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Yoo Y, Bae J, Kim H, Lee H, Moon JY, Kim YC. Percutaneous nucleoplasty and intradiscal electrothermal therapy in the management of lumbar discogenic pain: A retrospective comparative study. Medicine (Baltimore) 2024; 103:e39230. [PMID: 39121261 PMCID: PMC11315532 DOI: 10.1097/md.0000000000039230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 07/18/2024] [Indexed: 08/11/2024] Open
Abstract
Percutaneous lumbar nucleoplasty (PLN) and intradiscal electrothermal therapy (IDET) are effective treatment options for discogenic low back pain (D-LBP). We evaluated the effectiveness of PLN and IDET and the positive predictive factors associated with intradiscal procedures. We reviewed the medical records of 205 patients who underwent IDET or PLN in patients with D-LBP followed by positive provocation discography. A successful outcome was defined as ≥ 50% pain relief on the numerical rating scale (NRS) pain score at the 6-month follow-up visit. The relationship between the outcome of the intradiscal procedure and clinical variables was investigated using multivariate analyses. Of the 142 patients (89 with PLN and 53 with IDET), 86 (60.5%) experienced a successful outcome, which was more substantial in PLN (n = 61, 68.5%) than in IDET (n = 25, 47.2%; P = .010). The high-grade Modified Dallas Discogram Scale in provocation discography and a procedure at the L3/L4 spinal level were independent positive predictors of successful outcomes (P = .023 and .010, respectively). Coexisting psychiatric disorders, such as depression and anxiety, were negative predictors of successful treatment (P = .007). No serious complications related to the intradiscal procedures were reported during the 6-month follow-up period. PLN and IDET might be effective for managing low back pain (LBP) from internal disc disruption (IDD). The high-grade Modified Dallas Discogram, a procedure at the L3/4 spinal level, and the absence of neuropsychiatric disorders could be positive factors for the successful outcome of the intradiscal procedure.
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Affiliation(s)
- Yongjae Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jungil Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hangaram Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hongna Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Chul Kim
- Yong-Chul Kim’s Pain Clinic, Seoul, Republic of Korea
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Zhu F, Jia D, Zhang Y, Feng C, Peng Y, Ning Y, Leng X, Li J, Zhou Y, Li C, Huang B. Development and validation of a nomogram to predict the risk of residual low back pain after tubular microdiskectomy of lumbar disk herniation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2179-2189. [PMID: 38647605 DOI: 10.1007/s00586-024-08255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Tubular microdiskectomy (tMD) is one of the most commonly used for treating lumbar disk herniation. However, there still patients still complain of persistent postoperative residual low back pain (rLBP) postoperatively. This study attempts to develop a nomogram to predict the risk of rLBP after tMD. METHODS The patients were divided into non-rLBP (LBP VAS score < 2) and rLBP (LBP VAS score ≥ 2) group. The correlation between rLBP and these factors were analyzed by multivariate logistic analysis. Then, a nomogram prediction model of rLBP was developed based on the risk factors screened by multivariate analysis. The samples in the model are randomly divided into training and validation sets in a 7:3 ratio. The Receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the diskrimination, calibration and clinical value of the model, respectively. RESULTS A total of 14.3% (47/329) of patients have persistent rLBP. The multivariate analysis suggests that higher preoperative LBP visual analog scale (VAS) score, lower facet orientation (FO), grade 2-3 facet joint degeneration (FJD) and moderate-severe multifidus fat atrophy (MFA) are risk factors for postoperative rLBP. In the training and validation sets, the ROC curves, calibration curves, and DCAs suggested the good diskrimination, predictive accuracy between the predicted probability and actual probability, and clinical value of the model, respectively. CONCLUSION This nomogram including preoperative LBP VAS score, FO, FJD and MFA can serve a promising prediction model, which will provide a reference for clinicians to predict the rLBP after tMD.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Dongqing Jia
- Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Yan Peng
- Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Jianmin Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China.
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Cho PG, Yoon SJ, Shin DA, Chang MC. Finite Element Analysis of Stress Distribution and Range of Motion in Discogenic Back Pain. Neurospine 2024; 21:536-543. [PMID: 38317545 PMCID: PMC11224725 DOI: 10.14245/ns.2347216.608] [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: 11/15/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE Precise knowledge regarding the mechanical stress applied to the intervertebral disc following each individual spine motion enables physicians and patients to understand how people with discogenic back pain should be guided in their exercises and which spine motions to specifically avoid. We created an intervertebral disc degeneration model and conducted a finite element (FE) analysis of loaded stresses following each spinal posture or motion. METHODS A 3-dimensional FE model of intervertebral disc degeneration at L4-5 was constructed. The intervertebral disc degeneration model was created according to the modified Dallas discogram scale. The von Mises stress and range of motion (ROM) regarding the intervertebral discs and the endplates were analyzed. RESULTS We observed that mechanical stresses loaded onto the intervertebral discs were similar during flexion, extension, and lateral bending, which were greater than those occurring during torsion. Based on the comparison among the grades divided by the modified Dallas discogram scale, the mechanical stress during extension was greater in grades 3-5 than it was during the others. During extension, the mechanical stress loaded onto the intervertebral disc and endplate was greatest in the posterior portion. Mechanical stresses loaded onto the intervertebral disc were greater in grades 3-5 compared to those in grades 0-2. CONCLUSION Our findings suggest that it might be beneficial for patients experiencing discogenic back pain to maintain a neutral posture in their lumbar spine when engaging in daily activities and exercises, especially those suffering from significant intravertebral disc degeneration.
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Affiliation(s)
- Pyung-Goo Cho
- Department of Neurosurgery, Ajou University Medical Center, Suwon, Korea
| | - Seon-Jin Yoon
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Min Cheol Chang
- Department of Physical Medicine & Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
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Wegner M, Backhauß JC, Michalsky Y, Seesko H, Hensler J, Klueter T, Jansen O, Seekamp A, Lippross S. Prevalence of degenerative vertebral disc changes in elite female Crossfit athletes - a cross-sectional study. BMC Musculoskelet Disord 2023; 24:963. [PMID: 38082262 PMCID: PMC10712126 DOI: 10.1186/s12891-023-07071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Crossfit athletes consistently recruit or transfer high levels of repetitive forces through the spine, and MRI has documented a higher rate of intervertebral disc degeneration in athletes compared with matched controls. The aim of this study was to evaluate early degenerative spinal disc changes in elite female CrossFit athletes quantified by 3.0 Tesla magnetic resonance imaging (MRI) matched with female none-athletes. METHODS In a cross-sectional single-center study 19 asymptomatic adult participants, nine German female elite Crossfit athletes and ten female participants underwent spinal MRI (3.0T). Demographic data, spinal clinical examination results and sport-specific performance parameters were collected prior to the MRI. The primary outcome was the prevalence of degenerative spinal disc changes. The secondary outcome was the grade of degeneration using Pfirrmann grading. RESULTS A total of 437 discs underwent spinal MRI (3.0T). The prevalence of early degenerative disc disease was not increased. Pfirrmann degenerative grade did not show significant differences among groups. CONCLUSION Asymptomatic female elite Crossfit athletes do not show an increased prevalence of degenerative disc disease. Compared to a sex-matched control group, high training volume in Crossfit does not correlate to a higher incidence of degenerative disc changes in young females.
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Affiliation(s)
- Mathis Wegner
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany.
| | - Jan-Christoph Backhauß
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Yannik Michalsky
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Henrik Seesko
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Johannes Hensler
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Tim Klueter
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Andreas Seekamp
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Sebastian Lippross
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
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Latka K, Kozlowska K, Waligora M, Kolodziej W, Latka D. Effect of DiscoGel treatment of the intervertebral disc at MRI. Clin Radiol 2023; 78:928-934. [PMID: 37633745 DOI: 10.1016/j.crad.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/28/2023]
Abstract
AIM To determine the impact of ethanol gel chemonucleolysis (EGCh) on the radiological picture of the treated intervertebral disc, the relationship between the initial radiological status and the clinical status of the patient after EGCh treatment, and the optimal radiographic criteria for qualifying a patient for EGCh treatment. MATERIALS AND METHODS The study involved a group of 45 patients (25 men and 20 women) aged 23-68 years (46 ± 11) who underwent an EGCh procedure after qualification, radiography, and clinical questionnaire evaluation. RESULTS The results showed a decrease in the size of the protrusion and Gadolinium-Enhanced (GI) zone in the treated intervertebral disc. The presence of a high-intensity zone (HIZ) on baseline magnetic resonance imaging was found to be a good predictor of the timing and outcome of treatment, and an increase in disc height was observed in adjacent segments. CONCLUSION These findings suggest that EGCh is a promising treatment for spine diseases, and the HIZ on baseline magnetic resonance imaging can be used as a qualification criterion for this procedure.
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Affiliation(s)
- K Latka
- Department of Neurosurgery, University Hospital in Opole, 45-001, 26 Witosa Ave., Opole, Poland.
| | - K Kozlowska
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, 50-370, 27 Wybrzeze Wyspianskiego Str., Wroclaw, Poland
| | - M Waligora
- Clinical Department of Diagnostic Imaging, University of Opole, 45-040, 11a Kopernik Sq., Opole, Poland
| | - W Kolodziej
- Department of Neurosurgery, University Hospital in Opole, 45-001, 26 Witosa Ave., Opole, Poland
| | - D Latka
- Department of Neurosurgery, University Hospital in Opole, 45-001, 26 Witosa Ave., Opole, Poland
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Rosenqvist L, Hebelka H, Baranto A, Brisby H, Lagerstrand K. Detailed MRI evaluation of the spine: a 2-year follow-up study of young individuals reporting different training doses. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4145-4152. [PMID: 37815636 DOI: 10.1007/s00586-023-07961-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/21/2023] [Accepted: 09/16/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To characterize the discs and vertebrae in detail over time in a group of adolescent individuals with varying training doses using magnetic resonance imaging (MRI). METHOD Thirty-five students were recruited from regular high schools (n=13) as well as schools with athlete competitive skiing programmes (n = 22). The thoraco-lumbar spine of all individuals was examined at baseline and at 2-year follow-up using the same 1.5T scanner and imaging protocol. The individuals were grouped based on their reported training dose: low-to-normal training dose (≤5 h/week, n = 11, mean age 16.5 ± 0.5 years) and high training dose (>5 h/week, n = 24, mean age 17.2 ± 0.6 years.) RESULTS: At baseline, the signal intensity in the discs and vertebrae were significantly lower in individuals reporting high compared to low-to-normal training dose. The vertebral signal changed significantly over the 2-year period in both groups. However, only individuals reporting low-to-normal training dose displayed an overall disc signal change. Interestingly, the regional analysis displayed at baseline high annular signals in the more training-active individuals followed by a reduction over the two-year period. CONCLUSION This study suggests that disc degeneration is manifested earlier in individuals reporting a higher training dose. Over a 2-year period, however, the degeneration process did not accelerate further. Also, a significant difference in the vertebral signal, at baseline and follow-up as well as over time, could be seen between groups of individuals reporting high versus low-to-normal training dose.
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Affiliation(s)
- Louise Rosenqvist
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Hanna Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adad Baranto
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
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Masuda K, Shigematsu H, Maeda M, Okuda A, Tanaka Y. Ultrasound-guided disc pain induction test for diagnosis of discogenic lumbar pain: a cross-sectional study. J Orthop Surg Res 2023; 18:847. [PMID: 37941032 PMCID: PMC10631160 DOI: 10.1186/s13018-023-04327-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Several methods can be used to diagnose discogenic pain, but only discoblock can diagnose discogenic pain definitively. This study aimed to examine the usefulness of an ultrasound-guided disc pain induction test for a simple and accurate diagnosis of the culprit lesion. METHODS We included 41 patients with lumbar pain in whom pain was induced by an ultrasound-guided disc pain induction test. All patients had confirmed pain at L1/2 to L5/S1 based on an ultrasound-guided disc pain induction test and underwent X-ray photography and magnetic resonance imaging. Seventeen patients who required injection due to severe pain underwent discoblock procedures for discs with the most intense pain, and visual analogue scale (VAS) scores were obtained before and after the procedure for these patients. We analysed the association between painful discs and radiological findings. RESULTS Pain induction was noted in a total of 65 discs, and the pain was induced in 23 patients in only one disc. All patients had disc degeneration of Pfirrmann classification grade 1 or higher, with more significant disc degeneration in painful discs than in painless discs. There was no significant relationship between the presence or absence of pain and Modic type. The average VAS measurements improved significantly from 9.5 (pre-procedure) to 2.5 (post-procedure). These results suggest that the most painful discs were the causes of discogenic lumbar pain. CONCLUSIONS Our ultrasound-guided disc pain induction test may help diagnose disc degeneration and identify culprit lesions, even when multiple discs exhibit findings of degeneration.
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Affiliation(s)
- Keisuke Masuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan.
| | - Manabu Maeda
- Department of Orthopedic Surgery, Maeda Orthopaedic Clinic, 864-1, Kideracho, Nara City, Nara, 6308306, Japan
| | - Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan
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Yang L, Li W, Yang Y, Zhao H, Yu X. The correlation between the lumbar disc MRI high-intensity zone and discogenic low back pain: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:758. [PMID: 37805519 PMCID: PMC10559531 DOI: 10.1186/s13018-023-04187-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/10/2023] [Indexed: 10/09/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the correlation between the MRI high-intensity zone (HIZ) and the pathogenesis of discogenic low back pain. METHODS Literature from PubMed, EMBASE, Cochrane Library, Science Direct, China Knowledge Network, Wanfang Database, and China Biomedical Literature Database was searched until August 2023. Cohort studies including patients with low back pain who underwent lumbar spine MRI and discography, as well as the results evaluating the correlation between HIZ and discography for morphological changes in the disc and pain replication phenomena, were included in the analysis. The literature that met the inclusion criteria was screened, and the methodological quality of the included studies was evaluated. Meta-analysis of the extracted data was performed by using RevMan 5.1.1. RESULTS In total, 28 reports were included in this meta-analysis. There was a statistically significant correlation between a positive HIZ and abnormal disc morphology in discography (OR 28.15, 95% CI [7.38, 107.46], p < 0.00001). Patients with HIZ-positive discs had a significantly higher incidence of consistent pain (71.0%, 969/1365) than those with HIZ-negative imaging (29.0%, 1314/4524) (OR 7.71, 95% CI [5.29, 11.23], p < 0.00001).Segments that were HIZ-positive and had abnormal disc morphology had a higher incidence of consistent pain (86.1%, 230/267) than HIZ-negative subjects (32.2%, 75/233) (OR 14.09, 95% CI [2.12, 93.48], p = 0.006). CONCLUSION A positive MRI T2-weighted image of the lumbar disc with HIZ indicates disc degeneration. In addition, HIZ may be a specific indicator for the physical diagnosis of discogenic low back pain. A more advanced degree of disc degeneration on the basis of HIZ positivity corresponded to a greater probability of discography-induced consistent pain, whereas the degree of disc degeneration on the basis of HIZ negativity was less correlated with contrast-induced consistent pain.
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Affiliation(s)
- Lei Yang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Wenhao Li
- Department of Orthopedics III, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyun Warehouse, Dongcheng District, Beijing, 100700, China
| | - Yongdong Yang
- Department of Orthopedics III, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyun Warehouse, Dongcheng District, Beijing, 100700, China
| | - He Zhao
- Department of Orthopedics III, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyun Warehouse, Dongcheng District, Beijing, 100700, China.
| | - Xing Yu
- Department of Orthopedics III, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyun Warehouse, Dongcheng District, Beijing, 100700, China.
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Zhu F, Chen Y, Jia D, Zhang Y, Peng Y, Ning Y, Leng X, Feng C, Zhou Y, Li C, Huang B. Risk Factors of Low Back Pain Aggravation After Tubular Microdiscectomy of Lumbar Disc Herniation. World Neurosurg 2023; 178:e673-e681. [PMID: 37543197 DOI: 10.1016/j.wneu.2023.07.142] [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: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Although lumbar disc herniation (LDH) patients' sciatic symptoms such as leg pain can be improved by decompressive surgery, some patients report postoperative aggravated low back pain (LBP). However, the exact reason for this phenomenon remained unknown. METHODS We retrospectively analyzed the prospectively collected LDH data of patients who underwent tubular microdiscectomy between December 2015 and December 2020. The patients were divided into aggravated and non-aggravated group according to whether the postoperative LBP visual analogue scale (VAS) score was higher than the preoperative score. We analyzed the relationship of the clinical and radiologic parameters with aggravated LBP. RESULTS Postoperative aggravated LBP cases accounted for 14.1% (57 of 404) of this series. Of the 57 patients, 88% (50 of 57) had mild postoperative LBP aggravation (1-2), and 12% (7 of 57) had severe LBP aggravation (>2). The preoperative LBP VAS score of the aggravated group was significantly lower than that of the non-aggravated group (P < 0.001), while the LBP VAS score and Oswestry Disability Index at final follow-up was significantly higher in the aggravated group (P < 0.05). Additionally, the proportion of preoperative moderate-to-severe multifidus fatty atrophy (MFA) and lumbar facet joint degeneration (LFJD) was significantly higher in the aggravated group. A multiple stepwise logistic regression analysis indicated that the preoperative LBP VAS score (P < 0.001, odds ratio 0.266, 95% CI 0.161-0.439) and MFA (P < 0.001, odds ratio 4.491, 95% CI 2.092-9.640) were the risk factors for postoperative aggravated LBP. CONCLUSIONS A preoperative lower LBP VAS score and moderate-to-severe MFA were associated with postoperative aggravated LBP. This will provide important guidance for patient's preoperative assessment and education.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yu Chen
- Department of Urology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dongqing Jia
- Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yan Peng
- Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China.
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Rudisill SS, Hornung AL, Kia C, Mallow GM, Aboushaala K, Lim P, Martin J, Wong AYL, Toro S, Kozaki T, Barajas JN, Colman M, Phillips FM, An HS, Samartzis D. Obesity in children with low back pain: implications with imaging phenotypes and opioid use. Spine J 2023; 23:945-953. [PMID: 36963445 DOI: 10.1016/j.spinee.2023.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/07/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is common in children and adolescents, carrying substantial risk for recurrence and continuation into adulthood. Studies have linked obesity to the development of pediatric LBP; however, its association with lumbar spine degeneration, alignment parameters, and opioid use remains debated. PURPOSE Considering the increasing prevalence of pediatric obesity and LBP and the inherent issues with opioid use, this study aimed to assess the association of obesity with lumbar spine degeneration, spinopelvic alignment, and opioid therapy among pediatric patients. STUDY DESIGN/SETTING A retrospective study of pediatric patients presenting to a single institute with LBP and no history of spine deformity, tumor, or infection was performed. PATIENT SAMPLE A totasl of 194 patients (mean age: 16.7±2.3 years, 45.3% male) were included, of which 30 (15.5%) were obese. OUTCOME MEASURES Prevalence of imaging phenotypes and opioid use among obese to nonobese pediatric LBP patients. Magnetic resonance and plain radiographic imaging were evaluated for degenerative phenotypes (disc bulging, disc herniation, disc degeneration [DD], high-intensity zones [HIZ], disc narrowing, Schmorl's nodes, endplate phenotypes, Modic changes, spondylolisthesis, and osteophytes). Lumbopelvic parameters including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence and pelvic incidence-lumbar lordosis (PI-LL) mismatch were also examined. METHODS Demographic and clinical information was recorded, including use of opioids. The associations between obesity and lumbar phenotypes or opiod use were assessed by multiple regression models. RESULTS Based on multivariate analysis, obesity was significantly associated with the presence of HIZ (adjusted OR: 5.36, 95% CI: 1.30 to 22.09). Further analysis demonstrated obesity (adjusted OR: 3.92, 95% CI: 1.49 to 10.34) and disc herniation (OR: 4.10, 95% CI: 1.50 to 11.26) were associated with opioid use, independent of duration of symptoms, other potential demographic determinants, and spinopelvic alignment. CONCLUSIONS In pediatric patients, obesity was found to be significantly associated with HIZs of the lumbar spine, while disc herniation and obesity were associated with opioid use. Spinopelvic alignment parameters did not mitigate any outcome. This study underscores that pediatric obesity increases the risk of developing specific degenerative spine changes and pain severity that may necessitate opioid use, emphasizing the importance of maintaining healthy body weight in promoting lumbar spine health in the young.
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Affiliation(s)
- Samuel S Rudisill
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Alexander L Hornung
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Cameron Kia
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Gary Michael Mallow
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Khaled Aboushaala
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Perry Lim
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - John Martin
- The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Arnold Y L Wong
- The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Sheila Toro
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Takuhei Kozaki
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Juan Nicolas Barajas
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Matthew Colman
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Frank M Phillips
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Howard S An
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA.
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Han CS, Hancock MJ, Sharma S, Sharma S, Harris IA, Cohen SP, Magnussen J, Maher CG, Traeger AC. Low back pain of disc, sacroiliac joint, or facet joint origin: a diagnostic accuracy systematic review. EClinicalMedicine 2023; 59:101960. [PMID: 37096189 PMCID: PMC10121397 DOI: 10.1016/j.eclinm.2023.101960] [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: 01/09/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
Background The accuracy of diagnostic tests available in primary care to identify the disc, sacroiliac joint, and facet joint as the source of low back pain is uncertain. Methods Systematic review of diagnostic tests available in primary care. MEDLINE, CINAHL, and EMBASE were searched between March 2006 and 25th January 2023. Pairs of reviewers independently screened all studies, extracted data, and assessed risk of bias using QUADAS-2. Pooling was performed for homogenous studies. Positive likelihood ratios (+LR) ≥2 and negative likelihood ratios (-LR) ≤0.5 were considered informative. This review is registered with PROSPERO (CRD42020169828). Findings We included 62 studies: 35 investigated the disc, 14 the facet joint, 11 the sacroiliac joint, and 2 investigated all three structures in patients with persistent low back pain. For risk of bias, the domain 'reference standard' scored worst, however approximately half the studies were of low risk of bias for every other domain. For the disc, pooling demonstrated MRI findings of disc degeneration and annular fissure resulted in informative +LRs: 2.53 (95% CI: 1.57-4.07) and 2.88 (95% CI: 2.02-4.10) and -LRs: 0.15 (95% CI: 0.09-0.24) and 0.24 (95% CI: 0.10-0.55) respectively. Pooled results for Modic type 1, Modic type 2, and HIZ on MRI, and centralisation phenomenon yielded informative +LRs: 10.00 (95% CI: 4.20-23.82), 8.03 (95% CI: 3.23-19.97), 3.10 (95% CI: 2.27-4.25), and 3.06 (95% CI: 1.44-6.50) respectively, but uninformative -LRs: 0.84 (95% CI: 0.74-0.96), 0.88 (95% CI: 0.80-0.96), 0.61 (95% CI: 0.48-0.77), and 0.66 (95% CI: 0.52-0.84) respectively. For the facet joint, pooling demonstrated facet joint uptake on SPECT resulted in informative +LRs: 2.80 (95% CI: 1.82-4.31) and -LRs: 0.44 (95% CI: 0.25-0.77). For the sacroiliac joint, a combination of pain provocation tests and absence of midline low back pain resulted in informative +LRs of 2.41 (95% CI: 1.89-3.07) and 2.44 (95% CI: 1.50-3.98) and -LRs of 0.35 (95% CI: 0.12-1.01) and 0.31 (95% CI: 0.21-0.47) respectively. Radionuclide imaging yielded an informative +LR 7.33 (95% CI: 1.42-37.80) but an uninformative -LR 0.74 (95% CI: 0.41-1.34). Interpretation There are informative diagnostic tests for the disc, sacroiliac joint, and facet joint (only one test). The evidence suggests a diagnosis may be possible for some patients with low back pain, potentially guiding targeted and specific treatment approaches. Funding There was no funding for this study.
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Affiliation(s)
- Christopher S. Han
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, New South Wales, Australia
- Corresponding author.
| | - Mark J. Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Sweekriti Sharma
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, New South Wales, Australia
| | - Saurab Sharma
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Ian A. Harris
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, School of Clinical Medicine, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Steven P. Cohen
- Anaesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John Magnussen
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Chris G. Maher
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, New South Wales, Australia
| | - Adrian C. Traeger
- The University of Sydney, Sydney Musculoskeletal Health, Sydney, New South Wales, Australia
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Chen J, Liu Z, Xu Y, Liu Z, Zheng Z, Zhang Z, Fan C, Li Q, Zhao Q. Anatomic zone division and clinical significance of the lumbar sinuvertebral nerves. Spine J 2023:S1529-9430(23)00153-5. [PMID: 37031892 DOI: 10.1016/j.spinee.2023.03.017] [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: 10/25/2022] [Revised: 03/19/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND CONTEXT Discogenic low-back pain (DLBP) is one of the primary causes of low back pain (LBP) and is associated with internal disk disruptions and is mainly transmitted by the sinuvertebral nerve (SVN). The lack of a universal understanding of the anatomical characteristics of the SVN has compromised surgical treatment for DLPB. PURPOSE This study aims to elaborate on the anatomical characteristics of the SVN and to discuss their possible clinical significance. STUDY DESIGN The SVNs were dissected and immunostained in ten human lumbar specimens. METHODS The SVNs at the segments from L1-L2 to L5-S1 in ten human cadavers were studied, and the number, origin, course, diameter, anastomotic branches, and branching points of the SVNs were documented. Three longitudinal and five transverse zones were defined in the dorsal coronal plane of the vertebral body and disc. The vertebrae were divided longitudinally as follows: the region between the medial edges of the bilateral pedicles is divided into three equal parts, the middle third is zone I and the lateral third on both sides are zones II; the areas lateral to the medial margin of the pedicle were zones Ⅲ.The transverse zones were designated as follows: a)superior margin of the vertebral body to superior margin of the pedicle; b) between superior and inferior margins of the pedicle; c) inferior margin of the pedicle to inferior margin of the vertebral body; d) superior margin of the disc to the midline of the disc; and e) midline of the disc to the inferior margin of the disc. The distribution characteristics of SVNs in various zones were recorded, and tissue sections were immunostained with anti-NF 200 and anti-PGP 9.5. RESULTS The SVNs are divided into main trunks and deputy branches, with 109 main trunks and 451 deputy branches identified in the 100 lumbar intervertebral foramens (IVFs). The main trunks of the SVN originate from the spinal nerve and/or the communicating branch, but the deputy branch originating from both roots was not observed. All the main trunks and deputy branches of the SVNs originate from the posterolateral disc (Ⅲ d and Ⅲ e). The deputy branches of the SVN primarily innervate the posterolateral aspect of the intervertebral disc (Ⅲ d 46.78%, Ⅲ e 36.36%) and the subpedicular vertebral body (Ⅲ c 16.85%). The main trunk of the SVNs passes primarily through the subpedicular vertebral body (Ⅲ c 96.33%) and divides into ascending, transverse, and descending branches in the IVF: Ⅲ c (23/101, 22.77%) or spinal canal: Ⅱ c (73/101, 72.28%), Ⅱ d (3/101, 2.97%), Ⅱ b (2/101, 1.98%). The main trunk possesses extensive innervation, and except for the most medial discs (Ⅰ d and Ⅰ e), it almost dominates all other zones of the spinal canal. At the segments from L1-L2 to L5-S1, 39 ipsilateral anastomoses connecting the ascending branch to the main trunk or spinal nerve at the upper level were observed, with one contralateral anastomosis observed at L5. CONCLUSION The zone distribution characteristics of SVNs are similar across all levels. Comparatively, the proportion of double-root origin and the number of insertion points of the SVNs increased at the lower level. The three types of anastomosis offer connections between SVNs at the same level and at different levels. The posteromedial disc is innervated by corresponding and subjacent main trunks, with the posterolateral disc mainly innervated by the deputy branch. CLINICAL SIGNIFICANCE Detailed information and zone distribution characteristics of the lumbar SVNs can help improve clinicians' understanding of DLBP and improve the effectiveness of treatments targeting the SVNs.
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Affiliation(s)
- Junjie Chen
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Zexian Liu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Yejie Xu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Zezheng Liu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Zhiyang Zheng
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Zhenfeng Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Chaohui Fan
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Qingchu Li
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China..
| | - Qinghao Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China..
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Wan ZY, Zhang J, Shan H, Liu TF, Song F, Samartzis D, Wang HQ. Epidemiology of Lumbar Degenerative Phenotypes of Children and Adolescents: A Large-Scale Imaging Study. Global Spine J 2023; 13:599-608. [PMID: 33843321 DOI: 10.1177/21925682211000707] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE Recently, there has been a rise in children and adolescents developing low back pain and/or sciatica. Degenerative lumbar spine MRI phenotypes can occur in this population but reports have been sporadic and the true incidence of such spine changes remains debatable. As such, the study aimed to address the epidemiology of MRI phenotypes of the lumbar spine in this young population. METHODS 597 children and adolescents with lumbar MRIs were included in the study. T1- and T2-weighted lumbar images from L1/2 to L5/S1 were analyzed in axial and sagittal planes. Global phenotype assessment was performed of each level and based on established nomenclature protocols. RESULTS The cohort consisted of 57.3% (342) boys and 42.7% (255) girls, with a mean age of 10.75 ± 5.25 years (range: 0 to 18 years). The prevalence of imaging findings of lumbar disc degeneration (LDD) and lumbar disc herniation (LDH) were 2.2% (95% CI: 0.93-3.43) and 5.8% (95%CI: 2.58-8.99), respectively. There was significant difference between each disc segment from L1/2 to L5/S1 for both LDD and LDH. Schmorl's nodes were noted in 16 cases (2.7%, youngest case as 15 years), with 11 boys (68.8%) and most frequent segment as L3/4. Modic changes and high-intensity zones were absent in this cohort. CONCLUSIONS LDD can emerge as early as the first decade of life with Schmorl's nodes, without additional specific phenotypes, including Modic changes and high-intensity zones. The study provides valuable information of a unique age group that is often under-represented but equally important as adults.
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Affiliation(s)
- Zhong-Yuan Wan
- Department of Orthopedics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jun Zhang
- Department of Orthopedics, Baoji Central Hospital, Baoji, Shaanxi Province, People's Republic of China
| | - Hua Shan
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
| | - Tang-Fen Liu
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
| | - Fang Song
- Department of Stomatology, PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China
| | - Dino Samartzis
- Department of Orthopaedic Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Hai-Qiang Wang
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
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Cheung JPY, Kuang X, Zhang T, Wang K, Yang C. 5-Year progression prediction of endplate defects: Utilizing the EDPP-Flow convolutional neural network based on unbalanced data. J Orthop 2023; 38:7-13. [PMID: 36910507 PMCID: PMC9999205 DOI: 10.1016/j.jor.2023.03.001] [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: 02/09/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/14/2023] Open
Abstract
Background Lumbar disc degeneration (LDD) is considered as one of the main causes of low back pain. For clinical diagnosis of LDD, magnetic resonance imaging (MRI) is commonly used. Schmorl's node, high intensity zone (HIZ), Modic changes, and other MRI biomarkers of intervertebral disc (IVD) degeneration are also associated with low back pain. However, the progression and natural history of these features are unclear and there is limited predictive capacity with MRI. Purpose We aim to establish and validate a deep learning pipeline, EDPP-Flow, for the 5-year progression prediction of Schmorl's node, HIZ, and Modic changes, based on clinical MRIs. Materials and methods An MRI dataset developed on 1152 volunteers was used in this study. For each volunteer, two MRI scans, at baseline and 5-year follow-up, were collected and pathology labels were annotated as present or absent (with/without pathology) by two specialists with over 10 years of clinical experience. Our pipeline contained the published MRI-SegFlow and state-of-the-art convolutional neural network for progression prediction of endplate defects. The label distribution of the dataset is unbalanced, where the number of present samples was much smaller than absent samples. The resampling and data augmentation strategies were adopted to increase the number of present samples in the training process and balance the influence of different samples on the model, which can improve the prediction accuracy. Results Our pipeline achieved high weighted accuracy, sensitivity, and specificity for progression prediction of Schmorl's node (89.46 ± 3.71%, 89.19 ± 2.70%, 89.72 ± 2.42%), HIZ (91.75 ± 2.48%, 93.07 ± 3.96%, 90.43 ± 2.51%), and Modic changes (87.51 ± 2.23%, 87.93 ± 1.72%, 87.10 ± 1.99%), on the unbalanced dataset (present sample's percentages of the 3 pathologies above were 4.3%, 11.7%, and 6.7%). Conclusion We developed and validated a deep learning pipeline, for the progression prediction of endplate defects, which showed high prediction accuracy on unbalanced data. The method has significant potential for clinical implementation.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
- Digital Health Laboratory, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xihe Kuang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
- Digital Health Laboratory, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Teng Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
- Digital Health Laboratory, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kun Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Shenzhen Research Institute, Huazhong University of Science and Technology, Shenzhen, China
| | - Cao Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Shenzhen Research Institute, Huazhong University of Science and Technology, Shenzhen, China
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Akeda K, Fujiwara T, Takegami N, Yamada J, Sudo A. Retrospective Analysis of Factors Associated with the Treatment Outcomes of Intradiscal Platelet-Rich Plasma-Releasate Injection Therapy for Patients with Discogenic Low Back Pain. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040640. [PMID: 37109598 PMCID: PMC10146982 DOI: 10.3390/medicina59040640] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/06/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Recently, the clinical application of platelet-rich plasma (PRP) has gained popularity for the treatment of degenerative disc diseases. However, the regenerative effects and factors associated with treatment outcomes after intradiscal injection of PRP remain unknown. This study aimed to evaluate time-dependent changes in imaging findings related to intervertebral disc (IVD) degeneration and to identify factors associated with the outcomes of PRP injection therapy. Materials and Methods: A retrospective analysis of a previous randomized clinical trial of intradiscal injection of the releasate isolated from PRP (PRPr) in patients with discogenic low back pain (LBP) was performed. Radiographic parameters (segmental angulation and lumbar lordosis) and MRI phenotypes, including Modic changes, disc bulge, and high-intensity zones (HIZs), were evaluated at baseline and 6 and 12 months post-injection. Treatment outcomes were evaluated based on the degree of LBP and LBP-related disability at 12 months post-injection. Results: A total of 15 patients (mean age: 33.9 ± 9.5 years) were included in this study. Radiographic parameters showed no significant changes after the PRPr injection. There were no remarkable changes in the prevalence or type of MRI phenotype. Treatment outcomes were significantly improved after treatment; however, the number of targeted discs and the presence of posterior HIZs at baseline were significantly but negatively associated with treatment outcomes. Conclusions: Intradiscal injection of PRPr significantly improved LBP and LBP-related disability 12 months post-injection; however, patients with multiple target lesions or posterior HIZs at baseline were significantly associated with poor treatment outcomes.
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Affiliation(s)
- Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Tatsuhiko Fujiwara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Junichi Yamada
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
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Kim CW, Goldstein I, Komisaruk BR, Goldstein SW, Kim NN, Hartzell-Cushanick R, Uloko M, Yee A. Lumbar endoscopic spine surgery for persistent genital arousal disorder/genitopelvic dysesthesia resulting from lumbosacral annular tear-induced sacral radiculopathy. J Sex Med 2023; 20:210-223. [PMID: 36763933 DOI: 10.1093/jsxmed/qdac017] [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: 07/23/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by distressing, abnormal genitopelvic sensations, especially unwanted arousal. In a subgroup of patients with PGAD/GPD, cauda equina Tarlov cyst-induced sacral radiculopathy has been reported to trigger the disorder. In our evaluation of lumbosacral magnetic resonance images in patients with PGAD/GPD and suspected sacral radiculopathy, some had no Tarlov cysts but showed lumbosacral disc annular tear pathology. AIM The aims were 2-fold: (1) to utilize a novel multidisciplinary step-care management algorithm designed to identify a subgroup of patients with PGAD/GPD and lumbosacral annular tear-induced sacral radiculopathy who could benefit from lumbar endoscopic spine surgery (LESS) and (2) to evaluate long-term safety and efficacy of LESS. METHODS Clinical data were collected on patients with PGAD/GPD who underwent LESS between 2016 and 2020 with at least 1-year follow-up. LESS was indicated because all had lumbosacral annular tear-induced sacral radiculopathy confirmed by our multidisciplinary management algorithm that included the following: step A, a detailed psychosocial and medical history; step B, noninvasive assessments for sacral radiculopathy; step C, targeted diagnostic transforaminal epidural spinal injections resulting in a temporary, clinically significant reduction of PGAD/GPD symptoms; and step D, surgical intervention with LESS and postoperative follow-up. OUTCOMES Treatment outcome was based on the validated Patient Global Impression of Improvement, measured at postoperative intervals. RESULTS Our cohort included 15 cisgendered women and 5 cisgendered men (mean ± SD age, 40.3 ± 16.8 years) with PGAD/GPD who fulfilled the criteria of lumbosacral annular tear-induced sacral radiculopathy based on our multidisciplinary management algorithm. Patients were followed for an average of 20 months (range, 12-37) post-LESS. Lumbosacral annular tear pathology was identified at multiple levels, the most common being L4-L5 and L5-S1. Twenty-two LESS procedures were performed in 20 patients. Overall, 80% (16/20) reported improvement on the Patient Global Impression of Improvement; 65% (13/20) reported improvement as much better or very much better. All patients were discharged the same day. There were no surgical complications. CLINICAL IMPLICATIONS Among the many recognized triggers for PGAD/GPD, this subgroup exhibited lumbosacral annular tear-induced sacral radiculopathy and experienced long-term alleviation of symptoms by LESS. STRENGTHS AND LIMITATIONS Strengths include long-term post-surgical follow-up and demonstration that LESS effectively treats patients with PGAD/GPD who have lumbosacral annular tear-induced sacral radiculopathy, as established by a multidisciplinary step-care management algorithm. Limitations include the small study cohort and the unavailability of a clinical measure specific for PGAD/GPD. CONCLUSION LESS is safe and effective in treating patients with PGAD/GPD who are diagnosed with lumbosacral annular tear-induced sacral radiculopathy.
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Affiliation(s)
- Choll W Kim
- Excel Spine Center, San Diego, CA 92120, United States.,Alvarado Hospital, San Diego, CA 92120, United States
| | - Irwin Goldstein
- Alvarado Hospital, San Diego, CA 92120, United States.,San Diego Sexual Medicine, San Diego, CA 92120, United States
| | | | - Sue W Goldstein
- San Diego Sexual Medicine, San Diego, CA 92120, United States
| | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA 92121, United States
| | | | - Maria Uloko
- Alvarado Hospital, San Diego, CA 92120, United States.,San Diego Sexual Medicine, San Diego, CA 92120, United States.,University of California San Diego, San Diego, CA 92093, United States
| | - Alyssa Yee
- Alvarado Hospital, San Diego, CA 92120, United States.,San Diego Sexual Medicine, San Diego, CA 92120, United States
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17
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Ding S, Du X, Fu C, Zhao X, Ge Y, Wang Y. Conservative Treatments for Lumbar Disc Herniation at L3-4 or L4-5 Were More Likely to Fail When Ipsilateral Foraminal Stenosis Was Present at the Caudally Adjacent Segment. World Neurosurg 2023; 170:e577-e583. [PMID: 36403932 DOI: 10.1016/j.wneu.2022.11.070] [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] [Received: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Conservative treatments are important in lumbar disc herniation (LDH), but predictors for poor outcomes are unclear. METHODS Consecutive patients with unilateral single-level LDH at L3-4 or L4-5 were enrolled. Baseline clinical data were collected, and lumbar spine magnetic resonance imaging was evaluated. Foraminal stenosis was evaluated using Lee's approach and further categorized as absence (grade 0 and 1) or presence (grade 2 or 3). Each patient underwent conservative treatments (oral meloxicam and dexamethasone, corset, back extension exercise, physiotherapy, and manual therapy) for 6 weeks. Conservative treatments were defined as failed if a patient underwent surgery within 6 weeks or reported poor recovery at 6-week follow-up. Multivariate logistic regressions were used to examine the associations of failed conservative treatments with baseline characteristics and magnetic resonance imaging findings. RESULTS The study included 222 patients (mean age 45.5 ± 9.8 years). Of patients, 48 (21.6%) had concurrent ipsilateral foraminal stenosis at the caudal segment, and conservative treatments failed in 39 (17.6%). At baseline, patients with LDH and caudal foraminal stenosis were older (50.79 ± 6.14 years vs. 44.10 ± 10.13 years, P < 0.001), had greater leg pain (7.06 ± 1.17 vs. 6.39 ± 1.40, P = 0.003), and had a higher rate of positive straight leg raising test (54.2% vs. 33.3%, P = 0.008) than patients without caudal foraminal stenosis. In multivariate regression, failure of conservative treatments was associated with positive straight leg raising test (odds ratio 2.26, P = 0.046), and caudal foraminal stenosis (odds ratio 3.20, P = 0.007). CONCLUSIONS In the presence of caudal foraminal stenosis and positive SLR test, conservative treatments were more likely to fail in patients with LDH.
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Affiliation(s)
- Shuchen Ding
- Center of Orthopedics, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China
| | - Xiaotian Du
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chudi Fu
- Center of Orthopedics, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China
| | - Xinhua Zhao
- The 3(rd) Department of Orthopaedics, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Yunlin Ge
- Center of Orthopedics, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China
| | - Yue Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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18
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Pre-procedural Imaging. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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19
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Bartynski WS, Agarwal V, Trang H, Bandos AI, Rothfus WE, Tsay J, Delfyett WT, Nastasi B. Enhancing Annular Fissures and High-Intensity Zones: Pain, Internal Derangement, and Anesthetic Response at Provocation Lumbar Discography. AJNR Am J Neuroradiol 2023; 44:95-104. [PMID: 36549846 PMCID: PMC9835906 DOI: 10.3174/ajnr.a7749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE A high-intensity zone identified on preprocedural MR imaging is known to correlate with pain at provocation lumbar discography. The correlation between enhancing annular fissures and pain at provocation lumbar discography has not been comprehensively evaluated. The purpose of this study was to assess the pain response and imaging features at enhancing annular fissure nonoperated disc levels identified on preprocedural MR imaging with comparison with the high-intensity zone and nonenhancing disc levels in patients referred for provocation lumbar discography. MATERIALS AND METHODS One-hundred nonoperated discs in 44 patients were retrospectively evaluated for an enhancing annular fissure on sagittal postcontrast T1-weighted pre-discogram MR imaging. Enhancing annular fissure discs were graded on the sagittal T2-weighted sequence (Grade 4: like CSF to Grade 1: negative/barely visible) for high-intensity-zone conspicuity. High-intensity-zone detection was performed independently. In the primary assessment, enhancing annular fissure and high-intensity zones were associated with pain response at provocation lumbar discography. Additional analysis included intradiscal anesthetic response and postdiscogram CT appearance. RESULTS Thirty-nine discs demonstrated an enhancing annular fissure, with 23/39 demonstrating a high-intensity zone. The presence of a high-intensity zone predicted severe pain (concordant + nonconcordant; P = .005, sensitivity of 40%, specificity of 94%) and concordant pain (P = .007, sensitivity of 39%, specificity of 86%) at provocation lumbar discography. Enhancing annular fissures without a detected high-intensity zone were more frequently observed among severely painful (50%) and concordant (36%) discs than among discs negative for pain (9%; P = .01). This finding resulted in a substantially greater overall sensitivity of enhancing annular fissures for severe (P < .001, 64%) and concordant pain (P = .008, 61%), significantly improving the overall predictive ability of a high-intensity zone alone. A high-intensity zone went undetected in 9/11 Grade 1 disc levels with concordant pain present in 7/9. CONCLUSIONS Consideration of enhancing annular fissures on preprocedural MR imaging substantially improves the prediction of severe/concordant pain in provocation lumbar discography.
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Affiliation(s)
- W S Bartynski
- From the Department of Radiology (W.S.B., V.A., H.T., W.E.R., J.T., W.T.D., B.N.), Division of Neuroradiology, University of Pittsburgh, Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - V Agarwal
- From the Department of Radiology (W.S.B., V.A., H.T., W.E.R., J.T., W.T.D., B.N.), Division of Neuroradiology, University of Pittsburgh, Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - H Trang
- From the Department of Radiology (W.S.B., V.A., H.T., W.E.R., J.T., W.T.D., B.N.), Division of Neuroradiology, University of Pittsburgh, Presbyterian University Hospital, Pittsburgh, Pennsylvania
- Department of Radiology (H.T.), St. Clair Hospital, Pittsburgh, Pennsylvania
| | - A I Bandos
- Department of Biostatistics (A.I.B.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - W E Rothfus
- From the Department of Radiology (W.S.B., V.A., H.T., W.E.R., J.T., W.T.D., B.N.), Division of Neuroradiology, University of Pittsburgh, Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - J Tsay
- From the Department of Radiology (W.S.B., V.A., H.T., W.E.R., J.T., W.T.D., B.N.), Division of Neuroradiology, University of Pittsburgh, Presbyterian University Hospital, Pittsburgh, Pennsylvania
- Department of Radiology (J.T.), Cleveland Clinic, Cleveland, Ohio
| | - W T Delfyett
- From the Department of Radiology (W.S.B., V.A., H.T., W.E.R., J.T., W.T.D., B.N.), Division of Neuroradiology, University of Pittsburgh, Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - B Nastasi
- From the Department of Radiology (W.S.B., V.A., H.T., W.E.R., J.T., W.T.D., B.N.), Division of Neuroradiology, University of Pittsburgh, Presbyterian University Hospital, Pittsburgh, Pennsylvania
- Brighton Radiology Associates, PC (B.N.), Monaca, Pennsylvania
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Usefulness of discography, discoblock and a new mechanical method for identifying a painful segment/disc. Neurochirurgie 2023; 69:101397. [PMID: 36502874 DOI: 10.1016/j.neuchi.2022.101397] [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: 08/07/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND We previously described a procedure for eliciting deep spatial discrimination of individual segments in the healthy lumbar spine of normal subjects: the percutaneous mechanical provocation (PMP) test. Our goal was to devise a method for accurate identification of the spinal level of pathology in chronic low back pain (CLBP). In the present study, we validated the PMP test, using a subgroup of CLBP patients with isthmic spondylolisthesis (IS). Because there is clinical consensus that IS back pain originates in the slipped segment/disc, the level of pathology can be directly compared to the result of the PMP test. The test is agnostic with respect to the underlying pathological mechanism, and therefore might be useful in identifying the involved segment(s) irrespective of the painful structure. METHODS In 37 patients with confirmed IS (slippage 3-15mm), we compared sensitivity between the PMP test, the widely used provocative discography test and the discoblock test. RESULTS The PMP test reliably identified the slip level in patients with IS, with sensitivity of 92%. Accepting the slipped disc as the origin of pain in IS, the sensitivity of the provocative discography and discoblock tests were 49% and 35%, respectively: i.e., too low to be contributive in clinical practice. CONCLUSIONS The PMP test reliably identified the origin of localized pain in IS as the slip level, but should be used with care in CLBP patients in selecting discogenic pain patients for fusion surgery, since the specificity of the test is not known and it may be positive for any origin of localized pain.
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21
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Pauza KJ, Moradian M, Lutz G. Intra-annular Fibrin Discseel®. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Yang L, Sun C, Gong T, Li Q, Chen X, Zhang X. T1ρ, T2 and T2* mapping of lumbar intervertebral disc degeneration: a comparison study. BMC Musculoskelet Disord 2022; 23:1135. [PMID: 36575488 PMCID: PMC9793566 DOI: 10.1186/s12891-022-06040-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Early and accurate assessment of lumbar intervertebral disc degeneration (IVDD) is very important to therapeutic strategy. This study aims to correlate and compare the performances of T1ρ, T2 and T2* mapping for Pfirrmann grades and morphologic changes in the IVDD. METHODS This prospective study included 39 subjects with 195 lumbar discs. T1ρ, T2 and T2* mapping were performed, and T1ρ, T2 and T2* values of nucleus pulposus (NP), and anterior and posterior annulus fibrosus were measured. IVDD was assessed with Pfirrmann grading and morphologic changes (normal, bulging, herniation and annular fissure). The performances of T1ρ, T2 and T2* relaxation times were compared for detecting early (Pfirrmann grade II-III) and advanced degeneration (Pfirrmann grade IV-V), as well as for morphologic changes. RESULTS T2 relaxation times was strongly corelated with T1ρ and T2* relaxation times. Areas under the curves (AUCs) of T1ρ, T2 and T2* relaxation times of NP were 0.70, 0.87 and 0.80 for early degeneration, and 0.91, 0.95 and 0.82 for advanced degeneration, respectively. AUCs of T1ρ, T2 and T2* relaxation times of NP were 0.78, 0.83 and 0.64 for bulging discs, 0.87, 0.89 and 0.69 for herniated discs, and 0.79, 0.82 and 0.69 for annular tearing, respectively. The AUC of T2 relaxation time was significantly higher than those of T1ρ relaxation times (both P < 0.01) for early IVDD, and the AUCs of T1ρ and T2 relaxation times for assessing advanced degeneration and morphologic changes were similar (P > 0.05) but significantly higher than that of T2*relaxation time (P < 0.01). CONCLUSIONS T2 mapping performed better than T1ρ mapping for the detection of early IVDD. T1ρ and T2 mapping performed similarly but better than T2* mapping for advanced degeneration and morphologic changes of IVDD.
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Affiliation(s)
- Li Yang
- grid.413087.90000 0004 1755 3939Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, 200032 People’s Republic of China
| | - Cong Sun
- grid.414350.70000 0004 0447 1045Department of Radiology, Beijing Hospital, National Center of Gerontology, No. 1 Da-Hua Road, Dong Dan, Beijing, 100730 China
| | - Tao Gong
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Quanlin Li
- grid.479672.9Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250012 Shandong China
| | - Xin Chen
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Xinjuan Zhang
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
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23
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Niu XP, Zhu WH, Wang L, Zhao GN, Liu JT, Huang AB. Assessment of the correlation between clinical and radiological outcomes in patients suffering from mild to moderate cervical spine dysfunction symptoms: a prospective study. J Orthop Surg Res 2022; 17:559. [PMID: 36550557 PMCID: PMC9773613 DOI: 10.1186/s13018-022-03455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Neck pain and cervical disc degeneration (CDD) are common findings. Valid data on correlation between clinical scores and radiological grade of CDD in patients with mild to moderate clinical disability are not available. The study has been designed to investigate the correlation between clinical and radiological outcomes in these patients. METHODS A cohort of 150 patients who suffered from mild to moderate cervical spine dysfunction symptoms from September 2020 to May 2021 was enrolled. We evaluated functional status using Japanese Orthopaedic Association scores (JOA), the visual analog scale, and the Neck Disability Index. We assessed the CDD with magnetic resonance imaging-based grading systems. We analyzed relationships between radiological grades of CDD and clinical symptoms along with demographic data. RESULTS One hundred thirteen patients [mean age 44.78, 78 (69%) females] were finally included. CDD occurred most at the C5-C6 level, with 56.93% of higher grade III from Miyazaki. The grades of Miyazaki (P < 0.05) and the scores of Nakashima (P < 0.05) were positively correlated with the duration of symptoms, and the severity of the CDD increased with aging (P < 0.01). Moreover, we correlated patients' JOA scores with the current scoring and grading systems, especially the grades of Miyazaki (P < 0.01) and the scores of Nakashima (P < 0.01). CONCLUSION Increasing grades of CDD paralleled decreasing JOA scores in the population studied.
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Affiliation(s)
- Xiao-ping Niu
- grid.411971.b0000 0000 9558 1426Postgraduate School, Dalian Medical University, Dalian, 116000 Liaoning China ,grid.479690.50000 0004 1789 6747Department of Rehabilitation, Affiliated Hospital 5 of Nantong University (Taizhou People’s Hospital), Taizhou, 225300 Jiangsu China
| | - Wei-Hua Zhu
- grid.479690.50000 0004 1789 6747Department of Nursing, Affiliated Hospital 5 of Nantong University (Taizhou People’s Hospital), Taizhou, 225300 Jiangsu China
| | - Lu Wang
- grid.411971.b0000 0000 9558 1426Postgraduate School, Dalian Medical University, Dalian, 116000 Liaoning China ,grid.479690.50000 0004 1789 6747Department of Rehabilitation, Affiliated Hospital 5 of Nantong University (Taizhou People’s Hospital), Taizhou, 225300 Jiangsu China
| | - Gao-nian Zhao
- grid.479690.50000 0004 1789 6747Department of Rehabilitation, Affiliated Hospital 5 of Nantong University (Taizhou People’s Hospital), Taizhou, 225300 Jiangsu China
| | - Ji-tao Liu
- grid.411971.b0000 0000 9558 1426Postgraduate School, Dalian Medical University, Dalian, 116000 Liaoning China ,grid.479690.50000 0004 1789 6747Department of Rehabilitation, Affiliated Hospital 5 of Nantong University (Taizhou People’s Hospital), Taizhou, 225300 Jiangsu China
| | - Ai-bing Huang
- grid.479690.50000 0004 1789 6747Department of Orthopedics, Affiliated Hospital 5 of Nantong University (Taizhou People’s Hospital), Taizhou, 225300 Jiangsu China
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Waldenberg C, Eriksson S, Brisby H, Hebelka H, Lagerstrand KM. Detection of Imperceptible Intervertebral Disc Fissures in Conventional MRI-An AI Strategy for Improved Diagnostics. J Clin Med 2022; 12:jcm12010011. [PMID: 36614812 PMCID: PMC9821245 DOI: 10.3390/jcm12010011] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Annular fissures in the intervertebral discs are believed to be closely related to back pain. However, no sensitive non-invasive method exists to detect annular fissures. This study aimed to propose and test a method capable of detecting the presence and position of annular fissures in conventional magnetic resonance (MR) images non-invasively. The method utilizes textural features calculated from conventional MR images combined with attention mapping and artificial intelligence (AI)-based classification models. As ground truth, reference standard computed tomography (CT) discography was used. One hundred twenty-three intervertebral discs in 43 patients were examined with MR imaging followed by discography and CT. The fissure classification model determined the presence of fissures with 100% sensitivity and 97% specificity. Moreover, the true position of the fissures was correctly determined in 90 (87%) of the analyzed discs. Additionally, the proposed method was significantly more accurate at identifying fissures than the conventional radiological high-intensity zone marker. In conclusion, the findings suggest that the proposed method is a promising diagnostic tool to detect annular fissures of importance for back pain and might aid in clinical practice and allow for new non-invasive research related to the presence and position of individual fissures.
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Affiliation(s)
- Christian Waldenberg
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- Correspondence:
| | - Stefanie Eriksson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Helena Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Hanna Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Kerstin Magdalena Lagerstrand
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
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Predictive Factors for Poor Outcome following Chemonucleolysis with Condoliase in Lumbar Disc Herniation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121868. [PMID: 36557070 PMCID: PMC9781337 DOI: 10.3390/medicina58121868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Condoliase, a chondroitin sulfate ABC endolyase, is a novel and minimally invasive chemonucleolytic drug for lumbar disc herniation. Despite the growing number of treatments for lumbar disc herniation, the predicting factors for poor outcomes following treatment remain unclear. The aim of this study was to determine the predictive factors for unsuccessful clinical outcome following condoliase therapy. Material and Methods: We performed a retrospective single-center analysis of 101 patients who underwent chemonucleolysis with condoliase from January 2019 to December 2021. Patients were divided into good outcome (i.e., favorable outcome) and poor outcome (i.e., requiring additional surgical treatment) groups. Patient demographics and imaging findings were collected. Clinical outcomes were evaluated using the numerical rating scale and Japanese Orthopaedic Association scores at baseline and at 1- and 3-month follow-up. Pretreatment indicators for additional surgery were compared between the 2 groups. Results: There was a significant difference in baseline leg numbness between the good outcome and poor outcome groups (6.27 ± 1.90 vs. 4.42 ± 2.90, respectively; p = 0.033). Of the 101 included patients, 32 received a preoperative computed tomography scan. In those patients, the presence of calcification or ossification in disc hernia occurred more often in the poor outcome group (61.5% vs. 5.3%, respectively; p < 0.001; odds ratio = 22.242; p = 0.014). Receiver-operating characteristics curve analysis for accompanying calcification or ossification showed an area under the curve of 0.858 (95% confidence interval, 0.715−1.000; p = 0.001). Conclusions: Calcified or ossified disc herniation may be useful predictors of unsuccessful treatment in patients with condoliase administration.
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Her YF, Kubrova E, Martinez Alvarez GA, D’Souza RS. The Analgesic Efficacy of Intradiscal Injection of Bone Marrow Aspirate Concentrate and Culture-Expanded Bone Marrow Mesenchymal Stromal Cells in Discogenic Pain: A Systematic Review. J Pain Res 2022; 15:3299-3318. [PMID: 36299501 PMCID: PMC9590351 DOI: 10.2147/jpr.s373345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022] Open
Abstract
Pain originating from the intervertebral disc (discogenic pain) is a prevalent manifestation of low back pain and is often challenging to treat. Of recent interest, regenerative medicine options with injectable biologics have been trialed in discogenic pain and a wide variety of other painful musculoskeletal conditions. In particular, the role of bone marrow aspirate concentrate (BMAC) and culture-expanded bone marrow derived mesenchymal stromal cells (BM-MSCs) in treating discogenic pain remains unclear. The primary objective of this systematic review was to appraise the evidence of intradiscal injection with BMAC and culture-expanded BM-MSCs in alleviating pain intensity from discogenic pain. Secondary outcomes included changes in physical function after intradiscal injection, correlation between stromal cell count and pain intensity, and anatomical changes of the disc assessed by radiographic imaging after intradiscal injection. Overall, 16 studies consisting of 607 participants were included in qualitative synthesis without pooling. Our synthesis revealed that generally intradiscal autologous or allogeneic BMAC and culture-expanded BM-MSCs improved discogenic pain compared to baseline. Intradiscal injection was also associated with improvements in physical functioning and positive anatomical changes on spine magnetic resonance imaging (improved disc height, disc water content, Pfirrmann grading) although anatomical findings were inconsistent across studies. However, the overall GRADEscore for this study was very low due to heterogeneity and poor generalizability. There were no serious adverse events reported post intradiscal injection except for a case of discitis.
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Affiliation(s)
- Yeng F Her
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, 55905, USA
| | - Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, Rochester, MN, 55905, USA
| | | | - Ryan S D’Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, 55905, USA,Correspondence: Ryan S D’Souza, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA, Tel +507-284-9696, Email
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Lagerstrand K, Hebelka H, Brisby H. Identification of potentially painful disc fissures in magnetic resonance images using machine-learning modelling. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1992-1999. [PMID: 34854974 DOI: 10.1007/s00586-021-07066-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE It is suggested that non-specific low back pain (LBP) can be related to nerve ingrowth along granulation tissue in disc fissures, extending into the outer layers of the annulus fibrosus. Present study aimed to investigate if machine-learning modelling of magnetic resonance imaging (MRI) data can classify such fissures as well as pain, provoked by discography, with plausible accuracy and precision. METHODS The study was based on previously collected data from 30 LBP patients (age = 26-64 years, 11 males). Pressure-controlled discography was performed in 86 discs with pain-positive discograms, categorized as concordant pain-response at a pressure ≤ 50 psi and for each patient one negative control disc. The CT-discograms were used for categorization of fissures. MRI values and standard deviations were extracted from the midsagittal part and from 5 different sub-regions of the discs. Machine-learning algorithms were trained on the extracted MRI markers to classify discs with fissures extending into the outer annulus or not, as well as to classify discs as painful or non-painful. RESULTS Discs with outer annular fissures were classified in MRI with very high precision (mean of 10 repeated testings: 99%) and accuracy (mean: 97%) using machine-learning modelling, but the pain model only demonstrated moderate diagnostic accuracy (mean accuracy: 69%; precision: 71%). CONCLUSION The present study showed that machine-learning modelling based on MRI can classify outer annular fissures with very high diagnostic accuracy and, hence, enable individualized diagnostics. However, the model only demonstrated moderate diagnostic accuracy regarding pain that could be assigned to either a non-sufficient model or the used pain reference.
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Affiliation(s)
- Kerstin Lagerstrand
- Department of Medical Physics and Biomedical Enineering, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Sahlgrenska University Hospital, MR-center, Bruna straket 13, 413 45, Gothenburg, Sweden.
| | - Hanna Hebelka
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helena Brisby
- Departmetn of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Wáng YXJ, Martínez Barbero JP, García Espinosa J, Martínez Martínez A. The value of magnetic resonance imaging and computed tomography in the study of spinal disorders. Quant Imaging Med Surg 2022; 12:3947-3986. [PMID: 35782254 PMCID: PMC9246762 DOI: 10.21037/qims-2022-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/13/2022] [Indexed: 08/15/2023]
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders.
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Affiliation(s)
| | | | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - José Pablo Martínez Barbero
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Jade García Espinosa
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Alberto Martínez Martínez
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
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29
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Nguyen AQ, Harada GK, Leverich KL, Khanna K, Louie PK, Basques BA, Tao Y, Galbusera F, Niemeyer F, Wilke HJ, An HS, Samartzis D. High-Intensity Zones on MRI of the Cervical Spine in Patients: Epidemiology and Association With Pain and Disability. Global Spine J 2022; 12:829-839. [PMID: 33203250 PMCID: PMC9344501 DOI: 10.1177/2192568220966328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study aimed to address the prevalence, distribution, and clinical significance of cervical high-intensity zones (HIZs) on magnetic resonance imaging (MRI) with respect to pain and other patient-reported outcomes in the setting of patients that will undergo an anterior cervical discectomy and fusion (ACDF) procedure. METHODS A retrospective cohort study of ACDF patients surgically treated at a single center from 2008 to 2015. Based on preoperative MRI, HIZ subtypes were identified as either traditional T2-hyperintense, T1-hypointense ("single-HIZs"), or combined T1- and T2-hyperintense ("dual-HIZs"), and their level-specific prevalence was assessed. Preoperative symptoms, patient-reported outcomes, and disc degeneration pathology were assessed in relation to HIZs and HIZ subtypes. RESULTS Of 861 patients, 58 demonstrated evidence of HIZs in the cervical spine (6.7%). Single-HIZs and dual-HIZs comprised 63.8% and 36.2% of the overall HIZs, respectively. HIZs found outside of the planned fusion segment reported better preoperative Neck Disability Index (NDI; P = .049) and Visual Analogue Scale (VAS) Arm (P = .014) scores relative to patients without HIZs. Furthermore, patients with single-HIZs found inside the planned fusion segment had worse VAS Neck (P = .045) and VAS Arm (P = .010) scores. In general, dual-HIZ patients showed no significant differences across all clinical outcomes. CONCLUSIONS This is the first study to evaluate the clinical significance of HIZs in the cervical spine, noting level-specific and clinical outcome-specific variations. Single-HIZs were associated with significantly more pain when located inside the fusion segment, while dual-HIZs showed no associations with patient-reported outcomes. The presence of single-HIZs may correlate with concurrent spinal pathologies and should be more closely evaluated.
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Affiliation(s)
| | | | | | | | | | | | - Youping Tao
- Rush University Medical
Center, Chicago, IL, USA
| | - Fabio Galbusera
- Rush University Medical
Center, Chicago, IL, USA,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Frank Niemeyer
- Rush University Medical
Center, Chicago, IL, USA,Ulm University Medical
Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Rush University Medical
Center, Chicago, IL, USA,Ulm University Medical
Centre, Ulm, Germany
| | - Howard S. An
- Rush University Medical
Center, Chicago, IL, USA
| | - Dino Samartzis
- Rush University Medical
Center, Chicago, IL, USA,Dino Samartzis, DSc, Department of
Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, Suite
204-G, 1611W. Harrison Street, Chicago, IL 60612, USA.
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30
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Imaging Evaluation of Intervertebral Disc Degeneration and Painful Discs-Advances and Challenges in Quantitative MRI. Diagnostics (Basel) 2022; 12:diagnostics12030707. [PMID: 35328260 PMCID: PMC8946895 DOI: 10.3390/diagnostics12030707] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/07/2023] Open
Abstract
In recent years, various quantitative and functional magnetic resonance imaging (MRI) sequences have been developed and used in clinical practice for the diagnosis of patients with low back pain (LBP). Until now, T2-weighted imaging (T2WI), a visual qualitative evaluation method, has been used to diagnose intervertebral disc (IVD) degeneration. However, this method has limitations in terms of reproducibility and inter-observer agreement. Moreover, T2WI observations do not directly relate with LBP. Therefore, new sequences such as T2 mapping, T1ρ mapping, and MR spectroscopy have been developed as alternative quantitative evaluation methods. These new quantitative MRIs can evaluate the anatomical and physiological changes of IVD degeneration in more detail than conventional T2WI. However, the values obtained from these quantitative MRIs still do not directly correlate with LBP, and there is a need for more widespread use of techniques that are more specific to clinical symptoms such as pain. In this paper, we review the state-of-the-art methodologies and future challenges of quantitative MRI as an imaging diagnostic tool for IVD degeneration and painful discs.
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Zhang J, Li Q, Du Y, Yan Z, Chen L, Wang L. Efficacy Analysis of Percutaneous Endoscopic Spinal Surgery for Young Patients with Discogenic Low Back Pain. J Pain Res 2022; 15:665-674. [PMID: 35264884 PMCID: PMC8901256 DOI: 10.2147/jpr.s351296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the application value of percutaneous endoscopic spinal surgery for young patients with discogenic low back pain (DLBP) and to judge its clinical efficacy. Methods We retrospectively analyzed young patients with single-segment discogenic lumbago from July 2018 to June 2020 in our department who underwent percutaneous endoscopic surgery according to the inclusion and exclusion criteria. We finally enrolled 20 patients. The follow-up time was 6–30 months. In all patients, we recorded the visual analog scale (VAS) score for waist pain and the Oswestry Disability Index (ODI) preoperatively, immediately postoperatively and at the last follow-up. We used the modified MacNab criteria to assess the curative effect at the last follow-up. Results All 20 patients underwent successful operations without complications. No recurrence was observed during follow-up. The VAS score of low back pain was 5.05±1.19 points before surgery, 1.50±051 points immediately after surgery, and 1.10±0.72 points at the last follow-up (P < 0.05 preoperative vs both postoperative). At the last follow-up, the VAS scores of all 20 patients were ≤2, and 4 patients had no pain. The ODI was 46.66±7.03% before surgery, 9.78±4.05% immediately after surgery, and 4.11±3.18% at the last (P < 0.05, preoperative vs both postoperative). According to the evaluation under the modified MacNab standard, the good–excellent rate of clinical efficacy at the last follow-up was 95%. Conclusion Percutaneous endoscopic spinal surgery can significantly improve the symptoms and dysfunction of young patients with DLBP and has little effect on the biomechanical stability of the lumbar spine. This surgery has great clinical application value.
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Affiliation(s)
- Jianan Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Qichang Li
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Yu Du
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Zhengjian Yan
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Liang Chen
- Department of Musculoskeletal Tumor, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People’s Republic of China
| | - Liyuan Wang
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
- Correspondence: Liyuan Wang, Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China, Tel +89-13648380803, Email
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Kim DH, Jeong KW, Jo W, Lee SY, Im JA, Jung JY. Therapeutic effect of intradiscal pulsed radiofrequency on internal disc disruption: A case report. Medicine (Baltimore) 2022; 101:e28831. [PMID: 35147124 PMCID: PMC8830845 DOI: 10.1097/md.0000000000028831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/28/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Discogenic low back pain often persists despite medication and medical intervention. In this study, intradiscal pulsed radiofrequency (PRF) was performed in a patient with discogenic low back pain who did not respond to oral medication, posterior medial branch block, epidural steroid injection, and percutaneous epidural adhesiolysis. PATIENT CONCERNS A 28-year-old woman visited a pain clinic complaining of low back pain that was scored 8 out of 10 on a numerical rating scale. Her pain was present in any position throughout the day and worsened in the sitting position. DIAGNOSES Magnetic resonance imaging showed L5-S1 internal discal disruption. Based on the medical history, physical examination, and magnetic resonance imaging, we determined that her pain originated from the L5-S1 disc. INTERVENTIONS We performed an intradiscal PRF on the affected disc under C-arm fluoroscopy guidance. PRF was performed at 5 Hz, 20-ms pulse width, and 70 V for 15 minutes while ensuring that the electrode tip temperature was maintained below 42°C. OUTCOMES Immediately after the procedure, the patient's pain subsided. At the 1-month follow-up visit, the patient reported complete relief of her low back pain. The Oswestry disability index, which indicates the degree of disability, improved significantly. She also reported that she could sit for long periods because the pain was reduced. No adverse effects from the procedure were found. LESSONS Applying intradiscal PRF seems an effective and safe technique for treating discogenic low back pain.
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Kasch R, Truthmann J, Hancock MJ, Maher CG, Otto M, Nell C, Reichwein N, Bülow R, Chenot JF, Hofer A, Wassilew G, Schmidt CO. Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Spine (Phila Pa 1976) 2022; 47:201-211. [PMID: 34405825 DOI: 10.1097/brs.0000000000004198] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Population-based cohort study. OBJECTIVE We examined associations between common lumbar degenerative changes observed on magnetic resonance imaging (MRI) and present or future low back pain (LBP). SUMMARY OF BACKGROUND DATA The association between lumbar MRI degenerative findings and LBP is unclear. Longitudinal studies are sparse. METHODS Participants (n = 3369) from a population-based cohort study were imaged at study entry, with LBP status measured at baseline and 6-year follow-up. MRI scans were reported on for the presence of a range of MRI findings. LBP status was measured on a 0 to 10 scale. Regression models were used to estimate the cross-sectional and longitudinal associations between individual and multiple MRI findings and LBP severity. Separate longitudinal analyses were conducted for participants with and without baseline pain. RESULTS MRI findings were present in persons with and without back pain at baseline. Higher proportions were found in older age groups. 76.4% of participants had a least one MRI finding and 8.3% had five or more different MRI findings. Cross-sectionally, most MRI findings were slightly more common in those with LBP and pain severity was slightly higher in those with MRI findings (ranging from 0.06 for high intensity zone to 0.83 for spondylolisthesis). In the longitudinal analyses, we found most MRI findings were not associated with future LBP-severity regardless of the presence or absence of baseline pain. Compared to zero MRI findings, having multiple MRI findings (five or more) was associated with mildly greater pain-severity at baseline (0.84; 0.50-1.17) and greater increase in pain-severity over 6 years in those pain free at baseline (1.21; 0.04-2.37), but not in those with baseline pain (-0.30; -0.99 to 0.38). CONCLUSION Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with LBP, with almost all effects less than one unit on a 0 to 10 pain scale.Level of Evidence: 3.
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Affiliation(s)
- Richard Kasch
- Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Julia Truthmann
- Department of Family Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Mark J Hancock
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Markus Otto
- Institute for Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Christopher Nell
- Institute for Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Niklas Reichwein
- Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Robin Bülow
- Institute for Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Jean-François Chenot
- Department of Family Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Andre Hofer
- Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Georgi Wassilew
- Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Carsten Oliver Schmidt
- Department SHIP-KEF, Institute for Community Medicine, University Medicine of Greifswald, Greifswald, Germany
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Nakajima D, Yamashita K, Takeuchi M, Sugiura K, Morimoto M, Tezuka F, Yagi K, Kishima K, Sairyo K. Full-endoscopic Spine Surgery for Discogenic Low Back Pain with High-intensity Zones and Modic Type 1 Change in a Professional Baseball Player. NMC Case Rep J 2022; 8:587-593. [PMID: 35079521 PMCID: PMC8769472 DOI: 10.2176/nmccrj.cr.2021-0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/18/2021] [Indexed: 11/20/2022] Open
Abstract
Non-specific low back pain in athletes can be caused by discogenic back pain, Modic type 1 change, and facet joint arthritis. In this report, we describe a full-endoscopic surgical strategy that we have used to treat a patient with both discogenic pain and Modic type 1 change. The patient was a 32-year-old professional baseball player who played an infield position and had a 2-year history of low back pain. Three years earlier, he had undergone micro-endoscopic discectomy for left herniated nucleus pulposus at L5/S1. His leg symptoms resolved postoperatively, and he returned to playing baseball the following season. However, his low back pain gradually increased. Two years after the initial surgery, he was experiencing low back pain in daily life and found it very difficult to play baseball. Short T1 inversion recovery (STIR) magnetic resonance imaging (MRI) revealed Modic type 1 change and high-signal intensity zones in degenerated discs at L4/5 and L5/S1. Injection of xylocaine 1% reduced the pain temporarily, confirming that the pain generator was at L4/5 and L5/S1. The pathological diagnosis was discogenic pain with Modic type 1 change. We performed full-endoscopic disc cleaning (FEDC) surgery for the Modic type 1 change and thermal annuloplasty (TA) for the discogenic pain at these levels. The patient's low back pain decreased steadily thereafter. Six months after surgery, he returned to baseball, playing for a full season without pain. We have successfully treated a professional baseball player with discogenic pain and Modic type 1 change by full-endoscopic surgery.
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Affiliation(s)
- Daiki Nakajima
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Makoto Takeuchi
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Masatoshi Morimoto
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Kiyoshi Yagi
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Kazuya Kishima
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
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Doktor K, Hartvigsen J, Hancock M, Christensen HW, Fredberg U, Boyle E, Kindt M, Brix L, Jensen TS. Reliability of reporting differences in degenerative MRI findings of the lumbar spine from the supine to the upright position. Skeletal Radiol 2022; 51:2141-2154. [PMID: 35536357 PMCID: PMC9463326 DOI: 10.1007/s00256-022-04060-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the inter-rater reliability of identifying differences and types of differences in lumbar degenerative findings comparing supine and upright MRI. MATERIALS AND METHODS Fifty-nine participants, low back pain patients (LBP) with or without leg pain and no-LBP individuals were consecutively enrolled to receive supine and upright MRI of the lumbar spine. Three raters independently evaluated the MRIs for degenerative spinal pathologies and compared for differences. Presence/absence of degenerative findings were recorded for all supine and upright images, and then differences from the supine to the upright positions were classified into no-change, appeared, disappeared, worsened, or improved at each individual disc level. Reliability and agreement were calculated using Gwet's agreement coefficients (AC1 or AC2) and absolute agreement. RESULTS Inter-rater reliability of evaluating differences in eight degenerative lumbar findings comparing the supine and upright MRI position, ranged from 0.929 to 0.996 according to Gwet's agreement coefficients (AC2). The total number of positive MRI findings in the supine position ranged from 270 to 453, with an average of 366 per rater. Observed differences from supine to upright MRI ranged from 18 to 80, with an average of 56 per rater. CONCLUSION Inter-rater reliability was found overall acceptable for classification of differences in eight types of degenerative pathology observed with supine and upright MRI of the lumbar spine. Results were primarily driven by high numbers and high reliability of rating negative findings, whereas agreement regarding positive findings and positive positional differences was lower.
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Affiliation(s)
- Klaus Doktor
- Department of Sport Sciences and Clinical Biomechanics, Research Unit of Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ,Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark ,Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark
| | - Jan Hartvigsen
- Department of Sport Sciences and Clinical Biomechanics, Research Unit of Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ,Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark
| | - Mark Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | - Ulrich Fredberg
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark ,The Rheumatology Research Unit, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Department of Sport Sciences and Clinical Biomechanics, Research Unit of Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Morten Kindt
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark
| | - Lau Brix
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark ,Department of Procurement and Clinical Engineering, Region Midt, Aarhus, Denmark
| | - Tue Secher Jensen
- Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark ,Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark ,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Teraguchi M, Hashizume H, Oka H, Cheung JPY, Samartzis D, Tamai H, Muraki S, Akune T, Tanaka S, Yoshida M, Yoshimura N, Yamada H. Detailed Subphenotyping of Lumbar Modic Changes and Their Association with Low Back Pain in a Large Population-Based Study: The Wakayama Spine Study. Pain Ther 2021; 11:57-71. [PMID: 34782999 PMCID: PMC8861214 DOI: 10.1007/s40122-021-00337-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/22/2021] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION To examine the association between the five types of Modic changes and low back pain (LBP) in a large population-based cohort. METHODS Of the 952 participants in the second Wakayama Spine Study, 814 (men, 246; women, 568; mean age, 63.6 years) were included in this study. Endplate changes on magnetic resonance imaging were classified according to the Modic classification system. Low back pain (LBP) was defined as continuous back pain for at least 48 h in the past month that is currently present. The prevalence of Modic changes in the lumbar region was assessed. Multivariate logistic regression analysis was conducted to determine the association between detailed subphenotype of Modic change and LBP comparing no Modic change in the lumbar spine and each level, respectively. RESULTS Modic changes throughout the lumbar spine were noted in 63.5% (n = 516) of all participants, with types I, I/II, II, II/III, and III observed in 7.8% (n = 63), 10.8% (n = 88), 40.0% (n = 326), 2.1% (n = 17), and 2.7% (n = 22), respectively. Modic types I/II were associated with LBP [odds ratio (OR): 3.26; 95% confidence interval (CI) 1.9, 5.5]. Furthermore, Modic type I/II changes at L2/3 and L4/5 were significantly associated with LBP (odds ratio: 2.77; 95% CI 1.04, 7.39 at L2/3; odds ratio: 2.86; 95% CI 1.39, 5.90 at L4/5). CONCLUSIONS Type I/II Modic changes in the lumbar region are significantly associated with LBP. To the best of our knowledge, this is the first large population-based study on the association between various Modic changes and LBP.
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Affiliation(s)
- Masatoshi Teraguchi
- Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi Town, Ito, Wakayama, Japan.
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, Faculty of Medicine, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hidenobu Tamai
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Toru Akune
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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Wang ZX, Hu YG. Imaging Analysis of the High-Intensity Zone on Lumbar Spine Magnetic Resonance Images: Classification, Features and Correlation with Low Back Pain. J Pain Res 2021; 14:2981-2989. [PMID: 34588808 PMCID: PMC8473715 DOI: 10.2147/jpr.s332509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/10/2021] [Indexed: 11/23/2022] Open
Abstract
Aim Early studies suggested that the high-intensity zone (HIZ) on lumbar MRI was a diagnostic sign of painful internal disc disruption (IDD). However, recent studies have questioned its diagnostic value. This study is conducted to explore imaging features of HIZ and to investigate the correlation between these characteristics and low back pain (LBP), further studying the predictive value of HIZ. Methods A retrospective study of 1188 cases was performed. MR images were read and analyzed by two experienced, blinded radiologists. Results A total of 575 (48.4%) individuals exhibited HIZ. The prevalence of posterior HIZ (32.3%) was significantly higher than that of anterior HIZ (23.6%; P < 0.01). Round type was the most common shape (61.0%) on sagittal view. Only 37 HIZs (4.6%) were identified on axial views. A total of 263 HIZ discs (32.5%) were found to have additional diagnostic signs of IDD, which is difficult to distinguish from the annulus fibrosus. In subjects with consecutive slides showing HIZ, the incidence of LBP was significantly higher than in single-slide HIZ individuals (58.0% vs 48.6%, P < 0.05). Conclusion MRI-visualized HIZ is a highly valuable method of screening for lumbar IDD. It is demonstrated that consecutive-slide HIZ was a more reliable indicator for discogenic LBP than single-slide HIZ.
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Affiliation(s)
- Zi-Xuan Wang
- Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao, People's Republic of China
| | - You-Gu Hu
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
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Pelled G, Salas MM, Han P, Gill HE, Lautenschlager KA, Lai TT, Shawver CM, Hoch MB, Goff BJ, Betts AM, Zhou Z, Lynch C, Schroeder G, Bez M, Maya MM, Bresee C, Gazit Z, McCallin JP, Gazit D, Li D. Intradiscal quantitative chemical exchange saturation transfer MRI signal correlates with discogenic pain in human patients. Sci Rep 2021; 11:19195. [PMID: 34584114 PMCID: PMC8478892 DOI: 10.1038/s41598-021-97672-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/22/2021] [Indexed: 12/13/2022] Open
Abstract
Low back pain (LBP) is often a result of a degenerative process in the intervertebral disc. The precise origin of discogenic pain is diagnosed by the invasive procedure of provocative discography (PD). Previously, we developed quantitative chemical exchange saturation transfer (qCEST) magnetic resonance imaging (MRI) to detect pH as a biomarker for discogenic pain. Based on these findings we initiated a clinical study with the goal to evaluate the correlation between qCEST values and PD results in LBP patients. Twenty five volunteers with chronic low back pain were subjected to T2-weighted (T2w) and qCEST MRI scans followed by PD. A total of 72 discs were analyzed. The average qCEST signal value of painful discs was significantly higher than non-painful discs (p = 0.012). The ratio between qCEST and normalized T2w was found to be significantly higher in painful discs compared to non-painful discs (p = 0.0022). A receiver operating characteristics (ROC) analysis indicated that qCEST/T2w ratio could be used to differentiate between painful and non-painful discs with 78% sensitivity and 81% specificity. The results of the study suggest that qCEST could be used for the diagnosis of discogenic pain, in conjunction with the commonly used T2w scan.
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Affiliation(s)
- Gadi Pelled
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Margaux M Salas
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- 59th Medical Wing Air Force, San Antonio, TX, 78236, USA
| | - Pei Han
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Biomedical Research Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Howard E Gill
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Karl A Lautenschlager
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Tristan T Lai
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Cameron M Shawver
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Matthew B Hoch
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Brandon J Goff
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Aaron M Betts
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Zhengwei Zhou
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Biomedical Research Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Cody Lynch
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Biomedical Research Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Grant Schroeder
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Maxim Bez
- Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
| | - Marcel M Maya
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Catherine Bresee
- Biostatistics and Bioinformatics Research Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Zulma Gazit
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - John P McCallin
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Dan Gazit
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Faculty of Dental Medicine, Hebrew University, 91120, Jerusalem, Israel
| | - Debiao Li
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Biomedical Research Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, 90095, USA
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Bartynski WS, Agarwal V, Khan AS, Bandos AI. Motion Characteristics of the Functional Spinal Unit During Lumbar Disc Injection (Discography) Including Comparison Between Normal and Degenerative Levels. PAIN MEDICINE 2021; 22:1735-1742. [PMID: 33823017 DOI: 10.1093/pm/pnab121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE While provocation lumbar discography has been used to identify discs responsible for low back pain, the biomechanical effects of disc injection have received little attention. The purpose of this study was to assess the motion of the functional spinal unit including the endplate and facet/pedicle region during disc injection including comparison between normal and degenerative discs. SUBJECTS Subjects represent 91 consecutive patients referred for discography with chronic low back pain. METHODS Lateral projection vertebral motion was retrospectively analyzed at 232 levels (normal: 76 [32.8%], degenerative: 156 [67.2%]). Pre- and postinjection fluoroscopic images were size scaled, and lower endplates were superimposed on separate PowerPoint images. Upper endplate and facet/pedicle motion was separately and independently analyzed on toggled PowerPoint images, subjectively graded as prominent, intermediate, questionable/uncertain, or no motion. Disc morphology was graded using the anteroposterior/lateral postinjection disc appearance (Adams criteria). RESULTS Prominent or intermediate endplate and facet/pedicle motion was identified at most lumbar levels with substantial overall agreement (degenerative: κ = 0.93, 95% confidence intervals [CI] = 0.87-1.00; normal: κ = 0.80, 95% CI = 0.61-1.00). Degenerative levels were strongly associated with a lower degree of endplate and facet/pedicle motion compared with normal: ("prominent" motion grade: endplate: 61% [95/156] vs 89% [68/76], P < 0.001; facet/pedicle: 60% [93/156] vs 88% [67/76], P < 0.001). CONCLUSION Disc injection expands the disc space inducing endplate motion, pedicle motion, and facet translation in almost all normal and most degenerate levels. Disc injection therefore biomechanically "provokes" the entire functional spinal unit. When provoked pain is encountered during lumbar discography, contribution from the associated facet joint and myotendinous insertions should be considered.
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Affiliation(s)
| | - Vikas Agarwal
- Department of Radiology, Division of Neuroradiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Abdullah S Khan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andriy I Bandos
- Department or Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Latif R, Imran S, Ahmad I, Ilyas MS, Aziz A, Zehra U. Vertebral Endplate Changes Correlate with Presence of Cartilaginous Endplate in the Herniated Disc Tissue: Factor Predicting Failure of Conservative Treatment. Asian Spine J 2021; 16:212-220. [PMID: 34461689 PMCID: PMC9066261 DOI: 10.31616/asj.2021.0106] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/02/2021] [Indexed: 12/28/2022] Open
Abstract
Study Design Cross-sectional comparative. Purpose To characterize the scores of disc degeneration, inflammation, and nerve density in herniated disc samples and associate findings with the presence of vertebral endplate (VEP) changes on magnetic resonance imaging (MRI). Overview of Literature Considering the role of disc composition in spontaneous regression and persistence of pain during conservative management, it is important to identify the influencing factors. VEP changes are highly associated with disc degeneration, but their correlation with herniated disc composition has not yet been reported. Methods Fifty-one discs were obtained from patients undergoing surgery for herniated disc. Their ages ranged from 19–65 years, and 31/51 were male. Pre-surgical T1 and T2 weighted lumbar-spine MRIs were analyzed to observe Pfirrmann grade, VEP defects, herniation type, Modic changes, and high-intensity zones (HIZ) at the affected level. Five-micron thick sections were stained with hematoxylin and eosin, Alcian blue periodic acid–Schiff stain; examined for histological degeneration scores (HDS; 0–15), inflammation (0 [absence]–3 [severe]), and presence of cartilaginous endplate (CEP). Three-micron thick sections were stained with protein-gene-product 9.5 and expression was counted/mm2. Data was analyzed, and p<0.05 was considered to indicate statistical significance. Results VEP defects, Modic changes, and HIZ were respectively observed in 30/51, 16/51, and 6/51 of the samples. CEP was observed in 26/51 samples and in 23/51 with endplate defects. Discs with adjacent VEP defects showed increased HDS (p<0.001) and inflammation (p<0.001). Discs with adjacent Modic changes also revealed increased HDS (p=0.01). Histological sections with CEP showed increased HDS (p<0.001) and inflammation (p<0.001), and nerve density was significantly positively correlated with HDS (r=0.27, p=0.02). Conclusions VEP changes can modulate degeneration and inflammation of herniated discs. Presence of these changes is highly predictive of the occurrence of CEP in herniated discs, which leads to slow resorption and persistent clinical symptoms.
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Affiliation(s)
- Rabia Latif
- Department of Anatomy, University of Health Sciences Lahore, Lahore, Pakistan
| | - Sumera Imran
- Department of Anatomy, University of Health Sciences Lahore, Lahore, Pakistan
| | - Ijaz Ahmad
- Department of Orthopedics & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Muhammad Saad Ilyas
- Department of Orthopedics & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Amer Aziz
- Department of Orthopedics & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Uruj Zehra
- Department of Anatomy, University of Health Sciences Lahore, Lahore, Pakistan
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Yoo BR, Son S, Lee SG, Kim WK, Jung JM. Factors Predicting the Clinical Outcome After Trans-sacral Epiduroscopic Laser Decompression for Lumbar Disc Herniation. Neurospine 2021; 18:336-343. [PMID: 34218614 PMCID: PMC8255758 DOI: 10.14245/ns.2040824.412] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/21/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Previous literatures have demonstrated widely variable clinical results after transsacral epiduroscopic laser decompression (SELD) and the factors predicting outcomes are not yet established. Therefore, we analyzed the clinical outcome and associated predictive factors of SELD in patients with lumbar disc herniation.
Methods Between 2015 and 2018, 82 patients who underwent single-level SELD and followed up at least 6 months were enrolled. The overall success rate (excellent or good results at final follow-up) was 58.5% according to Odom’s criteria. Based on this result, patients were divided to 2 groups: a favorable group (n = 48) and an unfavorable group (n = 34). A retrospective review of the baseline characteristics and clinical outcome were conducted to reveal the predictive factors.
Results As expected, improvement of pain and patient satisfaction, was more favorable in the favorable group (p < 0.05). Moreover, the rate of additional procedure was lower in the favorable group (4.2%, 2 of 48 patients) than in the unfavorable group (35.3%, 12 of 34 patients) (p = 0.011). Among the various baseline characteristics, the only significant predictive factor for favorable outcome was the presence of a high-intensity zone (HIZ) on preoperative magnetic resonance imaging (50.0% [24 of 48 patients] in the favorable group vs. 11.8% [4 of 34 patients] in the unfavorable group; odds ratio, 15.67; p = 0.024).
Conclusion Although SELD for lumbar disc herniation resulted in a less favorable clinical outcome than that reported in previous studies, in patients with a HIZ, SELD can be an effective minimally invasive surgery to relieve low back pain and/or leg pain.
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Affiliation(s)
- Byung Rhae Yoo
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seong Son
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sang Gu Lee
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jong Myung Jung
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Deneuville JP, Yushchenko M, Vendeuvre T, Germaneau A, Billot M, Roulaud M, Sarracanie M, Salameh N, Rigoard P. Quantitative MRI to Characterize the Nucleus Pulposus Morphological and Biomechanical Variation According to Sagittal Bending Load and Radial Fissure, an ex vivo Ovine Specimen Proof-of-Concept Study. Front Bioeng Biotechnol 2021; 9:676003. [PMID: 34178965 PMCID: PMC8220087 DOI: 10.3389/fbioe.2021.676003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background and context: Low back pain is a dramatic burden worldwide. Discography studies have shown that 39% of chronic low back pain patients suffer from discogenic pain due to a radial fissure of intervertebral disc. This can have major implications in clinical therapeutic choices. The use of discography is restricted because of its invasiveness and interest in it remains low as it represents a static condition of the disc morphology. Magnetic Resonance Imaging (MRI) appears to be less invasive but does not describe the biomechanical dynamic behavior of the fissure. Purpose: We aimed to seek a quantitative MRI protocol combined with ex vivo sagittal loading to analyze the morphological and biomechanical changes of the intervertebral disc structure and stress distribution. Study design: Proof of concept. Methods: We designed a proof-of-concept ovine study including 3 different 3.0 T-MRI sequences (T2-weighted, T1 and T2 mapping). We analyzed 3 different mechanical states (neutral, flexion and extension) on a fresh ovine spine specimen to characterize an intervertebral disc before and after puncturing the anterior part of the annulus fibrosus. We used a mark tracking method to calculate the bending angles and the axial displacements of the discal structures. In parallel, we created a finite element model to calculate the variation of the axial stress and the maximal intensity shear stress, extrapolated from our experimental boundary conditions. Results: Thanks to an original combination of specific nuclear relaxation time quantifications (T1, T2) of the discal tissue, we characterized the nucleus movement/deformation into the fissure according to the synchronous mechanical load. This revealed a link between disc abnormality and spine segment range of motion capability. Our finite element model highlighted significant variations within the stress distribution between intact and damaged disc. Conclusion: Quantitative MRI appears to provide a new opportunity to characterize intra-discal structural morphology, lesions and stress changes under the influence of mechanical load. This preliminary work could have substantial implications for non-invasive disc exploration and could help to validate novel therapies for disc treatment.
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Affiliation(s)
- Jean-Philippe Deneuville
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France.,Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France
| | - Maksym Yushchenko
- Department of Biomedical Engineering, Center for Adaptable MRI Technology (AMT Center), University of Basel, Allschwil, Switzerland
| | - Tanguy Vendeuvre
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France.,Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France.,Department of Spine, Neuromodulation and Rehabilitation, Poitiers University Hospital, Poitiers, France
| | - Arnaud Germaneau
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Mathieu Sarracanie
- Department of Biomedical Engineering, Center for Adaptable MRI Technology (AMT Center), University of Basel, Allschwil, Switzerland
| | - Najat Salameh
- Department of Biomedical Engineering, Center for Adaptable MRI Technology (AMT Center), University of Basel, Allschwil, Switzerland
| | - Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France.,Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France.,Department of Spine, Neuromodulation and Rehabilitation, Poitiers University Hospital, Poitiers, France
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Le Maitre CL, Dahia CL, Giers M, Illien‐Junger S, Cicione C, Samartzis D, Vadala G, Fields A, Lotz J. Development of a standardized histopathology scoring system for human intervertebral disc degeneration: an Orthopaedic Research Society Spine Section Initiative. JOR Spine 2021; 4:e1167. [PMID: 34337340 PMCID: PMC8313169 DOI: 10.1002/jsp2.1167] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Histopathological analysis of intervertebral disc (IVD) tissues is a critical domain of back pain research. Identification, description, and classification of attributes that distinguish abnormal tissues form a basis for probing disease mechanisms and conceiving novel therapies. Unfortunately, lack of standardized methods and nomenclature can limit comparisons of results across studies and prevent organizing information into a clear representation of the hierarchical, spatial, and temporal patterns of IVD degeneration. Thus, the following Orthopaedic Research Society (ORS) Spine Section Initiative aimed to develop a standardized histopathology scoring scheme for human IVD degeneration. METHODS Guided by a working group of experts, this prospective process entailed a series of stages that consisted of reviewing and assessing past grading schemes, surveying IVD researchers globally on current practice and recommendations for a new grading system, utilizing expert opinion a taxonomy of histological grading was developed, and validation performed. RESULTS A standardized taxonomy was developed, which showed excellent intra-rater reliability for scoring nucleus pulposus (NP), annulus fibrosus (AF), and cartilaginous end plate (CEP) regions (interclass correlation [ICC] > .89). The ability to reliably detect subtle changes varied by IVD region, being poorest in the NP (ICC: .89-.95) where changes at the cellular level were important, vs the AF (ICC: .93-.98), CEP (ICC: .97-.98), and boney end plate (ICC: .96-.99) where matrix and structural changes varied more dramatically with degeneration. CONCLUSIONS The proposed grading system incorporates more comprehensive descriptions of degenerative features for all the IVD sub-tissues than prior criteria. While there was excellent reliability, our results reinforce the need for improved training, particularly for novice raters. Future evaluation of the proposed system in real-world settings (eg, at the microscope) will be needed to further refine criteria and more fully evaluate utility. This improved taxonomy could aid in the understanding of IVD degeneration phenotypes and their association with back pain.
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Affiliation(s)
| | - Chitra L. Dahia
- Orthopaedic Soft Tissue Research ProgramHospital for Special SurgeryNew YorkNew YorkUSA
- Department of Cell and Developmental BiologyWeill Cornell Medicine, Graduate School of Medical SciencesNew YorkNew YorkUSA
| | - Morgan Giers
- School of Chemical, Biological, and Environmental EngineeringOregon State UniversityCorvallisOregonUSA
| | | | - Claudia Cicione
- Laboratory of Regenerative Orthopaedics, Department of Orthopaedic and Trauma SurgeryCampus Bio‐Medico University of RomeRomeItaly
| | - Dino Samartzis
- Department of Orthopaedic SurgeryRush University Medical CenterChicagoIllinoisUSA
- International Spine Research and Innovation InitiativeRush University Medical CenterChicagoIllinoisUSA
| | - Gianluca Vadala
- Laboratory of Regenerative Orthopaedics, Department of Orthopaedic and Trauma SurgeryCampus Bio‐Medico University of RomeRomeItaly
| | - Aaron Fields
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | - Jeffrey Lotz
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
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Wang ZX, Hou ZT, Hu YG. Anterior High-Intensity Zone in Lumbar Discs: Prevalence and Association with Low Back Pain. PAIN MEDICINE 2021; 21:2111-2116. [PMID: 32951055 DOI: 10.1093/pm/pnaa236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To explore the features of high-intensity zone (HIZ) in anterior annulus fibrosus and assess the association of anterior HIZ with low back pain (LBP). DESIGN, SETTING, AND SUBJECTS A retrospective study of 5,940 discs in 1,188 individuals was conducted. METHODS Subjects' information and LBP symptoms confirmed by an orthopedic surgeon were acquired from the medical record. Magnetic resonance (MR) image reading and analysis were performed by two experienced blinded radiologists. RESULTS Two hundred eighty individuals exhibited 355 anterior HIZs in 355 discs. The prevalence was 23.57%; 88.45% were located in the inferior part of the annulus fibrosus. It frequently occurred in the middle and upper segments of lumbar spine, especially at L3/4 (45.63%). Of the 355 anterior HIZs, only 79 (22.25%) were consecutive-slides HIZ. Round type (63.38%) was the most common shape of anterior HIZs. The highest prevalence was found in individuals aged 60-69 years. LBP was confirmed in 141 anterior-HIZ individuals. The incidence of LBP in anterior-HIZ individuals was significantly higher than in non-HIZ subjects (50.36% vs 35.24%, χ2 = 18.314, P < 0.001). CONCLUSIONS Anterior HIZ is a lower-prevalence, age-related sign on lumbar MR images. The spatial distribution of anterior HIZ can be distinguished from posterior HIZ. The number of consecutive anterior HIZ slides might suggest fewer Dallas grade 4 anterior annular disruptions in this sample. Anterior HIZ was correlated with LBP.
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Affiliation(s)
- Zi-Xuan Wang
- Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Zeng-Tao Hou
- Department of Orthopedics, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - You-Gu Hu
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Lai MKL, Cheung PWH, Samartzis D, Karppinen J, Cheung KMC, Cheung JPY. The profile of the spinal column in subjects with lumbar developmental spinal stenosis. Bone Joint J 2021; 103-B:725-733. [PMID: 33789478 DOI: 10.1302/0301-620x.103b4.bjj-2020-1792.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS The aim of this study was to determine the differences in spinal imaging characteristics between subjects with or without lumbar developmental spinal stenosis (DSS) in a population-based cohort. METHODS This was a radiological analysis of 2,387 participants who underwent L1-S1 MRI. Means and ranges were calculated for age, sex, BMI, and MRI measurements. Anteroposterior (AP) vertebral canal diameters were used to differentiate those with DSS from controls. Other imaging parameters included vertebral body dimensions, spinal canal dimensions, disc degeneration scores, and facet joint orientation. Mann-Whitney U and chi-squared tests were conducted to search for measurement differences between those with DSS and controls. In order to identify possible associations between DSS and MRI parameters, those who were statistically significant in the univariate binary logistic regression were included in a multivariate stepwise logistic regression after adjusting for demographics. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported where appropriate. RESULTS Axial AP vertebral canal diameter (p < 0.001), interpedicular distance (p < 0.001), AP dural sac diameter (p < 0.001), lamina angle (p < 0.001), and sagittal mid-vertebral body height (p < 0.001) were significantly different between those identified as having DSS and controls. Narrower interpedicular distance (OR 0.745 (95% CI 0.618 to 0.900); p = 0.002) and AP dural sac diameter (OR 0.506 (95% CI 0.400 to 0.641); p < 0.001) were associated with DSS. Lamina angle (OR 1.127 (95% CI 1.045 to 1.214); p = 0.002) and right facet joint angulation (OR 0.022 (95% CI 0.002 to 0.247); p = 0.002) were also associated with DSS. No association was observed between disc parameters and DSS. CONCLUSION From this large-scale cohort, the canal size is found to be independent of body stature. Other than spinal canal dimensions, abnormal orientations of lamina angle and facet joint angulation may also be a result of developmental variations, leading to increased likelihood of DSS. Other skeletal parameters are spared. There was no relationship between DSS and soft tissue changes of the spinal column, which suggests that DSS is a unique result of bony maldevelopment. These findings require validation in other ethnicities and populations. Level of Evidence: I (diagnostic study) Cite this article: Bone Joint J 2021;103-B(4):725-733.
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Affiliation(s)
- Marcus Kin Long Lai
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, USA
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital, Finnish Institute of Occupational Health, Oulu, Finland
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Harada GK, Tao Y, Louie PK, Basques BA, Galbusera F, Niemeyer F, Wilke HJ, Goldberg E, An HS, Samartzis D. Cervical spine MRI phenotypes and prediction of pain, disability and adjacent segment degeneration/disease after ACDF. J Orthop Res 2021; 39:657-670. [PMID: 32159238 DOI: 10.1002/jor.24658] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
Degenerative spine imaging findings have been extensively studied in the lumbar region and are associated with pain and adverse clinical outcomes after surgery. However, few studies have investigated the significance of these imaging "phenotypes" in the cervical spine. Patients with degenerative cervical spine pathology undergoing anterior cervical discectomy and fusion (ACDF) from 2008 to 2015 were retrospectively and prospectively assessed using preoperative MRI for disc degeneration, narrowing, and displacement, high-intensity zones, endplate abnormalities, Modic changes, and osteophyte formation from C2-T1. Points were assigned for these phenotypes to generate a novel Cervical Phenotype Index (CPI). Demographics were evaluated for association with phenotypes and the CPI using forward stepwise regression. Bootstrap sampling and multiple imputations assessed phenotypes and the CPI in association with patient-reported outcomes (Neck Disability Index [NDI], Visual Analog Scale [VAS]-neck, VAS-arm) and adjacent segment degeneration (ASDeg) and disease (ASDz). Of 861 patients, disc displacement was the most common (99.7%), followed by osteophytes (92.0%) and endplate abnormalities (57.3%). Most findings were associated with age and were identified at similar cervical vertebral levels; at C5-C7. Imaging phenotypes demonstrated both increased and decreased associations with adverse patient-reported outcomes and ASDeg/Dz. However, the CPI consistently predicted worse NDI (P = .012), VAS-neck (P = .007), and VAS-arm (P = .013) scores, in addition to higher odds of ASDeg (P = .002) and ASDz (P = .004). The CPI was significantly predictive of postoperative symptoms of pain/disability and ASDeg/Dz after ACDF, suggesting that the totality of degenerative findings may be more clinically relevant than individual phenotypes and that this tool may help prognosticate outcomes after surgery.
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Affiliation(s)
- Garrett K Harada
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois
| | - Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois
| | | | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Edward Goldberg
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois
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Amirdelfan K, Bae H, McJunkin T, DePalma M, Kim K, Beckworth WJ, Ghiselli G, Bainbridge JS, Dryer R, Deer TR, Brown RD. Allogeneic mesenchymal precursor cells treatment for chronic low back pain associated with degenerative disc disease: a prospective randomized, placebo-controlled 36-month study of safety and efficacy. Spine J 2021; 21:212-230. [PMID: 33045417 DOI: 10.1016/j.spinee.2020.10.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT PURPOSE Evaluate the safety and efficacy of a single intradiscal injection of STRO-3+ adult allogeneic mesenchymal precursor cells (MPCs) combined with hyaluronic acid (HA) in subjects with chronic low back pain (CLBP) associated with degenerative disc disease (DDD) through 36-month follow-up. STUDY DESIGN/SETTING A multicenter, randomized, controlled study conducted at 13 clinical sites (12 in the United States and 1 in Australia). SUBJECT SAMPLE A total of 100 subjects with chronic low back pain associated with moderate DDD (modified Pfirrmann score of 3-6) at one level from L1 to S1 for at least 6 months and failing 3 months of conservative treatment, including physical therapy were randomized in a 3:3:2:2 ratio to receive 6 million MPCs with HA, 18 million MPCs with HA, HA vehicle control, or saline control (placebo) treatment. OUTCOME MEASURES Subjects were clinically and radiographically evaluated at 1, 3, 6, 12, 24, and 36 months postinjection. Subject-reported outcomes including adverse events, LBP on a Visual Analog Scale (VAS), Oswestry Disability Index (ODI), SF-36 and Work Productivity and Activity Index were collected. METHODS Clinical and radiographic measures were collected at each visit. All randomized subjects were included in the safety assessments and analyzed based on the treatment received. Safety assessments included assessments of AEs, physical and radiographic examinations and laboratory testing. Efficacy assessments evaluated changes in VAS, ODI, and modified Pfirrmann (MP) scores between all active and control groups, respectively. Assessments included least squares mean (Mean), LS mean change from baseline (Mean Change) and responder analyses in order to assess the clinical significance of observed changes from baseline. The population for efficacy assessments was adjusted for the confounding effects of post-treatment interventions (PTIs). This study was conducted under an FDA Investigational New Drug application sponsored and funded by Mesoblast. RESULTS There were significant differences between the control and MPC groups for improvement in VAS and ODI. The PTI-corrected VAS and ODI Means and Mean Change analyses; the proportion of subjects with VAS ≥30% and ≥50% improvement from baseline; absolute VAS score ≤20; and ODI reduction ≥10 and ≥15 points from baseline showed MPC therapy superior to controls at various time points through 36 months. Additionally, the proportion of subjects achieving the minimally important change and clinically significant change composite endpoints for the MPC groups was also superior compared with controls at various time points from baseline to 36 months. There were no significant differences in change in MP score from baseline across the groups. There were also no statistically significant differences in change in modified MP score at the level above or below the level treated between study arms. Both the procedure and treatment were well tolerated and there were no clinical symptoms of immune reaction to allogeneic MPCs. There was a low rate of Treatment Emergent Adverse Events (TEAEs) and Serious Adverse Events, and the rates of these events in the MPC groups were not significantly different from the control groups. One TEAE of severe back pain was possibly related to study agent and one TEAE of implantation site infection was considered to be related to the study procedure. CONCLUSIONS Results provide evidence that intradiscal injection of MPCs could be a safe, effective, durable, and minimally invasive therapy for subjects who have CLBP associated with moderate DDD.
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Affiliation(s)
- Kasra Amirdelfan
- IPM Medical Group, Inc., 450 Wiget Lane, Walnut Creek, CA 94598, USA.
| | - Hyun Bae
- The Spine Institute, 2811 Wilshire Blvd, Suite 850, Santa Monica, CA 90403, USA
| | - Tory McJunkin
- Arizona Pain Specialists, 9787 N. 91st St, Suite 101, Scottsdale, AZ 85258, USA
| | - Michael DePalma
- Virginia Spine Research Institute, Inc., 9020 Stony Point Parkway, Suite 140, Richmond, VA 23235, USA
| | - Kee Kim
- UC Davis Spine Center, 3301 C St, Suite 1500, Sacramento, CA 95816, USA
| | - William J Beckworth
- Department of Orthopaedics, Emory University School of Medicine, 59 Executive Park South, Suite 3000, Atlanta, GA 30329, USA
| | - Gary Ghiselli
- Denver Spine, 7800 E. Orchard Rd, Suite 100, Greenwood Village, CO 80111, USA
| | | | - Randall Dryer
- Central Texas Spine Institute, 6818 Austin Center Blvd, Suite 200, Austin, TX 78731, USA
| | - Timothy R Deer
- The Center for Pain Relief, Inc., 400 Court St, Suite 100, Charleston, WV 25301, USA
| | - Roger D Brown
- Mesoblast Inc., 12912 Hill Country Blvd, Building F, Suite 230, Bee Cave, TX 78738, USA
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Lai MKL, Cheung PWH, Samartzis D, Karppinen J, Cheung KMC, Cheung JPY. Clinical implications of lumbar developmental spinal stenosis on back pain, radicular leg pain, and disability. Bone Joint J 2021; 103-B:131-140. [PMID: 33380193 DOI: 10.1302/0301-620x.103b1.bjj-2020-1186.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To study the associations of lumbar developmental spinal stenosis (DSS) with low back pain (LBP), radicular leg pain, and disability. METHODS This was a cross-sectional study of 2,206 subjects along with L1-S1 axial and sagittal MRI. Clinical and radiological information regarding their demographics, workload, smoking habits, anteroposterior (AP) vertebral canal diameter, spondylolisthesis, and MRI changes were evaluated. Mann-Whitney U tests and chi-squared tests were conducted to search for differences between subjects with and without DSS. Associations of LBP and radicular pain reported within one month (30 days) and one year (365 days) of the MRI, with clinical and radiological information, were also investigated by utilizing univariate and multivariate logistic regressions. RESULTS Subjects with DSS had higher prevalence of radicular leg pain, more pain-related disability, and lower quality of life (all p < 0.05). Subjects with DSS had 1.5 (95% confidence interval (CI) 1.0 to 2.1; p = 0.027) and 1.8 (95% CI 1.3 to 2.6; p = 0.001) times higher odds of having radicular leg pain in the past month and the past year, respectively. However, DSS was not associated with LBP. Although, subjects with a spondylolisthesis had 1.7 (95% CI 1.1 to 2.5; p = 0.011) and 2.0 (95% CI 1.2 to 3.2; p = 0.008) times greater odds to experience LBP in the past month and the past year, respectively. CONCLUSION This large-scale study identified DSS as a risk factor of acute and chronic radicular leg pain. DSS was seen in 6.9% of the study cohort and these patients had narrower spinal canals. Subjects with DSS had earlier onset of symptoms, more severe radicular leg pain, which lasted for longer and were more likely to have worse disability and poorer quality of life. In these patients there is an increased likelihood of nerve root compression due to a pre-existing narrowed canal, which is important when planning surgery as patients are likely to require multi-level decompression surgery. Cite this article: Bone Joint J 2021;103-B(1):131-140.
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Affiliation(s)
- Marcus Kin Long Lai
- Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, Hong Kong
| | | | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, Illinois, USA
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | | | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, Hong Kong
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50
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Son S, Lee SG, Kim WK, Ahn Y, Jung JM. Disc height discrepancy between supine and standing positions as a screening metric for discogenic back pain in patients with disc degeneration. Spine J 2021; 21:71-79. [PMID: 32687982 DOI: 10.1016/j.spinee.2020.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The diagnosis of discogenic low back pain (LBP) from disc degeneration of the lumbar spine is often evaluated with discography. Noninvasive, simple screening methods other than invasive discography are useful, as evidence supporting clinical findings and magnetic resonance imaging (MRI) have come to the forefront. PURPOSE To investigate disc height (DH) discrepancy between supine and standing positions on simple radiography to clarify its clinical screening value in individuals with discogenic LBP. STUDY DESIGN/SETTINGS Retrospective matched cohort design. PATIENT SAMPLE Ninety-two patients with early to middle stage disc degeneration (Pfirrmann grade II, III, or IV). OUTCOME MEASURES Each subject underwent simple radiographs and MRI. Baseline characteristics, including demographic data and MRI findings, and radiological findings, including DH discrepancy, segmental angle, and sagittal balance, were analyzed. DH discrepancy ratio was calculated as (1 - [calibrated DH on standing radiography/calibrated DH on supine radiography]) × 100%. METHODS We matched LBP group of 46 patients with intractable discogenic pain (≥7 of visual analog scale scores) confirmed by discography with control group of 46 patients with similar stage disc degeneration with mild LBP (≤4 of visual analog scale scores). Binary regression analysis, receiver operating characteristic curve analysis, and cut-off value for diagnosis were used to evaluate and clarify diagnostic value of various factors. RESULTS There was no significant difference between the two groups in terms of baseline characteristics, including age, sex, body mass index, pathological level, and magnetic resonance findings such as disc degeneration, high intensity zone, and para-spinal muscle volume. Among the various radiological findings, the calibrated mean DH in the standing position (20.87±5.65 [LBP group] vs. 26.95±3.02 [control group], p<.001) and the DH discrepancy ratio (14.55±6.13% [LBP group] vs. 1.47±0.75% [control group], p=.007) were significantly different between the two groups. The cut-off value for DH discrepancy ratio to screen discogenic LBP was ≥6.04%. Additionally, as a compensation for pain, sagittal vertical axis (3.43±2.03 cm [LBP group] vs. -0.54±3.05 cm [control group], p=.002) and pelvic incidence (54.74±6.76° [LBP group] vs. 43.98±8.67° [control group]; p=.006) were different between the two groups. CONCLUSIONS The results suggest that DH discrepancy between the supine and standing positions could be a screening metric for discogenic LBP in early to middle stage disc degeneration of the lumbar spine.
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Affiliation(s)
- Seong Son
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Nadong-Gu, Incheon, 21565, South Korea.
| | - Sang Gu Lee
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Nadong-Gu, Incheon, 21565, South Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Nadong-Gu, Incheon, 21565, South Korea
| | - Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Nadong-Gu, Incheon, 21565, South Korea
| | - Jong Myung Jung
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Nadong-Gu, Incheon, 21565, South Korea
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