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This study aimed to delineate trends in intervertebral disc degeneration among Mexican patients, specifically focusing on the distribution and correlation between BMI and Pfirrmann classification results within the Mexican population. Conducted using the public health database of Mexico City. The study involved 51 patients sampled via convenience sampling, with exclusive utilization of internal MRI data from L4-L5 and L5-S1 discs. Data encompassed gender, age, height, weight, BMI, and radiographic findings. The dataset was stratified by gender and BMI categories, with analyses including measures of distribution and association, notably employing the Dunn test to compare BMI groups. Visualization tools such as violin plots and box-and-whisker charts were employed to elucidate the relationships between BMI, age, and Pfirrmann classification results. In both female and male groups, increasing BMI exhibited a positive correlation with disc degeneration severity, particularly pronounced in the obesity category. Statistical analyses revealed differences between normal BMI and overweight/ obesity groups. Furthermore, there is also an increase in severity between overweight and obesity groups. The odds ratios (ORs) for disc degeneration severity, comparing different BMI categories, reveal significant associations. Among women, overweight individuals have 3.333 times higher odds of presenting a Pfirrmann classification result ≥ 4 at L4-L5, and 6.545 times higher odds at L5-S1, compared to those with normal BMI. Similarly, women with obesity have 8 times higher odds of disc degeneration at both levels. For men, the ORs were 1.6 and 2.222 at L4-L5 and L5-S1, respectively, comparing normal BMI to overweight individuals, the ORs were 5 at L4-L5 and 4.166 at L5-S1 when comparing normal BMI to obesity. This study offers persuasive evidence that, among Mexican patients, body mass index (BMI) is probably correlated with the severity of lumbosacral degenerative disc degeneration (DDD). Acknowledging limitations in sample size, future investigations should delve into elucidating the underlying mechanisms driving this correlation. Multi-center studies with larger, diverse cohorts are warranted to validate and enhance the generalizability of our findings. We promote the focus on early detection and prevention, marking a paradigm change in the treatment of degenerative spine disorders and opening the door for creative methods of patient care and public health campaigns. [ABSTRACT FROM AUTHOR]

Lumbar degenerative disc disease (LDDD) significantly contributes to low back pain, with a complicated etiology involving genetic and environmental facts. The aim of study was to investigate the association between the Taq I (rs731236) polymorphism of the vitamin D receptor (VDR) gene with LDDD. In total, 248 patients with symptomatic LDDD and 146 control subjects were examined. The evaluation of clinical features of patients with LDDD comprised radiodiagnostic magnetic resonance imaging, neurologic examinations, pain scores including the visual analog scale (VAS), and disability investigation with Oswestry Disability Index (ODI). Genotyping of the VDR gene polymorphism was conducted using polymerase chain reaction–based methods. Individuals of the LDDD group who were VDR TaqI AA genotype carriers were significantly greater than the other group (P = 0.014), whereas those with GG genotype were significantly lower (P = 0.028) in the patient group. In addition, VAS and ODI scores were significantly lower in the GG genotype carrier group, whereas AA genotype carriers had the greatest scores (P = 0.004). Carrying the G allele decreased the risk of LDDD 1.7 times (P = 0.014) and carrying the A allele enhanced the risk 1.8 times (P = 0.028). Moreover, G-allele carriers had significantly lower VAS (P = 0.002) and ODI scores (P < 0.0001). VDR Taq I (rs731236) GG genotype and G allele have protective potential, whereas the AA genotype and A allele are risk factors for LDDD. The findings reveal a statistically significant association of the Taq I (rs731236) polymorphism of VDR gene polymorphism with LDDD. This result highlights the potential role of genetic factors in developing LDDD and suggests avenues for future research in genetic screening and personalized treatment strategies. [ABSTRACT FROM AUTHOR]

Objective: Given the distinct physiological and societal traits between women and men, we propose that there are distinct risk factors for lumbar degenerative disc disease surgeries, including lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS), in middle‐aged and older populations. However, few studies have focused on middle‐aged and older women. This study aims to identify these risk factors specifically in this population. Methods: In this case–control study, the study group comprised 1202 women aged ≥ 45 years who underwent operative treatment of lumbar degenerative disc disease (LDH, n = 825; LSS, n = 377), and the control group comprised 1168 women without lumbar disease who visited a health examination clinic during the same period. The study factors included demographics (age, body mass index [BMI], smoking, labor intensity, and genetic history), female‐specific factors (menopausal status, number of deliveries, cesarean section, and simple hysterectomy), surgical history (number of abdominal surgeries, hip joint surgery, knee joint surgery, and thyroidectomy), and systemic diseases (hypercholesterolemia, hypertriglyceridemia, hyper‐low‐density lipoprotein cholesterolemia, hypertension, diabetes, cardiovascular disease, and cerebrovascular disease). Multivariate binary logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) of associated factors. Results: The risk factors for surgical treatment of LDH in middle‐aged and older women included BMI (OR = 1.603), labor intensity (OR = 1.189), genetic history (OR = 2.212), number of deliveries (OR = 1.736), simple hysterectomy (OR = 2.511), hypertriglyceridemia (OR = 1.932), and hyper‐low‐density lipoprotein cholesterolemia (OR = 2.662). For surgical treatment of LSS, the risk factors were age (OR = 1.889), BMI (OR = 1.671), genetic history (OR = 2.134), number of deliveries (OR = 2.962), simple hysterectomy (OR = 1.968), knee joint surgery (OR = 2.527), hypertriglyceridemia (OR = 1.476), hyper‐low‐density lipoprotein cholesterolemia (OR = 2.413), and diabetes (OR = 1.643). Cerebrovascular disease was a protective factor against surgery for LDH (OR = 0.267). Conclusions: BMI, genetic history, number of deliveries, simple hysterectomy, hypertriglyceridemia, and hyper‐low‐density lipoprotein cholesterolemia were independent risk factors for surgical treatment of both LDH and LSS in middle‐aged and older women. Two disparities were found: labor intensity was a risk factor for LDH patients, and knee joint surgery and diabetes were risk factors for LSS patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of our meta-analyses is to find the most appropriate surgical technique treating lumbar degenerative disc disease (DDD). Spinal fusion is the conventional treatment for lumbar DDD. Total disc replacement (TDR) has been developed to avoid negative effects of fusions by preserving functionality. To our knowledge, there is no evaluation comparing meta-analytically the clinical results of three different surgical techniques with same inclusion and exclusion criteria for treating DDD. Methods: The surgical techniques TDR, anterior lumbar interbody fusion (ALIF) and circumferential fusion (CFF) are pairwise meta-analytically compared. Primary outcomes are pain measured by the Visual Analogue Scale (VAS) and function measured by the Oswestry Disability Index (ODI). Secondary outcomes are the mean number of complications per case (MNOC) at surgery and follow-up and the overall MNOC. Results: In our systematic search, we found finally six prospective studies with the minimum follow-up of two years: four randomized controlled trials and two cohort studies. In VAS and ODI, TDR is proved to be superior to ALIF and CCF (p < 0.05), whereat ALIF is more effective than CFF without statistical significance. CFF presents the best result in complications with the lowest overall MNOC (0.1), followed by TDR (1.2) and ALIF (1.5). Conclusion: According to our meta-analyses, we regard TDR to be the most appropriate surgical technique treating DDD, followed by ALIF. Further studies with a longer follow-up are needed using the same methodical approach to strengthen the VAS and ODI results and to explain the discrepant result to complications. [ABSTRACT FROM AUTHOR]

Introduction: Several treatment options exist for those with spinal stenosis, as well as degenerative changes. This series evaluates the use of an interspinous fixation (ISF) device as performed by interventional pain physicians. Methods: This is a retrospective analysis identifying 32 patients with the diagnosis of lumbar degenerative disc disease with secondary diagnosis of lumbar spinal stenosis being treated with ISF with Aurora Spine Zip Interspinous Spacer. Serious adverse events, specifically nerve injury, hematoma, infection, and death, were analyzed quantitatively for reported complications within 90 days from the procedure. In addition, VAS was analyzed for patient reported outcomes. Results: Adverse event rate was 0% with no incidences of reoperation, or device removal. Estimated blood loss was recorded as less than 50 cc for all patients. The preoperative pain assessment demonstrated an average pain score of 8.1 and a postoperative pain score of 2.65 equating to a percentage pain reduction of 67%. Conclusion: This case series demonstrates the success and safety of ISF being performed by interventional pain physicians in an outpatient setting. It is a valuable tool in the treatment of moderate to severe lumbar spinal stenosis and degenerative disc disease that has decreased morbidity and significant efficacy. [ABSTRACT FROM AUTHOR]

Background: The worldwide spread of smartphone usage enables new possibilities for longitudinal monitoring of objective functional impairment (OFI) in patients undergoing surgery for lumbar degenerative disc disease (DDD). Methods: Three patients, undergoing elective surgery for lumbar DDD, self-assessed OFI using a recently validated 6-min walking test (6WT) smartphone application. Results are presented as raw 6-min walking distance (6WD) as well as in reference to age- and sex-specific healthy population reference values using standardized z-scores (number of standard deviations). In parallel, patient-reported outcome measures (PROMs), including numeric rating scale (NRS) leg-pain and Core Outcome Measures Index (COMI) were obtained before (pre) and 6 weeks (6 W) as well as 3 months (3 M) after surgery. Descriptive analyses were used to compare PROMs with repeated 6WT measurements over time. The feasibility and benefits of the longitudinal OFI measurements using the 6WT app are discussed. Results: One patient presented a favorable outcome, reflected by a clinically meaningful improvement in PROMs. Correspondingly, the 6WT distance gradually improved above the normal population values ((pre 399 m (z-score − 1.96) vs. 6 W 494 m (− 0.85) vs. 3 M 557 m (− 0.1)). One patient experienced initial improvement at 6 W, followed by a decline in 6WD at 3 M which promoted further interventions with subsequent recovery ((358 m (z-score − 3.29) vs 440 m (− 2.2) vs 431 m (− 2.32) vs 471 m (− 1.78)). The last patient showed a lack of improvement in PROMs as well as in OFI (360 m (z-score 0.0) vs 401 m (0.30) vs 345 m (− 0.11)) resulting in secondary surgery. Conclusion: The longitudinal assessment of OFI using the 6WT app was feasible and provided the physician with a detailed history of patients' postoperative walking capacity complementing commonly used PROMs. [ABSTRACT FROM AUTHOR]

Background: Most of the literature on role of spinopelvic parameters in various lumbar spine pathologies has been based on studies done on Caucasian population. Aims and Objectives: The present study attempts to establish a database of measurements of the sagittal profile of spine in asymptomatic Indian population and their comparison with subjects having various lumbar spine pathologies. Materials and Methods: We performed a prospective case control study at All India Institute of Medical Sciences, New Delhi in which we enrolled 109 patients and 22 healthy asymptomatic subjects in 2 years from 2015 to 2017. All patients underwent standing lateral radiographs of the pelvis and the entire spine and various spino-pelvic parameters were measured using Surgimap software. Results: The mean Pelvic incidence (PI) in the asymptomatic individuals was 49.29 ± 5.95° which was significantly lower when compared with patients of chronic low backache (53.96 ± 9.47, P-<0.001), lumbar listhesis (59.4 ± 21.33, P-<0.001) and failed back surgery syndrome (56.7 ± 8.21, P-<0.001). The mean Pelvic Tilt (PT) in healthy subjects was 14.3±4.08° which was significantly lower when compared with patients of lumbar listhesis (23.35 ± 14.03, P-<0.001) and failed back surgery syndrome (22.8 ± 8.09, P-<0.001). Sacral slope (SS) and sagittal vertical axis (SVA) offset did not show any statistically significant difference. The mean Lumbar lordosis (LL) measured in healthy individuals was 42.5 ± 7.89° which was significantly lower when compared with patients of lumbar listhesis (46.24 ± 19.24, P-0.04) and failed back surgery syndrome (45.12 ± 6.87, P-0.05). Conclusion: PT and PI showed statistically significant difference in subjects having lumbar spondylolisthesis and failed back surgery syndrome as compared to healthy asymptomatic subjects. [ABSTRACT FROM AUTHOR]

Anterior instability after total hip arthroplasty (THA) has been described in patients with thoracolumbar kyphotic deformity. Although compensatory posterior pelvic tilt with subsequent increased functional anteversion has been described as the mechanism, there is a paucity of in vivo data. The purpose of our study was to compare pelvic tilt, anteversion, inclination, and position of head‐cup contact points in patients with lumbar degenerative disc disease (DDD) and a matched patient cohort without DDD. A total of 50 THA, 18 hips with lumbar DDD and 32 hips without DDD, underwent CT imaging for 3D hip reconstruction. Component orientations and in vivo hip gait kinematics was quantified using a validated dual fluoroscopic imaging system. Hip kinematics and head‐cup contact points were compared. Patients with lumbar DDD demonstrated decreased maximum (5.9° ± 4.2° vs. 9.3° ± 5.4°, p = 0.02) and minimum (2.4° ± 4.1° vs. 6.2° ± 5.6°, p = 0.01) anterior pelvic tilt, and increased maximum cup anteversion (29.3° ± 8.7° vs. 25.1° ± 8.1°, p = 0.05). The peak head‐cup contact points were shifted closer to the anterior edge of the polyethylene (7.8 ± 1.7 mm vs. 9.6 ± 2.2 mm, p = 0.02). Patients with lumbar degenerative disc disease demonstrated increased posterior pelvic tilt, functional acetabular anteversion, inclination as well as shifting of the peak head‐cup contact pattern significantly closer to an anterior edge, suggesting sagittal spinopelvic deformity may predispose to anterior instability in THA patients during upright activities. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res [ABSTRACT FROM AUTHOR]

Purpose: Although many meta-analyses have been performed to compare total disc replacement (TDR) and fusion for treating lumbar degenerative disc disease (LDDD), their findings are inconsistent. This study aimed to conduct a systematic review of overlapping meta-analyses comparing TDR with fusion for treating LDDD, to assist decision makers in selection among conflicting meta-analyses, and to provide treatment recommendations based on the best available evidence.Methods: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Multiple databases were comprehensively searched for meta-analyses comparing TDR with fusion for treating LDDD. Meta-analyses only comprising randomised controlled trials (RCTs) were included. Two authors independently assessed meta-analysis quality and extracted data. The Jadad decision algorithm was used to ascertain which meta-analyses represented the best evidence.Results: A total of five meta-analyses were included. All these studies only included RCTs were determined as Level-II evidence. The scores of Assessment of Multiple Systematic Reviews (AMSTAR) ranged from 6 to 9 (median 7). A high-quality Cochrane review was chosen according to the Jadad algorithm. This best available evidence found that statistical significances were observed between TDR and fusion for LDDD regarding disability, pain relief, and pain in the short term, but it was not over clinically important differences. The prevent effects on adjacent segment and facet joint degeneration, as the primary goal of adopting TDR stated by the manufacturers, were not appropriately evaluated.Conclusions: There is discord in results from meta-analyses that assessed TDR and fusion for LDDD. According to this systematic review of overlapping meta-analyses comparing TDR and fusion for LDDD, the current best available evidence suggests that TDR may be an effective technique for the treatment of selected patients with LDDD, and is at least equal to lumbar fusion in the short term. However, considering that disadvantages may appear after years, spine surgeons should be cautions about performing TDR on a large scale. [ABSTRACT FROM AUTHOR]

Background context Surgical treatment for lumbar degenerative disc disease (DDD) remains controversial. Options include anterior lumbar interbody fusion, posterior approach fusion procedures such as posterior lumbar interbody fusion (PLIF) and posterolateral lumbar fusion (PLF), anterior and posterior lumbar fusion (APLF), and total disc replacement (TDR). However, the trends during the last decade are uncertain. Purpose To examine the trends in the surgical treatment for lumbar DDD on a national level. Study design A retrospective analysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample (NIS). Patient sample In the NIS from 2000 to 2009, patients aged 18 years or older with primary diagnosis of lumbar/lumbosacral DDD who underwent surgical treatment were included. Outcome measures Trends in the surgical treatment for lumbar DDD. Methods Clinical data were derived from the NIS between 2000 and 2009. Patients aged 18 years or older with a primary diagnosis of lumbar/lumbosacral DDD who underwent spinal fusion or TDR were identified. Data regarding patient- and health care system-related characteristics were retrieved and analyzed. Results A total of 380,305 patients underwent surgical treatment for lumbar DDD between 2000 and 2009. Population adjusted incidence increased 2.4-fold from 2000 to 2009. Among the procedures, APLF increased 3.0-fold and PLIF/PLF increased 2.8-fold. Total disc replacement did not increase significantly. Anterior lumbar interbody fusion was performed in 16.8% of patients, PLIF/PLF in 67.9%, APLF in 13.6%, and TDR in 1.8%. Surgical treatment for lumbar DDD was 1.8 times more common in the Midwest region and 1.7 times more common in the South region than in the Northeast region. Total disc replacement was more common in younger patients and in the Northeast region. Poterior lumbar interbody fusion/PLF was more common in older patients and in the South region. Conclusions During the last decade, surgical treatment for lumbar DDD has increased 2.4-fold in the United States. Although all fusion procedures significantly increased, TDR did not increase. Surgical treatment for lumbar DDD was more common in the Midwest and South regions. Trends in the procedures were different depending on the age group and hospital region. [ABSTRACT FROM AUTHOR]

Purpose: ALIF with cages is expected to restore disc height and stabilize the spine promoting fusion, while avoiding damage attributed to rod-pedicle screw fixation. However, it may be related to an increased risk of fusion failure and subsidence. A prospective study was conducted by five investigators across three centers to confirm performance of a PEEK cage for stand-alone ALIF in the treatment of lumbar degenerative disc disease (DDD). Methods: Sixty-five patients, with back ± leg pain, requiring surgery for DDD, were included. Efficacy and safety were evaluated at 6 weeks, 3, 6, and 12 months post-operatively. Fusion and subsidence were assessed through CT-images at 12-month follow-up. Disc height was measured. Clinical outcomes included back and leg pain (VAS), disability (Oswestry Disability Index), Quality of Life (Short-Form 36), and adverse events. Results: The fusion and the subsidence rates were 96.3 and 2.0 %, respectively. ALIF surgery restored anterior and posterior disc height compared to baseline. There were no device-related serious adverse events, and no revision surgeries. Clinical outcomes improved significantly through 12-month follow-up. Conclusion: Safety and efficacy of this stand-alone cage with integrated intracorporeal plates was confirmed through 12 months for treatment of degenerative conditions. The design of the cage and plates may contribute to the decreased subsidence rate observed. [ABSTRACT FROM AUTHOR]

Background: Posterolateral spinal fusion with autologous bone graft is considered the "gold standard" for lumbar degenerative disc disease (DDD) when surgical treatment is indicated. The potential role of mesenchymal stromal cells (MSCs) to replace the bone graft in this setting has not been fully addressed. Objective: To analyze the safety, feasibility and potential clinical efficacy of the implantation of autologous MSCs embedded with tricalcium phosphate as a therapeutic alternative to bone graft in patients with DDD during posterolateral spine fusion. Study design: Phase I/II single-arm prospective clinical trial. Methods: Eleven patients with monosegmental DDD at L4–L5 or L5–S1 level were included. Autologous bone marrow-derived MSC were expanded in our Good Manufacturing Practice (GMP) Facility and implanted during spinal surgery embedded in a tricalcium phosphate carrier. Monitoring of patients included a postoperative period of 12 months with four visits (after the 1st, 3rd, 6th, and 12th month), with clinical and radiological assessment that included the visual analog scale (VAS), the Oswestry disability index (ODI), the Short-Form Health Survey (SF-36), the vertebral fusion grade observed through a simple Rx, and the evaluation of possible complications or adverse reactions. In addition, all patients were further followed up to 5 years for outcome. Results: Median age of patients included was 44 years (range 30–58 years), and male/female ratio was (6/5) L4–L5 and L5–S1 DDD was present five and six patients, respectively. Autologous MSCs were expanded in all cases. There were no adverse effects related to cell implantation. Regarding efficacy, both VAS and ODI scores improved after surgery. Radiologically, 80% of patients achieved lumbar fusion at the end of the follow-up. No adverse effects related to the procedure were recorded. Conclusions: The use of autologous MSCs for spine fusion in patients with monosegmental degenerative disc disease is feasible, safe, and potentially effective. Trial registration: no. EudraCT: 2010–018335-17; code Identifier: NCT01513694 (clinicaltrials.gov). [ABSTRACT FROM AUTHOR]