Predicting Lumbar Spondylolisthesis: A Hybrid Deep Learning Approach

Spondylolisthesis is a chronic disease,and a timely diagnosis of it may help in avoiding surgery.Disease identification in x-ray radiographs is very challenging.Strengthening the feature extraction tool in VGG16 has improved the classification rate.But the fully connected layers of VGG16 are not efficient at capturing the positional structure of an object in images.Capsule network(CapsNet)works with capsules(neuron clusters)rather than a single neuron to grasp the properties of the provided image to match the pattern.In this study,an integrated model that is a combination of VGG16 and CapsNet(S-VCNet)is proposed.In the model,VGG16 is used as a feature extractor.After feature extraction,the output is fed to CapsNet for disease identification.A private dataset is used that contains 466 X-ray radiographs,including 186 images displaying a spine with spondylolisthesis and 280 images depicting a normal spine.The suggested model is the first step towards developing a web-based radiological diagnosis tool that can be utilized in outpatient clinics where there are not enough qualified medical professionals.Experimental results demonstrate that the developed model outperformed the other models that are used for lumbar spondylolisthesis diagnosis with 98%accuracy.After the performance check,the model has been successfully deployed on the Gradio web app platform to produce the outcome in less than 20 s.

Treatment of Single Level Lumbar Spondylolisthesis with Lumbar Interbody Fusion via Oblique Lateral Approach (OLIF)

Objectives: To investigate the effect of lumbar interbody fusion via the oblique lateral approach (OLIF) in the treatment of single level lumbar spondylolisthesis. Methods: Retrospective analysis was made on 32 cases of single level lumbar spondylolisthesis treated by lumbar interbody fusion via the oblique lateral approach from July 2020 to July 2021. 14 males and 18 females;the age was (66.5 ± 11.5) years (55 - 82 years). 1) The operation time, intraoperative blood loss and complications were recorded;2) the scores of visual analog scale. VAS and Oswestry disability index (ODI) of low back pain and lower limb pain were collected before operation and at the last follow-up;by observing the imaging data, the height of the intervertebral space, the anterior convex angle of the intervertebral space, the anterior convex angle of the lumbar spine, the sagittal diameter of the dural sac and the spondylolisthesis were measured. Results: All patients successfully completed the operation, the average operation time was (103.9 ± 21.1) min, the average intraoperative bleeding volume was (72.3 ± 16.4) ml. There was no vascular injury during the operation, no infection occurred in all surgical incisions, and Class I/A healing was achieved. The VAS scores of low back pain and leg pain before operation and at the last follow-up were lower than those before operation, and the difference was statistically significant (P < 0.05);the ODI at the last follow-up was lower than that before operation, and the difference was statistically significant (P < 0.05). At the last follow-up, the height of intervertebral space, the height of intervertebral foramen and the sagittal diameter of dural sac were greater than those before operation, with statistically significant differences (P < 0.05);the spondylolisthesis rate at the last follow-up was lower than that before operation, with a statistically significant difference (P < 0.05). Left thigh surface numbness occurred in 2 cases (6.3%) and disappeared after 1 week;Hip flexion weakness occurred in 1 case (0.03%), which recovered after 12 days;there were no complications such as retroperitoneal hematoma, ureteral injury, retrograde ejaculation, intestinal and lumbar plexus injury. Conclusion: The early clinical effect of OLIF in the treatment of single level lumbar spondylolisthesis is significant. This surgical method is minimally invasive, safe and effective, which can significantly reduce the amount of intraoperative bleeding and reduce the risk of postoperative complications. Its main working principle is to make the annulus fibrosus, posterior longitudinal ligament and ligamentum flavum shrink and recover the height of the intervertebral space through decompression, loosening and stretching of the intervertebral space, so as to achieve the reduction of the slipped vertebral body, increase the height of the intervertebral foramen Enlarge the spinal canal volume and eliminate dynamic compression to play an indirect decompression role, improve the symptoms of low back and leg pain, and reconstruct the stability of the spine through interbody fusion.

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 observation of bone graft impaction on posterior intervertebral body fusion for lumbar spondylolisthesis

Objective To investigate the clinical effect of bone graft impaction on posterior intervertebral fusion for lumbar spondylolisthesis.Methods From January 2001 to July 2008,36 patients with lumbar spondylolisthesis were treated by

Surgical strategy for high-grade isthmic spondylolisthesis of 5th lumbar vertebrae

Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡ degree)of 5th lumbar vertebrae.Methods From August 2003 to October 2008,26 patients with high-grade isthmic spondylolisthesis (L5) were

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.

Long-Term Outcome of Dynesys Dynamic Stabilization for Lumbar Spinal Stenosis

Background： Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys for lumbar spinal stenosis are rarely reported. The aim of this study was to analyze the long-term clinical and radiologic outcomes for patients with lumbar spinal stenosis treated with Dynesys stabilization. Methods： Thirty-eight patients with lumbar spinal stenosis were treated with Dynesys stabilization from July 2008 to March 2010. The minimal duration of follow-up was 72 months. The patients were divided into stenosis and spondylolisthesis groups according to degenerative spondylolisthesis. Clinical outcomes were evaluated using the Oswestry Disability Index （ODI） and visual analog scale （VAS）. Radiographic evaluations included range of motion （ROM） and the disc heights of stabilized segments and the upper adjacent segments. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration （ASD）. Results： There were 23 patients in stenosis group and 15 patients in spondylolisthesis group. The ODl scores were significantly improved at the final follow-up evaluation, as compared to the baseline values （ 16.1± 5.7 vs. 57.2 ± 14.2, t = 61.4 l, P 〈 0.01 ）. The VA S scores for back and leg pain were significantly improved from 4.82 ±0.89 and 4.04 ± 0.82 preoperatively to 0.93± 0.61 and 0.54 ± 0.51 postoperatively （t = 6.59, P 〈 0.01, and t = 5.91, P 〈 0.01, respectively）. There were no differences between the two groups with respect to VAS and ODI scores. The ROM of stabilized segments decreased significantly from 7.8°± 2.4° to 4.5° ± 1.5° （t = 7.18, P 〈 0.05）, while the upper adjacent segments increased significantly from 8.3° ± 2.4° to 10.4° ± 2.4° （t = 2.87, P = 0.01）. The change in disc height of stabilized segments was not significant （11.9 ±2.1 preoperatively vs. 12.5 ± 1.5 postoperatively, t = 1.43, P = 0.15）, whereas the decrease in disc height of the upper adjacent segments was significant （12.5 ±2.0 preopcratively vs. 11.0 ± 1.7 postoperatively, t = 2.94, P = 0.01 ）. The occurrence of radiographic and symptomatic ASD was 16% （6/38） and 3% （1/38）, respectively. Conclusions： Decompression and Dynesys stabilization for lumbar stenosis with or without spondylolisthesis showed good long-term clinical and radiographic results. Lumbar stenosis with or without Grade I spondylolisthesis, particularly in patients 〈60 years of age with mild-to-moderate lumbar disc degeneration, would be one of the main indications for the Dynesys system.