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Abstract Background To establish a three-dimensional finite element model of the lumbar spine and investigate the impact of different fixation techniques on the biomechanical characteristics of oblique lumbar interbody fusion (OLIF). Methods The study aimed to establish and validate a comprehensive three-dimensional model of the lower lumbar spine (L3-S1) using the finite element method. L4-L5 was selected as the surgical segment, and four distinct OLIF surgical models were constructed: Stand-alone (SA), unilateral cortical bone trajectory screw (UCBT), bilateral cortical bone trajectory screw (BCBT), and bilateral pedicle screw (BPS). The models were underwent a pure moment of 10N·m to simulate lumbar extension, flexion, left bending, right bending, left and right rotation movements. Subsequently, the range of motion (ROM), cage stress, and fixation stress were calculated. Results In the L3-L5 segment, the BCBT group showed the most limited range of motion (ROM) under exercise load, indicating superior stability within this group. The ROM and cage stress values were found to be highest in the SA group. In contrast, the cage and internal fixation stress in the BPS group were observed to be lowest (9.91 ~ 53.83MPa, 44.93 ~ 84.85 MPa). With the exception of right bending and right rotation, the UCBT group demonstrated higher levels of internal fixation stress (102.20 ~ 164.62 MPa). Conclusions The study found that OLIF-assisted internal fixation improved segmental stability and reduced cage stress. The BPS group had advantages over the CBT group in preventing endplate damage and reducing the risk of cage subsidence. However, BCBT group has distinct merits in maintaining surgical segment stability, distributing stress load on the spinal motor unit, and reducing the likelihood of adjacent segment degeneration (ASD).

Abstract Background This meta-analysis compares the efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) to conventional interbody fusion in lumbar degenerative diseases (LDD). Methods An extensive literature search was conducted in PubMed, Web of Science, and the Cochrane Library. Research related to UBE-TLIF published up to November 2022 was reviewed. The relevant articles were selected based on inclusion and exclusion criteria, as well as an evaluation of the quality of the data extraction literature. Meta-analysis was performed using Review Manager 5.3 software. Results This meta-analysis included six high-quality case–control trials (CCTs) involving 621 subjects. The clinical outcomes assessment showed no statistical differences in complication rates, fusion rates, leg pain VAS scores, or ODI scores. After UBE-TLIF, low back pain VAS scores were significantly improved with less intraoperative blood loss and a shorter hospital stay. A longer time was required for UBE-TLIF, however. Conclusion Despite the lack of sufficient high quality randomized controlled trials (RCTs) in this study, the results of this meta-analysis suggest that UBE-TLIF is more effective than open surgery in terms of length of stay, blood loss reduction during surgery, and improved low back pain after surgery. Nevertheless, the evidence will be supplemented in the future by more and better quality multicenter randomized controlled trials.

Abstract Background The high signal of paravertebral muscle (PVM) on T2-weighted image (T2WI) is usually considered to be fatty degeneration. However, it is difficult to distinguish inflammatory edema from fatty degeneration on T2WI. The purpose of this study was to identify different types of PVM high signal in patients with low back pain (LBP) through magnetic resonance imaging (MRI) and histology. Methods Seventy patients with LBP underwent MRI. The signal change of multifidus both on T2WI and fat suppression image (FSI) was quantified by Image J. Furthermore, 25 of the 70 patients underwent surgery for degenerative lumbar disease and their multifidus were obtained during the operation. Histological analysis of the samples was performed by HE staining. Result Three types of PVM signal changes were identified from the MRI. Type 1 (n = 36) indicated fatty degeneration characterized by a high signal on T2WI and low signal on FSI. High signal on both T2WI and FSI, signifying type 2 meant inflammatory edema (n = 9). Type 3 (n = 25) showed high signal on T2WI and partial signal suppression on FSI, which meant a combination of fatty degeneration and inflammatory edema. Histological results were consistent with MRI. Among the 25 patients who underwent surgery, type 1 (n = 14) showed adipocytes infiltration, type 2 (n = 3) showed inflammatory cells infiltration and type 3 (n = 8) showed adipocytes and inflammatory cells infiltration. Conclusion From our results, there are three types of pathological changes in patients with PVM degeneration, which may help to decide on targeted treatments for LBP.

Objective: The aim of this study was to evaluate the treatment efficacy of lateral spinal stenosis through the decompression of the nerve root under a multiple planar endoscope.Methods: From January 2017 to March 2019, 52 patients with lumbar spinal stenosis or lumbar spinal stenosis combined with intervertebral disc herniation had been treated via transforaminal approach spinal endoscopy. Our study retrospectively analyzed the treatment outcome. All patients experienced complications with different degrees of facet joint hyperplasia and ligamentum flavum hyperplasia and hypertrophy. Some patients suffered disc herniation. All patients were treated with percutaneous transforaminal approach multiple planar endoscopic decompression. The visual analog scale (VAS) and the Oswestry Disability Index (ODI) were compared before and after the operation, as were the horizontal foramen areas of the medial margins of the upper and lower pedicles of the vertebral arch. The treatment effectiveness was evaluated.Results: VAS and ODI scores were significantly improved at postoperative 3 days, 3 months, 6 months, and the last follow-up (P < 0.05). The area of the intervertebral foramen was 422.5 ± 159.2 mm2 preoperatively and 890.8 ± 367.7 mm2 postoperatively, the difference was statistically significant (P < 0.05).Conclusion: Percutaneous transforaminal approach multiple planar endoscopic decompression could achieve an accurate and effective decompression of the lumbar lateral spinal canal. This procedure has good short-term effects, and is especially suitable for elderly patients.