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Ohyama S, Aoki Y, Inoue M, Nakajima T, Sato Y, Sato M, Yoh S, Takahashi H, Nakajima A, Eguchi Y, Orita S, Inage K, Shiga Y, Nakagawa K, Ohtori S. Reply to letter to the editor by Li et al. J Orthop Sci 2024:S0949-2658(24)00094-0. [PMID: 38902163 DOI: 10.1016/j.jos.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 06/22/2024]
Affiliation(s)
- Shuhei Ohyama
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan.
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan; Department of Orthopaedic Surgery, Oyumino Central Hospital, Chiba-city, Chiba, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Masashi Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Satoshi Yoh
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
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Zhou S, Xu F, Sun Z, Jiang S, Li Z, Han G, Li W. Preoperative and follow-up variations of psoas major muscle are related to S1 screw loosening in patients with degenerative lumbar spinal stenosis. BMC Musculoskelet Disord 2024; 25:418. [PMID: 38807200 PMCID: PMC11134934 DOI: 10.1186/s12891-024-07298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND It was reported the paraspinal muscle played an important role in spinal stability. The preoperative paraspinal muscle was related to S1 screw loosening. But the relationship between preoperative and postoperative change of psoas major muscle (PS) and S1 pedicle screw loosening in degenerative lumbar spinal stenosis (DLSS) patients has not been reported. This study investigated the effects of preoperative and follow-up variations in the psoas major muscle (PS) on the first sacral vertebra (S1) screw loosening in patients with DLSS. METHODS 212 patients with DLSS who underwent lumbar surgery were included. The patients were divided into the S1 screw loosening group and the S1 screw non-loosening group. Muscle parameters were measured preoperatively and at last follow-up magnetic resonance imaging. A logistic regression analysis was performed to investigate the risk factors for S1 screw loosening. RESULTS The S1 screw loosening rate was 36.32% (77/212). The relative total cross-sectional areas and relative functional cross-sectional areas (rfCSAs) of the PS at L2-S1 were significantly higher after surgery. The increased rfCSA values of the PS at L3-S1 in the S1 screw non-loosening group were significantly higher than those in the S1 screw loosening group. The regression analysis showed male, lower CT value of L1 and longer segment fusion were independent risk factors for S1 screw loosening, and postoperative hypertrophy of the PS was a protective factor for S1 screw loosening. CONCLUSIONS Compared to the preoperative muscle, the PS size increased and fatty infiltration decreased after surgery from L2-3 to L5-S1 in patients with DLSS after short-segment lumbar fusion surgery. Postoperative hypertrophy of the PS might be considered as a protective factor for S1 screw loosening. MRI morphometric parameters and postoperative selected exercise of PS for DLSS patients after posterior lumbar fusion surgery might contribute to improvement of surgical outcome.
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Affiliation(s)
- Siyu Zhou
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Fei Xu
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuoran Sun
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Shuai Jiang
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuofu Li
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Gengyu Han
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Weishi Li
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
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Wenghofer J, He Beange K, Ramos WC, Mavor MP, Graham RB. Dynamic assessment of spine movement patterns using an RGB-D camera and deep learning. J Biomech 2024; 166:112012. [PMID: 38443276 DOI: 10.1016/j.jbiomech.2024.112012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
In clinical practice, functional limitations in patients with low back pain are subjectively assessed, potentially leading to misdiagnosis and prolonged pain. This paper proposes an objective deep learning (DL) markerless motion capture system that uses a red-green-blue-depth (RGB-D) camera to measure the kinematics of the spine during flexion-extension (FE) through: 1) the development and validation of a DL semantic segmentation algorithm that segments the back into four anatomical classes and 2) the development and validation of a framework that uses these segmentations to measure spine kinematics during FE. Twenty participants performed ten cycles of FE with drawn-on point markers while being recorded with an RGB-D camera. Five of these participants also performed an additional trial where they were recorded with an optical motion capture (OPT) system. The DL algorithm was trained to segment the back and pelvis into four anatomical classes: upper back, lower back, spine, and pelvis. A kinematic framework was then developed to refine these segmentations into upper spine, lower spine, and pelvis masks, which were used to measure spine kinematics after obtaining 3D global coordinates of the mask corners. The segmentation algorithm achieved high accuracy, and the root mean square error (RMSE) between ground truth and predicted lumbar kinematics was < 4°. When comparing markerless and OPT kinematics, RMSE values were < 6°. This work demonstrates the feasibility of using markerless motion capture to assess FE spine movement in clinical settings. Future work will expand the studied movement directions and test on different demographics.
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Affiliation(s)
- Jessica Wenghofer
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Kristen He Beange
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada; Ottawa-Carleton Institute for Biomedical Engineering, Ottawa, ON, Canada
| | - Wantuir C Ramos
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Matthew P Mavor
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ryan B Graham
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Ottawa-Carleton Institute for Biomedical Engineering, Ottawa, ON, Canada.
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De Giorgio A, Angilletta S, Matteo B, Bonavolontà V, Bragazzi NL, Kuvačić G. Hatha yoga is more effective in improving kinesiophobia and subjective well-being when combined with self-compassion meditation in people with CLBP: a randomized control trial. Front Psychol 2023; 14:1272919. [PMID: 38054176 PMCID: PMC10694472 DOI: 10.3389/fpsyg.2023.1272919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/26/2023] [Indexed: 12/07/2023] Open
Abstract
Objective The present study aims to examine whether combining hatha yoga practice with self-compassion meditation could influence kinesiophobia, emotions, perceived stress, and perceived disability among individuals with chronic low back pain when compared with hatha yoga alone. Methods The randomized controlled study included 70 participants with chronic low back pain (CLBP) who were randomly assigned to a Hatha yoga group (HY; n = 35) or a Hatha yoga group plus self-compassion meditation (HYSCM; n = 35). Participants followed a protocol for 8 weeks, and the assessments were carried out before and after the intervention, with a follow-up evaluation conducted after one month. The participants completed the PANAS, PSS, TSK, and RMQ questionnaires. A Generalized Estimating Equation was used to explore the effect of interventions. Results Both HY and HYSCM groups improved kinesiophobia, perceived disability, and stress at the follow-up. However, the HYSCM group shown a more significant reduction in kinesiophobia compared to the HY group. Moreover, significant improvement in positive affect and a reduction in negative affect over time in the HYSCM group were observed. Conclusion Hatha yoga practice when combined with self-compassion meditation led to extra benefits by exhibiting a prolonged effect, especially on kinesiophobia positive and negative effects.
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Affiliation(s)
- Andrea De Giorgio
- Faculty of Psychology, eCampus University, Novedrate, Italy
- Klinikos Center for Psychodiagnostics and Psychotherapy, Rome, Italy
| | | | - Barbara Matteo
- Faculty of Psychology, eCampus University, Novedrate, Italy
| | - Valerio Bonavolontà
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, Faculty of Science, York University, Toronto, ON, Canada
| | - Goran Kuvačić
- Faculty of Kinesiology, University of Split, Split, Croatia
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Ma B, Smith A. Outpatient minimally invasive spine surgeries during the COVID-19 pandemic - A retrospective analysis of 164 consecutive cases. World Neurosurg X 2023; 20:100229. [PMID: 37456692 PMCID: PMC10344935 DOI: 10.1016/j.wnsx.2023.100229] [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: 12/28/2022] [Revised: 05/10/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To share our surgical experiences of minimally invasive cervical and lumbar procedures for patients who suffered from non-fatal motor vehicle accidents (MVAs) in the ambulatory surgery centers (ASCs) during the coronavirus disease 2019 (COVID-19) pandemic. Methods Anterior cervical discectomy and fusion (ACDF), anterior lumbar interbody fusion (ALIF), minimally invasive laminotomy and discectomy (MILD), percutaneous endoscopic laser-assisted discectomy (PELD) and percutaneous kyphoplasty (PK) were performed on carefully selected patients. Results From January 2020 to December 2021, our group performed 164 cases on 153 patients involving 249 intervertebral disc (IVD) levels. Of these, 116 cases (70.73%) on 114 patients (74.51%) were cervical, 48 cases (29.27%) were lumbar (including 8 PK cases). Eight patients had both cervical and lumbar procedures in a single anesthetic session (SAS) and were discharged on the same day. One hundred and six ACDF cases (92.17%) were at the C4-C5 and C5-C6 levels, which comprised of 146 (76.04%) IVDs. Of the 40 non-PK lumbar cases, 38 (95.0%) were at L4 to S1 lumbar levels. Six of these cases (15.0%) involved 2 lumbar levels. In contrast, 6 out of 8 kyphoplasties (75.0%) involved lower thoracic/higher lumbar vertebral columns (T11 to L2) and 2 were at the lower lumbar L4 level. Conclusions We successfully and safely performed various cervical and lumbar spine surgeries in the ASCs amid COVID-19 pandemic and all patients achieved the same-day discharge (SDD). In the non-fatal MVAs, mid-lower cervical (C4 to C6) and lower lumbar (L4 to S1) IVDs were the most affected levels.
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Huang W, Gong Z, Wang H, Zheng C, Chen Y, Xia X, Ma X, Jiang J. Use of MRI-based vertebral bone quality score (VBQ) of S1 body in bone mineral density assessment for patients with lumbar degenerative diseases. 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 2023; 32:1553-1560. [PMID: 36935451 DOI: 10.1007/s00586-023-07643-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/23/2023] [Accepted: 03/05/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE To evaluate the use of the modified and simplified vertebral bone quality (VBQ) method based on T1-weighted MRI images of S1 vertebrae in assessing bone mineral density (BMD) for patients with lumbar degenerative diseases. METHODS We reviewed the preoperative data of patients with lumbar degenerative diseases undergoing lumbar spine surgery between January 2019 and June 2022 with available non-contrast T1-weighted magnetic resonance imaging (MRI), computed tomography (CT) images and dual-energy X-ray absorptiometry (DEXA). S1 vertebral bone quality scores (S1 VBQ) and S1 CT Hounsfield units were measured with picture archiving and communication system (PACS). One-way ANOVA was applied to present the discrepancy between the S1 VBQ of patients with normal bone density (T-score ≥ - 1.0), osteopenia (- 2.5 < T-score < - 1.0) and osteoporosis (T-score ≤ - 2.5). The receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic performance of S1 VBQ in distinguishing low BMD. Statistical significance was set at p < 0.05. RESULTS A total of 207 patients were included. The S1 VBQ were significantly different between groups (p < 0.001). Interclass correlation coefficient for inter-rater reliability was 0.86 (95% CI 0.78-0.94) and 0.94(95% CI 0.89-0.98) for intra-rater reliability. According to the linear regression analysis, the S1 VBQ has moderate-to-strong correlations with DEXA T-score (r = - 0.48, p < 0.001). The area under the ROC curve indicated a predictive accuracy of 82%. A sensitivity of 77.25% with a specificity of 70% could be achieved for distinguishing low BMD by setting the S1 VBQ cutoff as 2.93. CONCLUSIONS The S1 VBQ was a promising tool in distinguishing poor bone quality in patients with lumbar degenerative diseases, especially in cases where the previously reported VBQ method based on L1-L4 was not available. S1 VBQ score could be useful as opportunistic assessment for screening and complementary evaluation to DEXA T-score before surgery.
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Affiliation(s)
- Weibo Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Zhaoyang Gong
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Chaojun Zheng
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Yu Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Xinlei Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China.
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Xu F, Zhou S, Li Z, Jiang S, Chen Z, Sun Z, Li W. The 6 degrees-of-freedom range of motion of the L1-S1 vertebrae in young and middle-aged asymptomatic people. Front Surg 2022; 9:1002133. [PMID: 36386544 PMCID: PMC9643460 DOI: 10.3389/fsurg.2022.1002133] [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: 07/24/2022] [Accepted: 09/28/2022] [Indexed: 01/25/2023] Open
Abstract
STUDY DESIGN Controlled laboratory study. OBJECTIVE To determine the 6 degrees of freedom of lumbar vertebra in vivo during different functional activities in young and middle-aged asymptomatic subjects. METHODS A total of 26 asymptomatic subjects (M/F, 15/11; age, 20-55 years) were recruited in this study. They were divided into two groups: young group (number: 14; age: 20-30 years old) and middle-aged group (number: 12; age: 45-55 years old). The lumbar segment of each subject was scanned by computed tomography for the construction of three-dimensional (3D) models of the vertebra from L1 to S1. The lumbar spine was imaged by using a dual fluoroscopic system when the subjects performed different trunk postures. The 3D models of vertebrae were matched to two fluoroscopic images simultaneously in software. The range of motion (ROM) of vertebrae in the young and middle-aged groups was compared by using multiway analysis of variance, respectively. RESULTS During the supine to the upright posture, vertebral rotation of the L1-S1 occurred mainly around the mediolateral axis (mean: 3.9 ± 2.9°). Along the mediolateral axis, vertebral translation was significantly lower at L1-2 (7.7 ± 2.4 mm) and L2-3 (8.0 ± 3.5 mm) than at L3-4 (1.6 ± 1.2 mm), L4-5 (3.3 ± 2.6 mm), and L5-S1 (2.6 ± 1.9 mm). At the L4-5 level, the young group had a higher rotational ROM than the middle-aged group around all three axes during left-right bending. Along the anteroposterior axis, the young group had a lower translational ROM at L4-5 than the middle-aged group during left-right bending (4.6 ± 3.3 vs. 7.6 ± 4.8 mm; P < 0.05). At L5-S1, the young group had a lower translational ROM than the middle-aged group during flexion-extension, left-right bending, and left-right torsion. CONCLUSION This study explored the lumbar vertebral ROM at L1-S1 during different functional postures in both young and middle-aged volunteers. There were higher coupled translations at L3-4 and L4-5 than at the upper lumbar segments during supine to upright. The vertebral rotation decreased with age. In addition, the older subjects had a higher anteroposterior translation at the L4-5 segment and higher mediolateral translation at the L5-S1 segment than the young group. These data might provide basic data to be compared with spinal pathology.
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Affiliation(s)
- Fei Xu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Peking University Health Science Center, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Siyu Zhou
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuofu Li
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Peking University Health Science Center, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Shuai Jiang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Ze Chen
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Peking University Health Science Center, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuoran Sun
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Weishi Li
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China,Correspondence: Weishi Li
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Zhou L, Li C, Zhang H. Correlation between bone mineral density of different sites and lumbar disc degeneration in postmenopausal women. Medicine (Baltimore) 2022; 101:e28947. [PMID: 35421060 PMCID: PMC9276261 DOI: 10.1097/md.0000000000028947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 02/09/2022] [Indexed: 01/04/2023] Open
Abstract
Osteoporosis and lumbar disc degeneration (LDD) have been common causes that make increasing patients suffer from different degrees of low back pain. At present, whether osteoporosis degenerates or protects disc is still controversial, and the correlation between hip bone mineral density (BMD) and LDD still remains unclear. Our study aims to analyze the correlation between BMD of different sites and LDD in postmenopausal women, and explore the potential pathophysiological mechanism of them.One hundred ninety-five postmenopausal female patients were enrolled and divided into osteoporosis, osteopenia, and normal bone mass groups. Their BMD and lumbar spine magnetic resonance imaging were retrospectively analyzed. Two spine surgeons were selected to assess LDD according to Pfirrmann grading system.Based on lumbar BMD, LDD of normal bone mass group was more severe than the other 2 groups in L1/2 and L2/3 segments (P < .05). Based on hip BMD, LDD of each disc from L1/2 to L5/S1 had no significant difference among the 3 groups (P > .05). Lumbar BMD (L1-L4) was positively correlated with corresponding degree of LDD (L1/2-L4/5) (P < .05), whereas there was no correlation between hip BMD and degree of LDD (P = .328).There is a positive correlation between lumbar BMD and LDD in postmenopausal women, which is more obvious in the upper lumbar spinal segments (L1, L2). However, there is no correlation between hip BMD and LDD, suggesting that in postmenopausal women with lumbar degenerative disease, hip BMD is more suitable for the diagnosis of osteoporosis.
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Xu F, Zhou S, Zou D, Li W, Sun Z, Jiang S. The relationship between S1 screw loosening and postoperative outcome in patients with degenerative lumbar scoliosis. BMC Musculoskelet Disord 2022; 23:186. [PMID: 35227237 PMCID: PMC8883643 DOI: 10.1186/s12891-022-05107-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background When choosing S1 as the lowest level of instrumentation, there are many complications may come out such as S1 screw loosening. Facing this problem, there has been various techniques for the protection of S1 screw including sacropelvic fixation, bicortical or tricortical insertion of S1 screw. Objective This study aimed to explore the risk factors for the S1 screw loosening, then to demonstrate the relationship between S1 screw loosening and postoperative outcome for patients with degenerative lumbar scoliosis (DLS). Methods Patients who underwent lumbosacral fixation for DLS were evaluated retrospectively. They were divided into two groups according to the S1 pedicle screw at the follow-up. Age, gender, bone mineral density, body mass index, history of smoking, the number of instrumented levels, comorbidities, complications and radiological parameters were collected. We established logistic regression analysis to determine independent risk factors for S1 screw loosening and multiple linear regression to identify whether S1 screw loosening would influence postoperative clinical outcome. Results S1 screw loosening rate was up to 41.0% (32/78). Patients were older in the S1 screw loosening group than those in the control group (P < 0.05). Compared with the control group, the rate of osteoporosis was higher in screw loosening group than that in the control group (P < 0.05). Older age and osteoporosis were independent risk factors for S1 screw loosening (P < 0.05). In the screw loosening group, the rate of hypertension was higher than that in the control group (P < 0.05). The relationship of S1 screw loosening and ODI was not significant in the multiple linear regression (P > 0.05). The clinical outcome was similar in the S1 screw loosening group and control group (P > 0.05). Conclusion Older age and osteoporosis are independent risk factors for the S1 screw loosening. Patients with complication of S1 screw loosening are not always along with worse clinical outcome. We should consider potential benefit, complications and medical cost when choosing the lowest instrumented vertebrae for patients with DLS.
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Affiliation(s)
- Fei Xu
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.,Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Reasearch, Beijing, China
| | - Siyu Zhou
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.,Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Reasearch, Beijing, China
| | - Da Zou
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.,Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Reasearch, Beijing, China
| | - Weishi Li
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China. .,Beijing Key Laboratory of Spinal Disease Reasearch, Beijing, China.
| | - Zhuoran Sun
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Reasearch, Beijing, China
| | - Shuai Jiang
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.,Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Reasearch, Beijing, China
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Does vitamin D status influence lumbar disc degeneration and low back pain in postmenopausal women? A retrospective single-center study. ACTA ACUST UNITED AC 2021; 27:586-592. [PMID: 32049928 DOI: 10.1097/gme.0000000000001499] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the relationship between serum vitamin D concentration and lumbar disc degeneration (LDD) in postmenopausal women and the epidemiologic factors affecting low back pain (LBP). METHODS Between July 2017 and December 2018, 232 participants were retrospectively enrolled. Serum concentrations of bone turnover markers were measured using electrochemiluminescence assays. Disc degeneration was evaluated using the Pfirrmann grading system. Other variables were assessed using relevant questionnaires. RESULTS The mean age of the women was 65.6 ± 10.1 and their serum 25(OH)D concentrations were 19.38 ± 9.21 ng/mL. The prevalences of severe vitamin D deficiency (<10 ng/mL) and normal status (>30 ng/mL) were 12.9% and 12.5%, respectively. The severely deficient group had higher visual analog scale (VAS) scores for LBP (P = 0.002) and lower bone mineral density T scores (P = 0.004) than the other groups. Lower 25(OH)D concentration (<10 ng/mL) was significantly associated with more severe LDD in the lumbosacral region (L4-S1, L1-S1, P < 0.05), but less so in the upper lumbar region. There was an inverse relationship between vitamin D concentration and the severity of disc degeneration (L2-L3, L4-S1, L1-S1, P < 0.05). After adjustment for confounding factors, smoking, vitamin D deficiency, lack of vitamin D supplementation, high body mass index, and low bone mineral density T score were associated with higher incidence of moderate-to-severe pain in postmenopausal women (P < 0.05). CONCLUSIONS Vitamin D deficiency is associated with LDD and LBP in postmenopausal women. Specifically, a serum vitamin D concentration < 10 ng/mL is a marker of severe LDD and LBP. Smoking, severe vitamin D deficiency, lack of vitamin D supplementation, high body mass index, and osteoporosis are associated with a higher prevalence of moderate-to-severe pain.
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Tavakoli J, Diwan AD, Tipper JL. Elastic fibers: The missing key to improve engineering concepts for reconstruction of the Nucleus Pulposus in the intervertebral disc. Acta Biomater 2020; 113:407-416. [PMID: 32531396 DOI: 10.1016/j.actbio.2020.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/24/2020] [Accepted: 06/03/2020] [Indexed: 12/20/2022]
Abstract
The increasing prevalence of low back pain has imposed a heavy economic burden on global healthcare systems. Intense research activities have been performed for the regeneration of the Nucleus Pulposus (NP) of the IVD; however, tissue-engineered scaffolds have failed to capture the multi-scale structural hierarchy of the native tissue. The current study revealed for the first time, that elastic fibers form a network across the NP consisting of straight and thick parallel fibers that were interconnected by wavy fine fibers and strands. Both straight fibers and twisted strands were regularly merged or branched to form a fine elastic network across the NP. As a key structural feature, ultrathin (53 ± 7 nm), thin (215 ± 20 nm), and thick (890 ± 12 nm) elastic fibers were observed in the NP. While our quantitative analysis for measurement of the thickness of elastic fibers revealed no significant differences (p < 0.633), the preferential orientation of fibers was found to be significantly different (p < 0.001) across the NP. The distribution of orientation for the elastic fibers in the NP represented one major organized angle of orientation except for the central NP. We found that the distribution of elastic fibers in the central NP was different from those located in the peripheral regions representing two symmetrically organized major peaks (±45⁰). No significant differences in the maximum fiber count at the major angles of orientation (±45⁰) were observed for both peripheral (p = 0.427) and central NP (p = 0.788). Based on these new findings a structural model for the elastic fibers in the NP was proposed. The geometrical presentation, along with the distribution of elastic fibers orientation, resulting from the present study identifies the ultrastructural organization of elastic fibers in the NP important towards understanding their mechanical role which is still under investigation. Given the results of this new geometrical analysis, more-accurate multiscale finite element models can now be developed, which will provide new insights into the mechanobiology of the IVD. In addition, the results of this study can potentially be used for the fabrication of bio-inspired tissue-engineered scaffolds and IVD models to truly capture the multi-scale structural hierarchy of IVDs. STATEMENT OF SIGNIFICANCE: Visualization of elastic fibers in the nucleus of the intervertebral disk under high magnification was not reported before. The present research utilized extracellular matrix partial digestion to address significant gaps in understanding of nucleus microstructure that can potentially be used for the fabrication of bio-inspired tissue-engineered scaffolds and disk models to truly capture the multi-scale structural hierarchy of discs.
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Zou D, Li W, Xu F, Du G. Use of Hounsfield units of S1 body to diagnose osteoporosis in patients with lumbar degenerative diseases. Neurosurg Focus 2020; 46:E6. [PMID: 31042659 DOI: 10.3171/2019.2.focus18614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe aim of this study was to evaluate the use of Hounsfield unit (HU) values of the S1 body to diagnose osteoporosis in patients with lumbar degenerative diseases.METHODSThe records of 316 patients of ages ≥ 50 years and requiring surgery for lumbar degenerative diseases were reviewed. The bone mineral density (BMD) of the S1 body and L1 was measured in HU with preoperative lumbar CT. Circular regions of interest (ROIs) were placed on midaxial and midsagittal images of the S1 body. Dual-energy x-ray absorptiometry (DXA) and the criterion of L1 HU ≤ 110 HU were used to diagnose osteoporosis. The area under the receiver operating characteristic curve (AUC) was calculated to assess the use of HUs of the S1 body to diagnose osteoporosis.RESULTSThe interobserver and intraobserver reliability of measuring HU of the S1 body was excellent with intraclass correlation coefficients over 0.8 (p < 0.001). The correlation between HUs of the S1 body and average T-score of L1-4 was significant with Pearson correlation coefficients ≥ 0.60 (p < 0.001). The AUCs for using HUs of the S1 body to diagnose osteoporosis were 0.86 and 0.88 for axial HU and sagittal HU, respectively (p < 0.001). The HU thresholds with balanced sensitivity and specificity for diagnosing osteoporosis were 202 HU for axial HU (sensitivity: 76%; specificity: 76%) and 185 HU for sagittal HU (sensitivity: 80%; specificity: 80%).CONCLUSIONSBoth sagittal and axial HUs of the S1 body are useful tools for assessing BMD and diagnosing osteoporosis. Measuring HUs of the S1 body preoperatively from lumbar CT may help with surgical planning for patients with lumbar degenerative diseases.
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Affiliation(s)
- Da Zou
- 1Orthopaedic Department, Peking University Third Hospital; and.,2Peking University Health Science Center, Haidian District, Beijing, People's Republic of China
| | - Weishi Li
- 1Orthopaedic Department, Peking University Third Hospital; and
| | - Fei Xu
- 1Orthopaedic Department, Peking University Third Hospital; and
| | - Guohong Du
- 1Orthopaedic Department, Peking University Third Hospital; and
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Yin J, Liu Z, Li C, Luo S, Lai Q, Wang S, Zhang B, Wan Z. Effect of facet-joint degeneration on the in vivo motion of the lower lumbar spine. J Orthop Surg Res 2020; 15:340. [PMID: 32819395 PMCID: PMC7439653 DOI: 10.1186/s13018-020-01826-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
Objective This research studied the in vivo motion characteristics of the L3–S1 lumbar spine with facet-joint degeneration during functional activities. Methods Thirteen male and 21 female patients with facet-joint degeneration at the L3–S1 spinal region were included in the study. The L3–S1 lumbar segments of all the patients were divided into 3 groups according to the degree of facet-joints degeneration (mild, moderate, or severe). The ranges of motion (ROM) of the vertebrae were analyzed using a combination of computed tomography and dual fluoroscopic imaging techniques. During functional postures, the ROMs were compared between the 3 groups at each spinal level (L3–L4, L4–L5, and L5–S1). Results At L3–L4 level, the primary rotations between the mild and moderate groups during left-right twisting activity were significantly different. At L4–L5 level, the primary rotation of the moderate group was significantly higher than the other groups during flexion-extension. During left-right bending activities, a significant difference was observed only between the moderate and severe groups. At L5–S1 level, the rotation of the moderate group was significantly higher than the mild group during left-right bending activity. Conclusions Degeneration of the facet joint alters the ROMs of the lumbar spine. As the degree of facet-joint degeneration increased, the ROMs of the lumbar vertebra that had initially increased declined. However, when there was severe facet-joint degeneration, the ROMs of the lumbar spine declined to levels comparative to the moderate group. The relationship between the stability of the lumbar vertebra and the degree of facet-joint degeneration requires further study.
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Affiliation(s)
- Jun Yin
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, Jiangxi, 330006, PR China
| | - Zhang Liu
- Science and Technology Office, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Chao Li
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, Jiangxi, 330006, PR China
| | - Shiwei Luo
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, Jiangxi, 330006, PR China
| | - Qi Lai
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, Jiangxi, 330006, PR China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Bin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, Jiangxi, 330006, PR China
| | - Zongmiao Wan
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, Jiangxi, 330006, PR China.
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Mesregah MK, Lee H, Roberts S, Gardner C, Shah I, Buchanan IA, Li C, Buser Z, Wang JC. Evaluation of facet joints and segmental motion in patients with different grades of L5/S1 intervertebral disc degeneration: a kinematic MRI study. 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 2020; 29:2609-2618. [PMID: 32504265 DOI: 10.1007/s00586-020-06482-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/27/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to evaluate facet joint parameters and osteoarthritis grades, and segmental angular and translational motions among different grades of L5/S1 intervertebral disc (IVD) degeneration. METHODS This retrospective study analysed kinematic magnetic resonance imaging (kMRI) images of the lumbar spine of 214 patients with low back pain. Degenerations of the L5/S1 IVDs and facet joints osteoarthritis were assessed using the Pfirrmann and Pathria grading scales, respectively. Facet joint parameters included facet joint angle and facet joint space width. Angular and translation segmental motions were measured using MRI Analyzer software. RESULTS The mean age of the studied patients was 44.1 ± 13.9 years. Patients with L5/S1 disc degeneration were associated with higher odds of facet joint osteoarthritis (odds ratio = 2.28, 95% confidence interval = 1.23-4.23, P = 0.008). There was a positive correlation between L5/S1 disc degeneration grade and the facet joint grade (r = 0.365, P > 0.001). Grade IV facet joint osteoarthritis did not appear in grades I or II disc degeneration (P > 0.001). The average facet joint width decreased significantly with increasing Pfirrmann grading (P = 0.017). The difference in facet joint angle between groups was not statistically significant (P = 0.532). The differences in the angular and translational motions were not statistically significant (P = 0.530, and 0.510, respectively). CONCLUSION A positive correlation exists between L5/S1 disc degeneration and facet joint osteoarthritis grades. The facet joint space width decreases significantly with increasing grade of disc degeneration.
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Affiliation(s)
- Mohamed Kamal Mesregah
- Department Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90033, USA.,Department Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Haiyin Lee
- Department Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90033, USA.,Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Sidney Roberts
- Department Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90033, USA
| | - Carson Gardner
- Department Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90033, USA
| | - Ishan Shah
- Department Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90033, USA
| | - Ian A Buchanan
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Changqing Li
- Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Zorica Buser
- Department Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90033, USA.
| | - Jeffrey C Wang
- Department Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90033, USA
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Byrne RM, Aiyangar AK, Zhang X. A Dynamic Radiographic Imaging Study of Lumbar Intervertebral Disc Morphometry and Deformation In Vivo. Sci Rep 2019; 9:15490. [PMID: 31664074 PMCID: PMC6820767 DOI: 10.1038/s41598-019-51871-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/04/2019] [Indexed: 12/11/2022] Open
Abstract
Intervertebral discs are important structural components of the spine but also are significant sources of morbidity, especially for the “low back” lumbar region. Mechanical damage to, or degeneration of, the lumbar discs can diminish their structural integrity and elicit debilitating low back pain. Advancement of reparative or regenerative means to treat damaged or degenerated discs is hindered by a lack of basic understanding of the disc load-deformation characteristics in vivo. The current study presents an in vivo analysis of the morphometry and deformation of lumbar (L2-S1) intervertebral discs in 10 healthy participants while performing a common lifting act, using novel dynamic radiographic imaging of the lumbar vertebral body motion. Data analyses show uniquely different (p < 0.05) characteristics in morphometry, normal and shear strain patterns of the L5S1 discs, while the rest of lumbar discs exhibit great similarity. In particular shear strains in L2-L5 discs exhibited stronger linear correlations (R2 ≥ 0.80) between strain changes and amount of lumbar flexion-extension motion compared to L5S1 (R2 ≤ 0.5). The study therefore advances the state of knowledge on in vivo mechanical responses of the lumbar intervertebral discs during functional tasks.
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Affiliation(s)
- Ryan M Byrne
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Ameet K Aiyangar
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15203, USA.,Mechanical Systems Engineering, EMPA (Swiss Federal Laboratories for Materials Science and Technology), 8600, Duebendorf, Switzerland
| | - Xudong Zhang
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX, 77843, USA. .,Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA. .,Department of Mechanical Engineering, Texas A&M University, College Station, TX, 77843, USA.
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16
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Sritharan K, Chamoli U, Kuan J, Diwan AD. Assessment of degenerative cervical stenosis on T2-weighted MR imaging: sensitivity to change and reliability of mid-sagittal and axial plane metrics. Spinal Cord 2019; 58:238-246. [PMID: 31558777 DOI: 10.1038/s41393-019-0358-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/18/2019] [Accepted: 09/05/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A retrospective cross-sectional study. OBJECTIVE To assess the sensitivity to change and reliability of various mid-sagittal and axial plane metrics in the assessment of patients with single-level degenerative cervical stenosis on T2-weighted MR imaging. SETTING A diagnostic MR imaging facility in Sydney (Australia). METHODS We retrospectively reviewed T2-weighted MR images of 85 consecutive patients (48 M and 37 F) with single-level degenerative cervical stenosis. Canal compromise and cord compression were evaluated using three mid-sagittal plane metrics (M1, M2, and M3) and two axial plane metrics (M4 and M5), at the level of stenosis and nonstenotic cephalad and caudal levels (controls). Sensitivity to change (SC) for each metric was evaluated as the percentage deviation of the measured value from the estimated normal value based on cephalad and caudal controls. Reliability for each metric was evaluated using intraclass correlation coefficients. RESULTS Degenerative cervical stenosis showed a bimodal distribution peaking at C5-6 (n = 32) and C3-4 (n = 29) levels. The changes in the canal and cord geometry along the rostrocaudal axis were inconsistent. Across all individual subjects (reflecting a range of stenosis severity), M3 (-32.87% ± 10.60%) was more sensitive to change compared with M1 (16.64% ± 16.48%) and M2 (-23.95% ± 11.12%). Similarly, M4 (-24.62% ± 12.17%) was more sensitive to change compared with M5 (-6.71% ± 11.08%). The level of reliability was "moderate" to "excellent" for mid-sagittal plane measurements, and "poor" to "excellent" for axial plane measurements. CONCLUSION Changes in canal dimensions in the mid-sagittal plane and cord shape in the axial plane are sensitive indicators of degenerative cervical stenosis on T2-weighted MR images.
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Affiliation(s)
- Keerthana Sritharan
- Spine Labs, St. George & Sutherland Clinical School, University of New South Wales Australia, Kogarah, Sydney, NSW, 2217, Australia
| | - Uphar Chamoli
- Spine Labs, St. George & Sutherland Clinical School, University of New South Wales Australia, Kogarah, Sydney, NSW, 2217, Australia. .,School of Biomedical Engineering, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
| | - Jeffrey Kuan
- St George MRI, Kirk Place, 1/15 Kensington Street, Kogarah, Sydney, NSW, 2217, Australia
| | - Ashish D Diwan
- Spine Labs, St. George & Sutherland Clinical School, University of New South Wales Australia, Kogarah, Sydney, NSW, 2217, Australia
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Bony stress in the lumbar spine is associated with intervertebral disc degeneration and low back pain: a retrospective case-control MRI study of patients under 25 years of age. 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 2019; 28:2470-2477. [PMID: 31529214 DOI: 10.1007/s00586-019-06148-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/04/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Abnormal stress in the lumbar vertebra, also known as bony stress, can be a precursor to degenerative changes which may manifest as low back pain (LBP). However, the prevalence of bony stress in the lumbar spine and its relationship with degenerative changes and LBP is unclear. The purpose of this study was to evaluate the prevalence of bony stress in the lumbar spine and its relationship with intervertebral disc (IVD) degeneration, facet osteoarthritis and LBP in patients under 25 years of age. METHODS A retrospective case-control study of 130 patients under 25 years of age was conducted from a population of 493 patients who had lumbar MRI across three imaging centres over three years. A cohort of 55 consecutive patients with bony stress was identified. A control group of consecutive patients (n = 75) without bony stress was also selected from the population. RESULTS Bony stress was prevalent in 11% (95% CI [8.4-14.5%]) of patients and was not diagnosed in 36% (95% CI [22-55%]) of these cases. Patients with bony stress had over twofold (OR 2.3, 95% CI [1.1-4.8]) and fivefold (OR 5.3, 95% CI [2.11-13.3]) higher likelihood of having IVD degeneration and LBP, respectively, when compared with the control group. Bony stress was not found to be associated with facet osteoarthritis. CONCLUSION Bony stress in the lumbar spine was prevalent in 11% of patients under 25 years of age. It was commonly undiagnosed in radiology reports (not reported in 36% of the cases). Being significantly associated and with an increased likelihood of IVD degeneration and LBP, we posit that bony stress is likely a symptomatic and clinically meaningful diagnostic entity in the assessment of LBP. These slides can be retrieved under Electronic Supplementary Material.
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Feigl GC, Mattersberger C, Rosmarin W, Likar R, Avila González C. [Lumbar CT-guided radiofrequency ablation of the medial branch of the dorsal ramus of the spinal nerve : Anatomic study and description of a new technique]. Schmerz 2019; 32:99-104. [PMID: 29564634 DOI: 10.1007/s00482-018-0283-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The success of radiofrequency ablation (RF) of the medial branch of the dorsal ramus in patients with facet joint pain depends on the effective coagulation distance. To date, computed tomography(CT)-guided techniques do not reach the nerve in parallel but rather than punctually. We report a new CT-guided technique to enhance parallelism and proximity of the RF needle to the nerve. MATERIALS AND METHODS Two examiners with different experience with CT-guided procedures in corpses performed all punctures at the lumbar spine on 10 corpses. A RF needle was inserted 1 cm lateral to the spinous process of the vertebra located caudal to the target nerve. The needle was advanced under CT guidance at a flat angle between the superior articular process and the base of the costal or transverse process of the cranial vertebra. The position was verified by dissection. Needle position was judged successful provided the needle could be positioned in the first attempt with no more than one angle correction. RESULTS In 86 out of 100 possible cases (50 per side) at the 5 lumbar segments, the RF needle could be depicted by CT in the target area with no more than one correction of the needle position. Anatomical dissections revealed that 47 out of 86 needles (54.6%) fulfilled the requirements of parallelism and proximity to the nerve. The dorsal ramus was never reached by the RF needle. Higher success rates were obtained in the middle segments compared to the border segments of L1-L2 and L5-S1. CONCLUSIONS We could demonstrate that the principle of parallelism and proximity of the needle to the nerve could be fulfilled with this new technique; however, needle positioning requires practice due to the oblique puncture direction.
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Affiliation(s)
- G C Feigl
- Institut für makroskopische und klinische Anatomie, Medizinische Universität Graz, Harrachgasse 21, 8010, Graz, Österreich.
| | - C Mattersberger
- Institut für makroskopische und klinische Anatomie, Medizinische Universität Graz, Harrachgasse 21, 8010, Graz, Österreich
| | - W Rosmarin
- Institut für makroskopische und klinische Anatomie, Medizinische Universität Graz, Harrachgasse 21, 8010, Graz, Österreich
| | - R Likar
- Abteilung für Anästhesie und Intensivmedizin, LKH Klagenfurt, Klagenfurt, Österreich
| | - C Avila González
- Klinik für Anästhesiologie, Intensiv‑, Palliativ- und Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
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Yu M, Wang X. Letter to the Editor concerning "Is L5-S1 motion segment different from the rest? A radiographic kinematic assessment of 72 patients with chronic low back pain" by AB Sabnis et al. (Eur Spine J; 27(5):1127-1135). 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 2019; 28:1248. [PMID: 29931566 DOI: 10.1007/s00586-018-5672-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Miao Yu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xu Wang
- Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7E-2, 9220, Aalborg, Denmark.
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China.
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Kuvačić G, Fratini P, Padulo J, Antonio DI, De Giorgio A. Effectiveness of yoga and educational intervention on disability, anxiety, depression, and pain in people with CLBP: A randomized controlled trial. Complement Ther Clin Pract 2018; 31:262-267. [DOI: 10.1016/j.ctcp.2018.03.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/07/2018] [Accepted: 03/14/2018] [Indexed: 12/13/2022]
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