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Lawan A, Leung A, Leung S, Faul J, Umoh JU, Holdsworth DW, Bryant DM, Battié MC. Detection and Characterization of Endplate Structural Defects on CT: A Diagnostic Accuracy Study. Spine (Phila Pa 1976) 2024; 49:1219-1226. [PMID: 38282481 DOI: 10.1097/brs.0000000000004936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
STUDY DESIGN Diagnostic test study. OBJECTIVE To determine the reliability and validity or diagnostic accuracy of two previously described endplate structural defect (EPSD) assessment methods. SUMMARY OF BACKGROUND DATA Studies of EPSD may further the understanding of pathoanatomic mechanisms underlying back pain. However, clinical imaging methods used to document EPSD have not been validated, leaving uncertainty about what the observations represent. MATERIALS AND METHODS Using an evaluation manual, 418 endplates on CT sagittal slices obtained from 19 embalmed cadavers (9 men and 10 women, aged 62-91 yr) were independently assessed by two experienced radiologists and a novice for EPSD using the two methods. The corresponding micro-CT (µCT) from the harvested T7-S1 spines were assessed by another independent rater with excellent intra-rater reliability (k=0.96). RESULTS Inter-rater reliability was good for the presence (k=0.60-0.69) and fair for specific phenotypes (k=0.43-0.58) of EPSD. Erosion, for which the Brayda-Bruno classification lacked a category, was mainly (82.8%) classified as wavy/irregular, while many notched defects (n=15, 46.9%) and Schmorl's nodes (n=45, 79%) were recorded as focal defects using Feng's classification. When compared to µCT, endplate fractures (n=53) and corner defects (n=28) were routinely missed on CT. Endplates classified as wavy/irregular on CT corresponded to erosion (n=29, 21.2%), jagged defects (n=21, 15.3%), calcification (n=19, 13.9%), and other phenotypes on µCT. Some focal defects on CT represented endplate fractures (n=21, 27.6%) on µCT. Overall, with respect to the presence of an EPSD, there was a sensitivity of 70.9% and a specificity of 79.1% using Feng's method, and 79.5% and 57.5% using Brayda-Bruno's method. Poor to fair inter-rater reliability (k=0.26-0.47) was observed for defect dimensions. CONCLUSION There was good inter-rater reliability and evidence of criterion validity supporting assessments of EPSD presence using both methods. However, neither method contained all needed EPSD phenotypes for optimal sensitivity, and specific phenotypes were often misclassified.
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Affiliation(s)
- Aliyu Lawan
- Faculty of Health Sciences, School of Physical Therapy, and Western's Bone and Joint Institute, Western University, London, ON, Canada
| | - Andrew Leung
- Department of Medical Imaging, Victoria Hospital, London Health Sciences Centre, London, ON, Canada
| | - Stephanie Leung
- Department of Medical Imaging, Victoria Hospital, London Health Sciences Centre, London, ON, Canada
| | - James Faul
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Joseph U Umoh
- Preclinical Imaging Research Centre, Robarts Research Institute, Western University, London, ON, Canada
| | - David W Holdsworth
- Preclinical Imaging Research Centre, Robarts Research Institute, Western University, London, ON, Canada
- Departments of Medical Biophysics and Surgery, Western University, London, ON, Canada
| | - Dianne M Bryant
- Faculty of Health Sciences, School of Physical Therapy, and Western's Bone and Joint Institute, Western University, London, ON, Canada
| | - Michele C Battié
- Faculty of Health Sciences, School of Physical Therapy, and Western's Bone and Joint Institute, Western University, London, ON, Canada
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Duan Y, Feng D, Zou K, Yang F, Chen R, Huang Y. The Relationship Between Modic Changes and Endplate Sclerosis in Patients with Lumbar Degenerative Disease: A Systematic Review and Network Meta-Analysis. World Neurosurg 2024; 186:7-16. [PMID: 38479643 DOI: 10.1016/j.wneu.2024.03.017] [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: 02/11/2024] [Accepted: 03/05/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To explore the relationship between modic changes (MCs) and endplate sclerosis in patients with lumbar degenerative disease. METHODS This network meta-analysis was performed on the basis of Preffered Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement. This study was registered at the International Prospective Register of Systematic Reviews (CRD42024497370). We performed a systematic search of the PubMed, Web of Science, Embase, China national knowledge infrastructure, China Science and Technology Journal Database, and Wanfang databases from inception to December 22, 2023. STATA13.0 and RevMan 5.3 were applied to perform the meta-analysis. RESULTS Seven studies with a total of 1510 endplates were divided into 6 groups according to the type of MCs. The endplate sclerosis rate in the single-type group was significantly lower than that in the mixed-type group. The endplate sclerosis rate in the type I MC (MC1) was significantly lower than that in the type II MC (MC2). The endplate sclerosis rate in the MC2 was significantly lower than that in the type III MC (MC3). The endplate sclerosis rate in the MC1/2 was significantly lower than that in the MC2/3. No significant difference was detected between MC1/2 and MC1/3 or between MC2/3 and MC1/3. For decreasing the endplate sclerosis rate, the order of the different types of MCs was MC1>MC2>MC1/2>MC2/3≈MC1/3>MC3. CONCLUSIONS Endplate sclerosis occurs in all kinds of MCs. With increasing grade of MCs, the incidence of endplate sclerosis gradually increased. The endplate sclerosis rate in mixed-type MCs was significantly greater than that in MC2 and significantly lower than that in MC3. The endplate sclerosis rate in the mixed-type, including MC3 (MC1/3 and MC2/3), was significantly greater than that in the MC1/2.
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Affiliation(s)
- Yuchen Duan
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dagang Feng
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Kai Zou
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fei Yang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Rigao Chen
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yong Huang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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Segar AH, Baroncini A, Urban JPG, Fairbank J, Judge A, McCall I. Obesity increases the odds of intervertebral disc herniation and spinal stenosis; an MRI study of 1634 low back pain patients. 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 2024; 33:915-923. [PMID: 38363366 DOI: 10.1007/s00586-024-08154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/13/2023] [Accepted: 01/20/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE The objective of this study was to examine the relationships between BMI and intervertebral disc degeneration (DD), disc herniation (DH) and spinal stenosis (SS) using a large, prospectively recruited and heterogeneous patient population. METHODS Patients were recruited through the European Genodisc Study. An experienced radiologist scored MRI images for DD, DH and SS. Multivariate linear and logistic regression analyses were used to model the relationship between these variables and BMI with adjustment for patient and MRI confounders. RESULTS We analysed 1684 patients with a mean age of 51 years and BMI of 27.2 kg/m2.
The mean DD score was 2.6 (out of 5) with greater DD severity with increasing age (R2 = 0.44). In the fully adjusted model, a 10-year increase in age and a 5 kg/m2 increase in BMI were associated, respectively, with a 0.31-unit [95% CI 0.29,0.34] and 0.04-unit [CI 0.01,0.07] increase in degeneration. Age (OR 1.23 [CI 1.06,1.43]) and BMI (OR 2.60 [CI 2.28,2.96]) were positively associated with SS. For DH, age was a negative predictor (OR 0.70 [CI 0.64,0.76]) but for BMI (OR 1.19 [CI 1.07,1.33]), the association was positive. BMI was the strongest predictor of all three features in the upper lumbar spine. CONCLUSIONS While an increase in BMI was associated with only a slight increase in DD, it was a stronger predictor for DH and SS, particularly in the upper lumbar discs, suggesting weight loss could be a useful strategy for helping prevent disorders associated with these pathologies.
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Affiliation(s)
- Anand H Segar
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | | | - Jocelyn P G Urban
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Jeremy Fairbank
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Andrew Judge
- Centre for Statistics in Medicine, Nuffield, Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, UK
| | - Iain McCall
- Department of Radiology, Robert Jones and Agnes Hunt Hospital, Oswestry, UK
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Wang HS, Lin S, Yu HM. Exosome-mediated Repair of Intervertebral Disc Degeneration: The Potential Role of miRNAs. Curr Stem Cell Res Ther 2024; 19:798-808. [PMID: 37150986 DOI: 10.2174/1574888x18666230504094233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 05/09/2023]
Abstract
Intervertebral disc degeneration (IVDD) is a serious condition that manifests as low back pain, intervertebral disc protrusion, and spinal canal stenosis. At present, the main treatment methods for IVDD are surgical interventions such as discectomy, total disc replacement, and spinal fusion. However, these interventions have shown limitations, such as recurrent lumbar disc herniation after discectomy, lesions in adjacent segments, and failure of fixation. To overcome these shortcomings, researchers have been exploring stem cell transplantation therapy, such as mesenchymal stem cell (MSC) transplantation, but the treatment results are still controversial. Therefore, researchers are in search of new methods that are more efficient and have better outcomes. The exosomes from stem cells contain a variety of bioactive molecules that mediate cell interactions, and these components have been investigated for their potential therapeutic role in the repair of various tissue injuries. Recent studies have shown that MSC-derived miRNAs in exosomes and vesicles have therapeutic effects on nucleus pulposus cells, annulus fibrosus, and cartilage endplate. miRNAs play a role in many cell activities, such as cell proliferation, apoptosis, and cytokine release, by acting on mRNA translation, and they may have immense therapeutic potential, especially when combined with stem cell therapy. This article reviews the current status of research on intervertebral disc repair, especially with regard to the latest research findings on the molecular biological mechanisms of miRNAs in MSC-derived exosomes in intervertebral disc repair.
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Affiliation(s)
- Han-Shi Wang
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
- Group of Neuroendocrinology, Garvan Institute of Medical Research, Sydney, Australia
| | - Hai-Ming Yu
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
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van der Graaf JW, Kroeze RJ, Buckens CFM, Lessmann N, van Hooff ML. MRI image features with an evident relation to low back pain: a narrative review. 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; 32:1830-1841. [PMID: 36892719 DOI: 10.1007/s00586-023-07602-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/27/2022] [Accepted: 02/11/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Low back pain (LBP) is one of the most prevalent health condition worldwide and responsible for the most years lived with disability, yet the etiology is often unknown. Magnetic resonance imaging (MRI) is frequently used for treatment decision even though it is often inconclusive. There are many different image features that could relate to low back pain. Conversely, multiple etiologies do relate to spinal degeneration but do not actually cause the perceived pain. This narrative review provides an overview of all possible relevant features visible on MRI images and determines their relation to LBP. METHODS We conducted a separate literature search per image feature. All included studies were scored using the GRADE guidelines. Based on the reported results per feature an evidence agreement (EA) score was provided, enabling us to compare the collected evidence of separate image features. The various relations between MRI features and their associated pain mechanisms were evaluated to provide a list of features that are related to LBP. RESULTS All searches combined generated a total of 4472 hits of which 31 articles were included. Features were divided into five different categories:'discogenic', 'neuropathic','osseous', 'facetogenic', and'paraspinal', and discussed separately. CONCLUSION Our research suggests that type I Modic changes, disc degeneration, endplate defects, disc herniation, spinal canal stenosis, nerve compression, and muscle fat infiltration have the highest probability to be related to LBP. These can be used to improve clinical decision-making for patients with LBP based on MRI.
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Affiliation(s)
- Jasper W van der Graaf
- Diagnostic Image Analysis Group, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
- Department of Orthopedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | - Robert Jan Kroeze
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Constantinus F M Buckens
- Department of Medical Imaging, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Nikolas Lessmann
- Diagnostic Image Analysis Group, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Miranda L van Hooff
- Department of Orthopedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
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Lower Prevalence and Severity of Degenerative Changes in the Lumbar Spine in Elderly Hong Kong Chinese Compared With Age-Matched Italian Caucasian Women. Spine (Phila Pa 1976) 2022; 47:1710-1718. [PMID: 35943213 DOI: 10.1097/brs.0000000000004445] [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: 05/09/2022] [Accepted: 07/06/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional observational study. OBJECTIVE The aim was to compare the prevalence and severity of radiographic lumbar spine degeneration between elderly Hong Kong Chinese and elderly Italian Caucasian women. SUMMARY OF BACKGROUND DATA Rates of symptomatic low back pain and osteoporotic vertebral fracture have been shown to be lower in Asian and Chinese populations compared with Caucasians, but ethnic differences in spinal degeneration are less established. METHODS Lumbar spine lateral radiographs of 566 age-matched (mean: 73.6 yr; range: 65-87 yr) female subjects from two population-based epidemiological studies from Hong Kong (n=283) and Rome, Italy (n=283) were reviewed. Grading of degeneration categories: disk height loss (none, <30%, 30%-60%, >60%), osteophyte formation (not present, minimal, small, large), endplate sclerosis (none, mild, moderate, severe), and antero/retrolisthesis (none, <25%, 25%-50%, >50%) was performed for vertebral levels from L1/2 to L5/S1 (five levels). Each category was assigned a score (0, 1, 2, 3) at individual vertebral level according to severity. The total degeneration score was obtained by adding scores for all categories across the vertebral levels. RESULTS Italian subjects [total score (mean±SD): 7.0±5.5] had a higher severity of overall degenerative changes compared with Hong Kong subjects (5.7±4.4), P <0.01. Italian subjects had higher scores for individual findings of disk height loss (Italian, 3.6±2.8 vs. Hong Kong 2.5±2.1, P <0.01); antero/retrolisthesis (Italian 0.3±0.7 vs. Hong Kong 0.2±0.4, P =0.01); and endplate sclerosis (Italian 1.0±1.2 vs. Hong Kong 0.6±1.0, P <0.01). At each individual level from L1/2 to L5/S1, total degeneration scores were higher in Italian than Hong Kong subjects ( P <0.01-0.04). CONCLUSION Degenerative changes in the lumbar spine are less prevalent and less severe in elderly Hong Kong Chinese women than in age-matched Italian Caucasian women. The observed differences may reflect a foundational background influence of genetic predisposition that requires further studies.
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Zhao Z, Deng L, Hua X, Liu H, Zhang H, Jia X, Wei R, Liu M, Lv N. A retrospective study on the efficacy and safety of bone cement in the treatment of endplate fractures. Front Surg 2022; 9:999406. [PMID: 36277290 PMCID: PMC9585934 DOI: 10.3389/fsurg.2022.999406] [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: 07/21/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Endplate fractures is an important factor affecting the curative effect of percutaneous kyphoplasty for spinal fracture. The purpose of this study is to investigate the effect of sealing endplate fracture with bone cement on minimally invasive treatment of spinal fracture. Methods A total of 98 patients with osteoporotic vertebral fractures combined with endplate fractures treated with bone cement surgery in our hospital were retrospectively analyzed. They were grouped according to whether bone cement was involved in the endplate fractures. Group A: bone cement was not only distributed in the fractured vertebral body, but also dispersed into the endplate fractures. Group B: bone cement was confined to the fractured vertebra but did not diffuse into the cracks of the endplate. The basic information, imaging changes of the fractured vertebral body, VAS score, ODI score, bone cement distribution and postoperative complications of the two groups were analyzed and compared. Results The height of the injured vertebra and the kyphotic Cobb angle in the two groups were significantly improved after surgery, but the anterior height of the vertebra in group B was lower than that in group A and the kyphotic Cobb angle was higher than that in group A at the last follow-up (P < 0.05). VAS score and ODI score in 2 groups were significantly improved after operation (P < 0.05), but the VAS score and ODI score in group A were lower than those in group B at the last follow-up (P < 0.05). The incidence of bone cement leakage and adjacent vertebral fracture in group A was higher than that in group B (P < 0.05). Conclusion Diffusion of bone cement into the cracks of the endplate may also restore and maintain the height of the injured vertebra, relieve pain and restore lumbar function. However, diffusion of bone cement into the cracks of the endplate can increase the incidence of cement leakage and adjacent vertebral fractures.
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Affiliation(s)
- Zhijian Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Lei Deng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Xi Hua
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Haojun Liu
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Hao Zhang
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Xuejun Jia
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Rushuai Wei
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Mingming Liu
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China,Correspondence: Nanning Lv Mingming Liu
| | - Nanning Lv
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China,Correspondence: Nanning Lv Mingming Liu
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McCormick ZL, Conger A, Smuck M, Lotz JC, Hirsch JA, Hickman C, Harper K, Burnham TR. Magnetic Resonance Imaging Characteristics Associated with Treatment Success from Basivertebral Nerve Ablation: An Aggregated Cohort Study of Multicenter Prospective Clinical Trials Data. PAIN MEDICINE 2022; 23:S34-S49. [PMID: 35856328 PMCID: PMC9297152 DOI: 10.1093/pm/pnac093] [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: 02/16/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 12/08/2022]
Abstract
Objective Investigate associations between endplate and motion segment magnetic resonance imaging (MRI) characteristics and treatment outcomes following basivertebral nerve radiofrequency ablation (BVN RFA) in patients with clinically suspected vertebral endplate pain (VEP). Design Aggregated cohort study of 296 participants treated with BVN RFA from three prospective clinical trials. Methods Baseline MRI characteristics were analyzed using stepwise logistic regression to identify factors associated with treatment success. Predictive models used three definitions of treatment success: (1) ≥50% low back pain (LBP) visual analog scale (VAS), (2) ≥15-point Oswestry Disability Index (ODI), and (3) ≥50% VAS or ≥15-point ODI improvements at 3-months post-BVN RFA. Results The presence of lumbar facet joint fluid (odds ratio [OR] 0.586) reduced the odds of BVN RFA treatment success in individuals with clinically suspected VEP. In patients with a less advanced degenerative disc disease (DDD) profile, a > 50% area of the endplate with bone marrow intensity changes (BMIC) was predictive of treatment success (OR 4.689). Both regressions areas under the curve (AUCs) were under 70%, indicating low predictive value. All other vertebral endplate, intervertebral disc, nerve roots facet joint, spinal segmental alignment, neuroforamina, lateral recesses, and central canal MRI characteristics were not associated with BVN RFA success. Conclusions In patients with vertebrogenic low back pain with Modic changes, the presence of degenerative findings of the anterior and posterior column was not associated with a clinically important impact on BVN RFA treatment success. None of the models demonstrated strong predictive value, indicating that the use of objective imaging biomarkers (Type 1 and/or 2 Modic changes) and a correlating presentation of pain remain the most useful patient selection factors for BVN RFA.
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Affiliation(s)
- Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Aaron Conger
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Matthew Smuck
- Department of Orthopedics, Stanford University, Palo Alto, California, USA
| | - Jeffrey C Lotz
- Department of Orthopedics, University of California San Francisco, San Francisco, California, USA
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Colton Hickman
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Taylor R Burnham
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Conger A, Smuck M, Truumees E, Lotz JC, DePalma MJ, McCormick ZL. Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain. PAIN MEDICINE 2022; 23:S63-S71. [PMID: 35856329 PMCID: PMC9297155 DOI: 10.1093/pm/pnac081] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/22/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Aaron Conger
- Correspondence to: Aaron Conger, DO, Department of Physical Medicine and Rehabilitation, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA. Tel: 801-587-5458; Fax: 801-587-7111; E-mail:
| | - Matthew Smuck
- Department of Orthopaedics, Stanford University, Redwood City, CA, USA
| | - Eeric Truumees
- The University of Texas Dell Medical School, Ascension Texas Spine and Scoliosis, Austin, TX, USA
| | - Jeffrey C Lotz
- Department of Orthopaedics, University of California San Francisco, San Francisco, CA, USA
| | | | - Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
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