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A Novel Grading System of Destructive Lumbar Spondyloarthropathy Based on Evaluation of the Facet Joints. Spine (Phila Pa 1976) 2022; 47:1227-1233. [PMID: 35797444 DOI: 10.1097/brs.0000000000004382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/16/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To develop and evaluate a new grading system for destructive lumbar spondyloarthropathy (DLSA) by assessing bony destruction of the facet joints; to evaluate interrater reliability; and to determine the association between anteroposterior (AP) dural sac diameter at the lumbar level and the new grading. SUMMARY OF BACKGROUND DATA The characteristics of DLSA are unknown, hindering clinical care and research. Imaging to determine the cause of DLSA may positively contribute to patient outcome or well-being by providing prognostic information. PATIENTS AND METHODS In the magnetic resonance images (MRIs), we measured an axial midline AP dural sac diameter and evaluated bone destruction caused by amyloidosis at the level of the center of each lumbar disk of the lumbar spine. Two orthopedic surgeons independently evaluated each case at two-month intervals and assigned the grade by rating bone destruction at each lumbar level. Weighted κ and intraclass correlation coefficients for interrater reliability were calculated. In addition, the correlation between the AP diameter of the spinal dural sac at the lumbar level and the new MRI-based DLSA grade was examined. RESULTS The sample size of 82 patients was reached by examining records of 118 consecutive patients. The mean (SD) age of the included patients was 65 (7.2) years, and 36 (43.9%) were women. The grading of DLSA showed moderate to good interrater reliability at both assessments (κ, 0.59-0.78). Intraclass correlation coefficient showed substantial to excellent agreement (intraclass correlation coefficient, 0.63-0.86). The AP diameter of the spinal dural sac at the lumbar level showed a significant correlation with the new grading ( P <0.001). CONCLUSIONS The new MRI-based grading system for DLSA has good interrater reliability, although the strength of agreement varies somewhat. The new grading system correlates with AP dural sac diameter. Thus, this classification focused on facet erosion, which leads to functional incompetence may be helpful in surgical decision-making.
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Chianca V, Chalian M, Harder D, Del Grande F. Imaging of Spine Infections. Semin Musculoskelet Radiol 2022; 26:387-395. [PMID: 36103882 DOI: 10.1055/s-0042-1749619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The incidence of spondylodiskitis has increased over the last 20 years worldwide, especially in the immunodepressed population, and it remains a complex pathology, both in terms of diagnosis and treatment. Because clinical symptoms are often nonspecific and blood culture negative, imaging plays an essential role in the diagnostic process. Magnetic resonance imaging, in particular, is the gold standard technique because it can show essential findings such as vertebral bone marrow, disk signal alteration, a paravertebral or epidural abscess, and, in the advanced stage of disease, fusion or collapse of the vertebral elements. However, many noninfectious spine diseases can simulate spinal infection. In this article, we present imaging features of specific infectious spine diseases that help radiologists make the distinction between infectious and noninfectious processes.
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Affiliation(s)
- Vito Chianca
- Clinica di Radiologia EOC IIMSI, Lugano, Switzerland.,Ospedale Evangelico Betania, Naples, Italy
| | - Majid Chalian
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, Washington
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Gulati V, Chalian M, Yi J, Thakur U, Chhabra A. Sclerotic bone lesions caused by non-infectious and non-neoplastic diseases: a review of the imaging and clinicopathologic findings. Skeletal Radiol 2021; 50:847-869. [PMID: 33040177 DOI: 10.1007/s00256-020-03644-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 02/02/2023]
Abstract
Bone sclerosis is a focal, multifocal, or diffuse increase in the density of the bone matrix on radiographs or computed tomography (CT) imaging. This radiological finding can be caused by a broad spectrum of diseases, such as congenital and developmental disorders, depositional disorders, and metabolic diseases. The differential diagnosis can be effectively narrowed by an astute radiologist in the light of the clinical picture and typical findings on imaging. Some of these lesions are rare and have been described as case reports and series in the literature. This article aims to collate the clinical-radiologic findings of non-infectious and non-neoplastic causes of bone sclerosis with relevant imaging illustrations.
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Affiliation(s)
| | - Majid Chalian
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA, USA
| | - Jaehyuck Yi
- Department of Radiology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Uma Thakur
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA.
- Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
- Musculoskeletal Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA.
- Johns Hopkins University, Baltimore, MD, USA.
- Walton Centre of Neurosciences, Liverpool, UK.
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Abstract
BACKGROUND Vestibular, neurological and musculoskeletal functions are affected in patients with renal failure. These problems can in turn affect the balance system in peritoneal dialysis (PD) patients. Previously, postural balance changes were shown in hemodialysis patients. This is the first study that evaluates whether there are similar changes in patients with PD. OBJECTIVE This study aimed to compare balance and fall risk between patients undergoing PD treatment and healthy subjects, and aimed to determine the correlation between biochemical parameters and fall risk and balance assessments in PD patients. METHODS This controlled study included 58 patients receiving PD treatment (PD Group) and 75 healthy subjects (Control Group). The Berg Balance Scale (BBS) and Tetrax® Interactive Balance System were used for the comparison of balance between groups. For patients in the PD Group, duration of PD, blood pressure, Kt/Vurea (actual mass of urea removed via peritoneal dialysis), and serum biochemical parameters were recorded and correlation analysis was performed between these parameters and balance measurements. RESULTS There were no statistically significant differences between groups in terms of demographics or BBS scores (p> 0.05). The fall risk of patients in the PD Group was significantly higher than those in the Control Group (p< 0.0001) according to Tetrax measurements. Female gender, older age, higher BMI, and higher blood glucose levels were negatively correlated with balance parameters of PD patients (r> 0.3). There was no statistically significant correlation between duration of PD, blood pressure, and Kt/Vurea with balance parameters or fall risk. CONCLUSIONS Balance was impaired in patients undergoing PD in comparison to healthy subjects. Fall risk may be evaluated using the Tetrax® instead of BBS for this population. Serum glucose level, BMI and age appear to affect balance and fall risk. Therefore, optimization of body weight and normalization of serum glucose levels are important factors for improving balance. The duration of PD, blood pressure, and Kt/Vurea do not affect balance system.
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Affiliation(s)
- Pınar Doruk Analan
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Rüya Özelsancak
- Department of Nephrology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Morales H. Infectious Spondylitis Mimics: Mechanisms of Disease and Imaging Findings. Semin Ultrasound CT MR 2018; 39:587-604. [PMID: 30527523 DOI: 10.1053/j.sult.2018.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infectious processes of the spine are on the rise; in this scenario recognition of entities imitating infection is very important. The discovertebral unit is regarded as one of the most important and active sites in the spine. Importantly, the vertebral bony rim and the anterior corners of the vertebral bodies have significant vascularization, they are the last regions to ossify in the developmental process and suffer mechanical forces. Early septic or aseptic discitis-osteomyelitis, properly called spondylitis, involves these anterior regions. Early degeneration is characterized by disc desiccation; however, there is preferential involvement for the corners of the vertebral bodies as well. Many entities to include degenerative changes, inflammatory spondyloarthropathies, neuropathic spine, or pseudo arthrosis, among others, affect the discovertebral unit and can imitate infection. With some exceptions, important imaging findings for the identification of an infectious mimic include the absence of soft tissue enhancement or fluid collections in the paraspinal or epidural regions, and the involvement of multiple levels or the posterior elements. We review developmental, anatomical, and pathologic concepts correlating with imaging clues. Overall, our goal is to increase awareness and to improve recognition of mimicking entities.
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Affiliation(s)
- Humberto Morales
- Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH.
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Talbott JF, Shah VN, Uzelac A, Narvid J, Dumont RA, Chin CT, Wilson DM. Imaging-Based Approach to Extradural Infections of the Spine. Semin Ultrasound CT MR 2018; 39:570-586. [PMID: 30527522 DOI: 10.1053/j.sult.2018.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jason F Talbott
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco; Department of Radiology and Biomedical Imaging, University of California, San Francisco.
| | - Vinil N Shah
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Alina Uzelac
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco; Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Jared Narvid
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco; Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Rebecca A Dumont
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Cynthia T Chin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
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Nishi S, Hoshino J, Yamamoto S, Goto S, Fujii H, Ubara Y, Motomiya Y, Morita H, Takaichi K, Yamagata K, Shigematsu T, Ueda M, Ando Y. Multicentre cross-sectional study for bone-articular lesions associated with dialysis related amyloidosis in Japan. Nephrology (Carlton) 2017; 23:640-645. [PMID: 28556529 DOI: 10.1111/nep.13077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/12/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
AIM Dialysis-related amyloidosis (DRA) exhibits multiple bone-articular lesions, such as carpal tunnel syndrome (CTS), trigger finger (TF), spinal canal stenosis (SCS), destructive spondyloarthropathy (DSA), bone cysts, and joint pains. DRA leads to a decrease in activities of daily living (ADL). We investigated the initiation of CTS and TF, and evaluated the relationship between walking disturbances and bone-articular lesions or joint pains. METHODS A multicentre cross-sectional study was performed. Eighty-two patients with clinical DRA from 20 hospitals in Japan were evaluated. RESULTS Of the 82 patients, the first symptom of DRA was CTS in 39 patients (47.6%) and TF in 21 (25.6%). The mean new-onset vintages of 21 earlier cases in the CTS and TF groups were 86.1 ± 36.3 and 133.2 ± 56.4 (mean ± SD) months, respectively (P = 0.0091). The development of SCS and DSA appeared to be later than CTS and TF. Multiple regression analysis revealed that knee joint pain was a significant contributor to walking disturbances. CONCLUSION Carpal tunnel syndrome appeared significantly earlier than TF since the initiation of dialysis. In the advanced phase, knee joint pain was a major cause of decreased ADL in patients with clinical DRA.
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Affiliation(s)
- Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Toranomon Hospital Kajigaya, Tokyo, Japan
| | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan
| | - Shunsuke Goto
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital Kajigaya, Tokyo, Japan
| | - Yoshihiro Motomiya
- Department of Laboratory Medicine, Suiyukai Clinic, Kashihara, Nara, Japan
| | | | | | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takashi Shigematsu
- Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
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Scarpioni R, Ricardi M, Albertazzi V, De Amicis S, Rastelli F, Zerbini L. Dialysis-related amyloidosis: challenges and solutions. Int J Nephrol Renovasc Dis 2016; 9:319-328. [PMID: 27994478 PMCID: PMC5153266 DOI: 10.2147/ijnrd.s84784] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Amyloidosis refers to the extracellular tissue deposition of fibrils composed of low-molecular-weight subunits of a variety of proteins. These deposits may result in a wide range of clinical manifestations depending upon their type, location, and the amount of deposition. Dialysis-related amyloidosis is a serious complication of long-term dialysis therapy and is characterized by the deposition of amyloid fibrils, principally composed of β2 microglobulins (β2M), in the osteoarticular structures and viscera. Most of the β2M is eliminated through glomerular filtration and subsequent reabsorption and catabolism by the proximal tubules. As a consequence, the serum levels of β2M are inversely related to the glomerular filtration rate; therefore, in end-stage renal disease patients, β2M levels increase up to 60-fold. Serum levels of β2M are also elevated in several pathological conditions such as chronic inflammation, liver disease, and above all, in renal dysfunction. Retention of amyloidogenic protein has been attributed to several factors including type of dialysis membrane, prolonged uremic state and/or decreased diuresis, advanced glycation end products, elevated levels of cytokines and dialysate. Dialysis treatment per se has been considered to be an inflammatory stimulus, inducing cytokine production (such as interleukin-1, tumor necrosis factor-α, interleukin-6) and complement activation. The released cytokines are thought to stimulate the synthesis and release of β2M by the macrophages and/or augment the expression of human leukocyte antigens (class I), increasing β2M expression. Residual renal function is probably the best determinant of β2M levels. Therefore, it has to be maintained as long as possible. In this article, we will focus our attention on the etiology of dialysis-related amyloidosis, its prevention, therapy, and future solutions.
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Affiliation(s)
- R Scarpioni
- Department of Nephrology and Dialysis, Azienda Unità Sanitaria Local (AUSL) Hospital "Guglielmo da Saliceto", Piacenza, Italy
| | - M Ricardi
- Department of Nephrology and Dialysis, Azienda Unità Sanitaria Local (AUSL) Hospital "Guglielmo da Saliceto", Piacenza, Italy
| | - V Albertazzi
- Department of Nephrology and Dialysis, Azienda Unità Sanitaria Local (AUSL) Hospital "Guglielmo da Saliceto", Piacenza, Italy
| | - S De Amicis
- Department of Nephrology and Dialysis, Azienda Unità Sanitaria Local (AUSL) Hospital "Guglielmo da Saliceto", Piacenza, Italy
| | - F Rastelli
- Department of Nephrology and Dialysis, Azienda Unità Sanitaria Local (AUSL) Hospital "Guglielmo da Saliceto", Piacenza, Italy
| | - L Zerbini
- Department of Nephrology and Dialysis, Azienda Unità Sanitaria Local (AUSL) Hospital "Guglielmo da Saliceto", Piacenza, Italy
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Jeong JH, Kim HK, Im SB. Surgical Management for Destructive Atlantoaxial Spondyloarthropathy in Long-Term Hemodialysis Patients. World Neurosurg 2016; 97:753.e7-753.e16. [PMID: 27771479 DOI: 10.1016/j.wneu.2016.10.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/07/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Atlantoaxial spondyloarthropathy most often results from rheumatoid arthritis, cancer metastasis, or basilar invagination. Dialysis-related spondyloarthropathy is a rare cause of spinal deformity and cervical myelopathy at the atlantoaxial joint. We report 2 patients on long-term hemodialysis who presented with atlantoaxial spondyloarthropathy. CASE DESCRIPTION Two patients with end-stage renal failure presented with a history of progressively worsening neck pain, motion limitation, and gait disturbance. In both patients, radiologic findings showed a bone-destroying soft tissue mass lateral to C1 and C2, compressing the spinal cord and causing atlantoaxial instability. We performed a C1 laminectomy and C12 transarticular screw fixation and biopsied the osteolytic mass. The neck pain, hand numbness, and gait disturbance improved. CONCLUSIONS Although the surgical management of these patients involves many challenges, appropriate decompression and fusion surgery is an effective treatment option.
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Affiliation(s)
- Je Hoon Jeong
- Department of Neurosurgery, Soonchunhyang University, Bucheon Hospital, Bucheon, Republic of Korea
| | - Hee Kyung Kim
- Department of Pathology, Soonchunhyang University, Bucheon Hospital, Bucheon, Republic of Korea
| | - Soo Bin Im
- Department of Neurosurgery, Soonchunhyang University, Bucheon Hospital, Bucheon, Republic of Korea.
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