This article reports a case series evaluating the short-term clinical outcomes of full-endoscopic disc cleaning (FEDC), which is one of the most minimally invasive surgical procedures for treating chronic low back pain (CLBP) due to Modic changes (MCs). Seven patients who underwent FEDC at Tokushima University Hospital between 2019 and 2021, with postoperative clinical outcomes available over a follow-up period of more than 12 months, were included in the study. Six men and one woman underwent FEDC. The average age of the patients was 48.7 years with an average CLBP duration of 9.4 years. Five of these patients showed favorable outcomes, with reductions in LBP. The other 2 required revision surgery at the 12-month follow-up due to recurrent symptoms. One of the patients who required revision surgery was the oldest in this series, a 73-year-old woman with mixed signal changes including Modic type 3 at the anterior corner at L2–3 to L4–5 levels with spinal malalignment. Although disc block was immediately effective, pain reproduction on discography yielded unclear results. The clinical outcomes of this series suggest that FEDC may be particularly effective for patients with inflammatory type 1 and type 2 changes and less advanced degenerative changes. However, in cases involving more complex degeneration, such as type 3 changes or notable spinal deformities, CLBP may arise from multiple contributing factors beyond MCs alone, underscoring the importance of a thorough evaluation when determining surgical indications for FEDC.

Transforaminal full-endoscopic lumbar surgery is widely accepted as a method of treating lumbar conditions, such as disc herniation, spinal stenosis, and lumbar foraminal stenosis (LFS). This minimally invasive approach, often performed under local anesthesia, is ideal for older patients and those with significant comorbidities. Full-endoscopic lumbar foraminotomy (FELF) has shown high success rates and notable symptom relief for LFS. However, complications including postoperative dysesthesia, dural tears, restenosis, and scoliosis progression, especially at L5–S1 due to extensive facet joint resection, remain challenges. In such cases, lumbar fusion may be more appropriate. A unique anatomical feature, the "lateral kissing spine," is characterized by contact between the L5 transverse process and the sacral ala. This feature appears to mitigate scoliosis progression, regardless of the preoperative Cobb angle or bone resection extent during FELF. We report two L5–S1 foraminal stenosis cases treated with FELF under local anesthesia: one with a lateral kissing spine, showing no scoliosis progression, and another without it, demonstrating significant progression. A review of 11 additional cases supports the protective role of the lateral kissing spine against scoliosis, even in cases with severe preoperative Cobb angles. This study reviews the complications of FELF, focusing on scoliosis progression, and proposes indications for FELF, highlighting the importance of the lateral kissing spine in surgical decision-making.

Methods: Hospitalized patients with acute VFs underwent assessment of vertebral morphology and paraspinal muscles. Two weeks post-admission, patients were evaluated for pain intensity (using the Verbal Rating Scale [VRS]), pain sensitivity (Pressure Pain Threshold [PPT] and Conditioned Pain Modulation), psychological factors, physical function, and activity levels. At 12 weeks, patients were categorized into CP and non-CP (NCP) groups based on VRS scores. Between-group comparisons and logistic regression analysis were performed to identify predictors of CP development. Results: The CP group exhibited significantly lower remote PPT and reduced low-intensity physical activity time, but higher Pain Catastrophizing Scale rumination scores and prolonged 5-Times Sit-to-Stand Test (5SST) compared to the NCP group. Logistic regression identified prolonged 5SST and reduced low-intensity physical activity as independent predictors of CP development. Conclusions Prolonged 5SST and reduced low-intensity physical activity may predict CP development after VFs. Early assessment of these factors may facilitate CP risk screening in hospitalized patients with VFs.

In the 2 decades or so since full-endoscopic spine surgery (FESS) was introduced, the procedure has advanced considerably. There are 2 major approaches of FESS, transforaminal (TF) and interlaminar. In this review article, we discuss the key strengths and merits of TF-FESS based on a literature search. First, the minimal invasiveness of the procedure allows for early return to work. Second, minimal invasiveness of the back muscles enables athletes to make a faster return to their previous competitive level. Third, the ability to perform TF-FESS under local anesthesia means it is suitable even in the elderly with poor general health.

Transforaminal full-endoscopic spine surgery (TF-FESS) is a minimally invasive surgical procedure that can be performed with only an 8-mm skin incision under local anesthesia. TF-FESS has been used to treat not only lumbar disc herniation, but also lumbar spinal stenosis. This paper describes transforaminal full-endoscopic lateral recess decompression. The best indication for this procedure is unilateral recess stenosis accompanied by transversing nerve root radiculopathy, with or without exiting nerve root radiculopathy. The skin entry point is about 6–8 cm from the midline, and the precise point is determined by preoperative planning. After local anesthesia, an 8-mm skin incision is made, and the cannula is placed on the surface of the superior articular process (SAP). Next, the SAP is resected from the pedicle to the tip using a high-speed drill to expose the facet joint space and flavum by the hand-down technique (gradually changing hand position to be downwards and moving the cannula inwards). After removing the flavum, the completely decompressed transversing nerve root can be clearly visualized and confirmed under fluoroscopy. Two hours postoperatively, patients can walk without restriction. Because this procedure requires the complete resection of the ventral side of the facet, it is also called full-endoscopic ventral facetectomy.

STUDY DESIGN: Prospective study. PURPOSE: During fluoroscopically guided spinal procedure, the hands of spinal surgeons are placed close to the field of radiation and may be exposed to ionizing radiation. This study directly measured the radiation exposure to the hand of a spinal interventionalist during fluoroscopically guided procedures. OVERVIEW OF LITERATURE: Fluoroscopically guided spinal procedures have been reported to be a cause for concern due to the radiation exposure to which their operators are exposed. METHODS: This prospective study evaluated the radiation exposure of the hand of one spinal interventionalist during 52 consecutive fluoroscopic spinal procedures over a 3-month period. The interventionalist wore three real-time dosimeters secured to the right forearm, under the lead apron over the chest, and outside the lead apron over the chest. Additionally, one radiophotoluminescence glass dosimeter was placed under the lead apron over the left chest and one ring radiophotoluminescence glass dosimeter was worn on the right thumb. The duration of exposure and radiation dose were measured for each procedure. RESULTS: The average radiation exposure dose per procedure was 14.9 µSv, 125.6 µSv, and 200.1 µSv, inside the lead apron over the chest, outside the lead apron over the chest, and on the right forearm, respectively. Over the 3-month period, the protected radiophotoluminescence glass dosimeter over the left chest recorded less than the minimum reportable dose, whereas the radiophotoluminescence glass ring dosimeter recorded 368 mSv for the thumb. CONCLUSIONS: Our findings indicated that the cumulative radiation dose measured at the dominant hand may exceed the annual dose limit specified by the International Commission on Radiological Protection. Spinal interventionalists should take special care to limit the duration of fluoroscopy and radiation exposure.
Fingers ; Fluoroscopy ; Forearm ; Glass ; Hand* ; Prospective Studies ; Radiation Exposure* ; Radiation, Ionizing ; Surgeons ; Thorax ; Thumb

We report a case with compression myelopathy due to proliferative changes around the C2 pars defects without instability. A 69-year-old man presented with progressive clumsy hands and spastic gait. Plain radiographs showed bilateral spondylolysis (pars defects) at C2 and fusion between C2 and C3 spinous processes. Dynamic views revealed mobility through the pars defects, but there was no apparent instability. Computed tomography showed proliferative changes at the pars defects, which protruded into spinal canal. On magnetic resonance imaging, the spinal cord was compressed and intramedullary high signal change was found. A diagnosis of compression myelopathy due to proliferative changes around the C2 pars defects was made. We performed posterior decompression. Postoperatively, symptoms have been alleviated and images revealed sufficient decompression and no apparent instability. In patients with the cervical spondylolysis, myelopathy caused by instability or slippage have been periodically reported. The present case involving C2 spondylolysis is extremely rare.
Aged ; Decompression ; Diagnosis ; Gait Disorders, Neurologic ; Hand ; Humans ; Magnetic Resonance Imaging ; Spinal Canal ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases* ; Spondylolysis

STUDY DESIGN: A radiologic study of sacropelvic morphology and vacuum phenomenon of sacroiliac joint in subjects unrelated to low back pain. PURPOSE: The aim of this study is to describe the relationship between sacropelvic morphology and vacuum phenomenon of the sacroiliac joint. OVERVIEW OF LITERATURE: Lumbopelvic alignment and sacropelvic morphology are associated with the pathomechanisms of various spinal disorders. The vacuum phenomena of the sacroiliac joint (SJVP) are often observed in clinical practice, but the relationships between these phenomena and sacropelvic morphology have not been investigated. This study examined the prevalence of SJVP in computed tomography (CT) images and the relationship between sacropelvic morphology and SJVP. METHODS: We analyzed multiplanar CT images of 93 subjects (59 men, 34 women). Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) were measured using the three-dimensional reconstruction method. The prevalence of SJVP in multiplanar CT images were reviewed. Roland-Morris Disability Questionnaire (RDQ) scores and the modified Japanese Orthopedic Association (JOA) score, which focuses on subjective symptoms and restriction of activities of daily living, were also obtained from all the subjects. RESULTS: Thirty-six of the 93 subjects had SJVP (39%), with marked female predominance (91% women, 8.5% men). Men with SJVP had significantly lower PI than men without SJVP (35.1° vs. 46.3°, p<0.05). There was no correlation between SJVP and the modified JOA or RDQ scores. CONCLUSIONS: These data suggest that differences in sacropelvic morphology can influence the biomechanical environment and contribute to SJVP in men. Presence of SJVP did not affect JOA or RDQ scores.
Activities of Daily Living ; Animals ; Asian Continental Ancestry Group ; Female ; Humans ; Incidence ; Lordosis ; Low Back Pain ; Lumbosacral Region ; Male ; Methods ; Orthopedics ; Pelvis ; Prevalence ; Sacroiliac Joint* ; Vacuum*

PURPOSE: Pain from osteoarthritis (OA) is generally classified as nociceptive (inflammatory). Animal models of knee OA have shown that sensory nerve fibers innervating the knee are significantly damaged with destruction of subchondral bone junction, and induce neuropathic pain (NP). Our objective was to examine NP in the knees of OA patients using painDETECT (an NP questionnaire) and to evaluate the relationship between NP, pain intensity, and stage of OA. MATERIALS AND METHODS: Ninety-two knee OA patients were evaluated in this study. Pain scores using Visual Analogue Scales (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), painDETECT, duration of symptoms, severity of OA using the Kellgren-Lawrence (KL) system, and amount of joint fluid were evaluated and compared using a Spearman's correlation coefficient by rank test. RESULTS: Our study identified at least 5.4% of our knee OA patients as likely to have NP and 15.2% as possibly having NP. The painDETECT score was significantly correlated with the VAS and WOMAC pain severity. Compared with the painDETECT score, there was a tendency for positive correlation with the KL grade, and tendency for negative correlation with the existence and amount of joint fluid, but these correlations were not significant. CONCLUSION: PainDETECT scores classified 5.4% of pain from knee OA as NP. NP tended to be seen in patients with less joint fluid and increased KL grade, both of which corresponded to late stages of OA. It is important to consider the existence of NP in the treatment of knee OA pain.
Aged ; Aged, 80 and over ; Female ; Humans ; Knee/pathology/physiopathology ; Male ; Middle Aged ; Neuralgia/*physiopathology ; Osteoarthritis, Knee/*physiopathology

The remarkable progress and spread of ultrasonic diagnostic equipment has maid it possible to diagnose various diseases more easily and quickly.
From August, 1983, we began to examine abdominal organs such as the liver, gallbladder, pancreas, kidney, spleen, and bile duct using ultrasonic diagnostic equipment in the Health Care Center. On the other hand, we began ultrasonographic (US) mass screening for the people in the rural areas and occupational areas from March, 1984.
We examined 9803 subjects in the Health Care Center and 11558 subjects in 23 rural areas and 15 occupational areas of Kumamoto Prefecture through June, 1986. Among these 21361 subjects, 6882 (32.2 percent) cases showed abnormal findings. Main diseases detected by US screening were gallstone, gallbladder polyp, liver cyst, liver tumor, renal cyst, renal tumor, renal stone, and so on.
In the Health Care Center we could find 23 cancer cases such as two gallbladder cancer cases, seven hepatoma cases, twelve renal cell carcinoma cases, one bile duct carcinoma case, and one gastric cancer case. The prevalence rate was 0.23 percent. On the other hand, 14 cancer cases such as two gallbladder cancer cases, three hepatoma cases, two metastatic liver cancer cases, four renal cell carcinoma cases, one transitional cell carcinoma case of the kidney, and one pancreas cancer case were found in the US mass screening. The prevalence rate was 0.12 percent.
By using ultrasonic diagnostic equipment, we can find many latent diseases which show no abdominal findings by the traditional screening systems. Especially the fact that we discovered many cancer cases and the majority of them were operated on in their early stage was highly important. If we had no chance to examine these patients by US examination, these cancer cases could probably not have been discovered.
To conqure various problems such as the training of examiners, the systematization of these thorough examinations as well as post examination therapy, and the education of examinees will difinitely contribute significantly to the effectiveness of the US mass screening method.