OBJECTIVE: To propose a new lumbar degenerative staging system using the current radiological classification system.
METHODS: A cross-sectional analysis of retrospective databases between January 2018 and December 2022 was performed. Total of 410 patients for Modic changes, paravertebral muscle fat infiltration, disc degeneration, articular process degeneration, vertebral endplate degeneration and other structures, and disc displacement, Spondylolisthesis, and stenosis, and grouped patients according to stage were assessed. Visual analog scale, Japanese Orthopaedic Association, and Oswestry Disability Index scores were used to assess low back pain strength, neurological function, and quality of life, respectively.
RESULTS: The lumbar degeneration staging system consists of 8 variables, which can be divided into 3 steps: early, middle and late, and the correlation between each variable is strong (P < 0.05). The later the staging, the worse the Japanese Orthopaedic Association, visual analog scale, and Oswestry Disability Index scores.
CONCLUSIONS: Patients with later stages have worse clinical scores. This staging system recommends a uniform classification to assess lumbar degeneration.

BACKGROUND: Data on equine lumbar pathology hardly exist in breeds other than Thoroughbreds.
OBJECTIVE: To describe pathological changes of the osseous lumbar vertebral column in Warmblood horses, Shetland ponies and Konik horses.
METHODS: Descriptive post-mortem study.
METHODS: The lumbar vertebral columns of 34 Warmblood horses, 28 Shetland ponies, and 18 Konik horses were examined by computed tomography (CT). Osteoarthritis (OA) of articular processes (APJs), OA of intertransverse joints (ITJs), intervertebral disc (IVD) mineralisation, impingement of spinous (SPs) and transverse (TPs) processes and spondylosis were scored. Breed differences in prevalence and severity of pathologies were analysed by linear regression analysis and by calculating Spearman\'s rank correlation coefficients (rs).
RESULTS: In Warmblood horses, the prevalence of OA of APJs, impingement of SPs and TPs was respectively 90%, 36%, and 35%, significantly higher than in the other breeds (p < 0.001). In Konik horses, IVD mineralisation (40%) and spondylosis (10%) were more frequent than in Warmbloods and Shetland ponies (p = 0.03). Severity score for OA of ITJs was highest in Shetland ponies (p < 0.001). For impingement of SPs, severity score was highest in Warmbloods (p = 0.03), and of TPs lowest in Shetland ponies (p = 0.003). For all parameters, except for spondylosis in Shetland ponies, there was a positive correlation between percentage of vertebrae affected and age, with IVD mineralisation scores increasing faster in Konik horses (p < 0.001). In all breeds, there was also a positive relation between scores of severity and age for OA of APJs and ITJs and for IVD mineralisation, with severity scores increasing faster in Shetland ponies (p = 0.04). Strong left/right correlations of the severity scores were seen for OA of the APJ, ITJ, impingement of TPs, and paramedian spondylosis (rs = 0.74-0.86, all p < 0.001).
CONCLUSIONS: Clinical histories were not available.
CONCLUSIONS: There are distinct breed differences between prevalence and severity of osseous pathologies of the lumbar spine. Warmblood horses have higher scores for most pathologies with IVD mineralisation being more important in Konik horses and OA of ITJs in Shetland ponies.

UNASSIGNED: This study aimed to evaluate the degeneration patterns of the facet joints (FJs) in patients with lumbar foraminal stenosis (LFS) and investigate the correlation between quantitative parameters and FJ osteoarthritis (FJ OA).
UNASSIGNED: A total of 171 patients with LFS at the L4/5 level and 146 control patients were enrolled in this study. The severity of FJ OA was graded according to the Weishaupt classification. The FJ orientation, FJ tropism, superior articular process cross-sectional area (SAPA), and FJ area were measured at the L3/4, L4/5, and L5/S1 spinal levels. Associations among the parameters were assessed using Pearson\'s correlation coefficients. Independent sample t-tests and Pearson\'s chi-square tests were used for univariate analyses. The association between LFS and the quantitative parameters was also analyzed using multivariate logistic regression models adjusted for age, gender, and body mass index.
UNASSIGNED: Patients with LFS had more sagittal FJ orientation (37.9 vs 45.0, p < 0.001), more FJ tropism (5.6 vs 3.8, p < 0.001), larger SAPA (129.0 vs 97.8, p < 0.001), and less FJ area (21.7 vs 23.3, p = 0.016). Logistic regression analysis showed that LFS was significantly associated with FJ tropism (odds ratio [OR]: 1.153; p = 0.003) and SAPA (OR: 1.113; p < 0.001). The SAPA showed the largest area under the curve (0.908, 95% confidence interval: 0.875-0.942) for the diagnosis of LFS. The optimal cutoff value was 114.75 mm2 with 85.4% sensitivity and 87.0% specificity. Additionally, a significant correlation was observed between FJ OA and SAPA and FJ area at each studied spinal level.
UNASSIGNED: This study confirmed that LFS is significantly associated with FJ hypertrophy and tropism. FJ hypertrophy and joint space narrowing correlated with the severity of FJ OA. These results are helpful in understanding the morphology and pathology of FJs.

暂无摘要。

BACKGROUND: Lumbar facet joint syndrome (LFJS) is a pain condition arising from lumbar facet joint diseases. Treatments of LFJS includes patient education, oral medication, bed rest, physical therapy, and procedural interventions. For some refractory cases that fail conservative therapies, dorsal ramus medial brunch radiofrequency ablation is warranted. However, as nerve fibers can regenerate, their efficacy is impermanent, and the recurrence rate is relatively high. Considering synovial impingement is a paramount pathogenesis of LFJS, in this case, we removed the culprit hyperplastic articular capsule and the articular process partially through a spinal endoscope. As the culprit hyperplastic joint capsule was excised, it is supposed to generate more prolonged efficacy and a lower recurrence rate than radiofrequency treatment.
METHODS: A 40-year-old female patient was diagnosed with LFJS. She complained of low back pain and right buttock pain for half a year. The patient was placed in the prone position. After disinfection and draping, a 25-cm 18-gauge needle was inserted into the dorsal surface of the right L5 articular process. Subsequently, a guidewire, dilating tubes, and a working cannula was inserted successively. The spinal endoscope was positioned in the working cannula. Under the endoscope, the microvascular tissue, muscle tissue attached on the L5 inferior articular process and S1 superior articular process, as well as the capsule and minor portion of the inferior articular process were removed. After the joint space was clear and no bleeding points existed, the endoscope and working cannula were shifted, and the incision was sutured. After treatment, the symptoms were completely relieved. The patient was pain-free during the follow-up period of 6 mo.
CONCLUSIONS: The endoscopic partial joint capsule and articular process excision is an effective procedure for LFJS, especially for cases caused by synovial impingement.

OBJECTIVE: The protection of articular processes (AP) in the transforaminal endoscopic discectomy (TED) was proven to optimise post-operative biomechanical environments. Published studies reported a large grade of nuclectomy leading to poor prognosis, but the underlying biomechanical mechanism was unclearly illustrated. This study aimed to investigate the changes of biomechanical environments after an in-out TED with intact AP and a large grade of nuclectomy and an out-in TED with limited foraminoplasty and a smaller grade of nuclectomy.
METHODS: A previously constructed and validated lumbo-sacral model was used in this study, and in-out TED with intact AP and out-in TED with limited foraminoplasty, a smaller grade of nuclectomy was simulated. Biomechanical changes in the L5-S1 segment related to the degeneration acceleration were computed under different directional loading conditions.
RESULTS: Post-operative biomechanical changes after the out-in TED with limited foraminoplasty were slight, except for the facet contact pressure under the extension position. By contrast, significant biomechanical deterioration, both in the adjacent disc and zygapophyseal joints, is observed under extension in the model after the in-out TED with large nuclectomy.
CONCLUSIONS: A large grade of nuclectomy is regarded as an independent risk factor of adjacent segment disease in the caudal functional spinal unit after the in-out TED.

Objective: To analyze the biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy using the finite element method. Methods: Three healthy adult males (aged 35.6 to 42.3 years) without spinal diseases were enrolled in this study and 3D-CT scans were carried out to obtain the parameters of lumbar spine. Mimics software was applied to build a 3D finite element model of lumbar spine. Graded resections (1/4, 2/4, 3/4 and 4/4) of the left superior articular process of L(5) were done via percutaneous transforaminal endoscopic lumbar discectomy. Then, the pressure of the L(4/5) right facets, the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine were recorded after simulating the normal flexion and extension, lateral flexion and rotation of the lumbar spine model during different resections. The data were compared among groups with analysis of variance. Results: Comparing with the normal group, after 1/4 resection of the left superior articular process of L(5), the pressure of the L(4/5) right facets showed significant differences during left lateral flexion and rotation of lumbar spine (q=8.823, 8.248, both P<0.05); and the pressure of L(4/5) intervertebral disc also changed significantly during extension and right rotation of lumbar spine (q=6.918, 6.438, both P<0.05); the motion of lumbar spine showed obvious differences during right lateral flexion and rotation (q=6.845, 7.772, 13.58, all P<0.05). Comparing with the normal group, after 2/4 resection of the left superior articular process of L(5), the pressure of the L(4/5) right facets presented significant differences during all conditions (q=5.670-17.830, all P<0.05); the pressure of L(4/5) intervertebral disc changed significantly during flexion, extension, lateral flexion and right rotation (q=5.260, 17.150, 5.727, 8.890, 15.660, all P<0.05); the motion of lumbar spine also existed differences during extension, lateral flexion and rotation (q=9.106, 5.431, 12.060, 11.160, 17.260, all P<0.05). However, after 3/4 resections, the pressure of the L(4/5) right facets, the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine presented differences during all conditions when compared with those in normal group (q=6.303-25.48, all P<0.05). After 4/4 resections, the pressure of the L(4/5) right facets and the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine showed significant differences during all conditions when compared with those in normal group (q=8.065-45.70, all P<0.05). Conclusions: The biomechanics and the stability of lumbar spine changed partly after 1/4 resection of the superior articular process and obviously after more than 2/4 is resected. The superior articular process should be paid more attention during foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy.
目的： 采用有限元法分析全脊柱内镜下椎间孔成型对腰椎生物力学的影响。 方法： 2016年8月选取健康成年男性3名，年龄35.6～42.3岁，排除脊柱疾患。进行腰椎3D－CT扫描，获取腰椎CT参数。应用Mimics等软件进行数据处理获得腰椎有限元三维模型。依次模拟腰椎侧路全脊柱内镜应用下将L(5)左侧上关节突进行1/4、2/4、3/4和4/4分级切除，并给予载荷模拟正常腰椎进行屈伸、侧屈和旋转活动，记录不同切除状态下L(4/5)右侧关节突间压力、L(4/5)椎间盘压力和腰椎活动度，并与未切除组或进行组间比较。组间比较用方差分析，两两比较用SNK检验。 结果： 与未切除组相比，L(5)左侧上关节突切除1/4时，L(4/5)右侧关节突间压力在左侧屈及左旋转载荷下差异有统计学意义(q＝8.823、8.248，均P<0.05)；L(4/5)椎间盘内压力在后伸及右旋转载荷下差异有统计学意义(q＝6.918、6.438，均P<0.05)；腰椎活动度在右侧屈及左右旋转载荷下差异有统计学意义(q＝6.845、7.772、13.580，均P<0.05)。L(5)左侧上关节突切除2/4时，与未切除组对比，L(4/5)右侧关节突间压力在各载荷下差异均有统计学意义(q＝5.670～17.830，均P<0.05)；L(4/5)椎间盘内压力在前屈后伸、左右侧屈及右旋转载荷下差异有统计学意义(q＝5.260、17.150、5.727、8.890、15.660，均P<0.05)；腰椎活动度在后伸、左右侧屈及左右旋转载荷下差异有统计学意义(q＝9.106、5.431、12.060、11.160、17.260，均P<0.05)。L(5)左侧上关节突切除3/4时，与未切除组相比，L(4/5)右侧关节突间压力在各载荷下差异均有统计学意义(q＝6.518～26.870，均P<0.05)；L(4/5)椎间盘内压力在各载荷下差异均有统计学意义(q＝6.867～25.190，均P<0.05)；腰椎活动度在各载荷下差异均有统计学意义(q＝6.303～20.720，均P<0.05)。L(5)左侧上关节突切除4/4时，与未切除组相比，L(4/5)右侧关节突间压力在各载荷下差异均有统计学意义(q＝11.880～45.70，均P<0.05)；L(4/5)椎间盘内压力在各载荷下差异均有统计学意义(q＝11.120～82.210，均P<0.05)；腰椎活动度在各载荷下差异均有统计学意义(q＝8.065～22.520，均P<0.05)。 结论： 腰椎上关节突切除1/4即会部分影响腰椎的力学并影响腰椎的稳定性，切除2/4及以上即会明显破坏腰椎的稳定性；全脊柱内镜下椎间孔成型时可能需要注意对腰椎上关节突的保护。.

BACKGROUND: Each part of the rear bone structure can become an anchor point for an attachment device. The objective of this study was to evaluate the stiffness and strength of different parts of the rear lumbar bone structure by axial compression damage experiments.
METHODS: Five adult male lumbar bone structures from L2 to L5 were exposed. The superior and inferior articular processes, upper and lower edges of the lamina, and upper and lower edges of the spinous process were observed and isolated and then divided into six groups (n = 10). The specimens were placed between the compaction disc and the load platform in a universal testing machine, which was first preloaded to 5.0 N tension to eliminate water on the surface and then loaded to the specimen curve decline at a constant tension loading rate of 0.01 mm/s, until the specimens had been destroyed.
RESULTS: Significant differences in mechanical properties were found among different parts of the rear lumbar bone structure. Compared with other parts, the lower edge of the lamina has good mechanical properties, which have a high modulus of elasticity; the superior and inferior articular processes have greater ultimate strength, which can withstand greater compressive loads; and the mechanical properties of the spinous process are poor, and it is significantly stiffer and weaker than the lamina and articular processes.
CONCLUSIONS: These data can be useful in future spinal biomechanics research leading to better biomechanical compatibility and provide theoretical references for spinal implant materials.

OBJECTIVE: A series of 18 patients with symptomatic synovial cysts was analysed from May 2009 to November 2013. Different approaches were performed for their removal.
METHODS: The study included 18 patients, 8 men and 10 women, aged between 50 and 77 years. An analysis was made of the variables including age, gender, symptoms, imaging studies, histopathology, surgery, follow-up, complications, and clinical outcome.
RESULTS: An articular synovial cyst was diagnosed in 17 cases, and a ganglion in one cases. The most common symptom was back pain with radiculopathy (94%). Motor deficits occurred in 4 cases (22%), and 1 case (5%) presented with urinary incontinence. The most common level was L4- L5 (67%), with one atypical case observed in the D12 -L1 location. Hemi-laminectomy was performed in 14 cases, with 9 of them having an interspinous spacer (ISP) device inserted. A laminectomy with a fusion procedure was performed in 3 patients and 1 patient had a bilateral decompression using a unilateral approach. The patients were followed-up for between 6 months to 2 years.
CONCLUSIONS: Synovial cysts are a cause of radiculopathy/neurogenic claudication. Spinal cysts are commonly found at the L4-L5 level. MRI is the tool of choice for diagnosis. The most common symptom was back pain with radiculopathy. Synovial cysts resistant to conservative therapy should be treated surgically. In our series, surgical resection of symptomatic juxtafacet cysts showed a good clinical outcome, but the optimal approach for patients with juxtafacet cysts remains unclear.

Articular process anomalies are considered congenital. Their occurrence in specific breeds may be indicative of undetermined genetics. Clinical significance varies and is interdependent upon location, function and anatomy. Etiology, uniform nomenclature and classification of vertebral articular process anomalies in the dog are lacking; however recent efforts are beginning to address this deficit. This author proposes that the term articular process dysplasia appropriately encompasses the spectrum of anomalies in severity as well as including those affecting both the cranial and caudal articular processes. The general category description of articular process dypslasia doesn\'t preclude, but rather allows for more specific designations.