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Tang M, Wang S, Wang Y, Zeng F, Chen M, Chang X, He M, Fang Q, Yin S. Nomogram Development and Validation for Predicting Postoperative Recurrent Lumbar Disc Herniation Based on Paraspinal Muscle Parameters. J Pain Res 2024; 17:2121-2131. [PMID: 38894861 PMCID: PMC11185253 DOI: 10.2147/jpr.s459846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/09/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose Previous studies highlight paraspinal muscles' significance in spinal stability. This study aims to assess paraspinal muscle predictiveness for postoperative recurrent lumbar disc herniation (PRLDH) after lumbar disc herniation patients undergo percutaneous endoscopic transforaminal discectomy (PETD). Patients and Methods Retrospectively collected data from 232 patients undergoing PETD treatment at our institution between January 2020 and January 2023, randomly allocated into training (60%) and validation (40%) groups. Utilizing Lasso regression and multivariable logistic regression, independent risk factors were identified in the training set to construct a Nomogram model. Internal validation employed Enhanced Bootstrap, with Area Under the ROC Curve (AUC) assessing accuracy. Calibration was evaluated through calibration curves and the Hosmer-Lemeshow goodness-of-fit test. Decision curve analysis (DCA) and clinical impact curve (CIC) were employed for clinical utility analysis. Results Diabetes, Modic changes, and ipsilesional multifidus muscle skeletal muscle index (SMI) were independent predictive factors for PRLDH following PETD (P<0.05). Developed Nomogram model based on selected predictors, uploaded to a web page. AUC for training: 0.921 (95% CI 0.872-0.970), validation: 0.900 (95% CI 0.828-0.972), respectively. The Hosmer-Lemeshow test yielded χ 2=5.638/6.259, P=0.688/0.618, and calibration curves exhibited good fit between observed and predicted values. DCA and CIC demonstrate clinical net benefit for both models at risk thresholds of 0.02-1.00 and 0.02-0.80. Conclusion The Nomogram predictive model developed based on paraspinal muscle parameters in this study demonstrates excellent predictive capability and aids in personalized risk assessment for PRLDH following PETD.
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Affiliation(s)
- Ming Tang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
- The Fifth Clinical College of Medicine, Anhui Medical University, Hefei City, Anhui Province, People’s Republic of China
| | - Siyuan Wang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
- The Fifth Clinical College of Medicine, Anhui Medical University, Hefei City, Anhui Province, People’s Republic of China
| | - Yiwen Wang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| | - Fanyi Zeng
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| | - Mianpeng Chen
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| | - Xindong Chang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| | - Mingfei He
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| | - Qingqing Fang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| | - Shiwu Yin
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
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Pojskic M, Bisson E, Oertel J, Takami T, Zygourakis C, Costa F. Lumbar disc herniation: Epidemiology, clinical and radiologic diagnosis WFNS spine committee recommendations. World Neurosurg X 2024; 22:100279. [PMID: 38440379 PMCID: PMC10911853 DOI: 10.1016/j.wnsx.2024.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
Objective To formulate the most current, evidence-based recommendations regarding the epidemiology, clinical diagnosis, and radiographic diagnosis of lumbar herniated disk (LDH). Methods A systematic literature search in PubMed, MEDLINE, and CENTRAL was performed from 2012 to 2022 using the search terms "herniated lumbar disc", "epidemiology", "prevention" "clinical diagnosis", and "radiological diagnosis". Screening criteria resulted in 17, 16, and 90 studies respectively that were analyzed regarding epidemiology, clinical diagnosis, and radiographic diagnosis of LDH. Using the Delphi method and two rounds of voting at two separate international meetings, ten members of the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated eleven final consensus statements. Results The lifetime risk for symptomatic LDH is 1-3%; of these, 60-90% resolve spontaneously. Risk factors for LDH include genetic and environmental factors, strenuous activity, and smoking. LDH is more common in males and in 30-50 year olds. A set of clinical tests, including manual muscle testing, sensory testing, Lasegue sign, and crossed Lasegue sign are recommended to diagnose LDH. Magnetic resonance imaging (MRI) is the gold standard for confirming suspected LDH. Conclusions These eleven final consensus statements provide current, evidence-based guidelines on the epidemiology, clinical diagnosis, and radiographic diagnosis of LDH for practicing spine surgeons worldwide.
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Affiliation(s)
- Mirza Pojskic
- Department of Neurosurgery, University of Marburg, Germany
| | - Erica Bisson
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Centre, Homburg, Saarland, Germany
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Japan
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
| | - Francesco Costa
- Spine Surgery Unit (NCH4) - Department of Neurosurgery - Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Pesesse P, Vanderthommen M, Durieux N, Zubkov M, Demoulin C. Clinical Value and Reliability of Quantitative Assessments of Lumbosacral Nerve Root Using Diffusion Tensor and Diffusion Weighted MR Imaging: A Systematic Review. J Magn Reson Imaging 2024. [PMID: 38190195 DOI: 10.1002/jmri.29213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Lumbosacral radicular pain diagnosis remains challenging. Diffusion tensor imaging (DTI) and diffusion weighted imaging (DWI) have potential to quantitatively evaluate symptomatic nerve root, which may facilitate diagnosis. PURPOSE To determine the ability of DTI and DWI metrics, namely fractional anisotropy (FA) and apparent diffusion coefficient (ADC), to discriminate between healthy and symptomatic lumbosacral nerve roots, to evaluate the association between FA and ADC values and patient symptoms, and to determine FA and ADC reliability. STUDY TYPE Systematic review. SUBJECTS Eight hundred twelve patients with radicular pain with or without radiculopathy caused by musculoskeletal-related compression or inflammation of a single, unilateral lumbosacral nerve root and 244 healthy controls from 29 studies. FIELD STRENGTH/SEQUENCE Diffusion weighted echo planar imaging sequence at 1.5 T or 3 T. ASSESSMENT An extensive systematic review of the literature was conducted in Embase, Scopus, and Medline databases. FA and ADC values in symptomatic and contralateral lumbosacral nerve roots were extracted and summarized, together with intra- and inter-rater agreements. Where available, associations between DWI or DTI parameters and patient symptoms or symptom duration were extracted. STATISTICAL TESTS The main results of the included studies are summarized. No additional statistical analyses were performed. RESULTS The DTI studies systematically found significant differences in FA values between the symptomatic and contralateral lumbosacral nerve root of patients suffering from radicular pain with or without radiculopathy. In contrast, identification of the symptomatic nerve root with ADC values was inconsistent for both DTI and DWI studies. FA values were moderately to strongly correlated with several symptoms (eg, disability, nerve dysfunction, and symptom duration). The inter- and intra-rater reliability of DTI parameters were moderate to excellent. The methodological quality of included studies was very heterogeneous. DATA CONCLUSION This systematic review showed that DTI was a reliable and discriminative imaging technique for the assessment of symptomatic lumbosacral nerve root, which more consistently identified the symptomatic nerve root than DWI. Further studies of high quality are needed to confirm these results. EVIDENCE LEVEL N/A TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Pierre Pesesse
- Department of Sport and Rehabilitation Sciences, University of Liege, Liège, Belgium
| | - Marc Vanderthommen
- Department of Sport and Rehabilitation Sciences, University of Liege, Liège, Belgium
| | - Nancy Durieux
- Research Unit for a Life-Course Perspective on Health & Education - RUCHE, Faculty of Psychology, Speech and Language Therapy, and Educational Sciences, University of Liege, Liège, Belgium
| | - Mikhail Zubkov
- GIGA-Research - Cyclotron Research Centre-In Vivo Imaging Unit, University of Liege, Liège, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liege, Liège, Belgium
- Spine Center of the Liege University Hospital (CHU), Liège, Belgium
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Lin PC, Chang WS, Hsiao KY, Liu HM, Shia BC, Chen MC, Hsieh PY, Lai TW, Lin FH, Chang CC. Development of a Machine Learning Algorithm to Correlate Lumbar Disc Height on X-rays with Disc Bulging or Herniation. Diagnostics (Basel) 2024; 14:134. [PMID: 38248010 PMCID: PMC10814412 DOI: 10.3390/diagnostics14020134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Lumbar disc bulging or herniation (LDBH) is one of the major causes of spinal stenosis and related nerve compression, and its severity is the major determinant for spine surgery. MRI of the spine is the most important diagnostic tool for evaluating the need for surgical intervention in patients with LDBH. However, MRI utilization is limited by its low accessibility. Spinal X-rays can rapidly provide information on the bony structure of the patient. Our study aimed to identify the factors associated with LDBH, including disc height, and establish a clinical diagnostic tool to support its diagnosis based on lumbar X-ray findings. In this study, a total of 458 patients were used for analysis and 13 clinical and imaging variables were collected. Five machine-learning (ML) methods, including LASSO regression, MARS, decision tree, random forest, and extreme gradient boosting, were applied and integrated to identify important variables for predicting LDBH from lumbar spine X-rays. The results showed L4-5 posterior disc height, age, and L1-2 anterior disc height to be the top predictors, and a decision tree algorithm was constructed to support clinical decision-making. Our study highlights the potential of ML-based decision tools for surgeons and emphasizes the importance of L1-2 disc height in relation to LDBH. Future research will expand on these findings to develop a more comprehensive decision-supporting model.
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Affiliation(s)
- Pao-Chun Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei City 10617, Taiwan; (P.-C.L.); (F.-H.L.)
- Department of Neurosurgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 24352, Taiwan
| | - Wei-Shan Chang
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 24352, Taiwan; (W.-S.C.); (K.-Y.H.); (B.-C.S.); (M.-C.C.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 24352, Taiwan
| | - Kai-Yuan Hsiao
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 24352, Taiwan; (W.-S.C.); (K.-Y.H.); (B.-C.S.); (M.-C.C.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 24352, Taiwan
| | - Hon-Man Liu
- Department of Radiology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 24352, Taiwan;
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 24352, Taiwan; (W.-S.C.); (K.-Y.H.); (B.-C.S.); (M.-C.C.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 24352, Taiwan
| | - Ming-Chih Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 24352, Taiwan; (W.-S.C.); (K.-Y.H.); (B.-C.S.); (M.-C.C.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 24352, Taiwan
| | - Po-Yu Hsieh
- Industrial Technology Research Institute (ITRI), Hsinchu City 310401, Taiwan; (P.-Y.H.); (T.-W.L.)
| | - Tseng-Wei Lai
- Industrial Technology Research Institute (ITRI), Hsinchu City 310401, Taiwan; (P.-Y.H.); (T.-W.L.)
| | - Feng-Huei Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei City 10617, Taiwan; (P.-C.L.); (F.-H.L.)
| | - Che-Cheng Chang
- Department of Neurology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 24352, Taiwan
- PhD Program in Nutrition and Food Science, Fu Jen Catholic University, New Taipei City 24352, Taiwan
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Patriat Q, Prigent FV, Aho S, Lenfant M, Ramon A, Loffroy R, Lambert A, Ornetti P. Diagnostic Value of an Additional Sequence (Large-Field Coronal Stir) in a Routine Lumbar Spine MR Imaging Protocol to Investigate Lumbar Radiculopathy. J Clin Med 2023; 12:6250. [PMID: 37834894 PMCID: PMC10573339 DOI: 10.3390/jcm12196250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE Lumbar radiculopathy mainly originates in the spine (lumbar disc herniation or spine osteoarthritis) but can sometimes be explained by extra-spinal nerve compression or confused with referred pain mimicking radiculopathy. Our main objective was to demonstrate the clinical benefit of the large-field coronal STIR (coroSTIR) sequence in the etiological assessment of lumbar radiculopathy with a duration of more than six weeks. MATERIALS AND METHODS Six hundred consecutive lumbar MRI scans performed using the same protocol were retrospectively reviewed. Two musculoskeletal radiologists independently assessed the coroSTIR sequence for the presence of extra-spinal anomalies (ESA) that could explain or contribute to the lumbar radiculopathy. The presence of an ESA was then correlated with sex, age, topography and lateralization of radiculopathy, history of vertebral surgery, as well as the presence of a spinal cause explaining the symptoms. Extra-spinal incidentalomas (ESI) with potential clinical impact visible only on the coroSTIR sequence were also systematically reported. RESULTS An extra-spinal cause was detected on the coroSTIR sequence in 68 cases (11.3%), mainly gluteal tendinobursitis (30.9%), congestive hip osteoarthritis (25%), degenerative sacroiliac arthropathy (14.7%), or inflammatory sacroilitis (7.3%). Their prevalence was significantly correlated in multivariate regression with age (58 years vs. 53 years, p = 0.01), but not with the type of radiating pain (sciatica or cruralgia). The presence of ESI was also frequent (70 cases, 11.7%), including some potentially severe diagnoses (38% of tumor or pseudo-tumor mass requiring further assessment or monitoring). CONCLUSIONS Considering its acceptable acquisition time, the detection of a significant number of potentially symptom-related extra-spinal anomalies, and the discovery of a non-negligible number of extra-spinal incidentalomas with potential clinical impact, the coronal STIR should be performed systematically in routine MRI for lumbar radiculopathy.
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Affiliation(s)
- Quentin Patriat
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 21079 Dijon, France; (Q.P.); (F.-V.P.); (R.L.)
| | - François-Victor Prigent
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 21079 Dijon, France; (Q.P.); (F.-V.P.); (R.L.)
| | - Serge Aho
- Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, 21079 Dijon, France;
| | - Marc Lenfant
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 21079 Dijon, France;
| | - André Ramon
- Department of Rheumatology, François-Mitterrand University Hospital, 21079 Dijon, France;
- INSERM, EFS Bourgogne Franche-Comté, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21079 Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 21079 Dijon, France; (Q.P.); (F.-V.P.); (R.L.)
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 9 Avenue Alain Savary, 21079 Dijon, France
| | - Aurelien Lambert
- Department of Radiology, IM2P, Clinique Valmy, 21079 Dijon, France;
| | - Paul Ornetti
- Department of Rheumatology, François-Mitterrand University Hospital, 21079 Dijon, France;
- INSERM UMR1093-CAPS, Bourgogne Franche-Comté University, UFR STAPS, 21079 Dijon, France
- INSERM, Bourgogne Franche-Comté University, CIC 1432, Module Plurithématique, Plateforme d’Investigation Technologique, François-Mitterrand University Hospital, 21079 Dijon, France
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Nader F, Bassil GF, Ali Sleiman M, Nicolas N. Case Report and Literature Review: Lumbar Disc Extrusion Misdiagnosed as an Epidural Hematoma. Cureus 2023; 15:e43115. [PMID: 37692663 PMCID: PMC10484154 DOI: 10.7759/cureus.43115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Accurate differentiation between epidural hematomas and lumbar disc extrusion is essential due to the potential overlap in clinical presentations. We present a case report highlighting a significant challenge in which a massive lumbar disc extrusion was mistaken for an epidural hematoma. This is a case report of a 38-year-old male patient who developed cauda equina syndrome four days after experiencing an audible cracking in the lower back during weightlifting activity. Magnetic resonance imaging (MRI) was inconclusive, unable to distinguish between an extruded nucleus pulposus and a spinal epidural hematoma. Subsequently, an urgent operation revealed a large herniated disc at the L4-L5 level, ruling out any hematoma. The patient's post-operative follow-up showed significant improvement, with almost complete recovery of motor and sensory functions. This case emphasizes the challenges faced when distinguishing between epidural hematomas and lumbar disc herniations, particularly on MRI. The lumbar disc herniation's substantial size, cranial and caudal migration on multiple levels, and signal intensity contributed to the misdiagnosis, underscoring the importance of careful interpretation and awareness of such complexities.
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Affiliation(s)
- Fadi Nader
- Orthopedics and Trauma, Université Paris Cité, Paris, FRA
- Orthopedics and Traumatology, Lebanese University Faculty of Medicine, Beirut, LBN
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien, Meaux, FRA
| | - Georges F Bassil
- Orthopedics and Traumatology, Lebanese University Faculty of Medicine, Beirut, LBN
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien, Meaux, FRA
| | - Mohamad Ali Sleiman
- Orthopedics and Traumatology, Lebanese University Faculty of Medicine, Beirut, LBN
| | - Nicolas Nicolas
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien, Meaux, FRA
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Geere JH, Swamy GN, Hunter PR, Geere JAL, Lutchman LN, Cook AJ, Rai AS. Incidence and risk factors for five-year recurrent disc herniation after primary single-level lumbar discectomy. Bone Joint J 2023; 105-B:315-322. [PMID: 36854329 DOI: 10.1302/0301-620x.105b3.bjj-2022-1005.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation. A retrospective study was conducted using prospectively collected data and patient-reported outcome measures, including the Oswestry Disability Index (ODI), between 2008 and 2019. Postoperative sRDH was identified from clinical notes and the centre's MRI database, with all imaging providers in the region checked for missing events. The Kaplan-Meier method was used to calculate five-year sRDH incidence. Cox proportional hazards model was used to identify independent variables predictive of sRDH, with any variable not significant at the p < 0.1 level removed. Hazard ratios (HRs) were calculated with 95% confidence intervals (CIs). Complete baseline data capture was available for 733 of 754 (97.2%) consecutive patients. Median follow-up time for censored patients was 2.2 years (interquartile range (IQR) 1.0 to 5.0). sRDH occurred in 63 patients at a median 0.8 years (IQR 0.5 to 1.7) after surgery. The five-year Kaplan-Meier estimate for sRDH was 12.1% (95% CI 9.5 to 15.4), sRDH reoperation was 7.5% (95% CI 5.5 to 10.2), and any-procedure reoperation was 14.1% (95% CI 11.1 to 17.5). Current smoker (HR 2.12 (95% CI 1.26 to 3.56)) and higher preoperative ODI (HR 1.02 (95% CI 1.00 to 1.03)) were independent risk factors associated with sRDH. Current smoker (HR 2.15 (95% CI 1.12 to 4.09)) was an independent risk factor for sRDH reoperation. This is one of the largest series to date which has identified current smoker and higher preoperative disability as independent risk factors for sRDH. Current smoker was an independent risk factor for sRDH reoperation. These findings are important for spinal surgeons and rehabilitation specialists in risk assessment, consenting patients, and perioperative management.
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Affiliation(s)
| | | | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jo-Anne L Geere
- School of Health Sciences, University of East Anglia, Norwich, UK
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Daniel ES, Lee RYW, Williams JM. The reliability of video fluoroscopy, ultrasound imaging, magnetic resonance imaging and radiography for measurements of lumbar spine segmental range of motion in-vivo: A review. J Back Musculoskelet Rehabil 2023; 36:117-135. [PMID: 35988213 DOI: 10.3233/bmr-210285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lower back pain (LBP) is a principal cause of disability worldwide and is associated with a variety of spinal conditions. Individuals presenting with LBP may display changes in spinal motion. Despite this, the ability to measure lumbar segmental range of motion (ROM) non-invasively remains a challenge. OBJECTIVE To review the reliability of four non-invasive modalities: Video Fluoroscopy (VF), Ultrasound imaging (US), Magnetic Resonance Imaging (MRI) and Radiography used for measuring segmental ROM in the lumbar spine in-vivo. METHODS The methodological quality of seventeen eligible studies, identified through a systematic literature search, were appraised. RESULTS The intra-rater reliability for VF is excellent in recumbent and upright positions but errors are larger for intra-rater repeated movements and inter-rater reliability shows larger variation. Excellent results for intra- and inter-rater reliability are seen in US studies and there is good reliability within- and between-day. There is a large degree of heterogeneity in MRI and radiography methodologies but reliable results are seen. CONCLUSIONS Excellent reliability is seen across all modalities. However, VF and radiography are limited by radiation exposure and MRI is expensive. US offers a non-invasive, risk free method but further research must determine whether it yields truly consistent measurements.
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Affiliation(s)
| | - Raymond Y W Lee
- Faculty of Technology, University of Portsmouth, Portsmouth, UK
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Huang Z, Zhao P, Zhang C, Wu J, Liu R. Value of imaging examinations in diagnosing lumbar disc herniation: A systematic review and meta-analysis. Front Surg 2023; 9:1020766. [PMID: 36704505 PMCID: PMC9872518 DOI: 10.3389/fsurg.2022.1020766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/07/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose To systematically review the clinical value of three imaging examinations (Magnetic Resonance Imaging, Computed Tomography, and myelography) in the diagnosis of Lumbar Disc Herniation. Methods Databases including PubMed, Embase, The Cochrane Library, Web of Science, CBM, CNKI, WanFang Data, and VIP were electronically searched to collect relevant studies on three imaging examinations in the diagnosis of Lumbar Disc Herniation from inception to July 1, 2021. Two reviewers using the Quality Assessment of Diagnostic Accuracy Studies-2 tool independently screened the literature, extracted the data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Meta-DiSc 1.4 software and Stata 15.0 software. Results A total of 38 studies from 19 articles were included, involving 1,875 patients. The results showed that the pooled Sensitivity, pooled Specificity, pooled Positive Likelihood Ratio, pooled Negative Likelihood Ratio, pooled Diagnostic Odds Ratio, Area Under the Curve of Summary Receiver Operating Characteristic, and Q* were 0.89 (95%CI: 0.87-0.91), 0.83 (95%CI: 0.78-0.87), 4.57 (95%CI: 2.95-7.08), 0.14 (95%CI: 0.09-0.22), 39.80 (95%CI: 18.35-86.32), 0.934, and 0.870, respectively, for Magnetic Resonance Imaging. The pooled Sensitivity, pooled Specificity, pooled Positive Likelihood Ratio, pooled Negative Likelihood Ratio, pooled Diagnostic Odds Ratio, Area Under the Curve of Summary Receiver Operating Characteristic, and Q* were 0.82 (95%CI: 0.79-0.85), 0.78 (95%CI: 0.73-0.82), 3.54 (95%CI: 2.86-4.39), 0.19 (95%CI: 0.12-0.30), 20.47 (95%CI: 10.31-40.65), 0.835, and 0.792, respectively, for Computed Tomography. The pooled Sensitivity, pooled Specificity, pooled Positive Likelihood Ratio, pooled Negative Likelihood Ratio, pooled Diagnostic Odds Ratio, Area Under the Curve of Summary Receiver Operating Characteristic, and Q* were 0.79 (95%CI: 0.75-0.82), 0.75 (95%CI: 0.70-0.80), 2.94 (95%CI: 2.43-3.56), 0.29 (95%CI: 0.21-0.42), 9.59 (95%CI: 7.05-13.04), 0.834, and 0.767 respectively, for myelography. Conclusion Three imaging examinations had high diagnostic value. In addition, compared with myelography, Magnetic Resonance Imaging had a higher diagnostic value.
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Affiliation(s)
- Zhihao Huang
- School of Big Data and Fundamental Sciences, Shandong Institute of Petroleum and Chemical Technology, Dongying, China
| | - Pengfei Zhao
- Department of Clinical Pharmacy, Weifang People's Hospital, Weifang, China
| | - Chengming Zhang
- School of Intelligent Manufacturing and Control Engineering, Shandong Institute of Petroleum and Chemical Technology, Dongying, China
| | - Jingtao Wu
- School of Physical Education, Leshan Normal University, Leshan, China
| | - Ruidong Liu
- Sports Coaching College, Beijing Sport University, Beijing, China,Correspondence: Ruidong Liu
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Sollmann N, Bonnheim NB, Joseph GB, Chachad R, Zhou J, Akkaya Z, Pirmoazen AM, Bailey JF, Guo X, Lazar AA, Link TM, Fields AJ, Krug R. Paraspinal Muscle in Chronic Low Back Pain: Comparison Between Standard Parameters and Chemical Shift Encoding-Based Water-Fat MRI. J Magn Reson Imaging 2022; 56:1600-1608. [PMID: 35285561 PMCID: PMC9470775 DOI: 10.1002/jmri.28145] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Paraspinal musculature (PSM) is increasingly recognized as a contributor to low back pain (LBP), but with conventional MRI sequences, assessment is limited. Chemical shift encoding-based water-fat MRI (CSE-MRI) enables the measurement of PSM fat fraction (FF), which may assist investigations of chronic LBP. PURPOSE To investigate associations between PSM parameters from conventional MRI and CSE-MRI and between PSM parameters and pain. STUDY TYPE Prospective, cross-sectional. POPULATION Eighty-four adults with chronic LBP (44.6 ± 13.4 years; 48 males). FIELD STRENGTH/SEQUENCE 3-T, T1-weighted fast spin-echo and iterative decomposition of water and fat with echo asymmetry and least squares estimation sequences. ASSESSMENT T1-weighted images for Goutallier classification (GC), muscle volume, lumbar indentation value, and muscle-fat index, CSE-MRI for FF extraction (L1/2-L5/S1). Pain was self-reported using a visual analogue scale (VAS). Intra- and/or interreader agreement was assessed for MRI-derived parameters. STATISTICAL TESTS Mixed-effects and linear regression models to 1) assess relationships between PSM parameters (entire cohort and subgroup with GC grades 0 and 1; statistical significance α = 0.0025) and 2) evaluate associations of PSM parameters with pain (α = 0.05). Intraclass correlation coefficients (ICCs) for intra- and/or interreader agreement. RESULTS The FF showed excellent intra- and interreader agreement (ICC range: 0.97-0.99) and was significantly associated with GC at all spinal levels. Subgroup analysis suggested that early/subtle changes in PSM are detectable with FF but not with GC, given the absence of significant associations between FF and GC (P-value range: 0.036 at L5/S1 to 0.784 at L2/L3). Averaged over all spinal levels, FF and GC were significantly associated with VAS scores. DATA CONCLUSION In the absence of FF, GC may be the best surrogate for PSM quality. Given the ability of CSE-MRI to detect muscle alterations at early stages of PSM degeneration, this technique may have potential for further investigations of the role of PSM in chronic LBP. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Nico Sollmann
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Noah B. Bonnheim
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Gabby B. Joseph
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Ravi Chachad
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Jiamin Zhou
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Zehra Akkaya
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Amir M. Pirmoazen
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Jeannie F. Bailey
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Xiaojie Guo
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Ann A. Lazar
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Aaron J. Fields
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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11
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Back to the Future: A Report From the 16th International Forum for Back and Neck Pain Research in Primary Care and Updated Research Agenda. Spine (Phila Pa 1976) 2022; 47:E595-E605. [PMID: 35797529 DOI: 10.1097/brs.0000000000004408] [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: 02/07/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The 16th meeting of the International Forum for Back and Neck Pain Research in Primary Care was held in Québec City in July 2019 under the theme of innovation. This paper addresses the state of research in the field. OBJECTIVE To ascertain the evolution of knowledge and clinical application in back and neck pain and identify shifting research priorities. MATERIALS AND METHODS After a brief presentation of the Forum and its history, the current state of the field was depicted from the scientific program and the recordings of the plenary and parallel oral and poster communications of Forum XVI. Research agendas established in 1995 and 1997 were updated from a survey of a multidisciplinary group of experts in the field. A discussion of the progress made and challenges ahead follows. RESULTS While much progress has been made at improving knowledge at managing back pain in the past 25 years, most research priorities from earlier decades are still pertinent. The need for integration of physical and psychological interventions represents a key challenge, as is the need to better understand the biological mechanisms underlying back and neck pain to develop more effective interventions. Stemming the tide of back and neck pain in low and middle-income countries and avoiding the adoption of low-value interventions appear particularly important. The Lancet Low Back Pain Series initiative, arising from the previous fora, and thoughts on implementing best practices were extensively discussed, recognizing the challenges to evidence-based knowledge and practice given competing interests and incentives. CONCLUSION With the quantity and quality of research on back and neck pain increasing over the years, an update of research priorities helped to identify key issues in primary care.
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Using hierarchical unsupervised learning to integrate and reduce multi-level and multi-paraspinal muscle MRI data in relation to low back pain. 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 2022; 31:2046-2056. [PMID: 35333958 PMCID: PMC9338899 DOI: 10.1007/s00586-022-07169-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The paraspinal muscles (PSM) are a key feature potentially related to low back pain (LBP), and their structure and composition can be quantified using MRI. Most commonly, quantifying PSM measures across individual muscles and individual spinal levels renders numerous separate metrics that are analyzed in isolation. However, comprehensive multivariate approaches would be more appropriate for analyzing the PSM within an individual. To establish and test these methods, we hypothesized that multivariate summaries of PSM MRI measures would associate with the presence of LBP symptoms (i.e., pain intensity). METHODS We applied hierarchical multiple factor analysis (hMFA), an unsupervised integrative method, to clinical PSM MRI data from unique cohort datasets including a longitudinal cohort of astronauts with pre- and post-spaceflight data and a cohort of chronic LBP subjects and asymptomatic controls. Three specific use cases were investigated: (1) predicting longitudinal changes in pain using combinations of baseline PSM measures; (2) integrating baseline and post-spaceflight MRI to assess longitudinal change in PSM and how it relates to pain; and (3) integrating PSM quality and adjacent spinal pathology between LBP patients and controls. RESULTS Overall, we found distinct complex relationships with pain intensity between particular muscles and spinal levels. Subjects with high asymmetry between left and right lean muscle composition and differences between spinal segments PSM quality and structure are more likely to increase in pain reported outcome after prolonged time in microgravity. Moreover, changes in PSM quality and structure between pre and post-spaceflight relate to increase in pain after prolonged microgravity. Finally, we show how unsupervised hMFA recapitulates previous research on the association of CEP damage and LBP diagnostic. CONCLUSION Our analysis considers the spine as a multi-segmental unit as opposed to a series of discrete and isolated spine segments. Integrative and multivariate approaches can be used to distill large and complex imaging datasets thereby improving the clinical utility of MRI-based biomarkers, and providing metrics for further analytical goals, including phenotyping.
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13
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Kim GN, Zhang HY, Cho YE, Ryu SJ. Differential Screening of Herniated Lumbar Discs Based on Bag of Visual Words Image Classification Using Digital Infrared Thermographic Images. Healthcare (Basel) 2022; 10:healthcare10061094. [PMID: 35742145 PMCID: PMC9222567 DOI: 10.3390/healthcare10061094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/29/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Doctors in primary hospitals can obtain the impression of lumbosacral radiculopathy with a physical exam and need to acquire medical images, such as an expensive MRI, for diagnosis. Then, doctors will perform a foraminal root block to the target root for pain control. However, there was insufficient screening medical image examination for precise L5 and S1 lumbosacral radiculopathy, which is most prevalent in the clinical field. Therefore, to perform differential screening of L5 and S1 lumbosacral radiculopathy, the authors applied digital infrared thermographic images (DITI) to the machine learning (ML) algorithm, which is the bag of visual words method. DITI dataset included data from the healthy population and radiculopathy patients with herniated lumbar discs (HLDs) L4/5 and L5/S1. A total of 842 patients were enrolled and the dataset was split into a 7:3 ratio as the training algorithm and test dataset to evaluate model performance. The average accuracy was 0.72 and 0.67, the average precision was 0.71 and 0.77, the average recall was 0.69 and 0.74, and the F1 score was 0.70 and 0.75 for the training and test datasets. Application of the bag of visual words algorithm to DITI classification will aid in the differential screening of lumbosacral radiculopathy and increase the therapeutic effect of primary pain interventions with economical cost.
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Affiliation(s)
- Gi Nam Kim
- Department of Spinal Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (G.N.K.); (Y.E.C.)
| | - Ho Yeol Zhang
- Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Yonsei University College of Medicine, Goyang 10444, Korea;
| | - Yong Eun Cho
- Department of Spinal Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (G.N.K.); (Y.E.C.)
| | - Seung Jun Ryu
- Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Yonsei University College of Medicine, Goyang 10444, Korea;
- Correspondence: ; Tel.: +82-10-2367-9263
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14
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Development and Validation of Deep Learning-Based Algorithms for Predicting Lumbar Herniated Nucleus Pulposus Using Lumbar X-rays. J Pers Med 2022; 12:jpm12050767. [PMID: 35629187 PMCID: PMC9145973 DOI: 10.3390/jpm12050767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 02/05/2023] Open
Abstract
Lumbar herniated nucleus pulposus (HNP) is difficult to diagnose using lumbar radiography. HNP is typically diagnosed using magnetic resonance imaging (MRI). This study developed and validated an artificial intelligence model that predicts lumbar HNP using lumbar radiography. A total of 180,271 lumbar radiographs were obtained from 34,661 patients in the form of lumbar X-ray and MRI images, which were matched together and labeled accordingly. The data were divided into a training set (31,149 patients and 162,257 images) and a test set (3512 patients and 18,014 images). Training data were used for learning using the EfficientNet-B5 model and four-fold cross-validation. The area under the curve (AUC) of the receiver operating characteristic (ROC) for the prediction of lumbar HNP was 0.73. The AUC of the ROC for predicting lumbar HNP in L (lumbar) 1-2, L2-3, L3-4, L4-5, and L5-S (sacrum)1 levels were 0.68, 0.68, 0.63, 0.67, and 0.72, respectively. Finally, an HNP prediction model was developed, although it requires further improvements.
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15
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Khalil YA, Becherucci EA, Kirschke JS, Karampinos DC, Breeuwer M, Baum T, Sollmann N. Multi-scanner and multi-modal lumbar vertebral body and intervertebral disc segmentation database. Sci Data 2022; 9:97. [PMID: 35322028 PMCID: PMC8943029 DOI: 10.1038/s41597-022-01222-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 03/03/2022] [Indexed: 12/12/2022] Open
Abstract
Magnetic resonance imaging (MRI) is widely utilized for diagnosing and monitoring of spinal disorders. For a number of applications, particularly those related to quantitative MRI, an essential step towards achieving reliable and objective measurements is the segmentation of the examined structures. Performed manually, such process is time-consuming and prone to errors, posing a bottleneck to its clinical applicability. A more efficient analysis would be achieved by automating a segmentation process. However, routine spine MRI acquisitions pose several challenges for achieving robust and accurate segmentations, due to varying MRI acquisition characteristics occurring in data acquired from different sites. Moreover, heterogeneous annotated datasets, collected from multiple scanners with different pulse sequence protocols, are limited. Thus, we present a manually segmented lumbar spine MRI database containing a wide range of data obtained from multiple scanners and pulse sequences, with segmentations of lumbar vertebral bodies and intervertebral discs. The database is intended for the use in developing and testing of automated lumbar spine segmentation algorithms in multi-domain scenarios. Measurement(s) | Vertebral Body • Intervertebral Disc | Technology Type(s) | Magnetic Resonance Imaging |
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Affiliation(s)
- Yasmina Al Khalil
- Biomedical Engineering Department, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Edoardo A Becherucci
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marcel Breeuwer
- Biomedical Engineering Department, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. .,Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany. .,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
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16
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Divi SN, Makanji HS, Kepler CK, Anderson DG, Goyal DKC, Warner ED, Galetta MS, Hilibrand AS, Kaye ID, Kurd MF, Radcliff KE, Rihn JA, Woods BI, Vaccaro AR, Schroeder GD. Does the Size or Location of Lumbar Disc Herniation Predict the Need for Operative Treatment? Global Spine J 2022; 12:237-243. [PMID: 32935569 PMCID: PMC8907636 DOI: 10.1177/2192568220948519] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The goal of this study was to determine whether the absolute size (mm2), relative size (% canal compromise), or location of a single-level, lumbar disc herniation (LDH) on axial and sagittal cuts of magnetic resonance imaging (MRI) were predictive of eventual surgical intervention. METHODS MRIs of 89 patients were reviewed, and patients were split into groups based on type of management received (34 nonoperative vs 55 microdiscectomy). Radiographic characteristics-including size of disc herniation (mm2), size of spinal canal (mm2), location of herniation on axial (central, paracentral, foraminal) and sagittal (disc level, suprapedicle, pedicle, infrapedicle) planes, and type of herniation (bulge, protrusion, extrusion, sequestration)-were measured by 2 independent, orthopedic spine fellows and compared between groups via univariate and multivariate analyses. RESULTS The operative group showed a significantly higher percentage of canal compromise (39.5% vs 31.1%, P = .001) compared to the nonoperative group. Multiple logistic regression analysis showed higher odds of eventual operative intervention for a disc protrusion (odds ratio [OR] 6.30 [1.99, 19.86], P = .002) or disc extrusion (OR 11.5 [1.63, 81.2], P = .014) for Rater 1 and a higher odds of eventual surgical management for a paracentral location for both Rater 1 and Rater 2 (OR = 3.39 [1.25, 9.22], P = .017, and OR = 5.46 [1.77, 16.8], P = .003, respectively). CONCLUSIONS Disc herniations in a paracentral location were more likely to undergo operative treatment than those more centrally located, on axial MRI views.
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Affiliation(s)
- Srikanth N. Divi
- Rothman Institute, Thomas Jefferson
University, Philadelphia, PA, USA
| | - Heeren S. Makanji
- Rothman Institute, Thomas Jefferson
University, Philadelphia, PA, USA
| | | | - D. Greg Anderson
- Rothman Institute, Thomas Jefferson
University, Philadelphia, PA, USA
| | - Dhruv K. C. Goyal
- Rothman Institute, Thomas Jefferson
University, Philadelphia, PA, USA,Dhruv K. C. Goyal, Rothman Orthopaedic
Institute, Department of Orthopaedic Surgery, 925 Chestnut Street, 5th Floor,
Philadelphia, PA 19107, USA.
| | - Eric D. Warner
- Rothman Institute, Thomas Jefferson
University, Philadelphia, PA, USA
| | | | - Alan S. Hilibrand
- Rothman Institute, Thomas Jefferson
University, Philadelphia, PA, USA
| | - I. David Kaye
- Rothman Institute, Thomas Jefferson
University, Philadelphia, PA, USA
| | - Mark F. Kurd
- Rothman Institute, Thomas Jefferson
University, Philadelphia, PA, USA
| | | | - Jeffrey A. Rihn
- Rothman Institute, Thomas Jefferson
University, Philadelphia, PA, USA
| | - Barrett I. Woods
- Rothman Institute, Thomas Jefferson
University, Philadelphia, PA, USA
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Diagnostic accuracy of color-coded virtual noncalcium reconstructions derived from portal venous phase dual-energy CT in the assessment of lumbar disk herniation. Eur Radiol 2021; 32:2168-2177. [PMID: 34820684 PMCID: PMC8921028 DOI: 10.1007/s00330-021-08354-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/02/2021] [Accepted: 09/24/2021] [Indexed: 11/03/2022]
Abstract
Objectives To investigate the diagnostic accuracy of color-coded contrast-enhanced dual-energy CT virtual noncalcium (VNCa) reconstructions for the assessment of lumbar disk herniation compared to unenhanced VNCa imaging. Methods A total of 91 patients were retrospectively evaluated (65 years ± 16; 43 women) who had undergone third-generation dual-source dual-energy CT and 3.0-T MRI within an examination interval up to 3 weeks between November 2019 and December 2020. Eight weeks after assessing unenhanced color-coded VNCa reconstructions for the presence and degree of lumbar disk herniation, corresponding contrast-enhanced portal venous phase color-coded VNCa reconstructions were independently analyzed by the same five radiologists. MRI series were additionally analyzed by one highly experienced musculoskeletal radiologist and served as reference standard. Results MRI depicted 210 herniated lumbar disks in 91 patients. VNCa reconstructions derived from contrast-enhanced CT scans showed similar high overall sensitivity (93% vs 95%), specificity (94% vs 95%), and accuracy (94% vs 95%) for the assessment of lumbar disk herniation compared to unenhanced VNCa images (all p > .05). Interrater agreement in VNCa imaging was excellent for both, unenhanced and contrast-enhanced CT (κ = 0.84 vs κ = 0.86; p > .05). Moreover, ratings for diagnostic confidence, image quality, and noise differed not significantly between unenhanced and contrast-enhanced VNCa series (all p > .05). Conclusions Color-coded VNCa reconstructions derived from contrast-enhanced dual-energy CT yield similar diagnostic accuracy for the depiction of lumbar disk herniation compared to unenhanced VNCa imaging and therefore may improve opportunistic retrospective lumbar disk herniation assessment, particularly in case of staging CT examinations. Key Points • Color-coded dual-source dual-energy CT virtual noncalcium (VNCa) reconstructions derived from portal venous phase yield similar high diagnostic accuracy for the assessment of lumbar disk herniation compared to unenhanced VNCa CT series (94% vs 95%) with MRI serving as a standard of reference. • Diagnostic confidence, image quality, and noise levels differ not significantly between unenhanced and contrast-enhanced portal venous phase VNCa dual-energy CT series. • Dual-source dual-energy CT might have the potential to improve opportunistic retrospective lumbar disk herniation assessment in CT examinations performed for other indications through reconstruction of VNCa images.
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18
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Wedatilake T, Palmer A, Fernquest S, Redgrave A, Arnold L, Kluzek S, McGregor A, Teh J, Newton J, Glyn-Jones S. Association between hip joint impingement and lumbar disc disease in elite rowers. BMJ Open Sport Exerc Med 2021; 7:e001063. [PMID: 34790361 PMCID: PMC8565560 DOI: 10.1136/bmjsem-2021-001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Lumbar disc disease is a known cause of back pain. Increasingly it is thought that cam morphology of the hip may have a causal role in development of lumbar disc disease. The aim of this study was to describe the morphology of the hip and investigate the association of cam morphology with lumbar disc disease observed on MRI in elite rowers. Methods Cross-sectional observational study of 20 elite rowers (12 male, 8 female, mean age 24.45, SD 2.1). Assessment included clinical examination, questionnaires, 3T MRI scans of the hips and lumbar spine. Alpha angle of the hips and Pfirrmann score of lumbar discs were measured. Results 85% of rowers had a cam morphology in at least one hip. Alpha angle was greatest at the 1 o’clock position ((bone 70.9 (SD 16.9), cartilage 71.4 (16.3)). 95% of the group were noted to have labral tears, but only 50% of the group had history of groin pain. 85% of rowers had at least one disc with a Pfirrmann score of 3 or more and 95% had a history of back pain. A positive correlation was observed between the alpha angle and radiological degenerative disc disease (correlation coefficient=3.13, p=0.012). A negative correlation was observed between hip joint internal rotation and radiological degenerative disc disease (correlation coefficient=−2.60, p=0.018). Conclusions Rowers have a high prevalence of labral tears, cam morphology and lumbar disc disease. There is a possible association between cam morphology and radiological lumbar degenerative disc disease, however, further investigation is required.
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Affiliation(s)
- Thamindu Wedatilake
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,England and Wales Cricket Board, London, UK
| | - Antony Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
| | - S Fernquest
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Liz Arnold
- British Rowing, London, UK.,English Institute of Sport, Bisham, UK
| | - Stefan Kluzek
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Department of SEM, University of Nottingham School of Medicine, Nottingham, UK
| | | | - James Teh
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Julia Newton
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Heritability of musculoskeletal pain and pain sensitivity phenotypes: two generations of the Raine Study. Pain 2021; 163:e580-e587. [PMID: 34686644 DOI: 10.1097/j.pain.0000000000002411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 07/12/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT There is a need to better understand biological factors that increase the risk of persistent musculoskeletal pain and heightened pain sensitivity. Knowing the heritability (how genes account for differences in people's traits) can enhance the understanding of genetic versus environmental influences of pain and pain sensitivity. However, there are gaps in current knowledge, including the need for intergenerational studies to broaden our understanding of the genetic basis of pain. Data from Gen1 and Gen2 of the Raine Study were used to investigate the heritability of musculoskeletal pain, and pressure and cold pain sensitivity. Participants included parents (Gen 1, n=1092) and their offspring (Gen 2, n=688) who underwent a battery of testing and questionnaires including pressure and cold pain threshold testing and assessments of physical activity, sleep, musculoskeletal pain, mental health and adiposity. Heritability estimates were derived using the Sequential Oliogenic Linkage Analysis Routines (SOLAR) software. Heritability estimates for musculoskeletal pain and pressure pain sensitivity were significant, accounting for between 0.190 and 0.289 of the variation in the phenotype. In contrast, heritability of cold pain sensitivity was not significant. This is the largest intergenerational study to date to comprehensively investigate the heritability of both musculoskeletal pain and pain sensitivity, using robust statistical analysis. This study provides support for the heritability of musculoskeletal pain and pain sensitivity to pressure, suggesting the need for further convergence of genetic and environmental factors in models for the development and/or maintenance of these pain disorders.
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20
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Langevin HM. Fascia Mobility, Proprioception, and Myofascial Pain. Life (Basel) 2021; 11:life11070668. [PMID: 34357040 PMCID: PMC8304470 DOI: 10.3390/life11070668] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 12/19/2022] Open
Abstract
The network of fasciae is an important part of the musculoskeletal system that is often overlooked. Fascia mobility, especially along shear planes separating muscles, is critical for musculoskeletal function and may play an important, but little studied, role in proprioception. Fasciae, especially the deep epimysium and aponeuroses, have recently been recognized as highly innervated with small diameter fibers that can transmit nociceptive signals, especially in the presence of inflammation. Patients with connective tissue hyper- and hypo-mobility disorders suffer in large number from musculoskeletal pain, and many have abnormal proprioception. The relationships among fascia mobility, proprioception, and myofascial pain are largely unstudied, but a better understanding of these areas could result in improved care for many patients with musculoskeletal pain.
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Affiliation(s)
- Helene M Langevin
- National Center for Complementary and Integrative Health, National Institutes of Health, 31 Center Drive, Suite 2B11, Bethesda, MD 20892, USA
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21
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Assessment of thoracic disk herniation by using virtual noncalcium dual-energy CT in comparison with standard grayscale CT. Eur Radiol 2021; 31:9221-9231. [PMID: 34076743 PMCID: PMC8589804 DOI: 10.1007/s00330-021-07989-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/04/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
Objectives To determine the diagnostic accuracy of dual-energy CT (DECT) virtual noncalcium (VNCa) reconstructions for assessing thoracic disk herniation compared to standard grayscale CT. Methods In this retrospective study, 87 patients (1131 intervertebral disks; mean age, 66 years; 47 women) who underwent third-generation dual-source DECT and 3.0-T MRI within 3 weeks between November 2016 and April 2020 were included. Five blinded radiologists analyzed standard DECT and color-coded VNCa images after a time interval of 8 weeks for the presence and degree of thoracic disk herniation and spinal nerve root impingement. Consensus reading of independently evaluated MRI series served as the reference standard, assessed by two separate experienced readers. Additionally, image ratings were carried out by using 5-point Likert scales. Results MRI revealed a total of 133 herniated thoracic disks. Color-coded VNCa images yielded higher overall sensitivity (624/665 [94%; 95% CI, 0.89–0.96] vs 485/665 [73%; 95% CI, 0.67–0.80]), specificity (4775/4990 [96%; 95% CI, 0.90–0.98] vs 4066/4990 [82%; 95% CI, 0.79–0.84]), and accuracy (5399/5655 [96%; 95% CI, 0.93–0.98] vs 4551/5655 [81%; 95% CI, 0.74–0.86]) for the assessment of thoracic disk herniation compared to standard CT (all p < .001). Interrater agreement was excellent for VNCa and fair for standard CT (ϰ = 0.82 vs 0.37; p < .001). In addition, VNCa imaging achieved higher scores regarding diagnostic confidence, image quality, and noise compared to standard CT (all p < .001). Conclusions Color-coded VNCa imaging yielded substantially higher diagnostic accuracy and confidence for assessing thoracic disk herniation compared to standard CT. Key Points • Color-coded VNCa reconstructions derived from third-generation dual-source dual-energy CT yielded significantly higher diagnostic accuracy for the assessment of thoracic disk herniation and spinal nerve root impingement compared to standard grayscale CT. • VNCa imaging provided higher diagnostic confidence and image quality at lower noise levels compared to standard grayscale CT. • Color-coded VNCa images may potentially serve as a viable imaging alternative to MRI under circumstances where MRI is unavailable or contraindicated.
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Divi SN, Goyal DK, Makanji HS, Kepler CK, Anderson DG, Warner ED, Galtta M, Mujica VE, Houlihan NV, Kaye ID, Kurd MF, Woods BI, Radcliff KE, Rihn JA, Hilibrand AS, Vaccaro AR, Schroeder GD. Can Imaging Characteristics on Magnetic Resonance Imaging Predict the Acuity of a Lumbar Disc Herniation? Int J Spine Surg 2021; 15:458-465. [PMID: 34074744 PMCID: PMC8176824 DOI: 10.14444/8032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Currently, no authors of existing studies have attempted to classify the signal characteristics of disc herniation on magnetic resonance imaging (MRI) and their temporal relationship to symptoms of lumbar radiculopathy. The purpose of this study was to determine whether the MRI signal characteristics are predictive of acuity of symptoms in patients with lumbar disc herniation (LDH). METHODS A retrospective cohort study was conducted on patients treated at an academic center for LDH from 2015 to 2018. Patients were divided into 2 groups based on symptom duration (acute: ≤6 weeks; or chronic: >4 months). Two independent observers measured T1, T2 signal, and other MRI characteristics at the affected disc level. Univariate analysis was used to compare differences between groups. Multiple logistic regression was used to determine predictors of acuity. RESULTS Eighty-nine patients were included (33 acute, 56 chronic) with no significant baseline differences between groups. Rater 2 observed a higher proportion of disc bulges in the chronic group (P = .021) and a higher abnormal T1 herniation signal in the acute group (P = .048). Rater 1 found a higher Pfirrmann grade (P = .005) and a higher prevalence of vertebral body spurring (P = .007) in the chronic group. Interobserver agreement for T1 central and herniation signals demonstrated poor to fair agreement, whereas the remainder of the measurements showed moderate to substantial agreement (κ = 0.4-0.8). Multiple logistic regression showed that Pfirrmann Grade 5 (odds ratio = 0.12, 95% confidence interval [0.02, 0.74], P = .022) and anterior/posterior spurring (odds ratio = 0.053 [0.03, 0.85], P = .023) were not associated with acuity. CONCLUSIONS Other than Pfirrmann grade or vertebral body spurring, no MRI characteristics could be reliably identified that correlate with acuity of symptoms. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Srikanth N. Divi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Dhruv K.C. Goyal
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Heeren S. Makanji
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - D. Greg Anderson
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eric D. Warner
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matt Galtta
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Victor E. Mujica
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nathan V. Houlihan
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - I. David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark F. Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Barrett I. Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kris E. Radcliff
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey A. Rihn
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Ren W, Cui S, Alini M, Grad S, Zhou Q, Li Z, Razansky D. Noninvasive multimodal fluorescence and magnetic resonance imaging of whole-organ intervertebral discs. BIOMEDICAL OPTICS EXPRESS 2021; 12:3214-3227. [PMID: 34221655 PMCID: PMC8221942 DOI: 10.1364/boe.421205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 06/13/2023]
Abstract
Low back pain (LBP) is a commonly experienced symptom posing a tremendous healthcare burden to individuals and society at large. The LBP pathology is strongly linked to degeneration of the intervertebral disc (IVD), calling for development of early-stage diagnostic tools for visualizing biomolecular changes in IVD. Multimodal measurements of fluorescence molecular tomography (FMT) and magnetic resonance imaging (MRI) were performed on IVD whole organ culture model using an in-house built FMT system and a high-field MRI scanner. The resulted multimodal images were systematically validated through epifluorescence imaging of the IVD sections at a microscopic level. Multiple image contrasts were exploited, including fluorescence distribution, anatomical map associated with T1-weighted MRI contrast, and water content related with T2 relaxation time. The developed multimodality imaging approach may thus serve as a new assessment tool for early diagnosis of IVD degeneration and longitudinal monitoring of IVD organ culture status using fluorescence markers.
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Affiliation(s)
- Wuwei Ren
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, University of Zurich and ETH Zurich, 8093 Zurich, Switzerland
- equal contribution
| | - Shangbin Cui
- AO Research Institute Davos, 7270 Davos, Switzerland
- The First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, China
- equal contribution
| | - Mauro Alini
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Sibylle Grad
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Quanyu Zhou
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, University of Zurich and ETH Zurich, 8093 Zurich, Switzerland
| | - Zhen Li
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Daniel Razansky
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, University of Zurich and ETH Zurich, 8093 Zurich, Switzerland
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Booz C, Yel I, Martin SS, Lenga L, Eichler K, Wichmann JL, Vogl TJ, Albrecht MH. Incremental Diagnostic Value of Virtual Noncalcium Dual-Energy Computed Tomography for the Depiction of Cervical Disk Herniation Compared With Standard Gray-Scale Computed Tomography. Invest Radiol 2021; 56:207-214. [PMID: 33109918 DOI: 10.1097/rli.0000000000000734] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigative the diagnostic accuracy of colored dual-energy computed tomography (CT) virtual noncalcium (VNCa) series for analyzing cervical disk herniation compared with standard gray-scale CT images, with magnetic resonance imaging (MRI) serving as standard of reference. MATERIALS AND METHODS Data from 57 patients who underwent noncontrast dual-source CT and 3.0-Tesla (T) MRI within 2 weeks between January 2017 and December 2018 were retrospectively analyzed. Five radiologists analyzed standard gray-scale dual-energy CT scans for the presence and degree of cervical disk herniation and spinal nerve root impingement. Readers reassessed scans after 8 weeks using colored VNCa series. Two experienced radiologists set the reference standard in consensus MRI reading sessions. Primary indices of diagnostic accuracy for both CT approaches were sensitivity and specificity, which were compared by application of the McNemar test. RESULTS A total of 57 patients (mean age, 64 ± 11 years; 30 women) were evaluated (337 intervertebral disks). Magnetic resonance imaging indicated a total of 103 cervical disk herniations. The VNCa reconstructions had higher overall sensitivity compared with gray-scale CT (487/515 [95%; 95% confidence interval (CI), 91%-98%] vs 392/515 [76%; 95% CI, 70%-83%]), as well as higher specificity (1107/1170 [95%; 95% CI, 90%-99%] vs 906/1170 [77%; 95% CI, 72%-82%]) for assessing cervical disk herniation (all P < 0.001). The VNCa reconstructions had higher diagnostic accuracy for analyzing spinal nerve root impingement in comparison with gray-scale CT (sensitivity, 195/230 [85%; 95% CI, 79%-90%] vs 115/230 [50%; 95% CI, 40%-59%]; specificity, 1430/1455 [98%; 95% CI, 94%-100%] vs 1325/1455 [91%; 95% CI, 88%-98%]; accuracy, 1625/1685 [96%; 95% CI, 93%-99%] vs 1440/1685 [86%; 95% CI, 82%-90%]; all P < 0.001). CONCLUSIONS Color-coded VNCa series improved the diagnostic accuracy for assessing cervical disk herniation and spinal nerve root impingement compared with standard gray-scale CT.
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Affiliation(s)
- Christian Booz
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology
| | - Ibrahim Yel
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology
| | - Simon S Martin
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology
| | - Lukas Lenga
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Julian L Wichmann
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Moritz H Albrecht
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology
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Du JP, Wang XH, Shan LQ, Wang WT, Li HK, Huang DG, Yan L, Hao DJ. Safety and Efficacy of Minimally Invasive Transforaminal Lumbar Interbody Fusion Combined with Gelatin Sponge Impregnated with Dexamethasone and No Drainage Tube after Surgery in the Treatment of Lumbar Degenerative Disease. Orthop Surg 2021; 13:1077-1085. [PMID: 33749136 PMCID: PMC8126907 DOI: 10.1111/os.12929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 12/14/2020] [Accepted: 12/20/2020] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of the present study was to use a gelatin sponge impregnated with dexamethasone, combined with minimally invasive transforaminal lumbar interbody fusion (MIS‐TLIF) and no drainage tube after the operation for early postoperative recurrence of root pain caused by edema. Methods A prospective case series study was designed. From September 2015 to January 2018, eligible patients diagnosed with lumbar degenerative disease underwent MIS‐TLIF combined with a gelatin sponge impregnated with dexamethasone and no drainage tube after surgery. The short‐term clinical data were collected, such as visual analog scale (VAS) scores for low back pain and leg pain preoperatively and on postoperative days (POD) 1–10, time bedridden postoperatively, and length of hospital stay postoperatively. Long‐term indicators include the Japanese Orthopaedic Association (JOA) score, the Oswestry Disability Index (ODI) score, and the 36‐Item Short‐Form Health Survey (SF‐36) score, evaluated preoperatively and 1 week, 3 months, and more than 1 year postoperatively. Results Complete clinical data was obtained for 139 patients. All patients were followed up for more than 12 months (13.7 ± 3.3 months). The average bedridden period was 1.5 ± 0.4 days and hospital stays were 2.7 ± 0.9 days. The VAS score of leg and back pain on POD 1–10 were all decreased compared with preoperation (all P < 0.0001). At the last follow up, the VAS scores for back pain and leg pain (0.69 ± 0.47; 1.02 ± 0.55) and the ODI score (11.1 ± 3.5) decreased (all P < 0.0001), and the JOA score (27.1 ± 3.2) and the SF‐36 (physical component summary, 50.5 ± 7.3; mental component summary, 49.4 ± 8.9) increased (all P < 0.0001) compared with preoperative values. Patients' early and long‐term levels of satisfaction postoperatively were 92.8% and 97.8%, respectively. At POD 7 and the last follow‐up, the improvement rate of the JOA score, respectively, was 41.8% ± 10.6% and 87.7% ± 8.2%, and clinical effects assessed as significantly effective according to the improvement rate of the JOA score was 16.5% and 66.9%, respectively. There were 2 (1.4%) cases with complications, including 1 (0.7%) case of wound infection and 1 (0.7%) case of deep vein thrombosis. There were no device‐related complications or neurological injuries. Conclusion Use of a gelatin sponge impregnated with dexamethasone combined with MIS‐TLIF and no drainage tube after the operation, compared with previous studies, appears to be safe and feasible to reduce recurrent back pain and leg pain after decompression in the treatment of lumbar degenerative disease.
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Affiliation(s)
- Jin-Peng Du
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiao-Hui Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Le-Qun Shan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Wen-Tao Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Hou-Kun Li
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Da-Geng Huang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Liang Yan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
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Elashmawy MA, Shaat RM, Abdelkhalek AM, El Boghdady E. Caudal epidural steroid injection ultrasound-guided versus fluoroscopy-guided in treatment of refractory lumbar disc prolapse with radiculopathy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00388-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundLumbar disc prolapse is a localized herniation of disc beyond intervertebral disc space and is the most common cause of sciatica; the aim of this study is to investigate the efficacy of ultrasound (US)-guided caudal epidural steroid injection (CESI) compared with fluoroscopy (FL)-guided CESI in treatment of patients with refractory lumbar disc prolapse (LDP) with radiculopathy.ResultsAt the beginning of the study, there was no significant difference between both groups in all parameters. (a) Group 1 had significantly improved the straight leg raising and modified Schober tests, VAS, and ODI at 1-month and 3-month post-injection evaluation in comparison to baseline recordings (p< 0.001); (b) Group 2 had significantly improved the straight leg raising and modified Schober tests, VAS, and ODI at 1-month and 3-month post-injection evaluation in comparison to baseline recordings (p< 0.001); and (c) US-guided CESI was not statistically different from the FL-guided CESI in the improvement of the straight leg raising (p= 0.87, 0.82) and modified Schober tests (p= 0.87, 0.82) as well as VAS (p= 0.40, 0.43) and ODI (p= 0.7, 0.2) at 1-month and 3-month post-injection evaluation. In a multivariate analysis using CI = 95%, the significant predictors for a successful outcome were duration<6 months (p= 0.03, OR = 2.25), target level not L2-3/L3-4 (p< 0.001, OR = 4.13), and LDP other than foraminal type (p= 0.002, OR = 3.78). However, age < 40 years was found to be non-significant in predicting a successful outcome (p= 0.38, OR = 0.98).ConclusionUS is excellent in guiding CESI with similar treatment outcomes as compared with FL-guided CESI.Trial registrationClinicalTrials.gov Identifier:NCT03933150.
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Yang DC, Lee HJ, Park JW, Nam K, Kim S, Cho KT, Kwon BS. Association Between Latency of Dermatomal Sensory-Evoked Potentials and Quantitative Radiologic Findings of Narrowing in Lumbar Spinal Stenosis. Ann Rehabil Med 2020; 44:353-361. [PMID: 32986946 PMCID: PMC7655228 DOI: 10.5535/arm.19164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/19/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To identify the difference of quantitative radiologic stenosis between a normal latency group and an abnormal latency group, and to investigate the association of dermatomal somatosensory-evoked potential (DSEP) with magnetic resonance imaging (MRI) findings of narrowing in patients with lumbar spinal stenosis (LSS). METHODS We retrospectively reviewed the clinical records and P40 latencies of L5 DSEP of 40 patients with unilateral symptoms of LSS at the L4-5 disc level. Quantitative assessments of stenosis in lumbar spine MRI were performed with measurements of the anteroposterior diameter (APD), cross-sectional area (CSA) of the dural sac, ligamentous interfacet distance (LID), CSA of the neural foramen (CSA-NF), and subarticular zone width. Analyses were conducted through comparisons of radiologic severity between the normal and abnormal latency groups and correlation between radiologic severity of stenosis and latency of DSEP in absolute (APD <10 mm) and relative (APD <13 mm) stenosis. RESULTS The radiologic severities of lumbar stenosis were not significantly different between the normal and abnormal latency groups. In absolute and relative stenosis, latency showed a significant negative correlation with APD (r=-0.539, r=-0.426) and LID (r=-0.459, r=-0.494). In patients with relative stenosis, a weak significant positive correlation was found between latency and CSA-NF (r=0.371, p=0.048). LID was the only significant factor for latency (β=-0.930, p=0.011). CONCLUSION The normal and abnormal DSEP groups showed no significant differences inradiologic severity. The latency of DSEP had a negative correlation with the severity of central stenosis, and LID was an influencing factor.
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Affiliation(s)
- Dong Chan Yang
- Department of Health Service, Gunsan-si Health Center, Gunsan, Korea
| | - Ho Jun Lee
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jin-Woo Park
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Kiyeun Nam
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Shengshu Kim
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Keun-Tae Cho
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Bum Sun Kwon
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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Rustagi T, Mendel E, Ferguson SA, Mallepally AR, Thomas WJ, Splittstoesser RE, Dufour JS, Marras WS. Differences in lumbar spine measures as a function of MRI posture in low back pain patients and its clinical implications. Int J Neurosci 2020; 132:511-520. [DOI: 10.1080/00207454.2020.1825420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tarush Rustagi
- Department of Neurosurgery, The Ohio State University, Columbus, OH, USA
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India
| | - Ehud Mendel
- Department of Neurosurgery, The Ohio State University, Columbus, OH, USA
| | - Sue A. Ferguson
- Biodynamics Laboratory, Spine Research Institute, The Ohio State University, Columbus, OH, USA
| | | | - William J. Thomas
- Department of Neurosurgery, The Ohio State University, Columbus, OH, USA
| | - Riley E. Splittstoesser
- Biodynamics Laboratory, Spine Research Institute, The Ohio State University, Columbus, OH, USA
| | - Jonathan S. Dufour
- Biodynamics Laboratory, Spine Research Institute, The Ohio State University, Columbus, OH, USA
| | - William S. Marras
- Biodynamics Laboratory, Spine Research Institute, The Ohio State University, Columbus, OH, USA
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Reconnecting the Brain With the Rest of the Body in Musculoskeletal Pain Research. THE JOURNAL OF PAIN 2020; 22:1-8. [PMID: 32553621 DOI: 10.1016/j.jpain.2020.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/27/2019] [Accepted: 02/01/2020] [Indexed: 02/06/2023]
Abstract
A challenge in understanding chronic musculoskeletal pain is that research is often siloed between neuroscience, physical therapy/rehabilitation, orthopedics, and rheumatology which focus respectively on 1) neurally mediated effects on pain processes, 2) behavior and muscle activity, 3) tissue structure, and 4) inflammatory processes. Although these disciplines individually study important aspects of pain, there is a need for more cross-disciplinary research that can bridge between them. Identifying the gaps in knowledge is important to understand the whole body, especially at the interfaces between the silos-between brain function and behavior, between behavior and tissue structure, between musculoskeletal and immune systems, and between peripheral tissues and the nervous system. Research on "mind and body" practices can bridge across these silos and encourage a "whole person" approach to better understand musculoskeletal pain by bringing together the brain and the rest of the body. PERSPECTIVE: Research on chronic musculoskeletal pain is limited by significant knowledge gaps. To be fully integrated, musculoskeletal pain research will need to bridge across tissues, anatomical areas, and body systems. Research on mind and body approaches encourages a "whole person" approach to better understand musculoskeletal pain.
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Scheidt S, Winnewisser J, Leichtle C, Gesicki M, Hofmann UK. The Value of Video Rasterstereography in the Detection of Alterations in Posture as a Marker of Pain Relief after Targeted Infiltrations of the Lumbar Spine. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:496-502. [PMID: 32434258 DOI: 10.1055/a-1161-9633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Targeted infiltrations to the lumbar spine are used to identify the correct scope for surgery in patients with chronic lumbar back pain (CLBP) and multi-segmental pathologies, where radiologic imaging and clinical presentation do not match. Conclusions from that method have so far been based on individual statements of pain relief. The main principle for the infiltrations is the assumption that by locally administering an analgesic agent to possible surgical target areas, the effect of surgery can be temporarily simulated. The aim was to investigate the use of rasterstereographic posture measurements to substantiate reported pain reduction after infiltrations. METHODS In this case-control study (Level II), rasterstereography was performed on 57 patients and 28 reference subjects to evaluate changes in posture during 1 week of injections under fluoroscopic guidance and correlated with changes in the Numeric Pain Rating Scale (NRS). Statistical analysis was performed with SPSS (α = .05, two-sided) and presented in the form of box, scatter, and Bland-Altman plots. RESULTS AND CONCLUSION The CLBP patients' trunk inclination (median 6°) and absolute lateral tilt were significantly increased (p < .01 each) compared to the reference group. No significant difference was observed for trunk length, kyphotic/lordotic angle, or lateral deviation. During infiltration, no significant difference in posture could be observed. A subgroup analysis of patients reporting the highest pain improvement indicated no significant difference. No correlation was observed with pain improvement reported by the patients during injections. Subsequent rasterstereography does not seem to be able to verify results of injections in the diagnostics of lumbar spine pathologies, as patients' reported pain relief does not correlate with a relevant alteration in posture. The short-term effect of the targeted infiltrations may not suffice to change false posture being developed over years.
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Affiliation(s)
- Sebastian Scheidt
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | | | | | - Marco Gesicki
- Orthopädische Klinik, Universitätsklinikum Tübingen.,Orthopädie und Unfallchirurgie, Praxis Dres. Falck und Gesicki, Tübingen
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Prevalence and Clinical Significance of Incidental Vertebral Marrow Signal Abnormality in Thoracolumbar Spine MRI. Spine (Phila Pa 1976) 2020; 45:390-396. [PMID: 31593057 DOI: 10.1097/brs.0000000000003278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE This study investigates the prevalence of incidental vertebral marrow signal abnormality (VMSA) in thoracolumbar spine magnetic resonance imaging (MRI) ordered for the evaluation of back and/or leg pain and assess the clinical work-up for VMSAs. SUMMARY OF BACKGROUND DATA Patients presenting with back pain are often referred for spine MRI for diagnostic evaluation. VMSA is most frequently found in the lumbar spine and is of clinical concern because it can represent malignancy. Standardized procedures for reporting and managing VMSAs do not exist. METHODS The radiology database at the Oregon Health & Science University health system was queried to identify patients with thoracolumbar spine MRI scans performed between January 2014 and June 2016. Patients 16 years or older with MRIs ordered by providers at a multidisciplinary spine specialty clinic for the diagnostic evaluation of back and/or leg pain were included. Radiology reports were searched for keywords pertaining to VMSAs, such as "malignancy." Medical records of these patients were further reviewed for the clinical work-up and final diagnoses pertaining to the VMSA. RESULTS The study sample included 1503 individual patients, of whom 65 (4%) had MRI radiology reports that described a VMSA. Thirty-one (48%) of the 65 patients with VMSAs had further evaluation recommended by radiology. Ten (32%) of these 31 patients were followed clinically without further diagnostic testing for the VMSA. Of the 65 patients with VMSAs, only one was diagnosed with malignancy (multiple myeloma). CONCLUSION While VMSAs are not frequently found on thoracolumbar MRIs ordered to evaluate back and/or leg pain, there is a large amount of heterogeneity in how these abnormalities are documented and managed. This may indicate the need for clinical guidelines for the reporting and management of VMSAs detected on spine MRI and for improvement in communication between radiologists and ordering providers. LEVEL OF EVIDENCE 3.
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SHADES of grey - The challenge of 'grumbling' cauda equina symptoms in older adults with lumbar spinal stenosis. Musculoskelet Sci Pract 2020; 45:102049. [PMID: 31439453 DOI: 10.1016/j.msksp.2019.102049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/06/2019] [Accepted: 08/11/2019] [Indexed: 01/16/2023]
Abstract
Diagnosing cauda equina syndrome is challenging in older adults with lumbar spinal stenosis. Understanding these challenges is vital for clinicians who are faced with difficult decisions about when to refer for investigation or surgical management. This is a growing clinical issue because of the escalating prevalence of lumbar spinal stenosis in our ageing population, and increasing demands on healthcare services including imaging and surgical services. This professional issue explores the challenges and evidence gaps relating to cauda equina syndrome in older adults with lumbar spinal stenosis. The degenerative patho-anatomical changes in the lumbar spine that are responsible for lumbar spinal stenosis also have the potential to lead to a gradual compromise of the cauda equina nerve roots. The clinical presentation may be unclear. As a result, there is a risk that slow-onset 'grumbling' cauda equina symptoms may be overlooked or dismissed in older patients with lumbar spinal stenosis. Furthermore, a lack of standardised diagnostic criteria and management pathways add to the challenges for clinicians diagnosing and managing potential cauda equina compromise associated with lumbar spinal stenosis. We recommend careful assessment, appropriate safety netting, and ongoing clinical monitoring and vigilance when assessing and managing this potentially vulnerable patient group.
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Rajasekaran S, Tangavel C, K S SVA, Soundararajan DCR, Nayagam SM, Matchado MS, Raveendran M, Shetty AP, Kanna RM, Dharmalingam K. Inflammaging determines health and disease in lumbar discs-evidence from differing proteomic signatures of healthy, aging, and degenerating discs. Spine J 2020; 20:48-59. [PMID: 31125691 DOI: 10.1016/j.spinee.2019.04.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The true understanding of aging and disc degeneration (DD) is still elusive. MRI has not helped our attempts to understand the health and disease status of the discs as it reflects mainly the end morphologic changes and not the changes at a molecular level. Understanding degeneration at a molecular level through proteomics might allow differentiation from normal aging and also aid in the development of biomarkers for early diagnosis and preventive therapies. PURPOSE To utilize proteomics to understand the molecular basis of healthy, aging, and degenerating discs and conclusively differentiate normal aging and degeneration. STUDY DESIGN Proteomic analysis of human intervertebral disc samples. METHODS L4-L5 disc samples from three groups were acquired and subjected to proteomic analysis. Samples from individuals aged in the second, third, and fourth decades were used to represent young healthy discs (Group A). Those from MRI normal donors aged in the fifth, sixth, and seventh decades represented normal aging (Group B). Five degenerated discs obtained from patients at surgery represented degeneration (Group C). The entire proteome map and alteration in protein expressions were further analyzed using bioinformatics analysis. This was a self-funded project. RESULTS There were 84 common proteins. Specific proteins numbered 225 in A, 315 in B, and 283 in C. By gene ontology biological process identification, Group A predominated with extracellular matrix organization, cytoskeletal structural and normal metabolic proteins. Group B differed in having additional basal expression of immune response, complement inhibitors, and senescence proteins. Group C was different, with upregulation of proteins associated with oxidative stress response, positive regulators of apoptosis, innate immune response, complement activation and defense response to gram positive bacteria indicating ongoing inflammaging. CONCLUSIONS Our study documented diverse proteome signatures between the young, aging and degenerating discs. Inflammaging was the main differentiator between normal biological aging and DD. CLINICAL SIGNIFICANCE Multiple inflammatory molecules unique to DD were identified, allowing the possibility of developing specific biomarkers for early diagnosis and thereby provide evidence-based metrics for preventive measures rather than surgical intervention and also to monitor progress of the disease.
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Affiliation(s)
- S Rajasekaran
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore, India.
| | - Chitraa Tangavel
- Ganga Research Centre, No 91, Mettupalayam Rd, Coimbatore 641030, India
| | - Sri Vijay Anand K S
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore, India
| | | | | | | | - M Raveendran
- Department of Plant Biotechnology, Tamil Nadu Agricultural University, Coimbatore 641003, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore, India
| | - K Dharmalingam
- Aravind Medical Research Foundation, Madurai 625020, India
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Zeitoun R, Mohieddin MSA. Coronal STIR sequence, a simple adjustment to routine MRI protocol for extra-spinal sciatica and sciatica-like symptoms. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0096-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The value of adding coronal STIR images to MR imaging of sciatica aiming to detect extra-spinal abnormalities.
Results
Additional coronal STIR images detected extra-spinal abnormalities in 20% of the patients, thereby downgraded the normal studies from 21 to 13%. The extra-spinal abnormalities included bone abnormalities (36.4%), soft tissue abnormalities (4.5%), neurological abnormalities (2.3%), gynecological abnormalities (50%), and miscellaneous (6.8%). In 6.9% of patients, the extra-spinal abnormalities explained the patients’ pain and influenced their management. Extra-spinal causes of pain significantly correlated to positive trauma and neoplasm history, normal routine protocol images, and absent nerve root impingement. Extra-spinal abnormalities were more prevalent in age groups (20–39 years).
Conclusion
Coronal STIR images (field of view: mid abdomen to the lesser trochanters) identify extra-spinal abnormalities that maybe overlooked on routine MRI protocol. It is of additional value in young adults, trauma, neoplasm, and negative routine images.
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Pangarkar SS, Kang DG, Sandbrink F, Bevevino A, Tillisch K, Konitzer L, Sall J. VA/DoD Clinical Practice Guideline: Diagnosis and Treatment of Low Back Pain. J Gen Intern Med 2019; 34:2620-2629. [PMID: 31529375 PMCID: PMC6848394 DOI: 10.1007/s11606-019-05086-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/27/2019] [Accepted: 04/25/2019] [Indexed: 01/07/2023]
Abstract
DESCRIPTION In September 2017, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved the joint Clinical Practice Guideline (CPG) for Diagnosis and Management of Low Back Pain. This CPG was intended to provide healthcare providers a framework by which to evaluate, treat, and manage patients with low back pain (LBP). METHODS The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through September 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. A patient focus group was also convened to ensure patient values and perspectives were considered when formulating preferences and shared decision making in the guideline. RECOMMENDATIONS The VA/DOD LBP CPG provides evidence-based recommendations for the diagnostic approach, education and self-care, non-pharmacologic and non-invasive therapy, pharmacologic therapy, dietary supplements, non-surgical invasive therapy, and team approach to treatment of low back pain.
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Affiliation(s)
- Sanjog S Pangarkar
- United States Department of Veterans Affairs, Washington, DC, USA. .,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Daniel G Kang
- United States Department of Defense, Washington, DC, USA
| | | | - Adam Bevevino
- United States Department of Defense, Washington, DC, USA
| | - Kirsten Tillisch
- United States Department of Veterans Affairs, Washington, DC, USA
| | - Lisa Konitzer
- United States Department of Defense, Washington, DC, USA
| | - James Sall
- United States Department of Defense, Washington, DC, USA
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Narouze S. Epidural blood patch is an iatrogenic epidural hematoma: asymptomatic or symptomatic? This is the question. Reg Anesth Pain Med 2019; 45:rapm-2019-100851. [PMID: 31541007 DOI: 10.1136/rapm-2019-100851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
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Sasani H, Solmaz B, Sasani M, Vural M, Ozer AF. Diagnostic Importance of Axial Loaded Magnetic Resonance Imaging in Patients with Suspected Lumbar Spinal Canal Stenosis. World Neurosurg 2019; 127:e69-e75. [PMID: 30857995 DOI: 10.1016/j.wneu.2019.02.091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/08/2019] [Accepted: 02/09/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE AND BACKGROUND To study the efficacy of lumbar (AL) magnetic resonance imaging (MRI) in patients with suspected lumbar spinal stenosis (LSS), with and without AL compression. Supine MRI is used in the assessment of patients with LSS. However, MRI findings may poorly correlate with neurologic findings because of the morphologic changes of the lumbar spinal canal between upright standing and supine positions. In patients without significant stenosis in routine lumbar MRI, by applying AL, MRI can show significant LSS. METHODS This study included 103 consecutive patients (188 disc levels) who presented with neurogenic claudication with and without low back pain. AL was performed using a nonmagnetic compression device for 5 minutes. T1- and T2-weighted axial and sagittal sequences were obtained during AL applied to the spine. The dural sac cross-sectional area (DSCA) appeared to be narrow at each disc level of L4-5 to L5-S1 in all patients and was measured using T2-weighted images in routine supine and AL images. RESULTS The groups included patients with a reduction in the DSCA (>15 mm2) according to patient age and DSCA in routine spine MRI. The mean DSCA of the disc levels without and with AL were 138 mm2 and 123 mm2, with a mean difference of 15 mm2 at L4-5, 134 mm2 and 125 mm2 and a mean difference of 9 mm2 at L5-S1, respectively. CONCLUSIONS The use of AL MRI in patients with clinically suspected LSS could reduce the risk of misdiagnosis of stenosis, leading to inappropriate treatment.
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Affiliation(s)
- Hadi Sasani
- Department of Radiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey.
| | - Bilgehan Solmaz
- Department of Neurosurgery, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Metin Vural
- Department of Radiology, American Hospital, Istanbul, Turkey
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
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Booz C, Nöske J, Martin SS, Albrecht MH, Yel I, Lenga L, Gruber-Rouh T, Eichler K, D'Angelo T, Vogl TJ, Wichmann JL. Virtual Noncalcium Dual-Energy CT: Detection of Lumbar Disk Herniation in Comparison with Standard Gray-scale CT. Radiology 2018; 290:446-455. [PMID: 30615548 DOI: 10.1148/radiol.2018181286] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess the diagnostic performance of dual-energy CT with reconstruction of virtual noncalcium (VNCa) images for the detection of lumbar disk herniation compared with standard CT image reconstruction. Materials and Methods For this retrospective study, 41 patients (243 intervertebral disks; overall mean age, 68 years; 24 women [mean age, 68 years] and 17 men [mean age, 68 years]) underwent clinically indicated third-generation, dual-source, dual-energy CT and 3.0-T MRI within 2 weeks between March 2017 and January 2018. Six radiologists, blinded to clinical and MRI information, independently evaluated conventional gray-scale dual-energy CT series for the presence and degree of lumbar disk herniation and spinal nerve root impingement. After 8 weeks, readers reevaluated examinations by using color-coded VNCa reconstructions. MRI evaluated by two separate experienced readers, blinded to clinical and dual-energy CT information, served as the standard of reference. Sensitivity and specificity were the primary metrics of diagnostic performance. Results A total of 112 herniated lumbar disks were depicted at MRI. VNCa showed higher overall sensitivity (612 of 672 [91%] vs 534 of 672 [80%]) and specificity (723 of 786 [92%] vs 665 of 786 [85%]) for detecting lumbar disk herniation compared with standard CT (all comparisons, P < .001). Interreader agreement was excellent for VNCa and substantial for standard CT (κ = 0.82 vs 0.67; P < .001). VNCa achieved superior diagnostic confidence, image quality, and noise scores compared with standard CT (all comparisons, P < .001). Conclusion Color-coded dual-energy CT virtual noncalcium reconstructions show substantially higher diagnostic performance and confidence for depicting lumbar disk herniation compared with standard CT. © RSNA, 2018.
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Affiliation(s)
- Christian Booz
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Jochen Nöske
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Simon S Martin
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Moritz H Albrecht
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Ibrahim Yel
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Lukas Lenga
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Tatjana Gruber-Rouh
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Katrin Eichler
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Tommaso D'Angelo
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Thomas J Vogl
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
| | - Julian L Wichmann
- From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.)
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Chiarotto A, Terwee CB, Kamper SJ, Boers M, Ostelo RW. Evidence on the measurement properties of health-related quality of life instruments is largely missing in patients with low back pain: A systematic review. J Clin Epidemiol 2018; 102:23-37. [DOI: 10.1016/j.jclinepi.2018.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/02/2018] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
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Kim JH, van Rijn RM, van Tulder MW, Koes BW, de Boer MR, Ginai AZ, Ostelo RWGJ, van der Windt DAMW, Verhagen AP. Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; a systematic review. Chiropr Man Therap 2018; 26:37. [PMID: 30151119 PMCID: PMC6102824 DOI: 10.1186/s12998-018-0207-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/05/2018] [Indexed: 12/13/2022] Open
Abstract
Main text We aim to summarize the available evidence on the diagnostic accuracy of imaging (index test) compared to surgery (reference test) for identifying lumbar disc herniation (LDH) in adult patients.For this systematic review we searched MEDLINE, EMBASE and CINAHL (June 2017) for studies that assessed the diagnostic accuracy of imaging for LDH in adult patients with low back pain and surgery as the reference standard. Two review authors independently selected studies, extracted data and assessed risk of bias. We calculated summary estimates of sensitivity and specificity using bivariate analysis, generated linked ROC plots in case of direct comparison of diagnostic imaging tests and assessed the quality of evidence using the GRADE-approach.We found 14 studies, all but one done before 1995, including 940 patients. Nine studies investigated Computed Tomography (CT), eight myelography and six Magnetic Resonance Imaging (MRI). The prior probability of LDH varied from 48.6 to 98.7%. The summary estimates for MRI and myelography were comparable with CT (sensitivity: 81.3% (95%CI 72.3-87.7%) and specificity: 77.1% (95%CI 61.9-87.5%)). The quality of evidence was moderate to very low. Conclusions The diagnostic accuracy of CT, myelography and MRI of today is unknown, as we found no studies evaluating today's more advanced imaging techniques. Concerning the older techniques we found moderate diagnostic accuracy for all CT, myelography and MRI, indicating a large proportion of false positives and negatives.
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Affiliation(s)
- Jung-Ha Kim
- 1Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands.,2Department of Family Medicine, Chung-ang University Medical Center, 102, Heukseok-ro, Dongjak-gu, Seoul, South Korea
| | - Rogier M van Rijn
- 1Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands.,3Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maurits W van Tulder
- 4Department of Health Sciences and EMGO-Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Medical Centre, Amsterdam, The Netherlands.,5Department of Epidemiology and Biostatistics and EMGO-Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Bart W Koes
- 1Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michiel R de Boer
- 4Department of Health Sciences and EMGO-Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Medical Centre, Amsterdam, The Netherlands
| | - Abida Z Ginai
- 6Department of Radiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Raymond W G J Ostelo
- 4Department of Health Sciences and EMGO-Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Medical Centre, Amsterdam, The Netherlands.,5Department of Epidemiology and Biostatistics and EMGO-Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Danielle A M W van der Windt
- 7Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Arianne P Verhagen
- 3Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,8School of Physiotherapy, Graduate school of Health, University Technology Sydney, Sydney, Australia
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Kurvers RHJM, de Zoete A, Bachman SL, Algra PR, Ostelo R. Combining independent decisions increases diagnostic accuracy of reading lumbosacral radiographs and magnetic resonance imaging. PLoS One 2018; 13:e0194128. [PMID: 29614070 PMCID: PMC5882099 DOI: 10.1371/journal.pone.0194128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 02/26/2018] [Indexed: 11/18/2022] Open
Abstract
Diagnosing the causes of low back pain is a challenging task, prone to errors. A novel approach to increase diagnostic accuracy in medical decision making is collective intelligence, which refers to the ability of groups to outperform individual decision makers in solving problems. We investigated whether combining the independent ratings of chiropractors, chiropractic radiologists and medical radiologists can improve diagnostic accuracy when interpreting diagnostic images of the lumbosacral spine. Evaluations were obtained from two previously published studies: study 1 consisted of 13 raters independently rating 300 lumbosacral radiographs; study 2 consisted of 14 raters independently rating 100 lumbosacral magnetic resonance images. In both studies, raters evaluated the presence of "abnormalities", which are indicators of a serious health risk and warrant immediate further examination. We combined independent decisions of raters using a majority rule which takes as final diagnosis the decision of the majority of the group. We compared the performance of the majority rule to the performance of single raters. Our results show that with increasing group size (i.e., increasing the number of independent decisions) both sensitivity and specificity increased in both data-sets, with groups consistently outperforming single raters. These results were found for radiographs and MR image reading alike. Our findings suggest that combining independent ratings can improve the accuracy of lumbosacral diagnostic image reading.
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Affiliation(s)
- Ralf H. J. M. Kurvers
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Lentzeallee, Berlin, Germany
- * E-mail:
| | - Annemarie de Zoete
- Department of Health Sciences, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Shelby L. Bachman
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Lentzeallee, Berlin, Germany
| | - Paul R. Algra
- Department of Radiology, Medical Centre Alkmaar, Alkmaar, the Netherlands
| | - Raymond Ostelo
- Department of Health Sciences, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, the Netherlands
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He A, Wang WZ, Qiao PF, Qiao GY, Cheng H, Feng PY. Quantitative Evaluation of Compressed L4-5 and S1 Nerve Roots of Lumbar Disc Herniation Patients by Diffusion Tensor Imaging and Fiber Tractography. World Neurosurg 2018; 115:e45-e52. [PMID: 29597019 DOI: 10.1016/j.wneu.2018.03.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To delineate fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of compressed nerve roots in patients with lumbar disc herniation by diffusion tensor imaging and fiber bundle tracing and investigate the relationship between FA and ADC values and Swiss Spinal Stenosis Questionnaire and visual analog scale scores. METHODS Twenty patients with lumbar disc herniation and 20 age- and sex-matched healthy volunteers were assessed using the Swiss Spinal Stenosis Questionnaire and visual analog scale. All subjects underwent conventional sagittal T1-weighted and T2-weighted magnetic resonance imaging, axial T2-weighted imaging, and diffusion tensor imaging and fiber tractography. RESULTS In 20 patients with lumbar disc herniation, there were 31 nerve roots involved (9/31 L4, 15/31 L5, and 7/31 S1). Mean Swiss Spinal Stenosis Questionnaire scores of patients were 53.55% ± 11.91%, and mean visual analog scale scores were 5.96 ± 1.64. FA values of lumbar nerve roots were 0.332 ± 0.014 in healthy volunteers. FA values of compressed lumbar nerve roots were 0.251 ± 0.022, significantly lower than FA values of contralateral noncompressed nerve roots and lumbar nerve roots of healthy volunteers. ADC values of lumbar nerve roots were 1.763 ± 0.075 in healthy volunteers. ADC values of compressed lumbar nerve roots were 2.090 ± 0.078, significantly higher than ADC values of contralateral noncompressed nerve roots and lumbar nerve roots of healthy volunteers. CONCLUSIONS Fiber tractography is capable of delineating microstructural changes of lumbosacral nerve roots, and radiculopathy in lumbar disc herniation is associated with significant changes in FA and ADC values.
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Affiliation(s)
- Ai He
- Department of Medical Imaging, The First People's Hospital of Nanning, Nanning, China
| | - Wen-Zheng Wang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Peng-Fei Qiao
- Department of Urology, Guilin Medical University, Guilin, China
| | - Guo-Yong Qiao
- Department of Orthopedics, Affiliated Hospital of Hebei University of Engineering, Handan, China
| | - Hao Cheng
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ping-Yong Feng
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
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Fishchenko IV, Kravchuk LD, Perepechay OA. Lumbar spinal stenosis: symptoms, diagnosis and treatment (meta-analysis of literature data). PAIN MEDICINE 2018. [DOI: 10.31636/pmjua.v3i1.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Lumbar spinal stenosis is a disease in which degenerated discs, ligamentum flavum, facet joints, while aging, lead to a narrowing of the space around the neurovascular structures of the spine. This article presents a meta-analysis of literature data on epidemiology, causes, pathogenesis, diagnosis and various types of treatment of lumbar spinal stenosis.
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Herman K, Lang ME, Pich A. Tunable clustering of magnetic nanoparticles in microgels: enhanced magnetic relaxivity by modulation of network architecture. NANOSCALE 2018; 10:3884-3892. [PMID: 29419839 DOI: 10.1039/c7nr07539a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In the present work we used microgels as colloidal containers for the loading of hydrophobic magnetic nanoparticles using the solvent exchange method. We varied systematically two parameters: (i) the crosslinking degree of microgels (1-4.5 mol% crosslinker) and (ii) loading of hydrophobic magnetite nanoparticles (d = 7 nm) in microgels (2-10 wt%). The experimental data show that the interplay between these two parameters provides efficient control over the clustering of magnetic nanoparticles in the microgel structure. Transverse magnetization relaxation measurements indicate that the formation of nanoparticle clusters in microgels induces non-linear enhancement of the relaxivity with the increase of nanoparticle loading in microgels. The results suggest that the modulation of the microgel network architecture can be efficiently applied to trigger self-assembly processes inside microgels and design hybrid colloids with unusual morphologies and properties.
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Affiliation(s)
- K Herman
- DWI Leibniz Institute for Interactive Materials e.V., Forckenbeckstr. 50, Aachen, 52074, Germany
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Gandhi J, Shah J, Joshi G, Vatsia S, DiMatteo A, Joshi G, Smith NL, Khan SA. Neuro-urological sequelae of lumbar spinal stenosis. Int J Neurosci 2017; 128:554-562. [DOI: 10.1080/00207454.2017.1400973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
- Medical Student Research Institute, St. George's University School of Medicine, Grenada, West Indies
| | - Janki Shah
- Department of Medicine, Touro College of Osteopathic Medicine, Middletown, NY, USA
| | - Gargi Joshi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Sohrab Vatsia
- Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Andrew DiMatteo
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Medicine at Southampton Hospital, Southampton, NY, USA
| | | | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
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Xiang A, Xu M, Liang Y, Wei J, Liu S. Immediate relief of herniated lumbar disc-related sciatica by ankle acupuncture: A study protocol for a randomized controlled clinical trial. Medicine (Baltimore) 2017; 96:e9191. [PMID: 29390461 PMCID: PMC5758163 DOI: 10.1097/md.0000000000009191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Around 90% of sciatica cases are due to a herniated intervertebral disc in the lumbar region. Ankle acupuncture (AA) has been reported to be effective in the treatment of acute nonspecific low back pain. This study aims to evaluate the efficacy of a single session of ankle acupuncture for disc-related sciatica. METHOD This will be a double-blinded, randomized controlled clinical trial. Patients diagnosed with disc-related sciatica will be randomly divided into 3 parallel groups. The treatment group (n = 30) will receive ankle acupuncture. The 2 control groups will either undergo traditional needle manipulation (n = 30) or sham acupuncture (n = 30) at the same point as the treatment group. The primary outcome will be pain intensity on a visual analog scale (VAS). The secondary outcomes will be paresthesia intensity on a VAS and the Abbreviated Acceptability Rating Profile (AAPR). The success of blinding will be evaluated, and the needle-induced sensation and adverse events will be recorded. All outcomes will be evaluated before, during, and after the treatment. DISCUSSION This study will determine the immediate effect and specificity of ankle acupuncture for the treatment of disc-related sciatica. We anticipate that ankle acupuncture might be more effective than traditional needle manipulation or sham acupuncture. TRIAL REGISTRATION ChiCTR-IPR-15007127 (http://www.chictr.org.cn/showprojen.aspx?proj=11989).
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Affiliation(s)
- Anfeng Xiang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mingshu Xu
- Shanghai Yueyang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, China
| | - Yan Liang
- Shanghai Yueyang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, China
| | - Jinzi Wei
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sheng Liu
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Surgical management for lumbar disc herniation in pregnancy. J Gynecol Obstet Hum Reprod 2017; 46:753-759. [DOI: 10.1016/j.jogoh.2017.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/23/2017] [Accepted: 09/27/2017] [Indexed: 12/29/2022]
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Second opinion for degenerative spinal conditions: an option or a necessity? A prospective observational study. BMC Musculoskelet Disord 2017; 18:354. [PMID: 28818047 PMCID: PMC5561586 DOI: 10.1186/s12891-017-1712-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Second opinions may improve quality of patient care. The primary objective of this study was to determine the concordance between first and second diagnoses and opinions regarding need for spinal surgery among patients with back or neck pain that have been recommended spinal surgery. METHODS We performed a prospective observational study of patients who had been recommended for spinal surgery and received a second opinion between May 2011 and May 2012 at the Hospital Israelita Albert Einstein on the advice of their health insurance company. A physiatrist and orthopaedic surgeon independently performed the second assessment. If both agreed surgery was indicated, or consensus could not be reached, participants attended a spine review panel for a final recommendation. Descriptive analyses compared diagnoses and management plans of the first and second opinions. RESULTS Of 544 referred patients, 16 (2.9%) did not meet inclusion criteria, 43 (7.9%) refused participation and 485 were included. Diagnoses differed from the first opinion for 290 (59.8%). Diagnoses of cervical and lumbar radiculopathy were concordant in 36/99 (36.4%) and 116/234 (49.6%) respectively. The second opinion was for conservative treatment for 168 (34.6%) participants, 27 (5.6%) were not considered to have a spine condition, and 290 (59.8%) were referred to the review board. 60 participants did not attend the board review and therefore did not receive a final recommendation. Board review was conservative treatment for an additional 67 participants, 20 were not considered to have a spine condition and 143 participants were recommended surgery. Overall, 33.6% received a final opinion of surgery (143/425) although only 66 (15.5%) received the same surgical recommendation, 235 (55.3%) were advised to have conservative treatment, and 47 (11.1%) were not considered to have a spinal diagnosis. CONCLUSIONS We found a large discordance between first and second opinions regarding diagnosis and need for spinal surgery. This suggests that obtaining a second opinion could reduce potentially unnecessary surgery. TRIAL REGISTRATION Current Controlled Trials ISRCTN07143259 . Registered 21 November 2011.
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