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Sorci OR, Madi R, Kim SM, Batzdorf AS, Alecxih A, Hornyak JN, Patel S, Rajapakse CS. Normative vertebral deformity measurements in a clinically relevant population using magnetic resonance imaging. World J Radiol 2024; 16:749-759. [PMID: 39801667 PMCID: PMC11718528 DOI: 10.4329/wjr.v16.i12.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 10/15/2024] [Accepted: 12/12/2024] [Indexed: 12/27/2024] Open
Abstract
BACKGROUND Osteoporosis is the leading cause of vertebral fractures. Dual-energy X-ray absorptiometry (DXA) and radiographs are traditionally used to detect osteoporosis and vertebral fractures/deformities. Magnetic resonance imaging (MRI) can be utilized to detect the relative severity of vertebral deformities using three-dimensional information not available in traditional DXA and lateral two-dimensional radiography imaging techniques. AIM To generate normative vertebral parameters in women using MRI and DXA scans, determine the correlations between MRI-calculated vertebral deformities and age, DXA T-scores, and DXA Z-scores, and compare MRI vertebral deformity values with radiography values previously published in the literature. METHODS This study is a retrospective vertebral morphometric analysis conducted at our institution. The patient sample included MR images from 1638 female patients who underwent both MR and DXA imaging between 2005 and 2014. Biconcavity, wedge, crush, anterior height (Ha)/posterior height (Hp), and middle height (Hm)/posterior height values were calculated from the MR images of the patient's vertebrae. Associations between vertebral deformity values, patient age, and DXA T-scores were analyzed using Spearman correlation. The MRI-derived measurements were compared with radiograph-based calculations from population-based data compiled from multiple studies. RESULTS Age was positively correlated with lumbar Hm/Hp (P = 0.04) and thoracic wedge (P = 0.03) and biconcavity (P = 0.001) and negatively correlated with thoracic Ha/Hp (P = 0.002) and Hm/Hp (P = 0.001) values. DXA T-scores correlated positively with lumbar Hm/Hp (P < 0.0001) and negatively with lumbar wedge (P = 0.046), biconcavity (P < 0.0001), and Ha/Hp (P = 0.046) values. Qualitative analysis revealed that Ha/Hp differed between MRI and radiography population-based data by no more than 0.3 and Hm/Hp by a maximum of 1.2. CONCLUSION Compared with traditional imaging techniques, MRI detects vertebral deformities with high accuracy and reliability. It may be a sensitive, ionizing, radiation-free tool for use in clinical settings.
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Affiliation(s)
- Olivia R Sorci
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Rashad Madi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Sun Min Kim
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Alexandra S Batzdorf
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Austin Alecxih
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Julia N Hornyak
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Sheenali Patel
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Chamith S Rajapakse
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
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Ma D, Wang Y, Zhang X, Su D, Ma M, Qian B, Yang X, Gao J, Wu Y. 3D U-Net Neural Network Architecture-Assisted LDCT to Acquire Vertebral Morphology Parameters: A Vertebral Morphology Comprehensive Analysis in a Chinese Population. Calcif Tissue Int 2024; 115:362-372. [PMID: 39017691 DOI: 10.1007/s00223-024-01255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024]
Abstract
To evaluate the feasibility of acquiring vertebral height from chest low-dose computed tomography (LDCT) images using an artificial intelligence (AI) system based on 3D U-Net vertebral segmentation technology and the correlation and features of vertebral morphology with sex and age of the Chinese population. Patients who underwent chest LDCT between September 2020 and April 2023 were enrolled. The Altman and Pearson's correlation analyses were used to compare the correlation and consistency between the AI software and manual measurement of vertebral height. The anterior height (Ha), middle height (Hm), posterior height (Hp), and vertebral height ratios (VHRs) (Ha/Hp and Hm/Hp) were measured from T1 to L2 using an AI system. The VHR is the ratio of Ha to Hp or the ratio of Hm to Hp of the vertebrae, which can reflect the shape of the anterior wedge and biconcave vertebrae. Changes in these parameters, particularly the VHR, were analysed at different vertebral levels in different age and sex groups. The results of the AI methods were highly consistent and correlated with manual measurements. The Pearson's correlation coefficients were 0.855, 0.919, and 0.846, respectively. The trend of VHRs showed troughs at T7 and T11 and a peak at T9; however, Hm/Hp showed slight fluctuations. Regarding the VHR, significant sex differences were found at L1 and L2 in all age bands. This innovative study focuses on vertebral morphology for opportunistic analysis in the mainland Chinese population and the distribution tendency of vertebral morphology with ageing using a chest LDCT aided by an AI system based on 3D U-Net vertebral segmentation technology. The AI system demonstrates the potential to automatically perform opportunistic vertebral morphology analyses using LDCT scans obtained during lung cancer screening. We advocate the use of age-, sex-, and vertebral level-specific criteria for the morphometric evaluation of vertebral osteoporotic fractures for a more accurate diagnosis of vertebral fractures and spinal pathologies.
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Affiliation(s)
- Duoshan Ma
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yan Wang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xinxin Zhang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Danyang Su
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Mengze Ma
- Medical 3D Printing Center, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Baoxin Qian
- Dongsheng Science and Technology Park, Room A206, B2, Huiying Medical Technology Co, Ltd, HaiDian District, Beijing City, 100192, China
| | - Xiaopeng Yang
- Medical 3D Printing Center, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yan Wu
- Medical 3D Printing Center, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China.
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Asadollahi S, Rafiee F, Luna R, Yousem DM, Gong G. MR imaging of thoracic annular fissures. Clin Imaging 2023; 101:227-233. [PMID: 37429169 DOI: 10.1016/j.clinimag.2023.06.016] [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: 01/06/2023] [Revised: 06/09/2023] [Accepted: 06/21/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Annular fissures are common findings on MR studies of the lumbar spine but have not been specifically examined in the thoracic spine. We sought to review the prevalence and stability of MRI imaging features of thoracic annular fissures and the association of thoracic AFs with intervertebral degenerative disk changes. MATERIALS AND METHODS We surveyed 10 years of MRI studies in which patients had one or more repeated examinations of the thoracic spine. For every annular fissure, we recorded its imaging features on all pulse sequences and the evolution of those imaging findings across all time periods. RESULTS We reviewed 210 patients and discovered that 66 (31.4%) had at least one thoracic annular fissure. The presence of annular fissures was positively correlated with older age and male gender. The initial annular fissure was always hyperintense on T2WI and annular fissures remained hyperintense on T2WI over time in all cases but showed less hyperintensity in 23.9% (n = 39/163) and more hyperintensity in 4.9% (n = 8/163). The rate of concomitant disk bulges was 85.8% (n = 140/163). Of the 71 annular fissures in which gadolinium-enhanced studies were performed, 20 (28.1%) showed enhancement and 14/20 (70%) annular fissures showed persistent enhancement over time (mean follow-up = 39.6 ± 44.1 months). CONCLUSION Thoracic annular fissures rarely resolve, remain hyperintense on T2WI, and, if they enhance, that enhancement generally persists.
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Affiliation(s)
- Shadi Asadollahi
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | | | - Rodrigo Luna
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - David M Yousem
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, MD, USA.
| | - Gary Gong
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, MD, USA
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Kondou H, Morohashi R, Ichioka H, Bandou R, Matsunari R, Kawamoto M, Idota N, Ting D, Kimura S, Ikegaya H. Deep Neural Networks-Based Age Estimation of Cadavers Using CT Imaging of Vertebrae. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4806. [PMID: 36981720 PMCID: PMC10049236 DOI: 10.3390/ijerph20064806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Although age estimation upon death is important in the identification of unknown cadavers for forensic scientists, to the best of our knowledge, no study has examined the utility of deep neural network (DNN) models for age estimation among cadavers. We performed a postmortem computed tomography (CT) examination of 1000 and 500 male and female cadavers, respectively. These CT slices were converted into 3-dimensional images, and only the thoracolumbar region was extracted. Eighty percent of them were categorized as training datasets and the others as test datasets for both sexes. We fine-tuned the ResNet152 models using the training datasets. We conducted 4-fold cross-validation, and the mean absolute error (MAE) of the test datasets was calculated using the ensemble learning of four ResNet152 models. Consequently, the MAE of the male and female models was 7.25 and 7.16, respectively. Our study shows that DNN models can be useful tools in the field of forensic medicine.
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Radiological Investigation of Guinea Pig ( Cavia porcellus) Lumbar Vertebral Morphology ‒ A Biomechanical Aspect. ACTA VET-BEOGRAD 2023. [DOI: 10.2478/acve-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Abstract
Numerous studies are based on the use of animal models; however, in bipedal and tetrapedal organisms there are significant differences in the biomechanics of the spinal column, which can significantly impair the quality and applicability of the results obtained. The aim of this study is to obtain basic data on the morphometric parameters of guinea pig lumbar vertebrae, the analysis of which will indicate the location of the biggest mechanical load. The lumbar vertebra morphometry test was performed by means of X-ray imageing obtained from 12 guinea pigs, with equal numbers of males and females. The results of investigations show that guinea pig lumbar vertebrae have an irregular trapezoid geometry and that the measured body lengths of L4 and L5 are the largest. The height parameters determined in the medial level showed that L4 had the most concave body. Moreover, L4 had the greatest depth of the spinal canal at the same measurement level. Consequently, in guinea pigs, the greatest load is in the L4 region, unlike in humans, where, due to the axial load of the spinal column, the highest pressure is exerted on the last lumbar vertebrae.
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Liebsch C, Wilke HJ. Even mild intervertebral disc degeneration reduces the flexibility of the thoracic spine: an experimental study on 95 human specimens. Spine J 2022; 22:1913-1921. [PMID: 35779838 DOI: 10.1016/j.spinee.2022.06.010] [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: 03/29/2022] [Revised: 05/31/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intervertebral disc degeneration represents one of multiple potential trigger factors for reduced passive spinal mobility and back pain. The effects of age-related degenerative intervertebral disc changes on spinal flexibility were however mainly investigated for the lumbar spine in the past, while intervertebral disc degeneration is also highly prevalent in the thoracic spine. PURPOSE To evaluate the effect of the degeneration grade on the range of motion and neutral zone of the thoracic spine. STUDY DESIGN Experimental study including combined radiological grading of intervertebral disc degeneration and biomechanical testing of 95 human thoracic functional spinal units (min. n=4 per level from T1-T2 to T11-T12) from 33 donors (15 female / 18 male, mean age 56 years, age range 37-80 years). METHODS Degeneration grades of the intervertebral discs were assessed using the validated x-ray grading scheme of Liebsch et al. (0=no, 1=mild, 2=moderate, 3=severe degeneration). Motion segments were loaded with pure moments in flexion/extension, lateral bending, and axial rotation to determine range of motion and neutral zone at 5 Nm. RESULTS All tested specimens exhibited degeneration grades between zero and two. Range of motion significantly decreased for grades one and two compared with grade zero in any motion direction (p<.05), showing the strongest decrease in extension comparing grade two with grade zero (-42%), while no significant differences were detected between grades one and two. Similar trends were found for the neutral zone with the strongest decrease in extension also comparing grade two with grade zero (-47%). Donor age did not significantly affect the range of motion, whereas the range of motion was significantly reduced in specimens from male donors due to the significantly higher degeneration grade in this study. CONCLUSIONS Even mild intervertebral disc degeneration reduces the range of motion and neutral zone of the thoracic spine in any motion plane, whereas progressing degeneration does not further affect its flexibility. This is in contrast to the lumbar spine, where a more gradual decrease of flexibility was found in prior studies, which might be explained by differences between thoracic and lumbar intervertebral disc morphologies. CLINICAL SIGNIFICANCE Thoracic intervertebral disc degeneration should be considered as one of multiple potential causal factors in patients showing reduced passive mobility and middle back pain.
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Affiliation(s)
- Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Helmholtzstr. 14, 89081 Ulm, Baden-Wuerttemberg, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Helmholtzstr. 14, 89081 Ulm, Baden-Wuerttemberg, Germany.
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Hipp JA, Grieco TF, Newman P, Reitman CA. Definition of normal vertebral morphometry using NHANES‐II radiographs. JBMR Plus 2022; 6:e10677. [PMID: 36248278 PMCID: PMC9549721 DOI: 10.1002/jbm4.10677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022] Open
Abstract
A robust definition of normal vertebral morphometry is required to confidently identify abnormalities such as fractures. The Second National Health and Nutrition Examination Survey (NHANES‐II) collected a nationwide probability sample to document the health status of the United States. Over 10,000 lateral cervical spine and 7,000 lateral lumbar spine X‐rays were collected. Demographic, anthropometric, health, and medical history data were also collected. The coordinates of the vertebral body corners were obtained for each lumbar and cervical vertebra using previously validated, automated technology consisting of a pipeline of neural networks and coded logic. These landmarks were used to calculate six vertebral body morphometry metrics. Descriptive statistics were generated and used to identify and trim outliers from the data. Descriptive statistics were tabulated using the trimmed data for use in quantifying deviation from average for each metric. The dependency of these metrics on sex, age, race, nation of origin, height, weight, and body mass index (BMI) was also assessed. There was low variation in vertebral morphometry after accounting for vertebrae (eg, L1, L2), and the R2 was high for ANOVAs. Excluding outliers, age, sex, race, nation of origin, height, weight, and BMI were statistically significant for most of the variables, though the F‐statistic was very small compared to that for vertebral level. Excluding all variables except vertebra changed the ANOVA R2 very little. Reference data were generated that could be used to produce standardized metrics in units of SD from mean. This allows for easy identification of abnormalities resulting from vertebral fractures, atypical vertebral body morphometries, and other congenital or degenerative conditions. Standardized metrics also remove the effect of vertebral level, facilitating easy interpretation and enabling data for all vertebrae to be pooled in research studies. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- John A. Hipp
- Medical Metrics, Imaging Core Laboratory Houston TX
| | | | | | - Charles A. Reitman
- Orthopaedics and Physical Medicine Medical University of South Carolina Charleston SC
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Noriega González DC, Ardura Aragón F, Crespo Sanjuan J, Santiago Maniega S, Labrador Hernández G, Bragado González M, Pérez-Valdecantos D, Caballero-García A, Córdova A. Restoration in Vertebral Compression Fractures (VCF): Effectiveness Evaluation Based on 3D Technology. J Funct Biomater 2022; 13:60. [PMID: 35645268 PMCID: PMC9149907 DOI: 10.3390/jfb13020060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023] Open
Abstract
There are few studies about anatomical reduction of the fractured vertebral body before stabilization for treatment of vertebral compression fracture (VCF). Although restoration on vertebral height has been useful, the reduction of fractured endplates is limited. The vertebra is part of a joint, and vertebral endplates must be treated like other weight-bearing joint to avoid complications. The aim of this study was to evaluate the feasibility of anatomic reduction of vertebral compression fracture, in different bone conditions, fracture types, and ages (VCF). Under methodological point of view, we followed different steps: first was the placement of two expandable titanium implants just below the fracture. Later, to push the fractured endplates into a more anatomical position, the implants were expanded. Finally, with the implants perfectly positioned, PMMA cement was injected to avoid any loss of correction. To evaluate the effectiveness of this procedure in anatomical fracture reduction, a method based on 3D CT reconstructions was developed. In this paper, we have developed the procedure in three case studies. In all of them, we were able to demonstrate the efficacy of this procedure to reduce the VCF. The percentage of correction of the kyphotic angle varied range between 49% and 62% with respect to the value after the fracture preoperative value. This was accompanied by a reduction of the pain level on the VAS scale around 50%. In conclusion, this novel approach to the vertebral fracture treatment (VCF) associated with 3D assessment have demonstrated the possibility of reducing the vertebral kyphosis angle and the vertebral endplate fractures. However, given the few cases presented, more studies are necessaries to confirm these results.
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Affiliation(s)
- David C. Noriega González
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
| | - Francisco Ardura Aragón
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (G.L.H.); (M.B.G.)
| | - Jesús Crespo Sanjuan
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (G.L.H.); (M.B.G.)
| | - Silvia Santiago Maniega
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (G.L.H.); (M.B.G.)
| | - Gregorio Labrador Hernández
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (G.L.H.); (M.B.G.)
| | - María Bragado González
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (G.L.H.); (M.B.G.)
| | - Daniel Pérez-Valdecantos
- Department of Biochemistry, Molecular Biology and Physiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain; (D.P.-V.); (A.C.)
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain;
| | - Alfredo Córdova
- Department of Biochemistry, Molecular Biology and Physiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain; (D.P.-V.); (A.C.)
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Use of machine learning to select texture features in investigating the effects of axial loading on T 2-maps from magnetic resonance imaging of the lumbar discs. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:1979-1991. [PMID: 34718864 DOI: 10.1007/s00586-021-07036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/20/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent advances in texture analysis and machine learning offer new opportunities to improve the application of imaging to intervertebral disc biomechanics. This study employed texture analysis and machine learning on MRIs to investigate the lumbar disc's response to loading. METHODS Thirty-five volunteers (30 (SD 11) yrs.) with and without chronic back pain spent 20 min lying in a relaxed unloaded supine position, followed by 20 min loaded in compression, and then 20 min with traction applied. T2-weighted MR images were acquired during the last 5 min of each loading condition. Custom image analysis software was used to segment discs from adjacent tissues semi-automatically and segment each disc into the nucleus, anterior and posterior annulus automatically. A grey-level, co-occurrence matrix with one to four pixels offset in four directions (0°, 45°, 90° and 135°) was then constructed (320 feature/tissue). The Random Forest Algorithm was used to select the most promising classifiers. Linear mixed-effect models and Cohen's d compared loading conditions. FINDINGS All statistically significant differences (p < 0.001) were observed in the nucleus and posterior annulus in the 135° offset direction at the L4-5 level between lumbar compression and traction. Correlation (P2-Offset, P4-Offset) and information measure of correlation 1 (P3-Offset, P4-Offset) detected significant changes in the nucleus. Statistically significant changes were also observed for homogeneity (P2-Offset, P3-Offset), contrast (P2-Offset), and difference variance (P4-Offset) of the posterior annulus. INTERPRETATION MRI textural features may have the potential of identifying the disc's response to loading, particularly in the nucleus and posterior annulus, which appear most sensitive to loading. LEVEL OF EVIDENCE Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Abdollah V, Parent EC, Dolatabadi S, Marr E, Croutze R, Wachowicz K, Kawchuk G. Texture analysis in the classification of T 2 -weighted magnetic resonance images in persons with and without low back pain. J Orthop Res 2021; 39:2187-2196. [PMID: 33247597 DOI: 10.1002/jor.24930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/30/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
Magnetic resonance imaging findings often do not distinguish between people with and without low back pain (LBP). However, there are still a large number of people who undergo magnetic resonance imaging to help determine the etiology of their back pain. Texture analysis shows promise for the classification of tissues that look similar, and machine learning can minimize the number of comparisons. This study aimed to determine if texture features from lumbar spine magnetic resonance imaging differ between people with and without LBP. In total, 14 participants with chronic LBP were matched for age, weight, and gender with 14 healthy volunteers. A custom texture analysis software was used to construct a gray-level co-occurrence matrix with one to four pixels offset in 0° direction for the disc and superior and inferior endplate regions. The Random Forests Algorithm was used to select the most promising classifiers. The linear mixed-effect model analysis was used to compare groups (pain vs. pain-free) at each level controlling for age. The Random Forest Algorithm recommended focusing on intervertebral discs and endplate zones at L4-5 and L5-S1. Differences were observed between groups for L5-S1 superior endplate contrast, homogeneity, and energy (p = .02). Differences were observed for L5-S1 disc contrast and homogeneity (p < .01), as well as for the inferior endplates contrast, homogeneity, and energy (p < .03). Magnetic resonance imaging textural features may have potential in identifying structures that may be the target of further investigations about the reasons for LBP.
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Affiliation(s)
- Vahid Abdollah
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Eric C Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Samin Dolatabadi
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Erica Marr
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Roger Croutze
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Keith Wachowicz
- Department of Oncology, Medical Physics Division, University of Alberta, Edmonton, Alberta, Canada.,Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Greg Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Liebsch C, Tao Y, Kienle A, Wilke HJ. Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part III. Thoracic spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:726-734. [PMID: 34460004 DOI: 10.1007/s00586-021-06970-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/06/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to assess the validity and objectivity of a new quantitative radiographic grading system for thoracic intervertebral disc degeneration. METHODS The new grading system involves the measurement variables "Height loss" and "Osteophyte formation", which are determined from lateral radiographs, resulting in the "Overall degree of degeneration" on a four-point scale from 0 (no degeneration) to 3 (severe degeneration). Validation was performed by comparing the radiographic degrees of degeneration of 54 human intervertebral discs to the respective macroscopic degrees, which were defined as the "real" degrees of degeneration. Interobserver agreement was examined using radiographs of 135 human thoracic intervertebral discs. Agreement was quantified by means of quadratically weighted Kappa coefficients with 95% confidence limits (CL). RESULTS Validation revealed almost perfect agreement between the radiographic and the macroscopic overall degrees of degeneration (Kappa 0.968, CL 0.944-0.991), while the macroscopic grades tended to be underestimated in low degeneration grades. Radiographic grading of two independent observers also exhibited almost perfect agreement (Kappa 0.883, CL 0.824-0.941) as well as tendencies towards rater-dependent differences in low degeneration grades. CONCLUSION The new quantitative radiographic grading scheme represents a valid, reliable, and almost objective method for assessing the degree of degeneration of individual thoracic intervertebral discs. Potential effects of interindividual variations and the radiographic superimposition of anatomical structures represent a limitation of this method should be taken into account when using the grading system for clinical and experimental purposes, especially with regard to specific morphological as well as patient- and donor-specific characteristics.
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Affiliation(s)
- Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | | | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany.
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Tao Y, Niemeyer F, Galbusera F, Jonas R, Samartzis D, Vogele D, Kienle A, Wilke HJ. Sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine and their associations with age, sex and cervical lordosis: A large-scale morphological study. Clin Anat 2021; 34:1111-1120. [PMID: 34309067 DOI: 10.1002/ca.23769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/11/2022]
Abstract
Many recent studies have focused on the functional and clinical importance of cervical lordosis. However, there is little accurate knowledge of the anatomical parameters that constitute cervical lordosis (i.e., the sagittal wedging angles of intervertebral discs and vertebral bodies) and their associations with age and sex. Standing lateral cervical radiographs of 1020 subjects (424 males, 596 females) with a mean age of 36.6 ± 17.0 years (range 7-95 years) were evaluated retrospectively. Cervical lordosis, the sum of intervertebral disc wedging angles from C2/C3 to C6/C7 and the sum of vertebral body wedging angles from C3 to C7 were measured. The sum of intervertebral disc wedging and the sum of vertebral body wedging were 20.6° ± 14.7° and -12.8° ± 10.3°, respectively. The sum of intervertebral disc wedging increased significantly with age and was significantly greater in males than females, whereas there was no sex-related difference in the sum of vertebral body wedging. The sum of intervertebral disc wedging was negatively correlated with sum of vertebral body wedging. Wedging of discs contributed to C2-C7 cervical lordosis more significantly than wedging of vertebral bodies. There were moderate positive correlations between cervical lordosis and intervertebral disc wedging angles at C3/C4, C4/C5 and C5/C6; weak correlations were observed at C2/C3 and C6/C7. This study constitutes the largest currently available analysis comprehensively documenting the anatomical characteristics of sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine. The findings could improve understanding of the internal architecture of cervical lordosis among clinicians.
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Affiliation(s)
- Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University Medical Centre, Ulm, Germany
| | | | - René Jonas
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center and Rush Graduate College, Chicago, Illinois, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | | | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University Medical Centre, Ulm, Germany
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Tao Y, Galbusera F, Niemeyer F, Jonas R, Samartzis D, Vogele D, Wilke HJ. The impact of age, sex, disc height loss and T1 slope on the upper and lower cervical lordosis: a large-scale radiologic study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2434-2442. [PMID: 34331122 DOI: 10.1007/s00586-021-06933-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To clarify the relative influence of age, sex, disc height loss and T1 slope on upper (Occiput-C2) and lower cervical lordosis (C2-C7). METHODS Standing lateral cervical radiographs of 865 adult subjects were evaluated. The presence and severity of disc height loss from C2/C3 to C6/C7 (a total of 4325 discs) were assessed using a validated grading system. The total disc height loss score for each subject was calculated as the sum of the score of each disc space. Sagittal radiographic parameters included: occipital slope, occiput-C2 (Oc-C2) lordosis, C2-C7 lordosis and T1 slope. Multivariable regression analyses were performed to examine the relative influence of the multiple factors on upper and lower cervical lordosis. RESULTS This study included 360 males and 505 females, with a mean age of 40.2 ± 16.0 years (range, 20-95 years). Linear multivariate regression analyses showed that greater age, male sex, greater T1 slope were each found to be significantly and independently associated with greater C2-C7 lordosis, whereas total disc height loss score was negatively associated with C2-C7 lordosis. T1 slope had the most independent influence on C2-C7 lordosis among these factors. Age, sex and disc height loss were not independently associated with Oc-C2 lordosis. CONCLUSIONS Results from our large-scale radiologic analysis may enhance the understanding of the factors that affect cervical lordosis, indicating that age, sex, disc height loss and T1 slope were each independently associated with C2-C7 lordosis. However, age, sex and disc height loss were not independently associated with upper cervical lordosis.
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Affiliation(s)
- Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany
| | | | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany
| | - René Jonas
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center and Rush Graduate College, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany.
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Mesregah MK, Repajic M, Patel K, Gardner C, Roberts S, Buser Z, Wang J. Trends and patterns of thoracic intervertebral disc degeneration in symptomatic subjects: a magnetic resonance imaging analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2221-2230. [PMID: 34114105 DOI: 10.1007/s00586-021-06895-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/26/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to analyse the trends and patterns of IVD degeneration in different age groups at each level of the thoracic spine. METHODS This cross-sectional MRI study included 1000 symptomatic patients who had undergone upright thoracic spine MRI. A total of 13,000 thoracic IVDs from C7/T1 to T12/L1 were classified into five grades using Pfirrmann classification. Patients were divided according to their ages into five groups (n = 200/group). The severity and pattern of IVD degeneration were analysed in each age group. A predictive model of the severity and pattern of IVD degeneration in each age group was proposed. RESULTS The total grade of IVD degeneration and the number of degenerated levels increased with increasing age (P < 0.001). The most common degenerated level was T6/7 (13.3%), while the least common degenerated level was T12/L1 (1.8%). The most common grades were grade I in group 1 (60.5%), grade II in groups 2 (39%) and 3 (37.3%), and grade III in groups 4 (42.5%) and 5 (44.6%). Adjacent-level degenerations were more common than skip-level degenerations. Severe disc degeneration (Pfirrmann grades IV or V) could be predicted to occur more in group 5 (patients with 60 years and above) (margin = 0.79, 95% CI = 0.73-0.84, P < 0.001). CONCLUSIONS The severity of thoracic IVD degeneration and the number of degenerated levels increased with age. Disc degeneration was more accelerated in the mid-thoracic spine. Adjacent-level degeneration was more common than skip-level degenerations.
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Affiliation(s)
- Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA.,Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Michael Repajic
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Kishan Patel
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Carson Gardner
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Sidney Roberts
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA.
| | - Jeffrey Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
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Walter C, Baumgärtner T, Trappe D, Frantz S, Exner L, Mederake M. Influence of Cage Design on Radiological and Clinical Outcomes in Dorsal Lumbar Spinal Fusions: A Comparison of Lordotic and Non-Lordotic Cages. Orthop Surg 2021; 13:863-875. [PMID: 33763988 PMCID: PMC8126915 DOI: 10.1111/os.12872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/14/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives To evaluate the comparison between lordotic and non‐lordotic transforaminal lumbar interbody fusion (TLIF) cages in degenerative lumbar spine surgery and analyze radiological as well as clinical outcome parameters in long‐term follow up. Methods In a retrospective study design, we compared 37 patients with non‐lordotic cage (NL‐group) and 40 with a 5° lordotic cage (L‐group) implanted mono‐ or bi‐segmental in TLIF‐technique from 2013 to 2016 and analyzed radiological parameters of pre‐ and postoperative (Lumbar lordosis (LL), segmental lordosis (SL), and pelvic tilt (PT), as well as clinical parameters in a follow‐up physical examination using the Oswestry disability index (ODI), Roland–Morris Score (RMS), and visual analog scale (VAS). Results Surgery was mainly performed in lower lumbar spine with a peak in L4/5 (mono‐segmental) and L4 to S1 (bi‐segmental), long‐term follow‐up was on average 4 years postoperative. According to the literature, we found significantly better results in radiological outcome in the L‐group compared to the NL‐group: LL increased 6° in L‐group (51° preoperative to 57° postoperative) and decreased 1° in NL‐group (50° to 49° (P < 0.001). Regarding SL, we found an increase of 5° in L‐group (13° to 18°) and no difference in NL‐group (15°)(P < 0.001). In PT, we found a clear benefit with a decrease of 2° in L‐group (21° to 19°) and no difference in NL‐group (P = 0.008). In direct group comparison, ODI in NL‐group was 23% vs 28% in L‐group (P = 0.25), RMS in NL‐group was 8 points vs 9 points in L‐group (P = 0.48), and VAS was in NL‐group 2.7 vs 3.2 in L‐group (P = 0.27) without significant differences. However, the clinical outcome in multivariate analysis indicated a significant multivariate influence across ODI and RMS of BMI (Wilks λ = 0.57, F [4, 44] = 3.61, P = 0.012) and preoperative SS (Wilks λ = 0.66, F [4, 44] = 2.54, P = 0.048). Age, gender, cage type and postoperative PT had no significant influence (P > 0.05). Intraoperatively, we saw three dura injuries that could be sutured without problems and had no consequences for the patient. In the follow‐up, we did not find any material‐related problems, such as broken screws or cage loosening, also no pseudarthrosis. Conclusion In conclusion, we think it's not cage design but other influenceable factors such as correct indication and adequate decompression that lead to surgical success and the minimal difference in the LL therefore seemed to be of subordinate importance.
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The effects of axial loading on the morphometric and T 2 characteristics of lumbar discs in relation to disc degeneration. Clin Biomech (Bristol, Avon) 2021; 83:105291. [PMID: 33596534 DOI: 10.1016/j.clinbiomech.2021.105291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intervertebral disc degeneration affects the morphology, biomechanics and biochemistry of the disc. The study aimed to compare the effects of compression and traction on lumbar discs measurements in relation to degeneration. METHODS Thirty-five volunteers (30 (SD 11) yrs.) with and without chronic back pain rested supine 15 min before an unloaded T2-mapping MRI, were then loaded 20 min with 50% body weight with imaging during the last 5 min, and then repeated this process under traction. For lumbar discs, height, angle, width, mean-T2, and T2-weighted centroid locations were calculated. A repeated measure ANCOVA and Cohen's d compared loading conditions. Relations between measurement changes between conditions and degeneration assessed by Pfirrmann ratings were examined graphically. FINDINGS From compression to traction, we observed significant: decrease in L1-2 mean-T2 (Effect size = -0.35); inferior and posterior shift in L4-5 (0.4, 0.14) and L5-S1 (0.25, 0.33) T2-weighted centroid. From unloaded to compression, we observed a significant: increase in L5-S1 width (Effect Size = 0.22); anterior shift in L1-2 T2-weighted centroid (0.39); and L3-4 (mean 2.1°) and L4-5 (1.8°) extension angle. More degeneration was graphically related with larger changes from Compression to Traction (more superior and, anterior position of the T2-weighted centroid, increased height, reduced extension of segmental angle) and from Unloaded to Compression larger changes in inferior displacement of the T2-weighted centroid, decrease in height) but less anterior displacement of the centroid and less change in segmental angles. INTERPRETATION The largest loading responses were at lower levels, generally with more degeneration. T2-weighted centroid locations, angle and disc height detected the largest loading response.
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Abdollah V, Parent EC, Su A, Wachowicz K, Battié MC. Could compression and traction loading improve the ability of magnetic resonance imaging to identify findings related to low back pain? Musculoskelet Sci Pract 2020; 50:102250. [PMID: 32947196 DOI: 10.1016/j.msksp.2020.102250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Diagnostic imaging is routinely used to depict structural abnormalities in people with low back pain (LBP), but most findings are prevalent in people with and without LBP. It has been suggested that LBP is related to changes induced in the spine due to loading. Therefore, new imaging measurements are needed to improve our ability to identify structures relating to LBP. OBJECTIVES To investigate the response of the lumbar spine to compression and traction in participants with and without chronic LBP using MRI T2-mapping. METHOD Fifteen participants with chronic LBP were matched for age, weight, and gender with 15 healthy volunteers. All participants underwent MRI under three loading conditions maintained for 20 min each: resting supine, followed by compression and traction, both using 50% body weight. Participants were imaged in the last 5 min of each loading condition. Disc morphometric and fluid-based measurements from T2-maps were obtained. RESULTS Traditional MRI measurements (i.e. disc height, width and mean signal intensity) were not able to capture any differences in the changes measured in response to loading between individuals with and without pain. The location of the T2 weighted centroid (WC) was able to capture the difference between groups in response to compression in the horizontal (p < 0.01) and vertical direction (p < 0.01), and in response to traction in the vertical direction (p < 0.01). While the location of T2WC moved anteriorly (Effect Size (ES): 0.44) and inferiorly with compression in those with pain (ES: 0.34), it moved posteriorly (ES: -0.14) and superiorly (ES: -0.05) in the group without pain. In response to traction, the vertical location of T2WC moved superiorly in both groups but the change was larger in those with pain (ES Pain = -0.52; ES No Pain: -0.13). CONCLUSION The novel measurements of the location of the T2WC in the intervertebral discs were the only measurements capturing differences in response to loading between those with and without low back pain.
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Affiliation(s)
- Vahid Abdollah
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, CA T6G 2G4, Canada.
| | - Eric C Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, CA T6G 2G4, Canada.
| | - Alex Su
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 3-48 Corbett Hall, Edmonton, AB, CA T6G 2G4, Canada.
| | - Keith Wachowicz
- Department of Oncology, Medical Physics Division, 11560 University of Alberta, Edmonton, AB, CA T6G 1Z2, Canada; Department of Medical Physics, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, CA T6G 1Z2, Canada.
| | - Michele C Battié
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, CA T6G 2G4, Canada.
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Wilke HJ, Herkommer A, Werner K, Liebsch C. In vitro Analysis of the Intradiscal Pressure of the Thoracic Spine. Front Bioeng Biotechnol 2020; 8:614. [PMID: 32626699 PMCID: PMC7311578 DOI: 10.3389/fbioe.2020.00614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Abstract
The hydrostatic pressure of the nucleus pulposus represents an important parameter in the characterization of spinal biomechanics, affecting the segmental stability as well as the stress distribution across the anulus fibrosus and the endplates. For the development of experimental setups and the validation of numerical models of the spine, intradiscal pressure (IDP) values under defined boundary conditions are therefore essential. Due to the lack of data regarding the thoracic spine, the purpose of this in vitro study was to quantify the IDP of human thoracic spinal motion segments under pure moment loading. Thirty fresh-frozen functional spinal units from 19 donors, aged between 43 and 75 years, including all segmental levels from T1-T2 to T11-T12, were loaded up to 7.5 Nm in flexion/extension, lateral bending, and axial rotation. During loading, the IDP was measured using a flexible sensor tube, which was inserted into the nucleus pulposus under x-ray control. Pressure values were evaluated from third full loading cycles at 0.0, 2.5, 5.0, and 7.5 Nm in each motion direction. Highest IDP increase was found in flexion, being significantly (p < 0.05) increased compared to extension IDP. Median pressure values were lowest in lateral bending while exhibiting a large variation range. Flexion IDP was significantly increased in the upper compared to the mid- and lower thoracic spine, whereas extension IDP was significantly higher in the lower compared to the upper thoracic spine, both showing significant (p < 0.01) linear correlation with the segmental level at 7.5 Nm (flexion: r = -0.629, extension: r = 0.500). No significant effects of sex or age were detected, however trends toward higher IDP in specimens from female donors and decreasing IDP with increasing age, potentially caused by fibrotic degenerative changes in the nucleus pulposus tissue. Sagittal and transversal cuttings after testing revealed possible relationships between nucleus pulposus quality and pressure moment characteristics, overall leading to low or negative intrinsic IDP and non-linear pressure-moment behavior in case of fibrotic tissue alterations. In conclusion, this study provides insights into thoracic spinal IDP and offers a large dataset for the validation of numerical models of the thoracic spine.
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Affiliation(s)
- Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Andrea Herkommer
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Karin Werner
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To identify age-related changes in cervical sagittal parameters using standard radiographs. SUMMARY OF BACKGROUND DATA Cervical sagittal balance is important for the maintenance of neutral head posture and horizontal gaze. Degenerative changes in the cervical spine that occur with aging may alter cervical sagittal balance, which can lead to chronic neck pain and predispose to various cervical spine pathologies. METHODS We performed a retrospective cohort study of 151 patients with lateral cervical spine radiographs taken at our institution between December 2017 and June 2018. Cervical sagittal parameters were measured, including C1 inclination, C2 slope, C2-C7 Cobb angle, cervical sagittal vertical axis (cSVA), cervical tilt, upper and lower C7 slopes, T1 slope, and T1 slope minus cervical lordosis (TS-CL). The association between age and cervical sagittal parameters was assessed using the Pearson correlation coefficient and a linear regression analysis. An analysis of variance (ANOVA) with Tukey adjustments was then performed to identify differences in cervical sagittal parameters among patients aged 18 to 39 years, 40 to 64 years, and >64 years of age. RESULTS There were positive correlations between age and C2-C7 Cobb angle (r = 0.231, P = 0.004), upper C7 slope (r = 0.280, P < 0.001), lower C7 slope (r = 0.283, P < 0.001), and T1 slope (r = 0.189, P = 0.020). Upper C7 slope (R = 0.079) and lower C7 slope (R = 0.074) had the strongest correlation with age in the linear regression analysis. The ANOVA found significant differences among the age subgroups in terms of C2-C7 Cobb angle (P = 0.002), upper C7 slope (P < 0.001), lower C7 slope (P < 0.001), and T1 slope (P = 0.031). Patients >64 years old had significantly higher C2-C7 Cobb angle, upper C7 slope, lower C7 slope, and T1 slope. CONCLUSION Changes in cervical sagittal alignment with age are characterized by increased cervical lordosis and increased thoracic kyphosis. LEVEL OF EVIDENCE 3.
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21
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Abdollah V, Parent EC, Battié MC. Reliability and validity of lumbar disc height quantification methods using magnetic resonance images. ACTA ACUST UNITED AC 2019; 64:111-117. [PMID: 29432200 DOI: 10.1515/bmt-2017-0086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/07/2017] [Indexed: 11/15/2022]
Abstract
Disc height has been a focus of research on disc degeneration and low back pain (LBP). However, choosing an appropriate method to quantify disc height remains controversial. The aim of the present study was to determine the reliability and construct validity of disc height quantification methods. Repeated semi-automatic measurements of L4-5 and L5-S1 discs were obtained from 43 T2-weighted mid-sagittal 3T magnetic resonance (MR) images of 22 subjects with LBP (43±13 years), blinded to prior measurements. Heights were calculated with area-based methods (using 60%, 80% and 100% of the disc width), and point-based methods (Hurxthal's, Dabbs' and combining the two). Intra-class correlation coefficients (ICC) and standard error of measurement (SEM) were estimated. Construct validity was assessed using correlation coefficients. Intra-rater ICC(3,1) of the area-based disc height measurements ranged from 0.84 to 0.99 with an inter-rater ICC(2,1) of 0.99. Measurements with point-based methods had lower intra- and inter-rater reliability ranging between 0.76 and 0.96 and between 0.84 and 0.98, respectively. Inter-rater SEM varied between 0.2 and 0.3 mm for area-based methods and between 0.3 and 0.7 mm for point-based methods. Excluding Dabbs', high correlations (r>0.9) were observed between methods. Area-based height measurements using partial disc width demonstrated excellent reliability and construct validity and outperformed point-based methods.
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Affiliation(s)
- Vahid Abdollah
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, 3-48 Corbett Hall, University of Alberta, Edmonton, AB, T6G 2G4, Canada
| | - Eric C Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, 2-50 Corbett Hall, University of Alberta, Edmonton, AB, T6G 2G4, Canada
| | - Michele C Battié
- Professor and Western Research Chair in Exercise, Mobility and Health, School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Rd., London, ON, N6G 1H1, Canada
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Engel R, Grace S, Broadbent S. The effect of manual therapy and exercise on age-related lung function: study protocol for a randomised controlled trial. Trials 2019; 20:163. [PMID: 30867017 PMCID: PMC6417040 DOI: 10.1186/s13063-019-3257-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ageing is associated with a range of anatomical and physiological changes. Establishing whether a change is part of 'normal' ageing or the early signs of disease will affect management strategies. Progressive stiffening of the thoracic spine, decreasing chest wall compliance and declining lung function begin as early as 40 years of age. Administering an intervention such as manual therapy, which has the potential to mitigate age-related changes in the thoracic spine and chest wall, has the potential to improve thoracic compliance and lung function. The aims of this trial are to investigate whether manual therapy can mitigate the effects of age-related changes in lung function and whether there is a difference in effect between different forms of manual therapy. METHODS The study design is a randomised controlled trial of 372 people with no history of respiratory disease between the ages of 50 and 65 years. The cohort will be divided into three equal groups. The first group will receive a simple 10-min treadmill walking program (Ex). The second group will receive joint mobilisation (MB) of the thoracic spine and ribs plus the same walking program (MB + Ex). The third group will receive joint manipulation (MT) of the thoracic spine and ribs plus the same walking program (MT + Ex). All interventions will be administered a total of six times over a 3-week period. The primary outcome measure is lung function: forced expiratory volume in the 1st second and forced vital capacity. The secondary outcome measures include chest wall expansion (tape measurements) and quality of life measurements (36-Item Short Form Health Survey). Outcome measurements will be taken by blinded assessors on four occasions over a 9-week period. Adverse event data will be gathered at the beginning of each intervention session. DISCUSSION This randomised controlled trial is designed to investigate whether manual therapy can mitigate the effects of age-related changes in lung function and whether there is a difference in effect between different forms of manual therapy. This is the first fully powered trial designed to test this hypothesis on healthy males and females in this age range. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), 12616001317482 . Registered on 20 September 2016.
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Affiliation(s)
- Roger Engel
- Department of Chiropractic, Macquarie University, North Ryde, Sydney, NSW, 2109, Australia.
| | - Sandra Grace
- School of Health and Human Sciences, Southern Cross University, Lismore, Australia
| | - Suzanne Broadbent
- School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Australia
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Frost BA, Camarero-Espinosa S, Foster EJ. Materials for the Spine: Anatomy, Problems, and Solutions. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E253. [PMID: 30646556 PMCID: PMC6356370 DOI: 10.3390/ma12020253] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/28/2018] [Accepted: 01/05/2019] [Indexed: 12/24/2022]
Abstract
Disc degeneration affects 12% to 35% of a given population, based on genetics, age, gender, and other environmental factors, and usually occurs in the lumbar spine due to heavier loads and more strenuous motions. Degeneration of the extracellular matrix (ECM) within reduces mechanical integrity, shock absorption, and swelling capabilities of the intervertebral disc. When severe enough, the disc can bulge and eventually herniate, leading to pressure build up on the spinal cord. This can cause immense lower back pain in individuals, leading to total medical costs exceeding $100 billion. Current treatment options include both invasive and noninvasive methods, with spinal fusion surgery and total disc replacement (TDR) being the most common invasive procedures. Although these treatments cause pain relief for the majority of patients, multiple challenges arise for each. Therefore, newer tissue engineering methods are being researched to solve the ever-growing problem. This review spans the anatomy of the spine, with an emphasis on the functions and biological aspects of the intervertebral discs, as well as the problems, associated solutions, and future research in the field.
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Affiliation(s)
- Brody A Frost
- Department of Materials Science and Engineering, Macromolecules Innovation Institute, Virginia Tech, Blacksburg, VA 24061, USA.
| | - Sandra Camarero-Espinosa
- Complex Tissue Regeneration Department, MERLN Institute for Technology-inspired Regenerative Medicine, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands.
| | - E Johan Foster
- Department of Materials Science and Engineering, Macromolecules Innovation Institute, Virginia Tech, Blacksburg, VA 24061, USA.
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Abdollah V, Parent EC, Battié MC. Is the location of the signal intensity weighted centroid a reliable measurement of fluid displacement within the disc? ACTA ACUST UNITED AC 2018. [PMID: 28632492 DOI: 10.1515/bmt-2016-0178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Degenerated discs have shorter T2-relaxation time and lower MR signal. The location of the signal-intensity-weighted-centroid reflects the water distribution within a region-of-interest (ROI). This study compared the reliability of the location of the signal-intensity-weighted-centroid to mean signal intensity and area measurements. L4-L5 and L5-S1 discs were measured on 43 mid-sagittal T2-weighted 3T MRI images in adults with back pain. One rater analysed images twice and another once, blinded to measurements. Discs were semi-automatically segmented into a whole disc, nucleus, anterior and posterior annulus. The coordinates of the signal-intensity-weighted-centroid for all regions demonstrated excellent intraclass-correlation-coefficients for intra- (0.99-1.00) and inter-rater reliability (0.97-1.00). The standard error of measurement for the Y-coordinates of the signal-intensity-weighted-centroid for all ROIs were 0 at both levels and 0 to 2.7 mm for X-coordinates. The mean signal intensity and area for the whole disc and nucleus presented excellent intra-rater reliability with intraclass-correlation-coefficients from 0.93 to 1.00, and 0.92 to 1.00 for inter-rater reliability. The mean signal intensity and area had lower reliability for annulus ROIs, with intra-rater intraclass-correlation-coefficient from 0.5 to 0.76 and inter-rater from 0.33 to 0.58. The location of the signal-intensity-weighted-centroid is a reliable biomarker for investigating the effects of disc interventions.
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Affiliation(s)
- Vahid Abdollah
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 3-48 Corbett Hall, Edmonton, AB T6G 2G4, Canada
| | - Eric C Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada
| | - Michele C Battié
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada
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Abdollah V, Parent EC, Battié MC. MRI evaluation of the effects of extension exercises on the disc fluid content and location of the centroid of the fluid distribution. Musculoskelet Sci Pract 2018; 33:67-70. [PMID: 29180112 DOI: 10.1016/j.msksp.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/06/2017] [Accepted: 11/18/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND McKenzie prone press-up exercises have been hypothesised to reduce intradiscal pressure, allowing fluid to be reabsorbed into the disc, which could improve the internal stability and local chemical milieu of the disc, potentially reducing symptoms. OBJECTIVE To investigate the immediate effects of prone press-up exercises on lumbar disc fluid content and movement. DESIGN Quantification of MRI changes before and after a single exercise session. METHODS The mid-sagittal T2-weighted MR images of 22 volunteers with low back pain were obtained before and immediately after performing press-up exercises. The whole disc and nucleus regions of the L4-5 and L5-S1 discs were then segmented, and their mean signal intensity (MSI) and signal intensity weighted centroid (SIWC) were computed to estimate disc fluid content and displacement. RESULTS There were no significant differences between the MSI and the vertical position of the SIWC of the whole disc before and after extension at either disc level (effect size [ES]: -0.23 to 0.09). There was a significant anterior displacement (0.1 ± 5.4 mm) of the location of the SIWC of the disc after extension exercise at L4-5 (ES: 0.22), but not at L5-S1 (ES: 0.00) or at either level for the nucleus region (ES: -0.06; 0.16). CONCLUSION Little evidence was found supporting the hypothesis that press-up exercises affect disc fluid content and distribution. Novel parameters reflecting fluid distribution detected similar or larger effects of the extension than MSI. If such exercises are effective in reducing symptoms, it is likely through other mechanisms than by changing fluid content or distribution.
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Affiliation(s)
- Vahid Abdollah
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, 3-48 Corbett Hall, University of Alberta, Edmonton, AB T6G 2G4, Canada
| | - Eric C Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada.
| | - Michele C Battié
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada
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Chen Y, Luo J, Pan Z, Yu L, Pang L, Zhong J, Li Z, Han Z, Cao K. The change of cervical spine alignment along with aging in asymptomatic population: a preliminary analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2363-2371. [PMID: 28685403 DOI: 10.1007/s00586-017-5209-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 06/27/2017] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE To investigate the correlation of cervical spine alignment changes with aging in asymptomatic population. BACKGROUND Previous studies demonstrated the influence of lumbar and thoracic spine on cervical spine alignment, but few has reported the cervical spine alignment change along with aging in asymptomatic population. METHODS Asymptomatic population were divided into four groups according to different ages (Group A: ≤20 years; Group B: 21-40 years; Group C: 41-60 years; Group D: ≥61 years). Each group was composed of 30 subjects. The following parameters were measured: C0-1 Cobb angle, C1-2 Cobb angle, C2-7 Cobb angle, C1-7 sagittal vertical axis (C1-7 SVA), C2-7 SVA, central of gravity to C7 sagittal vertical axis (CG-C7 SVA), Thoracic Inlet Angle (TIA), Neck Tilt (NT), cervical tilt, cranial tilt, T1 slope (TS), TS-CL, and ANOVA statistical method was used to analyze the differences among four groups, and then, linear regression analysis was performed to analyze correlation of the cervical spine alignment with the aging. RESULTS C1-7 SVA, C2-7 SVA, CG-C7 SVA, TIA, NT, TS, and cranial tilt were found statistically different among four groups (P < 0.01). From Group A to Group D, the mean C1-7 SVA were 30.7, 26.0, 21.8, and 36.9 mm, the mean C2-7 SVA were 18.7, 14.7, 11.9, and 24.7 mm, and the mean CG-C7 SVA were 19.6, 16.6, 9.4, and 26.7 mm. The mean TIA were 62.4°, 65.0°, 71.8°, and 76.9°, the mean NT were 39.4°, 43.8°, 46.3°, and 48.2°, the mean TS were 23.0°, 21.1°, 25.5°, and 28.7°, and the mean cranial tilt were 5.7°, 4.8°, 3.0°, and 9.5°. Further linear regression indicated that TIA (r = 0.472; P < 0.0001), NT (r = 0.337; P = 0.0006), and TS (r = 0.299; P = 0.0025) were positively correlated with aging. CONCLUSION A gradual increase of TIA, NT, and TS, accompanied with an increased CL, is found along with aging in asymptomatic population, among which TIA, NT, and TS are significantly correlated with physiological nature of aging.
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Affiliation(s)
- Yiwei Chen
- Spine Surgery, Orthopaedics Department, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Jiaquan Luo
- Spine Surgery, Orthopaedics Department, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zhimin Pan
- Spine Surgery, Orthopaedics Department, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Limin Yu
- Orthopaedic Surgery, Beijing University Shenzhen Hospital, Shenzhen, 518036, China
| | - Long Pang
- Spine Surgery, Orthopaedics Department, General Hospital of Ningxia Medical University, Ningxia, 750004, China
| | - Junlong Zhong
- Spine Surgery, Orthopaedics Department, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zhiyun Li
- Spine Surgery, Orthopaedics Department, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zhimin Han
- Spine Surgery, Orthopaedics Department, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Kai Cao
- Spine Surgery, Orthopaedics Department, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
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Pariente E, Olmos JM, Landeras R, Nan D, González-Macías J, Hernández JL. Relationship between spinal osteoarthritis and vertebral fractures in men older than 50 years: data from the Camargo Cohort Study. J Bone Miner Metab 2017; 35:114-121. [PMID: 26825659 DOI: 10.1007/s00774-016-0735-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
Spinal osteoarthritis has been suggested as a risk factor for vertebral fractures. However, results are conflicting: most of the data are focused on the lumbar region, and referred to postmenopausal women, whereas data for men are scarce. The aim of this study is to assess the relationship between spinal osteoarthritis and vertebral fractures in men over 50 years of age. We conducted a cross-sectional study, nested in a prospective population-based cohort, including 507 community-dwelling men, 93 of them with at least one vertebral fracture. Vertebral fractures, osteophytosis, and disc space narrowing (DSN) were assessed by lateral thoracic and lumbar radiographs. Anthropometric, clinical, and densitometric variables were also analyzed. A multiple logistic regression model was performed. Eighty-five percent of vertebral fractures were located at the thoracic spine. Osteophytosis and DSN showed a bimodal distribution, with major frequency peaks at mid- and distal lumbar spine. The three distributions overlapped around the T9 vertebra. We did not find any relationship between lumbar osteoarthritis and vertebral fractures. Nevertheless, thoracic osteophytosis (OR, 1.84; 95 % CI, 1.05-3.17; p = 0.03) and DSN (OR, 2.52; 95 % CI, 1.43-4.46; p = 0.001) were found to be independently associated with prevalent vertebral fractures, after adjusting for confounders. Our results suggest a positive relationship between radiologic osteoarthritic changes at the thoracic spine and prevalent vertebral fractures in men more than 50 years of age. Osteoarthritis may act as a local risk factor, in addition to other mechanical factors, resulting in a greater propensity to fracture, especially at the mid-thoracic region.
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Affiliation(s)
- Emilio Pariente
- "Camargo-Interior" Primary Care Center, Servicio Cántabro de Salud, OSPC, Muriedas, Cantabria, Spain
| | - José M Olmos
- Bone Metabolism Unit, Department of Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, IDIVAL, RETICEF, 39008, Santander, Cantabria, Spain
| | - Rosa Landeras
- Department of Radiology, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Daniel Nan
- Bone Metabolism Unit, Department of Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, IDIVAL, RETICEF, 39008, Santander, Cantabria, Spain
| | - Jesús González-Macías
- Bone Metabolism Unit, Department of Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, IDIVAL, RETICEF, 39008, Santander, Cantabria, Spain
| | - José Luis Hernández
- Bone Metabolism Unit, Department of Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, IDIVAL, RETICEF, 39008, Santander, Cantabria, Spain.
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Baeesa SS, Krueger A, Aragón FA, Noriega DC. The efficacy of a percutaneous expandable titanium device in anatomical reduction of vertebral compression fractures of the thoracolumbar spine. Saudi Med J 2016; 36:52-60. [PMID: 25630005 PMCID: PMC4362189 DOI: 10.15537/smj.2015.1.9463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To evaluate the feasibility of a minimally invasive technique using a titanium expandable device to achieve anatomical restoration of vertebral compression fractures (VCF) of the thoracolumbar spine. METHODS This prospective study included 27 patients diagnosed with VCF (Magerl classification A.1.2, A.1.3, and A.3.1) of the thoracolumbar spine treated with percutaneous cement augmentation using the SpineJack® device. The study was conducted in Valladolid University Hospital, Valladolid, Spain from January to December 2012, with a minimum one-year follow up. Preoperative evaluation included visual analogue scale (VAS) for pain, and radiological assessment of the VCF using 3-dimensional computed tomography (3D-CT) scans for measurements of vertebral heights and angles. The patients were followed at 3, 6, and 12 months with clinical VAS and radiological assessments. RESULTS The procedure was performed in 27 patients with a mean age of 55.9 ± 17.3 years, 55.6% females. All patients underwent surgery within 6 weeks from time of injury. No procedure related complications occurred. Pain measured by VAS score decreased from 7.0 preoperatively to 3.2 within 24 hours, and remained 2.2 at 3 months, 2.1 at 6 months, and 1.5 at 12-months follow-up (p<0.05). Mean height restorations for the anterior was 3.56 mm, central was 2.49, and posterior vertebral was 1.28 mm, and maintained at 12-months follow-up (p=0.001). CONCLUSION This new percutaneous technique for VCF has shown good clinical results in pain control and the possibility to reduce both vertebral kyphosis angles and fractured endplates seen in 3D-CT scans assessment method. Further studies are needed to confirm those results on larger cohorts with long-term follow up.
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Affiliation(s)
- Saleh S Baeesa
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia. Fax. +966 (12) 6408469. E-mail.
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Hayashi A, Emanovsky PD, Pietrusewsky M, Holland TD. A Procedure for Calculating the Vertical Space Height of the Sacrum When Determining Skeletal Height for Use in the Anatomical Method of Adult Stature Estimation. J Forensic Sci 2016; 61:415-423. [DOI: 10.1111/1556-4029.13030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 03/05/2015] [Accepted: 03/28/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Atsuko Hayashi
- Central Identification Laboratory Defense POW/MIA Accounting Agency 590 Moffet St JBPHH HI
| | - Paul D. Emanovsky
- Central Identification Laboratory Defense POW/MIA Accounting Agency 590 Moffet St JBPHH HI
| | | | - Thomas D. Holland
- Central Identification Laboratory Defense POW/MIA Accounting Agency 590 Moffet St JBPHH HI
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Midsagittal anatomy of lumbar lordosis in adult egyptians: MRI study. ANATOMY RESEARCH INTERNATIONAL 2014; 2014:370852. [PMID: 25210630 PMCID: PMC4151604 DOI: 10.1155/2014/370852] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/24/2014] [Indexed: 12/28/2022]
Abstract
Despite the increasing recognition of the functional and clinical importance of lumbar lordosis, little is known about its description, particularly in Egypt. At the same time, magnetic resonance imaging (MRI) has been introduced as a noninvasive diagnostic technique. The aim of this study was to investigate the anatomy of the lumbar lordosis using midsagittal MRIs. Normal lumbar spine MRIs obtained from 93 individuals (46 males, 47 females; 25–57 years old) were evaluated retrospectively. The lumbar spine curvature and its segments “vertebrae and discs” were described and measured. The lumbar lordosis angle (LLA) was larger in females than in males. Its mean values increased by age. The lumbar height (LH) was longer in males than in females. At the same time, the lumbar breadth (LB) was higher in females than in males. Lumbar index (LI = LB/LH × 100) showed significant gender differences (P < 0.0001). Lordosis was formed by wedging of intervertebral discs and bodies of lower lumbar vertebrae. In conclusion, MRI might clearly reveal the anatomy of the lumbar lordosis. Use of LI in association with LLA could be useful in evaluation of lumbar lordosis.
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Abstract
STUDY DESIGN In vivo 3-dimensional (3D) morphometric analysis of the lumbar foramen by using 3D computed tomographic models in normal subjects. OBJECTIVE To describe foraminal geometry in an asymptomatic cohort measured in 3D. SUMMARY OF BACKGROUND DATA Appropriate assessment of the complex 3D lumbar foraminal geometry is key to correct radiculopathy diagnosis and treatment planning. To the best of our knowledge, there is no other study that quantifies the normal lumbar foramen 3D geometry considering sex, age groups, and spinal levels in vivo. METHODS Subject-based 3D computed tomographic lumbar models were created in 59 asymptomatic volunteers and foraminal height and width were measured on the basis of the model by custom software. The foraminal height and width were compared by sex, age, and lumbar level. RESULTS Overall, the foraminal height decreased with age. However, although the foraminal height in males decreased with age at all spinal levels, the foraminal heights in females did not. The foraminal height was significantly larger in the upper lumbar levels in both sexes. The foraminal width in males was significantly smaller than in females for all age groups. The foraminal width in both sexes also decreased similarly with age. The foraminal widths at the lower lumbar levels were significantly smaller than those at the upper levels. Age-related foraminal width decreases were seen in all lumbar levels as well. CONCLUSION This study described foraminal geometry in vivo in an asymptomatic cohort measured in 3D. Age-related foraminal height decrease was noticeable in males and in the lower lumbar levels. Age-related foraminal width decrease was shown in both sexes and in all lumbar levels. Such information can be used as baseline data for diagnosis of foraminal stenosis and treatment modality planning.
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Rajapakse CS, Phillips EA, Sun W, Wald MJ, Magland JF, Snyder PJ, Wehrli FW. Vertebral deformities and fractures are associated with MRI and pQCT measures obtained at the distal tibia and radius of postmenopausal women. Osteoporos Int 2014; 25:973-82. [PMID: 24221453 PMCID: PMC4746757 DOI: 10.1007/s00198-013-2569-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 10/24/2013] [Indexed: 11/26/2022]
Abstract
SUMMARY We investigated the association of postmenopausal vertebral deformities and fractures with bone parameters derived from distal extremities using MRI and pQCT. Distal extremity measures showed variable degrees of association with vertebral deformities and fractures, highlighting the systemic nature of postmenopausal bone loss. INTRODUCTION Prevalent vertebral deformities and fractures are known to predict incident further fractures. However, the association of distal extremity measures and vertebral deformities in postmenopausal women has not been fully established. METHODS This study involved 98 postmenopausal women (age range 60-88 years, mean 70 years) with DXA BMD T-scores at either the hip or spine in the range of -1.5 to -3.5. Wedge, biconcavity, and crush deformities were computed on the basis of spine MRI. Vertebral fractures were assessed using Eastell's criterion. Distal tibia and radius stiffness was computed using MRI-based finite element analysis. BMD at the distal extremities were obtained using pQCT. RESULTS Several distal extremity MRI and pQCT measures showed negative association with vertebral deformity on the basis of single parameter correlation (r up to 0.67) and two-parameter regression (r up to 0.76) models involving MRI stiffness and pQCT BMD. Subjects who had at least one prevalent vertebral fracture showed decreased MRI stiffness (up to 17.9 %) and pQCT density (up to 34.2 %) at the distal extremities compared to the non-fracture group. DXA lumbar spine BMD T-score was not associated with vertebral deformities. CONCLUSIONS The association between vertebral deformities and distal extremity measures supports the notion of postmenopausal osteoporosis as a systemic phenomenon.
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Affiliation(s)
- C S Rajapakse
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA,
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Parenteau CS, Zhang P, Holcombe S, Wang S. Characterization of vertebral angle and torso depth by gender and age groups with a focus on occupant safety. TRAFFIC INJURY PREVENTION 2014; 15:66-72. [PMID: 24279968 DOI: 10.1080/15389588.2013.829217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The human body changes as it becomes older. The automotive safety community has been interested in understanding the effect of age on restraint performance. Focus has been placed on characterizing the body's structural changes associated with age and gender. In this study, spine alignment and torso depth were assessed, because both variables have been shown to affect injury risk. METHODS The data was obtained from computed tomography (CT) scans of more than 24,000 patients aged 16 and older. The data consisted of thoracic and lumbar vertebral angles relative to a fixed plane, as well as vertebra-to-front skin and spine-to-back skin distances. Angle measurements were taken in the sagittal plane at each vertebra level from T1 to L5; distance measurements were taken from T6 to L5. The data were analyzed as a function of gender and age with the young group defined as 16 to 29 years old and the older group as 75 and up. RESULTS Vertebral angles were different depending on location. They varied from -24.5 ± 8.9° at T2 to 12.2 ± 5.6° at L1. The vertebral angles also varied with age. Angles in the older male group were 1.74 times larger at T1 and 2.03 times larger at T7 than in the young male group. Similar findings were observed for females. The effect of age and gender was modeled with forward/backward selection using a regression model. The vertebra-to-front skin distance also differed depending on vertebral level. It was highest at T10 at 162.5 ± 30.9 mm and lowest at L4 at 125.3 ± 37.3 mm for the entire study population. On average, males had larger distances than females. The spine-to-back distances were greatest in the lumbar area. The spine-to-back distance increased with lower vertebral level, regardless of age. The vertebral angle and distance data were analyzed for a male subgroup approximating the height and weight of a 50th percentile male dummy. The results showed that the vertebra-to-front skin distance increased with age. There was not a clear trend for the spine-to-back skin distance and L1 vertebral angle. CONCLUSIONS The changes in the vertebral angles, as well as the anterior and posterior spine-to-skin distances along the sagittal plane, were determined as a function of age and gender. The effect was greatest in the mid-thoracic area. Spine alignment and body shape differences need to be considered in human mathematical models used to develop safety countermeasures for the older population, because they may affect the loading path and lead to different seating postures or belt positioning. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.
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Affiliation(s)
- Chantal S Parenteau
- a International Center for Automotive Medicine , University of Michigan , Ann Arbor , Michigan
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Spinal alignment in low back pain patients and age-related side effects: a multivariate cross-sectional analysis of video rasterstereography back shape reconstruction data. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1979-85. [PMID: 23616202 DOI: 10.1007/s00586-013-2787-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 02/11/2013] [Accepted: 04/14/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Spinal form in the sagittal plane and asymmetries of spinal alignment in the frontal plane were identified earlier to be associated with low back pain. This study was aiming at investigating whether age was influencing the significance of these findings. METHODS Spinal alignment of 155 older and 58 younger low back pain patients was investigated using non-invasive video rasterstereography and compared to 192 pain free controls. Trunk inclination and imbalance, pelvis tilt and torsion, and the thoracic kyphosis and lumbar lordosis angle served as dependent variables, which were analyzed using multivariate procedures. RESULTS Frontal plane parameters-trunk imbalance (λ > 0.60) in combination with pelvis tilt (λ > 0.64)-constituted an independent component in a factor analysis model of spine shape parameters in younger and older patients, but not in pain free controls. Trunk imbalance (frontal), trunk inclination (sagittal) and partially thoracic kyphosis angle (sagittal) were extracted to separate patients from controls (discriminant coefficients >0.50). Age could not be excluded as interfering variable for the lumbar lordosis angle. Significant univariate analyses revealed higher effect sizes for trunk imbalance and inclination (η (2) > 0.07) than for lordosis, kyphosis or pelvic parameters (η (2) < 0.06). CONCLUSIONS In line with corresponding findings trunk imbalance remained a low back pain-associated parameter not depending on age. Over all, sagittal trunk inclination and the thoracic kyphosis angle could not be established as being completely free from age influences, while the lumbar lordosis angle played a minor role and seemed to be influenced more by age than by low back pain in this rasterstereography study.
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Zukowski LA, Falsetti AB, Tillman MD. The influence of sex, age and BMI on the degeneration of the lumbar spine. J Anat 2011; 220:57-66. [PMID: 22050626 DOI: 10.1111/j.1469-7580.2011.01444.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Previous research on lumbar spine osteophyte formation has focused on patterned development and the relation of age and sex to degeneration within the vertebral bodies. The inclusion of osteophytes originating on the laminae and body mass index (BMI) may result in a more complete evaluation. This study investigates lumbar osteophyte development on the laminae and vertebral bodies to determine whether osteophyte development: (i) is related bilaterally, at different lumbar levels, and superior and inferior margins; (ii) on the laminae and vertebral bodies are reciprocally dependent responses; (iii) is correlated with sex, age and/or BMI. Seventy-six individuals (39 females, 37 males) were randomly selected from a modern skeletal collection (Bass Donated Collection). Osteophyte development was scored in eight regions on each vertebra at all five lumbar levels. A factor analysis considered all 40 scoring regions and Pearson's correlation analyses assessed the relatedness of age and BMI with the consequent factors. The factor analysis separated the variables into two similar factors for males and females defined as: (i) superior and inferior vertebral body scores and (ii) superior laminar scores at higher lumbar levels. The factor analysis also determined a third factor for females defined as: (iii) inferior laminar scores at lower lumbar levels. The severity of vertebral body osteophytes increased with age for both sexes. Additionally for females, as BMI increased, osteophyte severity increased for both the superior laminar margins higher in the column and the vertebral bodies. Dissimilarities between the factors in males and females and the correlation of BMI to osteophyte severity exclusively in females provide evidence for different biomechanical processes influencing osteophyte development.
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Affiliation(s)
- Lisa A Zukowski
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA.
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Kunkel ME, Herkommer A, Reinehr M, Böckers TM, Wilke HJ. Morphometric analysis of the relationships between intervertebral disc and vertebral body heights: an anatomical and radiographic study of the human thoracic spine. J Anat 2011; 219:375-87. [PMID: 21615399 DOI: 10.1111/j.1469-7580.2011.01397.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The main aim of this study was to provide anatomical data on the heights of the human intervertebral discs for all levels of the thoracic spine by direct and radiographic measurements. Additionally, the heights of the neighboring vertebral bodies were measured, and the prediction of the disc heights based only on the size of the vertebral bodies was investigated. The anterior (ADH), middle (MDH) and posterior heights (PDH) of the discs were measured directly and on radiographs of 72 spine segments from 30 donors (age 57.43 ± 11.27 years). The radiographic measurement error and the reliability of the measurements were calculated. Linear and non-linear regression analyses were employed for investigation of statistical correlations between the heights of the thoracic disc and vertebrae. Radiographic measurements displayed lower repeatability and were shorter than the anatomical ones (approximately 9% for ADH and 37% for PDH). The thickness of the discs varied from 4.5 to 7.2 mm, with the MDH approximately 22.7% greater. The disc heights showed good correlations with the vertebral body heights (R(2), 0.659-0.835, P-values < 0.005; anova), allowing the generation of 10 prediction equations. New data on thoracic disc morphometry were provided in this study. The generated set of regression equations could be used to predict thoracic disc heights from radiographic measurement of the vertebral body height posterior. For the creation of parameterized models of the human thoracic discs, the use of the prediction equations could eliminate the need for direct measurement on intervertebral discs. Moreover, the error produced by radiographic measurements could be reduced at least for the PDH.
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Affiliation(s)
- Maria E Kunkel
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, Germany
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Morosano ME, Menoyo I, Caferra DA, Sánchez A, Tomat MF, Bocanera R, Pezzotto SM, Masoni AM. Vulnerability of healthy vertebrae in patients with and without previous vertebral fracture. Bone 2011; 48:820-7. [PMID: 21185414 DOI: 10.1016/j.bone.2010.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 10/12/2010] [Accepted: 12/14/2010] [Indexed: 10/18/2022]
Abstract
Vertebral deformities are associated with a marked increase in morbidity, mortality, and burden in terms of sanitary expenditures. Patients with vertebral fractures have a negative impact in their health, less quality of life, and loss of functional capacity and independence. The purpose of this study was to explore the vulnerability of healthy vertebrae in patients who have sustained already a compression fracture and in patients who do not have prevalent fractures in the thoracic spine; and to explore the association of the deformity in healthy vertebrae with different variables, such as bone mineral density (BMD), body mass index, age, loss of height, presence of clinical kyphosis, history of other osteoporotic fractures, and falls occurring during the last year. Clinical data and complementary studies from 175 postmenopausal outpatients were analyzed. These women (age: 69.7±11.1 years) had not received any treatment for osteoporosis. Anteroposterior and lateral radiographs of the thoracic spine and bone densitometry of the hip were obtained; morphometry was performed in 1575 thoracic vertebrae from T4 to T12. The angle of wedging of each vertebral body was calculated using a trigonometric formula. Then, the sum of wedge angles of vertebral bodies (SWA) was determined, and Cobb angle was measured. In patients with vertebral fractures, after excluding the angles of fractured vertebral bodies, the mean wedge angle of the remaining vertebrae (MWAhealthy) was calculated. The same procedure was followed in patients without vertebral fractures. MWAhealthy was considered as an indicator of the structural vulnerability of non-fractured vertebrae. Patients with prevalent fractures had lower BMD, wider Cobb angle, and higher sum of wedge angles than patients without vertebral fractures. The proportion of patients with accentuation of clinical kyphosis was higher in the group with prevalent vertebral fractures. A highly significant difference was found in the MWAhealthy, which was higher in patients with prevalent fractures (4.1±1.3° vs. 3.0±1.1°; p<0.001). Patients showing vertebral fractures had 7.1±4.2 cm height loss in average, significantly superior than that found among non-fractured women (3.6±3.2 cm; p<0.01). In multivariate analysis, the increase of MWAhealthy was associated with advancing age (p<0.02), lower femoral neck BMD (p<0.005), presence of clinical kyphosis (p<0.01) and vertebral fractures (p<0.02). This study presents evidence that a series of factors independently influence the increase in wedging deformity of vertebral bodies that are not fractured yet. These factors could contribute to an increased vulnerability of the vertebrae, making them more susceptible to fracture.
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Affiliation(s)
- Mario E Morosano
- Cátedra de Química Biológica, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Argentina
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A review of methods for quantitative evaluation of axial vertebral rotation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:1079-90. [PMID: 19242736 DOI: 10.1007/s00586-009-0914-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 02/03/2009] [Accepted: 02/09/2009] [Indexed: 10/21/2022]
Abstract
Quantitative evaluation of axial vertebral rotation is essential for the determination of reference values in normal and pathological conditions and for understanding the mechanisms of the progression of spinal deformities. However, routine quantitative evaluation of axial vertebral rotation is difficult and error-prone due to the limitations of the observer, characteristics of the observed vertebral anatomy and specific imaging properties. The scope of this paper is to review the existing methods for quantitative evaluation of axial vertebral rotation from medical images along with all relevant publications, which may provide a valuable resource for studying the existing methods or developing new methods and evaluation strategies. The reviewed methods are divided into the methods for evaluation of axial vertebral rotation in 2D images and the methods for evaluation of axial vertebral rotation in 3D images. Key evaluation issues and future considerations, supported by the results of the overview, are also discussed.
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Abstract
STUDY DESIGN A cross-sectional study of thoracic magnetic resonance image (MRI) findings. OBJECTIVE To examine the prevalence of different thoracic MRI findings for T6-T12 and their associations with age and one another by level. SUMMARY OF BACKGROUND DATA There is a dearth of descriptive epidemiology of thoracic MRI findings in the general population. METHODS Thoracic MRIs of 524 men were assessed qualitatively and quantitatively for a variety of findings, including disc bulging, height and signal, vertebral deformities, endplate irregularities, osteophytes, and hemangiomas. Descriptive statistics, correlation coefficients and STATA's survey analysis were used. RESULTS In the lower thoracic spine, 5.4% to 9.5% of the discs, depending on level, were qualitatively assessed as moderately to severely narrowed. Anterior bulging was more common than posterior, which was relatively rare and mild when present. Signal was lower in the midthoracic than lower discs. At least 1 moderate or severe vertebral deformity was found in 6.1% of the subjects, suggesting fracture, and hemangiomas were identified in 2.3% of subjects. Disc signal correlated most highly with age (r = 0.31-0.42). Qualitatively assessed disc height narrowing (r = 0.29-0.46) and quantitative disc height (r = 0.11-0.29) were associated with disc signal. Upper and lower endplate irregularities were associated with one another (r = 0.17-0.32), as were bulging and osteophytes, anteriorly (r = 0.35-0.61) and posteriorly (r = 0.26-0.45). CONCLUSION Degenerative MRI findings beyond a mild grade were not commonly observed in the thoracic spine among 35-70-year-old men. Posterior bulges, in particular, were rare. The highest correlation with age existed for disc signal. Different MRI findings were associated with one another, but the magnitude of association varied by level. The effects of individual judgments and disc level on prevalence rates were apparent.
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Verlaan JJ, Oner FC. Kyphosis. J Neurosurg Spine 2008; 9:511. [DOI: 10.3171/spi.2008.9.11.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Braunstein V, Sprecher CM, Gisep A, Benneker L, Yen K, Schneider E, Heini P, Milz S. Long-term reaction to bone cement in osteoporotic bone: new bone formation in vertebral bodies after vertebroplasty. J Anat 2008; 212:697-701. [PMID: 18410315 DOI: 10.1111/j.1469-7580.2008.00883.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Elderly patients frequently suffer from osteoporotic vertebral fractures resulting in the need of vertebroplasty or kyphoplasty. Nevertheless, no data are available about the long-term consequences of cement injection into osteoporotic bone. Therefore, the aim of the present study was to evaluate the long-term tissue reaction on bone cement injected to osteoporotic bone during vertebroplasty. The thoracic spine of an 80-year-old female was explanted 3.5 years after vertebroplasty with polymethylmethacrylate. The treatment had been performed due to painful osteoporotic compression fractures. Individual vertebral bodies were cut in axial or sagittal sections after embedding. The sections were analysed using contact radiography and staining with toluidine blue. Furthermore, selected samples were evaluated with scanning electron microscopy and micro-compted tomography (in-plane resolution 6 microm). Large amounts of newly formed callus surrounding the injected polymethylmethacrylate were detected with all imaging techniques. The callus formation almost completely filled the spaces between the vertebral endplate, the cancellous bone, and the injected polymethylmethacrylate. In trabecular bone microfractures and osteoclast lacuna were bridged or filled with newly formed bone. Nevertheless, the majority of the callus formation was found in the immediate vicinity of the polymethylmethacrylate without any obvious relationship to trabecular fractures. The results indicate for the first time that, contrary to established knowledge, even in osteoporosis the formation of large amounts of new bone is possible.
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Sevinc O, Barut C, Is M, Eryoruk N, Safak AA. Influence of age and sex on lumbar vertebral morphometry determined using sagittal magnetic resonance imaging. Ann Anat 2007; 190:277-83. [PMID: 18489984 DOI: 10.1016/j.aanat.2007.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 01/15/2007] [Indexed: 11/16/2022]
Abstract
We evaluated age-related changes in the morphometric features of lumbar vertebrae in both sexes using magnetic resonance imaging (MRI). Midsagittal MRI scans of 366 individuals (156 males, 210 females; 25-82 years old) were evaluated retrospectively. The anterior height (H(a)), central height (H(c)), posterior height (H(p)), and anteroposterior diameter (D) of the body of each lumbar vertebra were measured. These measurements were used to calculate three indices, namely, the anterior wedge index (H(a)/H(p)), the biconcavity index (H(c)/H(p)), and the compression index (H(p)/D). The values of each of the three indices for the upper lumbar vertebrae of females were higher than those of the same vertebrae in males. The values of the compression index for all lumbar vertebrae decreased with age in females, whereas in males the compression index of the L1-L4 vertebrae decreased with age. No significant changes were observed in the value of the anterior wedge index in either sex. The biconcavity indices of the L1 and L5 vertebrae decreased with age in males. These results may be useful for evaluating age-related morphological changes that occur in the lumbar vertebrae.
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Affiliation(s)
- Ozdemir Sevinc
- Department of Anatomy, School of Medicine, Duzce University, Beciyorukler, 81100 Duzce, Turkey.
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Sizer PS, Brismée JM, Cook C. Medical Screening for Red Flags in the Diagnosis and Management of Musculoskeletal Spine Pain. Pain Pract 2007; 7:53-71. [PMID: 17305681 DOI: 10.1111/j.1533-2500.2007.00112.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
When a patient presents with pain in the different regions of the spine, the clinician executes a region-appropriate basic examination that includes appropriate historical cues and specific physical examination tests that can be used to identify red flags. The clinical tests include a specific examination of the sensory and motor systems. Test outcomes are best interpreted in context with the entire examination profile, where the sensitivity and specificity of these tests can influence their utility in uncovering red flags. These red flags can be categorized based on the nature and severity or the specific elements of the patient's presentation. Many general red flags can be observed in any region of the spine, while specific red flags must be categorized and discussed for each spinal region. This categorization can guide the clinician in the direction of management, whether that management is aimed at redirecting the patient's care to another specialist, reconsidering the presentation and observing for clusters of findings that may suggest red flags, or managing the patient within the clinician's specialty in context with the severity of the patient's presentation.
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Affiliation(s)
- Phillip S Sizer
- Texas Tech University Health Science Center, Rehabilitation Sciences, Lubbock, Texas, USA.
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Pfirrmann CWA, Metzdorf A, Elfering A, Hodler J, Boos N. Effect of aging and degeneration on disc volume and shape: A quantitative study in asymptomatic volunteers. J Orthop Res 2006; 24:1086-94. [PMID: 16609964 DOI: 10.1002/jor.20113] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Debate continues on the effect of disc degeneration and aging on disc volume and shape. So far, no quantitative in vivo MRI data is available on the factors influencing disc volume and shape. The objective of this MRI study was to quantitatively investigate changes in disc height, volume, and shape as a result of aging and/or degeneration omitting pathologic (i.e., painful) disc alterations. Seventy asymptomatic volunteers (20-78 years) were investigated with sagittal T1- and T2-weighted MR-images encompassing the whole lumbar spine. Disc height was determined by the Dabbs method and the Farfan index. Disc volume was calculated by the Cavalieri method. For the disc shape the "disc convexity index" was calculated by the ratio of central disc height and mean anterior/posterior disc height. Disc height, disc volume, and the disc convexity index measurements were corrected for disc level and the individuals age, weight, height, and sex in a multilevel regression analysis. Multilevel regression analysis showed that disc volume was negatively influenced by disc degeneration (p < 0.001) and positively correlated with body height (p < 0.001) and age (p < 0.01). Mean disc height and the disc convexity index were negatively influenced by disc degeneration but not by gender, weight, and height. Disc height was positively correlated with age (p < 0.01). From the results of this study, it can be concluded that disc degeneration generally results in a decrease of disc height and volume as well as a less convex disc shape. In the absence of disc degeneration, however, age tends to result in an inverse relationship on disc height, volume, and shape.
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Verlaan JJ, van de Kraats EB, Oner FC, van Walsum T, Niessen WJ, Dhert WJA. The reduction of endplate fractures during balloon vertebroplasty: a detailed radiological analysis of the treatment of burst fractures using pedicle screws, balloon vertebroplasty, and calcium phosphate cement. Spine (Phila Pa 1976) 2005; 30:1840-5. [PMID: 16103853 DOI: 10.1097/01.brs.0000173895.19334.e2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In a human cadaveric burst fracture model, the amount of endplate fracture reduction after posterior instrumentation and balloon vertebroplasty was investigated quantitatively. OBJECTIVES To assess, in a burst fracture model, the vertebral body and adjacent disc heights, in parallel sagittal planes with 3-dimensional (3D) rotational x-ray imaging, at various phases during pedicle screw fixation and subsequent balloon vertebroplasty. SUMMARY OF BACKGROUND DATA In recent human cadaveric thoracolumbar fracture studies, it was found that vertebral body height could be restored significantly with inflatable bone tamps. However, limited quantitative data exist on the amount of fracture reduction that can be achieved and how much of the reduction will be lost after deflation and removal of the bone tamps before the cement is injected. METHODS Twenty burst fractures were created and balloon vertebroplasty with calcium phosphate cement was performed after pedicle screw instrumentation. A 3D dataset was obtained during the following phases: intact, fractured, after reduction and stabilization with pedicle screws, after inflation of the balloons, after deflation and removal of the balloons, after injection of the cement. The fractured vertebral body and adjacent disc heights were measured from five reconstructed sagittal images and compared for the six phases of the procedure. Furthermore, the difference between the vertebral body height centrally and peripherally was calculated. RESULTS The mean vertebral body height at the thoracic level was Tintact = 19.5 +/- 2.2 mm, Tfractured = 14.6 +/- 3.8 mm, Treduction = 17.3 +/- 2.2 mm, Tinflation = 20.1 +/- 2.0 mm, Tdeflation = 18.0 +/- 2.0 mm, and Tcement = 17.8 +/- 1.8 mm. The overall change in vertebral body height between these phases was significant (P < 0.001). At the lumbar level the mean vertebral body height was Tintact = 23.2 +/- 3.8 mm, Tfractured = 14.7 +/- 3.0 mm, Treduction = 18.4 +/- 2.5 mm, Tinflation = 23.2 +/- 3.5 mm, Tdeflation = 19.3 +/- 2.3 mm, and Tcement = 20.2 +/- 2.8 mm. The overall change in MCVBH between these phases was also significant (P < 0.001). The increase in vertebral body height resulted in a decrease of the adjacent disc height. No difference was found for the amount of endplate reduction in the center or at the periphery. No leakage of cement was detected in the spinal canal. CONCLUSIONS Reduction of endplate fractures, both in the center and at the periphery, seems feasible and safe with combined fracture reduction and balloon vertebroplasty. The endplate fracture reduction that was gained by inflation of the bone tamps could not be maintained after deflation.
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Affiliation(s)
- Jorrit-Jan Verlaan
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
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Dabanoglu I, Kara ME, Turan E, Ocal MK. Morphometry of the thoracic spine in German shepherd dog: a computed tomographic study. Anat Histol Embryol 2004; 33:53-8. [PMID: 15027964 DOI: 10.1046/j.1439-0264.2003.00512.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Computed tomographic images of the thoracic spine of 13 German shepherd dogs were examined in order to determine the thoracic spine morphometry. Examinations were carried out in the transverse plane both intervertebral and mid-vertebral levels of the each thoracic vertebrae. The dorsoventral and interpedicular diameters of the spinal canal, the dorsoventral and transverse diameters of the vertebral body, the dorsoventral and transverse diameters of the spinal cord and also the cross-section area of the spinal canal were measured. The maximum values were found to be at the level of C7-T1. The shapes of the spinal canal and cord were circular in middle part, the shape became transverse oval in the cranial and caudal parts of the thoracic spine. The most significant correlation between the diameters was found to be in male dogs, except between dorsoventral diameters of the spinal canal and that of the vertebral body and between dorsoventral diameters of the spinal canal and transverse diameters of the vertebral body.
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Affiliation(s)
- I Dabanoglu
- Department of Anatomy, Faculty of Veterinary Medicine, University of Adnan Menderes, Aydin, Turkey.
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Girard CJ, Schweitzer ME, Morrison WB, Parellada JA, Carrino JA. Thoracic spine disc-related abnormalities: longitudinal MR imaging assessment. Skeletal Radiol 2004; 33:216-22. [PMID: 14991248 DOI: 10.1007/s00256-003-0736-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2003] [Accepted: 11/21/2003] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe and characterize the temporal changes in disc-related disorders of the thoracic spine using MR imaging. DESIGN AND PATIENTS A retrospective longitudinal cohort study was carried out of 40 patients with two sequential thoracic spine MR images at variable intervals. The images were assessed for baseline presence of, new incidence of and changes in disc herniation, degenerative disc disease, endplate marrow signal alteration and Schmorl nodes. RESULTS The range of follow-up was 4-149 weeks. Baseline presence was: disc herniation, 10% (49/480); degenerative disc disease, 14% (66/480); endplate marrow signal alteration, 2.3% (11/480); Schmorl nodes 9.6% (46/480). Most pre-existing lesions tended to remain unchanged. Herniations showed the most change, tending to improve in 27%. New incidence was: disc herniation, 1.5% (7/480), degenerative disc disease, 2% (10/480); endplate marrow signal alteration, 1.6% (8/480); Schmorl nodes, 2.1% (10/480). Disc degeneration was first visible at an 11-week interval and once established almost never changed over many weeks to months. Endplate signal alterations (Modic changes) were uncommon. Schmorl nodes show no change from baseline for up to 2 1/2 years. All findings predominated in the lower intervertebral levels from T6 to T10. CONCLUSION The most prevalent thoracic spine disc-related findings are degeneration and herniation. Disc herniations predominate in the lower segments and are a dynamic phenomenon. Disc degeneration can be rapidly evolving but tends to remain unchanged after occurrence. Endplate marrow signal changes were an uncommon manifestation of thoracic disc disease. Schmorl nodes showed the least change over time.
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Pollintine P, Dolan P, Tobias JH, Adams MA. Intervertebral disc degeneration can lead to "stress-shielding" of the anterior vertebral body: a cause of osteoporotic vertebral fracture? Spine (Phila Pa 1976) 2004; 29:774-82. [PMID: 15087801 DOI: 10.1097/01.brs.0000119401.23006.d2] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Mechanical testing of cadaveric lumbar motion segments. OBJECTIVES To test the hypothesis that degenerative changes in the intervertebral discs can influence loading of the anterior vertebral body in a manner that makes it vulnerable to fracture. SUMMARY OF BACKGROUND DATA Measurements of systemic bone loss do not fully explain the patterns of osteoporotic vertebral fractures. METHODS Thirty-three cadaveric lumbar motion segments (aged 19-82 years) were subjected to 2 kN of compressive loading while positioned to simulate habitual erect standing postures and forwards bending. Intradiscal stresses were measured in each posture by pulling a miniature pressure transducer along the midsagittal diameter of the disc. "Stress profiles" were then integrated over area to calculate the force acting on the anterior and posterior halves of the vertebral body. These forces were subtracted from the applied 2 kN to determine the compressive force on the neural arch. RESULTS In motion segments with nondegenerated discs, <5% of the compressive force was resisted by the neural arch, and forces on the vertebral body were always distributed evenly, irrespective of posture. However, with severely degenerated discs, neural arch load-bearing increased to 40% in the erect posture, and the compressive force on the vertebral body was concentrated anteriorly in forwards bending, and posteriorly in erect posture. CONCLUSIONS Severe disc degeneration causes the anterior vertebral body to be stress-shielded during the usual erect posture, and yet severely loaded whenever the spine is flexed. This could help to explain why this region is frequently the site of osteoporotic fracture, and why forward bending movements often precipitate the injury.
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Affiliation(s)
- Phill Pollintine
- Department of Anatomy, Rheumatology Unit, University of Bristol, UK
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Chanchairujira K, Chung CB, Kim JY, Papakonstantinou O, Lee MH, Clopton P, Resnick D. Intervertebral disk calcification of the spine in an elderly population: radiographic prevalence, location, and distribution and correlation with spinal degeneration. Radiology 2004; 230:499-503. [PMID: 14752191 DOI: 10.1148/radiol.2302011842] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the prevalence, distribution, and location of intervertebral disk calcification (IDC) in the thoracic and lumbar spine and the association of IDC with radiographically evident spinal degenerative changes in cadavers. MATERIALS AND METHODS Anterior vertebral columns comprising T1 through L5 were removed from 223 cadavers (183 men, 40 women; mean age at death, 67 years; range, 37-94 years). Approximately 5-mm-thick parasagittal sections were investigated with high-contrast radiography. The presence of IDC, osteophytes, vertebral endplate abnormalities, and vacuum phenomena was recorded, and the height of disk space was measured at 3,568 intervertebral levels. Logistic regression analysis was performed. RESULTS IDC was identified in 178 (80%) of the 223 cadavers. Of 3,568 disks, 459 (13%) had IDC, and 289 cases (63%) were located in the annulus fibrosus. IDC was most common in the lower thoracic spine, occurring in 275 (60%) of 459 disks. IDC occurred in 159 (87%) of 183 men and 19 (48%) of 40 women. Logistic regression analysis was adjusted for age, and results showed that the frequency of IDC was significantly higher in men in upper, middle, and lower segments of the thoracic spine (P <.05) but not in the lumbar spine (P =.09). IDC correlated with increasing age (P <.001) and disk space loss (P <.001) at all spinal levels. There was no association of IDC with vacuum phenomena or vertebral endplate abnormalities at any spinal level. CONCLUSION IDC is common in elderly persons, especially in the annulus fibrosus and lower thoracic spine. The prevalence of IDC increases with age and extent of disk space loss.
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Affiliation(s)
- Kullanuch Chanchairujira
- Department of Radiology, Veterans Administration Medical Center, University of California San Diego, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
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