1
|
Poot-Franco JA, Mena-Balan A, Perez-Navarrete A, Huchim O, Azcorra-Perez H, Mendez-Dominguez N. Association between the Thickness of Lumbar Subcutaneous Fat Tissue and the Presence of Hernias in Adults with Persistent, Non-Traumatic Low Back Pain. Tomography 2024; 10:277-285. [PMID: 38393290 PMCID: PMC10892227 DOI: 10.3390/tomography10020022] [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: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
We aimed to analyze the association between the average lumbar subcutaneous fat tissue thickness (LSFTT) at each intervertebral level and the presence of hernias in patients with low back pain from an insurance network hospital in Mexico. This observational prospective study included 174 patients with non-traumatic lumbago who underwent magnetic resonance imaging with a 1.5T resonator. Two independent radiologists made the diagnosis, and a third specialist provided a quality vote when needed. The sample size was calculated with a 95% confidence interval using random order selection. Anonymized secondary information was used. Percentages and means with confidence intervals were tabulated. The area under the curve, specificity, and sensitivity of LSFTT were calculated. A regression analysis was performed to analyze the presence of hernias with LSFTT using each intervertebral level as a predictor. The odds of herniation at any intervertebral level increased directly with LSFTT. The average LSFTT predicted the overall presence of hernias; however, the LSFTT at each intervertebral level better predicted hernias for each intervertebral space. The area under the curve for LSFTT in predicting hernias was 68%. In conclusion, the average LSFTT was associated with the overall presence of hernias; patients with more hernias had higher LSFTT values.
Collapse
Affiliation(s)
- Jorge Adolfo Poot-Franco
- Facultad de Medicina, Universidad Autónoma de Yucatán, Merida 97000, Mexico;
- Hospital Regional de Alta Especialidad de la Peninsula de Yucatán, IMSS-BIENESTAR, Merida 97300, Mexico
| | | | - Adrian Perez-Navarrete
- Hospital Regional de Alta Especialidad de la Peninsula de Yucatán, IMSS-BIENESTAR, Merida 97300, Mexico
| | - Osvaldo Huchim
- Escuela de Medicina, Universidad Anahuac, Naucalpan 52786, Mexico;
| | - Hugo Azcorra-Perez
- Centro de investigaciones Silvio Zavala, Universidad Modelo, Merida 97305, Mexico;
| | - Nina Mendez-Dominguez
- Hospital Regional de Alta Especialidad de la Peninsula de Yucatán, IMSS-BIENESTAR, Merida 97300, Mexico
| |
Collapse
|
2
|
Mahato NK, Maharaj P, Clark BC. Lumbar Spine Anatomy in Supine versus Weight- Bearing Magnetic Resonance Imaging: Detecting Significant Positional Changes and Testing Reliability of Quantification. Asian Spine J 2024; 18:1-11. [PMID: 38287663 PMCID: PMC10910142 DOI: 10.31616/asj.2023.0203] [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: 06/30/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 01/31/2024] Open
Abstract
STUDY DESIGN Testing between and within group differences and assessing reliability of measurements. PURPOSE To study and compare lumbar spine morphology in supine and weight-bearing (WB) magnetic resonance imaging (MRI). OVERVIEW OF LITERATURE Upright lumbar MRI may uncover anatomical changes that may escape detection when using conventional supine imaging. This study quantified anatomical dimensions of the lumbar spine in the supine and WB MRI, compared specific morphometric differences between them, and tested the intra-rater reliability of the measurements. Repeated measures analysis was used to compare within- and between-session measurements performed on the supine and WB images. Reliability and agreement were assessed by calculating intraclass correlation (ICC) coefficient. METHODS Data from 12 adults without any history of back pain were used in this study. Sagittal T2-weighted images of the lumbar spine were acquired in the supine and WB positions twice (in two separate sessions scheduled within a week). Linear, angular dimensions, and cross-sectional areas (CSAs) were measured using proprietary software. Supine and WB data acquired from the two imaging sessions were tested for intra-rater reliability. Quantified data were normalized for each session to test the significance of differences. ICC was calculated to test the reliability of the measurements. RESULTS Linear, angular, and CSA measurements demonstrated strong within-position (supine and WB) correlations (r -values, 0.75-0.97). Between-position (supine vs. WB) differences were significant for all measured dimensions (p<0.05). Between-session measurements demonstrated a strong correlation (r -values, 0.64-0.83). Calculated ICC showed strong agreement among the measurements. CONCLUSIONS Anatomical dimensions of the lumbar spine may demonstrate consistent and significant differences between supine and WB MRI for specific structural parameters.
Collapse
Affiliation(s)
- Niladri Kumar Mahato
- College of Osteopathic Medicine, Marian University, Indianapolis, IN,
USA
- Ohio Musculoskeletal and Neurological Institute, Athens, OH,
USA
- Department of Biomedical Sciences, Ohio University, Athens, OH,
USA
| | - Paramanand Maharaj
- Department of Radiology, Eric Williams Medical Science Complex, University of the West Indies, St. Augustine,
Trinidad and Tobago
| | - Brian C. Clark
- Ohio Musculoskeletal and Neurological Institute, Athens, OH,
USA
- Department of Biomedical Sciences, Ohio University, Athens, OH,
USA
| |
Collapse
|
3
|
Abhinav K, Jadhav D, Agrawal AK, Agrawal R, Agrawal A. Postoperative Evaluation of Pain and Disability in Patients Undergoing Spinal Discectomy. Cureus 2023; 15:e49963. [PMID: 38179379 PMCID: PMC10765259 DOI: 10.7759/cureus.49963] [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: 08/17/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND A spinal discectomy surgery (SDS) is a common surgical procedure performed to treat lumbosacral radiculopathy. AIM To evaluate postoperative patterns of pain and disability in patients undergoing spinal discectomy. METHODS AND MATERIALS This investigation was a retrospective longitudinal review of prospective information gathered from 543 enrolled patients for lumbar radiculoplasty. The study participants were divided into two categories: Category 1 (SDS) comprising patients of lumbar radiculoplasty managed with SDS (n=270) and Category 2 (non-SDS) comprising patients of lumbar radiculoplasty managed with therapy other than SDS (n=273). It included study participants taking medication for pain control including opioids and non-opioids and physiotherapy for strengthening lower back muscles. At baseline, three months, 12 months, and 24 months after surgery, patient-reported information was gathered. Leg pain magnitude, back pain magnitude, and pain-related impairment were the key outcome metrics of interest. RESULTS The mean postoperative visual analog scale (VAS) score for leg pain at three-month follow-up was 4.3±1.2 in study participants in SDS and 8.1±1.3 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). The mean postoperative VAS score at 12-month follow-up was 2.8±1.1 in study participants in SDS and 7.9±1.5 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). The mean postoperative VAS score at 24-month follow-up was 1.7±1.2 in study participants in SDS and 7.1±1.1 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). CONCLUSION It was observed that after discectomy, patients suffering from lumbar radiculopathy have significant pain and disability recovery. According to these results, only a small percentage of individuals exhibit negative results at the level of impairment.
Collapse
Affiliation(s)
- Kumar Abhinav
- Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, IND
| | - Dikpal Jadhav
- Department of Neurosurgery, King Edward Memorial (KEM) Hospital, Mumbai, IND
| | - Arun Kumar Agrawal
- Department of Neurosurgery, Patna Medical College and Hospital, Patna, IND
| | - Rama Agrawal
- Department of Physiology, Patna Medical College and Hospital, Patna, IND
| | - Ankita Agrawal
- Department of Conservative Dentistry and Endodontics, Buddha Institute of Dental Sciences and Hospital, Patna, IND
| |
Collapse
|
4
|
García Isidro M, Ferreiro Pérez A, Fernández López-Peláez MS, Moeinvaziri M, Fernández García P. Differences in MRI measurements of lateral recesses and foramina in degenerative lumbar segments in upright versus decubitus symptomatic patients. RADIOLOGIA 2023; 65 Suppl 2:S10-S22. [PMID: 37858348 DOI: 10.1016/j.rxeng.2021.01.005] [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: 06/16/2020] [Accepted: 01/11/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate differences in measurements of the lateral recesses and foramina in degenerative lumbar segments on MR images in symptomatic patients obtained with the patient standing versus lying down and to analyze the relationship between possible differences and patients' symptoms. MATERIAL AND METHODS We studied 207 disc levels in 175 patients aged between 17 and 75 years (median: 47 years) with low back pain. All patients underwent MRI in the decubitus position with their legs extended, followed by MRI in the standing position. We calculated the difference in the measurements of the lateral recesses (in mm) and in the foramina (area in mm2 and smallest diameter in mm) obtained in the two positions. To eliminate the effects of possible errors in measurement, we selected cases in which the difference between the measurements obtained in the two positions was ≥10%; we used Student's t-tests for paired samples to analyze the entire group and subgroups of patients according to age, sex, grade of disc degeneration, and postural predominance of symptoms. RESULTS Overall, the measurements of the spaces were lower when patients were standing. For the lateral recesses, we observed differences ≥10% in 68 (33%) right recesses and in 65 (31.5%) left recesses; when patients were standing, decreases were much more common than increases (26% vs. 7%, respectively, on the right side and 24% vs. 7.5%, respectively, on the left side; p < 0.005). For the foramina, decreases in both the area and in the smallest diameter were also more common than increases when patients were standing: on the right side, areas decreased in 23% and increased in 4%, and smallest diameters decreased in 20% and increased 6%; on the left side, areas decreased in 24% and increased in 4%, and smallest diameters decreased in 17% and increased in 8% (p < 0.005). Considering the group of patients in whom the postural predominance of symptoms was known, we found significant differences in patients whose symptoms occurred predominantly or exclusively when standing, but not in the small group of patients whose symptoms occurred predominantly while lying. We found no differences between sexes in the changes in measurements of the recesses or foramina with standing. The differences between the measurements obtained in different positions were significant in patients aged >40 years, but not in younger groups of patients. Differences in relation to the grade of disc degeneration were significant only in intermediate grades (groups 3-6 in the Griffith classification system). CONCLUSION MRI obtained with patients standing can show decreases in the lateral recesses and foramina related to the predominance of symptoms while standing, especially in patients aged >40 years with Griffith disc degeneration grade 3-6, thus providing additional information in the study of patients who have low back pain when standing in whom the findings on conventional studies are inconclusive or discrepant with their symptoms. Further studies are necessary to help better define the value of upright MRI studies for degenerative lumbar disease.
Collapse
Affiliation(s)
- M García Isidro
- Servicio de Radiodiagnóstico, Hospital Universitario de Madrid Montepríncipe, Madrid, Spain.
| | - A Ferreiro Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario de Madrid Montepríncipe, Madrid, Spain
| | | | - M Moeinvaziri
- Servicio de Radiodiagnóstico, Hospital Universitario de Madrid Montepríncipe, Madrid, Spain
| | - P Fernández García
- Servicio de Radiodiagnóstico, Hospital Universitario de Madrid Montepríncipe, Madrid, Spain
| |
Collapse
|
5
|
Shahzadi T, Ali MU, Majeed F, Sana MU, Diaz RM, Samad MA, Ashraf I. Nerve Root Compression Analysis to Find Lumbar Spine Stenosis on MRI Using CNN. Diagnostics (Basel) 2023; 13:2975. [PMID: 37761342 PMCID: PMC10529899 DOI: 10.3390/diagnostics13182975] [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: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Lumbar spine stenosis (LSS) is caused by low back pain that exerts pressure on the nerves in the spine. Detecting LSS is a significantly important yet difficult task. It is detected by analyzing the area of the anteroposterior diameter of the patient's lumbar spine. Currently, the versatility and accuracy of LSS segmentation algorithms are limited. The objective of this research is to use magnetic resonance imaging (MRI) to automatically categorize LSS. This study presents a convolutional neural network (CNN)-based method to detect LSS using MRI images. Radiological grading is performed on a publicly available dataset. Four regions of interest (ROIs) are determined to diagnose LSS with normal, mild, moderate, and severe gradings. The experiments are performed on 1545 axial-view MRI images. Furthermore, two datasets-multi-ROI and single-ROI-are created. For training and testing, an 80:20 ratio of randomly selected labeled datasets is used, with fivefold cross-validation. The results of the proposed model reveal a 97.01% accuracy for multi-ROI and 97.71% accuracy for single-ROI. The proposed computer-aided diagnosis approach can significantly improve diagnostic accuracy in everyday clinical workflows to assist medical experts in decision making. The proposed CNN-based MRI image segmentation approach shows its efficacy on a variety of datasets. Results are compared to existing state-of-the-art studies, indicating the superior performance of the proposed approach.
Collapse
Affiliation(s)
- Turrnum Shahzadi
- Department of Information Technology, University of Gujrat, Gujrat 50700, Pakistan; (T.S.); (F.M.); (M.U.S.)
| | - Muhammad Usman Ali
- Department of Computer Science, University of Gujrat, Gujrat 50700, Pakistan;
| | - Fiaz Majeed
- Department of Information Technology, University of Gujrat, Gujrat 50700, Pakistan; (T.S.); (F.M.); (M.U.S.)
| | - Muhammad Usman Sana
- Department of Information Technology, University of Gujrat, Gujrat 50700, Pakistan; (T.S.); (F.M.); (M.U.S.)
| | - Raquel Martínez Diaz
- Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain;
- Universidad Internacional Iberoamericana, Campeche 24560, Mexico
- Universidad Internacional do Cuanza, Cuito EN250, Bié, Angola
| | - Md Abdus Samad
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea
| | - Imran Ashraf
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea
| |
Collapse
|
6
|
Liu X, Hou Y, Shi H, Zhao T, Sun C, Shi J, Shi G. A retrospective cohort study on the significance of preoperative radiological evaluation of lumbar degenerative diseases for surgical reference. Quant Imaging Med Surg 2023; 13:5100-5108. [PMID: 37581089 PMCID: PMC10423347 DOI: 10.21037/qims-22-1414] [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: 12/20/2022] [Accepted: 04/25/2023] [Indexed: 08/16/2023]
Abstract
Background Radiography has low radiation exposure and the ability to acquire information. Due to its cost-effectiveness and availability, preoperative radiographic imaging examination is considered to be a valuable method to evaluate the condition of patients with spinal disease. The aim of this cohort study is to analyze the impact of evaluating preoperative X-rays on the surgical management of lumbar degenerative diseases (LDD). Methods We reviewed 49 patients with LDD underwent single-level posterior instrumented lumbar fusion (PILF) between November 2017 and October 2022 in this cohort study. The median iliac angle (MIA), iliac crest height, intervertebral facet joint degeneration, lumbosacral angle (LSA), L5/S1 intervertebral space angle (ISA), intervertebral foramen height (IFH) and intervertebral space height (ISH) were measured on preoperative radiographs. In addition, operative time, intraoperative blood loss and postoperative complications were used to evaluate the surgical management. Correlation analysis was used to determine the correlation between preoperative radiographic presentation and surgical managements. Multivariate linear regression analysis was used for determination of risk factors for surgical management. Results Correlation analysis showed that the median iliac angle, height of iliac crest, lumbosacral angle and intervertebral facet joint degeneration were significantly correlated with surgical managements (P<0.05). Height of iliac crest, intervertebral facet joint degeneration and lumbosacral angle were positively correlated with surgical management. Meanwhile, MIA was negatively correlated with surgical management. No significant difference was found between the IFH, ISA, ISH and surgical managements in posterior lumbar surgery (P>0.05). After multiple linear regression analysis, height of iliac crest, median iliac angle and intervertebral facet joint degeneration were independent influence factors for the single-level lumbar surgical managements. Conclusions Some variables measured in radiograph shows that height of iliac crest, median iliac angle and intervertebral facet joint degeneration have a potential influence on surgical managements. The lumbosacral angle was positively associated with surgical management, but it was not statistically significant in multiple linear regression analysis (P>0.05). The above measurements in plain film can reflect the surgical procedure and have some guiding implications for the operation.
Collapse
Affiliation(s)
- Xiaowen Liu
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yang Hou
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hongyang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Tianyi Zhao
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chenxi Sun
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jiangang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Guodong Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
7
|
Weisenthal BW, Glassman SD, Mkorombindo T, Nelson L, Carreon LY. When does CT myelography add value beyond MRI for lumbar degenerative disease? Spine J 2022; 22:787-792. [PMID: 34848342 DOI: 10.1016/j.spinee.2021.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In patients with lumbar spinal stenosis, it is crucial for clinicians to identify all symptomatic levels. Prior studies have demonstrated that CT myelography has a greater sensitivity in revealing stenosis (94.4%) compared to MRI (75.9%). However, this is an invasive test that should be used judiciously. No study has identified subgroups of patients that do or do not benefit from this additional invasive testing. PURPOSE The objective of this study was to identify subgroups of patients with lumbar stenosis for whom CT myelogram could be expected to provide additional information following an MRI scan. STUDY DESIGN Retrospective chart review. PATIENT SAMPLE Consecutive series of patients with lumbar degenerative disease seen at a single multisurgeon tertiary spine center. OUTCOME MEASURES Degree of stenosis on MRI or CT myelo. METHODS Medical records were reviewed to collect standard demographic and surgical data and patient diagnoses. MRI and CT myelo obtained within 6 months of each other in patients >45 years old with a diagnosis of central stenosis, spondylolisthesis or degenerative scoliosis were reviewed. Each lumbar level was recorded as mild, moderate, or severe based on the radiologist's report. Fisher exact test was performed with change in recorded severity of stenosis from MRI to CT myelo as the primary outcome of interest. RESULTS Of 269 patients, 207 (80%) had at least one level of moderate or severe central stenosis on MRI and 62 had mild or no stenosis on MRI. Of the 207, 139 (67%) had multilevel stenosis and 68 (33%) had single level stenosis. CT myelo identified a greater proportion of additional stenotic levels in patients with multilevel stenosis (80/139, 58%) compared to patients with single-level stenosis (27/68, 40%, p=.018). In 62 patients with a clinical diagnosis of lumbar stenosis but no moderate to severe stenosis on MRI, CT myelogram identified three additional stenotic levels (3/65, 5%, p=.836). CONCLUSIONS CT myelography is not as useful in providing additional information in patients with no stenosis or single level stenosis as compared to patients with multilevel stenosis.
Collapse
Affiliation(s)
- Benjamin W Weisenthal
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA
| | - Tino Mkorombindo
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA
| | - Lauren Nelson
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA.
| |
Collapse
|
8
|
Fiani B, Griepp DW, Lee J, Davati C, Moawad CM, Kondilis A. Weight-Bearing Magnetic Resonance Imaging as a Diagnostic Tool That Generates Biomechanical Changes in Spine Anatomy. Cureus 2020; 12:e12070. [PMID: 33489488 PMCID: PMC7805418 DOI: 10.7759/cureus.12070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Weight-bearing magnetic resonance imaging (MRI) is a unique modality in diagnostic imaging that allows for the assessment of spinal pathology in ways considered previously inaccessible or insufficient with the conventional MRI technique. Due to limitations in positioning within the MRI machine itself, difficulties would be posed in determining the underlying cause of a patient’s pain or neurological symptoms, as the traditional supine position utilized can, in many cases, alleviate the severity of presented symptoms. Weight-bearing MRI addresses this concern by allowing a clinician to position a patient (to a certain degree) into flexion, extension, rotation, or side-bending with an axial load that can mimic physiologic conditions in order to replicate the conditions the patient experiences in order to give clinicians a clearer understanding of the anatomical relationship of the spine and surrounding tissues that may lead to a particular presentation of symptoms. These findings can then guide treatment approaches that are better tailored to a patient’s needs in order to initiate treatment earlier and shorten the duration of treatment necessary for patient benefit. The goal of this review is to describe and differentiate weight-bearing MRI from conventional MRI as well as examine the advantages and disadvantages of either imaging modality. This will include assessing cost-effectiveness and improvements in clinical outcomes. Further, the advancements of weight-bearing MRI will be discussed, including potentially unique clinical applications in development.
Collapse
Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Daniel W Griepp
- Neurosurgery, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
| | - Jason Lee
- Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
| | - Cyrus Davati
- Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
| | - Christina M Moawad
- Neurosurgery, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, USA
| | - Athanasios Kondilis
- Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, USA
| |
Collapse
|
9
|
Berry DB, Hernandez A, Onodera K, Ingram N, Ward SR, Gombatto SP. Lumbar spine angles and intervertebral disc characteristics with end-range positions in three planes of motion in healthy people using upright MRI. J Biomech 2019; 89:95-104. [PMID: 31047693 DOI: 10.1016/j.jbiomech.2019.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 12/17/2022]
Abstract
Understanding changes in lumbar spine (LS) angles and intervertebral disc (IVD) behavior in end-range positions in healthy subjects can provide a basis for developing more specific LS models and comparing people with spine pathology. The purposes of this study are to quantify 3D LS angles and changes in IVD characteristics with end-range positions in 3 planes of motion using upright MRI in healthy people, and to determine which intervertebral segments contribute most in each plane of movement. Thirteen people (average age = 24.4 years, range 18-51 years; 9 females; BMI = 22.4 ± 1.8 kg/m2) with no history of low back pain were scanned in an upright MRI in standing, sitting flexion, sitting axial rotation (left, right), prone on elbows, prone extension, and standing lateral bending (left, right). Global and local intervertebral LS angles were measured. Anterior-posterior length of the IVD and location of the nucleus pulposus was measured. For the sagittal plane, lower LS segments contribute most to change in position, and the location of the nucleus pulposus migrated from a more posterior position in sitting flexion to a more anterior position in end-range extension. For lateral bending, the upper LS contributes most to end-range positions. Small degrees of intervertebral rotation (1-2°) across all levels were observed for axial plane positions. There were no systematic changes in IVD characteristics for axial or coronal plane positions.
Collapse
Affiliation(s)
- David B Berry
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Alejandra Hernandez
- Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Keenan Onodera
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Noah Ingram
- Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Samuel R Ward
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA; Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA; Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Sara P Gombatto
- Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA.
| |
Collapse
|
10
|
Kundakci YE, Unver Dogan N, Guler I, Uysal II, Fazliogullari Z, Karabulut AK. Evaluation of the facet joints with magnetic resonance images in the patients with disc degeneration and spondylolisthesis. Surg Radiol Anat 2018; 40:1063-1075. [DOI: 10.1007/s00276-018-2052-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/08/2018] [Indexed: 10/14/2022]
|
11
|
Centeno C, Markle J, Dodson E, Stemper I, Williams CJ, Hyzy M, Ichim T, Freeman M. Treatment of lumbar degenerative disc disease-associated radicular pain with culture-expanded autologous mesenchymal stem cells: a pilot study on safety and efficacy. J Transl Med 2017; 15:197. [PMID: 28938891 PMCID: PMC5610473 DOI: 10.1186/s12967-017-1300-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/14/2017] [Indexed: 12/17/2022] Open
Abstract
Background Degenerative disc disease (DDD) is a common cause of lower back pain with radicular symptoms and has a significant socioeconomic impact given the associated disability. Limited effective conservative therapeutic options result in many turning to surgical alternatives for management, which vary in the rate of success and also carry an increased risk of morbidity and mortality associated with the procedures. Several animal based studies and a few human pilot studies have demonstrated safety and suggest efficacy in the treatment of DDD with mesenchymal stem cells (MSCs). The use of bone marrow-derived MSCs for the treatment of DDD is promising and in the present study we report on the safety and efficacy findings from a registry based proof of concept study using a percutaneous intradiscal injection of cultured MSCs for the management of DDD with associated radicular symptoms. Methods Thirty-three patients with lower back pain and disc degeneration with a posterior disc bulge diagnosed on magnetic resonance imaging (MRI) met the inclusion criteria and were treated with culture-expanded, autologous, bone marrow-derived MSCs. Prospective registry data was obtained at multiple time intervals up to 6 years post-treatment. Collected outcomes included numeric pain score (NPS), a modified single assessment numeric evaluation (SANE) rating, functional rating index (FRI), measurement of the intervertebral disc posterior dimension, and adverse events. Results Three patients reported pain related to procedure that resolved. There were no serious adverse events (i.e. death, infection, or tumor) associated with the procedure. NPS change scores relative to baseline were significant at 3, 36, 48, 60, and 72 months post-treatment. The average modified SANE ratings showed a mean improvement of 60% at 3 years post-treatment. FRI post-treatment change score averages exceeded the minimal clinically important difference at all time points except 12 months. Twenty of the patients treated underwent post-treatment MRI and 85% had a reduction in disc bulge size, with an average reduction size of 23% post-treatment. Conclusions Patients treated with autologous cultured MSCs for lower back pain with radicular symptoms in the setting of DDD reported minor adverse events and significant improvements in pain, function, and overall subjective improvement through 6 years of follow-up. NCT03011398. A Clinical Registry of Orthobiologics Procedures. https://clinicaltrials.gov/ct2/show/NCT03011398?term=orthobiologics&rank=1
Collapse
Affiliation(s)
- Christopher Centeno
- Centeno-Schultz Clinic, Broomfield, CO, 80021, USA.,Regenerative Sciences, LLC, 403 Summit Blvd Suite 201, Broomfield, CO, 80021, USA
| | - Jason Markle
- Centeno-Schultz Clinic, Broomfield, CO, 80021, USA
| | - Ehren Dodson
- Regenerative Sciences, LLC, 403 Summit Blvd Suite 201, Broomfield, CO, 80021, USA.
| | - Ian Stemper
- Regenerative Sciences, LLC, 403 Summit Blvd Suite 201, Broomfield, CO, 80021, USA
| | | | - Matthew Hyzy
- Centeno-Schultz Clinic, Broomfield, CO, 80021, USA
| | | | - Michael Freeman
- CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
12
|
The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. Spine J 2017; 17:1180-1191. [PMID: 28476690 DOI: 10.1016/j.spinee.2017.04.034] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/14/2017] [Accepted: 04/25/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Clinicians regard lumbar lordotic curvature (LLC) with respect to low back pain (LBP) in a contradictory fashion. The time-honored point of view is that LLC itself, or its increment, causes LBP. On the other hand, recently, the biomechanical role of LLC has been emphasized, and loss of lordosis is considered a possible cause of LBP. The relationship between LLC and LBP has immense clinical significance, because it serves as the basis of therapeutic exercises for treating and preventing LBP. PURPOSE This study aimed to (1) determine the difference in LLC in those with and without LBP and (2) investigate confounding factors that might affect the association between LLC and LBP. STUDY DESIGN Systematic review and meta-analysis. PATIENT SAMPLE The inclusion criteria consisted of observational studies that included information on lumbar lordotic angle (LLA) assessed by radiological image, in both patients with LBP and healthy controls. Studies solely involving pediatric populations, or addressing spinal conditions of nondegenerative causes, were excluded. METHODS A systematic electronic search of Medline, Embase, Cochrane Library, CINAHL, Scopus, PEDro, and Web of Science using terms related to lumbar alignment and Boolean logic was performed: (lumbar lordo*) or (lumbar alignment) or (sagittal alignment) or (sagittal balance). Standardized mean differences (SMD) and 95% confidence intervals (CI) were estimated, and chi-square and I2 statistics were used to assess within-group heterogeneity by random effects model. Additionally, the age and gender of participants, spinal disease entity, and the severity and duration of LBP were evaluated as possible confounding factors. RESULTS A total of 13 studies consisting of 796 patients with LBP and 927 healthy controls were identified. Overall, patients with LBP tended to have smaller LLA than healthy controls. However, the studies were heterogeneous. In the meta-regression analysis, the factors of age, severity of LBP, and spinal disease entity were revealed to contribute significantly to variance between studies. In the subgroup analysis of the five studies that compared patients with disc herniation or degeneration with healthy controls, patients with LBP had smaller LLA (SMD: -0.94, 95% CI: -1.19 to -0.69), with sufficient homogeneity based on significance level of .1 (I2=45.7%, p=.118). In the six age-matched studies, patients with LBP had smaller LLA than healthy controls (SMD: -0.33, 95% CI: -0.46 to -0.21), without statistical heterogeneity (I2=0%, p=.916). CONCLUSIONS This meta-analysis demonstrates a strong relationship between LBP and decreased LLC, especially when compared with age-matched healthy controls. Among specific diseases, LBP by disc herniation or degeneration was shown to be substantially associated with the loss of LLC.
Collapse
|
13
|
Ozdemir B, Kanat A, Batcik OE, Erturk C, Celiker FB, Guvercin AR, Yazar U. First report of perforation of ligamentum flavum by sequestrated lumbar intervertebral disc. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:70-73. [PMID: 28250640 PMCID: PMC5324364 DOI: 10.4103/0974-8237.199867] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Disc fragments are well known to migrate to superior, inferior, or lateral sites in the anterior epidural space, posterior epidural migrated lumbar disc fragments is an extremely rare disorder, 61 cases have been reported to date. However, there were no cases with perforated ligamentum flavum (LF). We report a different case with perforation of ligamentum ligamentum by disc fragment. To the best of our knowledge, this is the first report of perforation LF by a posterior epidural migrated sequester disc.
Collapse
Affiliation(s)
- Bulent Ozdemir
- Department of Neurosurgery, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey
| | - Ayhan Kanat
- Department of Neurosurgery, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey
| | - Osman Ersegun Batcik
- Department of Neurosurgery, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey
| | - Cihangir Erturk
- Department of Neurosurgery, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey
| | - Fatma Beyazal Celiker
- Department of Radiology, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey
| | - Ali Riza Guvercin
- Department of Neurosurgery, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ugur Yazar
- Department of Neurosurgery, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| |
Collapse
|