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Nikpasand M, Middendorf JM, Ella VA, Jones KE, Ladd B, Takahashi T, Barocas VH, Ellingson AM. Automated magnetic resonance imaging-based grading of the lumbar intervertebral disc and facet joints. JOR Spine 2024; 7:e1353. [PMID: 39011368 PMCID: PMC11249006 DOI: 10.1002/jsp2.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024] Open
Abstract
Background Degeneration of both intervertebral discs (IVDs) and facet joints in the lumbar spine has been associated with low back pain, but whether and how IVD/joint degeneration contributes to pain remains an open question. Joint degeneration can be identified by pairing T1 and T2 magnetic resonance imaging (MRI) with analysis techniques such as Pfirrmann grades (IVD degeneration) and Fujiwara scores (facet degeneration). However, these grades are subjective, prompting the need to develop an automated technique to enhance inter-rater reliability. This study introduces an automated convolutional neural network (CNN) technique trained on clinical MRI images of IVD and facet joints obtained from public-access Lumbar Spine MRI Dataset. The primary goal of the automated system is to classify health of lumbar discs and facet joints according to Pfirrmann and Fujiwara grading systems and to enhance inter-rater reliability associated with these grading systems. Methods Performance of the CNN on both the Pfirrmann and Fujiwara scales was measured by comparing the percent agreement, Pearson's correlation and Fleiss kappa value for results from the classifier to the grades assigned by an expert grader. Results The CNN demonstrates comparable performance to human graders for both Pfirrmann and Fujiwara grading systems, but with larger errors in Fujiwara grading. The CNN improves the reliability of the Pfirrmann system, aligning with previous findings for IVD assessment. Conclusion The study highlights the potential of using deep learning in classifying the IVD and facet joint health, and due to the high variability in the Fujiwara scoring system, highlights the need for improved imaging and scoring techniques to evaluate facet joint health. All codes required to use the automatic grading routines described herein are available in the Data Repository for University of Minnesota (DRUM).
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Affiliation(s)
- Maryam Nikpasand
- Department of Mechanical Engineering University of Minnesota Minneapolis Minnesota USA
| | - Jill M Middendorf
- Department of Mechanical Engineering Johns Hopkins University Baltimore Maryland USA
| | - Vincent A Ella
- Department of Biomedical Engineering University of Minnesota Minneapolis Minnesota USA
| | - Kristen E Jones
- Department of Neurosurgery University of Minnesota Minneapolis Minnesota USA
| | - Bryan Ladd
- Department of Neurosurgery University of Minnesota Minneapolis Minnesota USA
| | - Takashi Takahashi
- Department of Radiology University of Minnesota Minneapolis Minnesota USA
| | - Victor H Barocas
- Department of Mechanical Engineering University of Minnesota Minneapolis Minnesota USA
- Department of Biomedical Engineering University of Minnesota Minneapolis Minnesota USA
| | - Arin M Ellingson
- Department of Orthopedic Surgery University of Minnesota Minneapolis Minnesota USA
- Division of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community Health University of Minnesota Minneapolis Minnesota USA
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Zhu F, Jia D, Zhang Y, Feng C, Peng Y, Ning Y, Leng X, Li J, Zhou Y, Li C, Huang B. Development and validation of a nomogram to predict the risk of residual low back pain after tubular microdiskectomy of lumbar disk herniation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2179-2189. [PMID: 38647605 DOI: 10.1007/s00586-024-08255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Tubular microdiskectomy (tMD) is one of the most commonly used for treating lumbar disk herniation. However, there still patients still complain of persistent postoperative residual low back pain (rLBP) postoperatively. This study attempts to develop a nomogram to predict the risk of rLBP after tMD. METHODS The patients were divided into non-rLBP (LBP VAS score < 2) and rLBP (LBP VAS score ≥ 2) group. The correlation between rLBP and these factors were analyzed by multivariate logistic analysis. Then, a nomogram prediction model of rLBP was developed based on the risk factors screened by multivariate analysis. The samples in the model are randomly divided into training and validation sets in a 7:3 ratio. The Receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the diskrimination, calibration and clinical value of the model, respectively. RESULTS A total of 14.3% (47/329) of patients have persistent rLBP. The multivariate analysis suggests that higher preoperative LBP visual analog scale (VAS) score, lower facet orientation (FO), grade 2-3 facet joint degeneration (FJD) and moderate-severe multifidus fat atrophy (MFA) are risk factors for postoperative rLBP. In the training and validation sets, the ROC curves, calibration curves, and DCAs suggested the good diskrimination, predictive accuracy between the predicted probability and actual probability, and clinical value of the model, respectively. CONCLUSION This nomogram including preoperative LBP VAS score, FO, FJD and MFA can serve a promising prediction model, which will provide a reference for clinicians to predict the rLBP after tMD.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Dongqing Jia
- Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Yan Peng
- Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Jianmin Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China.
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Saremi A, Goyal KK, Benzel EC, Orr RD. Evolution of lumbar degenerative spondylolisthesis with key radiographic features. Spine J 2024; 24:989-1000. [PMID: 38199449 DOI: 10.1016/j.spinee.2024.01.001] [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: 04/30/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Spondylolisthesis is a common finding in middle-aged and older adults with back pain. The pathophysiology of degenerative spondylolisthesis is a subject of controversy regarding not only its etiology but also the mechanisms of its progression. It is theorized that degeneration of the facets and discs can lead to segmental instability, leading to displacement over time. Kirkaldy-Willis divided degenerative spondylolisthesis into three phases: dysfunction, instability, and finally, restabilization. There is a paucity of literature on the unification of the radiological hallmarks seen in spondylolisthesis within these phases. The radiographic features include (1) facet morphology/arthropathy, (2) facet effusion, (3) facet vacuum, (4) synovial cyst, (5) interspinous ligament bursitis, and (6) vacuum disc as markers of dysfunction, instability, and/or restabilization. We discuss these features, which can be seen on X-ray, CT, and MRI, with the intention of establishing a timeline upon which they present clinically. Spondylolisthesis is initiated as either degeneration of the intervertebral disc or facet joints. Early degeneration can be seen as facet vacuum without considerable arthropathy. As the vertebral segment becomes increasingly dynamic, fluid accumulates within the facet joint space. Further degeneration will lead to the advancement of facet arthropathy, degenerative disc disease, and posterior ligamentous complex pathology. Facet effusion can eventually be replaced with a vacuum in severe facet osteoarthritis. Intervertebral disc vacuum continues to accumulate with further cleft formation and degeneration. Ultimately, autofusion of the vertebra at the facets and endplates can be observed. With this review, we hope to increase awareness of these radiographical markers and their timeline, thus placing them within the framework of the currently accepted model of degenerative spondylolisthesis, to help guide future research and to help refine management guidelines.
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Affiliation(s)
- Arvin Saremi
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH 44106, USA.
| | - Kush K Goyal
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Edward C Benzel
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - R Douglas Orr
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Wang X, Liu W, Zhao Y, Ma P. The impact of disc degeneration on the dynamic characteristics of the lumbar spine: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1384187. [PMID: 38751866 PMCID: PMC11094277 DOI: 10.3389/fbioe.2024.1384187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
The dynamics of disc degeneration was analyzed to determine the effect of disc degeneration at the L4-L5 segment on the dynamic characteristics of the total lumbar spine. A three-dimensional nonlinear finite element model of the L1-S1 normal lumbar spine was constructed and validated. This normal model was then modified to construct two degeneration models with different degrees of degeneration (mild, moderate) at the L4-L5 level. Modal analysis, harmonic response analysis, and transient dynamics analysis were performed on the total lumbar spine when experiencing following compressive loading (500 N). As the degree of disc degeneration increased, the vibration patterns corresponding to the first three orders of the model's intrinsic frequency were basically unchanged, with the first order being in the left-right lateral bending direction, the second order being in the forward-flexion and backward-extension direction, and the third order being in the axial stretching direction. The nucleus pulposus pressure peaks corresponding to the first order intrinsic frequency for the harmonic response analysis are all on the right side of the model, with sizes of 0.053 MPa, 0.061 MPa, and 0.036 MPa, respectively; the nucleus pulposus pressure peaks corresponding to the second order intrinsic frequency are all at the rear of the model, with sizes of 0.13 MPa, 0.087 MPa, and 0.11 MPa, respectively; and the nucleus pulposus pressure peaks corresponding to the third order intrinsic frequency are all at the front of the model, with sizes of 0.19 MPa, 0.22 MPa, and 0.22 MPa, respectively. The results of the transient analysis indicated that over time, the response curves of the healthy model, the mild model, and the moderate model all exhibited cyclic response characteristics. Intervertebral disc degeneration did not adversely affect the vibration characteristics of the entire lumbar spine system. Intervertebral disc degeneration significantly altered the dynamics of the degenerative segments and their neighboring normal segments. The process of disc degeneration gradually shifted the load from the nucleus pulposus to the annulus fibrosus when the entire lumbar spine was subjected to the same vibratory environment.
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Affiliation(s)
- Xue Wang
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Wei Liu
- The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Yaqiong Zhao
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Pengcheng Ma
- Shandong Public Health Clinical Center, Shandong University, Jinan, China
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Hipp J, Grieco T, Newman P, Patel V, Reitman C. Reference Data for Diagnosis of Spondylolisthesis and Disc Space Narrowing Based on NHANES-II X-rays. Bioengineering (Basel) 2024; 11:360. [PMID: 38671782 PMCID: PMC11048070 DOI: 10.3390/bioengineering11040360] [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: 03/08/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Robust reference data, representing a large and diverse population, are needed to objectively classify measurements of spondylolisthesis and disc space narrowing as normal or abnormal. The reference data should be open access to drive standardization across technology developers. The large collection of radiographs from the 2nd National Health and Nutrition Examination Survey was used to establish reference data. A pipeline of neural networks and coded logic was used to place landmarks on the corners of all vertebrae, and these landmarks were used to calculate multiple disc space metrics. Descriptive statistics for nine SPO and disc metrics were tabulated and used to identify normal discs, and data for only the normal discs were used to arrive at reference data. A spondylolisthesis index was developed that accounts for important variables. These reference data facilitate simplified and standardized reporting of multiple intervertebral disc metrics.
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Affiliation(s)
- John Hipp
- Medical Metrics, Houston, TX 77056, USA; (T.G.); (P.N.)
| | - Trevor Grieco
- Medical Metrics, Houston, TX 77056, USA; (T.G.); (P.N.)
| | | | - Vikas Patel
- Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA;
| | - Charles Reitman
- Medical University of South Carolina, Charleston, SC 29425, USA;
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Mazurek M, Kulesza B, Gołębiowska N, Tyzo B, Kura K, Szczepanek D. Factors Predisposing to The Formation of Degenerative Spondylolisthesis-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1430. [PMID: 37629720 PMCID: PMC10456558 DOI: 10.3390/medicina59081430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
The relationship between various factors predisposing to the formation of spondylolisthesis, including degenerative spondylolisthesis, has been analyzed by many authors. However, not all observations are consistent. In this review, we identified factors whose impact on the prevalence of spondylolisthesis was most often mentioned in the literature. These included gender, age, bone mineral density, ethnic origin, and oophorectomy. The results were inclusive in terms of physical activity, pregnancy status, and use of hormone replacement therapy. Associations between diabetes and smoking were very poorly marked. The literature so far has identified a number of factors significantly affecting the incidence of degenerative spondylolisthesis. These include age, gender, body weight, ethnic origin, bone mineral density, and hormonal balance. Radiological parameters, which include iliac crest, pelvic tilt, pelvic incidence, sacral slope, and lumbar lordosis, may also be of great importance for assessing changes in the occurrence and progression. However, the authors do not agree on the real significance of individual factors. The aim of this review was to identify the factors predisposing to the formation of degenerative spondylolisthesis, the importance of which has been suggested in the current literature. The systematization of knowledge in this field can allow a more accurate adjustment of the treatment plan for each patient affected by this condition.
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Affiliation(s)
- Marek Mazurek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Bartłomiej Kulesza
- Department of Medical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland
| | - Natalia Gołębiowska
- Department of Neurosurgery and Spine Surgery, Regional Hospital in Kielce, 25-736 Kielce, Poland
| | - Bartłomiej Tyzo
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Krzysztof Kura
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Dariusz Szczepanek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
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7
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Fine N, Lively S, Séguin CA, Perruccio AV, Kapoor M, Rampersaud R. Intervertebral disc degeneration and osteoarthritis: a common molecular disease spectrum. Nat Rev Rheumatol 2023; 19:136-152. [PMID: 36702892 DOI: 10.1038/s41584-022-00888-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/27/2023]
Abstract
Intervertebral disc degeneration (IDD) and osteoarthritis (OA) affecting the facet joint of the spine are biomechanically interdependent, typically occur in tandem, and have considerable epidemiological and pathophysiological overlap. Historically, the distinctions between these degenerative diseases have been emphasized. Therefore, research in the two fields often occurs independently without adequate consideration of the co-dependence of the two sites, which reside within the same functional spinal unit. Emerging evidence from animal models of spine degeneration highlight the interdependence of IDD and facet joint OA, warranting a review of the parallels between these two degenerative phenomena for the benefit of both clinicians and research scientists. This Review discusses the pathophysiological aspects of IDD and OA, with an emphasis on tissue, cellular and molecular pathways of degeneration. Although the intervertebral disc and synovial facet joint are biologically distinct structures that are amenable to reductive scientific consideration, substantial overlap exists between the molecular pathways and processes of degeneration (including cartilage destruction, extracellular matrix degeneration and osteophyte formation) that occur at these sites. Thus, researchers, clinicians, advocates and policy-makers should consider viewing the burden and management of spinal degeneration holistically as part of the OA disease continuum.
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Affiliation(s)
- Noah Fine
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Starlee Lively
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Cheryle Ann Séguin
- Department of Physiology & Pharmacology, Schulich School of Medicine & Dentistry, Bone and Joint Institute, University of Western Ontario London, London, Ontario, Canada
| | - Anthony V Perruccio
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohit Kapoor
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Raja Rampersaud
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada. .,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. .,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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8
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Hu XB, Gu C, Chen AQ, Ying GY, Shen F, Zhu YJ. Percutaneous Full Endoscopic Management of Spinal Foraminal Schwannomas: Case Series. Oper Neurosurg (Hagerstown) 2023; 24:483-491. [PMID: 36735518 DOI: 10.1227/ons.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Schwannoma, a benign peripheral nerve sheath tumor, is perhaps only secondary to degenerative pathology as the most common lesion at neural foramen. The surgical dilemma here is either risking nerve injury because of inadequate exposure or the need for internal fixation because of facet joint sacrifice. OBJECTIVE To evaluate the feasibility and safety of management of foraminal schwannomas by percutaneous full-endoscopic technique. METHODS A single-center retrospective review was conducted on patients who underwent full-endoscopic resection of neural foraminal schwannomas. Tumors were grouped into either medial type or lateral type based on relevant location to the neural foramen, and respective surgical approaches were adopted. Data including preoperative neurological status, tumor size, surgery time, the extension of resection, and clinical outcomes were collected. The learning curve was plotted as surgical time/tumor size against case number. RESULTS A total of 25 patients were treated between May 2015 and March 2022. Gross total resection was achieved in 24 patients, and near-total resection in 1 case, with 1 patient experienced transient voiding difficulty. No tumor recurrence or spinal instability was detected in the short-term follow-up (median follow-up 22 months, range 3 months-6 years). Surgical efficiency improved with the number of cases operated on and remained stable after the initial 10 cases. CONCLUSION Percutaneous full-endoscopic technique is a safe and minimally invasive technique for the resection of foraminal schwannomas.
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Affiliation(s)
- Xin-Ben Hu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chi Gu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ai-Qin Chen
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Guang-Yu Ying
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fang Shen
- Department of Surgery, Box Hill Hospital, Eastern Health, Box Hill, Australia
| | - Yong-Jian Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Liu J, Kong Q, Chirume WM, Feng P, Zhang B, Ma J, Hu Y. Clinical Efficacy of Large-Channel Percutaneous Lumbar Endoscopic Decompression in the Treatment of Lumbar Spinal Stenosis Secondary to Old Compression Fractures. World Neurosurg 2022; 166:e118-e124. [PMID: 35779755 DOI: 10.1016/j.wneu.2022.06.111] [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: 04/22/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We sought to explore the clinical efficacy of lumbar spinal stenosis (LSS) secondary to old vertebral compression fractures (OVCF) treatment by large-channel percutaneous endoscopic lumbar decompression. METHODS Medical data for a total of 17 patients diagnosed with LSS secondary to OVCF and treated with large-channel percutaneous endoscopic lumbar decompression in our institution from January 2019 to January 2021 were collected. The dural sac cross-sectional area and morphologic grading of the magnetic resonance imaging cross-sectional area were recorded. Lumbar spine stability was assessed using the White-Panjabi scoring system. Visual analog scale and Japanese Orthopaedic Association scores were used to evaluate the surgical efficacy, and the SF-36 health questionnaire was used to evaluate the quality of life of patients. Type and probability of complications were also recorded. RESULTS The operative segments of the enrolled patients were all in the lower lumbar spine. One-year follow-up post operation showed that the dural sac cross-sectional area was significantly enlarged compared with preoperation, and the morphologic grade was significantly improved (P < 0.05). There was no difference in White-Panjabi score between preoperation and postoperation (P > 0.05). Visual analog scale and Japanese Orthopaedic Association scores at each follow-up time point after operation were higher than those before operation and were significantly improved (P < 0.05). The SF-36 health survey score at 1 year after operation was significantly higher than that before operation (P < 0.05). The complication rate was 6%. CONCLUSIONS Large-channel percutaneous lumbar endoscopic decompression has an evident clinical effect in the treatment of LSS secondary to OVCF and has little effect on the stability of the lumbar spine, which is worthy of clinical application.
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Affiliation(s)
- Junlin Liu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengu, Sichuan, China
| | - Qingquan Kong
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengu, Sichuan, China; Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Walter Munesu Chirume
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Pin Feng
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengu, Sichuan, China
| | - Bin Zhang
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengu, Sichuan, China
| | - Junsong Ma
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengu, Sichuan, China
| | - Yuan Hu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengu, Sichuan, China
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10
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Cornaz F, Haupt S, Farshad M, Widmer J. Real-time assessment of anteroposterior stability of spinal segments. 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; 31:2368-2376. [PMID: 35767113 DOI: 10.1007/s00586-022-07286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/25/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE While anteroposterior instability of spinal segments is regarded as an important biomechanical aspect in the clinical evaluation of lumbar pathologies, the reliability of the available diagnostic tools is limited and an intraoperative method to quantify stability is lacking. The aim of this study was to develop and validate an instrument to measure the anteroposterior stability of a spinal segments in real-time. METHODS Torsi of five fresh-frozen human cadavers were used for this study. After pedicle screw insertion, a specifically modified reposition tool composed with load and linear sensors was used to measure the segmental anteroposterior motion caused by 100 N anterior and posterior force during 5 loading cycles on either side of the instrumentation by two different operators. The spinal segments were then resected from the torsi and anteroposterior loading with ± 100 N was repeated in an advanced biomechanical spine testing setup as a reference measurement. The Inter-correlation coefficient (ICC) was used for validation of the "intraoperative" device. RESULTS Inter-operator repeatability of the measurements showed an ICC of 0.93 (p < 0.0001) and the bilateral (left-right) comparison had an ICC of 0.73 (p < 0.0001). The ICC resulting from the comparison to the reference measurement was 0.82 (p < 0.0001) without offset correction, and 0.9 (p < 0.0001) with offset correction. The ICC converged at this value already after two of the five performed loading cycles. CONCLUSION An accurate and reliable measurement tool is developed and validated for real-time quantification of anteroposterior stability of spinal segments and serves as a basis for future intraoperative use.
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Affiliation(s)
- Frédéric Cornaz
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Balgrist Campus, Lengghalde 5, Zurich, CH - 8008, Switzerland
| | - Samuel Haupt
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Jonas Widmer
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland.
- Spine Biomechanics, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Balgrist Campus, Lengghalde 5, Zurich, CH - 8008, Switzerland.
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11
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The relationship between traction spurs, Modic change, vacuum phenomenon, and segmental instability of the lumbar spine. Sci Rep 2022; 12:9939. [PMID: 35705718 PMCID: PMC9200777 DOI: 10.1038/s41598-022-14244-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/03/2022] [Indexed: 12/04/2022] Open
Abstract
A thorough understanding of lumbar segmental motion is valuable to treat patients with degenerative lumbar disease, but kinematics associated with indicators of lumbar intervertebral instability [traction spur, Modic changes (MCs) and vacuum phenomenon (VP)] in the lumbar spine have not been well understood. The purpose of this study is to evaluate the relationships between traction spur, MCs and VP to radiographic measurements in the lumbar spine. A total of 525 lumbar discs from L1-2 to L5-S1 of 105 patients were evaluated. The sagittal translation (ST) and sagittal angulation were measured from the radiographs taken flexion–extension. The anterior disc height (ADH) was measured from the lateral radiographs, and ΔADH was measured as the difference from supine to sitting position. Logistic regression analyses were used to detect the association between the existence of traction spur, MCs and VP and related factors. Multivariate analysis showed that the traction spur was significantly related to translational motion (ST > 2 mm, OR 4.74) and the VP was significantly related to vertical motion (ΔADH > 3 mm, OR 1.94). These results suggest that the segments with traction spur and VP should be evaluated carefully because these may be a sign of lumbar intervertebral instability.
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12
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Meng H, Gao Y, Lu P, Zhao GM, Zhang ZC, Sun TS, Li F. Risk factor analysis of disc and facet joint degeneration after intersegmental pedicle screw fixation for lumbar spondylolysis. J Orthop Surg Res 2022; 17:247. [PMID: 35459170 PMCID: PMC9034521 DOI: 10.1186/s13018-022-03082-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/17/2022] [Indexed: 01/17/2023] Open
Abstract
Background Patients who do not respond to conservative treatment of the isthmus are often treated with surgery. We used direct repair plus intersegment pedicle screw fixation for the treatment of lumbar spondylolysis. The aim of this observational study was to assess the effects of this technique and evaluate various risk factors potentially predicting the probability of disc and facet joint degeneration after instrumentation. Methods The study included 54 male L5 spondylolysis patients who underwent pars repair and intersegment fixation using pedicle screws. Bony union was evaluated using reconstruction images of computed tomography. Radiographic changes, including disc height, vertebral slip, facet joint and disc degeneration in the grade of adjacent and fixed segments, were determined from before to final follow-up. Logistic regression analysis was performed to identify factors associated with the incidence of disc and facet joint degeneration. Results Bony union was achieved in all cases. Logistic regression analysis revealed that instrumentation durations of greater than 15.5 months and 21.0 months were significant risk factors for the incidence of L4/5 and L5S1 facet degeneration, respectively. Conclusions Intersegmental pedicle screw fixation provides good surgical outcomes and good isthmic bony union rates in patients with lumbar spondylolysis. The duration of fixation was confirmed as a risk factor for facet joint degeneration. Once bony union is achieved, instrument removal should be recommended.
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Affiliation(s)
- Hao Meng
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China.
| | - Yuan Gao
- Department of Gynecology and Obstetrics, The 1st Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peng Lu
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China
| | - Guang-Min Zhao
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China
| | - Zhi-Cheng Zhang
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China
| | - Tian-Sheng Sun
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China
| | - Fang Li
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China.
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13
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Foizer GA, Paiva VCD, Nascimento RDD, Gorios C, Cliquet Júnior A, Miranda JBD. Is There Any Association between the Severity of Disc Degeneration and Low Back Pain? Rev Bras Ortop 2022; 57:334-340. [PMID: 35652022 PMCID: PMC9142238 DOI: 10.1055/s-0041-1735831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/07/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To access the possibility that higher degrees of disc degeneration lead to higher levels of pain and dysfunction. Methods Magnetic resonance imaging (MRI) scans of 85 patients with low back pain lasting for more than 12 weeks were evaluated, and the degree of disc degeneration was quantified according to the Pfirrmann grading system. The Pfirrmann degree in each disc space from L1-L2 to L5-S1, the maximum degree of Pfirrmann (Pfirrmann-max) between the lumbar discs, and the sum of Pfirrmann (Pfirrmann-sum) degrees were correlated (through the Spearman test) with the Oswestry Disability Index (ODI) and the Visual Analogical Scale (VAS) for pain. Results In total, 87% of the patients had moderate to severe lumbar disc degeneration measured by Pfirrmann-max, and the most degenerated discs were L4-L5 and L5-S1. There was a week to moderate correlation regarding the Pfirrmann-max (r = 0,330; p = 0.002) and the Pfirrmann-sum (r = 0,266; p = 0,037) and the ODI, and the Pfirrmann scores in L1-L2 were correlated with the ODI and the VAS. Conclusion Patients with chronic idiopathic low back pain frequently have moderate to severe lumbar disc degeneration, which has a negative impact on the quality of life of the patients. Low degrees of degeneration in L1-L2 might be related with higher degrees of pain and of functional disability.
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Affiliation(s)
- Guilherme Augusto Foizer
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
- Ambulatório de Coluna Vertebral, Hospital Geral de Carapicuíba, São Paulo, SP, Brazil
| | | | | | - Carlos Gorios
- Ambulatório de Coluna Vertebral, Hospital Geral de Carapicuíba, São Paulo, SP, Brazil
| | - Alberto Cliquet Júnior
- Departamento de Ortopedia, Reumatologia e Traumatologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - João Batista de Miranda
- Departamento de Ortopedia, Reumatologia e Traumatologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
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14
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A preliminary assessment of intervertebral disc health and pathoanatomy changes observed two years following anterior vertebral body tethering. 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 2021; 30:3442-3449. [PMID: 34494139 DOI: 10.1007/s00586-021-06972-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/07/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Vertebral body tethering (VBT) has been reported as a safe and effective non-fusion surgical technique for the treatment of adolescent idiopathic scoliosis, but the postoperative health of the bone and soft tissues of the spine following instrumentation remains unknown. We aimed to evaluate pathoanatomy and degenerative changes of the spine in adolescent idiopathic scoliosis patients both prior to and two years following VBT. METHODS We prospectively enrolled nine patients who underwent VBT for the treatment of progressive adolescent idiopathic scoliosis. All patients received preoperative and two-year postoperative magnetic resonance imaging of their spine; images were assessed for pathoanatomy (e.g. nucleus pulposus positioning and muscle atrophy) and degenerative changes (e.g. Schmorl nodes, endplate oedema, disc degeneration, and osteoarthritis) at each vertebral level between T1 and S1. RESULTS Four patients (44%) exhibited a shift of the nucleus pulposus from an eccentric position at baseline towards midline at three or more levels, most of which were in the tethered region. Tethering did not affect preexisting fatty atrophy of multifidus. No patients exhibited postoperative Schmorl nodes, endplate oedema, or disc degeneration in either the tethered or untethered regions. Four patients (44%) presented with mild facet osteoarthritis in the lower lumbar spine, which did not change postoperatively. One patient developed moderate facet osteoarthritis at L5-S1. CONCLUSIONS These preliminary data indicate that VBT may not result in significant degenerative changes in either the intervertebral discs or the posterior facets two years following instrumentation.
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15
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Farshad M, Aichmair A, Götschi T, Senteler M, Urbanschitz L. How is spinal range of motion affected by disc- and facet degeneration and spinopelvic anatomy? NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 7:100076. [PMID: 35141641 PMCID: PMC8820096 DOI: 10.1016/j.xnsj.2021.100076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/21/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Alexander Aichmair
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Marco Senteler
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Switzerland
| | - Lukas Urbanschitz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
- Corresponding author at: Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
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16
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Takahashi M, Iwamoto K, Kuzuyama M, Inami H, Matsumoto Y, Ueda S, Miyauchi Y. Incidence of spinal instability among patients with discogenic low back pain with different backgrounds. J Phys Ther Sci 2021; 33:601-605. [PMID: 34393371 PMCID: PMC8332637 DOI: 10.1589/jpts.33.601] [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: 04/13/2021] [Accepted: 05/24/2021] [Indexed: 12/19/2022] Open
Abstract
[Purpose] To investigate the incidence of spinal instability among patients with
discogenic low back pain and its various effects with respect to the patients’ age,
gender, sports activity, and occupation. [Participants and Methods] We assessed 65
patients diagnosed with discogenic low back pain at our clinic between May 2016 and May
2020. After measuring segmental angulation using plain radiographs, we divided these
patients into two groups: (1) instability group with >10° of segmental angulation or
>3 mm of sagittal translation and (2) stability group with <10° of segmental
angulation and <3 mm of sagittal translation. Patient data such as age, gender, sports
activity, and occupation were collected using their medical records. [Results] The
incidence of spinal instability was 57% (37 patients) among the patients with discogenic
low back pain. No significant differences in age, gender, sports activity, and occupation
were identified between the groups. [Conclusion] The incidence of spinal instability
accounted for more than half of the total number of patients. Additionally, age, gender,
sports activity, and occupation did not affect the incidence of spinal instability. Our
results support the importance of rehabilitation, such as stability training for spinal
instability, for patients with discogenic low back pain.
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Affiliation(s)
- Makoto Takahashi
- Department of Physical Therapy School of Health Sciences, Japan University of Health Sciences: 2-555 Hirasuka, Satte-City, Saitama 340-0145, Japan.,Department of Rehabilitation, Hitachino Orthopedic Clinic, Japan
| | - Koji Iwamoto
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Motoki Kuzuyama
- Mansfield/Bulimba, PhysioWorks, Australia.,Moto Mobile Physio Pty Ltd, Australia
| | - Hiroshi Inami
- Department of Rehabilitation, Hitachino Orthopedic Clinic, Japan
| | - Yuto Matsumoto
- Department of Rehabilitation, Hitachino Orthopedic Clinic, Japan
| | - Shinji Ueda
- Department of Rehabilitation, Hitachino Orthopedic Clinic, Japan
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17
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Conger A, Burnham T, Salazar F, Tate Q, Golish M, Petersen R, Cunningham S, Teramoto M, Kendall R, McCormick ZL. The Effectiveness of Radiofrequency Ablation of Medial Branch Nerves for Chronic Lumbar Facet Joint Syndrome in Patients Selected by Guideline-Concordant Dual Comparative Medial Branch Blocks. PAIN MEDICINE 2021; 21:902-909. [PMID: 31609391 DOI: 10.1093/pm/pnz248] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Although the effectiveness of lumbar medial branch radiofrequency ablation (RFA) for the treatment of zygapophyseal joint (z-joint)-mediated low back pain has been characterized, few studies have described outcomes in patients selected using a guideline-concordant paradigm of ≥80% pain relief with dual comparative medial branch blocks (MBBs). We investigated long-term treatment outcomes of patients selected according to this paradigm. DESIGN Cross-sectional cohort study. METHODS The medical records of 111 consecutive patients were reviewed; 85 met inclusion criteria. A standardized telephone survey was used to capture current numerical rating scale (NRS) and Patient Global Impression of Change (PGIC) scores. The primary outcome was the proportion of patients reporting ≥50% reduction of index pain. Binary logistic regression analysis was performed to explore associations between the primary outcome and covariates, including age, duration of pain, presence of scoliosis, degenerative spondylolisthesis, and >75% disc height loss. RESULTS At six to 12, 12-24, and >24 months, 63.2% (95% confidence interval [CI] = 41-85%), 65.6% (95% CI = 49-82%), and 44.1% (95% CI = 27-61%) of patients reported a ≥50% pain reduction (P = 0.170), respectively. At a minimum of six months, 70.6% of patients reported a pain reduction of two or more points (minimally clinically important change), and 54.1% reported a PGIC score consistent with "much improved" or better. Older age and a smaller Cobb angle were associated with a ≥50% pain reduction (P < 0.05). CONCLUSION Lumbar medial branch RFA is an effective, durable treatment for a significant proportion of patients with recalcitrant lumbar z-joint pain when candidacy is determined by the guideline-concordant paradigm of ≥80% pain relief with dual comparative MBBs.
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Affiliation(s)
- Aaron Conger
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Taylor Burnham
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Fabio Salazar
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Quinn Tate
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Mathew Golish
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Russell Petersen
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Shellie Cunningham
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Masaru Teramoto
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Richard Kendall
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
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18
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Kirnaz S, Capadona C, Lintz M, Kim B, Yerden R, Goldberg JL, Medary B, Sommer F, McGrath LB, Bonassar LJ, Härtl R. Pathomechanism and Biomechanics of Degenerative Disc Disease: Features of Healthy and Degenerated Discs. Int J Spine Surg 2021; 15:10-25. [PMID: 34376493 DOI: 10.14444/8052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The human intervertebral disc (IVD) is a complex organ composed of fibrous and cartilaginous connective tissues, and it serves as a boundary between 2 adjacent vertebrae. It provides a limited range of motion in the torso as well as stability during axial compression, rotation, and bending. Adult IVDs have poor innate healing potential due to low vascularity and cellularity. Degenerative disc disease (DDD) generally arises from the disruption of the homeostasis maintained by the structures of the IVD, and genetic and environmental factors can accelerate the progression of the disease. Impaired cell metabolism due to pH alteration and poor nutrition may lead to autophagy and disruption of the homeostasis within the IVD and thus plays a key role in DDD etiology. To develop regenerative therapies for degenerated discs, future studies must aim to restore both anatomical and biomechanical properties of the IVDs. The objective of this review is to give a detailed overview about anatomical, radiological, and biomechanical features of the IVDs as well as discuss the structural and functional changes that occur during the degeneration process.
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Affiliation(s)
- Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Charisse Capadona
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Marianne Lintz
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Byumsu Kim
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York
| | - Rachel Yerden
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Branden Medary
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Lynn B McGrath
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
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19
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Ashinsky B, Smith HE, Mauck RL, Gullbrand SE. Intervertebral disc degeneration and regeneration: a motion segment perspective. Eur Cell Mater 2021; 41:370-380. [PMID: 33763848 PMCID: PMC8607668 DOI: 10.22203/ecm.v041a24] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Back and neck pain have become primary reasons for disability and healthcare spending globally. While the causes of back pain are multifactorial, intervertebral disc degeneration is frequently cited as a primary source of pain. The annulus fibrosus (AF) and nucleus pulposus (NP) subcomponents of the disc are common targets for regenerative therapeutics. However, disc degeneration is also associated with degenerative changes to adjacent spinal tissues, and successful regenerative therapies will likely need to consider and address the pathology of adjacent spinal structures beyond solely the disc subcomponents. This review summarises the current state of knowledge in the field regarding associations between back pain, disc degeneration, and degeneration of the cartilaginous and bony endplates, the AF-vertebral body interface, the facet joints and spinal muscles, in addition to a discussion of regenerative strategies for treating pain and degeneration from a whole motion segment perspective.
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Affiliation(s)
| | | | | | - S E Gullbrand
- Corporal Michael J. Crescenz VA Medical Centre, Research, Building 21, Rm A214, 3900 Woodland Ave, Philadelphia, PA 19104,
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20
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Song Y, Wen WQ, Xu J, Zhang ZP, Han Y, Li KP, Wang XD, Xu HX, Liu J, Miao J. Kinematic Characteristics and Biomechanical Changes of Lower Lumbar Facet Joints Under Different Loads. Orthop Surg 2021; 13:1047-1054. [PMID: 33709625 PMCID: PMC8126911 DOI: 10.1111/os.12894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/05/2022] Open
Abstract
Objective To explore the kinematic biomechanical changes and symmetry in the left and right sides of the facet joints of lumbar spine segments under different functional loads. Methods Participants (n = 10) performing standing flexion and extension movements were scanned using computed tomography (CT) and dual fluoroscopy imagine system. Instantaneous images of the L3–S1 vertebrae were captured, and by matching a three‐dimensional CT model with contours from dual fluoroscopy images, in vivo facet joint movements were reproduced and analyzed. Translations and rotations of lumbar vertebral (L3 and L4) facet joints of data were compared for different loads (0, 5, 10 kg). The participants performed flexion and extension movements in different weight‐bearing states, the translations and angles changes were calculated respectively. Results From standing to extension, there were no statistical differences in rotation angles for the facet joint processes of different vertebral segment levels under different weight loads (P > 0.05). Mediolateral axis and cranio‐caudal translations under different weight loads were not statistically different for vertebral segment levels (P > 0.05). Anteroposterior translations for L3 (1.4 ± 0.1 mm) were greater than those for L4 (1.0 ± 0.1 mm) under the different load conditions (P = 0.04). Bilaterally, mediolateral, anteroposterior, and cranio‐caudal translations of the facet joints under different weights (0, 10 kg) for each segment level (L3 and L4) were symmetric (P > 0.05). From flexion to standing, there were no statistical differences in rotation angles for different weights (0, 5, 10 kg) for each level (L3 and L4) (P > 0.05). There were no statistical differences between mediolateral, anteroposterior, and cranio‐caudal translations at each segment level (L3 and L4) under different loads (P > 0.05). Under the condition of no weight (0 kg), L3 mediolateral translations on the left side (1.7 ± 1.6 mm) were significantly greater (P = 0.03) than those on the right side (1.6 ± 1.6 mm). Left side (1.0 ± 0.7 mm) L4 mediolateral translations were significantly smaller (P = 0.03) than those on the right side (1.1 ± 0.7 mm). There were no statistical differences between different weights for either anteroposterior and cranio‐caudal translations (P > 0.05). There were no statistical differences for mediolateral, anteroposterior, and cranio‐caudal translations for 10 kg (P > 0.05). Conclusion Lumbar spine facet joint kinematics did not change significantly with increased loads. Anteroposterior translations for L3 were greater than those for L4 of the vertebral segments are related to the coronal facet joint surface. Changes in facet surface symmetry indicates that the biomechanical pattern between facet joints may change.
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Affiliation(s)
- Yang Song
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China.,Department of orthopaedics, Chifeng City Hospital, Inter Mongolia, China
| | - Wang-Qiang Wen
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China
| | - Jin Xu
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Ze-Pei Zhang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Ye Han
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China
| | - Ke-Peng Li
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China
| | - Xiao-Dong Wang
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China
| | - Hao-Xiang Xu
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China
| | - Jianan Liu
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China.,Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Jun Miao
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
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21
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Walter WR, Alizai H, Bruno M, Portugal S, Burke CJ. Real-time dynamic 3-T MRI assessment of spine kinematics: a feasibility study utilizing three different fast pulse sequences. Acta Radiol 2021; 62:58-66. [PMID: 32233646 DOI: 10.1177/0284185120913000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Half-Fourier acquisition single-shot turbo spin-echo (HASTE), continuous radial gradient-echo (GRE), and True FISP allow real-time dynamic assessment of the spine. PURPOSE To evaluate the feasibility of adding dynamic sequences to routine spine magnetic resonance imaging (MRI) for assessment of spondylolisthesis. MATERIAL AND METHODS Retrospective review was performed of patients referred for dynamic MRI of the cervical or lumbar spine between January 2017 and 2018 who had flexion-extension radiographs within two months of MRI. Exclusion criteria were: incomplete imaging; spinal hardware; and inability to tolerate dynamic examination. Blinded, independent review by two board-certified musculoskeletal radiologists was performed to assess for spondylolisthesis (>3 mm translation); consensus review of dynamic radiographs served as the gold standard. Cervical spinal cord effacement was assessed. Inter-reader agreement and radiographic concordance was calculated for each sequence. RESULTS Twenty-one patients were included (8 men, 13 women; mean age 47.9 ± 16.5 years). Five had MRI of the cervical spine and 16 had MRI of the lumbar spine. Mean acquisition time was 18.4 ± 1.7 min with dynamic sequences in the range of 58-77 s. HASTE and True FISP had the highest inter-reader reproducibility (κ = 0.88). Reproducibility was better for the lumbar spine (κ = 0.94) than the cervical spine (κ = 0.28). Sensitivity of sequences for spondylolisthesis was in the range of 68.8%-78.6%. All three sequences had high accuracy levels: ≥90.5% averaged across the cervical and lumbar spine. Cervical cord effacement was observed during dynamic MRI in two cases (100% agreement). CONCLUSION Real-time dynamic MRI sequences added to spine MRI protocols provide reliable and accurate assessment of cervical and lumbar spine spondylolisthesis during flexion and extension.
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Affiliation(s)
| | - Hamza Alizai
- Texas Scottish Rite Hospital for Children, Dallas, TX, USA
| | - Mary Bruno
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Salvador Portugal
- Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA
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22
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TISOT RODRIGOARNOLD, VIEIRA JULIANODASILVEIRA, COLLARES DIEGODASILVA, TISATTO DARBYLIRA, PASINI AUGUSTO, GOBETTI BRENDA, CORONEL EDUARDO, SCHARNOVSKI EDUARDO, AGOSTINI MAIARA, BORIN MATEUS, RUSCHEL PEDRO, ISERHARD WALTER, KOHLER LUIZARECH. FACET JOINT DEGENERATION IN PATIENTS WITH LUMBAR DISC HERNIATION AND PROBABLE DETERMINING FACTORS. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201904222827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective To evaluate facet joint degeneration following surgical treatment in patients with lumbar disc herniation, seeking to correlate it with possible determining factors. Methods Cross-sectional observational study, which analyzed medical records, radiographs and magnetic resonance images of 287 patients with lumbar disc herniation treated surgically at the Spine Surgery Service of the Hospital Ortopédico de Passo Fundo. Information about age and sex was collected. In the imaging exams, the following variables were evaluated: facet joint angulation and its tropism, measured by the Karacan method, sacral slope and lumbar lordosis, measured by the Cobb method, arthrosis of the interfacetary joints, measured by the Weishaupt classification, and intervertebral disc degeneration, measured by the Pfirrmann classification. Results A statistically significant relationship was observed between facet joint degeneration and age (p = 0.002), and also between facet joint degeneration and sacral slope (p = 0.038). No correlation was found between facet joint degeneration and lumbar lordosis (p = 0.934). It was found that the most degenerated facet joints were those that had the greatest facet joint asymmetry (tropism). However, the mean degree of facet tropism did not increase homogeneously with the progression of the joint degeneration score (p = 0.380). Conclusion It was verified that there are, in fact, a multiplicity of factors related to the degree of facet joint degeneration in the low lumbar spine. Additional studies, correlated with the asymmetry of the facet joints, would be important to elucidate better preventive management of this degeneration, aiming to avert secondary low back pain and sciatica with advancing age. Level of evidence II; Retrospective study.
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Affiliation(s)
- RODRIGO ARNOLD TISOT
- Universidade de Passo Fundo, Brazil; Hospital Ortopédico de Passo Fundo, Brazil; Hospital de Clínicas de Passo Fundo, Brazil
| | | | | | - DARBY LIRA TISATTO
- Hospital Ortopédico de Passo Fundo, Brazil; Hospital de Clínicas de Passo Fundo, Brazil
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Breen A, Mellor F, Morris A, Breen A. An in vivo study exploring correlations between early-to-moderate disc degeneration and flexion mobility in the lumbar spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2619-2627. [PMID: 32651632 DOI: 10.1007/s00586-020-06526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 06/14/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Early disc degeneration (DD) has been thought to be associated with loss of spine stability. However, before this can be understood in relation to back pain, it is necessary to know the relationship between DD and intervertebral motion in people without pain. This study aimed to find out if early-to-moderate DD is associated with intervertebral motion in people without back pain. METHODS Ten pain-free adults, aged 51-71, received recumbent and weight bearing MRI scans and quantitative fluoroscopy (QF) screenings during recumbent and upright lumbar flexion. Forty individual level and 10 composite (L2-S1) radiographic and MRI DD gradings were recorded and correlated with intervertebral flexion ROM, translation, laxity and motion sharing inequality and variability for both positions. RESULTS Kinematic values were similar to previous control studies. DD was evidenced up to moderate levels by both radiographic and MRI grading. Disc height loss correlated slightly, but negatively with flexion during weight bearing flexion (R = - 0.356, p = 0.0.025). Composite MRI DD and T2 signal loss evidenced similar relationships (R = - 0.305, R = - 0.267) but did not reach statistical significance (p = 0.056, p = 0.096). No significant relationships between any other kinematic variables and DD were found. CONCLUSION This study found only small, indefinite associations between early-to-moderate DD and intervertebral motion in healthy controls. Motion sharing in the absence of pain was also not related to early DD, consistent with previous control studies. Further research is needed to investigate these relationships in patients.
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Affiliation(s)
- Alan Breen
- Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK.
| | - Fiona Mellor
- Centre for Biomechanics Research, AECC University College, Parkwood Campus, Bournemouth, BH5 2DF, UK
| | - Andrew Morris
- Centre for Biomechanics Research, AECC University College, Parkwood Campus, Bournemouth, BH5 2DF, UK
| | - Alexander Breen
- Centre for Biomechanics Research, AECC University College, Parkwood Campus, Bournemouth, BH5 2DF, UK
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Cai XY, Sun MS, Huang YP, Liu ZX, Liu CJ, Du CF, Yang Q. Biomechanical Effect of L 4 -L 5 Intervertebral Disc Degeneration on the Lower Lumbar Spine: A Finite Element Study. Orthop Surg 2020; 12:917-930. [PMID: 32476282 PMCID: PMC7307239 DOI: 10.1111/os.12703] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/22/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To ascertain the biomechanical effects of a degenerated L4 -L5 segment on the lower lumbar spine through a comprehensive simulation of disc degeneration. METHODS A three-dimensional nonlinear finite element model of a normal L3 -S1 lumbar spine was constructed and validated. This normal model was then modified such that three degenerated models with different degrees of degeneration (mild, moderate, or severe) at the L4 -L5 level were constructed. While experiencing a follower compressive load (500 N), hybrid moment loads were applied to all models to determine range of motion (ROM), intradiscal pressure (IDP), maximum von Mises stress in the annulus, maximum shear stress in the annulus, and facet joint force. RESULTS As the degree of disc degeneration increased, the ROM of the L4 -L5 degenerated segment declined dramatically in all postures (flexion: 5.79°-1.91°; extension: 5.53°-2.62°; right lateral bending: 4.47°-1.46°; left lateral bending: 4.86°-1.61°; right axial rotation: 2.69°-0.74°; left axial rotation: 2.69°-0.74°), while the ROM in adjacent segments increased (1.88°-8.19°). The largest percent decrease in motion of the L4 -L5 segment due to disc degeneration was in right axial rotation (75%), left axial rotation (69%), flexion (67%), right lateral bending (67%), left lateral bending right (67%), and extension (53%). The change in the trend of the IDP was the same as that of the ROM. Specifically, the IDP decreased (flexion: 0.592-0.09 MPa; extension: 0.678-0.334 MPa; right lateral bending: 0.498-0.205 MPa; left lateral bending: 0.523-0.272 MPa; right axial rotation: 0.535-0.246 MPa; left axial rotation: 0.53-0.266 MPa) in the L4 -L5 segment, while the IDP in adjacent segments increased (0.511-0.789 MPa). The maximum von Mises stress and maximum shear stress of the annulus in whole lumbar spine segments increased (L4 -L5 segment: 0.413-2.626 MPa and 0.412-2.783 MPa, respectively; adjacent segment of L4 -L5 : 0.356-1.493 MPa and 0.359-1.718 MPa, respectively) as degeneration of the disc progressively increased. There was no apparent regularity in facet joint force in the degenerated segment as the degree of disc degeneration increased. Nevertheless, facet joint forces in adjacent healthy segments increased as the degree of disc degeneration increased (extension: 49.7-295.3 N; lateral bending: 3.5-171.2 N; axial rotation: 140.2-258.8 N). CONCLUSION Degenerated discs caused changes in the motion and loading pattern of the degenerated segments and adjacent normal segments. The abnormal load and motion in the degenerated models risked accelerating degeneration in the adjacent normal segments. In addition, accurate simulation of degenerated facet joints is essential for predicting changes in facet joint loads following disc degeneration.
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Affiliation(s)
- Xin-Yi Cai
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Meng-Si Sun
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Yun-Peng Huang
- Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Zi-Xuan Liu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Chun-Jie Liu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Cheng-Fei Du
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
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25
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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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Iii WS, Orías AAE, Shifflett GD, Lee JYB, Siemionow K, Gandhi S, Fogg L, Samartzis D, Inoue N, An HS. Image-Based Markers Predict Dynamic Instability in Lumbar Degenerative Spondylolisthesis. Neurospine 2020; 17:221-227. [PMID: 32252172 PMCID: PMC7136107 DOI: 10.14245/ns.1938440.220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/28/2020] [Indexed: 11/29/2022] Open
Abstract
Objective To identify possible radiographic predictors markers of dynamic instability including disc height (DH), disc degeneration, and spondylosis in the setting of degenerative spondylolisthesis (DS).
Methods A retrospective review with prospectively collected data was performed on 125 patients with L4–5 DS who underwent decompression and fusion. Patients were divided into groups with dynamic instability and those without. Radiographs of the lumbar spine in neutral, flexion, and extension were used to determine degree of slip, DH, translational motion, angular motion, spondylotic changes, and lumbar lordosis. Magnetic resonance imaging (MRI) scans were reviewed to assess disc degeneration.
Results Thirty-one percent of the patients met criteria for dynamic instability. Significant correlations (p < 0.05) were found between preserved DH and dynamic instability; increased spondylotic changes and decreased translational motion; as well as advanced MRI-based disc degeneration scores with decreased angular motion, respectively. Six radiographic parameters were utilized to create a predictive model for dynamic instability, and a receiver operating characteristic curve was able to validate the predictive model (area = 0.891, standard error = 0.034, p < 0.001).
Conclusion In DS patients, preserved DH was significantly related to dynamic instability. This finding may represent a greater potential for slip progression over time in these patients. In contrast, disc degeneration on MRI, and spondylotic changes were inversely related to dynamic instability and may represent restabilization mechanisms that decrease the chance of future slip progression in DS.
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Affiliation(s)
- William Slikker Iii
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA.,College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Alejandro A Espinoza Orías
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Grant D Shifflett
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Joe Y B Lee
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Krzysztof Siemionow
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Sapan Gandhi
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Louis Fogg
- College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Howard S An
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
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Bashkuev M, Reitmaier S, Schmidt H. Relationship between intervertebral disc and facet joint degeneration: A probabilistic finite element model study. J Biomech 2020; 102:109518. [DOI: 10.1016/j.jbiomech.2019.109518] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 12/25/2022]
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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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Biomechanical Comparison of Lumbar Motion Unit Stability Following Posterior Instrumentation with Facet Spacers and Facet Screws. J Med Biol Eng 2019. [DOI: 10.1007/s40846-019-00501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose
Lumbar posterior instrumentation for facet stabilization has become popular for the treatment of lumbar instability. The present study investigated and compared facet stabilization following lumbar posterior instrumentation with facet spacers and facet screws using porcine lumbar spines.
Methods
Eighteen L5–L6 lumbar motion units (LMUs) of the porcine spines were randomly divided into three groups (un-instrumented, facet-spacer and facet-screw). In the un-instrumented group (control), all ligamentous structures were preserved. In the facet-spacer group, two facet spacers were inserted into the joint spaces of the bilateral upper and lower facets. In the facet-screw group, two cannulated screws were used to transfix the bilateral upper and lower facets. With the use of a material testing machine, a gradually increasing moment of up to 6000 N-mm was generated in flexion, extension, lateral bending and torsion motions to compare facet stabilization among the groups.
Results
The facet-spacer group was significantly stiffer than the facet-screw group in extension (p = 0.013), whereas the facet-screw group was significantly stiffer than the facet-spacer group in axial rotation (p = 0.004). No statistically significant differences were observed between the two fixation techniques in flexion (p = 0.284) and lateral bending (p = 0.085).
Conclusion
Both facet-spacer and facet-screw fixation techniques significantly improve stability in a single LMU. Facet-spacer fixation provided better stabilization in extension, while facet-screw fixation provided better stabilization in axial rotation.
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张 继, 舒 永, 朱 权, 张 泽, 李 王, 沙 萍, 郑 帅. [Lumbar facet joint degeneration contributes to degenerative lumbar scoliosis induced by asymmetric stress in rabbits]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:993-997. [PMID: 31511222 PMCID: PMC6765594 DOI: 10.12122/j.issn.1673-4254.2019.08.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the role of lumbar facet joint degeneration in the development of degenerative lumbar scoliosis caused by asymmetric stress. METHODS Thirty-six New Zealand white rabbits were randomly divided into 3 groups (n=12): Group A with aspiration of the nucleus pulposus to induce disc degeneration; Group B with removal of the left capsule from the facet joints at L3/4 to L5/6 to induce degeneration; and Group C with both treatments. Springs were deployed on the left adjacent facets at L3/4, L5/6 and L5/6 to stress the facet joints. Serial radiographs were taken at 3 and 6 months, and the facet joint tissues were sampled at 6 months for Safranin O-fast green staining to assess the severity of cartilage degeneration based on the Mankin score. RESULTS The Cobb angle differed significantly among the 3 groups (F=24.865, P=0.000). In all the groups, the Cobb angles at 6 months increased significantly as compared with that at 3 months (P <0.05). The Cobb angles were significantly greater in group C than in the other 2 groups at both 3 and 6 months (P <0.05) but showed no significant difference between Groups A and B (P>0.05). The severity of facet joint degeneration also differed significantly among the 3 groups (F= 22.009, P=0.000), and was the most severe in group C (P <0.05); facet joint degeneration was more severe in group B than in group A (P <0.05). CONCLUSIONS Facet joint degeneration is an important factor that contributes to the development of degenerative lumbar scoliosis. Disc degeneration and facet joints degeneration can lead to lumbar scoliosis, which in turn aggravates disc degeneration, facet joints degeneration and asymmetric stress, thus forming a vicious circle to further exacerbate lumbar scoliosis.
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Affiliation(s)
- 继业 张
- 深圳市龙岗区第三人民医院骨科,广东 深圳 518115Department of Orthopedics, Third People's Hospital of Longgang District, Shenzhen 518115, China
| | - 永辉 舒
- 深圳市龙岗区第三人民医院骨科,广东 深圳 518115Department of Orthopedics, Third People's Hospital of Longgang District, Shenzhen 518115, China
| | - 权 朱
- 深圳市龙岗区第三人民医院骨科,广东 深圳 518115Department of Orthopedics, Third People's Hospital of Longgang District, Shenzhen 518115, China
| | - 泽宇 张
- 深圳市龙岗区第三人民医院骨科,广东 深圳 518115Department of Orthopedics, Third People's Hospital of Longgang District, Shenzhen 518115, China
| | - 王勣 李
- 南方医科大学南方医院脊柱骨科,广东 广州 510515Department of Orthopedics and Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 萍英 沙
- 深圳市龙岗区第三人民医院骨科,广东 深圳 518115Department of Orthopedics, Third People's Hospital of Longgang District, Shenzhen 518115, China
| | - 帅 郑
- 南方医科大学南方医院脊柱骨科,广东 广州 510515Department of Orthopedics and Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Rickers KW, Li H, Robie B, Bünger C. Temporary axial rotation stabilization for lumbar disc herniation surgery with the ARO ® spinal system: a prospective analysis of safety and clinical efficacy. JOURNAL OF SPINE SURGERY 2019; 5:124-131. [PMID: 31032447 DOI: 10.21037/jss.2018.12.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Decompressive surgery has a failure rate of between 25% and 32% based on patient reported improvement in clinical symptoms. Significant back pain is associated with 53% of failures of decompressive surgery, while also being associated with abnormal axial rotation motion. We report on the clinical performance of subjects receiving a novel axial rotation stabilization implant (ARO Spinal System, ARO Medical), while undergoing a surgical decompression for a herniated lumbar disc, a condition associated with low back pain and abnormal movement. Methods This Danish Medicines Agency and Ethics Committee approved clinical trial prospectively investigated the use of the ARO® Spinal System as part of lumbar discectomy surgery in 20 patients. All subjects had a single level posterolateral lumbar herniation with symptoms lasting more than 6 weeks. They underwent an open discectomy at the symptomatic level, and received the implant. Results No complications with the implant were observed. Four serious adverse events not related to the devices were reported, one subject had reoperation at 3 months. Leg pain median VAS score decreased from 70 to 2 at 1 year (P=0.01) back pain median VAS score from 48 to 6 (P=0.04). Satisfaction with surgery was 88%. Oswestry Disability Index scored likewise improvement going from 38 pre-operative to 5 at 1 year. Follow-up rate was excellent 100%. Conclusions Discectomy with the ARO Spinal System proves equally safe as a standard discectomy at 1 year follow-up. The subjects had significant improvements in both leg and back pain. In addition, they did better than historical controls, though not statistically so in this patient sample.
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Affiliation(s)
| | - Haisheng Li
- Department of Orthopedics, Aarhus University Hospital, Århus C, Denmark
| | | | - Cody Bünger
- Department of Orthopedics, Aarhus University Hospital, Århus C, Denmark
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Kinematics of the Spine Under Healthy and Degenerative Conditions: A Systematic Review. Ann Biomed Eng 2019; 47:1491-1522. [DOI: 10.1007/s10439-019-02252-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/21/2019] [Indexed: 01/05/2023]
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Bashkuev M, Reitmaier S, Schmidt H. Is the sheep a suitable model to study the mechanical alterations of disc degeneration in humans? A probabilistic finite element model study. J Biomech 2019; 84:172-182. [PMID: 30660378 DOI: 10.1016/j.jbiomech.2018.12.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 12/07/2018] [Accepted: 12/28/2018] [Indexed: 01/08/2023]
Abstract
Intervertebral disc degeneration is one major source of low back pain, which because of its complex multifactorial nature renders the treatment challenging and thus necessitates extensive research. Experimental animal models have proven valuable in improving our understanding of degenerative processes and potentially promising therapies. Currently, the sheep is the most frequently used large animal in vivo model in intervertebral disc research. However, despite its undoubted value for investigations of the complex biological and cellular aspects, to date, it is unclear whether the sheep is also suited to study the mechanical aspects of disc degeneration in humans. A parametric finite element (FE) model of the L4-5 spinal motion segment was developed. Using this model, the geometry and the material properties of both the human and the ovine spinal segment as well as different appearances of disc degeneration can be depicted. Under pure and combined loads, it was investigated whether degenerative changes to both the human and the ovine model equivalent caused the same mechanical response. Different patterns of degeneration resulted in large variations in the ranges of motion, intradiscal pressure, ligament and facet loads. In the human, but not in the ovine model, all these results differed significantly between different degrees of degeneration. This FE model study highlighted possible differences in the mechanical response to disc degeneration between human and ovine intervertebral discs and indicates the necessity of further, more detailed, investigations.
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Affiliation(s)
- Maxim Bashkuev
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Julius Wolff Institute, Germany
| | - Sandra Reitmaier
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Julius Wolff Institute, Germany
| | - Hendrik Schmidt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Julius Wolff Institute, Germany.
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Ramhmdani S, Ishida W, Perdomo-Pantoja A, Witham TF, Lo SFL, Bydon A. Synovial Cyst as a Marker for Lumbar Instability: A Systematic Review and Meta-Analysis. World Neurosurg 2019; 122:e1059-e1068. [DOI: 10.1016/j.wneu.2018.10.228] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 01/25/2023]
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Furtado ARR, Cherubini GB, Taeymans O. Low-field magnetic resonance changes in the paravertebral musculature of dogs with acute intervertebral disc extrusion. J Small Anim Pract 2019; 60:367-373. [PMID: 30701550 DOI: 10.1111/jsap.12979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/24/2018] [Accepted: 11/21/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the MRI features and prevalence of paravertebral muscle signal intensity changes in dogs with acute intervertebral disc extrusion and to search for associations between the signal changes and clinical history, signalment, neurological examination, serum creatine kinase activity and MRI characteristics of the disc herniation. MATERIALS AND METHODS Medical records and MRI examinations from 688 dogs with surgically confirmed acute intervertebral disc extrusion were reviewed retrospectively. T2-weighted and STIR MRI sequences were available for 276 cases and were examined for paravertebral muscle signal intensity changes. When present, extension, lateralisation and signal characteristics of these changes were recorded. Exclusion criteria were muscle injections 24 hours before MRI scan, trauma and previous spinal surgery. RESULTS Nineteen dogs met the inclusion criteria. There were signal changes in the multifidus muscle, mostly in the thoracolumbar region and often extending caudally from the level of the intervertebral disc herniation. Two cases had paravertebral muscle signal intensity changes in the cervical region. MRI signal changes were seen more frequently in the muscles of non-ambulatory dogs. Clinical history and neuro-examination did not allow differentiation between dogs with and without paravertebral muscle signal intensity changes. CLINICAL SIGNIFICANCE Paravertebral muscle signal intensity changes were observed infrequently in the epaxial musculature of 6.9% dogs with acute intervertebral disc extrusion in both the thoracolumbar and cervical regions. The pathophysiological processes responsible for these MRI changes remain unknown.
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Affiliation(s)
- A R R Furtado
- Dick White Referrals, Six Mile Bottom, Cambridge CB80UH, UK
| | - G B Cherubini
- Dick White Referrals, Six Mile Bottom, Cambridge CB80UH, UK
| | - O Taeymans
- Dick White Referrals, Six Mile Bottom, Cambridge CB80UH, UK
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Frost BA, Camarero-Espinosa S, Foster EJ. Materials for the Spine: Anatomy, Problems, and Solutions. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E253. [PMID: 30646556 PMCID: PMC6356370 DOI: 10.3390/ma12020253] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/28/2018] [Accepted: 01/05/2019] [Indexed: 12/24/2022]
Abstract
Disc degeneration affects 12% to 35% of a given population, based on genetics, age, gender, and other environmental factors, and usually occurs in the lumbar spine due to heavier loads and more strenuous motions. Degeneration of the extracellular matrix (ECM) within reduces mechanical integrity, shock absorption, and swelling capabilities of the intervertebral disc. When severe enough, the disc can bulge and eventually herniate, leading to pressure build up on the spinal cord. This can cause immense lower back pain in individuals, leading to total medical costs exceeding $100 billion. Current treatment options include both invasive and noninvasive methods, with spinal fusion surgery and total disc replacement (TDR) being the most common invasive procedures. Although these treatments cause pain relief for the majority of patients, multiple challenges arise for each. Therefore, newer tissue engineering methods are being researched to solve the ever-growing problem. This review spans the anatomy of the spine, with an emphasis on the functions and biological aspects of the intervertebral discs, as well as the problems, associated solutions, and future research in the field.
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Affiliation(s)
- Brody A Frost
- Department of Materials Science and Engineering, Macromolecules Innovation Institute, Virginia Tech, Blacksburg, VA 24061, USA.
| | - Sandra Camarero-Espinosa
- Complex Tissue Regeneration Department, MERLN Institute for Technology-inspired Regenerative Medicine, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands.
| | - E Johan Foster
- Department of Materials Science and Engineering, Macromolecules Innovation Institute, Virginia Tech, Blacksburg, VA 24061, USA.
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Paholpak P, Nazareth A, Khan YA, Khan SU, Ansari F, Tamai K, Buser Z, Wang JC. Evaluation of foraminal cross-sectional area in lumbar spondylolisthesis using kinematic MRI. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:17-23. [PMID: 30054742 DOI: 10.1007/s00590-018-2276-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/24/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the kinematic change of cross-sectional area of lumbar intervertebral foramen in degenerative lumbar spondylolisthesis patients using multi-positional MRI. METHODS Multi-positional MRI was performed on 31 patients diagnosed with single or multilevel degenerative lumbar spondylolisthesis and 31 control patients without degenerative lumbar spondylolisthesis. Foraminal area (FA) was measured at the lumbar spondylolisthesis level in degenerative lumbar spondylolisthesis group and at L3-4, L4-5, and L5-S1 level in the control group. FA was measured bilaterally in neutral, flexion, and extension positions. The difference in FA between the groups was analyzed using Mann-Whitney U test, and the difference between positions within groups was analyzed using Wilcoxon signed-rank test. RESULTS Degenerative lumbar spondylolisthesis group showed significantly smaller FA on both sides and on average in all three positions compared to the control group (p < 0.05 all). From neutral to flexion position, the change in FA was significantly smaller in the degenerative lumbar spondylolisthesis group than in the control group on both sides and on average (p < 0.005 all). In degenerative lumbar spondylolisthesis group, the FA showed no significant change from neutral to flexion, but showed significant change from neutral to extension (p < 0.005 all). CONCLUSIONS FA in the degenerative lumbar spondylolisthesis group was smaller than in the control group. There was no difference in FA in degenerative lumbar spondylolisthesis group from neutral to flexion, only from neutral to extension. Patients with degenerative lumbar spondylolisthesis have a higher chance of developing foraminal stenosis.
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Affiliation(s)
- Permsak Paholpak
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-2509N, Mail Code: 9601, Los Angeles, CA, 90033, USA.,Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Alexander Nazareth
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-2509N, Mail Code: 9601, Los Angeles, CA, 90033, USA
| | | | | | | | - Koji Tamai
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-2509N, Mail Code: 9601, Los Angeles, CA, 90033, USA.,Department of Orthopedics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-2509N, Mail Code: 9601, Los Angeles, CA, 90033, USA.
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-2509N, Mail Code: 9601, Los Angeles, CA, 90033, USA
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Cho IY, Park SY, Park JH, Suh SW, Lee SH. MRI findings of lumbar spine instability in degenerative spondylolisthesis. J Orthop Surg (Hong Kong) 2018; 25:2309499017718907. [PMID: 28685666 DOI: 10.1177/2309499017718907] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To find out the factors suggesting lumbar segmental instability in patients with degenerative spondylolisthesis (DS) on conventional magnetic resonance imaging (MRI). METHODS Ninety-four patients with DS who underwent decompression surgery with or without fusion were selected. Patient demographics and findings on simple radiographs and MRI were analyzed. We divided patients into two groups by the presence of lumbar instability on simple standing plain radiographs and measured degeneration status of intervertebral discs and facet joints and distance of facet fluid signal on T2 axial MRI on each groups. The data were analyzed to find out the correlation between facet fluid signal and lumbar instability. RESULTS Sixty-three patients were confirmed to have lumbar instability (unstable group (UG), 67%), while 31 patients (stable group (SG), 33%) did not have instability on simple radiographs. The mean age was slightly older in SG ( p < 0.05) and SG patients' degeneration status of intervertebral discs and facet joints was advanced than UG patients. Fifty-five of 63 patients had high signal intensity on T2-weighted MR images in the UG, but only 4 of 31 patients had high signal intensity in the SG ( p < 0.001) and UG patients have more larger facet joint distance than SG patients ( p < 0.001). CONCLUSION High signal in facet joints on T2 MR images can be a useful factor suggestive of lumbar instability. Thus, the identification of fluid signal in the facet joints on MRI should raise the suspicion for lumbar instability and prompt additional evaluations such as with stress radiographs.
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Affiliation(s)
- Il Youp Cho
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Si Young Park
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong Hoon Park
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Woo Suh
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Soon Hyuck Lee
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Korea
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TISOT RODRIGOARNOLD, VIEIRA JULIANODASILVEIRA, COLLARES DIEGODASILVA, STUMM LEONARDODOMINGUES, FONTANA MARIANOFERABOLI, PASINI AUGUSTO, CORONEL EDUARDO, SCHARNOVSKI EDUARDO, AGOSTINI MAIARA, BORIN MATEUS, KASPER VICTOR, SÁNCHEZ VICTOR, ISERHARD WALTER. INFLUENCE OF FACET TROPISM ON THE LOCATION OF LUMBAR DISC HERNIATION. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181701179264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To correlate facet tropism with the side and location of the intervertebral disc in which the lumbar disc herniation occurred. Methods: A retrospective descriptive study that evaluated Magnetic Resonance Imaging of 255 patients with lumbar disc herniation undergoing surgical treatment with the Spine Group of the Hospital Ortopédico de Passo Fundo between 2002 and 2014. The total patient number was stratified according to the side affected by the herniated disc (right or left), location of the hernia in the intervertebral disc (central, centrolateral, foraminal and extraforaminal) and demographic data, such as age, gender etc. The degree of facet joint tropism was measured by the Karakan method and classified as mild (difference less than 7º); moderate (between 7º and 15º) and severe (difference greater than 15º). Results: A statistical significant relationship (p= 0.023) was observed between the facet joint tropism and the side where the lumbar disc herniation occurred. No correlation was found between facet joint tropism and location of the herniation on the intervertebral disc. Conclusions: The degree of facet tropism presents a statistical significant correlation with the side of the intervertebral disc in which the lumbar disc herniation will develop. Level of Evidence: II. Type of study: Retrospective study.
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Ohtori S, Miyagi M, Inoue G. Sensory nerve ingrowth, cytokines, and instability of discogenic low back pain: A review. Spine Surg Relat Res 2018; 2:11-17. [PMID: 31440640 PMCID: PMC6698542 DOI: 10.22603/ssrr.2016-0018] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/30/2017] [Indexed: 01/07/2023] Open
Abstract
Introduction Many patients suffer from discogenic low back pain. However, the mechanisms, diagnosistic strategy, and treatment of discogenic low back pain all remain controversial. The purpose of this paper was to review the pathological mechanisms of discogenic low back pain. Methods Many authors have investigated the pathological mechanisms of discogenic low back pain using animal models and examining human patients. Central to most investigations is understanding the innervation and instabilities of diseased intervertebral discs and the role of inflammatory mediators. We discuss three pathological mechanisms of discogenic low back pain: innervation, inflammation, and mechanical hypermobility of the intervertebral disc. Results Sensory nerve fibers include C-fibers and A delta-fibers, which relay pain signals from the innervated outer layers of the intervertebral disc under normal conditions. However, ingrowth of these sensory nerve fibers into the inner layers of intervertebral disc occurs under disease conditions. Levels of neurotrophic factors and some cytokines are significantly higher in diseased discs than in normal discs. Stablization of the segmental hypermobility, which can be induced by intervertebral disc degeneration, suppresses inflammation and prevents sensitization of sensory nerve fibers innervating the disc. Conclusions Pathological mechanisms of discogenic low back pain include sensory nerve ingrowth into inner layers of the intervertebral disc, upregulation of neurotrophic factors and cytokines, and instability. Inhibition of these mechanisms is important in the treatment of discogenic low back pain.
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Affiliation(s)
- Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine Chiba University, Chiba, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Kanagawa, Japan
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Paholpak P, Dedeogullari E, Lee C, Tamai K, Barkoh K, Sessumpun K, Wang JC, Buser Z. Do modic changes, disc degeneration, translation and angular motion affect facet osteoarthritis of the lumbar spine. Eur J Radiol 2018; 98:193-199. [DOI: 10.1016/j.ejrad.2017.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/31/2017] [Accepted: 11/29/2017] [Indexed: 12/13/2022]
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Byrne RM, Zhou Y, Zheng L, Chowdhury SK, Aiyangar A, Zhang X. Segmental variations in facet joint translations during in vivo lumbar extension. J Biomech 2017; 70:88-95. [PMID: 29096984 DOI: 10.1016/j.jbiomech.2017.09.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/05/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
The lumbar facet joint (FJ) is often associated with pathogenesis in the spine, but quantification of normal FJ motion remains limited to in vitro studies or static imaging of non-functional poses. The purpose of this study was to quantify lumbar FJ kinematics in healthy individuals during functional activity with dynamic stereo radiography (DSX) imaging. Ten asymptomatic participants lifted three known weights starting from a trunk-flexed (∼75°) position to an upright position while being imaged within the DSX system. High resolution computed tomography (CT) scan-derived 3D models of their lumbar vertebrae (L2-S1) were registered to the biplane 2D radiographs using a markerless model-based tracking technique providing instantaneous 3D vertebral kinematics throughout the lifting tasks. Effects of segment level and weight lifted were assessed using mixed-effect repeated measures ANOVA. Superior-inferior (SI) translation dominated FJ translation, with L5S1 showing significantly less translation magnitudes (Median (Md) = 3.5 mm, p < 0.0001) than L2L3, L3L4, and L4L5 segments (Md = 5.9 mm, 6.3 mm and 6.6 mm respectively). Linear regression-based slopes of continuous facet translations revealed strong linearity for SI translation (r2 > 0.94), reasonably high linearity for sideways sliding (Z-) (r2 > 0.8), but much less linearity for facet gap change (X-) (r2 ∼ 0.5). Caudal segments (L4-S1), particularly L5S1, displayed greater coupling compared to cranial (L2-L4) segments, revealing distinct differences overall in FJ translation trends at L5S1. No significant effect of weight lifted on FJ translations was detected. The study presents a hitherto unavailable and highly precise baseline dataset of facet translations measured during a functional, dynamic lifting task.
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Affiliation(s)
- Ryan M Byrne
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA 15203, USA
| | - Yu Zhou
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Liying Zheng
- Health Effects Lab Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - Suman K Chowdhury
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Ameet Aiyangar
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15203, USA; Mechanical Systems Engineering, EMPA (Swiss Federal Laboratories for Materials Science and Technology), 8600 Duebendorf, Switzerland.
| | - Xudong Zhang
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; Department of Mechanical Engineering, Texas A&M University, College Station, TX 77843, USA.
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Abstract
Degenerative disease of the spine is a leading cause of back pain and radiculopathy, and is a frequent indication for spine MR imaging. Disc degeneration, disc protrusion/herniation, discarhtrosis, spinal canal stenosis, and facet joint arthrosis, as well as interspinous processes arthrosis, may require an MR imaging workup. This review presents the MR imaging patterns of these diseases and describes the benefit of the MR imaging in these indications compared with the other imaging modalities like plain radiographs or computed tomography scan.
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A non-ionizing technique for three-dimensional measurement of the lumbar spine. J Biomech 2016; 49:4073-4079. [DOI: 10.1016/j.jbiomech.2016.10.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
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Moderately degenerated lumbar motion segments: Are they truly unstable? Biomech Model Mechanobiol 2016; 16:537-547. [PMID: 27664020 PMCID: PMC5350258 DOI: 10.1007/s10237-016-0835-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022]
Abstract
The two main load bearing tissues of the intervertebral disc are the nucleus pulposus and the annulus fibrosus. Both tissues are composed of the same basic components, but differ in their organization and relative amounts. With degeneration, the clear distinction between the two tissues disappears. The changes in biochemical content lead to changes in mechanical behaviour of the intervertebral disc. The aim of the current study was to investigate if well-documented moderate degeneration at the biochemical and fibre structure level leads to instability of the lumbar spine. By taking into account biochemical and ultrastructural changes to the extracellular matrix of degenerating discs, a set of constitutive material parameters were determined that described the individual tissue behaviour. These tissue biomechanical models were then used to simulate dynamic behaviour of the degenerated spinal motion segment, which showed instability in axial rotation, while a stabilizing effect in the other two principle bending directions. When a shear load was applied to the degenerated spinal motion segment, no sign of instability was found. This study found that reported changes to the nucleus pulposus and annulus fibrosus matrix during moderate degeneration lead to a more stable spinal motion segment and that such biomechanical considerations should be incorporated into the general pathophysiological understanding of disc degeneration and how its progress could affect low back pain and its treatments thereof.
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Kim JY, Ryu DS, Paik HK, Ahn SS, Kang MS, Kim KH, Park JY, Chin DK, Kim KS, Cho YE, Kuh SU. Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion. Spine J 2016; 16:867-75. [PMID: 26970600 DOI: 10.1016/j.spinee.2016.03.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/21/2016] [Accepted: 03/04/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adjacent segment degeneration (ASD) is one of the major complications after lumbar fusion. Several studies have evaluated the risk factors of ASD. Although the paraspinal muscles play an important role in spine stability, no study has assessed the relationship between paraspinal muscle atrophy and the incidence of ASD after lumbar fusion. PURPOSE In the present study, we aimed to verify the known risk factors of ASD, such as body mass index (BMI), preoperative adjacent facet joint degeneration, and disc degeneration, and to assess the relationship between paraspinal muscle atrophy and ASD. STUDY DESIGN This is a retrospective 1:1 pair analysis matched by age, sex, fusion level, and follow-up period. PATIENT SAMPLE To calculate the appropriate sample size for the study, we performed a pre-study analysis of the paraspinal muscle cross-sectional area (CSA), and estimated that at least 35 cases would be needed for each group. Among the 510 patients who underwent posterior lumbar fusion for degenerative lumbar disease between January 2009 and October 2009, a total of 50 patients with ASD after surgery were selected. Another group of 50 matched patients with degenerative lumbar disease without ASD after spinal fusion were selected as the control group. Each patient in the ASD group was matched with a control patient according to age, sex, fusion level, and follow-up period. OUTCOME MEASURES Radiographic measurements and demographic data were reviewed. METHODS The risk factors considered were higher BMI, preoperative adjacent segment disc and facet degeneration, and preoperative paraspinal muscle atrophy and fatty degeneration. The radiographic data were compared between the ASD and control groups to determine the predictive factors of ASD after posterior lumbar fusion by using logistic regression analysis. The study was not externally funded. The authors have no conflict of interest to declare. RESULTS Multivariate logistic regression analysis indicated that higher BMI (odds ratio [OR]: 1.353, p=.008), preoperative facet degeneration on computed tomography examination (OR: 3.075, p=.011), disc degeneration on magnetic resonance imaging (MRI) (OR: 2.783, p=.003), fatty degeneration (OR: 1.080, p=.044), and a smaller relative CSA of the paraspinal muscle preoperatively (OR: 0.083, p=.003) were significant factors for predicting the development of ASD. CONCLUSIONS The occurrence of radiological ASD is most likely multifactorial, and is associated with a higher BMI, preexisting facet and disc degeneration on preoperative examination, and a smaller preoperative relative CSA of the paraspinal muscle on MRI.
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Affiliation(s)
- Jong Yeol Kim
- Department of Neurosurgery, Gospel Hospital, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan, 49267, Republic of Korea
| | - Dal Sung Ryu
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Ho Kyu Paik
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Sang Soak Ahn
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Moo Sung Kang
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Jeong Yoon Park
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Dong Kyu Chin
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Keun Su Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Yong Eun Cho
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Sung Uk Kuh
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea.
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Abstract
The spine has several important functions including load transmission, permission of limited motion, and protection of the spinal cord. The vertebrae form functional spinal units, which represent the smallest segment that has characteristics of the entire spinal column. Discs and paired facet joints within each functional unit form a three-joint complex between which loads are transmitted. Surrounding the spinal motion segment are ligaments, composed of elastin and collagen, and joint capsules which restrict motion to within normal limits. Ligaments have variable strengths and act via different lever arm lengths to contribute to spinal stability. As a consequence of the longer moment arm from the spinous process to the instantaneous axis of rotation, inherently weaker ligaments (interspinous and supraspinous) are able to provide resistance to excessive flexion. Degenerative processes of the spine are a normal result of aging and occur on a spectrum. During the second decade of life, the intervertebral disc demonstrates histologic evidence of nucleus pulposus degradation caused by reduced end plate blood supply. As disc height decreases, the functional unit is capable of an increased range of axial rotation which subjects the posterior facet capsules to greater mechanical loads. A concurrent change in load transmission across the end plates and translation of the instantaneous axis of rotation further increase the degenerative processes at adjacent structures. The behavior of the functional unit is impacted by these processes and is reflected by changes in the stress-strain relationship. Back pain and other clinical symptoms may occur as a result of the biomechanical alterations of degeneration.
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Hierarchical CT to Ultrasound Registration of the Lumbar Spine: A Comparison with Other Registration Methods. Ann Biomed Eng 2016; 44:2887-2900. [DOI: 10.1007/s10439-016-1599-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
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Szpalski M, Gunzburg R, Colloca CJ, Kosmopoulos V, Hegazy MA, Freeman BJC, Fabeck L. Restoring lumbar spine stiffness using an interspinous implant in an ovine model of instability. Clin Biomech (Bristol, Avon) 2016; 33:85-91. [PMID: 26963708 DOI: 10.1016/j.clinbiomech.2016.02.009] [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] [Received: 09/30/2015] [Revised: 01/08/2016] [Accepted: 02/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The objective of this study was to determine the effect of an interspinous implant on lumbar spine stability and stiffness during dorsoventral loading. METHODS Twelve Merino lambs were mechanically tested in vivo. Oscillatory (2 Hz) loads were applied to L2 under load control while displacements were monitored. Tri-axial accelerometers further quantified adjacent L3-L4 accelerations. Dorsoventral lumbar spine stiffness and L3 and L4 dorsoventral and axial displacements were determined over six trials of 20 cycles of loading. Four conditions were examined: 1) initial intact, 2) following destabilization at L3-L4, 3) following the insertion of an InSwing(®) interspinous device at L3-L4, and 4) with the implant secured with a tension band. Comparisons were performed using a one-way ANOVA with repeated measures and post-hoc Bonferroni correction. FINDINGS Compared to the intact condition, destabilization significantly decreased lumbar stiffness by 4.5% (P=.001) which was only recovered by the interspinous device with tension band. The interspinous device caused a significant 9.75% (P=.001) increase in dorsoventral stiffness from destabilization that increased 14% with the tension band added (P=.001). The tension band was responsible for decreased displacements from the intact (P=.038), instability (P=.001), and interspinous device (P=.005) conditions. Dorsoventral L3-L4 motion significantly improved with the interspinous device (P=.01) and the addition of the tension band (P=.001). No significant differences in L3-L4 intersegmental stability were noted for axial motion in the sagittal plane. INTERPRETATION This ovine model provided objective in vivo biomechanical evidence of lumbar instability and its restoration by means of an interspinous implant during dorsoventral spinal loading.
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Affiliation(s)
- Marek Szpalski
- Department of Orthopedics, Hôpitaux Iris Sud/IRIS South Teaching Hospitals, Brussels, Belgium.
| | - Robert Gunzburg
- Department of Orthopaedic Surgery, Edith Cavell Clinic Hospital, Brussels, Belgium
| | - Christopher J Colloca
- Biomechanics Laboratory, Kinesiology Program, College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Victor Kosmopoulos
- Bone and Joint Research Center, Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, TX, USA; Department of Materials Science and Engineering, University of North Texas, Denton, TX, USA
| | | | - Brian J C Freeman
- Department of Spinal Surgery, Royal Adelaide Hospital, Adelaide, Australia; Adelaide Centre for Spinal Research, SA Pathology, Adelaide, Australia; Centre for Orthopaedic and Trauma Research, University of Adelaide, Australia
| | - Laurent Fabeck
- Department of Orthopedics, St Pierre Hospital, Brussels, Belgium
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Ferrero E, Simon AL, Magrino B, Ould-Slimane M, Guigui P. Double-level degenerative spondylolisthesis: what is different in the sagittal plane? 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 2016; 25:2546-52. [DOI: 10.1007/s00586-016-4384-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 01/08/2016] [Accepted: 01/10/2016] [Indexed: 10/22/2022]
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