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Seyedhoseinpoor T, Sanjari MA, Taghipour M, Dadgoo M, Mousavi SJ. Spinopelvic malalignment correlates to lumbar instability and lumbar musculature in chronic low back pain-an exploratory study. Sci Rep 2024; 14:31974. [PMID: 39738674 DOI: 10.1038/s41598-024-83570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 12/16/2024] [Indexed: 01/02/2025] Open
Abstract
As PI-LL mismatch is an effective index for spinal surgery and PI-LL less than 10 probably indicates better quality of life, this study aimed to assess spinopelvic parameters, lumbar instability, and lumbar muscle morphology in patients with chronic low back pain (CLBP) with different PI-LL mismatches. This cross-sectional study included 158 CLBP patients. The association between lumbar extensor muscle morphology (measured from magnetic resonance imaging) and spinopelvic parameters (measured from standing lateral radiographs) and lumbar instability (measured from lumbar flexion/extension radiographs) was compared between two groups of patients with different PI-LL mismatch. PI-LL mismatch showed a significant medium association with lumbar spine stability (χ2 = 8.06, p-value = 0.005, OR = 0.26, 95% CI = 0.10 to 0.69). Total cross-sectional area (TCSA) (OR = < 0.001, 95% CI = < 0.001 to < 0.001), functional cross-sectional area (FCSA) (OR = < 0.001, 95% CI = < 0.001 to < 0. 001) of the multifidus, psoas major TCSA (OR = < 0.001, 95% CI = < 0.001 to < 0.001) and its FCSA (OR = < 0.001, 95% CI = < 0.001 to 0.009) showed a strong negative association with PI-LL mismatch. Patients with lower PI-LL mismatch are younger and have less spinopelvic deviation. They have more local spinal compensatory mechanisms such as increased lumbar lordosis. They have better lumbar musculature and less disability but more lumbar instability.
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Affiliation(s)
- Tahere Seyedhoseinpoor
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Mohammad Ali Sanjari
- Biomechanics Lab, Rehabilitation Research Center and Department of Basic Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, 1545913487, Islamic Republic of Iran.
| | - Mohammad Taghipour
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Mehdi Dadgoo
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Polzer C, Yilmaz E, Meyer C, Jang H, Jansen O, Lorenz C, Bürger C, Glüer CC, Sedaghat S. AI-based automated detection and stability analysis of traumatic vertebral body fractures on computed tomography. Eur J Radiol 2024; 173:111364. [PMID: 38364589 DOI: 10.1016/j.ejrad.2024.111364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/29/2023] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE We developed and tested a neural network for automated detection and stability analysis of vertebral body fractures on computed tomography (CT). MATERIALS AND METHODS 257 patients who underwent CT were included in this Institutional Review Board (IRB) approved study. 463 fractured and 1883 non-fractured vertebral bodies were included, with 190 fractures unstable. Two readers identified vertebral body fractures and assessed their stability. A combination of a Hierarchical Convolutional Neural Network (hNet) and a fracture Classification Network (fNet) was used to build a neural network for the automated detection and stability analysis of vertebral body fractures on CT. Two final test settings were chosen: one with vertebral body levels C1/2 included and one where they were excluded. RESULTS The mean age of the patients was 68 ± 14 years. 140 patients were female. The network showed a slightly higher diagnostic performance when excluding C1/2. Accordingly, the network was able to distinguish fractured and non-fractured vertebral bodies with a sensitivity of 75.8 % and a specificity of 80.3 %. Additionally, the network determined the stability of the vertebral bodies with a sensitivity of 88.4 % and a specificity of 80.3 %. The AUC was 87 % and 91 % for fracture detection and stability analysis, respectively. The sensitivity of our network in indicating the presence of at least one fracture / one unstable fracture within the whole spine achieved values of 78.7 % and 97.2 %, respectively, when excluding C1/2. CONCLUSION The developed neural network can automatically detect vertebral body fractures and evaluate their stability concurrently with a high diagnostic performance.
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Affiliation(s)
- Constanze Polzer
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Eren Yilmaz
- Section Biomedical Imaging, Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Computer Science, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
| | - Carsten Meyer
- Department of Computer Science, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany; Department of Computer Science, Faculty of Engineering, Kiel University, Kiel, Germany
| | - Hyungseok Jang
- Department of Radiology, University of California San Diego, San Diego, USA
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | - Claus-Christian Glüer
- Section Biomedical Imaging, Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sam Sedaghat
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
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Li X, Liu J, Liu Z. Comparison of the results of open PLIF versus UBE PLIF in lumbar spinal stenosis: postoperative adjacent segment instability is lesser in UBE. J Orthop Surg Res 2023; 18:543. [PMID: 37516831 PMCID: PMC10386635 DOI: 10.1186/s13018-023-04038-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/22/2023] [Indexed: 07/31/2023] Open
Abstract
OBJECTIVE To compare the difference in efficacy between open PLIF and UBE for lumbar spinal stenosis and the effect on postoperative adjacent segment instability. METHOD The clinical data of 37 patients with PLIF and 32 patients with UBE for lumbar spinal stenosis were retrospectively analyzed to compare the differences in perioperative conditions and short- and medium-term outcomes. RESULTS All 69 patients completed the surgery successfully. The operating time, number of intraoperative fluoroscopies and hospital days were higher in the UBE group than in the open PLIF group. Intraoperative bleeding and postoperative drainage were lower than in the open PLIF group (P < 0.05). The visual analogue scale (VAS) of low back pain was lower in the UBE group than in the open PLIF group at 1 month and 3 months postoperatively (P < 0.05), and there were no statistically significant VAS scores for low back pain in the two groups at 1 day and 6 months postoperatively (P > 0.05). Leg pain VAS scores were lower in the UBE group than in the open PLIF group at 1 month, 3 months and 6 months postoperatively (P < 0.05), and leg pain VAS scores were not statistically significant in both groups at 1 day postoperatively (P > 0.05). The ODI index was lower in the UBE group than in the open PLIF group at 1 day and 1 month postoperatively (P < 0.05) and was not statistically significant in the two groups at 3 months and 6 months postoperatively (P > 0.05). There was no statistically significant difference between the two groups in postoperative interbody height, sagittal diameter of the spinal canal, efficacy of modified MacNab and interbody fusion (P > 0.05). The open PLIF group was more prone to postoperative adjacent vertebral instability than the UBE group, and the difference was statistically significant (P < 0.05). CONCLUSION With appropriate indications, the open PLIF group and the UBE group had similar short- and medium-term clinical outcomes for the treatment of lumbar spinal stenosis, but patients in the UBE group had better symptomatic improvement than the open PLIF group at 3 months postoperatively, and the effect on postoperative adjacent vertebral instability was smaller in the endoscopic group than in the open PLIF group.
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Affiliation(s)
- Xiaobin Li
- The Third Affiliated Hospital of Soochow University, Changzhou, China
- Yangzhou University, Yangzhou, China
| | - Jie Liu
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhiwei Liu
- The Third Affiliated Hospital of Soochow University, Changzhou, China.
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Muacevic A, Adler JR. Excessive Fluid in the Lumbar Facet Joint as a Predictor of Radiological Outcomes After Lateral Lumbar Interbody Fusion. Cureus 2022; 14:e30217. [PMID: 36381790 PMCID: PMC9650774 DOI: 10.7759/cureus.30217] [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: 08/16/2022] [Accepted: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
Background Preoperative segmental instability maybe a predictor of postoperative outcomes when treated with lateral lumbar interbody fusion (LLIF). An abnormal collection of fluid within the facet joint has been described as a sign of segmental instability. The potential relationship between this radiological sign and its prognostic relevance for indirect decompression (ID) has not been investigated. Methods Clinical and radiologic results from patients undergoing LLIF in a single institution between 2007 and 2014 were evaluated retrospectively. Patients were divided into two groups: those presenting with excessive fluid (EF) in the facet joints on T2-MRI and those with a normal amount of facet fluid with less than 1mm, which were controls. Radiological parameters were foraminal height, disc height, Cobb angle, and lumbar lordosis. Results A total of 21 patients (43 operated levels) were evaluated pre- and postoperatively. Mean disc height, mean foraminal height, and coronal Cobb angles were statistically significantly improved after LLIF. Only the EF group showed significant improvement in radiological markers after ID; the mean disc height improved from 5.5±2 to 8.8±1mm (p=0.001), mean foraminal height improved from 16.88±3 to 20.53±3mm (p=0.002), and the mean Cobb angle improved from 27.7±16 to 14±13 (p=0.018). Conclusions Patients undergoing LLIF with the radiological findings of EF in the facet joints demonstrated significant improvement in radiological outcomes of ID. Further studies should validate these findings in larger data sets.
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Takahashi M, Iwamoto K, Tomita K, Ueda S, Igawa T, Miyauchi Y. Factors associated with spinal instability in low back lumbar diseases with leg pain: Analysis of sagittal translation and segmental angulation. J Back Musculoskelet Rehabil 2022; 36:437-444. [PMID: 36120768 DOI: 10.3233/bmr-220067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Determining the association between radiographic spinal instability assessment and lower back lumbar diseases with lower limb symptoms can contribute to evidence-based assessment and treatment in clinical practice and rehabilitation. Therefore, radiological evidence of lumbar spine instability assessment, such as sagittal translation (ST) and segmental angulation (SA), is clinically important. OBJECTIVE To identify factors associated with the assessment of spinal instability in lumbar disc herniation with leg pain and discogenic low back pain using ST and SA. METHODS We examined 112 patients with lumbar disc herniation with leg pain and 116 with discogenic low back pain at our clinic from 2016 to 2021. Data on age, gender, sports activities, and occupation were collected from medical records. Additionally, ST and SA of L4 and L5 during maximum trunk flexion and extension were measured using radiography. Simple and multiple logistic regression analyses were used for statistical analysis. RESULTS Simple logistic regression analysis showed that ST and SA (odds ratio [OR]: 1.11; 95% confidence interval [CI]: 1.03-1.19) were associated with lumbar disc herniation. Multiple logistic regression analysis showed that only ST was associated with lumbar disc herniation (OR: 2.29; 95% CI: 1.78-3.00). CONCLUSION Multiple logistic regression analysis showed that ST was associated with lumbar disc herniation with leg pain and had a stronger association than SA.
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Affiliation(s)
- Makoto Takahashi
- Department of Physical Therapy, School of Health Sciences, Japan University of Health Sciences, Saitama, Japan.,Department of Rehabilitation, Hitachino Orthopedic Clinic, Ibaraki, Japan
| | - Koji Iwamoto
- Department of Physical Therapy, School of Rehabilitation, Tokyo Professional University of Health Sciences, Tokyo, Japan
| | - Kazuhide Tomita
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Shinji Ueda
- Department of Rehabilitation, Hitachino Orthopedic Clinic, Ibaraki, Japan
| | - Takeshi Igawa
- Department of Rehabilitation, Hitachino Orthopedic Clinic, Ibaraki, Japan
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Seyedhoseinpoor T, Dadgoo M, Taghipour M, Ebrahimi Takamjani I, Sanjari MA, Kazemnejad A, Ebrahimi H, Hasson S. Combining clinical exams can better predict lumbar spine radiographic instability. Musculoskelet Sci Pract 2022; 58:102504. [PMID: 35063746 DOI: 10.1016/j.msksp.2022.102504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Several clinical tests have been proposed to diagnose lumbar instability, but their accuracy is still in question. The primary purpose of this study was to evaluate the diagnostic accuracy of the clinical lumbar instability tests. The secondary goal was to design a model to detect lumbar instability. DESIGN A prospective diagnostic cross-sectional study. METHOD A sample of 202 patients with chronic low back pain were participated in the study. Five lumbar instability tests including Aberrant movement, Passive lumbar extension, Prone segmental instability, H and I and pheasant tests were compared to flexion/extension radiography as the gold standard for diagnosing lumbar instability using two by two tables. Multiple Logistic Regression analysis was applied to develop a model using demographic information as well as the patients' pain intensity, disability level, lumbar lordosis and the clinical tests. RESULTS Among the five examined tests, Prone segmental instability, H and I and pheasant tests showed very small likelihood ratios and diagnostic odd's ratio. The largest values were for H and I test with the positive likelihood ratio of 1.28 (95% CI: 0.72 to 2.29) and diagnostic odd's ratio of 1.37 (95% CI: 0.66 to 2.83); the diagnostic accuracy measures were smaller for the other studied clinical tests. The model was developed using weight (t = 1.15, p = 0.03) and lumbar lordosis (t = 3.04, p = 0.00) (which showed a significant relationship with lumbar instability) and prone segmental instability test. The final model has the positive likelihood ratio of 2.07 (95% CI: 1.41 to 3.05) and diagnostic odd's ratio of 3.77 (95% CI: 2.03 to 7.01). CONCLUSION Each individual test had very small to no power in discriminating patients with lumbar instability. The developed model just slightly improved the accuracy of radiological instability detection.
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Affiliation(s)
- Tahere Seyedhoseinpoor
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadgoo
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Taghipour
- Mobility Impairment Research Center, Health Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ismail Ebrahimi Takamjani
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sanjari
- Biomechanics Lab, Rehabilitation Research Center and Department of Basic Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hadi Ebrahimi
- Department of Neurosurgery, School of Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Scott Hasson
- Department of Physical Therapy, Augusta University, Augusta, GA, USA
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An inter- and intra-rater agreement assessment of a novel classification of pyogenic spinal infections. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:448-453. [PMID: 35001199 DOI: 10.1007/s00586-021-07077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Pola et al. described a clinical-radiological classification of pyogenic spinal infections (PSI) based on magnetic resonance imaging (MRI) features including vertebral destruction, soft tissue involvement, and epidural abscess, along with the neurological status. We performed an inter- and intra-observer agreement evaluation of this classification. METHODS Complete MRI studies of 80 patients with PSI were selected and classified using the scheme described by Pola et al. by seven evaluators. After a four-week interval, all cases were presented to the same assessors in a random sequence for repeat assessment. We used the weighted kappa statistics (wκ) to establish the inter- and intra-observer agreement. RESULTS The inter-observer agreement was substantial considering the main categories (wκ = 0.77; 0.71-0.82), but moderate considering the subtypes (wκ = 0.51; 0.45-0.58). The intra-observer agreement was substantial considering the main types (wκ = 0.65; 0.59-0.71), and moderate considering the subtypes (wκ = 0.58; 0.54-0.63). CONCLUSION The agreement at the main type level indicates that this classification allows adequate communication and may be used in clinical practice; at the subtypes level, the agreement is only moderate.
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Yao XC, Shi XJ, Xu ZY, Tan J, Wei YZ, Qi L, Zhou ZH, Du XR. Preliminary establishment of a spinal stability scoring system for multiple myeloma. World J Clin Cases 2021; 9:9023-9037. [PMID: 34786385 PMCID: PMC8567514 DOI: 10.12998/wjcc.v9.i30.9023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/26/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multiple myeloma is an incurable malignant plasma cell disorder that represents the most common primary malignant bone tumor. It commonly involves bone metastasis in multiple vertebral bodies, and the Spinal Instability Neoplastic Score scoring system may not be fully applicable to multiple myeloma (MM) patients.
AIM To evaluate the spinal stability of patients with MM spinal involvement to guide their clinical treatment.
METHODS By using the Delphi method, we collected and extracted information through a series of questionnaires and improved it via feedback. We also preliminarily established a spinal stability scoring system for multiple myeloma.
RESULTS Fifteen clinicians completed a second round of questionnaires and compared their answers with those of the first round of questionnaires to identify significant comments or changes that required group discussions. As a result, no further feedback was used to improve the scoring system. After integrating the information from the expert consultation questionnaire, we established the initial scoring system for MM spine stability and used the scoring system to assess a series of representative clinical cases. The MM spinal stability scoring system was created by calculating the scores of the six separate components: location, pain, number of segments, physiological curvature, comorbidities, and neurological function. The minimum value was “0”, and the maximum value was “24”. A score of “0–10” indicated “spine stability”, a score of “11–17” indicated “potential instability”, and a score of “18–24” indicated “spine instability”. Patients with a score of “11–24” need an intervention such as surgery.
CONCLUSION The initial establishment of the MM spine stability scoring system provides a vital theoretical basis for the evaluation of spine stability in individuals with MM.
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Affiliation(s)
- Xing-Chen Yao
- Department of Orthopedic, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Xiang-Jun Shi
- Department of Hematology, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Zi-Yu Xu
- Department of Orthopedic, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Jie Tan
- Department of Hematology, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Yan-Zhe Wei
- Department of Orthopedic, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Lei Qi
- Department of Orthopedic, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Zi-Hao Zhou
- Department of Orthopedic, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Xin-Ru Du
- Department of Orthopedic, Beijing Chaoyang Hospital, Beijing 100020, China
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Adamietz B, Schönberg SO, Reiser M, Uder M, Frank A, Strecker R, Weiß C, Heiss R. Visualization of the epimysium and fascia thoracolumbalis at the lumbar spine using MRI. Radiologe 2021; 61:49-53. [PMID: 34013397 PMCID: PMC8677649 DOI: 10.1007/s00117-021-00849-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The fascia thoracolumbalis (FTL) is an important component for stabilization and motion control of the lumbar spine. It coordinates the traction forces of the autochthonous muscles of the back (AM) and connects them to the muscles of the abdominal wall, shoulder, and buttocks. OBJECTIVES The aim of our study was to describe the assessment of the normal FTL and epimysium of the AM in MRI and to identify patterns associated with pathological changes in the lumbar spine. MATERIAL AND METHODS A total of 33 patients were retrospectively evaluated: 15 patients had no pathology at the lumbar spine; six patients had previous hemilaminectomy, three had spondylodesis, two had ventrolisthesis, and seven had scoliosis. The thickness of the FTL and EM was measured, and the adhesion of both structures was assessed. RESULTS The fascial thickness at the levels of the lumbar vertebral bodies LVB 3 was 1.8, of LVB 4 it was 2.0, of LVB 5 it was 2.1, and at the sacral vertebra SVB 1 it was 1.8 mm. Fascial adhesions together with thickening of the EM occurred at the level of LVB 4 in 36% of the cases independently of the underlying disorder. Only thickening of the EM was seen in 48% of cases at the level of SVB 1. By contrast, adhesion of the FTL without epimysial changes occurred in 36% of cases at the level of LVB 3. CONCLUSION Thickening and adhesions at the EM and FTL occurred both postoperatively and in the case of scoliosis. Furthermore, lipomatous and muscular herniation could be detected in the FTL postoperatively. Epimysial and fascial alterations may be imaging manifestations of chronic myofascial back pain and should be included in radiological assessments.
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Affiliation(s)
- Boris Adamietz
- Radiologisches Zentrum für Diagnostik und Therapie München, Oberföhringer Str. 2, 81679 Munich, Germany
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan O. Schönberg
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Maximilian Reiser
- Radiologisches Zentrum für Diagnostik und Therapie München, Oberföhringer Str. 2, 81679 Munich, Germany
- Radiologische Klinik und Poliklinik, LMU-Klinikum, Munich, Germany
| | - Michael Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Frank
- Neurochirurgische Praxis in München, Munich, Germany
| | | | - Christel Weiß
- Abteilung für Medizinische Statistik und Biomathematik, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Rafael Heiss
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
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Ota Y, Connolly M, Srinivasan A, Kim J, Capizzano AA, Moritani T. Mechanisms and Origins of Spinal Pain: from Molecules to Anatomy, with Diagnostic Clues and Imaging Findings. Radiographics 2020; 40:1163-1181. [DOI: 10.1148/rg.2020190185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Yoshiaki Ota
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Michael Connolly
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Ashok Srinivasan
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - John Kim
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Aristides A. Capizzano
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Toshio Moritani
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
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Zileli M, Crostelli M, Grimaldi M, Mazza O, Anania C, Fornari M, Costa F. Natural Course and Diagnosis of Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X 2020; 7:100073. [PMID: 32613187 PMCID: PMC7322797 DOI: 10.1016/j.wnsx.2020.100073] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/13/2020] [Indexed: 11/26/2022] Open
Abstract
Lumbar spinal stenosis (LSS) is defined as a degenerative disorder showing a narrowing of the spinal canal. The diagnosis is straightforward in cases with typical neurogenic claudication symptoms and unequivocal imaging findings. However, not all patients present with typical symptoms, and there is obviously no correlation between the severity of stenosis and clinical complaint. The radiologic diagnosis of LSS is widely discussed in the literature. The best diagnostic test for the diagnosis of LSS is magnetic resonance imaging (MRI). However, canal diameter measurements have not gained much consensus from radiologists, whereas qualitative measures, such as cerebrospinal fluid space obliteration, have achieved greater consensus. Instability can best be defined by standing lateral radiograms and flexion-extension radiograms. For cases showing typical neurogenic claudication symptoms and unequivocal imaging findings, the diagnosis is straightforward. However, not all patients present with typical symptoms, and there is obviously no correlation between the severity of stenosis (computed tomography and MRI) and clinical complaint. In fact, recent MRI studies have shown that mild-to-moderate stenosis can also be found in asymptomatic individuals. Routine electrophysiological tests such as lower extremity electromyography, nerve conduction studies, F-wave, and H-reflex are not helpful in the diagnosis and outcome prediction of LSS. The electrophysiological recordings are complementary to the neurologic examination and can provide confirmatory information in less obvious clinical complaints. However, in the absence of reliable evidence, imaging studies should be considered as a first-line diagnostic test in the diagnosis of degenerative LSS.
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Key Words
- CT, Computed tomography
- Canal diameter
- Central stenosis
- DSEP, Dermatomal somatosensory evoked potential
- EMG, Electromyography
- Electrophysiological recordings
- Foraminal stenosis
- IONM, Intraoperative neurophysiological monitoring
- Intraoperative neurophysiological monitoring
- LS, Likert scale
- LSS, Lumbar spinal stenosis
- Lumbar spinal stenosis
- MEP, Motor evoked potential
- MRI, Magnetic resonance imaging
- Motor evoked potentials
- NASS, North American Spine Society
- Natural course
- SSEP, Somatosensory evoked potential
- Somatosensory evoked potentials
- VAS, Visual analog scale
- WFNS, World Federation of Neurosurgical Societies
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Affiliation(s)
- Mehmet Zileli
- Neurosurgery Department, Ege University, Bornova, Izmir, Turkey
| | - Marco Crostelli
- Spine Surgery Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Osvaldo Mazza
- Spine Surgery Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Carla Anania
- Neurosurgery Department, Humanitas Clinical and Research Hospital, Milan, Italy
| | - Maurizio Fornari
- Neurosurgery Department, Humanitas Clinical and Research Hospital, Milan, Italy
| | - Francesco Costa
- Neurosurgery Department, Humanitas Clinical and Research Hospital, Milan, Italy
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Gallastegui A, Davies E, Zwingenberger AL, Nykamp S, Rishniw M, Johnson PJ. MRI has limited agreement with CT in the evaluation of vertebral fractures of the canine trauma patient. Vet Radiol Ultrasound 2019; 60:533-542. [PMID: 31309654 DOI: 10.1111/vru.12785] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 11/26/2022] Open
Abstract
Complete assessment of vertebral trauma in dogs currently requires CT and MRI for evaluation of the osseous and soft tissue structures that contribute to vertebral stability. Some studies in people have suggested that MRI may be sensitive and specific at detecting vertebral fractures making this potentially a single modality that could be used in spinal trauma evaluation. This study aimed to assess the ability for observers to evaluate vertebral fractures using MRI when compared to CT, which was used as the reference standard. Twenty-nine dogs with previously diagnosed acute vertebral fractures and four dogs with no vertebral fracture that had undergone sequential CT and MRI were included into the study. One hundred twenty-eight vertebrae were evaluated for the presence of fractures. Imaging studies were read by two observers blinded to the history. While both observers had similarly high sensitivity and specificity for simple detection of any fractured vertebrae, interobserver agreement was only moderate (κ = 0.584). When evaluations were specifically limited to detection of structurally unstable fractured vertebrae both observers showed improved specificity and interobserver agreement became substantial (κ = 0.650). Complete agreement for exact fracture location between MRI and CT results was only achieved in 14.3-32.6% of fractured vertebra with up to 79% of fractures being missed in some vertebral structures. This suggests that although MRI may be able to detect the presence of fractured vertebrae, it is not able to replace CT for the complete evaluation of the traumatized spine and documentation of fracture morphology.
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Affiliation(s)
- Aitor Gallastegui
- College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Emma Davies
- Cornell College of Veterinary Medicine, Cornell University, Ithaca, New York
| | | | - Stephanie Nykamp
- The Ontario Veterinary College Health Sciences Center, University of Guelph, Guelph, Ontario, Canada
| | - Mark Rishniw
- Cornell College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Philippa J Johnson
- Cornell College of Veterinary Medicine, Cornell University, Ithaca, New York
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D'Aprile P, Nasuto M, Tarantino A, Cornacchia S, Guglielmi G, Jinkins JR. Magnetic Resonance Imaging in degenerative disease of the lumbar spine: Fat Saturation technique and contrast medium. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:208-219. [PMID: 29350649 PMCID: PMC6179082 DOI: 10.23750/abm.v89i1-s.7024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/12/2022]
Abstract
Purpose: To examine both anterior and posterior elements of the lumbar spine in patients with low back pain using MRI T2-weighted sequences with Fat Saturation (FS) and contrast enhanced T1-weighted sequences with FS.Materials and methods: Two thousand eight hundred and twenty (2820) patients (1628 male, 1192 female, mean age 54) presenting low back pain underwent MRI standard examination (Sagittal T1w TSE and T2w TSE, axial T1 SE) with the addition of sagittal and axial T2w Fat Sat (FS) sequences. Among all the patients, 987 (35%) have been studied adding Contrast Enhanced (CE) T1w FS sequences after administration of contrast medium. Results: Among 987 patients studied with contrast medium, we found: active-inflammatory intervertebral osteochondrosis in 646 (65%) patients; degenerative-inflammatory changes in facet joints (facet joint effusion, synovitis, synovial cysts) in 462 (47%); spondylolysis in 69 (7%); degenerative-inflammatory changes of the flava, interspinous and supraspinous ligaments in 245 (25%); inflammatory changes of posterior perispinal muscles in 84 (8%) patients. Conclusions: In patients with suspected no-disc-related low back pain, the implementation of T2w FS and CE T1w FS sequences to the standard MR protocol could allow a better identification of degenerative-inflammatory changes more likely associated to the pain. (www.actabiomedica.it)
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