OBJECTIVE: Chronic low back pain, affecting up to 58% of the population, often stems from intervertebral disc degeneration. Although magnetic resonance imaging (MRI) is commonly used for diagnostics, challenges arise in pinpointing pain sources due to frequent asymptomatic findings. Single-photon emission tomography (SPECT) integrated with computed tomography (CT) offers a promising approach, enhancing sensitivity and specificity. METHODS: In this retrospective study, spanning 2016 to 2022, SPECT/CT imaging was performed on 193 patients meeting specific criteria. We correlated SPECT/CT findings with lumbar MRI results, utilizing Pfirrmann and Rajasekaran classifications for disc degeneration and endplate damage assessment. Logistic regression analysis adjusted for age and sex evaluated associations. RESULTS: Of 965 spinal levels assessed, SPECT/CT positivity strongly correlated with higher Pfirrmann grades and Rajasekaran endplate classifications. Notably, Modic changes (MCs) on MRI displayed a nonsignificant relationship with SPECT/CT positivity. Significant associations were observed in older patients with positive MCs, Pfirrmann grades, and Rajasekaran classifications. CONCLUSIONS: This comprehensive study, the largest of its kind, establishes a significant link between SPECT/CT positivity and advanced lumbar degenerative changes. Higher Pfirrmann grades and increased Rajasekaran endplate damage demonstrated substantial correlations with SPECT/CT positivity. Notably, MCs did not exhibit such association. Our findings underscore the potential of SPECT/CT in identifying pain generators in degenerative spinal conditions, offering valuable insights for future interventions.

• Klíčová slova
• Axial pain, Degenerative disc disease, Low back pain, SPECT,
• MeSH
• bederní obratle diagnostické zobrazování   MeSH
• chronická bolest diagnostické zobrazování   etiologie   MeSH
• degenerace meziobratlové ploténky * diagnostické zobrazování   komplikace   MeSH
• dospělí MeSH
• jednofotonová emisní výpočetní tomografie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lumbalgie * diagnostické zobrazování   etiologie   MeSH
• magnetická rezonanční tomografie * metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• SPECT/CT metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION AND PURPOSE: With current imaging modalities and diagnostic tests, identifying pain generators in patients with non-specific chronic low back pain (CLBP) is difficult. There is growing evidence of the effectiveness of SPECT/CT examination in diagnosing the source of pain in the spine. The study aims to investigate the effect of posterior interbody fusion on a single-level SPECT/CT positive lumbar degenerative disc disease (DDD). MATERIAL AND METHODS: This is a prospective study of patients with chronic low back pain (CLBP) operated on for a single-level SPECT/CT positive DDD. Primary outcomes were changes in visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Secondary outcomes were complications, return to work, satisfaction and willingness to re-undergo surgery. RESULTS: During a 3-year period, 38 patients underwent single-level fusion surgery. The mean preoperative VAS score of 8.4 (± 1.1) decreased to 3.2 (± 2.5, p < 0.001) and the mean preoperative ODI of 51.5 (± 7.3) improved to 20.7 (± 14.68, p < 0.001) at a 2-year follow-up. A minimum clinically important difference (30% reduction in VAS and ODI) was achieved in 84.2% of patients. Some 71% of patients were satisfied with the surgery results and 89.4% would undergo surgery again. There were four complications, and two patients underwent revision surgery. Some 82.9% of patients returned to work. CONCLUSION: Fusion for one-level SPECT/CT positive lumbar DDD resulted in substantial clinical improvement and satisfaction with surgical treatment. Therefore, SPECT/CT imaging could be useful in assessing patients with CLBP, especially those with unclear MRI findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04876586.

• Klíčová slova
• Axial pain, Degenerative disc disease, Low back pain, SPECT, Spinal fusion,
• MeSH
• bederní obratle diagnostické zobrazování   chirurgie   MeSH
• degenerace meziobratlové ploténky * diagnostické zobrazování   chirurgie   MeSH
• fúze páteře * metody   MeSH
• jednofotonová emisní výpočetní tomografie MeSH
• lidé MeSH
• lumbalgie * diagnostické zobrazování   etiologie   chirurgie   MeSH
• počítačová rentgenová tomografie MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH

BACKGROUND: Chronic neck or back pain is a common clinical problem. The most likely cause is degenerative change, whereas other causes are relatively rare. There is increasing evidence on using hybrid single-photon emission computed tomography (SPECT) to identify the pain generator in spine degeneration. This systematic review explores the diagnostic and therapeutic evidence on chronic neck or back pain examined by SPECT. METHODS: This review is reported in accordance with the PRISMA guidelines. In October 2022, we searched the following sources: MEDLINE, Embase, CINAHL, SCOPUS, and 3 other sources. Titles and abstracts were screened and classified into diagnostic studies, facet block studies, and surgical studies. We synthesized the results narratively. RESULTS: The search yielded 2347 records. We identified 10 diagnostic studies comparing SPECT or SPECT/computed tomography (CT) with magnetic resonance imaging, CT, scintigraphy, or clinical examination. Furthermore, we found 8 studies comparing the effect of facet block intervention in SPECT-positive and SPECT-negative patients with cervicogenic headache, neck pain, and lower back pain. Five surgical studies describing the effect of fusion for facet arthropathy in the craniocervical junction, subaxial cervical spine, or the lumbar spine were identified. CONCLUSIONS: According to the available literature, a positive finding on SPECT in facet arthropathy is associated with a significantly higher facet blockade effect. Surgical treatment of positive findings has a good effect, but this has not been confirmed by controlled studies. SPECT/CT might therefore be a useful method in the evaluation of patients with neck or back pain, especially in cases of unclear findings or multiple degenerative changes.

• Klíčová slova
• Degenerative disc disease, Facet block, Nuclear medicine, SPECT, Spinal fusion,
• MeSH
• bederní obratle chirurgie   MeSH
• bolest krku etiologie   komplikace   MeSH
• bolesti zad diagnostické zobrazování   etiologie   MeSH
• degenerace meziobratlové ploténky * komplikace   diagnostické zobrazování   chirurgie   MeSH
• jednofotonová emisní výpočetní tomografie metody   MeSH
• lidé MeSH
• nemoci kloubů * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH

BACKGROUND: Midline lumbar fusion (MIDLF) is one promising new surgical technique that has been developed to minimize perioperative damage to the paravertebral stabilizing musculotendinous system. The aim of this study was to assess long-term clinical and radiological effects of MIDLF. METHODS: This prospective cohort study evaluated patients who underwent MIDLF for degenerative spinal instability. Clinical and radiological examinations were performed before and after surgery. Perioperative and postoperative complications were recorded. Follow-up was 2 years. P ≤ 0.05 was considered statistically significant. RESULTS: The study included 64 patients (mean age 58.9 ± 10.7 years; 41 women [64.1%]). The most frequent indication for MIDLF was degenerative spondylolisthesis grade I (28 cases [43.8%]); the prevalent spinal segment to be fused was L4-L5 (35 cases [54.7%]). Mean duration of surgery was 148.2 ± 28.9 minutes. Relief of low back pain and leg pain was significant and stable in the postoperative period as assessed by visual analog scale (P < 0.001). Of patients, 86.9% reported fair, good, or excellent outcomes in terms of pain relief based on MacNab score 2 years after surgery. Patients' level of function in activities of daily living improved significantly based on Oswestry Disability Index score: from 66.8 ± 9.8 before surgery to 33.9 ± 16.5 2 years after surgery (P < 0.001). X-rays and computed tomography at 12 months showed interbody fusion in 46 cases (73.4%), inconclusive results in 13 cases (20.3%), and no fusion in 4 cases (6.3%). No damage to neural or vascular structures and no failure of hardware or screw loosening were recorded. CONCLUSIONS: MIDLF is a safe, efficient method for surgical treatment of lumbar spine instability. Its limited invasiveness contributes to better preservation of paravertebral muscles and enhanced postoperative spinal stability.

• Klíčová slova
• Czech Republic, MIDLF, Midline lumbar fusion, Spinal fusion, Spinal instability, Spinal stabilization,
• MeSH
• bederní obratle diagnostické zobrazování   patologie   chirurgie   MeSH
• degenerace meziobratlové ploténky diagnostické zobrazování   patologie   chirurgie   MeSH
• dospělí MeSH
• fúze páteře * MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: Recent research shows an increasing recognition that organisms not traditionally considered infectious in nature contribute to disease processes. Propionibacterium acnes (P. acnes) is a gram-positive, aerotolerant anaerobe prevalent in the sebaceous gland-rich areas of the human skin. A ubiquitous slow-growing organism with the capacity to form biofilm, P. acnes, recognized for its role in acne vulgaris and medical device-related infections, is now also linked to a number of other human diseases. While bacterial culture and molecular techniques are used to investigate the involvement of P. acnes in such diseases, definitive demonstration of P. acnes infection requires a technique (or techniques) sensitive to the presence of biofilms and insensitive to the presence of potential contamination. Fortunately, there are imaging techniques meeting these criteria, in particular, fluorescence in situ hybridization and immunofluorescence coupled with confocal laser scanning microscopy, as well as immunohistochemistry. METHODS: Our literature review considers a range of microscopy-based studies that provides definitive evidence of P. acnes colonization within tissue from a number of human diseases (acne vulgaris, degenerative disc and prostate disease and atherosclerosis), some of which are currently not considered to have an infectious etiology. RESULTS/CONCLUSION: We conclude that P. acnes is an opportunistic pathogen with a likely underestimated role in the development of various human diseases associated with significant morbidity and, in some cases, mortality. As such, these findings offer the potential for new studies aimed at understanding the pathological mechanisms driving the observed disease associations, as well as novel diagnostic strategies and treatment strategies, particularly for degenerative disc disease. These slides can be retrieved under Electronic Supplementary Material.

• Klíčová slova
• Acne vulgaris, Arthroscopy, Atherosclerosis, Biofilm, Cutibacterium acnes, Degenerative disc disease, FISH-CLSM, Propionibacterium acnes, Prostate cancer,
• MeSH
• acne vulgaris diagnostické zobrazování   mikrobiologie   MeSH
• biofilmy * MeSH
• degenerace meziobratlové ploténky * diagnostické zobrazování   mikrobiologie   MeSH
• grampozitivní bakteriální infekce * diagnostické zobrazování   mikrobiologie   MeSH
• lidé MeSH
• mikroskopie * MeSH
• Propionibacterium acnes * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: The aim of this study was to document the prevalence of degenerative intervertebral disc changes in the patients who previously reported symptoms of neck pain and to determine the influence of education level on degenerative intervertebral disc changes and subsequent chronic neck pain. METHODS: One hundred and twelve patients were randomly selected from the University Hospital in Mostar, Bosna and Herzegovina, (aged 48.5±12.7 years) and submitted to magnetic resonance imaging (MRI) of the cervical spine. MRI of 3.0 T (Siemens, Skyrim, Erlangen, Germany) was used to obtain cervical spine images. Patients were separated into two groups based on their education level: low education level (LLE) and high education level (HLE). Pfirrmann classification was used to document intervertebral disc degeneration, while self-reported chronic neck pain was evaluated using the previously validated Oswestry questionnaire. RESULTS: The entire logistic regression model containing all predictors was statistically significant, (χ2(3)=12.2, p=0.02), and was able to distinguish between respondents who had chronic neck pain and vice versa. The model explained between 10.0% (Cox-Snell R2) and 13.8% (Nagelkerke R2) of common variance with Pfirrmann classification, and it had the strength to discriminate and correctly classify 69.6% of patients. The probability of a patient being classified in the high or low group of degenerative disc changes according to the Pfirrmann scale was associated with the education level (Wald test: 5.5, p=0.02). Based on the Pfirrmann assessment scale, the HLE group was significantly different from the LLE group in the degree of degenerative changes of the cervical intervertebral discs (U=1,077.5, p=0.001). CONCLUSION: A moderate level of intervertebral disc degenerative changes (grade II and III) was equally matched among all patients, while the overall results suggest a higher level of education as a risk factor leading to cervical disc degenerative changes, regardless of age differences among respondents.

• Klíčová slova
• cervical vertebra, chronic neck pain, disc degeneration, education,
• MeSH
• bolest krku epidemiologie   MeSH
• chronická bolest epidemiologie   MeSH
• degenerace meziobratlové ploténky diagnostické zobrazování   epidemiologie   MeSH
• komorbidita MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• meziobratlová ploténka diagnostické zobrazování   MeSH
• prevalence MeSH
• rizikové faktory MeSH
• stupeň vzdělání * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Bosna a Hercegovina epidemiologie   MeSH

Introduction We aim to assess the impact of the quantity of intradiscal cement leak during kyphoplasty on the rate of progression of degenerative changes in the affected disc. Methods Of 316 kyphoplasty procedures, we identified 32 episodes of intradiscal cement leak in 26 patients. The quantity of cement leaked was graded from I to IV. Disc degenerative changes were assessed at presentation and follow-up using radiographical scoring and magnetic resonance imaging (MRI) grading systems. Data for low-grade leaks (grade I) were compared with the medium- and high-grade leaks (grades II-IV) using a chi-squared test. Results Median follow-up radiographic and MRI assessments were made at 18 and 21 months, respectively. Medium- and high-grade leaks were associated with a significantly higher radiographic disc degeneration scores compared with low-grade leaks (P = 0.04295) but no difference was found in MRI disc degeneration grades and in adjacent vertebral fracture rates. Conclusions Our findings indicate that the quantity of cement leaking into the disc space significantly influences the rate of progression of disc degeneration.

• Klíčová slova
• Disc degeneration, Intradiscal cement leak, Osteoporosis, Percutaneous balloon kyphoplasty, Vertebral fracture,
• MeSH
• časové faktory MeSH
• degenerace meziobratlové ploténky diagnostické zobrazování   chirurgie   MeSH
• kostní cementy terapeutické užití   MeSH
• kyfoplastika škodlivé účinky   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• pooperační komplikace etiologie   MeSH
• progrese nemoci MeSH
• radiografie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• kostní cementy MeSH

OBJECTIVE Recent studies have described encouraging outcomes after cervical total disc replacement (cTDR), but there are also critical debates regarding the long-term effects of heterotopic ossification (HO) and the prevalence of adjacent-level degeneration. The aim in this paper was to provide 4-year clinical and radiographic outcome results on the activ C disc prosthesis. METHODS A total of 200 subjects underwent single-level activ C (Aesculap AG) implantation between C-3 and C-7 for the treatment of symptomatic degenerative disc disease. Clinical and radiographic assessments were performed preoperatively, intraoperatively, at discharge, and again at 6 weeks, 6 months, 1 year, 2 years, and 4 years. Radiographic evaluations were done by an independent core laboratory using a specific software for quantitative motion analysis. RESULTS Neck Disability Index (NDI) and visual analog scale (VAS) score for neck and arm pain decreased significantly from baseline to the 4-year follow-up. The mean improvement for NDI was 20, for VAS severity and frequency of neck pain 26.4 and 28, and for VAS severity and frequency of arm pain 30.7 and 35.1, respectively. The neurological situation improved for the majority of patients (86.4%); 76.1% of cases were asymptomatic. Subsequent surgical interventions were reported in 7% of the cases, including device removals in 3%. In 2.5% a subsidence greater than 3 mm was recorded; 1 of these cases also had a migration greater than 3 mm. No device displacement, expulsion, disassembly, loose or fractured device, osteolysis, or facet joint degeneration at the index level was observed. Segmental lordotic alignment changed from -2.4° preoperatively to -6.2° at 4 years, and postoperative height was maintained during the follow-up. Advanced HO (Grade III and IV) was present in 27.1% of the cases; 82.4% showed segmental mobility. A progression of radiographic adjacent-segment degeneration occurred in 28.2%, but only 4.5% required surgical treatment. CONCLUSIONS The activ C is a safe and effective device for cervical disc replacement confirming the encouraging results after cTDR. Clinical trial registration no.: NCT02492724 ( clinicaltrials.gov ).

• Klíčová slova
• ACDF = anterior cervical discectomy and fusion, AE = adverse event, AP = anteroposterior, ASD = adjacent-segment disease, BMI = body mass index, COI = conflict of interest, COR = center of rotation, FJD = facet joint degeneration, HO = heterotopic ossification, NDI = Neck Disability Index, Neck Disability Index, RCT = randomized controlled trial, ROM = range of motion, VAS = visual analog scale, activ C, adjacent-segment degeneration, cTDR = cervical total disc replacement, cervical spine, clinical outcome, degenerative disc disease, heterotopic ossification, long-term results, range of motion, total disc replacement, visual analog scale,
• MeSH
• artroplastika meziobratlové ploténky * přístrojové vybavení   metody   MeSH
• bolest krku diagnostické zobrazování   etiologie   chirurgie   MeSH
• časové faktory MeSH
• chirurgická dekomprese metody   MeSH
• degenerace meziobratlové ploténky komplikace   diagnostické zobrazování   chirurgie   MeSH
• diskektomie metody   MeSH
• dospělí MeSH
• krční obratle * MeSH
• lidé MeSH
• lordóza diagnostické zobrazování   etiologie   chirurgie   MeSH
• měření bolesti MeSH
• následné studie MeSH
• posuzování pracovní neschopnosti MeSH
• prospektivní studie MeSH
• protézy kloubů * MeSH
• software MeSH
• stupeň závažnosti nemoci MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa MeSH

PURPOSE OF THE STUDY: The original aim of this prospective semi-randomised study was to determine associations between segmental sagittal alignment after Anterior Cervical Discectomy and Fusion (ACDF) and subjective and clinical results. Two types of cages, cage P with parallel end-plates and cage A with 5-degree angulations, were used in the patients treated for degenerative conditions. MATERIAL AND METHODS: A total of 94 consecutive patients, 56 treated by single-level ACDF and 38 undergoing a two-level procedure, completed 8 years of follow-up. The patients in equally-sized A and P subgroups were examined at 6 weeks and 1, 2 and 8 years after surgery. The follow-up included X-ray in a neutral lateral position, a questionnaire assessing pain in neck and shoulder regions and JOA scores. The results including the cumulative incidence of surgical procedures indicated for adjacent segment diseases were statistically evaluated. RESULTS: An average increase in the lordotic angle at 6 weeks after surgery was 2.32° for the implant P and 2.02° for the implant A subgroup. During 8 years of follow-up the average values decreased to 1.51° and 1.36°, respectively. The proportion of patients with no or minimal neck and shoulder pain decreased, in subgroup P, from the initial 85% at 6 weeks to 59% at 8 years after the surgery and, in subgroup A, from 89% to 40 %. The average JOA score of 16 at 6 weeks in both subgroups, at 8 years, had a value of 15.9 in subgroup P and 16.0 in subgroup A. The cumulative incidence of surgery for adjacent segment disease 8 years was 8.3% for subgroup P and 6.3% for subgroup A. No statistically significant differences between the subgroups at any follow-up period were recorded in either morphological characteristics or clinical outcomes. CONCLUSIONS: The ability to lordotize a segment by stand-alone ACDF is below the angular resolution of current radiographic methods, irrespective of the sagittal profile of the implant used. Comparable morphological results haven´t been reflected by significant difference in subjective and clinical outcome and also in the incidence of surgery for adjacent segment disease. Such results were not expected and therefore post-operative sagittal alignment mechanisms in stand-alone cage assisted ACDF will require further investigation. Key words:cervical vertebrae, surgical technique, spinal fusion, sagittal alignment, clinical outcome.

• MeSH
• analýza selhání vybavení MeSH
• degenerace meziobratlové ploténky diagnostické zobrazování   chirurgie   MeSH
• design vybavení MeSH
• diskektomie přístrojové vybavení   MeSH
• dospělí MeSH
• fúze páteře přístrojové vybavení   MeSH
• interní fixátory MeSH
• krční obratle diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• prospektivní studie MeSH
• protézy a implantáty MeSH
• průzkumy a dotazníky MeSH
• radiografie MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

• MeSH
• degenerace meziobratlové ploténky diagnostické zobrazování   chirurgie   MeSH
• diskektomie metody   MeSH
• kohortové studie MeSH
• krční obratle diagnostické zobrazování   MeSH
• kyfóza diagnostické zobrazování   MeSH
• lidé MeSH
• lordóza diagnostické zobrazování   MeSH
• radiografie MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• práce podpořená grantem MeSH