To evaluate the association between surgeon experience, defined by post-fellowship years in practice, and perioperative outcomes for lumbar laminectomy, discectomy, and anterior cervical discectomy and fusion (ACDF). Although surgeon experience is recognized as an important factor in surgical outcomes, its role in common spine procedures remains unclear. We retrospectively reviewed patients from three institutions (2013–2023) undergoing single or two-level laminectomy, discectomy, or ACDF. Surgeons were grouped as early-career (< 5 years), mid-career (5–10 years), or late-career (≥ 11 years). Outcomes included operative time, extended length of stay (LOS), neurologic deficits, and revision within two years. Multivariable logistic regression adjusted for demographics, comorbidities, and procedure type. Among 1,660 patients, late-career surgeons had significantly lower odds of extended operative time than early-career surgeons (OR 0.41, 95
Magnetic resonance imaging (MRI) offers detailed visualization of vertebral and paravertebral anatomy, enabling direct assessment of pathophysiological conditions. This study aims to introduce OsteoSarcoScore (OSS), an MRI-derived bone-muscle quality measure, to assess vertebral fracture risk. This retrospective study included 234 postmenopausal women (mean age: 66.94 ± 8.87 years) who underwent both MRI and QCT. For muscle quality, the psoas-muscle (PM-Score), multifidus-erector-muscles (MF-Score), and MyoScore (PM-Score + MF-Score) were defined as muscles’ signal intensities (SIs) at the L2/3‒L4/5 levels divided by subcutaneous fat SIs. For bone quality, the F-score and vertebral bone quality (VBQ) were defined as the median L1‒L4−5 vertebrae SIs, normalized to relevant controls. The OSS was derived as composite of F-Score-MyoScore and compared with VBQ-MyoScore. Analyses included ANOVA with post hoc correction, DeLong’s test for ROC comparison, and multivariable logistic regression with standardized predictors (odds ratios for OSS per 1-SD). Primary models adjusted for age, BMI, vendor, and field strength, with additional adjustment for vBMD; propensity score matching served as a secondary analysis. Incremental value beyond vBMD was assessed by ∆AUC, continuous NRI/IDI, and decision-curve analysis. Reliability was assessed by ICC for scores and Cohen’s kappa for fractures. Among osteoporotic patients, MyoScore, VBQ‑MyoScore, and OSS were higher by 3.9
Transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are widely used to address single-level pathology at L4-L5. This study compares the spinopelvic and disc space radiographic outcomes between these two approaches. A retrospective review was conducted of patients who underwent L4-L5 TLIF or LLIF at a single institution from May 2017 to January 2025. Preoperative and postoperative scoliosis radiographs were analyzed to assess changes in spinopelvic alignment. Seventy-three patients who underwent TLIF and 93 patients who underwent LLIF procedures were included. TLIF cases included 54 minimally invasive and 19 open procedures; LLIF cases included 16 stand-alone procedures and 77 LLIFs with posterior instrumentation. No significant differences were seen between TLIF and LLIF in change in overall lumbar lordosis (0.06° vs. 0.75°, p = 0.51), L4-L5 segmental lordosis (1.85° vs. 1.35°, p = 0.38), or segmental lordosis at other levels (all p > 0.05). LLIF was associated with greater reductions in percent spondylolisthesis (2.9 vs. 1.9 mm, p = 0.02) and greater increases in anterior disc height (3.9 vs. 2.6 mm, p = 0.003), posterior disc height (1.8 vs. 1.3 mm, p = 0.03), and foraminal height (2.5 vs. 1.0 mm, p = 0.002). No differences were found in pelvic incidence–lumbar lordosis mismatch, sagittal vertical axis, lumbar pelvic angle, or T1-pelvic angle. Although TLIF and LLIF yielded similar outcomes in segmental and overall lumbar lordosis and spinopelvic alignment, LLIF demonstrated superior disc and foraminal height restoration and superior spondylolisthesis reduction. Further studies are needed for comprehensive comparison.
Low back pain (LBP) is a common condition that leads to functional impairment and reduced quality of life in the modern population. Given the complexity of its etiology, this study aims to systematically identify precise risk factors at the population level and establish predictive models to provide a scientific basis for the early prevention of low back pain. Using data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2020, a total of 93,022 middle-aged and older adults were included in the analysis. Feature selection was performed using L1 regularization (LASSO) and recursive feature elimination (RFE). Eight machine learning models including logistic regression, random forest, and LightGBM were constructed and their predictive performances were compared. Model interpretability was assessed using SHAP values. LASSO and RFE jointly identified 20 core risk features. Among the eight machine learning models, LightGBM demonstrated optimal predictive performance, achieving an AUC of 0.898. SHAP analysis revealed that the co-occurrence of pain in multiple sites, such as “leg pain-knee pain-back pain,” constituted the strongest predictor cluster for LBP. Poor self-rated health and depressive symptoms were also identified as significant risk factors. By integrating population-level big data, this study developed a highly accurate and easily interpretable predictive model for low back pain. The findings suggest that comprehensive prevention and treatment strategies for low back pain should focus on the coordinated management of pain in the “back-leg-knee” region, while also taking psychosocial factors into account.
Iliac venous stenting is an established treatment for symptomatic iliac venous obstruction and post-thrombotic disease. Although usually safe, malposition of a venous stent into the spinal canal is exceptionally rare and may cause serious neurological injury. A 53 years old woman with chronic left lower-limb swelling and pain caused by iliac venous thrombosis underwent left lower-limb venography, iliac vein balloon dilation, and stent implantation. During deployment she reported left lower-limb pain, which was initially considered procedure-related. On the first postoperative day, she developed severe right buttock pain radiating to the right lower limb, bilateral foot numbness, and reduced bilateral extensor hallucis longus strength. Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) showed that the metallic stent entered the spinal canal through the left L5/S1 intervertebral foramen, crossed the canal, and reached the right L5/S1 foramen. After 3 weeks of conservative treatment without meaningful recovery, posterior exploration was performed. Because the intraspinal stent segment appeared thrombosed and no active bleeding was identified, the segment was withdrawn, cut, and removed under direct visualization while protecting the dural sac and nerve roots. Internal fixation was not required because the involved L5/S1 segment was a stable lumbosacral transitional level. Inadvertent intraspinal deployment of an iliac venous stent is a rare but potentially serious complication. Radicular pain or neurological deficit during or after iliac venous stenting should prompt immediate multiplanar imaging. In this patient, posterior partial removal after multidisciplinary assessment was associated with favorable neurological recovery. Further cases are required to determine the safety and generalizability of this approach.
