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Zhao E, Hirase T, Kim AG, Du JY, Amen TB, Araghi K, Subramanian T, Kamil R, Shahi P, Fourman MS, Asada T, Simon CZ, Singh N, Korsun M, Tuma OC, Zhang J, Lu AZ, Mai E, Kim AYE, Allen MRJ, Kwas C, Dowdell JE, Sheha ED, Qureshi SA, Iyer S. The Impact of Posterior Intervertebral Osteophytes on Patient-Reported Outcome Measures After L5-S1 Anterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2024; 49:652-660. [PMID: 38193931 DOI: 10.1097/brs.0000000000004904] [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: 09/08/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE (1) To develop a reliable grading system to assess the severity of posterior intervertebral osteophytes and (2) to investigate the impact of posterior intervertebral osteophytes on clinical outcomes after L5-S1 decompression and fusion through anterior lumbar interbody fusion (ALIF) and minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF). BACKGROUND There is limited evidence regarding the clinical implications of posterior lumbar vertebral body osteophytes for ALIF and MIS-TLIF surgeries and there are no established grading systems that define the severity of these posterior lumbar intervertebral osteophytes. PATIENTS AND METHODS A retrospective analysis of patients undergoing L5-S1 ALIF or MIS-TLIF was performed. Preoperative and postoperative patient-reported outcome measures of the Oswestry Disability Index (ODI) and leg Visual Analog Scale (VAS) at 2-week, 6-week, 12-week, and 6-month follow-up time points were assessed. Minimal clinically important difference (MCID) for ODI of 14.9 and VAS leg of 2.8 were utilized. Osteophyte grade was based on the ratio of osteophyte length to foraminal width. "High-grade" osteophytes were defined as a maximal osteophyte length >50% of the total foraminal width. RESULTS A total of 70 consecutive patients (32 ALIF and 38 MIS-TLIF) were included in the study. There were no significant differences between the two cohorts in patient-reported outcome measures or achievement of MCID for Leg VAS or ODI preoperatively or at any follow-ups. On multivariate analysis, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with leg VAS or ODI scores at any follow-up time point. In addition, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with the achievement of MCID for leg VAS or ODI at 6 months. CONCLUSION ALIF and MIS-TLIF are both valid options for treating degenerative spine conditions and lumbar radiculopathy, even in the presence of high-grade osteophytes that significantly occupy the intervertebral foramen. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Eric Zhao
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Takashi Hirase
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Andrew G Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Jerry Y Du
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Troy B Amen
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Tejas Subramanian
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Robert Kamil
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | | | - Tomoyuki Asada
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Chad Z Simon
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Nishtha Singh
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Maximilian Korsun
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Olivia C Tuma
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Joshua Zhang
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Amy Z Lu
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Eric Mai
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Ashley Yeo Eun Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Myles R J Allen
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Cole Kwas
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - James E Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
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Wu T, Wang C, Li K. Quantitative analysis and stochastic modeling of osteophyte formation and growth process on human vertebrae based on radiographs: a follow-up study. Sci Rep 2024; 14:9393. [PMID: 38658644 PMCID: PMC11043460 DOI: 10.1038/s41598-024-60212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
Osteophytes are frequently observed in elderly people and most commonly appear at the anterior edge of the cervical and lumbar vertebrae body. The anterior osteophytes keep developing and will lead to neck/back pain over time. In clinical practice, the accurate measurement of the anterior osteophyte length and the understanding of the temporal progression of anterior osteophyte growth are of vital importance to clinicians for effective treatment planning. This study proposes a new measuring method using the osteophyte ratio index to quantify anterior osteophyte length based on lateral radiographs. Moreover, we develop a continuous stochastic degradation model with time-related functions to characterize the anterior osteophyte formation and growth process on cervical and lumbar vertebrae over time. Follow-up data of anterior osteophytes up to 9 years are obtained for measurement and model validation. The agreement test indicates excellent reproducibility for our measuring method. The proposed model accurately fits the osteophyte growth paths. The model predicts the mean time to onset of pain and obtained survival function of the degenerative vertebrae. This research opens the door to future quantification and mathematical modeling of the anterior osteophyte growth on human cervical and lumbar vertebrae. The measured follow-up data is shared for future studies.
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Affiliation(s)
- Tong Wu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Changxi Wang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Sichuan University - Pittsburgh Institute, Sichuan University, Chengdu, 610207, China.
| | - Kang Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Orthopedics Department of West China Hospital, Sichuan University, Chengdu, 610041, China.
- Sichuan University - Pittsburgh Institute, Sichuan University, Chengdu, 610207, China.
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Chen Z, Lei F, Ye F, Yuan H, Li S, Feng D. MRI-based vertebral bone quality score for the assessment of osteoporosis in patients undergoing surgery for lumbar degenerative diseases. J Orthop Surg Res 2023; 18:257. [PMID: 36991471 DOI: 10.1186/s13018-023-03746-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE To explore the value of vertebral bone quality (VBQ) scores in diagnosing osteoporosis in patients with lumbar degeneration. METHODS A retrospective analysis was conducted of 235 patients treated with lumbar fusion surgery at the age of ≥ 50; they were divided into a degenerative group and a control group according to the severity of degenerative changes on three-dimensional computed tomography. The L1-4 vertebral body and L3 cerebrospinal fluid signal intensities in the T1-weighted lumbar magnetic resonance imaging (MRI) image were recorded, and the VBQ score was calculated. Demographics, clinical data, and dual-energy X-ray absorptiometry (DXA) indicators were recorded, and the VBQ value was compared with bone density and T-score using the Pearson correlation coefficient. The VBQ threshold was obtained according to the control group and compared with the efficacy of osteoporosis diagnosis based on DXA. RESULTS A total of 235 patients were included in the study, and the age of the degenerative group was older than that of the control group (61.8 vs. 59.4, P = 0.026). The VBQ score of the control group suggested a higher correlation with the bone mineral density (BMD) value and T-score (r = - 0.611 and - 0.62, respectively). The BMD value and T-score in the degenerative group were higher than those in the control group (P < 0.05). Receiver-operating characteristic curve analysis showed that the VBQ score had a good predictive ability for osteoporosis (AUC = 0.818), with a sensitivity of 93% and a specificity of 65.4%. Among the undiagnosed osteoporosis patients with T-score, the VBQ score after adjusting the threshold was higher in the degenerative group (46.9% vs. 30.8%). CONCLUSIONS Emerging VBQ scores can reduce the interference caused by degenerative changes compared to traditional DXA measures. Screening for osteoporosis in patients undergoing lumbar spine surgery provides new ideas.
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Affiliation(s)
- Zan Chen
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Fei Lei
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Fei Ye
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Hao Yuan
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Songke Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Daxiong Feng
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.
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Naidoo N, Khan R, Abdulwahab T, Almqvist KF, Lakshmanan J, Prithishkumar IJ. A novel reconstructive approach of the lumbar vertebral column from 2D MRI to 3D models. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Farshad M, Cornaz F, Spirig JM, Sutter R, Farshad-Amacker NA, Widmer J. Spondylophyte classification based on biomechanical effects on segmental stiffness. Spine J 2022; 22:1903-1912. [PMID: 35671943 DOI: 10.1016/j.spinee.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/05/2022] [Accepted: 06/01/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The biomechanical impact of spondylophytes on segmental stiffness is largely unknown, despite their high incidence. PURPOSE The aim of this study was to quantify the biomechanical contribution according to location and cranio-caudal extent of spondylophytes and to create a clinically applicable radiological classification system. STUDY DESIGN Biomechanical cadaveric study. METHODS Twenty-six cadaveric human lumbar spinal segments with spondylophytes were tested with a displacement-controlled stepwise reduction method. The reduction in load required for the same motion after spondylophyte dissection was used to calculate the biomechanical contribution in flexion, extension, axial rotation, lateral bending, anterior, posterior and lateral shear. The spondylophytes were categorized by assessment of their anatomical position and cranio-caudal extent in computed tomography images (grade 1: spondylophytes spanning less than 50% of the disc-height, grade 2:>50%, grade 3:>90%, grade 4: bony bridging between the vertebrae) by two experienced radiologists. Cohen's kappa (κ) was used to report interreader reliability. RESULTS The largest biomechanical effect of non-bridging spondylophytes (grade 1-3) was recorded during contralateral bending with a grade-dependent contribution of up to 35%. Other loading directions including ipsilateral bending and translational loading were affected with values below 13%. Spondylophytes with osseous bridging (grade 4) show large contribution to the segmental stiffness in most loading conditions with values reaching over 80%. Interreader agreement for the spondylophyte grading was "substantial" (κ=0.73, p<.001). CONCLUSIONS The location and cranio-caudal extent of spondylophytes are essential parameters for their biomechanical effect. A reproducible classification has been validated biomechanically and helps evaluate the effect of specific spondylophyte configurations on segmental stiffness. CLINICAL SIGNIFICANCE Non-bridging spondylophytes primarily act as tensile structures and do not provide relevant propping. A classification system is presented to support understanding of the biomechanical consequences of different spondylophyte configuration for clinical decision making in surgical planning.
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Affiliation(s)
- Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.
| | - Frédéric Cornaz
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - José Miguel Spirig
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Reto Sutter
- Radiology, Balgrist University Hospital, Zurich, Switzerland
| | | | - Jonas Widmer
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland; Spine Biomechanics, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
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6
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Kim M. Thoracic spine deformation may predict prosthetic rehabilitation outcome. Prosthet Orthot Int 2022; 46:518-522. [PMID: 36215060 DOI: 10.1097/pxr.0000000000000141] [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: 05/23/2021] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND A considerable number of patients require prosthetic ambulation, which necessitates improvements in the success rate of prosthetics. OBJECTIVE This study aimed to determine the association between the presence of thoracic spinal osteophyte on imaging and the patient's ability to walk with lower leg prosthetics. STUDY DESIGN Retrospective cohort study. METHODS This study included 15 patients with lower leg amputations who underwent prosthetic rehabilitation. Medical records and spine radiographs of patients with lower leg amputations between 2013 and 2019 at a private rehabilitation hospital were reviewed. The primary outcome was achieving prosthetic ambulation with a single T-cane or without a walking aid. RESULTS Poor outcomes were associated with the presence of thoracic spinal deformation (P = 0.007) and the lower Berg Balance Scale score at admission (P = .067) and discharge (P = .033) groups. Monte Carlo simulation results showed a ≥33% difference in walking achieving rate between patients with and without thoracic spinal deformity. In addition, an 18% probability was found for randomly selected persons with an amputation to show a difference of ≥1 point in Berg Balance Scale scores. CONCLUSION Thoracic spinal deformity on radiography and Berg Balance Scale score at admission are potentially associated with successful prosthetic rehabilitation. These findings potentially affect the indications for prosthetic limbs.
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Affiliation(s)
- Mindae Kim
- Department of Rehabilitation Medicine, Akabane Rehabilitation Hospital, Tokyo, Japan
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7
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The relationship between traction spurs, Modic change, vacuum phenomenon, and segmental instability of the lumbar spine. Sci Rep 2022; 12:9939. [PMID: 35705718 PMCID: PMC9200777 DOI: 10.1038/s41598-022-14244-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/03/2022] [Indexed: 12/04/2022] Open
Abstract
A thorough understanding of lumbar segmental motion is valuable to treat patients with degenerative lumbar disease, but kinematics associated with indicators of lumbar intervertebral instability [traction spur, Modic changes (MCs) and vacuum phenomenon (VP)] in the lumbar spine have not been well understood. The purpose of this study is to evaluate the relationships between traction spur, MCs and VP to radiographic measurements in the lumbar spine. A total of 525 lumbar discs from L1-2 to L5-S1 of 105 patients were evaluated. The sagittal translation (ST) and sagittal angulation were measured from the radiographs taken flexion–extension. The anterior disc height (ADH) was measured from the lateral radiographs, and ΔADH was measured as the difference from supine to sitting position. Logistic regression analyses were used to detect the association between the existence of traction spur, MCs and VP and related factors. Multivariate analysis showed that the traction spur was significantly related to translational motion (ST > 2 mm, OR 4.74) and the VP was significantly related to vertical motion (ΔADH > 3 mm, OR 1.94). These results suggest that the segments with traction spur and VP should be evaluated carefully because these may be a sign of lumbar intervertebral instability.
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8
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Imaging of the Ageing Spine. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Marras D, Palanca M, Cristofolini L. Effects Induced by Osteophytes on the Strain Distribution in the Vertebral Body Under Different Loading Configurations. Front Bioeng Biotechnol 2021; 9:756609. [PMID: 34778229 PMCID: PMC8585771 DOI: 10.3389/fbioe.2021.756609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022] Open
Abstract
The mechanical consequences of osteophytes are not completely clear. We aimed to understand whether and how the presence of an osteophyte perturbs strain distribution in the neighboring bone. The scope of this study was to evaluate the mechanical behavior induced by the osteophytes using full-field surface strain analysis in different loading configurations. Eight thoracolumbar segments, containing a vertebra with an osteophyte and an adjacent vertebra without an osteophyte (control), were harvested from six human spines. The position and size of the osteophytes were evaluated using clinical computed tomography imaging. The spine segments were biomechanically tested in the elastic regime in different loading configurations while the strains over the frontal and lateral surface of vertebral bodies were measured using digital image correlation. The strain fields in the vertebrae with and without osteophytes were compared. The correlation between osteophyte size and strain alteration was explored. The strain fields measured in the vertebrae with osteophytes were different from the control ones. In pure compression, we observed a mild trend between the size of the osteophyte and the strain distribution (R2 = 0.32, p = 0.15). A slightly stronger trend was found for bending (R2 = 0.44, p = 0.075). This study suggests that the osteophytes visibly perturb the strain field in the nearby vertebral area. However, the effect on the surrounding bone is not consistent. Indeed, in some cases the osteophyte shielded the neighboring bone, and in other cases, the osteophyte increased the strains.
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Affiliation(s)
- Daniele Marras
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Marco Palanca
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.,Department of Oncology and Metabolism, INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
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Chiba F, Inokuchi G, Hoshioka Y, Sakuma A, Makino Y, Torimitsu S, Yamaguchi R, Saitoh H, Kono M, Iwase H. Age estimation by evaluation of osteophytes in thoracic and lumbar vertebrae using postmortem CT images in a modern Japanese population. Int J Legal Med 2021; 136:261-267. [PMID: 34642821 DOI: 10.1007/s00414-021-02714-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
Estimation of age at death is important in forensic investigations of unknown remains. There have been several reports on applying the degree of osteophyte formation-an age-related change in the vertebral body-for age estimation; however, this method is not yet established. This study investigated a method for age estimation of modern Japanese individuals using osteophytes measured on CT images. The sample included 250 cadavers (125 males) aged 20-95 years. The degree of osteophyte formation was evaluated as score O (0-5 points), and the degree of fusion of the osteophytes between the upper and lower vertebrae was evaluated as score B (0-2 points). Age estimation equations were developed using regression analyses with seven variables, determined by scores O and B, and the equation with the smallest standard error of estimate (SEE) was obtained when the number of vertebrae with score O ≥ 2 was used as the explanatory variable. Age estimation with SEE of about 10 years was possible even when partial vertebrae with a high degree of osteophyte formation were used, showing its potential for practical application. The cutoff value for age estimation was established using the receiver operating characteristic curve analysis, wherein good results were obtained for all variables (area under the curve ≥ 0.8). The combination of the estimation equation and the cutoff value can narrow the range of age estimates.
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Affiliation(s)
- Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan. .,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan.
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Ayaka Sakuma
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Yohsuke Makino
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Rutsuko Yamaguchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Hisako Saitoh
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Mei Kono
- Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
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A Case of Thoracic Spondylosis Deformans and Multilevel Instrumented Spinal Fusion in an 84-Year-Old Male. Case Rep Orthop 2020; 2020:8435816. [PMID: 32695541 PMCID: PMC7355359 DOI: 10.1155/2020/8435816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/24/2020] [Accepted: 06/20/2020] [Indexed: 11/18/2022] Open
Abstract
Spondylosis deformans is a type of spinal claw osteophytosis which can be found on the anterolateral vertebral bodies of any region, and which consists of protrusions of intervertebral disc tissue covered by a bony shell. We report here a case of thoracic spondylosis deformans and multilevel instrumented fusion found during routine dissection of a cadaver. Theories of the etiology of this condition are reviewed in general, and with respect to this specific case and the potential interaction of the presenting comorbidities. The clinical implications of these osteophytes, including musculoskeletal and visceral sequelae, are also discussed.
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12
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Dang L, Zhu J, Liu Z, Liu X, Jiang L, Wei F, Song C. A new approach to the treatment of spinal instability: Fusion or structural reinforcement without surgery? Med Hypotheses 2020; 144:109900. [PMID: 32562916 DOI: 10.1016/j.mehy.2020.109900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023]
Abstract
Spinal instability related low back pain is a common condition resulting from degeneration and loss of stiffness of the intervertebral joint. In order to restore stability, highly invasive surgical fusion is needed for patients who are not responding to conservative treatment. Given the risk and complications of surgery, there has been the urge for improvement with a less invasive solution. Formation of vertebral body osteophytes is a common observation that has been treated as a degenerative condition. However, recent studies have associated it with reduced motion of spinal segments. Unlike the traditional view, we regard it as adaptive reactions aiming to repair and hypothesize that the spinal segments could be stabilized or fused by intentionally induced osteophytes growth at the mobile parts of the intervertebral joint. This could be achieved by injecting Bone Morphogenetic Proteins to the anterior ends of the vertebral bodies and/or the facet joints on both sides of two consecutive vertebrae percutaneously. If verified, it would be the first time that fusion could be achieved without surgery. Hence it would provide a valuable alternative to current treatments of spinal instability. Preliminary test in favor of this hypothesis is presented and we recommend that a formal study with sufficient number of samples is needed for verification.
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Affiliation(s)
- Lei Dang
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Jinglin Zhu
- Department of Orthopedics, Beijing Shijitan Hospital, No. 10 Tieyi Rd., Yangfangdian Subdistrict, Haidian District, Beijing, PR China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Liang Jiang
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Feng Wei
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Chunli Song
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China.
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Praneatpolgrang S, Prasitwattanaseree S, Mahakkanukrauh P. Age estimation equations using vertebral osteophyte formation in a Thai population: comparison and modified osteophyte scoring method. Anat Cell Biol 2019; 52:149-160. [PMID: 31338232 PMCID: PMC6624338 DOI: 10.5115/acb.2019.52.2.149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/27/2022] Open
Abstract
Age estimation from skeletal remains is an important step in forensic biological identification. The main objective of this study is to develop an age estimation equation for the Thai population from vertebral osteophytes. Each vertebra in the cervical, thoracic and lumbar segments was scored for degree of osteophyte formation. Classification was carried out in accordance with the criteria established by Snodgrass and Watanabe, and used a new modified score of the length of vertebral osteophyte for age estimation. The sample included 400 individuals (262 males, 138 females) ranging in age from 22 to 97 years. A sample of Thai vertebral columns was used, the columns being divided into the following groups of vertebrae: cervical (C2–C7), thoracic (T1–T12), and lumbar (L1–L5). Each vertebra was scored for the degree of osteophyte formation and the accumulated data was analyzed statistically. Correlation coefficients and R-squared from mean in lumbar vertebrae for females of criteria established by the method of Snodgrass and Watanabe, the new modified score by length of vertebral osteophytes were 0.801 and 0.642 (P<0.01); 0.755 and 0.57 (P<0.01); 0.786 and 0.618 (P<0.01), respectively. This study presents all 23 subcategories (C2–L5) of the vertebrae to apply in real situations, showing all age estimation equations for males, females and combined sexes of unknown sex. One application of this study is age estimation when dealing with forensic cases in the Thai population.
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Affiliation(s)
- Sithee Praneatpolgrang
- Forensic Osteology Research Center, Faculty of Medicine and Graduate School, Chiang Mai University, Chiang Mai, Thailand.,Department of Anatomy, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Sukon Prasitwattanaseree
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.,Excellence Center in Osteology Research and Training Center, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.,Excellence Center in Osteology Research and Training Center, Chiang Mai University, Chiang Mai, Thailand
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14
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Ridley WE, Xiang H, Han J, Ridley LJ. Claw osteophyte: Spine. J Med Imaging Radiat Oncol 2018; 62 Suppl 1:124. [DOI: 10.1111/1754-9485.05_12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Hao Xiang
- Department of Radiology; Concord Repatriation General Hospital; Concord New South Wales Australia
| | - Jason Han
- Department of Radiology; Concord Repatriation General Hospital; Concord New South Wales Australia
| | - Lloyd J Ridley
- Department of Radiology; Concord Repatriation General Hospital; Concord New South Wales Australia
- Discipline of Medical Imaging; University of Sydney; Sydney New South Wales Australia
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15
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Kushchayev SV, Glushko T, Jarraya M, Schuleri KH, Preul MC, Brooks ML, Teytelboym OM. ABCs of the degenerative spine. Insights Imaging 2018; 9:253-274. [PMID: 29569215 PMCID: PMC5893484 DOI: 10.1007/s13244-017-0584-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/28/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022] Open
Abstract
Degenerative changes in the spine have high medical and socioeconomic significance. Imaging of the degenerative spine is a frequent challenge in radiology. The pathogenesis of this degenerative process represents a biomechanically related continuum of alterations, which can be identified with different imaging modalities. The aim of this article is to review radiological findings involving the intervertebral discs, end plates, bone marrow changes, facet joints and the spinal canal in relation to the pathogenesis of degenerative changes in the spine. Findings are described in association with the clinical symptoms they may cause, with a brief review of the possible treatment options. The article provides an illustrated review on the topic for radiology residents. TEACHING POINTS • The adjacent vertebrae, intervertebral disc, ligaments and facet joints constitute a spinal unit. • Degenerative change is a response to insults, such as mechanical or metabolic injury. • Spine degeneration is a biomechanically related continuum of alterations evolving over time.
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Affiliation(s)
- Sergiy V. Kushchayev
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Tetiana Glushko
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Mohamed Jarraya
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Karl H. Schuleri
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Mark C. Preul
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 West Thomas Rd, Phoenix, AZ USA
| | - Michael L. Brooks
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Oleg M. Teytelboym
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
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16
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Wagnac E, Aubin CÉ, Chaumoître K, Mac-Thiong JM, Ménard AL, Petit Y, Garo A, Arnoux PJ. Substantial vertebral body osteophytes protect against severe vertebral fractures in compression. PLoS One 2017; 12:e0186779. [PMID: 29065144 PMCID: PMC5655488 DOI: 10.1371/journal.pone.0186779] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 10/06/2017] [Indexed: 11/19/2022] Open
Abstract
Recent findings suggest that vertebral osteophytes increase the resistance of the spine to compression. However, the role of vertebral osteophytes on the biomechanical response of the spine under fast dynamic compression, up to failure, is unclear. Seventeen human spine specimens composed of three vertebrae (from T5-T7 to T11-L1) and their surrounding soft tissues were harvested from nine cadavers, aged 77 to 92 years. Specimens were imaged using quantitative computer tomography (QCT) for medical observation, classification of the intervertebral disc degeneration (Thomson grade) and measurement of the vertebral trabecular density (VTD), height and cross-sectional area. Specimens were divided into two groups (with (n = 9) or without (n = 8) substantial vertebral body osteophytes) and compressed axially at a dynamic displacement rate of 1 m/s, up to failure. Normalized force-displacement curves, videos and QCT images allowed characterizing failure parameters (force, displacement and energy at failure) and fracture patterns. Results were analyzed using chi-squared tests for sampling distributions and linear regression for correlations between VTD and failure parameters. Specimens with substantial vertebral body osteophytes present higher stiffness (2.7 times on average) and force at failure (1.8 times on average) than other segments. The presence of osteophytes significantly influences the location, pattern and type of fracture. VTD was a good predictor of the dynamic force and energy at failure for specimens without substantial osteophytes. This study also showed that vertebral body osteophytes provide a protective mechanism to the underlying vertebra against severe compression fractures.
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Affiliation(s)
- Eric Wagnac
- Department of Mechanical Engineering, École de technologie supérieure, Montréal, Québec, Canada
- Research Center, Sacré-Cœur Hospital, Montreal, Quebec, Canada
- iLAB-Spine, Associated International Laboratory on Spine Biomechanics and Imagery, Montreal, Canada
- * E-mail:
| | - Carl-Éric Aubin
- iLAB-Spine, Associated International Laboratory on Spine Biomechanics and Imagery, Montreal, Canada
- Department of Mechanical Engineering, École Polytechnique de Montréal, Montreal, Canada
- Research Center, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
| | - Kathia Chaumoître
- Department of medical imaging, North Hospital, Aix Marseille Université, Marseille, France
- Laboratoire d’Anthropologie Biologique, Aix Marseille Université, Marseille, France
| | - Jean-Marc Mac-Thiong
- Research Center, Sacré-Cœur Hospital, Montreal, Quebec, Canada
- Research Center, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
- Department of Surgery, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Anne-Laure Ménard
- Department of Mechanical Engineering, École de technologie supérieure, Montréal, Québec, Canada
| | - Yvan Petit
- Department of Mechanical Engineering, École de technologie supérieure, Montréal, Québec, Canada
- Research Center, Sacré-Cœur Hospital, Montreal, Quebec, Canada
- iLAB-Spine, Associated International Laboratory on Spine Biomechanics and Imagery, Montreal, Canada
| | - Anaïs Garo
- Department of Mechanical Engineering, École Polytechnique de Montréal, Montreal, Canada
- Laboratoire de Biomécanique Appliquée, IFSTTAR Aix Marseille Université, Marseille, France
| | - Pierre-Jean Arnoux
- Laboratoire de Biomécanique Appliquée, IFSTTAR Aix Marseille Université, Marseille, France
- iLAB-Spine, Associated International Laboratory on Spine Biomechanics and Imagery, Marseille, France
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Abstract
An osteophyte is a fibrocartilage-capped bony outgrowth that is one of the features of osteoarthritis. This study reviewed the types, risk factors, pathophysiology, clinical presentations, and medical and surgical treatment of osteophytes. Extraspinal osteophytes are classified as marginal, central, periosteal, or capsular, whereas vertebral osteophytes are classified as traction or claw. Risk factors for development of osteophytes include age, body mass index, physical activity, and other genetic and environmental factors. Transforming growth factor β plays a role in the pathophysiology of osteophyte formation. Osteophytes can cause pain, limit range of motion, affect quality of life, and cause multiple symptoms at the spine. Medical treatment involves the use of bisphosphonates and other non-steroidal anti-inflammatory agents. Surgical treatment in the form of cheilectomy for impingement syndromes during joint replacement is recommended.
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Affiliation(s)
- Siu Him Janus Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
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Maksymowych WP, Learch T, Lambert RG, Ward M, Haroon N, Inman R, Salonen D, Gensler LS, Weisman MH. Development and validation of the spondyloarthritis radiography module for calibration of readers using the modified Stoke Ankylosing Spondylitis Spine Score. Arthritis Care Res (Hoboken) 2014; 66:55-62. [PMID: 23926089 DOI: 10.1002/acr.22083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 07/12/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To develop and validate a reference image module aimed at calibration of readers using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) to assess radiographic progression in spondyloarthritis. METHODS Our working group comprised 6 rheumatologists and 3 musculoskeletal radiologists. The following developmental steps were conducted: (1) review of the literature to identify aspects of the mSASSS requiring methodologic clarity; (2) independent assessment of baseline and 2-year radiographs from 25 patients using the mSASSS (pilot exercise); (3) development of a training module (the Spondyloarthritis Radiography [SPAR] module) that clarifies definitions, rules, and scoring methodology and a set of reference radiographic images; (4) scoring exercise 1 by 6 readers on 39 patients, where baseline and 2-year radiographs were scored blinded to time point; and (5) revision of the SPAR module followed by scoring exercise 2 conducted by the same 6 readers on 35 patients. Reliability of status and 2-year change scores was assessed by the intraclass correlation coefficient (ICC) method. RESULTS ICCs for change scores for the radiologist reader pair improved from 0.46 to 0.62 after minimal calibration with the SPAR module. Recalibration from exercise 1 to exercise 2 with the SPAR module led to substantial improvement in interreader reliability for change in mSASSS score from ICC 0.44 (range 0.31-0.62) to ICC 0.62 (range 0.34-0.84). Simultaneous assessment of anteroposterior and lateral lumbar radiographs did not enhance reliability or detection of progression. CONCLUSION Calibration according to the SPAR module led to improved reliability in the scoring of the mSASSS, even for expert readers.
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19
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Controversies in conventional radiography in spondyloarthritis. Best Pract Res Clin Rheumatol 2012; 26:839-52. [DOI: 10.1016/j.berh.2012.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 09/28/2012] [Indexed: 01/27/2023]
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20
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Baraliakos X, Listing J, Buschmann J, von der Recke A, Braun J. A comparison of new bone formation in patients with ankylosing spondylitis and patients with diffuse idiopathic skeletal hyperostosis: A retrospective cohort study over six years. ACTA ACUST UNITED AC 2012; 64:1127-33. [DOI: 10.1002/art.33447] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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21
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Anderson DG, Limthongkul W, Sayadipour A, Kepler CK, Harrop JS, Maltenfort M, Vaccaro AR, Hilibrand A, Rihn JA, Albert TJ. A radiographic analysis of degenerative spondylolisthesis at the L4–5 level. J Neurosurg Spine 2012; 16:130-4. [DOI: 10.3171/2011.10.spine11140] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Lumbar degenerative spondylolisthesis (LDS) is common and has generally been characterized as a homogeneous disease entity in the literature and in clinical practice. Because disease variability has not been carefully characterized, stratification of treatment recommendations based on scientific evidence is currently lacking. In this study, the authors analyzed radiographic parameters of patients with LDS at the L4–5 level to better characterize this entity.
Methods
Demographic data were collected from 304 patients (200 women and 104 men) with LDS at the L4–5 level. Plain radiographs including anteroposterior, lateral, and flexion-extension lateral radiographs were analyzed for disc height, segmental angulation, segmental translation, and osteophyte formation. Correlations were sought between the variables of age, sex, disc height, segmental angulation, segmental translation, and osteophyte formation.
Results
The mean patient age was 63.8 years (range 40–86 years). The mean mid-disc height was 7 mm (range 0–14 mm) on the neutral lateral view. The mean angulation between the superior endplate of L-5 and the inferior endplate of L-4 was 6° of lordosis (range 13° of kyphosis to 23° lordosis) on the neutral lateral view. The mean angular change between flexion and extension lateral radiographs was 5° (range 0°–17°). The mean translation on the neutral lateral view was 6 mm (range 0–15 mm). The mean change in translational between flexion and extension was 2 mm (range 0–11 mm). Twenty patients (7%) exhibited spondylolisthesis only on the flexion view. A significant positive correlation was found between the change in angulation and the change in translation on flexion and extension views (ρ = 0.18, p = 0.001). No significant correlation was found between anterior osteophyte size and mobility with flexion-extension radiographs.
Conclusions
The wide range in all radiographic parameters for LDS confirms the heterogeneous nature of this condition and suggests that a grading system to subclassify LDS may be clinically useful. On flexion and extension radiographs, increased translational motion correlated with increased angular motion. Anterior osteophyte size was not found to be predictive of segmental stability. This data set should prove beneficial to those seeking to subcategorize LDS in the future.
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Affiliation(s)
| | | | | | | | - James S. Harrop
- 2Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mitchell Maltenfort
- 2Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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22
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Papadakis M, Papadokostakis G, Kampanis N, Sapkas G, Papadakis SA, Katonis P. The association of spinal osteoarthritis with lumbar lordosis. BMC Musculoskelet Disord 2010; 11:1. [PMID: 20044932 PMCID: PMC2824686 DOI: 10.1186/1471-2474-11-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 01/02/2010] [Indexed: 12/03/2022] Open
Abstract
Background Careful review of published evidence has led to the postulate that the degree of lumbar lordosis may possibly influence the development and progression of spinal osteoarthritis, just as misalignment does in other joints. Spinal degeneration can ensue from the asymmetrical distribution of loads. The resultant lesions lead to a domino- like breakdown of the normal morphology, degenerative instability and deviation from the correct configuration. The aim of this study is to investigate whether a relationship exists between the sagittal alignment of the lumbar spine, as it is expressed by lordosis, and the presence of radiographic osteoarthritis. Methods 112 female subjects, aged 40-72 years, were examined in the Outpatients Department of the Orthopedics' Clinic, University Hospital of Heraklion, Crete. Lumbar radiographs were examined on two separate occasions, independently, by two of the authors for the presence of osteoarthritis. Lordosis was measured from the top of L1 to the bottom of L5 as well as from the top of L1 to the top of S1. Furthermore, the angle between the bottom of L5 to the top of S1was also measured. Results and discussion 49 women were diagnosed with radiographic osteoarthritis of the lumbar spine, while 63 women had no evidence of osteoarthritis and served as controls. The two groups were matched for age and body build, as it is expressed by BMI. No statistically significant differences were found in the lordotic angles between the two groups Conclusions There is no difference in lordosis between those affected with lumbar spine osteoarthritis and those who are disease free. It appears that osteoarthritis is not associated with the degree of lumbar lordosis.
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Affiliation(s)
- Michael Papadakis
- 2nd Department of Orthopaedic Surgery, University of Athens, Athens, Greece.
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23
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Kim KH, Park JY, Chin DK. Fusion criteria for posterior lumbar interbody fusion with intervertebral cages : the significance of traction spur. J Korean Neurosurg Soc 2009; 46:328-32. [PMID: 19893721 DOI: 10.3340/jkns.2009.46.4.328] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 09/04/2009] [Accepted: 10/04/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to establish new fusion criteria to complement existing Brantigan-Steffee fusion criteria. The primary purpose of intervertebral cage placement is to create a proper biomechanical environment through successful fusion. The existence of a traction spur is an essential predictable radiologic factor which shows that there is instability of a fusion segment. We studied the relationship between the existence of a traction spur and fusion after a posterior lumbar interbody fusion (PLIF) procedure. METHODS This study was conducted using retrospective radiological findings from patients who underwent a PLIF procedure with the use of a cage without posterior fixation between 1993 and 1997 at a single institution. We enrolled 183 patients who were followed for a minimum of five years after the procedure, and used the Brantigan-Steffee classification to confirm the fusion. These criteria include a denser and more mature bone fusion area than originally achieved during surgery, no interspace between the cage and the vertebral body, and mature bony trabeculae bridging the fusion area. We also confirmed the existence of traction spurs on fusion segments and non-fusion segments. RESULTS The PLIF procedure was done on a total of 251 segments in 183 patients (71 men and 112 women). The average follow-up period was 80.4 +/- 12.7 months. The mean age at the time of surgery was 48.3 +/- 11.3 years (range, 25 to 84 years). Among the 251 segments, 213 segments (84.9%) were fused after five years. The remaining 38 segments (15.1%) were not fused. An analysis of the 38 segments that were not fused found traction spur formation in 20 of those segments (52.6%). No segments had traction spur formation with fusion. CONCLUSION A new parameter should be added to the fusion criteria. These criteria should be referred to as 'no traction spur formation' and should be used to confirm fusion after a PLIF procedure.
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Affiliation(s)
- Kyung Hoon Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
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