Social media has become a major source of health information. TikTok, a rapidly expanding global platform that enables broad dissemination of medical content, yet the accuracy and reliability of such information remain uncertain. In this context, assessing the educational quality of videos on spondylolisthesis is of increasing clinical relevance. To evaluate the quality, reliability, and educational value of TikTok videos on spondylolisthesis and identify factors associated with higher-quality content. TikTok was searched in August 2025 using the keyword “spondylolisthesis.” Video metrics, uploader type and content category were recorded. Two orthopedic surgeons independently assessed reliability and quality using the DISCERN tool, Journal of the American Medical Association (JAMA) benchmarks, and Global Quality Score (GQS). A total of 254 TikTok videos were screened, of which 82 met inclusion criteria, totaling 4.15 million views and 55,967 likes. Private users uploaded 46.3%, surgeons 28.0%, physiotherapists 23.2%, and researchers 2.4%. Overall quality was poor (DISCERN 34.1 ± 17.6; JAMA 1.8 ± 1.1; GQS 2.6 ± 1.1). Videos by surgeons and physiotherapists scored significantly higher (p < 0.001), and educational content outperformed patient experiences (p < 0.001). Longer videos correlated with higher quality scores, while engagement metrics were not predictive. Most TikTok videos on spondylolisthesis showed low quality and limited reliability. Educational content produced by healthcare professionals performed better, while popularity metrics were not indicative of quality. Spine specialists should recognize TikTok's growing role in patient education and contribute accurate, evidence-based content to improve information quality.

Background/Objectives: Total en bloc spondylectomy (TES) remains one of the most invasive and selectively used procedures in spine oncology. Its role has become more selective in the modern era of stereotactic body radiotherapy, separation surgery, targeted systemic therapy, immunotherapy, and multidisciplinary cancer care. This study evaluated long-term survival, imaging-defined systemic disease burden, operative morbidity, patient-reported outcomes, and frailty-related variables after TES in a rare single-center cohort, with the goal of identifying selection-relevant survival and treatment-burden signals rather than developing a validated decision algorithm. Methods: We performed a retrospective single-center cohort study of consecutive adults who underwent TES for spinal tumors between 2011 and 2022. Of the 36 screened patients, 30 had sufficient clinical and survival data for analysis; patients without reliable survival or last-contact data were not included. Contrast-enhanced CT and PET-CT were reviewed for extraspinal metastases, lymphadenopathy, pleural effusion, and soft-tissue extension. Survival was analyzed using Kaplan–Meier methods, log-rank testing, and exploratory univariate Cox regression. Patient-reported outcomes included the Oswestry Disability Index (ODI) and SF-36 when available; frailty was summarized with the modified frailty index-5 (mFI-5) when component data were present. Results: The cohort included 13 men and 17 women with a mean age of 54.8 ± 15.2 years. At final follow-up, 18 patients had died, and 12 were alive. Five-year overall survival was approximately 76% in the full cohort. Extraspinal metastases were present in 72.2% of deceased patients compared with 8.3% of survivors and showed the clearest exploratory association with increased mortality (HR 3.46, 95% CI 1.23–9.78; p = 0.019). Metastatic disease demonstrated inferior survival compared with primary bone or soft-tissue tumors. Perioperative blood loss and transfusion burden were substantial but were not associated with survival in univariate analysis. ODI and SF-36 data were available only in small subsets and were therefore interpreted as descriptive signals of treatment burden. Conclusions: TES remains relevant in modern spine oncology, but only as an increasingly selective intervention. In this rare cohort, systemic disease burden, particularly extraspinal metastases, was the clearest selection-relevant survival signal, while blood loss, transfusion requirements, complications, and limited patient-reported outcomes illustrated substantial treatment burden. These findings do not establish a validated selection algorithm but support a contemporary decision threshold that integrates tumor biology, systemic disease status, anticipated margins, physiologic reserve, operative morbidity, and patient goals.

Introduction: Isthmic lumbar spondylolisthesis (ILS) results from a defect of the pars interarticularis, leading to anterior vertebral displacement. We hypothesize that paraspinal muscle atrophy contributes to the degree of vertebral slippage in symptomatic ILS. Methods: This retrospective cross-sectional study included 78 patients (46 females, 32 males). Fat infiltration (FI) and height-adjusted functional cross-sectional area (HI) of the multifidus (MF), erector spinae (ES), and psoas (PS) muscles were quantified applying the Otsu thresholding method. Multivariable linear regression was used to analysis the association between the paraspinal musculature and vertebral slippage. Confounding variables such as sex, age, body mass index (BMI), disc (Pfirrmann classification) and facet joints degeneration (Weishaupt classification) were included. Results: The median age was 48.5 (interquartile range [IQR]: 31.5–55) years, median BMI was 26.4 (IQR: 22.8–29.4) kg/m², and the median translation was 33 (IQR: 24–47) %. After adjustment for demographic confounders and degeneration, the MF atrophy showed significant association with vertebral slippage (FI: η² = 0.164, p < 0.001; HI: η² = 0.052, p = 0.028). In contrast, no significant associations were observed for the ES (FI: η² = 0.012, p = 0.315; HI: η² = 0.000, p = 0.936) or PS (FI: η² = 0.001, p = 0.742; HI: η² = 0.000, p = 0.979) muscles. Conclusion: The degree of vertebral slippage in isthmic lumbar spondylolisthesis was specifically associated with multifidus atrophy, while other paraspinal muscles showed no such relationship. These results support the distinct biomechanical role of the multifidus in segmental stability.

Background: Spinal mobility and functional strength is an integral part in the orthopaedic and rheumatologic assessment of patients with spinal disorders and chronic low back pain (cLBP), yet their relationship with health-related quality of life (QoL) remains insufficiently explored. Patients and methods: This is a retrospective cross-sectional study that recruited volunteers with (cLBP) and without chronic low back pain (nLBP) between 2022 and 2025. Lumbar mobility was assessed using a device-assisted back-scan (Idiag M360 ^® ), as well as conventional functional assessments, including Schober and finger-to-floor-distance (FFD). Functional strength was assessed via sit-to-stand test (STS). Primary outcomes were the short form 36 domains Physical Functioning (SF36-PF) and Bodily Pain (SF36-BP) as well as cLBP. The International Physical Activity Questionnaire–Short Form (IPAQ-SF) served as a secondary outcome measure. Multivariable linear regression models were performed adjusted for baseline characteristics; and in a subgroup analysis stratified by LBP; binary logistic regression was performed to evaluate the independent associations of each measure for cLBP. Results: 1,309 adults (cLBP = 562, nLBP = 747) were included. LBP groups were comparable in BMI and physical activity. The STS, FFD and Idiag M360 thoracolumbar flexion/extension were significantly associated with SF36-PF and SF36-BP in both pain-status groups (all p ≤ 0.002). Greater STS performance, higher (inverted) FFD and Idiag M360 thoracolumbar flexion/extension were associated with a lower OR of cLBP (all p ≤ 0.001). The Schober test showed weaker associations with SF-36 overall (β* = 0.085–0.120). The IPAQ showed no meaningful associations with any mobility measure. Conclusions: Lumbar functional strength and mobility were strongly associated with cLBP and QoL and when reduced, was associated with higher odds for cLBP. The findings of this study support the adoption of STS and device-assisted mobility measurements for functional assessment of the spine; whether these measures can identify early, modifiable determinants of QoL or predict outcomes remains a hypothesis for prospective studies.

Background/Objectives: Sagittal spinal alignment is a key determinant of function and quality of life in degenerative spinal disorders. While age is an established determinant of sagittal balance, the independent contribution of BMI remains insufficiently characterized, particularly in degenerative scoliosis cases. This study aimed to investigate the association between BMI and sagittal alignment, quantify its effect relative to age, and explore potential sex-specific differences. Methods: This retrospective single-center study included 293 adults with degenerative scoliosis who underwent standing full-spine EOS imaging. Multivariable linear regression models assessed the association between BMI and sagittal vertical axis (SVA), adjusting for age, sex, diabetes mellitus, and osteoporosis. Secondary analyses examined associations with coronal deformity (Cobb angle) and lumbar degeneration (Wilke score). Sex-stratified analyses and Receiver Operating Characteristic (ROC) analyses for sagittal decompensation were also performed. Results: The cohort had a median BMI of 26.2 kg/m² (56% female; median age 71 years). Median SVA measured 56.4 mm (interquartile range 30.6–87.1), and 58% of patients exhibited sagittal decompensation. In sex-stratified analyses, higher BMI was independently associated with greater SVA in women (p = 0.015), whereas no significant association was observed in men (p = 0.061). ROC analysis demonstrated limited overall discrimination; however, a BMI ≥ 35 kg/m² showed high specificity and positive predictive values exceeding 80% for sagittal decompensation. Conclusions: BMI is independently associated with sagittal alignment in degenerative scoliosis and contributes to sagittal decompensation to a degree comparable to age. These findings suggest that body weight represents a clinically relevant biomechanical factor that should be considered alongside age and spinopelvic parameters when interpreting sagittal alignment, although BMI’s limited discriminatory performance for sagittal decompensation precludes its use as a standalone screening tool.