OBJECTIVE: Chronic low back pain, affecting up to 58% of the population, often stems from intervertebral disc degeneration. Although magnetic resonance imaging (MRI) is commonly used for diagnostics, challenges arise in pinpointing pain sources due to frequent asymptomatic findings. Single-photon emission tomography (SPECT) integrated with computed tomography (CT) offers a promising approach, enhancing sensitivity and specificity.
METHODS: In this retrospective study, spanning 2016 to 2022, SPECT/CT imaging was performed on 193 patients meeting specific criteria. We correlated SPECT/CT findings with lumbar MRI results, utilizing Pfirrmann and Rajasekaran classifications for disc degeneration and endplate damage assessment. Logistic regression analysis adjusted for age and sex evaluated associations.
RESULTS: Of 965 spinal levels assessed, SPECT/CT positivity strongly correlated with higher Pfirrmann grades and Rajasekaran endplate classifications. Notably, Modic changes (MCs) on MRI displayed a nonsignificant relationship with SPECT/CT positivity. Significant associations were observed in older patients with positive MCs, Pfirrmann grades, and Rajasekaran classifications.
CONCLUSIONS: This comprehensive study, the largest of its kind, establishes a significant link between SPECT/CT positivity and advanced lumbar degenerative changes. Higher Pfirrmann grades and increased Rajasekaran endplate damage demonstrated substantial correlations with SPECT/CT positivity. Notably, MCs did not exhibit such association. Our findings underscore the potential of SPECT/CT in identifying pain generators in degenerative spinal conditions, offering valuable insights for future interventions.

Background/Objectives: Expansive open-door laminoplasty results in favorable clinical outcomes for cervical myelopathy. However, some postoperative complications associated with surgical invasiveness, such as axial neck pain and kyphosis, have not been resolved. The use of an exoscope, which is a recently introduced novel magnification tool, allows for traditional open-door laminoplasty with minimal invasiveness. Therefore, we propose the use of exoscopic minimally invasive open-door laminoplasty (exLAP) and present its clinical outcomes during the acute postoperative period. Methods: A total of 28 patients who underwent open-door laminoplasty at C3-C6 were reviewed. Of these patients, 17 underwent exLAP (group M) and 11 underwent conventional Hirabayashi open-door laminoplasty (group H). Outcomes were evaluated using numerical rating scale (NRS) scores for neck pain and the frequency of oral analgesic use from postoperative day 1 to 7. Results: The NRS score for neck pain was significantly lower for patients in group M than for those in group H. Conclusions: ExLAP is a novel, practical, and minimally invasive surgical technique that may alleviate the postoperative axial pain of patients with cervical myelopathy.

暂无摘要。

With current imaging modalities and diagnostic tests, identifying pain generators in patients with non-specific chronic low back pain (CLBP) is difficult. There is growing evidence of the effectiveness of SPECT/CT examination in diagnosing the source of pain in the spine. The study aims to investigate the effect of posterior interbody fusion on a single-level SPECT/CT positive lumbar degenerative disc disease (DDD).
This is a prospective study of patients with chronic low back pain (CLBP) operated on for a single-level SPECT/CT positive DDD. Primary outcomes were changes in visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Secondary outcomes were complications, return to work, satisfaction and willingness to re-undergo surgery.
During a 3-year period, 38 patients underwent single-level fusion surgery. The mean preoperative VAS score of 8.4 (± 1.1) decreased to 3.2 (± 2.5, p < 0.001) and the mean preoperative ODI of 51.5 (± 7.3) improved to 20.7 (± 14.68, p < 0.001) at a 2-year follow-up. A minimum clinically important difference (30% reduction in VAS and ODI) was achieved in 84.2% of patients. Some 71% of patients were satisfied with the surgery results and 89.4% would undergo surgery again. There were four complications, and two patients underwent revision surgery. Some 82.9% of patients returned to work.
Fusion for one-level SPECT/CT positive lumbar DDD resulted in substantial clinical improvement and satisfaction with surgical treatment. Therefore, SPECT/CT imaging could be useful in assessing patients with CLBP, especially those with unclear MRI findings.
ClinicalTrials.gov Identifier: NCT04876586.

Chronic pain and depression are common comorbid conditions, but there is limited evidence-based guidance for management of the two conditions together. In recent years, there has been an increase in the number of chronic pain randomized controlled trials that collect depression outcomes, but it is unknown how often these trials include people with depression or significant depressive symptoms. If trials do not include participants representative of real-world populations, evidence and guidance generated from these trials risk being inapplicable for large proportions of the target population, or worse, risk harm. Thus, in order to identify pathways to improve the conduct of clinical trials, the aims of this study were to (1) estimate the proportion of randomized controlled trials evaluating chronic pain interventions and reporting depression outcomes that include participants with significant depressive symptoms; and (2) assess the variability of inclusion proportions by pain type, intervention type, gender, country of origin, and publication year.
Studies were extracted from an umbrella review of interventions for chronic pain that reported depression outcomes. Screening and data extraction were completed in duplicate and conflicts were resolved by a third author. Randomized controlled trials with at least 50% adult participants and validated depression scales were included, and randomized controlled trials with populations whose mean scores were at or above depression thresholds at baseline were considered to have included participants with depression.
Of the 346 randomized controlled trials analyzed, 142 (41%) included participants with depression. Eight pain-type groups and nine intervention types were identified. Randomized controlled trials investigating fibromyalgia and mixed chronic pain had the highest proportion of participants with depression, whereas studies of arthritis and axial pain had among the lowest. Randomized controlled trials from the United States had a significantly lower inclusion proportion compared with non-US studies, especially for studies on arthritis. The increase in inclusion proportion by publication year was driven by the increase in fibromyalgia studies.
This study highlights opportunities to improve the conduct of chronic pain clinical trials. The majority of randomized controlled trials s analyzed evaluated participants without significant depressive symptoms at baseline, thus the findings synthesized in systematic reviews and subsequent guidelines are most applicable to the subset of real-world populations that do not have significant depressive symptoms. As well, systemic biases around psychological conditions and gender may be important contributors to differences in the study of depression in fibromyalgia compared with common conditions such as arthritis and axial pain. In order to better inform clinical practice, future research must intentionally include individuals with comorbid depression in trials of common chronic pain conditions, and consider methods to mitigate biases that may distort study design.

Cervical laminoplasty is generally not indicated in patients with kyphosis because of poor outcomes. Therefore, data on the effectiveness of posterior structure-preserving techniques in patients with kyphosis are limited. This study investigated how laminoplasty with muscle and ligament preservation can benefit patients with kyphosis via risk factor analyses of postoperative complications.
Clinicoradiological outcomes of 106 consecutive patients, including patients with kyphosis, who had undergone C2-C7 laminoplasty in a muscle- and ligament-preserving fashion, were retrospectively analyzed. Surgical outcomes, including neurological recovery, were assessed, and sagittal parameters were measured on radiographs.
Surgical outcomes of patients with kyphosis were comparable to outcomes of other patients except for axial pain (AP), which was significantly more frequent in patients with kyphosis. Moreover, AP was significantly associated with alignment loss (AL) >0°. Substantial local kyphosis (local kyphosis angle >10°) and greater value of range of motion (ROM) during flexion minus ROM during extension were identified as risk factors for AP and AL >0°, respectively. Receiver operating characteristic curve analysis indicated ROM during flexion minus ROM during extension cutoff value of 0.7° for predicting AL >0° in patients with kyphosis (sensitivity: 77%; specificity: 84%). Substantial local kyphosis combined with ROM during flexion minus ROM during extension >0.7° had 56% sensitivity and 84% specificity for predicting AP in patients with kyphosis.
Although patients with kyphosis had a significantly higher incidence of AP, C2-C7 cervical laminoplasty with muscle and ligament preservation may not be contraindicated in selected patients with kyphosis by risk stratification for AP and AL using newly identified risk factors.

UNASSIGNED: osteoporosis seems to be uncommon in sub-Saharan Africa. The aim of this study was to determine prevalence and determinants of osteoporosis in Congolese outpatients attending rheumatology consultation for axial rheumatism in Kinshasa, Democratic Republic of the Congo.
UNASSIGNED: a cross-sectional hospital-based study from January to December 2018 among outpatients received for axial rheumatism in 8 hospitals of Kinshasa. The parameters of interest were age, sex, body mass index (BMI), alcoholism, smoking, physical activity, sunlight exposure, intake of dairy products, the notion of personal or parental fracture, a bone mineral density (BMD) and a phosphocalcic metabolism. The BMD was measured by using the dual energy X-ray absorptiométry. Serum level of calcium, Vitamin D, phosphore and parathormon were determined to assess the phosphocalcic metabolism. Osteoporosis was defined by a T-Score ≤ -2.5 SD. Standard statistical tests were used to analyze the results.
UNASSIGNED: ninety patients (75 women and 15 men) were included. Their mean age was 63.5 ± 12.2 years. Low back pain 71.1% (n=63) was the main symptom. The rate of patients with osteoporosis, osteopenia, and normal bone density was 34.4% (n=31), 43.9% (n=44), and 16.7% (n=15) respectively. Pathological bone fractures were not noted. Ageing (aOR: 1.31, IC95%: 1.11-1.54; p=0.002), smoking (aOR: 14.65, IC95%: 1.38-156.1; p=0.045) and non-obese status (aOR: 32.3, IC95% 1.50-696; p=0.032) were identified as determinants of osteoporosis.
UNASSIGNED: in the present study, osteoporosis is common in Congolese patients with axial pain and is more frequent in women. Its determinants are ageing, smoking and non-obese status.

BACKGROUND: The present study aimed to assess the efficacy of a new haplo-paraspinal-muscle-preserving (HMP) laminoplasty technique in the treatment of cervical myelopathy.
METHODS: The medical records of 68 patients diagnosed with multisegmental cervical myelopathy were retrospectively reviewed. Of these, 22 patients who underwent HMP laminoplasty were defined as the muscle-preserved group (MP), and 46 patients who underwent traditional open-door laminoplasty were enrolled and defined as the traditional open-door laminoplasty group (LP). Patient demographic data and surgical parameters like clinical and radiological parameters, operation duration, blood loss, and spinal canal expansion distance were compared.
RESULTS: Average surgical time and blood loss were significantly reduced in the MP group when compared with the LP group (P < 0.05). Both groups demonstrated significant improvements in neurological function and spinal canal expansion (P > 0.05). However, the visual analog scale score in the MP group was significantly lower compared with the LP group at the 6-month follow-up (P < 0.05), but no differences were found at the 1-year follow-up. The loss of lordosis was more prominent in the LP group when compared with the MP group at 1-year follow-up (P < 0.05). Lower events of persistent axial pain were found in the MP group but with no statistical significance. More hinge side laminae fractures could be found in the MP group, but more hinge side displacements were found in the LP group.
CONCLUSIONS: The HMP laminoplasty technique is relatively safe, effective, easier to perform, and better for lordosis maintenance and complication control compared with the traditional open-door technique.
CONCLUSIONS: Although traditional open-door laminoplasty is an efficient approach in treating multisegmental cervical myelopathy, the complications could significantly affect the clinical outcome. Our new HMP laminoplasty technique has a lower complication rate and a better lordosis maintenance ability; therefore, it could be a better choice in treating multisegmental cervical myelopathy.
METHODS:

OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) with zero-profile interbody has a lower incidence of complications in treating cervical spondylotic myelopathy (CSM). However, postoperative axial neck pain is still commonly occurred, and the factors affecting which is not known. Here, we retrospectively analyze the risk factors for postoperative axial pain after performing ACDF with zero-profile implant in single-level CSM.
METHODS: Patients who suffered from single-level CSM and who received ACDF with zero-profile implant between 2018 January to 2020 December were reviewed. Of 180 single-level CSM patients, 144 patients who passed the inclusion criteria were enrolled. Patients were divided into two groups according to the severity of postoperative axial pain as measured by postoperative neck visual analogue scale (nVAS). Clinical parameters including age, sex, smoking history, symptom duration, body mass index (BMI), the Japanese Orthopaedic Association (JOA) scores, as well as radiological parameters were obtained pre- and post-operatively, and the data were compared between two groups. Pearson\'s chi-square tests and Mann-Whitney U tests were implemented to identify statistically significant differences between subgroups for categorical and continuous data, respectively; otherwise, the data were tested with Student\'s t-test. Risk factors were identified using logistic regression.
RESULTS: Of the patients (97.8%) achieved satisfied neurological recovery, and 88.2% of the patients achieved fusion at 1-year follow-up. 33% of the patients (48 patients out of 144) had sustained postoperative axial pain after the surgery. Comparison of different severity groups exhibited no significant differences in terms of the possible risk factors (P > 0.05) except for pre- and post-operative C2-C7 Cobb angles (6.33 ± 6.53 vs. 11.88 ± 7.41, P < 0.05; 13.49 ± 5.31 vs 16.64 ± 7.34, P < 0.05). Furthermore, correlation analysis showed that the preoperative C2-C7 Cobb angle is significantly correlated with the severity of the postoperative axial pain (R2  = 0.83, P < 0.01). In addition, logistic regression analysis demonstrated that the preoperative C2-C7 Cobb angle is an independent predictor of postoperative axial pain (P < 0.01, OR = 0.53). Further receiver operating characteristic (ROC) analysis displayed an area under the curve (AUC) of 0.78 (P < 0.01) for preoperative C2-C7 Cobb angle, and the optimal cutoff was 8.4° (sensitivity 0.77, specificity 0.65).
CONCLUSIONS: The pre-operative C2-C7 Cobb angle is a risk factor for severe postoperative axial pain after anterior cervical discectomy and fusion with zero-profile interbody, and we should be cautious when poor preoperative C2-C7 Cobb angle is found in myelopathy patients planning to use zero-profile interbody to treat such patients.

UNASSIGNED: Cervical isometric muscle strengthening and cervical range of motion (ROM) training are recommended after laminoplasty (LP). However, their preventive effects on axial pain are unclear. We examined whether neck extension muscle strengthening and cervical ROM training from the early postoperative period effectively suppress postoperative axial pain.
UNASSIGNED: Sixty-one patients undergoing a muscle-preserving LP attached to C2 and C7 for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament were randomly allocated to the cervical exercise (33 patients) or nonexercize (28 patients) groups. Postoperative cervical collars were not worn in any cases. The cervical exercise group underwent neck extension isometric muscle strengthening and cervical ROM exercises for 3 months starting on postoperative day 2. Changes in axial pain (visual analog scale [VAS]) from baseline at 2 weeks and 3 months after surgery were evaluated as the primary outcome. Cervical muscle strength, cervical ROM, and Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) scores were evaluated as secondary outcomes.
UNASSIGNED: Axial pain was significantly exacerbated at 2 weeks after LP compared with before surgery, and then, a significant improvement was observed at 3 months after surgery. No significant interaction was observed between the intervention and nonintervention groups. There was no difference in secondary outcomes between groups. The change in the VAS of axial pain from before surgery to 3 months after surgery showed a greater decreased neck extension muscle strength resulting in severer axial pain.
UNASSIGNED: Cervical muscle strengthening and cervical ROM exercise from the early postoperative period did not relieve axial pain at 2 weeks and 3 months after a muscle-preserving LP attached to C2 and C7. No significant difference in neck extension muscle and cervical movement was observed between the intervention and nonintervention groups. Therefore, a muscle-preserving LP attached to C2 and C7 is a good strategy to prevent axial pain in the early postoperative period.
Clinical Trials Registration Number: UMIN000040692.