Radiological Assessment of Morphological Changes of Lumbar Spine: From First to 9th Decade of Life.

STUDY DESIGN: Analysis of lumbar spine radiograms of 1,496 Jeju islanders of Korea. PURPOSE: To look into the age- and gender-matched incidences of morphological changes and their severities. OVERVIEW OF LITERATURE: There have been several prior research on the prevalence and severity of age-related diseases, both related and unrelated. Those offer some fundamental clinical data for clinicians. METHODS: Radiograms of 1,496 patients (555 males and 941 females) from the first to 9th decade were examined for this study. Sagittal and coronal alignment, disc space narrowing, spur formation including diffuse idiopathic spinal hyperostosis (DISH), spondylolisthesis, and ballooned discs associated with biconcave bodies due to osteoporosis were among the parameters of lumbar spine morphologies examined on high-quality radiographs by both human observers and computers. RESULTS: The alignment of the lumbar spine altered after birth and set at growth maturity, and then the curve was maintained till the end of the 5th decade afterward and the curve gradually hypolordotic. There were three types of coronal alignment abnormalities can be seen: idiopathic, osteopathic, and discogenic (degenerative lumbar scoliosis [DLS]). DLS developed after 6th decade. There was no scoliosis associated with spondylolysis or the post-laminofacetectomy period. Disc space narrowing and corporal spur formation were not seen till the end of 3rd decade comparatively speaking, the corporal spurs generated in the non-scoliotic spine were smaller than those in the scoliotic spine. DISH began to appear in the 5th-decade patients and its incidences increased gradually afterward. Porosis-related vertebral body collapse started to happen after 6th decade. There are three different types of spondylolisthesis: anterior, posterior, and lateral. The lateral slip occurred only in the scoliotic spine. All types were related to degenerative discs. CONCLUSIONS: It has been shown that the morphology of the lumbar spine changes throughout time.

Effect of Congenital C4-5 Synostosis on Adjacent Mobile Segments: Radiographic Assessment.

STUDY DESIGN: Prospective case series. PURPOSE: To assess the corporal morphology of the fused body and adjacent segment conditions. OVERVIEW OF LITERATURE: It is known that two fused vertebral bodies take the similar shape of the single body with inwaisting, with or without caudal flaring of the fused body, and that the fused body can cause the fusion disease at the adjacent segment that can be a risk factor for potential neurological compromise. METHODS: Radiograms of the 11 study subjects (six men and five women), aged 22-90 years who visited the outpatients' clinic for various neck complaints without trauma history were examined. C4-5 synostosis was an incidental finding in all the subjects. RESULTS: All the fused bodies were inwaisted and had anterior caudal breaking but no interior corporal flaring. Adjacent segment disease was not found in eight patients aged <40 years. Disk degeneration was found at C3-4 and C5-6 in three patients each and at C6-7 in two patients. Disk degeneration was limited to the adjacent segments. CONCLUSIONS: Degenerative disk changes are associated with the natural aging process, and the corporal morphology of the fused vertebral becomes inwaisted similar to that in the single vertebrae.

Radiological Assessment of the Effect of Congenital C3-4 Synostosis on Adjacent Segments.

STUDY DESIGN: Retrospective case series. PURPOSE: To assess the effect of non-kyphotic aligned congenital C3-4 synostosis on the adjacent segment in 10 patients. OVERVIEW OF LITERATURE: In the cervical spine, fusion disease at the adjacent motion segments may be a risk factor for potential neurological compromise and death. METHODS: Radiograms of 10 patients 13 to 69 years of age presenting with neck/shoulder discomfort or pain with or without trauma history were examined. C3-4 synostosis was found incidentally in all patients on routine examination radiographs of cervical spine. RESULTS: Adjacent segment disease (ASD) was not found in the three patients younger than 39 years of age. Five of the 10 (50%) patients, including a 67-year-old man, did not develop spondylosis in any of the cervical mobile segments. Spondylosis was observed only in the caudal 1-2 mobile segments in the remaining five patients. The youngest was a 40-year-old male who had spondylosis in the two caudal mobile segments (C4-5 and C5-6). Spondylosis was limited to the two close caudal mobile segments and was not in the cranial segments. Flaring of the lower part of synostotic vertebra associated with advanced narrowed degenerate disc was evident in five patients. CONCLUSIONS: Mobile segment spondylosis in the individuals with congenital monosegment C3-4 synostosis over age of 40 years may be a natural manifestation of aging and is not solely an adjacent segment disease directly and fully related with congenital C3-4 synostosis.

Radiographic Assessment of Effect of Congenital Monosegment Synostosis of Lower Cervical Spine between C2-C6 on Adjacent Mobile Segments.

STUDY DESIGN: A prospective radiographic study of cervical spine with congenital monosegment fusion. PURPOSE: To evaluate the effect of cervical synostosis on adjacent segments and the vertebral morphology. OVERVIEW OF LITERATURE: There are numerous clinical studies of adjacent segment disease (ASD) after monosegment surgical fusion. However, there was no report on ASD in the cervical spine with congenital monosegment synostosis. METHODS: Radiograms of 52 patients, aged 5 to 90 years, with congenital monosegment synostosis (CMS) between C2 and C6, who complained of neck/shoulder discomfort or pain were studied. 51 were normally aligned and one was kyphotically aligned. RESULTS: Spondylosis was not found in the patients below 35 years of age. Only 12 out of 24 patients with normally aligned C2-3 synostosis had spondylosis in 19 more caudal segments, and only one at C3-4. A patient with kyphotic C2-3 had spondylolysis at C3-4. In 8 patients with C3-4 synostosis, spondylosis was found in only 9 caudal segments (4 at C4-5, 4 at C5-6, and 1 at C6-7). The caudate C4-5 disc was the most liable to degenerate in comparison with other caudate segments. Caudal corporal flaring and inwaisting of the synostotic vertebra were the features that were the most evident. In 2 of 9 C4-5 and 7 out of 10 C5-6 synostosis patients, spondylosis was found at the two adjacent cephalad and caudate segments, respectively. Only corporal inwaisting without flaring was found. In all cases, spondylosis was confined to the adjacent segments. More advanced spondylosis was found in the immediate caudal segment than the cephalad one. CONCLUSIONS: It is concluded that spondylosis at the mobile segments in a synostotic spine is thought to be a fusion-related pathology rather than solely age-related disc degeneration. Those data suggested that CMS definitely precipitated the disc degeneration in the adjacent segments.

Surgical management of severe rigid tuberculous kyphosis of dorsolumbar spine.

To assess the effectiveness of deformity correction and safety of the two major corrective spinal surgical procedures, 35 patients, aged 14-47 years, were placed into two groups according to procedures performed. Sixteen patients (group A) had four-stage procedures including initial halo-pelvic distraction after anterior release and a subsequent three procedural steps plus brace. Nineteen patients (group B) had one-set two-stage procedures: wire segmental stabilisation in eight cases and rod/hook and/or pedicle screw stabilisation in 11 cases. Average preoperative kyphosis in group A was 88° and postoperative at zero, three, six, and 18 months were 29˚, 33˚, 35˚ and 35˚, respectively, while those of group B were 86˚ preoperative and postoperative 27˚, 31˚, 33˚, and 33˚, respectively. Neural complication developed in five cases: one in group A and four in group B. It was concluded that the one-set two-stage procedure is more efficient, time-saving, and cost-effective, though it is highly challenging with relatively high rates of neural complication.

Radiographic assessment of congenital C2-3 synostosis.

PURPOSE: To evaluate the morphologies of congenital C2-3 synostosis in 25 patients. METHODS: Radiographs of 11 males and 14 females aged 5 to 74 years with congenital C2-3 synostosis were reviewed. All cases were found incidentally on radiographs when presenting with neck/shoulder discomfort/pain. RESULTS: 13 of the patients had spondylosis in 21 segments: C1-2 (n=1) and C3-4 (n=1), C4-5 (n=7), C5-6 (n=9), and C6-7 (n=3). Of whom 12 had normal sagittal alignment and one had kyphotic synostosis (who developed compensatory hyperlordosis of the caudal mobile segments and subsequent spondylosis at C3-4 and C5 retrolisthesis). The remaining 12 patients had no spondylosis and had normal sagittal alignment, but had other associated pathologies including disc herniation at C3-4, C1 ring hypoplasia, and calcification of the nuchal ligament. CONCLUSION: Normally aligned congenital synostosis of C2-3 is rarely associated with a junctional problem, whereas a kyphotic synostosis is associated with a caudal junctional problem. Spondylosis developing after age 40 years is not associated with C2-3 synostosis.