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Original Article

Special Issue: BioSpine
Epidemiology

Functional Resilience in Chronic Low Back Pain: Dissociating Magnetic Resonance Imaging Abnormalities From Real-World Disability in the Wakayama Spine Study
Masatoshi Teraguchi, Marinko Rade, Hiroshi Hashizume, Jeremy Fairbank, Yuyu Ishimoto, Keiji Nagata, Ryohei Kagotani, Shizumasa Murata, Hiroyuki Oka, Toshiko Iidaka, Sakae Tanaka, Noriko Yoshimura, Munehito Yoshida, Hiroshi Yamada
Neurospine 2026;23(2):276-289.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.26520312.0156

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Functional Resilience in Chronic Low Back Pain: Dissociating Magnetic Resonance Imaging Abnormalities From Real-World Disability in the Wakayama Spine Study
Neurospine. 2026;23(2):276-289.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.26520312.0156
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Functional Resilience in Chronic Low Back Pain: Dissociating Magnetic Resonance Imaging Abnormalities From Real-World Disability in the Wakayama Spine Study
Neurospine. 2026;23(2):276-289.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.26520312.0156
Close
Objective
Low back pain (LBP) is common, yet many individuals maintain normal activities of daily living despite chronic symptoms and structural changes evident on imaging. We hypothesized that functional resilience, defined as preserved functional capacity despite pain and age‑typical degenerative changes, represents a meaningful clinical phenotype, and that function‑centered outcome measures would better discriminate disability status than structural imaging features.
Methods
This study analyzed 347 participants reporting LBP from the Wakayama Spine Study (N=866). Maintained function was defined a priori as Oswestry Disability Index (ODI) ≤20%. We compared those with maintained function (n=220, 63.4%) to those with impairment (n=127) across demographics, lifestyle, metabolic components, physical performance (grip strength, gait speed), and lumbar magnetic resonance imaging (MRI) findings. Multivariable logistic regression among participants with LBP, including age, sex, obesity, metabolic factors, pain intensity, physical performance, and MRI phenotypes, was used to identify independent predictors of functional resilience.
Results
Functional resilience was common: 63.0% of LBP participants had ODI ≤20%. Resilient individuals were younger (65.0±11.9 years vs. 74.6±10.9 years, p<0.001) with superior physical performance. In multivariable models, male sex predicted maintained function (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.03–3.00; p<0.05), while obesity (body mass index ≥25 kg/m2) was associated with reduced odds of resilience (OR, 0.50; 95% CI, 0.30–0.84; p<0.01). Standard MRI features, including disc degeneration, Modic changes, and Schmorl nodes, were not independently associated with functional status after adjustment, despite disc degeneration being highly prevalent even among resilient participants (95.4%).
Conclusion
These data confirm that functional resilience is common in LBP and is not negated by the presence of structural MRI abnormalities. Among LBP patients, male sex and absence of obesity are independent predictors of maintained function, whereas standard MRI features do not independently predict functional status after age adjustment. Function-centered metrics (ODI, gait speed, grip strength) better discriminate functional status than structural imaging findings.

Citations

Citations to this article as recorded by  Crossref logo
  • From the Editor-in-Chief: Featured Articles in the April 2026 Issue
    Inbo Han
    Neurospine.2026; 23(2): 227.     CrossRef
  • A Commentary on “Functional Resilience in Chronic Low Back Pain: Dissociating Magnetic Resonance Imaging Abnormalities From Real-World Disability in the Wakayama Spine Study”
    Shigeo Ueda
    Neurospine.2026; 23(2): 290.     CrossRef
  • 594 View
  • 24 Download
  • 2 Crossref

Review Articles

Adapt, Mitigate, and Target: The Role of Oxidative Stress in Intervertebral Disc Homeostasis and Disc Degeneration
Shota Tamagawa, Jordy Schol, Luca Ambrosio, Hidetoshi Nojiri, Muneaki Ishijima, Daisuke Sakai
Neurospine 2026;23(2):316-334.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.26420332.0166

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Adapt, Mitigate, and Target: The Role of Oxidative Stress in Intervertebral Disc Homeostasis and Disc Degeneration
Neurospine. 2026;23(2):316-334.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.26420332.0166
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Adapt, Mitigate, and Target: The Role of Oxidative Stress in Intervertebral Disc Homeostasis and Disc Degeneration
Neurospine. 2026;23(2):316-334.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.26420332.0166
Close
The intervertebral disc (IVD) is defined by a uniquely avascular niche characterized by constitutive hypoxia, limited nutrient diffusion, acidic pH, hyperosmolarity, and repetitive mechanical loading. These stressors interact with each other rather than acting in isolation. Reduced endplate transport exacerbates hypoxia and glucose deprivation, driving glycolytic lactate accumulation and acidification. In parallel, acid-osmotic stress perturbs ion homeostasis and mitochondrial membrane potential, while mechanical loading promotes microdamage and inflammatory mediator release. Together they converge on common reactive oxygen species (ROS)-generating nodes, including mitochondrial electron transport disruption, membrane oxidase activation, and endoplasmic reticulum stress, while redox-sensitive signaling by nuclear factor erythroid 2-related factor 2, hypoxia-inducible factor 1/2, nuclear factor kappa B, and mitogen-activated protein kinases integrates metabolic rewiring with catabolic and inflammatory programs. In a healthy state, controlled ROS levels participate in healthy cell signaling and are counterbalanced by antioxidant systems; however, when compensatory capacity is exceeded, oxidative stress becomes self-reinforcing through inflammation-ROS feedback, mitochondrial dysfunction, and impaired proteostasis. This shift drives apoptosis and senescence of disc cells, extracellular breakdown, and endplate, thereby promoting IVD degeneration and creating a microenvironment for vascular and nerve ingrowth associated with discogenic low back pain. We propose an “Adapt-Mitigate-Target” framework that maps (1) physiological adaptation, (2) transition to redox breakdown, and (3) therapeutic opportunities to reduce the oxidative stress burden. We also highlight translational constraints imposed by disc transport barriers and discuss stage-appropriate systemic, local/intradiscal, and mitochondria-directed strategies, alongside a roadmap for biomarkers, precision phenotyping, and combination therapies.
  • 418 View
  • 20 Download

Systematic Review

Mesenchymal Stromal Cells for the Treatment of Discogenic Low Back Pain: A Systematic Review of Clinical Studies
Gianluca Vadalà, Fabrizio Russo, Giuseppe Francesco Papalia, Luca Ambrosio, Maria Tucci, Giorgia Petrucci, Inbo Han, Rocco Papalia, Vincenzo Denaro
Neurospine 2025;22(4):998-1011.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2551046.523

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Mesenchymal Stromal Cells for the Treatment of Discogenic Low Back Pain: A Systematic Review of Clinical Studies
Neurospine. 2025;22(4):998-1011.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2551046.523
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Mesenchymal Stromal Cells for the Treatment of Discogenic Low Back Pain: A Systematic Review of Clinical Studies
Neurospine. 2025;22(4):998-1011.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2551046.523
Close
This study aimed to elucidate the efficacy and safety of mesenchymal stromal cell (MSC) therapy for chronic discogenic low back pain (LBP). A systematic literature search was conducted on PubMed/Medline, Scopus, Cochrane, and ClinicalTrials.gov following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Eligible studies included published and ongoing clinical trials assessing intradiscal MSC injections in patients with chronic discogenic LBP unresponsive to conservative treatment. Risk-of-bias (RoB) assessment was performed through MINORS (Methodological Index for Non-randomized Studies) and RoB 2 tools. Within- and between-group differences were expressed as means and 95% confidence intervals. Effect sizes were calculated through Cohen d and g. Data from 10 published clinical studies (n=736; 470 in treatment and 266 in control groups) revealed a mean age of 41.5 years and an average follow-up of 21.6 (range, 6–72) months. Various MSC sources were employed, including autologous and allogeneic bone marrow-derived MSCs and adipose-derived MSCs, with doses ranging from 6×10⁶ to over 50×10⁶ cells/disc. Visual analogue scale, Oswestry Disability Index, and quality-of-life questionnaires indicated modest improvements in pain, disability, and functional status. Additionally, magnetic resonance imaging assessments occasionally demonstrated increased disc hydration and stabilization or improvement of Pfirrmann grade. Data from 8 ongoing trials (n=498 participants; 276 treatment, 222 control) with follow-up periods ranging 6–24 months further corroborate the feasibility and safety of MSC-based interventions. MSC therapy is a biologically-driven approach for managing chronic discogenic LBP. While preliminary data support its potential to alleviate pain and improve disc integrity, further high-quality, standardized trials are necessary to optimize treatment protocols and confirm long-term clinical benefits.
  • 1,836 View
  • 60 Download

Original Article

Basic Science – Intervertebral Disc Degeneration

Magnetic Resonance Spectroscopy Lipids Peak May Serve as a Potential Biomarker for Back Pain in Intervertebral Disc Degeneration: An Integrative Metabolomics and Proteomics Study Investigating the Role of the Lipid Droplets-Interleukin-17 Inflammatory Axis
Xi Chen, Jiang Jiang, Yijun Dong, Shuangshuang Tu, Chuanfu Li, Wenzhi Zhang, Yongjin Li, Jun Hu
Neurospine 2025;22(4):918-933.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2519750.395

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Magnetic Resonance Spectroscopy Lipids Peak May Serve as a Potential Biomarker for Back Pain in Intervertebral Disc Degeneration: An Integrative Metabolomics and Proteomics Study Investigating the Role of the Lipid Droplets-Interleukin-17 Inflammatory Axis
Neurospine. 2025;22(4):918-933.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2519750.395
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Magnetic Resonance Spectroscopy Lipids Peak May Serve as a Potential Biomarker for Back Pain in Intervertebral Disc Degeneration: An Integrative Metabolomics and Proteomics Study Investigating the Role of the Lipid Droplets-Interleukin-17 Inflammatory Axis
Neurospine. 2025;22(4):918-933.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2519750.395
Close
Objective
To explore and validate clinical magnetic resonance spectroscopy (MRS) biomarkers associated with patient-reported symptoms in intervertebral disc degeneration, and to further elucidate the pathogenic mechanisms linking these symptoms to MRS biomarkers via an integrative multiomics approach.
Methods
Patients categorized into the predominant lipids peak (pLP) group and the non-pLP group based on MRS spectrum lipids peak. Nucleus pulposus cells underwent lipidomics, proteomics and functional experiments. Outcome measures compared, and Pearson correlation coefficient evaluated relationships between symptoms, interleukin (IL)-17 immune-positive cells, and lipid contents. Multivariate linear analysis was employed to analyze the contributions of various variables to patient-reported symptoms.
Results
The pLP group exhibited significantly higher preoperative visual analogue scale (VAS)-back scores (6.5 vs. 4.7, p<0.01) and Oswestry Disability Index (ODI) scores (63.3% vs. 51.2%, p<0.01) compared to the non-pLP group. The multiomics analysis revealed the pLP group was characterized by lipid droplets accumulation in nucleus pulposus cells, and the activation of interleukin-17 (IL-17) inflammatory pathway. Preoperative VAS-back and ODI scores showed positive correlations with the expressions of IL-17 (r=0.555, p<0.001; r=0.566, p<0.001) and the relative lipid contents (r=0.567, p<0.001; r=0.561, p<0.001). Multivariate linear analysis revealed that percentage of IL-17 positive cells and the relative triglyceride contents were associated with preoperative VAS-back pain (p=0.021, p=0.046).
Conclusion
Patients with the MRS pLP spectrum showed reduced quality of life and upregulation of the lipid droplets-IL-17 inflammatory pathway in nucleus pulposus cells. Inflammatory factors contribute significantly to chronic low back pain development and progression, affecting patient-reported symptoms. The MRS lipids peak may serve as a potential biomarker for diagnosing and monitoring low back pain.

Citations

Citations to this article as recorded by  Crossref logo
  • A Commentary on “Magnetic Resonance Spectroscopy Lipids Peak May Serve as a Potential Biomarker for Back Pain in Intervertebral Disc Degeneration: An Integrative Metabolomics and Proteomics Study Investigating the Role of the Lipid Droplets-Interleukin-17
    Gianluca Vadalà, Luca Ambrosio, Fabrizio Russo, Vincenzo Denaro
    Neurospine.2025; 22(4): 934.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the December 2025 Issue
    Inbo Han
    Neurospine.2025; 22(4): 877.     CrossRef
  • 1,605 View
  • 47 Download
  • 2 Web of Science
  • 2 Crossref

Review Article

A Systematic Review of Treatment Guidelines for Lumbar Disc Herniation
Haiyue Jin, Alexander M. Lopez, Flor Garza Romero, Ryan Hoang, Ashish Ramesh, Hansen C. Bow
Neurospine 2025;22(2):389-402.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2550398.199

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A Systematic Review of Treatment Guidelines for Lumbar Disc Herniation
Neurospine. 2025;22(2):389-402.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2550398.199
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A Systematic Review of Treatment Guidelines for Lumbar Disc Herniation
Neurospine. 2025;22(2):389-402.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2550398.199
Close
Various treatments have been developed for treating herniated lumbar discs (HLD), which have been examined by professional associations when composing clinical guidelines that provide structured approaches to treating HLD. This paper aims to gather recent guidelines and summarize their conclusions on nonsurgical and surgical treatment options. PubMed, Web of Science, Scopus, Guidelines International Network, Turning Research into Practice databases, and websites of medical societies were searched for clinical guidelines of HLD. Full-text guidelines published by a professional association in English relevant to HLD were included. Comparisons among guidelines were made based on the treatments evaluated, and recommendation grades were recorded when provided by the guidelines. A total of 12 guidelines were included, with 4 by non-United States (US) or international associations, 3 by US pain societies, 2 by surgical societies, 2 by government agencies, and 1 by a multidisciplinary medical society. Treatments assessed included surgical, invasive nonsurgical, and noninvasive nonsurgical interventions. Three guidelines did not include surgical treatments, and 2 guidelines did not include nonsurgical therapies. Recommendation criteria varied among guidelines due to differences in the intended audience. HLD can be treated with various modalities with specific therapies offering better pain relief. Despite inconsistency in the recommendation grades of most treatments, established surgical techniques and epidural injections were reported with higher confidence in recommendation estimates, while inadequate supporting evidence was shown for noninvasive therapies except cognitive behavioral therapy. Future studies could incorporate and comment on some of the newer methods of treating HLD.

Citations

Citations to this article as recorded by  Crossref logo
  • Lumbar radiculopathy in adults: Clinical presentation, diagnosis, and approaches to treatment
    N. V. Pizova, A. V. Pizov
    Meditsinskiy sovet = Medical Council.2026; (22): 66.     CrossRef
  • The efficacy and safety of annulus fibrosus suture as adjuvant therapy for lumbar disc herniation: a systematic review and meta-analysis
    Wensi Ouyang, Guimei Guo, Yu Sun, Haobo Jiang, Long Chen, Shaofeng Yang
    Frontiers in Bioengineering and Biotechnology.2026;[Epub]     CrossRef
  • Mechanical and Biological Treatments for Annulus Fibrosus Repair and Closure: A Review of Clinical Studies
    Noah Willett, Chibuikem A. Ikwuegbuenyi, Evan Wang, Lawrance K. Chung, Anthony Robayo, Albert Antar, Galal Elsayed, Gianluca Vadalà, Ibrahim Hussain, Roger Härtl
    Neurospine.2026; 23(1): 117.     CrossRef
  • Beyond the Microscope: Is Endoscopic Discectomy the Next Gold Standard for Lumbar Disc Herniation?
    Borriwat Santipas, Jin Sung Kim, Korawish Mekariya, John Y.S. Choi, Samuel K. Cho
    Neurospine.2026; 23(1): 61.     CrossRef
  • Intraspinal versus Extraspinal Acupotomy Decompression, or Their Combination, for Lumbar Disc Herniation: Protocol for a Three-Arm, Randomized, Single-Blind Controlled Trial
    Wenlong Yang, Hailiang Liu, Muqing Liu, Lei Liu, Fangming Liu, Zike Dong, Xueqi Li
    Journal of Pain Research.2026; Volume 19: 1.     CrossRef
  • Quantifying Clinical Outcomes of IDD Therapy in Patients with Cervical and Lumbar Disc Bulges and Herniations
    Samuel Bartrom, Esa Syed, Tyler Graham
    Journal of Physical Medicine and Rehabilitation.2026; 8(1): 10.     CrossRef
  • Recent advances and evolving strategies in the treatment of lumbar disc herniation
    Yun Tong, Lanying Yu, Kaifeng Luo, Xiong Yan, Ming Chen, Libin Wang
    Frontiers in Neurology.2025;[Epub]     CrossRef
  • 54,211 View
  • 941 Download
  • 5 Web of Science
  • 7 Crossref

Original Article

Effectiveness of a Facet Joint Block Versus a Medial Branch Block in Spinal Pain Management: A Systematic Review and Meta-Analysis
Sung Hyeon Noh, Kyoung-Tae Kim, Dong Ah Shin, Je Hwi Yun, Pyung Goo Cho, Sang Hyun Kim
Neurospine 2025;22(2):441-450.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2550384.192

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Effectiveness of a Facet Joint Block Versus a Medial Branch Block in Spinal Pain Management: A Systematic Review and Meta-Analysis
Neurospine. 2025;22(2):441-450.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2550384.192
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Effectiveness of a Facet Joint Block Versus a Medial Branch Block in Spinal Pain Management: A Systematic Review and Meta-Analysis
Neurospine. 2025;22(2):441-450.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2550384.192
Close
Objective
Facet joint injections (FJIs) and medial branch blocks (MBBs) are commonly used interventions for chronic spinal pain, but their comparative effectiveness remains unclear. This meta-analysis aimed to compare the pain relief, functional improvement, complications, and patient satisfaction associated with FJI and MBB.
Methods
A systematic review and meta-analysis of randomized controlled trials and observational studies were conducted. Primary outcomes included pain relief (numerical rating scale) and functional improvement (Oswestry Disability Index [ODI]/Neck Disability Index). Secondary outcomes assessed adverse effects and patient satisfaction. The differences in characteristics between patients who were readmitted and those who were not were identified and analyzed using the Review Manager software.
Results
FJI resulted in lower pain and ODI scores compared to MBB, but the differences were not statistically significant. However, patient satisfaction was significantly higher in the FJI group (odds ratio, 1.81; 95% confidence interval, 1.02–3.24; p=0.04). Additionally, FJI had fewer adverse effects than MBB.
Conclusion
Both FJI and MBB are effective for chronic spinal pain, but FJI may be preferred for patients seeking immediate pain relief with fewer complications. Further high-quality studies are needed to refine treatment guidelines.
  • 13,261 View
  • 180 Download

Review Article

Comparative Review of the Socioeconomic Burden of Lower Back Pain in the United States and Globally
Diana Chang, Austin Lui, Alisa Matsoyan, Michael M. Safaee, Henry Aryan, Christopher Ames
Neurospine 2024;21(2):487-501.   Published online June 30, 2024
DOI: https://doi.org/10.14245/ns.2448372.186

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Comparative Review of the Socioeconomic Burden of Lower Back Pain in the United States and Globally
Neurospine. 2024;21(2):487-501.   Published online June 30, 2024
DOI: https://doi.org/10.14245/ns.2448372.186
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Comparative Review of the Socioeconomic Burden of Lower Back Pain in the United States and Globally
Neurospine. 2024;21(2):487-501.   Published online June 30, 2024
DOI: https://doi.org/10.14245/ns.2448372.186
Close
Internationally, the United States (U.S.) cites the highest cost burden of low back pain (LBP). The cost continues to rise, faster than the rate of inflation and overall growth of health expenditures. We performed a comprehensive literature review of peer-reviewed and non– peer-reviewed literature from PubMed, Scopus, and Google Scholar for contemporary data on prevalence, cost, and projected future costs. Policymakers in the U.S. have long attempted to address the high-cost burden of LBP through limiting low-value services and early imaging. Despite these efforts, costs (~$40 billion; ~$2,000/patient/yr) continue to rise with increasing rates of unindicated imaging, high rates of surgery, and subsequent revision surgery without proper trial of non-pharmacologic measures and no corresponding reduction in LBP prevalence. Globally, the overall prevalence of LBP continues to rise largely secondary to a growing aging population. Cost containment methods should focus on careful and comprehensive clinical assessment of patients to better understand when more resource-intensive interventions are indicated.

Citations

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    Open Journal of Rheumatology and Autoimmune Diseases.2026; 16(01): 25.     CrossRef
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Original Articles

Relationships Between Skeletal Muscle Mass, Lumbar Lordosis, and Chronic Low Back Pain in the Elderly
Myung Woo Park, Sang Jun Park, Sun Gun Chung
Neurospine 2023;20(3):959-968.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346494.247

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Relationships Between Skeletal Muscle Mass, Lumbar Lordosis, and Chronic Low Back Pain in the Elderly
Neurospine. 2023;20(3):959-968.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346494.247
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Relationships Between Skeletal Muscle Mass, Lumbar Lordosis, and Chronic Low Back Pain in the Elderly
Neurospine. 2023;20(3):959-968.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346494.247
Close
Objective
Loss of skeletal muscle mass is known to be associated with multiple morbidities. However, there is a dearth of reports on its association with lumbar lordosis and musculoskeletal pain. The aim of this study was to delineate the cross-sectional relationship between loss of skeletal muscle mass, lumbar lordosis, and chronic low back pain (CLBP).
Methods
A total of 721 medical records were reviewed, and data from 165 older subjects (over 65 years old; 81 men and 84 women) were retrospectively analyzed. Subjects were categorized into either the CLBP group (back pain for more than 6 months; 35 men and 36 women) or the control group (46 men and 48 women). The modified skeletal muscle mass index (MSMI, appendicular skeletal muscle mass [kg]/weight [kg] × 100), assessed by bioelectrical impedance analysis, and lumbar lordotic angle (LLA) were measured and compared between the CLBP group and the control group. The correlation between MSMI and LLA was investigated.
Results
The LLA of men and women in the CLBP group was significantly lower than that of the control group (p < 0.05). The MSMI was decreased in the CLBP group compared to the control group (p < 0.05). For both sexes, positive correlations were observed between the MSMI and LLA.
Conclusion
A close cross-sectional relationship was observed between MSMI, LLA, and CLBP. This suggests a potential interaction between the reduction in skeletal muscle mass and altered lumbar spine sagittal alignment, which could lead to CLBP.

Citations

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  • Improvement in low back pain following endoscopic decompression for spinal stenosis
    Maria Auron, Yihyun Roh, Maria C. Pedraza Ciro, Win Boonsirikamchai, Yi-Hao Liang, Jung Hoon Kim, Jin-Sung Kim
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The Effect of Transitioning to Remote Working in Patients Affected by Chronic Low Back Pain: A Cross-Sectional Study
Luca Ambrosio, Gianluca Vadalà, Fabrizio Russo, Leonardo Donnici, Giorgia Petrucci, Cristina Di Tecco, Sergio Iavicoli, Rocco Papalia, Vincenzo Denaro
Neurospine 2023;20(2):692-700.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2346510.255

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The Effect of Transitioning to Remote Working in Patients Affected by Chronic Low Back Pain: A Cross-Sectional Study
Neurospine. 2023;20(2):692-700.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2346510.255
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The Effect of Transitioning to Remote Working in Patients Affected by Chronic Low Back Pain: A Cross-Sectional Study
Neurospine. 2023;20(2):692-700.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2346510.255
Close
Objective
To assess the effect of transitioning to remote working during the coronavirus disease 2019 pandemic in a population of adults affected by chronic low back pain (cLBP).
Methods
An online questionnaire was sent by email to teleworkers affected by cLBP. Demographic data, remote working features and tasks, and LBP burden were analyzed. The psychological burden of remote working was evaluated with the World Health Organization Five Well-Being Index and the Patient Health Questionnaire-2. LBP severity was evaluated using a visual analogue scale. LBP-related disability was assessed using the Oswestry Disability Index. The effect of LBP on working capacity was examined with the Occupational Role Questionnaire. Independent risk factors related to LBP worsening were identified using a multivariate logistic regression model.
Results
During remote working, LBP severity was significantly higher compared to previous in-person working (p < 0.0001), as well as average weekly work hours (p < 0.001). Furthermore, the risk of LBP worsening was associated with higher depression scores (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.00–1.91; p = 0.048), increased stress levels (OR: 3.00, 95% CI: 1.04–8.65; p = 0.042), and being divorced (OR: 4.28, 95% CI: 1.27–14.47; p = 0.019). Conversely, living with others (OR: 0.24, 95% CI: 0.07–0.81; p = 0.021), and reporting unchanged stress levels (OR: 0.22, 95% CI: 0.08–0.65; p = 0.006) were associated with a lower risk of LBP worsening.
Conclusion
Our findings highlight key factors to consider for improving remote workers’ physical and mental wellbeing and decrease their LBP burden.

Citations

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  • Enhanced disc regeneration through CRISPR/Cas9-mediated SOX9 and TGFβ1 coexpression in tonsil-derived mesenchymal stromal cells
    Somin Lee, Yerin Yu, Dong hee Kim, Minsung Bock, Yeji Kim, Seong Bae An, Hyemin Choi, Hae Eun Shin, Dong-Youn Hwang, Inbo Han
    Stem Cell Research & Therapy.2025;[Epub]     CrossRef
  • Screening patients requiring secondary lumbar surgery for degenerative lumbar spine diseases: a nationwide sample cohort study
    Hangeul Park, Juhee Lee, Yunhee Choi, Jun-Hoe Kim, Sum Kim, Young-Rak Kim, Chang-Hyun Lee, Sung Bae Park, Kyoung-Tae Kim, John M. Rhee, Chi Heon Kim
    Scientific Reports.2024;[Epub]     CrossRef
  • 8,320 View
  • 180 Download
  • 2 Web of Science
  • 2 Crossref
Factors Predicting the Clinical Outcome After Trans-sacral Epiduroscopic Laser Decompression for Lumbar Disc Herniation
Byung Rhae Yoo, Seong Son, Sang Gu Lee, Woo Kyung Kim, Jong Myung Jung
Neurospine 2021;18(2):336-343.   Published online June 30, 2021
DOI: https://doi.org/10.14245/ns.2040824.412

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Factors Predicting the Clinical Outcome After Trans-sacral Epiduroscopic Laser Decompression for Lumbar Disc Herniation
Neurospine. 2021;18(2):336-343.   Published online June 30, 2021
DOI: https://doi.org/10.14245/ns.2040824.412
Download Citation

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Factors Predicting the Clinical Outcome After Trans-sacral Epiduroscopic Laser Decompression for Lumbar Disc Herniation
Neurospine. 2021;18(2):336-343.   Published online June 30, 2021
DOI: https://doi.org/10.14245/ns.2040824.412
Close
Objective
Previous literatures have demonstrated widely variable clinical results after transsacral epiduroscopic laser decompression (SELD) and the factors predicting outcomes are not yet established. Therefore, we analyzed the clinical outcome and associated predictive factors of SELD in patients with lumbar disc herniation.
Methods
Between 2015 and 2018, 82 patients who underwent single-level SELD and followed up at least 6 months were enrolled. The overall success rate (excellent or good results at final follow-up) was 58.5% according to Odom’s criteria. Based on this result, patients were divided to 2 groups: a favorable group (n = 48) and an unfavorable group (n = 34). A retrospective review of the baseline characteristics and clinical outcome were conducted to reveal the predictive factors.
Results
As expected, improvement of pain and patient satisfaction, was more favorable in the favorable group (p < 0.05). Moreover, the rate of additional procedure was lower in the favorable group (4.2%, 2 of 48 patients) than in the unfavorable group (35.3%, 12 of 34 patients) (p = 0.011). Among the various baseline characteristics, the only significant predictive factor for favorable outcome was the presence of a high-intensity zone (HIZ) on preoperative magnetic resonance imaging (50.0% [24 of 48 patients] in the favorable group vs. 11.8% [4 of 34 patients] in the unfavorable group; odds ratio, 15.67; p = 0.024).
Conclusion
Although SELD for lumbar disc herniation resulted in a less favorable clinical outcome than that reported in previous studies, in patients with a HIZ, SELD can be an effective minimally invasive surgery to relieve low back pain and/or leg pain.

Citations

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    Young Won Koo, Chang Su Lim, Anjani Darai, JiUn Lee, Wonjin Kim, Inbo Han, Geun Hyung Kim
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Direct and Intervertebral Disc-Mediated Sensitization of Dorsal Root Ganglion Neurons by Hypoxia and Low pH
Junxuan Ma, Despina Stefanoska, Sibylle Grad, Mauro Alini, Marianna Peroglio
Neurospine 2020;17(1):42-59.   Published online March 31, 2020
DOI: https://doi.org/10.14245/ns.2040052.026

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Direct and Intervertebral Disc-Mediated Sensitization of Dorsal Root Ganglion Neurons by Hypoxia and Low pH
Neurospine. 2020;17(1):42-59.   Published online March 31, 2020
DOI: https://doi.org/10.14245/ns.2040052.026
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Direct and Intervertebral Disc-Mediated Sensitization of Dorsal Root Ganglion Neurons by Hypoxia and Low pH
Neurospine. 2020;17(1):42-59.   Published online March 31, 2020
DOI: https://doi.org/10.14245/ns.2040052.026
Close
Objective
Ischemia-related risk factors are consistently correlated with discogenic pain, but it remains unclear how the ischemia-associated hypoxia and acidosis influence the peripheral sensory nervous system, namely the dorsal root ganglion (DRG), either directly or indirectly via intervertebral disc (IVD) mediation.
Methods
Bovine tail IVD organ cultures were preconditioned in different hypoxic and/or acidic conditions for 3 days to collect the conditioned medium (CM). The DRG-derived ND7/23 cells were either treated by the IVD CM or directly stimulated by hypoxic and/or acidic conditions. Neuronal sensitization was evaluated using calcium imaging (Fluo-4) after 3 days.
Results
We found that direct exposure of DRG cell line to hypoxia and acidosis increased both spontaneous and bradykinin-stimulated calcium response compared to normoxia-neutral pH cultures. Hypoxia and low pH in combination showed stronger effect than either parameter on its own. Indirect exposure of DRG to hypoxia-acidosis-stressed IVD CM also increased spontaneous and bradykinin-stimulated response, but to a lower extent than direct exposure. The impact of direct hypoxia and acidosis on DRG was validated in a primary sheep DRG cell culture, showing the same trend.
Conclusion
Our data suggest that targeting hypoxia and acidosis stresses both in IVD and DRG could be a relevant objective in discogenic pain treatment.

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    Barbora Kubincova, Marcia Muerner, Junxuan Ma, Jeannine Mueller, Amra Šećerović, Mazda Farshad, Sibylle Grad
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    Marcia Muerner, Junxuan Ma, Rathina V. Balasubramanian, Chencheng Feng, Julia Fernández Pérez, Aleksandr Ovsianikov, Sibylle Grad
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    Jing Feng, Lei Xu, Hong-yan Miao, Shi-yang Du, Jun-hui Wang, Xin Cao, Wei Liu, Yun-tao Wang
    Current Medical Science.2026; 46(2): 518.     CrossRef
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    Haotian Ge, Shuxia Yan, Mingwan Yin, Yujie Gao, Jiayi Wang, Qing Wang, Guihua Xu, Min Yang, Massimiliano Valeriani
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Gender Differences in the Self-assessment of Quality of Life and Disability After Spinal Fusion for Chronic Low Back Pain at a Neurosurgical Center in Eastern Europe
Gheorghe Ungureanu, Alexandra Chitu, Ioana Iancu, Cristian Kakucs, Tiberiu Maior, Ioan Stefan Florian
Neurospine 2018;15(3):261-268.   Published online August 29, 2018
DOI: https://doi.org/10.14245/ns.1836076.038

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Gender Differences in the Self-assessment of Quality of Life and Disability After Spinal Fusion for Chronic Low Back Pain at a Neurosurgical Center in Eastern Europe
Neurospine. 2018;15(3):261-268.   Published online August 29, 2018
DOI: https://doi.org/10.14245/ns.1836076.038
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Gender Differences in the Self-assessment of Quality of Life and Disability After Spinal Fusion for Chronic Low Back Pain at a Neurosurgical Center in Eastern Europe
Neurospine. 2018;15(3):261-268.   Published online August 29, 2018
DOI: https://doi.org/10.14245/ns.1836076.038
Close
Objective
Mechanical alterations of the spine, which can cause chronic low back pain (LBP), are a frequent indication for spinal fusion. Studies have shown differences between genders in patients’ evaluations of health-related quality of life (HRQoL) after spinal procedures, but results have been conflicting, and some authors have suggested that cultural variation could explain these discrepancies. The objectives of this study were to determine the influence that gender plays on HRQoL, disability, and the correlation between the 2 in people undergoing spinal fusion for chronic LBP at a neurosurgical centre in Eastern Europe.
Methods
Patients undergoing fusion surgery at a single centre for LBP with a duration of more than 3 months were included. They were evaluated using the Short Form Health Survey version-2.0 (SF-36v2) and Oswestry Low Back Pain Disability Index (ODI) questionnaire preoperatively and 1 year after the surgical procedure to identify differences between genders and to evaluate correlations between disability and quality of life.
Results
We included 31 female and 30 male patients. The male patients had higher disability scores at the preoperative evaluation, but improved more than females in all domains of disability at the postoperative evaluation. HRQoL improved similarly in both genders. The ODI score showed a strong or moderate correlation with 6 of the domains of the SF-36 in males, but with only 3 domains in females. Surgery had a positive impact on the mental status of more men than women at risk of depression.
Conclusion
The type of benefit that surgery offers seems to be influenced by gender. While HRQoL improved in both genders, disability decreased significantly more in male patients. Male patients also showed a closer correlation between HRQoL and disability. We conclude that men and women place different importance on specific aspects of their overall quality of life.

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    Mădălina Duceac (Covrig), Salim Camer, Irina Luciana Gurzu, Alina Pleșea-Condratovici, Liviu Stafie, Letiția Doina Duceac, Lucian Eva, Bogdan Gurzu, Mădălina Nicoleta Matei, Ciprian Adrian Dinu, Cristian Guțu, Doina Carina Voinescu
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    Xavier Pericot-Mozo, Rosa Suñer-Soler, Glòria Reig-Garcia, Josefina Patiño-Masó, Miquel Sitjar-Suñer, Afra Masià-Plana, Carme Bertran-Noguer
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The Characteristics and Incidence of Posterior Apophyseal Ring Fracture in Patients in Their Early Twenties With Herniated Lumbar Disc
Yoon Nae Seo, Young Jin Heo, Sang-Min Lee
Neurospine 2018;15(2):138-143.   Published online June 19, 2018
DOI: https://doi.org/10.14245/ns.1836002.001

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The Characteristics and Incidence of Posterior Apophyseal Ring Fracture in Patients in Their Early Twenties With Herniated Lumbar Disc
Neurospine. 2018;15(2):138-143.   Published online June 19, 2018
DOI: https://doi.org/10.14245/ns.1836002.001
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The Characteristics and Incidence of Posterior Apophyseal Ring Fracture in Patients in Their Early Twenties With Herniated Lumbar Disc
Neurospine. 2018;15(2):138-143.   Published online June 19, 2018
DOI: https://doi.org/10.14245/ns.1836002.001
Close
Objective
Posterior apophyseal ring fracture (PARF) is a common disorder that may be accompanied by herniated lumbar disc (HLD) in patients in their early twenties. However, there are very few reports on PARF in this clinical context. The objective of this study was to identify the incidence and characteristics of PARF with HLD in this age group.
Methods
We surveyed patients who visited Armed Forces Busan Hospital between May 2017 and October 2017 and included those aged between 19 and 25 years who had HLD accompanied by PARF. We retrospectively collected their demographic characteristics, clinical manifestations, and radiological findings on computed tomography (CT) scans. We categorized the PARF lesions according to Takata’s classification.
Results
Of 140 HLD patients, 43 (30.7%) had PARF lesions with HLD. We found that the presence of a PARF lesion was significantly related to a severe pain score on the visual analogue scale for lower back pain and/or lower leg radiating pain (p=0.001). The most common level and location of PARF were L5/S1 (n=25, 56.8%) and the superior endplate of the S1 vertebra, respectively. Type 1, according to Takata’s classification, was the most common type of PARF in the patients (n=34, 77.2%).
Conclusion
We recommend that spinal surgeons perform CT scans to check for PARF lesions in all young patients in their 20s who present with severe radiating and lower back pain.

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Review Article

Superior and Middle Cluneal Nerve Entrapment as a Cause of Low Back Pain
Toyohiko Isu, Kyongsong Kim, Daijiro Morimoto, Naotaka Iwamoto
Neurospine 2018;15(1):25-32.   Published online March 28, 2018
DOI: https://doi.org/10.14245/ns.1836024.012

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Superior and Middle Cluneal Nerve Entrapment as a Cause of Low Back Pain
Neurospine. 2018;15(1):25-32.   Published online March 28, 2018
DOI: https://doi.org/10.14245/ns.1836024.012
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Superior and Middle Cluneal Nerve Entrapment as a Cause of Low Back Pain
Neurospine. 2018;15(1):25-32.   Published online March 28, 2018
DOI: https://doi.org/10.14245/ns.1836024.012
Close
Low back pain (LBP) is encountered frequently in clinical practice. The superior and the middle cluneal nerves (SCN and MCN) are cutaneous nerves that are purely sensory. They dominate sensation in the lumbar area and the buttocks, and their entrapment around the iliac crest can elicit LBP. The reported incidence of SCN entrapment (SCN-E) in patients with LBP is 1.6%–14%. SCN-E and MCN entrapment (MCN-E) produce leg symptoms in 47%–84% and 82% of LBP patients, respectively. In such patients, pain is exacerbated by lumbar movements, and the symptoms mimic radiculopathy due to lumbar disorder. As patients with failed back surgery or Parkinson disease also report LBP, the differential diagnosis must include those possibilities. The identification of the trigger point at the entrapment site and the disappearance of symptoms after nerve block are diagnostically important. LBP due to SCN-E or MCN-E can be treated less invasively by nerve block and neurolysis. Spinal surgeons treating patients with LBP should consider SCN-E or MCN-E.

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Case Report

Concomitant Double Tumors of Myxopapillary Ependymoma Presented at Cauda Equina-Filum Terminale in Adult Patient
Ulaş Yener, Mustafa Güdük, Murat Şakir Ekşi, Murat Hamit Aytar, Aydın Sav, Serdar Özgen
Korean J Spine 2016;13(1):33-36.   Published online March 31, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.1.33

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Concomitant Double Tumors of Myxopapillary Ependymoma Presented at Cauda Equina-Filum Terminale in Adult Patient
Korean J Spine. 2016;13(1):33-36.   Published online March 31, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.1.33
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Include:
Concomitant Double Tumors of Myxopapillary Ependymoma Presented at Cauda Equina-Filum Terminale in Adult Patient
Korean J Spine. 2016;13(1):33-36.   Published online March 31, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.1.33
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A 32-year-old man presented with gradually increasing bilateral buttock pain. He had intermittent claudication. Multiple, homogenously enhanced intradural extramedullary lesions at L2-L3 and L5-S1 levels were observed on magnetic resonance imaging. The tumors were debulked and were removed in piecemeal pattern until they had completely been resected. Histopathological examination of the surgical specimens confirmed that both tumors were myxopapillary ependymomas (MPE). MPE presenting as concomitant double tumor at conus-cauda-filum level are very rare. This kind of presentation could not be directly considered as dissemination, since both tumors were in the site of classical origin of MPE. Ten cases of double spinal MPEs have been reported to date. Including the present case, analysis of the 11 patients revealed some facts. There is a male predominance, which is opposite to the ependymomas that are commonly observed in females. Median age at presentation is 15 years. Most pronounced symptom is low back pain that sometimes radiates to lower extremities. Surgical approach was aimed in all tumors, which could be succeeded in all tumors except one. Adjuvant radiation therapy was applied in 5 patients. No recurrences have been reported after surgery or surgery + radiotherapy regimens.

Citations

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