The CT assessment of uncovertebral joints degeneration in a healthy population.

BACKGROUND: A retrospective study investigated the degeneration trend of uncovertebral joints in a healthy population based on CT assessment. METHODS: A total of 200 males and 160 females, aged 21-79 years old (50.82 ± 17.06), who underwent CT examination in our hospital from September 2020 to March 2021 were enrolled. Sixty patients were included in each age group. According to the Kellgren and Lawrence classification and CT was used to evaluate the uncovertebral joints degeneration in different groups. RESULTS: With the increase of age, the degeneration of each segment was gradually aggravated. The uncovertebral joints started degenerating in the 20 s, and the C5-6 is the most degenerative segment, followed by the C4-5 and C6-7. Significant degeneration occurred in each segment between the 40 s and 60 s and became more severe after the 70 s. CONCLUSIONS: The modified Kellgren and Lawrence classification based on CT scan could provide a quantitative assessment of uncovertebral joints degeneration in a healthy population and could provide more details for artificial cervical arthroplasty.

3D virtual reconstruction and quantitative assessment of the human intervertebral disc's annulus fibrosus: a DTI tractography study.

The intervertebral disc's (IVD) annulus fibrosus (AF) retains the hydrostatic pressure of the nucleus pulposus (NP), controls the range of motion, and maintains the integrity of the motion segment. The microstructure of the AF is not yet fully understood and quantitative characterization is lacking, leaving a caveat in modern medicine's ability to prevent and treat disc failure (e.g., disc herniation). In this study, we show a reconstruction of the 3D microstructure of the fibers that constitute the AF via MRI diffusion tensor imaging (DTI) followed by fiber tracking. A quantitative analysis presents an anisotropic structure with significant architectural differences among the annuli along the width of the fibrous belt. These findings indicate that the outer annuli's construction reinforces the IVD while providing a sufficient degree of motion. Our findings also suggest an increased role of the outer annuli in IVD nourishment.

Percutaneous Transforaminal Endoscopic Discectomy Versus Open Microdiscectomy for Lumbar Disc Herniation: A Systematic Review and Meta-analysis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To give a systematic overview of effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared with open microdiscectomy (OM) in the treatment of lumbar disk herniation (LDH). SUMMARY OF BACKGROUND DATA: The current standard procedure for the treatment of sciatica caused by LDH, is OM. PTED is an alternative surgical technique which is thought to be less invasive. It is unclear if PTED has comparable outcomes compared with OM. METHODS: Multiple online databases were systematically searched up to April 2020 for randomized controlled trials and prospective studies comparing PTED with OM for LDH. Primary outcomes were leg pain and functional status. Pooled effect estimates were calculated for the primary outcomes only and presented as standard mean differences (SMD) with their 95% confidence intervals (CI) at short (1-day postoperative), intermediate (3-6 months), and long-term (12 months). RESULTS: We identified 2276 citations, of which eventually 14 studies were included. There was substantial heterogeneity in effects on leg pain at short term. There is moderate quality evidence suggesting no difference in leg pain at intermediate (SMD 0.05, 95% CI -0.10-0.21) and long-term follow-up (SMD 0.11, 95% CI -0.30-0.53). Only one study measured functional status at short-term and reported no differences. There is moderate quality evidence suggesting no difference in functional status at intermediate (SMD -0.09, 95% CI -0.24-0.07) and long-term (SMD -0.11, 95% CI -0.45-0.24). CONCLUSION: There is moderate quality evidence suggesting no difference in leg pain or functional status at intermediate and long-term follow-up between PTED and OM in the treatment of LDH. High quality, robust studies reporting on clinical outcomes and cost-effectiveness on the long term are lacking.Level of Evidence: 2.

Greater Socioeconomic Disadvantage Is Associated with Worse Symptom Severity at Initial Presentation in Patients Seeking Care for Lumbar Disc Herniation.

STUDY DESIGN: Retrospective, observational study. OBJECTIVE: To determine the association of patient socioeconomic disadvantage, insurance type, and other characteristics on presenting symptom severity in patients with isolated lumbar disc herniation. SUMMARY OF BACKGROUND DATA: Little is known of the impact of socioeconomic disadvantage and other patient characteristics on the level of self-reported symptom severity when patients first seek care for lumbar disc herniation. METHODS: Between April 2015 and December 2018, 734 patients newly presenting for isolated lumbar disc herniation who completed the Patient-Reported Outcomes Measurement Information System Physical Function (PF), Pain Interference (PI), and Depression Computer Adaptive Tests (CATs) were identified. Socioeconomic disadvantage was determined using the Area Deprivation Index, a validated measure of socioeconomic disadvantage at the census block group level (0-100, 100 = highest socioeconomic disadvantage). Bivariate analyses were used. Multivariable linear regression was used to determine if there was an association between socioeconomic disadvantage, insurance type, and other patient factors and presenting patient-reported health status. RESULTS: Significant differences in age, insurance type, self-reported race, marital status, and county of residence were appreciated when comparing patient characteristics by socioeconomic disadvantage levels (all comparisons, P < 0.01). In addition, significant differences in age, insurance type, marital status, and county of residence were appreciated when comparing patient characteristics by self-reported race (all comparisons, P < 0.01). Being in the most socioeconomically disadvantaged cohort was associated with worse presenting Patient-Reported Outcomes Measurement Information System scores (Physical Function: ß = -3.27 (95% confidence interval [CI]: -4.89 to -1.45), P < 0.001; Pain Interference: ß = 3.20 (95% CI: 1.58-4.83), P < 0.001; Depression: ß = 3.31 (95% CI: 1.08-5.55), P = 0.004. CONCLUSION: The most socioeconomically disadvantaged patients with symptomatic lumbar disc herniations present with worse functional limitations, pain levels, and depressive symptoms as compared to patients from the least socioeconomically disadvantaged cohort when accounting for other key patient factors.Level of Evidence: 3.

Assessment of intervertebral disc degeneration-related properties using finite element models based on [Formula: see text]-weighted MRI data.

Quantitative magnetic resonance imaging (MRI) provides useful information about intervertebral disc (IVD) biomechanical properties, especially those in relation to the fluid phase. These properties may improve IVD finite element (FE) models using data closer to physiological reality. The aim of this study is to investigate IVD degeneration-related properties using a coupling between MRI and FE modeling. To this end, proton density ([Formula: see text])-weighted MRI sequences of a porcine lumbar IVD were carried out to develop two biphasic swelling models with hyperelastic extracellular matrix behavior. The first model is isotropic, and the second one is anisotropic and takes into account the role of collagen fibers in the mechanical behavior of the IVD. MRI sequences permitted to determine the geometry and the real porosity mapping within the disc. The differentiation between disc components (nucleus pulposus, annulus fibrosus and cartilaginous end plates) was taken into account using spatial continuous distributions of the mechanical properties. The validation of the FE models was performed through two steps: the identification of the model's mechanical properties using relaxation compressive test and the comparison between the MRI after load porosity distributions and those numerically obtained using the set of identified properties. The results confirmed that the two developed FE models were able to predict the mechanical response of uniaxial time-dependent compressive test and the redistribution of porosity after load. A slight difference between the measured and the numerical local bulges of the disc was found. This study suggests that from the coupling between MRI imaging in different state of load and finite element modeling we can deduce relevant information that can be used in the assessment of the early intervertebral disc degeneration changes.

A cost-utility analysis of Dynesys dynamic stabilization versus instrumented fusion for the treatment of degenerative lumbar spine diseases.

BACKGROUND: Symptomatic chronic low back and leg pain resulting from lumbar spine degenerative disorders is highly prevalent in China, and for some patients, surgery is the final option for improvement. Several techniques for spinal non-fusion have been introduced to reduce the side-effects of fusion methods and hasten postoperative recovery. In this study, the authors have evaluated the cost-effectiveness of Dynesys posterior dynamic stabilization system (DY) compared with lumbar fusion techniques in the treatment of single-level degenerative lumbar spinal conditions. METHODS: A total of 221 patients undergoing single-level elective primary surgery for degenerative lumbar pathology were included. 2-Year postoperative health outcomes of Visual Analogue Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36) and EuroQol-5 Dimensions (EQ-5D) questionnaires were recorded. 2-Year back-related medical resource use, missed work, and health-state values (Quality-adjusted life-year [QALY]) were assessed. Cost-effectiveness was determined by the incremental cost per QALY gained. RESULTS: At each follow-up point, both cohorts were associated with significant improvements in VAS scores, ODI, SF-36 scores and EQ-5D QALY scores, which persisted at the 2-year evaluation. The 2-year total mean cost per patient were significantly lower for Dynesys system ($20,150) compared to fusion techniques ($25,581, $27,862 and $27,314, respectively) (P < 0.001). Using EQ-5D, the mean cumulative 2-year QALYs gained were statistically equivalent between the four groups (0.28, 0.27, 0.30 and 0.30 units, respectively) (P = 0.74). Results indicate that patients implanted with the DY system derive lower total costs and more utility, on average, than those treated with fusion. CONCLUSIONS: The Dynesys dynamic stabilization system is cost effective compared to instrumented lumbar fusion for treatment of single-level degenerative lumbar disorders. It is not possible to state whether DY or lumbar fusion is more cost-effective after 2 years.

Structural health monitoring (vibration) as a tool for identifying structural alterations of the lumbar spine: a twin control study.

Structural health monitoring (SHM) is an engineering technique used to identify mechanical abnormalities not readily apparent through other means. Recently, SHM has been adapted for use in biological systems, but its invasive nature limits its clinical application. As such, the purpose of this project was to determine if a non-invasive form of SHM could identify structural alterations in the spines of living human subjects. Lumbar spines of 10 twin pairs were visualized by magnetic resonance imaging then assessed by a blinded radiologist to determine whether twin pairs were structurally concordant or discordant. Vibration was then applied to each subject's spine and the resulting response recorded from sensors overlying lumbar spinous processes. The peak frequency, area under the curve and the root mean square were computed from the frequency response function of each sensor. Statistical analysis demonstrated that in twins whose structural appearance was discordant, peak frequency was significantly different between twin pairs while in concordant twins, no outcomes were significantly different. From these results, we conclude that structural changes within the spine can alter its vibration response. As such, further investigation of SHM to identify spinal abnormalities in larger human populations is warranted.

Efficacy and cost-effectiveness of intradiscal methylene blue injection for chronic discogenic low back pain: study protocol for a randomized controlled trial.

BACKGROUND: Low back pain (LBP) is a common health problem and a substantial part of LBP is presumed to be attributable to degeneration of the intervertebral disc. For patients suffering from intractable discogenic LBP, there are few evidence-based effective interventional treatment options available. In 2010, the results of a randomized controlled trial (RCT) were published concerning "intradiscal methylene blue injection" (IMBI), in which this intervention appeared to be very successful in relieving discogenic pain. Therefore, we decided to repeat this study to investigate whether we could replicate the published results. The results of our preliminary feasibility study gave reason to set up an RCT. The aim of this RCT is to evaluate if IMBI is a more effective treatment of discogenic low back pain as an intradiscal placebo intervention, and furthermore, to assess the cost-effectiveness of this intervention. METHODS/DESIGN: Consecutive discogenic low back pain patients referred to four specialized pain treatment facilities are being screened for eligibility. After a positive standardized provocation discography and informed consent, patients are randomized into two groups. The treatment group receives an intradiscal injection with methylene blue, lidocaine, and contrast, and the control group receives intradiscal isotonic saline with lidocaine and contrast. Main outcome measures are pain at the 6-month follow-up, patient's global impression of change, cost-effectiveness, quality of life, disability, and analgesic intake. DISCUSSION: The importance of this study is emphasized by the fact that for intractable discogenic low back pain patients, evidence-based effective pain treatments are rare. If this study establishes clinical success and cost-effectiveness, IMBI could become the "pain treatment of choice" for a selected group of patients with chronic discogenic low back pain for whom noninvasive treatment options have failed. TRIAL REGISTRATION: National Trial register NTR2547 Registered at 29 September 2010 and 31 March 2014.

[Principles of intervertebral disc assessment in private accident insurance]. / Grundlagen der Bandscheibenbegutachtung in der privaten Unfallversicherung (I).

Due to the spread of intervertebral disc degeneration, insurance companies and experts are regularly confronted with related assessments of insured persons under their private accident insurance. These claims pose a particular challenge for experts, since, in addition to the clinical assessment of the facts, extensive knowledge of general accident insurance conditions, case law and current study findings is required. Each case can only be properly assessed through simultaneous consideration of both the medical and legal facts. These guidelines serve as the basis for experts and claims.managers with respect to the appropriate individual factual assessment of intervertebral disc degeneration in private accident insurance.

Microscopic assessment of degenerated intervertebral disc: clinical implications and possible therapeutic challenge.

AIM: To investigate a possible correlation between the histological and morphometric properties of herniated intervertebral disc, clinical and magnetic resonance imaging (MRI) characteristics of patients with lumbar disc degeneration (LDD). MATERIALS AND METHODS: Thirty six patients with LDD were clinically evaluated using Japanese Orthopaedic Association Score (JOAS), visual analogue scale (VAS) for pain in the lower back or in the pelvic limb; MRI-based classification according to Pfirrmann and Modic criteria. All patients underwent decompressive surgery and herniated intervertebral disc samples were histologically and morphometrically analyzed. Data obtained were statistically analyzed for bivariate and partial correlations. RESULTS: The mean area size of chondron clusters correlated with age, JOAS (r=-0.385, p=0.032, tau=-0.279, rho=-0.380), Pfirrmann (r=0.505, p=0.002, tau=0.289, rho=0.365) and Modic (r=0.500, p=0.002, tau=0.331, rho=0.419) grading. There was a strong correlation between maximum area size of chondrons and JOAS (r=-0.427, p=0.009, tau=-0.299, rho=-0.430), Pfirrmann changes (r=0.432, p=0.008, tau=0.309, rho=0.388) and Modic endplate changes (r=0.444, p=0.007, tau=0.343, rho=0.434). JOAS correlated with both MRI classifications used for LDD. CONCLUSION: The intervertebral disc cells tend to aggregate in clusters and the size of the chondrons from LDD correlated with JOAS, Pfirrmann and Modic. JOAS correlates with the imagistic evaluation systems Pfirrmann and Modic.

Single-level lumbar fusion for degenerative disc disease is associated with worse outcomes compared with fusion for spondylolisthesis in a workers' compensation setting.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Compare lumbar fusion outcomes, return-to-work (RTW) status in particular, between workers' compensation (WC) subjects undergoing single-level posterolateral fusion for either spondylolisthesis or degenerative disc disease (DDD). SUMMARY OF BACKGROUND DATA: Lumbar fusion for spondylolisthesis tends to yield more consistent outcomes than fusion for DDD and discogenic low back pain. Within the clinically distinct WC population, relatively few studies exist that evaluate lumbar fusion outcomes. METHODS: A total of 889 Ohio WC subjects were identified that underwent single-level posterolateral lumbar fusion with or without posterior interbody fusion between 1993 and 2010 using Current Procedural Terminology procedural and International Classification of Diseases, Ninth Revision diagnostic codes. Of the total subjects, 269 underwent fusion for spondylolisthesis, and 620 underwent fusion for DDD. Subjects were considered to have returned-to-work (RTW) status within a reasonable timeline if they made a stable RTW within 2 years of fusion and remained working for greater than 6 months of the following year. To determine predictors of RTW status, we performed a multivariate logistic regression analysis. We measured a number of secondary outcomes. RESULTS: Fusion for spondylolisthesis was positively associated with RTW status (P = 0.050; odds ratio [OR], 1.42; 95% confidence interval [95% CI], 1.00-2.00). A total of 36.4% of the spondylolisthesis cohort and 24.4% of the DDD cohort returned to work in a reasonable timeline postoperatively. Other negative predictors included age more than 50 years at fusion (OR, 0.66; 95% CI, 0.45-0.95), time more than 2 years between injury and index fusion (OR, 0.59; 95% CI, 0.41-0.84), permanent disability (OR, 0.61; 95% CI, 0.43-0.86), legal representation (OR, 0.67; 95% CI, 0.46-0.97), and psychological comorbidity before fusion (OR, 0.30; 95% CI, 0.14-0.62). Subjects in the DDD cohort were prescribed opioid analgesics for an average of 294 of additional days postoperatively (P < 0.001), which equated to 24,759 additional milligrams of morphine equivalents (P < 0.001). CONCLUSION: Our study is supportive of the conclusion that DDD is a questionable indication for spinal fusion. Given the generally poor outcomes of this study, future studies should determine if lumbar fusion surgery is an effective treatment modality in similar patients with WC. LEVEL OF EVIDENCE: 3.

In vivo quantification of lumbar disc degeneration: assessment of ADC value using a degenerative scoring system based on Pfirrmann framework.

PURPOSE: To evaluate the role of apparent diffusion coefficient (ADC) as a quantitative means to assess the degree of intervertebral disc (IVD) degeneration contextually within the framework of a widely used Pfirrmann classification rather than in a direct correlation with Pfirrmann grades. METHODS: DWI and T2-weighted (T2w) of lumbar spine were acquired from nine healthy volunteers (age range 27-62 years, mean age 45 years) with a 3T MR scanner. ADC values were obtained from each of the five lumbar discs via a pixel-by-pixel ADC calculation as well as via region of interest-averaged image intensities. Disc degeneration was assessed by a scoring system via sequential application of Pfirrmann scale and use of intensity ratio of IVD/cerebrospinal fluid in T2w for discs in each Pfirrmann grade to be further separated. RESULTS: A significant correlation was observed between degenerative scores and ADC independent of how ADC was obtained (Spearman's ρ < -0.85, P < 2 × 10(-14)). CONCLUSIONS: This study demonstrates that previously perceived as an overlap in ADC value existing between different degenerative categories based on a visual inspection can be viewed as a quantitative role of ADC in assessment of disc degeneration. This reinforces the Pfirrmann classification system but also proceeds beyond mere qualitatively determining morphologic states.

Assessment of intervertebral disc degeneration based on quantitative magnetic resonance imaging analysis: an in vivo study.

STUDY DESIGN: Animal experimental study. OBJECTIVE: To evaluate a novel quantitative imaging technique for assessing disc degeneration. SUMMARY OF BACKGROUND DATA: T2-relaxation time (T2-RT) measurements have been used to assess disc degeneration quanti-tatively. T2 values correlate with the water content of intervertebral disc tissue and thereby allow for the indirect measurement of nucleus pulposus (NP) hydration. METHODS: We developed an algorithm to subtract out magnetic resonance imaging (MRI) voxels not representing NP tissue on the basis of T2-RT values. Filtered NP voxels were used to measure nuclear size by their amount and nuclear hydration by their mean T2-RT. This technique was applied to 24 rat-tail intervertebral discs (IVDs), which had been punctured with an 18-gauge needle according to different techniques to induce varying degrees of degeneration. NP voxel count and average T2-RT were used as parameters to assess the degeneration process at 1 and 3 months postpuncture. NP voxel counts were evaluated against radiograph disc height measurements and qualitative MRI studies on the basis of the Pfirrmann grading system. Tails were collected for histology to correlate NP voxel counts to histological disc degeneration grades and to NP cross-sectional area measurements. RESULTS: NP voxel count measurements showed strong correlations to qualitative MRI analyses (R = 0.79, P < 0.0001), histological degeneration grades (R = 0.902, P < 0.0001), and histological NP cross-sectional area measurements (R = 0.887, P < 0.0001).In contrast to NP voxel counts, the mean T2-RT for each punctured group remained constant between months 1 and 3. The mean T2-RTs for the punctured groups did not show a statistically significant difference from those of healthy IVDs (63.55 ms ± 5.88 ms mo 1 and 62.61 ms ± 5.02 ms) at either time point. CONCLUSION: The NP voxel count proved to be a valid parameter to assess disc degeneration quantitatively in a needle puncture model. The mean NP T2-RT does not change significantly in needle-puncture-induced degenerated IVDs. IVDs can be segmented into different tissue components according to their innate T2-RT.

Early versus late initiation of rehabilitation after lumbar spinal fusion: economic evaluation alongside a randomized controlled trial.

STUDY DESIGN: Economic evaluation conducted alongside a randomized controlled trial with 1-year follow-up. OBJECTIVE: To examine the cost-effectiveness of initiating rehabilitation 6 weeks after surgery as opposed to 12 weeks after surgery. SUMMARY OF BACKGROUND DATA: In a previously reported randomized controlled trial, we assessed the impact of timing of rehabilitation after a lumbar spinal fusion and found that a fast-track strategy led to poorer functional ability. Before making recommendations, it seems relevant to address the societal perspective including return to work, quality of life, and costs. METHODS: A cost-effectiveness analysis and a cost-utility analysis were conducted. Eighty-two patients undergoing instrumented lumbar spinal fusion due to degenerative disc disease or spondylolisthesis (grade I or II) were randomized to an identical protocol of 4 sessions of group-based rehabilitation and were instructed in home exercises focusing on active stability training. Outcome parameters included functional disability (Oswestry Disability Index) and quality-adjusted life years. Health care and productivity costs were estimated from national registries and reported in euros. Costs and effects were transformed into net benefit. Bootstrapping was used to estimate 95% confidence intervals (95% CI). RESULTS: The fast-track strategy tended to be costlier by €6869 (95% CI, -4640 to 18,378) while at the same time leading to significantly poorer outcomes of functional disability by -9 points (95% CI, -18 to -3) and a tendency for a reduced gain in quality-adjusted life years by -0.04 (95% CI, -0.13 to 0.01). The overall probability for the fast-track strategy being cost-effective does not reach 10% at conventional thresholds for cost-effectiveness. CONCLUSION: Initiating rehabilitation at 6 weeks as opposed to 12 weeks after surgery is on average more costly and less effective. The uncertainty of this result did not seem to be sensitive to methodological issues, and clinical managements who have already adapted fast-track rehabilitation strategies have reason to reconsider their choice. .

Assessment of glycosaminoglycan content in intervertebral discs using chemical exchange saturation transfer at 3.0 Tesla: preliminary results in patients with low-back pain.

OBJECTIVES: To evaluate glycosaminoglycan-dependent chemical exchange saturation transfer (gagCEST) imaging at 3-T magnetic resonance imaging (MRI) for quantification of glycosaminoglycan (GAG) content in intervertebral discs (IVDs) in patients with low-back pain (LBP). METHODS: Sixteen patients with LBP were examined in this Institutional Review Board-approved study using a clinical whole-body system. The MRI protocol included standard morphological imaging, sagittal T2-mapping and gagCEST imaging. IVD grading according to the Pfirrmann score and region-of-interest analysis of the annulus fibrosus (AF) and the nucleus pulposus (NP) in gagCEST and T2 maps were performed before data were statistically tested for correlations between imaging techniques and quantitative differences between different grades of IVD degeneration. RESULTS: GagCEST values of the NP were significantly (P < 0.001) lower in degenerative IVDs (Pfirrmann 3 + 4) compared with non-degenerative IVDs (Pfirrmann 1 + 2), but only a weak linear correlation (r = 0.299) with the T2 relaxation times was found. GagCEST values of the NP exhibited a moderate negative correlation with Pfirrmann grades (r = -0.449). CONCLUSIONS: The known loss of GAG in the NP with increasing grade of morphological degeneration can be assessed using gagCEST imaging at 3.0 T. The correlation with single Pfirrmann grades and T2 relaxation times only seems to be moderate, indicating a substantial difference in information provided by the techniques.

Socioeconomic and physical characteristics of individuals with degenerative lumbar spinal stenosis.

STUDY DESIGN: A descriptive study of the association between demographic factors, and physical characteristics, and degenerative lumbar spinal stenosis (DLSS). OBJECTIVE: To shed light on the association between socioeconomic parameters, physical characteristics, and DLSS. SUMMARY OF BACKGROUND DATA: Lumbar spinal stenosis is a prevalent and disabling condition in the aging population. DLSS is considered to be the most common type and is essentially associated with disc disease, facet joint arthrosis, ligamentum flavum thickening, and osteophyte formation. Although there is ample information regarding the association between body mass index, cardiovascular disorders, smoking habits, and disc disease, very little is known about their association with DLSS. Data on the association of body physique (e.g., height and weight) and DLSS are limited. METHODS: Two sample populations were studied. The first included 165 individuals with DLSS (mean age, 64 ± 9.9 yr) and the second 180 individuals without spinal stenosis related symptoms (mean age, 62.5 ± 12.6 yr). An evaluation of the cross-sectional area of the dural sac and degenerative listhesis for all participants was performed using computed tomographic lumbar spine images, obtained by Philips EBW station (Brilliance 64, Philips Medical System, Cleveland, OH). All participants were interviewed to obtain demographic, physical, and health data. Independent t test, Mann-Whitney and χ tests were used to determine the association between parametric and nonparametric variables and DLSS. Logistic regression analysis was carried out to reveal predicting variables for DLSS. RESULTS: Females with stenosis were significantly heavier and shorter than their counterparts in the control group. We also noticed that they delivered babies more often than those in the control group. Prevalence of individuals experiencing diabetes mellitus was significantly higher in the males with stenosis than control group. In the stenosis group, the frequencies of individuals engaged in heavy manual labor (males) and housekeeping (females) were significantly higher than that of their counterparts in the control group. CONCLUSION: Heavy manual labor and diabetes mellitus in males and housekeeping (females) play major roles in the genesis of DLSS.

MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the Pfirrmann grading systems.

BACKGROUND: To evaluate by MRI intervertebral disc degeneration in patients with lumbar degenerative disease using the Pfirrmann grading system and to determine whether Modic changes correlated with the Pfirrmann grades and modified Pfirrmann grades of disc degeneration. METHODS: The clinical data of 108 surgical patients with lumbar degenerative disease were reviewed and their preoperative MR images were analyzed. Disc degeneration was evaluated using the Pfirrmann grading system. Patients were followed up and low back pain was evaluated using the visual analog scale (VAS) and the effect of back pain on the daily quality of life was assessed using Oswestry disability index (ODI). RESULTS: Forty-four cases had normal anatomical appearance (Modic type 0) and their Pfirrmann grades were 3.77±0.480 and their modified Pfirrmann grades were of 5.81±1.006. Twenty-seven cases had Modic type I changes and their Pfirrmann grades were 4.79±0.557 and their modified Pfirrmann grades were 7.00±0.832. Thirty-six cases exhibited Modic type II changes and their Pfirrmann grades and modified Pfirrmann grades were 4.11±0.398 and 6.64±0.867, respectively. One case had Modic type III changes. Kruskal-Wallis test revealed significant difference in modified Pfirrmann grade among Modic type 0, I and II changes (P<0.01) but no significant difference between Modic type I and II changes (P>0.05). Binary regression analysis showed that Modic changes correlated most strongly with disc degeneration. Follow up studies indicated that the VAS and ODI scores were markedly improved postoperatively. However, no difference was noted in VAS and ODI scores among patients with different Modic types. CONCLUSION: Modic changes correlate with the Pfirrmann and modified Pfirrmann grades of disc degeneration in lumbar degenerative disease. There is no significant correlation between Modic types and surgical outcomes.

Preoperative "group and save" in lumbar microdiscectomy: is it necessary?

OBJECT: "Group and save" (type and screen) is commonly requested preoperatively in lumbar microdiscectomy. On average, less than 100 ml of blood is lost during lumbar microdiscectomy, and blood transfusion guidelines and resuscitation practice recommend that no transfusion would be required in almost all healthy patients with less than 750 ml of blood loss. The authors performed an audit of 319 consecutive lumbar microdiscectomies to determine if the practice of group and save can be justified. A telephone survey of the United Kingdom (UK) neurosurgical units to establish current UK neurosurgical practice was also conducted. METHODS: A telephone survey of all UK neurosurgical units and an audit of all patients who underwent primary lumbar microdiscectomy at our institution over a period of 2 consecutive years was performed. The health records of all patients were retrieved and critically reviewed. Information about hemoglobin measurements before and after surgery, group and save, and blood transfusion were collected. RESULTS: Thirty-two UK neurosurgical units were surveyed by telephone, with a 100% response rate. Group and save was commonly performed prior to lumbar microdiscectomy in 28 units (87.5%). The records of 319 consecutive patients who underwent lumber microdiscectomy were reviewed. All patients had group and save prior to lumbar microdiscectomy. No patient required a blood transfusion during or after surgery. The mean decrease in hemoglobin concentration was 0.8 g/dl in 121 patients who had postoperative hemoglobin measurements. CONCLUSIONS: Blood transfusion and hemoglobin decrease following lumbar microdiscectomy is exceptionally rare. Group and save and postoperative hemoglobin measurements are therefore nonessential in all patients undergoing lumbar microdiscectomy, with potentially significant cost savings from not performing these tests.

Interrater and intrarater reliability of lumbar spine magnetic resonance assessment of military aircraft pilot candidates.

BACKGROUND: The development of diagnostic imaging facilitates evaluation of spinal anatomy, but there is no full correspondence between morphologic and pathologic changes observed in radiographic studies and clinical findings. The aim of the study was to: 1. Evaluate the degree of signal intensity and degenerative changes of intervertebral discs in the lumbar spine on MRI. 2. Estimate interrater reliability of classification of pathology between experienced and inexperienced medical doctors. MATERIAL AND METHOD: The sample consisted of 89 persons aged between 18 and 21 years. MRI scans of the lumbar spine were evaluated by the use of a console for digital analysis by three medical doctors with different levels of experience. RESULTS: Evidence of dehydration of intervertebral disc was found in 3.37%-4.49% at the L4-L5 level, and in 13.48%-15.73% of cases at the L5-S1 level. Interrater reliability ranged from full agreement at levels where degenerative changes are rarely observed to fair and poor agreement at L4-L5 and L5-S1. Intrarater reliability showed full agreement on higher levels to good and very good at l4-l5 and l5-S1 levels. Interrater reliability concerning the degree of degenerative changes was 0.6 for Th12 to L4, but was poor at L4-L5 and L5-S1. Intrarater reliability ranged from full agreement at higher levels to poor at L3-L4-L5 and moderate at L5-S1. CONCLUSIONS: 1. Asymptomatic intervertebral disk changes were found in 30% of the study participants. 2. Evaluation of the degree of degenerative changes of intervertebral discs requires specialist training and experience.