Background: Lumbar paraspinal muscles play an important role in maintaining global spinal alignment and are associated with lower back pain; however, only a few studies on the effect of the paraspinal muscles on the surgical outcome exist. Therefore, this study aimed to analyze the association of preoperative muscularity and fatty infiltration (FI) of paraspinal muscles with the outcome of lumbar interbody fusion. Methods: Postoperative clinical and radiographic outcomes were analyzed in 206 patients who underwent surgery for a degenerative lumbar disease. The preoperative diagnosis was spinal stenosis or low-grade spondylolisthesis, and the surgery performed was posterior lumbar interbody fusion or minimally invasive transforaminal lumbar interbody fusion.Indications for surgery were a complaint of severe radiating pain that did not improve with conservative treatment and neurological symptoms accompanied by lower extremity motor weakness. Patients with fractures, infections, tumors, or a history of lumbar surgery were excluded from this study. Clinical outcome measures included functional status, measured using the Oswestry disability index (ODI) and visual analog scale (VAS) score for lower back and leg pain. Other radiographic parameters included measures of spinal alignment, including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, C7 sagittal vertical axis, and pelvic incidence-lumbar lordosis mismatch. Lumbar muscularity (LM) and FI were measured preoperatively using a lumbar magnetic resonance image (MRI). Results: The high LM group showed more significant improvement in VAS score for lower back pain than the low LM group. In contrast, the VAS score for leg pain demonstrated no statistical significance. The high LM group showed more significant improvement in ODI postoperatively than the medium group. The severe FI group showed more significant improvement in ODI postoperatively, whereas the less severe FI group showed more significant improvement in the sagittal balance postoperatively. Conclusion Patients with high LM and mild FI ratio observed on preoperative MRI demonstrated more favorable clinical and radiographic outcomes after lumbar interbody fusion. Therefore, preoperative paraspinal muscle condition should be considered when planning lumbar interbody fusion.

STUDY DESIGN: A nationwide, observational, and cross-sectional study targeting postmenopausal patients from 62 orthopedic outpatient clinics in Korea between October 2010 and February 2011. PURPOSE: This study was carried out to investigate comorbidity, trauma history, and the status of osteoporotic fracture treatment in Korean postmenopausal women. OVERVIEW OF LITERATURE: There has been little reports on the comorbidity, family history, trauma history, and treatment status of osteoporotic fractures in patients visiting the orthopedic outpatient clinics in Korea. METHODS: A total of 1,255 postmenopausal women between the ages of 50 and 80 years were enrolled in the study and the population distribution was reflected by region. Comorbidity, familial history of osteoporosis, familial history of osteoporotic fracture, history of falls, and status of osteoporotic fracture management were evaluated using an interview and questionnaire. The relationship between family history of osteoporosis and bone mineral density was analyzed. RESULTS: A number of patients (23%) had a family history of osteoporosis and 16.5% had a family history of fractures. Most (64.7%) of the patients had one or more comorbidities, including 58.8% exhibiting a chronic disease and 16.4% suffering from diseases that restrict exercise or walking. The results of the questionnaire indicated that 21.8% of these fracture patients had experienced a fracture previously and that the most common type of fracture was that of the spine. Lumbar spine bone mineral density was found to be lower in the presence of family history of osteoporosis. CONCLUSIONS: Postmenopausal women are liable to have osteoporotic fractures due to the high prevalence of osteoporosis, a history of falling, and the comorbidity with diseases that restrict ambulation. A better understanding of postmenopausal women in the orthopedic outpatient settings is important to the management of osteoporotic fractures.

Conventional treatments for degenerative disc disease have limitations in regenerating the intervertebral disc because of its anatomical characteristics. Hence, researchers are investigating biological therapies for degenerative disc disease. The advances in genetic engineering and fields, such as tissue engineering, are accelerating the development of biological treatments for degenerative discs.Biological treatments for degenerative discs focus on inhibiting cell apoptosis and maintaining cell populations within the disc. Current biological therapies studied include gene therapy, cell therapy, and growth factor therapy. Gene therapy involves the use of RiboNucleic Acid (RNA) interference, such as small interfering RNA (siRNA), to inhibit genes related to cell apoptosis and to explore therapeutic targets.Cell therapy, which involves a direct injection of stem cells into the disc, has attracted considerable attention. Mesenchymal stem cells and notochordal cells are commonly used, with mesenchymal stromal/stem cells (MSCs) being preferred because of their ease of production and anti-inflammatory effects. Several clinical trials using MSCs have reported favorable clinical outcomes, such as alleviating lower back pain, but disc height was not restored. These results were not from randomized trials, and double-blind clinical trials using MSCs are currently underway. Research is ongoing to promote anabolic processes within the nucleus pulposus by injecting growth factors into the disc. Preclinical studies have shown that a biglycan fragment targeting transforming growth factor (TGF)-β can inhibit degenerative changes in the disc, and clinical trials using growth/differentiation factor (GDF)-5 are currently in progress. Research on biological treatments for degenerative discs is being conducted in three main areas: gene therapy, cell-based therapy, and growth factor-based therapy. Although cell therapy using MSCs has shown symptomatic improvement in clinical trials, a double-blind clinical trial is still needed to confirm the therapeutic effects.

Conventional treatments for degenerative disc disease have limitations in regenerating the intervertebral disc because of its anatomical characteristics. Hence, researchers are investigating biological therapies for degenerative disc disease. The advances in genetic engineering and fields, such as tissue engineering, are accelerating the development of biological treatments for degenerative discs.Biological treatments for degenerative discs focus on inhibiting cell apoptosis and maintaining cell populations within the disc. Current biological therapies studied include gene therapy, cell therapy, and growth factor therapy. Gene therapy involves the use of RiboNucleic Acid (RNA) interference, such as small interfering RNA (siRNA), to inhibit genes related to cell apoptosis and to explore therapeutic targets.Cell therapy, which involves a direct injection of stem cells into the disc, has attracted considerable attention. Mesenchymal stem cells and notochordal cells are commonly used, with mesenchymal stromal/stem cells (MSCs) being preferred because of their ease of production and anti-inflammatory effects. Several clinical trials using MSCs have reported favorable clinical outcomes, such as alleviating lower back pain, but disc height was not restored. These results were not from randomized trials, and double-blind clinical trials using MSCs are currently underway. Research is ongoing to promote anabolic processes within the nucleus pulposus by injecting growth factors into the disc. Preclinical studies have shown that a biglycan fragment targeting transforming growth factor (TGF)-β can inhibit degenerative changes in the disc, and clinical trials using growth/differentiation factor (GDF)-5 are currently in progress. Research on biological treatments for degenerative discs is being conducted in three main areas: gene therapy, cell-based therapy, and growth factor-based therapy. Although cell therapy using MSCs has shown symptomatic improvement in clinical trials, a double-blind clinical trial is still needed to confirm the therapeutic effects.

Conventional treatments for degenerative disc disease have limitations in regenerating the intervertebral disc because of its anatomical characteristics. Hence, researchers are investigating biological therapies for degenerative disc disease. The advances in genetic engineering and fields, such as tissue engineering, are accelerating the development of biological treatments for degenerative discs.Biological treatments for degenerative discs focus on inhibiting cell apoptosis and maintaining cell populations within the disc. Current biological therapies studied include gene therapy, cell therapy, and growth factor therapy. Gene therapy involves the use of RiboNucleic Acid (RNA) interference, such as small interfering RNA (siRNA), to inhibit genes related to cell apoptosis and to explore therapeutic targets.Cell therapy, which involves a direct injection of stem cells into the disc, has attracted considerable attention. Mesenchymal stem cells and notochordal cells are commonly used, with mesenchymal stromal/stem cells (MSCs) being preferred because of their ease of production and anti-inflammatory effects. Several clinical trials using MSCs have reported favorable clinical outcomes, such as alleviating lower back pain, but disc height was not restored. These results were not from randomized trials, and double-blind clinical trials using MSCs are currently underway. Research is ongoing to promote anabolic processes within the nucleus pulposus by injecting growth factors into the disc. Preclinical studies have shown that a biglycan fragment targeting transforming growth factor (TGF)-β can inhibit degenerative changes in the disc, and clinical trials using growth/differentiation factor (GDF)-5 are currently in progress. Research on biological treatments for degenerative discs is being conducted in three main areas: gene therapy, cell-based therapy, and growth factor-based therapy. Although cell therapy using MSCs has shown symptomatic improvement in clinical trials, a double-blind clinical trial is still needed to confirm the therapeutic effects.