Clinimetric analysis of the numeric pain rating scale, Oswestry disability index, and the Roland-Morris disability questionnaire in patients with lumbar spinal stenosis treated with conservative interventions.

Selection of surgical strategy for patients with multilevel cervical spondylosis and concomitant developmental cervical spinal stenosis.

Immune system expression profiling in patients experiencing low back pain: A pilot study.

Abstract Gallbladder volvulus is a rare but potentially life-threatening condition, characterised by torsion of the gallbladder on its mesentery, compromising vascular supply and biliary drainage. Diagnosis is challenging due to non-specific clinical and radiological features. Prompt surgical intervention is crucial for a favourable outcome. We present a case of gallbladder volvulus presenting as an acute abdomen, successfully managed as a surgical emergency. The case also briefly reviews risk factors, pathophysiology, and diagnostic strategies for this unusual condition. A 77-year-old female presented with sudden-onset severe epigastric pain radiating to the back, associated with nausea, vomiting, and anorexia. The pain was unremitting and unresponsive to analgesia. Her comorbidities included GORD, CKD stage 3, hiatus hernia, and spinal stenosis. She was functionally independent and, despite these conditions, deemed a suitable surgical candidate. Initial blood tests were largely unremarkable, apart from a mildly elevated alkaline phosphatase. Initial differentials included acute cholecystitis and gastric volvulus. CT imaging demonstrated a distended gallbladder in an abnormal position between the diaphragm and liver segment VIII. MRCP confirmed displacement of the gallbladder with a possible twisted cystic pedicle. She underwent emergency laparoscopic cholecystectomy. Intra-operatively, the gallbladder was located above the liver dome with torsion of the cystic duct and artery, confirming volvulus. She recovered well and was discharged on postoperative day four with routine follow-up. This case highlights the diagnostic challenges posed by gallbladder volvulus and reinforces the need for early recognition. We also review cases reported in the literature since its first description by Wendel in 1898.

Study DesignProspective Study.ObjectivesDegenerative lumbar central spinal stenosis (DLCCS) commonly affects the elderly, causing back and leg pain that often necessitates surgical intervention. Perioperative tranexamic acid (TXA) effectively reduces blood loss in lumbar instrumented fusion surgeries. Its effectiveness in elderly patients undergoing posterolateral lumbar instrumented fusion and posterior decompression for DLCCS remains insufficiently investigated. This study aims to evaluate the potential benefits of TXA in these surgical interventions.Methods170 patients with DLCCS that underwent posterolateral lumbar instrumented fusion with posterior decompression at two consecutive vertebral levels were included. Patients were divided into two groups: Group A (87) without intravenous TXA and Group B (83) with intravenous TXA 30 minutes preoperatively. Outcomes included intraoperative blood loss, postoperative drainage, transfusion rates, surgical duration, initiation of mobilization and hospital stay.ResultsNo significant differences were found in patients' baseline demographics. Surgical duration was significantly shorter in the TXA group (103.6 ± 9.8min vs 128.6 ± 8.2min, P < 0.001). Intraoperative blood loss was lower in the TXA group (462.7 ± 92.0mL vs 864.4 ± 157.0mL, P < 0.001), as was postoperative drainage (85.2 ± 47.6mL vs 207.4 ± 153.5mL, P < 0.001). Postoperative transfusion was required in 3 TXA patients vs 27 in the non-TXA group (P < 0.001). TXA patients mobilized earlier (7.4 ± 3.4 hours vs 12.1 ± 8.1 hours, P < 0.001) and had a shorter hospital stay (2.1 ± 0.4 days vs 2.6 ± 0.9 days, P < 0.001).ConclusionsPreoperative TXA administration in this spinal surgery improved surgical and postoperative outcomes and should be considered more.

Screening for Transthyretin Amyloid Cardiomyopathy in Patients With Musculoskeletal symptoms: Red Flags in the Rheumatology/Orthopedics Practice Setting.

Background: Endoscopic lumbar decompression is a minimally invasive technique with advantages of reduced blood loss, shorter hospital stays and early mobilisation compared to conventional open procedures. This study reports outcomes of 40 patients who underwent lumbar endoscopic decompression at a single tertiary care center. Methods: Retrospective review of 40 consecutive patients with lumbar disc herniation or spinal stenosis who underwent endoscopic decompression. Clinical outcomes were measured using Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) pre-operatively and at final follow-up. Operative time, blood loss, hospital stay and complications were recorded. Results: The mean age was 52 years (range 30–72), with 24 males and 16 females. The most common level was L4–L5 (60%). Mean VAS for leg pain improved from 8.1 to 2.1 (p&lt;0.001) and ODI improved from 62% to 18% (p&lt;0.001). Complications included 2 dural tears and 1 superficial wound infection. No revision surgeries were required. Mean hospital stay was 1.8 days. Conclusions: Endoscopic lumbar decompression is a safe and effective technique for carefully selected patients, providing excellent pain relief, functional recovery and reduced morbidity.

This study aims to evaluate the effects of percutaneous large-channel spinal endoscopic decompression on stress response, lumbar stability, and disability index in elderly patients with single-segment degenerative lumbar spinal stenosis (LSS). A retrospective analysis was performed on 120 elderly patients with single-segment degenerative LSS treated from January 2020 to January 2024. Fifty-seven underwent percutaneous transforaminal endoscopic discectomy group, and 63 underwent percutaneous large-channel spinal endoscopic decompression (large-channel group). Surgical indicators, complications, stress response, lumbar and leg pain, lumbar function [Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI) score], and lumbar stability were compared. The large-channel group had shorter operative time and fewer intraoperative fluoroscopy sessions than the percutaneous transforaminal endoscopic discectomy group (P<.05), while intraoperative blood loss and incision length were greater (P<.05). Hospital stay and complication rates showed no difference (P>.05). At 3 days postoperatively, serum NE, DA, and 5-HT levels were elevated in both groups (P<.05) but were lower in the large-channel group (P<.05). Lumbar and leg visual analogue scale scores at 1 week, 3 months, and 6 months were lower than preoperative values in both groups (P<.05), with greater improvement in the large-channel group at 3 and 6 months (P<.05). At 1, 3, and 6 months, JOA scores increased and ODI scores decreased in both groups (P<.05). At 3 and 6 months, JOA scores were higher and ODI scores lower in the large-channel group (P<.05). At 6 months, lumbar curvature, lordosis angle, pelvic tilt, and intervertebral space height improved in both groups (P<.05), with greater gains in the large-channel group (P<.05). Percutaneous large-channel spinal endoscopic decompression for elderly patients with single-segment degenerative LSS can shorten operative time, alleviate stenosis and stress response, improve function, and enhance lumbar stability. Its definite efficacy supports clinical application.

Background and Objectives: The aim of this study was to evaluate the relationship between low back pain questionnaires and radiological stenosis severity in patients with lumbar spinal stenosis (LSS). Materials and Methods: Patients aged 50 years and over who presented with complaints of low back pain and were diagnosed or not diagnosed with LSS by magnetic resonance imaging (MRI) were included in the study. Demographic data, physical examination findings, and walking distance were recorded. Pain severity was assessed using the Visual Analog Scale (VAS), and patients completed the Oswestry Disability Index (ODI), the Istanbul Low Back Pain Disability Index (ILBPDI), and the Swiss Spinal Stenosis Questionnaire (SSS-Q). Results: A total of 120 patients with LSS (n = 56) and without LSS (n = 64) were included in the study. No significant differences were found between the groups in terms of demographic variables (p &gt; 0.05). Neurogenic claudication and lumbar extension limitation were higher in the LSS group (p = 0.033 and p = 0.008, respectively), and walking distance was significantly shorter compared to the group without LSS (p = 0.024). There were significant differences between the VAS, ODI, ILBPDI, and SSS-Q scores between the two groups (p &lt; 0.05). A strong positive correlation exists between the radiological severity of LSS and SSS-Q (p &lt; 0.001, r = 0.707). Additionally, ROC analysis revealed that the SSS-Q had a significantly higher diagnostic value for LSS compared to the ODI and ILBPDI (p &lt; 0.001). For the SSS-Q, likelihood ratios indicated limited diagnostic relevance (PLR 4.04 [95% CI: 2.45–6.67]; NLR 0.22 [95% CI: 0.13–0.44]). Conclusions: SSS-Q, ODI, and ILBPDI scores vary significantly between patients with and without LSS. Although the SSS-Q correlates most strongly with radiological LSS severity, its diagnostic utility appeared of minor importance, as likelihood ratios indicated limited discriminative ability.

Skeletal dysplasia includes numerous genetic disorders marked by abnormal bone and cartilage growth, causing various spinal issues. The 2023 nosology identifies 771 distinct dysplasias involving 552 genes, with achondroplasia being the most common and significantly affecting the spine. Other disorders include type II collagenopathies, sulphation defects, Filamin B disorders, and osteogenesis imperfecta, presenting with short stature, limb deformities, joint contractures, and spinal abnormalities. Spinal pathology often impacts physeal growth areas, leading to conditions like foramen magnum stenosis, atlantoaxial instability, spinal stenosis, kyphosis, and scoliosis. Non-orthopaedic symptoms can include hearing and vision loss, neurological issues like hydrocephalus, and cardiac abnormalities. The incidence is around 1 in 4000 to 5000 births, with achondroplasia at about 1 in 30000 live births. Advances in genetics and imaging enable prenatal diagnosis, though milder cases may go undetected. Effective management requires a multidisciplinary approach involving various specialists. This review emphasises early diagnosis, continuous monitoring, and comprehensive management of spinal pathology in skeletal dysplasia. In the current article, the authors present a thorough review on spinal conditions associated with skeletal dysplasia, their pathophysiology and management options.

Nonspecific (musculoskeletal) neck and back pain (NNBP) is one of the most common reasons for seeking medical advice. The diagnosis of NNBP is based on clinical examination, the absence of signs of dangerous disease ('red flags'), radiculopathy and spinal stenosis. If there are no signs of a dangerous disease, early (within the first 4 weeks) instrumental examination, including magnetic resonance imaging, is not recommended. Fibromyalgia is common among patients with chronic NNBP, but it is rarely diagnosed due to poor awareness among doctors about its manifestations and diagnostic criteria. In NNBP, it is recommended to inform the patient about the favourable prognosis of the disease and risk factors, the need to avoid excessive static and physical exertion, incorrect positions and postures, and the advisability of maintaining physical, social and professional activity. Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are most commonly used to relieve NNBP. Extensive clinical experience has been accumulated regarding the efficacy and safety of aceclofenac (Airtal) as an NSAID and tolperisone (Mydocalm) as a muscle relaxant in the treatment of NNBP. The combination of aceclofenac (Airtal) and tolperisone (Mydocalm) is more effective than monotherapy, as it reduces the duration of NSAID use and lowers the risk of complications from long-term use. For subacute and chronic NNBP, a multimodal approach is most effective, which should include physical exercise (therapeutic physical training – TPT), manual therapy, and, for some patients, psychological therapy methods as non-drug methods. In cases where chronic back pain is caused by fibromyalgia, antiepileptic drugs may be effective as part of complex therapy, among which gabapentin (Tebantin) has been shown to be effective and safe. To prevent NNBP, therapeutic exercise, an educational programme on avoiding excessive static and physical stress, and incorrect positions and postures are recommended.

A Radiological Comparison of Qualitative and Quantitative Grading Systems (Schizas Classification and Stenosis Ratio) For Lumbar Spinal Stenosis in a Low-Income Setting

KWC-YOLO: An efficient YOLO architecture for lumbar spinal stenosis grading through dynamic convolution and spatially-aware gating.

Lumbar canal stenosis (LCS) results in neurogenic claudication and functional impairment. Surgical decompression is advised when conservative treatment fails; however, the benefits of including instrumentation are still under debate. To prospectively compare clinical, functional, and radiological outcomes of instrumented versus non instrumented decompression in patients with LCS. A prospective cohort study was conducted at a tertiary care facility from August 2023 to February 2025, involving 59 patients with MRI verified LCS. Patients were grouped into instrumented (n = 25) and non instrumented (n = 25) decompression, with 9 patients lost to follow up. Clinical outcomes included Visual Analog Scale, neurogenic claudication, and Medical Research Council grading. Functional status was assessed using the Oswestry Disability Index, Swiss Spinal Stenosis Questionnaire, and Japanese Orthopaedic Association score. MRI evaluated cross sectional area, antero-posterior diameter, foraminal size, and lateral recess height. Spinal stability was assessed by dynamic X rays using White and Panjabi criteria. Operational times, hospital stays, and blood loss were documented. Follow-ups were conducted at 3 and 6 months. Both groups showed significant improvement (P < 0.01). The instrumented group showed superior pain relief, motor recovery, and functional improvement, along with better spinal stability, despite longer surgery and higher blood loss. Instrumented decompression offers better clinical, functional, and radiological outcomes in selected LCS cases, with trade offs of increased operative time and blood loss.

Systematic literature review. Update on diagnostic utility of electrophysiology in lumbar spinal canal stenosis (LSCS). LSCS is a highly prevalent degenerative spine condition characterized by neurogenic claudication, radicular pain, and muscle weakness. While lumbar spine MRI is the imaging modality for detecting spinal canal narrowing, it correlates poorly with clinical symptoms. Electrophysiological methods, including electromyography (EMG), nerve conduction studies (NCS), and evoked potentials (MEP and SEP), may provide complementary information on neural dysfunction. Current guidelines support paraspinal electromyography (EMG) mapping for symptomatic patients with imaging confirmed stenosis (grade B). In contrast, the diagnostic value of other electrophysiologic tests in lumbar spinal canal stenosis (LSCS) remains uncertain. A systematic literature search was conducted in Medline and Embase for original studies on LSCS between 2020 and 2024. Two independent reviewers screened studies for inclusion. Extracted data was synthesized qualitatively. Study quality was assessed using the Robins-V2 tool. PROSPERO registration (CRD42024622427). Thirteen studies met the inclusion criteria; study quality was moderate. Needle EMG of the limbs was evaluated in 23% of studies to detect denervation as a sign of radiculopathy. 23% of the studies examined tibial nerve SEP or cauda equina MEP conduction time for lesion localization, with varying findings and utility for diagnosing LSCS. Surface EMG was investigated in 31% of studies and revealed significantly altered muscle activation patterns and compensatory gait adaptations in LSCS. There is an increasing number of studies combining surface EMG with gait assessments and tasks. This approach is interesting for being non-invasive with clinical utility to be further determined. Based on previous guidelines, paraspinal mapping is considered the gold-standard electrophysiological diagnostic tool. Interestingly, there were no recent studies on paraspinal mapping, indicating a shift to alternative methods.

Achondroplasia is the most prevalent form of skeletal dysplasia and is characterized by rhizomelia, short stature, and distinctive facial features. Achondroplasia is frequently accompanied by spinal canal stenosis because of the distinctive morphology of the spine. For pediatric lumbar spinal canal stenosis, a meticulously constructed surgical plan is needed to prevent complications such as the development of thoracolumbar kyphosis. An 11-year-old Asian boy with achondroplasia presented with bilateral lower limb numbness and intermittent claudication, which limited his walking distance to 100m. Imaging revealed multilevel lumbar spinal canal stenosis from T12 to S1, with the most stenosis at the L4/5 level. Laminotomy with spinous process reconstruction using mini plates was performed to preserve the midline posterior tension band. The patient's postoperative course was uneventful, with immediate symptom resolution and no symptoms of recurrence or signs of kyphotic deformity at the 2-year follow-up. Achondroplasia-associated lumbar spinal canal stenosis arises from anatomical constraints, such as shortened pedicles and short interpedicular distances. Surgical intervention must provide effective decompression without increasing the risk of postoperative thoracolumbar kyphosis. This case highlights the importance of preserving posterior elements that are responsible for maintaining spinal stability and the pertinence of avoiding extensive fixation, particularly in pediatric patients with achondroplasia. This case demonstrates that, in patients with achondroplasia, laminotomy with spinous process reconstruction can effectively address lumbar spinal canal stenosis and preserve posterior elements with a minimal risk of complications. Long-term follow-up remains crucial for monitoring the potential development of thoracolumbar kyphosis.

Background and objectiveFull endoscopic interlaminar lumbar decompression is increasingly being adopted for lumbar spinal stenosis, yet the learning curve and its clinical consequences remain uncertain. In this study, we aimed to prospectively evaluate a single surgeon’s learning curve for full endoscopic interlaminar decompression.MethodsWe conducted a prospective, single-surgeon cohort (2018-2023) involving adults who underwent single-level full endoscopic interlaminar decompression for degenerative lumbar canal stenosis. Operative efficiency was prespecified as operative time ≤90 minutes. Learning-curve cumulative summation (LC-CUSUM) was applied to detect the transition from inadequate to adequate performance; competency was declared at the first boundary crossing. Patient-reported outcomes included the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores collected at baseline and at one, three, six, and 12 months. Safety endpoints included major complications and reoperations.ResultsA total of 77 patients were included (mean follow-up period: 47 months). LC-CUSUM signaled efficiency competency at case 44. Mean operative time was 98.6 ± 29.0 minutes overall; 111.2 ± 32.0 minutes in the early phase group (cases 1-44) and 81.7 ± 10.1 minutes in the late phase group (cases 45-77). Both groups demonstrated significant within-group improvements in ODI and VAS at each postoperative time point; however, the magnitude of improvement did not differ between phases. Major complications (1/44 early vs. 0/33 late) and reoperations (3/44 vs 2/33) were comparable. All patients were discharged within 24 hours.ConclusionsEfficiency competency was achieved without compromising patient‑reported outcomes or safety across the learning curve.

Amyloid deposition in the tenosynovium and transverse carpal ligament, and particularly cardiac involvement, are rare in patients with carpal tunnel syndrome; however, the prevalence may be underreported. This prospective study assessed the prevalence of amyloid deposits in the synovium and transverse carpal ligament and whether dual-site sampling improved detection. Risk factors for a positive test and asymptomatic cardiac involvement were also investigated. In a prospective cohort of 100 consecutive patients undergoing carpal tunnel release, intraoperative biopsies were taken from the tenosynovium and the transverse carpal ligament and examined using Congo red and immunohistochemistry staining. Concordance between biopsy sites was assessed, and independent predictors for a positive test were evaluated by multivariable logistic regression. Amyloid-positive patients underwent cardiac assessments, including cardiac biomarkers and 99mTc-pyrophosphate scintigraphy. Amyloid deposition was present in 62 patients. Concordance between biopsy sites was 91%. Older age, male sex, bilateral carpal tunnel syndrome, multiple trigger fingers, and spinal stenosis independently predicted tissue amyloid. Asymptomatic cardiac amyloid deposition was identified in eight patients: three fulfilled criteria for cardiac amyloidosis and five demonstrated scintigraphic uptake with preserved function. Amyloid deposition in carpal tunnel syndrome was common in our study population, and subclinical cardiac involvement was not rare. Dual-site biopsy improved detection compared with the single-site sampling, and we recommend this routinely during carpal tunnel release. If not feasible, we recommend prioritizing older or male patients and those with bilateral carpal tunnel syndrome, multiple trigger fingers or spinal stenosis. Multiple trigger fingers may indicate a systemic process and high amyloid/cardiac risk. III.

Study Design: Single-institution, multi-surgeon retrospective cohort study. Objective: Compare one-year Oswestry Disability Index (ODI) and EuroQol 5-D (EQ. 5D) scores between ALIFs with and without pedicle screw fixation (PSF) and identify demographic predictors of outcomes. Summary of Background Data: PSF supplementation of anterior lumbar interbody fusions (ALIF) remains the standard for patients with complex pathology and instability. Standalone ALIF procedures forgo PSF application, minimizing surgical trauma to the posterior anatomy at the expense of construct stability. It is unclear if PSF affects long-term patient-reported outcomes (PROs) in patients without considerable instability. Methods: Patients aged 18 to 89 who underwent a one-level or two-level ALIF between March 2015 and December 2023 for a diagnosis of disc degeneration, spondylosis, or spinal stenosis were included. Cases were grouped into standalone ALIF (SA-ALIF) or pedicle screw-fixated ALIF (PSF-ALIF) cohorts. Outcomes were assessed with multivariable regression. Backward stepwise multivariable linear regression with listwise deletion identified predictors of one-year PRO scores in each cohort. Results: Analysis included 396 ALIFs with 234 (59.1%) PSF-ALIFs and 162 (40.9%) SA-ALIFs. PSF-ALIF patients were older, with higher BMI and comorbidity burden. Both groups improved significantly in ODI and EQ. 5D scores at one year ( P &lt;0.001). ODI scores did not differ between groups, but PSF-ALIFs had higher one-year EQ. 5D scores (75.7±18.8 vs. 67.8±19.5, P =0.007) and improvement from baseline (18.5±16.7 vs. 13.9±19.1, P =0.013). Among PSF-ALIFs, higher CCI predicted improved ODI scores ( P =0.010). In SA-ALIFs, smoking predicted worse ODI ( P =0.021) and EQ. 5D ( P =0.012), and higher BMI predicted worse EQ. 5D ( P =0.039). Conclusions: Supplementation with pedicle screws can increase the quality of life of ALIF patients with stable degenerative pathology. PSF may be beneficial for active smokers and those of higher BMI, but may be limiting for healthier patients. Level of Evidence: Level III.

Background: Elderly patients with degenerative thoracolumbar scoliosis face difficult care issues, especially if they have spinal stenosis and vertebral compression fractures. Conservative care is still the primary strategy for older patients with stable neurological condition and substantial surgical risk factors, even if surgical intervention is frequently recommended for symptomatic spinal abnormalities. Case Presentation: We describe the case of an 88-year-old man who has had increasing lower back discomfort for the past three years due to bilateral spinal compression fractures (D10, D11, and burst fracture of D12), multilevel disc desiccation, and thoracolumbar scoliosis. The patient had intact neurological function (normal motor strength 5/5, preserved sensory function, and normal deep tendon reflexes) despite severe spinal canal stenosis with anterior thecal sac depression and bilateral neural foramina constriction on MRI. A thorough conservative treatment that included neuroprotective supplements (methylcobalamin, alpha-lipoic acid, and benfotiamine), multimodal physiotherapy, nutritional optimization, and pharmaceutical pain management with NSAIDs and antihypertensive medication was helpful in managing the patient. Results: The patient showed notable symptom relief, preserved neurological integrity, and improved functional mobility following five days of hospital care and ongoing outpatient conservative therapy. At the one-month follow-up, the patient was able to manage their discomfort, move around freely, and maintain their quality of life without the need for surgery. Conclusion: When neurological function is maintained, this case demonstrates the efficacy of properly chosen, multimodal conservative treatment for older individuals with degenerative thoracolumbar scoliosis and spinal compression fractures. While avoiding the significant perioperative risks associated with spine surgery in advanced age, comprehensive physiotherapy, neuroprotective supplements, nutritional optimization, and constant neurological monitoring yield good results.