Facet Joint Research Articles

Distribution of spinal damage in patients with axial spondyloarthritis as assessed by MRI: a prospective and blinded study

BackgroundAxial spondyloarthritis (SpA) leads to structural bone lesions in every part of the vertebral column. These lesions are only partially visualized on conventional radiographs, omitting posterior parts of the vertebral column and the thoracic spine, that may nevertheless contribute to impaired spinal mobility and function in patients with axial SpA.MethodsIn this prospective and blinded investigation, we assessed the distribution of structural spinal lesions using magnetic resonance imaging (MRI) of the whole spine in 55 patients with axial SpA classified according to the Assessment in Spondyloarthritis International Society (ASAS) criteria. After assessment of spinal mobility and function two blinded radiologists independently evaluated MRIs of 23 vertebral units in every patient. Non-parametric statistical methods, Spearman‘s correlation and linear regression models were used to analyze structural lesion distribution and the relationship with clinical spinal mobility and function parameters.ResultsIn 55 patients with axial SpA (13 females, average disease duration 14.9 years) 657 ventral and 139 dorsal vertebral body structural bone lesions and, notably, 534 facet joint lesions could be visualized. The median number of lesions per patient was higher in the thoracic (8.5, range 1.0–41.0) than in the lumbar (7.5, range 0.0-27.5) and the cervical spine (3.5, range 0.0-24.5). A negative correlation was noted between the number of osteoproliferative structural bone lesions and impairment of spinal mobility and function in univariate, but not in multivariate analyses.ConclusionMRI of the whole spine revealed a high prevalence of lesions in dorsal parts of the vertebral column and in the thoracic spine in patients with axial SpA that may not be adequately visualized on conventional radiographs. These findings could further contribute to a better understanding of reduced mobility of the spine typically associated with axial SpA and assist diagnostics.

Correlation between paraspinal muscle fat infiltration and thoracic vertebral degeneration based on phantom-less QCT: a novel insight into thoracic vertebral degeneration.

This study aimed to elucidate the correlation between the degree of fat infiltration (FI) in thoracic paraspinal muscles and thoracic vertebral degeneration (TVD). This cross-sectional study comprised 474 patients who underwent standard thoracic computed tomography (CT) scans. The FI was quantified as the percentage of adipose tissues within the cross-sectional area of thoracic paraspinal muscles. Thoracic vertebra was assessed in terms of osteoporosis, ossification of the anterior longitudinal ligament (OALL), ossification of the posterior longitudinal ligament (OPLL), intervertebral disc calcification, intervertebral disc cavity, and facet joint osteoarthritis (FJO). Logistic regression, linear regression, subgroup, and receiver operating characteristic (ROC) analyses were assessed to evaluate the association between FI and TVD. Multivariate logistic regression revealed that more severe FI was closely associated with more serious osteoporosis (P < 0.001). Furthermore, after adjusting for only age, higher FI was significantly associated with nastier FJO (P < 0.05). In male patients, severe FI was greatly associated with worse osteoporosis (P < 0.05). In female patients, severe FI maintained close correlations with more severe osteoporosis and FJO (P < 0.05). Furthermore, in patients aged < 60 or ≥ 60 years, higher FI had a strong correlation with more severe osteoporosis (P < 0.001). In patients aged < 60 years, higher FI was associated with worse intervertebral disc calcification, OALL, and FJO (P < 0.05). Meanwhile, in patients aged ≥ 60 years, increased FI was only associated with severe OPLL (P < 0.05). Multivariate linear regression showed that FI negatively correlated with bone mineral density in the general population and different sex and age groups (P < 0.001). ROC analysis indicated that FI could predict the occurrence of TVD (P < 0.05). Higher FI is associated with more severe TVD. Studies on TVD are currently limited; therefore, this study enriches the related research on TVD, and our findings would facilitate the early prediction and diagnosis of TVD in clinical practice. Furthermore, our findings indicate that thoracic spine pain (TSP) caused by TVD can be prevented, potentially improving the prognosis of patients with TSP.

Facet joint tropism in degenerative lumbar scoliosis: a retrospective case-control study.

To investigate the association between lumbar degenerative scoliosis and the dural sac cross-sectional area (DSCA), the lumbar canal anterior-posterior (LCAP) diameter, and the neural foraminal cross-sectional area (NFCA) in relation to facet joint tropism (FJT). In a retrospective case-control study, we analyzed data from 160 patients referred for lumbar magnetic resonance imaging (MRI) between January 2020 and December 2022. Cobb's angle on anteroposterior lumbosacral X-ray is served to identify the presence of degenerative lumbar scoliosis-Cobb's angle exceeding 10 degrees-, and axial T2W MRI is implemented to evaluate facet joint angles and tropism-defined as a difference exceeding 10 degrees between the facet joint angles at each level-, DSCA, LCAP, and NFCA. FJT was much more common in patients with degenerative lumbar scoliosis (69%) than in controls (14%). The frequency of FJT also incremented with the increasing severity of the scoliotic curve. We observed that LCAP and NFCA were significantly smaller in cases with FJT. However, no statistically significant difference was found in DSCA related to FJT. Age and gender did not exhibit significant associations with degenerative lumbar scoliosis, and no correlation was detected between different Cobb's angle groups and age. These findings underscore the importance of considering FJT as a potential contributing factor to degenerative lumbar scoliosis and may have implications for clinical diagnosis and management. Prospective research with larger and more diverse cohorts is needed to further investigate this complex relationship and its impact on lumbar spinal health.

Transoral C2 osteotomy for treatment of severe irreducible atlantoaxial dislocation after odontoid fracture: about 3 cases.

To report the outcomes of transoral C2 osteotomy (or partial odontoidectomy) and posterior fixation, regarding efficacy and safety, in patients with severe irreducible atlantoaxial dislocation (IAAD) following odontoid fracture. Transoral C2 osteotomy, soft tissue resection, with or without facet joint release, followed by posterior fixation were performed on 3 patients (2012, 2016, 2023) who were suffering from severe IAAD after an odontoid fracture with spinal cord compression. The radiological and clinical outcomes were then assessed. All 3 patients had satisfactory release of their spinal cord compression and good reduction of their IAAD. No neurological or vascular complications were reported. No instrumentation failure, radiolucent zone formation around the screws, infection, or recurrence of dislocation were encountered neither. Bony fusion was successfully achieved in every patient. Transoral C2 osteotomy (or partial odontoidectomy), soft tissue resection, with or without facet joint release, followed by posterior fixation is an effective and reliable method to treat severe IAAD after odontoid fractures.

Morphometric analysis of the C1-2 zygapophysial joint in atlantoaxial dislocation patients with sandwich fusion of the craniovertebral junction.

The combination of congenital C1 occipitalization and C2-3 non-segmentation (i.e. "sandwich fusion") results in early development of atlantoaxial dislocation (AAD). A thorough understanding of the morphometry of the C1-2 zygapophysial joints is important to ensure a safe surgery. This study was aimed to evaluate the C1-2 zygapophysial joint in AAD patients with sandwich fusion by morphological research based on CT scans. This was a retrospective case-control study including 155 AAD patients with sandwich fusion in sandwich group and 55 with os odontoideum (OO) in control group. The C1 listhetic distance, sagittal inclination angle (SIA), coronal inclination angles (CIA) were measured from the CT and compared between two groups. The listhetic grade was defined according to the ratio of the listhetic distance and length of the superior facet of C2: less than 25% as mild, 25-75% as moderate, and greater than 75% as severe. Patients in the sandwich group had higher listhetic grade than the OO group (17.4% vs. 70.6%, 50.3% vs. 29.4% and 32.3% vs. 0 were of mild, moderate, and severe, respectively). The SIA and CIA in the sandwich group were greater than those in the OO group (30.1° vs. 5.0°, 36.6° vs. 31.0°, respectively). Asymmetric listhesis was found in 0.0%, 63.3%, and 85.7% of sandwich patients with mild, moderate and severe listhetic grade, respectively. AAD with sandwich fusion was a three-dimensional deformity characterized by the high prevalence of asymmetric and moderate-to-severe listhesis.

Enhancing Clinical Insights: New Radiographic Grading for Lumbar Facet Joint Degeneration, A Reliability Study.

Lumbar facet joint diseases can often lead to reduced work efficiency and increased medical costs. As a primary imaging tool in orthopedics, X-rays offer numerous advantages. However, there is no consensus on the classification of lumbar facet joints based on X-ray imaging. This study was conducted for 356 patients between November 2017 and September 2023. A senior radiologist and a senior orthopedic surgeon discussed and established a grading system for lumbar facet joints based on both X-ray and MRI findings. Two double-blind attending spinal surgeons were asked to evaluate and grade the included cases. The intra-rater reliability and inter-rater reliability were evaluated by assessing the weighted kappa (κw) coefficient. The level of inter-rater reliability of MRI for complete agreement was good for Doctor A (κw = 0.792) and Doctor B (κw = 0.869). The inter-rater reliability coefficient for grading lumbar facet joint degeneration based on the radiograph was as follows: for Doctor A (κw = 0.702, session 1; κw = 0.847, session 2) and Doctor B (κw = 0.714, session 1; κw = 0.828, session 2). Moreover, the level of intra-rater reliability based on X-ray for complete agreement was excellent for Doctor A (κw = 0.843) and Doctor B (κw = 0.836). We propose a new grading system for lumbar facet joint degeneration based on X-rays, which serves as a supplement to the Weishaupt and Pathria classifications. This grading system aims to provide clinicians with a more comprehensive understanding of lumbar facet joint degeneration, allowing for the use of a broader range of diagnostic tools to evaluate facet joint degeneration from multiple perspectives. We believe that this grading system can be valuable in assessing potential anatomical changes related to the facet joint, thereby informing modifications to surgical techniques and procedural steps.

Posterior Ligamentum Complex Preservation Alleviate ASD-Related Biomechanical Deterioration in Lumbar Interbody Fusion Models: A Finite Element Analysis.

There are differences in the extent of excision of articular processes, spinal processes and posterior ligamentum complexes (PLC) for posterior approach lumbar interbody fusion. Given that the biomechanical significance of these structures has been verified and that deterioration of the biomechanical environment is the main trigger for complications in both fused and adjacent motion segments, changes in decompression ranges may affect the potential risk of adjacent segmental disease (ASD) biomechanically; however, this topic has yet to be identified. Posterior lumbar interbody fusion (PLIF) with different decompression strategies was simulated in a well-validated lumbosacral model. The excision and preservation of the cranial motion of the segmental PLC and the lateral articular process in the fusion segment were simulated in this model. The stress distribution in the cranial motion segment was computed under different loading conditions to determine the potential risk of ASD. Compared to complete bilateral articular process excision, preservation of the lateral two-thirds of the articular process did not alleviate stress concentration on the cranial motion segment both in PLC preserved and excised models. In contrast, preservation of the cranial segmental PLC can obviously alleviate the stress concentration tendency of the cranial intervertebral disc under flexion loading conditions. Preservation of the lateral parts of the articular process cannot optimize the biomechanical environment, in contrast, PLC preservation can effectively alleviate ASD related biomechanical deterioration of the cranium segment.

TMJ Metastasis: Evaluation of 3 Patients.

Metastases of the articular process, temporomandibular joint (TMJ), are rare findings. Their frequency is around 5% of patients with metastatic involvement of the mandible. The most common primary tumor is adenocarcinoma of the lung in women and adenocarcinoma of the prostate in men. The authors present 3 patients with TMJ metastasis. These were metastasis of breast adenocarcinoma, prostate adenocarcinoma, and lung adenocarcinoma. TMJ metastases are rare but complicated to diagnose because their presence may be accompanied by symptoms typical of other TMJ diseases (discopathy, arthritis, osteoarthritis). However, the authors recommend the unequivocal exclusion of a metastatic process in cases where the patient has a positive cancer history and their complaints do not respond to usual therapy.

Senolytics Cocktail Dasatinib and Quercetin alleviate chondrocyte senescence and facet joint osteoarthritis in mice

Background contextLow back pain (LBP) is a pervasive issue, causing substantial economic burden and physical distress worldwide. Facet joint osteoarthritis (FJ OA) is believed to be a significant contributor to this problem. However, the precise role of chondrocyte senescence in FJ OA remains unclear, as does whether the clearance of chondrocyte senescence can alleviate the progression of FJ OA. PurposeThe goal of this study was to understand the potential of Dasatinib (D) and Quercetin (Q) as a treatment to clear chondrocyte senescence during the progression of FJ OA. Study designWe used a preclinical bipedal standing mice model with the administration of Dasatinib (D) (5 mg/kg) and Quercetin (Q) (50 mg/kg) after 10 weeks of bipedal standing. Materials and methodsHuman degenerative lumbar facet joint (LFJ) samples were obtained to investigate the relationship between chondrocyte cellular senescence and LFJ osteoarthritis (OA). Subsequently, we established an in vitro model of excessive mechanical stress on chondrocytes and an in vivo bipedal standing mice model to induce LFJ OA. IHC (immunohistochemistry) staining in vivo and SA-β-gal staining, qRT-PCR and Western blot analysis were applied to test the senolytic effect of the combination of Dasatinib (D) and Quercetin (Q). IHC staining and X-ray microscope were also performed to examine the contribution of D+Q to the anabolism in cartilage and subchondral bone recoupling. Immunofluorescence and Western blot analysis in vitro and IHC staining in vivo were conducted to assess the impact of D+Q on the regulation of the NF-κB pathway activation during chondrocyte senescence. ResultsWe observed that facet joint cartilage degeneration is associated with chondrocyte cellular senescence in both human and mouse degenerative samples. Following treatment with D+Q in vitro, cellular senescence was significantly reduced. Upon oral gavage administration of D+Q in the bipedal standing mice model, decreased cellular senescence and reversed chondrocyte anabolism were observed. Furthermore, administration of D+Q maintained subchondral bone remodeling homeostasis and potentially reversed the activation of the NF-κB pathway in chondrocytes of the lumbar facet joint. ConclusionsIn summary, our investigation unveiled a significant correlation between chondrocyte senescence and LFJOA. Treatment with the senolytic combination of D+Q in FJ OA yielded a notable reduction in chondrocyte senescence, along with a decrease in the release of SASP factors. Additionally, it facilitated the promotion of cartilage anabolism, maintenance of subchondral bone coupling, and amelioration of NF-κB pathway activation. Clinical significanceOur outcomes revealed that D+Q, the renowned combination used for senolytic treatment, alleviate the progression of LFJ OA. The utilization of D+Q as a senolytic demonstrates a novel and promising alternative for LFJ OA treatment.

Overview of Available Treatments and Their Limitations for Hypertrophic Facet Joints—A Systematic Review of the Literature

Background: Physicians worldwide face the challenging task of improving patient satisfaction by reducing pain in injured patients. Currently, available therapeutic approaches provide only short-term relief of symptoms without addressing long-term satisfaction. This has led to exploring regenerative treatment options that can deliver better outcomes. One such promising option is platelet-rich plasma (PRP) injections, which are gaining popularity as an alternative to standard steroid injections. Objectives: This study examines the therapeutic effects of PRP injections in adult patients with stress or traumatic injuries. Methods: The systematic literature review yielded 60,301 articles, books, and websites verified and removed from the final project. The final studies used in the report comprised randomized trials, observational studies, and case reports on injecting biologics into the epidural space, facet joints, or sacroiliac joints. In total, 15 reviews and 13 studies were included in this review. Results: In the Wu et al study, 46 participants were randomly divided into group A (0.5 mL PRP injection) and group B (1.5 mL methylprednisolone injection). Although group B initially showed a notable pain reduction at one week, it diminished over 6 months, with group A consistently improving, reaching an 80.96% success rate and higher patient satisfaction. In the study by Singla et al comparing PRP (group P) and corticosteroid (group S) in 40 participants, PRP demonstrated a markedly greater reduction in VAS Scale at 6 weeks and 3 months, with a 90% effectiveness compared with 75% for steroids. Conclusion: PRP injections offer greater pain alleviation, disability reduction, and overall patient satisfaction improvements due to their effect on the immune response to promote the growth and proliferation of damaged tissue. It has also been shown to offer a safer alternative that carries fewer risks than that of transforaminal steroid injections due to promising clinical trials and scientific investigation outcomes. Several of the steroid injection studies proved to have mixed results and efficacy because patients reporting having similar pain relief with placebo groups that used saline injections. Further studies will be needed to evaluate PRP's long-term efficacy and cost-effectiveness for practical patient use in the future.

Full-Endoscopic J-Shaped Transforaminal L5 Nerve Decompression in Bertolotti Syndrome

This case report and video demonstrate the technique of full-endoscopic J-shaped transforaminal L5 exiting nerve decompression in Bertolotti syndrome. Bertolotti syndrome, characterized by a congenital lumbosacral transitional vertebra, often results in mechanical lower back pain and nerve root compression. A 69-year-old male presented with progressive radiating pain in the right leg and tingling in the L5 dermatome. Lumbar spine MRI revealed a right foraminal disc herniation at the L5–S1 level, with calcification and foraminal stenosis. The patient was also diagnosed with Castellvi type I Bertolotti syndrome, featuring a large L5 transverse process and a high iliac crest. These anatomical variations complicated the transforaminal approach, creating a narrow safety zone for conventional methods. The approach began with docking on the L5 transverse process. Endoscopic drilling was performed in a J-shaped configuration to partially resect the transverse process and alar wing, facilitating endoscope insertion into Kambin’s triangle. Foraminal decompression was achieved by removing the tip of the superior articular process (SAP), thereby decompressing the L5 exiting nerve root. Full-endoscopic spine surgery offers a safe and effective alternative to traditional open techniques for L5 nerve decompression in Bertolotti syndrome. This video presentation illustrates the intraoperative endoscopic approach, detailing the decompression techniques and highlighting the minimally invasive advantages of this method.

A new platanistoid (Odontoceti: Squalodelphinidae) from the Early Miocene of Japan

Extant Ganges and Indus river dolphins are endangered species, but their relatives were more diverse in the past. The family Squalodelphinidae is a group of Miocene relatives of Ganges and Indus river dolphins. Our knowledge of squalodelphinids increased slowly in the nineteenth century and has expanded dramatically since the 2010s. Italy, Switzerland, eastern USA, Argentina, and Peru are fossil localities of named and well-preserved squalodelphinid fossils. Squalodelphinids are also known from New Zealand, Germany and Venezuela. However, only two specimens of this family have been reported from the North Pacific, in Washington State, USA, and Japan. Here, a new fossil dolphin (including the skull, right and left periotics and bullae, malleus, incus, hyoid bones and ribs) from the Haze Formation, Ichishi Group, Early Miocene (18.7–18.5 Ma) of Mie Prefecture, Japan is named as the new genus and species Miodelphinus miensis. Phylogenetic analysis places Miodelphinus miensis among squalodelphinids. The periotic of Miodelphinus miensis shows a large, posteriorly widened, ventrally opening, funnel-like articular depression between the posterior and articular processes of the periotic. Miodelphinus miensis contributes to expanding our knowledge of squalodelphinid diversity. Squalodelphinids were distributed widely not only in the Atlantic but also the South and North Pacific by the Early Miocene. This suggests that the family had a chronologically deeper origin such as the beginning of the Early Miocene or older. https://zoobank.org/urn:lsid:zoobank.org:pub:DB7DDDE2-1095-4815-975B-8E1686559C2E

The emerging role of fluoroscopy-guided high-intensity focused ultrasound ablation in lumbar facet joint pain management.

The emerging role of fluoroscopy-guided high-intensity focused ultrasound ablation in lumbar facet joint pain management.

Emerging role of ultrasound guided interventional management in cervicogenic headache

The objective of this mini review is to discuss the role ofmusculoskeletal ultrasound (MSK US) in identification andtreatment of pain generators in cervical spine in patientspresenting with cervicogenic headache (CEH). CEH is asecondary headache arising from cervical nociceptivestructures emerging from facet joints, intervertebral discs,nerves, muscles, fascia and ligaments. It presents acomplex challenge in clinical management.Traditional treatments often provide limited relief,prompting the exploration of innovative interventionslike US guided techniques. MSK US is gaining momentumsince last 2 decades and it has transformed theinterventional management options for diverseconditions including CEH with improved accuracy andefficacy. The management of CEH needs to bemultidisciplinary keeping biopsychosocial model of painin mind. In countries like Pakistan, there is a hugepotential to apply US guided procedures in its population,as it reduces the number of visits by the patient andreduces the overall healthcare cost. By targetting specificpain generators and minimizing collateral damage, theseinterventions hold immense promise in improving themanagement. Herein, we briefly discuss the diagnosis ofCEH and evidence based US guided interventions oncervical pain generators.

Risk factors analysis and predictive model of degree I degenerative lumbar spondylolisthesis

Study designRetrospective Case-Control Study.BackgroundThere have been some previous studies on the risk factors associated with lumbar spondylolisthesis, but there are few studies on the risk factors for disease progression in mild degenerative lumbar spondylolisthesis (DLS). To analyze the risk factors associated with aggravation of spondylolisthesis in patients with grade I degenerative spondylolisthesis and construct a prediction model.MethodsWe conducted a retrospective analysis of 220 patients diagnosed with DLS who were admitted to our hospital between January 2019 and January 2023. Data collected included gender, age, body mass index (BMI), diabetes, hypertension, occupation, and imaging parameters.ResultsA total of 220 patients were included in this study, including 111 males and 109 females; 178 patients with no aggravation of lumbar spondylolisthesis (group A) and 42 patients with aggravation of lumbar spondylolisthesis (group B). Progression of grade I DLS was associated with single factors such as age, BMI, Occupation, vertebral CT value, facet joint angle (FJA), Modic change (MC), Pfirrmann grade of intervertebral disc (PG), Facet joint effusion (FJE), osteophyte formation, and Percentage of the Fat Infiltration (FIA%) of multifidus muscle (MM). BMI, FJA, PG, and FI% of MM had a significant impact on disease progression in lumbar spondylolisthesis.ConclusionBMI, FJA, PG, and FIA% of MM were independent risk factors for the progression of degenerative spondylolisthesis. The risk prediction model was established by including the above four variables and nomograms were drawn. The internal validation proved that the model had good discrimination, calibration, and clinical practicability.

Consistent use injectable and oral chondroprotectors in patients with osteoarthritis and lower back pain. Case report

Osteoarthritis (OA) is a disease of the entire joint, including structural changes in hyaline articular cartilage, subchondral bone, ligaments, capsule, synovial membrane and periarticular muscles. One of the causes of the development of nonspecific chronic lower back pain (LBP) is OA of the facet joints. In the treatment of OA and LBP against the background of OA facet joints, the chondroprotective agents are widely used: chondroitin sulfate (CS), glucosamine sulfate, undenatured type II collagen and their combinations. The aim of the article is to systematize the possibilities of practical application of Chondroguard TRIO® in patients with OA of different phenotypes and different localization. The experience of sequential administration of CS in patients (n=11) with OA and LBP with comorbid diseases is presented. At the initial stage of therapy, CS (Chondroguard®) was prescribed intramuscularly according to the scheme, then CS was prescribed perorally as part of a pharmaconutraceutical (Chondroguard® TRIO). The original pharmaconutraceutical Chondroguard® TRIO contains recommended doses of CS (1200 mg), glucosamine sulfate (1500 mg), undenatured type II collagen (40 mg). Clinical cases of the use of sequential administration of chondroprotectors (stage 1 – intramuscularly Chondroguard®, stage 2 – perorally Chondroguard® TRIO) demonstrate the clinical effectiveness of the proposed treatment regimen in patients of different age groups and OA phenotypes (posttraumatic, metabolic).

Central lumbar stenosis. Recommendations of the Russian Association for the Study of Pain (RASP)

Narrowing of the central spinal canal in the lumbar spine (central lumbar stenosis, CLS) is one of the most common causes of lumbar pain, disability and spinal surgery in the elderly. The most common is acquired degenerative CLS, in which the main role play lumen-narrowing medial intervertebral disc herniating with ossification phenomena and marginal bone proliferation on the sides of the vertebral bodies – osteophytes, hypertrophy of the facet joints with their medial displacement, hypertrophy of the yellow ligament. The development of CLS can also be a consequence of spondylolisthesis, postoperative changes, rheumatic diseases and other causes. Both the compression of the cauda equine roots due to narrowing of the spinal canal and their ischemia, caused by compression of the radicular vessels and venous congestion play an important role in the pathogenesis of CLS. CLS develops in elderly age and occurs predominantly in men. The main clinical manifestation of CLS is neurogenic (caudogenic) intermittent claudication, which manifests as pain, numbness and weakness in the legs when the patient walks or stands for a long time but subsides when the patient sits or stands and bends forwards (flexion in the lumbar spine). The diagnosis of CLS is confirmed by magnetic resonance imaging (MRI), which shows a narrowing of the spinal canal and makes it possible to rule out specific causes of lumbar pain. It is important to note that, according to MRI, CLS often occurs at an older age, so its detection in the absence of clinical manifestations does not require an immediate discussion of the prospects of surgical treatment. Pain in patients with CLS according to MRI may be musculoskeletal in nature. Therefore, the diagnosis of CLS should include specific clinical manifestations and stenosis on MRI. In patients without clinical manifestations of CLS, osteoporosis and severe concomitant somatic diseases, only conservative therapy is recommended. Modern conservative treatment of CLS includes an educational program, therapeutic exercises (kinesiotherapy), psychological therapy methods for emotional disorders (cognitive-behavioral therapy), manual therapy and pharmacotherapy. Complex conservative treatment of CLS can reduce pain, improve the patient's condition and in some cases increase the patient's walking distance.

Relationship Between Paraspinal Sarcopenia and Lumbar Alignment and Facet Joint Osteoarthritis in Patients with Degenerative Lumbar Spinal Stenosis.

Retrospective study analysis. To explore association between degenerative spinal conditions and paraspinal sarcopenia in patients with severe degenerative lumbar spinal stenosis (DLSS). Paraspinal muscles plays an essential role in stabilizing the spine. Paraspinal sarcopenia is progressively recognized as a crucial parameter influencing clinical outcomes in the field of spine surgery. The association between degenerative spinal conditions and paraspinal sarcopenia in patients with severe DLSS has been rarely investigated. This study was conducted on consecutive patients who underwent posterior lumbar interbody fusion at L4/5 single-level for lumbar spinal stenosis between January 2019 and July 2023. The study assessed paraspinal sarcopenia based on the fatty infiltration and Goutallier classification systems (GCS) of multifidus muscle on preoperative magnetic resonance imaging. The study evaluated the association between demographic/radiographic factors and paraspinal sarcopenia in patients with DSLL. Ordinal logistic regression analysis was then performed to adjust for confounding. A total of 129 patients were included, including 38 patients with mild paraspinal sarcopenia, 52 patients with moderate paraspinal sarcopenia, and 39 patients with severe paraspinal sarcopenia. Correlation analysis indicated that age (r=0.366, P<0.001), pelvic incidence (PI) (r=0.407, P<0.001), lumbar lordosis (LL) (r=0.362, P=0.023) were positively correlated with paraspinal sarcopenia, while weight (r=-0.422, P<0.001), cross-sectional area (CSA) of psoas (r=-0613, P<0.001), facet joint angle (FA) (r=-0.447, P=0.016), and The Hounsfield Unit values of L1-L4 (L1-4 HU) (r=0.298, P=0.005) were negatively correlated with paraspinal sarcopenia. Ordinal logistic regression showed that the Facet joint osteoarthritis (FJOA) (odds ratio=2.82, P=0.017), PI (odds ratio=1.15, P<0.001), age (odds ratio=1.14, =0.001), and female (odds ratio=5.26, P=0.04) were associated with paraspinal sarcopenia. Our study demonstrated FJOA, PI, age, and female were associated with paraspinal sarcopenia. The assessments of paraspinal muscles cross-sectional area were not associated with the severity of fatty infiltration.

Multicenter External Validation of the Accuracy of Computed Tomography Criteria for Detecting Thoracolumbar Posterior Ligamentous Complex Injury.

Recent studies have proposed computed tomography (CT) criteria for posterior ligamentous complex (PLC) injury: disrupted if ≥2 CT findings, indeterminate if single finding, and intact if 0 CT findings. The study aims to validate the CT criteria for PLC injury externally. Three level 1 trauma centers enrolled 614 consecutive patients with acute thoracolumbar fractures (T1-L5) who received CT and MRI. Three reviewers from each center assessed CT for facet joint malalignment, horizontal laminar fracture, spinous process fracture, and interspinous widening and MRI for disrupted PLC, defined as black stripe discontinuity. The primary outcome is the diagnostic accuracy of CT criteria (0, 1, ≥2 findings) in detecting disrupted PLC on MRI using all CT readings. A subgroup analysis was performed for each participating center and reviewer. The inter-reader agreement on PLC status on MRI and CT criteria was assessed using Fleiss Kappa (k). The positive predictive value for PLC injury was 0 findings 3%, single positive CT 43%, and ≥2 CT findings in 94%. The accuracy measures were consistent across various centers and reviewers. The area under the curve for ≥1 CT finding in detecting PLC injury ranged from 90% to 97%, indicating excellent discrimination for all centers. The inter-reader k on PLC status by MRI and overall CT findings was substantial (k > 0.60). This study externally validates the previously proposed CT criteria for PLC injury. A total of ≥2 positive CT findings or 0 CT findings can be used as criteria for a disrupted PLC (B-type injury) or intact PLC (A-type injuries), respectively, without added MRI. A single CT finding implies indeterminate PLC status and the need for further MRI assessment. The CT criteria will potentially guide MRI indications and treatment decisions for neurologically intact thoracolumbar burst fractures.

Comparative evaluation of ultrasound and fluoroscope guided intra-articular sacroiliac joint injection in patients with sacroiliac joint pain

Background: Tissues which transmit pain in the lower back include disc, nerve root, dura, muscles, ligaments, facet joints, and sacroiliac joint (SIJ). The SIJ contributes around 13–30% in patients with chronic low back pain. The SIJ is difficult to enter with a needle because of its complex configuration. Ultrasound and fluoroscopy are the two tools which guide in performing SIJ injections. Aims and Objectives: The SIJ is susceptible to arthritis, trauma, and degeneration which lead to pain and dysfunction. Intra-articular SIJ injections (IASIJIs) have diagnostic and therapeutic value and have been administered for the treatment of SIJ pain. Materials and Methods: Sixty patients (aged 20–60 years) with pain patterns consistent with SIJ pain who did not respond to conservative treatment were included in the study. The patients were randomly divided into two groups of 30 each: Group U (n=30): Ultrasound-guided IASIJI and Group F (n=30): Fluoroscope-guided IASIJI. A total of 3 mL drug solution comprising 1 mL of 0.25% bupivacaine plus 2 mL of methylprednisolone (80 mg) was injected in both groups. Results: There was a statistically significant improvement in pain scores after IASIJI in both groups. The change in pain score was significantly more in Group F as compared to Group U at 3 and 6 months after IASIJI. Two weeks after IASIJI, the mean pain score in both groups remained &lt; 2 at all time intervals throughout the study period. The variation in the Oswestry Disability Index (ODI) at different time intervals when compared to ODI before injection in both the groups was clinically and statistically significant (P&lt;0.001). The change in ODI was more in Group F as compared to Group U at all time intervals. Excellent patient satisfaction was reported by the majority of the patients at different time intervals in both groups. Conclusion: Both techniques were effective and provided good pain relief to the patients with SIJ pain. Fluoroscope-guided SIJ injection is better than ultrasound-guided SIJ injection in terms of improvement in pain score and functional disability.