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Goode AP, Cleveland RJ, George SZ, Kraus VB, Schwartz TA, Gracely RH, Jordan JM, Golightly YM. Different Phenotypes of Osteoarthritis in the Lumbar Spine Reflected by Demographic and Clinical Characteristics: The Johnston County Osteoarthritis Project. Arthritis Care Res (Hoboken) 2019; 72:974-981. [PMID: 31058435 DOI: 10.1002/acr.23918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/30/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine if associations between demographic and clinical characteristics and appendicular joint osteoarthritis (OA) reflect different phenotypes of OA in the lumbar spine. METHODS Participants were from the Johnston County OA Project. Demographic information consisted of age, sex, and race (white and African American), and clinical characteristics consisted of body mass index (BMI), low back pain and injury, and knee, hip, and hand OA. Participants were categorized as having spine OA, facet joint OA, both spine OA and facet joint OA, or neither spine OA nor facet joint OA (referent group). Multinomial regression models were used to determine odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS Of 1,793 participants, the mean ± SD age was 66.2 ± 10.1 years, and the mean ± SD BMI was 30.7 ± 6.2. The majority of the participants were women (n = 1,144 [63.8%]), and 31.8% of the participants (n = 570) were African American. Eighteen percent of participants had neither spine OA nor facet joint OA, 22.8% had facet joint OA, 13.2% had spine OA, and 46.0% had both spine OA and facet joint OA. In adjusted analyses, African Americans were less likely to have facet joint OA (OR 0.68 [95% CI 0.49-0.95]) or both spine OA and facet joint OA (OR 0.51 [95% CI 0.37-0.70]). Women were more likely to have facet joint OA (OR 1.71 [95% CI 1.24-2.36]). Having a BMI of ≥30 was associated with having facet joint OA (OR 1.76 [95% CI 1.28-2.42]) and both spine OA and facet joint OA (OR 1.85 [95% CI 1.37-2.51]). Knee OA was associated with all 3 OA groups, while lower back injury was associated only with those with spine OA. Participants with hip OA were less likely to have facet joint OA. CONCLUSION Race, sex, BMI, hip OA, and lower back injury may help identify different OA phenotypes in the lumbar spine.
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Affiliation(s)
- Adam P Goode
- Duke University School of Medicine and Duke University, Durham, North Carolina
| | | | - Steven Z George
- Duke University School of Medicine and Duke University, Durham, North Carolina
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Abstract
STUDY DESIGN This is a retrospective cohort review. OBJECTIVE To determine whether a correlation exists between facet cysts and lumbar instability. SUMMARY OF BACKGROUND DATA Lumbar facet cysts are common degenerative entities observed in patients with low-grade spondylolisthesis at a rate of 10%-50%. Surgical management with partial facetectomy with or without fusion remains controversial. METHODS Review of 86 patients with lumbar degenerative spondylolisthesis is performed. Preoperative magnetic resonance imagings were reviewed for the presence of lumbar facet cysts and Facet Fluid Indices (FFI)-calculated as the ratio of facet fluid width to facet width. Instability was defined as a difference of >3 mm in vertebral displacement between flexion and extension radiographs. T tests and the Pearson correlation analyses were used to determine statistical significance. RESULTS In total, 26 patients had unstable and 60 had stable spondylolisthesis. Facet cysts were present at an overall prevalence of 30.1%-in 10/26 patients in the unstable group and in 18/60 patients in the stable group (P>0.05). The average FFIs for the unstable and stable groups were 0.13 and 0.09, respectively (P>0.05). FFI in patients with facet cysts was significantly higher than those without (P<0.05). In addition, the group with facet cysts had a significantly higher proportion of patients with FF effusions >3 mm. CONCLUSIONS Lack of correlation with instability hints that the presence of facet cysts may not indicate instability in lumbar degenerative spondylolisthesis. Therefore, presence of facet cysts in static magnetic resonance imaging revealing spondylolisthesis should not preclude the physician from performing dynamic films to evaluate for instability. Significantly higher FFI in patients with facet cysts reaffirms the degenerative pathophysiology involved in their formation. Although this is not an outcomes study, it does spark interest into whether patients with stable spondylolisthesis and concurrent facet cysts are suitable for partial facetectomy alone with fusion.
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McDonald MA, Kirsch CF, Amin BY, Aulino JM, Bell AM, Cassidy RC, Chakraborty S, Choudhri AF, Gemme S, Lee RK, Luttrull MD, Metter DF, Moritani T, Reitman C, Shah LM, Sharma A, Shih RY, Snyder LA, Symko SC, Thiele R, Bykowski J. ACR Appropriateness Criteria® Cervical Neck Pain or Cervical Radiculopathy. J Am Coll Radiol 2019; 16:S57-S76. [DOI: 10.1016/j.jacr.2019.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 12/12/2022]
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Kinematics of the Spine Under Healthy and Degenerative Conditions: A Systematic Review. Ann Biomed Eng 2019; 47:1491-1522. [DOI: 10.1007/s10439-019-02252-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/21/2019] [Indexed: 01/05/2023]
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Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, Viswanath O, Jones MR, Sidransky MA, Spektor B, Kaye AD. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep 2019; 23:23. [PMID: 30854609 DOI: 10.1007/s11916-019-0757-1] [Citation(s) in RCA: 209] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Low back pain encompasses three distinct sources: axial lumbosacral, radicular, and referred pain. Annually, the prevalence of low back pain in the general US adult population is 10-30%, and the lifetime prevalence of US adults is as high as 65-80%. RECENT FINDINGS Patient history, physical exam, and diagnostic testing are important components to accurate diagnosis and identification of patient pathophysiology. Etiologies of low back pain include myofascial pain, facet joint pain, sacroiliac joint pain, discogenic pain, spinal stenosis, and failed back surgery. In chronic back pain patients, a multidisciplinary, logical approach to treatment is most effective and can include multimodal medical, psychological, physical, and interventional approaches. Low back pain is a difficult condition to effectively treat and continues to affect millions of Americans every year. In the current investigation, we present a comprehensive review of low back pain and discuss associated pathophysiology, diagnosis, and treatment.
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Affiliation(s)
- Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Aaron Burshtein
- Department of Orthopedic Surgery, Hofstra-Northwell Health System, Great Neck, NY, 11021, USA
| | - Medha Sharma
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Lauren Testa
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Peter A Gold
- Department of Orthopedic Surgery, Hofstra-Northwell Health System, Great Neck, NY, 11021, USA
| | - Vwaire Orhurhu
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Mark R Jones
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Moises A Sidransky
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Tyler, TX, USA
| | - Boris Spektor
- Department of Anesthesiology, Emory School of Medicine, Atlanta, GA, 30308, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, LA, 70112, USA
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Sugimoto K, Nakamura T, Tokunaga T, Uehara Y, Okada T, Taniwaki T, Fujimoto T, Oike Y, Nakamura E. Angiopoietin-Like Protein 2 Induces Synovial Inflammation in the Facet Joint Leading to Degenerative Changes via Interleukin-6 Secretion. Asian Spine J 2019; 13:368-376. [PMID: 30685956 PMCID: PMC6547404 DOI: 10.31616/asj.2018.0178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/11/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design Experimental human study. Purpose To determine whether angiopoietin-like protein 2 (ANGPTL2) is highly expressed in the hyperplastic facet joint (FJ) synovium and whether it activates interleukin-6 (IL-6) secretion in FJ synoviocytes. Overview of Literature Mechanical stress-induced synovitis is partially, but significantly, responsible for degenerative and subsequently osteoarthritic changes in the FJ tissues in patients with lumbar spinal stenosis (LSS). However, the underlying molecular mechanism remains unclear. IL-6 is highly expressed in degenerative FJ synovial tissue and is responsible for local chronic inflammation. ANGPTL2, an inflammatory and mechanically induced mediator, promotes the expression of IL-6 in many cells. Methods FJ tissues were harvested from five patients who had undergone lumbar surgery. Immunohistochemistry for ANGPTL2, IL-6, and cell markers was performed in the FJ tissue samples. After cultured synoviocytes from the FJ tissues were subjected to mechanical stress, ANGPTL2 expression and secretion were measured quantitatively using real-time quantitative reverse-transcription–polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA), respectively. Following ANGPTL2 administration in the FJ synoviocytes, anti-nuclear factor-κB (NF-κB) activation was investigated using immunocytochemistry, and IL-6 expression and secretion were assayed quantitatively with or without NF-κB inhibitor. Moreover, we assessed whether ANGPTL2-induced IL-6 modulates leucocyte recruitment in the degenerative process by focusing on the monocyte chemoattractant protein-1 (MCP-1) expression. Results ANGPTL2 and IL-6 were highly expressed in the hyperplastic FJ synovium samples. ANGPTL2 was co-expressed in both, fibroblast-like and macrophage-like synoviocytes. Further, the expression and secretion of ANGPTL2 in the FJ synoviocytes increased in response to stimulation by mechanical stretching. ANGPTL2 protein promoted the nuclear translocation of NF-κB and induced IL-6 expression and secretion in the FJ synoviocytes. This effect was reversed following treatment with NF-κB inhibitor. Furthermore, ANGPTL2-induced IL-6 upregulated the MCP-1 expression in the FJ synoviocytes. Conclusions Mechanical stress-induced ANGPTL2 promotes chronic inflammation in the FJ synovium by activating IL-6 secretion, leading to FJ degeneration and subsequent LSS.
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Affiliation(s)
- Kazuki Sugimoto
- Department of Orthopaedics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Takayuki Nakamura
- Department of Orthopaedics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Takuya Tokunaga
- Department of Orthopaedics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Yusuke Uehara
- Department of Orthopaedics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Tatsuya Okada
- Department of Orthopaedics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Takuya Taniwaki
- Department of Orthopaedics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Toru Fujimoto
- Department of Orthopaedics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Yuichi Oike
- Department of Molecular Genetics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Eiichi Nakamura
- Department of Orthopaedics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
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Clinical Characteristics and Risk Factors of Recurrent Lumbar Disk Herniation: A Retrospective Analysis of Three Hundred Twenty-One Cases. Spine (Phila Pa 1976) 2018; 43:1463-1469. [PMID: 30325345 DOI: 10.1097/brs.0000000000002655] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective clinical series. OBJECTIVE To investigate the clinical features and the risk factors for recurrent lumbar disc herniation (rLDH) in China. SUMMARY OF BACKGROUND DATA rLDH is a common cause of poor outcomes after lumbar microdiscectomy surgery. Risk factors for rLDH are increasingly being investigated. However, results in these previous studies were not always consistent. METHODS Between June 2005 and July 2012, 321 consecutive patients with single-level LDH, who underwent surgery, were enrolled in this study. We divided the patients into the recurrent group (R group) and the nonrecurrent group (N group) and compared their clinical parameters and preoperative radiologic parameters. The relationships between the variables and rLDH were evaluated by univariate analysis and multiple logistic regression analysis. RESULTS There was significant difference between groups in sex (P = 0.003), age (P = 0.003), current smoking (P = 0.004), body mass index (BMI) (P = 0.04), occupational lifting (P < 0.001), trauma history (P = 0.04), procedures (P = 0.04), herniation type (P = 0.006), disc height index (DUI) (P = 0.04), facet orientation (FO) (P = 0.04), facet tropism (FT) (P = 0.04), and sagittal range of motion (from) (P = 0.04). By putting these differences in logistic regression analysis, it showed that being male, young age, current smoking, higher BMI, herniation type (transligamentous extrusion), surgical procedures (bilateral laminectomy or total laminectomy), heavy works, undergoing a traumatic event, a large from, a high DUI, a large FT, and a small FO significantly related with rLDH. CONCLUSION Based on our data, sex, age, current smoking, BMI, occupational lifting, trauma, surgical procedures, herniation type, DUI, FO, FT, and from showed a significant correlation with the incidence of rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery. LEVEL OF EVIDENCE 3.
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Chuan Yen T, Mohler J, Dohm M, Laksari K, Najafi B, Toosizadeh N. The Effect of Pain Relief on Daily Physical Activity: In-Home Objective Physical Activity Assessment in Chronic Low Back Pain Patients after Paravertebral Spinal Block. SENSORS 2018; 18:s18093048. [PMID: 30213036 PMCID: PMC6163962 DOI: 10.3390/s18093048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 11/16/2022]
Abstract
This study evaluates the effect of paravertebral spinal injection (PSI), utilizing both subjective and objective assessments in chronic low back pain (LBP) associated with facet joint arthrosis over a one-month duration. Subjective questionnaires included the visual analogue scale (VAS) for pain, the Oswestry Disability Index, the Health Survey SF-12, and the short Falls Efficacy Scale International (FES-I). Objective assessments included in-clinic gait and Timed Up and Go (TUG) tests using wearable sensors, as well as 48 h daily physical activity (DPA) monitored using a chest-worn triaxial accelerometer. Subjective and objective measures were performed prior to treatment, immediately after the treatment, and one month after the treatment. Eight LBP patients were recruited for this study (mean age = 54 ± 13 years, body mass index = 31.41 ± 6.52 kg/m², 50% males). Results show significant decrease in pain (~55%, p < 0.05) and disability (Oswestry scores, ~21%, p < 0.05). In-clinic gait and TUG were also significantly improved (~16% and ~18% faster walking and shorter TUG, p < 0.05); however, DPA, including the percentage of physical activities (walking and standing) and the number of steps, showed no significant change after PSI (p > 0.25; effect size ≤ 0.44). We hypothesize that DPA may continue to be truncated to an extent by conditioned fear-avoidance, a psychological state that may prevent increase in daily physical activity to avoid pain.
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Affiliation(s)
- Tzu Chuan Yen
- Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ 85719, USA.
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
| | - Jane Mohler
- Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ 85719, USA.
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85719, USA.
- Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, AZ 85719, USA.
| | - Michael Dohm
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA.
| | - Kaveh Laksari
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85719, USA.
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Nima Toosizadeh
- Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ 85719, USA.
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85719, USA.
- Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, AZ 85719, USA.
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Jiang J, Zhang J, Wu C, Guo X, Chen C, Bao G, Sun Y, Chen J, Xue P, Xu G, Cui Z. Up-regulation of TRAF2 inhibits chondrocytes apoptosis in lumbar facet joint osteoarthritis. Biochem Biophys Res Commun 2018; 503:1659-1665. [PMID: 30054040 DOI: 10.1016/j.bbrc.2018.07.096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 07/19/2018] [Indexed: 01/07/2023]
Abstract
Tumor necrosis factor receptor-associated factor 2 (TRAF2) has been demonstrated that it plays a significant role in cell death receptor signal transduction. The purpose of this study was to investigate the expression of TRAF2 and its possible role in FJOA. We observed an up-regulation of TRAF2 in FJOA by immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR) compared to normal tissues. In vitro, we used TNF-α to stimulate Human SW1353 chondrosarcoma cells to establish the chondrocytes injury model. Western blot analysis revealed significant expression of TRAF2 and cleaved caspase-3/8 in SW1353 cells. Co-localization of TRAF2/cleaved caspase-3/8 was detected in the cells injury model by double-labeling immunofluorescent staining. We demonstrated a possible anti-apoptotic effect of TRAF2 in chondrocyte apoptosis in FJOA by knockdown of its expression with siRNA. Moreover, TRAF2 knockdown was demonstrated to enhance TNF-α-induced apoptosis by flow cytometry assay. In conclusion, our results show that the up-regulation of TRAF2 may play an important role in the inhibition of chondrocyte apoptosis of FJOA.
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Affiliation(s)
- Jiawei Jiang
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Jinlong Zhang
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Chunshuai Wu
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Xiaofeng Guo
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Chu Chen
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Guofeng Bao
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Yuyu Sun
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Jiajia Chen
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Pengfei Xue
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Guanhua Xu
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China.
| | - Zhiming Cui
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China.
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Park CJ, Shin YD, Lim SW, Bae YM. The effect of facet joint injection on lumbar spinal stenosis with radiculopathy. Pak J Med Sci 2018; 34:968-973. [PMID: 30190763 PMCID: PMC6115579 DOI: 10.12669/pjms.344.15010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: Facet Joint Injection (FJI) is known to be effective in axial back pain, but the purpose of this study was to assess the effects of FJI on patients treated with it among those with Lumbar Spinal Stenosis (LSS). Methods: We conducted a retrospective database analysis and investigated electronic medical records of 125 LSS patients treated with FJI in the pain clinic of Chungbuk National University Hospital from November 2, 2016 to July 31, 2017. Sex, age, histories of low back surgery, complaining of neurogenic claudication, symptomatic sites of patients, FJI sites, number of sites of FJI, triamcinolone dosage, Numeric Rating Scale (NRS) before and after treatment, facet joint capsule rupture during treatment, and improvement of neurogenic claudication after treatment, were examined. Results: Among 125 patients, we investigated 91 patients who met the criteria. There was significant difference in NRS before and after treatment (p<0.000). Forty one patients with reduction of NRS more than 30% after FJI were allocated to effect group. FJI was more effective in patients who did not have the surgery (p=0.044), as well as those who showed an improved neurogenic claudication after treatment (p=0.001). Other measured values did not show statistical significances. Conclusions: FJI has relatively a lower risk and is simpler in terms of techniques than other interventional treatments performed within the spinal canal. Therefore, FJI may be another interventional treatment option in patients with pain by LSS. In the future, studies for FJI indication in LSS patients should be additionally required.
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Affiliation(s)
- Chan Jin Park
- Chan Jin Park, MD. Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Korea
| | - Young Duck Shin
- Prof. Dr. Young Duck Shin, MD, PhD. Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Korea
| | - Seung Woon Lim
- Seung Woon Lim, MD, PhD. Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Korea
| | - Yoo Mee Bae
- Yoo Mee Bae, MD. Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Korea
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Gou Y, Tian F, Kong Q, Chen T, Li H, Lv Q, Zhang L. Salmon Calcitonin Attenuates Degenerative Changes in Cartilage and Subchondral Bone in Lumbar Facet Joint in an Experimental Rat Model. Med Sci Monit 2018; 24:2849-2857. [PMID: 29748528 PMCID: PMC5960220 DOI: 10.12659/msm.910012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Facet joint degeneration (FJD) is one of the common causes of low back pain (LBP), and estrogen deficiency is one of the triggers for FJD. Calcitonin may possess the potential for treating osteoarthritis, but to date the hormone has not been studied in the treatment of FJD. Therefore, the aim of this study was to investigate the effects of salmon calcitonin (sCT) on FJD induced by estrogen deficiency after ovariectomy (OVX). Material/Methods Thirty female Sprague-Dawley rats were randomly assigned to 3 groups: the OVX group received bilateral OVX, the OVX + sCT group received subcutaneous administration of sCT (16 IU/kg/2 days) following bilateral OVX, and the Sham group received sham surgery. All rats were euthanized at 12 weeks post-OVX. Serum COMP level, cartilage degradation, and subchondral bone micro-architecture were evaluated. Results sCT relieved cartilage surface lesions, reduced histological score, and significantly increased cartilage thickness. The OVX + sCT group exhibited significantly increased expression of aggrecan, as well as significantly decreased levels of ADAMTS-4, MMP-13, and caspase-3. The results of micro-computed tomography analysis revealed that the OVX + sCT group exhibited higher BMD, BV/TV, and Tb.Th values but a lower Tb.Sp value than that of the OVX group. Serum COMP concentrations were significantly correlated with histological score and cartilage thickness. Conclusions sCT can inhibit the progression of FJD in OVX rats, which is attributed to its inhibitory effects on cartilage metabolism imbalance, chondrocyte apoptosis, and subchondral bone remodeling. Serum COMP has diagnostic potential for FJD.
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Affiliation(s)
- Yu Gou
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Faming Tian
- Medical Research Center, North China University of Science and Technology, Tangshan, Hebei, China (mainland).,International Science and Technology Cooperation Base of Geriatric Medicine, Department of International Cooperation, Ministry of Science and Technology of China, Tangshan, Hebei, China (mainland)
| | - Qingfu Kong
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Tiangang Chen
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Hetong Li
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Qinglie Lv
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Liu Zhang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,Mine Medical Security Center, Meitan General Hospital, Beijing, China (mainland)
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Wu T, Ni S, Cao Y, Liao S, Hu J, Duan C. Three-dimensional visualization and pathologic characteristics of cartilage and subchondral bone changes in the lumbar facet joint of an ovariectomized mouse model. Spine J 2018; 18:663-673. [PMID: 29155252 DOI: 10.1016/j.spinee.2017.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/28/2017] [Accepted: 11/07/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is more prevalent among postmenopausal women than men. Ovariectomy (OVX) is an established animal model that mimics the estrogen deficiency of postmenopausal women. Little is known about the three-dimensional (3D) morphologic properties of cartilage and subchondral bone changes in the lumbar facet joint (LFJ) of an OVX mouse model. PURPOSE The purpose of this study was to characterize the 3D morphologic change of cartilage and subchondral bone in the LFJ of an OVX mouse model. STUDY DESIGN Three-dimensional visualization and a histologic study on degenerative changes in cartilage and subchondral bone in the LFJ of an OVX mouse model were conducted. MATERIALS AND METHODS Ovariectomy is performed to mimic postmenopausal changes in adult female mice. We present an imaging tool for 3D visualization of the pathologic characteristics of cartilage and subchondral bone changes LFJ degradation using propagation-based phase-contrast computed tomography (PPCT). The samples were further dissected, fixed, and stained for histologic examination. RESULTS Propagation-based phase-contrast computed tomography imaging provides a 3D visualization of altered cartilage with a simultaneous high detail of the subchondral bone abnormalities in an OVX LFJ model. A quantitative analysis demonstrated that the cartilage volume, the surface area, and thickness were decreased in the OVX group compared with the control group (p<.05). Meanwhile, these decreases were accompanied by an obvious destruction of the subchondral bone surface and a loss of trabecular bone in the OVX group (p<.05). The delineation of the 3D pathologic changes in the PPCT imaging was confirmed by a histopathologic method with Safranin-O staining. Tartrate-resistant acid phosphatase staining revealed an increased number of osteoclasts in the subchondral bone of the OVX mice compared with that of the control group. CONCLUSIONS These results demonstrated that a mouse model of OVX-induced LFJ osteoarthritis (OA)-like changes was successfully established and showed a good resemblance to the human OA pathology. Propagation-based phase-contrast computed tomography has great potential to becomea powerful 3D imaging method to comprehensively characterize LFJ OA and to effectively monitor therapeutics. Moreover, degenerative LFJ possesses a severe morphologic change in the subchondral bone, may be the source of postmenopausal LBP, and has the potential to be a novel therapeutic target for LBP treatment.
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Affiliation(s)
- Tianding Wu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Xiangya Rd No.87, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Xiangya Rd No.87, Changsha, Hunan, China
| | - Shuangfei Ni
- Department of Spine Surgery, Xiangya Hospital, Central South University, Xiangya Rd No.87, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Xiangya Rd No.87, Changsha, Hunan, China
| | - Yong Cao
- Department of Spine Surgery, Xiangya Hospital, Central South University, Xiangya Rd No.87, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Xiangya Rd No.87, Changsha, Hunan, China
| | - Shenghui Liao
- School of Information Science and Engineering, Central South University, Lushan South Rd, Changsha, 410008, China
| | - Jianzhong Hu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Xiangya Rd No.87, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Xiangya Rd No.87, Changsha, Hunan, China
| | - Chunyue Duan
- Department of Spine Surgery, Xiangya Hospital, Central South University, Xiangya Rd No.87, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Xiangya Rd No.87, Changsha, Hunan, China.
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Abstract
Purpose:
To investigate the association of facet joint asymmetry with lumbar disc herniation at the lower lumbar spine.
Methods:
A total of 90 patients (ages 18–40 years) with single-level disc herniation (L3–L4, L4–L5, or L5–S1) were included in the study. Facet asymmetry was defined as a difference of 10° in facet joint angles between right and left sides. Normal discs in the same segment of other individuals were used as a control. Patients had facet asymmetry measured for L3 to S1 through 3.0T magnetic resonance imaging, and information was collected, including age, sex, degenerative degree of lumbar facet joints, and the presence or absence of lumbar disc herniation and type.
Results:
At the L3 to L4 level, 2 cases had facet asymmetry in 8 patients with lumbar disc herniation, compared with 17 cases of facet asymmetry in 82 patients without disc herniation (P = 0.7776, r = 0.030). At the L4 to L5 level, there were 21 cases of facet asymmetry in 45 patients with lumbar disc herniation, compared with 5 cases of asymmetry in 45 patients without disc herniation (P = 0.00019, r = 0.392). At the L5 to S1 level, there were 25 cases of facet asymmetry in 37 patients with lumbar disc herniation, compared with 11 cases of facet asymmetry in 53 patients without disc herniation (P = 0.0000, r = 0.492). There were 23 cases of facet asymmetry in 28 disc herniations of side type compared with 2 cases of facet asymmetry in 9 herniations of center type (P = 0.0008, r = 0.364). There was no significant difference in the relationship between age, facet joint degeneration, and lumbar facet joint asymmetry (P > 0.05).
Conclusion:
Facet asymmetry is significantly associated with lumbar disc herniation at the L4 to L5 and the L5 to S1 levels, whereas there is an obvious association with the side type of lumbar disc herniation at the L5 to S1 level.
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64
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Association of facet tropism and orientation with lumbar disc herniation in young patients. Neurol Sci 2018; 39:841-846. [DOI: 10.1007/s10072-018-3270-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
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Muscle Atrophy Measurement as Assessment Method for Low Back Pain Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:437-461. [PMID: 30390264 DOI: 10.1007/978-981-13-1435-3_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Low back pain is one of the most common pain disorders defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, sometimes with accompanying leg pain. The meaning of the symptomatic atrophy of paraspinal muscles and some pelvic muscles has been proved. Nowadays, a need for new diagnostic tools for specific examination of low back pain patients is posited, and it has been proposed that magnetic resonance imaging assessment toward muscle atrophy may provide some additional information enabling the subclassification of that group of patients.
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66
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Chen C, Xu G, Yuan K, Sun Y, Bao G, Xu D, Cui Z. Transcriptional analysis of long non-coding RNAs in facet joint osteoarthritis. RSC Adv 2018; 8:33695-33701. [PMID: 35548800 PMCID: PMC9086565 DOI: 10.1039/c8ra04809f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/18/2018] [Accepted: 09/24/2018] [Indexed: 11/21/2022] Open
Abstract
It is recognized that facet joint osteoarthritis (FJOA) is commonly induced by the degeneration of articular cartilage of the facet joint.
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Affiliation(s)
- Chu Chen
- Department of Spine Surgery
- The Second Affiliated Hospital of Nantong University
- Nantong
- China
| | - Guanhua Xu
- Department of Spine Surgery
- The Second Affiliated Hospital of Nantong University
- Nantong
- China
| | - Kun Yuan
- Department of Spine Surgery
- The Second Affiliated Hospital of Nantong University
- Nantong
- China
| | - Yuyu Sun
- Department of Spine Surgery
- The Second Affiliated Hospital of Nantong University
- Nantong
- China
| | - Guofeng Bao
- Department of Spine Surgery
- The Second Affiliated Hospital of Nantong University
- Nantong
- China
| | - Dawei Xu
- Department of Spine Surgery
- The Second Affiliated Hospital of Nantong University
- Nantong
- China
| | - Zhiming Cui
- Department of Spine Surgery
- The Second Affiliated Hospital of Nantong University
- Nantong
- China
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67
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Correlation between facet tropism and lumbar degenerative disease: a retrospective analysis. BMC Musculoskelet Disord 2017; 18:483. [PMID: 29166933 PMCID: PMC5700519 DOI: 10.1186/s12891-017-1849-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to investigate the correlation between facet tropism and spinal degenerative diseases, such as degenerative lumbar spondylolisthesis, degenerative lumbar scoliosis, and lumbar disc herniation. Methods This study retrospectively analysed clinical data from the Department of Orthopaedics at The First Affiliated Hospital of Nanchang University. Ninety-two patients were diagnosed with lumbar spondylolisthesis, 64 patients with degenerative scoliosis, and 86 patients with lumbar disc herniation between 1 October 2014 and 1 October 2016. All patients were diagnosed using 3.0 T magnetic resonance imaging and underwent conservative or operative treatment. Facet tropism was defined as greater than a ten degree between the facet joint angles on both sides. Results For L3-L4 degenerative lumbar spondylolisthesis, one out of six cases had tropism compared to seven out of the 86 controls (p = 0.474). At the L4-L5 level, 17/50 cases had tropism compared to 4/42 cases in the control group (p = 0.013). At the L5-S1 level, 18/36 cases had tropism compared to 7/56 controls (p = 0.000). For degenerative lumbar scoliosis at the L1-L5 level, 83/256 cases had tropism as compared to 36/256 controls (p = 0.000). For L3-L4 lumbar disc herniation two out of eight cases had tropism compared to 14/78 controls (p = 0.625). At the L4-L5 level, 19/44 cases had tropism compared to four out of 42 controls (p = 0.001). At the L5-S1 level, 24/34 cases had tropism compared to 10/52 controls (p = 0.000). Conclusion At the L4–5 and L5-S1 levels, facet tropism is associated with degenerative spondylolisthesis. In the degenerative lumbar scoliosis group, the number of case with facet tropism was significantly higher than that of the control group. Facet tropism was associated with lumbar disc herniation at the L4–5 and L5-S1 levels. Overall, in these three lumbar degenerative diseases, facet tropism is a common phenomenon. Electronic supplementary material The online version of this article (10.1186/s12891-017-1849-x) contains supplementary material, which is available to authorized users.
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Byrne RM, Zhou Y, Zheng L, Chowdhury SK, Aiyangar A, Zhang X. Segmental variations in facet joint translations during in vivo lumbar extension. J Biomech 2017; 70:88-95. [PMID: 29096984 DOI: 10.1016/j.jbiomech.2017.09.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/05/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
The lumbar facet joint (FJ) is often associated with pathogenesis in the spine, but quantification of normal FJ motion remains limited to in vitro studies or static imaging of non-functional poses. The purpose of this study was to quantify lumbar FJ kinematics in healthy individuals during functional activity with dynamic stereo radiography (DSX) imaging. Ten asymptomatic participants lifted three known weights starting from a trunk-flexed (∼75°) position to an upright position while being imaged within the DSX system. High resolution computed tomography (CT) scan-derived 3D models of their lumbar vertebrae (L2-S1) were registered to the biplane 2D radiographs using a markerless model-based tracking technique providing instantaneous 3D vertebral kinematics throughout the lifting tasks. Effects of segment level and weight lifted were assessed using mixed-effect repeated measures ANOVA. Superior-inferior (SI) translation dominated FJ translation, with L5S1 showing significantly less translation magnitudes (Median (Md) = 3.5 mm, p < 0.0001) than L2L3, L3L4, and L4L5 segments (Md = 5.9 mm, 6.3 mm and 6.6 mm respectively). Linear regression-based slopes of continuous facet translations revealed strong linearity for SI translation (r2 > 0.94), reasonably high linearity for sideways sliding (Z-) (r2 > 0.8), but much less linearity for facet gap change (X-) (r2 ∼ 0.5). Caudal segments (L4-S1), particularly L5S1, displayed greater coupling compared to cranial (L2-L4) segments, revealing distinct differences overall in FJ translation trends at L5S1. No significant effect of weight lifted on FJ translations was detected. The study presents a hitherto unavailable and highly precise baseline dataset of facet translations measured during a functional, dynamic lifting task.
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Affiliation(s)
- Ryan M Byrne
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA 15203, USA
| | - Yu Zhou
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Liying Zheng
- Health Effects Lab Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - Suman K Chowdhury
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Ameet Aiyangar
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15203, USA; Mechanical Systems Engineering, EMPA (Swiss Federal Laboratories for Materials Science and Technology), 8600 Duebendorf, Switzerland.
| | - Xudong Zhang
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; Department of Mechanical Engineering, Texas A&M University, College Station, TX 77843, USA.
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69
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Goode AP, Nelson AE, Kraus VB, Renner JB, Jordan JM. Biomarkers reflect differences in osteoarthritis phenotypes of the lumbar spine: the Johnston County Osteoarthritis Project. Osteoarthritis Cartilage 2017; 25:1672-1679. [PMID: 28711584 PMCID: PMC5605465 DOI: 10.1016/j.joca.2017.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 06/02/2017] [Accepted: 07/05/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine differences in biomarker levels between radiographic phenotypes of facet joint osteoarthritis (FOA) only, spine OA only ((disc space narrowing (DSN) and vertebral osteophytes (OST)) or the combination of FOA and spine OA. DESIGN A cross-sectional analysis of data from 555 participants in the Johnston County Osteoarthritis Project was performed. Lumbar spine levels were graded by severity (OST and DSN) and presence (FOA) of degeneration. Biomarkers included hyaluronan (HA) and type II collagen (CTX-II). Adjusted risk ratios (aRRR) were estimated using multinomial regression, with adjustment for age, race, sex, body mass index (BMI), and radiographic OA (knee, hip, hand). Interactions were tested between sex, race and low back symptoms. RESULTS FOA only was present in 22.4%, 14.5% had spine OA only, and 34.6% had the combination of FOA and spine OA. Compared to the reference group of neither FOA or spine OA, a one unit higher ln HA level was associated with 31% higher relative risk ratio (RRR = 1.31 (95% 1.03, 1.67)) of having FOA only, while, a one unit higher lnuCTX-II level was associated with 84% higher relative risk ratio (RRR = 1.84 (95% CI 1.19, 2.84)) of having spine OA only. No significant interactions were identified. CONCLUSION Interestingly, OA affecting the synovial facet joint was associated with a marker of inflammation (HA). Spine OA, affecting intervertebral discs that contain collagen type II, was associated with a marker reflecting collagen type II degradation (CTX-II). These findings suggest that biomarkers may reflect the different pathophysiologic processes of lumbar spine OA phenotypes.
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Affiliation(s)
- Adam P. Goode
- Associate Professor, Department of Orthopedic Surgery, Duke Clinical Research Institute, Duke University School of Medicine
| | - Amanda E. Nelson
- Assistant Professor, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill
| | - Virginia B. Kraus
- Professor, Duke Molecular Physiology Institute and Division of Rheumatology, Duke University School of Medicine, Durham, NC
| | - Jordan B. Renner
- Professor, Thurston Arthritis Research Center, Department of Radiology, University of North Carolina, Chapel Hill
| | - Joanne M. Jordan
- Professor, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill
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Goehre F, Ludtka C, Hamperl M, Friedmann A, Straube A, Mendel T, Heilmann A, Meisel HJ, Schwan S. Micro-computed tomography, scanning electron microscopy and energy X-ray spectroscopy studies of facet joint degeneration: A comparison to clinical imaging. Micron 2017; 100:50-59. [DOI: 10.1016/j.micron.2017.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 11/28/2022]
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Russo VM, Dhawan RT, Baudracco I, Dharmarajah N, Lazzarino AI, Casey AT. Hybrid Bone SPECT/CT Imaging in Evaluation of Chronic Low Back Pain: Correlation with Facet Joint Arthropathy. World Neurosurg 2017; 107:732-738. [PMID: 28847557 DOI: 10.1016/j.wneu.2017.08.092] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence to support the use of bone hydroxydiphosphonate (HDP) single photon emission computed tomography (SPECT/CT) in patients with facetogenic low back pain (LBP) is still limited. In this study we compared the scintigraphic patterns on bone SPECT/CT with the degree of structural facet joint (FJ) degeneration on CT in patients with LBP. METHODS Ninety-nine consecutive patients with LBP were prospectively evaluated. Patients with known or suspected malignancy, trauma, infectious processes, chronic inflammatory diseases, and previous surgery were excluded. The effect of LBP on the daily quality of life was assessed with the Oswestry disability index (ODI). The Pathria grading system was used to score FJ degeneration on CT scans. The correlation between the degree of FJ degeneration and osteoblastic activity on SPECT/CT was analyzed with Kappa statistics. RESULTS Ninety-nine patients were included (59 female, mean age 56.2 years). The mean ODI score was 38.5% (range, 8% to 72%). In all, 792 FJ (L2-3 to L5-S1) were examined. Of the FJs, 49.6% were Pathria grade 0-1 (normal to mild degeneration) on CT, 35% were grade 2 (moderate degeneration), and 16% were grade 3 (severe degeneration). Sixty-seven percent of the patients had scintigraphically active FJs on SPECT/CT. Sixty-nine percent of Pathria grade 3 FJs were scintigraphically active; 5.5% and 16.8% of Pathria grade 0-1 and Pathria grade 2, respectively, were active. Of the metabolically active FJs, 71.4% were at the L4-5/L5-S1 levels. CONCLUSIONS The ability of SPECT/CT to precisely localize scintigraphically active FJs may provide significant improvement in the diagnosis and treatment of patients with LBP. In this study we demonstrate that in >40% of FJs, the scintigraphic patterns on SPECT/CT did not correlate with the degree of degeneration on CT.
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Affiliation(s)
- Vittorio M Russo
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Ranju T Dhawan
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Irene Baudracco
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK.
| | - Nishanth Dharmarajah
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Antonio I Lazzarino
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Adrian T Casey
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
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Shi W, Tian D, Liu D, Yin J, Huang Y. The comparison of measurement between ultrasound and computed tomography for abnormal degenerative facet joints: A STROBE-compliant article. Medicine (Baltimore) 2017; 96:e7680. [PMID: 28767595 PMCID: PMC5626149 DOI: 10.1097/md.0000000000007680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Besides the study on examining facet joints of lumbar spine by ultrasound in normal population, there has not been any related report about examining normal facet joints of lumbar spine by ultrasound so far. This study was aimed to explore the feasibility of ultrasound assessment of lumber spine facet joints by comparing ultrasound measure values of normal and degenerative lumber spine facet joints, and by comparing measure values of ultrasound and computed tomography (CT) of degenerative lumber spine facet joints.This study included 15 patients who had chronic low back pain because of degenerative change in lumbar vertebrae, and 19 volunteers who did not have low back pain or pain in the lower limb. The ultrasound measure values (height [H] and width [W]) of normal and degenerative lumber spine facet joints were compared. And the differentiation between measure values (H and W) of ultrasound and CT of degenerative lumber spine facet joints was also analyzed.The ultrasound clearly showed abnormal facet joints lesion, which was characterized by hyperostosis on the edge of joints, bone destruction under joints, and thinner or thicker articular cartilage. There were significant differences between the ultrasound measure values of the normal (H: 1.26 ± 0.03 cm, W: 0.18 ± 0.01 cm) and abnormal facet joints (H: 1.43 ± 0.05 cm, W: 0.15 ± 0.02 cm) (all P < .05). However, there were no significant differences between the measure values of the ultrasound (H: 1.43 ± 0.17 cm, W: 0.15 ± 0.03 cm) and CT (H: 1.42 ± 0.16, W: 0.14 ± 0.03) of the degenerative lumber spine facet joints (all P > .05).Ultrasound can clearly show the structure of facet joints of lumbar spine. It is precise and feasible to assess facet joints of lumbar spine by ultrasound. This study has important significance for the diagnosis of lumbar facet joint degeneration.
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Affiliation(s)
| | | | - Da Liu
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
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Abstract
Degenerative disease of the spine is a leading cause of back pain and radiculopathy, and is a frequent indication for spine MR imaging. Disc degeneration, disc protrusion/herniation, discarhtrosis, spinal canal stenosis, and facet joint arthrosis, as well as interspinous processes arthrosis, may require an MR imaging workup. This review presents the MR imaging patterns of these diseases and describes the benefit of the MR imaging in these indications compared with the other imaging modalities like plain radiographs or computed tomography scan.
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Cao Y, Ni S, Wu T, Duan C, Liao S, Hu J. WITHDRAWN: 3D visualization and pathological characteristics of cartilage and subchondral bone changes in the lumbar facet joint of an Ovariectomized mouse model. Spine J 2017:S1529-9430(17)30322-4. [PMID: 28713051 DOI: 10.1016/j.spinee.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/19/2017] [Accepted: 07/06/2017] [Indexed: 02/03/2023]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.spinee.2017.11.009. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Yong Cao
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Changsha, Hunan, PR China
| | - Shuangfei Ni
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Changsha, Hunan, PR China
| | - Tianding Wu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Changsha, Hunan, PR China.
| | - Chunyue Duan
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Changsha, Hunan, PR China.
| | - Shenghui Liao
- School of Information Science and Engineering, Central South University, Changsha, 410008, China.
| | - Jianzhong Hu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, China; The Key Laboratory of Organ Damage, Aging and Reproductive Medicine of Hunan Province, Changsha, Hunan, PR China
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Basques BA, Espinoza Orías AA, Shifflett GD, Fice MP, Andersson GB, An HS, Inoue N. The Kinematics and Spondylosis of the Lumbar Spine Vary Depending on the Levels of Motion Segments in Individuals With Low Back Pain. Spine (Phila Pa 1976) 2017; 42:E767-E774. [PMID: 27831966 PMCID: PMC5423857 DOI: 10.1097/brs.0000000000001967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE The aim of this study was to identify associations of spondylotic and kinematic changes with low back pain (LBP). SUMMARY OF BACKGROUND DATA The ability to characterize and differentiate the biomechanics of both the symptomatic and asymptomatic lumbar spine is crucial to alleviate the sparse literature on the association of lumbar spine biomechanics and LBP. METHODS Lumbar dynamic plain radiographs (flexion-extension), dynamic computed tomography (CT) scanning (axial rotation, disc height), and magnetic resonance imaging (MRI, disc and facet degeneration grades) were obtained for each subject. These parameters were compared between symptomatic and control groups using Student t test and multivariate logistic regression, which controlled for patient age and sex and identified spinal parameters that were independently associated with symptomatic LBP. Disc grade and mean segmental motion by level were tested by one-way analysis of variance (ANOVA). RESULTS Ninety-nine volunteers (64 asymptomatic/35 LBP) were prospectively recruited. Mean age was 37.3 ± 10.1 years and 55% were male. LBP showed association with increased L5/S1 translation [odds ratio (OR) 1.63 per mm, P = 0.005], decreased flexion-extension motion at L1/L2 (OR 0.87 per degree, P = 0.036), L2/L3 (OR 0.88 per degree, P = 0.036), and L4/L5 (OR 0.87 per degree, P = 0.020), increased axial rotation at L4/L5 (OR 2.11 per degree, P = 0.032), decreased disc height at L3/L4 (OR 0.52 per mm, P = 0.008) and L4/L5 (OR 0.37 per mm, p < 0.001), increased disc grade at all levels (ORs 2.01-12.33 per grade, P = 0.001-0.026), and increased facet grade at L4/L5 (OR 4.99 per grade, P = 0.001) and L5/S1 (OR 3.52 per grade, P = 0.004). Significant associations were found between disc grade and kinematic parameters (flexion-extension motion, axial rotation, and translation) at L4/L5 (P = 0.001) and L5/S1 (P < 0.001), but not at other levels (P > 0.05). CONCLUSION In symptomatic individuals, L4/L5 and L5/S1 levels were affected by spondylosis and kinematic changes. This study clarifies the relationships between kinematic alterations and LBP, mostly observed at the above-mentioned segments. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Bryce A Basques
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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Kim DH, An YS, Kim HD, Jeong KS, Ahn YS, Kim KH, Kim Y, Song HS, Lee CG, Kwon YJ, Yoon JH. Comparison of facet joint degeneration in firefighters and hospital office workers. Ann Occup Environ Med 2017; 29:24. [PMID: 28652921 PMCID: PMC5482944 DOI: 10.1186/s40557-017-0180-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/15/2017] [Indexed: 11/14/2022] Open
Abstract
Background There are few published studies on the relationship between occupational lumbar load and facet joint degeneration (FJD). This cross-sectional study was conducted to evaluate the effect of physical lumbar load on FJD by comparing magnetic resonance imaging (MRI) findings of firefighters (FFs) and hospital office workers (HOWs). Methods We randomly sampled 341 male FFs and 80 male HOWs by age stratification. A questionnaire and clinical examination, including MRI of the lumbar spine (T12-S1), were conducted. FJD was diagnosed and graded by using the classification of Pathria et al., and reclassified into two groups as follows: no FJD (grade 0) and FJD (grades 1, 2, and 3). The prevalence of FJD was analyzed according to occupational group. Results The prevalence of FJD ranged from 31% (L1–L2) to 75% (L4–L5) in the FFs, and from 18% (L1–L2) to 69% (L4–L5) in the HOWs. After adjustment for age, body mass index, and frequency of physical exercise, the adjusted odds ratios (OR) for FJD in the FFs were significantly higher than those in the HOWs at all lumbar spinal levels, except for L3–L4 (L1–L2: OR, 2.644; 95% confidence interval [CI], 1.317–5.310; L2–L3: OR, 2.285; 95% CI, 1.304–4.006; L4–L5: OR, 1.918; 95% CI, 1.037–3.544; L5–S1: OR, 1.811; 95% CI, 1.031–3.181). Conclusion This study shows that FFs exhibit a greater likelihood of having FJD than HOWs after controlling for other risk factors of FJD. This suggests that the physical occupational demands of FFs affect their risk of developing FJD.
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Affiliation(s)
- Dong Hyun Kim
- Department of Occupational Medicine, Dongguk University Ilsan Hospital, 29 Donggung-no, Ilsandong-gu, Goyang, 410-773 South Korea
| | - Yon Soo An
- Department of Occupational Medicine, Dongguk University Ilsan Hospital, 29 Donggung-no, Ilsandong-gu, Goyang, 410-773 South Korea
| | - Hyung Doo Kim
- Department of Occupational Medicine, Dongguk University Ilsan Hospital, 29 Donggung-no, Ilsandong-gu, Goyang, 410-773 South Korea
| | - Kyoung Sook Jeong
- Department of Occupational Medicine, Dongguk University Ilsan Hospital, 29 Donggung-no, Ilsandong-gu, Goyang, 410-773 South Korea
| | - Yeon-Soon Ahn
- Department of Occupational Medicine, Dongguk University Ilsan Hospital, 29 Donggung-no, Ilsandong-gu, Goyang, 410-773 South Korea
| | - Kun-Hyung Kim
- Department of Occupational and Environmental Medicine, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Youngki Kim
- Department of Occupational and Environmental Medicine, Busan National University Yangsan Hospital, Yangsan, South Korea
| | - Han-Soo Song
- Department of Occupational and Environmental Medicine, School of Medicine, Chosun University, Gwangju, South Korea
| | - Chul-Gab Lee
- Department of Occupational and Environmental Medicine, School of Medicine, Chosun University, Gwangju, South Korea
| | - Young-Jun Kwon
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heaty Hospital, Anyang, South Korea
| | - Jin-Ha Yoon
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, South Korea
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Zhang Y, Hu J, Duan C, Hu P, Lu H, Peng X. Correlation study between facet joint cartilage and intervertebral discs in early lumbar vertebral degeneration using T2, T2* and T1ρ mapping. PLoS One 2017; 12:e0178406. [PMID: 28570641 PMCID: PMC5453520 DOI: 10.1371/journal.pone.0178406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 05/14/2017] [Indexed: 01/31/2023] Open
Abstract
Recent advancements in magnetic resonance imaging have allowed for the early detection of biochemical changes in intervertebral discs and articular cartilage. Here, we assessed the feasibility of axial T2, T2* and T1ρ mapping of the lumbar facet joints (LFJs) to determine correlations between cartilage and intervertebral discs (IVDs) in early lumbar vertebral degeneration. We recruited 22 volunteers and examined 202 LFJs and 101 IVDs with morphological (sagittal and axial FSE T2-weighted imaging) and axial biochemical (T2, T2* and T1ρ mapping) sequences using a 3.0T MRI scanner. IVDs were graded using the Pfirrmann system. Mapping values of LFJs were recorded according to the degeneration grades of IVDs at the same level. The feasibility of T2, T2* and T1ρ in IVDs and LFJs were analyzed by comparing these mapping values across subjects with different rates of degeneration using Kruskal-Wallis tests. A Pearson's correlation analysis was used to compare T2, T2* and T1ρ values of discs and LFJs. We found excellent reproducibility in the T2, T2* and T1ρ values for the nucleus pulposus (NP), anterior and posterior annulus fibrosus (PAF), and LFJ cartilage (intraclass correlation coefficients 0.806-0.955). T2, T2* and T1ρ mapping (all P<0.01) had good Pfirrmann grade performances in the NP with IVD degeneration. LFJ T2* values were significantly different between grades I and IV (PL = 0.032, PR = 0.026), as were T1ρ values between grades II and III (PL = 0.002, PR = 0.006) and grades III and IV (PL = 0.006, PR = 0.001). Correlations were moderately negative for T1ρ values between LFJ cartilage and NP (rL = -0.574, rR = -0.551), and between LFJ cartilage and PAF (rL = -0.551, rR = -0.499). T1ρ values of LFJ cartilage was weakly correlated with T2 (r = 0.007) and T2* (r = -0.158) values. Overall, we show that axial T1ρ effectively assesses early LFJ cartilage degeneration. Using T1ρ analysis, we propose a link between LFJ degeneration and IVD NP or PAF changes.
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Affiliation(s)
- Yi Zhang
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Jianzhong Hu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Chunyue Duan
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Ping Hu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Hongbin Lu
- Department of Sports Medicine and Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Xianjing Peng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
- * E-mail:
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Jin WS, Choi EJ, Lee SY, Bae EJ, Lee TH, Park J. Relationships among Obesity, Sarcopenia, and Osteoarthritis in the Elderly. J Obes Metab Syndr 2017; 26:36-44. [PMID: 31089492 PMCID: PMC6484930 DOI: 10.7570/jomes.2017.26.1.36] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/04/2016] [Accepted: 05/16/2016] [Indexed: 02/06/2023] Open
Abstract
Background The present study examined the correlations between obesity, sarcopenia, and osteoarthritis in Korea’s elderly population. Methods A cross-sectional analysis of 1,865 and 1,769 respondents with knee osteoarthritis and lumbar spondylosis, respectively, was performed by using data from the 2010 and 2011 Korea National Health and Nutrition Examination Survey. Obesity was defined as a body mass index of ≥25 kg/m2; osteoarthritis, as a Kellgren/Lawrence grade of ≥2; and sarcopenia, as an appendicular skeletal muscle mass (ASM; ASM/weight ×100) on dual-energy X-ray absorptiometry of two standard deviations below the mean reference value. Results The unadjusted and age-adjusted risks of knee osteoarthritis were as follows: 1.88 and 1.92 times greater, respectively, for male subjects with sarcopenic obesity; 6.03 and 7.64 times greater, respectively, for female subjects with non-sarcopenic obesity; and 1.97 and 2.43 times greater, respectively, for female subjects with sarcopenic obesity. The age-and-waist circumference-adjusted risks were 5.88 and 1.80 times greater for the female subjects with non-sarcopenic and sarcopenic obesities, respectively. No statistically significant finding was obtained for lumbar spondylosis. Conclusion Obesity and sarcopenia were associated with knee osteoarthritis in the elderly subjects. The risk of knee osteoarthritis was greater in the male subjects with sarcopenic obesity than in the male subjects with non-sarcopenic obesity. In the female subjects, the risk of knee osteoarthritis was high in both obesity groups. Further research to explain the sex-related difference in knee osteoarthritis risk based on body composition will be beneficial.
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Affiliation(s)
- Woo Sung Jin
- Department of Family Medicine, Daedong Hospital, Busan, Korea
| | - Eun Jung Choi
- Department of Family Medicine, Daedong Hospital, Busan, Korea
| | - Sang Yeoup Lee
- Department of Medical Education, Pusan National University School of Medicine, Department of Family Medicine, Pusan National University Yangsan Hospital, Busan, Korea
| | - Eun Jin Bae
- Department of Family Medicine, Daedong Hospital, Busan, Korea
| | - Taeck-Hyun Lee
- Department of Family Medicine, Daedong Hospital, Busan, Korea
| | - Juwon Park
- Department of Family Medicine, Daedong Hospital, Busan, Korea
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The Association between Imaging Parameters of the Paraspinal Muscles, Spinal Degeneration, and Low Back Pain. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2562957. [PMID: 28409152 PMCID: PMC5376928 DOI: 10.1155/2017/2562957] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/10/2017] [Accepted: 03/01/2017] [Indexed: 11/17/2022]
Abstract
This narrative review investigated imaging parameters of the paraspinal muscles and their association with spinal degenerative features and low back pain (LBP) found in the literature. Three principal signs of muscle degeneration were detected on imaging: decreased muscle size, decreased radiographic density, and increased fat deposits. Men have a higher density of paraspinal muscles than women, younger individuals have a higher density than older ones, and lean individuals have a higher density than those with an increased body mass index. Fatty infiltration appears to be a late stage of muscular degeneration and can be measured noninvasively by an MRI scan. Fatty infiltration in the lumbar multifidus is common in adults and is strongly associated with LBP, especially in women, independent of body composition. Fatty infiltration develops in areas where most degenerative changes are found. MR spectroscopy studies have corroborated that the lumbar multifidus in LBP subjects has a significantly higher fat content than asymptomatic controls. There is a strong need for establishing uniform methods of evaluating normal parameters and degenerative changes of the paraspinal muscles. Additional imaging studies are needed to improve the understanding of the association and causal relationships between LBP, spinal degeneration, and changes in the paraspinal muscles.
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Weinberg DS, Liu RW, Xie KK, Morris WZ, Gebhart JJ, Gordon ZL. Increased and decreased pelvic incidence, sagittal facet joint orientations are associated with lumbar spine osteoarthritis in a large cadaveric collection. INTERNATIONAL ORTHOPAEDICS 2017; 41:1593-1600. [PMID: 28213647 DOI: 10.1007/s00264-017-3426-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 02/05/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Degenerative joint disease of the lumbar spine is a pervasive problem in healthcare; however, its aetiology and risk factors remain poorly defined. There have been recent attempts to correlate the anatomic parameters of facet angle and pelvic incidence with spine osteoarthritis, although data remains limited. The purpose of this experiment was to determine how age, gender, race, facet angle, tropism, and pelvic incidence correlate to facet joint osteoarthritis in the lumbar spine. METHODS A total of 576 cadaveric lumbar spines were obtained. Using validated techniques, facet angle, tropism, and pelvic incidence were measured. Osteoarthritis of the lumbar spines was graded from 0-4 at each level. Correlations between osteoarthritis and age, gender, facet angle, tropism, and pelvic incidence were evaluated with regression analysis. RESULTS Facet angle became more coronally oriented, and facet tropism increased from L1-L2 to L5-S1. Arthritis was highest at the L4-L5 joint (2.2 ± 1.1), compared to the L5-S1 (2.1 ± 1.1), L3-L4 (1.9 ± 1.1), L2-L3 (1.5 ± 1.0) and L1-L2 (1.0 ± 1.0) joints (p < 0.001). Age was the strongest predictor of arthritis at all levels (standardized betas 0.342 through 0.494, p < 0.001). Correlations between gender, race and osteoarthritis were not significant at any level. A decreased facet angle was predictive of increased arthritis at each joint level (standardized betas -0.091 through -0.153, p < 0.05 for all). Tropism was a predictor of increased arthritis at caudal levels. Pelvic incidence was a predictor of increased arthritis at L3-L4 (standardized beta 0.080, p = 0.02), L4-L5 (standardized beta 0.081,p = 0.02), and L5-S1 (standardized beta 0.100, p = 0.01). CONCLUSIONS Facet arthritis was correlated with a more sagittal orientation of the facet joints, increased tropism, and perturbations of pelvic incidence.
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Affiliation(s)
- Douglas S Weinberg
- Department of Orthopaedic Surgery, Case Western Reserve University, 11100 Euclid Avenue, HH 5043, Cleveland, OH, 44106, USA.
| | - Raymond W Liu
- Department of Orthopaedic Surgery, Case Western Reserve University, 11100 Euclid Avenue, HH 5043, Cleveland, OH, 44106, USA
| | - Katherine K Xie
- Department of Orthopaedic Surgery, Case Western Reserve University, 11100 Euclid Avenue, HH 5043, Cleveland, OH, 44106, USA
| | - William Z Morris
- Department of Orthopaedic Surgery, Case Western Reserve University, 11100 Euclid Avenue, HH 5043, Cleveland, OH, 44106, USA
| | - Jeremy J Gebhart
- Department of Orthopaedic Surgery, Case Western Reserve University, 11100 Euclid Avenue, HH 5043, Cleveland, OH, 44106, USA
| | - Zachary L Gordon
- Department of Orthopaedic Surgery, Case Western Reserve University, 11100 Euclid Avenue, HH 5043, Cleveland, OH, 44106, USA
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Facet joint injection versus epidural steroid injection for lumbar spinal stenosis: intra-individual study. Clin Radiol 2017; 72:96.e7-96.e14. [DOI: 10.1016/j.crad.2016.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/26/2016] [Accepted: 08/09/2016] [Indexed: 12/19/2022]
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Chiba D, Wada K, Tanaka T, Kumagai G, Sasaki E, Takahashi I, Nakaji S, Ishibashi Y. Serum pentosidine concentration is associated with radiographic severity of lumbar spondylosis in a general Japanese population. J Bone Miner Metab 2017; 35:65-72. [PMID: 26661661 DOI: 10.1007/s00774-015-0727-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/09/2015] [Indexed: 01/22/2023]
Abstract
The aim of this study was to investigate the relationship between the radiographic severity of lumbar spondylosis (LS) and serum bone metabolic markers. A total of 681 individuals volunteered for this study (269 men, 412 women; age: 54.9 ± 14.3; body mass index [BMI]: 23.1 ± 3.3 kg/m2). Lateral lumbar radiographs were evaluated in each intervertebral section (L1/2 to L5/S1) using the Kellgren-Lawrence grade (KL). If at least one intervertebral section was graded as KL 2 or greater, the participants were considered to have LS. The summation of each section of intervertebral section was used as the radiographic severity value of LS. In addition, bone status was evaluated with an osteo-sono assessment index (OSI) at the calcaneus. Serum bone alkaline phosphatase (μg/mL), N-telopeptide of type I collagen (nMBCE/L), and pentosidine (pmol/mL) concentrations were examined and used as the bone metabolism index. Stepwise multiple linear regression analysis was conducted with the radiographic severity value of LS as the dependent variable and age, sex, BMI, OSI, and the value of serum bone metabolic markers as the independent variables. The total number of LS participants was 470 (69.0 %); the frequency of LS was higher in men (n = 198) than in women (n = 272; P = 0.036, χ 2 test). The mean severity value of LS was 7.1 ± 4.4, and the mean value of pentosidine was 120.7 ± 54.8 pmol/mL. On multiple regression analysis, age (B = 0.190, β = 0.611), sex (men = 1, women = 2; B = -0.900, β = -0.099), BMI (B = 0.185, β = 0.136), and pentosidine (B = 0.009, β = 0.115) were significantly correlated with the severity of LS. Serum pentosidine concentration was positively correlated with the radiographic severity of LS in this cross-sectional study.
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Affiliation(s)
- Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Toshihiro Tanaka
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ippei Takahashi
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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El Abd O, Amadera JED, Pimentel DC, Bhargava A. Nonsurgical Treatment (Indications, Limitations, Outcomes): Injections. HIP JOINT RESTORATION 2017:299-314. [DOI: 10.1007/978-1-4614-0694-5_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Asymmetric Facet Joint Osteoarthritis and Its Relationships to Facet Orientation, Facet Tropism, and Ligamentum Flavum Thickening. Clin Spine Surg 2016; 29:394-398. [PMID: 23168391 DOI: 10.1097/bsd.0b013e31827ad875] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
STUDY DESIGN The degrees of osteoarthritis of the left and right facet joints were evaluated by using computerized tomography among elderly patients with low back or leg pain. OBJECTIVE To reveal the phenomenon of asymmetry regarding facet joint osteoarthritis (FJOA) in old patients and establish its relationships to spinal level, facet orientation, facet tropism and ligamentum flavum (LF) thickening. SUMMARY OF BACKGROUND DATA There were few reports regarding left-right asymmetry among severity of FJOA and its relationships to spinal level, facet orientation, facet tropism, and LF thickening remained unclear. METHODS The grade of bilateral FJOA was evaluated using 4-grade scale on computerized tomography images at the L3-4, L4-5, and L5-S1 levels of patients with age ranging from 60 to 80 years. All subjects were divided into 2 groups: symmetric FJOA group (FJOA I-II on both sides or FJOA III-IV on both sides) and asymmetric FJOA group (FJOA I-II on one side and FJOA III-IV on the other side). The relationships of FJOA to spinal level, facet orientation, facet tropism, and LF hypertrophy were evaluated. RESULTS No association between asymmetric FJOA and spinal level was noted (P>0.05). In asymmetric FJOA group, significant difference in facet orientation between 2 sides was observed at the L4-5 (P=0.018) and L5-S1 levels (P=0.033). Compared with symmetric FJOA, asymmetric FJOA showed significant difference in prevalence of facet tropism at the L5-S1 level (P<0.001). The LF showed significantly thicker on the side of FJOA III-IV than the side of FJOA I-II at each level in asymmetric FJOA group (P<0.05). However, no difference was found in thickness between 2 sides in symmetric FJOA group (P>0.05). CONCLUSIONS Asymmetric FJOA is associated with facet orientation and tropism, but not with spinal level. There is a close relationship between severity of FJOA and LF thickness.
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Indices of Paraspinal Muscles Degeneration: Reliability and Association With Facet Joint Osteoarthritis: Feasibility Study. Clin Spine Surg 2016; 29:465-470. [PMID: 27137159 DOI: 10.1097/bsd.0b013e31828be943] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
STUDY DESIGN A reliability and cross-sectional observational study. OBJECTIVE To introduce a scoring system for visible fat infiltration in paraspinal muscles; to evaluate intertester and intratester reliability of this system and its relationship with indices of muscle density; to evaluate the association between indices of paraspinal muscle degeneration and facet joint osteoarthritis. SUMMARY OF BACKGROUND DATA Current evidence suggests that the paraspinal muscles degeneration is associated with low back pain, facet joint osteoarthritis, spondylolisthesis, and degenerative disc disease. However, the evaluation of paraspinal muscles on computed tomography is not radiological routine, probably because of absence of simple and reliable indices of paraspinal degeneration. METHODS One hundred fifty consecutive computed tomography scans of the lower back (N=75) or abdomen (N=75) were evaluated. Mean radiographic density (in Hounsfield units) and SD of the density of multifidus and erector spinae were evaluated at the L4-L5 spinal level. A new index of muscle degeneration, radiographic density ratio=muscle density/SD of density, was calculated. To evaluate the visible fat infiltration in paraspinal muscles, we proposed a 3-graded scoring system. The prevalence of facet joint osteoarthritis was also evaluated. Intraclass correlation and κ statistics were used to evaluate inter-rater and intra-rater reliability. Logistic regression examined the association between paraspinal muscle indices and facet joint osteoarthritis. RESULTS Intra-rater reliability for fat infiltration score (κ) ranged between 0.87 and 0.92; inter-rater reliability between 0.70 and 0.81. Intra-rater reliability (intraclass correlation) for mean density of paraspinal muscles ranged between 0.96 and 0.99, inter-rater reliability between 0.95 and 0.99; SD intra-rater reliability ranged between 0.82 and 0.91, inter-rater reliability between 0.80 and 0.89. Significant associations (P<0.01) were found between facet joint osteoarthritis, fat infiltration score, and radiographic density ratio. CONCLUSIONS Two suggested indices of paraspinal muscle degeneration showed excellent reliability and were significantly associated with facet joint osteoarthritis. Additional studies are needed to evaluate the associations with other spinal degeneration features and low back pain.
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Increased Pelvic Incidence is Associated With a More Coronal Facet Orientation in the Lower Lumbar Spine: A Cadaveric Study of 599 Lumbar Spines. Spine (Phila Pa 1976) 2016; 41:E1138-E1145. [PMID: 27031765 DOI: 10.1097/brs.0000000000001577] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An anatomic study of facet angle orientation and morphology of the lumbar spine was performed. OBJECTIVE The aim of this study was to determine how age, gender, race, and pelvic incidence (PI) correlate with facet orientation in the lumbar spine. SUMMARY OF BACKGROUND DATA Lumbar facet orientation has important implications in the development of numerous pathologies of the spine, including arthritis, spondylolisthesis, and adult spinal deformity. Preliminary reports have suggested that sagittal balance of the spine may contribute to facet joint orientation. We therefore designed an anatomic study to investigate the relationship between PI and facet orientation, within the context of age, gender, and race. METHODS Five hundred ninety-nine cadaveric lumbar spines were obtained from the Hamann-Todd osteological collection. It was determined that facet angle was most reliably assessed by measuring the angle between the superior articular facet and the spinous process. Facet angles were measured bilaterally at each level from T12-L1 through L5-S1 in every specimen. Multivariate regression analysis was used to determine independent predictors of facet angle at each level. RESULTS Facet angle increased rostrally to caudally, from 22.6 ± 8.3° at T12-L1 to 49.1 ± 12.4° at L5-S1. Cadaver age was an independent predictor of a more sagittal facet angle at lower spinal levels. Caucasian race was an independent predictor of increasing facet angle. Increased PI had no effect on facet angle at T12-L1, L1-L2, L2-L3, or L3-L4, although was a significant predictor of more coronally oriented facet joints at L4-L5 (standardized beta 0.096, P = 0.009) and L5-S1 (standardized beta 0.079, P = 0.032). CONCLUSION The results of this study provide important data regarding differences in facet angle that exists between individuals. Moreover, the results of this study suggest that facet joints do possess the ability to remodel over time, perhaps in response to perturbations of sagittal balance, osteophyte formation, or other yet to be determined factors. LEVEL OF EVIDENCE N/A.
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Is There an Association Between Pain and Magnetic Resonance Imaging Parameters in Patients With Lumbar Spinal Stenosis? Spine (Phila Pa 1976) 2016; 41:E1053-E1062. [PMID: 26953669 DOI: 10.1097/brs.0000000000001544] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective multicenter cohort study. OBJECTIVE The aim of this study was to identify an association between pain and magnetic resonance imaging (MRI) parameters in patients with lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA At present, the relationship between abnormal MRI findings and pain in patients with LSS is still unclear. METHODS First, we conducted a systematic literature search. We identified relationships of relevant MRI parameters and pain in patients with LSS. Second, we addressed the study question with a thorough descriptive and graphical analysis to establish a relationship between MRI parameters and pain using data of the LSS outcome study (LSOS). RESULTS In the systematic review including four papers about the associations between radiological findings in the MRI and pain, the authors of two articles reported no association and two of them did. Of the latters, only one study found a moderate correlation between leg pain measured by Visual Analog Scale (VAS) and the degree of stenosis assessed by spine surgeons. In the data of the LSOS study, we could not identify a relevant association between any of the MRI parameters and buttock, leg, and back pain, quantified by the Spinal Stenosis Measure (SSM) and the Numeric Rating Scale (NRS). Even by restricting the analysis to the level of the lumbar spine with the most prominent radiological "stenosis," no relevant association could be shown. CONCLUSION Despite a thorough analysis of the data, we were not able to prove any correlation between radiological findings (MRI) and the severity of pain. There is a need for innovative "methods/techniques" to learn more about the causal relationship between radiological findings and the patients' pain-related complaints. LEVEL OF EVIDENCE 2.
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Mahmoud I, Gafsi L, Saidane O, Sahli H, Tekaya R, Abdelmoula L. Limit of the available spine radiologic scoring methods in ankylosing spondylitis when the facet joint is the only structure involved. THE EGYPTIAN RHEUMATOLOGIST 2016. [DOI: 10.1016/j.ejr.2015.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Degenerative lumbar spinal canal stenosis: intra- and inter-reader agreement for magnetic resonance imaging parameters. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:353-361. [PMID: 27334492 DOI: 10.1007/s00586-016-4667-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the inter- and intra-reader agreement of commonly used quantitative and qualitative image parameters for the assessment of degenerative lumbar spinal canal stenosis (LSS) by magnetic resonance imaging (MRI). METHODS In this ethical board approved cross-sectional multicenter study, MRI of 100 randomly selected patients (median age 72.5 years, 48 % female) of the prospective Lumbar Stenosis Outcome Study (LSOS) were evaluated by two independent readers. A set of five previously published core imaging parameters as well as nine qualitative and five quantitative additional parameters regarding LSS and degenerative changes of the lumbar spine were assessed to calculate κ and intraclass correlation coefficients (ICC) for the inter-reader agreement. Additional repeated image evaluations were performed by one reader to calculate the intra-reader agreement. RESULTS κ values for the core image parameters ranged between 0.42 (compromise of the foraminal zone) and 0.77 (relation between fluid and cauda equina) for inter-reader agreement and between 0.59 (compromise of the foraminal zone) and 0.8 (compromise of the central zone) for intra-reader agreement. The inter-reader agreement for the non-core parameters showed κ values of 0.27-0.69 and ICC values of 0.46-0.85. The intra-reader agreement showed κ values of 0.53-0.69 and ICC values of 0.81-0.88. CONCLUSIONS The inter- and intra-reader agreement of commonly used quantitative and qualitative image parameters for the assessment of LSS showed quite a variability with previously defined core parameters having good to excellent inter- and intra-reader agreements.
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90
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Chazen JL, Talbott J, Singh JR. Optimal Noninvasive Imaging for Suspected Zygapophyseal (Facet)-Mediated Low Back Pain. PM R 2016; 8:586-92. [PMID: 27297491 DOI: 10.1016/j.pmrj.2016.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Affiliation(s)
- J Levi Chazen
- Department of Radiology, Weill Cornell Medical College, New York, NY; Department of Radiology, New York-Presbyterian Hospital, New York, NY(∗)
| | - Jason Talbott
- Neuroradiology Section, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA; Zuckerberg San Francisco General Hospital, San Francisco, CA(†)
| | - Jaspal R Singh
- Physical Medicine and Rehabilitation, Weill Cornell Medical College, 525 E 68th Street, Baker 16, New York, NY 10065(‡).
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91
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Chiba D, Tsuda E, Wada K, Kumagai G, Sasaki E, Nawata A, Nakagomi S, Takahashi I, Nakaji S, Ishibashi Y. Lumbar spondylosis, lumbar spinal stenosis, knee pain, back muscle strength are associated with the locomotive syndrome: Rural population study in Japan. J Orthop Sci 2016; 21:366-72. [PMID: 27021251 DOI: 10.1016/j.jos.2016.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/27/2015] [Accepted: 02/09/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To comprehensively investigate the clinical and physical factors associating with locomotive syndrome (Loc-S); the locomotorium-disability for daily life. METHODS 647 volunteers participated (247 males, 400 females, Age: 58.4 ± 11.0, BMI: 22.5 ± 3.3). Three self-assessment questionnaires were administered: 1) "25-question Geriatric Locomotive Function Scale" (GFLS-25) for evaluating Loc-S (GLFS-25 ≥ 16 defined as Loc-S); 2) "diagnostic support tool for LSS" (LSS-DST) for evaluating the prevalence of lumbar spinal stenosis (LSS); 3) Knee injury and Osteoarthritis Outcome Score (KOOS). Plain radiographs of the bilateral knees and lumbar spine were evaluated, and the severity of lumbar spondylosis (LS) and knee osteoarthritis (KOA) defined by Kellgren-Lawrence grade. Bone status was evaluated by using the osteo-sono assessment index (OSI) at the calcaneus. Isometric muscle strength of trunk and leg (Nm/kg, both extension and flexion) were evaluated. Linear regression analysis was performed to elucidate the factors concerned with GFLS-25 including age, sex, and BMI. RESULTS Thirty-nine subjects (6.0%, 13 males, 26 females) were defined as having Loc-S. Single regression model showed that age, height, BMI, skeletal muscle mass, OSI, LSS, KOOS, the severity of LS and KOA, and trunk- and leg-muscle strength were correlated with the degree of GLFS-25. Stepwise multiple regression model showed that sex, height, LSS, KOOS, the severity of LS, and back muscle strength were significantly correlated with that of GLFS-25. CONCLUSION In this cross-sectional study, pain status associated with LSS and knee joint, structural severity for LS, and back muscle strength primarily affected the degree of GFLS-25. For managing Loc-S, we must pay more intensive attention to these factors.
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Affiliation(s)
- Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Eiichi Tsuda
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Atsushi Nawata
- Medical Engineering Laboratory, Alcare Co., Ltd, Kyojima, Sumida-ku, Tokyo, Japan
| | - Sho Nakagomi
- Medical Engineering Laboratory, Alcare Co., Ltd, Kyojima, Sumida-ku, Tokyo, Japan
| | - Ippei Takahashi
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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92
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A Narrative Review of Intra-articular Zygapophysial Steroid Injections for Lumbar Zygapophysial-Mediated Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0117-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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93
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Abstract
The spine has several important functions including load transmission, permission of limited motion, and protection of the spinal cord. The vertebrae form functional spinal units, which represent the smallest segment that has characteristics of the entire spinal column. Discs and paired facet joints within each functional unit form a three-joint complex between which loads are transmitted. Surrounding the spinal motion segment are ligaments, composed of elastin and collagen, and joint capsules which restrict motion to within normal limits. Ligaments have variable strengths and act via different lever arm lengths to contribute to spinal stability. As a consequence of the longer moment arm from the spinous process to the instantaneous axis of rotation, inherently weaker ligaments (interspinous and supraspinous) are able to provide resistance to excessive flexion. Degenerative processes of the spine are a normal result of aging and occur on a spectrum. During the second decade of life, the intervertebral disc demonstrates histologic evidence of nucleus pulposus degradation caused by reduced end plate blood supply. As disc height decreases, the functional unit is capable of an increased range of axial rotation which subjects the posterior facet capsules to greater mechanical loads. A concurrent change in load transmission across the end plates and translation of the instantaneous axis of rotation further increase the degenerative processes at adjacent structures. The behavior of the functional unit is impacted by these processes and is reflected by changes in the stress-strain relationship. Back pain and other clinical symptoms may occur as a result of the biomechanical alterations of degeneration.
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94
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Zhou X, Liu Y, Zhou S, Fu XX, Yu XL, Fu CL, Zhang B, Dai M. The correlation between radiographic and pathologic grading of lumbar facet joint degeneration. BMC Med Imaging 2016; 16:27. [PMID: 27025987 PMCID: PMC4812623 DOI: 10.1186/s12880-016-0129-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 03/21/2016] [Indexed: 11/25/2022] Open
Abstract
Background Before performing spine non-fusion surgery that retains the facet joints, choosing an accurate radiographic method to evaluate the degree of facet joint degeneration is extremely important. Therefore, the objective of this study was to determine the accuracy and reliability of different radiographic classifications by analyzing the correlation between radiographic and pathologic grading of lumbar facet joint degeneration. Taking the pathologic examination as standard, the consistency of computed tomography (CT) and magnetic resonance imaging (MRI) assessment of lumbar facet joint degeneration was compared. Methods A total of 74 facet joints obtained from 42 patients who underwent posterior lumbar surgery were evaluated. All patients underwent CT and MRI before surgery. The pathologic grade was evaluated with a method based on hematoxylin-eosin and toluidine blue staining. The radiographic grade was evaluated using the methods proposed by different authors. Results There was a moderate consistency between pathologic and radiographic grading for facet joint degeneration. The weighted kappa coefficients comparing pathologic with radiographic grading were 0.506 for CT, 0.561 for MRI, and 0.592 for CT combined with MRI, respectively. Taking the pathologic examination as standard, the consistency of CT and MRI examination was also moderate, and the weighted kappa coefficient was 0.459. Conclusion The radiographic examination has moderate accuracy and reliability for evaluating degeneration of facet joints. Therefore, a more accurate method for evaluating the degeneration of facet joints is necessary before performing spine non-fusion surgery that retains the facet joints. Electronic supplementary material The online version of this article (doi:10.1186/s12880-016-0129-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xin Zhou
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.,Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, China
| | - Yuan Liu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.,Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, China
| | - Song Zhou
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.,Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, China
| | - Xiao-Xing Fu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.,Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, China
| | - Xiao-Long Yu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.,Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, China
| | - Chang-Lin Fu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.,Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, China
| | - Bin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China. .,Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, China.
| | - Min Dai
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China. .,Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, China.
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95
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Snider KT, Johnson JC, Degenhardt BF, Snider EJ, Burton DC. Association of low back pain, somatic dysfunction, and lumbar bone mineral density: reproducibility of findings. J Osteopath Med 2016; 114:356-67. [PMID: 24778000 DOI: 10.7556/jaoa.2014.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Somatic dysfunction as diagnosed by palpation should be associated with an objective measure. Bone mineral density (BMD) has been shown to be elevated in lumbar vertebrae with somatic dysfunction and in the lumbar region of individuals with chronic low back pain (LBP). OBJECTIVE To investigate the association of lumbar somatic dysfunction and BMD T-score variability in participants with chronic LBP and without LBP (non-LBP) and to determine the reproducibility of previously published results. METHODS Two examiners, blinded to symptom history, evaluated participants for tissue texture abnormalities, rotational asymmetry, anterior motion restriction, and tenderness at vertebral levels L1 to L4. Participants also underwent dual-energy x-ray absorptiometry of vertebral levels L1 to L4 for the assessment of BMD T scores. Generalized linear models were used to compare the chronic LBP and non-LBP groups on the presence and severity of somatic dysfunction and to test whether group and the presence and severity of somatic dysfunction were related to BMD T scores. RESULTS Forty-three chronic LBP (54%) and 36 non-LBP participants (46%) completed the study. Although the presence of somatic dysfunction in the 2 groups was not significantly different, the presence of tenderness was significantly more common in the chronic LBP group (P<.001), as was the severity for tissue texture abnormalities (P=.03), motion restriction (P=.04), and tenderness (P<.001). Of the 316 vertebrae assessed, 31 (10%, all in the chronic LBP group) had moderate/severe tenderness. The vertebral somatic dysfunction burden score, the total somatic dysfunction burden score, the vertebral somatic dysfunction severity score, and the total somatic dysfunction severity score were higher in the chronic LBP group (all P<.001). The vertebral BMD T score was significantly higher for vertebrae demonstrating moderate/severe rotational asymmetry compared with those demonstrating mild or no rotational asymmetry (P=.01) and for vertebrae demonstrating moderate/severe tenderness compared with those demonstrating no tenderness (P=.04). CONCLUSION Study results suggest that somatic dysfunction was more significant in chronic LBP participants. Although the correlation between the presence of somatic dysfunction and segmental BMD T scores was not reproduced, BMD T scores were higher for vertebrae demonstrating moderate/severe rotational asymmetry and tenderness.
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Affiliation(s)
- Karen T Snider
- Department of Osteopathic Manipulative Medicine, A.T. Still University-Kirksville College of Osteopathic Medicine, 800 W Jefferson St, Kirksville, MO 63501-1443.
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Sae-Jung S, Jirarattanaphochai K. Outcomes of lumbar facet syndrome treated with oral diclofenac or methylprednisolone facet injection: a randomized trial. INTERNATIONAL ORTHOPAEDICS 2016; 40:1091-8. [DOI: 10.1007/s00264-016-3154-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/06/2016] [Indexed: 10/22/2022]
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97
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Omar EA, Pimentel DC, Amadera JED. Spinal Pathology. PATHOLOGY AND INTERVENTION IN MUSCULOSKELETAL REHABILITATION 2016:561-583. [DOI: 10.1016/b978-0-323-31072-7.00015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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98
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Lumbar juxta-facet joint cysts in association with facet joint orientation, -tropism and -arthritis: A case–control study. Clin Neurol Neurosurg 2015; 139:278-81. [DOI: 10.1016/j.clineuro.2015.10.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/26/2015] [Accepted: 10/22/2015] [Indexed: 11/19/2022]
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99
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Kim JS, Ali MH, Wydra F, Li X, Hamilton JL, An HS, Cs-Szabo G, Andrews S, Moric M, Xiao G, Wang JHC, Chen D, Cavanaugh JM, Im HJ. Characterization of degenerative human facet joints and facet joint capsular tissues. Osteoarthritis Cartilage 2015; 23:2242-2251. [PMID: 26117175 PMCID: PMC4663154 DOI: 10.1016/j.joca.2015.06.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 05/27/2015] [Accepted: 06/09/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Lumbar facet joint degeneration (FJD) may be an important cause of low back pain (LBP) and sciatica. The goal of this study was to characterize cellular alterations of inflammatory factor expression and neovascularization in human degenerative facet joint capsular (FJC) tissue. These alterations in FJC tissues in pain stimulation were also assessed. DESIGN FJs were obtained from consented patients undergoing spinal reconstruction surgery and cadaveric donors with no history of back pain. Histological analyses of the FJs were performed. Cytokine antibody array and quantitative real-time polymerase chain reaction (qPCR) were used to determine the production of inflammatory cytokines, and western blotting analyses (WB) were used to assay for cartilage-degrading enzymes and pain mediators. Ex vivo rat dorsal root ganglion (DRG) co-culture with human FJC tissues was also performed. RESULTS Increased neovascularization, inflammatory cell infiltration, and pain-related axonal-promoting factors were observed in degenerative FJCs surgically obtained from symptomatic subjects. Increased VEGF, (NGF/TrkA), and sensory neuronal distribution were also detected in degenerative FJC tissues from subjects with LBP. qPCR and WB results demonstrated highly upregulated inflammatory cytokines, pain mediators, and cartilage-degrading enzymes in degenerative FJCs. Results from ex vivo co-culture of the DRG and FJC tissue demonstrated that degenerative FJCs increased the expression of inflammatory pain molecules in the sensory neurons. CONCLUSION Degenerative FJCs possess greatly increased inflammatory and angiogenic features, suggesting that these factors play an important role in the progression of FJD and serve as a link between joint degeneration and neurological stimulation of afferent pain fibers.
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Affiliation(s)
- Jae-Sung Kim
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA,The Division of Natural Medical Sciences, College of Health Science, Chosun University, Gwangju, 501-759, Republic of Korea
| | - Mir H. Ali
- Department of Orthopedic Surgery, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - Frank Wydra
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - Xin Li
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - John L. Hamilton
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - Howard S. An
- Department of Orthopedic Surgery, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - Gabriella Cs-Szabo
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA,Department of Orthopedic Surgery, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | | | - Mario Moric
- Department of Anesthesiology, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - Guozhi Xiao
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA,Department of Biology and Shenzhen Key Laboratory of Cell Microenvironment, South University of Science and Technology of China, Shenzhen, 518055, China
| | - James H-C Wang
- MechanoBiology Laboratory Departments of Orthopaedic Surgery, Bioengineering, and Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Di Chen
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - John M. Cavanaugh
- Bioengineering Center, Wayne State University, Detroit, MI 48202, USA
| | - Hee-Jeong Im
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA,Department of Orthopedic Surgery, Rush University at Rush University Medical Center, Chicago, IL 60612, USA,Department of Internal Medicine, Section of Rheumatology, Rush University at Rush University Medical Center, Chicago, IL 60612, USA,Department of Bioengineering, University of Illinois, Chicago, IL 60612, USA,Jesse Brown Veterans Affair, Chicago IL 60612, USA,Address correspondence to: Dr. Hee-Jeong Im Sampen, Rush University Medical Center, Cohn Research BD 516, 1735 W. Harrison St., Chicago, IL 60612, Tel: 312-942-3091, Fax: 312-942-3053,
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100
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Abstract
Lumbar zygapophyseal joints act as primary pain generators in at least 10-15% of patients with chronic low back pain.Diagnostic nerve blocks are the most reliable way to diagnose lumbar zygapophyseal joint pain.IASP recommends either controlled or comparative blocks for diagnosis of zygapophyseal joint pain as there is a significant incidence of false positives with single blocks.Management should be multimodal comprising education, exercises, analgesics and procedural interventions to achieve functional restoration.There is a need for further RCTs with standardised diagnostic criteria and outcome measures as well as long-term data to determine the efficacy of radiofrequency denervation.
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Affiliation(s)
- K Saravanakumar
- Consultants in Anaesthesia and Pain Medicine, Department of Anaesthesia, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, United Kingdom
| | - A Harvey
- Consultants in Anaesthesia and Pain Medicine, Department of Anaesthesia, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, United Kingdom
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