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To analyse the intra- (IMCL) and extramyocellular lipids (EMCL) concentration in the multifidus muscle (Mm) using MR spectroscopy (MRS) in patients with low back pain (LBP), and to evaluate the correlation between those lipid concentrations and age, obesity, atrophy of the Mm and LBP intensity. 60 LBP patients underwent routine diagnostic MRI of the lumbar spine before undergoing imaging for the study. Body mass index, as an indicator of obesity and visual analogue scale, as an indicator of LBP were also measured. Proton MRS was acquired with a single-voxel point-resolved spectroscopy sequence. Furthermore, the MRS volume of interest for measuring the IMCL and EMCL concentration at L4/5 for the right Mm was determined, and we measured the cross-sectional area of Mm as an indicator of muscle atrophy. Age showed correlation with EMCL concentration (r = 0.314, p = 0.008). The body mass index showed correlation with EMCL concentration (r = 0.358, p = 0.005). The cross-sectional area of Mm showed correlation with EMCL concentration (r = −0.543, p < 0.001). Moreover, the LBP visual analogue scale showed correlation with IMCL concentration (r = 0.367, p = 0.004). There were correlations between age, obesity, muscle atrophy, and EMCL concentration in Mm. IMCL concentration in Mm showed a correlation with LBP intensity. This may suggest that IMCL concentration could become an effective objective indicator of chronic LBP intensity. We investigated the characteristics of fat content in Mm with LBP patients. This study was demonstrated the association of the IMCL and EMCL concentration in Mm with various patient parameters. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective multicenter study., Objectives: To investigate the treatments of the geriatric population with hangman's fractures using a multicenter database under the Japan Association of Spine Surgeons with Ambition (JASA)., Methods: The multicenter database included data from 1512 patients. We employed the Levine and Edwards classification for categorizing hangman's fractures. The study incorporated epidemiological data, including the prevalence of hangman's fractures, patient age, and follow-up duration. Bony fusion rates and length of hospitalization were recorded for Type I and Type II fractures, and the degree of neurological impairment was assessed., Results: Hangman's fractures represented 62 cases, accounting for 7.4% of all cervical spine injuries. The patients had an average age of 76.6 ± 6.5 years, and the mean duration of follow-up was 21.5 ± 23.6 months. The study found that the bony fusion rate for hangman's fractures in the geriatric population was 88.9%. Surgical treatment was associated with a shorter hospitalization period for Type II fractures compared to conservative treatment. Thirteen cases of hangman's fractures in the geriatric population, accounting for 21%, were complicated by spinal cord injury., Conclusions: This is the largest study to date on hangman's fractures in geriatric population ≥65 years. Type I and Type II fractures, according to the Levine and Edwards classification, had a bony fusion rate of up to 90%. In patients with Type II fractures, surgical treatment led to a shorter initial hospital stay. Geriatric patients are at risk of spinal cord injury due to hangman's fractures., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Study Design: Retrospective multicenter study., Objective: The purpose of this study was to compare the prognosis of elderly patients with injuries related to cervical diffuse idiopathic skeletal hyperostosis (cDISH) to matched control for each group, with and without fractures., Methods: The current multicenter study was a retrospective analysis of 140 patients aged 65 years or older with cDISH-related cervical spine injuries; 106 fractures and 34 spinal cord injuries without fracture were identified. Propensity score-matched cohorts from 1363 patients without cDISH were generated and compared. Logistic regression analysis was performed to determine the risk of early mortality for patients with cDISH-related injury., Results: Patients with cDISH-related injuries with fracture did not differ significantly in the incidence of each complication and ambulation or severity of paralysis compared to matched controls. In patients with cDISH-related injury without fracture, those who were nonambulatory at discharge comprised 55% vs 34% of controls, indicating significantly poorer ambulation in those with cDISH-related injuries ( P = .023). There was no significant difference in the incidence of complications and ambulation or paralysis severity at 6 months as compared with controls. Fourteen patients died within 3 months. Logistic regression analysis identified complete paralysis (odds ratio [OR] 36.99) and age (OR 1.24) as significant risk factors for mortality., Conclusions: The current study showed no significant differences in the incidence of complications, ambulation outcomes between patients with cDISH-related injury with fracture and matched controls, and that the ambulation at discharge for patients with cDISH-related injury without fractures were significantly inferior to those of matched controls., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: In elderly patients with cervical spinal cord injury, comorbidities such as cardiovascular and cerebrovascular diseases are common, with frequent administration of antiplatelet/anticoagulant (APAC) drugs. Such patients may bleed easily or unexpectedly during surgery despite prior withdrawal of APAC medication. Few reports have examined the precise relationship between intraoperative blood loss and history of APAC use regarding surgery for cervical spine injury in the elderly. The present multicenter database survey aimed to answer the question of whether the use of APAC drugs affected the amount of intraoperative blood loss in elderly patients with cervical spinal cord trauma., Methods: The case histories of 1512 patients with cervical spine injury at 33 institutes were retrospectively reviewed. After excluding cases without spinal surgery or known blood loss volume, 797 patients were enrolled. Blood volume loss was the outcome of interest. We calculated propensity scores using the inverse probability of treatment weighting (IPTW) method. As an alternative sensitivity analysis, linear mixed model analyses were conducted as well., Results: Of the 776 patients (mean age: 75.1±6.4 years) eligible for IPTW calculation, 157 (20.2%) were taking APAC medications before the injury. After weighting, mean estimated blood loss was 204 mL for non-APAC patients and 215 mL for APAC patients. APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses. Thus, it appeared possible to perform surgery expecting comparable blood loss in APAC and non-APAC cases., Conclusions: This multicenter study revealed no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs. Surgeons may be able to prioritize patient background, complications, and preexisting conditions over APAC use before injury when examining the surgical indications for cervical spine trauma in the elderly., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest., (Copyright © 2022 by The Japanese Society for Spine Surgery and Related Research.)

Background: The relation between segmental mobility and degree of lumbar degenerative change is still unknown. This cross-sectional study aimed to elucidate the association between intervertebral disc degeneration (IVDD) and segmental mobility in chronic low back pain using magnetic resonance imaging (MRI) T2 mapping., Methods: Subjects comprised 60 patients (29 men, 31 women; mean age, 61.8 ± 1.9 years; range, 41-79 years). T2 values of the anterior annulus fibrosus (AF), the nucleus pulposus (NP) and the posterior AF were evaluated with MRI T2 mapping. Facet joint degeneration was divided into 4 grades using MRI. We analyzed the correlation between segmental mobility and T2 values of anterior AF, NP and posterior AF using multiple linear regression analysis adjusted for age and facet joint degeneration., Results: The standardized partial regression coefficient of the anterior AF, NP and posterior AF T2 values were 0.125 ( p =0.72), 0.499 ( p <0.01) and -0.026 ( p =0.11), respectively, for the L1-2 level; 0.102 ( p =0.27), 0.395 ( p <0.01) and -0.094 ( p =0.20), respectively, for the L2-3 level; 0.108 ( p =0.38), 0.415 ( p <0.01) and -0.050 ( p =0.51), respectively, for the L3-4 level; 0.124 ( p =0.09), 0.396 ( p <0.01) and 0.025 ( p =0.73), respectively, for the L4-5 level; and 0.011 ( p =0.89), 0.443 ( p <0.01) and 0.030 ( p =0.72), respectively, for the L5-S level. There was a significantly positive correlation between segmental mobility and the T2 values of NP at L1-L2, L2-L3, L3-L4, L4-L5, and L5-S1. No significant correlations arose between segmental mobility and the T2 values of the anterior AF and the posterior AF at L1-L2, L2-L3, L3-L4, L4-L5, and L5-S1., Conclusion: Characterization of the relationship between NP degeneration and lumbar segmental mobility may enhance our ability to evaluate the changes seen in kinematics of functional spinal unit., Competing Interests: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper., (© 2020 The Authors. Published by Elsevier Ltd on behalf of North American Spine Society.)

Introduction: Although intervertebral disc degeneration (IVDD) and spinopelvic malalignment are likely key structural features of spinal degeneration and chronic low back pain (CLBP), the correlation analysis has not been fully conducted. This cross-sectional quantitative magnetic resonance imaging (MRI) T2 mapping study aimed to elucidate the association between IVDD and spinopelvic alignment in CLBP patients., Methods: The subjects included 45 CLBP patients (19 men and 26 women; mean age, 63.8 ± 2.0 years; range, 41-79 years). The T2 values of the anterior annulus fibrosus (AF), the nucleus pulposus (NP), and the posterior AF were evaluated using MRI T2 mapping. We compared the possible correlations of spinopelvic parameters with T2 values of anterior AF, NP, and posterior AF using Pearson's correlation coefficient analysis. T2 values in these regions were classified into upper (L1-L2 and L2-L3), middle (L3-L4), and lower (L4-L5 and L5-S1) disc levels, and we analyzed the correlations with spinopelvic parameters., Results: There were significant correlations of the anterior AF T2 values with lumbar lordosis (r = 0.51, p < 0.01), sacral slope (r = 0.43, p < 0.01), sagittal vertical axis (r = -0.40, p < 0.01), and pelvic tilt (r = -0.33, p < 0.01). In all lumbar levels, T2 values of anterior AF had significantly positive correlation with LL and significantly negative correlation with SVA. In lower disc level, T2 values of anterior AF had significantly positive correlation with SS and significantly negative correlation with PT. T2 values of NP and posterior AF had no significant correlations with spinopelvic parameters in all lumbar disc levels., Conclusions: In summary, this study indicated that the anterior AF degeneration is associated with hypolordosis of the lumbar spine, anterior translation of the body trunk, and posterior inclination of the pelvis in CLBP. Anterior AF degeneration in all lumbar disc levels was associated with hypolordosis of the lumbar spine and anterior translation of the body trunk. Anterior AF degeneration in lower disc level was associated with posterior inclination of the pelvis., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest., (Copyright © 2020 by The Japanese Society for Spine Surgery and Related Research.)

Various functional magnetic resonance imaging (MRI) techniques have been investigated in recent years and are being used in clinical practice for the patients with low back pain (LBP). MRI is an important modality for diagnosing intervertebral disc (IVD) degeneration. In recent years, there have been several reported attempts to use MRI T2 mapping and MRI T1ρ mapping to quantify lumbar disc degeneration. MRI T2 mapping involves digitizing water content, proteoglycan content, and collagen sequence breakdown as relaxation times (T2 values) at each site. These digitized values are used to create a map, that is, then used to quantitatively evaluate the metabolite concentrations within IVD tissues. MRI T2 mapping utilizes the T2 relaxation time to quantify moisture content and the collagen sequence breakdown. MRI T1ρ mapping digitizes water molecule dispersion within the cartilaginous matrix to evaluate the degree of cartilaginous degeneration. Magnetic resonance spectroscopy is a less-invasive diagnostic test that provides biochemical information. Adequate analysis of the IVD has not yet been performed, although there are indications of a relationship between the adipose content of the multifidus muscle in the low back and LBP. The ultra short TE technique has been recently used to investigate lumbar cartilaginous endplates. Unlike diagnosis based on contrast-enhanced images of the IVD, which depends on the recurrence of pain that is determined subjectively, MRI-based diagnosis is less-invasive and based on objective imaging findings. It is therefore expected to play a key role in the diagnostic imaging of IVD conditions in the future., Competing Interests: The authors declare no potential conflict of interests., (© 2019 The Authors. JOR Spine published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society.)

Objective:: Prior studies advocate the subjective visual differences between meningioma and schwannoma on T 2 weighted images, however objective measurement of signal intensity differences may be useful in certain cases. The aim of this study was to investigate whether an objective evaluation of SIs on T 2 weighted images would be useful to differentiate spinal schwannomas from meningiomas., Methods:: The patients with spinal MRIs demonstrating path proven and subsequently treated intradural extramedullary spinal tumors were selected between April 2008 and May 2017. Regions of interest (ROIs) were measured in the tumor and subcutaneous fat on the same image, and we calculated the SI ratio between tumor and fat ROIs., Results:: Twenty patients each with meningioma and schwannoma were enrolled. The SI ratios of schwannomas were significantly higher than those of meningiomas (both researcher 1 and 2: p = 0.002). The areas under the curve by researchers 1 and 2 were 0.780. The cutoff value of SI ratio by both of researchers 1 and 2 to differentiate between schwannomas from meningiomas was 0.420 (sensitivity: 80.0%, specificity: 70.0-75.0%)., Conclusion:: The SI ratio, calculated from the SIs of the tumor and fat on T 2 weighted images, is useful for differentiating spinal schwannomas from meningiomas to obtain an accurate diagnosis., Advances in Knowledge:: Signal intensity ratio of the spinal tumor and fat on T 2 weighted images is useful for differentiating schwannomas from meningiomas to obtain an accurate diagnosis.

Introduction: There have been several reports on surgical techniques involving microendoscopy or percutaneous endoscopy for treating lumbar foraminal stenosis (LFS). However, no studies have assessed the mid-term clinical results of endoscopic techniques in spite of their relatively long history. In this study, we report 20 consecutive cases of LFS treated by our microendoscopic technique focusing on clinical results with a follow-up of at least two years., Methods: Twenty consecutive cases of LFS treated with microendoscopic decompression were followed up at 1, 2, 6, and 12 months postoperatively and annually thereafter. The patients were 14 males and 6 females, and the mean age at the time of surgery was 64.7 years. The Japanese Orthopaedic Association (JOA) score was used as the clinical outcome index., Results: Of the 20 patients, 16 were monitored successfully for more than 2 years. The follow-up rate was 80.0%, and the mean follow-up period was 66.3 months. The JOA score improved from 13.8 points before surgery to 24.6 points at final follow-up. Revision fusion surgeries were performed in two cases for LFS recurrence., Conclusions: The microendoscopic technique effectively treats LFS., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Study Design:  A retrospective comparative study., Objective:  To compare retrospectively the clinical results and surgical invasiveness of two different types of minimally invasive surgery for lumbar spinal canal stenosis: microendoscopic muscle-preserving interlaminar decompression (ME-MILD) and spinal process splitting laminectomy (SPSL)., Summary of Background Data:  ME-MILD and SPSL are minimally invasive procedures. However, the two procedures have not been compared in the literature., Materials and Methods:  We retrospectively enrolled patients who underwent ME-MILD or SPSL from 2011 to 2015. The surgical invasiveness of each technique was determined by evaluating the time required for the surgical procedure, amount of blood loss, serum creatine kinase (CK) levels on postoperative day (POD) 1, C-reactive protein (CRP) levels on POD 3 and 7, and the hospitalization. The clinical results were evaluated using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire score, the Short Form (36) Health Survey patient-reported outcome score, the visual analog scale for pain, a patient satisfaction score, and the incidence of surgical complications., Results:  A total of 97 patients were evaluated: 58 patients underwent ME-MILD, and 39 patients underwent SPSL. No significant differences were observed in the clinical results between the two groups. Regarding surgical invasiveness, no significant difference was found in the amount of blood loss, levels of CK, hospitalization, or time required for the procedure. However, CRP levels were significantly lower in the ME-MILD group., Conclusions:  ME-MILD and SPSL are both minimally invasive procedures. In a comparison of these two procedures, CRP was significantly lower in the ME-MILD group., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)