Results The total number of lumbar discs with decreased SI increased from 23/130 (18%) to 92/130 (71%) - from 0.9 to 3.5 per subject during the follow-up. Distribution of DD changed from being mostly in L4 - L5 and L5 - S1 discs to being almost even between the four lowermost discs. Discs that had even slightly decreased SI at baseline were more likely to have severely decreased SI at follow-up, compared to healthy discs (57% vs 11%, p less then 0.001). Other degenerative changes were also more common in these discs. Severity of DD at baseline did not have a significant association with current pain or disability. Conclusions In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms. Level of evidence 4.Study design A retrospective single-center study. Objective To investigate the influence of the K-line in the neck-flexed position (flexion K-line) on the surgical outcome after muscle-preserving selective laminectomy (SL) for cervical spondylotic myelopathy (CSM).  https://www.selleckchem.com/products/carfilzomib-pr-171.html  Summary of background data Development of CSM is associated with dynamic factors and cervical alignment. The flexion K-line, which reflects both dynamic and alignment factors, provides an indicator of surgical outcome after posterior decompression surgery for patients with ossification of the posterior longitudinal ligament. However, the value of the flexion K-line for patients with CSM has not been evaluated. Methods Our study group included 159 patients treated with SL for CSM. Patients were divided into a flexion K-line (+) group and a flexion K-line (-) group. The influence of the flexion K-line on radiological and surgical outcomes was analyzed, with multivariate analysis conducted to identify factors affecting the surgical outcome. Results Paidence 4.Study design Retrospective comparative study. Objective To investigate the radiographic and clinical effectiveness of surgical treatment using a posterior-only approach, as compared to a combined antero-posterior approach, in patients with infective spondylodiscitis. Summary of background data Spondylodiscitis is the most common infectious disease of the spine. There is currently no consensus over the surgical approach, use of bone graft, and type of instrumentation for optimal treatment of infective spondylodiscitis. Methods Seventy-nine patients who received surgical treatment for infective spondylodiscitis were divided into a combined antero-posterior (AP) group and a posterior-only (P) group. Significant differences in pre- and post-operative radiographic and clinical characteristics between the 2 groups were identified, and univariate and stepwise multivariate logistic regression analyses were used to determine the factors that affected the decision for treatment approach between the 2 groups. Results Preoperatively, initial height loss, wedge angle, and kyphotic angle were significantly higher in the AP group. However, estimated blood loss, operation time, and last visual analogue scale score for back pain were significantly lower in the P group. There was no difference in post-operative time to reach solid fusion. Post-operative corrected kyphotic angle was 12.8° in the AP group and 5.3° in the P group. The regional wedge angle was identified as a factor that influenced use of the combined antero-posterior approach, with a sensitivity of 60%, and specificity of 89.8% at the optimal cut-off value of 8.2°. Conclusions Interbody fusion with long-level pedicle screws fixation through a posterior-only approach was shown to be as effective as a combined antero-posterior approach for the surgical treatment of infective spondylodiscitis. A posterior-only approach is recommended when the regional wedge angle of the collapsed vertebra is less than 8.2°. Level of evidence 4.Study design Follow-up study OBJECTIVE. To determine whether minimally invasive lumbar spine surgery outcomes are different between those who are lost to follow-up and those who are not. Summary of background data Lost to follow-up patients are a common source of selection bias for clinical outcomes research. Currently, there are no US based studies that evaluate the differences in outcomes of lost to follow-up patients after spine surgeries. Methods A retrospective review of prospectively collected data of 289 patients who underwent minimally invasive lumbar surgery and were at least 1 year post-surgery was performed. Patients were divided into two groups (1) Lost to follow-up (LTF), defined as patients who had missed >2 consecutive follow-up visits and had not attended their 1-year follow-up appointment; and (2) Not lost to follow-up. For the not-LTF cohort, PROMs (ODI, VAS back/leg, SF-12 Physical/Mental, PROMIS) and return to activities data were collected prospectively at each follow-up. For LTF patientstients who are lost to follow-up do not fare worse than those who do follow-up. However, an opposite response cannot be excluded in those who did not respond to email and phone interviews. Level of evidence 3.Study design Prospective cohort study OBJECTIVE. We aimed to determine the 2-year survival and to identify clinical and microbiological characteristics of patients with native vertebral osteomyelitis (VO) as compared to post-operative VO to find further strategies for improvement of the management of VO. Summary of background data A relevant subgroup (20-30%) of patients with VO has a history of spine surgery. Infection in these patients might be clinically different from native VO. However, clinical, microbiological and outcome characteristics of this disease entity have not been well studied as most trials either excluded these patients or are limited by a small cohort and short observation period. Methods Between 2008-2013, patients who presented at a tertiary care centre with symptoms and imaging findings suggestive of VO were reviewed by specialists in infectious diseases, clinical microbiology and orthopaedics to confirm the diagnosis and followed prospectively for a period of 2 years. Statistical analys with postoperative VO should not attenuate clinical suspicion of physicians. Level of evidence 3.