ObjectiveTo evaluate the radiologic parameters of degenerative lumbar spondylolisthesis (DLS) and determine the radiographic risk factors for DLS by making comparisons with healthy control subjects.MethodsSeventy-five patients with L4/5 DLS (Meyerding grade I) and 53 healthy control subjects were analyzed. The L1-S1 disc height index (DHI), L4/5 facet joint angle (FJA), and relative cross-sectional area (RCSA) of paravertebral muscles were measured in both groups. The initial L4/5 DHI (iDHI) before the onset of DLS were estimated based on the L3/4 DHI of the DLS group and DHI of the control group. The sagittal parameters of DLS were also included in this study.ResultsThe DHI of L4/5 was lower in the DLS group than in the control group (P < 0.05), but the DHI of the L1-L4 segments were much higher than in the control group (P < 0.05). The initial L4/5 DHI and FJA of the DLS group were significantly higher than those of the control group (P < 0.05). The RCSA of the paravertebral muscles were smaller in the DLS group than in the control group (P < 0.05). Binary logistic regression analysis showed that iDHI, FJA, and RCSA of the total paraspinal muscles were risk factors for DLS. The cutoff values for iDHI, FJA, and RCSA were 0.504, 56.968°, and 1.991 respectively. The iDHI was associated with lumbar lordosis (LL), while L4/5 DHI was associated with the RCSA of the multifidus muscle and psoas major muscle (P < 0.05).ConclusionA large initial lumbar disc height, large FJA, and paravertebral muscle atrophy may be risk factors for DLS.

Background:Although it has been established that adolescent idiopathic cervical kyphosis (AICK) has no known cause, there are associated risk factors. However, the underlying causes remain puzzling. This case report presents severe AICK linked to chronic neck flexion postural habit, treated with combined anterior and posterior correction surgery and review of the literature.Case presentation: A 16-year-old male with no history of trauma, surgery, or family history of spinal deformity complained of intolerable neck pain and rigidity. He developed an incessant reading of comic books at a very young age, and he preferred placing the book on the floor with his head flexed between his thighs. Acupuncture and massage therapy failed to relief symptoms. He had no neurological symptoms on examination and X-ray showed Cobb angle of 70.5 . MRI and CT scans showed no spinal cord compression or osteophyte formation. A combined anterior and posterior correction surgery was performed after a week of skull traction. The deformity was corrected, neck pain disappeared, and neck rotatory function maintained after posterior implant removal. The maximum follow-up was 10 years. Conclusions:The potential underlying risk factor observed in this case is unusual. Chronic neck flexion postural habit is a potential risk factor of severe AICK in some individuals.

Objective To investigate the differences, correlations, and clinical significance of the paraspinal muscles among patients with isthmic spondylolisthesis (IS), degenerative lumbar spondylolisthesis (DLS), and age-matched healthy subjects. Methods This study involved 159 age-matched patients with L4 anterior spondylolisthesis. The patients were divided into the IS group (n = 81) and DLS group (n = 78). Eighty-four age-matched healthy adults were enrolled as the control group. The cross-sectional area (CSA) of paraspinal muscles (multifidus [MF], erector spinae [ES], and psoas [PS]) and the relative CSA of the paraspinal muscles (paraspinal muscle CSA/vertebral CSA) were measured in the IS group, DLS group, and control group. The degree of fat infiltration was simultaneously observed. Results There was no significant difference in age or sex among the three groups. The relative CSA of the MF and PS was higher in control group than in IS and DLS groups (p < 0.05). The relative CSA of ES was higher in IS and control groups than in DLS group (p < 0.05). The relative CSA of total paraspinal muscles decreased in the order of control group > IS group > DLS group (p < 0.05). Logistic regression analysis showed that the relative CSA of MF, and the degree of fat infiltration of ES were independent protective factors for IS (odds ratio < 1, p < 0.05). The relative CSA of MF was an independent protective factor for DLS (odds ratio < 1, p < 0.05), whereas BMI and the degree of fat infiltration of MF were independent risk factor for DLS (odds ratio > 1, p < 0.05). Conclusion Compared with the control group, patients with IS and DLS showed varying degrees of degeneration, and the degree of degeneration in patients with DLS was more severe at the same age. Lower fat infiltration and higher paraspinal muscle CSA are protective factors for IS and DLS, whereas the higher BMI is risk factor for DLS.

Introduction: Reconstruction surgeries of the inguinal area pose a challenge for oncological and orthopedic surgeons, especially after radical local resection (RLR), radical inguinal lymph node dissection (RILND), or both. Although numerous surgical procedures have been reported, there is no report about a pedicle adductor longus flap method. The aim of this work is to show our experience about inguinal reconstruction with pedicled adductor longus flap and associated outcomes.Patients and Methods: A retrospective study of 16 patients with localized inguinal region interventions and reconstructed by adductor longus flap from March 2016 to July 2020. Patients' average age was 60.0 years (range = 38–79 years) and had postoperative follow-up of 10 months (ranging 2–19 months). All patients had unilateral inguinal region involvement—seven cases on the left and nine cases on the right. The patients' clinical course, operative course, and postoperative follow-up data were evaluated.Results: All 16 patients recovered well post-operatively and did not require any re-intervention. Four patients experienced negligible discomfort around the groin area. Five patients experienced a minor strength deficit in thigh adduction compared with that of preoperative strength in the same or contralateral leg. The aforementioned complications resolved during the postoperative course and had no functional impact on their activity of daily living. All adductor longus flaps survived, completely filled the inguinal dead space, and wounds healed uneventfully within 3 weeks except for three patients who suffered delayed wound healing for more than 4 weeks. Other common complications such as infection, seroma, or wound dehiscence were not encountered in this series.Conclusion: The adductor longus flap is a reliable alternative method for inguinal region reconstruction following radical local resection (RLR), radical inguinal lymph node dissection (RILND), or both.