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Vertebral Regions

Anatomical and pathological overview of the cervical, thoracic, and lumbar regions, including congenital scoliosis and degenerative Modic changes.

Overview

Chronic low back pain and radicular symptoms often lack large-magnitude associations with specific MRI findings [1], while cervical Modic changes do not impact clinical outcomes in cervical spine procedures [4]. In contrast, outcomes for multiple myeloma of the spine are critically dependent on the presence of multiple fractures in the thoracolumbar and lumbar regions and the failure to prevent kyphosis [7]. Long-term spinal stability remains a significant challenge in kyphoscoliotic patients with neurological deficits, frequently necessitating additional fusion procedures [8].

Surgical indications vary by region and pathology. For herniated discs, relative indications include six months of persisting symptoms for the cervical level, failure of conservative measures for the thoracic level, and failure to improve after six weeks for the lumbar level [13]. Management of metastatic disease in the thoracic and lumbar spine is guided by neurologic compromise, spinal instability, and individual patient factors [12]. Surgical intervention is indicated for adult Scheuermann kyphosis in patients with persistent pain and unacceptable deformity caused by significant kyphosis [29].

Preoperative planning and clearance require specific assessments. Pediatric cervical spine clearance relies on consensus definitions and an algorithmic approach based on Glasgow Coma Scale scores [28]. Bone density data from individual spinal segments measured using Hounsfield units may be helpful to comprehensively evaluate the status of the spine and design a better preoperative plan before instrumentation [24]. In elderly patients requiring revision surgery for proximal junctional kyphosis or additional postoperative vertebral fracture, the mean bone densities of vertebral bodies at T8 and T9 were significantly lower [48]. Instrumentation should never extend beyond the contralateral intervertebral disc border regardless of presumed vascular anatomy in oblique lumbar interbody fusion [26].

Anatomy & Pathophysiology

Osseous Morphology and Variations

The unique microarchitecture of the cervical spine delays fracture occurrence relative to the thoracic or lumbar regions [3]. Spinal morphology provides axial support, significant flexibility, and neural protection through its bony, ligamentous, neural, and vascular components [38]. Vertebral body morphometry differs between neuromuscular and idiopathic scoliosis in skeletally immature patients, and vertebral wedging in idiopathic scoliosis cannot be attributed solely to asymmetric loading [63]. Anatomical variations in vertebral counts (11 thoracic, 6 lumbar) exist in asymptomatic adults, necessitating surgeon awareness during alignment assessment and surgery [30]. Structural variations of the lumbosacral joint are clinically insignificant except in extreme cases, contradicting common opinions regarding posterior displacement and facet inclination [52].

Kinematics and Biomechanics

Quantifying multi-segmental thoracolumbar motion lacks standard guidelines and remains limited clinically [14]. Simplified approaches using sacral slope changes from standing to seated positions risk a 7-fold overprediction of stiff lumbar spines, leading to unnecessary dual-mobility bearings and incorrect component alignment targets [46]. In osteoporotic models, both cementless and cement-augmented pedicle screw instrumentation increase range of motion and disc stresses, though cement augmentation carries a higher risk of adjacent segment degeneration [50]. Spinal sagittal parameters correlate poorly with gait parameters in asymptomatic subjects [47]. While spinal curvatures change significantly during skeletal maturity, these modifications are not large enough to impact clinical practice or surgical planning [53].

Pathophysiology of Deformity and Pain

In severe scoliosis, deformity severity, rather than curvature direction, primarily determines cardiac health impact [17]. Spinal morphology and its correction influence the intensity and location of back pain in adolescent idiopathic scoliosis, whereas balance does not influence pain severity [25]. Paraspinal muscle activity (SI) and coronal Cobb angles in adolescent idiopathic scoliosis vary with posture changes [59]. Forces in zone 3 applied by spinal orthoses do not significantly reduce thoracic kyphosis or exacerbate sagittal deviation in adolescent idiopathic scoliosis [54]. The cervical sagittal profile undergoes compensatory changes following lumbar fusion after spontaneous compensation of global sagittal imbalance [65].

Spinopelvic and Acetabular Implications

Increased age, standing posterior pelvic tilt, and decreased lumbar flexion are significant risk factors for unfavourable sagittal pelvic motion, which causes unfavourable acetabular orientation, functional malorientation, and increased dislocation or wear risk in total hip arthroplasty [62]. Further biomechanical and clinical studies are required to validate Tektona®'s capabilities for height and volume restoration in osteoporotic vertebral compression fractures [60].

Classification

Pediatric Cervical Clearance: Consensus definitions and an algorithmic approach for pediatric cervical spine clearance based on Glasgow Coma Scale scores were established to guide institutional protocols [28].

Spinopelvic Alignment: The Hip-Spine Classification system allows surgeons to make appropriate preoperative evaluations and guides the use of dual mobility components in patients with spinopelvic pathology to reduce the risk of dislocation [36]. The T4-L1-Hip axis is conceptually aligned with the description of spinal shapes in the Roussouly classification but utilizes continuous measures of spinal alignment [40].

Thoracic Pedicle Instrumentation: A CT-based classification determined by inner cortical width of pedicles can help surgeons predict whether screws can be inserted into the thoracic pedicle, guiding instrumentation when posterior vertebral column resection is performed [49].

Other Considerations: Few MRI findings showed large magnitude associations with chronic low back pain or radicular symptoms even when applying more specific definitions for spine-related symptom outcomes [1]. Fractures occur much later in the cervical spine region than in the thoracic or lumbar spine due to the unique microarchitecture of cervical vertebrae [3]. The pattern and sequence of vertebral and intervertebral disc wedging are related to the location of the curve rather than the presence of curve progression in adolescent idiopathic scoliosis [5]. A rapid and simple technique exists for accurate localization of vertebrae at surgery that offers unparalleled accuracy in identifying the involved vertebral area without introducing a substance that cannot be readily removed [6]. The prevalence of different accessory ossicles of the back shows notable heterogeneity, highlighting the need for careful differential diagnosis to prevent misinterpretation of fractures or other spinal pathologies [15]. Although an ideal classification for thoracic and lumbar fractures does not exist, standardization of terminology related to treatment decisions and prognosis is key to improved understanding of the clinical behavior of these injuries [21]. Bone density 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 [24]. There is a relationship between the morphological characteristics of the human lumbar pedicle and geographical location [45]. Overall, 24% of subjects had anomalies in the thoracolumbar region, with the type of anomaly differing between males and females [55]. Osteophytes and Schmorl's nodes are associated with significant morphometric deviations that may have implications for multiple aspects of spinal instrumentation [57].

Clinical Presentation

Pain distribution varies significantly by vertebral region. Pain reported from the lumbar and cervical spines is relatively common, whereas pain in the thoracic spine and pain radiating into the chest is much less common [34]. In children, Langerhans Cell Histiocytosis of the spine demonstrates a particularly high prevalence of lesions in the cervical spine and a high prevalence of multiple skeletal lesions [2]. Spinal deformities in Noonan syndrome tend to develop early and are relatively severe [9].

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 [16]. Cervical spine morphology in asymptomatic adolescents varies widely from lordotic to kyphotic [18]. The severity of spinal deformity, rather than curvature direction, is the main determinant of its impact on cardiac health in patients with severe scoliosis [17]. In adolescent idiopathic scoliosis, the pattern and sequence of vertebral and intervertebral disc wedging are related to the location of the curve rather than the presence of curve progression [5].

Diagnostic Imaging: Few MRI findings of the lumbar spine showed large magnitude associations with chronic low back pain or radicular symptoms [1]. Findings on magnetic resonance scans of the lumbar spine were not predictive of the development or duration of low-back pain in asymptomatic subjects [10]. The presence of cervical Modic changes did not impact clinical outcomes in cervical spine procedures [4]. Careful differential diagnosis is needed for accessory ossicles of the back to prevent the misinterpretation of fractures or other spinal pathologies, as the prevalence of different accessory ossicles shows notable heterogeneity [15].

Stability and Special Tests: Fractures occur much later in the cervical spine than in the thoracic or lumbar spine due to unique microarchitecture [3]. Multiple vertebral fractures in the elderly present a risk for the progression of vertebral deformities [11]. Except for the unsegmented unilateral bar, the specific anomaly present in congenital scoliosis was of less prognostic value than the pattern of the curve and the area of the spine involved [19]. A technique for accurate localization of vertebrae at surgery is rapid, simple, and offers unparalleled accuracy in identifying the involved vertebral area without introducing a substance that cannot be readily removed [6].

Red-Flag Patterns and Management: Management of metastatic disease in the thoracic and lumbar spine is guided by neurologic compromise, spinal instability, and individual patient factors [12]. Standardization of terminology related to treatment decisions and prognosis is key to an improved understanding of the clinical behavior of thoracic and lumbar fractures [21]. Treatment for anomalies of the occipitocervical articulation depends on symptom severity and neurological involvement [35]. Fusion is indicated for anomalies of the occipitocervical articulation when instability causes cord compression [35]. Laminectomy or foramen magnum enlargement may be necessary for anomalies of the occipitocervical articulation when compression is present [35].

Investigations

Plain radiography: Roentgenograms are required to differentiate persistent synchondrosis of the second cervical vertebra from a hangman's fracture when a definitive diagnosis cannot be made [70]. The pubic symphysis to sacrococcygeal joint distance is weakly correlated with all evaluated lateral lumbar radiographic metrics in both sexes, despite strong inter-observer reliability [73]. In adolescent idiopathic scoliosis, the pattern and sequence of vertebral and intervertebral disc wedging are related to the location of the curve rather than the presence of curve progression [5].

MRI: Few MRI findings in the lumbar spine show large magnitude associations with chronic low back pain or radicular symptoms [1]. MRI findings in asymptomatic subjects are not predictive of the development or duration of low-back pain [10]. MR images can distinguish the histological structures of normal and malformed mouse spines, where malformed vertebrae are accompanied by adjacent intervertebral structures corresponding to fully segmented structures in human congenital scoliosis, though intervertebral conditions vary [68]. Repeat imaging may be necessary for sacral stress fractures as MRI is not always definitive for early stage injuries [58]. Routine MRI evaluation appears warranted for infantile and juvenile patients with presumed idiopathic scoliosis if aged less than 10 years, being male, or having a left thoracic or right lumbar curve [27].

CT: Computerized tomographic scans are needed alongside roentgenograms and possibly magnetic resonance imaging studies to differentiate persistent synchondrosis of the second cervical vertebra from a hangman's fracture when a definitive diagnosis cannot be made [70]. Radiologists should be familiar with the imaging characteristic of giant cell tumors of the mobile spine with invasion of adjacent vertebrae [67].

Bone scan: 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 [71].

Other Considerations: Due to unique microarchitecture, fractures occur much later in the cervical vertebrae than in the thoracic or lumbar spine [3]. The axis (C2) is a predilection site for fractures, requiring special attention in radiological diagnostics after trauma [72]. Langerhans Cell Histiocytosis of the spine in children shows a particularly high prevalence of lesions in the cervical spine and a high prevalence of multiple skeletal lesions [2]. Cervical spine morphology in asymptomatic adolescents varies widely, from lordotic to kyphotic [18]. Except for the unsegmented unilateral bar, the specific congenital anomaly present is of less prognostic value than the pattern of the curve and the area of the spine involved [19]. Asymptomatic cases of Os Odontoideum without evidence of radiologic instability are typically managed with periodic observation and serial imaging [64]. A technique for accurate localization of vertebrae at surgery is rapid, simple, and offers unparalleled accuracy in identifying the involved vertebral area without introducing a substance that cannot be readily removed [6].

Treatment

Non-Operative

Evidence regarding the utility of imaging and conservative management remains mixed. Few MRI findings demonstrate large magnitude associations with chronic low back pain or radicular symptoms, even when applying specific definitions for spine-related outcomes [1]. While general physical examination principles include inspection, palpation, range of motion testing, and neurologic evaluation to identify pathology or symptom magnification [16], the literature notes limited clinical utility in stereophotogrammetric protocols for quantifying multi-segmental thoracolumbar motion due to a lack of standard guidelines [14].

Operative

Indications: Surgical intervention is indicated for adult Scheuermann kyphosis in patients presenting with persistent pain and unacceptable deformity caused by significant kyphosis [29]. Routine MRI evaluation is warranted for patients with presumed idiopathic scoliosis if they are aged less than 10 years, male, or present with a left thoracic or right lumbar curve [27]. Percutaneous techniques for thoracolumbar fractures in ankylosing spondylitis are utilized to improve pain, neurological function, and kyphotic deformity [39].

Surgical Approach / Technique: For unstable thoracolumbar burst fractures with or without neurologic deficit, the posterior-only approach has become a well-accepted method [79]. Both percutaneous and open posterior stabilization and decompression are safe and effective for AOSpine-type A3 thoracolumbar fractures with neurological deficit, though minimally invasive surgery (MIS) may provide earlier pain relief and better functional outcomes compared with open surgery (OS) [41]. Halo traction combined with a posterior-only approach is a safe and effective method for cervical kyphosis correction in patients with Neurofibromatosis-1, achieving satisfactory correction, successful bone fusion, and improvement of neurological deficits [44]. Successful treatment of complete spondylolisthesis in an infant consisted of spine fusion from the third lumbar vertebra to the sacrum [37].

Implant Selection: Instrumentation should never extend beyond the contralateral intervertebral disc border regardless of presumed vascular anatomy in oblique lumbar interbody fusion [26]. Setting the lowest instrumented vertebra at L4 is best for facilitating the recovery of thoracic kyphosis, improving symptoms, and preventing complications and pelvic deformities in Lenke 5 adolescent idiopathic scoliosis patients [43].

Pain Management: Oral duloxetine demonstrates a better short-term outcome than conventional non-drug therapy in patients with axial symptoms following posterior decompression surgery in the cervical spine [74].

Other Considerations: The presence of cervical Modic changes does not impact clinical outcomes in cervical spine procedures [4]. The efficacy of percutaneous vertebroplasty (PVP) alone is not satisfactory for osteoporotic vertebral compression fractures (OVCF) with severe anterior edge compression and kyphosis, and the rate of complications is high [20]. Twenty percent of acute osteoporotic vertebral compression fractures can involve multiple vertebra without significant spine trauma or lower baseline bone mineral density [78]. A unique case describes non-traumatic unilateral lumbar spondylolysis with a contralateral pedicle and lamina fracture, a specific combination not previously reported [76]. Narrative reviews highlight key controversies and areas for future research regarding the diagnosis, management, and treatment of teardrop fractures in the cervical spine due to limited high-quality studies and significant heterogeneity [77].

Complications

Adjacent Segment Disease: Following cervical spine fusion, adjacent segment disease occurs in approximately 3% of patients per year [32], with an expected cumulative incidence of 25% within the first 10 years [32].

Deformity Progression and Instability: In kyphoscoliotic patients with neurological deficits, long-term spinal stability remains a significant challenge, often necessitating additional fusion procedures [8]. Spinal deformities in Noonan syndrome tend to develop early and are relatively severe [9], while congenital kyphosis and kyphoscoliosis require thorough knowledge of their natural history to prevent progression and neurological complications [22]. Multiple vertebral fractures in the elderly present a risk for the progression of vertebral deformities [11]. In patients with globally involved cerebral palsy, spinal fusion can arrest deformity progression and improve posture, though functional benefits remain unclear and no randomized controlled trials compare fusion with the natural history of the disease [31].

Osteoporotic Fractures and Kyphosis: The efficacy of percutaneous vertebroplasty (PVP) alone is not satisfactory for osteoporotic vertebral compression fractures with kyphosis, and complication rates are high in patients with severe anterior edge compression and kyphosis treated with PVP alone [20]. Subsequent vertebral body fractures occurred in 19.2% of patients after posterior stabilization of unstable geriatric fractures of the thoracolumbar spine [42]. These subsequent fractures are significantly associated with higher pain levels and worse ODI scores [42].

Neoplastic and Metabolic Complications: Outcomes in multiple myeloma of the spine are particularly affected by multiple fractures in the thoracolumbar and lumbar regions and by failure to prevent kyphosis [7]. Langerhans Cell Histiocytosis of the spine in children has a particularly high prevalence of lesions in the cervical spine and a high prevalence of multiple skeletal lesions [2]. Monostotic fibrous dysplasia of the spine is a rare condition with a benign natural history; symptoms typically resolve within two years, and lesions generally remain static over long-term follow-up without progression to sarcoma or pathologic fracture [33].

Neurological and General Surgical Risks: Complication rates following spine surgery are higher in patients with Parkinson disease than in those without the disease [51]. Marines with a history of back pain are at risk of further back pain episodes [69].

Other Considerations: Few MRI findings showed large magnitude associations with chronic low back pain or radicular symptoms [1]. The presence of cervical Modic changes did not impact clinical outcomes in cervical spine procedures [4]. Fractures occur much later in the cervical spine region than in the thoracic or lumbar spine due to unique microarchitecture [3]. Fusion length selection for posterior hemivertebra resection should consider hemivertebra location, deformity severity, and kyphotic component to balance operative morbidity with long-term stability [23]. Spinal surgeons and researchers should be aware of variations in the number of thoracic and lumbar vertebrae when performing surgery and assessing alignment [30].

Recovery

Light activity (weeks): Specific timelines for light activity are not defined in the available evidence; however, relative indications for surgical intervention in herniated discs vary by region, with failure to improve after six weeks serving as an indication for lumbar procedures, while six months of persisting symptoms is a relative indication for cervical cases [13].

Full activity (months): Evidence does not provide specific month ranges for full activity return; however, functional recovery trajectories differ by pathology, with monostotic fibrous dysplasia symptoms typically resolving within two years [33], and good functional recovery occurring after posterior decompression and local radiation for solitary eosinophilic granuloma [61].

Complete recovery / outcome plateau (months): Long-term stability remains a significant challenge in kyphoscoliotic patients with neurological deficits, often requiring additional fusion procedures [8], while adjacent segment disease incidence is expected to reach 25% within the first 10 years following cervical spine fusion [32].

Rehabilitation protocol: No specific rehabilitation protocols, immobilisation durations, or weight-bearing progressions are detailed in the provided evidence base.

Functional milestones: Outcome in patients with multiple myeloma of the spine is particularly affected by multiple fractures in the thoracolumbar and lumbar regions and by failure to prevent kyphosis [7]. Spinal morphology and its correction appear to have influenced the intensity and location of back pain in adolescent idiopathic scoliosis, although balance did not influence pain severity [25]. Most patients with cervical spondylotic myelopathy become worse clinically if the disorder is left untreated, with more than 50 percent progressing to severe disability [80].

Other Considerations: Few MRI findings showed large magnitude associations with chronic low back pain or radicular symptoms [1], and findings on magnetic resonance scans of the lumbar spine were not predictive of the development or duration of low-back pain in asymptomatic subjects [10]. The presence of cervical Modic changes did not impact clinical outcomes in cervical spine procedures [4]. Pattern and sequence of vertebral and IVD wedging were related to the location of the curve rather than the presence of curve progression in adolescent idiopathic scoliosis [5]. Multiple vertebral fractures in the elderly present a risk for the progression of vertebral deformities [11]. Spinal deformities in Noonan syndrome tend to develop early and are relatively severe, necessitating clinical and radiographic assessment with careful follow-up [9]. A thorough knowledge of the natural history of congenital kyphosis and kyphoscoliosis is essential in planning appropriate and timely treatment to prevent progression of the deformity and neurological complications [22]. Fusion length selection for posterior hemivertebra resection in congenital early-onset scoliosis should consider HV location, deformity severity, and kyphotic component to balance operative morbidity with long-term stability [23]. Spinal fusion can arrest deformity progression and improve posture in patients with globally involved cerebral palsy, but functional benefits remain unclear, and there are no randomized controlled trials comparing spinal fusion with the natural history of the disease in these patients [31]. Lesions in monostotic fibrous dysplasia of the spine generally remain static over long-term follow-up without progression to sarcoma or pathologic fracture [33]. Fusion from the occiput to the fourth cervical vertebra was indispensable for sustaining life in a patient with chordoma of the atlas despite nearly complete disappearance of anterior supporting structures [66]. Adjacent segment disease occurs in approximately 3% of patients per year following cervical spine surgery [32]. Failure of conservative measures is a relative indication for surgery for thoracic herniated discs [13].

Key Evidence

  • [L2] Even when applying more specific definitions for spine-related symptom outcomes, few MRI findings showed large magnitude associations with symptom outcomes. (10.1186/1471-2474-15-152)
  • [L4] We found a particularly high prevalence of lesions in the cervical spine and a high prevalence of multiple skeletal lesions. (10.2106/00004623-200408000-00019)
  • [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)
  • [L1] The presence of cervical Modic changes did not impact clinical outcomes in cervical spine procedures. (10.3390/ijerph191610158)
  • [L2] Pattern and sequence of vertebral and IVD wedging were related to the location of the curve rather than the presence of curve progression. (10.1186/s12891-022-05863-z)
  • [L4] The technique is rapid, simple, and offers unparalleled accuracy in identifying the involved vertebral area without introducing a substance that cannot be readily removed. (10.2106/00004623-195739030-00022)
  • [L4] Outcome is particularly affected by multiple fractures in the thoracolumbar and lumbar regions and by failure to prevent kyphosis. (10.1302/0301-620x.98b9.37786)
  • [L4] However, long-term spinal stability remains a significant challenge, often requiring additional fusion procedures. (10.2106/00004623-196042060-00010)
  • [L4] Since the deformities tend to develop early and are relatively severe, a clinical and, if necessary, radiographic assessment of the spine with careful follow-up should be performed for early detection and treatment of spinal deformity. (10.2106/00004623-200110000-00006)
  • [L2] The findings on magnetic resonance scans were not predictive of the development or duration of low-back pain. (10.2106/00004623-200109000-00002)
  • [L2] Multiple vertebral fractures in the elderly present a risk for the progression of vertebral deformities. (10.1186/s12891-024-07254-y)
  • [L5] Management is guided by three key issues: neurologic compromise, spinal instability, and individual patient factors. (10.5435/00124635-201101000-00005)
  • [L5] Relative indications vary by level: six months of persisting symptoms for cervical, failure of conservative measures for thoracic, and failure to improve after six weeks for lumbar. (10.1302/2058-5241.6.210020)
  • [L1] The literature offers various stereophotogrammetric protocols to quantify multi-segmental motion of the thoracolumbar spine without a standard guideline, and approaches remain limited from a clinical point of view. (10.1186/s12891-022-05925-2)
  • [L4] The prevalence of different ossicles shows notable heterogeneity, highlighting the need for careful differential diagnosis to prevent the misinterpretation of fractures or other spinal pathologies. (10.1186/s13018-024-05407-2)
  • [L3] The severity of the spinal deformity, rather than the curvature direction, is the main determinant of its impact on cardiac health. (10.1186/s13018-025-06113-3)
  • [L4] The cervical spine morphology of asymptomatic adolescents varies widely, from lordotic to kyphotic. (10.1186/s12891-022-05792-x)
  • [L4] Except for the unsegmented unilateral bar, the specific anomaly present was of less prognostic value than the pattern of the curve and the area of the spine involved. (10.2106/00004623-196850010-00002)
  • [L3] The efficacy of PVP alone was not satisfactory, and the rate of complications was high for OVCF patients with severe anterior edge compression with kyphosis. (10.1186/s13018-020-1583-1)
  • [L5] Although the ideal classification for thoracic and lumbar fractures does not exist, standardization of terminology as related to treatment decisions and prognosis is key to an improved understanding of the clinical behavior of these injuries. (10.5435/00124635-200209000-00008)
  • [L3] A thorough knowledge of the natural history is essential in the planning of appropriate and timely treatment to prevent progression of the deformity and neurological complications. (10.2106/00004623-199910000-00002)
  • [L3] Fusion length selection should consider HV location, deformity severity, and kyphotic component to balance operative morbidity with long-term stability. (10.1186/s13018-025-05971-1)
  • [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)
  • [L3] Although balance did not influence pain severity, spinal morphology and its correction appear to have influenced the intensity and location of back pain. (10.1186/s12891-020-03462-4)
  • [L5] Nevertheless, the general surgical principle remains paramount: instrumentation should never extend beyond the contralateral intervertebral disc border, regardless of presumed vascular anatomy. (10.1186/s13018-025-06066-7)
  • [L3] Thus, a routine MRI evaluation appears warranted for those patients if aged less than 10 years, being male or having left thoracic or right lumbar curve. (10.1186/s12891-016-1026-7)
  • [L5] The Pediatric Cervical Spine Clearance Working Group established consensus definitions and developed an algorithmic approach for pediatric cervical spine clearance based on Glasgow Coma Scale scores to guide institutional protocols. (10.2106/jbjs.18.00217)
  • [L5] Surgical intervention is indicated in patients with persistent pain and unacceptable deformity caused by significant kyphosis. (10.5435/00124635-201202000-00007)
  • [L4] The authors encourage spinal surgeons and researchers to be aware of such variations when performing thoracic- and lumbar-level surgery and assessing spinal alignment and parameters. (10.1186/s13018-018-0835-9)
  • [L5] It notes that while spinal fusion can arrest deformity progression and improve posture, there are no randomized controlled trials comparing fusion with the natural history of the disease, and functional benefits remain unclear. (10.2106/jbjs.n.00468)
  • [L5] Adjacent segment disease occurs in approximately 3% of patients per year, with an expected incidence of 25% within the first 10 years following fusion. (10.5435/jaaos-21-01-3)
  • [L4] Monostotic fibrous dysplasia of the spine is a rare condition with a benign natural history; symptoms typically resolve within two years, and lesions generally remain static over long-term follow-up without progression to sarcoma or pathologic fracture. (10.2106/jbjs.i.00727)
  • [L4] Pain reported for and from the lumbar and cervical spines was found to be relatively common whereas pain in the thoracic spine and pain radiating into the chest was much less common. (10.1186/1471-2474-10-39)
  • [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)
  • [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)
  • [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)
  • [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)
  • [L3] Both treatment strategies are safe and effective; however, MIS could provide earlier pain relief and better functional outcomes compared with OS. (10.1186/s12891-023-06486-8)
  • [L3] Subsequent vertebral body fractures occurred in 19.2% of patients and were significantly associated with higher pain levels and worse ODI scores. (10.1186/s12891-022-06031-z)
  • [L3] Setting the lowest instrumented vertebra at L4 is best for facilitating the recovery of thoracic kyphosis, improving symptoms, and preventing complications and pelvic deformities. (10.1186/s13018-023-03680-1)
  • [L4] Halo traction combined with posterior-only approach surgery is a safe and effective method for cervical kyphosis correction in patients with NF-1, achieving satisfactory correction, successful bone fusion, and improvement of neurological deficits. (10.1186/s12891-021-04864-8)
  • [L2] There is a relationship between the morphological characteristics of the human lumbar pedicle and geographical location. (10.1186/s13018-023-03499-w)
  • [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] Spinal sagittal parameters also showed a low correlation with gait parameters. (10.1186/s12891-023-06672-8)
  • [L3] In elderly patients who required revision surgery, the mean bone densities of vertebral bodies at T8 and T9 were significantly lower. (10.1186/s13018-018-0960-5)
  • [L4] The proposed CT-based classification can help surgeons predict whether screws can be inserted into the thoracic pedicle, thus guiding instrumentation when PVCR is performed. (10.1186/1471-2474-15-278)
  • [L5] Biomechanical analysis showed that both CPS and CAPSI increase ROM and disc stresses in osteoporotic lumbar models, but CAPSI is more likely to increase the potential risk of adjacent segment degeneration compared to CPS. (10.1186/s13018-020-01650-5)
  • [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] The findings eliminate structural variations of the lumbosacral joint as being of clinical importance except when extreme, contradicting commonly accepted opinions regarding posterior displacement and facet inclination. (10.2106/00004623-195941050-00012)
  • [L4] Despite significant changes during skeletal maturity, the modifications in spinal curvatures are not large enough to be considered in clinical practice and to impact surgical planning. (10.2106/jbjs.22.00977)
  • [L4] Notably, only forces in zone 3 neither significantly reduced thoracic kyphosis nor exacerbated the deviation of the scoliotic spine from the sagittal plane. (10.1186/s12891-024-08014-8)
  • [L3] Overall, 24% of subjects had anomalies in the thoracolumbar region, with the type of anomaly differing between males and females, which could have significant implications for spinal surgery. (10.1302/0301-620x.103b7.bjj-2020-1760.r1)
  • [L4] Osteophytes and Schmorl's nodes are associated with significant morphometric deviations that may have implications for multiple aspects of spinal instrumentation. (10.1186/s12891-026-09547-w)
  • [L4] Repeat imaging may be necessary as MRI is not always definitive for early stage injuries. (10.1177/0363546506296519)
  • [L3] The coronal Cobb angle and the SI of paraspinal muscle activity in AIS patients vary with posture changes. (10.1186/s12891-024-07329-w)
  • [L5] Further biomechanical tests and clinical studies have to proof Tektona®'s capabilities. (10.1186/s12891-020-03899-7)
  • [L4] Good recovery of function occurred after posterior decompression and local radiation therapy. (10.2106/00004623-196648080-00014)
  • [L3] Increased age, increased standing posterior pelvic tilt, and decreased lumbar flexion (stiff spine) are significant risk factors for unfavourable sagittal pelvic mobility, which can lead to functional malorientation of the acetabular component and increased risk of dislocation or accelerated wear. (10.1302/0301-620x.100b7.bjj-2017-1599.r1)
  • [L3] Morphometric characteristics of vertebral bodies differed according to the pathogenesis of scoliosis, and the pathology of the wedging of vertebral bodies in idiopathic scoliosis could not be a result only of asymmetric loading to the vertebral bodies. (10.1186/s12891-017-1801-0)
  • [L5] Asymptomatic cases without evidence of radiologic instability are typically managed with periodic observation and serial imaging. (10.5435/jaaos-d-18-00637)
  • [L3] Cervical sagittal profile would have compensatory changes after short lumbar fusion. (10.1186/s12891-024-07518-7)
  • [L4] The fusion from the occiput to the fourth cervical vertebra was indispensable for sustaining the patient's life during five years of follow-up despite nearly complete disappearance of the anterior supporting structures. (10.2106/00004623-197961010-00026)
  • [L4] Radiologists should be familiar with this imaging characteristic. (10.1186/s12891-021-04610-0)
  • [L5] MR images could be used to distinguish the histological structures of normal and malformed mouse spines, and malformed vertebrae were accompanied by adjacent intervertebral structures that corresponded to the fully segmented structures observed in human congenital scoliosis, but the intervertebral conditions varied. (10.1186/s12891-024-07460-8)
  • [L2] Marines with a history of back pain are at risk of further back pain episodes, emphasizing the importance of early preventive actions. (10.1186/s12891-016-1172-y)
  • [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)
  • [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] This area seems to be a predilection site for fractures of the 2nd cervical vertebra, which is why special attention should be paid here in radiological diagnostics after a trauma. (10.1186/s13018-023-03560-8)
  • [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)
  • [L3] Oral duloxetine has a better short-term outcome than conventional non-drug therapy in patients with axial symptoms following posterior decompression surgery in the cervical spine. (10.1186/s13018-023-03970-8)
  • [Case_report] This unique case describes a non-traumatic unilateral lumbar spondylolysis with a contralateral pedicle and lamina fracture, a specific combination not previously reported. (10.1186/s12891-025-08293-9)
  • [L5] This narrative review provides a comprehensive overview of the diagnosis, management, and treatment of teardrop fractures in the cervical spine, highlighting key controversies and areas for future research due to the limited number of high-quality studies and significant heterogeneity in existing evidence. (10.1530/eor-2025-0010)
  • [L3] 20% of acute osteoporotic vertebral compression fractures can involve multiple vertebra without significant spine trauma or lower baseline bone mineral density. (10.1186/s13018-023-03874-7)
  • [L5] The posterior-only approach has become a well-accepted method for managing unstable thoracolumbar burst fracture with or without an associated neurologic deficit. (10.5435/00124635-200711000-00008)
  • [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)

See Also

References

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[4] Evaluating the Impact of Modic Changes on Operative Treatment in the Cervical and Lumbar Spine: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2022. DOI: 10.3390/ijerph191610158

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[30] Rate of presence of 11 thoracic vertebrae and 6 lumbar vertebrae in asymptomatic Chinese adult volunteers. Journal of Orthopaedic Surgery and Research. 2018. DOI: 10.1186/s13018-018-0835-9

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[33] Monostotic Fibrous Dysplasia of the Spine. The Journal of Bone and Joint Surgery-American Volume. 2010. DOI: 10.2106/jbjs.i.00727

[34] Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20–71 years of age. BMC Musculoskeletal Disorders. 2009. DOI: 10.1186/1471-2474-10-39

[35] Anomalies of the Occipitocervical Articulation. The Journal of Bone & Joint Surgery. 1968. DOI: 10.2106/00004623-196850020-00008

[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

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[40] 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

[41] Percutaneous versus open posterior stabilization and decompression in AOSpine-type A3 thoracolumbar fractures with neurological deficit. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06486-8

[42] Effect of subsequent vertebral body fractures on the outcome after posterior stabilization of unstable geriatric fractures of the thoracolumbar spine. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-06031-z

[43] How to make a more optimal surgical plan for Lenke 5 adolescent idiopathic scoliosis patients: a comparative study based on the changes of the sagittal alignment and selection of the lowest instrumented vertebra. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03680-1

[44] Halo traction combined with posterior-only approach correction for cervical kyphosis with Neurofibromatosis-1: minimum 2 years follow-up. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04864-8

[45] Morphometric measurement of lumbar pedicle in different regions: a systematic review. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03499-w

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a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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