Lumbar Spine Research Articles

Research on bionic design and protection performance of ship’s impact resistant seat

ABSTRACT With the advancement of China’s maritime defense, occupant safety in ships has become critical. Conventional seats fail to absorb impact energy during collisions or explosions, increasing injury risks. To address this, an energy-absorbing bionic seat was designed and analyzed via finite element modeling, comparing its performance with a rigid seat. Results demonstrate significant improvements: the impact-resistant seat reduces peak pelvic acceleration by ≥75.31%, lumbar spine longitudinal force by ≥91.18%, and calf tibial force by ≥39.87%. Further optimization explored alternative sandwich structures, evaluating performance using injury criteria. The Rotating Thin-walled Quadruple-arc Honeycomb (RTQH) structure exhibited superior protection, reducing pelvic acceleration, lumbar force, and tibial force by 78.33%, 94.54%, and 47.87%, respectively, versus the rigid seat. This study confirms the effectiveness of bionic impact-resistant seating in enhancing occupant safety under dynamic loads, with the RTQH design offering optimal performance.

Transformer-based skeletal muscle deep-learning model for survival prediction in gastric cancer patients after curative resection.

We developed and evaluated a skeletal muscle deep-learning (SMDL) model using skeletal muscle computed tomography (CT) imaging to predict the survival of patients with gastric cancer (GC). This multicenter retrospective study included patients who underwent curative resection of GC between April 2008 and December 2020. Preoperative CT images at the third lumbar vertebra were used to develop a Transformer-based SMDL model for predicting recurrence-free survival (RFS) and disease-specific survival (DSS). The predictive performance of the SMDL model was assessed using the area under the curve (AUC) and benchmarked against both alternative artificial intelligence models and conventional body composition parameters. The association between the model score and survival was assessed using Cox regression analysis. An integrated model combining SMDL signature with clinical variables was constructed, and its discrimination and fairness were evaluated. A total of 1242, 311, and 94 patients were assigned to the training, internal, and external validation cohorts, respectively. The Transformer-based SMDL model yielded AUCs of 0.791-0.943 for predicting RFS and DSS across all three cohorts and significantly outperformed other models and body composition parameters. The model score was a strong independent prognostic factor for survival. Incorporating the SMDL signature into the clinical model resulted in better prognostic prediction performance. The false-negative and false-positive rates of the integrated model were similar across sex and age subgroups, indicating robust fairness. The Transformer-based SMDL model could accurately predict survival of GC and identify patients at high risk of recurrence or death, thereby assisting clinical decision-making.

Changes in Lumbar Lordosis Curvature from 2016 to 2024 in Asymptomatic Chinese Populations.

A retrospective cross-sectional study conducted across four centers. This study seeks to investigate recent trends in lumbar lordosis (LL) curvature over the past eight years and evaluate the influence of contemporary lifestyles on LL. The significance of lumbar sagittal alignment in clinical practice is gaining increased recognition, owing to its influence on spinal health and its correlation with conditions such as low back pain and facet joint arthritis. Nonetheless, there is a paucity of literature addressing the effects of contemporary lifestyle changes on LL. A cohort of asymptomatic individuals who had undergone lumbar spine radiography at four hospitals was randomly selected for data comparison between 2016 and 2024. LL curvature was evaluated using four distinct methodologies: the L1-S1 Cobb angle (Cobb A), the L1-L5 Harrison posterior tangent angle (Harrison A), the sacral slope angle (SSA), and the lumbar curve index (LCI). The LL curvature measurements were performed by two authors using a Picture Archiving and Communication System. Participants were categorized into two cohorts: young adults (aged <40y) and older adults (aged ≥40y). In both 2016 and 2024 cohorts, age-related differences between genders were insignificant. In 2016, females had higher Harrison A and LCI values than males, while older adults had smaller measurements than younger ones across all assessment methods. By 2024, males and older adults showed increased LL values, except SSA, compared to 2016. There were no significant LL differences for females and younger adults between the two cohorts. Males and older adults show increased LL curvature, which may impact low back pain prevalence. Further research is needed to understand contributing factors.

In Vitro Biomechanical Experiment on the Effect of Unilateral Partial Facetectomy Performed by Percutaneous Endoscopy on the Stability of Lumbar Spine

Objectives: This study’s purpose is to investigate the lumbar biomechanical effects of unilateral partial facetectomy (UPF) of different facet joint (FJ) portions under percutaneous endoscopy. Methods: Forty fresh calf spine models were used to simulate UPF under a physiological load performed through three commonly used needle insertion points (IPs): (1) The apex of the superior FJ (as the first IP); (2) The midpoint of the ventral side of the superior FJ (as the second IP); (3) The lowest point of the ventral side of the superior FJ (as the third IP). The range of motion (ROM) and the L4/5 intradiscal maximum pressure (IMP) were measured and analyzed under a physiological load in all models during flexion, extension, left–right lateral flexion, and left–right axial rotation. Results: When UPF was performed through the second IP, the ROM of the lumbar spine and the L4/5 IMP in the calf spine models were not statistically different from the intact calf spine model. Conclusions: UPF through the second IP resulted in a minimal impact on the biomechanics of the lumbar spine. Thus, it might be considered the most appropriate IP for UPF.

How Does Bone Recover in Patients with Tumor-Induced Osteomalacia? Long term Follow-up in a National Cohort Study

Abstract Tumor-induced osteomalacia (TIO) is a rare disorder characterized by impaired bone mineralization due to phosphate wasting. Long-term changes in bone mineral density (BMD) and microarchitecture after surgical cure or medical therapy in TIO are not well understood. This study describes changes in BMD, microarchitecture, and bone strength in patients with TIO following surgical cure or medical therapy. A prospective cohort study included adults diagnosed with TIO from May 2018 to 2024, categorized into those with surgical cure and those on medical therapy. Follow-up assessments were classified as early (median 8 months), intermediate (median 17 months), and long-term (median 26 months). Fifteen patients were included: seven achieved surgical cure, and eight remained on medical therapy. Lumbar spine BMD increased by +19% at early, +27% at intermediate, and + 15% at long-term follow-up. Total hip BMD increased by +31%, +36% and + 31% at early, intermediate and long-term assessments, respectively. All patients achieved a normal lumbar spine BMD, while 91% attained a normal total hip BMD. At the distal tibia, substantial increases in bone microarchitecture parameters—cortical area (Ct.Ar), cortical volumetric density (Ct.vBMD), and cortical thickness (Ct.Th)—were observed. Notably, Ct.Th improved to levels comparable to healthy controls. Bone strength improved by 13% but was not statistically significant, probably due to the small sample size. At the distal radius, most parameters remained stable. Patients with surgical cure showed more rapid and substantial improvements in BMD and cortical microarchitecture than non-cured patients, but these differences did not reach statistical significance. Overall, bone recovery in TIO is gradual, with gains in spine and hip BMD and significant improvements in tibial cortical parameters. However, some aspects of bone microarchitecture remained below control levels, underscoring the need for ongoing monitoring and individualized management strategies.

Reliability of surgeon-reported MRI findings to a national spine register

PurposeSpine registries contribute to valuable knowledge and research; however, the data quality has been questioned. MRI findings are crucial for diagnostics and grading of degenerative spinal disorders. We aimed to explore the reliability of surgeon-reported MRI findings in a national spine registry (NORspine).MethodsWe assessed the reliability of MRI findings from three spine centres. Two spine surgeons re-examined previously surgeon-reported MRI findings for a sample of NORspine patients. We assessed the inter-rater reliability and the reliability between the NORspine registry and each study rater by Cohen's Kappa (ƙ).ResultsTwo spine surgeons reassessed preoperative MRI of the lumbar spine for 276 previously enrolled NORspine patients; 92 at each treating centre equally distributed by three categories of spinal procedures: removal of disc herniation (LDH), decompression of lumbar spinal stenosis (LSS), and lumbar fusion. The inter-rater reliability varied from fair (0.21) to substantial (0.75) (most reliable for detecting LDH and LSS). The reliability between the NORspine registry and each rater varied from slight (0.13) to substantial (0.75). The highest reliability was found for LDH and LSS (ƙ = 0.72–0.75), while degenerative disc (DDD), foraminal stenosis (FS) and Modic changes had lower reliability (ƙ = 0.27–0.49).ConclusionThe reliability for surgeon-reported MRI diagnostics to the NORspine registry varied and was substantial for LDH and LSS, moderate for DDD and FS, and slight or fair for Modic changes.

Impact of corticosteroid withdrawal on bone mineral density after kidney transplantation

BackgroundBone abnormalities are common after kidney transplantation (KTx) and are associated with an increased risk of fractures. The pathophysiology of post-KTx bone disorders is multifactorial, with corticosteroid (CS) therapy being a contributor to the loss of bone mineral density (BMD). This study aimed to evaluate the impact of CS withdrawal versus continued CS therapy on BMD evolution in a kidney transplant recipients (KTRs) cohort.MethodsWe retrospectively analyzed BMD data from 132 patients who underwent KTx between 2005 and 2021. BMD was assessed using dual-energy X-ray absorptiometry at the time of KTx (T0) and two-years post-KTx (2yT). Patients were categorized into two groups: those who discontinued CS (CS−) within the first-year post KTx and those who continued CS therapy (CS+).ResultsThe mean age at KTx was 52.2 (± 12.6) years, and 62.1% of the patients were male. Overall, BMD increased significantly at the lumbar spine (LS) but decreased at the radius at 2yT, while BMD at the hip site remained stable. CS was discontinued in 44.7% of patients between T0 and 2yT, with an average discontinuation time of 6.3 (± 4.9) months post-KTx. The CS− group showed significant BMD improvements at LS and hip sites. In a multivariate analysis, a higher cumulative CS dose was independently associated with a larger BMD decline.ConclusionsCS withdrawal after KTx positively impacts BMD, while higher cumulative CS doses are associated with a greater BMD loss. These findings underscore the importance of minimizing CS exposure to preserve bone health in KTRs.

Impact of asymmetric L4–L5 facet joint degeneration on lumbar spine biomechanics using a finite element approach

This study investigated the effects of asymmetric facet joint degeneration on spinal behavior and adjacent structures using finite element analysis (FEA). Facet joints play a critical role in providing spinal stability and facilitating movement. Degenerative changes in these joints can lead to reduced spinal function and pain. Specifically, asymmetric degeneration occurs when one side deteriorates more rapidly due to alignment issues, subsequently impacting adjacent structures. In this study, facet joint degeneration grades (G00, G40, G42, and G44) were assigned to the L4–L5 segment to simulate spinal behavior during extension, left and right lateral bending, and left and right axial rotations. As degeneration progressed, the range of motion in the affected segment decreased, resulting in altered stress distribution across the intervertebral discs and posterior bone. The analysis showed that the posterior bending angle during extension decreased with increasing degeneration severity. Additionally, during lateral bending, the bending angle in the corresponding direction decreased, while the anterior bending angle increased. Maximum equivalent stress analysis of the intervertebral disc in the affected segment revealed a decreasing trend as degeneration worsened, a pattern also observed during extension, left lateral bending, and right axial rotation. In the G40 model, the maximum equivalent stress in the posterior bone of L4 and L5 exhibited a significant disparity between the left and right sides. These findings provide quantitative insights into the progression of spinal degeneration, enhancing our understanding of how asymmetric facet joint degeneration (FJD) affects spinal motion and adjacent structures.

Probability of Achieving Bone Mineral Density Treatment Targets with Abaloparatide and Teriparatide.

The goal of treatment for women at high risk of fracture who have a T-score ≤ -2.5 is to mitigate fracture risk by achieving T-scores at least above -2.5. In the ACTIVE trial, 2463 women with osteoporosis aged 49 to 86yr were treated for 18 mo with abaloparatide (80μg), teriparatide (20μg), or placebo. Eligible women from the abaloparatide and placebo groups were then treated weekly with 70mg alendronate for 2 additional years in ACTIVExtend. This post hoc analysis of ACTIVE and ACTIVExtend included women with baseline total hip (TH) or lumbar spine (LS) T-scores ≤ - 2.5. Logistic regression was used to predict the probability of achieving a T-score > -2.5 at the TH or LS during 18 mo of treatment with abaloparatide or teriparatide and during 3.5yr with the sequence of abaloparatide/alendronate compared to placebo/alendronate. At baseline, 23% and 74% of women enrolled in ACTIVE had T-scores ≤ - 2.5 at the TH and LS, respectively. Over 18 mo of treatment, >50% of women were likely to achieve TH T-scores > - 2.5, with baseline TH T-scores as low as -2.7 for both abaloparatide and teriparatide. More than 50% of women were predicted to achieve an LS T-score > -2.5 with a baseline LS T-score as low as -3.3 for abaloparatide or - 3.2 on teriparatide. Over 3.5yr of sequential treatment with abaloparatide/alendronate, >50% of women with baseline TH T-scores ≥ - 2.9 and LS T-scores ≥ - 3.5 were predicted to achieve T-scores > - 2.5, respectively. A patient's bone mineral density at baseline and the probability of achieving target T-scores with treatment should be considered when determining which treatment should be initiated in patients at high or very high risk of fracture.

A network analysis of changing pain cooccurrence in older adults findings from the second wave of the COPERNICUS study

Over one-third of patients with chronic pain report pain at multiple anatomical sites. The current study examined the co-localization of pain and its intensity over a 2-year follow-up period. Kendall rank correlation coefficient (denoted as tau) was applied for the co-occurrence of pain in specific locations. Individuals over the age of 60 years were recruited from the general population in Poland (N = 205, 60–88 years old). The lumbar spine was the most frequently occurring site for chronic pain, present in 31% of individuals at baseline and in 38% after 2 years. The number of pain sites did not change over 2 years (p = 0.53). An increase of co-occurrence between anatomical sites for pain was noted after 2 years. Cervical spine pain co-occurred with pain in the thoracic spine (tau = 0.31), lumbar spine (tau = 0.45), chest (tau = 0.18), hips (tau = 0.17), legs (tau = 0.18), knee(s) (tau = 0.31), and feet (tau = 0.17). The observed increase in pain co-occurrence over 2 years suggests the need for modified approaches to pain treatment in older adults.

Adrenalectomy reduces the risk of vertebral fractures in patients with mild autonomous cortisol secretion.

Mild autonomous cortisol secretion (MACS) is associated with increased risk of vertebral fractures (VFx). The impact of recovery from MACS on bone health remains unclear. Retrospective intervention Study (Study1): 53 patients with MACS were followed for 35.2±18.6 months; 31 patients underwent surgery (Study1-GroupA, 74.2% women, age 63 years [57-67]), while 22 patients received conservative treatment (Study1-GroupB, 45.5% women, age 64 years [61-72]).Prospective Randomized Study (Study 2): Fifty-one outpatients with MACS were randomly assigned to either adrenalectomy (Study2-GroupA, 21 patients, 67% women, age 63 [56.5-72.5]) or conservative approach (Study2-GroupB, 28 patients, 78% women, age 69 [61-73]) and were followed for 24 months. MACS was diagnosed in patients with adrenal incidentalomas (AI)>1 cm and cortisol after 1-mg dexamethasone suppression test (F-1mgDST) ≥1.8 µg/dL (50 nmol/L). At baseline and at the end of follow-up we assessed: calcium-phosphorus metabolism, bone mineral density (BMD) at the lumbar spine (LS), total hip (TH) and femoral neck (FN) using Dual-energy X-ray Absorptiometry, and the presence of VFx. Study 1: At the end of the follow-up, Study1-GroupB showed an increased incidence of VFx (n=11, 50%) than Study1-GroupA (n=3, 9.7%, p<0.005). In both groups BMD at LS, FN and TH was comparable between baseline and the end of follow-up.Study 2: After 24 months in Study2-GroupA, but not in Study2-GroupB, calcium and phosphorus levels increased compared to baseline (p=0.03 and p=0.04, respectively). At the end of follow up, BMD remained stable across both groups, but Study2-GroupB showed a significantly higher incidence of VFx (n=7, 25%) compared to Study2-GroupA (n=1, 4.8%, p=0.04). In patients with AI and MACS, adrenalectomy significantly reduces the risk of VFx.

Treatment period and changes in bone markers according to the application of teriparatide in treating medication-related osteonecrosis of the jaw

BackgroundThis study aimed to explore the effects of teriparatide (TPTD) on treatment duration, surgical procedures, and bone turnover markers in medication-related osteonecrosis of the jaw (MRONJ).MethodsWe analyzed 76 patients with MRONJ post-treatment and divided them into conservative/surgical and TPTD/non-TPTD groups. Key assessments included treatment duration, surgery count, and changes in bone markers (serum C-terminal telopeptide of type 1 collagen [CTX], osteocalcin [OC], procollagen type 1 N-terminal propeptide [P1NP], parathyroid hormone [PTH], 25-OH-vitamin D [25(OH)D], calcium, and inorganic phosphorus) measured at the initial and post-treatment stages.ResultsTPTD-treated surgical patients experienced shorter treatment periods and underwent fewer surgeries than did non-TPTD counterparts. Post-treatment, both groups showed significant increases in CTX, OC, and 25(OH)D levels. P1NP elevation was significant only in the non-TPTD group. Although the PTH levels decreased in both groups, the difference was not statistically significant. Calcium and phosphorus levels increased in both groups, but only calcium levels increased significantly in the TPTD group. Additionally, TPTD-treated patients showed significant improvements in T-scores, particularly in the lumbar spine and femur neck, compared to the non-TPTD group.ConclusionsTPTD administration during MRONJ treatment potentially reduces the need for surgical intervention and accelerates recovery, significantly affecting bone metabolism. These findings highlight TPTD’s role in enhancing the efficacy of MRONJ treatment. TPTD could potentially offer the dual benefit of promoting bone healing and reducing the need for surgical intervention, thus improving overall outcomes for patients with MRONJ.

Successful total en bloc resection of a lumbar vertebra for a giant cell tumor: A case report

Background Giant cell tumor (GCT) is a benign neoplasm that most commonly arises in the long bones; when these tumors rarely present as primary spinal bone tumors, they may exhibit local aggressive behavior, warranting extensive surgical resection. Case Description An 11-year-old female presented with lower back, radicular pain, and paraparesis. The magnetic resonance imaging showed an L5 tumor with an extension into the spinal canal. Total en bloc spondylectomy of the L5, vertebra revealed a GCT. Postoperatively, the patient did well for 3 months. Conclusion GCTs of bone are aggressive benign bone tumors that rarely involve the spine. Gross total surgical excision is the treatment of choice for these lesions that exhibit high local recurrence rates.

Prevalence of vertebral fractures in patients with acromegaly: A multicenter cross-sectional study.

Acromegaly is a chronic disease characterized by excessive growth hormone (GH) secretion leading to high insulin-like growth factor 1 (IGF- 1) levels. It results in systemic complications, including vertebral fractures (VFs), which impair quality of life. Bone mineral density (BMD) may not fully capture fracture risk, warranting further research into alternative predictors and mitigation strategies. This study aimed to assess the prevalence of VFs in patients with acromegaly and identify associated risk factors. A multicenter, cross-sectional study was conducted at three centers in Saudi Arabia and one in the United Arab Emirates (UAE). Data for patients with acromegaly evaluated between 2010 and 2024 were reviewed. The cohort consisted of 101 patients (63% male) with a median age of 45 years and an median disease duration of 7 years. VFs were present in 10 patients, predominantly affecting the lumbar spine and were generally mild. Although not statistically significant, patients with VFs had longer disease durations. BMD measurements did not significantly differ between those with and without VFs; however, patients with VFs showed a trend toward lower trabecular bone score (TBS), suggesting compromised bone microarchitecture. This study underscores the importance of comprehensive bone health assessment in patients with acromegaly incorporating BMD, TBS, and hormonal evaluations. Continuous long-term monitoring of bone health parameters is necessary in this population. Future research is needed to delineate risk factors associated with VFs.

The umbilicus and pelvic incidence to inform surgical incisions for anterior lumbar interbody fusions: A radiographic analysis.

To radiographically assess the umbilicus' level (i.e. latitude) relative to the anterior lumbar spine based on varying pelvic incidence (PI) magnitudes. Pediatric patients (ages 10-18 years) with a previously obtained CT abdomen/pelvis were reviewed. Excluded were patients with prior spine surgery, spinal deformity, and/or underlying lumbar spinal degenerative pathology. On sagittal CT images, 2 radiologists recorded the vertebral level/disc space that corresponded to the umbilicus' latitude level. On the CTs' scout lateral images, two spine surgeons measured the PI. The spinal level corresponding to the umbilicus' latitude was compared between 3 groups based on PI magnitude: low (< 45°), middle (45°-65°), and high (65°). 107 patients (average age = 14.82.0 years; 62.6% female; average BMI=25.9±10.1) met inclusion criteria. Of all patients, the umbilicus' level ranged from the L3-4 disc to the L5 vertebral body with the L4-5 disc (36.4%) and L4 vertebral body (29.0%) being the most common levels. Average PI was 47.2° 11.9° (Low PI-41.1%; Middle PI-46.7%; High PI-12.1%). The umbilicus' level relative to the spine significantly varied based on PI magnitude (p<0.001). In Low PI, the majority's umbilicus corresponded to the L4-5 disc (50%) or L5 vertebral body (18.2%). In Middle PI, the majority's umbilicus was at the L4 vertebral body (34.0%) and L4-5 disc (34.0%). In High PI, the majority's umbilicus corresponded to the L3-4 disc (38.5%) or L4 vertebral body (46.2%). The umbilicus' level relative to the lumbar spine significantly varies based on PI magnitude. Patients with lower PIs (low sacral slope) have their umbilicus more commonly located over the distal lumbar spine (L4-5 disc/L5 vertebral body), while high PI patients (high sacral slope) have more superiorly located vertebral levels when referencing the umbilicus. Additional clinical investigations will be beneficial to confirm utility of these findings in guiding location of ALIF incisions.

Pediatric densitometry: is the Z score adjustment necessary in all cases?

BackgroundThe International Society for Clinical Densitometry recommends adjusting the bone mineral density (BMD) Z-score in children with short stature or growth delay. However, it is not clear whether height-for-age Z-score (HAZ) adjustment is required in all children. The aim of this study was to determine whether HAZ adjustment is necessary by examining variability in unadjusted and adjusted Z-scores for the main regions of interest in a large pediatric cohort.MethodsWe evaluated 103 patients ≤ 20 years of age who underwent lumbar spine and whole-body dual-energy x-ray absorptiometry (DXA) at our tertiary care hospital from 2016 to 2018. The formula proposed by Zemel was used to calculate the HAZ.ResultsA total of 103 participants were included (54 females; 52.4%). The mean age was 9.8 years. Height percentiles were ≤ 3 or ≥ 97 in seven (6.8%) and five (4.9%) patients. Diagnostic criteria for low bone mineral density (LBMD; BMD Z-score ≤ −2) were met in 8 lumbar spine scans and 10 whole-body scans. After HAZ adjustment, the prevalence of LBMD decreased from 8.2% (n=8) to 6.4% (n=6) in the lumbar spine scans and from 10.5% (n=10) to 7.2% (n=8) in the whole-body scans. Agreement between the adjusted and non-adjusted HAZ data was 0.498 for the lumbar spine and 0.557 for the whole body. The diagnostic discrepancy rate for LBMD diagnosis was 7%. After HAZ adjustment, 5% patients no longer met LBMD criteria while conversely 2% met LBMD criteria only after adjustment.ConclusionsThe high diagnostic discrepancy rate (7%) for LBMN in this unselected pediatric cohort underscores the value of performing HAZ adjustment of Z-scores to improve diagnostic accuracy. This divergence between adjusted and unadjusted Z-scores suggests that all pediatric patients, not only those with short stature or growth retardation, may benefit from densitometric size adjustment. This is especially true in individuals whose stature is at the upper end of the range, where size may obscure a diagnosis of LBMD.

Clinical presentation, risk factors and management of pregnancy-associated osteoporosis: a systematic review and meta-analysis.

Pregnancy-associated osteoporosis (PAO) is a rare disorder most often presenting with vertebral fractures during pregnancy or postpartum. This meta-analysis aimed to evaluate the presenting features of PAO, its risk factors and the effectiveness of various treatments atimproving bone mineral density (BMD) and preventing further fractures. A systematic search of PubMed, EMBASE and Web of Science identified 35 studies comprising 943 cases of PAO. A meta-analysis was conducted to evaluate the effect of treatment on change in BMD at the lumbar spine, femoral neck and total hip. Vertebral fractures and back pain occurred in 89.2% and 90.2% of cases, respectively. The diagnosis was predominantly made postpartum. The most common risk factor was a family history of osteoporosis (40.5%). Calcium and vitamin D supplements (31.8%) and teriparatide (30.8%) were the most commonly used treatments. The meta-analysis of BMD response was inconclusive due to limited availability of data. The BMD change at the lumbar spine was greater with teriparatide compared with calcium/vitamin D and bisphosphonates but this was based on only two studies. There was no difference in BMD response at the femoral neck. Recurrent fractures were reported in 12.9% with no difference between treatment groups. While this review can assist clinicians with the diagnosis and management of PAO, it highlights some key knowledge gaps that may inform conduct of a Delphi process on the diagnosis and management of this disorder, pending conduct of randomised controlled trials.

Comparative Study of Short Segment Fixation with or Without Transpedicular Bone Graft for Surgical Treatment of Burst Fractures of Thoracic &amp; Lumbar Spine in Adults After Trauma

Background And Objective: Thoracolumbar fractures are among the most common fractures of the spine because of high energy trauma. A short segment fixation with two proximal &amp; two distal screw fixation including the fractured vertebra at single level thoracolumbar fracture with or without transpedicular intracorporeal bone graft provides the adequate support &amp; stability. The objective of this study was to assess the clinical effectiveness of short segment fixation with or without transpedicular bone grafting substitutes in patients with single level Thoracolumbar spine Burst fracture.Methods: This Randomized Controlled Trial was conducted from December 2016 to December 2019 in the Department of Orthopedic &amp; Spine Surgery at Lahore General Hospital, Lahore. After approval from Hospital Ethical Review Board, 64 patients having single level burst fractures of thoracolumbar Spine were divided into two equal groups A &amp; B. In Group A, all patients were treated with short segment trans pedicle screw fixation with bone graft while in group B patients, only short segment fixation was done. All the patients were followed for one year to assess the Kyphotic angle, vertebral body height and visual analogue score (VAS) and was noted in a predesigned proforma.Results: Group A and Group B demonstrated statistically significant differences in various measured outcomes. For the kyphotic angle, Group A recorded a mean of 18.5° ± 4.0°, while Group B had a slightly higher mean of 19.5° ± 4.2° (p = 0.03). Vertebral height measurements revealed that Group A maintained a mean height of 23.1 ± 2.8 mm, whereas Group B exhibited a lower mean height of 21.3 ± 3.3 mm (p = 0.02). Lastly, the VAS score, reflecting pain intensity, showed Group A with a mean score of 2.0 ± 0.8, slightly lower than Group B's 2.05 ± 0.7 (p = 0.01), indicating a statistically significant improvement in pain levels in both groups but more significant in Group A over the year.Conclusion: Short Segment Fixation is an effective treatment option for maintaining the anterior vertebral height and prevention of loss of kyphotic angle at single level thoracolumbar fracture of the spine. Moreover, the VAS score was also improved where the short segment fixation with transpedicular bone graft was done. Key Words: Anterior vertebral height, Kyphotic Angle, Short segment fixation, Trans pedicle graft substitutes,Trans pedicle screw fixation, Thoracolumbar Burst fractures

Differential contributions of lean and fat mass on bone mineral density in Asian women of reproductive age: The S-PRESTO study

Abstract The relationships between fat mass (FM), lean mass (LM), and bone mass are complex with significant implications for obesity, sarcopenia, and osteoporosis later in life. While greater LM is associated with higher bone mineral density (BMD), the association between FM and BMD is less clear. Such relationships warrant further investigation especially in Asians who have higher risk of metabolic diseases and osteoporotic fractures compared to Western populations. This study investigated the associations of LM, FM and modifiable risk factors with BMD in Asian women aged 18-45 yr. 191 women from the Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) cohort study underwent dual-energy x-ray absorptiometry scanning at the first study visit for BMD and body composition measurements. LM, FM and four body composition phenotypes derived from dichotomizing LM and FM were related to cohort specific Z-scores of BMD at femoral neck (BMDFN), lumbar spine (BMDLS) and whole-body (BMDWB). Adjusting for covariates, LM showed positive associations with Z-BMDFN, [β (95%CI)], [0.38 (0.22, 0.55)], Z-BMDLS, [0.43 (0.25, 0.62)] and Z-BMDWB, [0.63 (0.44, 0.81)]. FM by contrast showed an inverse association only with Z-BMDWB, [−0.39 (−0.58, −0.20)]. Compared to women with healthy body composition (higher LM-lower FM), women with lower LM-higher FM had similar BMI, mean(SD) 20.9(1.5)kg/m2 but disproportionately higher percent fat, 38.4 (2.2)%, and lower Z-BMDFN, [−0.58 (−0.97, −0.18)], Z-BMDLS, [−0.41 (−0.81, 0.00)] and Z-BMDWB [−0.66 (−1.06, −0.25)]. Chinese women had lower BMD than Malay women. Physical activity and education attainment were positively, while the age of menarche was negatively associated with BMD. These findings in young women underscore the importance of early interventions recognizing ethnic differences in BMD to improve lifecourse musculoskeletal health. Most importantly, intervention strategies for Asian women should focus on healthy body composition beyond BMI, with a goal to preserve or increase LM.

Degenerative relationships in lumbar intervertebral discs and facet joints: an MRI-based comparative study of asymptomatic individuals and patients with chronic and intermittent low back pain

Degeneration of intervertebral discs and facet joints are common conditions that are thought to be interrelated. This study aimed to investigate the morphological interplay between disc and facet degeneration, as well as relationships between adjacent discs and facets. This prospective study involved 712 participants (307 males, 405 females) categorized into three groups: no back pain (no-BP), intermittent (iLBP), and chronic low back pain (cLBP). The Pfirrmann classification was used to assess intervertebral disc degeneration of index and adjacent segments, while the Fujiwara classification evaluated facet joint degeneration. Spearman’s correlation coefficient analyzed relationships between degenerative changes in discs and facets. Overall, from the 712 participants 254 were with no-BP, 159 with intermittent LBP, and 299 with chronic LBP. The severity of both intervertebral disc and facet joint degeneration in the MRI sequences increased from upper to lower segments, with a significant clear directionality in differences between the uppermost and lowermost levels (p &amp;lt; 0.01). A strong positive correlation was observed between degenerative changes of adjacent intervertebral discs, especially in the upper and middle lumbar spine (ρ &amp;gt; 0.69). However, correlations between intervertebral disc and facet joint degeneration were weak in all populations studied (ρ &amp;lt; 0.31). The data indicate a directionality in the disease progression, with a strong correlation observed between adjacent intervertebral discs, suggesting a concurrent degenerative process. In contrast, the weak correlations between disc and facet joint degeneration imply that these structures undergo independent degenerative processes, particularly in the early stages of degeneration. Further research is essential to elucidate the underlying mechanisms and to develop precise therapeutic interventions for lumbar spine degeneration.