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Li J, Gössel L, Kunze B, Kessler O, Alharbi Y, Gärtner O, Mihalca V, Krebs S, Dreimann M. Traumatic lumbar disc herniation: A systemic case review and meta-analysis. BRAIN & SPINE 2023; 3:102350. [PMID: 38021008 PMCID: PMC10668050 DOI: 10.1016/j.bas.2023.102350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 12/01/2023]
Abstract
Introduction Traumatic lumbar disc herniation (TLDH) without fracture in the in-situ motion segment is a rare occurrence compared with degenerative herniation. Research question This study provides a systematic discussion of various aspects related to the diagnosis of TLDH. Material and methods This review includes 12 cases of TLDH with MR-images since 2009 published in the PubMed and one adjunct illustration. The cases were categorized into two groups for a comprehensive analysis, TLDH with or without in-situ segment fracture. Additionally, we reported a case of a 43-year-old female patient with a recent stenosing TLDH at L5/S1, accompanied by a large sequestration (disc herniation stage-4, and Michigan State University Classification: MSU 3-AB) and an endplate compression fracture at L2 (AO A1). Results Isolated traumatic lumbar disc herniation is possible, but it is required exclude cases with fractures in the in-situ motion segment. Discussion and conclusion Trauma with related injury mechanisms is the highest priority for the diagnosis of TLDH. Low-grade disc degeneration without significant instability could be accepted for diagnosing TLDH. A TLDH on MR images might show a slightly lower T2-signal compared to the CSF and a homogeneous T1-signal like the spinal cord, as well as a similar STIR-signal of the sequestration and CSF. If necessary, a histological examination could be performed to evaluate the degenerative changes in the injured disc, especially to assist the evaluation due to legal reasons.
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Affiliation(s)
- J. Li
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - L. Gössel
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - B. Kunze
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - O. Kessler
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - Y. Alharbi
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - O. Gärtner
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - V.A. Mihalca
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - S. Krebs
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
| | - M. Dreimann
- Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopedic Clinic Markgröningen, Markgröningen, Germany
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Harada GK, Alter K, Nguyen AQ, Tao Y, Louie PK, Basques BA, Galbusera F, Niemeyer F, Wilke HJ, An HS, Samartzis D. Cervical Spine Endplate Abnormalities and Association With Pain, Disability, and Adjacent Segment Degeneration After Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2020; 45:E917-E926. [PMID: 32675603 DOI: 10.1097/brs.0000000000003460] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study with prospectively-collected data. OBJECTIVE To determine how type, location, and size of endplate lesions on magnetic resonance imaging (MRI) may be associated with symptoms and clinical outcomes after anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Structural endplate abnormalities are important, yet understudied, phenomena in the cervical spine. ACDF is a common surgical treatment for degenerative disc disease; however, adjacent segment degeneration/disease (ASD) may develop. METHODS Assessed the imaging, symptoms and clinical outcomes of 861 patients who underwent ACDF at a single center. MRI and plain radiographs of the cervical spine were evaluated. Endplate abnormalities on MRI were identified and stratified by type (atypical, typical), location, relation to operative levels, presence at the adjacent level, and size. These strata were assessed for association with presenting symptoms, patient-reported, and postoperative outcomes. RESULTS Of 861 patients (mean follow-up: 17.4 months), 57.3% had evidence of endplate abnormalities, 39.0% had typical abnormalities, while 18.2% had atypical abnormalities. Patients with any endplate abnormality had greater odds of myelopathy irrespective of location or size, while sensory deficits were associated with atypical lesions (P = 0.016). Typical and atypical abnormalities demonstrated differences in patient-reported outcomes based on location relative to the fused segment. Typical variants were not associated with adverse surgical outcomes, while atypical lesions were associated with ASD (irrespective of size/location; P = 0.004) and reoperations, when a large abnormality was present at the proximal adjacent level (P = 0.025). CONCLUSION This is the first study to examine endplate abnormalities on MRI of the cervical spine, demonstrating distinct risk profiles for symptoms, patient-reported, and surgical outcomes after ACDF. Patients with typical lesions reported worsening postoperative pain/disability, while those with atypical abnormalities experienced greater rates of ASD and reoperation. This highlights the relevance of a degenerative spine phenotypic assessment, and suggests endplate abnormalities may prognosticate clinical outcomes after surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Garrett K Harada
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL
| | - Kevin Alter
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL
| | - Austin Q Nguyen
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL
| | - Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL
| | | | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL
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Engle AM, Chen Y, Marascalchi B, Wilkinson I, Abrams WB, He C, Yao AL, Adekoya P, Cohen ZO, Cohen SP. Lumbosacral Radiculopathy: Inciting Events and Their Association with Epidural Steroid Injection Outcomes. PAIN MEDICINE 2019; 20:2360-2370. [DOI: 10.1093/pm/pnz097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
Objective
Low back pain is the leading cause of worldwide disability, with lumbosacral radiculopathy accounting for over one-third of these cases. There are limited data on the relationship between etiologies and lumbosacral radiculopathy, and it is unknown whether specific causes predict treatment outcomes.
Design, Setting, and Subjects
This study explores patient-reported etiologies for lumbosacral radiculopathy in a chronic pain clinic between January 2007 and December 2015 and examines whether these causes affected epidural steroid injection outcomes.
Methods
We reviewed the medical records of 1,242 patients with lumbosacral radiculopathy who received epidural steroid injections. The recording of an inciting event was done contemporaneously based on note templates. A positive outcome following an epidural steroid injection was defined as ≥30% pain relief sustained for six or more weeks without additional intervention. Factors associated with epidural steroid injection outcome were analyzed by multivariable logistic regression.
Results
Fifty point seven percent reported an inciting event, and 59.9% of patients experienced a positive epidural steroid injection outcome. The most commonly reported causes were falls (13.1%), motor vehicle collisions (10.7%), and lifting (7.8%). Individuals with a herniated disc (56.3%) were more likely to report a precipitating cause than those with stenosis (44.7%) or degenerative discs (47.8%, P = 0.012). An inciting event did not predict treatment outcome. Factors associated with negative treatment outcome included opioid consumption (odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.39–0.95, P = 0.027), secondary gain (OR = 0.69, 95% CI = 0.50–0.96, P = 0.030), and baseline pain score (OR = 0.90, 95% CI = 0.84–0.97, P = 0.006). The number of levels injected was associated with a positive outcome (OR = 2.72, 95% CI = 1.28–6.47, P = 0.008).
Conclusions
Reported inciting events are common in patients with lumbosacral radiculopathy but are not associated with outcome following epidural steroid injection, and their occurrence is not always consistent with the purported mechanism of injury.
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Affiliation(s)
| | - Yian Chen
- Departments of Anesthesiology and Critical Care Medicine
| | | | - Indy Wilkinson
- Departments of Anesthesiology and Critical Care Medicine
| | - Winfred B Abrams
- Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cathy He
- Departments of Anesthesiology and Critical Care Medicine
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ada Lyn Yao
- Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
- Division of Pain Medicine, Stanford University, Palo Alto, California
| | - Peju Adekoya
- Departments of Anesthesiology and Critical Care Medicine
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Steven Paul Cohen
- Departments of Anesthesiology and Critical Care Medicine
- Departments of Neurology and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
- Departments of Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Ruofeng Y, Cohen JR, Buser Z, Yoon ST, Meisel HJ, Youssef JA, Park JB, Wang JC, Brodke DS. Trends of Posterior Long Segment Fusion with and without Recombinant Human Bone Morphogenetic Protein 2 in Patients with Scoliosis. Global Spine J 2016; 6:422-31. [PMID: 27433425 PMCID: PMC4947408 DOI: 10.1055/s-0035-1564416] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/06/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE Symptomatic scoliosis can be a source of severe pain and disability. When nonoperative treatments fail, spine fusion is considered as an effective procedure in scoliosis management. The purpose of this study was to evaluate the trends of patients with scoliosis undergoing posterior long segment fusion (PLSF) with and without recombinant human bone morphogenetic protein 2 (rhBMP-2). METHODS Patients within the orthopedic subset of Medicare database undergoing PLSF from 2005 to 2011 were identified using the PearlDiver Patient Records Database. Both diagnosis and procedural International Classification of Diseases, ninth edition and Current Procedural Terminology codes were used. The year of procedure, age, sex, region, and rhBMP-2 use were recorded. RESULTS In total, 1,265,591 patients with scoliosis were identified with 29,787 PLSF surgeries between 2005 and 2011. The incidence of PLSF procedures increased gradually from 2005 to 2009, decreased in 2010 (p < 0 0.01), and grew again in 2011. Patients over age 84 years had the highest incidence of PLSF. The lowest incidence of the procedures was in the Northeast, 5.96 per 100,000 patients. Sex differences were observed with a male-to-female ratio of 0.40 (p < 0.01). The use of rhBMP-2 for PLSF increased steadily from 2005 to 2009; the numbers dropped dramatically in 2010 and returned by 2011. CONCLUSIONS According to our study, patients with scoliosis demonstrated a 0.6575 average incidence increase of PLSF treatments annually. There were significant differences in incidence of PLSF procedure and patient demographics. Additionally, rhBMP-2 consumption significantly changed when we stratified it by sex, age, and region respectively.
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Affiliation(s)
- Yin Ruofeng
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, United States,Department of Orthopedic Surgery, China-Japan Union Hospital, Jilin University, ChangChun City, JiLin Province, China
| | - Jeremiah R. Cohen
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California, United States
| | - Zorica Buser
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, United States,Address for correspondence Zorica Buser, PhD Department of Orthopaedic Surgery, Keck School of MedicineUniversity of Southern California, Elaine Stevely Hoffman Medical Research CenterHMR 710, 2011 Zonal Avenue, Los Angeles, CA 90033United States
| | - S. Tim Yoon
- Department of Orthopedics, Emory Spine Center, Atlanta, Georgia, United States
| | | | - Jim A. Youssef
- Durango Orthopedic Associates, P.C./Spine Colorado, Durango, Colorado, United States
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, Uijongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine, Uijongbu, Korea
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, United States
| | - Darrel S. Brodke
- Department of Orthopedics, University of Utah School of Medicine, Salt Lake City, Utah, United States
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Distribution of Schmorl nodes in the lumbar spine and their relationship with lumbar disk degeneration and range of motion. Spine (Phila Pa 1976) 2015; 40:E49-53. [PMID: 25341975 DOI: 10.1097/brs.0000000000000658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A kinematic magnetic resonance imaging study. OBJECTIVE To investigate the distribution of Schmorl nodes (SNs) in the lumbar spine in healthy adults, and determine the association with lumbar disk degeneration and lumbar spine motion. SUMMARY OF BACKGROUND DATA SNs have been associated with several pathologies of the lumbar spine, although it has been demonstrated that they also occur in the healthy adult population without a clearly identified cause. A thorough understanding of SN distribution may help reveal reasons for their formation. How disk degeneration and lumbar spine motion relate to SNs is poorly understood. METHODS Kinematic magnetic resonance images (0.6 T) were available for 1179 healthy individuals from 15 to 85 years of age. Spine specialists performed computer-based measurements. All parameters were measured and calculated automatically using the eRAD PACS Viewer (eRAD Inc., version 6.2.1.1). Lumbar disk degeneration was documented according to the Pfirrmann classification system. Lumbar spine lordosis was quantified as the angle between the inferior endplate of L1 and superior endplate of S1. The level of significance was defined as P ≤ 0.05. The distribution of SNs along the lumbar spine and their relationship with age and sex was investigated using the single factor analysis of variance χ test. The relationship between SNs, age group, disk location, and overall grades of lumbar disk degeneration were investigated by multiple logistic regression analysis. Lumbar spine motion was compared between patients with and without SNs via independent t test among 585 individuals with qualified kinematic images. Multiple logistic regression analysis was performed on associations of lumbar motion range among the SN population. RESULTS The prevalence of SNs in our study population was 28.4%, and SNs were observed to be present more frequently in males (34.6%) than in females (20.2%) (ρ< 0.01). There was no significant difference in the incidence of SNs between age groups (ρ= 0.18). SNs were more common at the L2 and L3 vertebral bodies (14.3% and 14.4%), whereas SNs were least common at S1 vertebral bodies (1.5%). The highest incidences of SNs presentation was on disks with degeneration grade III (41.9%) and grade IV (45.3%). SN occurrence, aging, and disk location were positively correlated with lumbar disk degeneration grade. The lumbar spine range of motion was significantly different between individuals with and without SNs (31.4° vs. 37.9°, ρ< 0.01). The frequency of SNs was associated with decreased lumbar range of motion in all age groups except 51 to 60 years and 61 to 70 years. CONCLUSION SNs have a high incidence in individuals without persistent lumbar disorders and were found in disks at all degrees of degeneration. SNs occurrence were positively associated with lumbar disk degeneration In addition, the presence of SNs was correlated with decreased overall lumbar motion across all age groups.
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Liu N, Guo X, Chen Z, Qi Q, Li W, Guo Z, Zeng Y, Sun C, Liu Z. Radiological signs of Scheuermann disease and low back pain: retrospective categorization of 188 hospital staff members with 6-year follow-up. Spine (Phila Pa 1976) 2014; 39:1666-75. [PMID: 24979145 PMCID: PMC4222801 DOI: 10.1097/brs.0000000000000479] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/04/2014] [Accepted: 06/11/2014] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate the relationship between radiological signs of Scheuermann disease (SD) and low back pain (LBP) in a local population using lumbar magnetic resonance (MR) images. SUMMARY OF BACKGROUND DATA SD is a spinal disorder, and both its classic and atypical (lumbar) forms are associated with LBP. However, radiological signs of SD are present in 18% to 40% of the general population, in whom the clinical significance of "SD-like" spine remains largely unknown. METHODS This retrospective cohort study included 188 staff members from a single hospital. Participants' lumbar MR images and self-administered questionnaires concerning demographic information, LBP status, consequences, and functional limitations were collected. Participants were classified into 2 groups according to whether lumbar MR images met SD diagnostic criteria, and LBP status, consequences, and functional limitation were compared. Follow-up interviews were conducted after 6 years to compare LBP progression. RESULTS Thirty-four participants (18.1%) had SD-like spine. Rates of lifetime, previous 1-year, and point LBP did not significantly differ between groups. However, among participants who had ever had LBP, SD-like spine was associated with higher rates of work absence (42.1% vs. 9.5%, χ = 9.620, P = 0.002) and seeking medical care (68.4% vs. 39.2%, χ = 5.216, P = 0.022) due to LBP, as well as significantly greater intensity of the most severe LBP episode in the past 2 years (6.4 ± 2.5 vs. 4.1 ± 2.5, t = 3.564, P = 0.001). Among the 159 participants who completed the 6-year follow-up, a significantly higher proportion of people with SD-like spine reported aggravated LBP during the follow-up. CONCLUSION Our results suggest that in the general population, lumbar MR images of many people meet SD diagnostic criteria, and having SD-like spine seemed to be associated with the severity and progressive nature of LBP. Our findings should inspire further research in this field. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Ning Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
- Department of Orthopaedic Surgery, Spine Service, Massachusetts General Hospital, Boston, MA
| | - Xinhu Guo
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Qiang Qi
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Zhaoqing Guo
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Yan Zeng
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Zhongjun Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
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The relationship of symptomatic thoracolumbar disc herniation and Scheuermann’s disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:1059-66. [DOI: 10.1007/s00586-013-3108-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 10/26/2022]
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