Erector spinae could be the game changer in surgical decision-making in patients with lumbar spondylolisthesis: a cross-sectional analysis of an age-, sex-, subtype-, level-matched patients with similar spinopelvic parameters received surgical or conservative management.

PURPOSE: In this study we aimed to identify whether paraspinal muscle morphology could play a role in surgical decision-making in patients with lumbar spondylolisthesis. METHODS: We conducted a cross-sectional analysis of a prospectively collected database between January 2013 and May 2023. Consecutive women and men, who visited our outpatient clinics with chronic LBP, neurogenic claudication, and had lumbar spine magnetic resonance imaging (MRI) for their complaints were included into the preliminary dataset. We compared the patients who had conservative management (conservative group) or underwent surgery for lumbar spondylolisthesis (surgical group) in terms of intervertebral disc degeneration, end-plate changes, fatty infiltration in the paraspinal muscles and spinopelvic parameters. RESULTS: Conservative and surgical groups were similar in terms of severe IVDD and Modic changes at any lumbar level. Surgical group had significantly fattier erector spinae compared to the conservative group. Regression analysis and ROC analysis revealed an OR of 1.088 and a cut-off value of 17 points for fatty infiltration in the erector spinae to predict which patient could undergo surgery for lumbar spondylolisthesis. CONCLUSION: Each 1-point increment in fatty infiltration in the erector spinae at any lumbar level increased the likelihood of surgery by 8%. Lumbar spondylolisthesis patients with fatty infiltration score for erector spinae at or above 17 were more likely to have surgery. We recommend clinicians to focus on improving erector spinae muscles in patients with lumbar spondylolisthesis.

Mo-fi-disc scoring system: Towards understanding the radiological tools to better delineate the disease process and enhancing our solutions for low back pain in artificial intelligence era.

BACKGROUND: 'Mo-fi-disc' is a new scoring system that quantifies degeneration of the lumbar spine and predicts the intensity of low back pain (LBP). However, its association with LBP-related disability is unknown. In the present study, we aimed to analyze whether 'Mo-fi-disc' scoring system could predict LBP-related disability and distinguish patients with LBP from asymptomatic subjects, while the spine medicine marching towards the era of artificial intelligence (AI). METHODS: This is a cross-sectional analysis of a prospectively collected database. We included age-, gender-, and BMI-matched 132 subjects (patients: 66, asymptomatic subjects: 66). Modic changes (Mo), fatty infiltration in the paraspinal muscles (fi), and intervertebral disc degeneration (disc) were evaluated using 'Mo-fi-disc' scoring system on lumbar spine magnetic resonance imaging. Pain and disability were evaluated with visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. RESULTS: A Mo-fi-disc score of 5.5 was the most appropriate cut-off value. Mo-fi-disc scoring system had an OR of 1.79 in distinguishing patients with LBP from asymptomatic subjects. One point increment in VAS and ODI had ORs of 1.82 and 1.13 for predicting higher Mo-fi-disc scores. CONCLUSION: 'Mo-fi-disc' scoring system is a useful tool depicting intensity of LBP and LBP-related disability. The cut off value of Mo-fi-disc score is 5.5 to distinguish patients with LBP from asymptomatic subjects. This scoring system, with progressive improvement of its faults, could help clinicians to select appropriate patients for conservative and surgical management in the very near future, in AI-based spine medicine. IRB APPROVAL NO: ATADEK 2019-12/4.

Health-related quality of life measures in patients undergoing decompressive craniectomy for severe traumatic brain injury: a 6-year follow-up analysis.

PURPOSE: We aimed to assess the long-term neurological outcomes and the functionality and QoL in patients undergoing decompressive craniectomy for severe traumatic brain injury, respectively. MATERIALS AND METHODS: Among the 120 patients who underwent decompressive craniectomy for severe TBI between 2002 and 2007, 101 were included based on the inclusion criteria. Long-term follow-up results (minimum 3 years) were available for 22 patients. The outcomes were assessed using the Glasgow Outcome Scale (GOS) and the functionality and HRQoL were assessed using the Short Form-36 (SF-36) (v2) and Quality of Life After Brain Injury (QoLIBRI) questionnaires. RESULTS: Among the patients with severe TBI, 62 (61.4%) died and 39 (38.6%) were discharged to either home or a physical therapy facility. Eleven of the thirty-nine patients could not be reached and were excluded from the final analysis. The mean GOS of the remaining 28 patients was 4.14 ± 0.8 after 6.46 ± 1.64 years of follow-up. The HRQoL was assessed in 22 of the 28 patients. The HRQoL scores were lower in patients with TBI than in healthy controls. Furthermore, there was a significant difference in the HRQoL scores in patients with improved GOS scores than in those with unimproved GOS scores. CONCLUSIONS: Health-related outcome scores could help clinicians understand the requirements of survivors of severe TBI to create a realistic rehabilitation target for them. QoLIBRI served as a good way of communication in these subjects.

Potential blood markers as screening tools for subjects with low back pain: an age- and gender-matched cross-sectional analysis.

BACKGROUND: Mechanical and inflammatory factors were suggested as the causes of spine degeneration and low back pain (LBP). Previous studies partly reported the association of LBP with inflammation. However, none of them compared patients with LBP and asymptomatic subjects in terms of complete blood count and inflammatory markers in detail. We aimed to analyze the association of serum white blood cell (WBC) count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) with chronic LBP by comparing the patients with chronic LBP and age- and gender-matched asymptomatic subjects. METHODS: Lumbar intervertebral disc degeneration and vertebral end-plates were evaluated using Pfirrmann grading and Modic classification on lumbar spine magnetic resonance images, respectively. Serum WBC counts, CRP levels, and ESRs were recorded from chart reviews. RESULTS: We included 147 patients with chronic LBP and 101 asymptomatic subjects. Patients with chronic LBP had significantly higher serum neutrophil, monocyte, and basophil counts, higher neutrophil-to-lymphocyte ratio, higher ESR, and lower serum CRP levels compared to the asymptomatic subjects. Serum monocyte and basophil cell counts and ESR were the most remarkable predictive factors for chronic LBP, severe IVDD, and Modic changes. Higher serum monocyte and basophil cell counts and higher serum ESR above cut-off values of 0.42 × 103/µL, 0.025 × 103/µL, and 3.5 mm/hour could be used as screening tools for subjects with persistent LBP in primary care. DISCUSSION: Higher serum monocyte and basophil counts and serum ESR above new cut-off values should highlight the need to obtain early spinal imaging to prevent chronicity in patients with LBP.

Fatty infiltration of the erector spinae at the upper lumbar spine could be a landmark for low back pain.

PURPOSE: Intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles are possible causes of low back pain (LBP). Multifidus has been the most commonly blamed paraspinal muscle in the etiology of LBP. However, it contributes to 20% of the extensor moment on the lumbar spine. In the present study, we aimed to identify whether patients with LBP and asymptomatic subjects differed in terms of intervertebral discs, end-plates, and fatty infiltration in their paraspinal muscles. METHODS: Consecutive women and men, who visited the spine outpatient clinics with chronic LBP and had lumbar spine MRI for their LBP without leg pain were included. Asymptomatic subjects without LBP/leg pain for the last year were recruited. Modic changes, IVDD, and fatty infiltration in the paraspinal muscles were evaluated on lumbar spine magnetic resonance imagings of the patients with LBP and age-, gender- and BMI-matched asymptomatic controls. RESULTS: Low back pain was closely associated with fatty infiltration in the paraspinal muscles at all lumbar levels whereas it had association with severe IVDD and Modic changes at lower lumbar levels. Multifidus at the lower lumbar levels was the fattiest paraspinal muscle in both asymptomatic subjects and patients with LBP. Patients with LBP had severe fatty infiltration in the erector spinae at the upper lumbar levels. CONCLUSION: Severe IVDD and Modic changes were more common at lower lumbar levels in patients with LBP. Both asymptomatic subjects and those with LBP had fatty multifidus at lower lumbar levels, whereas those with LBP had fatty infiltration in the erector spinae at upper lumbar levels. We suggest that fatty infiltration could have started in the multifidus. The erector spinae had greater contribution to the lumbar extension compared to the multifidus. Thus, LBP could develop when the quality of the erector spinae at the upper lumbar levels impairs due to fatty infiltration.

Are serum thyroid hormone, parathormone, calcium, and vitamin D levels associated with lumbar spine degeneration? A cross-sectional observational clinical study.

PURPOSE: Low back pain (LBP) impairs the quality of life and rises healthcare costs. The association of spine degeneration and LBP with metabolic disorders have been reported, previously. However, metabolic processes related with spine degeneration remained unclear. We aimed to analyze whether serum thyroid hormones, parathormone, calcium, and vitamin D levels were associated with lumbar intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles. METHODS: We cross-sectionally analyzed a retrospective database. Patients who visited internal medicine outpatient clinics with suspect of endocrine disorders and chronic LBP were searched. Patients with biochemistry results within 1 week before lumbar spine magnetic resonance imaging (MRI) were included. Age- and gender-matched cohorts were made-up and analyzed. RESULTS: Patients with higher serum free thyroxine levels were more likely to have severe IVDD. They were also more likely to have fattier multifidus and erector spinae at upper lumbar levels, less fatty psoas and less Modic changes at lower lumbar levels. Higher PTH levels were observed in patients with severe IVDD at L4-L5 level. Patients with lower serum vitamin D and calcium levels had more Modic changes and fattier paraspinal muscles at upper lumbar levels. CONCLUSION: Serum hormone, vitamin D, and calcium levels were associated with not only IVDD and Modic changes but also with fatty infiltration in the paraspinal muscles, mainly at upper lumbar levels in patients with symptomatic backache presenting to a tertiary care center. Complex inflammatory, metabolic, and mechanical factors present in the backstage of spine degeneration.

Facet Joint Orientation/Tropism Could Be Associated with Fatty Infiltration in the Lumbar Paraspinal Muscles.

BACKGROUND: Facet joint orientation (FJO) and facet joint tropism (FJT) are associated with intervertebral disc degeneration and paraspinal muscle atrophy. However, none of the previous studies has evaluated the association of FJO/FJT with fatty infiltration in the multifidus, erector spinae, and psoas muscles at all lumbar levels. In the present study, we aimed to analyze whether FJO and FJT were associated with fatty infiltration in the paraspinal muscles at any lumbar level. METHODS: Paraspinal muscles and FJO/FJT were evaluated from L1-L2 to L5-S1 intervertebral disc levels on T2-weighted axial lumbar spine magnetic resonance imaging. RESULTS: Facet joints were more sagittally and coronally oriented at the upper and lower lumbar levels, respectively. FJT was more obvious at lower lumbar levels. The FJT/FJO ratio was higher at upper lumbar levels. Patients with sagittally oriented facet joints at the L3-L4 and L4-L5 levels had fattier erector spinae and psoas muscles at the L4-L5 level. Patients with increased FJT at upper lumbar levels had fattier erector spinae and multifidus at lower lumbar levels. Patients with increased FJT at the L4-L5 level had less fatty infiltration in the erector spinae and psoas at the L2-L3 and L5-S1 levels, respectively. CONCLUSIONS: Sagittally oriented facet joints at lower lumbar levels could be associated with fattier erector spinae and psoas muscles at lower lumbar levels. The erector spinae at upper lumbar levels and psoas at lower lumbar levels might have become more active to compensate the FJT-induced instability at lower lumbar levels.

Accessory Hand Muscles Over the Transverse Carpal Ligament: An Obstacle in Carpal Tunnel Surgery.

BACKGROUND: Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve throughout the carpal tunnel. It is the most common entrapment neuropathy, with an estimated prevalence of 4%-7%. Surgical management is more effective in moderate to severe and severe CTS. CTS recurs in approximately 20% of patients, and up to 12% of these patients require reoperation. Knowledge of normal anatomy and variations would improve the success rate of the index surgery. Atypical causes of CTS were reported, including ganglion cysts, synovial hypertrophy, lipomas, bone fracture, bone fragments, tumor of soft tissues or bones, neurofibromas, neuromas, vascular malformations, and accessory muscles. Accessory muscles are commonly detected in upper limbs. However, their concomitant presentation with CTS has rarely been reported. We aimed to present different accessory muscles diagnosed during CTS surgery through a systematic review of the literature with our exemplary case. METHODS: A systematic review/meta-analysis was performed concomitant with a case presentation. RESULTS: Accessory muscles associated with CTS were as follows: palmaris longus, 28.6%; lumbrical muscles, 19.3%; palmaris profundus, 17.8%; flexor digitorum superficialis, 16.1%; transverse carpal muscle, 5%; flexor digitorum indicis, 4.2%; flexor superficialis indicis, 4.2%; flexor sublimis, 0.8%; accessory superficialis longus, 0.8%; flexor pollicis longus, 0.8%; abductor digiti minimi, 0.8%; abductor digiti quinti, 0.8%; and flexor digitorum superficialis brevis, 0.8%. Accessory muscles were mostly noticed during CTS surgery (88.2%). CONCLUSIONS: Knowledge of possible variations within the carpal tunnel would improve the surgeon's capability during CTS surgery.

Schmorl's nodes could be associated with intervertebral disc degeneration at upper lumbar levels and end-plate disease at lower lumbar level in patients with low back pain.

Schmorl's nodes (SNs) have increasingly been recognized on vertebral end-plates using advanced imaging techniques. Even though vertebral end-plates are the closest structures to discs, their pathologies are underestimated in the etiology of low back pain (LBP). We aimed to detect the prevalence of SNs and other end-plate defects in subjects with/without LBP and to understand whether SNs were associated with LBP and spinal degeneration. Subjects were evaluated in terms of end-plate defects, intervertebral disc degeneration (IVDD), and vertebral end-plate changes (Modic changes) at all lumbar levels on lumbar spine magnetic resonance imagings (MRI). Control subjects were compared to patients with LBP. Higher Pfirrmann scores (OR: 2.696) and higher SN scores (OR: 8.076) were significantly associated with Modic changes at L4-L5 disc level. Patients with higher SN scores at L1-L2 or L2-L3 levels had approximately 7-fold increased risk of severe IVDD at the corresponding levels. The most significant factor associated with presence of SNs was body weight of the patients (OR: 1.417). The most significant factor associated with intensity of LBP was severe IVDD at L5-S1 level (OR: 3.670). Having higher total SN score had an OR of 1.230 (95% CI: 1.003-1.509; p = 0.047) for predicting LBP. Schmorl's nodes were seen in 33.1% of patients and 11.5% of asymptomatic subjects. Body weight was the most significant factor associated with SNs. The most significant factor associated with LBP was severe IVDD at L5-S1 level.

Subcutaneous fat index: a reliable tool for lumbar spine studies.

OBJECTIVES: Obesity has been proposed as a risk factor for low back pain (LBP), and the body mass index (BMI) has been used for obesity; however, a more reliable tool is required to assess obesity-related health issues. A recent study depicted the subcutaneous fat tissue thickness (SFTT) at the L1-L2 level as superior to BMI in predicting LBP and spine degeneration. However, the study failed to answer the following questions: (1) What was the cutoff value for the SFTT to predict LBP and spine degeneration? (2) Could this new index be adjusted according to gender? (3) Could this new index predict fatty infiltration in the paraspinal muscles, severe intervertebral disk degeneration (IVDD), and Modic changes in the lumbar spine? Therefore, the current study aimed to answer these questions by developing and validating a new anthropometric index-the subcutaneous fat index (SFI). METHODS: This study retrospectively reviewed the magnetic resonance imaging database of patients with LBP and compared them with asymptomatic volunteers. RESULTS: Appropriate cutoff values for females and males were 8.45 mm and 9.4 mm, respectively. Females and males with the SFI of > 8.45 mm and > 9.4 mm, respectively, had significantly higher rates of spine degeneration. CONCLUSION: The SFI reliably distinguished patients with LBP from the asymptomatic subjects and could reliably distinguish patients with severe IVDD/Modic changes at the lower lumbar levels and those with moderate-to-severe fat-infiltrated paraspinal muscles at all lumbar levels with reliable cutoff values for males and females. KEY POINTS: • The subcutaneous fat tissue thickness at L1-L2 level (subcutaneous fat index [SFI]) was superior to BMI in predicting LBP and spine degeneration. However, a reliable cutoff value has not been previously defined. • The subcutaneous fat index had reliable cutoff values of 8.45 mm and 9.4 mm for females and males, respectively. • Females with an SFI of > 8.45 mm and males with > 9.4 mm had significantly higher rates of severe IVDD, Modic changes, and fatty infiltration in their paraspinal muscles.

At what speed does spinal degeneration gear up?: Aging Paradigm in patients with Low Back Pain.

OBJECTIVE: Aging is a cause of spinal degeneration. However, the natural history of degeneration process is unclear. We aimed to analyze change of intervertebral disc degeneration (IVDD) and Modic changes in Caucasians with LBP decade by decade. We also aimed to find out breaking points of having severe IVDD and Modic changes throughout human life. PATIENTS AND METHODS: We conducted a cross-sectional analysis of a retrospective database in patients aged between 10 and 100 years. All patients were evaluated in terms of IVDD and Modic changes. Optimal binning was conveyed to group age of the patients in terms of major changes in percentages of severe IVDD and Modic changes. RESULTS: We evaluated 2434 patients (female: 1328 and male: 1106; mean age: 47.2 ± 17.2 years; age range = 10-98 years). In all patients, 50.5% and 23.6% had severe IVDD and Modic changes at any lumbar level, respectively. Women were significantly more likely to have severe IVDD than men. Frequency of Modic changes at any lumbar level significantly increased in 40 s and 60 s, whereas frequency of severe IVDD at any lumbar level significantly increased in 20 s, 30 s, 50 s and 70 s CONCLUSION: Spinal degeneration had specific gear-up periods in human life. Age groups of future spine studies could be defined according to the new defined change periods of severe IVDD and Modic changes in human life.

Management of Pregnancy-and Lactation-Related Osteoporosis: Case Series.

AIM: To share the experience regarding management and follow-up of patients with Pregnancy- and lactation-related osteoporosis (PLRO) who were effectively treated. MATERIAL AND METHODS: This case series presented 10 patients diagnosed with PLRO and treated from January 2010 to December 2019. Visual analog scale and laboratory findings were evaluated. Spinal and extremity magnetic resonance imaging was obtained for patients with spinal and extremity pains. Dual energy X-ray absorptiometry was used for the measurement of bone mineral density. Values assessed on dual energy X-ray absorptiometry were L1?L4 T score, L2?L4 T score, and femoral neck T score. RESULTS: In the first-month follow-ups, all patients had meaningful pain relief and symptom resolution. The mean duration of pain control during the treatment period was 2.4 months. Two patients who continued breast-feeding were also the patients whose pain control was achieved at the latest. One patient required vertebroplasty. CONCLUSION: Patients with PLRO should be promptly treated and followed up. Discontinuation of breast-feeding will provide rapid advantage and should be the first step of the management. Early diagnosis and treatment of calcium and vitamin D with conservative procedures with spinal braces are very important for the treatment of PLRO patients. Additionally, bisphosphonates or teriparatide can improve the bone mineral density in patients with PLRO.

A new radiological index for the assessment of higher body fat status and lumbar spine degeneration.

OBJECTIVE: Obesity has been proposed as a risk factor for low back pain (LBP) and intervertebral disc degeneration (IVDD). Even though body mass index (BMI) is used as a parameter for obesity, it could not represent percentage and distribution of the body fat. Subcutaneous fat tissue thickness (SFTT) was proposed as one of the magnetic resonance imaging (MRI) parameters to evaluate the percentage of the body fat. In this study, we aimed to find out whether SFTT at lower back correlated with LBP and spine degeneration. MATERIALS AND METHODS: We retrospectively reviewed a database of the patients with LBP. Concomitantly, asymptomatic control subjects were retrieved. Patients and control subjects were evaluated in terms of IVDD and Modic changes at all lumbar levels on MRI. SFTT was measured both on MRI and computed tomography (CT) scans, where applicable. RESULTS: SFTT at the lumbar spine had moderate-to-strong correlations with BMI. SFTT at L1-L2 level was significantly associated with severe IVDD at L5-S1 level, and Modic changes at L4-L5 and L5-S1 levels. BMI had no significant association with severe IVDD and Modic changes at lumbar spine. BMI and mean SFTT of all lumbar levels had ORs of 0.735 (95% CI: 0.631-0.857, p < 0.001) and 1.389 (95% CI: 1.266-1.524, p < 0.001) in predicting symptomatic subjects with LBP. CONCLUSION: SFTT at upper lumbar levels could predict severe IVDD and Modic changes better than BMI, specifically in men. SFTT was better than BMI in predicting a symptomatic patient with LBP.

Intradiscal vacuum phenomenon and spinal degeneration: a cross-sectional analysis of 219 subjects.

INTRODUCTION: Intradiscal vacuum phenomenon (IVP) is the collection of gas within the intervertebral discs. It has been reported with various spinal disorders. The exact role of IVP in spinal degeneration leading to low back pain (LBP) is unclear. We aimed to obtain the prevalence of IVP in patients with LBP. Our second aim was to understand whether IVP was associated with intervertebral disc degeneration (IVDD), Modic changes, and subchondral sclerosis (SS). METHODS: A total of 12.450 consecutive patients with chronic LBP were evaluated in terms of having abdominal computed tomography (CT) scan concomitant with lumbar spine magnetic resonance imaging (MRI) using radiological database of three spine centers. We excluded the patients with a history of malignancy, metabolic disease, spinal infection, traumatic or osteoporotic spine fracture, and spine surgery. All lumbar levels were evaluated in terms of IVDD and Modic changes on MRI, while they were evaluated in terms of IVP and SS on CT scans. RESULTS: We included 219 patients. Severe IVDD, Modic changes, IVP, and SS were seen in 53.9% (n: 118), 38.8% (n: 85), 26.5% (n: 58), and 16% (n: 35) of the patients, respectively. Intradiscal vacuum phenomenon was closely associated with severe IVDD (OR: 8.204), Modic changes (OR: 3.547) and SS (OR: 4.231). DISCUSSION: Intradiscal vacuum phenomenon was closely associated with severe IVDD, Modic changes, and SS. Further prospective clinical and laboratory studies are necessary to better delineate the pathogenesis of IVP.

Obesity could be associated with poor paraspinal muscle quality at upper lumbar levels and degenerated spine at lower lumbar levels: Is this a domino effect?

Vertebral end-plate changes and paraspinal muscles are recently getting much more attention, since they could be associated with intervertebral disc degeneration (IVDD) and low back pain (LBP). Even though obesity is known as a risk factor for LBP, the role of obesity in the process of LBP is still controversial. In this study, we aimed to identify whether increased body mass index (BMI) was associated with IVDD, vertebral end-plate changes and paraspinal muscle quality. Consecutive women and men, aged between 20 and 50 years, presented with chronic LBP to the outpatient clinics were included. Patients were evaluated in terms of IVDD, vertebral end-plate changes, fatty infiltration in the paraspinal muscles at all lumbar levels on magnetic resonance imaging. Severe IVDD was more common in obese patients than in non-obese patients (73.5% vs. 50.4%, p = 0.017). When we compared the groups level by level, the significant difference for severe IVDD was present only at L4-L5 disc level (50% vs. 27.4%, p = 0.013). There was a higher trend of harboring Modic change at any lumbar level in obese patients, significantly in women (35.9% vs. 16.4%, p = 0.026). More severe fatty infiltration in the paraspinal muscles was seen at upper lumbar levels of the obese patients, particularly in women. Patients with higher BMI and suffering from LBP, had more fatty infiltration in the paraspinal muscles at the upper lumbar levels, more severe IVDD, and Modic changes at the lower lumbar levels; particularly women.

Is the Distribution Pattern of Modic Changes in Vertebral End-plates Associated With the Severity of Intervertebral Disc Degeneration?: A Cross-sectional Analysis of 527 Caucasians.

BACKGROUND: Low back pain (LBP) is one of the most common disorders, with many possible causes including intervertebral disc degeneration (IVDD) and Modic changes. In this study we aimed to analyze whether the distribution pattern of Modic changes in the vertebral end-plates was associated with the severity of IVDD. METHODS: We conducted a cross-sectional analysis of a retrospective database. Patients with constant LBP were evaluated in terms of IVDD and Modic changes on lumbar spine magnetic resonance imaging. Statistical analyses were specifically performed for the lower lumbar levels. RESULTS: We evaluated 527 patients. Modic changes were detected in 25% of the patients. Severe IVDD was detected in 90% and 88% of patients with Modic changes through the whole end-plates at L4-L5 and L5-S1 levels, respectively. Patients with Modic changes at L5-S1 level had significantly lower lumbar lordosis. Presence of severe IVDD at L4-L5 and L5-S1 levels was associated with 2.7- and 2.9-times higher risk of more widely distributed Modic changes in those vertebral end-plates, respectively. CONCLUSIONS: Severe IVDD was significantly more common in patients with Modic changes through the whole end-plate and in those with Modic type I changes.

Reciprocal relationship between multifidus and psoas at L4-L5 level in women with low back pain.

Background Low back pain (LBP) may originate from different sources such as intervertebral disc degeneration (IVDD), end-plate and paraspinal muscle changes. Our aim is to explore the relevance of paraspinal muscles' fat-infiltration in women with LBP and its association with IVDD and Modic changes.Methods Consecutive female patients presenting with chronic LBP to the outpatient clinics were included. Patients were evaluated in terms of IVDD, vertebral end-plate changes, and fatty infiltration in the paraspinal muscles at all lumbar levels on lumbar spine magnetic resonance imaging (MRI). Visual Analogue Scale (VAS) scores were recorded using our prospectively collected database.Results Patients with higher VAS scores were significantly more likely to have more fatty infiltration in the multifidus and less fatty infiltration in the psoas at L4-L5 level when compared to those with lower VAS scores (69.1 vs. 31.8%, p = 0.003). To predict LBP, fatty infiltration in the multifidus and psoas had odds ratio (OR) of 4 (p = 0.010), and 0.3 (p = 0.013), respectively; whereas disc degeneration had an OR of 0.5 (p = 0.028).Conclusion This is the first clinical cross-sectional study suggested that women with chronic low back pain could have less fat-infiltrated psoas to compensate more fat-infiltrated multifidus at L4-L5 disc level.

Association between facet joint orientation/tropism and lumbar intervertebral disc degeneration.

Background: The aim of this study was to understand how facet joint orientation (FJO) and facet joint tropism (FJT) affected severe intervertebral disc degeneration (IVDD) process at lower lumbar levels in patients with LBP.Methods: This study is a cross-sectional analysis of a retrospective database. Patients were evaluated in terms of IVDD, FJO, and FJT at all lumbar levels on magnetic resonance imaging.Results: In this study (n: 123) facet joints were aligned more coronal in men than in women at upper lumbar levels. Men had less FJT compared to women, significantly at L2-L3 and L3-L4 levels. Severe IVDD at L4-L5 was associated with more coronal aligned L1-L2 (29.0 ± 2.5° vs. 23.3 ± 2.3°, p = 0.006) and misaligned L5-S1 (8.3 ± 1.9° vs. 4.5 ± 1.7°, p = 0.008). Besides, severe IVDD at L3-L4 was associated with more coronal aligned L4-L5 (49.1 ± 3.2° vs. 41.4 ± 2.8°, p = 0.014).Conclusion: There is a close association between FJO/FJT with lumbar IVDD. Facet joint orientation and FJT do not affect the disc at only the corresponding level; the lumbar spine should be evaluated as a whole.

Proposal for a new scoring system for spinal degeneration: Mo-Fi-Disc.

OBJECTIVE: We aimed to develop a new scoring system for spinal degeneration including Modic changes, fatty infiltration (fi) in the paraspinal muscles, and intervertebral disc degeneration (IVDD), briefly Mo-fi-disc, using current radiological classification systems. We also aimed to understand whether Mo-fi-disc could predict patients with more intense low back pain (LBP). PATIENTS AND METHODS: We conducted a cross-sectional analysis of a retrospective database between March 2018 and July 2020. We evaluated patients in terms of Modic changes, fatty infiltration in the paraspinal muscles, and IVDD at all lumbar levels on lumbar spine MRI. We grouped patients based on their LBP intensity. Visual analog scale (VAS) scores were used for LBP intensity. RESULTS: We evaluated 134 patients (female: 66, male: 68; mean age: 35.44 ± 6.5 years). Patients with higher VAS scores had significantly higher 'Mo-disc' scores and higher 'fi' scores compared to those with lower VAS scores (3.54 ± 2.7 vs. 2.55 ± 2.8, p = 0.0075; 6.85 ± 3.2 vs. 5.25 ± 2.9, p = 0.0092). Patients with higher VAS scores had significantly higher 'Mo-fi-disc' scores compared to those with lower VAS scores (10.4 ± 4.2 vs. 7.94 ± 3.8, p = 0.0003). The most significant predictor for patients with higher VAS scores was 'Mo-fi-disc' scoring system with an OR of 1.193 (95 % CI: 1.055-1.349, p = 0.005). CONCLUSION: Patients with more intense LBP had higher 'Mo-fi-disc' scores. This scoring system suggests an easy and objective classification to evaluate the spinal degeneration.

Stronger Together in Lab: Multi-Center and Laboratory Spine Studies Are Closer to Publication than Single-Center and Clinical Spine Studies: Snapshot of Annual Meetings of the Spine Society of Europe.

STUDY DESIGN: This is a cross-sectional study of literature databases. PURPOSE: The purpose of this study is to analyze the predictive factors for the publication rates of spine studies. OVERVIEW OF LITERATURE: Spine research has garnered worldwide interest due to the increased number of spinal disorders in aging population. METHODS: We evaluated the abstracts presented at the annual meetings of the Spine Society of Europe between 2009 and 2012. Additionally, we recorded presentation categories, study designs, research types, random assignments of the subjects, single- or multi-center- based methodologies, and significance of the results. RESULTS: We evaluated 965 abstracts, 53.5% of which were published in peer-reviewed journals. Publication rates were significantly higher for oral presentations (62.9%) and prospective studies (61.3%) as compared to the poster presentations (46.7%) and retrospective studies (44.2%), respectively (p<0.001). Clinical studies contributed to about 86.1% of the published abstracts. However, publication rates were significantly higher for laboratory studies as compared to clinical studies (70.1% vs. 50.8%, p<0.001). Multi-center studies were closer to publication than single-center studies (67.1% vs. 52.2%, p=0.009). Our study demonstrated that multi-center studies (odds ratio, 1.81; p=0.016) and laboratory studies (odds ratio, 2.60; p<0.001) are more likely to be published. CONCLUSIONS: Multi-center collaborations dedicated to experimental studies in spine research are highly ranked and more likely to be published in peer-reviewed journals.