Lumbar Vertebrae

BackgroundIatrogenic injury and approach-related complications in lumbar fusion surgery have become significant concerns. This study aims to assess the muscle damage with oblique lumbar interbody fusion (OLIF) compared with unilateral biportal endoscopic-transforaminal lumbar interbody fusion (UBE-TLIF). This assessment will guide better clinical surgical choice in lumbar degeneration diseases.MethodsThis was a retrospective study comparing OLIF combined with anterolateral single screw-rod fixation and UBE-TLIF combined with percutaneous pedicle screws under navigation from January 2021 to December 2023. Individuals with single-level degenerative lumbar disease participated in the study. This study compared the baseline and perioperative parameters (blood loss, operation time, and haematological indicators) and clinical outcome (visual analogue scale scores, Japanese Orthopaedic Association scores, fusion rate, and complications). Measurements of the total cross-sectional area of psoas muscles and paraspinal muscles were obtained using regions of interest defined by manual tracing.ResultsThe cohort comprised 192 patients: 112 underwent OLIF (64 female; mean age 65.1 years) and 80 underwent UBE-TLIF (44 female; mean age 64 years). The operation time (P ConclusionWith OLIF there were lower creatine kinase levels, less blood loss, and less damage to paraspinal muscles. Therefore, in cases where both procedures are equally appropriate, OLIF is safer and less damaging to muscles and is the first choice for patients.

IntroductionIn adolescent idiopathic scoliosis (AIS), the choice of upper and lowest instrumented vertebrae and related complications remain debated. Bone quality is a relevant factor in this context. The vertebral bone quality (VBQ) score has recently been proposed as a radiation-free magnetic resonance imaging (MRI)-based measure of bone quality. However, the role of the VBQ score in AIS and its relationship with the severity of scoliosis characteristics has not yet been explored. We hypothesize that the VBQ score is associated with key features of AIS, including curve type, Cobb angle, lumbar modifier, and thoracic kyphosis.MethodsThis retrospective study included AIS patients who underwent posterior spinal fusion between 2011 and 2025 at a university hospital. The lumbar VBQ score was determined using preoperative MRI, and the Lenke classification was assessed based on preoperative radiographs. To ensure comparability, curve types were categorized based on the flexibility of the lumbar curvature into non-structural (Lenke types 1 and 2) and structural (Lenke types 3 to 6) groups. The association between VBQ and curve type, Cobb angle, lumbar modifier, and thoracic kyphosis-while considering MRI field strength, age, sex, and body mass index (BMI)-was analyzed using multiple linear regression analyses.ResultsThis single-center study included 60 patients (male: 15%, female: 85%) with a median age of 15 years (interquartile range (IQR): 14-16 years) and a median BMI of 18.9 kg/m2 (IQR: 17.5-22.4 kg/m2), diagnosed with AIS presenting with non-structural (55%) and structural (45%) lumbar curves. A significant association was found with lumbar curve flexibility (r2 = 0.298, p = 0.035), indicating that structural lumbar curves correlated with lower bone quality. Additionally, female patients showed significantly better bone quality (r2 = -0.446, p = 0.005). No significant correlation was observed between the VBQ score and Cobb angle (r2 = -0.003, p = 0.370), thoracic kyphosis (r2 = 0.001, p = 0.734), lumbar modifier (r2 = -0.116, p = 0.123), MRI field strength (r2 = -0.181, p = 0.098), age (r2 = 0.018, p = 0.558), or BMI (r2 = -0.014, p = 0.275).ConclusionOur study demonstrated a significant correlation between the VBQ score and both lumbar curve flexibility and sex. Opportunistic assessment of the VBQ score may therefore be particularly useful in male patients with a structural lumbar curve to identify individuals who may benefit from further evaluation of bone quality.

ImportanceSpine pain is a prevalent and costly condition affecting up to 85% of individuals throughout their lifetime, and spinal stenosis is one of the most debilitating sources of spine pain. Although conservative management is the first line of treatment for spinal stenosis, radiographically severe cases often are directly referred to surgical intervention due to the belief that conservative strategies delay necessary treatment. However, no studies support the premise that individuals with more radiographically severe stenosis respond poorly to conservative management.ObjectiveThe purpose of this study was to compare improvements in pain, disability, strength, medication usage, and patient function after an exercise-based physical therapist-led program.DesignThis study was a retrospective analysis of a single arm clinical trial.SettingThis was in the setting of an outpatient exercise-based physical therapist-led program.ParticipantsOne thousand eight hundred six individuals with radiographically mild, moderate, or severe lumbar spine stenosis participated in this study.InterventionThe intervention was an exercise-based physical therapist-led program.Outcomes and measuresOutcome measures included pain, low back pain related disability, patient specific function, analgesic medication use, and lumbar extensor strength.ResultsParticipants demonstrated significant improvements in all variables of interest, and 11.5% of participants reported cessation of narcotic use with treatment. There were no significant differences in treatment response across radiographically mild, moderate, or severe stenosis groups for any outcome.ConclusionsExercise-based rehabilitation is as beneficial in the short term for individuals presenting for nonoperative care with radiographically severe stenosis compared to their milder counterparts.RelevanceExercise-based rehabilitation results in the same magnitude of improvement in individuals with chronic low back pain regardless of radiographic severity of spinal stenosis.