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Mallio CA, Russo F, Vadalà G, Papalia R, Pileri M, Mancuso V, Bernetti C, Volpecina M, Di Gennaro G, Beomonte Zobel B, Denaro V. The importance of psoas muscle on low back pain: a single-center study on lumbar spine MRI. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100326. [PMID: 38947493 PMCID: PMC11214412 DOI: 10.1016/j.xnsj.2024.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 07/02/2024]
Abstract
Background Low back pain (LBP) is the most frequent indication to magnetic resonance imaging (MRI) examinations of the lumbosacral spine. The individual role of soft tissues, including muscles, on LBP is not fully understood and the contribution of each MRI-derived parameter of soft tissues status on the intensity of LBP has not been investigated in detail. Methods The study design was observational retrospective, single center carried out at a University Hospital. Images were acquired using a using a 1.5 Tesla scanner. Patients completed a symptom questionnaire and rated their pain intensity using the Visual Analogue Scale (VAS). The VAS scores were categorized as mild, moderate, and severe using cutoff values of 3.8 and 5.7, based on the literature. Biometric data, including weight and height, were also recorded to calculate the body mass index (BMI). The ratios between intramuscular fat infiltration and net muscle area were also calculated. Patient sample included 94 patients with LBP underwent MRI of the lumbosacral spine. Results The stepwise analysis revealed that increasing psoas net area was associated with lower VAS levels (odds ratio [OR]: 0.94: 95% confidence interval [CI]: 0.90-0.98; p=.005), and an increase of one square centimeter of total psoas area resulted in a greater probability of reporting a mild (+1.21%; 95% CI: 0.37, 2.05%) or a moderate VAS (+0.40%; 95% CI: -0.02, 0.82%), Furthermore, a more severe VAS was associated with a higher BMI (OR: 1.13; 95% CI: 1.00-1.27). Conclusion Our study demonstrates a relationship between LBP and MRI parameters of paravertebral and psoas muscles status. The psoas muscle is extremely important for spine stabilization and is linked to clinical symptoms of patients affected by LBP. These findings could contribute to future studies and improve treatment options in patients with LBP, possibly reducing the impact on disability, quality of life and socioeconomical burden.
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Affiliation(s)
- Carlo A. Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Fabrizio Russo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Gianluca Vadalà
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Matteo Pileri
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Valeria Mancuso
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Caterina Bernetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Manuel Volpecina
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Gianfranco Di Gennaro
- Department of Health Sciences, Chair of Medical Statistics, University of Catanzaro Magna Græcia, Viale Europa, 88100 Catanzaro, Italy
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Vincenzo Denaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Lavrova A, Seiberlich N, Kelsey L, Richardson J, Comer J, Masotti M, Itriago-Leon P, Wright K, Mishra S. Comparison of image quality and diagnostic efficacy of routine clinical lumbar spine imaging at 0.55T and 1.5/3T. Eur J Radiol 2024; 175:111406. [PMID: 38490129 DOI: 10.1016/j.ejrad.2024.111406] [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: 12/13/2023] [Revised: 01/19/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE To compare image quality, assess inter-reader variability, and evaluate the diagnostic efficacy of routine clinical lumbar spine sequences at 0.55T compared with those collected at 1.5/3T to assess common spine pathology. METHODS 665 image series across 70 studies, collected at 0.55T and 1.5/3T, were assessed by two neuroradiology fellows for overall imaging quality (OIQ), artifacts, and accurate visualization of anatomical features (intervertebral discs, neural foramina, spinal cord, bone marrow, and conus / cauda equina nerve roots) using a 4-point Likert scale (1 = non-diagnostic to 4 = excellent). For the 0.55T scans, the most appropriate diagnosis(es) from a picklist of common spine pathologies was selected. The mean ± SD of all scores for all features for each sequence and reader at 0.55T and 1.5/3T were calculated. Paired t-tests (p ≤ 0.05) were used to compare ratings between field strengths. The inter-reader agreement was calculated using linear-weighted Cohen's Kappa coefficient (p ≤ 0.05). Unpaired VCG analysis for OIQ was additionally employed to represent differences between 0.55T and 1.5/3T (95 % CI). RESULTS All sequences at 0.55T were rated as acceptable (≥2) for diagnostic use by both readers despite significantly lower scores for some compared to those at 1.5/3T. While there was low inter-reader agreement on individual scores, the agreement on the diagnosis was high, demonstrating the potential of this system for detecting routine spine pathology. CONCLUSIONS Clinical lumbar spine imaging at 0.55T produces diagnostic-quality images demonstrating the feasibility of its use in diagnosing spinal pathology, including osteomyelitis/discitis, post-surgical changes with complications, and metastatic disease.
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Affiliation(s)
- Anna Lavrova
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States; Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Lauren Kelsey
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Jacob Richardson
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - John Comer
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Maria Masotti
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | | | - Katherine Wright
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Shruti Mishra
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States.
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Nijs J, Kosek E, Chiarotto A, Cook C, Danneels LA, Fernández-de-Las-Peñas C, Hodges PW, Koes B, Louw A, Ostelo R, Scholten-Peeters GGM, Sterling M, Alkassabi O, Alsobayel H, Beales D, Bilika P, Clark JR, De Baets L, Demoulin C, de Zoete RMJ, Elma Ö, Gutke A, Hanafi R, Hotz Boendermaker S, Huysmans E, Kapreli E, Lundberg M, Malfliet A, Meziat Filho N, Reis FJJ, Voogt L, Zimney K, Smeets R, Morlion B, de Vlam K, George SZ. Nociceptive, neuropathic, or nociplastic low back pain? The low back pain phenotyping (BACPAP) consortium's international and multidisciplinary consensus recommendations. THE LANCET. RHEUMATOLOGY 2024; 6:e178-e188. [PMID: 38310923 DOI: 10.1016/s2665-9913(23)00324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/20/2023] [Accepted: 12/06/2023] [Indexed: 02/06/2024]
Abstract
The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.
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Affiliation(s)
- Jo Nijs
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Alessandro Chiarotto
- Erasmus MC, University Medical Center Rotterdam, Department of General Practice, Rotterdam, Netherlands; Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
| | - Chad Cook
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Lieven A Danneels
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Bart Koes
- Erasmus MC, University Medical Center Rotterdam, Department of General Practice, Rotterdam, Netherlands; Research Unit of General Practice, Department of Public Health and Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Adriaan Louw
- Department of Pain Science, Evidence in Motion, Story City, IA, USA
| | - Raymond Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
| | - Michele Sterling
- RECOVER Injury Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Othman Alkassabi
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Physiotrio, Riyadh, Saudi Arabia; Research Chair for Healthcare Innovation, College of Applied Medical Sciences, Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hana Alsobayel
- Research Chair for Healthcare Innovation, College of Applied Medical Sciences, Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Darren Beales
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Paraskevi Bilika
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Greece
| | - Jacqui R Clark
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Pains and Brains specialist pain physiotherapy clinic, Tauranga, New Zealand
| | - Liesbet De Baets
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liège, Belgium
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, Australia
| | - Ömer Elma
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Annelie Gutke
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Rikard Hanafi
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden; Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Sabina Hotz Boendermaker
- University of Applied Sciences ZHAW, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland
| | - Eva Huysmans
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Research Foundation-Flanders, Brussels, Belgium
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Greece
| | - Mari Lundberg
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden; University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anneleen Malfliet
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Research Foundation-Flanders, Brussels, Belgium
| | - Ney Meziat Filho
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta-UNISUAM, Rio de Janeiro, Brazil
| | - Felipe J J Reis
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Physical Therapy Department of Instituto Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lennard Voogt
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; University of Applied Sciences, Rotterdam, Netherlands
| | - Kory Zimney
- Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
| | - Rob Smeets
- Maastricht University, Maastricht, Netherlands; Clinics in Rehabilitation, Eindhoven, Netherlands
| | - Bart Morlion
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, Unit Anaesthesiology and Algology, KU Leuven, Belgium
| | - Kurt de Vlam
- Division of Rheumatology, University Hospitals Leuven, Belgium; Skeletal Biology and Engineering Research Center, Dept of Development and Regeneration, KU Leuven, Belgium
| | - Steven Z George
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA
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Dahmani D, Taik FZ, Berrichi I, Fourtassi M, Abourazzak FE. Impact of central sensitization on pain, disability and psychological distress in patients with knee osteoarthritis and chronic low back pain. BMC Musculoskelet Disord 2023; 24:877. [PMID: 37950225 PMCID: PMC10636971 DOI: 10.1186/s12891-023-07019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Central sensitization (CS) is becoming increasingly recognized as a significant factor in many chronic pain conditions, including knee osteoarthritis (KOA) and chronic low back pain (CLBP). Yet it presently remains unclear how strong is the involvement of CS in KOA and CLBP and which factors are involved in CS in these two chronic disabling diseases. METHODS This is a cross-sectional study in which included a total of 178 patients with KOA and 118 patients with CLBP. Inclusion criteria for eligible participants for the KOA group were a confirmed diagnosis of KOA according to the American College of Rheumatology criteria, and for the CLBP group a chronic low back pain for more than 3 months. Subjects were excluded if they presented with a diagnosed psychiatric disorder or if they lacked the capacity to provide informed consent, understand study questionnaires or perform physical performance tests. In each group, were assessed; CS-related symptoms using the Central Sentization Inventory (CSI); demographic and clinical characteristics such as disease duration, pain intensity on a visual analog scale, self-reported function using the Lequesne index for KOA patients and the Oswestry Disability index for CLBP patients, and physical performance with the 6 minutes' walk test; as well as psychosocial risk factors using the Patient Health Questionnaire for depression (PHQ-9), the Generalized Anxiety Disorder (GAD-7) and the Pain Catastrophizing Scale (PCS). RESULTS CSI scores significantly correlated with pain intensity and disability in KOA and CLBP patients, and were highly correlated with self-reported symptoms of depression, anxiety and pain catastrophizing. Depression significantly predicted the CSI score in both groups. CONCLUSION These findings provide further evidence for the impact of CS on pain, function and physical performance in KOA and CLBP patients. Psychosocial symptoms such as pain catastrophizing, anxiety and depression should also be considered as they are also associated with CS.
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Affiliation(s)
- Doha Dahmani
- Rheumatology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Abdelmalek Essaadi University, Tangier, Morocco.
| | - Fatima Zahrae Taik
- Rheumatology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Abdelmalek Essaadi University, Tangier, Morocco
- Laboratory of Life and Health Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Imane Berrichi
- Rheumatology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Abdelmalek Essaadi University, Tangier, Morocco
| | - Maryam Fourtassi
- Laboratory of Life and Health Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Fatima Ezzahra Abourazzak
- Rheumatology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Abdelmalek Essaadi University, Tangier, Morocco
- Laboratory of Life and Health Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
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Breit HC, Vosshenrich J, Hofmann V, Rusche T, Kovacs BK, Bach M, Manneck S, Harder D. Image Quality of Lumbar Spine Imaging at 0.55T Low-Field MRI is Comparable to Conventional 1.5T MRI - Initial Observations in Healthy Volunteers. Acad Radiol 2023; 30:2440-2446. [PMID: 36841743 DOI: 10.1016/j.acra.2023.01.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/29/2023] [Accepted: 01/29/2023] [Indexed: 02/27/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the potential of 0.55T low-field MRI system in lumbar spine imaging with and without the use of additional advanced postprocessing techniques. MATERIALS AND METHODS The lumbar spine of 14 volunteers (32.9 ± 3.6 years) was imaged both at 0.55T and 1.5T using sequences from clinical routine. On the 0.55T scanner system, additional sequences with simultaneous multi-slice acquisition and artificial intelligence-based postprocessing techniques were acquired. Image quality of all 28 examinations was assessed by three musculoskeletal radiologists with respect to signal/contrast, resolution, and assessability of the spinal canal and neuroforamina using a 5-point Likert scale (1 = non-diagnostic to 5 = perfect quality). Interrater agreement was evaluated with the Intraclass Correlation Coefficient and the Mann-Whitney U test (significance level: p < 0.05). RESULTS Image quality at 0.55T was rated lower on the 5-point Likert scale compared to 1.5T regarding signal/contrast (mean: 4.16 ± 0.29 vs. 4.54 ± 0.29; p < 0.001), resolution (4.07 ± 0.31 vs. 4.49 ± 0.30; p < 0.001), assessability of the spinal canal (4.28 ± 0.13 vs. 4.73 ± 0.26; p < 0.001) and the neuroforamina (4.14 ± 0.28 vs. 4.70 ± 0.27; p < 0.001). Image quality for the AI-processed sagittal T1 TSE and T2 TSE at 0.55T was also rated slightly lower, but still good to perfect with a concomitant reduction in measurement time. Interrater agreement was good to excellent (range: 0.60-0.91). CONCLUSION While lumbar spine image quality at 0.55T is perceived inferior to imaging at 1.5T by musculoskeletal radiologists, good overall examination quality was observed with high interrater agreement. Advanced postprocessing techniques may accelerate intrinsically longer acquisition times at 0.55T.
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Affiliation(s)
- Hanns-Christian Breit
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Jan Vosshenrich
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Verena Hofmann
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Thilo Rusche
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Balázs K Kovacs
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Michael Bach
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sebastian Manneck
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Radiology, Gesundheitszentrum Fricktal AG, Rheinfelden, Switzerland
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
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Bassimtabar A, Alfuth M. [Development and validation of a questionnaire to assess physiotherapists' postural-structural-biomechanical-oriented beliefs about pain]. Schmerz 2023:10.1007/s00482-023-00757-y. [PMID: 37845560 DOI: 10.1007/s00482-023-00757-y] [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: 10/31/2022] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Therapists frequently use the postural-structural-biomechanical (PSB) model in clinical practice to explain the symptom of pain using biomechanical deficits. Adequate knowledge about pain encompasses not only the neurophysiology of pain but also knowledge that existing PSB-oriented explanations of the development and enhancement of pain are outdated. There is no assessment to evaluate physiotherapists' PSB-oriented beliefs about pain. AIM The aim of the present study was to develop a questionnaire to assess physiotherapists' PSB-oriented beliefs about pain and to evaluate its reliability (internal consistency), validity, and agreement. METHODS The Essential Knowledge of Pain Questionnaire (EKPQ) was constructed on the basis of a literature search and discussions between experts. In a pilot study, 32 pupils of a physiotherapy school were then asked to complete the German version of the revised Neurophysiology of Pain Questionnaire (rNPQ-D) and the EKPQ using the SoSci Survey in order to assess their knowledge and beliefs about pain. RESULTS The internal consistency of the EKPQ was acceptable with a Cronbach's α = 0.784. There was a strong positive significant correlation between the questionnaires (r = 0.518; p = 0.002). The Bland-Altman analysis revealed a mean difference of 28.9% (± standard deviation of the difference 15.3%) with an upper limit of 95% agreement of 58.8% and a lower limit of 95% agreement of -1.0% between the questionnaires. Participants achieved a mean score of 60.7% in the rNPQ‑D and a mean score of 31.8% in the EKPQ. CONCLUSION The newly developed EKPQ questionnaire seems to be a reliable and valid assessment to determine physiotherapists' PSB-oriented beliefs about pain. The results also confirm that a high level of knowledge about the neurophysiology of pain does not exclude a PSB orientation. Whether the EKPQ can be used alongside the rNPQ as an additional assessment to evaluate beliefs about pain should be investigated in the future with suitable study designs, e.g. Delphi study.
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Affiliation(s)
- Ahura Bassimtabar
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstr. 49, 47805, Krefeld, Deutschland
- Universitäre Weiterbildung M.Sc. Sportphysiotherapie, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland
- Bayer 04 Leverkusen Fußball GmbH, Bismarckstr. 122-124, 51373, Leverkusen, Deutschland
| | - Martin Alfuth
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstr. 49, 47805, Krefeld, Deutschland.
- Universitäre Weiterbildung M.Sc. Sportphysiotherapie, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland.
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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Wáng YXJ, Martínez Barbero JP, García Espinosa J, Martínez Martínez A. The value of magnetic resonance imaging and computed tomography in the study of spinal disorders. Quant Imaging Med Surg 2022; 12:3947-3986. [PMID: 35782254 PMCID: PMC9246762 DOI: 10.21037/qims-2022-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/13/2022] [Indexed: 08/15/2023]
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders.
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Affiliation(s)
| | | | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - José Pablo Martínez Barbero
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Jade García Espinosa
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Alberto Martínez Martínez
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
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8
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Blauwet CA, Chakraverty J, Derman W, Idrisova G, Martin P, Miller SC, Morrissey D, Webborn N. Shoulder Pain, Function, and Ultrasound-Determined Structure in Elite Wheelchair-Using Para Athletes: An Observational Study. Med Sci Sports Exerc 2022; 54:896-904. [PMID: 35081095 DOI: 10.1249/mss.0000000000002875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to determine the relationship between shoulder pain, physical examination, and tissue pathology in manual wheelchair users competing in elite sport. METHODS Eighty elite para athletes who used a manual wheelchair for daily mobility were recruited from international track (n = 40), field (n = 19), and powerlifting (n = 21) competitions. Athletes were surveyed regarding shoulder pain history and symptoms (Wheelchair User's Shoulder Pain Index (WUSPI)), whereas independent blind observers measured signs (Physical Examination of the Shoulder Scale (PESS)) and tissue pathology (Ultrasound Shoulder Pathology Rating Scale (USPRS)). Relationships between measures for the total cohort and for subgroups defined by sporting discipline were calculated. RESULTS A large proportion of athletes reported a history of upper limb pain (39% dominant and 35% nondominant). For the total cohort, WUSPI score was 22.3 ± 26.9, PESS score was 7.4 ± 6.7, and USPRS score was 5.2 ± 4.0. There were no USPRS score differences between athlete subgroups; however, track athletes had lower WUSPI and PESS scores, especially compared with field athletes. The first principal component explained most of the variance in the WUSPI and PESS, which were strongly correlated (r = 0.71), and the second orthogonal component explained the USPRS, which did not correlate with either the PESS (r = 0.21) or WUSPI (r = 0.20). Subgroup analysis showed that track athletes had lower symptom scores for a given physical examination score. CONCLUSIONS Elite para athletes who use manual wheelchairs for daily mobility have a high prevalence of shoulder symptoms, positive signs on physical examination, and ultrasound-determined tissue pathology. Ultrasound-determined tissue pathology does not correlate with symptoms or signs. This information can help to guide clinicians in managing shoulder problems in this athlete population at high risk of injury.
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Affiliation(s)
| | - Julian Chakraverty
- University Hospitals of Bristol & Weston NHS Foundation Trust, Bristol, UNITED KINGDOM
| | | | | | - Paul Martin
- English Institute of Sport, Manchester Institute of Health and Performance, Manchester, UNITED KINGDOM
| | - Stuart C Miller
- Sport and Exercise Medicine, Queen Mary University of London, London, UNITED KINGDOM
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9
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Lagerbäck T, Kastrati G, Möller H, Jensen K, Skorpil M, Gerdhem P. MRI Characteristics at a Mean of Thirteen Years After Lumbar Disc Herniation Surgery in Adolescents: A Case-Control Study. JB JS Open Access 2021; 6:JBJSOA-D-21-00081. [PMID: 34841186 PMCID: PMC8613359 DOI: 10.2106/jbjs.oa.21.00081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to describe the prevalence of lumbar spine degeneration in adult individuals who had undergone lumbar disc herniation surgery during adolescence.
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Affiliation(s)
- Tobias Lagerbäck
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden.,Department of Reconstructive Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Gránit Kastrati
- Department of Clinical Neuroscience, Division of Neuro, Karolinska Institutet, Stockholm, Sweden
| | - Hans Möller
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden.,Center for Spine Surgery in Stockholm, Södra Fiskartorpsvägen, Stockholm, Sweden
| | - Karin Jensen
- Department of Clinical Neuroscience, Division of Neuro, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Skorpil
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden.,Department of Reconstructive Orthopedics, Karolinska University Hospital, Stockholm, Sweden
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10
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Lo WC, Chen YT, Chen CC. The Effects of Elgucare on Degenerated Intervertebral Disc-Induced Low Back Pain and Disc Regeneration: A Clinical Trial. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5824956. [PMID: 34790253 PMCID: PMC8592736 DOI: 10.1155/2021/5824956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Chronic low back pain (LBP) has a wide range of causes. However, most cases are induced by degeneration of the lumbar intervertebral discs (IVDs), and the aching caused by local compression of the affected region has considerable impacts on quality of life. This clinical trial investigated the use of Elgucare, a Chinese herbal formula, as a food supplement to reduce the pain of patients with LBP induced by degeneration of the lumbar IVDs. METHODS The study assessed patient subjective quality of life, functional limitations caused by LBP, and variations in pain. The assessment was done through the visual analogue scale (VAS) and effects on lumbar IVD thickness, water content, and bone mineral density (BMD). These parameters were evaluated before and after the administration of Elgucare or a placebo, one of which was taken by each participant for a 12-month period. RESULTS Elgucare reduced the patients' mean VAS pain score by 2.25 points and improved their mean LBP-hampered mobility as assessed by the Roland-Morris Questionnaire by 5.17 points. The results of another questionnaire indicated that Elgucare slowed the LBP-induced deterioration of patients' quality of life, while objective assessment indices obtained through X-ray and magnetic resonance imaging showed that the height and water retention of their IVDs were increased. However, the BMD results showed no improvements. CONCLUSIONS Elgucare can increase the water retention and height of IVDs and reduce LBP, thereby enhancing quality of life. Therefore, Elgucare can potentially be used as a clinical supplement.
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Affiliation(s)
- Wen-Cheng Lo
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu Ting Chen
- Research and Development of DC Botanical Biotechnology CO., LTD, LDY Chinese Medicine Hospital, New Taipei City, Taiwan
| | - Chen Ching Chen
- DC Botanical Biotechnology CO., LTD, LDY Chinese Medicine Hospital, New Taipei City, Taiwan
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11
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Pelled G, Salas MM, Han P, Gill HE, Lautenschlager KA, Lai TT, Shawver CM, Hoch MB, Goff BJ, Betts AM, Zhou Z, Lynch C, Schroeder G, Bez M, Maya MM, Bresee C, Gazit Z, McCallin JP, Gazit D, Li D. Intradiscal quantitative chemical exchange saturation transfer MRI signal correlates with discogenic pain in human patients. Sci Rep 2021; 11:19195. [PMID: 34584114 PMCID: PMC8478892 DOI: 10.1038/s41598-021-97672-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/22/2021] [Indexed: 12/13/2022] Open
Abstract
Low back pain (LBP) is often a result of a degenerative process in the intervertebral disc. The precise origin of discogenic pain is diagnosed by the invasive procedure of provocative discography (PD). Previously, we developed quantitative chemical exchange saturation transfer (qCEST) magnetic resonance imaging (MRI) to detect pH as a biomarker for discogenic pain. Based on these findings we initiated a clinical study with the goal to evaluate the correlation between qCEST values and PD results in LBP patients. Twenty five volunteers with chronic low back pain were subjected to T2-weighted (T2w) and qCEST MRI scans followed by PD. A total of 72 discs were analyzed. The average qCEST signal value of painful discs was significantly higher than non-painful discs (p = 0.012). The ratio between qCEST and normalized T2w was found to be significantly higher in painful discs compared to non-painful discs (p = 0.0022). A receiver operating characteristics (ROC) analysis indicated that qCEST/T2w ratio could be used to differentiate between painful and non-painful discs with 78% sensitivity and 81% specificity. The results of the study suggest that qCEST could be used for the diagnosis of discogenic pain, in conjunction with the commonly used T2w scan.
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Affiliation(s)
- Gadi Pelled
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Margaux M Salas
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- 59th Medical Wing Air Force, San Antonio, TX, 78236, USA
| | - Pei Han
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Biomedical Research Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Howard E Gill
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Karl A Lautenschlager
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Tristan T Lai
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Cameron M Shawver
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Matthew B Hoch
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Brandon J Goff
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Aaron M Betts
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Zhengwei Zhou
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Biomedical Research Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Cody Lynch
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Biomedical Research Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Grant Schroeder
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Maxim Bez
- Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
| | - Marcel M Maya
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Catherine Bresee
- Biostatistics and Bioinformatics Research Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Zulma Gazit
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - John P McCallin
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Dan Gazit
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Faculty of Dental Medicine, Hebrew University, 91120, Jerusalem, Israel
| | - Debiao Li
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Biomedical Research Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, 90095, USA
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12
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Dindorf C, Konradi J, Wolf C, Taetz B, Bleser G, Huthwelker J, Werthmann F, Bartaguiz E, Kniepert J, Drees P, Betz U, Fröhlich M. Classification and Automated Interpretation of Spinal Posture Data Using a Pathology-Independent Classifier and Explainable Artificial Intelligence (XAI). SENSORS (BASEL, SWITZERLAND) 2021; 21:6323. [PMID: 34577530 PMCID: PMC8470313 DOI: 10.3390/s21186323] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 01/10/2023]
Abstract
Clinical classification models are mostly pathology-dependent and, thus, are only able to detect pathologies they have been trained for. Research is needed regarding pathology-independent classifiers and their interpretation. Hence, our aim is to develop a pathology-independent classifier that provides prediction probabilities and explanations of the classification decisions. Spinal posture data of healthy subjects and various pathologies (back pain, spinal fusion, osteoarthritis), as well as synthetic data, were used for modeling. A one-class support vector machine was used as a pathology-independent classifier. The outputs were transformed into a probability distribution according to Platt's method. Interpretation was performed using the explainable artificial intelligence tool Local Interpretable Model-Agnostic Explanations. The results were compared with those obtained by commonly used binary classification approaches. The best classification results were obtained for subjects with a spinal fusion. Subjects with back pain were especially challenging to distinguish from the healthy reference group. The proposed method proved useful for the interpretation of the predictions. No clear inferiority of the proposed approach compared to commonly used binary classifiers was demonstrated. The application of dynamic spinal data seems important for future works. The proposed approach could be useful to provide an objective orientation and to individually adapt and monitor therapy measures pre- and post-operatively.
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Affiliation(s)
- Carlo Dindorf
- Department of Sports Science, Technische Universität Kaiserslautern, 67663 Kaiserslautern, Germany; (E.B.); (M.F.)
| | - Jürgen Konradi
- Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Centre, Johannes Gutenberg University Mainz, 55122 Mainz, Germany; (J.K.); (C.W.); (J.H.); (U.B.)
| | - Claudia Wolf
- Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Centre, Johannes Gutenberg University Mainz, 55122 Mainz, Germany; (J.K.); (C.W.); (J.H.); (U.B.)
| | - Bertram Taetz
- Department Augmented Vision, German Research Center for Artificial Intelligence, 67663 Kaiserslautern, Germany; (B.T.); (G.B.)
| | - Gabriele Bleser
- Department Augmented Vision, German Research Center for Artificial Intelligence, 67663 Kaiserslautern, Germany; (B.T.); (G.B.)
| | - Janine Huthwelker
- Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Centre, Johannes Gutenberg University Mainz, 55122 Mainz, Germany; (J.K.); (C.W.); (J.H.); (U.B.)
| | - Friederike Werthmann
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Johannes Gutenberg University Mainz, 55122 Mainz, Germany; (F.W.); (J.K.); (P.D.)
| | - Eva Bartaguiz
- Department of Sports Science, Technische Universität Kaiserslautern, 67663 Kaiserslautern, Germany; (E.B.); (M.F.)
| | - Johanna Kniepert
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Johannes Gutenberg University Mainz, 55122 Mainz, Germany; (F.W.); (J.K.); (P.D.)
| | - Philipp Drees
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Johannes Gutenberg University Mainz, 55122 Mainz, Germany; (F.W.); (J.K.); (P.D.)
| | - Ulrich Betz
- Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Centre, Johannes Gutenberg University Mainz, 55122 Mainz, Germany; (J.K.); (C.W.); (J.H.); (U.B.)
| | - Michael Fröhlich
- Department of Sports Science, Technische Universität Kaiserslautern, 67663 Kaiserslautern, Germany; (E.B.); (M.F.)
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13
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Udby PM, Ohrt-Nissen S, Bendix T, Brorson S, Carreon LY, Andersen MØ. The Association of MRI Findings and Long-Term Disability in Patients With Chronic Low Back Pain. Global Spine J 2021; 11:633-639. [PMID: 32875907 PMCID: PMC8165932 DOI: 10.1177/2192568220921391] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Longitudinal cohort study with 13-year follow-up. OBJECTIVE To assess whether long-term disability is associated with baseline degenerative magnetic resonance imaging (MRI) findings in patients with low back pain (LBP). METHODS In 2004-2005, patients aged 18 to 60 years with chronic LBP were enrolled in a randomized controlled trial and lumbar MRI was performed. Patients completed the Roland-Morris Disability Questionnaire (RMDQ) and the LBP Rating Scale, at baseline and 13 years after the MRI. Multivariate regression analysis was performed with 13-year RMDQ as the dependent variable and baseline disc degeneration (DD, Pfirrmann grade), Modic changes (MC), facet joint degeneration (FJD, Fujiwara grade) smoking status, body mass index, and self-reported weekly physical activity at leisure as independent variables. RESULTS Of 204 patients with baseline MRI, 170 (83%) were available for follow-up. Of these, 88 had Pfirrmann grade >III (52%), 67 had MC (39%) and 139 had Fujiwara grade >2 (82%) on at least 1 lumbar level. Only MC (β = -0.15, P = .031) and weekly physical activity at leisure (β = -0.51, P < .001) were significantly, negatively, associated with 13-year RMDQ-score (R2 = 0.31). CONCLUSION DD and FJD were not associated with long-term disability. Baseline MC and weekly physical activity at leisure were statistically significantly associated with less long-term disability.
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Affiliation(s)
- Peter Muhareb Udby
- Zealand University Hospital, Køge, Denmark,Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Spine Center of Southern Denmark, part of Lillebaelt Hospital, Middelfart, Denmark,Peter Muhareb Udby, Spine Unit, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
| | | | - Tom Bendix
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Leah Y. Carreon
- Spine Center of Southern Denmark, part of Lillebaelt Hospital, Middelfart, Denmark
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14
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Saifuddin A, Rajakulasingam R, Santiago R, Siddiqui M, Khoo M, Pressney I. Comparison of lumbar degenerative disc disease using conventional fast spin echo T2W MRI and T2 fast spin echo dixon sequences. Br J Radiol 2021; 94:20201438. [PMID: 33684306 DOI: 10.1259/bjr.20201438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To compare the grading of lumbar degenerative disc disease (DDD), Modic end-plate changes (MEPC) and identification of high intensity zones (HIZ) on a combination of sagittal T1weighted turbo spin echo (T1W TSE), T2weighted fast spin echo (T2W FSE) and short tau inversion recovery (STIR) sequences (routine protocol) with a single sagittal T2W FSE Dixon MRI sequence which provides in-phase, opposed-phase, water only and fat only images in a single acquisition (Dixon protocol). METHODS 50 patients underwent lumbar spine MRI using the routine protocol with the addition of a T2W FSE Dixon sequence. DDD grade, MEPC and HIZ for each disc level were assessed on the routine and Dixon protocols. Each protocol was reviewed independently by three readers (consultant musculoskeletal radiologists with 26-, 8- and 4 years' experience), allowing assessment of inter-reader agreement and inter protocol agreement for each assessed variable. RESULTS The study included 17 males and 33 females (mean age 51 years; range 8-82 years). Inter-reader agreement for DDD grade on the routine protocol was 0.57 and for the Dixon protocol was 0.63 (p = 0.08). Inter-reader agreement for MEPC on the routine protocol was 0.45 and for the Dixon protocol was 0.53 (p = 0.02), and inter-reader agreement for identification of the HIZ on the routine protocol was 0.52 and for the Dixon protocol was 0.46 (p = 0.27). Intersequence agreement for DDD grade ranged from 0.61 to 0.97, for MEPC 0.46-0.62 and for HIZ 0.39-0.5. CONCLUSION A single sagittal T2W FSE Dixon MRI sequence could potentially replace the routine three sagittal sequence protocol for assessment of lumbar DDD, MEPC and HIZ resulting in ~60% time saving. ADVANCES IN KNOWLEDGE Grading of lumbar DDD, presence of Modic changes and high intensity zones were compared on sagittal T1W TSE, T2W FSE and STIR sequences with a T2W FSE Dixon sequence, with fair-to-good correlation suggesting that three conventional sequences could be replaced by a single Dixon sequence.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Rodney Santiago
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Mateen Siddiqui
- Department of Radiology, North West Anglia Foundation Trust, Hinchingbrooke Hospital, Huntingdon, UK
| | - Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Ian Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
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15
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Krogh SB, Jensen TS, Rolving N, Laursen M, Thomsen JNL, Hansen CB, Werenberg CH, Rasmussen E, Carlson R, Jensen RK. Categorisation of lumbar spine MRI referrals in Denmark as compliant or non-compliant to international imaging guidelines: an inter-rater reliability study. Chiropr Man Therap 2021; 29:12. [PMID: 33761956 PMCID: PMC7988995 DOI: 10.1186/s12998-021-00370-9] [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: 11/27/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Managing low back pain (LBP) often involves MRI despite the fact that international guidelines do not recommend routine imaging. To allow us to explore the topic and use this knowledge in further research, a reliable method to review the MRI referrals is needed. Consequently, this study aimed to assess the inter-rater reliability of a method evaluating lumbar spine MRI referrals' appropriateness. METHODS Four inexperienced students (chiropractic master's students) and a senior clinician (chiropractor) were included as independent raters in this inter-rater reliability study. Lumbar spine MRI referrals from primary care on patients (> 18 years) with LBP with or without leg pain were included. The referrals were classified using a modified version of the American College of Radiology (ACR) imaging appropriateness criteria for LBP. Categories of appropriate referrals included; fractures, cancer, previous surgery, candidate for surgery or suspicion of cauda equina. Inappropriate referrals included lacking information on previous non-surgical treatment, no word on non-surgical treatment duration, or "other reasons" for inappropriate referrals. After two rounds of training and consensus sessions, 50 lumbar spine MRI referrals were reviewed independently by the five raters. Inter-rater reliability was quantified using unweighted Kappa statistics, and the observed agreement was calculated with both a pairwise comparison and an overall five-rater comparison. RESULTS Inter-rater reliability was substantial, with a Kappa value for appropriate vs. inappropriate referrals of 0.76 (95% CI: 0.55-0.89). When six and eight subcategories were evaluated, the Kappa values were 0.77 (95% CI: 0.58-0.91) and 0.82 (95% CI: 0.72-0.92), respectively. The overall percentage of agreement for appropriate and inappropriate referrals was 92% and ranged from 88 to 98% for the pairwise comparisons of the five raters' results. For the six and eight subcategories, the overall agreement was 92 and 88%, respectively, ranging from 88 to 98% and 84-92%, respectively, for the pairwise comparisons. CONCLUSION The inter-rater reliability of the evaluation of the appropriateness of lumbar spine MRI referrals, according to the modified ACR-appropriateness criteria, was found to range from substantial to almost perfect and can be used for research and quality assurance purposes.
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Affiliation(s)
| | - Tue Secher Jensen
- Department of Diagnostic Imaging, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | | | - Malene Laursen
- Research Unit, Centre of Elective Surgery, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | | | - Casper Brink Hansen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Christoffer Høj Werenberg
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Erik Rasmussen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rune Carlson
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rikke Krüger Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
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Karstens S, Lang S, Saunders B. Patients' Views on the Implementation Potential of a Stratified Treatment Approach for Low Back Pain in Germany: A Qualitative Study. Health Serv Insights 2020; 13:1178632920977894. [PMID: 33343197 PMCID: PMC7727085 DOI: 10.1177/1178632920977894] [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] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/10/2020] [Indexed: 12/30/2022] Open
Abstract
Stratified care for low back pain (LBP) has been shown to be clinically- and cost-effective in the UK, but its transferability to the German healthcare system is unknown. This study explores LBP patients’ perspectives regarding future implementation of stratified care, through in-depth interviews (n = 12). The STarT-Back-Tool was completed by participants prior to interviews. Interview data were analysed using Grounded Theory. The overarching theme identified from the data was ‘treatment-success’, with subthemes of ‘assessment and treatment planning’, ‘acceptance of the questionnaire’ and ‘contextual factors’. Patients identified the underlying cause of pain as being of great importance (whereas STarT-Back allocates treatment based on prognosis). The integration of the STarT-Back-Tool in consultations was considered helpful as long as it does not disrupt the therapeutic relationship, and was acceptable if tool results are handled confidentially. Results indicate that for patients to find STarT-Back acceptable, the shift from a focus on identifying a cause of pain and subsequent diagnosis, to prediction-orientated treatment planning, must be made clear. Patient ‘buy in’ is important for successful uptake of clinical interventions, and findings can help to inform future strategies for implementing STarT-Back in the Germany, as well as having potential implications for transferability to other similar healthcare systems.
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Affiliation(s)
- Sven Karstens
- Department of Computer Science; Therapeutic Sciences, Trier University of Applied Sciences, Trier, Germany
| | - Sarah Lang
- MSc Sport Physiotherapy, German Sport University Cologne, Cologne, Germany
| | - Benjamin Saunders
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
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Yang M, Wang N, Xu X, Zhang Y, Xu G, Chang Y, Li Z. Facet joint parameters which may act as risk factors for chronic low back pain. J Orthop Surg Res 2020; 15:185. [PMID: 32448378 PMCID: PMC7245951 DOI: 10.1186/s13018-020-01706-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/13/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Facet orientation (FO) and facet tropism (FT) are two important structural parameters of lumbar facet joint. The purpose of this study was to evaluate the association between facet joint parameters and chronic low back pain (LBP). METHODS From June 2017 to January 2019, a total of 542 cases were enrolled in this study. There were 237 males and 305 females with a mean age of 35.8 years (range 18~59 years). All the cases were divided into a LBP group (LBP group) and a non-LBP group (N-LBP group) in this study. We compared their clinical parameters and facet joint parameters between two groups. RESULTS The LBP group was composed of 190 male and 252 female, whose ages ranged from 17 to 59 years (35.6 ±7.9 y). The N- LBP group was composed of 47 male and 53 female, whose ages ranged from 18 to 59 years (35.9 ± 7.5 y). Of these parameters, BMI (P = 0.008) and FT (P = 0.003) at all three levels were found to be significantly associated with incidence of chronic LBP (P < 0.05), but FO were only found to be significant at L3-L4 level and L5-S1 level (P < 0.05). Logistic regression analysis showed that high BMI and large FT were significant risk factors for chronic LBP (P < 0.05), and FT were found to might be independent risk factors for chronic LBP. CONCLUSION FT may play a more important role in the pathogenesis of chronic LBP.
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Affiliation(s)
- Ming Yang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 5, Longbin Road, Dalian, 116600, People's Republic of China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Naiguo Wang
- Department of Spinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Xiaoxin Xu
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 5, Longbin Road, Dalian, 116600, People's Republic of China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Yu Zhang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 5, Longbin Road, Dalian, 116600, People's Republic of China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Gang Xu
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 5, Longbin Road, Dalian, 116600, People's Republic of China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Yvang Chang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 5, Longbin Road, Dalian, 116600, People's Republic of China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China
| | - Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 5, Longbin Road, Dalian, 116600, People's Republic of China. .,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, People's Republic of China.
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Rahyussalim AJ, Zufar MLL, Kurniawati T. Significance of the Association between Disc Degeneration Changes on Imaging and Low Back Pain: A Review Article. Asian Spine J 2020; 14:245-257. [PMID: 31679325 PMCID: PMC7113468 DOI: 10.31616/asj.2019.0046] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/19/2019] [Accepted: 05/03/2019] [Indexed: 12/19/2022] Open
Abstract
Low back pain (LBP) is a major health issue resulting in a huge economic burden on the community. It not only increases the medical costs directly, but also raises the disability and loss of productivity in the general population. Symptoms include local pain over the spinal area, pain radiating to the lower leg, stiffness, and muscle tension. LBP is strongly linked with intervertebral disc degeneration that is further associated with the disruption of the complex anatomy of nucleus pulposus, annulus fibrosus, and adjacent supporting structures of the spine. Change in the shape and intensity of nucleus pulposus, decreased disc height, disc herniation, vertebral endplate changes, presence of osteophyte, and posterior high intensity zones are degenerative changes found in imaging studies. Every feature is considered while grading the severity score. Modic changes, DEBIT (disc extension beyond interspace) score, and Pfirrmann criteria are some of the scoring criteria used for evaluating disc degeneration severity. Moreover, the total number and contiguous pattern of affected discs play a crucial role in symptom generation of back pain. Many studies have reported asymptomatic patients. Thus, the correlation between degeneration severity found in imaging study and symptom severity of LBP remain unclear. This review discusses and summarizes the available literature on the significance of the association between the severity of degenerative changes found in imaging study with the presence and intensity of LBP.
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Affiliation(s)
- Ahmad Jabir Rahyussalim
- Department of Orthopaedic and Traumatology, Cipto Mangukusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Luqman Labib Zufar
- Department of Orthopaedic and Traumatology, Cipto Mangukusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tri Kurniawati
- Stem Cell and Tissue Engineering Cluster, Cipto Mangukusumo Hospital, MERC Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
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Arrieta C, Urrutia J, Besa P, Montalba C, Lafont N, Andia ME, Uribe S. Automatic quantification of fat infiltration in paraspinal muscles using T2-weighted images: An OsiriX application. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Schwarz-Nemec U, Friedrich KM, Prayer D, Trattnig S, Schwarz FK, Weber M, Bettelheim D, Grohs JG, Nemec SF. Lumbar Intervertebral Disc Degeneration as a Common Incidental Finding in Young Pregnant Women as Observed on Prenatal Magnetic Resonance Imaging. J Womens Health (Larchmt) 2020; 29:713-720. [PMID: 31934808 DOI: 10.1089/jwh.2019.7964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Obstetric imaging, subserving fetal evaluation, may yield incidental maternal findings. Based on prenatal magnetic resonance (MR) imaging, this study aims to investigate incidental intervertebral disc degeneration and displacement in young, pregnant women. Methods: This retrospective study included the sagittal 1.5 Tesla, T2-weighted lumbar spine images of 943 pregnant Central Europeans (age range, 18-47 years), who initially had undergone MR imaging because of sonographically suspected fetal abnormalities. Qualitatively, 4715 lumbar intervertebral discs were evaluated for degeneration using a modified Pfirrmann MR classification (nondegenerated, low-grade, moderate, and high-grade degeneration), as well as for displacement. In addition to descriptive statistics, an ordinal regression analysis was performed to analyze the relationship between degeneration and the women's age, and body weight. Results: With regard to the highest degree of degeneration in each woman, 578 (61.3%) showed low-grade, 211 (22.4%) moderate, and 154 (16.3%) high-grade degeneration, and no woman had entirely nondegenerated discs. For the span from 18 to 47 years of age, moderate and high-grade degeneration increased from 6.7% to 36.7% and from 13.3% to 22.4%, respectively. Of 943 women, 57 (6%) had disc displacements, of which 97% were in conjunction with high-grade degeneration. There was a statistically significant relationship (p < 0.001) between degeneration and age, and between degeneration and body weight. Conclusions: In young pregnant women, lumbar intervertebral disc degeneration is a ubiquitous, incidental finding, increasing from the late second decade of life onward, which may be part of physiological aging, as opposed to a small percentage of incidental disc displacements.
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Affiliation(s)
- Ursula Schwarz-Nemec
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Klaus M Friedrich
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- MR Center of Excellence, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Felix K Schwarz
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Dieter Bettelheim
- Division of Obstetrics and Fetomaternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Josef G Grohs
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan F Nemec
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Sorokin YN. [Back pain and intervertebral disc degeneration in the International Classification of Diseases 11th revision]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:153-159. [PMID: 31626184 DOI: 10.17116/jnevro2019119081153] [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: 11/17/2022]
Abstract
In 2018, the World Health Organization introduced a new version of the International Classification of Diseases (ICD-11), which is preliminary and introductory in nature and will come into force on 1 January 2022. One of the most changed sections compared to ICD-10 is the section characterizing the spine pain syndrome and other manifestations of discogenic pathology. The article describes the terms and codes for the degenerative lesion of the intervertebral disk (IVD) in accordance with the requirements of ICD-11, which also agree with the definitions of the 2nd revision of the nomenclature and classification of the pathology of the lumbar IVD from 2014. The basic concepts of IVD degenerative changes are also revealed. The need to create a new revision of the domestic clinical classification of vertebrogenic neurologic pathology adapted to ICD-11 codes is underlined.
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Affiliation(s)
- Yu N Sorokin
- Rostov State Medical University, Rostov-on-Don, Russia
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High Prevalence of Spinal Magnetic Resonance Imaging Findings in Asymptomatic Young Adults (18-22 Yrs) Candidate to Air Force Flight. Spine (Phila Pa 1976) 2019; 44:872-878. [PMID: 30540719 DOI: 10.1097/brs.0000000000002961] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional, retrospective, magnetic resonance (MR) imaging study, performed during cadets' selection procedures of the Italian Air Force Academy. OBJECTIVE To assess the prevalence of spinal MR imaging findings in asymptomatic young adults (18-22 yrs) candidate to Air Force Flight. SUMMARY OF BACKGROUND DATA Spinal MR imaging findings are frequently detected in asymptomatic subjects. Literature prevalence data come from studies that analyze different patient populations, in a wide age range and in different spinal tracts. Chronic degenerative disease of the vertebral column often occurs in pilots exposed to high flight acceleration forces, thus resulting crucial for Air Force Academy to exclude vertebral disease in cadets. METHODS Three hundred fifty asymptomatic young adults underwent a 3T MR examination of the entire spine. A structured radiological report was set up to classify and calculate the prevalence of spinal MR imaging findings. RESULTS Two hundred seventy of 350 subjects (77%) presented spinal MR findings, while 80 of 350 candidates (23%) had no detectable MR imaging findings. One hundred six of 350 (30%) candidates had at least one disc desiccation and 47 of 350 (13%) presented at least one disc narrowing. Disc bulging was found in 176 of 350 (49%) cadets. Sixty-two of 350 (18%) subjects showed disc protrusion while 28 of 350 (8%) had disc extrusion. Forty-five of 350 (13%) candidates presented low grade intervertebral spondylosis and of these 12 had also facet joints spondylosis. Asymptomatic vertebral fractures were observed in 2 of 350 (<1%) cadets. CONCLUSION A high rate of MR spinal imaging findings, similar to that of the adult population, was detected in our population of young asymptomatic subjects. Our results suggest that the process of aging spine, which is supposed to begin in the second decade of life, is morphologically appreciable in the immediate postadolescent period and this issue is of crucial importance when selecting military pilots. LEVEL OF EVIDENCE 4.
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Voirin-Hertz M, Carvajal Alegria G, Garrigues F, Simon A, Feydy A, Reijnierse M, van der Heijde D, Loeuille D, Claudepierre P, Marhadour T, Saraux A. Associations of lumbar scoliosis with presentation of suspected early axial spondyloarthritis. Semin Arthritis Rheum 2019; 50:48-53. [PMID: 31277929 DOI: 10.1016/j.semarthrit.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/06/2019] [Accepted: 06/10/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Scoliosis may impact the mechanical loading and cause secondary changes of the sacroiliac joints and lumbar spine. Our goal was to look how lumbar scoliosis modify the clinical and imaging-study in patients with recent-onset inflammatory back pain (IBP) suggesting axial spondyloarthritis (axSpA). METHODS Baseline weight-bearing lumbar-spine radiographs obtained in the DESIR cohort of patients aged 18-50 years and having IBP for at least 3 months but less than 3 years suggesting axSpA were studied. After training on scoliosis detection based on Cobb's angle>10° plus Nash-Moe grade≥1, readers blinded to patient data measured spine lumbar scoliosis, sacral horizontal angle, lumbosacral angle and lumbar lordosis on the radiograph of the lumbar and scored sacroiliitis on the radiograph of the pelvis. Baseline MRIs T1 and STIR of the lumbar spine and sacroiliac joints were evaluated for respectively degenerative changes and signs of axSpA. RESULTS Of the 360 patients (50.8% females) 88.7% had lumbar pain and 69.3% met ASAS criteria for axSpA. Mean Cobb's angle was 3.2°±5.0° and 28 (7.7%) patients had lumbar scoliosis. No statistical differences were observed for radiographic sacroiliitis, MRI sacroiliitis, modified Stoke Ankylosing Spondylitis Spinal Score, Pfirmmann score, high-intensity zone, protrusion, extrusion, MODIC score between patients with and without scoliosis. In both groups, degenerative changes by MRI were rare and predominated at L4-L5 and L5-S1. CONCLUSION In patients with early IBP suggesting axSpA, lumbar scoliosis was not associated with inflammatory or degenerative changes.
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Affiliation(s)
| | | | | | | | - Antoine Feydy
- Radiology B Department, Paris Descartes University, AP-HP, Cochin Hospital, Paris, France
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Pascal Claudepierre
- AP-HP, Groupe Hospitalier Henri-Mondor, Service de Rhumatologie, Créteil 94000, France; Université Paris Est Créteil, EA 7379 - EpidermE, Créteil 94000, France
| | | | - Alain Saraux
- Rheumatology Unit, CHU Brest, BP 824, F-29609 Brest Cedex, France; INSERM 1227, Université de Bretagne Occidentale, LabEx IGO, Brest, France.
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«Prehabilitación» en cirugía de columna degenerativa: revisión de la literatura. Neurocirugia (Astur) 2019; 30:124-132. [DOI: 10.1016/j.neucir.2018.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/19/2018] [Indexed: 01/16/2023]
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Wirth B, Riner F, Peterson C, Humphreys BK, Farshad M, Becker S, Schweinhardt P. An observational study on trajectories and outcomes of chronic low back pain patients referred from a spine surgery division for chiropractic treatment. Chiropr Man Therap 2019; 27:6. [PMID: 30766664 PMCID: PMC6362585 DOI: 10.1186/s12998-018-0225-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/13/2018] [Indexed: 01/21/2023] Open
Abstract
Background A close collaboration between surgeons and non-surgical spine experts is crucial for optimal care of low back pain (LBP) patients. The affiliation of a chiropractic teaching clinic to a university hospital with a large spine division in Zurich, Switzerland, enables such collaboration. The aim of this study was to describe the trajectories and outcomes of patients with chronic LBP referred from the spine surgery division to the chiropractic teaching clinic. Methods The patients filled in an 11-point numeric rating scale (NRS) for pain intensity and the Bournemouth Questionnaire (BQ) (bio-psycho-social measure) at baseline and after 1 week, 1, 3, 6 and 12 months. Additionally, the Patient’s Global Impression of Change (PGIC) scale was recorded at all time points apart from baseline. The courses of NRS and BQ were analyzed using linear mixed model analysis and repeated measures ANOVA. The proportion of patients reporting clinically relevant overall improvement (PGIC) was calculated and the underlying factors were determined using logistic regression analyses. Results Between June 2014 and October 2016, 67 participants (31 male, mean age = 46.8 ± 17.6 years) were recruited, of whom 46 had suffered from LBP for > 1 year, the rest for > 3 months, but < 1 year. At baseline, mean NRS was 5.43 (SD 2.37) and mean BQ was 39.80 (SD 15.16) points. NRS significantly decreased [F(5, 106.77) = 3.15, p = 0.011] to 4.05 (SD 2.88) after 12 months. A significant reduction was not observed before 6 months after treatment start (p = 0.04). BQ significantly diminished [F(5, 106.47) = 6.55, p < 0.001] to 29.00 (SD 17.96) after 12 months and showed a significant reduction within the first month (p < 0.01). The proportion of patients reporting overall improvement significantly increased from 23% after 1 week to 47% after 1 month (p = 0.004), when it stabilized [56% after 3 and 6 months, 44% after 12 months]. Reduction in bio-psycho-social impairment (BQ) was of higher importance for overall improvement than pain reduction. Conclusions Chiropractic treatment is a valuable conservative treatment modality associated with clinically relevant improvement in approximately half of patients with chronic LBP. These findings provide an example of the importance of interdisciplinary collaboration in the treatment of chronic back pain patients.
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Affiliation(s)
- Brigitte Wirth
- 1Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital, Forchstr. 340, 8008 Zurich, Switzerland
| | - Fabienne Riner
- 1Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital, Forchstr. 340, 8008 Zurich, Switzerland
| | - Cynthia Peterson
- 1Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital, Forchstr. 340, 8008 Zurich, Switzerland
| | - Barry Kim Humphreys
- 1Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital, Forchstr. 340, 8008 Zurich, Switzerland
| | - Mazda Farshad
- 2Spine Division, Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Susanne Becker
- 3Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Petra Schweinhardt
- 1Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital, Forchstr. 340, 8008 Zurich, Switzerland
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Athertya JS, Saravana Kumar G, Govindaraj J. Detection of Modic changes in MR images of spine using local binary patterns. Biocybern Biomed Eng 2019. [DOI: 10.1016/j.bbe.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jiang X, Chen D. Magnetic resonance imaging analysis of work-related chronic low back pain: comparisons of different lumbar disc patterns. J Pain Res 2018; 11:2687-2698. [PMID: 30464586 PMCID: PMC6216966 DOI: 10.2147/jpr.s162988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Currently, there is a lack of comparative research about different lumbar disc patterns in patients with work-related chronic low back pain (CLBP) based on magnetic resonance imaging (MRI) analysis. Therefore, this study, on different patterns of lumbar disc degeneration or herniation in patients with CLBP, is valuable. In this study, we retrospectively investigated lumbar degenerative changes in patients with CLBP by using MRI analysis. Materials and methods Two hundred and eighty-three patients (110 women and 173 men) with work-related CLBP were enrolled and divided into four groups based on intervertebral disc morphology from MRI analysis, including normal discs (ND) group, degenerative discs (DD) group, bulging discs (BD) group, and herniated discs (HD) group. Demographic characteristics, occupational information, Visual Analog Scale (VAS) scores, and Oswestry Disability Index (ODI) scores were analyzed. Moreover, multiple parameters were investigated in the MRI analysis. Results The mean age of all 283 patients was 41.8±12.0 years (range, 18-80) and the mean duration of CLBP for all patients was 24.5±24.9 months. There were no significant differences in the patients' BMI, history of smoking, and education level (P>0.05). The three most common occupational types were manual worker, desk worker, and technician. The VAS and ODI scores of patients with CLBP in the DD, BD, and HD groups were significantly higher than those of patients in the ND group (P<0.05). The degrees of degeneration of L4/5 and L5/S1 were significantly higher than those of other intervertebral discs (P<0.05). The disc heights of L4/5 in the BD and HD groups were significantly lower than those of the ND group (P<0.05) and the disc height of L5/S1 in the HD group was significantly lower than that of the ND group (P<0.05). At the neutral position, the distances of L3/4, L4/5, and L5/S1 discs' bulge/herniation in the BD and HD groups were significantly higher than those in the ND and DD groups (P<0.05). Conclusion In summary, more severe degenerative changes of lower lumbar discs (L4/5 and L5/S1) such as higher degree of degeneration of disc, lower disc height, and significant displacement of disc were found in patients with work-related CLBP based on MRI analysis.
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Affiliation(s)
- Xin Jiang
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China,
| | - Dong Chen
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China,
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Fallah F, Walter SS, Bamberg F, Yang B. Simultaneous Volumetric Segmentation of Vertebral Bodies and Intervertebral Discs on Fat-Water MR Images. IEEE J Biomed Health Inform 2018; 23:1692-1701. [PMID: 30281501 DOI: 10.1109/jbhi.2018.2872810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fat-water magnetic resonance (MR) images allow automated noninvasive analysis of morphological properties and fat fractions of vertebral bodies (VBs) and intervertebral discs (IVDs) that constitute an important part of human biomechanical systems. In this paper, we propose a fully automated approach for simultaneously segmenting multiple VBs and IVDs on fat-water MR images without prior localization or geometry estimation. This method involved a hierarchical random forest (HRF) classifier and a hierarchical conditional random field (HCRF) that encoded a multi-resolution image pyramid based on a set of multiscale local and contextual features. The HRF classifier employed penalized multivariate linear discriminants and SMOTEBagging to handle limited and imbalanced training data with large feature dimension. The HCRF estimated optimum labels according to their spatial and hierarchical consistencies by using the layer-wise significant features determined over the trained HRF classifier. To handle variable sample numbers at different resolutions, resolution-specific hyperparameters were used. This method was trained and evaluated for segmenting 15 thoracic and lumbar VBs and their IVDs on fat-water MR images of a subset of a large cohort data set. It was further evaluated for segmenting seven IVDs of the lower spine on fat-water images of a public grand challenge. These evaluations revealed the comparable accuracy of this method with the state-of-the-art while requiring less computational burden due to a simultaneous localization and segmentation.
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Wáng YXJ, Wu AM, Ruiz Santiago F, Nogueira-Barbosa MH. Informed appropriate imaging for low back pain management: A narrative review. J Orthop Translat 2018; 15:21-34. [PMID: 30258783 PMCID: PMC6148737 DOI: 10.1016/j.jot.2018.07.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 12/13/2022] Open
Abstract
Most patients with acute low back pain (LBP), with or without radiculopathy, have substantial improvements in pain and function in the first 4 weeks, and they do not require routine imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their LBP. It is also considered for those patients presenting with suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture and infection. In western country primary care settings, the prevalence has been suggested to be 0.7% for metastatic cancer, 0.01% for spinal infection and 0.04% for cauda equina syndrome. Of the small proportion of patients with any of these conditions, almost all have an identifiable risk factor. Osteoporotic vertebral compression fractures (4%) and inflammatory spine disease (<5%) may cause LBP, but these conditions typically carry lower diagnostic urgency. Imaging is an important driver of LBP care costs, not only because of the direct costs of the test procedures but also because of the downstream effects. Unnecessary imaging can lead to additional tests, follow-up, referrals and may result in an invasive procedure of limited or questionable benefit. Imaging should be delayed for 6 weeks in patients with nonspecific LBP without reasonable suspicion for serious disease. The translational potential of this article: Diagnostic imaging studies should be performed only in patients who have severe or progressive neurologic deficits or are suspected of having a serious or specific underlying condition. Radiologists can play a critical role in decision support related to appropriateness of imaging requests, and accurately reporting the potential clinical significance or insignificance of imaging findings.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Ai-Min Wu
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The Key Orthopaedic Laboratory of Zhejiang Province, Wenzhou, China
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Scheidt S, Endreß S, Gesicki M, Hofmann UK. Using video rasterstereography and treadmill gait analysis as a tool for evaluating postoperative outcome after lumbar spinal fusion. Gait Posture 2018; 64:18-24. [PMID: 29803082 DOI: 10.1016/j.gaitpost.2018.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The rise in the number of patients with lumbar back pain has led to an increase in the number of spinal surgeries. To avoid unfavorable outcomes, high accuracy and reliability of indication for surgery are essential. This requires critical evaluation of postoperative outcomes with its two key dimensions pain and function. While imaging findings give details about the technical dimension of the intervention, they are prone to high inter-/intra-observer variability, with limited relation to functional outcomes. Pain improvement can be directly asked from patients or documented by questionnaires. There is abundant literature on postoperative function based on questionnaires, but quantifiable data such as gait or posture analysis are scarce. Highprecision measurement tools are available and easy to implement in a clinician's work routine. OBJECTIVE This study evaluates whether lumbar fusion surgery changes gait and postural variables and how these changes are related to patients' descriptions of alterations in their levels of pain. METHODS Back profiles and gait analyses were measured by video rasterstereography and treadmill gait analysis. Measurements were recorded before surgery, at discharge, after 3 months in a longitudinal (n = 30), and after 12 months in a cross-sectional group (n = 29). A reference group was formed (n = 28). The improvement on the Numeric Pain Rating Scale was documented and compared with changes in gait and posture. RESULTS A significant reduction in kyphotic (52-43°, p = 0.014) and lordotic (28-11°, p < 0.001) angles was observed. The values again increased after 3 months, with a significant reduction in cadence (98-91 steps/min, p = 0.006). While improvements in pain were also obtained by surgery (p < 0.001), no clear correlation could be detected between 3-month alleviation in pain and changes in kyphotic/lordotic angle or cadence. CONCLUSIONS Although both methods offer high-precision measurement, changes in gait and posture were not related with the patients' reported pain relief after lumbar fusion surgery.
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Affiliation(s)
- Sebastian Scheidt
- Department of Orthopaedic Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, D-72076, Tuebingen, Germany; Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
| | - Sandra Endreß
- Medical Faculty of the University of Tuebingen, D-72076, Tuebingen, Germany.
| | - Marco Gesicki
- Department of Orthopaedic Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, D-72076, Tuebingen, Germany; Praxis Dres. Falck and Gesicki, Horemer 4, D-72076, Tübingen, Germany.
| | - Ulf Krister Hofmann
- Department of Orthopaedic Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, D-72076, Tuebingen, Germany.
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31
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Jensen RK, Kent P, Jensen TS, Kjaer P. The association between subgroups of MRI findings identified with latent class analysis and low back pain in 40-year-old Danes. BMC Musculoskelet Disord 2018; 19:62. [PMID: 29463258 PMCID: PMC5819254 DOI: 10.1186/s12891-018-1978-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Research into the clinical importance of spinal MRI findings in patients with low back pain (LBP) has primarily focused on single imaging findings, such as Modic changes or disc degeneration, and found only weak associations with the presence of pain. However, numerous MRI findings almost always co-exist in the lumbar spine and are often present at more than one lumbar level. It is possible that multiple MRI findings are more strongly associated with LBP than single MRI findings. Latent Class Analysis is a statistical method that has recently been tested and found useful for identifying latent classes (subgroups) of MRI findings within multivariable datasets. The purpose of this study was to investigate the association between subgroups of MRI findings and the presence of LBP in people from the general population. Methods To identify subgroups of lumbar MRI findings with potential clinical relevance, Latent Class Analysis was initially performed on a clinical dataset of 631 patients seeking care for LBP. Subsequently, 412 participants in a general population cohort (the ‘Backs on Funen’ project) were statistically allocated to those existing subgroups by Latent Class Analysis, matching their MRI findings at a segmental level. The subgroups containing MRI findings from the general population were then organised into hypothetical pathways of degeneration and the association between subgroups in the pathways and the presence of LBP was tested using exact logistic regression. Results Six subgroups were identified in the clinical dataset and the data from the general population cohort fitted the subgroups well, with a median posterior probability of 93%–100%. These six subgroups described two pathways of increasing degeneration on upper (L1-L3) and lower (L4-L5) lumbar levels. An association with LBP was found for the subgroups describing severe and multiple degenerative MRI findings at the lower lumbar levels but none of the other subgroups were associated with LBP. Conclusion Although MRI findings are common in asymptomatic people and the association between single MRI findings and LBP is often weak, our results suggest that subgroups of multiple and severe lumbar MRI findings have a stronger association with LBP than those with milder degrees of degeneration. Electronic supplementary material The online version of this article (10.1186/s12891-018-1978-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rikke K Jensen
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark. .,Medical Department, Spine Centre of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark. .,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
| | - Peter Kent
- Department of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Tue S Jensen
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Medical Department, Spine Centre of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.,Department of Diagnostic Imaging, Silkeborg Hospital, Silkeborg, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Sanzarello I, Merlini L, Rosa MA, Perrone M, Frugiuele J, Borghi R, Faldini C. Central sensitization in chronic low back pain: A narrative review. J Back Musculoskelet Rehabil 2016; 29:625-633. [PMID: 27062464 DOI: 10.3233/bmr-160685] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Low back pain is one of the four most common disorders in all regions, and the greatest contributor to disability worldwide, adding 10.7% of total years lost due to this health state. The etiology of chronic low back pain is, in most of the cases (up to 85%), unknown or nonspecific, while the specific causes (specific spinal pathology and neuropathic/radicular disorders) are uncommon. Central sensitization has been recently recognized as a potential pathophysiological mechanism underlying a group of chronic pain conditions, and may be a contributory factor for a sub-group of patients with chronic low back pain. The purposes of this narrative review are twofold. First, to describe central sensitization and its symptoms and signs in patients with chronic pain disorders in order to allow its recognition in patients with nonspecific low back pain. Second, to provide general treatment principles of chronic low back pain with particular emphasis on pharmacotherapy targeting central sensitization.
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Affiliation(s)
- Ilaria Sanzarello
- Section of Orthopedics and Traumatology, University of Messina, Messina, Italy
| | - Luciano Merlini
- Laboratory of Musculoskeletal Cell Biology, Istituto Ortopedico Rizzoli, IRCCS, Bologna, Italy
| | | | - Mariada Perrone
- Anesthesia and Post-Operative Intensive Care, Rizzoli-Sicilia Department, Rizzoli Orthopedic Institute, Bagheria (Palermo), Italy
| | - Jacopo Frugiuele
- Anesthesia and Post-Operative Intensive Care, Rizzoli-Sicilia Department, Rizzoli Orthopedic Institute, Bagheria (Palermo), Italy
| | - Raffaele Borghi
- General Orthopedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopedic Institute, Bagheria (Palermo), Italy
| | - Cesare Faldini
- General Orthopedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopedic Institute, Bagheria (Palermo), Italy
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Law SW, Szeto GPY, Chau WW, Chan C, Kwok AWL, Lai HS, Lee RKL, Griffith JF, Hung LK, Cheng JCY. Multi-disciplinary Orthopaedics Rehabilitation Empowerment (MORE) program: A new standard of care for injured workers in Hong Kong. J Back Musculoskelet Rehabil 2016; 29:503-13. [PMID: 26836833 DOI: 10.3233/bmr-150650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objective of this study is to evaluate the effects of the Multi-disciplinary Orthopaedics Rehabilitation Empowerment (MORE) Program on reducing chronic disability among injured workers and improving efficiency of work rehabilitation process. METHODS A cohort of patients with workplace injuries in the lower back were recruited from orthopaedics clinics and assigned to either MORE group (n= 139) or control group (n= 106). Patients in MORE group received an early MRI screening and a coordinated multi-disciplinary management, while patients in the control group received conventional care. Outcome variables are time to return-to-work (RTW) from date of injury, waiting time for MRI screening and time to medical assessment board (MAB). RESULTS Patients in the MORE Program had significantly shorter duration for RTW (MORE: 6.1 months, CONTROL 12.8 months, p< 0.01), and more RTW cases (n= 64, 46.0%) compared to CONTROL group (n= 29, 27.4%). The MORE group also had much shorter waiting time for MRI scans (91.85 vs. 309.2 days, p< 0.001) and MAB referral after MRI scans (97.2 vs. 178.9 days, p= 0.001) compared to CONTROL group. CONCLUSIONS The MORE Program which emphasizes early intervention and early MRI screening, is shown to be effective in shortening sick leave and improving RTW outcomes of injured workers.
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Affiliation(s)
- S W Law
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - G P Y Szeto
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - W W Chau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Carol Chan
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Anthony W L Kwok
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - H S Lai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.,Total Rehabilitation Management (Hong Kong) Limited, Hong Kong, China
| | - Ryan K L Lee
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - L K Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - J C Y Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
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Zhu X, He X, Wang P, He Q, Gao D, Cheng J, Wu B. A method of localization and segmentation of intervertebral discs in spine MRI based on Gabor filter bank. Biomed Eng Online 2016; 15:32. [PMID: 27000749 PMCID: PMC4802867 DOI: 10.1186/s12938-016-0146-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spine magnetic resonance image (MRI) plays a very important role in the diagnosis of various spinal diseases, such as disc degeneration, scoliosis, and osteoporosis. Accurate localization and segmentation of the intervertebral disc (IVD) in spine MRI can help accelerate the diagnosis time and assist in the treatment by providing quantitative parameters. In this paper, a method based on Gabor filter bank is proposed for IVD localization and segmentation. METHODS First, the structural features of IVDs are extracted using a Gabor filter bank. Second, the Gabor features of spine are calculated and spinal curves are detected. Third, the Gabor feature images (GFI) of IVDs are calculated and adjusted according to the spinal curves. Fourth, the IVDs are localized by clustering analysis with GFI. Finally, an optimum grayscale-based algorithm with self-adaptive threshold, combined with the localization results and Gabor features of the spine, is performed for IVDs segmentation. RESULTS The proposed method is verified by an MRI dataset consisting of 278 IVDs from 37 patients. The accuracy of localization is 98.23 % and the dice similarity index for segmentation evaluation is 0.9237. CONCLUSIONS The proposed Gabor filter based method is effective for IVD localization and segmentation. It would be useful in computer-aided diagnosis of IVD diseases and computer-assisted spine surgery.
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Affiliation(s)
- Xinjian Zhu
- State Key Laboratory for Trauma, Burn and Combined Injury, Fifth Department, Research Institute of Field Surgery, Daping Hospital, Third Military Medical University of Chinese PLA, Chongqing, 400042, China
| | - Xuan He
- College of Communication Engineering, Chongqing University, Chongqing, 400044, China
| | - Pin Wang
- College of Communication Engineering, Chongqing University, Chongqing, 400044, China
| | - Qinghua He
- State Key Laboratory for Trauma, Burn and Combined Injury, Fifth Department, Research Institute of Field Surgery, Daping Hospital, Third Military Medical University of Chinese PLA, Chongqing, 400042, China
| | - Dandan Gao
- State Key Laboratory for Trauma, Burn and Combined Injury, Fifth Department, Research Institute of Field Surgery, Daping Hospital, Third Military Medical University of Chinese PLA, Chongqing, 400042, China
| | - Jiwei Cheng
- Department of Orthopaedics, 113th Hospital, Ningbo, 315040, Zhejiang, China.
| | - Baoming Wu
- State Key Laboratory for Trauma, Burn and Combined Injury, Fifth Department, Research Institute of Field Surgery, Daping Hospital, Third Military Medical University of Chinese PLA, Chongqing, 400042, China.
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Moustarhfir M, Bresson B, Koch P, Perozziello A, Barreau G, Schouman-Claeys E, Henry-Feugeas MC, Ou P, Dallaudière B. MR imaging of Schmorl's nodes: Imaging characteristics and epidemio-clinical relationships. Diagn Interv Imaging 2016; 97:411-7. [PMID: 26947187 DOI: 10.1016/j.diii.2016.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/19/2015] [Accepted: 02/03/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of our prospective study was to assess the presentation of Schmorl's nodes (SN) on magnetic resonance imaging (MRI) and investigate their possible association with demographic and clinical findings. MATERIALS AND METHODS Three hundred and thirty-three patients were prospectively included. Thirteen (3.9%) patients were excluded because of contraindication to MRI and/or Scheuermann's disease. The final study population included 320 patients. T1-weighted and short TI inversion recovery sequences were performed to assess SN prevalence, the vertebral level and their anatomical distribution in vertebra. Medical history was recorded focusing on previous diseases including degenerative, rheumatoid and neoplastic disease, and any existing spinal traumatism. Epidemiological information was also obtained, including age, gender, ethnicity, professional and sporting activity. RESULTS The final study population included 320 patients (172 men, 148 women) with a mean age of 54 years±17.5 (SD) (range: 19-87 years). A total of 421 SN were found in 158/320 patients (49.4%). SN were localized in thoracic spine for 48%, in lumbar spine for 46% and cervical spine for 6%. The middle part of the thoracic vertebra was the most affected area (80%), mostly in the middle superior endplate (41%). SN were more frequently observed in manual workers who worked more than 10 years (P<0.0001) and less frequently in patients of the 30-39-year-old age group (P=0.0048). No significant associations were found with gender (P=0.17) and remarkable medical history (P=0.21). SN were less frequently observed in patients with sport activities of 1-5hours/week (P=0.04) and those with an African origin (P<0.0001). CONCLUSION Our study suggests a potential role for ethnical and physical factors in the pathogenesis of SN. Furthers studies are mandatory to evaluate their clinical relevance, especially in patients such as Caucasian manual workers in whom SN have a high prevalence.
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Affiliation(s)
- M Moustarhfir
- Department of radiology, hôpital Bichat, 18, rue Henri-Huchard, 75018 Paris, France
| | - B Bresson
- Department of radiology, hôpital Bichat, 18, rue Henri-Huchard, 75018 Paris, France
| | - P Koch
- Department of radiology, hôpital Bichat, 18, rue Henri-Huchard, 75018 Paris, France
| | - A Perozziello
- Department of biostastistics, hôpital Bichat, 18, rue Henri-Huchard, 75018 Paris, France
| | - G Barreau
- Department of radiology, hôpital Bichat, 18, rue Henri-Huchard, 75018 Paris, France
| | - E Schouman-Claeys
- Department of radiology, hôpital Bichat, 18, rue Henri-Huchard, 75018 Paris, France; Inserm U698, 75018 Paris, France
| | - M-C Henry-Feugeas
- Department of radiology, hôpital Bichat, 18, rue Henri-Huchard, 75018 Paris, France
| | - P Ou
- Department of radiology, hôpital Bichat, 18, rue Henri-Huchard, 75018 Paris, France; Inserm U698, 75018 Paris, France
| | - B Dallaudière
- Department of radiology, hôpital Bichat, 18, rue Henri-Huchard, 75018 Paris, France; Inserm U698, 75018 Paris, France.
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