Appropriate Minimal Dose of Gadobutrol for 3D Time-Resolved MRA of the Supra-Aortic Arteries: Comparison with Conventional Single-Phase High-Resolution 3D Contrast-Enhanced MRA

BACKGROUND AND PURPOSE

The development of nephrogenic systemic fibrosis and neural tissue deposition is gadolinium dose-dependent. The purpose of this study was to determine the appropriate minimal dose of gadobutrol with time-resolved MRA to assess supra-aortic arterial stenosis with contrast-enhanced MRA as a reference standard.

MATERIALS AND METHODS

Four hundred sixty-two consecutive patients underwent both standard-dose contrast-enhanced MRA and low-dose time-resolved MRA and were classified into 3 groups; group A (a constant dose of 1 mL for time-resolved MRA), group B (2 mL), or group C (3 mL). All studies were independently evaluated by 2 radiologists for image quality by using a 5-point scale (from 0 = failure to 4 = excellent), grading of arterial stenosis (0 = normal, 1 = mild [<30%], 2 = moderate [30%-69%], 3 = severe to occlusion [≥70%]), and signal-to-noise ratio.

RESULTS

The image quality of time-resolved MRA was similar to that of contrast-enhanced MRA in groups B and C, but it was inferior to contrast-enhanced MRA in group A. For the grading of arterial stenosis, there was an excellent correlation between contrast-enhanced MRA and time-resolved MRA (R = 0.957 for group A, R = 0.988 for group B, R = 0.991 for group C). The SNR of time-resolved MRA tended to be lower than that of contrast-enhanced MRA in groups A and B. However, SNR was higher for time-resolved MRA compared with contrast-enhanced MRA in group C.

CONCLUSIONS

Low-dose time-resolved MRA is feasible in the evaluation of supra-aortic stenosis and could be used as an alternative to contrast-enhanced MRA for a diagnostic technique in high-risk populations.

Accuracy of inclinometer functions of the activPAL and ActiGraph GT3X+: A focus on physical activity

PURPOSE

The purpose of the study was to examine the accuracy of inclinometer functions of the ActiGraph GT3X+ (AG) (worn on the waist and wrist) and the activPAL (AP) in assessing time spent sitting, standing, and stepping.

METHODS

A total of 62 adults (age: 18-40 yrs; male:37; female:25) wore three activity monitors (AG waist, and AG wrist, and AP) while completing 15 different types of activities. The 15 activities were classified into 3 different postures (sitting, standing, and stepping) based on the directly observed behaviors. Minutes estimated from the inclinometers of the three monitors were directly compared to those from direct observation (criterion method) using mean absolute percent error (MAPE) values, effect sizes (Cohen's D), and equivalence testing.

RESULTS

The AP was more accurate than the both waist- and wrist-worn AG in both sitting and standing activities, but the AG was more accurate than the AP in stepping activity when the stepping activity was determined with 0.7 step/s threshold. Equivalence testing indicated that the time measured by the waist-, wrist-worn AG, and AP showed significant equivalence to the time in the equivalence zone (90% confidence interval: 2.7 to 3.3min) for 6, 5, and 7 activities, respectively.

CONCLUSIONS

The AP was reasonably accurate for detecting sitting, standing, and stepping, and the AG was very accurate for classifying stepping when the stepping activity was determined by the formula created by 0.7 step/s threshold. It is expected that the result of the study would contribute to performing movement pattern analyses and health promotion research for classifying activities.

How accurate are the wrist-based heart rate monitors during walking and running activities? Are they accurate enough?

BACKGROUND

Heart rate (HR) monitors are valuable devices for fitness-orientated individuals. There has been a vast influx of optical sensing blood flow monitors claiming to provide accurate HR during physical activities. These monitors are worn on the arm and wrist to detect HR with photoplethysmography (PPG) techniques. Little is known about the validity of these wearable activity trackers.

AIM

Validate the Scosche Rhythm (SR), Mio Alpha (MA), Fitbit Charge HR (FH), Basis Peak (BP), Microsoft Band (MB), and TomTom Runner Cardio (TT) wireless HR monitors.

METHODS

50 volunteers (males: n=32, age 19-43 years; females: n=18, age 19-38 years) participated. All monitors were worn simultaneously in a randomised configuration. The Polar RS400 HR chest strap was the criterion measure. A treadmill protocol of one 30 min bout of continuous walking and running at 3.2, 4.8, 6.4, 8.0, and 9.6 km/h (5 min at each protocol speed) with HR manually recorded every minute was completed.

RESULTS

For group comparisons, the mean absolute percentage error values were: 3.3%, 3.6%, 4.0%, 4.6%, 4.8% and 6.2% for TT, BP, RH, MA, MB and FH, respectively. Pearson product-moment correlation coefficient (r) was observed: r=0.959 (TT), r=0.956 (MB), r=0.954 (BP), r=0.933 (FH), r=0.930 (RH) and r=0.929 (MA). Results from 95% equivalency testing showed monitors were found to be equivalent to those of the criterion HR (±10% equivalence zone: 98.15-119.96).

CONCLUSIONS

The results demonstrate that the wearable activity trackers provide an accurate measurement of HR during walking and running activities.

Comparison of genetic diversity between wild-caught broodstock and hatchery-produced offspring populations of the vulnerable Korean kelp grouper (Epinephelus bruneus) by microsatellites

The kelp grouper Epinephelus bruneus (Perciformes: Haemulidae), is one of the most economically important fishery resources in Korea. This fish is regarded as a target for prospective aquaculture diversification; therefore, maintenance of stock quality is important. To investigate the effects of current artificial reproduction in a hatchery facility, genetic variation in wild-caught broodstock and hatchery-produced offspring of kelp grouper was analyzed using eight polymorphic nuclear microsatellite DNA loci; 77 alleles were identified. Allelic variability ranged from 2 to 22 in the broodstock and from 1 to 10 in the offspring. The average observed and expected heterozygosities were 0.620 and 0.623 in the broodstock and 0.600 and 0.513 in the offspring, respectively. The possibility of a recent genetic bottleneck was suggested in both populations of E. bruneus. The minor, but significant, genetic differentiation (FST = 0.047, P < 0.05) observed was mainly due to statistically significant reductions in the number of alleles in the offspring compared with the broodstock, suggesting that these genetic changes could be related to genetic drift. Our results demonstrate the usefulness of microsatellite markers to monitor genetic variation and raise concerns about potential harmful genetic effects of inappropriate hatchery procedures. Therefore, genetic variation between broodstock and offspring in a hatchery should be monitored in both breeding and release programs as a routine hatchery operation, and inbreeding should ideally be controlled to improve kelp grouper hatchery management. Our data provide a useful genetic basis for future planning of sustainable culture and management of E. bruneus in fisheries.

Genetic differences between the wild and hatchery-produced populations of Korean short barbeled grunter (Hapalogenys nitens) determined with microsatellite markers

Short barbeled grunter, Hapalogenys nitens, is an economically important fishery resource. In Korea, this fish is in the early stage of domestication, and it has been regarded as the candidate marine fish species for prospective aquaculture diversification. This study presents a preliminary investigation of the future viability of sustainable fry production from short barbeled grunter. We used 12 polymorphic nuclear microsatellite DNA loci to analyze the possible genetic variability between the wild and hatchery-produced populations of short barbeled grunter from Korea and identified 91 alleles. Compared to the wild population, significant genetic changes including reduced genetic diversity (average allele number: 7.42 vs 3.75; average expected heterozygosity: 0.713 vs 0.598, Wilcoxon signed-rank test; P < 0.05) and differentiation [overall fixation index (FST) = 0.088, P < 0.01] occurred in the hatchery-produced population, as indicated by the observation of allele richness, unique allele, heterozygosity, FST, and results of molecular analysis of variance. These findings indicate that genetic drift may have promoted the differentiation between these 2 populations, which may have negative effects on sustainable fry production. Therefore, genetic variations of the wild and hatchery-produced populations should be monitored and subjected to control inbreeding through a commercial breeding program. The information presented by this paper would provide a useful genetic basis for future sustainable culturing planning and management of H. nitens.

New polymorphic microsatellite markers for the Korean manila clam (Ruditapes philippinarum) and their application to wild populations

Manila clam (Ruditapes philippinarum) is a valuable and intensively exploited shellfish species in Korea. Despite its importance, information on its genetic background is scarce. For the genetic characterization of R. philippinarum, expressed sequence tag-derived microsatellite markers were developed using next-generation sequencing. A total of 5879 tandem repeats containing di- to hexanucleotide repeat motifs were obtained from 236,746 reads (mean = 413 bp). Of the 62 loci screened, 24 (38.7%) were successfully amplified, and 10 were polymorphic in 144 individuals from 2 manila clam populations (Incheon and Geoje, Korea). The number of alleles ranged from 2 to 17 in the Incheon population and from 3 to 13 in the Geoje population (overall AR = 7.21). The mean observed and expected heterozygosities were estimated to be 0.402 and 0.555, respectively. Hence, there is less genetic variability in the Geoje population than in the Incheon population, although no significant reductions of genetic diversity were found between the populations (P > 0.05). However, significant genetic differentiation was detected between the populations (FST = 0.064, P < 0.001). Significant deviations from Hardy-Weinberg equilibrium and high inbreeding coefficients (mean FIS = 0.22-0.26) were detected in both populations. The 10 novel polymorphic microsatellite loci used in this study will be useful for future genetic mapping studies and for characterizing population structures, monitoring genetic diversity for successful aquaculture management, and developing conservation strategies for manila clam populations in Korea.

Genetic characterization of hatchery populations of Korean spotted sea bass (Lateolabrax maculatus) using multiplex polymerase chain reaction assays

The spotted sea bass, Lateolabrax maculatus, is an important commercial and recreational fishery resource in Korea. Aquacultural production of this species has increased because of recent resource declines, growing consumption, and ongoing government-operated stock release programs. Therefore, the genetic characterization of hatchery populations is necessary to maintain the genetic diversity of this species and to develop more effective aquaculture practices. In this study, the genetic diversity and structure of three cultured populations in Korea were assessed using multiplex assays with 12 highly polymorphic microsatellite loci; 144 alleles were identified. The number of alleles per locus ranged from 6 to 28, with an average of 13.1. The mean observed and expected heterozygosities were 0.724 and 0.753, respectively. Low levels of inbreeding were detected according to the inbreeding coefficient (mean FIS = 0.003-0.073). All hatchery populations were significantly differentiated from each other (overall fixation index (FST) = 0.027, P < 0.01), and no population formed a separate cluster. Pairwise multilocus FST tests, estimates of genetic distance, mantel test, and principal component analyses did not show a consistent relationship between geographic and genetic distances. These results could reflect the exchange of breeds and eggs between hatcheries and/or genetic drift due to intensive breeding practices. For optimal resource management, the genetic variation of hatchery stocks should be monitored and inbreeding controlled within the spotted sea bass stocks that are being released every year. This genetic information will be useful for the management of both L. maculatus fisheries and the aquaculture industry.

Mitochondrial and microsatellite DNA analyses showed comparative genetic diversity between parent and offspring populations of Korean black rockfish in a hatchery facility

The black rockfish, Sebastes inermis (Sebastidae), is an important commercial fishery resource in Korea. As a preliminary investigation into the effect of artificial reproduction in a hatchery facility, the genetic divergence between parent and offspring populations of black rockfish was accessed using 10 polymorphic nuclear microsatellite DNA loci and a mitochondrial (mt) control gene. All loci that were screened showed marked polymorphisms. mtDNA control region sequences were also highly variable. Of approximately 350 base pairs (bp) sequenced, 52 variable sites, comprising 56 base substitutions, were found among 233 individuals. Offspring populations showed less genetic variability than the parent population in terms of numbers of microsatellite alleles and mtDNA haplotypes, as well as mtDNA haplotype diversity. Statistical analysis of the fixation index (ΦST and F(ST)) and analysis of molecular variance using both DNA markers showed significant genetic differences between the parent and offspring populations. These results suggest that random genetic drift and/or inbreeding events, as well as artificial selection and founder effects, occurred when the offspring strain was reproduced in a hatchery facility despite thousands of males and females from different hatcheries being maintained for artificial reproduction. Therefore, it is necessary to improve current hatchery programs by monitoring genetic variation in both the broodstock and progeny and controlling inbreeding within stocks in commercial breeding facilities to maintain the production of high-quality black rockfish. This information will be useful for determining suitable guidelines for establishing and maintaining cultured stocks and the aquaculture industry of S. inermis.

Genetic relationships of Pacific abalone (Haliotidae) species determined using universal rice primer-polymerase chain reaction fingerprinting

Random amplified polymorphic DNA (RAPD) with universal rice primers (URP) was used to identify species and to determine phylogenetic relationships for the 6 economically important Korean Pacific abalone species: Haliotis discus hannai, H. discus discus, H. madaka, H. gigantea, H. diversicolor supertexta, and H. diversicolor diversicolor, whose morphological differentiation is difficult. Of the 12 URPs used in this study, 7 were effective in producing reproducible RAPD markers for these 6 species. Amplifications with the 7 URP primers yielded 129 reproducible amplified fragments ranging between 100 and 6000 bp in length. The dendrogram generated by the unweighted pair-group method using arithmetic averages showed that the 6 species were divided into 4 groups at 0.44 similarity level, indicating that they were genetically distant from each other and had little internal phylogenetic resolution. One group included H. discus hannai, H. discus discus, H. madaka, and H. gigantea, which were divided into 2 groups at 0.52 similarity level: one group of H. discus hannai, H. discus discus, and H. madaka, and the other of H. gigantea. H. diversicolor supertexta and H. diversicolor diversicolor belonged to the other group. Furthermore, the reproducible pattern of amplified DNA bands by URP primers indicated the possibility of using these as molecular markers for the discrimination of the 6 Pacific abalone species. These results suggest that the URP-PCR approach will be a useful tool for obtaining accurate taxonomic identification and genetic relationship of Korean Pacific abalones, which is one of the first prerequisites in effective conservation programs.

Comparative genetic variability between broodstock and offspring populations of Korean starry flounder used for stock enhancement in a hatchery by using microsatellite DNA analyses

Korean starry flounder, Platichthys stellatus (Pleuronectidae), is one of the most economically important fishery resources in Korea. We investigated the effect of current artificial reproduction in a hatchery facility, genetic divergence between the broodstock and their offspring populations of starry flounder in a hatchery strain to be stocked into natural sea areas was accessed using 9 polymorphic nuclear microsatellite DNA loci. High levels of polymorphism were observed between the 2 populations. A total of 96 alleles were detected at the loci, with some alleles being unique in the broodstock. Allelic variability ranged from 8 to 17 in the broodstock and from 7 to 12 in the offspring population. Average observed and expected heterozygosities were estimated at 0.565 and 0.741 in the broodstock samples and 0.629 and 0.698 in the offspring population, respectively. Although no statistically significant reductions were found in heterozygosity or allelic diversity in the offspring population, a considerable loss of rare alleles was observed in the offspring population compared with that in the broodstock. Significant genetic difference was detected between the broodstock and offspring populations (FST = 0.021, P < 0.05). These results suggest that more intensive breeding practices for stock enhancement might have resulted in a further decrease of genetic diversity. Thus, genetic variations of broodstock and progeny should ideally be monitored in both breeding and release programs as a routine hatchery operation in order to improve the starry flounder hatchery management. This information might be useful for fishery management and aquaculture industry of P. stellatus.

Fibroblast growth factor control of cartilage homeostasis

Osteoarthritis (OA) and degenerative disc disease (DDD) are similar diseases involving the breakdown of cartilage tissue, and a better understanding of the underlying biochemical processes involved in cartilage degeneration may allow for the development of novel biologic therapies aimed at slowing the disease process. Three members of the fibroblast growth factor (FGF) family, FGF-2, FGF-18, and FGF-8, have been implicated as contributing factors in cartilage homeostasis. The role of FGF-2 is controversial in both articular and intervertebral disc (IVD) cartilage as it has been associated with species- and age-dependent anabolic or catabolic events. Recent evidence suggests that FGF-2 selectively activates FGF receptor 1 (FGFR1) to exert catabolic effects in human articular chondrocytes and IVD tissue via upregulation of matrix-degrading enzyme production, inhibition of extracellular matrix (ECM) accumulation and proteoglycan synthesis, and clustering of cells characteristic of arthritic states. FGF-18, on the other hand, most likely exerts anabolic effects in human articular chondrocytes by activating the FGFR3 pathway, inducing ECM formation and chondrogenic cell differentiation, and inhibiting cell proliferation. These changes result in dispersed chondrocytes or disc cells surrounded by abundant matrix. The role of FGF-8 has recently been identified as a catabolic mediator in rat and rabbit articular cartilage, but its precise biological impact on human adult articular cartilage or IVD tissue remains unknown. The available evidence reveals the promise of FGF-2/FGFR1 antagonists, FGF-18/FGFR3 agonists, and FGF-8 antagonists (i.e., anti-FGF-8 antibody) as potential therapies to prevent cartilage degeneration and/or promote cartilage regeneration and repair in the future.

Focal nodular hyperplasia: characterisation at gadoxetic acid-enhanced MRI and diffusion-weighted MRI

PURPOSE

The aim of this study was to assess the enhancement patterns of hepatic focal nodular hyperplasia (FNH) on gadoxetic acid-enhanced MRI and diffusion-weighted (DW) MRI.

METHODS

This retrospective study had institutional review board approval. Gadoxetic acid-enhanced and DW MR images were evaluated in 23 patients with 30 FNHs (26 histologically proven and 4 radiologically diagnosed). The lesion enhancement patterns of the hepatobiliary phase images were classified as heterogeneous or homogeneous signal intensity (SI), and as dominantly high/iso or low SI compared with those of adjacent liver parenchyma. Heterogeneous (any) SI lesions and homogeneous low SI lesions were categorised into the fibrosis group, whereas homogeneous high/iso SI lesions were categorised into the non-fibrosis group. Additionally, lesion SI on T2 weighted images, DW images and apparent diffusion coefficient (ADC) values were compared between the two groups.

RESULTS

The lesions showed heterogeneous high/iso SI (n=16), heterogeneous low SI (n=5), homogeneous high/iso SI (n=7) or homogeneous low SI (n=2) at the hepatobiliary phase MR images. The fibrosis group lesions were more likely to show high SI on DW images and T2 weighted images compared with those in the non-fibrosis group (p<0.05). ADC values tended to be lower in the fibrosis group than those in the non-fibrosis group without significance.

CONCLUSION

FNH showed variable enhancement patterns on hepatobiliary phase images during gadoxetic acid-enhanced MRI. SI on DW and T2 weighted images differed according to the fibrosis component contained in the lesion.

ADVANCES IN KNOWLEDGE

FNH shows a wide spectrum of imaging findings on gadoxetic acid-enhanced MRI and DW MRI.

New polymorphic microsatellite loci of threadsail filefish, Stephanolepis cirrhifer (Teleostei, Monacanthidae), from Korean waters

The threadsail filefish, Stephanolepis cirrhifer (Monacanthidae), is found mainly in the western Pacific. It is intensively caught in Korea and is a highly appreciated seafood delicacy. Consequently, the natural population of this species has drastically decreased, despite introductions from hatcheries. To provide information necessary for its conservation and management, we developed 24 polymorphic microsatellite markers using a combination of a total enriched genomic library and a small-scale 454 pyrosequencing. A total of 90,847 raw reads were obtained, and 75,128 unique sequences were generated, with an average length of 477 bp; 5350 (7.12%) sequences contained a minimum of 5 di- to tetranucleotide repeat motifs. Seventy-four sequences were used for microsatellite primer design. They all amplified successfully; 24 were polymorphic, with 8 containing trinucleotide repeats and 3 containing tetranucleotide repeats. The genetic variations based on 15 primer sets were investigated using 45 wild individuals from the coastal waters of Geomun Island. The number of alleles per locus varied from 4 to 15, with an average of 7.47. The observed and expected heterozygosities ranged from 0.333 to 0.956 and from 0.316 to 0.870, with averages of 0.692 and 0.701, respectively. No linkage disequilibrium was found between any pair of loci, indicating their independence. One locus significantly deviated from Hardy-Weinberg equilibrium after Bonferroni's correction; this may be due to the existence of a null allele. Cross-amplification was also tested for all 24 polymorphic loci in another monacanthid species, Thamnaconus modestus; 7 loci were effectively amplified. The high degree of polymorphism that was exhibited by the 15 newly developed microsatellites will be useful for assessing genetic variation and for conservation genetic studies of these 2 monacanthid species.

Population genetics of the Pacific abalone (Haliotis discus hannai) in Korea inferred from microsatellite marker analysis

Populations of the Pacific abalone, Haliotis discus hannai, have been severely overexploited over the past few decades in Korea. Information regarding the levels of genetic variability and structure within populations is insufficient for the development of effective strategies for conservation of genetic diversity of this species. To assess the genetic status of this species, we examined variation at six microsatellite loci in 842 individuals of Pacific abalone collected from three hatchery stocks of the main aquaculture areas and eight wild populations, which were two from the East Sea, two from the West Sea and three from the South Sea. High levels of polymorphism at these microsatellite loci were found in both the wild and hatchery populations. The genetic variation in the hatchery stocks [overall number of alleles (N(A)) = 24.00; allelic richness (A(R)) = 19.71; observed heterozygosity (H(O)) = 0.733] was similar to that of the wild (overall N(A) = 28.13; A(R) = 22.62; H(O) = 0.775) populations. Low levels of inbreeding and significant Hardy-Weinberg equilibrium deviations were detected in both the wild and hatchery populations. Significant F(ST) values were observed for the hatchery stocks and in most cases between the wild and hatchery populations (overall F(ST) = 0.017, P < 0.01); however, only a minor portion of the genetic diversity was distributed between the wild and hatchery populations. These results reflect intensive seedling and stocking practices. This preliminary study showed genetic separation between the eastern and pooled western and southern wild populations in Korea, which was based on the F(ST) value, phylogenetic tree clustering, PCA and MDS analyses, structure analysis, and AMOVA. This strong biogeographic structure of H. d. hannai in Korea may be considered to be independent management units. This study demonstrates the feasibility of microsatellite analyses for the monitoring of genetic diversity and for revealing the population structure of the wild Pacific abalone. This information will be useful for the proper management and conservation of H. d. hannai in Korea.

Population genetic structure of wild and hatchery black rockfish Sebastes inermis in Korea, assessed using cross-species microsatellite markers

The population structure of the black rockfish, Sebastes inermis (Sebastidae), was estimated using 10 microsatellite loci developed for S. schlegeli on samples of 174 individuals collected from three wild and three hatchery populations in Korea. Reduced genetic variation was detected in hatchery strains [overall number of alleles (N(A)) = 8.07; allelic richness (A(R)) = 7.37; observed heterozygosity (H(O)) = 0.641] compared with the wild samples (overall N(A) = 8.43; A(R) = 7.83; H(O) = 0.670), but the difference was not significant. Genetic differentiation among the populations was significant (overall F(ST) = 0.0237, P < 0.05). Pairwise F(ST) tests, neighbor-joining tree, and principal component analyses showed significant genetic heterogeneity among the hatchery strains and between wild and hatchery strains, but not among the wild populations, indicating high levels of gene flow along the southern coast of Korea, even though the black rockfish is a benthic, non-migratory marine species. Genetic differentiation among the hatchery strains could reflect genetic drift due to intensive breeding practices. Thus, in the interests of optimal resource management, genetic variation should be monitored and inbreeding controlled within stocks in commercial breeding programs. Information on genetic population structure based on cross-species microsatellite markers can aid in the proper management of S. inermis populations.

Relationship between disc injury and manual lifting: a poroelastic finite element model study

Understanding how failure originates in a lumbar motion segment subjected to loading conditions that are representative of manual lifting is important because it will pave the way for a better formulation of the exposure-injury relationship. The aim of the current investigation was to use a poroelastic finite element model of a human lumbar disc to determine its biomechanical characteristics under loading conditions that corresponded to three different, commonly occurring lifting activities and to identify the most hazardous type of loading with regard to damage to the disc. The current study showed that asymmetric lifting may increase the risk of back injury and pain. Lifting that involved lateral bending (asymmetric lifting) of the trunk was found to produce stresses at a localized area in the annulus, annuluar fibres, end plates, and facet joints that were higher than their respective tissue failure strength. Thus asymmetric lifting, if performed over a large number of cycles, might help to propagate this localized failure of the disc tissue to a larger area, owing to fatigue. The analyses also showed that largest fluid exchange between the nucleus and the end plates occurred during asymmetric lifting. If the fluid exchange is restricted owing to end plate calcification or sclerosis of the subchondral bone, high intradiscal pressure might develop, leading to higher disc bulge causing back pain.

In vivo segmental motion of the cervical spine in rheumatoid arthritis patients with atlantoaxial subluxation

OBJECTIVE

The dynamic mechanism underlying cervical spine involvement in rheumatoid arthritis (RA) remains unidentified. The purpose of the current study was to determine the in vivo cervical segmental motion in RA patients with atlantoaxial subluxation (AAS) using a patient-based three-dimensional magnetic resonance imaging (MRI) computer model.

METHODS

Healthy volunteers and RA patients with AAS (all females, n=10) underwent MRI examination of the cervical spine. Each vertebral body from the occipital bone (Oc) to the first thoracic vertebra (T1) was reconstructed from slices of T2-weighted sagittal MR images in the neutral, flexion, and extension positions. Using volume merge methods, each reconstructed vertebral body was virtually rotated and translated. Rotational segmental and translational segmental motions were obtained in three major planes.

RESULTS

Overall, the axial translational motions in the RA group were lower than those in the healthy volunteers; however the axial translational motion at only C1-C2 during flexion was at the same level as that in the healthy volunteers and was greater on the bottom side than that at other intervertebral levels. The frontal rotational motions at C1-C2 during extension were greater in the RA patients than those in the healthy volunteers (p<0.05).

CONCLUSION

The atlantoaxial joints in the RA patients with AAS showed great frontal rotational motion during extension and great axial translation on the bottom side during flexion. The current noninvasive MRI-based method could be useful in evaluating the 3-D dynamic mechanism underlying cervical involvement in RA in vivo.

Platelet-rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis

OBJECTIVE

Platelet-rich plasma (PRP) is a fraction of plasma that contains high levels of multiple growth factors. The purpose of this study was to examine the effects of PRP on cell proliferation and matrix synthesis by porcine chondrocytes cultured in alginate beads, conditions that promote the retention of the chondrocytic phenotype, in order to determine the plausibility of using this plasma-derived material for engineering cartilage.

DESIGN

PRP and platelet-poor plasma (PPP) were prepared from adult porcine blood. Adult porcine chondrocytes were cultured in the presence of 10% PRP, 10% PPP or 10% fetal bovine serum (FBS) for 3 days. Cell proliferation, proteoglycan (PG) and collagen synthesis were quantified, and the structure of newly synthesized PG and collagen was characterized.

RESULTS

Treatment with 10% PRP resulted in a small but significant increase in DNA content (+11%, vs FBS; P<0.01; vs PPP; P<0.001). PG and collagen syntheses by the PRP-treated chondrocytes were markedly higher than those by chondrocytes treated by FBS or PPP (PG; PRP: +115% vs FBS; +151% vs PPP, both P<0.0001, collagen; PRP: +163% vs FBS; +163% vs PPP, both P<0.0001). Biochemical analyses revealed that treatment with PRP growth factors did not markedly affect the types of PGs and collagens produced by porcine chondrocytes, suggesting that the cells remained phenotypically stable in the presence of PRP.

CONCLUSION

PRP isolated from autologous blood may be useful as a source of anabolic growth factors for stimulating chondrocytes to engineer cartilage tissue.

Apoptosis induction by 4beta-acetoxyscirpendiol from Paecilomyces tenuipes in human leukaemia cell lines

The carpophores of Paecilomyces tenuipes are known in the Orient for their strong antitumor activity. In continuation of our study on acetoxyscirpendiol (ASD, 4beta-acetoxyscirpene-3alpha,15-diol) as a cytotoxic component from this fungus, we report particularly on the mode of action of ASD in inducing apoptosis in human MOLT-4, THP-1 and Jurkat T cell leukaemia in vitro. The antiproliferative effects of ASD seem attributable to its induction of apoptosis in the cells, as it blocked the cell cycle, induced hypodiploidity and bound annexin V and also cleaved poly-(ADP-ribose) polymerase (PARP) in these cell lines. The 50% inhibitory concentrations (IC50) of ASD on MOLT-4, THP-1 and Jurkat T cells were found to be 60, 85 and 60 ng/ml, respectively. ASD arrested the cell cycle at the G1/S transition and showed hypodiploidity due to the accumulation of sub-G0 population. Annexin V binding was increased in the presence of ASD in the MOLT-4 cell line in a time-dependent manner. ASD and three of its derivatives also induced cleavage of PARP in both MOLT-4 and Jurkat T cell lines. From these data, it is suggested that ASD exerts its cytotoxic activity by inducing apoptosis in leukaemia cell lines in vitro.

Biomechanical evaluation of diagonal fixation in pedicle screw instrumentation

STUDY DESIGN

Flexibility tests and finite element analyses were performed for the biomechanical evaluation of diagonal transfixation in pedicle screw instrumentation.

OBJECTIVE

To assess the biomechanical advantages of diagonal transfixation compared with conventional horizontal transfixation.

SUMMARY AND BACKGROUND DATA

A few pedicle screw instrumentation systems allow the use of cross-links in the diagonal direction. Such a diagonal transfixation is anticipated to improve the surgical construct stability, but its biomechanical qualities have not been completely evaluated.

METHODS

Flexibility tests were performed on 10 calf lumbar spines (L2-L5). Specimens were subjected to pure moments up to 8.2 Nm in flexion, extension, lateral bending, and extension while the resulting movements of L3 and L4 were measured by a three-dimensional motion analysis system. The tested cases included (1) intact, (2) pedicle screw fixation without transfixation after total removal of the L3-L4 disc, (3) pedicle screw fixation with diagonal transfixation, and (4) pedicle screw fixation with horizontal transfixation. Three-dimensional finite element models of the tested surgical constructs were also developed by use of three-dimensional beam elements to investigate the effect of diagonal transfixation and horizontal transfixation on the construct stability and the corresponding stress changes in the screws.

RESULTS

When compared with no transfixation, horizontal transfixation significantly improved the lateral bending and axial rotation stability by 15.7% and 13.9%, respectively, but there was no improvement of stability in flexion and extension. By contrast, diagonal transfixation significantly improved the flexion and extension stability by 12% and 10.7%, respectively, but not the lateral bending and axial rotation stability in comparison with no transfixation. Comparison between horizontal transfixation and diagonal transfixation showed that the stabilizing effect of diagonal transfixation was greater in flexion and extension (13% and 11%, P < 0.01) than that of horizontal transfixation but smaller in lateral bending (11%, P < 0.05) and axial rotation (6.6%, P > 0.1). Finite element model predictions of the motion changes were similar to the changes observed in flexibility tests. In horizontal transfixation, the load changes, compared with no transfixion, were a 0.02% increase in flexion-extension, a 27.5% increase in lateral bending, and a 58% decrease in axial rotation, and the magnitudes of the moments applied on both the right and left pedicle screws were identical. However, when diagonal transfixation was achieved by connecting the left superior screw and the right inferior screw, the loads in the left screw were increased by 11.5% in flexion-extension, 43.6% in lateral bending, and 7.9% in axial rotation, whereas the loads in the right screw were decreased by 10.9% in flexion-extension, increased by 0.06% in lateral bending, and decreased by 18.1% in axial rotation.

CONCLUSIONS

The results of this study showed that diagonal transfixation provides more rigid fixation in flexion and extension but less in lateral bending and axial rotation in comparison with horizontal transfixation. Furthermore, greater stresses in the pedicle screws were predicted in the diagonal transfixation model. These limitations of diagonal transfixation should be considered carefully for clinical application.

Dorsal root ganglia morphologic features in patients with herniation of the nucleus pulposus: assessment using magnetic resonance myelography and clinical correlation

STUDY DESIGN

Morphologic features of the dorsal root ganglia were investigated in patients with herniation of the nucleus pulposus by means of magnetic resonance myelography.

OBJECTIVES

This study was undertaken to assess morphologic changes of the dorsal root ganglia in patients with herniation of the nucleus pulposus and to determine the relations between the morphologic features of the dorsal root ganglia and clinical features.

SUMMARY OF BACKGROUND DATA

It has recently been reported that application of the nucleus pulposus to a nerve root induces edema in the rat dorsal root ganglion. Edema in the human dorsal root ganglion resulting from lumbar disc herniation has not been discussed in the literature, to the authors' knowledge.

METHODS

Eighty-three consecutive patients (average age 42.1 years; range 17 to 77 years) with monoradicular symptoms were examined. Dorsal root ganglion morphologic features, i.e., indentations and swelling, were evaluated by magnetic resonance myelography. The dorsal root ganglion swelling at each level was quantitatively expressed as a ratio of the dorsal root ganglion width on the involved side to that of the contralateral side and was termed dorsal root ganglion ratio. Eighty-three uninvolved levels were chosen as controls in a randomized manner. Factors possibly contributing to the morphologic changes in the dorsal root ganglion were investigated. Neurologic symptoms, evaluated by the Japan Orthopaedic Association scoring system, were correlated to the morphologic changes. The morphologic features were followed up for 1 year after treatment in a small group of patients.

RESULTS

Dorsal root ganglion indentations were always found in the narrowed intervertebral foramens. The incidence of indentations was significantly higher at the involved nerve roots (10.8%) than at the uninvolved nerve roots (4.0%) (P = 0.026). Patients with dorsal root ganglion indentations were significantly older (P = 0.0008). Leg pain scores in patients with indentations were significantly poor (P = 0.007). The dorsal root ganglion ratios were significantly higher at the involved levels than at the uninvolved levels (P = 0.001); the means +/- SD were 1.19 +/- 0.25 and 1.08 +/- 0.13, respectively. Patients with lateral herniated nucleus pulposus had significantly higher dorsal root ganglion ratios than those with central herniated nucleus pulposus (P = 0.0001); the mean ratios +/- SD were 1.48 +/- 0.32 and 1.10 +/- 0.12, respectively. A moderate positive correlation was found between dorsal root ganglion ratio and age (Pearson's correlation coefficient = 0.313). There was moderate negative correlation between the dorsal root ganglion ratio and leg pain, gait, motor, and total Japan Orthopaedic Association score (correlation coefficients were = -0.385, -0.350, -0.422, and -0.358, respectively). The dorsal root ganglion ratios were significantly diminished at 1-year follow-up (P = 0.001); the means +/- SD were 1.22 +/- 0.22 and 1.09 +/- 0.07, respectively. Indentations observed before treatment disappeared after treatment.

CONCLUSIONS

Swelling and impingement in the involved dorsal root ganglion were clearly visualized by magnetic resonance myelography. The swelling and indentations were well correlated with severity of leg pain. These findings have important value in understanding the pathophysiology of the nerve roots in herniated nucleus pulposus.

A multicenter, prospective, randomized trial evaluating a new hemostatic agent for spinal surgery

STUDY DESIGN

A prospective, randomized trial comparing Proceed, a gelatin-based hemostatic sealant (treatment), with Gelfoam-thrombin (control) in stopping intraoperative bleeding during spinal surgery.

OBJECTIVES

To determine the effectiveness and safety of Proceed.

SUMMARY OF BACKGROUND DATA

Proceed has been tested in animal models to determine its safety and effectiveness as a hemostatic agent. The current study was conducted under a Food and Drug Administration-approved Investigational Device Exemption to evaluate the effectiveness and safety of Proceed in humans.

METHODS

For this study, 127 patients undergoing spinal surgery were randomized into either the treatment or control group after standard surgical means to control bleeding had failed. The bleeding site was evaluated at 1, 2, 3, 6, and 10 minutes after the hemostatic agent was applied. The application was considered successful if the bleeding stopped within 10 minutes. Follow-up evaluation was performed at 12 to 36 hours, then at 6 to 8 weeks after surgery.

RESULTS

Proceed stopped bleeding in 98% of the patients (first bleeding site only) within 10 minutes, as compared with 90% of the control patients (P = 0.001). At 3 minutes, successful hemostasis had been achieved in 97% of the Proceed group, as compared with 71% of the control group (P = 0.0001). There was no difference in the adverse event profile between the two groups.

CONCLUSIONS

A significantly larger number of bleeding sites had achieved hemostasis with Proceed than with Gelfoam-thrombin at 1, 2, and 3 minutes after application. Proceed was as safe as Gelfoam-thrombin when used for hemostasis during spinal surgery procedures.

Morphologic changes in the lumbar intervertebral foramen due to flexion-extension, lateral bending, and axial rotation: an in vitro anatomic and biomechanical study

STUDY DESIGN

A biomechanical and anatomic study with human cadaveric lumbar spine.

OBJECTIVES

The purpose of this study is to examine the morphologic changes in the intervertebral foramen during flexion, extension, lateral bending, and axial rotation of the lumbar spine and to correlate these changes with the flexibility of the spinal motion segments.

SUMMARY OF BACKGROUND DATA

Previous studies showed morphologic changes in the intervertebral foramen during flexion and extension; however, those changes during lateral bending and axial rotation were not well known.

METHODS

There were 81 motion segments obtained from 39 human cadaveric lumbar spines (mean age 69 years). The motion segments were imaged with CT scanner with 1-mm thick consecutive sections. For biomechanical testing each motion segment was applied with incremental pure moments of flexion, extension, lateral bending, and axial rotation. Rotational movements of the motion segment were measured using VICON cameras. After application of the last load, the specimens were frozen under load, and then CT was performed with the same technique described above. Six parameters of the intervertebral foramen were measured, including foraminal width (maximum and minimum), foraminal height, disc bulging, thickness of ligamentum flavum, and cross-sectional area of the foramen.

RESULTS

Flexion increased the foraminal width (maximum and minimum), height, and area significantly while significantly decreasing the disc bulging and thickness of ligamentum flavum (P < 0.05). However, extension decreased the foraminal width (maximum and minimum), height, and area significantly. Lateral bending significantly decreased the foraminal width (maximum and minimum), height, and area at the bending side, whereas lateral bending significantly increased the foraminal width (minimum), height, and area at the opposite side of bending. Likewise, axial rotation decreased the foraminal width (minimum) and area at the rotation side significantly while significantly increasing the foraminal height and foraminal area at the opposite side. The percent change in the foraminal area was found significantly correlated with the amount of segmental spinal motion except for the extension motion.

CONCLUSIONS

This study showed that the intervertebral foramen of the lumbar spine changed significantly not only on flexion-extension but also on lateral bending and axial rotation. The percent change in cross-sectional foraminal area was correlated with the amount of segmental motion except for extension motions. Further studies are needed to assess the morphologic changes in the intervertebral foramen in vivo and to correlate clinically.

Effect of endplate conditions and bone mineral density on the compressive strength of the graft-endplate interface in anterior cervical spine fusion

STUDY DESIGN

Destructive compression tests and finite element analyses were conducted to investigate the biomechanical strength at the graft-endplate interface in anterior cervical fusion.

OBJECTIVES

To investigate the effect of endplate thickness, endplate holes, and bone mineral density of the vertebral body on the biomechanical strength of the endplate-graft interface in an anterior interbody fusion of the cervical spine.

SUMMARY OF BACKGROUND

Subsidence of the graft into the vertebral body is a well-known complication in anterior cervical fusion. However, there is no information in the literature regarding the compressive strength of the graft-endplate interface in relation to the endplate thickness, holes in the endplate, and bone mineral density of the vertebral body.

METHODS

Biomechanical destructive compression tests and finite element analyses were performed in this study. Cervical vertebral bodies (C3-C7) isolated from seven cadaveric cervical spines (age at death 69-86 years, mean 79 years) were used for compression tests. Bone mineral density of each vertebral body was measured using a dual energy radiograph absorptiometry unit. Endplate thickness was measured using three coronal computed tomography images of the middle portion of the vertebral body obtained using a computer-assisted imaging analysis. Then each vertebral body was cut into halves through the horizontal plane. A total of 54 specimens, consisting of one endplate and half of the vertebral body, were obtained after excluding eight vertebrae with gross pathology on plain radiograph. Specimens were assigned to one of three groups with different endplate conditions (Group I, intact; Group II, partial removal; and Group III, complete removal) so that group mean bone mineral density became similar. Each endplate was slowly compressed until failure using an 8-mm-diameter metal indenter, and the load to failure was determined as a maximum force on a recorded force-displacement curve. The effect on the strength of the graft-endplate interface of various hole patterns in the endplate was studied using a finite element technique. The simulatedhole patterns included the following: one large central hole, two lateral holes, two holes in the anterior and posterior portion of the endplate, and four holes evenly distributed from the center of the endplate. Stress distribution in the endplate was predicted in response to an axial compressive force of 110 N, and the elements with von Mises stress greater than 4.0 MPa were determined as failed.

RESULTS

The endplate thickness and bone mineral density were similar at all cervical levels, and the superior and inferior endplates had similar thickness at all cervical levels. There was no significant association between bone mineral density and endplate thickness. Load to failure was found to have a significant association with bone mineral density but not with endplate thickness. However, load to failure tends to decrease with incremental removal of the endplate, and load to failure of the specimens with an intact endplate was significantly greater than that of the specimens with no endplate. Finite element model predictions showed significant influence of the hole pattern on the fraction of the upper endplate exposed to fracture stress. A large hole was predicted to be more effective than the other patterns at distributing a compressive load across the remaining area and thus minimizing the potential fracture area.

CONCLUSION

Results of this study suggest that it is important to preserve the endplate as much as possible to prevent graft subsidence into the vertebral body, particularly in patients with poor bone quality. It is preferable to make one central hole rather than multiple smaller holes in the endplate for vascularity of the bone graft because it reduces the surface area exposed to fracture stresses.

Orientation and osteoarthritis of the lumbar facet joint

Several studies have shown an association between sagittal orientation of the facet joint and degenerative spondylolisthesis. There is currently no information available on the association between orientation of the facet joint and osteoarthritis. This study examined the association between orientation and osteoarthritis of the lumbar facet joints. One hundred eleven consecutive patients underwent plain radiography and magnetic resonance imaging. These patients were divided into two groups: No Degenerative Spondylolisthesis Group (98 patients) and Degenerative Spondylolisthesis Group (13 patients). In the No Degenerative Spondylolisthesis Group, segments with higher grades of osteoarthritis showed more sagittal orientation of the facetjoints at the L3-L4 and L4-L5 levels. The facet joint was oriented significantly more sagittally in the Degenerative Spondylolisthesis Group than in the No Degenerative Spondylolisthesis Group at the L4-L5 and L5-S1 levels. The severity of facet joint osteoarthritis was significantly higher in the Degenerative Spondylolisthesis Group than in the No Degenerative Spondylolisthesis Group at the L3-L4, L4-L5, and L5-S1 levels. A significant association was found between sagittal orientation and osteoarthritis of the lumbar facet joints, even in patients without degenerative spondylolisthesis. Facet joint osteoarthritis, rather than spondylolisthesis, is the pathoanatomic feature that is associated with sagittal orientation of the facet joints in patients with degenerative spondylolisthesis.

Foraminal stenosis of the lumbar spine: a review of 65 surgical cases

This study provides clinical and radiographic information and characteristics that may best define the presence of significant lumbar foraminal stenosis and reports on the outcome of surgical intervention. Although anatomy of the lumbar intervertebral foramen (including static and dynamic pathologic compression of the exiting nerve root) has been described, few studies have focused on the clinical and radiographic features of foraminal stenosis requiring surgical intervention. We retrospectively studied 65 patients with lumbar foraminal stenosis for presenting clinical and radiographic features and intraoperative findings. Symptoms included leg and back pain (100%), paresthesias (45%), and subjective weakness (31%). Examination revealed lumbar tenderness (71%), limited lumbar extension (57%), focal motor weakness (48%), and positive tension signs (42%). The L5 nerve root was most often involved (75%). Almost 50% of patients had already undergone spinal decompression surgery. Surgical procedures included laminectomy and foraminotomy (52 patients) and laminotomy and foraminotomy (23 patients). A concomitant arthrodesis was performed in 63 patients. There were 29 excellent, 25 good, 6 fair, and 5 poor results based on a modified outcome scale at 32.5-month follow-up. Findings suggest that foraminal stenosis is a frequent cause of persistent symptoms after surgery, is most common at the lumbosacral junction, is best identified on parasagittal magnetic resonance images or on images reconstructed with computed tomography, and may be static or dynamic in etiology.

Comparison of biomechanical response to surgical procedures used for cervical radiculopathy: posterior keyhole foraminotomy versus anterior foraminotomy and discectomy versus anterior discectomy with fusion

The objective of this study was to compare the change in flexibility of C5-C6 caused by three procedures using a three-dimensional nonlinear finite element model: posterior foraminotomy (keyhole procedure), anterior foraminotomy with discectomy, and anterior discectomy with fusion. The keyhole procedure produced a minor increase in motion. The anterior foraminotomy and discectomy produced one to two times greater motion. Anterior discectomy with fusion produced 50% to 100% reduction in motion. The posterior keyhole foraminotomy has a much lesser effect on the stability of the cervical spine segment than does an anterior procedure, and fusion is a requisite part of the anterior decompression procedure.

A biomechanical comparison of modern anterior and posterior plate fixation of the cervical spine

STUDY DESIGN

A biomechanical study was designed to assess relative rigidity provided by anterior, posterior, or combined cervical fixation using cadaveric cervical spine models for flexion-distraction injury and burst fracture.

OBJECTIVES

To compare the construct stability provided by anterior plating with locked fixation screws, posterior plating with lateral mass screws, and combined anterior-posterior fixation in clinically simulated 3-column injury or corpectomy models.

SUMMARY OF BACKGROUND DATA

Anterior plating with locked fixation screws is the most recent design and is found to provide better stability than the conventional unlocked anterior plating. However, there are few data on the direct comparison of biomechanical stability provided by anterior plating with locked fixation screws versus posterior plating with lateral mass screws. Biomechanical advantages of using combined anterior-posterior fixation compared with that of using either anterior or posterior fixation alone also have not been well investigated yet.

METHODS

Biomechanical flexibility tests were performed using cervical spines (C2-T1) obtained from 10 fresh human cadavers. In group I (5 specimens), one-level, 3-column injury was created at C4-C5 by removing the ligamentum flavum and bilateral facet capsules, the posterior longitudinal ligament, and the posterior half of the intervertebral disc. In group II (5 specimens), complete corpectomy of C5 was performed to simulate burst injury. In each specimen, the intact spine underwent flexibility tests, and the following constructs were tested: (1) posterior lateral mass screw fixation (Axis plate) after injury; (2) polymethylmethacrylate anterior fusion block plus posterior fixation; (3) polymethylmethacrylate block plus anterior (Orion plate) and posterior plate fixation; and (4) polymethylmethacrylate block plus anterior fixation. Rotational angles of the C4-C5 (or C4-C6) segment were measured and normalized by the corresponding angles of the intact specimen to study the overall stabilizing effects.

RESULTS

Posterior plating with an interbody graft showed effective stabilization of the unstable cervical segments in all loading modes in all cases. There was no significant stability improvement by the use of combined fixation compared with the posterior fixation with interbody grafting, although combined anterior-posterior fixation tended to provide greater stability than both anterior and posterior fixation alone. Anterior fixation alone was found to fail in stabilizing the cervical spine, particularly in the flexion-distraction injury model in which no contribution of posterior ligaments is available. Anterior plating fixation provided much greater fixation in the corpectomy model than in the flexion-distraction injury model. This finding suggests that preservation of the posterior ligaments may be an important factor in anterior plating fixation.

CONCLUSIONS

This study showed that the posterior plating with interbody grafting is biomechanically superior to anterior plating with locked fixation screws for stabilizing the one-level flexion-distraction injury or burst injury. More rigid postoperative external orthoses should be considered if the anterior plating is used alone for the treatment of unstable cervical injuries. It was also found that combined anterior and posterior fixation may not improve the stability significantly as compared with posterior grafting with lateral mass screws and interbody grafting.

The relationship between disc degeneration and flexibility of the lumbar spine

BACKGROUND CONTEXT

A relationship between degenerative changes of the intervertebral disc and biomechanical functions of the lumbar spine has been suggested. However, the exact relationship between the grade of disc degeneration and the flexibility of the motion segment is not known.

PURPOSE

To investigate the relationship between degenerative grades of the intervertebral disc and three-dimensional (3-D) biomechanical characteristics of the motion segment under multidirectional loading conditions.

STUDY DESIGN/SETTING

A biomechanical and imaging study of human cadaveric spinal motion segments.

METHODS

One hundred fourteen lumbar motion segments from T12-L1 to L5-S1 taken from 47 fresh cadaver spines (average age at death, 68 years; range, 39 to 87 years) were used in this study. The severity of degeneration (grades I to V according to Thomson's system) was determined using magnetic resonance (MR) images and cryomicrotome sections. Pure unconstrained moments with dead weights were applied to the motion segments in six load steps. The directions of loading included flexion, extension, right and left axial rotation, and right and left lateral bending.

RESULTS

When the MR images were graded, 2 segments had grade I disc degeneration; 45, grade II; 20, grade III; 26, grade IV; and 21, grade V. When the cryomicrotome sections were graded, 14 segments had grade I disc degeneration; 31, grade II; 22, grade III; 26, grade IV; and 21, grade V. Segments from the upper lumbar levels (T12-L1 to L3-4) tended to have greater rotational movement in flexion, extension, and axial rotation with disc degeneration up to grade IV, whereas the motion decreased when the disc degenerated to grade V. In the lower lumbar spine at L4-5 and L5-S1, motion in axial rotation and lateral bending was increased in grade III.

CONCLUSIONS

These results suggest that kinematic properties of the lumbar spine are related to disc degeneration. Greater motion generally was found with disc degeneration, particularly in grades III and IV, in which radial tears of the annulus fibrosus are found. Disc space collapse and osteophyte formation as found in grade V resulted in stabilization of the motion segments.

The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine

STUDY DESIGN

A biomechanical and imaging study of human cadaveric spinal motion segments.

OBJECTIVE

To investigate the effect of both disc degeneration and facet joint osteoarthritis on lumbar segmental motion.

SUMMARY OF BACKGROUND DATA

Spinal degeneration includes the osteoarthritic changes of the facet joint as well as disc degeneration. Disc degeneration has been reported to be associated with spinal motion. The association of facet joint osteoarthritis with lumbar segmental motion characteristics and the combined influence of disc degeneration and facet osteoarthritis has not yet been investigated.

METHODS

A total of 110 lumbar motion segments (52 female, 58 male) from 44 human lumbar spines were studied (mean age = 69 years). Magnetic resonance images were used to assess the disc degeneration from Grade I (normal) to Grade V (advanced) and the osteoarthritic changes in the facet joints in terms of cartilage degeneration, subchondral sclerosis, and osteophytes. Disc height, endplate size, and facet joint orientation and width also were measured from the computed tomographic images. Rotational movements of the motion segment in response to the flexion, extension, lateral bending, and axial rotational moments were measured using a three-dimensional motion analysis system.

RESULTS

Female motion segments showed significantly greater motion (lateral bending: P < 0. 001, flexion: P < 0.01, extension: P < 0.05) and smaller endplate size (P < 0.001) than male ones. The segmental motion increased with increasing severity of disc degeneration up to Grade IV, but decreased in both genders when the disc degeneration advanced to Grade V. In male segments, the disc degeneration-related motion changes were significant in axial rotation (P < 0.001), lateral bending (P < 0.05), and flexion (P < 0.05), whereas female segments showed significant changes only in axial rotation (P < 0.001). With cartilage degeneration of the facet joints, the axial rotational motion increased, whereas the lateral bending and flexion motion decreased in female segments. In male segments, however, motion in all directions increased with Grade 3 cartilage degeneration and decreased with Grade 4 cartilage degeneration. Subchondral sclerosis significantly decreased the motion (female: axial rotation, P < 0. 05; extension, P < 0.05 vs.- male:flexion,P < 0.05). Severity of osteophytes had no significant association with the segmental motion.

CONCLUSION

Axial rotational motion was most affected by disc degeneration, and the effects of disc degeneration on the motion were similar between genders. Facet joint osteoarthritis also affected segmental motion, and the influence differed for male and female spines. Further studies are needed to clarify whether the degenerative process of facet joint osteoarthritis differs between genders and how facet joint osteoarthritis affects the stability of the spinal motion segment.

Anatomy of the iliolumbar ligament

Information is lacking in the literature on the precise anatomy of the iliolumbar ligament and its individual differences. The morphologic pattern, length, and width of the iliolumbar ligament were determined in 56 embalmed lumbosacral spines from human cadavers. It was possible to classify the iliolumbar ligament into two groups: Type A (74 ligaments), in which anterior and posterior ligaments had separate courses; and Type B (32 ligaments), in which anterior and posterior ligaments moved together as one band. The angle of the posterior iliolumbar ligament in Type A was oriented significantly more posteriorly than that in Type B. The posterior iliolumbar ligament was significantly shorter and oriented more posteriorly in male anatomic specimens than in female ones.

The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine

Degenerative processes in the disc and facet joints affect the stability of the motion segment. The exact relations among disc degeneration, facet joint osteoarthritis, and the kinematics of the motion segment are not well defined in the literature. Magnetic resonance imaging and functional radiography of the lumbar spine were analyzed to examine the relations among segmental instability, facet joint osteoarthritis, and disc degeneration in patients with degenerative disorders of the lumbar spine. Seventy consecutive patients (mean age, 46 years) had both magnetic resonance imaging and flexion and extension radiographs of the lumbar spine. The lumbar instability was classified into abnormal tilting on flexion, rotatory instability in the sagittal plane, and translatory instability. Translatory instability was subdivided into anterior, posterior, and anteroposterior translatory instability. Disc degeneration as seen on T2-weighted sagittal images was classified into five grades. Facet joint osteoarthritis as seen on axial T1-weighted images was divided into four grades. This study revealed that the kinematics of the lumbar motion segment are affected by disc degeneration and facet joint osteoarthritis. Abnormal tilting movement on flexion and anteroposterior translatory instability both had negative associations with facet joint osteoarthritis. However, anterior translatory instability was positively associated with disc degeneration and facet joint osteoarthritis. Rotatory instability in the sagittal plane and posterior translatory instability were not associated with disc degeneration and facet joint osteoarthritis.