Study Design: Retrospective cohort study. Objectives: To identify imaging predictors on pre- and perioperative imaging that are associated with a future revision surgery for adjacent segment disease (ASD) following lumbar fusion. Methods: Patients undergoing open posterior lumbar fusion between 2014-2022 were followed-up for >2-year. The initial MRI was evaluated for disc degeneration by Pfirrmann (grade 1-5); Modic changes (0-3); as well as fatty infiltration and functional cross-sectional area (fCSA) of the multifidus, erector spinae, and psoas. Spinopelvic alignment was measured pre- and postoperatively. Results: Of 216 patients, 14.8% (n = 32) required revision surgery for ASD in the further course. There were no significant differences in Modic changes or Pfirrmann grades between the ASD group and controls. Fatty infiltration was significantly higher in the ASD group for both the erector spinae (40.5% vs 36.9%, P = 0.043) and multifidus muscles (61.0% vs 53.9%, P = 0.003). Additionally, the multifidus fCSA was smaller in patients who developed ASD (5.7 cm ² vs 6.7 cm ² ). Pre- and postoperative spinopelvic parameters were not significantly different between groups, and no other MRI measurements showed a significant difference. In a multivariable logistic regression model adjusting for age and sex, multifidus fatty infiltration emerged as the only significant predictor of ASD revision surgery ( P = 0.004). Patients with more than 58% multifidus fatty infiltration had over double the risk of developing ASD (OR 2.7, 95% CI: 1.1-6.5, P = 0.032). Conclusions: Multifidus fatty infiltration is the key imaging predictor for the development of ASD requiring surgical revision. Disc degeneration and spinopelvic alignment appear to have less impact.

Study Design.: A retrospective analysis of prospectively collected data. Objective.: To report the decision-making process for decompression alone (DA) and decompression and fusion (DF) at a tertiary orthopedic center and compare the operative outcomes between both groups. Background.: Controversy exists around the optimal operative treatment for DLS, either with DF or DA. Although previous studies tried to establish specific indications, clinical decision-making algorithms are needed. Materials and Methods.: Patients undergoing spinal surgery for DLS at L4/5 were retrospectively analyzed. A survey of spine surgeons was performed to identify factors influencing surgical decision-making, and their association with the surgical procedure was tested in the clinical data set. We then developed a clinical score based on the statistical analysis and survey results. The predictive capability of the score was tested in the clinical data set with a receiver operating characteristic (ROC) analysis. To evaluate the clinical outcome, two years follow-up postoperative Oswestry Disability Index (ODI), postoperative low back pain (LBP) (Numeric Analog Scale), and patient satisfaction were compared between the DF and DA groups. Results.: A total of 124 patients were included in the analysis; 66 received DF (53.2%) and 58 DA (46.8%). Both groups showed no significant differences in postoperative ODI, LBP, or satisfaction. The degree of spondylolisthesis, facet joint diastasis and effusion, sagittal disbalance, and severity of LBP were identified as the most important factors for deciding on DA or DF. The area under the curve of the decision-making score was 0.84. At a cutoff of three points indicating DF, the accuracy was 80.6%. Conclusions.: The two-year follow-up data showed that both groups showed similar improvement in ODI after both procedures, validating the respective decision. The developed score shows excellent predictive capabilities for the decision processes of different spine surgeons at a single tertiary center and highlights relevant clinical and radiographic parameters. Further studies are needed to assess the external applicability of these findings.

Purpose: This study aimed to investigate the associations between electromyography (EMG) activity and key muscle quality parameters, including cross-sectional area (CSA), functional cross-sectional area (FCSA), fat area (FA), and fat infiltration (FI), in individuals with chronic low back pain (cLBP) and those without back pain (no-BP). The objective was to explore how variations in muscle quality affect muscle activation patterns in the erector spinae (ES) and multifidus (MF) muscles during a standardized lifting task in both groups. Methods: A total of 102 participants were enrolled, comprising 60 individuals with cLBP and 42 without back pain. Muscle activation was measured using a bipolar wireless EMG system during the performance of a 10 kg lifting task. Magnetic resonance imaging (MRI) was utilized to assess muscle quality indicators (CSA, FCSA, FA, and FI) at the L3 level for the ES muscle and the L5 level for the MF muscle. Linear regression models were applied to examine the associations between EMG activity and muscle quality metrics, with adjustments for age, sex, and body mass index (BMI). Results: In the no-BP group, significant negative associations were found between CSA, FCSA, and EMG activity in the ES muscles (p < 0.05). However, in the cLBP group, no significant associations were observed between CSA or FCSA and EMG activity. Instead, there was a significant negative association between EMG activity and FA/FI in the ES muscles of the cLBP group (p < 0.05). Conclusion: Muscle quality, particularly fat infiltration, appears to have a greater impact on the amplitude of muscle activities in cLBP patients compared to CSA and FCSA. In contrast to the no-BP group, CSA and FCSA were not significantly associated with muscle activation in the cLBP group, highlighting the need for rehabilitation strategies focused on reducing fat infiltration to improve muscle performance in these patients.

Scoliosis and Scheuermann’s disease are common spinal deformities that affect a substantial population, particularly adolescents, often impacting their quality of life. This comprehensive review aims to present a detailed understanding of these conditions, their diagnosis, and various treatment strategies. Through an extensive exploration of current literature, the review discusses the etiology of these spinal deformities and the use of diagnostic tools such as X-rays and MRI. It further delves into the range of treatment options available, from conservative approaches such as physiotherapy and bracing to more invasive surgical interventions. The review underscores the necessity of an individualized treatment approach, taking into account factors such as the patient’s age, the severity of the curvature, and overall health. This all-encompassing perspective on scoliosis and Scheuermann’s disease will aid in evidence-based decision making in their management with the goal of improving patient outcomes.