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Yabe Y, Ishikawa K, Kurosawa D, Murakami E, Aizawa T. Buckling of the Ligamentum Flavum in Patients with Lumbar Spinal Canal Stenosis. Spine (Phila Pa 1976) 2024; 49:E284-E290. [PMID: 39133228 DOI: 10.1097/brs.0000000000004941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/10/2024] [Indexed: 08/13/2024]
Abstract
STUDY DESIGN Experimental study. OBJECTIVE We sought to elucidate the association between ligamentum flavum thickening and tissue buckling, and the clinical and imaging factors related to buckling by comparing the ligamentum flavum thickness on MRI images and within the actual tissue. SUMMARY OF BACKGROUND DATA Ligamentum flavum thickening is a main contributor to lumbar spinal canal stenosis. Buckling of the tissue may contribute to ligamentum flavum thickening along with tissue hypertrophy; however, this association has not been established conclusively. MATERIALS AND METHODS Ligamentum flavum samples (135 ligament samples) from 70 patients with lumbar spinal canal stenosis were evaluated. The ligamentum flavum thicknesses on magnetic resonance imaging (MRI) and in the tissue samples were compared to assess for the presence of buckling. The ligamentum flavum samples were divided into groups with or without buckling based on the difference between their thicknesses on MRI and in the tissues. The Pearson correlation coefficient test was used to assess the relationships between the LF thicknesses on MRI and in the tissues, MRI-tissue difference and LF thickness in the tissues, and MRI-tissue difference and LF thickness on MRI. Further, differences between the buckling+ and buckling- groups were compared using the unpaired t-test (LF thickness on MRI, LF thickness in the tissues, age, disc angle, and disc height) and χ2 (disc level, disc degeneration, and receival/nonreceival of dialysis) test. RESULTS The ligamentum flavum thickness on MRI and in the tissues had a positive linear relationship, although the thickness was estimated to be significantly larger on MRI than in the tissues themselves. The ligamentum flavum with buckling had a larger thickness on MRI, less tissue hypertrophy, more severe disc degeneration, and was present in patients with a higher rate of dialysis. There were no differences in age and disc height, angle, or level between the two groups. CONCLUSIONS Buckling of the ligamentum flavum coexists with tissue hypertrophy and contributes to perceived ligamentum thickening on imaging. Buckling of the ligamentum flavum tends to occur in less hypertrophied tissues and is associated with the grade of disc degeneration and the presence of other characteristics associated with spinal degeneration.
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Affiliation(s)
- Yutaka Yabe
- Department of Orthopaedic Surgery, National Hospital Organisation Sendai Nishitaga Hospital, Sendai, Japan
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Keisuke Ishikawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Daisuke Kurosawa
- Department of Orthopaedic Surgery, JCHO Sendai Hospital, Sendai, Miyagi, Japan
| | - Eiichi Murakami
- Department of Orthopaedic Surgery, JCHO Sendai Hospital, Sendai, Miyagi, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Su Y, Ren D, Chen Y, Geng L, Yao S, Wu H, Wang P. Effect of endplate reduction on endplate healing morphology and intervertebral disc degeneration in patients with thoracolumbar vertebral fracture. 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 2023; 32:55-67. [PMID: 35435517 DOI: 10.1007/s00586-022-07215-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/25/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the effect of endplate reduction on the final healing morphology and degenerative changes in intervertebral discs. METHODS Forty-eight patients with single-level thoracolumbar fractures with endplate injury were included. All patients underwent posterior reduction and pedicle screw fixation, and postoperative imaging was used to determine whether endplate reduction was successful. The healing morphology of the endplate was divided into three types: increased endplate curvature, irregular healing and traumatic Schmorl node. MRI was performed at baseline and at the last follow-up evaluation to observe changes in disc degeneration (disc height and nucleus pulposus signal) and Modic changes. RESULTS The reduction rate in the central area was significantly lower than that in the peripheral area (P = 0.017). In patients with successful reduction, 90.9% (20/22) of the endplates healed with increased curvature. In patients with an unsuccessful endplate reduction, 63.4% (26/41) of the endplates healed irregularly, and 34.1% (14/41) of the endplates formed traumatic Schmorl nodes. Endplate reduction was closely related to the final healing morphology of the endplate (P < 0.001), which had a significant protective effect on the degeneration of the intervertebral disc. At the last follow-up evaluation, there was no statistically significant correlation between different endplate healing morphologies and new Modic changes. CONCLUSIONS The reduction rate in the central area is significantly lower than that in the peripheral area. Although all of the intervertebral discs corresponding to fractured endplates had degenerated to different degrees, successful endplate fracture reduction can obviously delay the degeneration of intervertebral discs.
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Affiliation(s)
- Yunshan Su
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China
| | - Dong Ren
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China
| | - Yufeng Chen
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China
| | - Lindan Geng
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China
| | - Shuangquan Yao
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China
| | - Haotian Wu
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China
| | - Pengcheng Wang
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China.
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Ex vivo biomechanical evaluation of Acute lumbar endplate injury and comparison to annulus fibrosus injury in a rat model. J Mech Behav Biomed Mater 2022; 131:105234. [DOI: 10.1016/j.jmbbm.2022.105234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/14/2022] [Accepted: 04/09/2022] [Indexed: 11/20/2022]
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Novel Methods to Measure Height and Volume in Healthy and Degenerated Lumbar Discs in MRIs: A Reliability Assessment Study. Diagnostics (Basel) 2022; 12:diagnostics12061437. [PMID: 35741247 PMCID: PMC9221833 DOI: 10.3390/diagnostics12061437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/23/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background: In the regeneration and therapy of degenerated intervertebral discs, the height, volume or categorizing assessments, such as Pfirrmann classification, are used to quantify the discs themselves and the effects of therapy. Here, the question of transferability, in the sense of reliability, of the results arises in the common exchange. Methods: We have investigated two established and a newly developed (9-point measurement), easy to use methods for height measurement and volume measurement on degenerated and healthy lumbar intervertebral discs of 66 patients regarding inter- and intra-observer reliability. Results: In overview, we found very different reliabilities. While the intra-observer reliability showed good to excellent agreement for both healthy and degenerated lumbar discs for the height and volume measurements, the inter-observer reliability was low or moderate in some cases. The 9-point method for height determination consistently showed better reliability for both healthy and degenerated discs, for both intra- and inter-observer reliability, compared to the two established methods. Conclusions: We recommend using the 9-point measurement as the method to communicate lumbar disc height, both for healthy and degenerated discs. Due to the partly low or moderate reliability, significant differences in the measured heights can already occur, which can lead to a worsened comparability.
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Lu X, Zhu Z, Pan J, Feng Z, Lv X, Battié MC, Wang Y. Traumatic vertebra and endplate fractures promote adjacent disc degeneration: evidence from a clinical MR follow-up study. Skeletal Radiol 2022; 51:1017-1026. [PMID: 34599674 DOI: 10.1007/s00256-021-03846-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/13/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The integrity of endplate is important for maintaining the health of adjacent disc and trabeculae. Yet, pathological impacts of traumatic vertebra and endplate fractures were less studied using clinical approaches. This study aims to investigate their effects on the development of adjacent disc degeneration, segmental kyphosis, Modic changes (MCs), and high-intensity zones (HIZs). MATERIALS AND METHODS Magnetic resonance (MR) images of patients with acute traumatic vertebral compression fractures (T11-L5) were studied. On MR images, endplate fractures were evaluated as present or absent. Disc signal, height, bulging area, sagittal Cobb angle, MCs, and HIZs were measured on baseline and follow-up MR images to study the changes of the disc in relation to vertebra fractures and endplate fractures. RESULTS Ninety-seven patients were followed up for 15.4 ± 14.0 months. There were 123 fractured vertebrae, including 79 (64.2%) with endplate fractures and 44 (35.8%) without. Both the adjacent and control discs decreased in signal and height over time (p < 0.001), and the disc adjacent to vertebral fractures had greater signal and height loss than the control disc (p < 0.05). In the presence of endplate fractures, the adjacent discs had greater signal decrease in follow-up (p < 0.05), as compared to those without endplate fractures. Sagittal Cobb angle significantly increased in segments with endplate fractures (p < 0.05). Vertebra fractures were associated with new occurrence of MCs in the fractured vertebra (p < 0.001) but not HIZs in the adjacent disc. CONCLUSIONS Traumatic vertebral fractures were associated with accelerated adjacent disc degeneration, which appears to be further promoted by concomitant endplate fractures. Endplate fractures were associated with progression of segmental kyphosis.
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Affiliation(s)
- Xuan Lu
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, China
| | - Zhiwei Zhu
- Department of Radiology, Dongyang People's Hospital, Dongyang, China
| | - Jianjiang Pan
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, China
| | - Zhiyun Feng
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, China
| | - Xiaoqiang Lv
- Department of Orthopedic Surgery, Dongyang People's Hospital, Dongyang, China
| | - Michele C Battié
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, ON, Canada
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, China.
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Sneath RJS, Khan A, Hutchinson C. An Objective Assessment of Lumbar Spine Degeneration/Ageing Seen on MRI Using An Ensemble Method-A Novel Approach to Lumbar MRI Reporting. Spine (Phila Pa 1976) 2022; 47:E187-E195. [PMID: 34224512 DOI: 10.1097/brs.0000000000004159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective, randomized, radiographic study assessing age-related changes (ARCs) on lumbar magnetic resonance imaging (MRI) using an ensemble method. OBJECTIVES This study proposed to develop a novel reporting method to calculate a predicted "age estimate" for the ARC seen on lumbar MRI. SUMMARY OF BACKGROUND DATA Lumbar MRI reports include pathological findings but usually not the prevalence data of common findings which has been shown to decrease the need for narcotics in the management of non-specific lower back pain (NSLBP). Comparing the normal age estimation for lumbar spine degenerative changes/ARC on MRI and comparing this to the patient's real age may improve patient outcome in the management of NSLBP. METHODS A total of 60 lumbar MRI were taken from patients aged between 0 and 100 years. Lumbar MRI features reported as associated with age on review of the literature were measured on each MRI and statistically evaluated for correlation with age. Factors found to be associated were then entered into an ensemble model consisting of several machine learning techniques. The resulting ensemble model was then tested to predict age for a further 10 random lumbar MRI scans. One further lumbar MRI was then assessed for observer variability. RESULTS Features that correlated with age were disc signal intensity, the appearance of paravertebral and psoas muscle, disc height, facet joint size, ligamentum flavum thickness, Schmorl nodes, Modic changes, vertebral osteophytes, and high-intensity zones. With the ensemble model, 80% of estimated spinal age were within 11 years of the subjects' physical age. CONCLUSION It would appear that the intervertebral discs, and many other structures that are subjected to loading in and around the lumbar spine change their lumbar MRI appearance in a predictable way with increasing age. ARC on lumbar MRI can be assessed to predict an "expected age" for the subject.Level of Evidence: 2.
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Zheng HD, Sun YL, Kong DW, Yin MC, Chen J, Lin YP, Ma XF, Wang HS, Yuan GJ, Yao M, Cui XJ, Tian YZ, Wang YJ. Deep learning-based high-accuracy quantitation for lumbar intervertebral disc degeneration from MRI. Nat Commun 2022; 13:841. [PMID: 35149684 PMCID: PMC8837609 DOI: 10.1038/s41467-022-28387-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/21/2022] [Indexed: 11/14/2022] Open
Abstract
To help doctors and patients evaluate lumbar intervertebral disc degeneration (IVDD) accurately and efficiently, we propose a segmentation network and a quantitation method for IVDD from T2MRI. A semantic segmentation network (BianqueNet) composed of three innovative modules achieves high-precision segmentation of IVDD-related regions. A quantitative method is used to calculate the signal intensity and geometric features of IVDD. Manual measurements have excellent agreement with automatic calculations, but the latter have better repeatability and efficiency. We investigate the relationship between IVDD parameters and demographic information (age, gender, position and IVDD grade) in a large population. Considering these parameters present strong correlation with IVDD grade, we establish a quantitative criterion for IVDD. This fully automated quantitation system for IVDD may provide more precise information for clinical practice, clinical trials, and mechanism investigation. It also would increase the number of patients that can be monitored.
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Affiliation(s)
- Hua-Dong Zheng
- School of Automation and Mechanical Engineering, Shanghai University, Shanghai, 200072, China
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai, 200072, China
| | - Yue-Li Sun
- Longhua Hospital, Shanghai University of TCM, Shanghai, 200032, China
- Spine Research Institute, Shanghai Academy of TCM, Shanghai, 200032, China
- Key Laboratory of the Ministry of Education of Chronic Musculoskeletal Disease, Shanghai, 200032, China
| | - De-Wei Kong
- Longhua Hospital, Shanghai University of TCM, Shanghai, 200032, China
| | - Meng-Chen Yin
- Longhua Hospital, Shanghai University of TCM, Shanghai, 200032, China
- Key Laboratory of the Ministry of Education of Chronic Musculoskeletal Disease, Shanghai, 200032, China
| | - Jiang Chen
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yong-Peng Lin
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Xue-Feng Ma
- Shenzhen Pingle Orthopedics Hospital, Shenzhen, 518118, China
| | - Hong-Shen Wang
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Guang-Jie Yuan
- School of Automation and Mechanical Engineering, Shanghai University, Shanghai, 200072, China
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai, 200072, China
| | - Min Yao
- Longhua Hospital, Shanghai University of TCM, Shanghai, 200032, China
- Spine Research Institute, Shanghai Academy of TCM, Shanghai, 200032, China
- Key Laboratory of the Ministry of Education of Chronic Musculoskeletal Disease, Shanghai, 200032, China
| | - Xue-Jun Cui
- Longhua Hospital, Shanghai University of TCM, Shanghai, 200032, China
- Spine Research Institute, Shanghai Academy of TCM, Shanghai, 200032, China
- Key Laboratory of the Ministry of Education of Chronic Musculoskeletal Disease, Shanghai, 200032, China
| | - Ying-Zhong Tian
- School of Automation and Mechanical Engineering, Shanghai University, Shanghai, 200072, China.
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai, 200072, China.
| | - Yong-Jun Wang
- Longhua Hospital, Shanghai University of TCM, Shanghai, 200032, China.
- Spine Research Institute, Shanghai Academy of TCM, Shanghai, 200032, China.
- Key Laboratory of the Ministry of Education of Chronic Musculoskeletal Disease, Shanghai, 200032, China.
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Shen H, Huang J, Zheng Q, Zhu Z, Lv X, Liu Y, Wang Y. A Deep-Learning-Based, Fully Automated Program to Segment and Quantify Major Spinal Components on Axial Lumbar Spine Magnetic Resonance Images. Phys Ther 2021; 101:6124778. [PMID: 33517461 DOI: 10.1093/ptj/pzab041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/04/2020] [Accepted: 01/03/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The paraspinal muscles have been extensively studied on axial lumbar magnetic resonance imaging (MRI) for better understanding of back pain; however, the acquisition of measurements mainly relies on manual segmentation, which is time consuming. The study objective was to develop and validate a deep-learning-based program for automated acquisition of quantitative measurements for major lumbar spine components on axial lumbar MRIs, the paraspinal muscles in particular. METHODS This study used a cross-sectional observational design. From the Hangzhou Lumbar Spine Study, T2-weighted axial MRIs at the L4-5 disk level of 120 participants (aged 54.8 years [SD = 15.0]) were selected to develop the deep-learning-based program Spine Explorer (Tulong). Another 30 axial lumbar MRIs were automatically measured by Spine Explorer and then manually measured using ImageJ to acquire quantitative size and compositional measurements for bilateral multifidus, erector spinae, and psoas muscles; the disk; and the spinal canal. Intersection-over-union and Dice score were used to evaluate the performance of automated segmentation. Intraclass coefficients and Bland-Altman plots were used to examine intersoftware agreements for various measurements. RESULTS After training, Spine Explorer (Tulong) measures an axial lumbar MRI in 1 second. The intersections-over-union were 83.3% to 88.4% for the paraspinal muscles and 92.2% and 82.1% for the disk and spinal canal, respectively. For various size and compositional measurements of paraspinal muscles, Spine Explorer (Tulong) was in good agreement with ImageJ (intraclass coefficient = 0.85 to approximately 0.99). CONCLUSION Spine Explorer (Tulong) is automated, efficient, and reliable in acquiring quantitative measurements for the paraspinal muscles, the disk, and the canal, and various size and compositional measurements were simultaneously obtained for the lumbar paraspinal muscles. IMPACT Such an automated program might encourage further epidemiological studies of the lumbar paraspinal muscle degeneration and enhance paraspinal muscle assessment in clinical practice.
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Affiliation(s)
- Haotian Shen
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiawei Huang
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiangqiang Zheng
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiwei Zhu
- Department of Radiology, Dongyang People's Hospital, Dongyang, China
| | - Xiaoqiang Lv
- Department of Orthopedic Surgery, Dongyang People's Hospital, Dongyang, China
| | - Yong Liu
- Department of Control Science, Institute of Cyber-Systems and Control, Zhejiang University, Hangzhou, China
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Hu X, Feng Z, Shen H, Zhang W, Huang J, Zheng Q, Wang Y. New MR-based measures for the evaluation of age-related lumbar paraspinal muscle degeneration. 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; 30:2577-2585. [PMID: 33740145 DOI: 10.1007/s00586-021-06811-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 02/09/2021] [Accepted: 03/07/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE Although signal intensity on T2W axial images is sensitive in detection of fatty infiltration to assess paraspinal muscle degeneration, it is affected by inhomogeneities of magnetic fields and individual variabilities. The purpose of this study was to propose reference adjusted signal measures on T2W axial images and determine their capacities in reflecting age-related lumbar paraspinal muscle degeneration. METHODS Lumbar MR images of 421 population-based subjects (177 men and 244 women, mean age 53.1 years, range 19.8-87.9 years) were studied. A custom software Spine Explore (Tulong 2.0) was used to automatically obtain paraspinal measurements of multifidus, erector spinae and psoas major. FCSA/TCSA was defined as functional cross-sectional area relative to total cross-sectional area of paraspinal muscle. Two new signal measures were canal-adjusted and cerebrospinal fluid (CSF)-adjusted signal, defined as the ratio between mean signal measurements and the mean signal of the canal and CSF. RESULTS The raw signal measurements of the paraspinal muscles were weakly correlated to age (r = 0.28-0.39, P < 0.001). When the signal of canal (r = 0.43-0.59, P < 0.001) or CSF (r = 0.45-0.61, P < 0.001) was used as reference, the correlations substantially increased. Signal measurements of three paraspinal muscles, adjusted or not, were strongly associated with Goutallier score (ρ = 0.60-0.65, P < 0.001) and FCSA/TCSA (r = -0.64 to -0.82, P < 0.001). Greater Goutallier score was associated with greater age (r = 0.38-0.60, P < 0.001), while Lumbar indentation value (LIV) not. CONCLUSION On routine T2W axial MR images the adjusted signal measurements using an internal reference of CSF or canal can better reflect age-related degenerative changes in the paraspinal muscles.
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Affiliation(s)
- Xiaojian Hu
- Spine Lab, Department of Orthopedic Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, 79# Qingchun Road, Hangzhou, China
| | - Zhiyun Feng
- Spine Lab, Department of Orthopedic Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, 79# Qingchun Road, Hangzhou, China
| | - Haotian Shen
- Spine Lab, Department of Orthopedic Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, 79# Qingchun Road, Hangzhou, China
| | - Wenming Zhang
- Department of Orthopedic Surgery, Jinyun People's Hospital, Lishui, China
| | - Jiawei Huang
- Spine Lab, Department of Orthopedic Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, 79# Qingchun Road, Hangzhou, China
| | - Qiangqiang Zheng
- Spine Lab, Department of Orthopedic Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, 79# Qingchun Road, Hangzhou, China
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, 79# Qingchun Road, Hangzhou, China.
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Lu X, Yang J, Zhu Z, Lv X, Wu J, Huang J, Yu L, Wen Z, Luo J, Wang Y. Changes of the adjacent discs and vertebrae in patients with osteoporotic vertebral compression fractures treated with or without bone cement augmentation. Spine J 2020; 20:1048-1055. [PMID: 32105771 DOI: 10.1016/j.spinee.2020.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although vertebral augmentation with bone cement has been commonly used to treat symptomatic osteoporotic vertebral compression fractures, relatively little is known about the impact of augmentation on the adjacent spinal components. PURPOSE To determine the imaging effects of vertebral augmentation on the adjacent discs, the augmented vertebra, and the involved spinal segment. STUDY DESIGN Retrospective radiographic study. PATIENT SAMPLE Patients with acute osteoporotic vertebral compression fractures who underwent vertebral augmentation or nonoperative treatments. OUTCOME MEASURES On baseline and follow-up mid-sagittal T2W magnetic resonance images, quantitative measurements of disc degeneration, including disc height, bulging, and signal, vertebral height, wedge angle, and segmental kyphotic angle were acquired. METHODS Lumbar spine magnetic resonance images of patients with acute osteoporotic vertebral compression fractures at a local hospital in Eastern China between 2010 and 2017 were reviewed. Student's t-tests and χ2 tests were used to examine the differences of baseline and changes over time between vertebrae underwent vertebral augmentation and those did not. Paired t-tests were used to examine the differences between baseline and follow-up to study the changes of adjacent disc degeneration, creep deformity of the vertebra and progression of segmental kyphosis. RESULTS There were 112 acute vertebral compression fractures (72 treated with kyphoplasty and 40 with nonoperative treatments) in 101 subjects. At final follow-up (mean 21.5 months), the cranial disc of the augmented vertebra decreased in height (p<.001), and both cranial and caudal discs decreased in signal intensity (p≤.02). The discs in the nonoperative group did not undergo such degenerative changes. For the fractured vertebra, vertebral height significantly decreased (p<.01 for both) and vertebral wedge angle significantly increased (p≤.01 for both), regardless of augmentation treatment or not. Segmental kyphotic angle significantly increased in vertebral fractures that underwent vertebral augmentation (p<.001), but not in those underwent nonoperative treatments. CONCLUSIONS Patients that underwent vertebral augmentation had more advanced disc degeneration at adjacent disc levels as compared to those without augmentation. The fractured vertebral body height decreased and the wedge angle increased, regardless of vertebral augmentation treatment or not. Vertebral augmentation may be associated with increased creep deformity of the adjacent vertebra and the progression of segmental kyphosis.
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Affiliation(s)
- Xuan Lu
- Spine lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiang Yang
- Spine lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiwei Zhu
- Department of Radiology, Dongyang People's Hospital, Dongyang, China
| | - Xiaoqiang Lv
- Department of Orthopedic Surgery, Dongyang People's Hospital, Dongyang, China
| | - Jialong Wu
- Spine lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiawei Huang
- Spine lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liedao Yu
- Spine lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiqiang Wen
- Spine lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jin Luo
- School of Applied Sciences, London South Bank University, London, UK.
| | - Yue Wang
- Spine lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Hu S, Shao Z, Zhang C, Chen L, Mamun AA, Zhao N, Cai J, Lou Z, Wang X, Chen J. Chemerin facilitates intervertebral disc degeneration via TLR4 and CMKLR1 and activation of NF-kB signaling pathway. Aging (Albany NY) 2020; 12:11732-11753. [PMID: 32526705 PMCID: PMC7343479 DOI: 10.18632/aging.103339] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/18/2020] [Indexed: 12/25/2022]
Abstract
Now days, obesity is a major risk factor for intervertebral disc degeneration (IDD). However, adipokine, such as chemerin is a novel cytokine, which is secreted by adipose tissue, and are thought to be played major roles in various degenerative diseases. Obese individuals are known to have high concentration of serum chemerin. Our purpose was to study whether chemerin acts as a biochemical relationship between obesity, and IDD. In this study, we found that the expression level of chemerin was significantly increased in the human degenerated nucleus pulposus (NP) tissues, and had higher level in the obese people than the normal people. Chemerin significantly increased the inflammatory mediator level, contributing to ECM degradation in nucleus pulposus cells (NPCs). Furthermore, chemerin overexpression aggravates the puncture-induced IVDD progression in rats, while knockdown CMKLR1 reverses IVDD progression. Chemerin activates the NF-kB signaling pathway via its receptors CMKLR1, and TLR4 to release inflammatory mediators, which cause matrix degradation, and cell aging. These findings generally provide novel evidence supporting the causative role of obesity in IDD, which is essentially important to literally develop novel preventative or generally therapeutic treatment in the disc degenerative disorders.
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Affiliation(s)
- Sunli Hu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhenxuan Shao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Chenxi Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Liang Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Abdullah Al Mamun
- Molecular Pharmacology Research Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Ning Zhao
- The First School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jinfeng Cai
- The First School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhiling Lou
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiangyang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jiaoxiang Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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12
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Huang J, Shen H, Wu J, Hu X, Zhu Z, Lv X, Liu Y, Wang Y. Spine Explorer: a deep learning based fully automated program for efficient and reliable quantifications of the vertebrae and discs on sagittal lumbar spine MR images. Spine J 2020; 20:590-599. [PMID: 31759132 DOI: 10.1016/j.spinee.2019.11.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although quantitative measurements improve the assessment of disc degeneration, acquirement of quantitative measurements relies on manual segmentation on lumbar magnetic resonance images (MRIs), which may introduce subjective bias. To date, only a few semiautomatic systems have been developed to quantify important components on MRIs. PURPOSE To develop a deep learning based program (Spine Explorer) for automated segmentation and quantification of the vertebrae and intervertebral discs on lumbar spine MRIs. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE The study was extended on the Hangzhou Lumbar Spine Study, a population-based study of mainland Chinese with focuses on lumbar degenerative changes. From this population-based database, 50 sets lumbar MRIs were randomly selected as training dataset, and another 50 as test dataset. OUTCOME MEASURES Regions of vertebrae and discs were manually segmented on T2W sagittal MRIs to train a convolutional neural network for automated segmentation. Intersection-over-union was calculated to evaluate segmentation performance. Computational definitions were proposed to acquire quantitative morphometric and signal measurements for lumbar vertebrae and discs. MRIs in the test dataset were automatically measured with Spine Explorer and manually with ImageJ. METHODS Intraclass correlation coefficient (ICC) were calculated to examine inter-software agreements. Correlations between disc measurements and Pfirrmann score as well as age were examined to assess measurement validity. RESULTS The trained Spine Explorer automatically segments and measures a lumbar MRI in half a second, with mean Intersection-over-union of 94.7% and 92.6% for the vertebra and disc, respectively. For both vertebra and disc measurements acquired with Spine Explorer and ImageJ, the agreements were excellent (ICC=0.81~1.00). Disc measurements significantly correlated to Pfirrmann score, and greater age was associated with greater anterior disc bulging area (r=0.35~0.44) and fewer signal measurements (r=-0.62~-0.77) as automatically acquired with Spine Explorer. CONCLUSIONS Spine Explorer is an efficient, accurate, and reliable tool to acquire comprehensive quantitative measurements for lumbar vertebra and disc. Implication of such deep learning based program can facilitate clinical studies of the lumbar spine.
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Affiliation(s)
- Jiawei Huang
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China
| | - Haotian Shen
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China
| | - Jialong Wu
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China
| | - Xiaojian Hu
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China
| | - Zhiwei Zhu
- Department of Radiology, Dongyang People's Hospital, Dongyang, China
| | - Xiaoqiang Lv
- Department of Orthopedic Surgery, Dongyang People's Hospital, Dongyang, China
| | - Yong Liu
- Department of Control Science, Institute of Cyber-Systems and Control, Zhejiang University, Hangzhou 310027, China.
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China.
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Owlia M, Kamachi M, Dutta T. Reducing lumbar spine flexion using real-time biofeedback during patient handling tasks. Work 2020; 66:41-51. [PMID: 32417812 PMCID: PMC7369082 DOI: 10.3233/wor-203149] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/06/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient handling activities require caregivers to adopt postures that increase the risk of back injury. Training programs relying primarily on didactic methods have been shown to be ineffective at reducing this risk. The use of real-time biofeedback has potential as an alternative training method. OBJECTIVE To investigate the effect of real-time biofeedback on time spent by caregivers in end-range lumbar spine flexion. METHODS Novice participants were divided into intervention (n = 10) and control (n = 10) groups and were asked to perform a set of simulated care activities eight times on two consecutive days. Individuals in the intervention group watched a training video on safer movement strategies and received real-time auditory feedback from a wearable device (PostureCoach) in four training trials whenever their lumbar spine flexion exceeded a threshold (70% of maximum flexion). Changes in end-range lumbar spine flexion were compared between groups and across trials. RESULTS Participants in the intervention group saw reductions in end-range lumbar spine flexion during the simulated patient handling tasks at the end of the training compared to their baseline trials while there was no change for the control group. CONCLUSIONS The training program including PostureCoach has the potential to help caregivers learn to use safer postures that reduce the risk of back injury.
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Affiliation(s)
- Mohammadhasan Owlia
- Toronto Rehabilitation Institute, University Health Network, ON, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, ON, Canada
| | - Megan Kamachi
- Toronto Rehabilitation Institute, University Health Network, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, ON, Canada
| | - Tilak Dutta
- Toronto Rehabilitation Institute, University Health Network, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, ON, Canada
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14
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Xiao Q, Zeng JH, Zhou H, Qiu QH, Ke B, Deng L, Hu ZM, Roh J, Dai M. Expression and effects of leukemia inhibitory factor on nucleus pulposus degeneration. Mol Med Rep 2019; 19:2377-2385. [PMID: 30664218 PMCID: PMC6392089 DOI: 10.3892/mmr.2019.9874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/14/2018] [Indexed: 12/18/2022] Open
Abstract
Leukemia inhibitory factor (LIF) is a multifunctional cytokine. The present study aimed to determine the expression and effects of LIF on nucleus pulposus generation. Degenerated nucleus pulposus samples were obtained from animal models and patients with lumbar intervertebral disc herniation. Degradation scores of intervertebral discs were evaluated via magnetic resonance imaging (MRI) and histology, and the protein expression levels of LIF were detected. Furthermore, cultured primary human degenerated nucleus pulposus cells (DNPCs) were stimulated with various concentrations of recombinant human LIF protein (rhLIF), and aggrecan and collagen type II α1 (COL2α1) protein expression levels were detected by western blotting. In addition, aggrecan expression was determined by toluidine blue staining. The effects of rhLIF on proliferation and apoptosis of DNPCs were evaluated by Cell Counting Kit-8 and flow cytometry, respectively. The results revealed that the degradation scores of intervertebral discs were significantly associated with modeling time, as determined by MRI and histology. In addition, the protein expression levels of LIF were initially increased in patients with lumbar disc herniation and in rabbit models, particularly in the 2-week modeling group; however, its expression decreased with the progression of disc degeneration. Notably, LIF expression in each modeling group was higher than that in the control and 0 week modeling group. The in vitro study revealed that the protein expression levels of aggrecan and COL2α1 were significantly increased in response to rhLIF, in a dose-dependent manner, and statistical differences were identified between the treatment groups and control group. The results of toluidine blue staining were consistent with this finding. Although rhLIF had no effect on proliferation, it inhibited apoptosis of DNPCs in a concentration-dependent manner. In conclusion, LIF was upregulated during the process of intervertebral disc degeneration, and may promote the expression of extracellular matrix components. It may also be hypothesized that LIF acts as a potential protective factor by inhibiting apoptosis of DNPCs without affecting cell proliferation.
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Affiliation(s)
- Qiang Xiao
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Ji-Huan Zeng
- Department of Orthopaedics, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi 330006, P.R. China
| | - Hao Zhou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Quan-He Qiu
- Department of Orthopaedics, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi 330029, P.R. China
| | - Bo Ke
- Department of Hematopathology, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi 330006, P.R. China
| | - Liang Deng
- Department of Orthopaedics, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi 330006, P.R. China
| | - Zhen-Ming Hu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Jeffrey Roh
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA 98122, USA
| | - Min Dai
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
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15
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Modic Changes in the Lumbar Spine are Common Aging-related Degenerative Findings that Parallel With Disk Degeneration. Clin Spine Surg 2018; 31:312-317. [PMID: 29847414 DOI: 10.1097/bsd.0000000000000662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a cross-sectional study. OBJECTIVE To determine the prevalence and distribution patterns of Modic changes (MCs) in the lumbar spine and their associations with disk degeneration in mainland Chinese using a sample of general population. SUMMARY OF BACKGROUND DATA Previous studies reported that the prevalence of MCs in Hong Kong Chinese was much lower than in other populations. Moreover, their associations with disk degeneration need further study. MATERIALS AND METHODS The study sample consisted of 442 subjects (53.6±14.9 y; range, 20-88 y) randomly selected from a typical Chinese community. Lumbar spines were imaged using a 3.0 T magnetic resonance scanner. Eleven endplates (L1-S1) in the lumbar spine were evaluated for the presence of MCs, type, location, and size to determine MCs prevalence and distribution patterns. Disk degeneration was graded using a Pfirrmann scale. RESULTS MCs were present in 209 (47.3%) subjects and 593 (12.2%) endplates. Among these endplates, 84.1% (499) were type II, 9.1% (54) were type I, and 6.4% (38) were mixed MCs. Approximately 2/3 MCs were present in the lower lumbar spine and 44.9% of MCs were at the L5/S1 disk level. Most MCs (73.9%) involved both endplates of a disk. Greater age [odds ratio (OR)=2.44 for each 10-year increase, P<0.001] and body mass index (OR=1.07, P=0.016) were associated with the presence of MCs, as was adjacent disk degeneration (OR=6.00, P<0.001), controlling for age and other covariates. Greater age, body mass index, and adjacent disk degeneration were also associated with greater MCs size. CONCLUSIONS MCs are common in mainland Chinese, with type II predominating. MCs mainly present in the lower lumbar region and tend to occur in pairs. MCs were strongly associated with age and disk degeneration, suggesting MCs may be aging-related degenerative findings that parallel disk degeneration. LEVEL OF EVIDENCE Level II.
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16
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Hu X, Chen M, Pan J, Liang L, Wang Y. Is it appropriate to measure age-related lumbar disc degeneration on the mid-sagittal MR image? A quantitative image study. 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 2017; 27:1073-1081. [PMID: 29147797 DOI: 10.1007/s00586-017-5357-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/09/2017] [Accepted: 10/17/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Even though phenotypes of disc degeneration vary on different sagittal magnetic resonance images (MRI), measurements typically are acquired on the mid-sagittal MRI. This study investigated the appropriateness of using the mid-sagittal MRI to measure various phenotypes of age-related disc degeneration. METHODS Lumbar spine MRIs of 66 subjects (mean age 50.3 years, standard deviation 16.5 years, range 22-84 years) were studied. An image analysis program Spine Explorer was used to obtain quantitative measurements for disc height, bulging, and signal on para- and mid-sagittal T2-weighted MRIs. Measurements on para- and mid-sagittal MRIs and their associations with age were compared. RESULTS Measurements of disc height, signal, and posterior disc bulging acquired on the mid-sagittal MRI were greater than those on the para-sagittal MRIs. Disc height measurements were not linearly associated with age. Greater age was correlated with greater anterior (r = 0.45, P < 0.001) and posterior (r = 0.33, P < 0.01) bulging on para-sagittal MRIs, but not posterior disc bulging on the mid-sagittal MRI (r = - 0.10, P > 0.05). Disc signal intensity measurements on the mid-sagittal MRI had stronger correlations with age than those on para-sagittal MRIs. Mean and standard deviation of disc signal intensity acquired on the mid-sagittal MRI had the strongest correlations with age among all measures of disc degeneration studied (r = - 0.50, - 0.67, respectively, P < 0.001 for both). CONCLUSIONS Disc signal measurements acquired on the mid-sagittal MRI were reliable and had strong correlations with age and thus can be used as an appropriate measure of disc degeneration. Disc bulging had better be measured on para-sagittal MRIs. Although severe disc narrowing clearly is a sign of severe disc degeneration, disc height was not linearly associated with age.
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Affiliation(s)
- Xiaojian Hu
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Mingjian Chen
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Jianjiang Pan
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Liang Liang
- The Wallace H. Coulter, Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30313, USA
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, People's Republic of China.
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Takatalo J, Karppinen J, Näyhä S, Taimela S, Niinimäki J, Blanco Sequeiros R, Tammelin T, Auvinen J, Tervonen O. Association between adolescent sport activities and lumbar disk degeneration among young adults. Scand J Med Sci Sports 2017; 27:1993-2001. [DOI: 10.1111/sms.12840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 12/16/2022]
Affiliation(s)
- J. Takatalo
- Medical Research Center Oulu; University of Oulu and Oulu University Hospital; Oulu Finland
- Center for Life Course Health Research; University of Oulu; Oulu Finland
| | - J. Karppinen
- Medical Research Center Oulu; University of Oulu and Oulu University Hospital; Oulu Finland
- Center for Life Course Health Research; University of Oulu; Oulu Finland
- Finnish Institute of Occupational Health; Oulu Finland
| | - S. Näyhä
- Center for Environmental and Respiratory Health Research; University of Oulu; Oulu Finland
| | - S. Taimela
- Department of Orthopedics and Traumatology; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
| | - J. Niinimäki
- Research Unit of Medical Imaging, Physics and Technology; University of Oulu; Oulu Finland
| | - R. Blanco Sequeiros
- Research Unit of Medical Imaging, Physics and Technology; University of Oulu; Oulu Finland
| | - T. Tammelin
- LIKES Research Center for Sport and Health Sciences; Jyväskylä Finland
| | - J. Auvinen
- Medical Research Center Oulu; University of Oulu and Oulu University Hospital; Oulu Finland
- Center for Life Course Health Research; University of Oulu; Oulu Finland
| | - O. Tervonen
- Research Unit of Medical Imaging, Physics and Technology; University of Oulu; Oulu Finland
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Type II Modic Changes May not Always Represent Fat Degeneration: A Study Using MR Fat Suppression Sequence. Spine (Phila Pa 1976) 2016; 41:E987-E994. [PMID: 26909837 DOI: 10.1097/brs.0000000000001526] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A radiological study of type II Modic changes (MCs). OBJECTIVES The aim of this study was to determine the characteristics of type II MCs on fat suppression (FS) magnetic resonance (MR) images and its association with radiological disc degeneration. SUMMARY OF BACKGROUND DATA Type II MCs are common endplate signal changes on MR images. On the basis of limited histological samples, type II MCs are thought to be stable fat degeneration. FS technique on MR, which can quantify fat content, may be an alternative to explore the pathology of MCs. To date, however, the characteristics of type II MCs on FS sequence have not been studied. METHODS Lumbar MR images conducted in a single hospital during a defined period were reviewed to include those with type II MCs and FS images. On FS images, signal status of type II MCs was visually classified as suppressed or not-suppressed. Signal intensity of vertebral regions with and without MCs was measured quantitatively on T2-weighted (T2W) and FS images to calculate fat content index and validate the visual classification. Using image analysis program Osirix, MCs size and adjacent disc degeneration were measured quantitatively. Paired t-tests and logistic regressions were used to determine the associations studied. RESULTS Sixty-four lumbar MRIs were included and 150 endplates with type II MCs were studied. Although signal of 37 (24.7%) type II MCs was suppressed on FS images, that of 113 (75.3%) was not suppressed. The discs adjacent to type II MCs had lower signal intensity (0.13 ± 0.003 vs. 0.14 ± 0.004, P < 0.001), lesser disc height (9.73 ± 1.97 vs. 11.07 ± 1.99, P < 0.001) and greater bulging area (80.0 ± 31.4 vs. 61.3 ± 27.5 for anterior bulging, 33.72 ± 21.24 vs. 27.93 ± 12.79 for posterior bulging, and 113.7 ± 39.9 vs. 89.2 ± 35.2 for total bulging, P < 0.05) than normal controls. Type II MCs that were not suppressed on FS image were associated with greater age [odds ratio (OR) = 1.11, P < 0.001], lower height (OR = 0.94, P < 0.05), and greater posterior bulging (OR = 1.05, P < 0.001) at the adjacent disc. CONCLUSION Signal of most type II MCs was not suppressed on FS MR images, suggesting that there are ongoing complicated pathologies. Type II MCs may not merely represent fat replacement. LEVEL OF EVIDENCE 3.
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Hansen BB, Hansen P, Carrino JA, Fournier G, Rasti Z, Boesen M. Imaging in mechanical back pain: Anything new? Best Pract Res Clin Rheumatol 2016; 30:766-785. [DOI: 10.1016/j.berh.2016.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/21/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022]
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Salamat S, Hutchings J, Kwong C, Magnussen J, Hancock MJ. The relationship between quantitative measures of disc height and disc signal intensity with Pfirrmann score of disc degeneration. SPRINGERPLUS 2016; 5:829. [PMID: 27386278 PMCID: PMC4917505 DOI: 10.1186/s40064-016-2542-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/08/2016] [Indexed: 11/23/2022]
Abstract
Purpose To assess the relationship between quantitative measures of disc height and signal intensity with the Pfirrmann disc degeneration scoring system and to test the inter-rater reliability of the quantitative measures. Methods Participants were 76 people who had recently recovered from their last episode of acute low back pain and underwent MRI scan on a single 3T machine. At all 380 lumbar discs, quantitative measures of disc height and signal intensity were made by 2 independent raters and compared to Pfirrmann scores from a single radiologist. For quantitative measures of disc height and signal intensity a “raw” score and 2 adjusted ratios were calculated and the relationship with Pfirrmann scores was assessed. The inter-tester reliability of quantitative measures was also investigated. Results There was a strong linear relationship between quantitative disc signal intensity and Pfirrmann scores for grades 1–4, but not for grades 4 and 5. For disc height only, Pfirrmann grade 5 had significantly reduced disc height compared to all other grades. Results were similar regardless of whether raw or adjusted scores were used. Inter-rater reliability for the quantitative measures was excellent (ICC > 0.97). Conclusions Quantitative measures of disc signal intensity were strongly related to Pfirrmann scores from grade 1 to 4; however disc height only differentiated between grade 4 and 5 Pfirrmann scores. Using adjusted ratios for quantitative measures of disc height or signal intensity did not significantly alter the relationship with Pfirrmann scores.
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Affiliation(s)
- Sara Salamat
- Physical Therapy Department,Tehran university of Medical Sciences, District 12, Enghelab, Pich-e-Shemiran, Tehran, Iran
| | - John Hutchings
- Faculty of Medicine and Health Sciences, Macquarie University, Talavera Rd North Ryde, Sydney, NSW 2109 Australia
| | - Clemens Kwong
- Faculty of Medicine and Health Sciences, Macquarie University, Talavera Rd North Ryde, Sydney, NSW 2109 Australia
| | - John Magnussen
- Macquarie Medical Imaging, Macquarie University Hospital, Talavera Rd North Ryde, Sydney, NSW 2109 Australia
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Talavera Rd North Ryde, Sydney, NSW 2109 Australia
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The effects of intervertebral disc degeneration combined with osteoporosis on vascularization and microarchitecture of the endplate in rhesus monkeys. 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; 25:2705-15. [PMID: 27220969 DOI: 10.1007/s00586-016-4593-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the influence of osteoporosis on the microarchitecture and vascularization of the endplate in rhesus monkeys with or without intervertebral disc (IVD) degeneration using micro-computerized tomography (micro-CT), and to further analyze the correlation between osteoporosis and IVD degeneration. METHODS Twelve rhesus monkeys were randomly divided into the ovariectomy (OVX, n = 6) and the sham group (n = 6). The subchondral bone adjacent to the lumbar IVDs (from L4/5 to L6/7) of each monkey was randomly injected with 4 ml pingyangmycin (PYM) solution (1.5 mg/ml, PYM), or 4 ml phosphate buffered saline (PBS) as vehicle treatment, or exteriorized but not injected anything as control (Cntrl). Degenerative and osteoporotic processes were evaluated at different time points. Micro-CT and histology were performed to analyze microarchitecture, calcification area and vascularization of the endplate. RESULTS OVX resulted in significant decrease of bone mineral density (BMD). PYM injection induced progressively IVD degeneration, which was more progressive when combined with OVX. There was a negative correlation between BMD and Pfirrmann grade in the subgroups with PYM injection. The micro-CT analysis showed the combination of osteoporosis and IVD degeneration led to more calcification of endplate than any one thereof. The decrease of vascular volume percent in the endplate of the OVX-PYM subgroup was significantly greater than that in the Sham-PYM subgroup, both of which showed significant less vascularization compared to the other subgroups. CONCLUSION In conclusion the osteoporosis could accumulate the calcification and decrease the vascularization in the endplates adjacent to the degenerated IVDs, which subsequently exacerbated degeneration of the degenerated IVDs.
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Dario AB, Ferreira ML, Refshauge KM, Lima TS, Ordoñana JR, Ferreira PH. The relationship between obesity, low back pain, and lumbar disc degeneration when genetics and the environment are considered: a systematic review of twin studies. Spine J 2015; 15:1106-17. [PMID: 25661432 DOI: 10.1016/j.spinee.2015.02.001] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/13/2015] [Accepted: 02/01/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The relationships between obesity and low back pain (LBP) and lumbar disc degeneration (LDD) remain unclear. It is possible that familial factors, including genetics and early environment, affect these relationships. PURPOSE To investigate the relationship between obesity-related measures (eg, weight, body mass index [BMI]) and LBP and LDD using twin studies, where the effect of genetics and early environment can be controlled. STUDY DESIGN A systematic review with meta-analysis. METHODS MEDLINE, CINAHL, Scopus, Web of Science, and EMBASE databases were searched from the earliest records to August 2014. All cross-sectional and longitudinal observational twin studies identified by the search strategy were considered for inclusion. Two investigators independently assessed the eligibility, conducted the quality assessment, and extracted the data. Metaanalyses (fixed or random effects, as appropriate) were used to pool studies' estimates of association. RESULTS In total, 11 articles met the inclusion criteria. Five studies were included in the LBP analysis and seven in the LDD analysis. For the LBP analysis, pooling of the five studies showed that the risk of having LBP for individuals with the highest levels of BMI or weight was almost twice that of people with a lower BMI (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.6-2.0; I(2)=0%). A dose-response relationship was also identified. When genetics and the effects of a shared early environment were adjusted for using a within-pair twin case-control analysis, pooling of three studies showed a reduced but statistically positive association between obesity and prevalence of LBP (OR 1.5; 95% CI 1.1-2.1; I(2)=0%). However, the association was further diminished and not significant (OR 1.4; 95% CI 0.8-2.3; I(2)=0%) when pooling included two studies on monozygotic twin pairs only. Seven studies met the inclusion criteria for LDD. When familial factors were not controlled for, body weight was positively associated with LDD in all five cross-sectional studies. Only two cross-sectional studies investigated the relationship between obesity-related measures and LDD accounting for familial factors, and the results were conflicting. One longitudinal study in LBP and three longitudinal studies in LDD found no increase in risk in obese individuals, whether or not familial factors were controlled for. CONCLUSIONS Findings from this review suggest that genetics and early environment are possible mechanisms underlying the relationship between obesity and LBP; however, a direct causal link between these conditions appears to be weak. Further longitudinal studies using the twin design are needed to better understand the complex mechanisms underlying the associations between obesity, LBP, and LDD.
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Affiliation(s)
- Amabile B Dario
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, PO Box 170, 75 East Street Lidcombe, Sydney, NSW, Australia 2141.
| | - Manuela L Ferreira
- The George Institute for Global Health and Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, The University of Sydney, Level 13, 321 Kent Street, Sydney, NSW, Australia 2141
| | - Kathryn M Refshauge
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, PO Box 170, 75 East Street Lidcombe, Sydney, NSW, Australia 2141
| | - Thais S Lima
- Biomechanics and Motor Control Research Group, Science and Technology Faculty-Universidade Estadual Paulista, Presidente Prudente, Sao Paulo, Brazil 19060-900
| | - Juan R Ordoñana
- Murcia Twin Registry, Department of Human Anatomy and Psychobiology, University of Murcia, Spain 30100; IMIB-Arrixaca, Department of Human Anatomy and Psychobiology, Murcia, Spain 30100
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, PO Box 170, 75 East Street Lidcombe, Sydney, NSW, Australia 2141
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Marfia G, Navone SE, Di Vito C, Tabano S, Giammattei L, Di Cristofori A, Gualtierotti R, Tremolada C, Zavanone M, Caroli M, Torchia F, Miozzo M, Rampini P, Riboni L, Campanella R. Gene expression profile analysis of human mesenchymal stem cells from herniated and degenerated intervertebral discs reveals different expression of osteopontin. Stem Cells Dev 2014; 24:320-8. [PMID: 25203751 DOI: 10.1089/scd.2014.0282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Gene expression analysis provides an effective methodology to identify clinically relevant genes implicated in intervertebral disc (IVD) pathology. The analysis of gene profile in mesenchymal stem cells (MSCs) from human herniated IVD (H-IVD) and degenerated IVD (D-IVD) has not yet been investigated. We present in this study a characterization of MSCs isolated from clinically categorized H-IVD and D-IVD disc samples. H-IVD-MSCs and D-IVD-MSCs showed multipotent mesenchymal differentiation ability, expressing positivity for adipogenic, osteogenic, and chondrogenic markers with an immunophenotypical profile representative of MSCs. FACS analyses revealed a higher expression of CD44 in D-IVD-MSCs compared to H-IVD-MSCs. Gene expression profile revealed that most genes under investigation displayed large variations and were not significantly different in the two types of analyzed IVD-MSCs. Conversely, the gene expression of osteopontin (OPN), a protein involved in bone matrix mineralization and extracellular matrix destruction, was found markedly increased (more than 400-fold) in D-IVD-MSCs compared to H-IVD-MSCs. Moreover, the OPN protein expression was detectable only in D-IVD-MSCs, and its levels were directly related with D-IVD severity. These findings suggest that an abnormal expression of OPN in D-IVD-MSCs occurs and plays a pivotal role in the pathophysiological process of human disc degeneration. We speculate that the regulation of the OPN pathway might be a therapeutic target to counteract disc degeneration.
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Affiliation(s)
- Giovanni Marfia
- 1 Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, University of Milan , Milan, Italy
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Khan AA, Iliescu DD, Sneath RJ, Hutchinson CE, Shah AA. Principal component and factor analysis to study variations in the aging lumbar spine. IEEE J Biomed Health Inform 2014; 19:745-51. [PMID: 25486654 DOI: 10.1109/jbhi.2014.2328433] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Human spine is a multifunctional structure of human body consisting of bones, joints, ligaments, and muscles which all undergo a process of change with the age. A sudden change in these features either naturally or through injury can lead to some serious medical conditions which puts huge burden on health services and economy. While aging is inevitable, the effect of aging on different areas of spine is of clinical significance. This paper reports the growth and degenerative pattern of human spine using principal component analysis. Some noticeable lumbar spine features such as vertebral heights, disc heights, disc signal intensities, paraspinal muscles, subcutaneous fats, psoas muscles, and cerebrospinal fluid were used to study the variations seen on lumbar spine with the natural aging. These features were extracted from lumbar spine magnetic resonance images of 61 subjects with age ranging from 2 to 93 years. Principal component analysis is used to transform complex and multivariate feature space to a smaller meaningful representation. PCA transformation provided 2-D visualization and knowledge of variations among spinal features. Further useful information about correlation among the spinal features is acquired through factor analysis. The knowledge of age related changes in spinal features are important in understanding different spine related problems.
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Jin L, Liu Q, Scott P, Zhang D, Shen F, Balian G, Li X. Annulus fibrosus cell characteristics are a potential source of intervertebral disc pathogenesis. PLoS One 2014; 9:e96519. [PMID: 24796761 PMCID: PMC4010482 DOI: 10.1371/journal.pone.0096519] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/08/2014] [Indexed: 01/07/2023] Open
Abstract
In the end stage of intervertebral disc degeneration, cartilage, bone, endothelial cells, and neurons appear in association with the worsening condition. The origin of the abnormal cells is not clear. This study investigated the properties of progenitor cells in the annulus fibrosus (AF) using one in vitro and two in vivo models. Cultivation of rabbit AF cells with chondrogenic media significantly increased expressions of collagen and aggrecan. Upon exposure to osteogenic conditions, the cultures showed increased mineralization and expression of osteopontin, runx2, and bmp2 genes. Two models were used in the in vivo subcutaneous implantation experiments: 1) rabbit AF tissue in a demineralized bone matrix (DBM) cylinder (DBM/AF), and, 2) rat intact and needle punctured lumbar discs. Bone formation in the AF tissue was detected and hypertrophic chondrocytes and osteoblasts were present 1 month after implantation of the DBM/AF to nude mice. In addition to collagen I and II, immunostaining shows collagen X and osteocalcin expression in DBM/AF specimens 4 months after implantation. Similar changes were detected in the injured discs. Almost the entire needle punctured disc had ossified at 6 months. The results suggest that AF cells have characteristics of progenitor cells and, under appropriate stimuli, are capable of differentiating into chondrocytes and osteoblasts in vitro as well as in vivo. Importantly, these cells may be a target for biological treatment of disc degeneration.
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Affiliation(s)
- Li Jin
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, United States of America
- * E-mail:
| | - Qihai Liu
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, United States of America
| | - Phillip Scott
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, United States of America
| | - Dawei Zhang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, United States of America
| | - Francis Shen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, United States of America
| | - Gary Balian
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, United States of America
| | - Xudong Li
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, United States of America
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Adams MA, Lama P, Zehra U, Dolan P. Why do some intervertebral discs degenerate, when others (in the same spine) do not? Clin Anat 2014; 28:195-204. [PMID: 24753325 DOI: 10.1002/ca.22404] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 03/04/2014] [Accepted: 04/01/2014] [Indexed: 02/06/2023]
Abstract
This review suggests why some discs degenerate rather than age normally. Intervertebral discs are avascular pads of fibrocartilage that allow movement between vertebral bodies. Human discs have a low cell density and a limited ability to adapt to mechanical demands. With increasing age, the matrix becomes yellowed, fibrous, and brittle, but if disc structure remains intact, there is little impairment in function, and minimal ingrowth of blood vessels or nerves. Approximately half of old lumbar discs degenerate in the sense of becoming physically disrupted. The posterior annulus and lower lumbar discs are most affected, presumably because they are most heavily loaded. Age and genetic inheritance can weaken discs to such an extent that they are physically disrupted during everyday activities. Damage to the endplate or annulus typically decompresses the nucleus, concentrates stress within the annulus, and allows ingrowth of nerves and blood vessels. Matrix disruption progresses by mechanical and biological means. The site of initial damage leads to two disc degeneration "phenotypes": endplate-driven degeneration is common in the upper lumbar and thoracic spine, and annulus-driven degeneration is common at L4-S1. Discogenic back pain can be initiated by tissue disruption, and amplified by inflammation and infection. Healing is possible in the outer annulus only, where cell density is highest. We conclude that some discs degenerate because they are disrupted by excessive mechanical loading. This can occur without trauma if tissues are weakened by age and genetic inheritance. Moderate mechanical loading, in contrast, strengthens all spinal tissues, including discs.
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Affiliation(s)
- Michael A Adams
- Centre for Comparative and Clinical Anatomy, University of Bristol, United Kingdom
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Quantitative estimation of the high-intensity zone in the lumbar spine: comparison between the symptomatic and asymptomatic population. Spine J 2014; 14:391-6. [PMID: 24139862 DOI: 10.1016/j.spinee.2013.06.078] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 05/28/2013] [Accepted: 06/24/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The high-intensity zone (HIZ) on magnetic resonance imaging (MRI) has been studied for more than 20 years, but its diagnostic value in low back pain (LBP) is limited by the high incidence in asymptomatic subjects. Little effort has been made to improve the objective assessment of HIZ. PURPOSE To develop quantitative measurements for HIZ and estimate intra- and interobserver reliability and to clarify different signal intensity of HIZ in patients with or without LBP. STUDY DESIGN A measurement reliability and prospective comparative study. PATIENT SAMPLE A consecutive series of patients with LBP between June 2010 and May 2011 (group A) and a successive series of asymptomatic controls during the same period (group B). OUTCOME MEASURES Incidence of HIZ; quantitative measures, including area of disc, area and signal intensity of HIZ, and magnetic resonance imaging index; and intraclass correlation coefficients (ICCs) for intra- and interobserver reliability. METHODS On the basis of HIZ criteria, a series of quantitative dimension and signal intensity measures was developed for assessing HIZ. Two experienced spine surgeons traced the region of interest twice within 4 weeks for assessment of the intra- and interobserver reliability. The quantitative variables were compared between groups A and B. RESULTS There were 72 patients with LBP and 79 asymptomatic controls enrolling in this study. The prevalence of HIZ in group A and group B was 45.8% and 20.2%, respectively. The intraobserver agreement was excellent for the quantitative measures (ICC=0.838-0.977) as well as interobserver reliability (ICC=0.809-0.935). The mean signal of HIZ in group A was significantly brighter than in group B (57.55±14.04% vs. 45.61±7.22%, p=.000). There was no statistical difference of area of disc and HIZ between the two groups. The magnetic resonance imaging index was found to be higher in group A when compared with group B (3.94±1.71 vs. 3.06±1.50), but with a p value of .050. CONCLUSIONS A series of quantitative measurements for HIZ was established and demonstrated excellent intra- and interobserver reliability. The signal intensity of HIZ was different in patients with or without LBP, and significant brighter signal was observed in symptomatic subjects.
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Is the transport of a gadolinium-based contrast agent decreased in a degenerated or aged disc? A post contrast MRI study. PLoS One 2013; 8:e76697. [PMID: 24146913 PMCID: PMC3795705 DOI: 10.1371/journal.pone.0076697] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 08/24/2013] [Indexed: 11/19/2022] Open
Abstract
A post contrast magnetic resonance imaging study has been performed in a wide population of low back pain patients to investigate which radiological and phenotypic characteristics influence the penetration of the contrast agent in lumbar discs in vivo. 37 patients affected by different pathologies (disc herniation, spondylolisthesis, foraminal stenosis, central canal stenosis) were enrolled in the study. The selected population included 26 male and 11 female subjects, with a mean age of 42.4 ± 9.3 years (range 18-60). Magnetic resonance images of the lumbar spine were obtained with a 1.5 T scanner (Avanto, Siemens, Erlangen, Germany) with a phased-array back coil. A paramagnetic non-ionic contrast agent was injected with a dose of 0.4 ml/kg. T1-weighted magnetic resonance images were subsequently acquired at 5 time points, 5 and 10 minutes, 2, 4 and 6 hours after injection. Endplates presented clear enhancement already 5 minutes after injection, and showed an increase in the next 2 hours followed by a decrease. At 5 and 10 minutes, virtually no contrast medium was present inside the intervertebral disc; afterwards, enhancement significantly increased. Highly degenerated discs showed higher enhancement in comparison with low and medium degenerated discs. Discs classified as Pfirrmann 5 showed a statistically significant higher enhancement than Pfirrmann 1, 2 and 3 at all time points but the first one, possibly due to vascularization. Disc height collapse and Modic changes significantly increased enhancement. Presence of endplate defects did not show any significant influence on post contrast enhancement, but the lack of a clear classification of endplate defects as seen on magnetic resonance scans may be shadowing some effects. In conclusion, disc height, high level of degeneration and presence of Modic changes are factors which increase post contrast enhancement in the intervertebral disc. The effect of age could not be demonstrated.
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Wang Y, Owoc JS, Boyd SK, Videman T, Battié MC. Regional variations in trabecular architecture of the lumbar vertebra: associations with age, disc degeneration and disc space narrowing. Bone 2013; 56:249-54. [PMID: 23810839 DOI: 10.1016/j.bone.2013.06.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/16/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
Previous studies suggest that age and disc degeneration are associated with variations in vertebral trabecular architecture. In particular, disc space narrowing, a severe form of disc degeneration, may predispose the anterior portion of a vertebra to fracture. We studied 150 lumbar vertebrae and 209 intervertebral discs from 48 cadaveric lumbar spines of middle-aged men to investigate regional trabecular differences in relation to age, disc degeneration and disc narrowing. The degrees of disc degeneration and narrowing were evaluated using radiography and discography. The vertebrae were dried and scanned on a μCT system. The μCT images of each vertebral body were processed to include only vertebral trabeculae, which were first divided into superior and inferior regions, and further into central and peripheral regions, and then anterior and posterior regions. Structural analyses were performed to obtain trabecular microarchitecture measurements for each vertebral region. On average, the peripheral region had 12-15% greater trabecular bone volume fraction and trabecular thickness than the central region (p<0.01). Greater age was associated with better trabecular structure in the peripheral region relative to the central region. Moderate and severe disc degeneration were associated with higher trabecular thickness in the peripheral region of the vertebral trabeculae (p<0.05). The anterior region was of lower bone quality than the posterior region, which was not associated with age. Slight to moderate narrowing was associated with greater trabecular bone volume fraction in the anterior region of the inferior vertebra (p<0.05). Similarly, greater disc narrowing was associated with higher trabecular thickness in the anterior region (p<0.05). Better architecture of peripheral trabeculae relative to central trabeculae was associated with both age and disc degeneration. In contrast to the previous view that disc narrowing stress-shields the anterior vertebra, disc narrowing tended to associate with better trabecular architecture in the anterior region, as opposed to the posterior region.
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Affiliation(s)
- Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China.
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30
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In vivo quantification of T1ρ in lumbar spine disk spaces at 3 T using parallel transmission MRI. AJR Am J Roentgenol 2013; 201:W110-6. [PMID: 23789682 DOI: 10.2214/ajr.12.9523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE T1ρ MRI is an emerging, quantitative imaging modality that has been shown to correlate with proteoglycan content of disk material in vitro at 1.5 T. The purpose of this study is to quantify T1ρ values at all lumbar spine disk space levels at 3 T with parallel-transmission MRI in healthy adult volunteers. SUBJECTS AND METHODS Thirty-four subjects (15 men, ages 21-60 years [mean age, 38.4 years]; and 19 women, ages 20-56 years [mean age, 36.5 years]) with no history of back pain or surgery underwent T1ρ MRI of the lumbar spine at 3 T with parallel transmission and sagittal T2-weighted imaging. Mean T1ρ values of all lumbar spine disk space levels were quantified. Linear regression analysis and Spearman rank correlation were performed on age, sex, degenerative grade (Pfirrmann scores), and T1ρ with significance set at p < 0.05 and correlations considered strong for r > 0.7 and moderate for r = 0.5-0.7. RESULTS There was a statistically significant moderate negative correlation between T1ρ and subject age at disk space levels L1-2 through L4-5 (inclusive) (p < 0.001) and L5-S1 (p < 0.01). There was a statistically significant difference in T1ρ between all age groups sampled (p < 0.01) and a significant difference between T1ρ and Pfirrmann grades 1-3 (p < 0.01). CONCLUSION T1ρ MRI in the lumbar spine with parallel transmission shows signifi-cant negative correlations with age at all disk space levels, which lends support to a potential role for T1ρ as a quantitative, in vivo biomarker of disk degeneration.
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Mayer JE, Iatridis JC, Chan D, Qureshi SA, Gottesman O, Hecht AC. Genetic polymorphisms associated with intervertebral disc degeneration. Spine J 2013; 13:299-317. [PMID: 23537453 PMCID: PMC3655694 DOI: 10.1016/j.spinee.2013.01.041] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 01/02/2013] [Accepted: 01/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Disc degeneration (DD) is a multifaceted chronic process that alters the structure and function of the intervertebral discs and can lead to painful conditions. The pathophysiology of degeneration is not well understood, but previous studies suggest that certain genetic polymorphisms may be important contributing factors leading to an increased risk of DD. PURPOSE To review the genetic factors in DD with a focus on polymorphisms and their putative role in the pathophysiology of degeneration. Elucidating the genetic components that are associated with degeneration could provide insights into the mechanism of the process. Furthermore, defining these relationships and eventually using them in a clinical setting may allow an identification and early intervention for those who are at a high risk for painful DD. STUDY DESIGN Literature review. METHODS This literature review focused on the studies concerning genetic polymorphisms and their associations with DD. RESULTS Genetic polymorphisms in 20 genes have been analyzed in association with DD, including vitamin D receptor, growth differentiation factor 5 (GDF5), aggrecan, collagen Types I, IX, and XI, fibronectin, hyaluronan and proteoglycan link protein 1 (HAPLN1), thrombospondin, cartilage intermediate layer protein (CILP), asporin, MMP1, 2, and 3, parkinson protein 2, E3 ubiquitin protein ligase (PARK2), proteosome subunit β type 9 (PSMB9), tissue inhibitor of metalloproteinase (TIMP), cyclooxygenase-2 (COX2), and IL1α, IL1β, and IL6. Each genetic polymorphism codes for a protein that has a functional role in the pathogenesis of DD. CONCLUSIONS There are known associations between several genetic polymorphisms and DD. Of the 20 genes analyzed, polymorphisms in vitamin D receptor, aggrecan, Type IX collagen, asporin, MMP3, IL1, and IL6 show the most promise as functional variants. Genetic studies are crucial for understanding the mechanism of the degeneration. This genetic information could eventually be used as a predictive model for determining a patient's risk for symptomatic DD.
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Affiliation(s)
- Jillian E. Mayer
- Leni and Peter W May Department of Orthopaedics, Mount Sinai Medical Center, 5 East 98th Street, 9th Floor, New York, NY 10029, USA
| | - James C. Iatridis
- Leni and Peter W May Department of Orthopaedics, Mount Sinai Medical Center, 5 East 98th Street, 9th Floor, New York, NY 10029, USA
| | - Danny Chan
- Department of Biochemistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Sheeraz A. Qureshi
- Leni and Peter W May Department of Orthopaedics, Mount Sinai Medical Center, 5 East 98th Street, 9th Floor, New York, NY 10029, USA
| | - Omri Gottesman
- Institute for Personalized Medicine, Mount Sinai Medical Center, 1468 Madison Avenue, 18th Floor, New York, NY 10029, USA
| | - Andrew C. Hecht
- Leni and Peter W May Department of Orthopaedics, Mount Sinai Medical Center, 5 East 98th Street, 9th Floor, New York, NY 10029, USA,Corresponding Author: Andrew C. Hecht, Mount Sinai Medical Center. 5 East 98 Street, 9 Floor, New York, NY 10029, USA. Tel: (212) 241-8892; Fax: (212) 423-0827.
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Iatridis JC, Nicoll SB, Michalek AJ, Walter BA, Gupta MS. Role of biomechanics in intervertebral disc degeneration and regenerative therapies: what needs repairing in the disc and what are promising biomaterials for its repair? Spine J 2013; 13:243-62. [PMID: 23369494 PMCID: PMC3612376 DOI: 10.1016/j.spinee.2012.12.002] [Citation(s) in RCA: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 07/26/2012] [Accepted: 12/09/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Degeneration and injuries of the intervertebral disc (IVD) result in large alterations in biomechanical behaviors. Repair strategies using biomaterials can be optimized based on the biomechanical and biological requirements of the IVD. PURPOSE To review the present literature on the effects of degeneration, simulated degeneration, and injury on biomechanics of the IVD, with special attention paid to needle puncture injuries, which are a pathway for diagnostics and regenerative therapies and the promising biomaterials for disc repair with a focus on how those biomaterials may promote biomechanical repair. STUDY DESIGN A narrative review to evaluate the role of biomechanics on disc degeneration and regenerative therapies with a focus on what biomechanical properties need to be repaired and how to evaluate and accomplish such repairs using biomaterials. Model systems for the screening of such repair strategies are also briefly described. METHODS Articles were selected from two main PubMed searches using keywords: intervertebral AND biomechanics (1,823 articles) and intervertebral AND biomaterials (361 articles). Additional keywords (injury, needle puncture, nucleus pressurization, biomaterials, hydrogel, sealant, tissue engineering) were used to narrow the articles down to the topics most relevant to this review. RESULTS Degeneration and acute disc injuries have the capacity to influence nucleus pulposus (NP) pressurization and annulus fibrosus (AF) integrity, which are necessary for an effective disc function and, therefore, require repair. Needle injection injuries are of particular clinical relevance with the potential to influence disc biomechanics, cellularity, and metabolism, yet these effects are localized or small and more research is required to evaluate and reduce the potential clinical morbidity using such techniques. NP replacement strategies, such as hydrogels, are required to restore the NP pressurization or the lost volume. AF repair strategies including cross-linked hydrogels, fibrous composites, and sealants offer promise for regenerative therapies to restore AF integrity. Tissue engineered IVD structures, as a single implantable construct, may promote greater tissue integration due to the improved repair capacity of the vertebral bone. CONCLUSIONS IVD height, neutral zone characteristics, and torsional biomechanics are sensitive to specific alterations in the NP pressurization and AF integrity and must be addressed for an effective functional repair. Synthetic and natural biomaterials offer promise for NP replacement, AF repair, as an AF sealant, or whole disc replacement. Meeting mechanical and biological compatibilities are necessary for the efficacy and longevity of the repair.
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Affiliation(s)
- James C. Iatridis
- Leni and Peter W. May Department of Orthopaedics, Mount Sinai School of Medicine, New York, NY
| | - Steven B. Nicoll
- Department of Biomedical Engineering, The City College of New York, New York, NY
| | - Arthur J. Michalek
- Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT
| | - Benjamin A. Walter
- Leni and Peter W. May Department of Orthopaedics, Mount Sinai School of Medicine, New York, NY,Department of Biomedical Engineering, The City College of New York, New York, NY
| | - Michelle S. Gupta
- Department of Biomedical Engineering, The City College of New York, New York, NY
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Adams MA, Dolan P. Intervertebral disc degeneration: evidence for two distinct phenotypes. J Anat 2012; 221:497-506. [PMID: 22881295 DOI: 10.1111/j.1469-7580.2012.01551.x] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2012] [Indexed: 11/29/2022] Open
Abstract
We review the evidence that there are two types of disc degeneration. 'Endplate-driven' disc degeneration involves endplate defects and inwards collapse of the annulus, has a high heritability, mostly affects discs in the upper lumbar and thoracic spine, often starts to develop before age 30 years, usually leads to moderate back pain, and is associated with compressive injuries such as a fall on the buttocks. 'Annulus-driven' disc degeneration involves a radial fissure and/or a disc prolapse, has a low heritability, mostly affects discs in the lower lumbar spine, develops progressively after age 30 years, usually leads to severe back pain and sciatica, and is associated with repetitive bending and lifting. The structural defects which initiate the two processes both act to decompress the disc nucleus, making it less likely that the other defect could occur subsequently, and in this sense the two disc degeneration phenotypes can be viewed as distinct.
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Affiliation(s)
- Michael A Adams
- Centre for Comparative and Clinical Anatomy, University of Bristol, UK.
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Fan SW, Zhou ZJ, Hu ZJ, Fang XQ, Zhao FD, Zhang J. Quantitative MRI analysis of the surface area, signal intensity and MRI index of the central bright area for the evaluation of early adjacent disc degeneration after lumbar fusion. 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 2012; 21:1709-15. [PMID: 22526697 DOI: 10.1007/s00586-012-2293-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 03/10/2012] [Accepted: 03/29/2012] [Indexed: 01/05/2023]
Abstract
PURPOSE The aim of this study was to evaluate early ASD at short-term follow-up in fused and unoperated patients with degenerative disc disease, using quantitative magnetic resonance imaging (MRI) analysis of the area, signal intensity and their product, i.e., MRI index of the central bright area of the disc as well as measures of intervertebral disc height and Pfirrmann grading scale. The further purpose was to determine whether fusion accelerates ASD compared with non-surgical treatment in short-term follow-up. METHODS One hundred and eight chronic low back patients diagnosed as L4/L5 degeneration undertook either one-level instrumented posterior lumbar interbody fusion or conservative treatment. They were followed up for about 1 year. Finally 46 fused and 45 conservatively treated patients with MRI follow-up were included. Pre- and post-treatment MRIs were compared to determine the progression of disc degeneration at the two cranial adjacent segments. RESULTS The area, signal intensity and MRI index of the central bright area of the adjacent discs decreased in the operated and unoperated groups from pre-treatment to follow-up, except for an insignificant decrease of signal intensity at the second adjacent segment in the unoperated group. The changes in these parameters were statistically greater at the first than the second adjacent segment in the fused group, but not in the unoperated group. And the changes in the fused group were more pronounced than those at both neighbouring levels in the unoperated group. However, the Pfirrmann grading scale and intervertebral disc height did not detect any changes at adjacent discs in either group. CONCLUSIONS Decrease in the parameters of quantitative MRI analysis indicated early degeneration at discs adjacent to lumbar spinal fusion. Fusion had an independent effect on the natural history of ASD during short-term follow-up. Continued longitudinal follow-up is required to determine whether these MRI changes lead to pathologic changes.
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Affiliation(s)
- Shun-Wu Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Wang Y, Boyd SK, Battié MC, Yasui Y, Videman T. Is greater lumbar vertebral BMD associated with more disk degeneration? A study using µCT and discography. J Bone Miner Res 2011; 26:2785-91. [PMID: 21786320 DOI: 10.1002/jbmr.476] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
It is well documented that osteoarthritis is associated with greater BMD in peripheral extremities. Yet the relationship between vertebral BMD and disk degeneration (DD) remains controversial in the lumbar spine, which may be due largely to the inadequacies of BMD and DD measures. Aiming to clarify the association between vertebral BMD and adjacent DD, we studied 137 cadaveric lumbar vertebrae and 209 corresponding intervertebral disks from the spines of 48 white men aged 21 to 64 years. DD was evaluated using discography. The vertebrae were scanned using a micro-computed tomography (µCT) system to obtain volumetric BMD for the whole vertebra, the vertebral body, the vertebral body excluding osteophytes, and the vertebral body excluding osteophytes and endplates. A random effects model was used to examine the association between the different definitions of vertebral BMD and adjacent DD. No significant association was found between the BMD of the whole vertebra and adjacent DD. However, when the posterior elements were excluded, there was a significant association between greater vertebral body BMD and more severe degeneration in the disk cranial to the vertebra. This association remained after further excluding osteophytes and endplates from the vertebral body BMD measurements. Also, a trend of greater BMD of the vertebral body associated with more adjacent DD was evident. These results clarify the association between vertebral BMD and DD and specifically indicate that it is higher BMD of the vertebral body, not the entire vertebra, that is associated with more severe adjacent DD. This association may be obscured by the posterior elements and is not confounded by osteophytes and endplate sclerosis.
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Affiliation(s)
- Yue Wang
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Quantitative measures of modic changes in lumbar spine magnetic resonance imaging: intra- and inter-rater reliability. Spine (Phila Pa 1976) 2011; 36:1236-43. [PMID: 21217445 DOI: 10.1097/brs.0b013e3181ecf283] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A measurement reliability study. OBJECTIVE To develop quantitative measures for Modic changes (MCs) on magnetic resonance (MR) images and evaluate measurement reliability. SUMMARY OF BACKGROUND DATA MCs have been studied for more than 20 years but the clinical significance remains controversial. Little effort has been made to improve the measurement of MCs. METHODS The study was approved by the responsible institutional review board. On the basis of Modic classification, a series of quantitative dimension and signal intensity measures were developed for assessing MCs. Midsagittal T1- and T2-weighted MR images from 83 lumbar spines were then qualitatively and quantitatively assessed by two observers independently. Kappa and intraclass correlation coefficient (ICC) were used to examine intra- and inter-rater reliability. Pearson correlation coefficient was used to assess the relationships between the quantitative measurements of MCs. Mean absolute deviation (MAD) and Bland-Altman plots also were used to evaluate measurement errors and limits of agreement for selected measures. RESULTS For Modic classification, intrarater agreement was excellent (κ = 0.88) and inter-rater agreement was substantial (κ = 0.79). Intrarater agreement also was excellent when obtaining dimension measurements (ICC = 0.82-0.96) from T1- or T2-weighted images and inter-rater agreement was slightly greater using T1-weighted images (ICC = 0.73-0.88) than T2-weighted images (ICC = 0.66-0.82). Signal intensity measurements on T2-weighted images were found to have almost perfect intra- and inter-rater reliability (ICC = 0.92-0.99). The correlation analysis demonstrated that the quantitative measures represent different constructs. The MAD and Bland-Altman Plots further confirmed the high reliability of the area ratio, MCs mean signal intensity and MCs total signal intensity measurements. CONCLUSION Three quantitative measures are suggested to assess the severity of MCs, which provide reliable, precise measurements for research on the etiology, pathogenesis, and clinical relevance of MCs.
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O’Connell GD, Vresilovic EJ, Elliott DM. Human intervertebral disc internal strain in compression: the effect of disc region, loading position, and degeneration. J Orthop Res 2011; 29:547-55. [PMID: 21337394 PMCID: PMC3428014 DOI: 10.1002/jor.21232] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 06/28/2010] [Indexed: 02/04/2023]
Abstract
The primary function of the disc is mechanical; therefore, degenerative changes in disc mechanics and the interactions between the annulus fibrosus (AF) and nucleus pulposus (NP) in nondegenerate and degenerate discs are important to functional evaluation. The disc experiences complex loading conditions, including mechanical interactions between the pressurized NP and the surrounding fiber-reinforced AF. Our objective was to noninvasively evaluate the internal deformations of nondegenerate and degenerate human discs under axial compression with flexion, neutral, and extension positions using magnetic resonance imaging and image correlation. The side of applied bending (e.g., anterior AF in flexion) had higher tensile radial and compressive axial strains, and the opposite side of bending exhibited tensile axial strains even though the disc was loaded under axial compression. Degenerated discs exhibited higher compressive axial and tensile radial strains, which suggest that load distribution through the disc subcomponents are altered with degeneration, likely due to the depressurized NP placing more of the applied load directly on the AF. The posterior AF exhibited higher compressive axial and higher tensile radial strains than the other AF regions, and the strains were not correlated with degeneration, suggesting this region undergoes high strains throughout life, which may predispose it to failure and tears. In addition to understanding internal disc mechanics, this study provides important new data into the changes in internal strain with degeneration, data for validation of finite element models, and provides a technique and baseline data for evaluating surgical treatments.
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Affiliation(s)
- Grace D. O’Connell
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia PA
| | | | - Dawn M. Elliott
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia PA
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Wang Y, Battié MC, Boyd SK, Videman T. The osseous endplates in lumbar vertebrae: thickness, bone mineral density and their associations with age and disk degeneration. Bone 2011; 48:804-9. [PMID: 21168539 DOI: 10.1016/j.bone.2010.12.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/09/2010] [Accepted: 12/09/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION As the gateway of nutrient supply, the vertebral endplate is essential to maintain the integrity and function of the avascular intervertebral disk. While a link between calcium deposition in the endplate and disk degeneration is well established from histological studies, findings on the association between endplate thickness and age and disk degeneration are conflicting. Moreover, the association between endplate bone mineral density (BMD) and disk degeneration remains unexplored in humans. OBJECTIVES To determine the thickness and BMD of lumbar spine osseous endplates in men and explore their associations with age and disk degeneration. METHODS From a spine archive, 150 cadaveric lumbar vertebrae (L1-L5) from 48 male human spines (mean age 50 years, range 21-64) were scanned using micro-CT (μCT). The osseous endplates were extracted from the vertebral body to measure the mean thickness and volumetric BMD. The difference between cranial and caudal endplates, associations of endplate thickness and BMD with age and discographic degeneration pathology were examined. RESULTS Overall, the mean thickness was 1.03±0.24 mm for cranial (to disk) endplates and 0.78±0.16 mm for caudal endplates. For lumbar intervertebral disks, the cranial endplate was significantly thicker and denser than the caudal endplate (p<0.001-0.05). Thickness and BMD of endplates were independent of age. Based on discography, a trend of more severe disk degeneration associated with greater thickness in both the cranial and caudal endplates was observed, and was most marked in severely degenerated disks (p<0.05). However, no evidence was detected for a link between more severe disk degeneration and elevated endplate BMD (p>0.05). CONCLUSIONS In the lumbar spine, both the thickness and BMD of endplates were independent of age, which ranged from 21 to 64 years. The endplates cranial to intervertebral disks were thicker and had higher BMD than the corresponding caudal endplates. Judged from discography, more degeneration in the adjacent intervertebral disk was associated with greater endplate thickness, but not higher endplate BMD. Thus, endplate sclerosis, reflecting elevated endplate BMD, may not be a risk factor for disk pathology in men.
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Affiliation(s)
- Yue Wang
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
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Abstract
STUDY DESIGN Exposure discordant twin study. OBJECTIVE To investigate the effect of injury on lumbar disc degeneration in monozygotic twins with discordant exposures to recalled previous injury/trauma to the lumbar spine. SUMMARY OF BACKGROUND DATA Disc degeneration is considered a primary source of low back pain. Despite this, important determinants of disc degeneration other than genotype have not been identified. One possible important determinant of disc degeneration that has undergone limited investigation is previous back injury. METHODS We compared disc degeneration between 37 male monozygotic twin pairs with discordant exposures to recalled previous injury/trauma to the lumbar spine. Data on injury history were obtained through an extensive structured interview. Disc degeneration was assessed using quantitative measures of disc height and disc signal intensity. RESULTS.: Disc degeneration did not differ between twins who reported previous back injury and their uninjured co-twins. This finding was consistent for both disc height and disc signal intensity regardless of whether mean scores or greatest difference at any one lumbar level was used in the analysis. Disc height averaged 0.3 mm higher in the injured twin (P = 0.302), and was on average 0.05% higher at the level of the greatest co-twin difference (P = 0.302). There was no evidence that greater period since injury resulted in greater twin differences in disc degeneration. CONCLUSION The current study suggests that back injury based on patient report is not an important predictor of future disc degeneration.
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Videman T, Gibbons LE, Kaprio J, Battié MC. Challenging the cumulative injury model: positive effects of greater body mass on disc degeneration. Spine J 2010; 10:26-31. [PMID: 19926343 DOI: 10.1016/j.spinee.2009.10.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 09/28/2009] [Accepted: 10/13/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There are differing views as to the causes of disc degeneration. One view, referred to as a cumulative or repetitive injury model, explains disc degeneration, in great part, as the result of "wear and tear" on the disc from routine daily exposures to physical loading or biomechanical forces. Perhaps paradoxically, such physical loading has been thought to be generally beneficial for other structures of the musculoskeletal system. PURPOSE The goal of this study was to investigate the associations of physical loading from body weight using quantitative measures of disc degeneration. STUDY DESIGN This is an exposure-discordant twin study. METHODS We selected 44 pairs of healthy male monozygotic (MZ) twins with 8 kg or more discordance in body weight (mean 13 kg), with lumbar magnetic resonance imaging and bone density measurements available. The main outcome of disc degeneration was assessed through quantitatively measured disc height, and disc signal intensity and signal variation adjusted by the intrabody reference, adjacent cerebrospinal fluid signal, at L1-L4. Data on suspected constitutional and environmental risk factors were available for control of possible confounding factors. RESULTS Higher body weight was associated with 6.2% higher bone density in the lumbar spine, confirming an effective discordance (p<.0001). Disc signal variation was 5.4% higher ("better") among the heavier MZ co-twins (p=.005), but the 2.6% higher disc heights and 2.9% higher adjusted disc signals were not statistically significant. CONCLUSIONS Contrary to common beliefs, our findings suggest that cumulative or repetitive loading because of higher body mass (nearly 30 pounds on average) was not harmful to the discs. In fact, a slight delay in L1-L4 disc desiccation was observed in the heavier men, as compared with their lighter twin brothers.
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Affiliation(s)
- Tapio Videman
- The Finnish Twin Cohort Study, Department of Public Health, University of Alberta, Edmonton T6G 2G4, Canada.
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