Non-specific low back pain (NSLBP) represents about 80-95% of all LBP cases, yet the optimal lumbar traction position for effective treatment remains debated. To investigate the effect of different positions during lumbar traction on pain, function, and ROM in adults with NSLBP. Thirty participants were randomly allocated to one of three lumbar traction position groups: supine, side-lying, or prone. Outcome measures included the Oswestry Disability Index (ODI), International Physical Activity Questionnaire short form (IPAQ-SF), Finger-to-Floor Test (FFT), and Numerical Pain Rating Scale (NPRS). Measurements were obtained at baseline, after the third session, and after completion of the 3-week intervention. Within-group analysis showed significant improvements in ODI and NPRS scores over time in all three groups (p < 0.001). The supine group demonstrated earlier within-group improvement after the third session (p = 0.012). IPAQ improved significantly only in the side-lying group (p = 0.01), whereas FFT did not show significant changes in any group (p > 0.05). However, between-group analysis revealed no statistically significant differences among the three traction positions at any measurement point for any outcome (p > 0.05). Lumbar traction was associated with improvements in pain and disability regardless of position. However, no traction position demonstrated superiority over the others. The earlier improvement observed in the supine group should be interpreted cautiously because it was based on within-group change rather than between-group superiority. Future studies with larger samples are needed to clarify whether positional differences are clinically meaningful. Also, these findings are limited to male participants and should not be generalized to female populations.Trial registration: The trial was registered on 02/02/2025, clinicaltrials.gov, Identifier: (NCT06812338).

Intervertebral disc degeneration (IVDD) is one of the main causes of spinal diseases and chronic low back pain. Nucleus pulposus (NP) cells are in a hypoxic environment, and their functions may be regulated by the hypoxia-inducible factor (HIF) family. In recent years, ferroptosis has been confirmed to be closely related to IVDD. HIF-2α plays a key role in hypoxic response, but its mechanism of regulating ferroptosis in IVDD remains unclear. This study aims to explore whether HIF-2α promotes ferroptosis of NP cells by activating the IL-6/hepcidin pathway and inhibiting the expression of iron transporter FPN1. Primary nucleus pulposus cells from rats were cultured under normoxic and hypoxic conditions, with RSL3 and TBHP used as ferroptosis inducers. Cell viability was detected by CCK-8 assay. The expressions of HIF-2α, IL-6 and hepcidin were regulated by siRNA and overexpression plasmids. Gene and protein expressions and their interaction were analyzed by RT-qPCR, Western blot, Co-IP and immunofluorescence. A rat tail vertebra needling-induced IVDD model was established, and MRI assessment, histological staining and biochemical index detection were performed. Hypoxia significantly increased the sensitivity of NP cells to RSL3 and TBHP at 6, 12, and 24 h, and upregulated HIF-2α expression at both mRNA and protein levels. HIF-2α overexpression promoted IL-6 transcription and hepcidin expression, while HIF-2α knockdown blocked hypoxia-induced upregulation of IL-6 and hepcidin. Dual-luciferase reporter assay confirmed that HIF-2α directly activated the IL-6 promoter. Co-IP demonstrated direct binding between hepcidin-25 and FPN1. HIF-2α overexpression increased cell death, lipid ROS, Fe²⁺, MDA and 4-HNE levels, and induced mitochondrial shrinkage characteristic of ferroptosis; these effects were reversed by knockdown of IL-6 or hepcidin. In the rat IVDD model, MRI showed that the Sham group had Grade I-II degeneration, while the IVDD group and IVDD+adenovirus vector group exhibited severe degeneration (Grade III-IV). HIF-2α knockdown significantly alleviated degeneration to Grade II-III. HE staining revealed that HIF-2α knockdown reduced NP tissue damage. HIF-2α knockdown also decreased lipid ROS levels, restored FPN1 and GPX4 protein expression, and reduced hepcidin-25, HIF-2α and IL-6 expression in NP tissues. Immunohistochemistry confirmed that HIF-2α knockdown partially restored FPN1 positive expression and reduced HIF-2α, IL-6 and hepcidin signals. HIF-2α in IVDD promotes ferroptosis by activating the IL-6/hepcidin signaling pathway, inhibiting FPN1 expression, and thereby exacerbating intervertebral disc degeneration. Targeting this pathway may offer a new therapeutic strategy for IVDD.

Sacral insufficiency fractures (SIFs) are stress fractures that occur when normal biomechanical forces act on weakened bone, most commonly in elderly patients with osteoporosis or other conditions that compromise bone integrity. Because symptoms are often nonspecific, typically presenting as low back, sacral, or pelvic pain, SIFs are frequently underdiagnosed or misinterpreted as other pathologies, including lumbar spine disorders or metastatic disease. Conventional radiographs have low sensitivity, and although computed tomography (CT) can help identify fracture lines and assist in surgical planning, magnetic resonance imaging (MRI) remains the most sensitive modality for early detection. We present two cases of SIFs with progressive pain and functional impairment. The first case involved an 86-year-old woman who developed severe low back pain following a fall, with imaging revealing bilateral sacral fractures involving Denis zones I and III. The second case involved a 61-year-old woman with a prior history of lumbar fusion who presented with worsening lumbar pain radiating to the lower extremities, saddle numbness, and fecal incontinence; imaging demonstrated bilateral sacral fractures with displacement. Both patients had persistent symptoms and fracture instability despite conservative measures and underwent minimally invasive bilateral sacroiliac fusion with trans-sacral screw fixation. Postoperatively, both patients experienced significant pain reduction and improved functional status. These cases highlight the importance of maintaining a high index of suspicion for SIF in patients with unexplained lumbosacral pain and risk factors for bone fragility. While conservative management remains the first-line treatment, surgical stabilization with trans-sacral screw fixation may provide effective mechanical stability, rapid pain relief, and improved functional recovery in patients with unstable fractures or failure of nonoperative therapy.

Nerve sheath tumors account for approximately 30% of all spinal cord tumors, with schwannomas and neurofibromas being the most common types. These benign lesions often remain asymptomatic until they reach a size sufficient to compress adjacent neural structures. We present a case of a giant thoracolumbar intraspinal schwannoma successfully resected with no recurrence at 13 month follow-up. A 73-year-old Asian woman with controlled hypertension presented with a 2 year history of progressive low back pain, bilateral lower limb numbness, and weakness. MRI revealed an intradural extramedullary tumor extending from T10 to L1. The patient underwent T10-T12 total laminectomy with complete tumor resection and posterolateral bone grafting. Histopathology and immunohistochemistry (S100+, SOX10+) confirmed schwannoma. No recurrence was observed at 13 months postoperatively. Complete microsurgical resection of giant thoracolumbar intraspinal schwannoma is safe and effective. Longterm follow-up is recommended to monitor for recurrence.

Study DesignSystematic review and meta-analysis.ObjectiveTo compare expandable and static interbody cages in MIS-TLIF with respect to subsidence, radiographic outcomes, fusion rates, and patient-reported outcomes.MethodsFollowing PRISMA 2020 guidelines and a preregistered PROSPERO protocol, we searched PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library, and OVID through December 2025. Studies reporting clinical or radiographic outcomes of MIS-TLIF using expandable or static cages were included. Random-effects meta-analyses were performed, and risk of bias was assessed using Joanna Briggs Institute tools.ResultsTwenty-three studies encompassing 1838 patients and 2074 fused levels met inclusion criteria. Expandable cages demonstrated a lower pooled subsidence rate than static cages (12.8% vs 25.7%), representing roughly a 50% relative reduction. When subsidence occurred, its magnitude was similar between groups (5.33 mm vs 4.54 mm). Improvements in VAS back pain (4.27 vs 4.29), VAS leg pain (3.80 vs 4.28), and ODI (20.16 vs 28.29) were comparable. Sensitivity analyses limited to low-risk studies showed consistent trends, although Egger's regression suggested possible small-study effects for subsidence.ConclusionsIn MIS-TLIF, expandable cages are associated with lower subsidence rates while achieving radiographic and clinical outcomes similar to static cages. However, only three studies directly compared the two cage types; the synthesis largely relies on indirect comparisons is susceptible to confounding. These findings should not be regarded as evidence of a causal effect of cage design.

Various cognitive-affective and behavioral factors contribute to the maintenance of low back pain, but these factors are often evaluated in isolation. The network approach provides an avenue to evaluate multiple cognitive-affective and behavioral factors at once and across time. This study explored the relationship between pain, expectancies, avoidance, and related cognitive-affective and behavioral factors using network analysis. A total of 30 individuals with chronic low back pain completed ecological momentary assessments regarding their physical symptoms and related cognitive-affective and behavioral factors 5 times per day for a duration of 2 weeks. Temporal and contemporaneous networks were estimated using vector autoregressive models on a group and individual level. Networks show that the relationship among cognitive-affective and behavioral factors reinforces each other within the same time frame as well as across time. The strongest temporal connections were found between pain and attention, while the strongest contemporaneous connections were found between fear and attention at the group level. On an individual level, different variations of network structures can be found, suggesting that a more individualized approach is needed for better treatment outcomes. Further research is warranted to confirm the causal relations between cognitive-affective and behavioral factors in the maintenance of chronic pain. The network approach may be a useful tool to develop more effective individualized treatment to manage chronic pain.