Purpose: Segmental instability guides surgical decision-making in isthmic lumbar spondylolisthesis (ILS). Despite concerns regarding radiation exposure, reproducibility and applicability in patients with pain or limited mobility, flexion–extension (FE) radiographs remain the standard for instability assessment. Combining upright radiographs with supine magnetic resonance imaging (MRI), both routinely obtained in clinical practice, may offer a comparable, lower-radiation alternative. This study aimed to compare segmental motion at L5/S1 between FE and upright–supine (US) imaging and to evaluate their ability to detect radiographic instability. Methods: In this retrospective cross-sectional study, consecutive patients surgically treated for isolated L5/S1 ILS were screened for eligibility. Segmental motion was assessed using FE radiographs and US imaging, including measurements of dynamic sagittal translation and the proportion of patients identified with radiographic signs of instability. Preoperative pain intensity was assessed using the Numeric Rating Scale (NRS). Results: Of 126 screened patients, 78 met inclusion criteria (59% female; median age 48.5 years; median BMI 26.4 kg/m²). Dynamic sagittal translation was significantly greater on US than on FE ( p < 0.001). US imaging identified more cases of radiographic instability ( p < 0.001). Only US-measured translation was associated with preoperative low back pain intensity ( p = 0.025) and was inversely associated with intervertebral disc degeneration ( p = 0.014). Conclusions: US imaging detected a higher proportion of radiographically unstable ILS cases than FE radiographs. Furthermore, only US-derived translation was associated with pain intensity, suggesting greater clinical relevance. Combining upright radiographs with supine MRI may offer a practical, low-radiation alternative for preoperative instability assessment.

Degenerative lumbar spondylolisthesis (DLS) is a major indication for lumbar surgery. Surgical decision-making, particularly regarding the need for fusion, often depends on radiographic detection of segmental instability. Flexion–extension (FE) radiographs remain the reference standard but are limited by radiation exposure, motion-related discomfort, and poor reproducibility, whereas upright–supine (US) imaging - combining upright lateral radiographs with supine MRI - may offer a comparable, low-radiation alternative using routinely acquired images. To compare segmental motion at L4/5 between FE and US imaging and evaluate their respective abilities to identify patients with radiographic signs of instability. In this retrospective cross-sectional study, 128 patients surgically treated for isolated L4/5 DLS were included. Segmental motion was analyzed using FE and US imaging by determining relative slippage, dynamic slip angle, and radiographic instability, defined as sagittal translation ≥8% and/or a dynamic slip angle ≥10°. Relative slippage was comparable between US and FE imaging (US: 7.43 ± 5.10%; FE: 7.29 ± 4.57%; p = 0.994). The dynamic slip angle was significantly higher in US imaging compared to FE imaging (US: 6.42 ± 4.20°; FE: 4.03 ± 2.98°; p < 0.001). US imaging identified more patients with radiographic signs of instability compared to FE imaging (US: n = 68, 53.1%; FE: n = 42, 32.8%; p < 0.001). US imaging identified a higher proportion of patients meeting established thresholds for radiographic instability compared to FE radiographs. Although FE imaging remains the diagnostic standard, US imaging may offer a practical, low-radiation alternative for preoperative assessment. Prospective investigations are warranted to confirm its clinical utility.

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: Recent studies highlight the crucial role of the paraspinal musculature (PM), particularly the multifidus (MF), in spinal health and patient outcomes. However, factors associated with PM atrophy and their relative importance remain unclear. To address this gap, we analyzed factors linked to PM atrophy in patients undergoing lumbar fusion using machine learning, aiming to clarify the multifactorial mechanisms underlying this condition. Methods: Fatty infiltration (FI) of the lumbar MF was measured as a proxy for muscular atrophy in patients undergoing lumbar spinal fusion. Two machine learning models, logistic regression and extreme gradient boosting (XGBoost), were trained to predict severe FI (> 50%) of the MF. Model performance was evaluated on unseen test data using receiver operating characteristic (ROC) analysis and Brier score, and predictor importance was assessed via SHAP (SHapley Additive exPlanations). Results: The study included 316 patients, primarily treated due to lumbar spinal stenosis. Both machine learning models effectively predicted severe MF atrophy, with an area under the curve (AUC) of 0.83 (95% CI 0.74–0.83) for the logistic regression and 0.88 (95% CI 0.81–0.88) for the XGBoost. In the logistic regression model, only sex, age, and facet joint degeneration were significant predictors. The XGBoost model identified the same top three variables, while the lumbar endplate score and bone mineral density ranked higher than in logistic regression. Conclusion: This study introduces a novel framework for analyzing factors influencing PM atrophy, highlighting the intricate interplay between demographic variables like age and sex and facet joint degeneration. By applying modern machine learning techniques, we improved predictive accuracy and identified endplate and bone changes as strongly associated factors, offering valuable insights into the mechanisms shaping muscle health in lumbar conditions.

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.

Introduction: The increasing demand for arthroscopic procedures, combined with limited access to affordable training opportunities, emphasizes the need to explore alternative methods for developing essential surgical skills. The objective of this study was to determine whether regular video game playing, known to enhance visuospatial perception and motor skills, improves initial performance on an arthroscopic box trainer and to investigate the relationship between video game proficiency and basic arthroscopic skills. Methods: This prospective study included 50 students. Participants were divided into two groups, gamers and non-gamers, based on their weekly gaming activity. Arthroscopic skills were assessed using three specific modules on an arthroscopic box trainer, while video gaming performance was assessed using Super Monkey Ball (Nintendo Wii) and Splatoon 2 (Nintendo Switch). Quantitative analyses were performed for all tasks, including time and error rates. Results: Fifty participants (76% male, 24% female; age 19–30 years) were analyzed. Gamers performed significantly better in Splatoon ( p < 0.001), while differences in Super Monkey Ball were not significant ( p = 0.172). In the arthroscopy modules, completion times and error rates did not differ significantly between groups. A significant correlation was observed between Super Monkey Ball scores and the Numbers module ( r = -0.418, p = 0.003) as well as overall arthroscopy performance ( r = -0.356, p = 0.011), indicating that higher scores were associated with shorter completion times and better performance. Conclusions: The study did not confirm that regular video gaming improves initial performance on an arthroscopic box trainer. However, the observed associations between specific video game performance measures and arthroscopic performance suggest that gaming may support the development of skills relevant to minimally invasive surgery. Level of Evidence: Level II, Prospective comparative study.