Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: a prospective randomized double-blind sham-controlled multi-center study” by Fischgrund JS, et al. [Eur Spine J; (2018) 27(5): 1146–1156]

Announcement

Letter to the editor concerning “Head to pelvis alignment of adolescent idiopathic scoliosis patients both in and out of brace” by Vergari C, Courtois I, Ebermeyer E, Pietton R, Bouloussa H, Vialle R, Skalli W (Eur Spine J; 2019: https://doi.org/10.1007/s00586-019-05981-8)

Answer to the letter to the editor of Y. Li et al. concerning “Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: a prospective randomized double-blind sham-controlled multi-center study” by Fischgrund JS, et al. [Eur Spine J; (2018) 27(5): 1146–1156]

Answer to the Letter to the Editor of Weiss HR et al. concerning “Head to pelvis alignment of adolescent idiopathic scoliosis patients both in and out of brace” by Vergari C, Courtois I, Ebermeyer E, Pietton R, Bouloussa H, Vialle R, Skalli W (Eur Spine J; 2019: https://doi.org/10.1007/s00586-019-05981-8)

Rheumatoid arthritis-associated spinal neuroarthropathy with double-level isthmic spondylolisthesis Abstract Introduction To the best of our knowledge, there has been no report regarding rheumatoid arthritis associated with spinal neuroarthropathy and combined double-level isthmic spondylolisthesis. Here, we report a rare case of spinal neuroarthropathy with double-level isthmic spondylolisthesis in a rheumatoid arthritis (RA) patient. Case summary A 56-year-old female patient under medical treatment for RA during the last 13 years presented aggravating radiating pain to her right lower extremity and a limping gait developed 4 months ago. The disease activity of RA had remained low for a long time. Serial radiographs during last 8-year follow-up showed progressive dislocation at L4–L5 and L5–S1 with double-level isthmic spondylolisthesis and severe destructive status at the last follow-up. The patient underwent decompression and circumferential fusion with sacropelvic fixation and acceptable reduction was obtained. Conclusion A RA patient with double-level isthmic spondylolisthesis showed a progressive destructive lesion. In addition to clinical presentations, the imaging findings were very similar to ones of spinal neuroarthropathy. The authors conclude that this Grand Round case probably had SNA secondary to RA and that this, combined with two-level isthmic spondylolisthesis, resulted in her rapidly progressing destructive lumbar lesion.

Expert’s comment concerning Grand Rounds case entitled “Rheumatoid arthritis-associated spinal neuroarthropathy with double-level isthmic spondylolisthesis” by S. I. Kim et al. (Eur Spine J; 2017: doi:10.1007/s00586-017-5220-6)

A comparative study of diffusion kurtosis imaging and T2* mapping in quantitative detection of lumbar intervertebral disk degeneration Abstract Purpose To assess the feasibility of diffusion kurtosis imaging (DKI) for diagnosing lumbar intervertebral disk degeneration (IDD) and to compare the potential of DKI and T2* mapping in the diagnosis of early IDD. Methods Sagittal T2WI, DKI, and T2* mapping were performed in 75 subjects with 375 lumbar intervertebral disks at a 3.0-T MRI. DKI-related parameters including mean kurtosis (MK), mean diffusivity (MD), fractional anisotropy (FA), and T2* values were calculated for each disk which was segmented into three regions: nucleus pulposus (NP), anterior annulus fibrosus (AAF), and posterior annulus fibrosus (PAF). Results MK and FA were positively correlated with Pfirrmann grade (all P < 0.001). MD and T2* were negatively correlated with Pfirrmann grade (all P < 0.001) except for T2* value of AAF (r = 0.087, P > 0.05). MK and FA values increased, while MD and T2* values decreased with age. No statistical significance was found between men and women (P > 0.05). Cephalic lumbar disks (L1/L2 and L2/L3) got lower MK and FA values than caudal lumbar disks (L4/L5 and L5/S1) (all P < 0.05), while cephalic lumbar disks got higher MD value than caudal lumbar disks (all P < 0.05). ROC analysis demonstrated that MK, MD, and FA showed significantly higher diagnostic accuracies than T2*, especially in NP and PAF. Conclusions DKI can be used to assess human lumbar IDD. And DKI was more sensitive to the quantitative detection of early lumbar IDD than T2* mapping. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.

Thoracolumbar junction orientation: its impact on thoracic kyphosis and sagittal alignment in both asymptomatic volunteers and symptomatic patients Abstract Purpose The thoracolumbar junction (TLJ) has not been explored in regard to its contribution to global sagittal alignment. This study aims to define novel sagittal parameters of the TLJ and to assess their roles within global sagittal alignment. Methods Included for cross-sectional, retrospective analysis were asymptomatic volunteers and symptomatic patients who had undergone operation for adult spinal deformity. Unique sagittal parameters of the TLJ were measured using the midline of the T12–L1 disk space: The TLJ orientation [TLJO; thoracolumbar tilt (TLT) and slope (TLS)]. Thoracic kyphosis (TK; T5–12), C7–S1 sagittal vertical axis (SVA), lumbar lordosis (LL; L1–S1), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured. Continuous variables were compared using the independent t test. Pearson correlations examined relationships between the parameters in each group. The asymptomatic TK was calculated using the measurement of the asymptomatic volunteer’s TLJO by linear regression. Results One hundred fifteen asymptomatic volunteers and 127 symptomatic patients were included. Only LL among the lumbopelvic parameters correlated with TK (asymptomatic volunteers: r = − 0.42; symptomatic patients: r = − 0.40). All the pelvic parameters have no direct correlation with TK in both groups. TLJO had stronger correlation with TK [asymptomatic volunteers: r = − 0.68 (TLS), r = 0.41 (TLT); symptomatic patients: r = − 0.56 (TLS), r = 0.44 (TLT)] than the lumbopelvic parameters. TLS correlated with LL (asymptomatic volunteers: r = 0.78; symptomatic patients: r = 0.73). Most pelvic parameters correlated with TLJO except for PI. The asymptomatic TK was estimated by the derived formula: 20.847 + TLS × (− 1.198). Conclusion The TLJO integrates the status of the lumbopelvic sagittal parameters and simultaneously correlates with thoracic and global sagittal alignment. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

Immediate postoperative coronal imbalance in Lenke 5 and Lenke 6 adolescent idiopathic scoliosis: Is it predictable? Abstract Purpose Immediate postoperative coronal imbalance (IPCIB) is a common reason for worse postoperative appearance in adolescent idiopathic scoliosis (AIS) patients and rarely improves on its own at follow-up, thereby greatly influencing the patients’ health-related quality of life. However, no studies have been performed to detect the primary risk factors for IPCIB and it remains unclear whether the condition can be predicted preoperatively. The purpose of this study is to detect the primary risk factors for IPCIB in Lenke 5 and Lenke 6 AIS patients and to explore whether IPCIB can be predicted preoperatively. Methods Medical records of Lenke 5 and Lenke 6 AIS patients who underwent correction surgery in our hospital from June 2017 to October 2018 were analyzed. Anteroposterior films were evaluated before and after surgery. Patients were divided into two groups, i.e., occurrence and non-occurrence of IPCIB. The risk factors for IPCIB were analyzed, and an IPCIB index was proposed and verified. Results Thirty-seven Lenke 5/Lenke 6 AIS patients with IPCIB and 48 patients without IPCIB were recruited. Univariate analysis showed that there were significant differences between the two groups in the number of unfused vertebrae, preoperative thoracic Cobb angle, preoperative lumbar Cobb angle, preoperative translation of lumbar apex, preoperative coronal balance, preoperative L5 tilt, preoperative bending L5 tilt, postoperative translation of thoracic apex, postoperative lumbar Cobb angle, postoperative translation of lumbar apex, postoperative radiographic shoulder height, and postoperative L5 tilt. Logistic regression analysis showed that the preoperative bending L5 tilt, postoperative translation of the thoracic apex, and postoperative lumbar Cobb angle were the primary risk factors for IPCIB. The IPCIB index was defined as 1.3 * preoperative bending L5 tilt + 1.5 * postoperative translation of thoracic apex − 0.8 * postoperative lumbar Cobb angle. The receiver operating characteristics curve indicated that the occurrence rate of IPCIB was 88% and the non-occurrence rate was 90% when the IPCIB index was greater than 16. Conclusion The preoperative bending L5 tilt, postoperative translation of the thoracic apex, and the postoperative lumbar Cobb angle were the primary risk factors for IPCIB in Lenke 5 and Lenke 6 AIS patients. The IPCIB index can be used to predict the occurrence of IPCIB with high accuracy. Our results indicate that the thoracic curve should be adequately corrected during surgery; however, moderate correction of the lumbar curve is recommended. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.