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Wangaryattawanich P, Condos AM, Rath TJ. Bacterial and Viral Infectious Disease of the Spine. Magn Reson Imaging Clin N Am 2024; 32:313-333. [PMID: 38555143 DOI: 10.1016/j.mric.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Spinal infections are a diverse group of diseases affecting different compartments of the spine with variable clinical and imaging presentations. Diagnosis of spinal infections is based on a combination of clinical features, laboratory markers, and imaging studies. Imaging plays a pivotal role in the diagnosis and management of spinal infections. The characteristic imaging manifestations of bacterial and viral infections in the spine are discussed with key teaching points emphasized.
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Affiliation(s)
- Pattana Wangaryattawanich
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195-7115, USA.
| | - Amy M Condos
- Department of Radiology, University of Washington School of Medicine, 2545 Northeast 85th Street Seattle, WA 98115, USA
| | - Tanya J Rath
- Neuroradiology Section, Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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2
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Yoo YM, Kim KH. Facet joint disorders: from diagnosis to treatment. Korean J Pain 2024; 37:3-12. [PMID: 38072795 PMCID: PMC10764212 DOI: 10.3344/kjp.23228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 12/30/2023] Open
Abstract
One of the most common sources of spinal pain syndromes is the facet joints. Cervical, thoracic, and lumbar facet joint pain syndromes comprise 55%, 42%, and 31% of chronic spinal pain syndromes, respectively. Common facet joint disorders are degenerative disorders, such as osteoarthritis, hypertrophied superior articular process, and facet joint cysts; septic arthritis; systemic and metabolic disorders, such as ankylosing spondylitis or gout; and traumatic dislocations. The facet pain syndrome from osteoarthritis is suspected from a patient's history (referred pain pattern) and physical examination (tenderness). Other facet joint disorders may cause radicular pain if mass effect from a facet joint cyst, hypertrophied superior articular process, or tumors compress the dorsal root ganglion. However, a high degree of morphological change does not always provoke pain. The superiority of innervating nerve block or direct joint injection for diagnosis and treatment is still a controversy. Treatment includes facet joint injection in facet joint osteoarthritis or whiplash injury provoking referred pain or decompression in mass effect in cases of hypertrophied superior articular process or facet joint cyst eliciting radicular pain. In addition, septic arthritis is treated using a proper antibiotic, based on infected tissue or blood culture. This review describes the diagnosis and treatment of common facet joint disorders.
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Affiliation(s)
- Yeong-Min Yoo
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Kyung-Hoon Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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3
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Van den Heuvel SAS, Cohen SPC, de Andrès Ares J, Van Boxem K, Kallewaard JW, Van Zundert J. 3. Pain originating from the lumbar facet joints. Pain Pract 2024; 24:160-176. [PMID: 37640913 DOI: 10.1111/papr.13287] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Pain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well-designed studies, the prevalence is generally between 10% and 20%, increasing with age. METHODS The literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized. RESULTS There are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni- or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non-dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After "red flags" are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation. CONCLUSIONS Well-selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.
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Affiliation(s)
- Sandra A S Van den Heuvel
- Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Steven P C Cohen
- Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Koen Van Boxem
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Willem Kallewaard
- Anesthesiology and Pain Medicine, Rijnstate Ziekenhuis, Velp, The Netherlands
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jan Van Zundert
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Suputtitada A, Chen JL, Wu CK, Peng YN, Yen TY, Chen CPC. Determining the Most Suitable Ultrasound-Guided Injection Technique in Treating Lumbar Facet Joint Syndrome. Biomedicines 2023; 11:3308. [PMID: 38137529 PMCID: PMC10741858 DOI: 10.3390/biomedicines11123308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Lower back pain is often caused by lumbar facet joint syndrome. This study investigated the effectiveness of three different injection methods under ultrasound guidance in treating elderly patients with lumbar facet joint syndrome. The difficulty in performing these injections was also evaluated; (2) Methods: A total of 60 elderly patients with facet joint syndrome as the cause of lower back pain were recruited and divided into 3 groups. Group 1 received medial branch block (MBB). Group 2 received intra-articular facet joint injections. Group 3 received injection into the multifidus muscle portion that covers the facet joint. Five percent dextrose water (D5W) was used as the injectant. The visual analog scale (VAS) was used to measure the degree of lower back pain; (3) Results: Before the injection treatments, the VAS score averaged about 7.5. After three consecutive injection treatments (two weeks interval), the VAS score decreased significantly to an average of about 1 in all 3 groups, representing mild to no pain. Between group analyses also did not reveal significant statistical differences, suggesting that these procedures are equally effective; (4) Conclusions: Ultrasound-guided injection of the multifidus muscle may be a feasible option in treating elderly patients with lower back pain caused by facet joint syndrome as it is easier to perform as compared to MBB and intra-articular facet joint injection.
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Affiliation(s)
- Areerat Suputtitada
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand;
| | - Jean-Lon Chen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan; (J.-L.C.); (C.-K.W.); (Y.-N.P.); (T.-Y.Y.)
| | - Chih-Kuan Wu
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan; (J.-L.C.); (C.-K.W.); (Y.-N.P.); (T.-Y.Y.)
| | - Yu-Ning Peng
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan; (J.-L.C.); (C.-K.W.); (Y.-N.P.); (T.-Y.Y.)
| | - Tzu-Yun Yen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan; (J.-L.C.); (C.-K.W.); (Y.-N.P.); (T.-Y.Y.)
| | - Carl P. C. Chen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan; (J.-L.C.); (C.-K.W.); (Y.-N.P.); (T.-Y.Y.)
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5
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Cotten A, Henry S, Scarciolla L, Abou Diwan R, Demondion X, Badr S. Crystal Diseases of the Spine. Semin Musculoskelet Radiol 2023; 27:545-552. [PMID: 37816362 DOI: 10.1055/s-0043-1770763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Gout, calcium pyrophosphate deposition disease, and apatite calcifications, the three main crystal disorders, may involve the spine. These disorders can be completely asymptomatic or associated with various clinical symptoms, such as acute flares and more chronic manifestations. This article presents the typical and more unusual imaging features encountered in these disorders.
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Affiliation(s)
- Anne Cotten
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
- University of Lille, MABlab ULR 4490, Lille, France
| | - Simon Henry
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Laura Scarciolla
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Ralph Abou Diwan
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Xavier Demondion
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
- University of Lille, CHU Lille, Unité de Taphonomie Médicolégale & d'Anatomie, Lille, France
| | - Sammy Badr
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
- University of Lille, MABlab ULR 4490, Lille, France
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Dzefi-Tettey K, Edzie EKM, Mensah SK, Osei S, Piersson AD, Amedi MK, Asemah AR, Kusodzi H. Lumbar facet joint arthrosis on magnetic resonance imaging and its association with low back pain in a selected Ghanaian population. J Neurosci Rural Pract 2023; 14:681-685. [PMID: 38059220 PMCID: PMC10696332 DOI: 10.25259/jnrp_94_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/27/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Facet joint arthrosis is a common radiologic finding but remains controversial as a source of low back pain. We conducted a study to evaluate some of the potential risk factors contributing to the development of facet joint arthrosis, such as age, gender, and body mass index (BMI). The study aimed at establishing an association between these factors and facet joint arthrosis in the Ghanaian population, as a foundation for further research on low back pain. Materials and Methods This was a retrospective study done at the Department of Radiology, Korle Bu Teaching Hospital from January 2019 to December 2021. The study population included all cases referred to our department with complaints of low back pain. Patients below 18 years and those with a history of congenital lesions, trauma, infection, and malignancies were excluded. A total of 1017 cases were identified with facet joint arthrosis. The mean difference in age and BMI between males and females was compared using an independent sample t-test. Statistical association was done using Pearson's Chi-square test. P ≤ 0.05 was used as statistical significance. Results Majority of the study subjects were overweight with a mean BMI of 27.31 ± 5.37 kg/m2. The mean age was 53.61 ± 16.22 years, and majority were within the age of 51-60 years. Age was significantly associated with the prevalence of facet joint arthrosis. Conclusion The prevalence of facet joint arthrosis is significantly associated with increasing age but not with the BMI. Lumbar facet joint arthrosis is more prevalent in women than in men, which may be due to the sensitivity of cartilage to female sex hormones.
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Affiliation(s)
| | - Emmanuel Kobina Mesi Edzie
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, Cape Coast, Ghana
| | | | - Samson Osei
- Department of Radiology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Albert Dayor Piersson
- Department of Imaging Technology and Sonography, University of Cape Coast, Cape Coast, Ghana
| | | | - Abdul Raman Asemah
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, Cape Coast, Ghana
| | - Henry Kusodzi
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, Cape Coast, Ghana
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Moka E, Allam AES, Rekatsina M, Abed L, Paladini A, AlKharabsheh A, Vadalouca A, Varrassi G. Current Approaches to Four Challenging Pain Syndromes. Cureus 2023; 15:e45573. [PMID: 37868397 PMCID: PMC10586888 DOI: 10.7759/cureus.45573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
During a conference of pain specialists, some of the experts addressed the potential management of four prevalent but difficult painful conditions, namely, chronic postsurgical pain (CPSP), knee osteoarthritis, chest trauma, and facet joint arthropathy. In all cases, the conditions posed challenges in accurate diagnoses as well as safe, effective treatments, especially using locoregional blocks. It is not clear why some surgical patients develop CPSP and others do not, although some risk factors have been identified. More importantly, the transitional phase of pain from acute to chronic deserves greater scrutiny. It appears as if more aggressive and more effective perioperative and postoperative analgesia could help mitigate or possibly prevent CPSP. Knee osteoarthritis is prevalent but is often managed pharmacologically and then with joint replacement; many patients simply live with the condition which can be viewed as a disease of the entire joint. New approaches with intra-articular injections of hyaluronic acid, platelet-rich plasma, and botulinum toxin may provide safe, effective, and durable pain control. Chest trauma can be extremely painful and a source of morbidity, but its management tends to rely on watchful waiting and drug therapy. New approaches to regional nerve blocks can be beneficial and may reduce troublesome symptoms such as the inability to cough or clear the lungs. Facet joint arthropathy is very prevalent among older people but is not completely clarified. It may be the source of intense pain with limited management strategies. The role of nerve blocks in facet joint arthropathy is an important new addition to the armamentarium of pain management, particularly for geriatric patients.
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Affiliation(s)
- Eleni Moka
- Department of Anesthesiology, Creta InterClinic Hospital, Herakleion, GRC
| | - Abdallah El-Sayed Allam
- Morphological Madrid Research Center (MoMaRC), UltraDissection Spain EchoTraining School, Madrid, ESP
- Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals & Faculty of Medicine, Tanta University, Tanta, EGY
| | | | - Lynda Abed
- Anesthesia and Intensive Care, Djilali Bounaama Douera Hospital University, Algiers, DZA
| | - Antonella Paladini
- Department of Life, Health and Environmental Sciences (MESVA, University of L'Aquila, L'Aquila, ITA
| | - Abdullah AlKharabsheh
- King Abdullah University Hospital, Jordan University of Science and Technology, Amman, JOR
| | - Athina Vadalouca
- Pain and Palliative Care Center, Athens Medical Hospital, Athens, GRC
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Rodriguez A, Nunez L, Timaran-Montenegro D, Riascos R. Imaging of Common and Infrequent Extradural Tumors. Neuroimaging Clin N Am 2023; 33:443-457. [PMID: 37356861 DOI: 10.1016/j.nic.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Spinal extradural tumors, although uncommon, have high morbidity and mortality rates. Radiographs and computed tomography scans are typically used to assess and determine the characteristics of these tumors. However, MR imaging is the preferred method for the evaluation of complications that can increase morbidity, such as spinal cord and nerve compression. Imaging features, such as type of matrix, cortical involvement, and margins, aid in determining the diagnosis. This article discusses common and infrequent extradural spinal tumors, their imaging characteristics, and how age, location, and clinical presentation help in diagnosing these neoplasms.
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Affiliation(s)
- Andres Rodriguez
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street MSB 2130B, Houston, TX 77030, USA
| | - Luis Nunez
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street MSB 2130B, Houston, TX 77030, USA
| | - David Timaran-Montenegro
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street MSB 2130B, Houston, TX 77030, USA
| | - Roy Riascos
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street MSB 2130B, Houston, TX 77030, USA.
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9
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Han Y, Wang X, Wang J, Sun S, Xia X, Wang J, Miao J. Influence of weight-bearing on the 3D movement of lumbar facet joints in the sitting position. BMC Musculoskelet Disord 2023; 24:561. [PMID: 37430257 DOI: 10.1186/s12891-023-06698-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE To analyze the motion characteristics of lumbar facet joints and to observe the effect of weight-bearing on lumbar facet joints in the sitting position. METHODS Ten normal subjects (5 males and 5 females) were recruited and scanned by CT, and their lumbar 3D models were reconstructed by software. The images of flexion and extension of lumbar facet joints in the sitting position were collected without weight-bearing and weight-bearing 10 kg, and the 2D model was constructed by software. The 2D-3D model was matched to restore the flexion and extension motion changes of the subjects' lumbar spine in the sitting position. Coordinates were established in the middle of the vertebral body and copied to the facet joints. Measure and record the lumbar facet joint movement distance through coordinate system. The relevant data of facet joints were collected. RESULTS In the L3/4 segment, after weight loading, the displacement of the left facet joint in the X axis became larger, while that in the Y axis and Z axis decreased. The displacement of the right facet joint in the X axis and Y axis increased, and the Z axis displacement decreased. The rotation angle of the bilateral facet joints also decreased. In the L4/5 segment, after loading, the displacements of the X, Y, and Z axis displacements of both sides increase, while the rotation angles of α and β increase, while the rotation angle of γ decreases. In the L5/S1 segment, the displacements of the X, Y, and Z axes on the left side decrease. The displacement of the X and Y axes on the right side decreases, while the displacement on the Z axis increases. The rotation angles of α and γ increase, and the rotation angle of the β axis decreases. CONCLUSION When sitting, the flexion and extension distance and rotational displacement of lumbar facet joints are not affected by weight-bearing. In addition, there is asymmetry in the movement of the left and right facet joints, and weight bearing has no effect on the asymmetry of the motion.
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Affiliation(s)
- Ye Han
- Department of Orthopedics, The Affiliated Hospital of Hebei University, Hebei, China
| | - Xiaodong Wang
- Department of Orthopedics, The Affiliated Hospital of Hebei University, Hebei, China
| | - Jianzhong Wang
- Department of Orthopedics, The Affiliated Hospital of Hebei University, Hebei, China
| | - Shaosong Sun
- Department of Orthopedics, The Affiliated Hospital of Hebei University, Hebei, China
| | - Xi Xia
- Department of Orthopedics, Baoding First Central Hospital, Hebei, China
| | - Jing Wang
- Department of Orthopedics, Gaoyang County Hospital, Hebei, China
| | - Jun Miao
- Department of Orthopedics, Tianjin Hospital of Tianjin University, Tianjin, China.
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10
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Girão MMV, Miyahara LK, Dwan VSY, Baptista E, Taneja AK, Gotfryd A, do Amaral E Castro A. Imaging features of the postoperative spine: a guide to basic understanding of spine surgical procedures. Insights Imaging 2023; 14:103. [PMID: 37278946 DOI: 10.1186/s13244-023-01447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 06/07/2023] Open
Abstract
Spinal surgical procedures are becoming more common over the years, and imaging studies can be requested in the postoperative setting, such as a baseline study when implants are used, or when there is a new postoperative issue reported by the patient or even as routine surveillance. Therefore, it helps the surgeon in the appropriate management of cases. In this context, there is increasing importance of the radiologist in the adequate interpretation of postoperative images, as well as in the choice of the most appropriate modality for each case, especially among radiographs, computed tomography, magnetic resonance imaging and nuclear medicine. It is essential to be familiar with the main types of surgical techniques and imaging characteristics of each one, including the type and correct positioning of hardware involved, to differentiate normal and abnormal postoperative appearances. The purpose of this pictorial essay is to illustrate and discuss the more frequently used spine surgical interventions and their imaging characteristics, with an emphasis on classical decompression and fusion/stabilization procedures. KEY POINTS: Plain radiographs remain the main modality for baseline, dynamic evaluation, and follow-ups. CT is the method of choice for assessing bone fusion, hardware integrity and loosening. MRI should be used to evaluate bone marrow and soft tissue complications. Radiologists should be familiar with most performed spinal procedures in order to differentiate normal and abnormal. CRITICAL RELEVANCE STATEMENT: This article discusses the main surgical procedures involved in the spine, which can be didactically divided into decompression, stabilization-fusion, and miscellaneous, as well as the role of diagnostic imaging methods and their main findings in this context.
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Affiliation(s)
| | - Lucas Kenzo Miyahara
- Federal University of São Paulo, Rua Napoleão de Barros, n° 800, São Paulo, 04024-002, Brazil.
| | | | | | - Atul Kumar Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Adham do Amaral E Castro
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Federal University of São Paulo, Rua Napoleão de Barros, n° 800, São Paulo, 04024-002, Brazil
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11
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Pu D, Yuan H, Ma G, Duan H, Zhang M, Yu N. CT quantitative analysis of pulmonary changes in rheumatoid arthritis. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2023; 31:545-553. [PMID: 36847056 DOI: 10.3233/xst-221329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To explore the application of quantitative computed tomography (CT) in analyses of lung changes in patients with rheumatoid arthritis (RA). METHODS A total of 150 clinically diagnosed RA patients underwent chest CT and 150 matched non-smokers subjects with normal chest CT are enrolled. A CT software is applied to analyze CT obtained from both groups. The quantitative indices of emphysema are expressed as the percentage of lung area with attenuation < -950HU to the total lung volume (LAA-950%), and pulmonary fibrosis was expressed as the percentage of lung area with a attenuation of -200 to -700HU to the total lung volume (LAA-200--700%), quantitative indicators of pulmonary vascular include aortic diameter (AD), pulmonary artery diameter (PAD), the ratio of PAD to AD (PAD/AD ratio), the number of blood vessels (TNV), and the cross area of blood vessels (TAV). The receiver operating characteristic (ROC) curve is used to evaluate the ability of these indexes in identifying the changes in the lung in RA patients. RESULTS Compared to the control group, the RA group has significantly lower TLV, larger AD, and smaller TNV and TAV (3921±1101 vs. 4490±1046, 33.26±4.20 vs. 32.95±3.76, 13.14±4.93 vs. 17.53±3.34, and 96.89±40.62 vs. 163.32±34.97, respectively, with all p < 0.001). Peripheral vascular indicator TAV has the better ability to identify lung changes in RA patients (area under ROC curve AUC = 0.894) than TNV (AUC = 0.780) or LAA-200 &sim-700% (AUC = 0.705). CONCLUSION Quantitative CT can detect changes in lung density distribution and peripheral vascular injury in patients with RA and assess the severity.
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Affiliation(s)
- Doudou Pu
- School of Medical Technology, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Hui Yuan
- Department of Rheumatology Immunohematology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Guangming Ma
- Department of Medical Imaging, Affiliated Hospitalof Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Haifeng Duan
- Department of Medical Imaging, Affiliated Hospitalof Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Min Zhang
- Department of Medical Imaging, Affiliated Hospitalof Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Nan Yu
- School of Medical Technology, Shaanxi University of Chinese Medicine, Xian Yang, China
- Department of Medical Imaging, Affiliated Hospitalof Shaanxi University of Chinese Medicine, Xian Yang, China
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12
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Becker-Capeller D, El-Nawab-Becker S, Hul M, Weber N, Kapsimalakou S, Baraliakos X. Facet Joint Involvement in Early MRI Positive Axial
Spondyloarthritis. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1978-7633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background The disease course of non-radiographic axial spondyloarthritis
(nr-axSpA), usually detected by magnetic resonance imaging (MRI), is often
unclear at the time of diagnosis. We investigated which MRI findings in the
sacroiliac joints (SIJs) and lumbar spine including the facet joints can be
observed over a two-year period in patients with newly diagnosed active
inflammatory lesions in the SIJs fufilling the Assessment of SpondyloArthritis
International Society criteria (ASAS) for Axial Spondyloarthritis (axSpA).
Methods Patients (n=56, age<45 years, 30 female and 26
male, symptom duration 3–30 months) consecutively diagnosed with
unilateral or bilateral sacroiliitis through MRI during an 18-month period and
meeting the ASAS criteria for axial SpA were followed up for two years. Clinical
examination, laboratory tests and an MRI of the sacroiliac joints (SIJs), lumbar
spine and facet joints were performed at diagnosis (t0), after one year (t1) and
after two years (t2).
Results At t0, 31 patients (55%) with a bone marrow edema (BME) in
the SIJs already had detectable changes in the facet joints, including signs of
inflammation or degenerative changes. At t2, patients with facet joint
involvement in t0 not only had more significant changes in the SIJs but also
significantly more changes in the vertebral bodies, including BME, fat lesions
and vertebral body erosions than patients without changes in the facet joints at
t0. All vertebral changes described might be potential indicators of progression
to radiographic axSpA (r-axSpA). These MRI findings are seen more frequently
over a short period of time than previously thought.
Conclusions MRI progression in the SIJs over a two-year period is
associated with increasing damage to the facet joints and vertebral bodies.
Involvement of the facet joints in the early stages of the disease may indicate
increasing changes in the vertebral bodies and thus a less favourable course of
axSpA.
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Affiliation(s)
| | | | - Marcus Hul
- Radiology, Clinic Dr. Hancken GmbH, Stade, Germany
| | - Nermin Weber
- Radiology Buxtehude, Clinic Dr. Hancken GmbH, Buxtehude,
Germany
| | | | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum,
Bochum, Germany
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Slobodin G, Sagiv M, Khreish T, Croitoru S, Shouval A, Eshed I. Facet joint disease in patients with axial spondyloarthritis: a retrospective computed tomography study. Semin Arthritis Rheum 2022; 55:151991. [DOI: 10.1016/j.semarthrit.2022.151991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
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14
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Aggarwal A, Garg K. Additional Findings in Differential Diagnosis of Facet Joint Disorders. Radiographics 2021; 41:E94. [PMID: 33939550 DOI: 10.1148/rg.2021210059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ankita Aggarwal
- Department of Radiodiagnosis, VMMC and Safdarjung Hospital, Ansari Nagar, New Delhi 110029, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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