Low Leg Research Articles

ID: 214607 First-in-Human Study Protocol to Evaluate a Multiphase Spinal Cord Stimulation System With Remote Device Management

Short-term clinical results from the BENEFIT-02 study1 provided evidence to support the use of novel multiphase spinal cord stimulation (SCS) to aid in the management of chronic low back and leg pain. Other recent SCS paradigms require in-person reprogramming and stimulation adjustments to optimize stimulation parameters. It is hypothesized that providing patients with more convenient access to optimize SCS therapy through remote device management (i.e., automated remote device monitoring and remote programming) may improve their experience with SCS therapy. BENEFIT-03 (NCT04683718) is the first long-term study of an SCS system with remote management capabilities.

A Prospective Study to Evaluate the Clinical and Diffusion Tensor Imaging (DTI) Correlation in Patients with Lumbar Disc Herniation with Radiculopathy.

Conventional magnetic resonance imaging findings frequently do not correlate with the symptoms of lumbar disc herniation (LDH). Diffusion-weighted imaging can reveal important details about the microstructure of tissues. This study assessed the role of diffusion-weighted imaging (DTI) in LDH with radiculopathy and explored the relationship between DTI values and clinical scores. Forty-five patients with LDH with radiculopathy were evaluated via DTI at the intraspinal (IS), intraforaminal (IF), and extraforaminal (EF) levels. A visual analog scale (VAS) was used for low back and leg pain. The Japanese Orthopaedic Association (JOA) scoring system, Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ) were used for functional evaluation. There was a statistically significantly (p<0.05) difference between the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values on the affected side compared with those on contralateral normal side. The VAS score had a weak positive correlation with RMDQ score (r=0.279, P=0.050). The JOA score had a moderate negative correlation with RMDQ score (r=-0.428, P=0.002), whereas the ODI score had a moderate positive correlation with RMDQ score (r=0.554, P<0.001). There was a moderate positive correlation between ADC values at the IF level and the RMDQ score on the affected side (r=0.310, P=0.029). There was no correlation between FA values and JOA score. ODI had a significantly positive correlation with the contralateral normal side FA values at the IF (r=0.399, P=0.015), EF (r=0.368, P=0.008) and IS (r=0.343, P=0.015) levels. RMDQ had a weak positive correlation with the contralateral normal side FA values at the IF (r=0.311, P=0.028), IS (r=0.297, P=0.036) and EF (r=0.297, P=0.036) levels. The decrease in FA values and the increase in ADC values are useful markers of compression. ADC correlates well with the patient's neurological symptoms and functional status. Conversely, FA correlates well with the patient's neurological symptoms, but is not correlated well with the functional status.

Effect of bone cement-reinforced pedicle screws combined with fusion repositioning therapy on lumbar spine function and postoperative complications in patients with severe lumbar spondylolisthesis

ObjectiveTo retrospectively study the efficacy of bone cement-enhanced pedicle screws combined with interbody fusion reduction in the treatment of severe lumbar spondylolisthesis, its effect on lumbar function and complications. MethodsFrom January 2019 to June 2021, 82 cases of severe lumbar spondylolisthesis in our hospital were analyzed. According to the different treatment plans, the patients were divided into two groups: A and B, in which group A patients were treated with pedicle screws combined with fusion and reduction, and group B patients were treated with bone cement reinforced pedicle screws combined with fusion and reduction. Perioperative indexes, pain severity (VAS), Oswestry dysfunction index (ODI), and low back and leg pain score of Japan Orthopedic Association (JOA), spondylolisthesis reduction, intervertebral space height, intervertebral foramen height, complications, and screw loosening were compared between the two groups. ResultsThere was no significant difference in the amount of intraoperative bleeding between group A and group B (P > 0.05). The operation time of group B was longer than that of group A, and the hospitalization time was shorter than that of group A. The vertebral fusion rate of group B was higher than that of group A (P < 0.05). The VAS, ODI and JOA scores at the last follow-up in both groups were lower than those before surgery, and group B was lower than group A (P < 0.05). Compared with the preoperative period, the postoperative slippage degree grading improved in both groups, while the improvement rate in group B was higher than that in group A (P < 0.05). At the last follow-up, the scores of intervertebral foramen height and intervertebral space height in both groups were higher than those before operation, and those in group B were higher than those in group A (P < 0.05). There was no difference in the incidence of complications and screw loosening between the two groups (P > 0.05). ConclusionCompared with conventional screw treatment, bone cement-reinforced pedicle screws combined with fusion repositioning can further improve the repositioning rate of slipped vertebrae in the treatment of severe LSL, while achieving a better intervertebral fusion rate. Therefore, the treatment of severe LSL with bone cement reinforced pedicle fusion and reduction is a safe and effective method.

Observation of early clinical efficacy of unilateral biportal endoscopy technique in the treatment of lumbar postoperative adjacent segmental diseases

To investigate early clinical efficacy of unilateral biportal endoscopy technique for the treatment of lumbar postoperative adjacent segmental diseases. Fourteen patients with lumbar postoperative adjacent segmental diseases were treated with unilateral biportal endoscopy technique from June 2019 to June 2020. Among them, there were 9 males and 5 females, aged from 52 to 73 years old, and the interval between primary and revision operations ranged from 19 to 64 months. Adjacent segmental degeneration occurred after lumbar fusion in 10 patients and after lumbar nonfusion fixation in 4 patients. All the patients received unilateral biportal endoscopy assisted posterior unilateral lamina decompression or unilateral approach to the contralateral decompression. The operation time, postoperative hospital stay and complications were observed. The visual analogue scale (VAS) of low back pain and leg pain, Oswestry Disability Index (ODI), modified Japanese Orthopaedic Association (mJOA) score were recorded before operation and at 3 days, 3 months, and 6 months after operation. All procedures were successfully completed. Surgical duration ranged from 32 to 151 min. Postoperative CT showed adequate decompression and preservation of most joints. Out of bed walking 1 to 3 days after surgery, postoperative hospital stay was 1 to 8 days, and postoperative follow-up was 6 to 11 months. All 14 patients returned to normal life within 3 weeks after surgery, and VAS, ODI, and mJOA scores improved significantly at 3 days and 3, 6 months after surgery. One patient occurred cerebrospinal fluid leak after operation, received local compression suture, and the wound healed after conservative treatment. One patient occurred postoperative cauda equina neurologic deficit, which was gradually recovered about 1 month after rehabilitation therapy. One patients advented transient pain of lower limbs after surgery, and the symptoms were relieved after 7 days of treatment with hormones, dehydration drugs and symptomatic management. Unilateral biportal endoscopy technique has a good early clinical efficacy in the treatment of lumbar postoperative adjacent segmental diseases, which may provide a new minimally invasive, non-fixation option for the treatment of adjacent segment disease.

Causes of asymptomatic side limb pain after minimally invasive transforaminal lumbar interbody fusion

To investigate possible causes and preventive measures for asymptomatic pain in the limbs after minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF). Clinical data from 50 patients with lumbar degenerative disease who underwent MIS-TLIF between January 2019 and September 2020 were retrospectively analyzed. The group included 29 males and 21 females aged from 33 to 72 years old, with an average age of (65.3±7.13) years. Twenty-two patients underwent unilateral decompression, and 28 underwent bilateral decompression. The side(ipsilateral or contralateral) and site(low back, hip, or leg) of the pain were recorded before surgery, 3 days after surgery, and 3 months after surgery. The pain degree was evaluated using the visual analogue scale(VAS) at each time point. The patients were further grouped based on whether contralateral pain occurred postoperatively (8 cases in the contralateral pain group and 42 in the no contralateral pain group), and the causes and preventive measures of pain were analyzed. All surgeries were successful, and the patients were followed up for at least 3 months. Preoperative pain on the symptomatic side improved significantly, with the VAS score decreasing from (7.00±1.79) points preoperatively to (3.38±1.32) points at 3 days postoperatively and (3.98±1.17) points at 3 months postoperatively. Postoperative asymptomatic side pain (contralateral pain) occurred in 8 patients within 3 days after surgery, accounting for 16% (8/50) of the group. The sites of contralateral pain included the lumbar area (1 case), hip(6 cases), and leg (1 case). The contralateral pain was significantly relieved 3 months after surgery. More cases of contralateral limb pain occur after unilateral decompression MIS-TLIF, and the reason may include contralateral foramen stenosis, compression of medial branches, and other factors. To reduce this complication, the following procedures are recommended: restoring intervertebral height, inserting a transverse cage, and withdrawing screws minimally.

Comparison of clinical effect and muscle injury imaging between oblique lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of single-segment degenerative lumbar spinal stenosis

To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis. The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females, aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females, aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time, intraoperative blood loss, postoperative drainage volume, and complications were recorded for both groups. Radiologic data including disc height (DH), the left psoas major muscle, multifidus muscle, longissimus muscle area, T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy. There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly, the area of the left multifidus muscle and longissimus muscle, as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group, were lower than those in the TLIF group (P<0.05) .On the 1st day and the 5th day after operation, CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation, the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months, low back and leg pain VAS at 3, 6, 12 months between the two groups(P>0.05). In the OLIF group, 1 case of left lower extremity skin temperature increased after the operation, and the sympathetic chain was considered to be injured during the operation, and 2 cases of left thigh anterior numbness occurred, which was considered to be related to psoas major muscle stretch, resulting in a complication rate of 10% (3/30). In the TLIF group, one patient had limited ankle dorsiflexion, which was related to nerve root traction, two patients had cerebrospinal fluid leakage, and the dural sac was torn during the operation, and one patient had incision fat liquefaction, which was related to paraspinal muscle dissection injury, resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6- month follow-up. Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However, OLIF surgery has obviously advantages, including less intraoperative blood loss, less postoperative pain, and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle, multifidus muscle, longissimus muscle area, and high signal intensity of T2 image on imaging, it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.

Increasing movement during office work at sit-stand workstations: A novel seating device to facilitate transitions

A novel active office chair (Movably Pro) was designed to facilitate frequent sit-stand movement 1) through auditory and tactile prompts and 2) with minimal-to-no work surface adjustment when transitioning. The purpose of this study was to compare lumbopelvic kinematics, discomfort, and task performance between the novel chair and traditional sitting/standing. Sixteen participants completed three separate 2-h sedentary exposures. Although participants transitioned every 3 min between sitting and standing with the novel chair, productivity was not affected. When standing in the novel chair, the lumbopelvic angles fell in between traditional sitting and standing (p < 0.01). Movement and/or postural changes that occurred with the novel chair reduced low back and leg discomfort for pain developers (PDs) (p < 0.01). All participants classified as PDs in traditional standing were non-PDs with the novel chair. This intervention was effective in reducing sedentary time without the time loss associated with desk movement.

Efficacy of Spinal Cord Stimulation for Failed Back Surgery Syndrome in Elderly Patients: A Retrospective Study.

Failed back surgery syndrome (FBSS) refers to a condition where symptoms such as low back pain, leg pain, and numbness persist or recur after lumbar surgery; it has been reported to occur in 10%-40% of patients who have undergone lumbar surgery. Spinal cord stimulation (SCS) has been reported useful for low back and leg pain due to FBSS. In this study, we studied the efficacy and safety of SCS for FBSS in older adults. Among FBSS patients who underwent an SCS trial between November 2017 and December 2020, those with at least 50% pain reduction during the trial phase who requested spinal cord stimulator implantation underwent implantation of a stimulator under local anesthesia. The patients were divided into two groups: patients aged <75 years (<75-year-old group) and patients aged ≥75 years (≥75-year-old group). The male/female ratio, symptom duration, operative duration, visual analog scale (VAS) scores before and after one year of surgery, responder rate (RR), complications one year after surgery, and stimulator removal rate were analyzed. There were 27 cases in the <75-year-old group and 46 in the ≥75-year-old group, with no significant differences in male/female ratio, duration of pain, or operative time between the two groups. VAS scores for low back pain, leg pain, and overall pain one year after surgery were improved significantly from respective preoperative scores in both groups (P < 0.001). There were no significant differences in low back pain VAS, leg pain VAS, overall pain VAS, RR, complications one year after surgery, or stimulator removal rate between the two groups. SCS reduced pain effectively in both <75-year-old and ≥75-year-old groups with no differences in complications. Therefore, spinal cord stimulator implantation was considered a viable option for FBSS treatment in older adults because it can be performed under local anesthesia and is associated with a low incidence of complications.

Effectiveness of Evidence Based Physical Therapy Management Approaches in Sacroiliac Joint Dysfunction: A Meta-analysis.

Worldwide the prevalence of sacroiliac joint dysfunction (SIJD) lies within a range of 13% to 30%. In approximately 10% to 25% of patients, SIJD is a cause of mechanical low back and leg pain. A total of 498 subjects included in 10 studies conducted from 2018 to 2022 were included in this analysis. The guidelines of PRISMA were followed for study identifications and analysis in which pain and disability were monitored as an outcome measure. The results revealed statistically significant findings of physical therapy-based management approaches in decreasing pain (SMD -1.068, p=0.0001, I2=95.11%) and lowering the levels of disability (SMD -0.997, p=0.0001, I2=95.76%) among patients with SIJD as estimated using a random effect model. It was concluded that physical therapy-based management approaches ranging from combined exercise therapy to MET and K-taping are significantly more effective than traditional approaches. Key Words: Exercise, Sacroiliac joint, Pain, Disability, Physical therapy, Muscle energy technique, Kinesiotaping.

No evidence for regeneration of pectines in the scorpion Euscorpius italicus (Herbst, 1800)

AbstractAlthough scorpions have comparatively low regenerative potential, legs and pedipalps are able to regenerate some structures in an often incomplete manner. The most intriguing scorpion appendages are the ventrally located pectines. These organs are equipped with numerous sensilla that scan the substrate for mechanosensory‐ and chemosensory cues. Due to their ventral position and frequent substrate contact, pectines are vulnerable to traumatic injuries. Pecten malformations have been hypothesized to be the result of incomplete regeneration. To investigate their regeneration capabilities, the pectines of postembryonic stages of Euscorpius italicus (Herbst, 1800) were amputated before the second moult at three different positions. Data on intermoult periods and the number of pectinal teeth were gathered for approximately 2.5 years. The regeneration process on exuviae of up to six moulting events was documented by photographs and confocal laser‐scanning microscopy. Regardless of the amputation site, no evidence for regenerative capabilities of pectines in E. italicus could be reported. Thus, incomplete regenerations mentioned in the literature are likely the result of simple wound healing. Depending on habitat complexity, substrate contact time of the pectines seem to differ, which might be interpreted as a trade‐off between highest sensory input and the avoidance of traumatic injury of the pectines.

Value of nerve root sedimentation sign in diagnosis and surgical indication of lumbar spinal stenosis

BackgroundLumbar spinal stenosis (LSS) is a prevalent and disabling cause of low back and leg pain in elderly people and nerve root sedimentation sign (NRSS) has been demonstrated to have high sensitivity and specificity in diagnosing LSS in selected patients. The purpose of this study was to investigate the diagnosis of LSS and the predictive value of NRSS.MethodsThe clinical and imaging data of 176 patients diagnosed with LSS and 156 patients with non-specific low back pain (LBP) were analyzed retrospectively. Transverse magnetic resonance images (MRI) of the narrowest spinal canal in all patients were acquired and graded by two experienced doctors using the Braz classification, Schizas classification and Chen Jia classification. Receiver operating curve (ROC) was used to compare the diagnostic efficacy of the three classifications. Univariate and multivariate logistic regression models were established to predict the surgical indications of LSS patients.ResultThe diagnostic efficacy of Schizas classification (AUC:0.943; 95%CI:0.918,0.969) and Chen Jia classification (AUC:0.942; 95%CI:0.918,0.966) was significantly higher than that of Braz classification (AUC:0.853; 95%CI:0.808,0.898). Chen Jia classification had the highest correlation with the degree of dural sac cross-sectional area (DCSA) stenosis. In the multivariate analysis of LSS surgical indications, Chen Jia classification (odds ratio [OR], 2.127; 95%CI:1.596,2.835), DCSA (OR,0.398; 95%CI:0.169,0.802) and intermittent claudication (OR,9.481; 95%CI:3.439,26.142) were associated with surgical indications.ConclusionAmong the three types, it is found that Chen Jia classification has better diagnostic efficacy in differentiating LSS from LBP. In addition, Chen Jia classification is simple to be implemented in clinical practice and has high clinical application value. Hence, Chen Jia classification can be used as an effective surgical treatment indicator for LSS patients.

Characteristics of the Patients with Poor Clinical Outcomes After Symptomatic Postoperative Lumbar Epidural Hematoma.

Symptomatic postoperative lumbar epidural hematoma (PLEH) may lead to poor outcomes even after evacuation. This study aimed to verify the short-term clinical outcomes after the evacuation of PLEH and to clarify the characteristics of the patients with poor postoperative outcomes. Twenty-five patients (average age; 70.4years) underwent PLEH evacuation after lumbar spine surgery. The mean follow-up period was 12.0 (range 3-37) months. Pre and postoperative Japanese Orthopedic Association scores and visual analog scale (VAS) of low back pain (LBP), leg pain, and leg numbness were retrospectively collected. The dural sac cross-sectional area at the most compressed level was measured on magnetic resonance imaging. The patients were classified into 2 groups: poor outcome group (P group) had less than 50% of Japanese Orthopedic Associationrecovery rate and good group (G group) with 50% or more recovery rate. The rate of delayed evacuation (over 24hours of onset) was significantly higher in P group than in G group (P= 0.027). There was no significant difference in dural sac cross-sectional areabetween the 2 groups (P= 0.438). VAS of LBP, leg pain, and leg numbness in G group significantly improved postoperatively. Although VAS of LBP and leg pain in P group significantly improved postoperatively, there was no significant difference between the pre and postoperative VAS of leg numbness. Delayed evacuation of PLEH can lead to poor postoperative outcomes after lumbar spine surgery. Moreover, patients with poor outcomes remained with postoperative leg numbness. Early evacuation of symptomatic PLEH is key to avoid poor outcomes and persistent leg numbness.

The Analysis of Preoperative Roussouly Classification on Pain Scores and Radiological Data in Lateral Lumbar Interbody Fusion for Patients with Lumbar Degenerative Disease

A retrospective observational study. The type of sagittal profile defined by Roussouly has affected spinal degeneration and surgical outcome. This study aimed to investigate the effect of preoperative Roussouly classification on pain intensity and radiological data of patients with lumbar degenerative disease who underwent indirect decompression with lateral lumbar interbody fusion (LLIF). We retrospectively investigated 102 patients who underwent LLIF without direct decompression. Patients were subdivided into 4 groups according to the Roussouly classification determined from preoperative full-length and lateral spine X-rays, and classified according to Roussouly types I, II, and IV in the nonstandard group and Roussouly type III in the standard group. The nonstandard group showed improved sagittal vertical axis and lumbar lordosis after LLIF surgery, but the midsagittal canal diameter and axial central canal area of the thecal sac using T2-weighted sagittal and axial magnetic resonance imaging were smaller than those in the standard group. On the other hand, each numeric rating scale score 1year after surgery improved in all patients. Changes in numeric rating scale scores in low back pain, leg pain, and numbness were not statistically significant between Roussouly classification types. These results suggest that the nonstandard group may have less indirect decompression effect from LLIF than the standard group. In the short term, we show for the first time after LLIF surgery that preoperative sagittal spinal alignment and the pelvic position may not significantly impact pain improvement.

Clinical outcomes of uniportal compared with biportal endoscopic decompression for the treatment of lumbar spinal stenosis: a systematic review and meta-analysis.

Systematic review and meta-analysis. Lumbar spinal stenosis (LSS) treatment has evolved with the introduction of minimally invasive surgery (MIS) techniques. Endoscopic methods take the concepts applied to MIS a step further, with multiple studies showing that endoscopic techniques have outcomes that are similar to those of more traditional approaches. The aim of this study was to perform an updated meta-analysis and systematic review of studies comparing the outcomes between both available endoscopic techniques (uni and biportal) for the treatment of LSS. Following PRISMA guidelines, we conducted a systematic literature search and compared the randomized controlled trials and retrospective studies of uniportal and biportal endoscopy in the treatment of LSS from several databases. Bias was assessed using quality assessment criteria and funnel plots. Meta-analysis using a random-effects model was used to synthesize the metadata. The authors used Review Manager 5.4 to manage the date and perform the review. After a preliminary selection of 388 studies from electronic databases, the full inclusion criteria were applied; three studies were found to be eligible for inclusion. There were 184 patients from three unique studies. Meta-analysis of visual analog scale score for low back pain and leg pain showed no significant difference at the final follow-up (P = 0.51 and P = 0.66). ODI score after biportal surgery was lower than uniportal surgery [SMD = 0.34, 95% CI (0.04, 0.63), P = 0.02]. The mean operation time was similar in the unilateral biportal endoscopy (UBE) and uniportal groups (P = 0.53). The UBE group was associated with a shorter length of hospital stay (P = 0.05). Complications were similar in both groups (P = 0.89). Current evidence shows no significant differences in most clinical outcomes between uniportal and biportal surgery. UBE may have a better ODI score at the end of the follow-up compared to uniportal. Further studies are required before drawing a definite conclusion. PROSPERO prospective register of systematic reviews: Registration Nº. CRD42022339078, Available from: https://www.crd.york.ac.uk/prospero/displayrecord.php?ID=CRD42022339078.

Bioimpedance phase angle is independently associated with myosteatosis: The Shizuoka study

Phase angle (PhA) calculated from the resistance and reactance measured using a bioimpedance device was suggested to represent the degree of fat deposition in muscle (myosteatosis), though no direct evidence is available. We aimed to clarify the possible association between PhA and skeletal muscle myosteatosis in community-dwelling middle-aged to older adults. Participants consisted of 424 Japanese (aged ≥50 years). Leg PhA and skeletal muscle mass index (SMI) were obtained by bioelectrical impedance analysis. The mean attenuation values and cross-sectional area of the mid-thigh skeletal muscle were calculated from computed tomography images and considered as indexes of myosteatosis and skeletal muscle mass, respectively. Leg PhA was positively associated with SMI, and cross-sectional area and mean attenuation value at mid-thigh. Multiple regression analysis adjusted for possible covariates identified leg PhA (β=0.214) and SMI (β=0.260) as independent factors of mid-thigh muscle cross-sectional area (P<0.001), while leg PhA (β=0.349, P<0.001) but not SMI (P=0.645) was associated with mean attenuation value. Similar results were observed in the analysis in the older (≥65 years) subpopulation. The combination of low SMI and low leg PhA showed stepwise association with cross-sectional area, while only individuals with low leg PhA had lower mean attenuated value. Leg PhA was independently associated with mean attenuated value of the mid-thigh skeletal muscle, suggesting that the assessment of PhA in combination with SMI could provide additional information for the evaluation of muscle properties.

Clinical Characteristics of Minimal Lumbar Disc Herniation and Efficacy of Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach: A Retrospective Study.

To define the characteristics of Mini LDH, develop new diagnostic references and examine the clinical efficacy of percutaneous endoscopic lumbar discectomy via a transforaminal approach (TF-PELD) for it. A total of 72 patients who underwent TF-PELD with Mini LDH from September 2019 to October 2022 were enrolled in this retrospective study. The patients' basic information, symptoms, number of outpatient visits, duration of conservative treatment, physical examination findings and so on were obtained from the medical records. Clinical effects of TF-PELD for Mini LDH were assessed by means of the following: the Visual Analog Scale (VAS) for low back pain (LBP) and leg pain, Oswestry Disability Index (ODI) for functional status assessment and Modified Mac Nab criteria for patient satisfaction. Mini LDH have specific clinical characteristics and imaging features. All included patients achieved obvious pain relief after TF-PELD surgery. Pain scores were repeated at postoperative day 1 and 1, 3, 6, 12 and 24 months later. Results were statistically analyzed. The average VAS-Back, VAS-Leg and ODI scores were all significantly reduced at the first postoperative day and gradually decreased with the follow-up time continuing. In total, 66 out of 72 patients received an excellent or good recovery and no poor result was reported according to the Modified Mac Nab criteria. Mini LDH is a type of LDH with special characteristics and in need of correct diagnosis and active treatment in clinical work. TF-PELD was also found to be an effective procedure for the treatment of Mini LDH.

Association between periodontitis and disc structural failure in older adults with lumbar degenerative disorders: A prospective cohort study

BackgroundBacterial microbiome as a putative trigger of inflammation might indicate the cascade of mouth-gut-disc axis for causing intervertebral disc (IVD) structural failures (such as IVD degeneration and endplate change) processed. However, direct evidence for the mouth-gut-disc axis still unclear. Therefore, it is interesting to explore periodontal inflammation related to IVD structural failures and clinical outcomes.MethodsThis prospective cohort study enrolled older adults (aged ≥ 75 years) who scheduled to undergo elective open lumbar spine surgery. Demographic, radiological, clinical, and periodontal parameters were recorded. Independent samples t-test and Pearson’s correlation analysis were calculated.ResultsA total of 141 patients with lumbar degenerative disorders (56 males and 85 females; age 79.73 ± 3.34 years) were divided into edentulous group (19 patients), No/Mild group (84 patients), and Moderate/Severe group (38 patients). The incidence rates of IVD degeneration in each lumbar segmental level based on Pfirrmann grade and endplate change in the fourth and fifth lumbar vertebrae, and Visual Analogue Scale (VAS) low back pain (LBP) and leg pain of patients at preoperative in dentate group was significantly higher compared with edentulous group, especially the comparisons between Moderate/Severe and edentulous groups. There were no significant differences in the range of motion, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, and disc height between dentate and edentulous groups. There was a positive association between plaque index (PLI) and pain scores (VAS LBP: r = 0.215, P = 0.030 and VAS leg pain: r = 0.309, P = 0.005), but no significant difference in Oswestry disability index (ODI) score.ConclusionResults show that the severity of periodontitis is associated with higher incidence rates of IVD degeneration and endplate change and clinical outcomes in older adults with lumbar degenerative disorders. Furthermore, the discovery of these relationships unveils a novel mechanism through which the alterations in oral microbiome composition potentially promote IVD degeneration and pain.

A new method for establishing operative channels in unilateral biportal endoscopic surgery: Technical notes and preliminary results.

The unilateral biportal endoscopic (UBE) technique has been widely used in spine surgery. At present, a traditional rigid working channel is available for the UBE system. A metal semicircular canal is located in the working channel. However, due to the metal material of the working channel, arthroscopy and instruments are constrained from moving in UBE surgery. Additionally, an assistant is needed during the procedure to hold the traditional working channel. For simplicity of operation and convenient movement of the arthroscopy and instrument, we describe a new method for establishing operative channels in UBE surgery. We retrospectively reviewed 50patients who underwent unilateral biportal endoscopic discectomy (UBED) from February 2020 to August 2020 via our new method. The Oswestry Disability Index (ODI) and visual analogue scale (VAS) score were measured preoperatively and 1month, 3months, 6months and 12months postoperatively. Statistical comparisons were made using analysis of covariance and paired t tests. The VAS scores for back pain at the five time points were 5.20 ± 2.57, 1.96 ± 0.95, 1.50 ± 0.84, 1.64 ± 1.08 and 1.18 ± 0.39. The leg pain VAS scores were 7.02 ± 2.25, 2.02 ± 1.27, 1.48 ± 0.89, 1.32 ± 0.79 and 0.88 ± 0.52. The ODI values were 51.08 ± 19.97, 19.62 ± 15.51, 8.26 ± 7.40, and 7.54 ± 6.42 to 3.24 ± 1.10. The postoperative ODIs and VAS scores of low back pain and leg pain were significantly lower than those before surgery, and differences were statistically significant (all p< 0.05). The pressure of the closed outflow was significantly higher than that of the open outflow (37.35 ± 13.11mm Hg vs. 24.55 ± 12.64mm Hg p= 0.003). After we tightened the infusion strap to open the outflow, the pressure decreased significantly (26.4 ± 14.08mm Hg vs. 37.35 ± 13.11mm Hg p= 0.015). There were 2cases of complications, including 1case of postoperative recurrence and 1case of dural tears. This study demonstrates the technical feasibility, safety, and efficacy of modified channel establishment in UBE surgery.

Spinal cord stimulation for low back pain.

Spinal cord stimulation for low back pain.

Robotics planning in minimally invasive surgery for adult degenerative scoliosis: illustrative case.

Minimally invasive surgical techniques are changing the landscape in adult spinal deformity (ASD) surgery, enabling surgical correction to be achievable in increasingly medically complex patients. Spinal robotics are one technology that have helped facilitate this. Here the authors present an illustrative case of the utility of robotics planning workflow for minimally invasive correction of ASD. A 60-year-old female presented with persistent and debilitating low back and leg pain limiting her function and quality of life. Standing scoliosis radiographs demonstrated adult degenerative scoliosis (ADS), with a lumbar scoliosis of 53°, a pelvic incidence-lumbar lordosis mismatch of 44°, and pelvic tilt of 39°. Robotics planning software was utilized for preoperative planning of the multiple rod and 4-point pelvic fixation in the posterior construct. To the authors' knowledge, this is the first report detailing the use of spinal robotics for complex 11-level minimally invasive correction of ADS. Although additional experiences adapting spinal robotics to complex spinal deformities are necessary, the present case represents a proof-of-concept demonstrating the feasibility of applying this technology to minimally invasive correction of ASD.