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Rogers CJ, Elchert CR, Hackney ME. Chiropractic Management of a 67-Year-Old Veteran With Chronic Low Back Pain Utilizing Low-Velocity Flexion-Distraction: A Case Report. J Chiropr Med 2023; 22:157-163. [PMID: 37346235 PMCID: PMC10280086 DOI: 10.1016/j.jcm.2023.03.002] [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: 08/18/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 06/23/2023] Open
Abstract
Objective The purpose of this case report was to describe the treatment of an older veteran with chronic low back pain, utilizing flexion-distraction as a primary intervention for management. Clinical Features A 67-year-old man with chronic low back pain for several decades presented to the chiropractic clinic for evaluation. He reported low back pain that extended into the right lower extremity intermittently. The patient's imaging demonstrated significant degenerative changes in the lumber spinal anatomy. He had never experienced chiropractic interventions or management for his condition. Intervention and Outcome A trial of conservative care with flexion-distraction was applied as a primary intervention for the management of chronic low back pain. Instrument-assisted soft-tissue mobilization and moist heat were also applied for interventions. Despite having no changes in outcome assessments, the patient reported an improvement in his condition, reduced use of pain medication, and increased mobility after 4 sessions over a 4-week period. Conclusion Flexion-distraction was a beneficial chiropractic approach to the management of an older veteran with chronic low back pain and intermittent lower extremity pain for several decades.
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Affiliation(s)
- Casey J. Rogers
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Health Care System, Birmingham, Alabama
- Birmingham VA Medical Center, Birmingham, Alabama
| | | | - Madeleine E. Hackney
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Health Care System, Decatur, Georgia
- Department of Medicine, Division of Geriatrics & Gerontology, Emory University School of Medicine, Atlanta, Georgia
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Differentiating Lumbar Spinal Etiology from Peripheral Plexopathies. Biomedicines 2023; 11:biomedicines11030756. [PMID: 36979737 PMCID: PMC10044821 DOI: 10.3390/biomedicines11030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Clinicians have managed and treated lower back pain since the earliest days of practice. Historically, lower back pain and its accompanying symptoms of radiating leg pain and muscle weakness have been recognized to be due to any of the various lumbar spine pathologies that lead to the compression of the lumbar nerves at the root, the most common of which is the radiculopathy known as sciatica. More recently, however, with the increased rise in chronic diseases, the importance of differentially diagnosing a similarly presenting pathology, known as lumbosacral plexopathy, cannot be understated. Given the similar clinical presentation of lumbar spine pathologies and lumbosacral plexopathies, it can be difficult to differentiate these two diagnoses in the clinical setting. Resultingly, the inappropriate diagnosis of either pathology can result in ineffective clinical management. Thus, this review aims to aid in the clinical differentiation between lumbar spine pathology and lumbosacral plexopathy. Specifically, this paper delves into spine and plexus anatomy, delineates the clinical assessment of both pathologies, and highlights powerful diagnostic tools in the hopes of bolstering appropriate diagnosis and treatment. Lastly, this review will describe emerging treatment options for both pathologies in the preclinical and clinical realms, with a special emphasis on regenerative nerve therapies.
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Taylor JL, Regier NG, Li Q, Liu M, Szanton SL, Skolasky RL. The impact of low back pain and vigorous activity on mental and physical health outcomes in older adults with arthritis. FRONTIERS IN PAIN RESEARCH 2022; 3:886985. [PMID: 35935669 PMCID: PMC9355128 DOI: 10.3389/fpain.2022.886985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background Nearly 50% of Americans aged 65 and above have been diagnosed with arthritis and an estimated 80% of adults experience low back pain (LBP). Little is known about the experience of LBP in older adults with arthritis and its relationships with mental and physical health. Objective In this study, we examined the relationships between LBP and four physical and mental health conditions (psychological distress, insomnia, mobility limitations, and self-rated health) in older adults with arthritis in the National Health and Aging Trends Study (NHATS). We also examined whether vigorous exercise mediated the relationships between LBP and these four conditions. Materials and Methods The data from this study comes from waves five through nine of the NHATS. The sample size ranged from 3,490 to 2,026 across these waves. All variables in this study are based on self-report. We used descriptive analyses including means and standard deviations for continuous variables or frequencies and proportions for demographic data. We used structural equation modeling (SEM) to examine if vigorous activity mediated the relationship between LBP with the four conditions. Results The age range of the sample was 65 years of age and older. Among those with back pain 78.53% had no mobility limitations. There was a significant relationship between LBP with insomnia (B = 0.48, p < 0.001), perceived health status (B = −0.38, p < 0.0010), and psychological distress (0.67, p < 0.001). Activity mediated the relationship between LBP and insomnia, psychological distress and physical health in adjusted models. Discussion The presence of low back pain in older adults with arthritis increases the risk of insomnia, psychological distress, mobility limitations, and poorer self-rated health. Consequently, targeting comorbid LBP may be an important component of the treatment plans of older adults with arthritis. In addition, providers of patients with arthritis and LBP should conduct routine assessments of mental and physical health to ensure the LBP is being adequately addressed.
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Affiliation(s)
- Janiece L. Taylor
- Johns Hopkins School of Nursing, Baltimore, MD, United States
- Johns Hopkins School of Nursing Center for Innovative Care in Aging, Baltimore, MD, United States
- *Correspondence: Janiece L. Taylor
| | - Natalie G. Regier
- Johns Hopkins School of Nursing, Baltimore, MD, United States
- Johns Hopkins School of Nursing Center for Innovative Care in Aging, Baltimore, MD, United States
| | - Qiwei Li
- Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Minhui Liu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Sarah L. Szanton
- Johns Hopkins School of Nursing, Baltimore, MD, United States
- Johns Hopkins School of Nursing Center for Innovative Care in Aging, Baltimore, MD, United States
| | - Richard L. Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Non-surgical therapy for the treatment of chronic low back pain in patients with Modic changes: A systematic review of the literature. Heliyon 2022; 8:e09658. [PMID: 35800246 PMCID: PMC9253919 DOI: 10.1016/j.heliyon.2022.e09658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/13/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background In absence of uniform therapeutic recommendations, knowledge of the available treatment options for Modic changes (MCs) patients and their safety and effectiveness would be crucial and significant for clinicians and such patients. Objectives The aim of this study was to provide a systematic review of available studies on non-surgical treatments of MCs. Methods We performed a systematic review of multiple electronic databases including PubMed, Web of Science, Embase, Cochrane Library, and China National Knowledge Infrastructure for the period until 31st August 2021 to search for studies on non-surgical treatments for MCs in accordance with the guidance of the Cochrane Handbook. Potential studies were screened by their titles and abstracts. The methodological quality of the included studies was independently evaluated by two authors. Final recommendations for the included interventions were developed based on grades of recommendations. The narrative format was adopted to synthesize the findings of the present work. Results Fifth studies involving a total of 1147 patients were identified for this systematic review. The results of this review demonstrated that spinal manipulation has been suggested as an alternative option for patients with MCs. However, there was insufficient evidence to support that patients with MCs can benefit from the medication and wearing the rigid lumbar brace. Moreover, the rationale and safety for the use of antibiotics in such patients remain highly controversial. Low evidence revealed that exercise therapy might decrease pain intensity only for special subgroups of MCs patients. Conclusions There is not yet enough evidence to suggest that non-surgical treatments are useful for patients with MCs. Further high-quality, multicenter trials are required to validate the effectiveness of these non-surgical treatments.
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Kim S, Choe J. Association between metabolic syndrome and radiographic spine osteoarthritis: Cross‐sectional analysis using data from the Korea National Health and Nutrition Examination Survey. Int J Rheum Dis 2022; 25:466-473. [DOI: 10.1111/1756-185x.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Seong‐Kyu Kim
- Division of Rheumatology Department of Internal Medicine Catholic University of Daegu School of Medicine Daegu Korea
| | - Jung‐Yoon Choe
- Division of Rheumatology Department of Internal Medicine Catholic University of Daegu School of Medicine Daegu Korea
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Roggio F, Trovato B, Ledda C, Rapisarda V, Musumeci G. Kinesiological Treatment of Early Spine Osteoarthritis in a Motorcyclist. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020961. [PMID: 35055784 PMCID: PMC8776179 DOI: 10.3390/ijerph19020961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/26/2021] [Accepted: 01/11/2022] [Indexed: 12/10/2022]
Abstract
This case report speculates that the prolonged vibrations from enduro off-road sports are deleterious to the spine. The results of this case report may also aid sports physicians in better understanding this complex and relatively unknown phenomenon. No published data are present in the current literature that demonstrate the correlation between early spine osteoarthritis from enduro motorcycle overuse and the long-term management effects of a non-invasive kinesiological approach to reduce pain and inflammation and improve spine mobility and muscle strength.
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Affiliation(s)
- Federico Roggio
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (F.R.); (B.T.)
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy
| | - Bruno Trovato
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (F.R.); (B.T.)
| | - Caterina Ledda
- Department of Clinical and Experimental Medicine, Occupational Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (C.L.); (V.R.)
| | - Venerando Rapisarda
- Department of Clinical and Experimental Medicine, Occupational Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (C.L.); (V.R.)
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (F.R.); (B.T.)
- Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n°97, 95123 Catania, Italy
- Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
- Correspondence: ; Tel.: +39-095-378-2043
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Comorbidities and Health-Related Quality of Life in Subjects with Spine Osteoarthritis at 50 Years of Age or Older: Data from the Korea National Health and Nutrition Examination Survey. Medicina (B Aires) 2022; 58:medicina58010126. [PMID: 35056434 PMCID: PMC8777974 DOI: 10.3390/medicina58010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/21/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objective: This study assessed comorbidities and health-related quality of life (HRQOL) in subjects with lumbar spine osteoarthritis (OA) in the Korean population. Materials and Methods: We analyzed 3256 subjects who were 50 years or older and underwent plain radiography of the lumbar spine as part of the Korea National Health and Nutrition Examination Survey (KNHANES) 2012. Radiographic assessment was based on Kellgren–Lawrence (K-L) grade ranging from 0 to 2, with K-L grade 2 defined as lumbar spine OA. HRQOL was assessed by EuroQol-5 dimensions (EQ-5D), which include the EQ-5D index and visual analogue scale (EQ-VAS) measurements. Results: Comorbidities such as hypertension, myocardial infarction, angina, cerebral infarction, and diabetes mellitus were more frequent in spine OA than in controls, while dyslipidemia was less common. Subjects with spine OA had higher mean number of comorbid conditions than controls (1.40 (SE 0.05) vs. 1.20 (SE 0.03), p = 0.001). Subjects with spine OA had much lower EQ-5D index than controls (p < 0.001) but not lower EQ-VAS score. Multivariate binary logistic analysis showed that hypertension and colon cancer were associated with spine OA compared to controls (OR 1.219, 95% CI 1.020–1.456, p = 0.030 and OR 0.200, 95% CI 0.079–0.505, p = 0.001, respectively) after adjustment for confounding factors. Lower EQ-5D index was related to spine OA (95% CI 0.256, 95% CI 0.110–0.595, p = 0.002) but not EQ-VAS score. Conclusion: In this study, we found that comorbidities such as hypertension and colon cancer as well as lower HRQOL were associated with spine OA.
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Perruccio AV, Power JD, Yip C, Badley EM, Canizares M, Rampersaud YR. The impact of multijoint symptoms on patient-reported disability following surgery for lumbar spine osteoarthritis. Spine J 2021; 21:80-89. [PMID: 32805432 DOI: 10.1016/j.spinee.2020.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In the lumbar spine osteoarthritis (LS-OA) population having surgery for lumbar spinal stenosis (LSS) symptoms, a significant proportion of patients experience limited benefit following the intervention. Thus, identifying contributing factors to this is important. Individuals with OA often have multiple joint symptoms, yet this has received limited attention in this population. PURPOSE Document the occurrence of joint symptoms among patients undergoing surgery for LS-OA, and investigate the influence of these symptoms on disability postsurgery. DESIGN Prospective study of consecutive patients followed to 12-month postsurgery. PATIENT SAMPLE Patients undergoing surgery (decompression surgery, with or without fusion) for neurogenic claudication with or without back pain due to LSS with a primary pathology diagnosis of LS-OA. OUTCOMES MEASURES Patient self-reported: Oswestry Disability Index (ODI), completed pre- and 12-month postsurgery; and, completed presurgery, age, sex, education, smoking, comorbid conditions, opioid use, short/long-term disability, depression and anxiety symptoms, back and leg pain intensity, presence of spondylolisthesis, procedure, prior spine surgery, and joints with arthritis and "pain/stiffness/swelling most days of the month" indicated on a homunculus (a joint site count was derived). ASSESSMENTS Height and weight, used to calculate body mass index; timed-up-and-go performance-based test. METHODS Outcome of interest was achieving a clinically important improvement (CII) in ODI by 12-month postsurgery (yes/no). The association between joint site count and achieving a CII was examined by multivariable logistic regression analyses, adjusted for other measures. RESULTS In all, 165 patients were included. The mean age was 67 years (range: 44-90) and 47% were female. Seventy-seven percent reported 1+ joint site other than the back, 62% reported 2+, and 25% reported 4+. Among those achieving a CII, 21% had 4+ joint sites, compared with 31% among those not achieving a CII. Adjusted analyses: Increasing joint site count was associated with increasing risk (odds ratio [OR]: 1.32, 95% confidence interval [CI]: 1.05, 1.66) of not achieving a CII; for those with 4+ joints, adjusted probability of not achieving a CII exceeded 50%. Also associated with an increased risk of not achieving a CII was presurgery anxiety (OR: 2.97, 95% CI: 1.02, 8.65), opioid use (OR: 2.89, 95% CI: 1.07, 7.82), and worse back pain intensity score (OR: 1.27, 95% CI: 1.05, 1.53). CONCLUSIONS Multijoint involvement was highly prevalent in this LS-OA surgical sample. Its association with poorer postsurgery outcome supports a comprehensive approach to OA management and care. Knowledge of multijoint symptoms should inform patient education, shared decision-making, and recommendations for postsurgical rehabilitation and self-management strategies.
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Affiliation(s)
- Anthony V Perruccio
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - J Denise Power
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Calvin Yip
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Elizabeth M Badley
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mayilee Canizares
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Y Raja Rampersaud
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
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Reliability of the assessment of disc degeneration on the lateral DXA scans. Joint Bone Spine 2020; 88:105123. [PMID: 33346108 DOI: 10.1016/j.jbspin.2020.105123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/16/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Given the prevalence and costs induced by osteoarthritis (OA), it is necessary to find a cheap and safe technique to evaluate it reliably. OBJECTIVE To assess the value of the lateral dual energy X-ray absorptiometry (DXA) spine scans for the diagnosis of disc degeneration. METHOD Seventy-seven individuals aged 18 and over, with or without disc degeneration, had both lateral thoracolumbar spine radiographs and DXA spine scans (≤6months between both exams). Disc degeneration was assessed using the Lane score. The images of 20 randomly selected individuals were assessed by two readers. RESULTS Almost 13% of the thoracic levels were not assessable on the DXA scans. For the identification of the intervertebral levels on the DXA scans as interpretable or not, the intra-reader agreement was good (κ=0.81) and the inter-reader agreement was fair (κ=0.27-0.36). For the diagnostic criteria (osteophytes, disc space narrowing, osteosclerosis, overall grade), the intra-reader agreement was excellent for the radiographs (κ=0.89-0.92), good for the DXA scans (κ=0.64-0.83) and fair to moderate for the between-method comparison (κ=0.25-0.44). The inter-reader agreement was moderate to good for the radiographs (κ=0.49-0.66) and fair to good for the DXA scans (κ=0.32-0.74). In the per patient analysis (the most severe grade), the intra-reader agreement was excellent for the radiographs (κ=0.85-0.94), moderate to excellent for the DXA scans (κ=0.53-0.85) and poor to good for the between-methods comparison (κ=0.17-0.63). CONCLUSION Our results do not support the use of DXA scans for the assessment of thoracolumbar disc degeneration.
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Rydman E, Kasina P, Ponzer S, Järnbert-Pettersson H. Association between cervical degeneration and self-perceived nonrecovery after whiplash injury. Spine J 2019; 19:1986-1994. [PMID: 31394280 DOI: 10.1016/j.spinee.2019.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pre-existing radiological degenerative changes have not previously been considered a risk factor for nonrecovery from neck pain due to motor vehicle accidents (MVA). Results from previous studies are however often based on assessment of plain radiography or MRI and little consideration has been given to facet joints. Furthermore, previous studies have often lacked a validated scoring system for degenerative changes. PURPOSE To investigate the association between cervical degeneration on computed tomography (CT) and nonrecovery after whiplash trauma. STUDY DESIGN Longitudinal cohort study. PATIENT SAMPLE One hundred twenty-one patients attending the Emergency Department because of neck pain after MVA, 2015-2017, with a valid CT-scan of the cervical spine and completion of follow up after 6 months. OUTCOME MEASURES The primary outcome measure was self-perceived nonrecovery (yes/no) after 6 months. A secondary outcome measure was self-reported pain level (Numeric Rating Scale). METHODS Baseline data regarding demographics and health factors were gathered through a web-based questionnaire. Degeneration of facet joints and intervertebral discs was assessed on CT-scans according to a validated scoring system. Binary logistic regression was used to study the association between cervical degeneration and nonrecovery. RESULTS Moderate facet joint degeneration was associated with nonrecovery. In the group with moderate degree of facet joint degeneration, 69.6% reported nonrecovery compared with 23.6% among patients without any signs of degeneration (adjusted odds ratio 6.7 [95% confidence interval: 1.9-24.3]). There was no association between disc degeneration and nonrecovery. Combined facet joint degeneration and disc degeneration were associated with nonrecovery (adjusted odds ratio 6.2 [2.0-19.0]). CONCLUSIONS These results suggest that cervical degeneration, especially facet joint degeneration, is a risk factor for nonrecovery after whiplash trauma. We hypothesize that whiplash trauma can be a trigger for painful manifestation of previously asymptomatic facet joint degeneration.
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Affiliation(s)
- Eric Rydman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden.
| | - Piotr Kasina
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden
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Martineau P, Leslie WD. Trabecular bone score (TBS): Method and applications. Bone 2017; 104:66-72. [PMID: 28159710 DOI: 10.1016/j.bone.2017.01.035] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/10/2017] [Accepted: 01/29/2017] [Indexed: 01/14/2023]
Abstract
Trabecular bone score (TBS) is a texture index derived from standard lumbar spine dual energy X-ray absorptiometry (DXA) images and provides information about the underlying bone independent of the bone mineral density (BMD). Several salient observations have emerged. Numerous studies have examined the relationship between TBS and fracture risk and have shown that lower TBS values are associated with increased risk for major osteoporotic fracture in postmenopausal women and older men, with this result being independent of BMD values and other clinical risk factors. Therefore, despite being derived from standard DXA images, the information contained in TBS is independent and complementary to the information provided by BMD and the FRAX® tool. A procedure to generate TBS-adjusted FRAX probabilities has become available with the resultant predicted fracture risks shown to be more accurate than the standard FRAX tool. With these developments, TBS has emerged as a clinical tool for improved fracture risk prediction and guiding decisions regarding treatment initiation, particularly for patients with FRAX probabilities around an intervention threshold. In this article, we review the development, validation, clinical application, and limitations of TBS.
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Affiliation(s)
- P Martineau
- University of Ottawa, Ottawa, Ontario, Canada
| | - W D Leslie
- University of Manitoba, Winnipeg, Manitoba, Canada.
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Omar EA, Pimentel DC, Amadera JED. Spinal Pathology. PATHOLOGY AND INTERVENTION IN MUSCULOSKELETAL REHABILITATION 2016:561-583. [DOI: 10.1016/b978-0-323-31072-7.00015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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13
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Rudy IS, Poulos A, Owen L, Batters A, Kieliszek K, Willox J, Jenkins H. The correlation of radiographic findings and patient symptomatology in cervical degenerative joint disease: a cross-sectional study. Chiropr Man Therap 2015; 23:9. [PMID: 25671078 PMCID: PMC4322563 DOI: 10.1186/s12998-015-0052-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 01/11/2015] [Indexed: 11/30/2022] Open
Abstract
Background There are few known studies investigating the correlation of symptomatology with the specific subtypes of cervical spine degenerative joint disease demonstrated on radiograph. The aim of this study was to assess the correlation and diagnostic test accuracy of specific symptoms in determining the presence, type and severity of degenerative joint disease on radiograph. Methods A retrospective cross-sectional design was used to correlate cervical radiographic findings with neck pain and related symptomatology. Radiographs of 322 patients from April 2010 to June 2012 were assessed and evidence of radiographic cervical degenerative joint disease was extracted. Clinical data for each patient was obtained from their patient files including: pain using a VAS, presence of neck stiffness, presence of headaches, presence of shoulder referral, presence of hand radiculopathy and presence of hand numbness. Measures of diagnostic test accuracy and regression analysis were used to assess for any correlation between symptoms and radiographic findings. Results Referral of pain to the shoulder and neck stiffness showed small degrees of correlation with cervical degenerative joint disease, however, these correlations were not maintained when age was accounted for. Only age showed consistent statistical significance as a predictor for degree of disc degeneration (correlation coefficient (95% confidence interval): 0.06 (0.055, 0.066)); the presence of facet hypertrophy (odds ratio (95% confidence interval): 1.12 (1.09, 1.15)); or uncinate process hypertrophy (odds ratio (95% confidence interval): 1.15 (1.12, 1.18)). Neck stiffness demonstrated a small degree of diagnostic test accuracy for the degree of cervical disc degeneration (area under the curve (95%CI): 0.62 (0.56, 0.68)) and the presence of either facet (diagnostic OR (95%CI):1.69 (1.04, 2.76)) and uncinated process hypertrophy (LR+ (95%CI): 1.17 (1.00, 1.38)). Conclusion The results of this study indicate that clinical symptoms such as pain level, headaches, shoulder referral and hand radiculopathy or numbness are not reliably correlated with radiographic findings of degenerative joint disease in the cervical spine. A small increase in diagnostic accuracy between the presence of neck stiffness and all forms of cervical degenerative joint disease is shown, however, this increase is not at the level expected to change clinical practice.
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Maataoui A, Vogl TJ, Middendorp M, Kafchitsas K, Khan MF. Association between facet joint osteoarthritis and the Oswestry Disability Index. World J Radiol 2014; 6:881-885. [PMID: 25431643 PMCID: PMC4241495 DOI: 10.4329/wjr.v6.i11.881] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/30/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the correlation of facet joint osteoarthritis (FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index (ODI).
METHODS: The study involved lumbar MRIs of 591 patients with a mean age of 47.3 years. The MRIs of the lumbar spine were performed on a 1.5 Tesla scanner (Magnetom® Avanto, Siemens AG, Erlangen, Germany) using a dedicated receive only spine coil. After initial blinding, each dataset was evaluated by 2 board certified radiologist with more than 5 years experience in musculoskeletal imaging. In total 2364 facet joints were graded. Degenerative changes of the facet joints were evaluated according to the 4-point scale as proposed by Weishaupt et al Functional status was assessed using the ODI. The index is scored from 0 to 100 and interpreted as follows: 0%-20%, minimal disability; 20%-40%, moderate disability; 40%-60%, severe disability; 60%-80%, crippled; 80%-100%, patients are bedbound. Spearman’s coefficient of rank correlation was used for statistical analysis, with significance set at P < 0.05.
RESULTS: In total 2364 facet joints at lumbar levels L4/5 and L5/S1 were analysed in 591 individuals. FJOA was present in 97% (L4/L5) and 98% (L5/S1). At level L4/5 (left/right) 17/15 (2.9%/2.5%) were described as grade 0, 146/147 (24.7%/24.9%) as grade 1, 290/302 (49.1%/51.1%) as grade 2 and 138/127 (23.4%/21.5%) as grade 3. At level L5/S1 (left/right) 10/11 (1.7%/1.9%) were described as grade 0, 136/136 (23.0%/23.0%) as grade 1, 318/325 (53.8%/55.0%) as grade 2 and 127/119 (21.5%/20.1%) as grade 3. Regarding the ODI scores, patients’ disability had a minimum of 0% and a maximum of 91.11% with an arithmetic mean of 32.77% ± 17.02%. The majority of patients (48.39%) had moderate functional disability (21%-40%). There was no significant correlation between FJOA and ODI on both sides of lumbar level L4/5 and on the left side of lumbar level L5/S1. A weak positive correlation was evaluated between ODI and FJOA on the right side of lumbar level L5/S1.
CONCLUSION: The missing correlation of FJOA and ODI confirms our clinical experience that imaging alone is an insufficient approach explaining low back pain. Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain.
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Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, McCloskey EV, Kanis JA, Bilezikian JP. Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res 2014; 29:518-30. [PMID: 24443324 DOI: 10.1002/jbmr.2176] [Citation(s) in RCA: 520] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 01/11/2014] [Accepted: 01/14/2014] [Indexed: 12/16/2022]
Abstract
The trabecular bone score (TBS) is a gray-level textural metric that can be extracted from the two-dimensional lumbar spine dual-energy X-ray absorptiometry (DXA) image. TBS is related to bone microarchitecture and provides skeletal information that is not captured from the standard bone mineral density (BMD) measurement. Based on experimental variograms of the projected DXA image, TBS has the potential to discern differences between DXA scans that show similar BMD measurements. An elevated TBS value correlates with better skeletal microstructure; a low TBS value correlates with weaker skeletal microstructure. Lumbar spine TBS has been evaluated in cross-sectional and longitudinal studies. The following conclusions are based upon publications reviewed in this article: 1) TBS gives lower values in postmenopausal women and in men with previous fragility fractures than their nonfractured counterparts; 2) TBS is complementary to data available by lumbar spine DXA measurements; 3) TBS results are lower in women who have sustained a fragility fracture but in whom DXA does not indicate osteoporosis or even osteopenia; 4) TBS predicts fracture risk as well as lumbar spine BMD measurements in postmenopausal women; 5) efficacious therapies for osteoporosis differ in the extent to which they influence the TBS; 6) TBS is associated with fracture risk in individuals with conditions related to reduced bone mass or bone quality. Based on these data, lumbar spine TBS holds promise as an emerging technology that could well become a valuable clinical tool in the diagnosis of osteoporosis and in fracture risk assessment.
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Affiliation(s)
- Barbara C Silva
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Lumbar facet joint arthritis is associated with more coronal orientation of the facet joints at the upper lumbar spine. Radiol Res Pract 2013; 2013:693971. [PMID: 24260713 PMCID: PMC3821951 DOI: 10.1155/2013/693971] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/07/2013] [Accepted: 09/07/2013] [Indexed: 11/22/2022] Open
Abstract
We retrospectively analyzed CT scans of 620 individuals, who presented to our traumatology department between 2008 and 2010. Facet joint (FJ) arthritis was present in 308 (49.7%) individuals with a mean grade of 1. It was seen in 27% of individuals ≤40 years and in 75% of individuals ≥41 years (P < 0.0001) as well as in 52% of females and 49% of males (P = 0.61). Mean FJ orientation was 30.4° at L2/3, 38.7° at L3/4, 47° at L4/5, and 47.3° at L5/S1. FJ arthritis was significantly associated with more coronal (increased degree) FJ orientation at L2/3 (P = 0.03) with a cutoff point at ≥32°. FJs were more coronally oriented (48.8°) in individuals ≤40 years and more sagittally oriented (45.6°) in individuals ≥41 years at L5/S1 (P = 0.01). Mean FJ asymmetry was 4.89° at L2/3, 6.01° at L3/4, 6.67° at L4/5, and 7.27° at L5/S1, without a significant difference for FJ arthritis. FJ arthritis is common, increases with age, and affects both genders equally. More coronally oriented FJs (≥32°) in the upper lumbar spine may be an individual risk factor for development of FJ arthritis.
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Ultrasound Guided Spine Injections: Advancement Over Fluoroscopic Guidance? CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0016-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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