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Spinal Structures

Anatomy of the spinal column and paraspinal musculature, focusing on the relationship between segmental stability, sagittal balance, and the pathogenesis of spinal deformities.

Overview

The spine's unique bony, ligamentous, neural, and vascular anatomy facilitates multiple biologic and biomechanical functions, providing axial support with significant flexibility while protecting neural structures [1]. Comprehensive anatomical overviews detail embryologic development, nervous system structure, osseous components, ligamentous stabilizers, alignment parameters, and surgical considerations [15]. For preoperative planning and status evaluation, bone density data of the cervical, thoracic, and lumbar spine measured via Hounsfield units on computed tomography may be helpful [4]. Surgeons must consider morphometric deviations caused by osteophytes and Schmorl's nodes to optimize implant compatibility and surgical navigation in degenerative spines [56].

Treatment strategies are condition-specific, ranging from observation and brace treatment to spinal fusion for kyphosis [6]. Achieving normal sagittal spinal alignment may improve long-term patient satisfaction and functional outcomes in kyphosis management [6]. For anomalies of the occipitocervical articulation, treatment depends on symptom severity and neurological involvement; fusion is indicated for instability causing cord compression, while laminectomy or foramen magnum enlargement may be necessary for compression [14]. In the context of spinal stiffness measurement, a consensus approach serves as an operations manual emphasizing safety protocols, operator training, and participant preparation using the VerteTrack device, though it does not report clinical outcomes [25].

Advances in the management of cervical and lumbar spine conditions, pediatric and adult spinal deformity, spinal cord injury, and spinal fracture and trauma are highlighted in specialty updates to support treatment decision-making [7]. MRI and CT serve as comprehensive, up-to-date reference sources for scanning the entire spine and are useful texts for spine surgeons and radiologists [11]. While a new cervicothoracic fixation device offers good segmental fixation of the cervical and thoracic spine despite some disadvantages, longer-term clinical follow-up studies are needed to more clearly define the role of interspinous process spacers in the management of lumbar spinal stenosis [3, 26].

Anatomy & Pathophysiology

The spine's unique bony, ligamentous, neural, and vascular anatomy facilitates multiple biologic and biomechanical functions, providing axial support while allowing significant flexibility and protecting neural structures [1]. Su's three-column theory aligns with the characteristics of vertebral physiological structure, vertebral fracture, and vertebral biomechanics [18]. Critical spinal lytic defects result in kinematic abnormalities and lower the compressive strength of the spine [37].

Kinematics: The position of the lumbar spine center of rotation changes with variations in load and differs between movement types, suggesting distinct motion patterns in the lower lumbar spine [17]. Load-displacement curves of the human lumbar and lumbosacral spine are non-linear and motions are coupled, with ranges of motion comparing favorably with reported in vivo values [42]. Increasing the load has a significant impact on the coupled translational movement of lumbar facet joints [34]. There are weak to moderate effects of individual kinematic variables and lumbar lordosis on maximum intervertebral range of motion at other intervertebral levels [41]. The biomechanics of the lumbar spine may differ with each individual, and L4–5 dislocation may be a variant to lumbosacral (L5-S1) dislocation, owing to hyperextension injury [20].

Implants and Modeling: The dual-cord dynamic stabilization system demonstrates improved biomechanical stability with minimal adjacent segment compromise [10]. Interspinous devices reduce range of motion in extension and can reduce disc pressure, but they often fail to fully compensate for destabilization in other planes or adjacent levels [48]. No mechanical failures were observed in viscoelastic discs or articulating total disc replacements after each 30-million-cycle interval, which simulates approximately 80 years of lumbar-bending motions [39]. The patient-specific spine digital twin modeling approach enhances the understanding of scoliosis biomechanics, facilitating risk assessment for disc prolapse and aiding in treatment selection [45]. The data provide theoretical references for spinal implant materials and can be useful in future spinal biomechanics research leading to better biomechanical compatibility regarding the posterior bony column of the lumbar spine [40].

Spinopelvic and Biomechanical Considerations: Longer spinal fusion or inclusion of the pelvis in the fusion critically impacts hip-spine biomechanics and significantly affects the ability to compensate in the standing-to-sitting transition [33]. Using the simplified approach of sacral slope change from standing to relaxed-seated could lead to a 7-fold overprediction of patients with a stiff lumbar spine and abnormal spinopelvic mobility [51]. The data provide a useful reference for future research in spinal biomechanics and musculoskeletal modeling regarding the effect of walking speed on spinal loads and trunk muscle forces [31]. The effect of asymmetry on facet joint response should be fully considered in biomechanical studies of the lumbar spine, especially in post structures subjected to physiological loadings [32].

Classification

Spinal Anatomy & Biomechanics: The unique bony, ligamentous, neural, and vascular anatomy of the spine facilitates multiple biologic and biomechanical functions, providing axial support while allowing significant flexibility and protecting neural structures [1]. Comprehensive overviews of spinal anatomy include embryologic development, nervous system structure, osseous components, ligamentous stabilizers, alignment parameters, and surgical considerations [15]. Due to the unique microarchitecture of the cervical vertebrae, fractures occur much later in this region than they do in the thoracic or lumbar spine [2]. Su's three-column theory complies with the characteristics of vertebral physiological structure, vertebral fracture, and vertebral biomechanics [18]. The position of the lumbar spine center of rotation changes with variations in load and differs between movement types, suggesting distinct motion patterns in the lower lumbar spine [17]. The biomechanics of the lumbar spine may differ with each individual, and L4–5 dislocation may be a variant to lumbosacral (L5-S1) dislocation, owing to hyperextension injury [20].

Cervical Spine Classification: No existing prognostic classification system can predict which patients with a congenital osseous anomaly of the cervical spine are at risk for future neurologic injury [21]. The intrinsic dimensions of the cervical spinal canal, specifically the shape defined by the ratio of sagittal to transverse diameter, may constitute a predisposition to spinal cord injury in the cervical segments [24]. Various measurements of the posterior structures of subaxial cervical vertebrae differed between the left and right sides, females and males, and the DCS and NDCS groups [52].

Thoracolumbar & Pelvic Alignment Systems: Further analysis by an expert panel is required to develop specific classification criteria for thoracolumbar fascia [5]. The Hip-Spine Classification system allows surgeons to make appropriate evaluations preoperatively and guides the use of DM components in patients with spinopelvic pathology in order to reduce the risk of dislocation in these high-risk patients [36]. The T4-L1-Hip axis is conceptually aligned with the description of spinal shapes in the Roussouly classification but with the advantage of utilizing continuous measures of spinal alignment [46].

Scoliosis & Imaging Classification: A novel classification system for early-onset scoliosis was developed with all core components demonstrating substantial to excellent interobserver reliability [44]. Data from individual spinal segments measured using Hounsfield units of computed tomography may be helpful to comprehensively evaluate the status of the spine and to design a better preoperative plan before instrumentation [4].

Other Considerations: - Cervical Congenital Anomalies: No existing prognostic classification system can predict which patients with a congenital osseous anomaly of the cervical spine are at risk for future neurologic injury [21]. - Thoracolumbar Fascia: Further analysis by an expert panel is required to develop specific classification criteria for thoracolumbar fascia [5].

Clinical Presentation

The spine's unique bony, ligamentous, neural, and vascular anatomy facilitates multiple biologic and biomechanical functions, providing axial support while allowing significant flexibility and protecting neural structures [1]. Physical examination of the spine includes inspection, palpation, range of motion testing, and neurologic evaluation to identify spinal pathology, nonspinal conditions, and signs of symptom magnification [12].

Injuries to the cervical spine constitute a range of conditions from acute traumatic injuries to chronic overuse and degenerative conditions [47]. Due to the unique microarchitecture of the cervical vertebrae, fractures occur much later in this region than they do in the thoracic or lumbar spine [2]. Most patients with cervical spondylotic myelopathy become worse clinically if the disorder is left untreated, with more than 50 percent progressing to severe disability [9].

Imaging modalities include MRI, a non-invasive, high-resolution, multiplanar modality essential for evaluating the spectrum of cervical spinal disease by providing detailed visualization of osseous and soft-tissue structures, including the intervertebral discs, spinal cord, and nerve roots [13]. Magnetic resonance is also an excellent modality for imaging pathologic processes in the pediatric spine, allowing high-resolution views of osseous and soft-tissue structures [19]. Gas accumulation in the spinal canal is a common clinical disease identifiable by CT and MRI [22]. Spinal osteoblastoma presents with multiple unique characteristic radiological features [23]. Accessory ossicles of the spine exhibit varied prevalence and clinical significance, with some presenting minor associations with symptoms and others linked to specific syndromes or spinal disorders [35].

Treatment for anomalies of the occipitocervical articulation depends on symptom severity and neurological involvement; fusion is indicated for instability causing cord compression, while laminectomy or foramen magnum enlargement may be necessary for compression [14]. Pushing conditions in idiopathic scoliosis warrant attention to the lower spinal cord and the nerve roots on both sides of the main thoracic curve [50]. Echinococcosis of the spine presents specific clinical findings, laboratory and diagnostic findings, and treatment options that affect patient outcomes [38].

Red-flag patterns include cauda equina syndrome, for which the treatment is urgent surgical decompression of the spinal canal regardless of the setting [43]. The sagittal orientation of the lumbar facet joints was part of the preexisting morphology and was not solely a secondary result of spondylolisthesis [8]. The major determinants of sacral dysmorphism are upper sacral segment coronal and axial angulation [49].

Specialty updates review the highest-quality peer-reviewed research in spinal conditions to support treatment decision-making for cervical and lumbar spine conditions, pediatric and adult spinal deformity, spinal cord injury, and spinal fracture and trauma [7]. Longer-term clinical follow-up studies are needed to more clearly define the role of interspinous process spacers in the management of lumbar spinal stenosis [3]. Further analysis by an expert panel is required to develop specific classification criteria for thoracolumbar fascia [5].

Investigations

Plain radiography: Standing pelvic lateral radiographs require superposition of femoral heads at the center and a straight sacral endplate, often referenced via CT or MRI, to accurately define pelvic incidence [67]. The distance from the pubic symphysis to the sacrococcygeal joint is weakly correlated with all evaluated lateral lumbar radiographic metrics in both sexes, despite strong inter-observer reliability [68]. Biplanar low-dose stereoradiography largely represents scoliotic curvatures in preoperative adolescent idiopathic scoliosis patients, despite differences in body positioning compared to CT [64]. Roentgenograms, CT scans, and possibly MRI studies are necessary to differentiate persistent synchondrosis of the second cervical vertebra from a hangman's fracture in children when a definitive diagnosis cannot be made [61].

MRI: MRI is a non-invasive, high-resolution, multiplanar imaging modality essential for evaluating cervical spinal disease by providing detailed visualization of osseous and soft-tissue structures including discs, spinal cord, and nerve roots [13]. Magnetic resonance is an excellent modality for imaging pathologic processes in the pediatric spine, allowing high-resolution views of osseous and soft-tissue structures [19]. The proposed method for defining muscular regions of interest from axial MRI provides an option for quantifying cervical spine muscle composition and morphology but is not a final position [58]. SpineNet offers potential to grade lumbar spinal stenosis in large-scale epidemiological studies involving high volumes of MRI data with high consistency and objectivity [28].

CT: Bone density data from individual spinal segments measured via Hounsfield units on CT can help comprehensively evaluate spinal status and design better preoperative plans for instrumentation [4]. CT-based neuroforaminal dimensions from L1 to S1 have been described in young, healthy patients presenting without back pain or neuroforamen pathology [59]. Gas accumulation in the spinal canal is a common clinical disease identifiable by CT and MRI [22]. Spinal osteoblastoma presents with multiple unique characteristic radiological features [23]. Radiologists should be familiar with the imaging characteristic of giant cell tumors of the mobile spine invading adjacent vertebrae [55]. A patient-specific three-dimensional in vivo kinetic model of the cervical spine has been presented using CT, MRI, and fluoroscopy data [69].

Other Considerations: Fractures in the cervical spine occur much later than in the thoracic or lumbar spine due to unique microarchitecture [2]. The sagittal orientation of lumbar facet joints is part of preexisting morphology and not solely a secondary result of spondylolisthesis [8]. MRI and CT serve as comprehensive reference sources for scanning the entire spine [11]. Physical examination of the spine includes inspection, palpation, range of motion testing, and neurologic evaluation to identify pathology, nonspinal conditions, and signs of symptom magnification [12]. Radiographic and clinical natural history data regarding cervical degeneration provide critical evidence for discussions with patients about MRI findings [16]. Specific classification criteria for thoracolumbar fascia require further analysis by an expert panel [5].

Treatment

Non-Operative

Conservative management is the primary approach for separation of the symphysis pubis associated with childbearing, which is generally treated non-operatively [63]. Similarly, non-operative treatment is typically successful for bilateral fractures of the pedicle of the second cervical vertebra in young children [66]. For kyphosis, initial options include observation and brace treatment [6].

Operative

Indications: Surgical intervention is indicated for instability causing cord compression in anomalies of the occipitocervical articulation [14]. Surgery for symphysis pubis separation is reserved for cases of inadequate reduction or persistent symptoms [63]. Surgical stabilization is suggested for bilateral fractures of the second cervical vertebra in patients with unstable delayed union or those who are uncooperative [66]. Most patients with cervical spondylotic myelopathy deteriorate clinically if left untreated, with more than 50 percent progressing to severe disability, necessitating intervention [9]. Treatment for anomalies of the occipitocervical articulation depends on symptom severity and neurological involvement [14].

Surgical Approach / Technique: For anomalies of the occipitocervical articulation, laminectomy or foramen magnum enlargement may be necessary to address compression [14]. Percutaneous surgical treatment is an ideal approach for thoracolumbar fractures in patients with ankylosing spondylitis, as it improves pain, neurological function, and kyphotic deformity [53]. This percutaneous method achieves effects similar to traditional methods [53].

Implant Selection: The dual-cord dynamic stabilization system demonstrates improved biomechanical stability with minimal adjacent segment compromise [10]. A novel cervicothoracic fixation device serves as a good option for segmental fixation of the cervical and thoracic spine despite some disadvantages [26]. The height-adjustable nano-hydroxyapatite/polyamide-66 vertebral body (HAVB) exhibits similar biomechanical efficacy in spinal stability reconstruction compared with TMC and AVB [54].

Alignment / Balancing Strategy: Achieving normal sagittal spinal alignment may improve long-term patient satisfaction and functional outcomes in the treatment of kyphosis [6].

Other Considerations: Longer-term clinical follow-up studies are needed to more clearly define the role of interspinous process spacers in the management of lumbar spinal stenosis [3].

Complications

Cervical Spine Pathology: Fractures in the cervical spine occur much later than in the thoracic or lumbar spine due to unique microarchitecture [2]. The intrinsic dimensions of the cervical spinal canal, specifically the shape defined by the ratio of sagittal to transverse diameter, may constitute a predisposition to spinal cord injury in the cervical segments [24]. No existing prognostic classification system can predict which patients with a congenital osseous anomaly of the cervical spine are at risk for future neurologic injury [21].

Myelopathy Progression: Most patients with cervical spondylotic myelopathy become worse clinically if left untreated, with more than 50 percent progressing to severe disability [9].

Cauda Equina Syndrome: Autonomic and non-autonomic dysfunction is common in long-term follow-up of cauda equina syndrome patients, even in those with the most optimistic prognosis [30]. Early decompression did not show a statistically significant correlation with improved outcomes in cauda equina syndrome [30].

Scoliosis Management: It is currently impossible to state that bracing effectively alters the natural history of scoliosis in immature patients who are at high risk for progression [27].

Intervertebral Disc Injuries: Rupture of intervertebral disc injuries in persons under twenty is rare [65]. Degeneration is present in practically all instances of lumbar and cervical intervertebral disc injuries [65].

Other Considerations: Complication rates following spine surgery are higher in patients with Parkinson disease than in those without the disease [60]. Longer-term clinical follow-up studies are needed to more clearly define the role of interspinous process spacers in the management of lumbar spinal stenosis [3]. The dual-cord dynamic stabilization system demonstrates improved biomechanical stability with minimal adjacent segment compromise [10].

Recovery

Light activity (weeks): Evidence does not specify a discrete week range for light activity initiation; however, microsurgical decompression of the lumbar spine does not increase intersegmental movement or instability over a follow-up period of 12 months [70], and complete resolution of sciatica in patients with intraspinal synovial cysts was observed in follow-up ranging from eighteen to twenty-five months [29].

Full activity (months): No specific month range for full activity return is provided in the current evidence base; however, overall bone metabolism of the operated intervertebral disc space at six weeks had the highest diagnostic accuracy for predicting fusion status at one year after posterior lumbar interbody fusion [72].

Complete recovery / outcome plateau (months): Long-term clinical follow-up studies are needed to more clearly define the role of interspinous process spacers in managing lumbar spinal stenosis [3], and further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time for autologous matrix-induced chondrogenesis treatment of focal cartilage defects [57].

Rehabilitation protocol: Treatment options for kyphosis include observation, brace treatment, and spinal fusion, with long-term patient satisfaction and functional outcomes potentially improved by achieving normal sagittal spinal alignment [6]. It is currently impossible to state that bracing effectively alters the natural history of scoliosis in immature patients who are at high risk for progression [27]. Early recognition and repair of pseudarthrosis or extension of a fusion area which is too short prevent further loss of correction and increasing deformity in patients in whom vertebral growth is not yet complete [73].

Functional milestones: Most patients with cervical spondylotic myelopathy become worse clinically if the disorder is left untreated, with more than 50 percent progressing to severe disability [9]. Autonomic and non-autonomic dysfunction is common in long-term follow-up of cauda equina syndrome patients, even in those with the most optimistic prognosis [30], and early decompression did not show a statistically significant correlation with improved outcomes in long-term follow-up of cauda equina syndrome patients [30]. The sagittal orientation of lumbar facet joints was part of the preexisting morphology and was not solely a secondary result of spondylolisthesis [8].

Other Considerations: Fractures occur much later in the cervical spine region than in the thoracic or lumbar spine due to unique microarchitecture [2]. Data from individual spinal segments measured via Hounsfield units on computed tomography may be helpful to comprehensively evaluate spine status and design better preoperative plans before instrumentation [4]. A dual-cord dynamic stabilization system demonstrates improved biomechanical stability with minimal adjacent segment compromise [10]. The investigation represents the best available evidence regarding the radiographic and clinical natural history of cervical degeneration, with data that will have a critical influence on discussions with patients regarding their MRI findings [16]. Prognosis for spinal deformity depends on severity, with severe cases often incurable and requiring palliative operations, while less severe cases may recover spontaneously or with minimal treatment [71].

Key Evidence

  • [L5] Due to the unique microarchitecture of the cervical vertebrae, fractures occur much later in this region than they do in the thoracic or lumbar spine. (10.1186/s13018-022-03105-5)
  • [L5] Longer-term clinical follow-up studies are needed to more clearly define their role in the management of lumbar spinal stenosis. (10.5435/00124635-200704000-00003)
  • [L4] These data from the individual spinal segments may be helpful to comprehensively evaluate the status of the spine and to design a better preoperative plan before instrumentation. (10.1186/s12891-024-07324-1)
  • [L4] Further analysis by an expert panel is required to develop specific classification criteria for thoracolumbar fascia. (10.1186/s12891-018-2088-5)
  • [L5] This Specialty Update reviews the highest-quality peer-reviewed research in the area of spinal conditions, highlighting advances in the management of cervical and lumbar spine conditions, pediatric and adult spinal deformity, spinal cord injury, and spinal fracture and trauma to support treatment decision-making. (10.2106/jbjs.17.00276)
  • [L3] The sagittal orientation of the facets was part of the preexisting morphology and was not solely a secondary result of spondylolisthesis. (10.2106/00004623-199603000-00012)
  • [L5] Most patients with cervical spondylotic myelopathy become worse clinically if the disorder is left untreated, with more than 50 percent progressing to severe disability. (10.2106/00004623-199409000-00020)
  • [Paper] The dual-cord dynamic stabilization system demonstrates improved biomechanical stability with minimal adjacent segment compromise. (10.1186/s13018-025-06130-2)
  • [L5] This is a comprehensive, up-to-date reference source on the use of magnetic resonance imaging and computed tomography for the scanning of the entire spine, serving as a useful text for any spine surgeon or radiologist. (10.2106/00004623-199410000-00028)
  • [L5] MRI is a non-invasive, high-resolution, multiplanar imaging modality that provides detailed visualization of osseous and soft-tissue structures of the cervical spine, including the intervertebral discs, spinal cord, and nerve roots, and is essential for evaluating the spectrum of cervical spinal disease. (10.2106/00004623-200200002-00009)
  • [L4] Treatment depends on symptom severity and neurological involvement; fusion is indicated for instability causing cord compression, while laminectomy or foramen magnum enlargement may be necessary for compression. (10.2106/00004623-196850020-00008)
  • [L4] The investigation represents the best available evidence regarding the radiographic and clinical natural history of cervical degeneration, with data that will have a critical influence on discussions with patients regarding their MRI findings. (10.2106/jbjs.18.00071)
  • [L4] The position of the lumbar spine center of rotation changes with variations in load and differs between movement types, suggesting distinct motion patterns in the lower lumbar spine. (10.1186/s12891-025-08410-8)
  • [L4] The authors provide strong evidence that Su's three-column theory complies with the characteristics of vertebral physiological structure, vertebral fracture, and vertebral biomechanics. (10.1186/s12891-020-03550-5)
  • [L5] Magnetic resonance is an excellent modality for imaging pathologic processes in the pediatric spine, allowing high-resolution views of osseous and soft-tissue structures. (10.5435/00124635-200307000-00004)
  • [L4] The biomechanics of the lumbar spine may differ with each individual, and L4–5 dislocation may be a variant to lumbosacral (L5-S1) dislocation, owing to hyperextension injury. (10.1186/s12891-019-2921-5)
  • [L5] No existing prognostic classification system can predict which patients with a congenital osseous anomaly of the cervical spine are at risk for future neurologic injury. (10.2106/00004623-200202000-00017)
  • [L4] Gas accumulation in the spinal canal is a common clinical disease, which can be identified by CT and MRI. (10.1186/s13018-025-05895-w)
  • [L4] Spinal osteoblastoma has multiple unique characteristic radiological features. (10.1186/s12891-020-03252-y)
  • [L3] The intrinsic dimensions of the cervical spinal canal, specifically the shape defined by the ratio of sagittal to transverse diameter, may constitute a predisposition to spinal cord injury in the cervical segments. (10.2106/00004623-198971020-00003)
  • [L5] The document serves as an operations manual and consensus guide for standardizing spinal stiffness measurement using the VerteTrack device, emphasizing safety protocols, operator training, and participant preparation rather than reporting clinical outcomes. (10.1186/s12891-021-04313-6)
  • [L4] Despite some disadvantages, it is a good device for segmental fixation of the cervical and thoracic spine. (10.1186/s12891-024-07953-6)
  • [L4] It is currently impossible to state that bracing effectively alters the natural history of scoliosis in immature patients who are at high risk for progression. (10.2106/00004623-199604000-00009)
  • [L3] Thus SpineNet offers potential to grade LSS in large-scale epidemiological studies involving a high volume of MRI spine data with a high level of consistency and objectivity. (10.1186/s12891-020-3164-1)
  • [L4] Follow-up ranging from eighteen to twenty-five months revealed complete resolution of the sciatica in all patients. (10.2106/00004623-198567060-00006)
  • [L3] Autonomic and non-autonomic dysfunction is common in long-term follow-up of cauda equina syndrome patients, even in those with the most optimistic prognosis, and early decompression did not show a statistically significant correlation with improved outcomes. (10.1302/0301-620x.103b9.bjj-2021-1152)
  • [L4] These data provide a useful reference for future research in spinal biomechanics and musculoskeletal modeling. (10.1186/s13018-025-06408-5)
  • [Paper] The effect of asymmetry on facet joint response should be fully considered in biomechanical studies of lumbar spine, especially in post structures subjected to physiological loadings. (10.1186/s12891-016-0980-4)
  • [L3] Longer spinal fusion or inclusion of the pelvis in the fusion critically impacts hip-spine biomechanics and significantly affects the ability to compensate in the standing-to-sitting transition. (10.1016/j.arth.2017.04.051)
  • [L5] Increasing the load has a significant impact on the coupled translational movement of lumbar facet joints. (10.1186/s13018-022-03016-5)
  • [L4] Accessory ossicles of the spine exhibit varied prevalence and clinical significance, with some presenting minor associations with symptoms and others linked to specific syndromes or spinal disorders. (10.1186/s13018-024-05407-2)
  • [L3] The Hip-Spine Classification system allows surgeons to make appropriate evaluations preoperatively, and it guides the use of DM components in patients with spinopelvic pathology in order to reduce the risk of dislocation in these high-risk patients. (10.1302/0301-620x.103b7.bjj-2020-2448.r2)
  • [L5] Critical spinal lytic defects result in kinematic abnormalities and lower the compressive strength of the spine. (10.2106/jbjs.19.00419)
  • [L4] This article summarizes the clinical findings of echinococcosis of the spine, discusses specific laboratory and diagnostic findings, lists current treatment options, and reviews patient outcomes. (10.1302/2058-5241.6.200130)
  • [L5] No mechanical failures were observed, even after each 30-million-cycle interval, which simulates approximately 80 years of lumbar-bending motions. (10.2106/jbjs.25.00594)
  • [L5] These data can be useful in future spinal biomechanics research leading to better biomechanical compatibility and provide theoretical references for spinal implant materials. (10.1186/s13018-017-0631-y)
  • [L4] This study found weak to moderate effects of individual kinematic variables and lumbar lordosis on IV-RoMmax at other intervertebral levels. (10.1186/s12891-016-0975-1)
  • [L5] The study documented the complete three-dimensional elastic physical properties of each lumbar intervertebral level, finding that load-displacement curves are non-linear and motions are coupled, with ranges of motion comparing favorably with reported in vivo values. (10.2106/00004623-199403000-00012)
  • [L5] Regardless of the setting, when cauda equina syndrome is diagnosed, the treatment is urgent surgical decompression of the spinal canal. (10.5435/00124635-200808000-00006)
  • [L4] Utilizing formal consensus-building methods in a large group of surgeons experienced in treating early-onset scoliosis, a novel classification system for early-onset scoliosis was developed with all core components demonstrating substantial to excellent interobserver reliability. (10.2106/jbjs.m.00253)
  • [L5] This modeling approach enhances the understanding of scoliosis biomechanics, facilitating risk assessment for disc prolapse and aiding in treatment selection. (10.1186/s13018-024-05417-0)
  • [L2] The T4-L1-Hip axis is conceptually aligned with the description of spinal shapes in the Roussouly classification but with the advantage of utilizing continuous measures of spinal alignment. (10.2106/jbjs.24.01489)
  • [L4] The paper reviews biomechanical studies to clarify the effects of interspinous devices on treated and adjacent spinal segments, noting that while devices reduce range of motion in extension and can reduce disc pressure, they often fail to fully compensate for destabilization in other planes or adjacent levels. (10.1155/2014/839325)
  • [L4] The major determinants of sacral dysmorphism are upper sacral segment coronal and axial angulation. (10.2106/jbjs.m.00895)
  • [L5] Pushing conditions also warrant attention to the lower spinal cord and the nerve roots on both sides of the main thoracic curve. (10.1186/s12891-024-07832-0)
  • [L2] Using this simplified approach could lead to a 7-fold overprediction of patients with a stiff lumbar spine and abnormal spinopelvic mobility, unnecessary use of dual-mobility bearings, and incorrect component alignment targets. (10.1016/j.arth.2022.05.020)
  • [L4] Various measurements of the posterior structures of subaxial cervical vertebrae differed between the left and right sides, females and males, and the DCS and NDCS groups. (10.1186/s13018-015-0194-8)
  • [L3] This procedure can improve patients' pain, neurological function and kyphotic deformity and achieve effects similar to traditional methods, making it an ideal surgical treatment for thoracolumbar fractures in AS patients. (10.1186/s13018-022-03378-w)
  • [L5] HAVB had similar biomechanical efficacy in spinal stability reconstruction as compared with TMC and AVB. (10.1186/s13018-019-1432-2)
  • [L4] Radiologists should be familiar with this imaging characteristic. (10.1186/s12891-021-04610-0)
  • [L4] Surgeons should consider these morphometric deviations to optimize implant compatibility and surgical navigation in degenerative spines. (10.1186/s12891-026-09547-w)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L5] The proposed method provides an option rather than a final position for quantifying cervical spine muscle composition and morphology using MRI. (10.1186/s12891-018-2074-y)
  • [L3] This study describes CT-based L1-S1 neuroforaminal dimensions in young, healthy patients who presented with reasons other than back pain or pathology affecting the neuroforamen. (10.2106/jbjs.22.01394)
  • [L5] Following spine surgery, complication rates are higher in patients with Parkinson disease than in those without the disease. (10.5435/jaaos-d-16-00627)
  • [L4] Roentgenograms, computerized tomographic scans, and possibly magnetic resonance imaging studies are needed for differentiation when a definitive diagnosis cannot be made. (10.2106/00004623-199308000-00014)
  • [Case_report] The authors note that treatment is generally non-operative, with surgery reserved for inadequate reduction or persistent symptoms. (10.2106/00004623-198870020-00020)
  • [L3] Findings suggested that scoliotic curvatures in preoperative AIS patients can be largely represented by both imaging modalities despite the difference in body positioning. (10.1186/s12891-020-03561-2)
  • [L5] The monograph describes clinical, roentgenographic, and laboratory findings in lumbar and cervical intervertebral disc injuries, noting that degeneration is present in practically all instances and that rupture in persons under twenty is rare. (10.2106/00004623-195032020-00042)
  • [L4] Non-operative treatment usually is successful; however, surgical stabilization is suggested in patients who have unstable delayed union or when the patient is uncooperative. (10.2106/00004623-198668060-00011)
  • [L4] In the standing pelvic lateral radiographs, ensuring superposition of the femoral heads at the center and obtaining the straight sacral endplate by referring to CT or magnetic resonance imaging would be a more accurate measurement method to define PI. (10.1186/s12891-022-05063-9)
  • [L3] The PSCD was weakly correlated with all evaluated lateral lumbar radiographic metrics in both sexes, despite strong inter-observer reliability. (10.1016/j.arth.2023.01.052)
  • [L5] This study presents the first patient-specific three-dimensional in vivo kinetic model of the cervical spine using CT, MRI, and fluoroscopy data. (10.2106/jbjs.h.00626)
  • [L4] Results demonstrate no increase of intersegmental movement or instability after microsurgical decompression of the lumbar spine over a follow-up period of 12 months. (10.1186/s12891-022-05701-2)
  • [L5] Prognosis depends on the severity of the deformity, with severe cases often incurable and requiring palliative operations, while less severe cases may recover spontaneously or with minimal treatment. (10.2106/00004623-195941080-00017)
  • [L2] Overall bone metabolism of the operated intervertebral disc space at six weeks had the highest diagnostic accuracy for predicting the fusion status at one year. (10.1186/s13018-025-05814-z)
  • [L4] Early recognition and repair of pseudarthrosis or extension of a fusion area which is too short prevent further loss of correction and increasing deformity in those patients in whom vertebral growth is not yet complete. (10.2106/00004623-195840030-00006)

See Also

References

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[3] Interspinous Process Spacers. Journal of the American Academy of Orthopaedic Surgeons. 2007. DOI: 10.5435/00124635-200704000-00003

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[5] Measuring the morphological characteristics of thoracolumbar fascia in ultrasound images: an inter-rater reliability study. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2088-5

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[10] Evaluating the performance of a novel double-threaded dynamic stabilization system: a finite element study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06130-2

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[33] What is the Impact of a Spinal Fusion on Acetabular Implant Orientation in Functional Standing and Sitting Positions?. The Journal of Arthroplasty. 2017. DOI: 10.1016/j.arth.2017.04.051

[34] The effect of various weight-bearing activities on the motion of lumbar facet joints in vivo. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03016-5

[35] Anatomical variability, morphofunctional characteristics, and clinical relevance of accessory ossicles of the back: implications for spinal pathophysiology and differential diagnosis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-024-05407-2

[36] 2021 Otto Aufranc Award: A simple Hip-Spine Classification for total hip arthroplasty. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b7.bjj-2020-2448.r2

[37] Large Lytic Defects Produce Kinematic Instability and Loss of Compressive Strength in Human Spines. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.19.00419

[38] Echinococcosis of the spine. EFORT Open Reviews. 2021. DOI: 10.1302/2058-5241.6.200130

[39] Comparative in Vitro Analysis of Wear Particles Generated by a Viscoelastic Disc Versus 2 Articulating Total Disc Replacements. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.25.00594

[40] Biomechanical analysis of the posterior bony column of the lumbar spine. Journal of Orthopaedic Surgery and Research. 2017. DOI: 10.1186/s13018-017-0631-y

[41] Relationships between lumbar inter-vertebral motion and lordosis in healthy adult males: a cross sectional cohort study. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-0975-1

[42] Mechanical behavior of the human lumbar and lumbosacral spine as shown by three-dimensional load-displacement curves.. The Journal of Bone & Joint Surgery. 1994. DOI: 10.2106/00004623-199403000-00012

[43] Cauda Equina Syndrome. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200808000-00006

[44] Development and Initial Validation of the Classification of Early-Onset Scoliosis (C-EOS). Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.00253

[45] Patient-specific spine digital twins: a computational characterization of the idiopathic scoliosis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-024-05417-0

[46] The T4-L1-Hip Axis Objectifies the Roussouly Classification Using Continuous Measures. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.01489

[47] Chapter 34 The Cervical Spine. 2019.

[48] Biomechanics of Interspinous Devices. BioMed Research International. 2014. DOI: 10.1155/2014/839325

[49] Anatomic Determinants of Sacral Dysmorphism and Implications for Safe Iliosacral Screw Placement. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.00895

[50] Biomechanical study of spinal cord and nerve root in idiopathic scoliosis: based on finite element analysis. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07832-0

[51] Sacral Slope Change From Standing to Relaxed-Seated Grossly Overpredicts the Presence of a Stiff Spine. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2022.05.020

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[53] Surgical treatment of thoracolumbar fracture in ankylosing spondylitis: A comparison of percutaneous and open techniques. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03378-w

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[56] Structural remodeling impact of osteophytes and Schmorl’s nodes on lumbar vertebral morphometry: anatomical basis for spinal instrumentation. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09547-w

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