-month follow-up. As expected, the MLD group had statistically significantly lower duration of surgery and less bleeding than TDR group. At a 1-year follow-up period, the TDR group had significantly better ODI, VAS and SF-36 than the MLD group. The postoperative X-ray revealed a statistically significant difference of the range of motion (ROM) and global lumbar lordosis in TDR group compared to the MLD group. After TDR procedure in light-moderate and heavy-very heavy workload patients groups had a statistically significantly higher RWR compared with MLD. The analysis revealed a comparable number of symptomatic complications in both groups (P=0.47), with a greater frequency of reoperations in the follow-up period in MLD group in comparison TDR group (P=0.04). The use of single-level TDR in railway workers has made it possible to significantly improve long-term clinical results, reduce the risk of reoperations, restore of segmental mobility at operation level, preserve of global lumbar lordosis and RWR compared to MLD. Russian Clinical Trial Registry 622011400059-4.

Low Back Pain During and After Spaceflight: A Systematic Review with Meta-Analysis.

Space flights can produce physiological changes in the spine, leading to the development of acute and chronic pain in passengers. However, there is a lack of comprehensive literature exploring physiological spine changes and acute and chronic pain in space passengers (astronauts and animals). The first aim of this study was to identify the physiological changes experienced by passengers (humans and animals) after space flight. The second aim was to identify the incidence of low back pain during and after space flight. This systematic review was conducted following PRISMA guidelines and was pre-registered in PROSPERO (ID 451144). We included Randomized Controlled Trials or longitudinal studies in humans and animals, and the variables must be assessed either in-flight or post-flight. We conducted a literature search in major databases combining the keywords: Pain; Space; Low Back Pain; Astronauts; Spine Changes; Microgravity; Physiological Changes; Humans; Animals. Risk of bias and quality of studies were analyzed, and the level of evidence was assessed using the GRADE system. After duplicates were removed, 115 abstracts were screened by two reviewers, and finally, 11 articles were included in this review. The evidence indicates that astronauts experience muscle atrophy in the lumbar multifidus with a moderate to large effect, especially in the L4-L5 and L5-S1 segments. Space flights also decrease the range of motion with a moderate effect, along with disc herniations and disc dehydration. 77% of astronauts experience pain during spaceflight, and 47% develop acute pain after spaceflight. Chronic pain was reported by 33% of the astronauts. After space flights, astronauts suffer from lumbar muscle atrophy, reduced range of motion, disc herniations, and disc dehydration, with a high incidence of both acute and chronic pain.

Study on the clinical effect of meridian massage in the treatment of lumbar disc herniation

To observe the clinical efficacy of meridian massage in the treatment of lumbar disc herniation(LDH). Between July 2020 and April 2023, 82 patients with lumbar disc herniation were selected, including 58 males and 24 females, aged from 23 to 55 years old with an average of (43.76±6.64) years old. According to the different treatment methods, they were divided into observation group and control group with 41 cases in each group. The control group was treated with routine treatment, and the observation group was treated with meridian massage on the basis of routine treatment. In the control group, there were 30 males and 11 females;aged from 22 to 52 years old with an average of (42.27±9.34) years old;the Body mass index (BMI) ranged from 19 to 28 kg·m-2 with an average of(23.82±1.08) kg·m-2;the course of disease ranged from 0.5 to 3.0 years (2.40±0.48) years. There were 28 cases in L4,5 segment and 13 cases in L5S1 segment. In the observation group, there were 28 males and 13 females;the age ranged from 19 to 54 years old (42.19±9.26) years old;the BMI ranged from 18 to 29 kg·m-2 with an average of(23.73±1.15) kg·m-2;the course of disease ranged from 0.6 to 2.8 with an average of(2.56±0.45) years;there were 26 cases in L4,5 segment and 15 cases in L5S1 segment. Visual analogue scale(VAS), Oswestry disability index(ODI), M-JOA score and TCM syndrome score were measured before and after 3 courses of treatment, and the clinical efficacy was evaluated by the standard of curative effect evaluation. After treatment, VAS [(3.24±1.45) vs(4.46±0.64)], ODI [(11.45±1.98)% vs (17.21±2.74)%] and TCM symptom score [(2.03±0.27) vs (3.99± 0.54)] of the observation group were lower than those of the control group. The score of M-JOA [(23.43±2.61) vs (19.37±1.62)] increased (P<0.05). The scores of VAS, ODI and TCM symptoms in the observation group were lower than those in the control group, while the scores of M-JOA were higher than those in the control group (P<0.05). Meridian massage is effective in the treatment of LDH, which can effectivelyrelieve low back pain, improve clinical symptoms and increaselumbar function, which is worthy of clinical promotion.

The Implications of Sacralized Transitional Vertebra on Spinal Alignment.

Retrospective study of a multicentric prospective database. This study aimed to determine, in a cohort of healthy volunteers, the impact of sacralized lumbo-sacral transitional vertebra (LSTV) on spinal alignment according to its grade, particularly regarding lumbar lordosis magnitude and distribution, and the implications for spinopelvic parameters measurement. There is little data regarding spinopelvic alignment assessment in LSTV patients. This study included healthy volunteers with full-body stereoradiographs in free-standing position aged over 18. Castellvi grade, pelvic parameters (measured on S1 and L5), L1-S1 lumbar lordosis (LL) and segmental lordosis for each disc and vertebral body, thoracic kyphosis, cervical lordosis, lower limb, and global alignment parameters were assessed. Castellvi I and II were considered as Low-grade and Castellvi III and IV as High-grade LSTV. Alignment parameters between No-LSTV, Low- and High-grade LSTV were compared. Propensity score matching was used to match PI in No-LSTV and Low-grades. Spinopelvic parameters measured on S1 in No-LSTV group and on L5 in High-grade were compared. 713 subjects were included, of whom 23 Low-grades and 27 High-grades. Mean pelvic incidence was 51.0±11.0° and mean age was 37.5±16.2 years. LL distribution was different between groups, with an apex and inflexion point significantly higher in High-grade (P<0.001). Kyphosis in the LSTV segment was compensated for by a steeper increase of LL above L5 in the High-grades. Low-grades and PI-matched No-LSTV presented similar alignment parameters. There were minor differences in parameters measured on S1 in No-LSTV and no L5 in High-grades. Subjects with low-grade LSTV present similar alignment as PI-matched No-LSTV subjects, and S1 should be taken as reference to measure spinopelvic parameters. High-grade LSTV subjects have kyphotic L5-S1 segment with more cranial lumbar apex and thoracolumbar inflexion point. In these subjects, spinopelvic parameters should be measured on L5.

In-silico study on cumulative effects of degeneration and anterior circumferential annular tear on the L5-S1 spinal unit

Low back pain is a serious health concern prevalent in majority of the people around the world, especially in case of the elderly. The root cause for this is mostly observed to be the development of lesions/ tears complemented by degenerative effects in the intervertebral disc of L4-L5 and L5-S1 segments. This study aims to analyse the effects of disc degeneration and tears on the mechanical responses of the L5-S1 spinal unit, which has not been investigated. The annulus is represented by an anisotropic hyperelastic Gasser-Ogden-Holzapfel (GOH) model wherein the effect of degeneration is defined by varying the constants responsible for the behaviour of the material in different strain-ranges. A systematic approach is proposed for modelling the effects of disc degeneration in the annulus. Further, the commonly found anterior circumferential tear is modelled to understand its combined effects with degeneration of the annulus. The damaging effect of the tear was limited only to extension movement, causing critical stress variations in its vicinity. However, degeneration had a significant influence on both stress and range of motion of the spinal unit across all types of movements. This study highlights the complex relationship of the physiological movements with pathogenesis of tear and degeneration leading to discogenic pain thus enabling clinicians to develop conservative treatment strategies for specific age groups.

Fully Endoscopic Transforaminal Approach for L5–S1 Foraminal Stenosis: A Narrative Review

Lumbar foraminal stenosis (LFS) is a fairly common degenerative condition of the spine that can often occur in the L5–S1 segment. Traditional surgical approaches for LFS can be categorized into microscopic foraminotomy via the Wiltse approach and interbody fusion. Microscopic foraminotomy via the Wiltse approach was previously considered the gold standard for treating LFS. However, with advancements in endoscopic equipment and techniques, fully endoscopic foraminotomy through various approaches is now widely performed for the treatment of LFS. Among these approaches, endoscopic foraminotomy via the transforaminal approach offers many advantages, but difficulties may be encountered when there are anatomical barriers, which are often present in the L5–S1 segment. This study aimed to explore the overall clinical outcomes and complications of transforaminal endoscopic lumbar foraminotomy, as well as the challenges specific to the L5–S1 segment and techniques to overcome them.

Artificial intelligence automatic measurement technology of lumbosacral radiographic parameters.

Currently, manual measurement of lumbosacral radiological parameters is time-consuming and laborious, and inevitably produces considerable variability. This study aimed to develop and evaluate a deep learning-based model for automatically measuring lumbosacral radiographic parameters on lateral lumbar radiographs. We retrospectively collected 1,240 lateral lumbar radiographs to train the model. The included images were randomly divided into training, validation, and test sets in a ratio of approximately 8:1:1 for model training, fine-tuning, and performance evaluation, respectively. The parameters measured in this study were lumbar lordosis (LL), sacral horizontal angle (SHA), intervertebral space angle (ISA) at L4-L5 and L5-S1 segments, and the percentage of lumbar spondylolisthesis (PLS) at L4-L5 and L5-S1 segments. The model identified key points using image segmentation results and calculated measurements. The average results of key points annotated by the three spine surgeons were used as the reference standard. The model's performance was evaluated using the percentage of correct key points (PCK), intra-class correlation coefficient (ICC), Pearson correlation coefficient (r), mean absolute error (MAE), root mean square error (RMSE), and box plots. The model's mean differences from the reference standard for LL, SHA, ISA (L4-L5), ISA (L5-S1), PLS (L4-L5), and PLS (L5-S1) were 1.69°, 1.36°, 1.55°, 1.90°, 1.60%, and 2.43%, respectively. When compared with the reference standard, the measurements of the model had better correlation and consistency (LL, SHA, and ISA: ICC = 0.91-0.97, r = 0.91-0.96, MAE = 1.89-2.47, RMSE = 2.32-3.12; PLS: ICC = 0.90-0.92, r = 0.90-0.91, MAE = 1.95-2.93, RMSE = 2.52-3.70), and the differences between them were not statistically significant (p > 0.05). The model developed in this study could correctly identify key vertebral points on lateral lumbar radiographs and automatically calculate lumbosacral radiographic parameters. The measurement results of the model had good consistency and reliability compared to manual measurements. With additional training and optimization, this technology holds promise for future measurements in clinical practice and analysis of large datasets.

COMPARISON OF THE EFFECT OF TWO REHABILITATION PROGRAMS ON SPINAL MOBILITY AND PAIN INTENSITY IN PATIENTS WITH SPINAL DISCOPATHY

Introduction. Approximately 80% of people experience back pain throughout their lives. A common problem of patients with low back pain is a significant limitation of mobility. Rehabilitation programs are usually recommended. Programs should include exercises that build flexibility, endurance, and strength. Kinesiotherapy is complemented by physiotherapy procedures, which are mainly aimed at analgesic and relaxing effects.&#x0D; The aim of the study was to compare the effect of two rehabilitation programs that differ in the type of kinesiotherapy on the mobility of the lumbar spine and the level of pain intensity in people with L5-S1 segment discopathy.&#x0D; Materials and methods. The study involved 30 patients undergoing 14 days of rehabilitation treatment. The criterion for dividing the subjects into groups was the method of kinesitherapy. The first group (Gr1) consisted of 15 patients who did gymnastics in the pool twice a day, and the second group (Gr2) consisted of 15 patients who attended therapeutic gymnastics classes in the gym twice a day. The exercises were aimed at improving the range of motion of the spine, strength and endurance of postural muscles. A visual analog scale was used to assess the intensity of pain. The distance between standard anthropometric points in the resting position and in the extreme position of movement was measured to assess the range of spinal movements.&#x0D; Results. After rehabilitation, the amplitude of movements of the lumbar spine increased in most patients. In Gr1, an increase in the range of forward spinal flexion by 9.2 cm (p = 0.001), rotation to the right by 0.63 cm (p = 0.03), and to the left by 1.33 cm (p = 0.007) was detected. In Gr2, the range of forward flexion increased by 12.6 cm (p = 0.005), left rotation by 0.94 cm (p = 0.035), and right flexion by 1.41 cm (p = 0.002). In the case of other movements, no statistically significant changes were found.&#x0D; In Gr1, the average pain intensity according to the VAS was 4.9 ± 2.3 points before the start of the physiotherapy program and 3.6 ± 1.7 points after its completion (p = 0.04). In Gr2, the VAS values were 5.1 ± 2.5 points and 3.9 ± 1.8 points, respectively (p = 0.03). The magnitude of changes in pain intensity was similar (-1.3 points and -1.2 points) for both programs.&#x0D; Conclusions. 1. The applied rehabilitation programs increased the mobility of the lumbar spine and reduced pain in patients with L5-S1 segment discopathy. 2. Both the hydrokinesitherapy program and the gym program were equally effective in increasing the range of motion of the spine and reducing the intensity of pain.

Pelvic Ring Fractures: A Biomechanical Comparison of Sacral and Lumbopelvic Fixation Techniques.

Pelvic ring fractures are becoming more common in the aging population and can prove to be fatal, having mortality rates between 10% and 16%. Stabilization of these fractures is challenging and often require immediate internal fixation. Therefore, it is necessary to have a biomechanical understanding of the different fixation techniques for pelvic ring fractures. A previously validated three-dimensional finite element model of the lumbar spine, pelvis, and femur was used for this study. A unilateral pelvic ring fracture was simulated by resecting the left side of the sacrum and pelvis. Five different fixation techniques were used to stabilize the fracture. A compressive follower load and pure moment was applied to compare different biomechanical parameters including range of motion (contralateral sacroiliac joint, L1-S1 segment, L5-S1 segment), and stresses (L5-S1 nucleus stresses, instrument stresses) between different fixation techniques. Trans-iliac-trans-sacral screw fixation at S1 and S2 showed the highest stabilization for horizontal and vertical displacement at the sacral fracture site and reduction of contralateral sacroiliac joint for bending and flexion range of motion by 165% and 121%, respectively. DTSF (Double transiliac rod and screw fixation) model showed highest stabilization in horizontal displacement at the pubic rami fracture site, while the L5_PF_W_CC (L5-Ilium posterior screw fixation with cross connectors) and L5_PF_WO_CC (L5-Ilium posterior screw fixation without cross connectors) showed higher rod stresses, reduced L1-S1 (approximately 28%), and L5-S1 (approximately 90%) range of motion. Longer sacral screw fixations were superior in stabilizing sacral and contralateral sacroiliac joint range of motion. Lumbopelvic fixations displayed a higher degree of stabilization in the horizontal displacement compared to vertical displacement of pubic rami fracture, while also indicating the highest rod stresses. When determining the surgical approach for pelvic ring fractures, patient-specific factors should be accounted for to weigh the advantages and disadvantages for each technique.

Effect and complication among different kinds of spinal endoscopic surgery for lumbar disc herniation

To compare clinical efficacy and complication rate of percutaneous endoscopic transforaminal discectomy(PETD),percutaneous endoscopic interlaminar discectomy (PEID) and unilateral biportal endoscopic (UBE) in treating single-segment lumbar disc herniation(LDH). From October 2019 to August 2021,121 LDH patients with single-segment treated by spinal endoscopy were retrospectively analyzed and divided into three groups. In PETD group,there were 48 patients,including 19 males and 29 females,aged from 18 to 72 years old with an average of (44.0±13.9) years old;3 patients with L3,4 segments,27 patients with L4,5 segments,and 18 patients with L5S1 segments. In PEID group,there were 43 patients,including 23 males and 20 females,aged from 20 to 69 years old with an average of (40.1±12.1) years old;1 patient with L3,4 segments,15 patients with L4,5 segments,and 27 patients with L5S1 segments. In UBE group,there were 30 patients,including 12 males and 18 females,aged from 29 to 72 years old with an average of (41.2±15.0) years old;1 patient with L3,4 segments,18 patients with L4,5 segments,and 11 patients with L5S1 segments. Operation time,blood loss,fluoroscopy times and complications among three groups were observed and compared. Before opertaion,3 months after operation and at the latest follow-up,visual analogue scale (VAS) was used to evaluate low back pain and lower extremity pain,Oswestry disfunction index (ODI) was used to evaluate lumbar function,and modified MacNab was used to evaluate clinical efficacy at the latest follow-up. All patients were performed endoscopic spinal surgery completly and were followed up for at least 12 months. One patient occurred dural sac rupture both in PETD and PEID group,and dural sac rupture was small,and there was no obvious discomfort after operation. Two patients were occurred intraoperative rupture of dural sac in UBE group. One patient was occurred cerebrospinal fluid leakage after operation,and was improved after rest in supine position and fluid rehydration. One patient without no significant postoperative discomfort. (1)There were no significant difference in operating time,blood loss and hospital stay between PETD and PEID group (P>0.05),while UBE group was higher than those of PETD and PEID group (P<0.05). There was no statistical significance in fluoroscopy times between PEID and UBE group (P>0.05),but PETD group was higher than that of PEID and UBE group (P<0.05). (2)VAS of low back pain at 3 months after operation in UBE group was higher than that in PETD and PEID group (P<0.05),but there was no significant difference between PETD and PEID group (P>0.05). At the latest follow-up,there was no significant difference in VAS of low back pain among three groups (P>0.05). (3)Lower extremity pain of VAS and ODI among 3 groups after operation were significantly improved at all time points compared with those before opertaion(P<0.05),and there were no statistical significance between groups (P>0.05),and there were no statistical significance in interaction between different time points and operation groups (P>0.05). (4) At the latest follow-up,according to the modified MacNab standard,the results of PETD group were excellent in 27 patients,good in 16 patients,moderate in 4 patients,poor in 1 patient;in PEID group,27 patients got excellent result,12 good,3 moderate,and 1 poor;in UBE group,16 patients got excellent,10 good,2 moderate,and 2 poor. There was no significant difference among three groups (χ2=0.308,P>0.05). Recurrence of lumbar disc herniation occurred in 1 patient among each three groups,symptoms were improved in 2 patients after symptomatic treatment,and 1 patient was treated in other hospitals. PETD,PEID and UBE techniques could achieve good early clinical effects in treating lumbar disc herniation with similar complication rates. Both of PETD and PEID are single-channel minimally invasive surgery,with mild intraoperative tissue damage and quick postoperative recovery; while intraoperative fluoroscopy of PETD was relatively more frequent, and PEID was more suitable for L5S1 segment;UBE is a two-channel surgery,in which the intraoperative soft tissue damage is more severe,but exposure is broad,which is more suitable for complex cases.

Clinical outcomes and bone resection analysis of unilateral double-channel endoscopic technique in treating lumbar disc herniation

To explore clinical outcomes and bone resection of interlaminar fenestration decompression and unilateral biportal endoscopic (UBE) technique in treating lumbar disc herniation(LDH). A retrospective study was performed on 105 patients with single-level LDH treated from December 2019 to December 2021. Fifty-four patients in UBE group,including 32 males and 22 females,aged from 18 to 50 years old with an average of(38.7±9.3) years old,were treated with UBE,29 patients with L4,5 and 25 patients with L5S1. There were 51 patients in small fenestration group,including 27 males and 24 females,aged from 18 to 50 years old with an average of (39.9±10.0) years old,were treated with small fenestration,25 patients with L4,5 and 26 patients with L5S1. Perioperative indexes,such as operation time,postoperative time of getting out of bed and hospital stay were observed and compared between two groups. Visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between two groups before operation and 1,3,6 and 12 months after operation,respectively;and modified MacNab evaluation criteria was used to evaluate clinical efficacy. Amount of bone resection and retention rate of inferior articular process laminoid complex were compared between two groups. All 105 patients were successfully completed operation. Both of two groups were followed up from 6 to 12 months with an average of (10.69±2.49) months. Operation time,postoperative time of getting out of bed and hospital stay were (58.20±5.54) min,(2.40±0.57) d and (3.80±0.61) d in UBE group,and (62.90±7.14) min,(4.40±0.64) d and (4.40±0.64) d in small fenestrum group,respectively;and had statistically difference between two groups(P<0.05). Postoperative VAS of low back and leg pain and ODI in both groups were significantly lower than those before surgery (P<0.05). VAS of lumbar pain in UBE group (1.37±0.49) score was lower than that of small fenestration group (2.45±0.64) score,and had statistically difference (t=9.745,P<0.05). Postoperative ODI in UBE group at 1 and 3 months were (28.54±3.31) % and (22.87±3.23) %,respectively,which were lower than those in small fenestra group (36.31±9.08) % and (29.90±8.36) %,and the difference was statistically significant (P<0.05). There were no significant difference in VAS and ODI between two groups at other time points (P>0.05). According to the modified MacNab evaluation criteria at the latest follow-up,49 patients got excellent result,3 good,and 2 fair in UBE group. In small fenestration group,35 patients got excellent,12 good,and 4 fair. In UBE group,amount of bone resection on L4,5 segment was (0.45±0.08) cm3 and (0.31±0.08) cm3 on the segment of L5S1. In small fenestration group,amount of bone resection on L4,5 segment was (0.57±0.07) cm3 and (0.49±0.04) cm3 on the segment of L5S1,and amount of bone resection of lower articular process laminar complex on the same segment in UBE group was less than that in small fenestration group (P<0.05). In UBE group,retention rate of laminoid complex on L4,5 segment was (0.73±0.04) and L5S1 segment was (0.83±0.03),while L4,5 segment was(0.68±0.06) and L5S1 segment was (0.74±0.04) in small fenestration group,the lower articular process laminar complex retention rate in UBE group was higher than that in small fenestration group(P<0.05). Both unilateral double-channel endoscopy and small fenestration of laminae could achieve good clinical results in treating LDH,but UBE has advantages of less trauma,higher efficiency,faster postoperative recovery and less damage to bone structure.

Molecular mechanism of residual lumbago and leg pain after transforaminal endoscopic treatment of lumbar disc herniation

To observe the residual of lumbago and leg pain with contained type （CT） and non-contained type （NCT） lumbar disc herniation （LDH） after transforaminal endoscopic treatment, and to explore the role of hypoxia-inducible factor-1α（HIF-1α） and transient receptor potential vanillate 1（TRPV1） pathway. A total of 68 single-segment LDH patients were selected from July 2021 to October 2022, including 44 males and 24 females；aged 26 to 67 years old with an average of（43.63±11.94） years old；course of disease was 4 to 36 （18.91±10.34） months；body mass index was （24.45±4.00） kg·m-2；there were 7 cases of L3,4 segments, 32 cases of L4,5 segments, and 29 cases of L5S1 segments. All of them were performed with percutaneous intervertebral endoscopic extraction of nucleus pulposus and were divided into contained group（CT group） and non-contained group （NCT group） with 34 cases respectively according to the integrity of outer layer of fibrous annulus observed during operation. A total of 17 patients who underwent open surgery for scoliosis or vertebral fracture were selected as control group, including 12 males and 5 females；aged 21 to 65 years old with an average of （39.41±12.80） years old；body mass index was （24.86±4.11） kg·m-2. The relative mRNA expression quantity of HIF-1α, TRPV1 in nucleus pulposus were measured by quantitative real-time PCR. The contents of neurokinin 1 receptor （NK1R）, nerve growth factor （NGF）, vascular endothelial growth factor （VEGF） in nucleus pulposus and the serum substance P （SP） and calcitonin gene-related peptide （CGRP） were detected by enzyme linked immunosorbent assay （ELISA）. The threshold of lumbar tenderness was detected by a pressure pain meter. The degree of lumbago and lumbar function were evaluated by visual analog scale （VAS） and Oswestry disability index （ODI） separately. The residual rate of postoperative lumbago and leg pain was assessed. The mRNA relative expression quantity of HIF-1α and TRPV1, and the contents of NK1R, NGF and VEGF in nucleus pulposus, and the levels of serum SP and CGRP before surgery in the NCT group were higher than those in the CT group（P<0.05）, and those in the CT group were higher than the control group（P<0.05）. At day 7 after surgery, the serum SP and CGRP levels, lumbago and leg pain VAS scores and lumbar ODI index in two LDH groups were lower than before surgery （P<0.05）, and those in the NCT group were higher than the CT group（P<0.05）, and the threshold of lumbar tenderness in the NCT group was lower than the CT group（P<0.05）. The differences of lumbago and leg pain VAS scores, lumbar ODI index and lumbar tenderness threshold between preoperative and postoperative 7 days in the NCT group were lower than those in the CT group（P<0.05）. The residual rate of lumbago and leg pain at 7 days after surgery in the NCT group was higher than that in the CT group（P<0.05）. HIF-1α and TRPV1 pathway promoted the excessive production of NGF, VEGF, NK1R in nucleus pulposus and serum neuropeptides SP and CGRP, which may lead to the higher residual rate of lumbago and leg pain with non-contained lumbar disc herniation postoperative.

How to Choose Surgical Corridor in Left Oblique Approach Lumbar Interbody Fusion at the L5-S1 Segment: A Prospective Cohort Study

How to Choose Surgical Corridor in Left Oblique Approach Lumbar Interbody Fusion at the L5-S1 Segment: A Prospective Cohort Study

Quantitative anatomical analysis of lumbar interspaces based on 3D CT imaging: optimized segment selection for lumbar puncture in different age groups

BackgroundOptimal lumbar puncture segment selection remains controversial. This study aims to analyze anatomical differences among L3-4, L4-5, and L5-S1 segments across age groups and provide quantitative evidence for optimized selection.Methods80 cases of CT images were collected with patients aged 10–80 years old. Threedimensional models containing L3-S1 vertebrae, dural sac, and nerve roots were reconstructed. Computer simulation determined the optimal puncture angles for the L3-4, L4-5, and L5-S1 segments. The effective dural sac area (ALDS), traversing nerve root area (ATNR), and area of the lumbar inter-laminar space (ALILS) were measured. Puncture efficacy ratio (ALDS/ALILS) and nerve injury risk ratio (ATNR/ALILS) were calculated. Cases were divided into four groups: A (10–20 years), B (21–40 years), C (41–60 years), and D (61–80 years). Statistical analysis was performed using SPSS.Results1) ALDS was similar among segments; 2) ATNR was greatest at L5-S1; 3) ALILS was greatest at L5-S1; 4) Puncture efficacy ratio was highest at L3-4 and lowest at L5-S1; 5) Nerve injury risk was highest at L5-S1. In group D, L5-S1 ALDS was larger than L3-4 and L4-5. ALDS decreased after age 40. Age variations were minimal across parameters.ConclusionThe comprehensive analysis demonstrated L3-4 as the optimal first-choice segment for ages 10–60 years, conferring maximal efficacy and safety. L5-S1 can serve as an alternative option for ages 61–80 years when upper interspaces narrow. This study provides quantitative imaging evidence supporting age-specific, optimized lumbar puncture segment selection.

Biomechanical evaluation of modified and traditional cortical bone trajectory technique on adjacent segment degeneration in transforaminal lumbar interbody fusion—finite element analysis

ObjectivesModified cortical bone trajectory (MCBT) technique was proposed by our team in previous studies, but its biomechanical properties at adjacent segments have not been discussed yet. Therefore, the purpose of this study is to investigate the biomechanical properties of modified cortical bone trajectory (MCBT) technique on adjacent segment degeneration (ASD) in transforaminal intradiscal lumbar disc fusion (TLIF) compare to traditional bone trajectory (TT) technique and cortical bone trajectory (CBT) technique.MethodsThe four human cadaveric lumbar specimens were provided by the anatomy teaching and research department of Xinjiang Medical University and four intact finite element models of the L1-S1 segment were generated. For each of these, three transforaminal lumbar interbody fusion procedures with three different fixation techniques were reconstructed at the L4-L5 segment, as follows: TT-TT (TT at both L4 and L5 segments), CBT-CBT (CBT at both L4 and L5 segments), MCBT-MCBT (MCBT at both L4 and L5 segments). The range of motion and von Mises stress of the intervertebral disc of the L3-L4 and L5-S1 segments were recorded with a 400N compressive load and 7.5 Nm moments in flexion, extension, left–right bending, and left–right rotation.ResultsThe peak ROM of the L3-L4 segment in the MCBT-MCBT group was reduced by 10.5%, 6.1%, 12.2%, 4.1%, and 1.5% in flexion, extension, left–right bending, and left rotation compared to the TT-TT group and reduced by 1.8%, 5.5%, 10.0%, 12.8%, and 8.8% in flexion, left–right bending, and left–right rotation compared to the CBT-CBT group, respectively. The MCBT-MCBT group has the lowest peak ROM of the L3-L4 segment in flexion, left bending, and right rotation, the lowest peak ROM of the L5-S1 segment in extension and right rotation, and the lowest peak von Mises stress of the intervertebral disc at the L5-S1 segment in right rotation compared to the TT-TT and CBT-CBT group. In addition, the peak von Mises stress at the L3-L4 segment was lowest and more dispersed in all motions, the MCBT-MCBT group exhibited lower peak ROM of the L5-S1 segment in flexion, extension, and right rotation, and showed lower peak von Mises stress of the disc at the L5-S1 segment in flexion, extension, and right rotation compared with the TT-TT group.ConclusionThe modified cortical bone trajectory technique may have a beneficial effect on reducing the incidence of ASD in the L4-L5 TLIF model compared to the traditional bone trajectory technique and cortical bone trajectory technique.