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J Emerg Med 2019 Apr 16. Epub 2019 Apr 16.

Emergency Medicine Residency Program, Good Samaritan Hospital Medical Center, West Islip, New York.

Background: Spinal epidural abscesses have a prevalence of 3 out of every 10,000 admissions. Abscesses above the level of C2, defined as upper cervical epidural abscesses, are even rarer still.

Case Report: We discuss a case in which a 45-year-old male patient developed an upper cervical epidural abscess 48 h after receiving a lumbar steroid injection. Read More

J Neurosci Rural Pract 2019 Apr-Jun;10(2):374-378

Department of Neurosurgery, L.T.M.G. Hospital, Mumbai, Maharashtra, India.

Spinal epidural abscess (SEA) presents with vertebral body involvement. SEA is mostly pyogenic in developed countries, but in developing countries, tuberculosis is more common cause. Young female presented with fever, neck, and right upper limb pain for 1 month followed by acute onset weakness in the right upper limb. Read More

J Craniovertebr Junction Spine 2019 Jan-Mar;10(1):3-9

Department of Human Neurosciences, Division of Neurosurgery, Sapienza University of Rome, Rome, Italy.

Background: Primary spinal infections are rare pathologies with an estimated incidence of 5% of all osteomyelitis. The diagnosis can be challenging and this might result in a late identification. The etiological diagnosis is the primary concern to determine the most appropriate treatment. Read More

Rev Soc Bras Med Trop 2019 Apr 11;52:e20180243. Epub 2019 Apr 11.

Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China.

Brucellosis, a zoonosis with worldwide distribution, is a systemic infection caused by bacteria of the genus Brucella. Meanwhile, brucellosis often causes complications, such as osteoarticular involvement, and spondylitis is the most prevalent and important clinical form. Here, is a case of cervical brucellar spondylitis causing incomplete limb paralysis in a middle-aged male. Read More

Reg Anesth Pain Med 2019 Apr 16. Epub 2019 Apr 16.

Anesthesiology, Clement Zablocki VA Medical Center/Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Stellate ganglion nerve blockade (SGNB) is a vital tool in our armamentarium for the treatment of various chronic pain syndromes. SGNB can be performed using the traditional landmark-based approach, or with image guidance using either fluoroscopy or ultrasound. In this review, we systematically analyzed reported SGNB-related complications between 1990 and 2018. Read More

Cureus 2019 Feb 1;11(2):e3994. Epub 2019 Feb 1.

Internal Medicine, Ocala Regional Medical Center/ University of Central Florida College of Medicine, Ocala, USA.

This case involves a 62-year-old male with a prior history of epidural abscess and L1-L2 osteodiscitis who was admitted because of low back pain. The patient was previously treated for methicillin-susceptible Staphylococcus aureus (MSSA) discitis in the L1/L2 vertebral region with intravenous (IV) nafcillin through a peripherally inserted central catheter (PICC). However, he returned after four months with recurrent low back pain along with chills and fever. Read More

J Hosp Med 2019 Apr 8;14:E1-E5. Epub 2019 Apr 8.

Icahn School of Medicine at Mount Sinai, New York, New York.

Background: Hospital medicine continues to grow in workforce, clinical scope, and academic inquiry. This article provides a summary of recent high-impact publications for busy clinicians who provide care to hospitalized adults.

Methods: Authors reviewed articles that were published between March 2017 and March 2018 for the Update in Hospital Medicine presentations at the 2018 Society of Hospital Medicine and Society of General Internal Medicine annual meetings. Read More

Childs Nerv Syst 2019 Apr 13. Epub 2019 Apr 13.

Department of Neurological Surgery, Nemours Children's Hospital, Orlando, FL, USA.

Purpose: The purpose of this study was to review a case comprised of a cervical spinal epidural abscess, cervical and thoracic paraspinous edema, and widening of the right thoracic neural foramen secondary to a phlegmon.

Methods: We reviewed the case of a spinal epidural abscess managed medically in a 4-year-old male and performed a review of the literature with 15 other cases that have previously been reported.

Results: The current mainstay of treatment is largely variant but generally falls into a laminectomy-based surgical approach or longstanding antibiotics. Read More

Eur Rev Med Pharmacol Sci 2019 Apr;23(2 Suppl):117-128

Department Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.

Objective: This systematic review focuses on 5 key elements that may improve the decision-making process in spondylodiscitis: the infective agent, segmental instability, abscess development, neurological compromise and focus of infection.

Materials And Methods: We included 64 studies published between May 2012 and May 2017, that reported both a description of the discitis and comparative data regarding the disease and its complications.

Results: The majority of cases were caused by Staphylococcus spp (40. Read More

Eur Rev Med Pharmacol Sci 2019 Apr;23(2 Suppl):1-5

Department of Medical and Surgical Sciences, University Magna Græcia, Catanzaro, Italy.

Introduction: The leading cause of pyogenic vertebral osteomyelitis is Staphylococcus aureus, and its incidence is rising, particularly in the elderly. We report an unusual case of cervical spondylodiscitis and epidural abscess mimicking Pott's disease.

Case Report: A 67-year-old man was admitted to our institution with a 15-day history of neck pain radiating to the head, shoulders and left arm that was associated with weakness and paresthesia. Read More

N Z Med J 2019 Apr 12;132(1493):69-72. Epub 2019 Apr 12.

General Medicine Consultant, Department of General Medicine, Auckland District Health Board, Auckland.

Asian J Neurosurg 2019 Jan-Mar;14(1):338-339

Department of Radiology, Hospital General Dr. Manuel Gea González, National Autonomous University of Mexico, Ciudad de Mexico, Mexico, USA.

Eur J Orthop Surg Traumatol 2019 Mar 26. Epub 2019 Mar 26.

Department of Orthopedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago, Karatsu, Saga, 847-8588, Japan.

Gan To Kagaku Ryoho 2019 Feb;46(2):271-273

Dept. of Surgery, Takarazuka Daiichi Hospital.

Recently, bisphosphonate and denosumab have been widely used for the treatment of bone metastasis of breast cancer. However, medication-related osteonecrosis of the jaw(MRONJ)has often been reported as a side effect of these drugs. We experienced a rare case of intracranial epidural abscess secondary to MRONJ. Read More

Eur Ann Otorhinolaryngol Head Neck Dis 2019 Mar 22. Epub 2019 Mar 22.

Department of Neurosurgery, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.

Background: Iatrogenic cervical spondylodiscitis is rare, but may occur after various medical interventions.

Methods: We report a case of a diabetic 70-years-old female with C5-C6 spondylodiscitis and symptomatic epidural abscess with neck pain and upper limb paresis after endoscopic botulinum toxin injection for the treatment of dysphagia. Treatment included antibiotic therapy with amoxicillin and later on benzylpenicillin for the next ten weeks and corporectomy with spondylodesis. Read More

Zh Vopr Neirokhir Im N N Burdenko 2019;83(1):75-82

Tyumen State Medical University, Tyumen, Russia.

The article presents the results of a retrospective analysis of 200 patients with hematogenous osteomyelitis of the spine who were treated in the Tyumen Regional Clinical Hospital #2. Neurological disorders were present in 37 patients (group I); 163 patients (group II) had no neurological disorders; according to CT and MRI, secondary spondylogenic epidural abscess was diagnosed in 24 patients. At admission, the severity of neurological deficit assessed using the Frankel scale was as follows: Grade A - 6 cases, Grade B - 7 cases, Grade C - 17 cases, Grade D - 5 cases, and Grade E - 2 cases (epidural abscess without neurological deficit). Read More

BMJ Case Rep 2019 Mar 20;12(3). Epub 2019 Mar 20.

Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA.

First reported in 1988, is a virulent coagulase-negative species often associated with endocarditis. This is the first case report describing this infection in the cervical spine. A 58-year-old, left-handed Caucasian woman with no significant medical history presented with neck and left arm pain. Read More

Am J Case Rep 2019 Mar 16;20:345-348. Epub 2019 Mar 16.

Department of Pulmonary and Critical Care, NYU Langone, New York City, NY, USA.

BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) is an idiosyncratic life-threatening reaction comprised of fevers, rash, and leukocytosis with eosinophilia. Though characteristically associated with leukocytosis, there are rare case reports of DRESS-induced agranulocytosis. DRESS is most frequently caused by antiepileptic medications; however, it has very rarely been reported in relation to oxacillin. Read More

Asian Spine J 2019 Mar 15. Epub 2019 Mar 15.

Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.

Study Design: Retrospective cohort study.

Purpose: To describe our experience in the management and outcomes of vertebral column osteomyelitis (VCO), particularly focusing on the risk factors of early and late mortality.

Overview Of Literature: Previous reports suggest a global increase in spinal column infections highlighting significant morbidity and mortality. Read More

Ear Nose Throat J 2019 Mar 6:145561318823645. Epub 2019 Mar 6.

1 Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Korea.

Case Rep Infect Dis 2019 30;2019:7413089. Epub 2019 Jan 30.

Department of Infectious Disease, Mayo Clinic, Jacksonville, Florida, USA.

Spinal epidural abscess caused by MRSA, a life-threatening organism resistant to methicillin and other antibiotics, is a rare but important infectious pathology due to its potential damage to the spinal cord. We present the case of a 74-year-old man who hematogenously seeded his entire epidural spinal canal from C1 to sacrum with MRSA bacteria and remained infected even after maximal treatment with vancomycin and daptomycin. Ceftaroline, a new 5th generation antibiotic with recently described clearance of widespread MRSA infection in epidural complex spine infections, was added to vancomycin as dual therapy for his MRSA infection. Read More

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019 Feb;33(2):181-182

Epidural epidural abscess is usually secondary to acute frontal sinusitis and osteomyelitis of the frontal bone. Nose-derived intracranial connplications are less common than otogenic ones, and infections caused by nasal and sinus trauma, foreign bodies and surgery are more common than those caused by inflammation alone. The frontal lobe abscess caused by frontal sinusitis is more common in brain abscess with nasal intracranial complications. Read More

Case Rep Surg 2019 22;2019:4860420. Epub 2019 Jan 22.

Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.

Abscesses involving the spine are usually located in the epidural space. In rare circumstances, intradural spinal abscesses can occur, typically in the setting of tuberculosis or other predisposing systemic conditions. In this illustrated case report, we discuss the imaging and intraoperative findings of an otherwise healthy patient with an intradural abscess of the caused by . Read More

World Neurosurg 2019 Feb 21. Epub 2019 Feb 21.

MD, FAANS, Director of Pediatric Neurological Surgery at Goryeb Children's Hospital.

Background: Spinal epidural abscess (SEA) is a rare but serious infection that develops in the epidural space anywhere along the spinal cord. Early diagnosis is imperative to prevent permanent neurological sequelae. SEA should be considered in patients with backache, fever, neurological deficits and/ or spinal tenderness. Read More

BMJ Case Rep 2019 Feb 21;12(2). Epub 2019 Feb 21.

Emergency Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.

Although cocaine induced myopathy and myotoxicity are described in the literature, we report a rare case of cocaine induced paraspinal myositis presenting with acute sciatic symptoms. A 35-year-old man presented with acute left-sided sciatica and was discharged from the emergency department (ED). He subsequently attended ED the following day in severe pain and bilateral sciatic symptoms, but denied symptoms of neurogenic bowel/bladder disturbance. Read More

Pain Pract 2019 Feb 21. Epub 2019 Feb 21.

Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Background: Pain management after surgery is crucial to decrease perioperative morbidity and mortality. Acute pain services (APS) are multidisciplinary teams that represent a modern strategy to address pain inside hospitals. The APS defines and applies pain treatment protocols specific for each surgery. Read More

World J Orthop 2019 Feb 18;10(2):54-62. Epub 2019 Feb 18.

Boston University School of Medicine, Boston, MA 02118, United States.

Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. Read More

Spinal Cord Ser Cases 2019 12;5:18. Epub 2019 Feb 12.

Department of Orthopaedics, Max Smart Super Specialty Hospital, New Delhi, India.

Introduction: The commonly recognized causes of post-operative neurological deterioration in spinal tuberculosis are inadequate decompression, damage to vascular supply of the spinal cord, and multi-drug resistant organisms. There are no known cases of syringomyelia developing after surgical decompression of spinal tuberculosis.

Case Presentation: A teenage girl presented with rapid onset quadriparesis secondary to a tubercular epidural abscess extending from C4-T8. Read More

Acta Ortop Bras 2018 ;26(6):401-405

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Instituto de Ortopedia e Traumatología, Spine Surgery Division, São Paulo, SP, Brazil.

Objective: To describe a case of disseminated tuberculosis affecting the lumbar spine that was treated using a non-conventional anterior support system.

Background: Tuberculous spondylodiscitis is the most common and most severe form of extrapulmonary tuberculosis. Although antibiotic therapy is the most frequently used treatment, surgery is necessary in cases of neurological deficit, spinal instability, significant deformity, severe sepsis, paravertebral and epidural abscesses or in cases wherein clinical treatment has failed. Read More

J Neurosci Rural Pract 2019 Jan-Mar;10(1):148-150

Department of Neurosciences, Hospital Aleman, Buenos Aires, Argentina.

The authors describe a case of infratentorial epidural abscess caused by community-associated methicillin-resistant (CA-MRSA) in a patient with a recent history of cutaneous furunculosis. This 29-year-old male presented with an occipital headache associated with fever, vomiting, and neck stiffness. Admission magnetic resonance imaging showed a retrocerebellar epidural abscess. Read More

Spine J 2019 Feb 11. Epub 2019 Feb 11.

Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA. Electronic address:

Background Context: Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio have been previously identified as markers for overall survival in oncology but remain heretofore unexplored in spinal epidural abscess (SEA).

Purpose: The purpose of this study was to determine the impact of these routinely collected assessments on 90-day mortality in SEA.

Study Design/setting: Retrospective, case-control study. Read More

Pain Pract 2019 Feb 13. Epub 2019 Feb 13.

Anesthesiology Service, Tondela Viseu Hospital Centre, Viseu, Portugal.

Introduction: Supplementary strategies, in combination with conventional analgesia, for pain control after lumbar fusion surgery remain limited.

Case Description: Here, we describe a 79-year-old woman who experienced pain (10/10 on a numeric rating scale) on postoperative day 1 after undergoing L2 to S1 spine fusion. Erector spinae plane (ESP) blocks were performed at T8 and, after a bolus of ropivacaine 0. Read More

World Neurosurg 2019 Feb 8. Epub 2019 Feb 8.

Sunnybrook Health Sciences Centre, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.

Background: Acupuncture is a common form of alternative medicine that is used for pain control among other modalities of treatment. It is a relatively safe procedure, but complications, including those of infectious etiology, may still occur.

Case Description: A 47-year-old immunosuppressed woman presented with fever, altered level of consciousness, dysphasia, and a left occipital subgaleal fluctuant mass after acupuncture for headaches in the same area. Read More

Oper Neurosurg (Hagerstown) 2019 Feb 5. Epub 2019 Feb 5.

Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background And Importance: Although many studies have demonstrated the biomechanical superiority of cervical pedicle screw (CPS) placement with sufficient safety and accuracy, it also has an inevitable major drawback in that an extensive posterior neck muscle dissection results in immediate postoperative neck pain. To avoid this disadvantage and highlight the several biomechanical advantages of CPS, we conducted the first minimally invasive surgery using both a tubular retractor through the posterolateral approach and a freehand placement technique.

Clinical Presentation: A 77-yr-old man presented with quadriparesis and neck pain. Read More

Medicine (Baltimore) 2019 Feb;98(5):e14196

Department of Orthopedics.

Rationale: Spinal epidural abscess (SEA) is a rare condition that shows a high prevalence in immunocompromised patients. The clinical presentation of SEA includes the "classic triad" of pain, fever, and neurological dysfunction. However, these nonspecific features can lead to a high rate of misdiagnosis. Read More

J Clin Neurophysiol 2019 Mar;36(2):161-165

Departments of Clinical Neurophysiology and.

Purpose: Monitoring of somatosensory evoked potentials (SSEPs) serves as an early warning system to detect spinal cord injury and is correlated with postoperative sensory findings. It is an indirect indicator of motor function. This study aimed to evaluate the usefulness of intraoperative SSEPs monitoring as a stand-alone tool during spinal surgeries when motor evoked potentials are not available, to prevent and predict new postoperative neurologic deficits. Read More

Int J Infect Dis 2019 Apr 23;81:1-3. Epub 2019 Jan 23.

Zhejiang-California International Nanosystems Institute, Zhejiang University, Hangzhou, China; Department of Pathology and Laboratory Medicine, UCLA School of Medicine, Los Angeles, CA, USA. Electronic address:

We report a rare case of culture negative L4-L5 discitis and epidural abscess in an immunocompetent child who had dry cupping therapy performed to treat low back strain. The causative pathogen was identified as Stenotrophomonas maltophilia by shotgun metagenomic sequencing of spinal cord aspirate after more than one month of unsuccessful empirical treatment with 6 different antibiotics. The patient was successfully treated with Sulfamethoxazole-trimethoprim and minocycline. Read More

Ceylon Med J 2018 12;63(4):190-191

Teaching Hospital Karapitiya, Sri Lanka.

Clin Case Rep 2019 Jan 20;7(1):229-230. Epub 2018 Nov 20.

Department of Internal Medicine, Hurley Medical Center Michigan State University Flint Michigan.

New onset low back pain which is recalcitrant to usual treatment should be evaluated aggressively even in the absence of fever or neurologic deficits. Corticosteroids given for back pain will accelerate occult spinal infection and may mask symptomatology leading to more severe disease. Read More

Cochrane Database Syst Rev 2019 01 16;1:CD012819. Epub 2019 Jan 16.

Department of Anesthesiology, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada.

Background: Spine surgery may be associated with severe acute postoperative pain. Compared with systemic analgesia alone, epidural analgesia may offer better pain control. However, epidural analgesia has sometimes been associated with rare but serious complications. Read More

Int J Infect Dis 2019 Apr 11;81:107-109. Epub 2019 Jan 11.

Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.

Methicillin-resistant Staphylococcus aureus (MRSA) clonal complex (CC) 398 has spread from pigs to humans, but rarely from person to person. This strain of MRSA has been considered less virulent than others. Livestock-associated MRSA CC398 (LA-MRSA CC398) is particularly known to colonize pig farmers. Read More

J Med Case Rep 2019 Jan 8;13(1). Epub 2019 Jan 8.

Orthopaedics Department, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Sarawak, Malaysia.

Background: Gout is a monosodium urate deposition disease which is prevalent worldwide. The usual manifestations are crystal arthropathy and tophi deposition in the soft tissues. Spinal tophi may also occur and are rarely reported, resulting in various clinical manifestations such as back pain, spinal cord compression, radiculopathy, and even mimicking epidural abscess and spondylodiscitis. Read More

Int J Spine Surg 2018 Dec 21;12(6):743-750. Epub 2018 Dec 21.

Department of Orthopaedic Surgery, Rehovot, Israel.

Background: The study aimed to assess the effectiveness of antibiotic treatment for spondylodiscitis, its failure rates, and the need for surgical intervention.

Methods: This is a retrospective study of patients who presented with spontaneous deep spinal infections and spondylodiscitis between 2011 and 2013. Clinical, bacteriologic, and radiographic data during hospitalization were analyzed. Read More

Neurosurg Focus 2019 Jan;46(1):E4

1Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and.

OBJECTIVEFew studies have been published specifically examining intravenous drug abuse (IVDA)-associated spinal epidural abscesses (SEAs), an unfortunate sequela of the opioid crisis in the United States. Here, the authors examined a series of patients with IVDA-associated SEAs in order to shed light on this challenging disease entity.METHODSThis study is a retrospective chart review of patients presenting with IVDA-associated SEAs at the authors' institution from 2013 to 2018, spanning the statewide implementation of opioid-prescribing restrictions. Read More

J Neurosurg 2019 Jan 4:1-7. Epub 2019 Jan 4.

1Department of Neurological Surgery.

OBJECTIVEA short-term lumbar drain (LD) trial is commonly used to assess the response of normal pressure hydrocephalus (NPH) patients to CSF diversion. However, it remains unknown whether the predictors of passing an LD trial match the predictors of improvement after ventriculoperitoneal shunting. The aim of this study was to examine outcomes, complication rates, and associations between predictors and outcomes after an LD trial in patients with NPH. Read More

Acta Neurochir Suppl 2019;125:345-353

Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy.

Purpose: An extensive spinal epidural abscess is a rare condition and causes significant morbidity and mortality. Few authors have described this uncommon entity, which requires early diagnosis and optimal treatment to avoid devastating complications. The purpose of this study was to evaluate a minimally invasive technique for treatment of an extensive spinal epidural abscess by describing two cases. Read More

Diagn Microbiol Infect Dis 2019 May 4;94(1):66-72. Epub 2018 Dec 4.

Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea. Electronic address:

Objectives: Functional disability may persist after completing treatment for hematogenous pyogenic vertebral osteomyelitis (HPVO). The objective of this study was to identify factors associated with residual sequelae after treatment of HPVO.

Methods: We conducted a retrospective study of patients diagnosed with HPVO at 5 tertiary-care hospitals between January 2005 and December 2012. Read More

Clin Spine Surg 2019 Feb;32(1):18-29

Department of Neurological Surgery, Duke University, Durham, NC.

Study Design: This is a meta-analysis.

Objective: Perform a systematic review and quantitative meta-analysis of neurological outcomes from all available spinal epidural abscess (SEA) literature published between 1980 and 2016.

Summary Of Background Data: Current literature on SEAs lacks large-scale data characterizing prognostic factors and surgical indications. Read More

Biomed J 2018 10 5;41(5):306-313. Epub 2018 Nov 5.

Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. Electronic address:

Background: Cervical spine infections are uncommon but potentially dangerous, having the highest rate of neurological compromise and resulting disability. However, the factors related to surgical success is multiple yet unclear.

Methods: We retrospectively reviewed the medical records of 27 patients (16 men and 11 women) with cervical spine infection who underwent surgical treatment at Chang Gung Memorial Hospital, Linkou branch, between 2001 and 2014. Read More

Global Spine J 2018 Dec 13;8(4 Suppl):85S-95S. Epub 2018 Dec 13.

Cleveland Clinic, Cleveland, OH, USA.

Study Design: Systematic review.

Objectives: Spinal epidural abscesses (SEAs) are rare, but when missed or when diagnosis is delayed, SEA can lead to permanent neurological impairment or death. Limited information exists on the optimal treatment modalities for SEA, especially in the lumbar spine. Read More