Clinical perspectives on secular trends of intervertebral foramen diameters in an industrialized European society

Short-term lumbar disc and lumbar stability changes of one-hole split endoscope technique treatment of spinal stenosis

OBJECTIVE

Investigating the early biomechanical effects of the one-hole split endoscope (OSE) technique on lumbar spine after decompression surgery.

METHODS

A retrospective analysis was conducted on 66 patients with lumbar spinal stenosis (LSS) who underwent OSE technique surgery at the affiliated hospital of Binzhou Medical University from September 2021 to September 2022. The patients had complete postoperative follow-up records. The mean age was (51.73 ± 12.42) years, including 33 males and 33 females. The preoperative and postoperative imaging data were analyzed, including disc height (DH), foraminal height (FH), lumbar lordosis angle (LLA), changes in disc angle, anterior-posterior translation distance, and lumbar intervertebral disc Pfirrmann grading. The visual analogue scale (VAS) was applied to evaluate the severity of preoperative, postoperative day 1, postoperative 3 months, and final follow-up for back and leg pain. The Oswestry Disability Index (ODI) was applied to assess the functionality at all the listed time points. The modified MacNab criteria were applied to evaluate the clinical efficacy at the final follow-up.

RESULTS

In 66 patients, there were statistically significant differences (p < 0.05) in DH and FH at the affected segments compared to preoperative values, whereas no significant differences (p > 0.05) were found in DH and FH at the adjacent upper segments compared to preoperative values. There was no statistically significant difference in the LLA compared to preoperative values (p > 0.05). Both the affected segments and adjacent upper segments showed statistically significant differences in Pfirrmann grading compared to preoperative values (p < 0.05). There were no statistically significant differences in the changes in disc angle or anterior-posterior translation distance in the affected or adjacent segments compared to preoperative values (p > 0.05). The VAS scores for back and leg pain, as well as the ODI, significantly improved at all postoperative time points compared to preoperative values. Among the comparisons at different time points, the differences were statistically significant (p < 0.05). The clinical efficacy was evaluated at the final follow-up using the modified MacNab criteria, with 51 cases rated as excellent, 8 cases as good, and 7 cases as fair, resulting in an excellent-good rate of 89.39%.

CONCLUSIONS

The OSE technique, as a surgical option for decompression in the treatment of LSS, has no significant impact on lumbar spine stability in the early postoperative period. However, it does have some effects on the lumbar intervertebral discs, which may lead to a certain degree of degeneration.

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Objectives:

The objective of this study was to investigate the dimensions of the osseous lumbar intervertebral foramen (IVF) regarding a sample without any clinical indication of spine pathology and, additionally, survey possible correlations of these measurements with clinical characteristics of the individuals.

Materials and Methods:

CT images of spine-related asymptomatic individuals were examined on parasagittal and oblique projections for the evaluation of cranial foramen width (CrFW), caudal foramen width (CaFW), vertebral height (VH) and foraminal height (FH) in accordance with gender, age, height, weight, body mass index (BMI) and vertebral level.

Results:

Overall, CT images of 73 individuals, 40 men and 33 women, with mean age 56.81 (± 14.79) years, mean height 1.69 (± 0.09) meters, mean weight 81.27 (± 18.14) kilograms and mean BMI 28.35 (± 5.62) were included. The maximum mean FW was the CaFWL1 and the minimum the CrFWL5, with values of 8.11 and 6.01 mm, respectively. Height and weight were presented as significantly bigger in men than women; however, women had bigger lumbar IVF values and no significant width measurement for IVF was morphoobserved at any level for either sex. Age showed a negative impact on the elderly by reducing height and the majority of FW measurements. Statistically important differences in accordance with BMI were not seen.

Conclusions:

Data comparison with previous studies is ambiguous due to methodological differences and possible populational variations and they reveal just a glimpse of the in vivo lumbar IVF. Our data could have clinical application on lumbar spine interventions.

A case of T2 radiculopathy after anterior C5-6 fusion

Thoracic radiculopathy is a rare entity. Symptomatic adjacent-segment disease after anterior cervical fusion occurs commonly in the lower cervical spine segment. We describe the clinical presentation and treatment of T2 radiculopathy after C5–6 anterior fusion. A 60-year-old man presented with the right axillary pain for 3 months. He had undergone C5–6 anterior fusion for cervical spondylosis 5 years prior. Computed tomography (CT) and magnetic resonance images showed T2–3 degenerative disease. C5–6 anterior fusion exacerbated the T2–3 segment involved in the patient’s scoliotic deformity. After 2 months of conservative treatment, we decompressed the T2 foramen via T2–3 hemilaminectomy and partial facet resection. After the surgery, his symptoms disappeared. T2 radiculopathy is rare but should be considered in the differential diagnosis of chest pain. Surgeons should pay attention not only to adjacent-segment disease but also to segmental degeneration at the apex of a scoliotic deformity after cervical anterior fusion.

The estrogen hypothesis of obesity

The explanation of obesity as a simple result of positive energy balance fails to account for the scope of variable responses to diets and lifestyles. It is postulated that individual physiological and anatomical variation may be responsible for developing obesity. Girls in poor families develop greater adiposity than their male siblings, a trend not present in richer environments. This indicates strong influence of estrogen on fat accumulation irrespective of poor socioeconomic conditions. Obesity rates in males and females of developed nations are similar, while in poorer nations obesity is much more prevalent in females. Female to male ratio of obesity correlates inversely with gross domestic product. Therefore, the parity of male and female obesity in developed countries may result from male exposure to environmental estrogen-like substances associated with affluence. These hormonally driven mechanisms may be equally active within both sexes in more developed areas, thereby increasing overall obesity.

Human osseous intervertebral foramen width

Alterations of the width of the human intervertebral foramen can play a pathophysiological role in low back pain. Osseous dimensions of the human intervertebral foramen are rarely recorded. Therefore, we present reference data obtained from skeletal samples of known lifestyle, population affinity, sex, and age at death. Cervical, thoracic, and lumbar vertebrae of functional transition zones of 71 macroscopically normal spines from early 19th century AD Swiss burial sites were selected. The intervertebral foramen widths (IFW) were analyzed with respect to possible lateralization and the impact of sex, individual age, and stature. Neither a significant side difference nor a correlation of IFW with individual age or stature could be found. Females show somewhat larger IFW than males, especially in the lumbar region. Data comparisons with earlier studies are limited due to methodological differences and possible interpopulational variations. Furthermore, the osseous intervertebral foramen only reveals a glimpse of the clinically relevant in vivo structure. Nevertheless, more focus on the osseous dimensions of the intervertebral foramen will provide baseline data of this important anatomical landmark. These data could also explore the peculiarities of the intervertebral foramen, such as its reverse sex dimorphism.

Age-dependent changes of the normal human spine during adulthood

The impact of aging on the morphology of the osseous spine is still debated. Clinical studies usually record combined aging effects, as well as age-related degenerative changes. The aim of this study was to determine the impact of (degeneration-independent) aging on the morphology of the osseous human spine during adulthood. Various osseous dimensions of human spinal landmarks at all major vertebral levels have been assessed in macroscopically normal Swiss skeletons (N = 71), with historically known sex and age at death, as well as in larger Central European skeletal samples (N = 277) with anthropologically determined individual age and sex. All measurements were correlated with individual age (or age group) by linear regression and analyzed separately for each sex. Only few osseous spinal dimensions, and only in men, correlate significantly with individual age. Generally, the significant dimensions show an increase in size during adulthood. Similar tendencies, but with significant alterations of spinal measurements in women as well, can be found in the larger samples with anthropologically determined sex and age group. Increase of certain spinal dimensions found in this study may be a reflection of an increase in the robustness of individuals with age. Because of the absence of a significant secular alteration of stature within the well-recorded sample, we exclude secular change in body dimensions as a major bias.