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Ambrosio L, Mazzuca G, Maguolo A, Russo F, Cannata F, Vadalà G, Maffeis C, Papalia R, Denaro V. The burden of low back pain in children and adolescents with overweight and obesity: from pathophysiology to prevention and treatment strategies. Ther Adv Musculoskelet Dis 2023; 15:1759720X231188831. [PMID: 37694186 PMCID: PMC10492481 DOI: 10.1177/1759720x231188831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/28/2023] [Indexed: 09/12/2023] Open
Abstract
Nonspecific low back pain (LBP) is one of the most common causes of disability, affecting all individuals at least once in their lifetime. Such a condition is also becoming increasingly frequent in the pediatric population, especially in children and adolescents with overweight/obesity. Furthermore, new-onset LBP during adolescence has been demonstrated to be a strong predictor of developing LBP later in life, contributing to poorer outcomes and increasing social and medical costs. Several causes and different mechanisms have been considered for the development of LBP in pediatric individuals affected by obesity. For this reason, planning adequate prevention and treatment strategies, mainly through conservative lifestyle changes, would be crucial to anticipate the negative consequences of persisting LBP in adulthood. The aim of this narrative review was to characterize the relationship between LBP and overweight/obesity in the pediatric population, highlighting epidemiological and pathophysiological aspects. In addition, prevention and treatment approaches will be reviewed considering the need to reduce the burden of LBP on this population. According to our search, LBP was more frequent in children and adolescents with overweight and obesity and has been associated with several anthropometric and lifestyle factors, including lumbar hyperlordosis, sedentary habits, physical inactivity, carrying a heavy schoolbag, low vitamin D levels, psychosocial ill-being, and premature intervertebral disc degeneration. Most of these conditions may be addressed with conservative strategies mainly consisting of dietary adjustments, physical exercise, education programs, and physical therapy.
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Affiliation(s)
- Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giorgia Mazzuca
- Section of Pediatric Diabetes and Metabolic Disorders, Department of Surgical Sciences, Dentistry, Pediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Alice Maguolo
- Section of Pediatric Diabetes and Metabolic Disorders, Department of Surgical Sciences, Dentistry, Pediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Fabrizio Russo
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesca Cannata
- Operative Research Unit of Endocrinology and Diabetes, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Rome, 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Claudio Maffeis
- Section of Pediatric Diabetes and Metabolic Disorders, Department of Surgical Sciences, Dentistry, Pediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Rocco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Mousavi SR, Farrokhi MR, Liaghat A, Hassani A, Kazeminezhad A, Ghaffarpasand F. Atypical Scheuermann's disease with severe kyphosis and negative sagittal balance in the thoracolumbar region: A case report and literature review. Int J Surg Case Rep 2023; 109:108618. [PMID: 37557040 PMCID: PMC10424201 DOI: 10.1016/j.ijscr.2023.108618] [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: 07/17/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Scheuermann's kyphosis is a structural deformity of the thoracolumbar spine that is classified in typical (thoracic) and atypical (lumbar and thoracolumbar) Scheuermann's disease. Surgical intervention is reserved for those with progressive kyphosis, intractable pain and neurological impairment. Although, previous literature focuses on the correction of the thoracic kyphosis (TK), recent lines of evidence recommend considering all the sagittal balance parameters when performing a surgery. We herein, report a posterior-only approach in a patient with Scheuermann's kyphosis, considering all the sagittal balance parameters. CASE PRESENTATION The patient was a 17-year-old boy with a kyphotic deformity in the lumbar region, with urinary retention and upper back intractable pain. The preoperative physical examination was normal except for a kyphotic gait. The patient was first treated with thoracic lumbosacral orthoses (TLSO) brace that was not effective; consequently, the patient underwent posterior only approach (pedicular screw fixation along with Smith-Peterson osteotomy) with correction of the sagittal balance and kyphosis. The patient's sign and symptoms improved significantly. The surgery was uneventful and no complication was recorded. The 1-year follow-up revealed normal neurological examination and normal sagittal balance parameters. CLINICAL DISCUSSION Atypical Scheuermann's kyphosis with neurological impairment and progressive kyphosis should be treated with surgical intervention. CONCLUSION Considering the sagittal parameters of the spine, the surgical intervention should be designed to correct the kyphosis and the other indices of the sagittal balance. Posterior-only approach is safe and effective method for correction of the TK and improving the signs and symptoms of the patients.
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Affiliation(s)
- Seyed Reza Mousavi
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Reza Farrokhi
- Shiraz Neurosciences Research Center, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Alireza Liaghat
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Hassani
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Kazeminezhad
- Department of Neurosurgery, Peymanieh Hospital, Trauma Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Fariborz Ghaffarpasand
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran.
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Caetano AP, Mascarenhas VV, Machado PM. Axial Spondyloarthritis: Mimics and Pitfalls of Imaging Assessment. Front Med (Lausanne) 2021; 8:658538. [PMID: 33968964 PMCID: PMC8100693 DOI: 10.3389/fmed.2021.658538] [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] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/11/2021] [Indexed: 01/15/2023] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder that predominantly involves the axial skeleton. Imaging findings of axSpA can be divided into active changes, which include bone marrow edema, synovitis, enthesitis, capsulitis, and intra-articular effusion, and structural changes, which include erosions, sclerosis, bone fatty infiltration, fat deposition in an erosion cavity, and bone bridging or ankylosis. The ability to distinguish between imaging lesions suggestive of axSpA and artifacts or lesions suggestive of other disorders is critical for the accurate diagnosis of axSpA. Diagnosis may be challenging, particularly in early-stage disease and magnetic resonance imaging (MRI) plays a key role in the detection of subtle or inflammatory changes. MRI also allows the detection of structural changes in the subchondral bone marrow that are not visible on conventional radiography and is of prognostic and monitoring value. However, bone structural changes are more accurately depicted using computed tomography. Conventional radiography, on the other hand, has limitations, but it is easily accessible and may provide insight on gross changes as well as rule out other pathological features of the axial skeleton. This review outlines the imaging evaluation of axSpA with a focus on imaging mimics and potential pitfalls when assessing the axial skeleton.
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Affiliation(s)
- António Proença Caetano
- Radiology Department, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Grupo Luz Saúde, Radiology Department, Imaging Center, Hospital da Luz, Lisbon, Portugal.,EpiDoC Unit, Chronic Diseases Research Centre, NOVA Medical School, Lisbon, Portugal
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom.,Department of Rheumatology, London North West University Healthcare National Health Service Trust, London, United Kingdom
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Wong JS, Lalam R, Cassar-Pullicino VN, Tyrrell PN, Singh J. Stress Injuries of the Spine in Sports. Semin Musculoskelet Radiol 2020; 24:262-276. [DOI: 10.1055/s-0040-1709484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractSpine sports stress injuries account for a significant amount of time loss at play in athletes, particularly if left unrecognized and allowed to progress. Spondylolysis makes up most of these stress injuries. This article focuses on spondylolysis, bringing together discussion from the literature on its pathomechanics and the different imaging modalities used in its diagnosis. Radiologists should be aware of the limitations and more importantly the roles of different imaging modalities in guiding and dictating the management of spondylolysis. Other stress-related injuries in the spine are also discussed including but not limited to pedicle fracture and apophyseal ring injury.
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Affiliation(s)
- Jenn Shiunn Wong
- Department of Radiology, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Radhesh Lalam
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Victor N. Cassar-Pullicino
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | | | - Jaspreet Singh
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
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Chen L, Battié MC, Yuan Y, Yang G, Chen Z, Wang Y. Lumbar vertebral endplate defects on magnetic resonance images: prevalence, distribution patterns, and associations with back pain. Spine J 2020; 20:352-360. [PMID: 31669615 DOI: 10.1016/j.spinee.2019.10.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/26/2019] [Accepted: 10/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although the roles of Modic Changes (MCs) and disc degeneration in back pain remain controversial, clues from cadaveric studies suggest that lumbar vertebral endplate lesions may be important in back pain. Endplate lesions can be detected on magnetic resonance (MR) images as various endplate defects, including focal, corner, and erosive defects. Yet, the clinical significance of such endplate defects remains unknown. PURPOSE To determine the prevalence and distribution patterns of lumbar vertebral endplate defects and their associations with back pain in a population-based sample. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE Subjects were randomly selected from a typical community in Hangzhou Eastern China, regardless of back pain status. OUTCOME MEASURES Each subject underwent a structured interview and lumbar MR imaging. Back pain history, including today, over the past 4 weeks, 12 months, and lifetime, were acquired. Endplate defects, MCs, and disc degeneration were evaluated on MRIs. Age, gender and body mass index (kg/m2), as well as lifetime exposures, including smoking history, riding in motorized vehicles and associated vibration, and occupational physical demands were assessed. METHODS Descriptive statistics were used to depict prevalence and distribution patterns of endplate defects in the lumbar spine. Logistic regressions were used to examine associations of endplate defects with back pain. The research grant was obtained from the National Natural Science Foundation of China (115,000 USD), Key Platform Project of the Health Department of Zhejiang Province (14,000 USD), Technology Program of Traditional Chinese Medicine Department of Zhejiang Province (21,000 USD), and 2015 Qianjiang Talent Program of Zhejiang Province (7,000 USD) toward this work. There is no conflict to disclose. RESULTS There were 478 subjects (53.3±14.4 years, range 20-88 years) studied. Endplate defects presented in 301 (63.0%) subjects and 842 (16.0%) endplates. The presence of endplate defects, but not MCs and disc degeneration, was associated with lifetime back pain (odds ratio=1.64, p=.026) in multivariate analyses. Focal and erosive endplate defects were associated with lifetime back pain history (odds ratio=1.74-2.23, p<.05 for both), whereas all three types of defects were associated with intensity of worst back pain over the past 12 months (Coef=5.84-7.19, p<.05 for all). CONCLUSIONS Endplate defects are common findings on lumbar MRIs in adults. Specific types of endplate defects were associated with back pain history. Endplate defects may be an independent risk factor for back pain.
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Affiliation(s)
- Lunhao Chen
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Michele C Battié
- Faculty of Health Sciences, School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Ying Yuan
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Ge Yang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Zhong Chen
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of medicine, Zhejiang University, Hangzhou, People's Republic of China.
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Dai Y, Li Y, Li P, Li L, Tu Z, Wang B. Familial lumbar Scheuermann disease with idiopathic scoliosis in China: First case report. Medicine (Baltimore) 2017; 96:e7100. [PMID: 28640085 PMCID: PMC5484193 DOI: 10.1097/md.0000000000007100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Given that Scheuermann disease rarely occurs in the lumbar region and that the co-occurrence of Scheuermann disease and idiopathic scoliosis (IS) has not been reported-the etiology of Scheuermann disease and IS is not clear. In this case report, we present familaiar lumbar Scheuermann disease with IS, in a Chinese proband, who was successfully treated with surgery. PATIENT CONCERNS A 16-year-old boy presented at the Second XiangYa Hospital of Central South University with a chief complaint of kyphotic deformity in the lower back for 4 years and obvious lower back pain. In addition, he complained of limited lumbar activity. And The proband's family history was obtained by routine inquiring. In this Chinese family with 17 members over 3 generations. The 3 patients (proband, proband's sister and father) shared the characteristics of vertebral wedging from L1 to L3 and a kyphosis Cobb angle of 37°, 70°, or 73°, respectively. The main deformity of the proband's mother was at T7-L1 with a Cobb angle of 102° in the coronal plane at T7-L1, thoracic kyphosis of 73°, and lumbar lordosis of 62°. DIAGNOSES Scheuermann's disease. INTERVENTIONS Clinical history, physical examination, laboratory tests, and radiographs of those in the pedigree were recorded, and the related literature was reviewed. The proband accepted osteotomy and orthopedic surgery for treatment. OUTCOMES After 3 months of treatment, postoperative lateral radiographs showed a significantly improved sagittal vertical axis (SVA). The other patients were continued to be seen in follow-up visits. LESSONS This series of lumbar Scheuermann patients with IS in a pedigree support the genetic contribution to Scheuermann disease. Therefore, this study provides some insight into the genetic etiology of Scheuermann disease with IS.
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Khanna V, Vaishya R. Lumbar Scheuermann disease – Disease without the deformity! APOLLO MEDICINE 2016. [DOI: 10.1016/j.apme.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gokce E, Beyhan M. Radiological imaging findings of scheuermann disease. World J Radiol 2016; 8:895-901. [PMID: 27928471 PMCID: PMC5120249 DOI: 10.4329/wjr.v8.i11.895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/12/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To find accompanying anomalies of typical and atypical Scheuermann’s disease (SD) is reported in the present study.
METHODS Study included 20 patients (16 men and 4 women) who had radiological imaging radiography, magnetic resonance imaging (MRI) and computed tomography, if available, due to back pain, curved back and low back pain in November 2011-February 2016 period. Patients were categorized into typical and atypical patterns based on the region involved. Thoracic kyphosis values were measured using real Cobb angle. Accompanying disc degeneration, herniations and spinal cord pathologies were studied using MRI.
RESULTS Age of the patients ranged from 11.0 to 23.0 (mean 17.2 ± 3.0). Typical pattern of SD were detected in 15 patients while atypical pattern were detected in 5 patients. Cobb angle range was 40.2-67.2 (mean 55.5 ± 8.7) in typical Scheuermann’s patients and 24.7-49.9 (mean 36.7 ± 10.8) in atypical ones. Intervertebral level was affected and had the measures of 3-8 (mean 5.3 ± 1.6) and 7-9 (mean 8.2 ± 0.8) in typical and atypical Scheuermann’s patients, respectively. Level of degenerative disc disease in MRI was 1-7 discs (mean 4.1 ± 1.7) in typical patients and 5-10 discs (mean 7.6 ± 1.9) in atypical patients.
CONCLUSION SD can be seen in typical and atypical patterns, typical being more frequent. Because degenerative disc diseases, herniations and cord pathologies such as syringomyelia can accompany SD (albeit more common in atypical pattern), it is necessary to evaluate these patients with plain radiography and MRI together.
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Dizdarevic I, Bishop M, Sgromolo N, Hammoud S, Atanda A. Approach to the pediatric athlete with back pain: more than just the pars. PHYSICIAN SPORTSMED 2015; 43:421-31. [PMID: 26513167 DOI: 10.1080/00913847.2015.1093668] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Back pain in a pediatric patient can present a worrisome and challenging diagnostic dilemma for any physician. Although most back pain can be attributed to muscle strains and poor mechanics, it is necessary to appreciate the full differential of etiologies causing back pain in the pediatric population. The physician must recognize areas of mechanical weakness in the skeletally immature spine and the sport specific forces that can predispose a patient to injury. A comprehensive history involves determining the onset, chronicity, and location of the pain. A focused physical exam includes a neurological exam as well as provocative testing. The combination of a thorough history and focused physical exam should guide appropriate imaging. Radiographic tests are instrumental in narrowing the differential, making a diagnosis, and uncovering associated pathology. Treatment modalities such as activity modification, heat/cold compresses, and NSAIDs can provide pain relief and allow for effective physical therapy. In most cases nonoperative methods are successful in providing a safe and quick return to activities. Failure of conservative measures requires referral to an orthopedic surgeon, as surgical intervention may be warranted.
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Affiliation(s)
| | - Meghan Bishop
- b 2 Thomas Jefferson University , Philadelphia, PA, USA
| | | | - Sommer Hammoud
- d 4 Department of Orthopaedic Surgery, Thomas Jefferson University , Philadelphia, PA, USA
| | - Alfred Atanda
- e 5 Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children , Wilmington, DE, USA
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Liu N, Guo X, Chen Z, Qi Q, Li W, Guo Z, Zeng Y, Sun C, Liu Z. Radiological signs of Scheuermann disease and low back pain: retrospective categorization of 188 hospital staff members with 6-year follow-up. Spine (Phila Pa 1976) 2014; 39:1666-75. [PMID: 24979145 PMCID: PMC4222801 DOI: 10.1097/brs.0000000000000479] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/04/2014] [Accepted: 06/11/2014] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate the relationship between radiological signs of Scheuermann disease (SD) and low back pain (LBP) in a local population using lumbar magnetic resonance (MR) images. SUMMARY OF BACKGROUND DATA SD is a spinal disorder, and both its classic and atypical (lumbar) forms are associated with LBP. However, radiological signs of SD are present in 18% to 40% of the general population, in whom the clinical significance of "SD-like" spine remains largely unknown. METHODS This retrospective cohort study included 188 staff members from a single hospital. Participants' lumbar MR images and self-administered questionnaires concerning demographic information, LBP status, consequences, and functional limitations were collected. Participants were classified into 2 groups according to whether lumbar MR images met SD diagnostic criteria, and LBP status, consequences, and functional limitation were compared. Follow-up interviews were conducted after 6 years to compare LBP progression. RESULTS Thirty-four participants (18.1%) had SD-like spine. Rates of lifetime, previous 1-year, and point LBP did not significantly differ between groups. However, among participants who had ever had LBP, SD-like spine was associated with higher rates of work absence (42.1% vs. 9.5%, χ = 9.620, P = 0.002) and seeking medical care (68.4% vs. 39.2%, χ = 5.216, P = 0.022) due to LBP, as well as significantly greater intensity of the most severe LBP episode in the past 2 years (6.4 ± 2.5 vs. 4.1 ± 2.5, t = 3.564, P = 0.001). Among the 159 participants who completed the 6-year follow-up, a significantly higher proportion of people with SD-like spine reported aggravated LBP during the follow-up. CONCLUSION Our results suggest that in the general population, lumbar MR images of many people meet SD diagnostic criteria, and having SD-like spine seemed to be associated with the severity and progressive nature of LBP. Our findings should inspire further research in this field. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Ning Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
- Department of Orthopaedic Surgery, Spine Service, Massachusetts General Hospital, Boston, MA
| | - Xinhu Guo
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Qiang Qi
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Zhaoqing Guo
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Yan Zeng
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Zhongjun Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
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Mick TJ. Congenital Diseases. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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The relationship of symptomatic thoracolumbar disc herniation and Scheuermann’s disease. 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 2013; 23:1059-66. [DOI: 10.1007/s00586-013-3108-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 10/26/2022]
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Lee SH, Oh CH, Yoon SH, Park HC, Park CO. Prevalence and geographic distribution of herniated intervertebral disc in Korean 19-year-old male from 2008 to 2009: a study based on Korean conscription -national and geographic prevalence of herniated intervertebral disc in Korean 19YO male-. Yonsei Med J 2013; 54:1098-103. [PMID: 23918557 PMCID: PMC3743194 DOI: 10.3349/ymj.2013.54.5.1098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study was to determine the prevalence of herniated intervertebral disc (HIVD) among Korean 19-year-old male in a large national sample and to compare the prevalence across geographic regions based on the data of conscription. MATERIALS AND METHODS We analyzed the conscription data of 615508 cases who were 19-year-old male, given an examination for conscription at nationwide Korean Military Manpower Administration from January 2008 to December 2009. Prevalence was determined by dividing the number of cases by the number of persons enrolled for 2 years. The analyses included of a cross-tabulations and nonparametric chi-square to compare the prevalence according to geographic region, disc severity, and conscription year. RESULTS The prevalence of HIVD among 19-year-old male was 0.47%. Seoul had the highest prevalence of HIVD (total HIVD was 0.60%, and severe HIVD was 0.44%). The prevalence of HIVD was lower in Jeollabuk- do and Jeollanam-do (total HIVD was 0.25-0.27%, and severe HIVD was 0.16-0.17%). Annual prevalence of HIVD was slightly decreased in 2009, but geographic distribution annually was not different. CONCLUSION In Korean 19-year-old male, the national prevalence of adolescent HIVD was 0.60%, but different geographic distribution was observed. It is quite possible that secondary contributing factor(s) interfere with the different geographic prevalence of HIVD.
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Affiliation(s)
- Sang Hun Lee
- Department of Neurosurgery, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Chang Hyun Oh
- Seoul Regional Military Manpower Administration, Seoul, Korea
- Department of Neurosurgery, Guro Teun Teun Hospital, Seoul, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Hyeong-chun Park
- Department of Neurosurgery, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Chong Oon Park
- Department of Neurosurgery, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
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Abstract
STUDY DESIGN Observational population-based study. OBJECTIVE To determine the prevalence of radiographical Scheuermann disease in a Dutch population and evaluate the consistency of diagnostic criteria. SUMMARY OF BACKGROUND DATA Scheuermann disease is a form of osteochondrosis characterized by increased posterior rounding of the thoracic spine with structural vertebral deformity. Different expert opinion-based radiological criteria exist, yet these have not been validated. The prevalence in the general population reported ranged from 1% to 10%. METHODS Lateral spine radiographs of 2753 Rotterdam Study participants (aged 45-89 yr) were assessed for Scheuermann disease using Sørensen and Sachs' radiographical criteria in 2 phases. Cohen κ statistics were calculated for interrater agreement. Prevalence estimates were calculated and sex differences were tested with Pearson χ test. We evaluated whether varying the kyphosis angle criterion would change the prevalence estimate. RESULTS A total of 677 (24.6%) individuals had endplate irregularities and 140 (5.1%) individuals had vertebral wedging. Abnormalities were significantly more prevalent among males (P < 0.05). The interrater agreement κ statistics were 78.8% for vertebral wedging and 79.4% for endplate irregularity. A total of 127 individuals had both criteria, of which 111 had a kyphosis angle greater than 45°, resulting in a prevalence of 4.0% (95% confidence interval [CI]: 3.3%-4.7%). The disease prevalence was 4.5% in males versus 3.6% in females, yet this difference was not statistically significant (P = 0.23). Adjustment of the kyphosis angle criterion from 45° to 40° or 35° increased the number of cases marginally, corresponding to prevalence estimates not significantly different from the estimates using original criteria (4.2% [95% CI: 3.3%-4.7%] and 4.4% [95% CI: 3.6%-5.2%]). CONCLUSION Our results revealed a prevalence of 4.0% of radiographical Scheuermann disease in Dutch individuals aged 45 years and older. Although there is no current "gold standard" for the radiographical definition, standardized scoring of independent features resulted in substantial interobserver agreement, and different applications of diagnostic criteria did not significantly alter the classification.
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Lucas-García FJ, Vicent-Carsí V, Sánchez-González M. [Atypical lumbar Schuermann's disease: a presentation of 6 cases]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 57:135-9. [PMID: 23608214 DOI: 10.1016/j.recot.2012.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 10/22/2012] [Accepted: 11/01/2012] [Indexed: 11/13/2022] Open
Abstract
Scheuermann's disease is the most common cause of kyphosis in adolescence, and one of the most common causes of back pain in this age group. It is most commonly located in thoracic spine and is generally painless. Scheuermann's disease in the lumbar spine is less known and may go undetected in daily clinical practice. Blumenthal described this entity as atypical lumbar Scheuermann's disease. This form presents with Schmorl's hernias in one or two vertebral bodies, with narrowing of disc space and changes in the vertebral plates. It is more often painful and it can be confused with traumatic, infectious or tumor diseases. In most patients, a radiographic study is enough to establish the diagnosis and to differentiate both forms. Our series consists of six patients affected with the atypical form of lumbar Scheuermann's disease and diagnosed by us. All patients had a repeated history of back pain with associated Schmorl's hernias, and a very high increase in lateral diameter in radiographic views of the lumbar spine. Involvement of a single vertebral body was the most prevalent (50% of cases), and the 4th lumbar vertebra was the most commonly affected. All patients returned to normal activities after conservative treatment with temporary immobilization and NSAIDs during pain episodes.
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Affiliation(s)
- F J Lucas-García
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Fe, Valencia, España.
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Lucas-García F, Vicent-Carsí V, Sánchez-González M. Atypical lumbar Scheuermann's disease: A presentation of 6 cases. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013. [DOI: 10.1016/j.recote.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Association of modic changes, Schmorl's nodes, spondylolytic defects, high-intensity zone lesions, disc herniations, and radial tears with low back symptom severity among young Finnish adults. Spine (Phila Pa 1976) 2012; 37:1231-9. [PMID: 22166927 DOI: 10.1097/brs.0b013e3182443855] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional magnetic resonance imaging (MRI) study. OBJECTIVE We investigated the association among Modic changes, Schmorl's nodes, spondylolytic defects, high-intensity zone lesions, radial tears, herniations, and low back symptom severity. SUMMARY OF BACKGROUND DATA Disc degeneration is associated with low back pain in early adulthood, but the associations between other MRI findings and low back pain are not well known. METHODS Questionnaire data and MRI scans (1.5-T) were available for 554 subjects derived from a birth cohort at 21 years of age. Data on low back pain and back-related functional limitations at 18, 19, and 21 years of age were used for clustering of subjects, using latent class analysis. We used logistic regression with adjustment for the degree of disc degeneration to evaluate the associations between specific imaging findings and low back symptom severity. RESULTS The prevalence of herniations was 20%, Schmorl's nodes 17%, radial tears 9.9%, high-intensity zone lesions 3.2%, spondylolytic defects 5.8%, and Modic changes 0.7%. Latent class analysis produced 5 clusters: "Always Painful" (n = 65) meant painful at all time points and "Recent Onset Pain" (n = 56) meant increasing symptom severity, whereas subjects in the "Moderately Painful" (n = 73), "Minor Pain" (n = 193), and "No Pain" (n = 167) clusters had fewer symptoms. Compared with the "No Pain" cluster, Schmorl's nodes were more likely to occur in the "Always Painful" cluster (P = 0.017) and herniations in the 3 most painful clusters (P < 0.001). Herniations were associated with low back symptom severity (odds ratio, 2.5; 95% confidence interval, 1.4-4.4). Schmorl's nodes and radial tears were associated with symptoms in crude analyses only, whereas high-intensity zone lesions and spondylolytic defects occurred in similar frequencies in all clusters. CONCLUSION Herniations were most likely in the subjects with recent onset or persistent (3-yr period) low back symptoms, although they were also detected in subjects with no symptoms. The clinical relevance of herniations on MRI remains to be evaluated in the context of symptoms.
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Kim DK, Oh CH, Lee MS, Yoon SH, Park HC, Park CO. Prevalence of Lumbar Disc Herniation in Adolescent Males in Seoul, Korea: Prevalence of Adolescent LDH in Seoul, Korea. KOREAN JOURNAL OF SPINE 2011; 8:261-6. [PMID: 26064143 PMCID: PMC4461737 DOI: 10.14245/kjs.2011.8.4.261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/25/2011] [Accepted: 10/09/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The authors surveyed the prevalence and the clinical character of lumbar disc herniation (LDH) in Korean male adolescents, and the usefulness of current conscription criteria. METHODS The data of 39,673 nineteen-year-old males that underwent a conscription examination at the Seoul Regional Korean Military Manpower Administration (MMA) from October 2010 to May 2011 were investigated. For those diagnosed as having lumbar disc herniation, prevalences, subject characteristics, herniation severities, levels of herniation, and modified Korean Oswestry low back pain disability scores by MMA physical grade were evaluated. The analysis was performed using medical certificates, medical records, medical images, and electromyographic and radiologic findings. RESULTS The prevalence of adolescent LDH was 0.60%(237 of the 39,673 study subjects), and the prevalence of serious adolescent LDH with thecal sac compression or significant discogenic spinal stenosis was 0.28%(110 of the 39,673 study subjects). Of the 237 adolescent LDH cases, 105 (44.3%) were of single level LDH and 132 (55.7%) were of multiple level LDH, and the L4-5 level was the most severely and frequently affected. Oswestry back pain disability scores increased with herniation severity (p<0.01), and were well correlated with MMA grade. CONCLUSIONS In this large cohort of 19-year-old Korean males, the prevalence of adolescent LDH was 0.60% and the prevalence of serious adolescent LDH, which requires management, was relatively high at 0.28%. MMA physical grade was confirmed to be a useful measure of the disability caused by LDH.
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Affiliation(s)
- Do-Keun Kim
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Chang Hyun Oh
- Seoul Regional Military Manpower Administration, Seoul, Korea
| | - Myoung Seok Lee
- Seoul Regional Military Manpower Administration, Seoul, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Hyung-chun Park
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Chong Oon Park
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
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Samartzis D, Karppinen J, Mok F, Fong DYT, Luk KDK, Cheung KMC. A population-based study of juvenile disc degeneration and its association with overweight and obesity, low back pain, and diminished functional status. J Bone Joint Surg Am 2011; 93:662-70. [PMID: 21471420 DOI: 10.2106/jbjs.i.01568] [Citation(s) in RCA: 206] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known regarding juvenile disc degeneration in individuals with normal spinal alignment. Consequently, the purpose of this study was to assess the prevalence, determinants, and clinical relevance associated with juvenile disc degeneration of the lumbar spine in individuals without spinal deformities. METHODS A cross-sectional assessment of disc degeneration in juveniles was performed as part of a population-based study of 1989 Southern Chinese volunteers. Adolescents and young adults from thirteen to twenty years of age were defined as "juveniles." Juvenile subjects with no spinal deformity (n = 83) were stratified into two groups, those with and those without juvenile disc degeneration. Sagittal T2-weighted magnetic resonance images (MRI) were evaluated for the presence and extent of disc degeneration as well as other spinal findings. Demographics were assessed and clinical profiles were collected with use of standardized questionnaires. RESULTS Juvenile disc degeneration was present in 35% (twenty-nine) of the juveniles without spinal deformity. Disc bulging or extrusion (p < 0.001), high-intensity zones on MRI (p = 0.040), and greater weight (p < 0.001) and height (p = 0.002) were significantly more prevalent in subjects with juvenile disc degeneration. Adjusted multivariate logistic regression modeling demonstrated that Asian-modified body-mass index (BMI) values in the overweight or obese range had a significant association with juvenile disc degeneration (odds ratio = 14.19; 95% confidence interval = 1.44 to 140.40; p = 0.023). Overweight and obese individuals had greater severity of disc degeneration than underweight and normal-weight individuals (p = 0.036). Furthermore, individuals with juvenile disc degeneration had an increased prevalence of low back pain and/or sciatica (p = 0.002), greater low back pain intensity (p < 0.001), diminished social functioning (p = 0.049), and greater physical disability (p < 0.05) than individuals without disc degeneration. The p value of <0.05 for physical disability represents both the physical function (p = 0.006) and the physical component (p = 0.032) of the SF-36. CONCLUSIONS This study demonstrated that the presence of juvenile disc degeneration was strongly associated with overweight and obesity, low back pain, increased low back pain intensity, and diminished physical and social functioning. Furthermore, an elevated BMI was significantly associated with increased severity of disc degeneration. This study has public health implications regarding overweight and obesity and the development of lumbar disc disease.
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Affiliation(s)
- Dino Samartzis
- Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, SAR, China.
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Anakwenze OA, Kancherla V, Rendon N, Drummond DS. Adolescent disc dysplasia and back pain. J Child Orthop 2011; 5:49-53. [PMID: 22295049 PMCID: PMC3024481 DOI: 10.1007/s11832-010-0302-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 10/27/2010] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Adolescent disc dysplasia can be a cause of significant back pain and functional impairment in patients. We present a case series of patients inflicted with adolescent disc dysplasia (ADD). METHODS A retrospective search was performed identifying patients presenting with ADD. Radiographic studies and advanced imaging were described. We documented presenting symptoms and clinical course. RESULTS Six patients were identified. All patients presented with mechanical back pain, which worsened with flexion and extension. Magnetic resonance imaging was most accurate imaging modality. CONCLUSION Among our patient cohort, treatment for adolescent disc dysplasia consisted of a combination of physical therapy and bracing. Neither approach proved to be very effective, with only one patient asymptomatic at follow-up.
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Affiliation(s)
| | - Vamsi Kancherla
- School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Norma Rendon
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 2nd Floor Wood Building, Philadelphia, PA 19104 USA
| | - Denis S. Drummond
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 2nd Floor Wood Building, Philadelphia, PA 19104 USA
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Fotiadis E, Kenanidis E, Samoladas E, Christodoulou A, Akritopoulos P, Akritopoulou K. Scheuermann's disease: focus on weight and height role. 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 2008; 17:673-8. [PMID: 18301929 DOI: 10.1007/s00586-008-0641-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 01/16/2008] [Accepted: 01/31/2008] [Indexed: 12/16/2022]
Abstract
The aim of this cross-sectional case-control study is the comparison of the weight and height between a group of children with Scheuermann's disease (SD) and a comparable group of healthy ones and also the correlation of them with the degree and the morphology of the kyphotic curve. Following a school-screening program of 10,057 school students, aged between 11 and 17 years old, 175 adolescents with Scheuermann's disease were diagnosed. The mean height and weight of 175 adolescents diagnosed to have SD compared with this of a group of normal children taken randomly from the group of 9,882 healthy children screened. The control group was comparable with the study group concerning age (p = 0.605) and sex. The weight, height and body mass index (BMI) were significantly lower in the healthy (control) group (p < 0.001). However, there was no correlation between weight (r = -0.019, p = 0.804), height (r = 0.053, p = 0.484) and BMI (r = -0.177, p = 0.019) with the magnitude of kyphotic curve. There was also no correlation between weight (r = -0.27, p = 0.722), height (r = -0.025, p = 0.744) and BMI (r = -0.038, p = 0.619) with Voutsinas index as well. Scheuermann's disease is probably a multifactorial skeletal deformity. Weight and height do not seem to affect the magnitude and morphology of the main kyphotic curve in SD. It seems probably that this observation is not part of the pathogenetic mechanism of SD but a result of its cascade. The increased weight and height of these patients may be the secondary result of other disturbances (i.e. hormonal), which may play more crucial role in Scheuermann's disease pathogenesis.
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Affiliation(s)
- E Fotiadis
- Orthopaedic Department, General Hospital of Veria, Veria, Greece.
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23
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Varol T, Iyem C, Cezayirli E, Erturk M, Kayalioglu G, Hayretdag C. Comparative morphometry of the lower lumbar vertebrae: osteometry in dry bones and computed tomography images of patients with and without low back pain. J Int Med Res 2007; 34:316-30. [PMID: 16866027 DOI: 10.1177/147323000603400312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Various factors affect the development of the vertebral canal. The dimensions of the vertebral canal and the intervertebral foramen can be altered by these factors before or after birth. Sex differences in dimensions have also been reported. When there is a stenosis of the vertebral canal or the intervertebral foramen, neural structures confined within them can be affected easily, resulting in symptoms. Using computed tomography images, we compared vertebral canal dimensions in 100 patients with low back pain and/or radiculopathy with those in 40 healthy, non-symptomatic controls. We also measured the dimensions of 275 dry bones. We found significant correlations among the variables in the live subjects. We found significant differences between patients and controls in the variables that were measured. Stenoses were more prevalent in females. Dry bone measurements showed some sex differences, and stenosis mainly in vertebrae L4, L5 and S1.
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Affiliation(s)
- T Varol
- Department of Anatomy, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
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Sakellaridis N. The influence of diabetes mellitus on lumbar intervertebral disk herniation. ACTA ACUST UNITED AC 2006; 66:152-4. [PMID: 16876608 DOI: 10.1016/j.surneu.2006.01.019] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 01/16/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND It has recently been proven that smoking has a negative influence on lumbar disk herniation. This is probably due to microangiopathy. Our purpose was to find out if patients operated on for lumbar disk disease also have an increased incidence of diabetes mellitus. We have also examined if this increased incidence could be the result of diagnostic uncertainties (diabetic neuropathy operated as lumbar disk disease). METHODS This is a prospective study. One hundred two patients operated on in our department for lumbar disk herniation were compared with 98 patients of the same age who were admitted for elective surgery and did not take cortisone. History for diabetes mellitus, blood glucose, and glycated hemoglobin were examined. chi(2) test was used for statistical analysis. We have also compared the results of the diabetics and nondiabetic patients operated on for lumbar disk disease. RESULTS There was a statistically significant increased incidence of diabetes mellitus in patients operated on for lumbar disk disease. There was no difference in the results at 3 months of the 2 groups of patients operated on for lumbar disk disease. CONCLUSIONS Patients operated on for lumbar disk disease have a statistically significant increased incidence of diabetes mellitus compared with similar patients operated on for other reasons. This difference cannot be explained by diagnostic uncertainties because if patients with diabetic polyneuropathy were wrongly operated on for lumbar disk disease, their results would not be as good as those of the other patients operated on for lumbar disk disease. Diabetes mellitus must be a predisposing factor in patients operated on for lumbar disk disease.
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Affiliation(s)
- Nick Sakellaridis
- Neurosurgical Department, KAT National Hospital, Athens 14561, Greece.
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Smorgick Y, Floman Y, Millgram MA, Anekstein Y, Pekarsky I, Mirovsky Y. Mid- to long-term outcome of disc excision in adolescent disc herniation. Spine J 2006; 6:380-4. [PMID: 16825042 DOI: 10.1016/j.spinee.2005.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 08/29/2005] [Accepted: 10/27/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adolescent disc herniation and its surgical treatment have been the subjects of many published clinical series. The majority of these series were heterogeneous; the number of adolescent patients (12-17 years) as opposed to young adults (18-20 years) was generally small and the length of follow-up varied greatly. Although the short-term outcome of disc excision in adolescents was mostly favorable, their long-term outcome is unknown. OBJECTIVES To evaluate the mid- and long-term results of discectomy in patients younger than 17 years of age. STUDY DESIGN Retrospective examination of a series of adolescent patients under the age of 17 years who underwent surgery for lumbar intervertebral disc herniation. PATIENT SAMPLE The medical records of 26 patients (15 males, 11 females, 12-17 years old [average 14.6]) who were operated for lumbar intervertebral disc herniation in three spine centers between 1984 and 2002 were reviewed. These subjects represented the total number of patients meeting the criteria of adolescents undergoing discectomy for lumbar disc herniation in these institutions during the study period. All patients were located and contacted by an independent observer not involved in the care of these patients. Low back pain associated with leg pain was the main clinical symptom in 20 patients (77%), leg pain in 4 (15%), and back pain in 2 (8%). They all underwent posterior disc excision: 23 (88%) patients had one level discectomy, and 3 (12%) had simultaneous discectomy at two levels. The L4-L5 interspace was involved 19 times, and the L5-S1 interspace 10 times. Slipped vertebral apophysis was diagnosed in 4 patients (15%). Twelve of the 26 patients (46%) had a first-degree relative with a history of lumbar disc herniation. OUTCOME MEASURES Telephone interviews provided follow-up data for 26 patients. Results were classified as excellent, good, moderate, or poor according to current symptom status, the need for additional surgery, the Oswestry Disability Index, and back and leg pain scores. RESULTS The average time from surgery to follow-up was 8.9 years (range 3-21 years). At follow-up, the clinical results were excellent in 13 patients (50%), good in 4 (15%), moderate in 8 (31%), and poor in 1 (4%). Four subjects (15%) underwent a subsequent disc excision in the lumbar region, and one of them later underwent fusion. CONCLUSIONS Discectomy provides satisfactory clinical results in young patients with disc herniation. The rate of reintervention (15%) is comparable to that in adults, indicating that discectomy for young patients should be approached similarly to that in adults.
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Affiliation(s)
- Yossi Smorgick
- Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, 70300, Israel.
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Giri PJ, Sharma MS, Jaiswal AK, Behari S, Jain VK. Extruded lumbar disc associated with epidural hematoma. Case report. J Neurosurg 2006; 104:282-4. [PMID: 16619642 DOI: 10.3171/ped.2006.104.4.282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lumbar disc herniation and spinal epidural hematomas (SEHs) are highly unusual causes of secondary lumbar canal stenosis in the adolescent population. The authors report a unique concomitant occurrence in a 16-year-old boy who presented with left-sided L-5 radiculopathy. Magnetic resonance imaging T1-weighted sequences revealed a left-sided posterolateral prolapsed L4-5 disc with an isointense extruded fragment lying behind the L-5 body. On T2-weighted sequences a hyperintense area was seen in the region of the extruded disc fragment with thecal compression. At surgery the extradural encapsulated hematoma was removed, together with the extruded disc fragment and the L4-5 disc. The characteristics of the biopsy specimen from the epidural collection were consistent with those of a hematoma. At 6 months' follow up, the patient had returned to his normal activities. An SEH may result from tearing of delicate epidural veins following disc extrusion. It can occur at any age, regardless of whether there is a history of significant trauma. Magnetic resonance imaging allows preoperative characterization of the lesion. Results after surgical evacuation are excellent. Distinguishing between a solitary SEH and one caused by a lumbar disc extrusion has significant implications, as the former may resolve completely with conservative management.
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Affiliation(s)
- Pramod Janardhan Giri
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Burton CV. Failed back surgery patients: the alarm bells are ringing. ACTA ACUST UNITED AC 2006; 65:5-6. [PMID: 16378838 DOI: 10.1016/j.surneu.2005.08.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Accepted: 08/03/2005] [Indexed: 11/25/2022]
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Campbell RSD, Grainger AJ, Hide IG, Papastefanou S, Greenough CG. Juvenile spondylolysis: a comparative analysis of CT, SPECT and MRI. Skeletal Radiol 2005; 34:63-73. [PMID: 15668821 DOI: 10.1007/s00256-004-0878-3] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Revised: 09/02/2004] [Accepted: 09/27/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate whether MRI correlates with CT and SPECT imaging for the diagnosis of juvenile spondylolysis, and to determine whether MRI can be used as an exclusive image modality. DESIGN AND PATIENTS Juveniles and young adults with a history of extension low back pain were evaluated by MRI, CT and SPECT imaging. All images were reviewed blindly. Correlative analyses included CT vs MRI for morphological grading and SPECT vs MRI for functional grading. Finally, an overall grading system compared MRI vs CT and SPECT combined. Statistical analysis was performed using the kappa statistic. RESULTS Seventy-two patients (mean age 16 years) were recruited. Forty pars defects were identified in 22 patients (31%), of which 25 were chronic non-union, five acute complete defects and ten acute incomplete fractures. Kappa scores demonstrated a high level of agreement for all comparative analyses. MRI vs SPECT (kappa: 0.794), MRI vs CT (kappa: 0.829) and MRI vs CT/SPECT (kappa: 0.786). The main causes of discrepancy were between MRI and SPECT for the diagnosis of stress reaction in the absence of overt fracture, and distinguishing incomplete fractures from intact pars or complete defects. CONCLUSIONS MRI can be used as an effective and reliable first-line image modality for diagnosis of juvenile spondylolysis. However, localised CT is recommended as a supplementary examination in selected cases as a baseline for assessment of healing and for evaluation of indeterminate cases.
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Affiliation(s)
- R S D Campbell
- Department of Radiology, Royal Liverpool University Hospital, Prescot St., Liverpool L7 8XP, UK.
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Karppinen J, Pääkkö E, Paassilta P, Lohiniva J, Kurunlahti M, Tervonen O, Nieminen P, Göring HHH, Malmivaara A, Vanharanta H, Ala-Kokko L. Radiologic phenotypes in lumbar MR imaging for a gene defect in the COL9A3 gene of type IX collagen. Radiology 2003; 227:143-8. [PMID: 12601188 DOI: 10.1148/radiol.2271011821] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate whether the COL9A3 tryptophan allele (Trp3 allele) is associated with a specific radiologic phenotype among patients with sciatica. MATERIALS AND METHODS One hundred fifty-three patients with sciatica were evaluated for the presence of Trp3 allele, Scheuermann disease, intervertebral disk degeneration, Schmorl nodules, dorsal anular tears, hyperintense lesions, and endplate degeneration on sagittal T2-weighted lumbar magnetic resonance images. The Trp3 genotype was determined by means of sequencing the COL9A3 gene. Radiologic phenotypes were evaluated while blinded to the genotype. Scheuermann disease was diagnosed if either endplate irregularities or Schmorl nodules and two of the other three criteria (disk space narrowing, disk dehydration, and wedging of anterior vertebral body margins) were present at three or more adjacent disk levels from T10-11 to L3-4. Disk degeneration was evaluated separately for each disk (T11-12 to L5-S1) and for all disks combined. Frequencies of radiologic phenotypes between individuals with or without Trp3 allele were compared. RESULTS Thirty-four patients had at least one Trp3 allele. When compared with the matched control subjects, they had an increased likelihood of Scheuermann disease (P =.035) and an increased number of degenerated disks from T11 to S1 (P =.021). Comparisons at individual disks showed a statistically significant increase in disk degeneration at T11-12 (analysis of all grades of degeneration [graded], P =.018; analysis of any degeneration vs none [dichotomous], P =.039) and L4-5 (graded, P =.011; dichotomous, P =.016). Prevalences of anular tears, endplate degeneration, Schmorl nodules, and hyperintense lesions were comparable. CONCLUSION The results of this study indicate that the presence of Trp3 allele is associated with Scheuermann disease and intervertebral disk degeneration. No associations were found for other radiologic phenotypes.
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Affiliation(s)
- Jaro Karppinen
- Department of Physical Medicine and Rehabilitation, University Hospital of Oulu, PL 25, FIN-90029 Oulu, Finland.
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Moquin RR, Rosner MK, Cooper PB. Combined anterior–posterior fusion with laterally placed threaded interbody cages and pedicle screws for Scheuermann kyphosis. Neurosurg Focus 2003; 14:e10. [PMID: 15766217 DOI: 10.3171/foc.2003.14.1.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report their preferred method for correcting Scheuermann disease via a combined anterior–posterior approach; their procedure is associated with a lower morbidity rate than the standard approach. Twenty-month follow-up examination demonstrated excellent maintenance of correction. The results satisfied the requirements to function without restriction in a vigorous military environment.
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Affiliation(s)
- Ross R Moquin
- National Capital Consortium, Neurosurgery Program, Walter Reed, Army Medical Center, Washington, DC, USA.
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Mupparapu M, Vuppalapati A, Mozaffari E. Radiographic diagnosis of Limbus vertebra on a lateral cephalometric film: report of a case. Dentomaxillofac Radiol 2002; 31:328-30. [PMID: 12203133 DOI: 10.1038/sj.dmfr.4600698] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2001] [Revised: 02/01/2002] [Accepted: 02/05/2002] [Indexed: 11/09/2022] Open
Abstract
Although Limbus vertebra is not an uncommon radiological finding in an adult, it is a rare finding in the child or adolescent. The most common site for the presence of Limbus vertebra is the mid-lumbar region and less commonly occurs in the mid cervical region. It is a defect (tiny unfused apophyseal fragment) in the anterior margin of the vertebral body usually at the superior anterior margin in the lumbar vertebrae and at the anteroinferior margin in the cervical vertebrae. These margins are the sites of epiphyseal centers on vertebrae. A case of Limbus vertebra seen on a routine lateral cephalometric radiograph taken prior to Orthodontic treatment is reported and the literature is reviewed. The Limbus vertebra is thought to result from herniation of the nucleus pulposus through the ring apophysis prior to fusion isolating a small segment of the vertebral rim. This could be mistaken for a fracture, infection or tumor resulting in further invasive diagnostic procedures. It is important to recognize that this represents the sequela of a remote injury in an immature skeleton. A sound knowledge of this anomaly is essential for all clinicians so that appropriate measures can be taken without unduly alarming patients.
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Affiliation(s)
- M Mupparapu
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania 19104, USA.
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Parisini P, Di Silvestre M, Greggi T, Miglietta A, Paderni S. Lumbar disc excision in children and adolescents. Spine (Phila Pa 1976) 2001; 26:1997-2000. [PMID: 11547199 DOI: 10.1097/00007632-200109150-00011] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The authors examined a case series of patients under the age of 18 years treated for lumbar intervertebral disc herniation. OBJECTIVES To evaluate postoperative and long-term results of surgery in patients younger than 18 years. SUMMARY OF BACKGROUND DATA There are only a few series, with controversial results, available on the surgical treatment of disc herniation in growing patients. METHODS Between 1975 and 1991, a consecutive series of 129 patients 9-18 years of age (average age, 16.2 years) underwent surgery for lumbar intervertebral disc herniation. Low back pain associated with leg pain was the main clinical symptom in 106 subjects (82%), back pain in 17 (13%), and leg pain in 6 (5%). RESULTS Short-term results were excellent or good for 123 cases (95%), with complete pain relief in 97 (75%) and moderate but incomplete relief in 26 (20%). A total of 98 (76%) long-term responses obtained at a mean follow-up of 12.4 years revealed excellent outcomes in 40% of the cases, good in 47%, and poor in 13%. Ten patients (10%) underwent reintervention after 9 years on average (2 fusions and 8 re-explorations for herniated disc). CONCLUSIONS Results have confirmed a tendency for outcomes to deteriorate between the short-term and long-term follow-up in young patients treated by discectomy: this tendency and the rate of reintervention (10%) confirmed the need for long-term follow-up of children and adolescents treated for disc herniation.
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Affiliation(s)
- P Parisini
- Department of Spine Surgery, Rizzoli Orthopedic Institute, Bologna, Italy.
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Pietilä TA, Stendel R, Kombos T, Ramsbacher J, Schulte T, Brock M. Lumbar disc herniation in patients up to 25 years of age. Neurol Med Chir (Tokyo) 2001; 41:340-4. [PMID: 11487997 DOI: 10.2176/nmc.41.340] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Retrospective analysis of 165 patients (105 males, 60 females) with a mean age of 21.2 years (range 14 to 25 years) of 6933 surgically treated patients from January 1987 to May 1999 focused on age and sex distribution, body mass, familial predisposition, trauma, histology, and clinical course. The incidence of herniated lumbar discs was 2.3% in patients aged up to 25 years. A valid family history was obtained in 121 patients and a positive history was found in 82 of these patients (67.8%). The patients had a higher body mass index compared to a group of individuals with a similar age structure. Radiography demonstrated bony changes in 124 patients (75.2%), primarily attributable to postural deformities such as scoliosis. The condition of the bony structures seems to be more important than the condition of the disc tissue in the occurrence of this disease in young patients.
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Affiliation(s)
- T A Pietilä
- Department of Neurosurgery, Benjamin Franklin Medical Center, Free University of Berlin, Berlin, Germany
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Abstract
The diagnosis of back pain in the young athlete should be specific and not attributed to nonspecific, mechanical causes. Risk factor identification and intervention are required. Treatment is then initiated in a specific pattern, addressing flexibility and muscular imbalances. Bracing is often used to allow healing of growth tissue. The lumbosacral orthosis may be molded in a lordotic posture to unload the disc or antilordotic posture to relieve the posterior column; however, customizing the lordosis to the individual biomechanics may be required. Spinal stabilization is initiated with therapy for strengthening isolated weaknesses and progressing to coactivation and proprioceptive techniques, such as the balance ball. Returning to competition is preceded with sport-specific training.
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Affiliation(s)
- P A d'Hemecourt
- Department of Orthopaedic Surgery, Children's Hospital, Boston, Massachusetts, USA
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Abstract
Scheuermann's disease is a kyphotic deformity of the spine that develops in early adolescence. This condition has been reported to occur in 0.4% to 8% of the general population, with an equal distribution between sexes. Diagnosis of Scheuermann's disease is suggested on clinical examination; however, parents of children affected often confuse it with poor posture. Radiographs are the standard imaging modality used to confirm the diagnosis of Scheuermann's disease. Classic signs include vertebral end plate irregularity, disk space narrowing, and anterior wedging of involved vertebral bodies. Other diagnostic tools such as CT scans or magnetic resonance imaging may also be of value in the evaluation of Scheuermann's disease. The mode of treatment for this condition depends upon the severity of the deformity, remaining growth, and presence or absence of symptoms. Early treatment may be limited to observation and exercises, whereas patients who have kyphosis of up to 75 degrees and how have growth remaining may benefit from bracing. Surgical correction is reserved for severe cases that are symptomatic and refractory to conservative management.
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Affiliation(s)
- R M Ali
- Yale University, Department of Orthopedics and Rehabilitation, New Haven, CT 06520-8071, USA
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Abstract
Magnetic resonance imaging has revolutionized the noninvasive evaluation of degenerative disc disease and its complications. Compared with computed tomography and computed tomographic myelography, magnetic resonance allows specific determination of the nature of disc protrusions and other degenerative related soft tissues about the spine. Magnetic resonance offers the most complete evaluation of specific degenerative disorders including degenerative facet disease, spondylolysis, spondylolisthesis, spontaneous lumbar epidural hematomas, and juvenile discogenic disease.
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Affiliation(s)
- C R Gundry
- Center for Diagnostic Imaging, Minneapolis, MN 55416, USA
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