Manipulation for degenerative lumbar spondylolisthesis:A systematic review of randomized controlled trials

Objective: To assess the effectiveness and safety of manipulation intervention for degenerative lumbar spondylolisthesis(DLS).Methods: This is a systematic review and meta-analysis. A full-scale retrieval method was performed until February 1, 2021, including nine databases. The homogeneity of different studies was summarized using the Review Manager. The quality of studies was determined with the Cochrane risk-of-bias tool.The evidence quality was graded with the Grading of Recommendations, Assessment, Development, and Evaluations approach.Results: A total of 6 studies involving 524 participants were included. The review demonstrated that manipulation has statistically significant improvements for treating DLS according to Japanese Orthopedic Association scores(mean difference, 3.76;95% confidence interval, 2.63 to 4.90;P <.001) and visual analog scale scores(mean difference,-1.50;95% confidence interval,-1.66 to-1.33;P <.001)compared to the control group. One study reported that the difference in the Oswestry Disability Index between the traction group and the combination of manipulation and traction group was statistically significant(P <.05), while another reported that manipulation treatment can significantly improve the lumbar spine rotation angle on X-ray images compared with the baseline data(P <.05). Moreover, the manipulation group(experimental group) had fewer adverse events than the lumbar traction group(control group).Conclusion: Manipulation intervention is more effective and safer for DLS. Nevertheless, large-scale randomized controlled trials are required to confirm the current conclusions.

Hot Spots and Frontiers of Research on Degenerative Lumbar Spondylolisthesis in China-Visualization Analysis Based on Citespace

Objective:Through the presentation and visual analysis of the Citespace knowledge map,the future research hotspots and trends of domestic research on degenerative lumbar spondylolisthesis are predicted.Methods:By searching the relevant literature on"degenerative lumbar spondylolisthesis"included in the CNKI database from the establishment of the database to January 1,2021,the annual publication volume,fund projects,research authors,research institutions,and research of the included literature For hotspots and other aspects,visual analysis was carried out with the help of Citespace software.Results:(1)A total of 266 related documents were included,of which 27 were published at the end of 2020;(2)The most funded projects are the National Natural Science Foundation of China(9 projects)and the National Science and Technology Support Program(5 projects);(3)In terms of author analysis,Zhu Liguo(16 articles),Yu Jie(13 articles),and Gao Chunyu(8 articles)rank the top three in terms of author analysis;(4)In terms of research institutions,Wangjing Hospital of China Academy of Chinese Medical Sciences(17 articles),Henan University of Chinese Medicine(4 articles),and Nanjing University of Chinese Medicine(4 articles)were the top 3 research institutions in terms of publication volume;(5)The keyword clustering label was"degenerative lumbar spondylolisthesis","lumbar spine","lumbar spondylolisthesis","degenerative lumbar spondylolisthesis","clinical observation"and"tuina".Conclusion:Research on"degenerative lumbar spondylolisthesis"has gradually received widespread attention,but the amount of publications is still relatively small;relevant domestic researchers and research institutions have formed a certain degree of influence across the country,but large-scale national cooperation research is still scarce,and strengthening academic exchanges and cooperation is still an important direction for researchers and research institutions in this field in the future.The research direction of lumbar spinal stenosis caused by degenerative lumbar spondylolisthesis will be a new direction and entry point for the study of degenerative lumbar spondylolisthesis in recent years.

Clinical Study of Accelerated Rehabilitation Concept Combined with Tianji Robot-Assisted Surgery in Lumbar Degenerative Diseases

Objective: To compare the effectiveness and safety of two surgical methods for lumbar degenerative diseases;the combination of the concept of accelerated rehabilitation with the assistance of Tianji Robotics and the concept of accelerated rehabilitation combined with manual pedicle screw placement assisted by conventional C-arm fluoroscopy. Methods: A retrospective analysis was performed on 70 patients who received the concept of accelerated rehabilitation combined with spinal surgery for lumbar degenerative diseases in Baise People’s Hospital from January 2022 to January 2024. Among them, 35 patients in the robot group received accelerated rehabilitation concept combined with robot-assisted surgery;In the conventional C-arm group, 35 patients received the accelerated rehabilitation concept combined with manual pedicle screw placement assisted by conventional C-arm fluoroscopy. VAS score (preoperative/postoperative), ODI score (preoperative/postoperative), intraoperative bleeding volume, postoperative hospital stay, postoperative complications and the accuracy rate of screw placement were compared between the two groups. Result: There was no statistically significant difference in preoperative VAS scores between the robot group and the conventional C-arm group (6.45 ± 0.82 VS 6.63 ± 0.81, P = 0.6600). The postoperative VAS score of the robot group was better than that of the conventional C-arm group (1.69 ± 0.80 VS 2.45 ± 0.85, P = 0.0000*). There was no statistically significant difference in preoperative ODI scores between the robot group and the conventional C-arm group (32.11 ± 3.18 VS 31.66 ± 2.25, P = 0.4900). The postoperative ODI score of the robot group was better than that of the conventional C-arm group (22.68 ± 1.94 VS 24.57 ± 2.25, P = 0.0000*). The postoperative complications in the robot group were less than those in the conventional C-arm group (2.7778% VS 28.5724%, P = 0.0030*). The intraoperative bleeding in the robot group was lower than that in the conventional C-arm group (320.85 ± 276.28 VS 490.00 ± 395.34, P = 0.0420*). The postoperative hospital stay of the robot group was shorter than that of the conventional C-arm group (10.00 ± 9.32 VS 14.49 ± 7.55, P = 0.0300*). The screw placement inaccuracy score of the robot group was lower than that of the conventional C-arm group (0.17 ± 0.51 VS 1.45 ± 1.46, P = 0.0000*). Conclusion: The combination of the concept of accelerated rehabilitation and Tianji Orthopedic robot-assisted surgery is more effective and safer in posterior lumbar decompression and internal fixation surgery with a screw rod system, and is worthy of promotion and application.

Comparing minimally invasive and open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease： a meta-analysis

Background Transforaminal lumbar interbody fusion （TLIF） through a minimally invasive approach （mTLIF） was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have been carried out, comparing mTLIF with traditional open TLIF （oTLIF）, but inconsistent outcomes were reported.

Is Dynesys dynamic stabilization system superior to posterior lumbar fusion in the treatment of lumbar degenerative diseases?

Dynesys,a pedicle-based dynamic stabilization system,was introduced to overcome some undesirable complications of fusion procedures.Nevertheless,the theoretical advantages of Dynesys over fusion have not been clearly confirmed.The purpose of this editorial was to compare clinical and radiological outcomes of patients who underwent Dynesys system with those who underwent posterior lumbar fusion according to the existing literature and to see if the application of the Dynesys system is superior to the traditional lumbar fusion surgery.According to published clinical reports,the short-term effects of the Dynesys dynamic stabilization system are similar to that of traditional lumbar fusion surgery.Three comparative studies of Dynesys dynamic stabilization and fusion surgery with medium-term follow-up are encouraging.However,the results from four single-treatment-arm and small-sample studies of case series with long-term follow-up were not encouraging.In the present circumstances,it is not possible to conclude that the Dynesys dynamic stabilization system is superior to fusion surgery for lumbar degenerative diseases.

Cortical bone trajectory screws in the treatment of lumbar degenerative disc disease in patients with osteoporosis

Lumbar degenerative disc disease(DDD)in the elderly population remains a global health problem,especially in patients with osteoporosis.Osteoporosis in the elderly can cause failure of internal fixation.Cortical bone trajectory(CBT)is an effective,safe and minimally invasive technique for the treatment of lumbar DDD in patients with osteoporosis.In this review,we analyzed the anatomy,biomechanics,and advantages of the CBT technique in lumbar DDD and revision surgery.Additionally,the clinical trials and case reports,indications,advancements and limitations of this technique were further discussed and reviewed.Finally,we concluded that the CBT technique can be a practical,effective and safe alternative to traditional pedicle screw fixation,especially in DDD patients with osteoporosis.

Cortical bone trajectory fixation in cemented vertebrae in lumbar degenerative disease:A case report

BACKGROUND Percutaneous vertebroplasty(PVP)has been widely used in osteoporotic vertebral compression fracture(OVCF).Following surgery,the bone cement would be positioned permanently.However,in some cases of lumbar degenerative disease,the cemented vertebrae needs to be fixed after decompression and fusion procedure.It is difficult to implant traditional pedicle screws into the cemented vertebrae because of the bone cement filling.At present,the main treatment strategy is to skip the cemented vertebra and conduct a long segment fixation.This article presents a cortical bone trajectory(CBT)fixation technique for cemented vertebrae.CASE SUMMARY PVP involving the L3 and L4 was performed in an 82-year-old man due to OVCF.During the surgery,bone cement leakage occurred,resulting in compression of the root of the right L3 nerve.We performed a partial facetectomy to retrieve the leaked bone cement and to relieve the patient’s neurological symptoms.After 3 mo,the patient developed lumbar disc herniation in L3/4,potentially due to instability caused by the previous surgery.Therefore,it was necessary to perform intervertebral fusion and fixation.It was difficult to implant traditional trajectory pedicle screws in L3 and L4 because of the bone cement filling.Hence,we implanted CBT screws in the L3 and L4 vertebrae.As a result,the patient’s symptoms resolved and he reported satisfaction with the surgery at follow-up after 8 mo.CONCLUSION It is feasible to utilize CBT in cemented vertebrae for the treatment of lumbar degenerative disease.

Application of Finite Element Analysis in Biomechanical Research of Degenerative Diseases of Lumbar Spine

As the elderly population continues to grow, the number of patients with low back pain is gradually increasing. Among them, Lumbar Degenerative Diseases (LDD) is one of the major contributors to low back pain. Biomechanical in vivo studies of the lumbar spine are mainly performed by implants or imaging data to record the real-time changes of form and stress on the intervertebral disc during motion. However, the current developments are slow due to the technological and ethical limitations. In vitro experiments include animal experiments and cadaver experiments, which are difficult to operate or differ greatly from normal human structures, and the results still need to be verified repeatedly to test their accuracy. As for finite element method, it is relatively low cost and can repeat the experimental results. Therefore, we believe that finite element analysis plays an extremely important role in biomechanical research, especially in analyzing the relationship between different surgical models and the degeneration caused by different mechanics.

Unilateral pedicle screw fixation combined with lumbar interbody fusion for the treatment of lumbar degenerative diseases

Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) procedures in which unilateral pedicle screw fixation was used.

Adjacent segment disease following Dynesys stabilization for lumbar disorders:A case series of mid-and long-term follow-ups

BACKGROUND Radiologic adjacent segment degeneration(ASDeg)can occur after spinal surgery.Adjacent segment disease(ASDis)is defined as the development of new clinical symptoms corresponding to radiographic changes adjacent to the level of previous spinal surgery.Greater pre-existing ASDeg is generally considered to result in more severe ASDis;nonetheless,whether the ASDeg status before index surgery influences the postoperative risk of revision surgery due to ASDis warrants investigation.AIM To identify possible risk factors for ASDis and verify the concept that greater preexisting ASDeg leads to more severe ASDis.METHODS Data from 212 patients who underwent posterior decompression with Dynesys stabilization from January 2006 to June 2016 were retrospectively analyzed.Patients who underwent surgery for ASDis were categorized as group A(n=13),whereas those who did not were classified as group B(n=199).Survival analysis and Cox proportional hazards models were used to compare the modified Pfirrmann grade,University of California-Los Angeles grade,body mass index,number of Dynesys-instrumented levels,and age.RESULTS The mean time of reoperation was 7.22(1.65–11.84)years in group A,and the mean follow-up period was 6.09(0.10–12.76)years in group B.No significant difference in reoperation risk was observed:Modified Pfirrmann grade 3 vs 4(P=0.53)or 4 vs 5(P=0.46)for the upper adjacent disc,University of California-Los Angeles grade 2 vs 3 for the upper adjacent segment(P=0.66),age of<60 vs>60 years(P=0.9),body mass index<25 vs>25 kg/m2(P=0.3),and sex(P=0.8).CONCLUSION Greater preexisting upper ASDeg was not associated with a higher rate of reoperation for ASDis after Dynesys surgery.Being overweight tended to increase reoperation risk after Dynesys surgery for ASDis.

Central plasticity resulting from chronic low back pain in degenerative disorders of the spine

Degenerative disorders of the spine are the most common cause of chronic low back pain（c LBP）;in Western Europe alone,billions of euros are spent each year on both conservative and surgical treatments for c LBP.And though only 5%of all patients with low back pain suffer from lumbar disc herniation（LDH）,

Interspinous Process Implants Causes Wear of the Spinous Processes in Patients Treated for Spinal Stenosis—An Experimental Biomechanical Study with Comparison to Clinical Cases

There are few biomechanical studies on Interspinous Process Implants (IPD);however none investigate the amount of wear on spinous processes. Therefore the objective of the present study was to investigate the effect of repetitive loading of the IPD Aperius on the spinous processes in a biomechanical porcine model. For comparison, three patients treated surgically with the same device have been followed for one to two years clinically and with image analyses (X-rays, MRI, CT-scans). Four lumbar spines from 6 months old porcine were divided into seven segments, which received IPD. The segments were exposed to 20,000 cyclical loads. Afterwards the deformation (wear) of the segments was registered. The wear of the spinous processes was measured in mm on a following CT-scan. Additionally, the wear of the ex-vivo was compared to that of the spinous processes investigated by CT-scans or X-ray in three patients treated surgically with the same interspinous implant. The mean maximal deformation of porcine specimens was 1.79 mm (SD 0.25) with the largest deformation occurring in the first quarter of the loading (<5000 cycles). The mean wear of the spinous processes after loading was 6.57 mm. A similar level of wear (mean 12.7 mm) of the spinous processes was detected in the patients. The Aperius IPD creates significant wear on the spinous processes in an experimental biomechanical study. Similar wear of the spinous processes is also present in patients treated with the same device post-operatively. How these findings influence the short and long term result of this implant device remains to be investigated in further biomechanical as well as clinical studies. For future development of this type of devices a proper selection of materials and design is essential to minimize wear effects on the spinous processes and thereby increases the possibilities for the devices to function as suggested.

Dynesys dynamic stabilization system for the lumbar degenerative disease： a preliminary report from China

Background Dynesys dynamic stabilization system in 2007. Therefore, it was a new technique for Ch about Dynesys in China. The objective of this study degenerative disease in China. was first implanted in patients in 1994, and introduced to China nese orthopedics and hence necessary to collect clinical data was to report the preliminary results of Dynesys for the lumbar Methods Twenty-seven patients were treated with the Dynesys between July 2007 and January 2009. The diagnosis included degenerative spondylolisthesis （12 cases）, degenerative spinal stenosis （nine cases）, and lumbar intervertebral disc herniation （six cases）. Back pain and leg pain were evaluated using 100-mm visual analog scales （VAS）. The Oswestry Disability Index （ODI） was used to evaluate the patients＇ function. The intervertebral disc height and range of motion at the operative level were taken on radiographs. Results All the patients were followed-up, with an average of （22.40±4.23） months （range 15±32 months）. VAS of back pain and leg pain were improved significantly （P 〈0.05） at foUow-up. The ODI scores were reduced from （62.58±12.01）% preoperatively to （15.01±5.71）% at follow-up （P 〈0.05）. The preoperative mean height of the intervertebral disc was （11.21±1.58） mm （range 8.5±13.8 mm） and mean was （10.10±1.78） mm （range 7.0±13.4 mm） at follow-up （P 〈0.05）. The mean range of motion of the implanted segment was （6.00±1.79）° （range 2.5-9.3°） preoperatively and （5.47±1.27）° （range 2.9±7.8°） at follow-up （P=0.11）. Conclusions The preliminary results of Dynesys for the lumbar degenerative disease in China are similar to the published results of other countries. It can significantly improve the clinic symptoms and preserved motion at the level of implantation. However, the long-term follow-up data need to be collected.

Minimum 5-year follow-up study on the effects of the Wallis dynamic stabilization system in the treatment of lumbar degenerative disease

Background Short-term outcomes of the Wallis system in the treatment of lumbar degenerative disease （LDD） have been shown to be effective, whereas there is a paucity of studies on the mid-long-term effects of the treatment of the Wailis system. This study was to evaluate the mid-long-term effects of the Wallis dynamic stabilization system in the treatment of LDD. Methods A total of 26 patients who received the treatment of the Wallis system between February 2008 and January 2009 were included in the study, with 14 patients （Group 1） with L4/5 disc herniation and 12 patients （Group 2） with L5/S1 disc herniation and L4/5 intervertebral disc degeneration （IDD）. Visual analog scale （VAS） and Oswestry Disability Index （ODI） were used to evaluate the clinical outcomes and lumbar X-rays and MRI were obtained to observe imaging changes before and after operation. Results The mean follow-up period was （63.50＋2.12） months. The mean ODI and VAS scores decreased obviously three months and five years after operation （P 〈0.05）. In Groups 1 and 2, L4/5 Cobb angle and range of motion （ROM） decreased and L4/5 posterior disc height increased at the last follow-up （P 〈0.05）. There were no statistically significant changes in L4/5 anterior disc height and L3/4 University of California at Los Angeles grading before and after operation. There was no statistically significant change in Pfirrmann grading system of L4/5 IDD in Group 2 before and after operation. Adjacent segment degeneration at the last follow-up was found in two patients （2/26, 7.69%） and Modic changes in L4/5 endplates were detected in one patient （1/26, 3.85%）. Conclusions The mid-long-term effects of the Wallis system in the treatment of LDD were satisfied. The Wallis system, as a dynamic stabilization system, which can preserve some ROM of the fixed segment, sustain the lumbar stabilization, and prevent adjacent segment disease and fixed segment degeneration, is an effective instrument to treat LDD.

Preliminary evaluation of posterior dynamic lumbar stabilization in lumbar degenerative disease in Chinese patients

Background There has been some controversy related to the use of the Wallis system,rather than disc fusion in the treatment of patients with degenerative spine disease.Furthermore,there are no reports concerning the application of this dynamic stabilization system in Chinese patients,who have a slightly different lifestyle with Western patients.The aim of this study was to assess the safety and efficacy of the dynamic stabilization system in the treatment of degenerative spinal diseases in Chinese patients.Methods The clinical outcomes of 20 patients with lumbar degenerative disease treated by posterior decompression with the Wallis posterior dynamic lumbar stabilization implant were studied.All of the patients completed the visual analogue scale and the Chinese version of the Oswestry Disability Index.The following radiologic parameters were measured in all patients：global lordotic angles and segmental lordotic angles （stabilized segments,above and below adjacent segments）.The range of motion was then calculated.Results Nineteen patients （95%） were available for follow-up.The mean follow-up period was （27.25±5.16） months （range 16-35 months）.The visual analogue scale decreased from 8.55±1.21 to 2.20±1.70 （P 〈0.001）,and the mean score on the Chinese version of the Oswestry Disability Index was improved from 79.58%±15.93% to 22.17%±17.24% （P 〈0.001）.No significant changes were seen in the range of motion at the stabilized segments （P=0.502） and adjacent segments （above,P=0.453; below,P=0.062）.The good to excellent result was 94.4% at the latest follow-up.No complications related to the use of the Wallis posterior dynamic lumbar stabilization occurred.Conclusions It was found to be both easy and safe to use the Wallis posterior dynamic lumbar stabilization implant in the treatment of degenerative lumbar disease,and the early therapeutic effectiveness is good.The Wallis system provides an alternative method for the treatment of lumbar degenerative disease.

Mineralized collagen-modified PMMA cement enhances bone integration and reduces fibrous encapsulation in the treatment of lumbar degenerative disc disease

As a minimally invasive surgery,percutaneous cement discoplasty(PCD)is now contemplated to treat lumbar disc degeneration disease in elder population.Here,we investigated whether the osteogenic mineralized collagen(MC)modified polymethylmethacrylate(PMMA)cement could be a suitable material in PCD surgery.Injectability,hydrophilicity and mechanical properties of the MC-modified PMMA(PMMA-MC)was characterized.The introduction of MC did not change the application and setting time of PMMA and was easy to be handled in minimally invasive operation.Hydrophilicity of PMMA-MC was greatly improved and its elastic modulus was tailored to complement mechanical performance of bone under dynamic stress.Then,PCD surgery in a goat model with induced disc degeneration was performed with implantation of PMMA-MC or PMMA.Three months after implantation,micro-computed tomography analysis revealed a 36.4%higher circumferential contact index between PMMA-MC and bone,as compared to PMMA alone.Histological staining confirmed that the surface of PMMA-MC was in direct contact with new bone,while the PMMA was covered by fibrous tissue.The observed gathering of macrophages around the implant was suspected to be the cause of fibrous encapsulation.Therefore,the interactions of PMMA and PMMA-MC with macrophages were investigated in vitro.We discovered that the addition of MC could hinder the proliferation and fusion of the macrophages.Moreover,expressions of fibroblaststimulating growth factors,insulin-like growth factor,basic fibroblast growth factor and tumor necrosis factor-b were significantly down-regulated in the macrophages cocultured with PMMA-MC.Together,the promoted osteointegration and reduced fibrous tissue formation observed with PMMA-MC material makes it a promising candidate for PCD surgery.

A comparison of unilateral and bilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion for lumbar degenerative diseases

Background Bilateral transpedicular screw fixation in conjunction with interbody fusion is widely used to treat lumbar degenerative diseases; however, there are some disadvantages of using this fixation system. This study comparatively analyzes the results of unilateral and bilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion （TLIF） for one-level lumbar degenerative diseases. Methods Sixty-six cases with one-level lumbar degenerative diseases were studied. The patients were divided according to surgical approach into a unilateral group （Group A） and a bilateral group （Group B）. The patients were evaluated for pain by visual analog scale （VAS） and Oswestry Disability Index （ODI）. Operating time, blood loss, duration of hospitalization, and complication rate were also evaluated. Patients were examined at 1, 3, 6, and 12 months postoperatively and every year thereafter. Results Group A patients＇ average preoperative VAS and ODI scores were 7.03 ±0.98 and （64.22±6.38）%, respectively, significantly decreased to 2.91 ± 0.88 and （14.42＋2.08）%, respectively, at the last follow-up （P = 0.000）. In Group B, the average preoperative VAS and ODI scores were 6.79±0.86 and （63.22±4.70）%, respectively, significantly decreased to 3.12±0.96 and （14.62±2.08）%, respectively, at the last follow-up （P=-0.000）. No significant difference in the duration of hospitalization was found between groups. Operating time and blood loss of （125.9±13.0） minutes and （211.4±28.3） ml, respectively, in Group A were significantly less than （165.2±15.3） minutes and （258.6±18.3） ml, respectively, in Group B （P=0.000）. All patients achieved good bone union and had no pseudarthrosis at the last follow-up. Conclusions There are no clinical differences between unilateral and bilateral pedicle screw fixation combined with TLIF for one-level lumbar degenerative diseases. Unilateral fixation reduces operating time, bleeding, and cost of hospitalization.

Radiological Analysis of Thoracolumbar Junctional Degenerative Kyphosis in Patients with Lumbar Degenerative Kyphosis

Background： Thoracolumbar junction （TLJ） is the transitional area between the lower thoracic spine and the upper lumbar spine. Vertebral compression fractures and proximal junctional kyphosis following spine surgery often occur in this area. Therefore, the study of development and mechanisms of thoracolumbar junctional degeneration is important for planning surgical management. This study aimed to review radiological parameters of thoracolumbar junctional degenerative kyphosis （TLJDK） in patients with lumbar degenerative kyphosis and to analyze compensatory mechanisms of sagittal balance. Methods： From January 2016 to March 2017, patients with lumbar degenerative kyphosis were enrolled in this radiographic study. Patients were divided into two groups according to thoracolumbar junctional angle （TLJA）： the non-TLJDK （NTLJDK） group （TLJA 〈10°） and the TLJDK group （TLJA≥10°）. Complete spinopelvic radiographic parameters were analyzed and compared between two groups. Pearson or Spearman correlation coefficients and independent two-sample t-test or Mann-Whitney U-test were used. Results： Atotal of 77 patients with symptomatic sagittal imbalance due to lumbar degenerative kyphosis were enrolled in this study. There were 34 patients in NTLJDK group （TLJA 〈10°） and 43 patients in TLJDK group （TLJA ≥10°）. The median angle of lumbar lordosis （LL） in the NTLJDK or TLJDK groups was 23.40° （18.50°, 29.48°） or 19.50° （13.30°, 24.55°）, respectively. The median TLJAs in all patients and both groups were -11.20° （-14.60°, -4.80°）, -3.70° （-7.53°, -1.73°）, and -14.30° （-17.45°, -13.00°）, respectively. In the NTLJDK group, LLwas correlated with thoracic kyphosis （TK; r = -0.400, P = 0.019）, sacral slope （SS; r = 0.681, P 〈 0.001）, and C7-sagittal vertical axis （r = -0.402, P = 0.018）. In the TLJDK group, LL was correlated with TK （r = -0.345, P = 0.024）, SS （r = 0.595, P 〈 0.001）, and pelvic tilt （r = -0.363, P = 0.017）. There were significant differences in LL, TLJA, TK, SS, and pelvic incidence （PI） between two groups. Conclusions：Although TLJDK is common in patients with lumbar degenerative kyphosis, it might be generated by special characteristics of morphology and biomechanics of the TLJ. To maintain sagittal balance, pelvis back tilt might be more important in patients with TLJDK, whereas thoracic curve changes might be more important in patients without TLJDK.

Diagnosis of lumbar degenerative disc disease by using L^(p)-spaces related to generalized interval-valued m-polar neutrosophic choquet integral Operator

Innovative and astonishing developments in the field of spine analysis can commence with this manuscript.The lumbar disks(L1−L2 to L5−S1)are most commonly impaired by degeneration due to their long-standing degeneration and associated strain.We investigate the indications,purposes,risk factors,and therapies of lumbar degenerated disc disease(L-DDD).We assume that the degeneration of five discs creates many effects,making it difficult to differentiate between the different types of degenerated discs and their seriousness.Since the indeterminacy and falsity portions of science or clinical diagnosis are often ignored.Due to this complexity,the reliability of the patient’s progress report cannot be calculated,nor can the period of therapy be measured.The revolutionary concept of interval-valued m-polar neutrosophic Choquet integral aggregation operator(IVmPNCIAO)is proposed to eliminate these problems.We associate generalized interval-valued m-polar neutrosophic Choquet integral aggregation operator(GIVmPNCIAO)with the statistical formulation of L^(p)-spaces and use it to identify the actual kind of degenerative disc in the lumbar spine.For the classification of interval-valued m-polar neutrosophic numbers(IVMPNNs),we set the ranking index and score function.These concepts are appropriate and necessary in order to better diagnose degeneration by associating it with mathematical modeling.We construct a pre-diagnosis map based on the fuzzy interval[0,1]to classify the types of degenerative discs.We develop an algorithm by using GIVmPNCIAO based on interval-valued m-polar neutrosophic sets(IVMPNNs)to identify the degenerative disc appropriately and to choose the most exquisite treatment for the corresponding degeneration of every patient.Furthermore,we discuss the sensitivity analysis with parameter p in GIVmPNCIAO to investigate the patient’s improvement record.

Decompression and fusion combined with rehabilitation training for the foot drop secondary to lumbar degenerative disease:Case report and literature review

Foot drop(FD)secondary to lumbar degenerative disease is a relatively uncommon finding in spinal practice.Although only a part of patients with FD can obtain satisfactory recovery of their muscle strength after operation,most of the articles still advocate surgical intervention at early stage.Despite the double roots compression is one of the accepted causes for FD,we describe an extremely rare case of a middle-age man presenting with a severe foot drop(tibialis anterior=0/5)resulted from three roots compression(L4-S1),who had undergone pedicle screws fixation(L3-S1),transforaminal lumbar interbody fusion(TLIF)at L4/5,laminotomy and discectomy at L5/S1 with laminotomy at L3/4 as well as conventional rehabilitation training postoperatively,which included strength training of the active and antagonistic muscles in the week lower extremity.Twelve months after surgery,the patient recovered from his deficit(tibialis anterior improved from 0/5 to 4/5).Therefore,we discuss the possible pathological mechanism and surgical option for the foot drop due to the lumbar degenerative disease as well as the potential risk factors portending prognosis postoperatively.