Study design: Retrospective cohort analysis. Objective: Our study aimed to investigate the effect of preoperative lumbar muscle quality (including muscle cross-sectional area (CSA) and muscle fatty infiltration rate (FIR) on L5-S1 foraminal stenosis degeneration after L4-5 TLIF. Summary of Background Data: Adjacent segment degeneration (ASD) was a major spinal fusion complication. The paraspinal muscle had been proven to be an essential factor influencing the happening of ASD. However, few studies had investigated the association between paraspinal muscle and adjacent segment foraminal stenosis degeneration (ASD-FS). Methods: One hundred-thirteen patients diagnosed with lumbar spinal stenosis at L4-5 were involved. Paraspinal muscle measurements were obtained preoperatively and bilaterally from axial T2-weighted MR images. The parameters included the, psoas cross-sectional area (p-CSA), erector spinae cross-sectional area (es-CSA), multifidus cross-sectional area (m-CSA), psoas fatty infiltration rate (p-FIR), erector spinae fatty infiltration rate (es-FIR), and multifidus fatty infiltration rate(m-FIR). The foraminal parameters were obtained in the Computed Tomography system bilaterally, including posterior disc height (PDH), disc-to-facet distance (D-F), foraminal height (FH), and foraminal area (FA). The association between muscle quality and ASD-FS had also been studied. Results: At the last follow-up, the DF, FH, and FA were significantly decreased compared to pre-operation, and the decrease in FA was significantly positively related to es-FIR and m-FIR. Conclusion: FIR for lumbar muscles preoperative was a predictor for L5-S1 ASD-FS after TLIF surgery, and patients who had higher es-FIR and higher m-FIR were more inclined to develop L5-S1 ASD-FS.

Objective: Cervical traumatic spinal cord injury (CTSCI) is a seriously disabling disease that severely affects the physical and mental health of patients and imposes a huge economic burden on patients and their families. Accurate identification of the prognosis of CTSCI patients helps clinicians to design individualized treatment plans for patients. For this purpose, a dynamic nomogram was developed to predict the recovery of CTSCI patients after 6 months. Methods:We retrospectively included 475 patients with CTSCI in our institution between March 2013 and January 2022.The outcome variable of the current study was a satisfactory recovery of patients with CTSCI at 6 months. Univariate analyses and univariate logistic regression analyses were used to assess the factors affecting the prognosis of patients with CTSCI. Subsequently, variables (P < 0.05) were included in the multivariate logistic regression analysis to evaluate these factors further. Eventually, a nomogram model was constructed according to these independent risk factors. The concordance index (C-index) and the calibration curve were utilized to assess the model's predictive ability. The discriminating capacity of the prediction model was measured by the receiver operating characteristic (ROC) area under the curve (AUC). One hundred nine patients were randomly selected from 475 patients to serve as the center's internal validation test cohort. Results:The multivariate logistic regression model further screened out six independent factors that impact the recovery of patients with CTSCI. Including admission to the American Spinal Injury Association Impairment Scale (AIS) grade, the length of high signal in the spinal cord, maximum spinal cord compression (MSCC), spinal segment fractured, admission time, and hormonal therapy within 8 h after injury. A nomogram prediction model was developed based on the six independent factors above. In the training cohort, the AUC of the nomogram that included these predictors was 0.879, while in the test cohort, it was 0.824. The nomogram C-index incorporating these predictors was 0.872 in the training cohort and 0.813 in the test cohort, while the calibration curves for both cohorts also indicated good consistency. Furthermore, this nomogram was converted into a Web-based calculator, which provided individual probabilities of recovery to be generated for individuals with CTSCI after 6 months and displayed in a graphical format. Conclusion:The nomogram, including ASIA grade, the length of high signal in the spinal cord, MSCC, spinal segment fractured, admission time, and hormonal therapy within 8 h after injury, is a promising model to predict the probability of content recovery in patients with CTSCI. This nomogram assists clinicians in stratifying patients with CTSCI, enhancing evidence-based decision-making, and individualizing the most appropriate treatment.

OBJECTIVE: To introduce a novel visualized foraminoplasty technique in patients with lumbar disc herniation with lumbar foraminal stenosis.METHODS: We retrospectively analyzed patients who had undergone surgery in our hospital for lumbar disc herniation with foraminal stenosis. We enrolled 35 patients who received the traditional TESSYS technique and 70 who received the new technique. We compared the foraminalplasty time, fluoroscopy times, intraoperative blood loss, intraoperative dural and nerve root injuries, length of postoperative hospital stay, clinical outcome according with modified MacNab criteria, Visual Analog Scale (VAS) and Oswestry Disability Index (ODI)between the new technique group and the traditional TESSYS technique group.RESULTS: The intraoperative VAS score(1.84±0.96) and fluoroscopic times(13.30±3.79) in the new technique group were significantly lower than those in the traditional TESSYS group (intraoperative VAS score,3.60±1.09,P=0.000;fluoroscopic times,20.00±4.24,P=0.000).The foraminalplasty time in the TESSYS group(17.60±3.46) was significantly shorter than that in the new technique group (22.81±4.86)(P=0.000).There were no significant differences in length of hospital stay after surge, postoperative VAS score and postoperative ODI score between the two groups (P=0.835, P=0.779, P=0.350). In addition, the amount of blood loss during foraminoplasty could not be calculated due to the presence of continuous saline irrigation in the new technique group. In the conventional TESSYS technique group, there was 1 patient with exiting nerve root injury who developed significant leg pain after surgery.CONCLUTIONS: The novel visualized foraminoplasty technique is a safe and effective surgical method. Compared with traditional surgical methods, it has obvious advantages in reducing intraoperative pain and radiation exposure.

Study design: Retrospective study. Objectives: Adjacent segment degeneration (ASD) is a major complication associated with spinal fusion. The lumbar paraspinal muscle is an essential factor influencing the occurrence of ASD. This study aimed to investigate the effect of preoperative lumbar paraspinal muscle quality on L5-S1 adjacent lumbar foraminal stenosis degeneration (ASLFSD) after L4-5 transforaminal lumbar interbody fusion (TLIF). Methods: 113 patients diagnosed with lumbar spinal stenosis at L4-5 were treated with TLIF. Lumbar paraspinal muscle measurements were obtained preoperatively and bilaterally from axial T2-weighted MR images. The measurementsincluded the total cross-sectional area of psoas (PS-tCSA), of erector spinae (ES-tCSA), and of multifidus (MF-tCSA); and fatty infiltration of psoas (PS-FI), of erector spinae (ES-FI) and of multifidus (MF-FI). Foraminal measurements, including posterior disc height (PDH), disc-to-facet distance (D-F), foraminal height (FH), and foraminal area (FA), were obtained bilaterally using a computed tomography system. The association between lumbar paraspinal muscle quality and changes in foraminal measurements was also studied. Results: We observed that the FH and FA significantly reduced at 1 year postoperatively at the mean follow-up period of 41.56 ± 8.38 months (range. 43–50 months), and PDH, D-F, FH, and FA all significantly reduced at final follow-up. These changes in foraminal measurements were significantly and negatively correlated with PS-FI, ES-FI, and MF-FI. Conclusion: During the clinical follow-up, we found that patients with a higher degree of paraspinal muscle FI were more likely to develop L5-S1 ASLFSD after L4-5 TLIF.