Aims. Lumbar spinal stenosis (LSS) is a common skeletal system disease that has been partly attributed to genetic variation. However, the correlation between genetic variation and pathological changes in LSS is insufficient, and it is difficult to provide a reference for the early diagnosis and treatment of the disease. Methods. We conducted a transcriptome-wide association study (TWAS) of spinal canal stenosis by integrating genome-wide association study summary statistics (including 661 cases and 178,065 controls) derived from Biobank Japan, and pre-computed gene expression weights of skeletal muscle and whole blood implemented in FUSION software. To verify the TWAS results, the candidate genes were furthered compared with messenger RNA (mRNA) expression profiles of LSS to screen for common genes. Finally, Metascape software was used to perform enrichment analysis of the candidate genes and common genes. Results. TWAS identified 295 genes with permutation p-values < 0.05 for skeletal muscle and 79 genes associated for the whole blood, such as RCHY1 (PTWAS = 0.001). Those genes were enriched in 112 gene ontology (GO) terms and five Kyoto Encyclopedia of Genes and Genomes pathways, such as ‘chemical carcinogenesis - reactive oxygen species’ (LogP value = −2.139). Further comparing the TWAS significant genes with the differentially expressed genes identified by mRNA expression profiles of LSS found 18 overlapped genes, such as interleukin 15 receptor subunit alpha (IL15RA) (PTWAS = 0.040, PmRNA = 0.010). Moreover, 71 common GO terms were detected for the enrichment results of TWAS and mRNA expression profiles, such as negative regulation of cell differentiation (LogP value = −2.811). Conclusion. This study revealed the genetic mechanism behind the pathological changes in LSS, and may provide novel insights for the early diagnosis and intervention of LSS. Cite this article: Bone Joint Res 2023;12(6):387–396

Purpose/Background. Health inequalities are defined as unfair and avoidable differences in health across the population. People belonging to inclusion health groups are most at risk of experiencing these inequalities and tackling them is an NHS priority. Inclusion health groups include ‘people in contact with the justice system’ and BCHC NHS FT is commissioned to provide physiotherapy to prisoners at HMP Birmingham. The purpose of this study was to better understand the MSK health-status and MSK conditions affecting this minoritised patient population. Methods/Results. The MSK service at HMP Birmingham collects the MSK-HQ PROM for all prisoners attending physiotherapy. A retrospective analysis of the electronic patient record was performed using convenience sampling, with baseline MSK-HQ scores of prisoners seen between 01/04/2023 and 01/02/2024 captured alongside the primary presenting MSK condition. Simple descriptive statistics were used to evaluate the data. A total of 129 patients attended initial physiotherapy appointments within the time-period. Baseline MSK-HQ was collected for 62 patients (48%) with a mean (SD) score of 23.08(11.38). The most common MSK condition was Back pain with a count of 12(19.35%). The mean (SD) MSK-HQ score for prisoners with back pain was 22.08(9.98). Conclusion. This is the first known evaluation in the published literature of the baseline MSK health-status and primary MSK conditions affecting prisoners. A published evaluation of baseline MSK health-status for patients attending a community MSK service reported a mean (SD) MSK-HQ of 28.59(10.80) indicating that, a poorer MSK health-status is experienced by this minoritised group. Further work, co-produced with prisoners, is planned to explore further. Conflicts of interest. None. Sources of funding. None

Purposes and Background. Musculoskeletal disorders including as back and neck pain are leading causes of work disability. Effective interventions exist (i.e. functional restoration, multidisciplinary biopsychosocial rehabilitation, workplace-based interventions, etc.), but it is difficult to select the optimal intervention for specific patients. The Work Assessment Triage Tool (WATT) is a clinical decision support tool developed using machine learning to help select interventions. The WATT algorithm categorizes patients based on individual, occupational, and clinical characteristics according to likelihood of successful return-to-work following rehabilitation. Internal validation showed acceptable classification accuracy, but WATT has not been tested beyond the original development sample. Our purpose was to externally validate the WATT. Methods and Results. A population-based cohort design was used, with administrative and clinical data extracted from a Canadian provincial compensation database. Data were available on workers being considered for rehabilitation between January 2013 and December 2016. Data was obtained on patient characteristics (ie. age, sex, education level), clinical factors (ie. diagnosis, part of body affected, pain and disability ratings), occupational factors (ie. occupation, employment status, modified work availability), type of rehabilitation program undertaken, and return-to-work outcomes (receipt of wage replacement benefits 30 days after assessment). Analysis included classification accuracy statistics of WATT recommendations for selecting interventions that lead to successful RTW outcomes. The sample included 5296 workers of which 33% had spinal conditions. Sensitivity of the WATT was 0.35 while specificity was 0.83. Overall accuracy was 73%. Conclusion. Accuracy of the WATT for selecting successful rehabilitation programs was modest. Algorithm revision and further validation is needed. No conflicts of interest. Sources of funding: Funding was provided by the Workers' Compensation Board of Alberta

Background. The aim of the Groningen Spine Center (GSC) is to provide personalized and effective interventions to patients with spine-related disorders. The GSC comprises a multidisciplinary team to triage and treat patients most optimally. Aim. To investigate the patient reported clinical results of the treatments of the GSC during seven years of its existence. Patients and methods. The basis of this study is a natural cohort of all patients admitted to the GSC. Treatments existed of rehabilitation, surgery, anesthesiology, medication, referral to else, advice and self-management, or any combination of the above. Baseline characteristics, pain (Numeric Rating Scale; NRS), disability (Pain Disability Index; PDI) and quality of life (Euroqol 5-D;EQ5D) were obtained at baseline and discharge. Per calendar year, effects will be presented. Descriptive statistics, effect sizes and t-tests were calculated. Results are compared to the minimal clinically important change (MCIC) of the corresponding scales. Results. In total, 9.897 patients (43% male, mean age 49.2±16.1 yrs) were analyzed on T0, of whom 1.373 filled in a discharge questionnaire. All measures showed statistically significant changes (p<0.01), but for pain and disability mean changes were not always higher than the clinical important change. Effect sizes (d) for pain ranged between 0.44 and 1.01, for disability between 0.40 and 0.80, and for quality of life between 0.41 and 0.76. Conclusion. The Groningen Spine Center provides positive patient reported results over the past 7 years Effect sizes are moderate to high. The results are considered to be clinically important to patients. Non-response and regression to the mean may be sources for bias and should be topic for further research. No conflicts of interest. No funding obtained

Introduction. A minority of patients with chronic low back pain (CLBP) account for a majority of disability and costs. This subgroup has potentially most to gain from effective treatment. The Groningen Spine Cohort will provide a 10-year prospective insight into the burden of CLBP for patients referred to multispecialty tertiary spine care in the Netherlands. This study reports first baseline results. Objective. To study the personal and societal impact of CLBP in patients visiting the UMCG tertiary spine center. Patients. Adult patients with CLBP. Methods. Patient-reported baseline questionnaire and health insurance costs one year prior to visiting the Spine Center. Primary outcomes: NIH minimal dataset Impact Stratification score (range 8–50), functioning (Pain Disability Index, PDI; 0–70), quality of life (EuroQol-5D, EQ5D; -0.33–1.00), work ability (single-item Work Ability Score, WAS; 0–10), work participation (absenteeism, disability), and health insurance costs. Descriptive statistics were applied. Results. N=1503 patients (age m=46.3, sd=12.8 years, 57% female) were included. NIH Impact Stratification m=35.2±7.5; severe impact (≥35) for 58% of patients. PDI = 38.2±14.1; EQ5D = 0.44±0.30; WAS = 3.8±2.9. Absenteeism: 43% of workers. Permanent work disability: 17%. Health insurance costs: med= €2432, IQR €4739. Discussion And Conclusions. In patients seeking multispecialty tertiary spine care, the personal and societal impact of CLBP is very high. Costs are substantially higher than what is already known about the burden of the average patient with CLBP. Clinical Message. More effective personalized stepped and matched care is urgently needed to reduce the burden of CLBP in a subgroup of patients seeking multispecialty tertiary spine care. No conflicts of interest. Sources of Funding: Funding from the University Medical Center Groningen

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Degenerative cervical spondylosis (DCS) is a common musculoskeletal disease that encompasses a wide range of progressive degenerative changes and affects all components of the cervical spine. DCS imposes very large social and economic burdens. However, its genetic basis remains elusive.

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People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial).

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Developmental cervical spinal stenosis (DcSS) is a well-known predisposing factor for degenerative cervical myelopathy (DCM) but there is a lack of consensus on its definition. This study aims to define DcSS based on MRI, and its multilevel characteristics, to assess the prevalence of DcSS in the general population, and to evaluate the presence of DcSS in the prediction of developing DCM.

The exact prevalence of scoliosis remains unknown however it appears to be stable over time. In contrast the surgical management of spinal deformity has evolved considerably. In the UK this can be observed by examining recorded hospital statistics. Specifically the volume of procedures undertaken and preferred technique to correct deformity can be analysed and trends captured providing a comprehensive picture of changing UK practice. Annual data tables from 2000 to 2013 were downloaded from the health information and social care UK website which contains Hospital Episode Statistics (HES) data online. Numbers of completed consultant episodes for the four character primary procedure codes V41.1 (posterior attachment of correctional instrument to spine), V41.2 (anterior attachment of correctional instrument to spine), V41.4 (Anterior and posterior attachment of correctional instrument to spine), V41.8 and V41.9 (other specified and other non-specified instrumental correction of spinal deformity respectively) as main procedure where recorded. The total number of attachment of correctional instrument procedures listed as main procedure has increased significantly. The increase consists of higher numbers of posterior attachment procedures over this time from 352 in 2011–2012 to 1967 in 2012–2013 with data demonstrating a year on year increase to 2009–2010 before plateauing. Unspecified and other specified instrumental correctional spinal procedures have also contributed to the overall rise increasing from 206 in 2000–2001 to 447 in 2012–2013. Anterior attachment procedures listed as the main procedure are currently declining in number from a peak of 230 in 2005–2006 to 89 in 2012–2013. Combined posterior and anterior attachment procedures have also decreased marginally from 27 in 2009–2010 to 19 in 2012–2013. Unfortunately combined anterior and posterior procedures were not uniquely coded until 2009–2010. There is also some inherent variability in accuracy of coding which may distort HES data. Despite these limitations these results are likely to represent genuine changes in practice for the surgical correction of spinal deformity over the time period examined

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Only a few studies have investigated the long-term health-related quality of life (HRQoL) in patients with an idiopathic scoliosis. The aim of this study was to investigate the overall HRQoL and employment status of patients with an idiopathic scoliosis 40 years after diagnosis, to compare it with that of the normal population, and to identify possible predictors for a better long-term HRQoL.

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Implant-related postoperative spondylodiscitis (IPOS) is a severe complication in spine surgery and is associated with high morbidity and mortality. With growing knowledge in the field of periprosthetic joint infection (PJI), equivalent investigations towards the management of implant-related infections of the spine are indispensable. To our knowledge, this study provides the largest description of cases of IPOS to date.

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The aim of this study was to reassess the rate of neurological, psoas-related, and abdominal complications associated with L4-L5 lateral lumbar interbody fusion (LLIF) undertaken using a standardized preoperative assessment and surgical technique.

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Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of ‘full-time bracing’ versus ‘night-time bracing’ in adolescent idiopathic scoliosis (AIS).

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The aim of this study was to investigate the incidence and characteristics of instrumentation failure (IF) after total en bloc spondylectomy (TES), and to analyze risk factors for IF.

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To determine the major risk factors for unplanned reoperations (UROs) following corrective surgery for adult spinal deformity (ASD) and their interactions, using machine learning-based prediction algorithms and game theory.

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Postoperative complication rates remain relatively high after adult spinal deformity (ASD) surgery. The extent to which modifiable patient-related factors influence complication rates in patients with ASD has not been effectively evaluated. The aim of this retrospective cohort study was to evaluate the association between modifiable patient-related factors and complications after corrective surgery for ASD.

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Frailty has been gathering attention as a factor to predict surgical outcomes. However, the association of frailty with postoperative complications remains controversial in spinal metastases surgery. We therefore designed a prospective study to elucidate risk factors for postoperative complications with a focus on frailty.

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Traumatic central cord syndrome (CCS) typically follows a hyperextension injury and results in motor impairment affecting the upper limbs more than the lower, with occasional sensory impairment and urinary retention. Current evidence on mortality and long-term outcomes is limited. The primary aim of this study was to assess the five-year mortality of CCS, and to determine any difference in mortality between management groups or age.

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The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc’s cross-sectional area on T2 axial MRI scans.

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The aims of this study were to determine the diagnostic yield of image-guided biopsy in providing a final diagnosis in patients with suspected infectious spondylodiscitis, to report the diagnostic accuracy of various microbiological tests and histological examinations in these patients, and to report the epidemiology of infectious spondylodiscitis from a country where tuberculosis (TB) is endemic, including the incidence of drug-resistant TB.