Purpose
This retrospective study investigated the distinct clinical and radiographic drivers of early- versus late-onset proximal junctional kyphosis (PJK) following multilevel thoracolumbar (TL) fusion.
Methods
After applying the exclusion criteria (spinal infection, neuromuscular disease, age <50 years), the analysis included 136 patients who underwent ≥4-level TL fusion and were followed up for a minimum of 2 years. PJK was classified as early (≤6 months) or late (>6 months) onset. Patient-related factors, surgical variables, sagittal spinopelvic parameters, and preoperative magnetic resonance imaging findings were analyzed using multivariate logistic regression to identify independent predictors of early PJK.
Results
Among 24 patients (17.6%) who developed PJK, the early and late-onset groups included 13 and 11 patients, respectively. The early PJK group exhibited significantly greater preoperative and postoperative TL angles compared with the late group (preoperative: 23.03±13.83° vs. 9.67±9.67°, p=0.024; postoperative: 19.6±6.95° vs. 6.95±6.35°, p<0.001). The Pfirrmann grade of the L1–2 intervertebral disc was significantly higher in the early PJK group (3.92±0.95 vs. 2.81±0.60, p=0.006). No surgical variables differed significantly between the groups. Multivariate analysis confirmed greater postoperative TL angle and more advanced L1–2 disc degeneration as independent predictors of early PJK.
Conclusion
Early-onset PJK following multilevel TL fusion is primarily driven by regional biomechanical vulnerabilities, specifically residual postoperative TL kyphosis and advanced adjacent L1–2 disc degeneration, rather than by surgical variables. Meticulous evaluation of regional TL alignment and adjacent disc health during surgical planning is critical for risk stratification and prevention of early junctional failure.

Chondroma is a benign cartilaginous neoplasm, rarely encountered in the lumbar spine. We report a case involving a 70-year-old female who presented with lower limb radiating pain that started four years ago. Although no pronounced muscle weakness was noted, the patient experienced progressively worsening radiating pain in the L4 dermatome. Initial evaluation, including magnetic resonance imaging (MRI) performed at another medical facility, suggested a potential lesion associated with left L4–5 lumbar disc herniation. Despite non-surgical interventions, the patient experienced limited symptomatic relief, prompting her to seek further care at our clinic. Subsequent contrast-enhanced MRI conducted at our facility revealed a mass exhibiting peripheral rim enhancement surrounding the L4 nerve root. Suspecting a neurogenic tumor, we decided to perform surgical excision of the mass. Postsurgery, histopathological analysis confirmed the presence of hyaline cartilage with lobular architecture and chondrocytes in lacunae, leading to the conclusive diagnosis of chondroma. Following the surgical procedure, the previously reported radiating pain exhibited notable improvement.

Purpose
Few studies have assessed the prevalence of cervical and thoracic and lumbar (thoracolumbar) intervertebral disc disorders, respectively, using data from the Korean National Health Insurance Service (KNHIS). The aim is to show the changing prevalence of cervical and thoracolumbar intervertebral disc disorder over the last decade.
Methods
Data spanning 2012 to 2021 were collected from the KNHIS, encompassing primary diagnoses related to cervical and thoracolumbar intervertebral disc disorder (ICD 10 code: M50.x and M51.x except M51.4). The agestandardized prevalence was computed using the estimated Korean population in 2020 as a reference. Additionally, age-standardized number of general spinal operations per year was illustrated using the Statistical Yearbook of Major Surgeries in 2021.
Results
In 2012, the age-standardized prevalence of cervical intervertebral disc disorder was 11,383 persons per 100,000 decreasing to 8,860 persons per 100,000 persons in 2021. This decline was observed in both male (from 10,101 to 8,012) and female (from 12,690 to 9,709). For thoracolumbar intervertebral disc disorders, the agestandardized prevalence decreased from 27,506 to 18,903 persons per 100,000 persons from 2012 to 2021. Notably, the age-standardized prevalence showed a greater increase in individuals aged 60 or older compared to those aged 50, for both sexes. However, there was an increase in the number of general spinal operation from 2012 to 2021.
Conclusions
While the overall age-standardized prevalence of cervical and thoracolumbar intervertebral disc disorders decreased between 2012 and 2021 across all age groups, the number of general spinal operations increased during the same period.

Purpose
The current study aims to report the results of analyzed factors that ultimately undergo surgical treatment after selective nerve root block in patients with spinal structural pathology that cause lower back pain and radiating pain in the lower extremities. Material and methods: A retrospective study was performed on 537 patients diagnosed with spinal canal stenosis or disc herniation among patients who underwent selective nerve root block at our hospital for five years from May 2015 to December 2017. The patients were divided into Group A (patients with an only selective spinal nerve root, n=99) and Group B (patients with surgical treatment, n=20). We evaluated the primary demographic factors, including age, sex, onset, symptom duration, diabetes mellitus, hypertension, angina, osteoporosis. The clinical variables included in the analysis were the preoperative visual analog scale (VAS) pain score, the Korean version of the Oswestry Disability Index (K-ODI), and the Roland-Morris disability questionnaire (RMDQ).
Results
The average symptom duration was 22.6±1.2 weeks in group A, and 35.7±0.9 in group B. Of a total of 20 patients (16.8%), four males (20%) and 16 females (80%) were underwent surgical procedures because there was no improvement in symptoms. Group B had a significantly higher proportion of female patients and longer symptom duration than group A. And there were no statistically significant differences between groups in other variables.
Conclusions
Although the frequency of surgical treatment decreased after selective nerve root block, the longer symptom duration and the female gender might be related to the risk factors for surgical treatment.

Chronic low back pain is a common cause of disability causing major socioeconomic consequences. Recent advances in disc biology and tissue engineering techniques enable a new emerging field of biologic treatments for degenerative disc disease. These new treatment modalities aim to achieve structural and functional restoration of the degenerated discs by introducing protein, cells, genetic modifications of resident disc cells or exogenous cultured cells, and use of biomaterials. So far, these techniques have been successfully applied to treat degenerated discs in preclinical setting, including in vitro or in animal studies. Application of these treatment modalities for degenerative disc disease should be individualized according to the degree of disc degeneration. For the successful application in clinical field, the biologic treatment should achieve the functional restoration of the disc, resulting in pain regulation.