BACKGROUND Lumbar interbody fusion(LIF)is the primary treatment for lumbar degenerative diseases.Elderly patients are prone to anxiety and depression after undergoing surgery,which affects their postoperative recovery...BACKGROUND Lumbar interbody fusion(LIF)is the primary treatment for lumbar degenerative diseases.Elderly patients are prone to anxiety and depression after undergoing surgery,which affects their postoperative recovery speed and quality of life.Effective prevention of anxiety and depression in elderly patients has become an urgent problem.AIM To investigate the trajectory of anxiety and depression levels in elderly patients after LIF,and the influencing factors.METHODS Random sampling was used to select 239 elderly patients who underwent LIF from January 2020 to December 2024 in Shenzhen Pingle Orthopedic Hospital.General information and surgery-related indices were recorded,and participants completed measures of psychological status,lumbar spine dysfunction,and quality of life.A latent class growth model was used to analyze the post-LIF trajectory of anxiety and depression levels,and unordered multi-categorical logistic regression was used to analyze the influencing factors.RESULTS Three trajectories of change in anxiety level were identified:Increasing anxiety(n=26,10.88%),decreasing anxiety(n=27,11.30%),and stable anxiety(n=186,77.82%).Likewise,three trajectories of change in depression level were identified:Increasing depression(n=30,12.55%),decreasing depression(n=26,10.88%),and stable depression(n=183,76.57%).Regression analysis showed that having no partner,female sex,elevated Oswestry dysfunction index(ODI)scores,and reduced 36-Item Short Form Health Survey scores all contributed to increased anxiety levels,whereas female sex,postoperative opioid use,and elevated ODI scores all contributed to increased depression levels.CONCLUSION During clinical observation,combining factors to predict anxiety and depression in post-LIF elderly patients enables timely intervention,quickens recovery,and enhances quality of life.展开更多
Objective:To explore the effect of combining Duhuo Jisheng decoction with warm acupuncture and moxibustion in the treatment of patients with lumbar disc herniation.Methods:Using a random number table method,a total of...Objective:To explore the effect of combining Duhuo Jisheng decoction with warm acupuncture and moxibustion in the treatment of patients with lumbar disc herniation.Methods:Using a random number table method,a total of 100 patients with lumbar disc herniation treated at Xianning Matang Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were divided into a control group of 50 patients treated with Duhuo Jisheng decoction and a study group of 50 patients treated with Duhuo Jisheng decoction combined with warm acupuncture and moxibustion.The TCM syndrome scores,lumbar function,lumbar pain,and lumbar activity were compared between the two groups.Results:After intervention,the TCM syndrome scores,ODI,and VAS scores of both groups showed a decreasing trend compared to before intervention,and the decreasing trend was more significant in the study group(P<0.05).After intervention,the JOA and lumbar activity indicators of both groups showed an increasing trend compared to before intervention,and the increasing trend was more significant in the study group(P<0.05).Conclusion:Duhuo Jisheng decoction combined with warm acupuncture and moxibustion is an effective and safe treatment method for lumbar disc herniation,which can improve lumbar function and activity.展开更多
Background: Lumbar disc herniation is a common injury among athletes, especially those who practice disciplines with repetitive flexion movements, twisting and axial loading on the spine, such as weightlifting, gymnas...Background: Lumbar disc herniation is a common injury among athletes, especially those who practice disciplines with repetitive flexion movements, twisting and axial loading on the spine, such as weightlifting, gymnastics, hockey and American football. In refractory cases to conservative treatment, microscopic discectomy or full endoscopic discectomy are used as surgical options to relieve pain and restore patient functionality. However, the ideal time for a return to sports activities remains a matter of debate due to variations in recovery times and risks of complications associated with each technique. Methods: A review was conducted, including articles published in the last 33 years (1991-2024), as it was the earliest date matching our search criteria. Clinical studies, systematic reviews, meta-analyses, and clinical guidelines were included. Results: The most common complications when returning to sport prematurely include recurrence of the hernia, persistent pain (VAS leg 7 or higher after surgery) and reduced physical performance. The return to full activity rate of patients who underwent microdiscectomy reaches up to 90%, while the endoscopic technique shows a success rate that reaches 99%. Return to play meantime was 5.19 months (range 1.00 - 8.7 months) and mean time of 4.6 months (range 2 - 8 months) with Microdiscectomy and full endoscopic discectomy respectively. Conclusions: There is no unanimous consensus on the exact timing of return to sport due to variability in recovery times and clinical outcomes. In both techniques, evidence highlights the need for a multidisciplinary approach that integrates surgeons, physical therapists and trainers to optimize recovery and ensure a safe return.展开更多
Background: Surgical treatment of lumbar disc herniation is a widely debated topic, with several techniques available. Percutaneous endoscopic discectomy (PELD) has gained popularity due to its lower invasiveness comp...Background: Surgical treatment of lumbar disc herniation is a widely debated topic, with several techniques available. Percutaneous endoscopic discectomy (PELD) has gained popularity due to its lower invasiveness compared to conventional techniques such as microdiscectomy/open lumbar microdiscectomy (OLMD)/tubular microdiscectomy (TMD). However, evidence on the effectiveness, recovery time and complications of these techniques is not yet clearly established. This systematic review aims to compare the preoperative and postoperative outcomes of both techniques. Methods: A comprehensive search was performed in databases including PubMed and Cochrane, following strict inclusion and exclusion criteria. Comparative studies and narrative reviews on PELD and OLMD/TMD published between 2019 and 2024 were included. Key outcomes considered were pre- and postoperative Visual Analogue Scale (VAS), hospitalization time, time to return to work, and postoperative complications. Results: The reviewed studies indicated that PELD is associated with a greater reduction in postoperative pain compared to OLMD/TMD, with a significant decrease in VAS, according to the study by Priola et al. (2019). The hospital stay was also shorter for patients undergoing PELD, averaging 2 days compared to OLMD/TMD. Furthermore, PELD favored a faster return to work and had a lower rate of postoperative complications, such as dural tears and reoperations, compared to OLMD/TMD. Conclusions: PELD demonstrates clear advantages over OLMD/TMD in terms of pain reduction, shorter hospital stay, faster return to work, and fewer postoperative complications. However, the implementation of this technique requires a significant learning curve, suggesting that its effectiveness may vary depending on the surgeon’s experience. PELD should be considered a preferred option in the resection of lumbar disc herniations, especially in patients seeking a quick and less invasive recovery.展开更多
In this editorial,the authors of this paper comment on the article by Bokov et al published in the recent issue of World Journal of Orthopedics.We reviewed a general overview of oblique lumbar interbody fusions(OLIF)a...In this editorial,the authors of this paper comment on the article by Bokov et al published in the recent issue of World Journal of Orthopedics.We reviewed a general overview of oblique lumbar interbody fusions(OLIF)and lateral lumbar interbody fusions(LLIF),their indications and complications as an increasingly popular minimally invasive technique to address several lumbar pathologies.This editorial thoroughly discusses and reviews the literature regarding factors affecting outcomes of indirect decompression utilized through OLIF and LLIF procedures.Several parameters play a critical role in patient outcomes including restoration of disc height,foraminal height,central canal squared,and foraminal area.The indirect decompression allows for unbuckling of the ligamentum flavum which can significantly decompress the neural elements as well as aid in reduction of spondylolisthesis.However,the authors further highlight the limitations of indirect decompression and factors that may predict unsuccessful outcomes including bony foraminal stenosis,severe central canal stenosis,and osteoporosis.As a result,failure of indirect decompression can lead to persistent pain,radiculopathy and unsatisfied patients.Spinal surgeons may be left to reimage patients and consider additional procedures with direct decompression.展开更多
Lower back pain is one of the most common medical problems in the world and it is experienced by a huge percentage of people everywhere.Due to its ability to produce a detailed view of the soft tissues,including the s...Lower back pain is one of the most common medical problems in the world and it is experienced by a huge percentage of people everywhere.Due to its ability to produce a detailed view of the soft tissues,including the spinal cord,nerves,intervertebral discs,and vertebrae,Magnetic Resonance Imaging is thought to be the most effective method for imaging the spine.The semantic segmentation of vertebrae plays a major role in the diagnostic process of lumbar diseases.It is difficult to semantically partition the vertebrae in Magnetic Resonance Images from the surrounding variety of tissues,including muscles,ligaments,and intervertebral discs.U-Net is a powerful deep-learning architecture to handle the challenges of medical image analysis tasks and achieves high segmentation accuracy.This work proposes a modified U-Net architecture namely MU-Net,consisting of the Meijering convolutional layer that incorporates the Meijering filter to perform the semantic segmentation of lumbar vertebrae L1 to L5 and sacral vertebra S1.Pseudo-colour mask images were generated and used as ground truth for training the model.The work has been carried out on 1312 images expanded from T1-weighted mid-sagittal MRI images of 515 patients in the Lumbar Spine MRI Dataset publicly available from Mendeley Data.The proposed MU-Net model for the semantic segmentation of the lumbar vertebrae gives better performance with 98.79%of pixel accuracy(PA),98.66%of dice similarity coefficient(DSC),97.36%of Jaccard coefficient,and 92.55%mean Intersection over Union(mean IoU)metrics using the mentioned dataset.展开更多
BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgica...BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.展开更多
Background:There is a gap in understanding the effects of different acupoints and treatment methods(acupuncture and moxibustion)on microcirculatory changes in the lumbar region.Objective:This study aimed to assess the...Background:There is a gap in understanding the effects of different acupoints and treatment methods(acupuncture and moxibustion)on microcirculatory changes in the lumbar region.Objective:This study aimed to assess the thermal effects of acupuncture at Weizhong(BL40),with acupuncture at Chize(LU5)and moxibustion at both acupoints as control interventions.Design,setting,participants and interventions:In this randomized controlled trial,140 healthy participants were equally divided into four groups:acupuncture at BL40(Acu-BL40),acupuncture at LU5(Acu-LU5),moxibustion at BL40(Mox-BL40)and moxibustion at LU5(Mox-LU5).Participants underwent a 30-minute session of their assigned treatment.Infrared thermal imaging was used to collect temperature data on the areas of interest for analysis.Main outcome measures:The primary measure was the change in average temperature of the observed area after the intervention.The secondary measures included periodic temperature changes every5 min and the temperature changes of the Governor Vessel and Bladder Meridian in the observed area after the intervention.Results:Significant interactions were observed between treatments and acupoints affecting temperature(P<0.001).The Acu-BL40 group showed a notably higher increase in mean temperature after 30 min compared to the Acu-LU5 and Mox-BL40 groups,with increases of 0.29(95%confidence interval[CI]=0.17 to 0.41)and 0.24(95%CI=0.08 to 0.41)℃,respectively.Conclusion:Acupuncture at BL40 acupoint can significantly increase the mean temperature in the observed area,highlighting the specific thermal effect of acupuncture compared to moxibustion in the lumbar area.This suggests a potential therapeutic benefit of acupuncture at BL40 for managing lumbar conditions.展开更多
Objective To determine the prevalence of lumbar spondylolysis(LS)and the proportion of spondylolytic spondylolisthesis(SS)in China,and to evaluate the musculoskeletal status of patients with LS and SS.Methods Spine Co...Objective To determine the prevalence of lumbar spondylolysis(LS)and the proportion of spondylolytic spondylolisthesis(SS)in China,and to evaluate the musculoskeletal status of patients with LS and SS.Methods Spine Computed Tomography(CT)images were collected from community populations aged 40 and above in a nationwide multi-center project.LS was diagnosed,and SS was graded by an experienced radiologist.Bone mineral density(BMD)and paraspinal muscle parameters were quantified based on CT images.Results One hundred and seventeen patients of a total of 3,317 individuals were diagnosed with LS,corresponding to a prevalence rate of 3.53%.63 of the 1,214 males(5.18%)and 54 of the 2,103 females(2.57%)were diagnosed with LS.SS occurred in 64/121 vertebrae(52.89%).BMD was not associated with LS(P=0.341).The L5 extensor paraspinal muscle density was higher in the LS group than in the non-LS group.In the LS group,patients with SS had a smaller L5 paraspinal extensor muscle cross-sectional area than those without SS(P=0.003).Conclusion The prevalence of LS in Chinese adults was 3.53%,with prevalence rates of 5.18%in males and 2.57%in females.Patients with LS have higher muscle density,whereas those with SS have smaller muscle cross-sectional areas at the L5 level.展开更多
[Objectives]To investigate the clinical efficacy of Cyclic Flexion Traction(CFT)in treating Lumbar Disc Herniation(LDH)and its effects on lumbocrural pain relief,functional improvement,and nerve root decompression.[Me...[Objectives]To investigate the clinical efficacy of Cyclic Flexion Traction(CFT)in treating Lumbar Disc Herniation(LDH)and its effects on lumbocrural pain relief,functional improvement,and nerve root decompression.[Methods]Seventy LDH patients treated at the orthopedic rehabilitation outpatient and inpatient departments of Shiyan Taihe Hospital from June 2022 to December 2024 were randomly divided into a treatment group(CFT therapy,n=35)and a control group(traditional traction,n=35).The treatment group received cyclic flexion traction(traction force of 30%-50%body weight with a cycle of 60-30-30 sec),while the control group received supine position linear traction.Both groups underwent 4 weeks of treatment,with assessments including visual analog scale(VAS),Oswestry Disability Index(ODI),and straight leg raising test(SLRT)angles.[Results]The treatment group showed a significantly greater reduction in VAS scores(from 6.97 to 2.31)compared to the control group(from 6.89 to 3.74)(P<0.05).Similarly,ODI improvement(41.62→15.73 compared with 40.98→22.84)and SLRT angle increase(41.23°→76.47°compared with 42.09°→64.19°)were more pronounced in the treatment group(all P<0.05).[Conclusions]Through dynamic decompression mechanisms,CFT therapy demonstrates superior efficacy to traditional traction in pain relief,functional recovery,and nerve root decompression(effective rate 94.29%compared with 77.14%,P<0.05),representing a superior non-surgical treatment option.展开更多
BACKGROUND Lumbar disc extrusion,a common spinal disorder,is particularly uncommon in its severely displaced form,especially in young patients.This condition can pose diagnostic challenges due to its nonspecific prese...BACKGROUND Lumbar disc extrusion,a common spinal disorder,is particularly uncommon in its severely displaced form,especially in young patients.This condition can pose diagnostic challenges due to its nonspecific presentation.CASE SUMMARY A 36-year-old male patient presented with persistent low back pain and radiating leg pain lasting half a month,which had worsened over the previous four days.Lumbar magnetic resonance imaging scans showed an abnormal signal within the vertebral canal at the L3 level,suggesting either a disc cyst or an epidural hematoma.Based on these findings,the patient was provisionally diagnosed with either condition.Surgical exploration was conducted,revealing an extruded lumbar disc,which was subsequently excised.Following surgery,the patient's symptoms completely resolved.CONCLUSION High-grade lumbar disc extrusion in young patients is rare but should be considered in sedentary,physically inactive individuals presenting with lumbocrural pain and abnormal magnetic resonance imaging findings.Early and accurate diagnosis is crucial to avoid misdiagnosis,and prompt open surgery may be necessary in severe cases to alleviate symptoms.The case highlights the impotance of a thorough diagnostic workup and timely surgical intervention in managing such rare but potentially severe spinal disorders.展开更多
Objective:To investigate the diagnostic value of magnetic resonance imaging(MRI)in patients with Modic changes and endplate sclerosis of the lumbar spine.Methods:A total of 66 patients with lumbar spine diseases who u...Objective:To investigate the diagnostic value of magnetic resonance imaging(MRI)in patients with Modic changes and endplate sclerosis of the lumbar spine.Methods:A total of 66 patients with lumbar spine diseases who underwent MRI and CT diagnostic examinations at the hospital from May 2024 to April 2025 were included in this study.The MRI findings of Modic changes were compared between Type I and Type II patients,and the presence or absence of endplate sclerosis signals and the HU value ratio on CT were analyzed.The pathological characteristics of Modic changes in Type I and Type II patients were observed.The imaging features of Modic changes in patients with lumbar spine diseases were analyzed.Results:Modic changes were present in 34 patients,with a total of 204 endplates evaluated,of which 74 were affected.MRI classification showed:Type I in 8 cases(10.81%),Type I/II mixed in 10 cases(13.51%),Type II in 51 cases(68.92%),and Type II/III mixed in 5 cases(6.76%).In CT reconstruction images,26 endplates with Modic changes on MRI showed sclerosis in the vertebral body,presenting high-density sclerotic features.These sclerotic areas did not exhibit distinct signal characteristics on MRI but pathologically demonstrated Type II Modic changes concurrently with fatty degeneration and sclerosis;In patients with Modic changes of Type I and Type II,regardless of the presence or absence of endplate sclerosis,the sagittal T1/T2 signal intensity ratio showed no statistically significant difference(P>0.05).However,the HU value ratio in Type II changes with sclerotic regions(2.74±0.61)was significantly higher than that in regions without sclerosis(1.16±0.23),with a statistically significant difference(P<0.05).Conclusion:CT reconstruction images of patients with lumbar Modic changes clearly demonstrate endplate sclerosis,a phenomenon closely associated with the bone marrow repair process.MRI has limited sensitivity for detecting sclerosis,potentially due to the following factors:first,differences in the radiographic characterization of endplate mineral content;second,the specific influence of different Modic types on signal intensity.This suggests that MRI classification should be combined with CT features for comprehensive interpretation.展开更多
Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treati...Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treating infants younger than 90 d.Guidelines for investigating fever without a source(meaning without an apparent source of infection,or of nonobvious origin) are numerous around the world but remain conflicting,particularly on whether to perform a lumbar puncture for cerebrospinal fluid (CSF) analysis in infants older than 22 d and hence at lower risk than younger infants.展开更多
BACKGROUND In this aging population,lumbar spinal stenosis(LSS)reduces walking distance and impairs functionality.The definitive treatment is still controversial.AIM To assess the efficacy of physical therapy and surg...BACKGROUND In this aging population,lumbar spinal stenosis(LSS)reduces walking distance and impairs functionality.The definitive treatment is still controversial.AIM To assess the efficacy of physical therapy and surgery in improving function and reducing pain levels in patients with LSS,both in the short and long term.METHODS This prospective study screened patients aged 50-80 years with LSS and divided them into two groups based on certain criteria:Surgical and conservative.The conservative group received a supervised physical therapy and exercise program for 45 minutes,five days a week,for one month.The surgery group underwent micro endoscopic decompression surgery based on their LSS levels.Assessments,conducted before treatment and at one-month and one-year intervals,included the participants'walking distance,pain level using the visual analog scale,func tionality using the Istanbul low back pain disability index(ILBDI)and Swiss Spinal Stenosis Questionnaire(SSS)Scale,and activities of daily living level using the Nottingham Extended Activities of Daily Living.RESULTS The study comprised 40 participants,equally divided into surgical and conservative treatment groups,with no significant demographic differences.After one year,both groups exhibited similar changes in walking distance and pain levels.However,the conservative group demonstrated significantly greater improvements in sub-parameters of functional activity and symptom severity of the SSS.After one year,the surgical group showed greater functionality,as assessed by ILBDI,and superior improvement in activities of daily living compared to the conservative group.CONCLUSION Both treatments showed comparable efficacy in core outcomes(pain,walking distance).However,complementary advantages were observed:Conservative management demonstrated superior improvement in SSS functional subscales,while surgery yielded greater gains in daily living activities and low-back-pain-related disability.展开更多
Objective:To evaluate the application of spinal endoscopy in treating elderly patients with osteoporotic lumbar spinal stenosis,and to assess its impact on pain relief,functional improvement,and postoperative satisfac...Objective:To evaluate the application of spinal endoscopy in treating elderly patients with osteoporotic lumbar spinal stenosis,and to assess its impact on pain relief,functional improvement,and postoperative satisfaction.Methods:A total of 86 elderly patients with osteoporotic lumbar spinal stenosis who underwent surgery at our hospital from March 1,2023,to February 28,2024,were selected.These patients were divided into an observation group(spinal endoscopy,n=44)and a control group(traditional open decompression,n=42).Preoperative,1 month postoperatively,and 3 months postoperatively,visual analog scale(VAS),Oswestry functional disability index(ODI),and patient satisfaction were assessed.Intraoperative blood loss,hospital stay,and the incidence of postoperative complications were compared as safety indicators.Data analysis was performed using SPSS 26.0 software.Measurement data were presented as mean±standard deviation,and inter-group comparisons were conducted using independent samples t-tests.Categorical data were analyzed using χ^(2) tests.Results:One month and three months postoperatively,the VAS scores in the observation group were 2.8±0.6 and 1.9±0.4,respectively,significantly lower than those in the control group(3.6±0.7 and 2.7±0.5)(P=0.015,P=0.008).The ODI scores were 24.3±4.5 and 17.8±3.2,respectively,also significantly better than those in the control group(30.6±5.1 and 22.9±3.7)(P=0.021,P=0.010).The observation group had a median intraoperative blood loss of 52.6±13.8 mL and an average hospital stay of 4.3±1.2 days,significantly lower than the control group's 108.4±21.5 mL and 7.2±1.6 days(P<0.001).The postoperative complication rate in the observation group was 4.5%(2/44),compared to 16.7%(7/42)in the control group(P=0.043).Postoperative satisfaction scores were 92.6±4.1 for the observation group and 84.7±5.6 for the control group(P<0.001).Conclusion:The application of spinal endoscopy technology in elderly patients with osteoporotic lumbar spinal stenosis can effectively reduce postoperative pain,improve functional status,minimize intraoperative trauma and complications,and significantly enhance patient satisfaction,demonstrating excellent clinical value for widespread adoption.展开更多
Low back pain(LPB)is a common and impactful health concern globally,affecting individuals across various demographics and imposing a significant burden on the health care system.Nonspecific chronic LBP(NCLBP),charac-t...Low back pain(LPB)is a common and impactful health concern globally,affecting individuals across various demographics and imposing a significant burden on the health care system.Nonspecific chronic LBP(NCLBP),charac-terized as pain lasting over 12 weeks without an identifiable cause,leads to notable functional limitations and reduced quality of life.Traditional rehabil-itation programs,often focusing on dynamic exercises for lumbar strengthening,typically do not target the deep stabilizing muscles crucial for lumbar support and effective recovery.Multi-angular isometric lumbar exercise(MAILE)offers a low-impact method for strengthening lumbar stabilizers through multi-angular isometric contractions,reducing risks from dynamic movements.This article examines MAILE’s potential in addressing motor control dysfunctions in NCLBP,highlighting studies on lumbar muscle activation,core stability,and isometric exercises.The article explores the prevalence and socioeconomic impact of NCLBP in the Middle East,highlighting the need for affordable treatment options in areas like Qatar and Saudi Arabia.This article aims to validate the efficacy of MAILE in reducing pain,enhancing mobility,and improving lumbar stability,offering a valuable option for NCLBP management.Future research should focus on large-scale clinical trials to substantiate these findings and guide clinical practice.展开更多
BACKGROUND Spinal tuberculosis,a destructive extrapulmonary form,often causes severe deformity and neurological deficits.Surgical intervention aims to debride lesions,reconstruct stability,and correct deformities.This...BACKGROUND Spinal tuberculosis,a destructive extrapulmonary form,often causes severe deformity and neurological deficits.Surgical intervention aims to debride lesions,reconstruct stability,and correct deformities.This study evaluates a combined posterior fixation and minimally invasive anterior approach for lumbar tuberculosis.AIM To evaluate the clinical outcomes and radiological parameters of posterior internal fixation combined with minimally invasive anterior lesion clearance and bone graft fusion for the treatment of lumbar tuberculosis.METHODS Clinical data from 24 patients with lumbar tuberculosis who underwent posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance were analyzed.The Cobb angle,visual analog scale(VAS)score,and Frankel classification were statistically assessed preoperatively and postoperatively.Complications and bone graft fusion were also recorded.RESULTS Wounds healed in the first stage in 22 patients;one patient developed a posterior incisional sinus tract,and one experienced postoperative tuberculosis recurrence.At the final follow-up,according to the Frankel classification,there were 1,2,and 21 cases classified as grade C,grade D,and grade E,respectively.By the last follow-up,the Cobb angle,VAS score,and erythrocyte sedimentation rate had all decreased.Both X-ray and computed tomography images confirmed bone healing.The fusion time ranged from 3 to 9 months,with an average of 5.2 months.CONCLUSION Posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance is an effective and safe treatment for lumbar tuberculosis.展开更多
BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)wit...BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)with positive serum cryptococcal antigen(CrAg)and do not have evidence of CM.AIM To estimate pooled prevalence of uptake of LP,CM and mortality among patients with AHD.METHODS PubMed,Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024.LP uptake was defined as percentage of people who underwent LP procedures among those with AHD(CD4≤200 cells/mm3 or WHO stage III/IV)and positive serum CrAg.Using random effects models,we computed the pooled estimate of LP uptake,CM and mortality and 95%CI.Stratified analyses were used to compare uptake of LP between studies that involved multiple vs single sites,and mortality analyses between patients with positive and negative serum CrAg were performed.Sensitivity analysis on LP uptake was done by excluding prospective cohort studies that reported 100%uptake.RESULTS A total of 32 studies with 46890 people with AHD screened for serum CrAg and 2730(5.8%)had positive serum CrAg.Overall,pooled prevalence of LP uptake was 67.7%(95%CI:54.0-81.5).The overall pooled prevalence of CM was 54.3%(95%CI:39.7-69.0),and mortality was 6.2%(95%CI:4.5-8.0).There is disparities in the pooled prevalence of LP uptake with studies involving multiple sites having lower prevalence compared to those that involved single sites(54.8%vs 84.7%,P=0.004).By excluding prospective cohort studies that reported 100%uptake,the overall LP uptake was 54.5%(95%CI:38.8-70.1).The pooled prevalence of CM was significantly lower among studies that involved multiple sites compared to those that involved single sites(6.8%vs 8.1%,P≤0.001).Mortality was significantly twice as high among patients who had positive serum CrAg compared to those who had negative serum CrAg[risk ratio=2.0(95%CI:1.6-2.5),P≤0.001].CONCLUSION Nearly three to five in 10 people with AHD with positive serum CrAg did not have LP procedures done,indicating significant gaps in identifying patients with CM.Establishing a confirmed diagnosis of CM is critical to avoid exposing patients to subtherapeutic levels of antifungals preemptively.Capacity to perform LP and patient refusals are among the reasons for not performing the procedure.Capacity building in training health care providers to perform LP procedures and professional counselling to obtain patient consent are critical for appropriate treatment to reduce mortality associated with CM infection.展开更多
BACKGROUND Uniportal full-endoscopy(UFE)technique has been continuously developed and applied for treating lumbar spinal stenosis.However,achieving effective decompression outcome of using the UFE technique remains te...BACKGROUND Uniportal full-endoscopy(UFE)technique has been continuously developed and applied for treating lumbar spinal stenosis.However,achieving effective decompression outcome of using the UFE technique remains technically demanding and uncertain.Previously,we have proposed the biportal full-endoscopy(BFE)technique to integrate the respective advantages of both UFE and unilateral biportal endoscopy technique.There is limited published data on the comparison of clinical outcomes between biportal and UFE techniques in lumbar spinal stenosis with bilateral symptoms.AIM To contrast the clinical outcomes between biportal and UFE techniques for treating lumbar spinal stenosis with bilateral symptoms.METHODS This study retrospectively examined 100 patients diagnosed with lumbar spinal stenosis and bilateral symptoms.Among them,52 cases were part of group A(BFE technique group),and 48 cases belonged to group B(UFE technique group).The visual analogue scale(VAS),Oswestry Disability Index(ODI),and modified Macnab criteria were used to evaluate the clinical outcomes.RESULTS Group A had significantly shorter operation time than group B.Both groups experienced substantial relief in lower back and lower extremity pain on the severe side at postoperative 3 days,3 months,and 12 months.Group A had notably lower VAS scores for mild side lower extremity pain at postoperative 3 months and 12 months compared to group B.Group A's ODI scores were significantly lower at postoperative 3 months and 12 months,whereas group B's scores did not significantly differ from preoperative values.Group A's ODI scores were significantly lower than group B's at postoperative 3 months and 12 months.Group A had a significantly higher excellent and good response rate(94.23%)compared to group B(81.25%)at postoperative 12 months based on the modified Macnab scale outcomes.CONCLUSION The BFE technique offers multiple benefits,including reduced trauma and quicker recovery as a minimally invasive surgery,and enhanced decompression efficiency over the UFE technique when treating lumbar spinal stenosis with bilateral symptoms.展开更多
Objective:To investigate the positive eff ect of mindfulness training and exercise therapy on functional recovery and quality of life in elderly patients with fractures of the lower back.Methods:Collection of medical ...Objective:To investigate the positive eff ect of mindfulness training and exercise therapy on functional recovery and quality of life in elderly patients with fractures of the lower back.Methods:Collection of medical records of patients with lumbar vertebral fractures in Suzhou Municipal Hospital(North District),60 patients underwent percutaneous vertebroplasty(PVP/PKP),they were divided into control and experimental groups according to a random number table,30 people per group;In addition to traditional care method,Also intervened with behavioural awareness training and exercise therapy,By comparing the Oswestry dysfunction index score(ODI),visual simulation score(VAS),ability of daily living score(ADL),quality of life score(SF-36),To evaluate the eff ectiveness of the intervention.Results:Before the intervention,the ODI,VAS,ADL,and SF-36 scores were basically the same,with no significant diff erence(P>0.05).After treatment,the ODI and VAS scores of the experimental group and the control group were signifi cantly lower,and the experimental group was significantly lower than the control group(P<0.05);the ADL scores of the experimental group were signifi cantly higher than those of the control group(P<0.05);their SF-36 quality of life scores in all dimensions were signifi cantly higher(P<0.05).Conclusion:Through the rehabilitation treatment method combining mindfulness behavior training and exercise intervention,it can eff ectively promote the functional recovery of osteoporotic lumbar fractures in the elderly,thus reducing their pain and improving their quality of life.展开更多
基金Supported by the Scientific Research Projects of the Health System in Pingshan District,No.2023122.
文摘BACKGROUND Lumbar interbody fusion(LIF)is the primary treatment for lumbar degenerative diseases.Elderly patients are prone to anxiety and depression after undergoing surgery,which affects their postoperative recovery speed and quality of life.Effective prevention of anxiety and depression in elderly patients has become an urgent problem.AIM To investigate the trajectory of anxiety and depression levels in elderly patients after LIF,and the influencing factors.METHODS Random sampling was used to select 239 elderly patients who underwent LIF from January 2020 to December 2024 in Shenzhen Pingle Orthopedic Hospital.General information and surgery-related indices were recorded,and participants completed measures of psychological status,lumbar spine dysfunction,and quality of life.A latent class growth model was used to analyze the post-LIF trajectory of anxiety and depression levels,and unordered multi-categorical logistic regression was used to analyze the influencing factors.RESULTS Three trajectories of change in anxiety level were identified:Increasing anxiety(n=26,10.88%),decreasing anxiety(n=27,11.30%),and stable anxiety(n=186,77.82%).Likewise,three trajectories of change in depression level were identified:Increasing depression(n=30,12.55%),decreasing depression(n=26,10.88%),and stable depression(n=183,76.57%).Regression analysis showed that having no partner,female sex,elevated Oswestry dysfunction index(ODI)scores,and reduced 36-Item Short Form Health Survey scores all contributed to increased anxiety levels,whereas female sex,postoperative opioid use,and elevated ODI scores all contributed to increased depression levels.CONCLUSION During clinical observation,combining factors to predict anxiety and depression in post-LIF elderly patients enables timely intervention,quickens recovery,and enhances quality of life.
文摘Objective:To explore the effect of combining Duhuo Jisheng decoction with warm acupuncture and moxibustion in the treatment of patients with lumbar disc herniation.Methods:Using a random number table method,a total of 100 patients with lumbar disc herniation treated at Xianning Matang Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were divided into a control group of 50 patients treated with Duhuo Jisheng decoction and a study group of 50 patients treated with Duhuo Jisheng decoction combined with warm acupuncture and moxibustion.The TCM syndrome scores,lumbar function,lumbar pain,and lumbar activity were compared between the two groups.Results:After intervention,the TCM syndrome scores,ODI,and VAS scores of both groups showed a decreasing trend compared to before intervention,and the decreasing trend was more significant in the study group(P<0.05).After intervention,the JOA and lumbar activity indicators of both groups showed an increasing trend compared to before intervention,and the increasing trend was more significant in the study group(P<0.05).Conclusion:Duhuo Jisheng decoction combined with warm acupuncture and moxibustion is an effective and safe treatment method for lumbar disc herniation,which can improve lumbar function and activity.
文摘Background: Lumbar disc herniation is a common injury among athletes, especially those who practice disciplines with repetitive flexion movements, twisting and axial loading on the spine, such as weightlifting, gymnastics, hockey and American football. In refractory cases to conservative treatment, microscopic discectomy or full endoscopic discectomy are used as surgical options to relieve pain and restore patient functionality. However, the ideal time for a return to sports activities remains a matter of debate due to variations in recovery times and risks of complications associated with each technique. Methods: A review was conducted, including articles published in the last 33 years (1991-2024), as it was the earliest date matching our search criteria. Clinical studies, systematic reviews, meta-analyses, and clinical guidelines were included. Results: The most common complications when returning to sport prematurely include recurrence of the hernia, persistent pain (VAS leg 7 or higher after surgery) and reduced physical performance. The return to full activity rate of patients who underwent microdiscectomy reaches up to 90%, while the endoscopic technique shows a success rate that reaches 99%. Return to play meantime was 5.19 months (range 1.00 - 8.7 months) and mean time of 4.6 months (range 2 - 8 months) with Microdiscectomy and full endoscopic discectomy respectively. Conclusions: There is no unanimous consensus on the exact timing of return to sport due to variability in recovery times and clinical outcomes. In both techniques, evidence highlights the need for a multidisciplinary approach that integrates surgeons, physical therapists and trainers to optimize recovery and ensure a safe return.
文摘Background: Surgical treatment of lumbar disc herniation is a widely debated topic, with several techniques available. Percutaneous endoscopic discectomy (PELD) has gained popularity due to its lower invasiveness compared to conventional techniques such as microdiscectomy/open lumbar microdiscectomy (OLMD)/tubular microdiscectomy (TMD). However, evidence on the effectiveness, recovery time and complications of these techniques is not yet clearly established. This systematic review aims to compare the preoperative and postoperative outcomes of both techniques. Methods: A comprehensive search was performed in databases including PubMed and Cochrane, following strict inclusion and exclusion criteria. Comparative studies and narrative reviews on PELD and OLMD/TMD published between 2019 and 2024 were included. Key outcomes considered were pre- and postoperative Visual Analogue Scale (VAS), hospitalization time, time to return to work, and postoperative complications. Results: The reviewed studies indicated that PELD is associated with a greater reduction in postoperative pain compared to OLMD/TMD, with a significant decrease in VAS, according to the study by Priola et al. (2019). The hospital stay was also shorter for patients undergoing PELD, averaging 2 days compared to OLMD/TMD. Furthermore, PELD favored a faster return to work and had a lower rate of postoperative complications, such as dural tears and reoperations, compared to OLMD/TMD. Conclusions: PELD demonstrates clear advantages over OLMD/TMD in terms of pain reduction, shorter hospital stay, faster return to work, and fewer postoperative complications. However, the implementation of this technique requires a significant learning curve, suggesting that its effectiveness may vary depending on the surgeon’s experience. PELD should be considered a preferred option in the resection of lumbar disc herniations, especially in patients seeking a quick and less invasive recovery.
文摘In this editorial,the authors of this paper comment on the article by Bokov et al published in the recent issue of World Journal of Orthopedics.We reviewed a general overview of oblique lumbar interbody fusions(OLIF)and lateral lumbar interbody fusions(LLIF),their indications and complications as an increasingly popular minimally invasive technique to address several lumbar pathologies.This editorial thoroughly discusses and reviews the literature regarding factors affecting outcomes of indirect decompression utilized through OLIF and LLIF procedures.Several parameters play a critical role in patient outcomes including restoration of disc height,foraminal height,central canal squared,and foraminal area.The indirect decompression allows for unbuckling of the ligamentum flavum which can significantly decompress the neural elements as well as aid in reduction of spondylolisthesis.However,the authors further highlight the limitations of indirect decompression and factors that may predict unsuccessful outcomes including bony foraminal stenosis,severe central canal stenosis,and osteoporosis.As a result,failure of indirect decompression can lead to persistent pain,radiculopathy and unsatisfied patients.Spinal surgeons may be left to reimage patients and consider additional procedures with direct decompression.
文摘Lower back pain is one of the most common medical problems in the world and it is experienced by a huge percentage of people everywhere.Due to its ability to produce a detailed view of the soft tissues,including the spinal cord,nerves,intervertebral discs,and vertebrae,Magnetic Resonance Imaging is thought to be the most effective method for imaging the spine.The semantic segmentation of vertebrae plays a major role in the diagnostic process of lumbar diseases.It is difficult to semantically partition the vertebrae in Magnetic Resonance Images from the surrounding variety of tissues,including muscles,ligaments,and intervertebral discs.U-Net is a powerful deep-learning architecture to handle the challenges of medical image analysis tasks and achieves high segmentation accuracy.This work proposes a modified U-Net architecture namely MU-Net,consisting of the Meijering convolutional layer that incorporates the Meijering filter to perform the semantic segmentation of lumbar vertebrae L1 to L5 and sacral vertebra S1.Pseudo-colour mask images were generated and used as ground truth for training the model.The work has been carried out on 1312 images expanded from T1-weighted mid-sagittal MRI images of 515 patients in the Lumbar Spine MRI Dataset publicly available from Mendeley Data.The proposed MU-Net model for the semantic segmentation of the lumbar vertebrae gives better performance with 98.79%of pixel accuracy(PA),98.66%of dice similarity coefficient(DSC),97.36%of Jaccard coefficient,and 92.55%mean Intersection over Union(mean IoU)metrics using the mentioned dataset.
文摘BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.
基金funded by the National Key Research and Development Program of China(No.2018YFC1704600)Top-notch Innovative Talent Cultivation Program of Zhejiang Chinese Medicine University(No.741100G00726)。
文摘Background:There is a gap in understanding the effects of different acupoints and treatment methods(acupuncture and moxibustion)on microcirculatory changes in the lumbar region.Objective:This study aimed to assess the thermal effects of acupuncture at Weizhong(BL40),with acupuncture at Chize(LU5)and moxibustion at both acupoints as control interventions.Design,setting,participants and interventions:In this randomized controlled trial,140 healthy participants were equally divided into four groups:acupuncture at BL40(Acu-BL40),acupuncture at LU5(Acu-LU5),moxibustion at BL40(Mox-BL40)and moxibustion at LU5(Mox-LU5).Participants underwent a 30-minute session of their assigned treatment.Infrared thermal imaging was used to collect temperature data on the areas of interest for analysis.Main outcome measures:The primary measure was the change in average temperature of the observed area after the intervention.The secondary measures included periodic temperature changes every5 min and the temperature changes of the Governor Vessel and Bladder Meridian in the observed area after the intervention.Results:Significant interactions were observed between treatments and acupoints affecting temperature(P<0.001).The Acu-BL40 group showed a notably higher increase in mean temperature after 30 min compared to the Acu-LU5 and Mox-BL40 groups,with increases of 0.29(95%confidence interval[CI]=0.17 to 0.41)and 0.24(95%CI=0.08 to 0.41)℃,respectively.Conclusion:Acupuncture at BL40 acupoint can significantly increase the mean temperature in the observed area,highlighting the specific thermal effect of acupuncture compared to moxibustion in the lumbar area.This suggests a potential therapeutic benefit of acupuncture at BL40 for managing lumbar conditions.
基金Funding National Key R&D Program of China(2021YFC2501701,2021YFC2501703)Beijing Jishuitan Hospital Scientific Research Fund(QN202404)+1 种基金Beijing Municipal Health Commission(BJRITO-RDP-2023)Beijing Municipal Public Welfare Development and Reform Pilot Project for Medical Research Institutes(JYY2023-8).
文摘Objective To determine the prevalence of lumbar spondylolysis(LS)and the proportion of spondylolytic spondylolisthesis(SS)in China,and to evaluate the musculoskeletal status of patients with LS and SS.Methods Spine Computed Tomography(CT)images were collected from community populations aged 40 and above in a nationwide multi-center project.LS was diagnosed,and SS was graded by an experienced radiologist.Bone mineral density(BMD)and paraspinal muscle parameters were quantified based on CT images.Results One hundred and seventeen patients of a total of 3,317 individuals were diagnosed with LS,corresponding to a prevalence rate of 3.53%.63 of the 1,214 males(5.18%)and 54 of the 2,103 females(2.57%)were diagnosed with LS.SS occurred in 64/121 vertebrae(52.89%).BMD was not associated with LS(P=0.341).The L5 extensor paraspinal muscle density was higher in the LS group than in the non-LS group.In the LS group,patients with SS had a smaller L5 paraspinal extensor muscle cross-sectional area than those without SS(P=0.003).Conclusion The prevalence of LS in Chinese adults was 3.53%,with prevalence rates of 5.18%in males and 2.57%in females.Patients with LS have higher muscle density,whereas those with SS have smaller muscle cross-sectional areas at the L5 level.
基金Supported by the Hospital-level Program of Shiyan Taihe Hospital(2022JJXM144).
文摘[Objectives]To investigate the clinical efficacy of Cyclic Flexion Traction(CFT)in treating Lumbar Disc Herniation(LDH)and its effects on lumbocrural pain relief,functional improvement,and nerve root decompression.[Methods]Seventy LDH patients treated at the orthopedic rehabilitation outpatient and inpatient departments of Shiyan Taihe Hospital from June 2022 to December 2024 were randomly divided into a treatment group(CFT therapy,n=35)and a control group(traditional traction,n=35).The treatment group received cyclic flexion traction(traction force of 30%-50%body weight with a cycle of 60-30-30 sec),while the control group received supine position linear traction.Both groups underwent 4 weeks of treatment,with assessments including visual analog scale(VAS),Oswestry Disability Index(ODI),and straight leg raising test(SLRT)angles.[Results]The treatment group showed a significantly greater reduction in VAS scores(from 6.97 to 2.31)compared to the control group(from 6.89 to 3.74)(P<0.05).Similarly,ODI improvement(41.62→15.73 compared with 40.98→22.84)and SLRT angle increase(41.23°→76.47°compared with 42.09°→64.19°)were more pronounced in the treatment group(all P<0.05).[Conclusions]Through dynamic decompression mechanisms,CFT therapy demonstrates superior efficacy to traditional traction in pain relief,functional recovery,and nerve root decompression(effective rate 94.29%compared with 77.14%,P<0.05),representing a superior non-surgical treatment option.
文摘BACKGROUND Lumbar disc extrusion,a common spinal disorder,is particularly uncommon in its severely displaced form,especially in young patients.This condition can pose diagnostic challenges due to its nonspecific presentation.CASE SUMMARY A 36-year-old male patient presented with persistent low back pain and radiating leg pain lasting half a month,which had worsened over the previous four days.Lumbar magnetic resonance imaging scans showed an abnormal signal within the vertebral canal at the L3 level,suggesting either a disc cyst or an epidural hematoma.Based on these findings,the patient was provisionally diagnosed with either condition.Surgical exploration was conducted,revealing an extruded lumbar disc,which was subsequently excised.Following surgery,the patient's symptoms completely resolved.CONCLUSION High-grade lumbar disc extrusion in young patients is rare but should be considered in sedentary,physically inactive individuals presenting with lumbocrural pain and abnormal magnetic resonance imaging findings.Early and accurate diagnosis is crucial to avoid misdiagnosis,and prompt open surgery may be necessary in severe cases to alleviate symptoms.The case highlights the impotance of a thorough diagnostic workup and timely surgical intervention in managing such rare but potentially severe spinal disorders.
基金Key Laboratory of Spinal Degenerative Diseases,Xianyang City(Project No.:L2023-CXNL-CXPT-ZDSYS-010)Key Technology Innovation Team Project for Minimally Invasive Spinal Surgery,Xianyang City(Grant No.:L2022CXNLTD002)University-level Scientific Research Project,Shaanxi University of Traditional Chinese Medicine(Project No.:2020FS06).
文摘Objective:To investigate the diagnostic value of magnetic resonance imaging(MRI)in patients with Modic changes and endplate sclerosis of the lumbar spine.Methods:A total of 66 patients with lumbar spine diseases who underwent MRI and CT diagnostic examinations at the hospital from May 2024 to April 2025 were included in this study.The MRI findings of Modic changes were compared between Type I and Type II patients,and the presence or absence of endplate sclerosis signals and the HU value ratio on CT were analyzed.The pathological characteristics of Modic changes in Type I and Type II patients were observed.The imaging features of Modic changes in patients with lumbar spine diseases were analyzed.Results:Modic changes were present in 34 patients,with a total of 204 endplates evaluated,of which 74 were affected.MRI classification showed:Type I in 8 cases(10.81%),Type I/II mixed in 10 cases(13.51%),Type II in 51 cases(68.92%),and Type II/III mixed in 5 cases(6.76%).In CT reconstruction images,26 endplates with Modic changes on MRI showed sclerosis in the vertebral body,presenting high-density sclerotic features.These sclerotic areas did not exhibit distinct signal characteristics on MRI but pathologically demonstrated Type II Modic changes concurrently with fatty degeneration and sclerosis;In patients with Modic changes of Type I and Type II,regardless of the presence or absence of endplate sclerosis,the sagittal T1/T2 signal intensity ratio showed no statistically significant difference(P>0.05).However,the HU value ratio in Type II changes with sclerotic regions(2.74±0.61)was significantly higher than that in regions without sclerosis(1.16±0.23),with a statistically significant difference(P<0.05).Conclusion:CT reconstruction images of patients with lumbar Modic changes clearly demonstrate endplate sclerosis,a phenomenon closely associated with the bone marrow repair process.MRI has limited sensitivity for detecting sclerosis,potentially due to the following factors:first,differences in the radiographic characterization of endplate mineral content;second,the specific influence of different Modic types on signal intensity.This suggests that MRI classification should be combined with CT features for comprehensive interpretation.
基金the financial contribution of the Groupe de Recherche En Médecine d’Urgence du CHUL (GREMUC)which is the local emergency department research group。
文摘Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treating infants younger than 90 d.Guidelines for investigating fever without a source(meaning without an apparent source of infection,or of nonobvious origin) are numerous around the world but remain conflicting,particularly on whether to perform a lumbar puncture for cerebrospinal fluid (CSF) analysis in infants older than 22 d and hence at lower risk than younger infants.
文摘BACKGROUND In this aging population,lumbar spinal stenosis(LSS)reduces walking distance and impairs functionality.The definitive treatment is still controversial.AIM To assess the efficacy of physical therapy and surgery in improving function and reducing pain levels in patients with LSS,both in the short and long term.METHODS This prospective study screened patients aged 50-80 years with LSS and divided them into two groups based on certain criteria:Surgical and conservative.The conservative group received a supervised physical therapy and exercise program for 45 minutes,five days a week,for one month.The surgery group underwent micro endoscopic decompression surgery based on their LSS levels.Assessments,conducted before treatment and at one-month and one-year intervals,included the participants'walking distance,pain level using the visual analog scale,func tionality using the Istanbul low back pain disability index(ILBDI)and Swiss Spinal Stenosis Questionnaire(SSS)Scale,and activities of daily living level using the Nottingham Extended Activities of Daily Living.RESULTS The study comprised 40 participants,equally divided into surgical and conservative treatment groups,with no significant demographic differences.After one year,both groups exhibited similar changes in walking distance and pain levels.However,the conservative group demonstrated significantly greater improvements in sub-parameters of functional activity and symptom severity of the SSS.After one year,the surgical group showed greater functionality,as assessed by ILBDI,and superior improvement in activities of daily living compared to the conservative group.CONCLUSION Both treatments showed comparable efficacy in core outcomes(pain,walking distance).However,complementary advantages were observed:Conservative management demonstrated superior improvement in SSS functional subscales,while surgery yielded greater gains in daily living activities and low-back-pain-related disability.
文摘Objective:To evaluate the application of spinal endoscopy in treating elderly patients with osteoporotic lumbar spinal stenosis,and to assess its impact on pain relief,functional improvement,and postoperative satisfaction.Methods:A total of 86 elderly patients with osteoporotic lumbar spinal stenosis who underwent surgery at our hospital from March 1,2023,to February 28,2024,were selected.These patients were divided into an observation group(spinal endoscopy,n=44)and a control group(traditional open decompression,n=42).Preoperative,1 month postoperatively,and 3 months postoperatively,visual analog scale(VAS),Oswestry functional disability index(ODI),and patient satisfaction were assessed.Intraoperative blood loss,hospital stay,and the incidence of postoperative complications were compared as safety indicators.Data analysis was performed using SPSS 26.0 software.Measurement data were presented as mean±standard deviation,and inter-group comparisons were conducted using independent samples t-tests.Categorical data were analyzed using χ^(2) tests.Results:One month and three months postoperatively,the VAS scores in the observation group were 2.8±0.6 and 1.9±0.4,respectively,significantly lower than those in the control group(3.6±0.7 and 2.7±0.5)(P=0.015,P=0.008).The ODI scores were 24.3±4.5 and 17.8±3.2,respectively,also significantly better than those in the control group(30.6±5.1 and 22.9±3.7)(P=0.021,P=0.010).The observation group had a median intraoperative blood loss of 52.6±13.8 mL and an average hospital stay of 4.3±1.2 days,significantly lower than the control group's 108.4±21.5 mL and 7.2±1.6 days(P<0.001).The postoperative complication rate in the observation group was 4.5%(2/44),compared to 16.7%(7/42)in the control group(P=0.043).Postoperative satisfaction scores were 92.6±4.1 for the observation group and 84.7±5.6 for the control group(P<0.001).Conclusion:The application of spinal endoscopy technology in elderly patients with osteoporotic lumbar spinal stenosis can effectively reduce postoperative pain,improve functional status,minimize intraoperative trauma and complications,and significantly enhance patient satisfaction,demonstrating excellent clinical value for widespread adoption.
文摘Low back pain(LPB)is a common and impactful health concern globally,affecting individuals across various demographics and imposing a significant burden on the health care system.Nonspecific chronic LBP(NCLBP),charac-terized as pain lasting over 12 weeks without an identifiable cause,leads to notable functional limitations and reduced quality of life.Traditional rehabil-itation programs,often focusing on dynamic exercises for lumbar strengthening,typically do not target the deep stabilizing muscles crucial for lumbar support and effective recovery.Multi-angular isometric lumbar exercise(MAILE)offers a low-impact method for strengthening lumbar stabilizers through multi-angular isometric contractions,reducing risks from dynamic movements.This article examines MAILE’s potential in addressing motor control dysfunctions in NCLBP,highlighting studies on lumbar muscle activation,core stability,and isometric exercises.The article explores the prevalence and socioeconomic impact of NCLBP in the Middle East,highlighting the need for affordable treatment options in areas like Qatar and Saudi Arabia.This article aims to validate the efficacy of MAILE in reducing pain,enhancing mobility,and improving lumbar stability,offering a valuable option for NCLBP management.Future research should focus on large-scale clinical trials to substantiate these findings and guide clinical practice.
基金Supported by Medical Research Project of Wuhan Municipal Health Commission,No.WX21M02.
文摘BACKGROUND Spinal tuberculosis,a destructive extrapulmonary form,often causes severe deformity and neurological deficits.Surgical intervention aims to debride lesions,reconstruct stability,and correct deformities.This study evaluates a combined posterior fixation and minimally invasive anterior approach for lumbar tuberculosis.AIM To evaluate the clinical outcomes and radiological parameters of posterior internal fixation combined with minimally invasive anterior lesion clearance and bone graft fusion for the treatment of lumbar tuberculosis.METHODS Clinical data from 24 patients with lumbar tuberculosis who underwent posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance were analyzed.The Cobb angle,visual analog scale(VAS)score,and Frankel classification were statistically assessed preoperatively and postoperatively.Complications and bone graft fusion were also recorded.RESULTS Wounds healed in the first stage in 22 patients;one patient developed a posterior incisional sinus tract,and one experienced postoperative tuberculosis recurrence.At the final follow-up,according to the Frankel classification,there were 1,2,and 21 cases classified as grade C,grade D,and grade E,respectively.By the last follow-up,the Cobb angle,VAS score,and erythrocyte sedimentation rate had all decreased.Both X-ray and computed tomography images confirmed bone healing.The fusion time ranged from 3 to 9 months,with an average of 5.2 months.CONCLUSION Posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance is an effective and safe treatment for lumbar tuberculosis.
文摘BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)with positive serum cryptococcal antigen(CrAg)and do not have evidence of CM.AIM To estimate pooled prevalence of uptake of LP,CM and mortality among patients with AHD.METHODS PubMed,Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024.LP uptake was defined as percentage of people who underwent LP procedures among those with AHD(CD4≤200 cells/mm3 or WHO stage III/IV)and positive serum CrAg.Using random effects models,we computed the pooled estimate of LP uptake,CM and mortality and 95%CI.Stratified analyses were used to compare uptake of LP between studies that involved multiple vs single sites,and mortality analyses between patients with positive and negative serum CrAg were performed.Sensitivity analysis on LP uptake was done by excluding prospective cohort studies that reported 100%uptake.RESULTS A total of 32 studies with 46890 people with AHD screened for serum CrAg and 2730(5.8%)had positive serum CrAg.Overall,pooled prevalence of LP uptake was 67.7%(95%CI:54.0-81.5).The overall pooled prevalence of CM was 54.3%(95%CI:39.7-69.0),and mortality was 6.2%(95%CI:4.5-8.0).There is disparities in the pooled prevalence of LP uptake with studies involving multiple sites having lower prevalence compared to those that involved single sites(54.8%vs 84.7%,P=0.004).By excluding prospective cohort studies that reported 100%uptake,the overall LP uptake was 54.5%(95%CI:38.8-70.1).The pooled prevalence of CM was significantly lower among studies that involved multiple sites compared to those that involved single sites(6.8%vs 8.1%,P≤0.001).Mortality was significantly twice as high among patients who had positive serum CrAg compared to those who had negative serum CrAg[risk ratio=2.0(95%CI:1.6-2.5),P≤0.001].CONCLUSION Nearly three to five in 10 people with AHD with positive serum CrAg did not have LP procedures done,indicating significant gaps in identifying patients with CM.Establishing a confirmed diagnosis of CM is critical to avoid exposing patients to subtherapeutic levels of antifungals preemptively.Capacity to perform LP and patient refusals are among the reasons for not performing the procedure.Capacity building in training health care providers to perform LP procedures and professional counselling to obtain patient consent are critical for appropriate treatment to reduce mortality associated with CM infection.
基金Supported by National Natural Science Foundation of China,No.82202694Clinical Research Innovation Plan of Shanghai General Hospital,No.CTCCR-2021C10.
文摘BACKGROUND Uniportal full-endoscopy(UFE)technique has been continuously developed and applied for treating lumbar spinal stenosis.However,achieving effective decompression outcome of using the UFE technique remains technically demanding and uncertain.Previously,we have proposed the biportal full-endoscopy(BFE)technique to integrate the respective advantages of both UFE and unilateral biportal endoscopy technique.There is limited published data on the comparison of clinical outcomes between biportal and UFE techniques in lumbar spinal stenosis with bilateral symptoms.AIM To contrast the clinical outcomes between biportal and UFE techniques for treating lumbar spinal stenosis with bilateral symptoms.METHODS This study retrospectively examined 100 patients diagnosed with lumbar spinal stenosis and bilateral symptoms.Among them,52 cases were part of group A(BFE technique group),and 48 cases belonged to group B(UFE technique group).The visual analogue scale(VAS),Oswestry Disability Index(ODI),and modified Macnab criteria were used to evaluate the clinical outcomes.RESULTS Group A had significantly shorter operation time than group B.Both groups experienced substantial relief in lower back and lower extremity pain on the severe side at postoperative 3 days,3 months,and 12 months.Group A had notably lower VAS scores for mild side lower extremity pain at postoperative 3 months and 12 months compared to group B.Group A's ODI scores were significantly lower at postoperative 3 months and 12 months,whereas group B's scores did not significantly differ from preoperative values.Group A's ODI scores were significantly lower than group B's at postoperative 3 months and 12 months.Group A had a significantly higher excellent and good response rate(94.23%)compared to group B(81.25%)at postoperative 12 months based on the modified Macnab scale outcomes.CONCLUSION The BFE technique offers multiple benefits,including reduced trauma and quicker recovery as a minimally invasive surgery,and enhanced decompression efficiency over the UFE technique when treating lumbar spinal stenosis with bilateral symptoms.
文摘Objective:To investigate the positive eff ect of mindfulness training and exercise therapy on functional recovery and quality of life in elderly patients with fractures of the lower back.Methods:Collection of medical records of patients with lumbar vertebral fractures in Suzhou Municipal Hospital(North District),60 patients underwent percutaneous vertebroplasty(PVP/PKP),they were divided into control and experimental groups according to a random number table,30 people per group;In addition to traditional care method,Also intervened with behavioural awareness training and exercise therapy,By comparing the Oswestry dysfunction index score(ODI),visual simulation score(VAS),ability of daily living score(ADL),quality of life score(SF-36),To evaluate the eff ectiveness of the intervention.Results:Before the intervention,the ODI,VAS,ADL,and SF-36 scores were basically the same,with no significant diff erence(P>0.05).After treatment,the ODI and VAS scores of the experimental group and the control group were signifi cantly lower,and the experimental group was significantly lower than the control group(P<0.05);the ADL scores of the experimental group were signifi cantly higher than those of the control group(P<0.05);their SF-36 quality of life scores in all dimensions were signifi cantly higher(P<0.05).Conclusion:Through the rehabilitation treatment method combining mindfulness behavior training and exercise intervention,it can eff ectively promote the functional recovery of osteoporotic lumbar fractures in the elderly,thus reducing their pain and improving their quality of life.
